1
|
Alomari M, El-Sayed Ahmed MM, Ali M, Wadiwala IJ, Pham SM, Sareyyupoglu B. Quadricuspid Aortic Valve: Imaging, Diagnosis, and Prognosis. Tex Heart Inst J 2024; 51:e238256. [PMID: 38686682 DOI: 10.14503/thij-23-8256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Quadricuspid aortic valve is a rare congenital cardiac anomaly with an incidence of 0.008% to 0.043%. Its clinical course varies depending on cusp anatomy, function, and associated cardiac malformations. It frequently progresses to aortic valve regurgitation that may require surgical valve replacement. Detection has shifted from incidental discovery during autopsies or cardiac surgeries in the early 20th century to various cardiac imaging methods in recent decades. In addition to contributing to the literature, this report supports the use of transesophageal echocardiography more liberally to detect aortic valve abnormalities. The case presents a 48-year-old female patient with an incidentally discovered quadricuspid aortic valve.
Collapse
Affiliation(s)
- Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
- Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt
| | - Mostafa Ali
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ishaq J Wadiwala
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
2
|
Gillam LD, Marcoff L. Echocardiography: Past, Present, and Future. Circ Cardiovasc Imaging 2024; 17:e016517. [PMID: 38516797 DOI: 10.1161/circimaging.124.016517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Linda D Gillam
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, NJ
| | - Leo Marcoff
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, NJ
| |
Collapse
|
3
|
Alegre-García G, Segovia-Reyes J, Rodríguez-Capitán J, García-Rodríguez L, Morcillo-Hidalgo L, Gómez-Doblas JJ, Jiménez-Navarro MF. Massive Mitral Valve Prosthetic Thrombosis in a Patient Undergoing Nintedanib Treatment: A Challenging Case Highlighting the Role of Echocardiography. Circ Cardiovasc Imaging 2024:e016212. [PMID: 38477141 DOI: 10.1161/circimaging.123.016212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Affiliation(s)
- Germán Alegre-García
- Unidad de Gestión Clínica, Área de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
- Instituto de Investigación Biomédica de Málaga (plataforma IBIMA-BIONAND), Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
| | - Jorge Segovia-Reyes
- Unidad de Gestión Clínica, Área de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
- Instituto de Investigación Biomédica de Málaga (plataforma IBIMA-BIONAND), Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
| | - Jorge Rodríguez-Capitán
- Unidad de Gestión Clínica, Área de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
- Instituto de Investigación Biomédica de Málaga (plataforma IBIMA-BIONAND), Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
- Red de Investigación Biomédica en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (J.R.-C., J.G.-D., M.F.J.-N.)
- Facultad de Medicina, Universidad de Málaga, Spain (J.R.-C., J.G.-D., M.F.J.-N.)
| | - Luis García-Rodríguez
- Unidad de Gestión Clínica, Área de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
- Instituto de Investigación Biomédica de Málaga (plataforma IBIMA-BIONAND), Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
| | - Luis Morcillo-Hidalgo
- Unidad de Gestión Clínica, Área de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
- Instituto de Investigación Biomédica de Málaga (plataforma IBIMA-BIONAND), Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
| | - Juan José Gómez-Doblas
- Unidad de Gestión Clínica, Área de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
- Instituto de Investigación Biomédica de Málaga (plataforma IBIMA-BIONAND), Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
- Red de Investigación Biomédica en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (J.R.-C., J.G.-D., M.F.J.-N.)
- Facultad de Medicina, Universidad de Málaga, Spain (J.R.-C., J.G.-D., M.F.J.-N.)
| | - Manuel F Jiménez-Navarro
- Unidad de Gestión Clínica, Área de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
- Instituto de Investigación Biomédica de Málaga (plataforma IBIMA-BIONAND), Spain (G.A.-G., J.S.-R., J.R.-C., L.G.-R., L.M.-H., J.G.-D., M.F.J.-N.)
- Red de Investigación Biomédica en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (J.R.-C., J.G.-D., M.F.J.-N.)
- Facultad de Medicina, Universidad de Málaga, Spain (J.R.-C., J.G.-D., M.F.J.-N.)
| |
Collapse
|
4
|
Baddour LM, Esquer Garrigos Z, Rizwan Sohail M, Havers-Borgersen E, Krahn AD, Chu VH, Radke CS, Avari-Silva J, El-Chami MF, Miro JM, DeSimone DC. Update on Cardiovascular Implantable Electronic Device Infections and Their Prevention, Diagnosis, and Management: A Scientific Statement From the American Heart Association: Endorsed by the International Society for Cardiovascular Infectious Diseases. Circulation 2024; 149:e201-e216. [PMID: 38047353 DOI: 10.1161/cir.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The American Heart Association sponsored the first iteration of a scientific statement that addressed all aspects of cardiovascular implantable electronic device infection in 2010. Major advances in the prevention, diagnosis, and management of these infections have occurred since then, necessitating a scientific statement update. An 11-member writing group was identified and included recognized experts in cardiology and infectious diseases, with a career focus on cardiovascular infections. The group initially met in October 2022 to develop a scientific statement that was drafted with front-line clinicians in mind and focused on providing updated clinical information to enhance outcomes of patients with cardiovascular implantable electronic device infection. The current scientific statement highlights recent advances in prevention, diagnosis, and management, and how they may be incorporated in the complex care of patients with cardiovascular implantable electronic device infection.
Collapse
|
5
|
Sykora D, Chaliki HP, Cummings KW, Sell-Dottin K, Stanton ML, Scott LR. Incidentally Discovered Right Atrial Mass: A Rare and Unexpected Etiology. Tex Heart Inst J 2023; 50:492268. [PMID: 37060553 PMCID: PMC10178659 DOI: 10.14503/thij-21-7735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Primary cardiac sarcoma is a rare type of intracardiac mass. This report describes a patient with atrial flutter who had a new right atrial mass incidentally discovered on transesophageal echocardiography. A thrombus was suspected based on radiographic appearance, but there was minimal change with anticoagulation. The mass was resected and found to be an undifferentiated pleomorphic cardiac sarcoma, an uncommon sub-type within the already rare category of primary cardiac neoplasms. This report highlights the importance of considering primary malignancy and thoroughly correlating radiographic and clinical evidence during the diagnostic workup of patients with intracardiac masses.
Collapse
Affiliation(s)
- Daniel Sykora
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Hari P Chaliki
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Kristen Sell-Dottin
- Department of Cardiovascular Surgery, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Luis R Scott
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona
| |
Collapse
|
6
|
Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center/NY Presbyterian Hospital, New York (R.T.H.)
| | - Vincent Chan
- Department of Surgery, University of Ottawa Heart Institute, Canada (V.C.)
| | - David H Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine, New York (D.H.A.)
| |
Collapse
|
7
|
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with increased risk of heart failure, stroke, and death. In current medical practice, multimodality imaging is routinely used in the management of AF. Twenty-one years ago, the ACUTE trial (Assessment of Cardioversion Using Transesophageal Echocardiography) results were published, and the management of AF changed forever by incorporating transesophageal echocardiography guided cardioversion of patients in AF for the first time. Current applications of multimodality imaging in AF in 2022 include the use of transesophageal echocardiography and computed tomography before cardioversion to exclude left atrial thrombus and in left atrial appendage occlusion device implantation. Transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance are clinically used for AF ablation planning. The decision to use a particular imaging modality in AF is based on patient's characteristics, guideline recommendation, institutional preferences, expertise, and cost. In this first of 2-part review series, we discuss the preprocedural role of echocardiography, computed tomography, and cardiac magnetic resonance in the AF, with regard to their clinical applications, relevant outcomes data and unmet needs, and highlights future directions in this rapidly evolving field.
