1
|
Jiang L, Zhang H. Letter to the editor: "Resuscitative transesophageal echocardiography during the acute resuscitation of trauma: A retrospective observational study". J Crit Care 2024; 81:154539. [PMID: 38359517 DOI: 10.1016/j.jcrc.2024.154539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/10/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Libing Jiang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou 310009, China.
| | - Hongyu Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou 310009, China
| |
Collapse
|
2
|
Liu X, Li X, Xiong S, Zhang H, Suo R, Zhang X, Liu D, Fu H, Liu T, Li G. Neutrophil Extracellular Traps: Potential Prothrombotic State Markers and Therapeutic Targets for Atrial Fibrillation. Thromb Haemost 2024; 124:441-454. [PMID: 37734390 DOI: 10.1055/s-0043-1774310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Recently, the mechanism of thrombogenesis has taken a new direction with the involvement of neutrophil extracellular traps (NETs). However, little is known about the relationship between NETs and thrombogenesis in atrial fibrillation (AF). OBJECTIVE Our study aimed to evaluate NETs in AF patients and their potential association with thrombogenesis. In addition, we studied the effect of NETs on thrombogenesis in rat models. METHODS A total of 125 AF patients and 172 controls were studied. Spontaneous echo contrast (SEC) was examined using transesophageal echocardiography to assess the prothrombotic state. We used rapid atrial pacing (RAP) rat models to study NETs' formation and their effects on thrombogenesis. The levels of NETs were analyzed by flow cytometry. To deeply understand the regulatory mechanism of NET formation, the transcriptional characteristics of the left atrial appendage (LAA) tissue from RAP rats were analyzed. RESULTS We found that NETs were increased significantly in AF patients and positively correlated with SEC grades. And inserting the NET level could significantly enhance the predictivity of CHA2DS2-VASc scores for the AF prothrombotic state. In the RAP models, we observed that NET levels increased significantly in the LAA and promoted thrombosis. Meanwhile, we found that these changes could be suppressed by the NET formation inhibitor. Transcriptomic analysis of the LAA tissue from RAP rats suggested that RAP might stimulate the NET formation by promoting the expression of inflammatory cytokine and adhesion genes. CONCLUSION NETs may constitute useful thrombogenesis risk markers in AF patients and provide a potential therapeutic strategy for AF management.
Collapse
Affiliation(s)
- Xing Liu
- Department of Cardiology, Tianjin key laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xinjian Li
- Department of Cardiology, Tianjin key laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Shenglin Xiong
- Department of Cardiology, You Country People's Hospital, Zhuzhou, Hunan, China
| | - Haipeng Zhang
- Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Rong Suo
- Department of Cardiology, Tianjin Hospital, Tianjin, China
| | - Xu Zhang
- Department of Cardiology, Tianjin key laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Daiqi Liu
- Department of Cardiology, Tianjin key laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Huaying Fu
- Department of Cardiology, Tianjin key laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Department of Cardiology, Tianjin key laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guangping Li
- Department of Cardiology, Tianjin key laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| |
Collapse
|
3
|
Huang L, Mahmood F, Laham R, Sharma RK, Belani K. Percutaneous Approach to Mechanical Aortic Valve Prosthesis Paravalvular Leak Closure: Lessons Learned. J Cardiothorac Vasc Anesth 2024; 38:1203-1210. [PMID: 38423882 DOI: 10.1053/j.jvca.2024.01.031] [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] [Received: 11/23/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Lisa Huang
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Roger Laham
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ravi K Sharma
- Jewish Hospital Cardiology, University of Louisville Jewish Hospital, Louisville, KY
| | - Kiran Belani
- Department of Anesthesiology, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
4
|
Lee IH, Heo J, Lee H, Jeong J, Kim J, Han M, Yoo J, Kim J, Baik M, Park H, Jung JW, Kim YD, Nam HS. Long-term outcomes of patients with embolic stroke of undetermined source according to subtype. Sci Rep 2024; 14:9295. [PMID: 38653743 DOI: 10.1038/s41598-024-58292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
The prognosis of patients with embolic stroke of undetermined source (ESUS) may vary according to the underlying cause. Therefore, we aimed to divide ESUS into subtypes and assess the long-term outcomes. Consecutive patients with acute ischemic stroke who underwent a comprehensive workup, including transesophageal echocardiography and prolonged electrocardiography monitoring, were enrolled. We classified ESUS into minor cardioembolic (CE) ESUS, arteriogenic ESUS, two or more causes ESUS, and no cause ESUS. Arteriogenic ESUS was sub-classified into complex aortic plaque (CAP) ESUS and non-stenotic (< 50%) relevant artery plaque (NAP) ESUS. A total of 775 patients were enrolled. During 1286 ± 748 days follow-up, 116 major adverse cardiovascular events (MACE) occurred (4.2 events/100 patient-years). Among the ESUS subtypes, CAP ESUS was associated with the highest MACE frequency (9.7/100 patient-years, p = 0.021). Cox regression analyses showed that CAP ESUS was associated with MACE (hazard ratio 2.466, 95% confidence interval 1.305-4.660) and any stroke recurrence (hazard ratio 2.470, 95% confidence interval, 1.108-5.508). The prognosis of ESUS varies according to the subtype, with CAP ESUS having the worst prognosis. Categorizing ESUS into subtypes could improve patient care and refine clinical trials.
Collapse
Affiliation(s)
- Il Hyung Lee
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyungwoo Lee
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - JaeWook Jeong
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Joonho Kim
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Minho Han
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Jinkwon Kim
- Department of Neurology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Minyoul Baik
- Department of Neurology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Hyungjong Park
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jae Wook Jung
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
5
|
Guerreiro C, Barreiro-Perez M, Estevez-Loureiro R, Baz JA, Caneiro-Queija B, Gonzalez-Ferreiro R, Iñiguez-Romo A. Fully Percutaneous Fusion-Guided Transcatheter Mitral Valve Replacement With a New Transseptal System. JACC Cardiovasc Interv 2024; 17:1063-1064. [PMID: 38520452 DOI: 10.1016/j.jcin.2024.01.290] [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] [Received: 12/09/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Claudio Guerreiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Manuel Barreiro-Perez
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain.
| | - Rodrigo Estevez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Jose Antonio Baz
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Berenice Caneiro-Queija
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Rocio Gonzalez-Ferreiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Andres Iñiguez-Romo
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| |
Collapse
|
6
|
Brown B, Frasco PE, Stoker AD. Intrapulmonary Shunting and Paradoxical Air Embolism in Liver Transplantation: A Case Report. Am J Case Rep 2024; 25:e943042. [PMID: 38627956 PMCID: PMC11034387 DOI: 10.12659/ajcr.943042] [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] [Received: 10/31/2023] [Revised: 03/05/2024] [Accepted: 02/21/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND A paradoxical air embolism (PAE) occurs when air entering the central venous circulation reaches the systemic circulation, occurring through an intracardiac shunt or intrapulmonary shunting. Patients presenting for liver transplantation often have intrapulmonary shunting due to pulmonary arterial vasodilation, even in the absence of hepatopulmonary syndrome. Here, we present a case of hemodynamic collapse believed to be caused by a PAE, which was diagnosed intraoperatively with transesophageal echocardiography (TEE). CASE REPORT A 60-year-old man who was diagnosed with non-alcoholic steatohepatitis cirrhosis presented for deceased donor orthotopic liver transplantation with utilization of normothermic machine perfusion. Following reperfusion of the liver allograft, TEE detected intrapulmonary shunting resulting in air within the left atrium, left ventricle, and ascending aorta. The patient developed severe biventricular dysfunction with ST-segment changes on electrocardiography monitoring and became acutely hypotensive with significant hepatic congestion 5 min after liver reperfusion. High doses of inotropic and vasopressor support were used as well as inhaled nitric oxide. The patient recovered after 30 min of medical management. The liver transplantation operation was successfully completed and the patient was discharged home on postoperative day 7. CONCLUSIONS Intracardiac air at the time of reperfusion during liver transplantation can originate from the donor allograft and result in PAE in the setting of intrapulmonary shunting. PAE can result in intracoronary air and should be considered in cases of hemodynamic instability in liver transplantation, especially if air is seen within the left atrium, left ventricle, and ascending aorta.
Collapse
|
7
|
Zhang RS, Bailey E, Maqsood MH, Harari R, Bernard S, Xia Y, Keller N, Alviar CL, Bangalore S. Intracardiac Versus Transesophageal Echocardiography Guided Percutaneous Debulking of Tricuspid Endocarditis. Am J Cardiol 2024; 217:141-143. [PMID: 38401653 DOI: 10.1016/j.amjcard.2024.01.036] [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] [Received: 12/11/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Robert S Zhang
- Division of Cardiovascular Medicine, New York University, New York, New York
| | - Eric Bailey
- Department of Medicine, New York University, New York, New York
| | - Muhammad H Maqsood
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Rafael Harari
- Division of Cardiovascular Medicine, New York University, New York, New York
| | - Samuel Bernard
- Division of Cardiovascular Medicine, New York University, New York, New York
| | - Yuhe Xia
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Norma Keller
- Division of Cardiovascular Medicine, New York University, New York, New York
| | - Carlos L Alviar
- Division of Cardiovascular Medicine, New York University, New York, New York
| | - Sripal Bangalore
- Division of Cardiovascular Medicine, New York University, New York, New York.
| |
Collapse
|
8
|
Noubiap JJ, Nyaga UF, Middeldorp ME, Stokes MB, Sanders P. Cardiac imaging correlates and predictors of stroke in patients with atrial fibrillation: a meta-analysis. J Cardiovasc Med (Hagerstown) 2024; 25:280-293. [PMID: 38407860 DOI: 10.2459/jcm.0000000000001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND New nonclinical parameters are needed to improve the current stroke risk stratification schemes for patients with atrial fibrillation. This study aimed to summarize data on potential cardiac imaging correlates and predictors of stroke or systemic embolism in patients with atrial fibrillation. METHODS MEDLINE, EMBASE, and Web of Science were searched to identify all published studies providing relevant data through 16 November 2022. Random effects meta-analysis method was used to pool estimates. RESULTS We included 64 studies reporting data from a pooled population of 56 639 patients. Left atrial spontaneous echo-contrast [adjusted odds ratio (aOR) 3.32, 95% confidence interval (CI) 1.98-5.49], nonchicken wing left atrial appendage (LAA) morphology (aOR 2.15, 95% CI 1.11-4.18), left atrial enlargement (aOR 2.12, 95% CI 1.45-3.08), and higher LAA orifice diameter (aOR 1.56, 95% CI 1.18-2.05) were highly associated with stroke. Other parameters associated with stroke included higher left atrial sphericity (aOR 1.14, 95% CI 1.01-1.29), higher left atrial volume (aOR 1.03, 95% CI 1.01-1.04), higher left atrial volume index (aOR 1.014, 95% CI 1.004-1.023), lower left atrial reservoir strain [adjusted hazard ratio (aHR) 0.86, 95% CI 0.76-0.98], higher left ventricular mass index (aOR 1.010, 95% CI 1.005-1.015) and E / e' ratio (aOR 1.12, 95% CI 1.07-1.16). There was no association between LAA volume (aOR 1.37, 95% CI 0.85-2.21) and stroke. CONCLUSION These cardiac imaging parameters identified as potential predictors of thromboembolism may improve the accuracy of stroke risk stratification schemes in patients with atrial fibrillation. Further studies should evaluate the performance of holistic risk scores including clinical factors, biomarkers, and cardiac imaging.
Collapse
Affiliation(s)
- Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | | | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Smidt Heart Institute, Cedar-Sinai Medical Centre, Los Angeles, California, USA
| | - Michael B Stokes
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| |
Collapse
|
9
|
Yu J, Taskén AA, Flade HM, Skogvoll E, Berg EAR, Grenne B, Rimehaug A, Kirkeby-Garstad I, Kiss G, Aakhus S. Automatic assessment of left ventricular function for hemodynamic monitoring using artificial intelligence and transesophageal echocardiography. J Clin Monit Comput 2024; 38:281-291. [PMID: 38280975 DOI: 10.1007/s10877-023-01118-x] [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] [Received: 08/28/2023] [Accepted: 12/03/2023] [Indexed: 01/29/2024]
Abstract
We have developed a method to automatically assess LV function by measuring mitral annular plane systolic excursion (MAPSE) using artificial intelligence and transesophageal echocardiography (autoMAPSE). Our aim was to evaluate autoMAPSE as an automatic tool for rapid and quantitative assessment of LV function in critical care patients. In this retrospective study, we studied 40 critical care patients immediately after cardiac surgery. First, we recorded a set of echocardiographic data, consisting of three consecutive beats of midesophageal two- and four-chamber views. We then altered the patient's hemodynamics by positioning them in anti-Trendelenburg and repeated the recordings. We measured MAPSE manually and used autoMAPSE in all available heartbeats and in four LV walls. To assess the agreement with manual measurements, we used a modified Bland-Altman analysis. To assess the precision of each method, we calculated the least significant change (LSC). Finally, to assess trending ability, we calculated the concordance rates using a four-quadrant plot. We found that autoMAPSE measured MAPSE in almost every set of two- and four-chamber views (feasibility 95%). It took less than a second to measure and average MAPSE over three heartbeats. AutoMAPSE had a low bias (0.4 mm) and acceptable limits of agreement (- 3.7 to 4.5 mm). AutoMAPSE was more precise than manual measurements if it averaged more heartbeats. AutoMAPSE had acceptable trending ability (concordance rate 81%) during hemodynamic alterations. In conclusion, autoMAPSE is feasible as an automatic tool for rapid and quantitative assessment of LV function, indicating its potential for hemodynamic monitoring.