Collapse
Affiliation(s)
- Raymundo A Quintana
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (R.A.Q.)
| | - Tiffany Dong
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Ramya Vajapey
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Reza Reyaldeen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Serge Harb
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| |
Collapse
|
8
|
Ranard LS, Guber K, Khalique OK, Leb J, Hamid N, Donald E, Hahn RT, Forman J, Ng V, Leon MB, Sommer R, Vahl TP. Improved Left Atrial Appendage Closure With the New-Generation WATCHMAN FLX by Cardiac Computed Tomography Angiography at 45 Days Postimplant. Circ Cardiovasc Interv 2022; 15:e011727. [PMID: 35313734 DOI: 10.1161/circinterventions.121.011727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lauren S Ranard
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Kenneth Guber
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Omar K Khalique
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Jay Leb
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Nadira Hamid
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Elena Donald
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Rebecca T Hahn
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Jessica Forman
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Vivian Ng
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Martin B Leon
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Robert Sommer
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Torsten P Vahl
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| |
Collapse
|
9
|
Marquetand C, Stierle U, Rausch S, Eitel I, Aboud A, Reil GH, Reil JC. Invasive and Echocardiographic Characteristics of a Patient With Severe Pulmonary Valve Regurgitation Pretending Severe Pulmonary Stenosis. Circ Heart Fail 2020; 14:e007486. [PMID: 33356361 DOI: 10.1161/circheartfailure.120.007486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christoph Marquetand
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Germany (C.M., I.E., J.-C. R.)
| | - Ulrich Stierle
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany (U.S., A.A.)
| | | | - Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Germany (C.M., I.E., J.-C. R.)
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany (U.S., A.A.)
| | | | - Jan-Christian Reil
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Germany (C.M., I.E., J.-C. R.)
| |
Collapse
|
10
|
Sivakumar K, Qureshi S, Pavithran S, Vaidyanathan S, Rajendran M. Simple Diagnostic Tools May Guide Transcatheter Closure of Superior Sinus Venosus Defects Without Advanced Imaging Techniques. Circ Cardiovasc Interv 2020; 13:e009833. [PMID: 33233933 DOI: 10.1161/circinterventions.120.009833] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a recent interest in nonsurgical correction of superior sinus venosus defects. Patient selection is currently based on advanced imaging and printing technologies. Simple clinical tools to select patients will expand its applicability in developing countries. METHODS Defects caudally extending toward the oval fossa and right upper pulmonary veins draining beyond the cavoatrial junction on transesophageal echocardiography were excluded. Balloon interrogation of cavoatrial junction confirmed complete occlusion of the defect with unobstructed pulmonary venous drainage to left atrium. Single long covered stents or overlapping covered stents were used to exclude sinus venosus defects. Closure of left-to-right interatrial shunt without causing pulmonary vein occlusion was confirmed on follow-up imaging. RESULTS Forty-four patients selected after transesophageal echocardiography underwent balloon interrogation with monitoring of right upper pulmonary vein. Eighteen out of 44 patients were ineligible. Twenty-four eligible patients with closure of left-to-right interatrial shunt without pulmonary vein occlusion underwent covered stent exclusion using single long stents in 15 and overlapping stents in the rest, while 2 patients are awaiting the procedure. Four patients aged 6 to 16 years received stents that were 18 mm or larger. Three patients had stent embolization that required surgical correction in 2 but in the last patient was managed nonsurgically with an overlapping covered stent with good final outcomes. Procedure was successful in 22 patients. At a median follow-up of 20 months (range, 3-54 months), there were no adverse events. Follow-up imaging showed trivial left-to-right shunt in 4 and unobstructed pulmonary veins in all patients. CONCLUSIONS Transesophageal echocardiography and balloon interrogation identified 60% of the patients with sinus venosus defects to be eligible for catheter closure. Overlapping stents are an alternative to custom-made long stents. Transesophageal echocardiography confirms procedural success on follow-up. Advanced imaging and printing technologies are not essential for successful outcomes and thus simple tests increase the feasibility in developing countries.
Collapse
Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Shakeel Qureshi
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, United Kingdom (S.Q.)
| | - Sreeja Pavithran
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Sunitha Vaidyanathan
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Monica Rajendran
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| |
Collapse
|
11
|
El Mourad MB, Shaaban AE, El Sharkawy SI, Afandy ME. Effects of Propofol, Dexmedetomidine, or Ketofol on Respiratory and Hemodynamic Profiles in Cardiac Patients Undergoing Transesophageal Echocardiography: A Prospective Randomized Study. J Cardiothorac Vasc Anesth 2020; 35:2743-2750. [PMID: 33262033 DOI: 10.1053/j.jvca.2020.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The authors aimed to evaluate sedation characteristics, as well as cardiorespiratory effects, of propofol, dexmedetomidine, and ketofol used for conscious sedation during transesophageal echocardiography (TEE). DESIGN Prospective double-blind randomized study. SETTINGS Tanta University hospitals. PARTICIPANTS Seventy-five participants with left-to-right shunt requiring diagnostic TEE interventions. Patients were randomized into three groups-P, Dex, and K-to receive propofol, dexmedetomidine, or ketofol, respectively. MEASUREMENTS AND MAIN RESULTS Time to reach targeted sedation level, duration of the procedure, recovery time, hemodynamic parameters, incidence of oxygen desaturation <90%, as well as the cardiologist's satisfaction were recorded. The time onset and offset of sedation, duration of TEE procedure, and the need for rescue propofol were significantly less in the P and K groups compared with group Dex (p value 0.000*, 0.003*, 0.000*, and 0.000* and effect size 0.39, 0.15, 0.21, and 0.34, respectively). Mean arterial pressure, heart rate, and cardiac output significantly decreased in groups P and Dex compared with either baseline or group K. Hypoxic events were more manifest in group P; whereas group K had better cardiologist's satisfaction than the other two groups. CONCLUSIONS In the TEE settings, the three agents were capable of attaining the targeted sedation levels , with propofol and ketofol having a faster onset and recovery times compared with dexmedetomidine. Even though dexmedetomidine and ketofol provided a more stable respiratory profile than propofol, ketofol was favorable in providing fewer hemodynamic alterations with better satisfaction scores than both propofol and dexmedetomidine.
Collapse
|
12
|
Burns D, Kluger R, Uda Y, Cowie B. Aortic Acceleration Time and the Intraoperative Assessment of Aortic Stenosis. J Cardiothorac Vasc Anesth 2020; 35:820-825. [PMID: 33250431 DOI: 10.1053/j.jvca.2020.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Aortic acceleration time (AAT) and the ratio of AAT to ejection time (AAT/ET) are relatively new echocardiographic measures of the severity of aortic stenosis (AS). This study investigated the utility of transesophageal echocardiography (TEE) measurements of AAT and AAT/ET to predict the severity of AS under intraoperative conditions. DESIGN Retrospective diagnostic accuracy study. SETTING St. Vincent's Hospital, Melbourne, Australia, from July 2007 to February 2017. PARTICIPANTS The study comprised 199 patients who underwent aortic valve replacement (AVR) and whose aortic valves were evaluated with spectral Doppler analysis in both preoperative transthoracic echocardiography (TTE) and intraoperative TEE studies fewer than three months apart. Exclusion criteria included AVR for only aortic regurgitation, AVR of prosthetic aortic valves, and known left ventricular outflow tract obstruction. MEASUREMENTS AND MAIN RESULTS Standard echocardiography assessment of AS and the AAT and AAT/ET measurements was performed using preoperative TTE and intraoperative TEE. The intraoperative AAT and AAT/ET were increased significantly in patients with both high- and low-gradient severe AS compared with patients without severe AS (p < 0.01). Comparing preoperative TTE and intraoperative TEE measurements showed that the AAT was significantly prolonged during general anesthesia (mean difference 9.67 msec [95% confidence interval -13.54 to -5.81]), whereas the AAT/ET was preserved (mean difference -0.0018 [95% confidence interval -0.013 to 0.0091]). An intraoperative TEE cutoff of 109 msec for AAT and 0.35 for AAT/ET had a 74% and 67% sensitivity and 72% and 78% specificity, respectively, to differentiate severe from non-severe AS. CONCLUSIONS The AAT and AAT/ET may be useful adjuncts for the intraoperative measurement of AS. The agreement between intraoperative TEE and preoperative TTE was better with AAT/ET compared with AAT alone.
Collapse
Affiliation(s)
- David Burns
- Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Melbourne, Australia.
| | - Roman Kluger
- Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Melbourne, Australia
| | - Yoshiaki Uda
- Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Melbourne, Australia
| | - Brian Cowie
- Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Melbourne, Australia
| |
Collapse
|
13
|
Tiller C, Reinstadler SJ, Bonaros N, Metzler B, Klug G. Massive Pulmonary Embolism With a Large Thrombus Trapped in the Patent Foramen Ovale. Circ Cardiovasc Imaging 2020; 13:e010501. [PMID: 32972236 DOI: 10.1161/circimaging.120.010501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology (C.T., S.J.R., B.M., G.K.), Medical University of Innsbruck, Austria
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology (C.T., S.J.R., B.M., G.K.), Medical University of Innsbruck, Austria
| | - Nikolaos Bonaros
- University Clinic of Cardiac Surgery (N.B.), Medical University of Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology (C.T., S.J.R., B.M., G.K.), Medical University of Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology (C.T., S.J.R., B.M., G.K.), Medical University of Innsbruck, Austria
| |
Collapse
|
14
|
Abstract
Septic shock is the leading cause of cardiovascular failure in the intensive care unit (ICU). Cardiac output is a primary component of global oxygen delivery to organs and a sensitive parameter of cardiovascular failure. Any mismatch between oxygen delivery and rapidly varying metabolic demand may result in tissue dysoxia, hence organ dysfunction. Since the intricate alterations of both vascular and cardiac function may rapidly and widely change over time, cardiac output should be measured repeatedly to characterize the type of shock, select the appropriate therapeutic intervention, and evaluate patient's response to therapy. Among the numerous techniques commercially available for measuring cardiac output, transpulmonary thermodilution (TPT) provides a continuous monitoring with external calibration capability, whereas critical care echocardiography (CCE) offers serial hemodynamic assessments. CCE allows early identification of potential sources of inaccuracy of TPT, including right ventricular failure, severe tricuspid or left-sided regurgitations, intracardiac shunt, very low flow states, or dynamic left ventricular outflow tract obstruction. In addition, CCE has the unique advantage of depicting the distinct components generating left ventricular stroke volume (large cavity size vs. preserved contractility), providing information on left ventricular diastolic properties and filling pressures, and assessing pulmonary artery pressure. Since inotropes may have deleterious effects if misused, their initiation should be based on the documentation of a cardiac dysfunction at the origin of the low flow state by CCE. Experts widely advocate using CCE as a first-line modality to initially evaluate the hemodynamic profile associated with shock, as opposed to more invasive techniques. Repeated assessments of both the efficacy (amplitude of the positive response) and tolerance (absence of side-effect) of therapeutic interventions are required to best guide patient management. Overall, TPT allowing continuous tracking of cardiac output variations and CCE appear complementary rather than mutually exclusive in patients with septic shock who require advanced hemodynamic monitoring.
Collapse
Affiliation(s)
- Philippe Vignon
- Medical-Surgical Intensive Care Unit, Dupuytren Teaching hospital, Limoges, France.,Inserm CIC 1435, Dupuytren Teaching hospital, Limoges, France.,Faculty of Medicine, University of Limoges, Limoges, France
| |
Collapse
|
15
|
Cho SA, Jang YE, Kim EH, Lee JH, Ji SH, Kim HS, Kim JT. Catastrophic Case Scenario During Percutaneous Pulmonary Valve Replacement. J Cardiothorac Vasc Anesth 2020; 35:1466-1468. [PMID: 32591251 DOI: 10.1053/j.jvca.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Sung-Ae Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| |
Collapse
|
16
|
Massicotte G, Bernier M, Piché ME, Cantin L, Couture C. Case Report of Aggressive Primary Pericardial Mesothelioma Presenting as a Constrictive Pericarditis. Circ Cardiovasc Imaging 2020; 12:e008621. [PMID: 30841705 DOI: 10.1161/circimaging.118.008621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gabriel Massicotte
- Faculty of Medicine, Laval University, QC (G.M., M.B., M.-E.P., L.C., C.C.)
| | - Mathieu Bernier
- Faculty of Medicine, Laval University, QC (G.M., M.B., M.-E.P., L.C., C.C.).,Quebec Heart and Lung Institute, QC (M.B., M.-E.P., L.C., C.C.)
| | - Marie-Eve Piché
- Faculty of Medicine, Laval University, QC (G.M., M.B., M.-E.P., L.C., C.C.).,Quebec Heart and Lung Institute, QC (M.B., M.-E.P., L.C., C.C.)
| | - Luce Cantin
- Faculty of Medicine, Laval University, QC (G.M., M.B., M.-E.P., L.C., C.C.).,Quebec Heart and Lung Institute, QC (M.B., M.-E.P., L.C., C.C.)
| | - Christian Couture
- Faculty of Medicine, Laval University, QC (G.M., M.B., M.-E.P., L.C., C.C.).,Quebec Heart and Lung Institute, QC (M.B., M.-E.P., L.C., C.C.)
| |
Collapse
|
17
|
Shapeton AD, Leissner KB, Zorca SM, Amirfarzan H, Stock EM, Biswas K, Haime M, Srinivasa V, Quin JA, Zenati MA. Epiaortic Ultrasound for Assessment of Intraluminal Atheroma; Insights from the REGROUP Trial. J Cardiothorac Vasc Anesth 2019; 34:726-732. [PMID: 31787434 DOI: 10.1053/j.jvca.2019.10.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the use of epiaortic ultrasound in contemporary cardiac surgery, as well as its impact on surgical cannulation strategy and cerebrovascular events. DESIGN Epiaortic ultrasound data was prospectively collected in the Randomized Endovein Graft Prospective (REGROUP) trial (VA Cooperative Studies Program #588, ClinicalTrials.gov, NCT01850082), which randomized 1,150 coronary artery bypass graft patients between 2014 and 2017 to endoscopic or open-vein graft harvest. SETTING Sixteen cardiac surgery programs within the Veterans Affairs Healthcare System with expertise at performing endoscopic vein-graft harvesting. PARTICIPANTS Veterans Affairs patients, greater than 18 years of age, undergoing elective or urgent coronary artery bypass grafting with cardiopulmonary bypass and cardioplegic arrest with at least one planned saphenous vein graft were eligible for enrollment. INTERVENTIONS Epiaortic ultrasound was performed by the surgeon using a high frequency (>7 MHz) ultrasound transducer. Two-dimensional images of the ascending aorta in multiple planes were acquired before aortic cannulation and cross-clamping. MEASUREMENTS AND MAIN RESULTS Epiaortic ultrasound was performed in 34.1% (269 of 790) of patients in REGROUP. Among these patients, simple intraluminal atheroma was observed in 21.9% (59 269), and complex intraluminal atheroma comprised 2.2% (6 of 269). The aortic cannulation or cross-clamp strategy was modified based on these findings in 7.1% of cases (19 of 269). There was no difference in stroke between patients who underwent epiaortic ultrasound and those who did not (1.9% v 1.2% p = 0.523). CONCLUSIONS Despite current guidelines recommending routine use of epiaortic ultrasound (IIa/B) to reduce the risk of stroke in cardiac surgery, in this contemporary trial, use remains infrequent, with significant site-to-site variability.
Collapse
Affiliation(s)
- Alexander D Shapeton
- Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD.
| | - Kay B Leissner
- Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD
| | - Suzana M Zorca
- Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD
| | - Houman Amirfarzan
- Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD
| | - Eileen M Stock
- Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD
| | - Kousick Biswas
- Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD
| | - Miguel Haime
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA
| | - Venkatesh Srinivasa
- Department of Anesthesia, Critical Care and Pain Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA
| | - Jacquelyn A Quin
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA
| | - Marco A Zenati
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA
| |
Collapse
|
18
|
Affiliation(s)
| | - Jonathan P Piccini
- Duke Center for Atrial Fibrillation, Duke Clinical Research Institute, and Duke University Medical Center, Durham, NC (J.P.P.)
| |
Collapse
|
19
|
Gupta S, Ge Y, Ghouri MA, Blankstein R, Steigner ML, Aghayev A. Caseous Calcification of the Mitral Annulus With Atrial and Ventricular Fistulization. Circ Cardiovasc Imaging 2018; 11:e007588. [PMID: 29970380 DOI: 10.1161/circimaging.118.007588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/25/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Sumit Gupta
- Department of Radiology (S.G., M.A.G., M.L.S., A.A.)
| | - Yin Ge
- Departments of Medicine (Cardiovascular Division) and Radiology (Y.G., R.B.), Cardiovascular Imaging Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Maaz A Ghouri
- Department of Radiology (S.G., M.A.G., M.L.S., A.A.)