Collapse
Affiliation(s)
- Jinyang Yu
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
- Clinic of Cardiology St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Anders Austlid Taskén
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans Martin Flade
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Erik Andreas Rye Berg
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjørnar Grenne
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Audun Rimehaug
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Idar Kirkeby-Garstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gabriel Kiss
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svend Aakhus
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
10
|
Sonaglioni A, Grasso E, Nicolosi GL, Lombardo M. Modified Haller Index is inversely associated with asymptomatic status in atrial fibrillation patients undergoing electrical cardioversion: a preliminary observation. Minerva Cardiol Angiol 2024; 72:190-203. [PMID: 38127440 DOI: 10.23736/s2724-5683.23.06446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND No previous study evaluated the possible influence of chest wall conformation on symptoms perception in atrial fibrillation (AF) patients candidates for electrical cardioversion (ECV). We aimed at evaluating the anthropometric and clinical characteristics of patients with persistent AF undergoing ECV, categorized according to the presence or absence of symptoms. METHODS This study retrospectively analyzed a series of persistent AF patients scheduled for early ECV who underwent pre-procedural clinical evaluation, MHI (the ratio of chest transverse diameter over the distance between sternum and spine) assessment, transthoracic and transesophageal echocardiography implemented with strain analysis of both left atrium and left atrial appendage. Thromboembolic risk and burden of comorbidities were assessed by CHA2DS2-VASc Score and Charlson Comorbidity Index (CCI), respectively. The independent predictors of "asymptomatic AF" were assessed. RESULTS A total of 25 asymptomatic and 90 symptomatic AF patients were retrospectively examined. Compared to symptomatic AF patients, those asymptomatic were significantly older (78.4±3.8 vs. 71.0±7.7 years, P<0.001), predominantly males (84 vs. 44.4%, P<0.001), with significantly lower MHI (2.0±0.1 vs. 2.4±0.1, P<0.001), higher CHA2DS2-VASc Score (5.8±1.1 vs. 3.6±1.1, P<0.001) and CCI (6.8±1.4 vs. 2.3±0.9, P<0.001), and greater impairment in biventricular systolic function and atrio-auricolar myocardial strain indices. On multivariate logistic regression analysis, CHA2DS2-VASc Score (OR=2.65, 95% CI: 1.53-4.60) and CCI (OR=2.36, 95% CI: 1.16-4.66) were linearly associated with the endpoint "asymptomatic AF," whereas MHI (OR 0.76, 95% CI 0.59-0.97) was inversely associated with the asymptomatic status. A MHI <2.2 was the best cut-off for detecting asymptomatic AF patients. CONCLUSIONS MHI is inversely associated with asymptomatic status in persistent AF patients undergoing ECV. MHI assessment might represent an innovative practical approach to AF patients.
Collapse
Affiliation(s)
| | - Enzo Grasso
- Division of Cardiology, IRCCS MultiMedica, Milan, Italy
| | - Gian L Nicolosi
- Division of Cardiology, Policlinico San Giorgio, Pordenone, Italy
| | | |
Collapse
|
11
|
Oliva OA, Giugno L, Moroni A, Sturla F, Piazza L, Saracino A, Micheletti A, d'Aiello AF, Reali M, Chessa M, Carminati M. Right disc thrombosis of the new Gore Cardioform ASD Occluder. Catheter Cardiovasc Interv 2024; 103:741-750. [PMID: 38451154 DOI: 10.1002/ccd.31002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/04/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The GCA is a well performing device in terms of efficacy despite complex anatomies (aortic rim <5 mm and ASD diameter >17 mm) with a good safety profile. AIMS To evaluate atrial septal defect (ASD) features impacting on right disc device thrombosis in patients who underwent Gore Cardioform ASD Occluder (GCA) implantation. METHODS A total of 44 consecutive patients undergoing percutaneous ASD with GCA device from January 2020 to September 2022 at our tertiary care Center were evaluated. The minimum follow-up was 6 months. RESULTS The patients were stratified in two groups according to a cut-off value of ASD diameter equal to 20 mm at sizing balloon, derived from ROC analysis (AUC = 0.894; p = 0.024). Baseline characteristics were comparable between groups in terms of age, sex, weight, height, and interatrial septum dimensions. Patients with ASD > 20 mm (n = 9) had a higher ASD/device dimension ratio, both at echocardiography (p = 0.009) and at sizing balloon (p = 0.001), longer fluoroscopic time (p = 0.022), and higher incidence of device thrombosis (0.006). Right disc thrombosis was observed in three patients of the ASD > 20 mm group, always in the inferior portion of the right disc. On univariate analysis, ASD diameter at sizing balloon (OR 1.360; p = 0.036) was the only positive predictor of device thrombosis. CONCLUSIONS Right disc thrombosis of the GCA device may be under-recognized at follow-up, hence deserving clinical attention, especially in those patients with larger ASD diameters.
Collapse
Affiliation(s)
- Omar A Oliva
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Giugno
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alice Moroni
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Luciane Piazza
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonio Saracino
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Angelo Micheletti
- ACHD Unit - Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Angelo Fabio d'Aiello
- ACHD Unit - Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Matteo Reali
- Congenital Cardiac Surgery Unit, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Chessa
- ACHD Unit - Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Faculty of Medicine and Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Mario Carminati
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| |
Collapse
|
12
|
Singh A, Nanda C, Mehta Y. Remote Embolization of an Atrial Septal Occluder Device. J Cardiothorac Vasc Anesth 2024; 38:1054-1055. [PMID: 38246821 DOI: 10.1053/j.jvca.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 12/29/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Ajmer Singh
- Department of Cardiac Anesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram, India.
| | - Chinmaya Nanda
- Department of Cardiac Anesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram, India
| | - Yatin Mehta
- Department of Cardiac Anesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurugram, India
| |
Collapse
|
13
|
Egawa A. Transesophageal Echocardiography-Guided Elephant Trunk Procedure for Repair of Descending Thoracic Aorta: A Case Report. Ann Card Anaesth 2024; 27:159-161. [PMID: 38607880 DOI: 10.4103/aca.aca_132_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/03/2023] [Indexed: 04/14/2024] Open
Abstract
ABSTRACT The elephant trunk procedure, an endovascular strategy for retrograde type A acute aortic dissection, is associated with several complications, hemolytic anemia being a rare one. We performed endovascular stent-graft insertion in a patient who developed hemolytic anemia. Transesophageal echocardiography (TEE) detected turbulent jet flow and stenosis position, which was not detected by angiography and intravascular ultrasound (IVUS). This imaging technique proved effective for malperfusion diagnosis and enabled us to confirm its resolution after the endovascular procedure. Intraoperative TEE is a useful adjunct to angiography and IVUS for diagnosis and therapeutic assessment during endovascular repair of a stenosed elephant trunk.