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Division) and Radiology (Y.G., R.B.), Cardiovascular Imaging Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Ayaz Aghayev
- Department of Radiology (S.G., M.A.G., M.L.S., A.A.)
| |
Collapse
|
20
|
Koechlin L, Erb JM, Kohler C, Schaeffer T, Eckstein FS, Grapow MTR. Three-Dimensional Transesophageal Echocardiography Reconstruction in Removal of a 7-cm Left Atrial Thrombus Attached to a Displaced Amplatzer Device. Circ Cardiovasc Imaging 2018; 11:e007654. [PMID: 29650792 DOI: 10.1161/circimaging.118.007654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Luca Koechlin
- Department of Cardiac Surgery (L.K., T.S., F.S.E., M.T.R.G.) and Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy (J.M.E.), University Hospital Basel, Switzerland. Department of Cardiology, St. Claraspital Basel, Switzerland (C.K.)
| | - Joachim M Erb
- Department of Cardiac Surgery (L.K., T.S., F.S.E., M.T.R.G.) and Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy (J.M.E.), University Hospital Basel, Switzerland. Department of Cardiology, St. Claraspital Basel, Switzerland (C.K.)
| | - Christoph Kohler
- Department of Cardiac Surgery (L.K., T.S., F.S.E., M.T.R.G.) and Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy (J.M.E.), University Hospital Basel, Switzerland. Department of Cardiology, St. Claraspital Basel, Switzerland (C.K.)
| | - Thibault Schaeffer
- Department of Cardiac Surgery (L.K., T.S., F.S.E., M.T.R.G.) and Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy (J.M.E.), University Hospital Basel, Switzerland. Department of Cardiology, St. Claraspital Basel, Switzerland (C.K.)
| | - Friedrich S Eckstein
- Department of Cardiac Surgery (L.K., T.S., F.S.E., M.T.R.G.) and Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy (J.M.E.), University Hospital Basel, Switzerland. Department of Cardiology, St. Claraspital Basel, Switzerland (C.K.)
| | - Martin T R Grapow
- Department of Cardiac Surgery (L.K., T.S., F.S.E., M.T.R.G.) and Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy (J.M.E.), University Hospital Basel, Switzerland. Department of Cardiology, St. Claraspital Basel, Switzerland (C.K.).
| |
Collapse
|
21
|
Griffee MJ, Tonna JE, McKellar SH, Zimmerman JM. Echocardiographic Guidance and Troubleshooting for Venovenous Extracorporeal Membrane Oxygenation Using the Dual-Lumen Bicaval Cannula. J Cardiothorac Vasc Anesth 2017; 32:370-378. [PMID: 29249578 DOI: 10.1053/j.jvca.2017.07.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew J Griffee
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT.
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Stephen H McKellar
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | | |
Collapse
|
22
|
Müller K, Jorbenadze R, Walker T, Schüler R, Hammerstingl C, Schlensak C, Gawaz M, Langer HF, Seizer P. Percutaneous Transfemoral Tricuspid Valve Edge-to-Edge Repair: A Case Series. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.003965. [PMID: 28377441 DOI: 10.1161/circheartfailure.117.003965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/01/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Karin Müller
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Rezo Jorbenadze
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Tobias Walker
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Robert Schüler
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Christoph Hammerstingl
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Christian Schlensak
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Meinrad Gawaz
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.)
| | - Harald F Langer
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.).
| | - Peter Seizer
- From the Department of Cardiology and Cardiovascular Medicine (K.M., R.J., M.G., H.F.L., P.S.) and Department of Cardiovascular Surgery (T.W., C.S.), University Hospital, Eberhard Karls University Tuebingen, Germany; and Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany (R.S., C.H.).
| |
Collapse
|
23
|
Utsunomiya H, Itabashi Y, Mihara H, Berdejo J, Kobayashi S, Siegel RJ, Shiota T. Functional Tricuspid Regurgitation Caused by Chronic Atrial Fibrillation. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.004897. [DOI: 10.1161/circimaging.116.004897] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 11/07/2016] [Indexed: 01/24/2023]
Abstract
Background—
Functional tricuspid regurgitation (TR) with a structurally normal tricuspid valve (TV) may occur secondary to chronic atrial fibrillation (AF). However, the clinical and echocardiographic differences according to functional TR subtypes are unclear. Therefore, characterization of functional TR because of chronic AF (AF-TR) remains undetermined.
Methods and Results—
To investigate the prevalence of AF-TR, 437 patients with moderate to severe TR underwent 3-dimensional (3D) transesophageal echocardiography. TR severity was determined by the averaged vena contracta width on apical and parasternal inflow views. The prevalence of AF-TR was 9.2%, whereas that of functional TR because of left-sided heart disease was 45.3%. Clinical features of AF-TR included advanced age, female sex, greater right atrial than left atrial enlargement and lower systolic pulmonary artery pressure compared with left-sided heart disease-TR with sinus rhythm (all
P
<0.05). In 3D TV assessment, patients with AF-TR had a larger TV annular area with weaker annular contraction (both
P
<0.001) but a smaller tethering angle (
P
<0.001) despite a similar leaflet coaptation status compared with patients with left-sided heart disease-TR with sinus rhythm. On multivariable analysis, only the TV annular area in midsystole (coefficient, 0.059; 95% confidence interval, 0.041–0.078 per 100 mm
2
;
P
<0.001) was associated with TR severity in AF-TR. The annular area was more closely correlated with the right atrial volume than right ventricular end-systolic volume in AF-TR (
P
<0.001).
Conclusions—
AF-TR is not rare and is associated with advanced age and right atrial enlargement. TV deformations and their association with right heart remodeling differ between AF-TR and left-sided heart disease-TR. Our results suggest that in patients with TR secondary to AF, TV annuloplasty should be effective because this entity has annular dilatation without leaflet deformation.
Collapse
Affiliation(s)
- Hiroto Utsunomiya
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Yuji Itabashi
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Hirotsugu Mihara
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Javier Berdejo
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Sayuki Kobayashi
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Robert J. Siegel
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| | - Takahiro Shiota
- From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.)
| |
Collapse
|
24
|
Garg A, Balasubramaniyam N, Lafaro R, Timmermans R, Aronow WS, Cooper HA, Panza JA. Contained Rupture of Sinus of Valsalva Aneurysm in a 64-Year-Old Man. Tex Heart Inst J 2016; 43:433-436. [PMID: 27777531 DOI: 10.14503/thij-15-5182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report a contained rupture of a right coronary sinus of Valsalva aneurysm, in which repair resulted in symptomatic improvement. Patients often present with symptoms secondary to rupture of the sinus of Valsalva aneurysm into one of the cardiac chambers, or secondary to the compression of adjacent structures. Whereas sinus of Valsalva aneurysms and their rupture are well reported in the literature, contained ruptures have been described only rarely. In those cases, symptoms often arose from compression of adjacent structures. Although transesophageal echocardiography is considered to be the diagnostic method of choice, cardiac magnetic resonance imaging and computed tomography can be equally helpful in establishing the diagnosis and delineating the lesion. Diagnosis and prompt repair in our 64-year-old patient resulted in the rapid resolution of his symptoms.
Collapse
|
25
|
Taleyratne JDS, Henderson RA. Transcatheter Closure of Iatrogenic VSDs after Aortic Valve Replacement Surgery: 2 Case Reports and a Literature Review. Tex Heart Inst J 2016; 43:329-33. [PMID: 27547145 DOI: 10.14503/thij-15-5083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report 2 new cases of transcatheter closure of iatrogenic ventricular septal defects after aortic valve replacement surgery, together with our finding, in a literature review, of 9 additional patients who had undergone this procedure from 2004 through 2013. In all 11 cases, transcatheter device closure was indicated for a substantial intracardiac shunt with symptomatic heart failure, and such a device was successfully deployed across the iatrogenic ventricular septal defect, with clinical improvement. Our review suggests that transcatheter closure of iatrogenic ventricular septal defects in patients with previous aortic valve replacement surgery is a safe and effective treatment option, providing anatomic defect closure and relief of symptoms in the short-to-medium term.
Collapse
|
26
|
Marchese N, Facciorusso A, Vigna C. Mitral Perivalvular Leak after Blunt Chest Trauma: A Rare Cause of Severe Subacute Mitral Regurgitation. Tex Heart Inst J 2015; 42:579-81. [PMID: 26664317 DOI: 10.14503/thij-14-4439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Blunt chest trauma is a very rare cause of valve disorder. Moreover, mitral valve involvement is less frequent than is aortic or tricuspid valve involvement, and the clinical course is usually acute. In the present report, we describe the case of a 49-year-old man with a perivalvular mitral injury that became clinically manifest one year after a violent, nonpenetrating chest injury. This case is atypical in regard to the valve involved (isolated mitral damage), the injury type (perivalvular leak in the absence of subvalvular abnormalities), and the clinical course (interval of one year between trauma and symptoms).
Collapse
|
27
|
Taherkhani M, Hashemi SR, Hekmat M, Safi M, Taherkhani A, Movahed MR. Thrombolytic Therapy for Right-Sided Mechanical Pulmonic and Tricuspid Valves: The Largest Survival Analysis to Date. Tex Heart Inst J 2015; 42:543-7. [PMID: 26664307 DOI: 10.14503/thij-14-4659] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Data regarding thrombolytic treatment of right-sided mechanical valve thrombosis are almost nonexistent, and all current guidelines arise from very small case series. We retrospectively studied the in-hospital and long-term outcome data of a larger series of patients who had received, from September 2005 through June 2012, thrombolytic therapy for right-sided mechanical pulmonary valve or tricuspid valve thrombosis. We identified 16 patients aged 8-67 years who had undergone thrombolytic therapy for definite thrombotic mechanical valve obstruction in the tricuspid or pulmonary valve position (8 in each position). All study patients except one had subtherapeutic international normalized ratios. The 8 patients with pulmonary mechanical valve thrombosis had a 100% response rate to thrombolytic therapy, and their in-hospital survival rate was also 100%. The 8 patients with tricuspid mechanical valve thrombosis had a 75% response rate to thrombolytic therapy, with an in-hospital survival rate of 87.5%. The one-year survival rate for mechanical valve thrombosis treated with thrombolytic therapy (whether pulmonary or tricuspid) was 87.5%. On the basis of our data, we recommend that thrombolytic therapy remain the first-line therapy for right-sided mechanical valve thrombosis in adults or children-including children with complex congenital heart disease and patients with mechanical pulmonary valve thrombosis. Surgery should be reserved for patients in whom this treatment fails.
Collapse
|
28
|
Abstract
New interventional techniques have made transcatheter closure of aortic paravalvular leaks a viable therapeutic option to treat the sequelae of these defects, including congestive heart failure and hemolysis. We report the transcatheter closure of an aortic paravalvular leak via a combined retrograde/antegrade approach. This was necessary because of difficulty in crossing the defect with a sheath from the retrograde approach. This technique might be useful in application to other difficult structural heart interventions. To our knowledge, this is the first report of a treated paravalvular leak around a Mitroflow(®) Aortic Pericardial Heart Valve.
Collapse
|
29
|
Michalsen KL, Iguidbashian JP, Kyser JP, Long WB. Low-Velocity Nail-Gun Injuries to the Interventricular Septum: Report of Two Cases, One in a Child. Tex Heart Inst J 2015; 42:393-6. [PMID: 26413027 DOI: 10.14503/thij-13-4023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nail-gun injury to the heart is rare. Nail-gun injury to the interventricular septum is rarer: we could find only 5 reported cases, and none involving a child. We report 2 additional cases, in which nails penetrated the interventricular septum without causing acute pericardial tamponade, heart block, or shunt across the septum. Transesophageal echocardiography provides a dynamic way to evaluate the patient preoperatively, intraoperatively, and postoperatively. In the cases reported here, both the adult with multiple interventricular nails and the child with a single nail underwent foreign-object removal via median sternotomy. The child needed cardiopulmonary bypass for removal of the nail. There were no short-term or long-term sequelae from these interventricular septal injuries.
Collapse
|
30
|
Yong MS, Saxena P, Killu AM, Coffey S, Burkhart HM, Wan SH, Malouf JF. The Preoperative Evaluation of Infective Endocarditis via 3-Dimensional Transesophageal Echocardiography. Tex Heart Inst J 2015; 42:372-6. [PMID: 26413022 DOI: 10.14503/thij-14-4375] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Transesophageal echocardiography continues to have a central role in the diagnosis of infective endocarditis and its sequelae. Recent technological advances offer the option of 3-dimensional imaging in the evaluation of patients with infective endocarditis. We present an illustrative case and review the literature regarding the potential advantages and limitations of 3-dimensional transesophageal echocardiography in the diagnosis of complicated infective endocarditis. A 51-year-old man, an intravenous drug user who had undergone bioprosthetic aortic valve replacement 5 months earlier, presented with prosthetic valve endocarditis. Preoperative transesophageal echocardiography with 3D rendition revealed a large abscess involving the mitral aortic intervalvular fibrosa, together with a mycotic aneurysm that had ruptured into the left atrium, resulting in a left ventricle-to-left atrium fistula. Three-dimensional transesophageal echocardiography enabled superior preoperative anatomic delineation and surgical planning. We conclude that 3-dimensional transesophageal echocardiography can be a useful adjunct to traditional 2-dimensional transesophageal echocardiography as a tool in the diagnosis of infective endocarditis.
Collapse
MESH Headings
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Anti-Bacterial Agents/therapeutic use
- Aortic Valve/abnormalities
- Aortic Valve/diagnostic imaging
- Aortic Valve/microbiology
- Aortic Valve/surgery
- Bicuspid Aortic Valve Disease
- Echocardiography, Three-Dimensional
- Echocardiography, Transesophageal
- Endocarditis, Bacterial/diagnostic imaging
- Endocarditis, Bacterial/microbiology
- Endocarditis, Bacterial/surgery
- Heart Valve Diseases/complications
- Heart Valve Diseases/diagnostic imaging
- Heart Valve Diseases/surgery
- Heart Valve Prosthesis/adverse effects
- Heart Valve Prosthesis Implantation/adverse effects
- Heart Valve Prosthesis Implantation/instrumentation
- Humans
- Male
- Middle Aged
- Mitral Valve/diagnostic imaging
- Mitral Valve/microbiology
- Mitral Valve/surgery
- Predictive Value of Tests
- Preoperative Care
- Reoperation
- Substance Abuse, Intravenous/complications
- Treatment Outcome
Collapse
|
31
|
Abstract
Blood cysts of the heart are benign cardiovascular tumors found incidentally in approximately 50% of infants who undergo autopsy at less than 2 months of age. These congenital cysts, frequently present on the atrioventricular valves of infants, are exceedingly rare in adults. Nonetheless, in adults, cardiac blood cysts have been found on the mitral valve, papillary muscles, right atrium, right ventricle, left ventricle, and aortic, pulmonic, and tricuspid valves. Reported complications include left ventricular outflow obstruction, occlusion of the coronary arteries, valvular stenosis or regurgitation, and embolic stroke. In high-risk patients with severe aortic stenosis, transcatheter aortic valve replacement has emerged as an alternative to surgical replacement. Transesophageal echocardiography plays a fundamental role in evaluating the feasibility of intraprocedural transcatheter aortic valve replacement, in measuring aortic annular size, in guiding placement of the prosthetic device, and in looking for possible complications. The embolic risk of rapid pacing and transcatheter aortic valve replacement in a patient with an intracardiac blood cyst is unknown, and such a case has not, to our knowledge, been reported heretofore. We present the case of a 78-year-old woman with severe aortic stenosis, in whom a blood cyst was incidentally found in the left atrium upon transesophageal echocardiography. She underwent successful transcatheter aortic valve replacement without embolic complication.