Collapse
Affiliation(s)
- Atsushi Egawa
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, Yakushiji, Shimotsuke, Tochigi, Japan
| |
Collapse
|
14
|
Wilson HC, Ferguson ME, Border WL, Sachdeva R. Contemporary transesophageal echocardiography practice patterns among paediatric cardiology centres in the United States and Canada. Cardiol Young 2024; 34:846-853. [PMID: 37905328 DOI: 10.1017/s1047951123003633] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To characterise transesophageal echocardiography practice patterns among paediatric cardiac surgical centres in the United States and Canada. METHODS A 42-question survey was sent to 80 echocardiography laboratory directors at paediatric cardiology centres with surgical programmes in the United States and Canada. Question domains included transesophageal echocardiography centre characteristics, performance and reporting, equipment use, trainee participation, and quality assurance. RESULTS Fifty of the 80 centres (62.5%) responded to the survey. Most settings were academic (86.0%) with 42.0% of centres performing > 350 surgical cases/year. The median number of transesophageal echocardiograms performed/cardiologist/year was 50 (26, 73). Pre-operative transesophageal echocardiography was performed in most surgical cases by 91.7% of centres. Transesophageal echocardiography was always performed by most centres following Norwood, Glenn, and Fontan procedures and by < 10% of centres following coarctation repair. Many centres with a written guideline allowed transesophageal echocardiography transducer use at weights below manufacturer recommendations (50.0 and 61.1% for neonatal and paediatric transducers, respectively). Most centres (36/37, 97.3%) with categorical fellowships had rotations which included transesophageal echocardiography participation. Large surgical centres (>350 cases/year) had higher median number of transesophageal echocardiograms/cardiologist/year (75.5 [53, 86] versus 35 [20, 52], p < 0.001) and more frequently used anaesthesia for diagnostic transesophageal echocardiography ≥ 67% of time (100.0 versus 62.1%, p = 0.001). CONCLUSIONS There is significant variability in transesophageal echocardiography practice patterns and training requirements among paediatric cardiology centres in the United States and Canada. Findings may help inform programmatic decisions regarding transesophageal echocardiography expectations, performance and reporting, equipment use, trainee involvement, and quality assurance.
Collapse
Affiliation(s)
- Hunter C Wilson
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - M Eric Ferguson
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - William L Border
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Ritu Sachdeva
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| |
Collapse
|
15
|
Lucarelli K, Acquaviva T, Ferrero P, De Cillis E, Casamassima V, Basile E, Cacciapaglia E, Iorio E, Martimucci M, Cecere G, Petti P, Caruso R, Langialonga T, Bortone A, Grimaldi M, Chessa M. Transcatheter closure of atrial septal defect using intracardiac echocardiography: a two-center, retrospective study. J Cardiovasc Med (Hagerstown) 2024; 25:311-317. [PMID: 38488065 DOI: 10.2459/jcm.0000000000001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
AIMS We present the experience and long-term results of intracardiac echocardiography (ICE)-guided closure of ostium secundum atrial septal defects (ASDs) in two Italian centers and investigate its systematic applicability as the gold standard in routine clinical practice. METHODS We retrospectively evaluated all consecutive patients who underwent an ASD percutaneous closure procedure from March 2008 to February 2020. All patients underwent a preprocedural transesophageal echocardiography (TEE) evaluation. The closures were carried out under fluoroscopic and ICE guidance. A follow-up visit was performed at 1, 3 and 12 months, followed by telephone evaluations approximately every 2 years. RESULTS Sixty-six patients (29% male individuals), mean age 43 ± 16 years, were treated. In 15 cases, the TEE defect diameter was less than 10 mm, and in 8 of these patients, the ICE intraprocedural sizing increased the maximum diameter by more than 5 mm. Sizing balloon of the defect was performed in 51 cases; 2 patients received an ASD 38 mm device. Eight patients had multiple defects; in three of these, it was necessary to apply two devices. Four patients showed nonsignificant residual shunt; no complications related to the use of ICE were observed. One patient presented the migration of the ASD device into the abdominal aorta, percutaneously retrieved with a snare. No major complications were recorded during the entire follow-up period. CONCLUSION This study confirms that ICE monitoring during ASD percutaneous closure is well tolerated and effective; it might be achievable as a routine gold standard by operators willing to use ICE systematically in all transcatheter closure interventions of interatrial communications.
Collapse
Affiliation(s)
- Katya Lucarelli
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Tommaso Acquaviva
- Interdepartmental Unit of Hemodynamics, Policlinico Hospital, University of Bari, Bari
| | | | - Emanuela De Cillis
- Interdepartmental Unit of Hemodynamics, Policlinico Hospital, University of Bari, Bari
| | - Vito Casamassima
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Eloisa Basile
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | | | - Elia Iorio
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | | | - Giacomo Cecere
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Pierpaolo Petti
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Rosa Caruso
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | | | - Alessandro Bortone
- Interdepartmental Unit of Hemodynamics, Policlinico Hospital, University of Bari, Bari
| | - Massimo Grimaldi
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Massimo Chessa
- ACHD Unit Head, IRCCS Policlinico San Donato & Vita Salute San Raffaele University, Milan, Italy
| |
Collapse
|
16
|
Okada A, Kubo S, Chatani R, Mushiake K, Nishiura N, Ono S, Maruo T, Kadota K. Feasibility of contrast-free left atrial appendage closure with WATCHMAN FLX device for patients with chronic kidney disease. Cardiovasc Interv Ther 2024; 39:191-199. [PMID: 38064131 DOI: 10.1007/s12928-023-00972-5] [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] [Received: 07/26/2023] [Accepted: 11/02/2023] [Indexed: 03/16/2024]
Abstract
Contrast media are generally necessary for transcatheter left atrial appendage closure (LAAC), however, it should be avoided in patients with chronic kidney disease (CKD). The objective of this study was to evaluate the safety and feasibility of contrast-free LAAC with WATCHMAN FLX device for patients with CKD. Among 141 patients undergoing LAAC using the WATCHMAN FLX between May 2021 and March 2023, we performed LAAC without contrast media in 10 patients. Procedural and follow-up results were evaluated. The device size was selected based on the transesophageal echocardiographic (TEE) measurements. The device shape was assessed by fluoroscopy, and the device position was adjusted by TEE images. The mean age was 78 ± 4.9 years, CHADS2 score was 3.2 ± 1.1, and the estimated glomerular filtration rate (eGFR) was 28 ± 12 mL/min/1.73m2. The procedure was completed without contrast media in ten patients. Partial recapture of the device was required in four patients, but the initially selected device was finally implanted in all patients. Mean procedure time was significantly shorter in the contrast-free LAAC than in the contrast-use LAAC (41.6 ± 14.1 min vs 30.3 ± 7.6 min, p = 0.01). Postprocedural eGFR did not change from baseline, and there were no adverse events during the hospital stay. Follow-up TEE or cardiac computed tomography performed within 3 months after the procedure revealed no device-related thrombus or peri-device leak > 3 mm, and oral antithrombotic therapy was discontinued in all patients. Our experience shows that contrast-free LAAC using the WATCHMAN FLX device was safe and feasible. Non-contrast LAAC is one of the therapeutic options for patients with severe CKD.