Collapse
|
32
|
Abstract
Left atrial wall dissection is a rare condition; most cases are iatrogenic after mitral valve surgery. A few have been reported as sequelae of blunt chest trauma, acute myocardial infarction, and invasive cardiac procedures. On occasion, infective endocarditis causes left atrial wall dissection. We report a highly unusual case in which a 41-year-old man presented with native mitral valve infective endocarditis that had caused left atrial free-wall dissection. Although our patient died within an hour of presentation, we obtained what we consider to be a definitive diagnosis of a rare sequela, documented by transthoracic and transesophageal echocardiography.
Collapse
|
33
|
El-Sayed Ahmed MM, Al-Najjar RM, Aftab M, Anton JM, Colen JS, Reul RM. Early detection of a cavopulmonary tumor embolus with the use of transesophageal echocardiography. Tex Heart Inst J 2015; 42:66-9. [PMID: 25873804 DOI: 10.14503/thij-13-3731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pulmonary tumor embolization from renal cell carcinoma is associated with severe cardiopulmonary morbidity and high perioperative mortality rates. We report the case of a 71-year-old woman who presented with right-sided abdominal pain. Magnetic resonance images revealed a mass originating from the upper pole of the right kidney and extending into the infrahepatic portion of the inferior vena cava. Transesophageal echocardiography was continuously used to monitor the mass during intended radical nephrectomy and tumor resection. When the right kidney was mobilized, intracaval thrombus detached and migrated to the patient's right atrium, causing severe hemodynamic instability. After emergent sternotomy and during the initiation of cardiopulmonary bypass, the mass was no longer echocardiographically detectable in the heart; it was soon removed completely from the left pulmonary artery. The mass was a renal cell carcinoma. We recommend the use of transesophageal echocardiography as an efficient diagnostic tool in the early detection of pulmonary tumor embolization during the resection of renal cell carcinoma that involves the inferior vena cava.
Collapse
|
34
|
Abstract
This report concerns a 69-year-old woman who presented with an asymptomatic myxoma in the left ventricle. The tumor was successfully excised. We provide a very brief review of 72 other published cases of surgically treated left ventricular myxoma.
Collapse
Affiliation(s)
- Cipriano Abad
- Departments of Cardiovascular Surgery (Dr. Abad), Cardiology (Drs. Delgado and Novoa), and Pathology (Dr. Alonso), Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria 35010, Spain
| | - José Novoa
- Departments of Cardiovascular Surgery (Dr. Abad), Cardiology (Drs. Delgado and Novoa), and Pathology (Dr. Alonso), Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria 35010, Spain
| | - Antonio Delgado
- Departments of Cardiovascular Surgery (Dr. Abad), Cardiology (Drs. Delgado and Novoa), and Pathology (Dr. Alonso), Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria 35010, Spain
| | - Ana Alonso
- Departments of Cardiovascular Surgery (Dr. Abad), Cardiology (Drs. Delgado and Novoa), and Pathology (Dr. Alonso), Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria 35010, Spain
| |
Collapse
|
35
|
Cagli K, Gedik HS, Korkmaz K, Budak B, Yener U, Lafci G. Transventricular mitral valve repair in patients with acute forms of ischemic mitral regurgitation. Tex Heart Inst J 2014; 41:312-5. [PMID: 24955051 DOI: 10.14503/thij-13-3201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transventricular mitral valve surgery combined with left ventricular restoration avoids atriotomy and provides a larger operative field. We describe a series of 5 patients in whom we performed transventricular mitral valve repair by various techniques, such as band annuloplasty, papillary muscle reattachment, chordal cutting, and edge-to-edge repair. The more acute forms of ischemic mitral regurgitation, as found in our patients, can coexist with post-myocardial infarction contained rupture or post-myocardial infarction ventricular septal rupture. Because these patients already have an indication for ventriculotomy, concomitant transventricular repair of the mitral valve can render a separate atriotomy unnecessary and thereby shorten the duration of cardiopulmonary bypass. Moreover, in patients with acute presentations, the absence of atrial dilation (this last associated with chronic cases) might make transventricular repair a better choice than the more difficult atrial approach.
Collapse
Affiliation(s)
- Kerim Cagli
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Hikmet Selcuk Gedik
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Kemal Korkmaz
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Baran Budak
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Umit Yener
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Gokhan Lafci
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| |
Collapse
|
36
|
Warraich HJ, Gandhavadi M, Manning WJ. Mechanical discordance of the left atrium and appendage: a novel mechanism of stroke in paroxysmal atrial fibrillation. Stroke 2014; 45:1481-4. [PMID: 24643411 DOI: 10.1161/strokeaha.114.004800] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Thromboembolism in paroxysmal atrial fibrillation (AF) has often been attributed to occult AF. We hypothesized that the surface ECG may not always reflect left atrial appendage (LAA) mechanical function. METHODS Transesophageal echocardiographic images from 201 consecutive patients undergoing transesophageal echocardiography by a single operator were reviewed. LAA pulse wave Doppler phenotype, ECG rhythm, and mitral valve motion for rhythm of the body of the left atrium and the electronic medical record were reviewed by 3 blinded, independent observers. RESULTS Of 201 patients (63.4±15 years; 61% men) undergoing transesophageal echocardiography, 15 (7.5%) demonstrated LA-LAA discordance including 7 (3.5%) with a sinus rhythm ECG/mitral valve motion and an AF LAA pulse wave Doppler phenotype. Of 24 patients with a clinical history of AF but sinus rhythm ECG, 25% demonstrated a discordant AF LAA pulse wave Doppler phenotype. Compared with concordant AF, the AF discordant group had greater CHA2DS2-VASc (CHADS2, vascular disease, age, sex category; P=0.008) and lower LAA ejection velocity (P=0.02). CONCLUSIONS A quarter of patients with paroxysmal AF demonstrate a prothrombotic AF LAA pulse wave Doppler phenotype, despite concurrent sinus rhythm ECG. These findings provide a novel explanation for ongoing thromboembolism in the paroxysmal AF population, despite apparent ECG maintenance of sinus rhythm.
Collapse
Affiliation(s)
- Haider J Warraich
- From the Departments of Medicine, Cardiovascular Division (H.J.W., M.G., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | | |
Collapse
|
37
|
Biaggi P, Felix C, Gruner C, Herzog BA, Hohlfeld S, Gaemperli O, Stähli BE, Paul M, Held L, Tanner FC, Grünenfelder J, Corti R, Bettex D. Assessment of mitral valve area during percutaneous mitral valve repair using the MitraClip system: comparison of different echocardiographic methods. Circ Cardiovasc Imaging 2013; 6:1032-40. [PMID: 24134955 DOI: 10.1161/circimaging.113.000620] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Quantification of the mitral valve area (MVA) is important to guide percutaneous mitral valve repair using the MitraClip system. However, little is known about how to best assess MVA in this specific situation. METHODS AND RESULTS Immediately before and after MitraClip implantation, comprehensive 3-dimensional (3D) transesophageal echocardiography data were acquired for MVA assessment by the pressure half-time method and by two 3D quantification methods (mitral valve quantification software and 3D quantification software). In addition, transmitral gradients by continuous-wave Doppler (dPmeanCW) were measured to indirectly assess MVA. Data are given as median (interquartile range). Thirty-three patients (39% women) with a median age of 77.1 years (12.4 years) were studied. Before intervention, the median MVAs by the pressure half-time method, mitral valve quantification software, and 3D quantification software were 4.4 cm(2) (2.0 cm(2)), 4.7 cm(2) (2.4 cm(2)), and 6.2 cm(2) (2.4 cm(2)), respectively (P<0.001). After intervention, MVA was reduced to 1.9 cm(2) (0.7 cm(2)), 2.1 cm(2) (1.1 cm(2)), and 2.8 cm(2) (1.1 cm(2)), respectively (P=0.001). The median values for dPmeanCW before and after intervention were 1.0 mm Hg (1.0 mm Hg) and 3.0 mm Hg (3.0 mm Hg; P<0.001), respectively. At discharge, the median dPmeanCW was 4.0 mm Hg (3.0 mm Hg). In multivariate regression analyses including body surface area, the 3 different MVA methods, and dPmeanCW, a post-dPmeanCW ≥5 mm Hg was the best independent predictor of an elevated transmitral gradient at discharge. CONCLUSIONS Transmitral gradients by continuous-wave Doppler are quick, feasible in all patients, and superior to direct peri-interventional assessment of MVA. A postinterventional transmitral gradient by continuous-wave Doppler of ≥5 mm Hg best predicted elevated transmitral gradients at discharge.
Collapse
Affiliation(s)
- Patric Biaggi
- Division of Echocardiography, Andreas Grüntzig Cardiac Catheterization Laboratories, Cardiology, Clinic for Cardiovascular Surgery, and Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; and the Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Goel SS, Aksoy O, Tuzcu EM, Krasuski RA, Kapadia SR. Embolization of patent foramen ovale closure devices: incidence, role of imaging in identification, potential causes, and management. Tex Heart Inst J 2013; 40:439-444. [PMID: 24082375 PMCID: PMC3783141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Transcatheter patent foramen ovale (PFO) closure is an alternative to antiplatelet or anticoagulative therapy in patients with cryptogenic stroke, and it is associated with a small incidence of periprocedural sequelae. Because embolization of PFO closure devices is a very rare procedural complication, data on its frequency, causes, and management are sparse. We sought to review the medical literature and the cases of PFO closure-device embolization at our institution with the aim of identifying likely problems and reporting potential solutions. Out of 310 adult patients who underwent transcatheter PFO closure from June 2002 through April 2011, there were 2 cases (0.6%) of PFO closure-device embolization. In both patients, hypermobile septum primum and thick septum secundum were present. In one patient, failure to use a sizing balloon might have resulted in an underestimation of the PFO's size. In both patients, device embolization was identified in a timely fashion, the embolized device was safely retrieved, and the PFO was percutaneously closed with success. The incidence of PFO closure-device embolization is very low. The cases described here underscore the importance of imaging in the identification of morphologic predispositions to closure-device malpositioning, in the recognition of impending embolization, and in the timely management of embolization.
Collapse
Affiliation(s)
- Sachin S Goel
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195
| | | | | | | | | |
Collapse
|
39
|
Rubio Alvarez J, Martinez de Alegria A, Sierra Quiroga J, Adrio Nazar B, Rubio Taboada C, Martinez Comendador JM. Rapid growth of left atrial myxoma after radiofrequency ablation. Tex Heart Inst J 2013; 40:459-461. [PMID: 24082379 PMCID: PMC3783123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Atrial myxoma is the most common benign tumor of the heart, but its appearance after radiofrequency ablation is very rare. We report a case in which an asymptomatic, rapidly growing cardiac myxoma arose in the left atrium after radiofrequency ablation. Two months after the procedure, cardiovascular magnetic resonance, performed to evaluate the right ventricular anatomy, revealed a 10 × 10-mm mass (assumed to be a thrombus) attached to the patient's left atrial septum. Three months later, transthoracic echocardiography revealed a larger mass, and the patient was diagnosed with myxoma. Two days later, a 20 × 20-mm myxoma weighing 37 g was excised. To our knowledge, the appearance of an atrial myxoma after radiofrequency ablation has been reported only once before. Whether tumor development is related to such ablation or is merely a coincidence is uncertain, but myxomas have developed after other instances of cardiac trauma.
Collapse
Affiliation(s)
- José Rubio Alvarez
- Departments of Cardiac Surgery (Drs. Adrio Nazar, Martinez Comendador, Rubio Alvarez, Rubio Taboada, and Sierra Quiroga) and Radiology (Dr. Martinez de Alegria), University Hospital, 15706 Santiago de Compostela, Spain
| | | | | | | | | | | |
Collapse
|
40
|
David TE. Cusp repair in aortic valve procedures: advanced techniques. Tex Heart Inst J 2013; 40:547-548. [PMID: 24391316 PMCID: PMC3853832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Tirone E David
- Division of Cardiovascular Surgery of Toronto General Hospital, Peter Munk Cardiac Centre and the University of Toronto, Toronto, Ontario M5G 2C4, Canada
| |
Collapse
|
41
|
Satya K, Kalife G, Navarijo J, Rasekh A, Wilson JM. Transseptal biopsy of a left atrial mass with 3-dimensional transesophageal echocardiographic guidance. Tex Heart Inst J 2012; 39:707-710. [PMID: 23109774 PMCID: PMC3461650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 31-year-old man presented with a large cardiac mass that originated from the basal posterior left atrial wall and occupied most of the dilated atrium. Minimally invasive studies yielded inconclusive results, but the patient was considered at high risk for an open cardiac biopsy due to the size of the mass. To establish a tissue diagnosis for definitive treatment, we performed a transseptal cardiac biopsy guided by 3-dimensional transesophageal echocardiography. We thereby determined that the mass was a primary left atrial sarcoma. To the best of our knowledge, this is the first report concerning the use of 3-dimensional transesophageal echocardiography for biopsy of a left atrial mass.
Collapse
Affiliation(s)
- Kumar Satya
- Department of Cardiology, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Texas 77030, USA
| | | | | | | | | |
Collapse
|
42
|
Bai W, An Q, Tang H. Application of transesophageal echocardiography in minimally invasive surgical closure of ventricular septal defects. Tex Heart Inst J 2012; 39:211-214. [PMID: 22740733 PMCID: PMC3384042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We sought both to evaluate the clinical value of transesophageal echocardiography in minimally invasive surgical closure of ventricular septal defects and to evaluate the feasibility, safety, and efficacy of the surgical occlusion procedure. We selected 49 pediatric patients who had perimembranous ventricular septal defects as determined by preoperative transthoracic echocardiographic examination. After the patients were under general anesthesia, we used transesophageal echocardiography to determine the number of defects and their positions, shapes, and sizes, these last in order to choose the appropriate occluder. Under transesophageal echocardiographic monitoring and guidance, we introduced and deployed the occluder. The evaluation of therapy was performed by means of transesophageal echocardiography immediately after occluder release. All patients underwent follow-up transthoracic echocardiography within 2 to 5 postoperative days. Satisfactory occluder deployment was achieved in 38 patients. No death occurred. No occluder displacement or valve dysfunction was observed during the last transesophageal echocardiographic study. In addition, follow-up by transthoracic echocardiography showed improvement of left ventricular dimensions and ejection fractions. Our initial experience has been encouraging. Transesophageal echocardiography plays a crucial role in performing minimally invasive surgical closure of cardiac defects. It enables the feasible, safe, and effective closure of ventricular septal defects. However, larger sample sizes and longer-term follow-up are necessary for the accurate evaluation of this procedure's safety and effectiveness as an alternative to cardiopulmonary bypass surgery and transcatheter closure of congenital cardiac defects.
Collapse
Affiliation(s)
- Wenjuan Bai
- Departments of Cardiology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | | | | |
Collapse
|
43
|
Telich-Tarriba JE, Anaya-Ayala JE, Reardon MJ. Surgical repair of right atrial wall rupture after blunt chest trauma. Tex Heart Inst J 2012; 39:579-581. [PMID: 22949784 PMCID: PMC3423265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Right atrial wall rupture after blunt chest trauma is a catastrophic event associated with high mortality rates. We report the case of a 24-year-old woman who was ejected 40 feet during a motor vehicle accident. Upon presentation, she was awake and alert, with a systolic blood pressure of 100 mmHg. Chest computed tomography disclosed a large pericardial effusion; transthoracic echocardiography confirmed this finding and also found right ventricular diastolic collapse. A diagnosis of cardiac tamponade with probable cardiac injury was made; the patient was taken to the operating room, where median sternotomy revealed a 1-cm laceration of the right atrial appendage. This lesion was directly repaired with 4-0 polypropylene suture. Her postoperative course was uneventful, and she continued to recover from injuries to the musculoskeletal system. This case highlights the need for a high degree of suspicion of cardiac injuries after blunt chest trauma. An algorithm is proposed for rapid recognition, diagnosis, and treatment of these lesions.