Collapse
Affiliation(s)
- Azusa Okada
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan.
| | - Ryuki Chatani
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Kazunori Mushiake
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Naoki Nishiura
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Sachiyo Ono
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Takeshi Maruo
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| |
Collapse
|
17
|
González-Suárez S, Corbett M, Hernández-Martínez A. Impact of graft reperfusion on cardiac function assessed by transesophageal echocardiography during liver transplantation: an observational retrospective study. J Clin Monit Comput 2024; 38:301-311. [PMID: 38032448 PMCID: PMC10995086 DOI: 10.1007/s10877-023-01110-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
Cardiovascular instability is common during the reperfusion phase of orthotopic liver transplantation (OLT), and some patients experience a postreperfusion syndrome (PRS). However, there are no reports comparing the cardiac dysfunction between patients with PRS and those without. Thus, the aim of this study was to evaluate cardiac dysfunction in patients exhibiting PRS. This observational retrospective study included 34 patients who underwent OLT and were monitored with transesophageal echocardiography (TEE). The right ventricular/left ventricular (RV/LV) end diastolic area, tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF) by Simpson method, pulsed Doppler of the mitral valve, and tissue Doppler motion of the mitral annulus were determined. Echocardiographic measurements were registered at the beginning of surgery and at 1 and 30 min after vascular unclamping. Patients with PRS (PRS group) were identified, and their echocardiographic parameters of ventricular function were compared with those in patients without PRS (non-PRS group). To check the evolution of diastolic-systolic dysfunction, general linear model-repeated measures were estimated. No patient presented systolic/diastolic dysfunction on the basal echocardiogram. One minute after vascular unclamping, the incidence of RV dilation was 4.5 times greater in patients with PRS (Cramer´s V > 0.6), and the incidence of RV systolic dysfunction was 62.5% in patients with PRS compared to 15.40% in patients without PRS (Cramer´s V = 0.45). The incidence of LV systolic dysfunction was 25% in patients with PRS compared to 0% in those without (Cramer´s V = 0.45), and left ventricular diastolic dysfunction was 4.8 times greater in patients with PRS (Cramer´s V = 0.45). No patient presented diastolic dysfunction type III. There were significant differences between groups in the evolutionary pattern at 1 and 30 min after unclamping for RV dilation (p = 0.008) and for TAPSE (p = 0.014). Liver graft reperfusion may alter cardiac function. Cardiac dysfunction was more frequent in patients with PRS. These patients exhibited temporary dysfunction of the RV associated with a varying degree of LV diastolic-systolic dysfunction. Trial registration: clinicaltrials.gov (NCT05175534). January 03, 2022; "retrospectively registered".
Collapse
Affiliation(s)
- Susana González-Suárez
- Department of Surgery, Universitat Autònoma de Barcelona, Unitat Docent Vall d´Hebron, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain.
- Department of Anesthesiology, Vall d´Hebron University Hospital, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain.
- Vall d´Hebron Institut de Recerca (VHIR), Cardiovascular diseases Research Group, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain.
| | - Matthew Corbett
- Department of Anesthesiology, Vall d´Hebron University Hospital, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain
| | - Alberto Hernández-Martínez
- Department of Anesthesiology and Intensive Care, Grupo Policlínica, Ibiza. Islas Baleares. Vía Romana s/n, Ibiza, Baleares, 07800, Spain
| |
Collapse
|
18
|
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
|
19
|
Hosono K, Saji M, Wada R, Ohara H, Fujino T, Ikeda T. Pacing for better visualization of the left atrial appendage prior to transcatheter left atrial appendage closure. Cardiovasc Interv Ther 2024; 39:221-222. [PMID: 37995074 DOI: 10.1007/s12928-023-00969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Keisuke Hosono
- Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1 Omori-Nishi, Otaku, Tokyo, Japan
| | - Mike Saji
- Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1 Omori-Nishi, Otaku, Tokyo, Japan.
| | - Ryo Wada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1 Omori-Nishi, Otaku, Tokyo, Japan
| | - Hiroshi Ohara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1 Omori-Nishi, Otaku, Tokyo, Japan
| | - Tadashi Fujino
- Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1 Omori-Nishi, Otaku, Tokyo, Japan
| | - Takanori Ikeda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1 Omori-Nishi, Otaku, Tokyo, Japan
| |
Collapse
|
20
|
Tabrizi MT, Girardo M, Naqvi TZ. In Situ Transesophageal Echocardiography During Electrical Cardioversion in Patients With Atrial Fibrillation-Safety and Echocardiographic Findings. J Am Soc Echocardiogr 2024; 37:420-427. [PMID: 38036012 DOI: 10.1016/j.echo.2023.11.022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/07/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Transesophageal echocardiography (TEE) can reliably detect left atrial (LA) and LA appendage (LAA) thrombus in patients with atrial fibrillation (AF) before electrical cardioversion (ECV). However, evaluating cardiac and valve function pre-ECV can be challenging due to the increased and irregular heart rate. Additionally, post-ECV atrial stunning increases the risk of LAA thrombosis. Therefore, post-ECV TEE may allow for useful appendage, ventricular, and valve function assessment. However, the safety and usefulness of leaving the TEE probe in situ during ECV for post-ECV cardiac evaluation in clinical practice have not been previously evaluated. METHODS We analyzed 37 out of 86 consecutive patients who had the TEE probe left in situ, for clinical reasons, during ECV by a single operator between February 20, 2019, and January 3, 2023. We examined changes in left ventricular (LV) function, dynamic changes in valvular regurgitation, electromechanical coupling of the left atrium, and qualitative spontaneous echo contrast. We also assessed the presence of any complications related to the periprocedural TEE exam. RESULTS The mean age of the patients was 74 ± 9.65 years, and 29 (78%) were male. The periprocedural TEE time ranged from 7 to 55 minutes, with an average of 20.78 minutes. Immediately after ECV and restoration of normal sinus rhythm, there was an improvement in LV ejection fraction (47% ± 11.9% vs 40% ± 15.8%; P = .035). There was also a reduction in baseline mitral regurgitation of greater than moderate degree. However, spontaneous echo contrast worsened in the LAA in 11 (31.4%) patients. Additionally, 1 patient developed a new LAA thrombus, and 24 patients (72%) had evidence of electromechanical coupling with Doppler evidence of LA contraction. Clinically significant degenerative aortic and mitral stenosis were identified in 8% and mild or greater aortic regurgitation in 8% of patients post-ECV. No procedural complications were observed. CONCLUSIONS In situ TEE before, during, and after ECV is safe and provides useful clinical information regarding immediate cardiac changes after ECV, with diagnostic and therapeutic implications.