Collapse
Affiliation(s)
- Jose E Telich-Tarriba
- Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas 77030, USA
| | | | | |
Collapse
|
44
|
Mehrotra D, Dalley P, Mahon B. Tricuspid valve avulsion after blunt chest trauma. Tex Heart Inst J 2012; 39:668-670. [PMID: 23109764 PMCID: PMC3461659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Blunt cardiac trauma causing tricuspid regurgitation is rare and is most often associated with traffic accidents. Falling from a height can also cause such injuries, resulting in hemodynamic compromise and arrhythmias. The signs of traumatic tricuspid regurgitation can appear early or be delayed, depending upon the severity of injury. We present the case of a 68-year-old woman who fell from a height onto rocks during a hike. She sustained blunt cardiac injury with complete tricuspid valve avulsion, and underwent successful repair. In addition, we review the relevant medical literature.
Collapse
Affiliation(s)
- Deepak Mehrotra
- Department of Cardiothoracic Surgery, Wellington Hospital, Wellington 6021, New Zealand.
| | | | | |
Collapse
|
45
|
Portillo-Sanchez J, Hessein-Abdou Y, Puga-Alcalde E, Perez-Martinez MA, Del Carmen Jimenez-Meneses M, Camacho-Pedrero A, Valdepeñas-Herrero LR. Primary pulmonary artery sarcoma extending retrograde into the superior vena cava. Tex Heart Inst J 2011; 38:77-80. [PMID: 21423477 PMCID: PMC3060731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Primary pulmonary artery sarcoma is a rare tumor that is highly fatal. It can be misdiagnosed as acute or chronic pulmonary thromboembolic disease. Herein, we report the case of a 22-year-old woman with a preoperative diagnosis of pulmonary embolism and superior vena caval thrombosis. Intraoperatively, an extensive sarcoma was seen to extend retrograde from the pulmonary artery, past the right ventricle and right atrium, and into the superior vena cava. Surgical resection of the tumor and reconstruction of the central pulmonary arteries, followed by adjuvant chemotherapy, relieved the clinical symptoms. The patient remained free of cancer at 14 months postoperatively. We believe that this is the 1st report of a primary pulmonary artery sarcoma that extended retrograde into the superior vena cava.
Collapse
Affiliation(s)
- José Portillo-Sanchez
- Departments of Internal Medicine, Hospital General Ciudad Real, 10034 Ciudad Real, Spain
| | | | | | | | | | | | | |
Collapse
|
46
|
Yorgun H, Canpolat U, Kaya EB, Aytemir K, Oto A. Thrombus formation during percutaneous closure of an atrial septal defect with an Amplatzer septal occluder. Tex Heart Inst J 2011; 38:427-430. [PMID: 21841876 PMCID: PMC3147222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Percutaneous closure of an ostium secundum-type atrial septal defect is typically a safe and effective therapeutic option in the presence of significant shunting or paradoxical embolism. Infrequently, however, periprocedural sequelae occur.Herein, we report the cases of 2 patients, each of whom underwent transcatheter closure of an atrial septal defect with the use of an Amplatzer Septal Occluder under transesophageal echocardiographic guidance. In both patients, acute thrombi formed periprocedurally, despite preprocedural anticoagulation. In patient 1, the infusion of unfractionated heparin for 24 hours prevented the recurrence of thrombus; in patient 2, the thrombus was isolated under the arm of the occluder, and unfractionated heparin was infused. Both patients were asymptomatic and without detectable thrombus after the procedure and at follow-up. These reports highlight a rare early sequela and the importance of transesophageal echocardiographic monitoring during the percutaneous closure of an atrial septal defect.
Collapse
Affiliation(s)
- Hikmet Yorgun
- Department of Cardiology, Hacettepe University, 06100 Ankara, Turkey
| | | | | | | | | |
Collapse
|
47
|
Darwazah AK, Eida M, Bader V, Khalil M. Surgical management of double-chambered right ventricle in adults. Tex Heart Inst J 2011; 38:301-304. [PMID: 21720479 PMCID: PMC3113143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Double-chambered right ventricle is a congenital anomaly in which the right ventricle is divided into 2 portions by anomalous muscle bundles. These cases often present in children, but rarely in adults. We discuss 2 cases of double-chambered right ventricle, in patients aged 42 and 35 years. When cases remain asymptomatic until adulthood, they can present with unusual symptoms that lead to incorrect diagnosis. Our cases represent 2 very different manifestations of double-chambered right ventricle, which differ in presentation, in the site of abnormal obstructive muscle bundles, and in the presence of associated lesions. Both of our patients underwent successful surgical resection of the obstruction. One patient also underwent closure of a ventricular septal defect. We also review the literature on the various mechanisms that have been proposed to account for the complex morphology of the abnormal muscle bundles.
Collapse
Affiliation(s)
- Ahmad K Darwazah
- Department of Cardiac Surgery, Ramallah Hospital, West Bank, Ramallah, Israel.
| | | | | | | |
Collapse
|
48
|
Hoffmayer KS, Zellner C, Kwan DM, Konety S, Foster E, Moore P, Yeghiazarians Y. Closure of a para-valvular aortic leak: with the use of 2 AMPLATZER devices and real-time 2- and 3-dimensional transesophageal echocardiography. Tex Heart Inst J 2011; 38:81-84. [PMID: 21423478 PMCID: PMC3060745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Paravalvular leaks are well-recognized sequelae of mechanical aortic valve implantation. Clinical manifestations include hemolysis, arrhythmias, and congestive heart failure. Frequently, patients who receive mechanical aortic valves are poor candidates for repeat valve surgery, and the reoperative mortality rate is high. Percutaneous intervention has recently become an alternative to surgery in selected patients. Herein, we describe the percutaneous closure of an aortic paravalvular leak in a 45-year-old man who had undergone 2 aortic valve replacements with mechanical valves. The patient, who was at high surgical risk due to comorbidities, underwent the implantation of 2 AMPLATZER devices with the use of real-time 2- and 3-dimensional transesophageal echocardiography. The early outcome of the procedure was favorable and without sequelae. To our knowledge, this is the 1st report of the closing of an aortic paravalvular leak with the use of 2 closure devices and real-time echocardiographic guidance.
Collapse
Affiliation(s)
- Kurt S Hoffmayer
- Division of Cardiology, Department of Medicine, University of California, San Francisco; San Francisco, California 94143, USA.
| | | | | | | | | | | | | |
Collapse
|
49
|
Bathina JD, Daher IN, Plana JC, Durand JB, Yusuf SW. Acute myocardial infarction associated with nonbacterial thrombotic endocarditis. Tex Heart Inst J 2010; 37:208-212. [PMID: 20401296 PMCID: PMC2851431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Herein, we describe the cases of 4 patients who each experienced a myocardial infarction in association with nonbacterial thrombotic endocarditis. We discuss the clinical presentation of this rare condition, distinguish between infective and nonbacterial thrombotic endocarditis via a review of the medical literature, and present treatment options for myocardial infarction that is associated with nonbacterial thrombotic endocarditis.
Collapse
Affiliation(s)
- Jaya D Bathina
- Department of Cardiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
| | | | | | | | | |
Collapse
|
50
|
Hussain J, Strumpf R, Ghandforoush A, Jamal A, Diethrich E. Transhepatic approach to closure of patent foramen ovale: report of 2 cases in adults. Tex Heart Inst J 2010; 37:553-556. [PMID: 20978566 PMCID: PMC2953222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Patent foramen ovale is increasingly diagnosed in patients who are undergoing clinical study for cryptogenic stroke or migraine. In addition, patent foramen ovale is often suspected as a cause of paradoxical embolism in patients who present with arterial thromboembolism. The femoral venous approach to closure has been the mainstay. When the femoral approach is not feasible, septal occluder devices have been deployed via a transjugular approach.Herein, we describe 2 cases of patent foramen ovale in which the transhepatic approach was used for closure. To our knowledge, this is the 1st report of a transhepatic approach to patent foramen ovale closure in an adult patient. Moreover, no previous case of patent foramen ovale closure has been reported in a patient with interrupted inferior vena cava.
Collapse
Affiliation(s)
- Jamal Hussain
- Cardiology Department, Arizona Heart Hospital & Institute, Phoenix, Arizona 85016, USA
| | | | | | | | | |
Collapse
|