Collapse
Affiliation(s)
| | - Marlene Girardo
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | - Tasneem Z Naqvi
- Division of Echocardiography, Department of Medicine, Mayo Clinic, Scottsdale, Arizona.
| |
Collapse
|
21
|
Vrublevsky AV, Saushkin VV. Role of Imaging Modalities in the Quantitative Assessment of Atherosclerotic Plaques in the Thoracic Aorta. Kardiologiia 2024; 64:40-45. [PMID: 38597761 DOI: 10.18087/cardio.2024.3.n2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/02/2023] [Indexed: 04/11/2024]
Abstract
AIM Comparative analysis of the height of atherosclerotic plaques (AP) in the descending thoracic aorta (TA) according to two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE), and contrast-enhanced multislice computed tomography (MSCT). MATERIAL AND METHODS The TA was examined using 2D, 3D TEE and contrast-enhanced MSCT in 34 patients (20 men and 14 women aged 68 [62; 71] years). AP heights were compared using the Bland-Altman method and the Spearman correlation analysis. This was a blinded comparative study which assessed the AP morphometry using each of the radiation modalities without knowing the results of the method being compared. RESULTS 100 APs were examined in the descending TA. The mean height of all analyzed APs in the descending TA was 2.2 mm [2; 2.7] for 2D TEE, 3.1 mm [2.7; 3.55] for 3D TEE, and 3.05 mm [2.55; 3.55] for MSCT. The AP heights measured with 2D TEE was statistically significantly smaller than the heights of similar APs measured either with 3D TEE or MSCT. The mean difference (bias) was 0.88±0.34 mm between 2D and 3D TEE, and 0.83±0.41 mm between 2D TEE and MSCT. The correlation coefficients for the AP heights were r=0.87 (p<0.001) between 2D and 3D TEE and r=0.86 (p<0.001) between 2D TEE and MSCT. There were no differences in the height of similar APs between 3D TEE and MSCT. CONCLUSION The three-dimensional reconstruction of AP in the TA by TEE is more accurate for quantitative assessment of AP than a two-dimensional study.
Collapse
Affiliation(s)
- A V Vrublevsky
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| | - V V Saushkin
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| |
Collapse
|
22
|
Unno T, Kato R, Kuwada M, Ishino M, Nagase T, Tanaka T, Yoshino C, Nishida T, Yoshida Y, Oyama R, Kikuchi T, Tatebayashi T, Kuwao S. Coexistence Case of Papillary Fibroelastoma and Lambl's Excrescence of the Left Heart, Which Is Occasionally Associated with Significant Stroke. Int Heart J 2024; 65:367-370. [PMID: 38479845 DOI: 10.1536/ihj.23-570] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Papillary fibroelastoma (PFE) is a benign tumor that arises mostly from left-sided valves. PFE can cause stroke, and surgical resection may be needed. Lambl's excrescence (LE) is a filiform valvular lesion and is considered a possible cause of stroke. A 79-year-old man with light-headedness and left-sided hemiparesis was diagnosed with stroke. Transesophageal echocardiography (TEE) revealed a round-shaped mobile mass in the left ventricular outflow tract (LVOT), which was considered the cause of the stroke. Surgical resection was performed transaortically, and during surgery, a mass was incidentally detected on the noncoronary cusp (NCC), which was also resected followed by aortic valve replacement. Pathology confirmed that the mass in the LVOT was a PFE and that the filiform mass on the NCC was LE. We herein report a rare case of PFE in the LVOT and coexisting LE on the NCC. A careful examination via TEE helps to identify other possible causes of stroke hidden behind the obvious cause.
Collapse
Affiliation(s)
- Takatoshi Unno
- Department of Cardiology, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Ryuichi Kato
- Department of Cardiology, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Masao Kuwada
- Department of Cardiology, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Mitsunori Ishino
- Department of Cardiology, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Takahiko Nagase
- Department of Cardiology, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Takahisa Tanaka
- Department of Cardiology, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Chiyo Yoshino
- Department of Cardiology, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Takafumi Nishida
- Department of Cardiology, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Yoshinori Yoshida
- Department of Cardiology, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Ryo Oyama
- Department of Cardiology, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Takafumi Kikuchi
- Department of Cardiology, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Takayuki Tatebayashi
- Department of Cardiovascular Surgery, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| | - Sadahito Kuwao
- Department of Pathology & Clinical Laboratory Medicine, Social Medical Corporation Yamatokai Foundation Higashiyamato Hospital
| |
Collapse
|
23
|
Liu Y, Yang Z, Sun X, Yang M, Zhang T, Li R, Wei Y, Cao H. Successful surgical treatment of impending paradoxical embolism with pulmonary embolism and myocardial infarction. J Cardiothorac Surg 2024; 19:137. [PMID: 38504353 PMCID: PMC10949575 DOI: 10.1186/s13019-024-02606-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Paradoxical embolism is a rare cause of acute arterial occlusion. This phenomenon arises when embolic material travels from the venous system crosses an abnormal shunt such as patent foramen ovale, atrial septal defects, ventricular septal defects, or pulmonary arteriovenous malformations, into the arterial system. Impending paradoxical embolism refers to the presence of an entrapped thrombus in the patent foramen ovale. CASE PRESENTATION We report a case of a 68-year-old female patient who presented with an impending paradoxical embolism, alongside both concomitant pulmonary embolism and myocardial infarction with ST-segment elevation. Swiftly addressed through emergency cardiac surgery and systemic anticoagulation, the patient's condition was effectively treated. CONCLUSIONS While the ideal treatment strategy for impending paradoxical embolism remains a topic of debate due to limited and inconclusive evidence, emergent open surgery should be contemplated in patients as it signifies a critical clinical emergency.
Collapse
Affiliation(s)
- Yong Liu
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Zhiyun Yang
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Xinxin Sun
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Mei Yang
- Department of ICU, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Tao Zhang
- Department of ICU, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Ruilin Li
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Ying Wei
- Department of Ultrasound in Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Hao Cao
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
- Shanghai Heart Failure Institute, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
| |
Collapse
|
24
|
Alshaabi H, Donaghue JF, Franko DM, McCullough JN. Recognition and management of left atrial dissection during mitral repair. J Cardiothorac Surg 2024; 19:139. [PMID: 38504295 PMCID: PMC10949757 DOI: 10.1186/s13019-024-02641-x] [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] [Received: 09/06/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Left atrial dissection (LAtD) is a rare but potentially life-threatening complication of mitral valve surgery. Its management is not well stablished in the literature. However, early recognition through intraoperative TEE and attention to changes in the left atrial free wall during saline leak testing can lead to avoidance of severe complications. CASE PRESENTATION We report a case of LAtD detected by intraoperative transesophageal echocardiogram (TEE) following mitral valve repair for primary mitral valve regurgitation secondary to degenerative mitral valve disease with MAZE IV procedure for atrial fibrillation. LAtD was noted on TEE as an expanding double density along the wall of the left atrium with a jet originating at the posterior annulus flowing into the LAtD which was repaired. Separation from bypass following LAtD repair was complicated by severe biventricular dysfunction requiring significant inotropic support and placement of an intra-aortic balloon pump (IABP). Patient's post-operative course was further complicated by right sided heart failure requiring placement of a right sided impella which was subsequently removed on POD 4. Patient was discharged home on POD 17. Transthoracic echo at 1 month, 3 months demonstrated resolution of the LAtD. A follow up echo at 4 years showed complete resolution of the LAtD with an intact mitral repair, trace mitral regurgitation, and a mean gradient across the repair of 3 mm Hg. CONCLUSIONS Left atrial dissection is a rare but serious complication of mitral valve surgery. We provide a review of the current literature regarding LAtD, emphasizing the need to consider this complication early during mitral surgery to allow for uncomplicated repair.
Collapse
Affiliation(s)
- Haya Alshaabi
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | | | | | | |
Collapse
|
25
|
Izumi K, Utsunomiya H, Takeuchi M, Hamada A, Hyodo Y, Mogami A, Tsuchiya A, Takemoto H, Takahari K, Ueda Y, Itakura K, Nakano Y. Relationship between duration of atrial fibrillation and right heart structure remodeling as assessed by 3-dimensional transesophageal echocardiography. Int J Cardiol 2024; 399:131667. [PMID: 38141729 DOI: 10.1016/j.ijcard.2023.131667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 11/02/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Tricuspid valve (TV) remodeling occurs in patients with atrial fibrillation (AF); however, the affecting factor related to TV remodeling in AF remains to be elucidated. We sought to explore whether the AF persistence itself affects right heart remodeling. METHODS A total of 372 lone AF patients (234 paroxysmal AF [paroxAF] and 138 persistent AF [persAF]) who underwent 3-dimensional transesophageal echocardiography (3D-TEE) was retrospectively reviewed. The duration from first-detected episode of AF to the TEE exam date was defined as AF duration. RESULTS PersAF patients had a larger TV area index (625.4 vs 719.0 mm2/m2; P < 0.001) and a higher right atrium area-to-right ventricle end-systolic area ratio (RA/RVESA ratio, 1.7 vs 1.9; P = 0.005) than paroxAF patients. The prevalence of AF-tricuspid regurgitation was higher in persAF than in paroxAF patients (1.3% vs 12.3%; P < 0.001). In persAF patients, AF duration was moderately correlated with TV diameter and 3D-TEE-derived TV annular area but not in paroxAF. On multivariable analysis, AF duration was independently associated with TV annular dilatation even after adjustment for RA/RVESA ratio and tricuspid regurgitation severity (β 0.37 [95% CI: 0.77-1.81]; P < 0.001). Additionally, AF duration with cutoff values of 20 months for predicting TV annular dilatation and 37 months for predicting RA/RVESA ratio > 2.1 had both high diagnostic accuracies among persAF patients (both P < 0.01). CONCLUSIONS AF duration itself is independently associated with right heart remodeling in persAF but not in paroxAF, such as TV annular dilatation and predominant RA remodeling which may lead to subsequent TR progression and adverse outcomes.
Collapse
Affiliation(s)
- Kanako Izumi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Makoto Takeuchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ayano Hamada
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yohei Hyodo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Atsuo Mogami
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akane Tsuchiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hajime Takemoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kosuke Takahari
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yusuke Ueda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kiho Itakura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
26
|
Beygui F, Guillemot V, Saloux E. Complex mitral para-prosthetic leak closure as a bridge to heart transplant. Eur Heart J 2024; 45:968. [PMID: 37769354 DOI: 10.1093/eurheartj/ehad602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- Farzin Beygui
- Department of Cardiology, Caen University Hospital, Avenue de la Cote de Nacre, Caen 14000, France
- INSERM U1237, GIP CYCERON, Campus Jules Horowitz, Bd Henri Becquerel, Caen 14074, France
| | - Valentin Guillemot
- Department of Cardiology, Caen University Hospital, Avenue de la Cote de Nacre, Caen 14000, France
| | - Eric Saloux
- Department of Cardiology, Caen University Hospital, Avenue de la Cote de Nacre, Caen 14000, France
| |
Collapse
|
27
|
Amat-Santos IJ, Fernández-Cordón C. The Tootsie Roll Technique for Paravalvular Leak Closure: A New Candy in the Catheterization Laboratory. JACC Cardiovasc Interv 2024; 17:645-647. [PMID: 38244003 DOI: 10.1016/j.jcin.2023.12.029] [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] [Received: 12/04/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Ignacio J Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Spain; Centro de investigación biomédica en red - Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | | |
Collapse
|
28
|
Mill J, Harrison J, Saiz-Vivo M, Albors C, Morales X, Olivares AL, Iriart X, Cochet H, Noailly J, Sermesant M, Camara O. The role of the pulmonary veins on left atrial flow patterns and thrombus formation. Sci Rep 2024; 14:5860. [PMID: 38467726 DOI: 10.1038/s41598-024-56658-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
Atrial fibrillation (AF) is the most common human arrhythmia, forming thrombi mostly in the left atrial appendage (LAA). However, the relation between LAA morphology, blood patterns and clot formation is not yet fully understood. Furthermore, the impact of anatomical structures like the pulmonary veins (PVs) have not been thoroughly studied due to data acquisition difficulties. In-silico studies with flow simulations provide a detailed analysis of blood flow patterns under different boundary conditions, but a limited number of cases have been reported in the literature. To address these gaps, we investigated the influence of PVs on LA blood flow patterns and thrombus formation risk through computational fluid dynamics simulations conducted on a sizeable cohort of 130 patients, establishing the largest cohort of patient-specific LA fluid simulations reported to date. The investigation encompassed an in-depth analysis of several parameters, including pulmonary vein orientation (e.g., angles) and configuration (e.g., number), LAA and LA volumes as well as their ratio, flow, and mass-less particles. Our findings highlight the total number of particles within the LAA as a key parameter for distinguishing between the thrombus and non-thrombus groups. Moreover, the angles between the different PVs play an important role to determine the flow going inside the LAA and consequently the risk of thrombus formation. The alignment between the LAA and the main direction of the left superior pulmonary vein, or the position of the right pulmonary vein when it exhibits greater inclination, had an impact to distinguish the control group vs. the thrombus group. These insights shed light on the intricate relationship between PV configuration, LAA morphology, and thrombus formation, underscoring the importance of comprehensive blood flow pattern analyses.
Collapse
Affiliation(s)
- Jordi Mill
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain.
| | - Josquin Harrison
- Inria, Université Côte d'Azur, Epione team, 06902, Sophia Antipolis, France
| | - Marta Saiz-Vivo
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Carlos Albors
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Xabier Morales
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Andy L Olivares
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Xavier Iriart
- IHU Liryc, CHU Bordeaux, Université Bordeaux, Inserm, 33600, Pessac, France
- Bordeaux University Hospital, 33600, Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, CHU Bordeaux, Université Bordeaux, Inserm, 33600, Pessac, France
- Bordeaux University Hospital, 33600, Bordeaux, France
| | - Jerome Noailly
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Maxime Sermesant
- Inria, Université Côte d'Azur, Epione team, 06902, Sophia Antipolis, France
| | - Oscar Camara
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| |
Collapse
|
29
|
Somani S, Makhija N, Francis J, Devagourou V. Noncoronary Cusp Thrombus on Transesophageal Echocardiography Altering the Surgical Approach. J Cardiothorac Vasc Anesth 2024; 38:855-857. [PMID: 38105127 DOI: 10.1053/j.jvca.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Shruti Somani
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Neeti Makhija
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Jijo Francis
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
30
|
Masada K, Morita M, Kanegawa M, Sumimoto Y, Shimonaga T, Kinoshita H, Sugino H. Spontaneous esophageal rupture visualized by means of transthoracic echocardiography. J Echocardiogr 2024; 22:58-60. [PMID: 37115406 DOI: 10.1007/s12574-023-00601-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Kenji Masada
- Department of Cardiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure, 737-0023, Japan.
| | - Masashi Morita
- Department of Cardiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure, 737-0023, Japan
| | - Munehiro Kanegawa
- Department of Cardiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure, 737-0023, Japan
| | - Yoji Sumimoto
- Department of Cardiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure, 737-0023, Japan
| | - Takashi Shimonaga
- Department of Cardiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure, 737-0023, Japan
| | - Haruyuki Kinoshita
- Department of Cardiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure, 737-0023, Japan
| | - Hiroshi Sugino
- Department of Cardiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure, 737-0023, Japan
| |
Collapse
|
31
|
Paugsch D, Dabrowski M. [You only ECHO Twice]. Praxis (Bern 1994) 2024; 113:78-82. [PMID: 38655734] [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] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Ischaemic stroke results from a sudden interruption of cerebral blood flow, often caused by thrombosis, embolism or hypoperfusion. Rarely, cardiac tumours are the cause of an embolic event. We report on an 80-year-old woman with a cerebral stroke. Successful thrombectomy revealed a histopathologically confirmed papillary fibroelastoma as the embolic source. Although it was not detectable on initial echocardiography, the tumour was discovered by transesophageal echocardiography. This case emphasises the importance of considering primary cardiac tumours as potential sources of emboli in ischaemic stroke. Keywords.
Collapse
Affiliation(s)
- Dominik Paugsch
- Luzerner Kantonsspital Herzzentrum Spitalstrasse 6004 Luzern
| | | |
Collapse
|
32
|
Jimenez RO, Agarwal V, Lerakis S, Argulian E. Use of biplane echocardiographic imaging for diagnosis of left atrial appendage thrombi during transesophageal examination. Echocardiography 2024; 41:e15791. [PMID: 38516837 DOI: 10.1111/echo.15791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/23/2024] Open
Affiliation(s)
- Roberto Ochoa Jimenez
- Division of Cardiology, Department of Medicine, Mount Sinai Fuster Heart Hospital and the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vikram Agarwal
- Division of Cardiology, Department of Medicine, Mount Sinai Fuster Heart Hospital and the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stamatios Lerakis
- Division of Cardiology, Department of Medicine, Mount Sinai Fuster Heart Hospital and the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Edgar Argulian
- Division of Cardiology, Department of Medicine, Mount Sinai Fuster Heart Hospital and the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
33
|
Ho YJ, Sung CW, Chen YC, Lien WC, Chang WT, Huang CH. Performance of Intra-arrest Echocardiography: A Systematic Review. West J Emerg Med 2024; 25:166-174. [PMID: 38596913 PMCID: PMC11000560 DOI: 10.5811/westjem.18440] [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] [Received: 08/21/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Intra-arrest transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been introduced in adult patients with cardiac arrest (CA). Whether the diagnostic performance of TTE or TEE is superior during resuscitation is unclear. We conducted a systematic review following PRISMA guidelines. Methods We searched databases from PubMed, Embase, and Google Scholar and evaluated articles with intra-arrest TTE and TEE in adult patients with non-traumatic CA. Two authors independently screened and selected articles for inclusion; they then dual-extracted study characteristics and target conditions (pericardial effusion, aortic dissection, pulmonary embolism, myocardial infarction, hypovolemia, left ventricular dysfunction, and sonographic cardiac activity). We performed quality assessment using the Quality Assessment of Diagnostic Accuracy Studies Version 2 criteria. Results A total of 27 studies were included: 14 studies with 2,145 patients assessed TTE; and 16 with 556 patients assessed TEE. A high risk of bias or applicability concerns in at least one domain was present in 20 studies (74%). Both TTE and TEE found positive findings in nearly one-half of the patients. The etiology of CA was identified in 13% (271/2,145), and intervention was performed in 38% (102/271) of patients in the TTE group. In patients who received TEE, the etiology was identified in 43% (239/556), and intervention was performed in 28% (68/239). In the TEE group, a higher incidence regarding the etiology of CA was observed, particularly for those with aortic dissection. However, the outcome of those with aortic dissection in the TEE group was poor. Conclusion While TEE could identify more causes of CA than TTE, sonographic cardiac activity was reported much more in the TTE group. The impact of TTE and TEE on the return of spontaneous circulation and further survival was still inconclusive in the current dataset.
Collapse
Affiliation(s)
- Yi-Ju Ho
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
| | - Chih-Wei Sung
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University Hsin-Chu Hospital, Department of Emergency Medicine, Hsinchu, Taiwan
| | - Yi-Chu Chen
- National Taiwan University, Institute of Epidemiology and Preventive Medicine, College of Public Health, Taipei, Taiwan
| | - Wan-Ching Lien
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Wei-Tien Chang
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Chien-Hua Huang
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| |
Collapse
|
34
|
Ebadi-Tehrani M, Sheu R, Alfirevic A, Kazanjian P, Zimmerman K, Mathis M, Swaminathan M, Mackensen GB, Nicoara A. Practical Considerations for Obtaining Perioperative Transesophageal Echocardiography Accreditation: Collective Experiences at Early-Adopting Centers. J Cardiothorac Vasc Anesth 2024; 38:616-625. [PMID: 38087669 DOI: 10.1053/j.jvca.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 02/18/2024]
Abstract
The Intersocietal Accreditation Commission (IAC) is a nonprofit accrediting organization committed to ensuring the quality of diagnostic imaging and related procedures. It comprises a collaboration of stakeholders spanning numerous medical professionals and specialties. In a recent initiative, IAC Echocardiography introduced a new accreditation specifically for Perioperative Transesophageal Echocardiography (PTE). This accreditation process is anchored in rigorous clinical peer review to ensure diagnostic quality and report accuracy, thus maintaining high standards of medical care. The authors present the inaugural 4 sites to achieve IAC accreditation for PTE, which have collaborated to share their experiences in achieving this accreditation. This review endeavors to offer actionable insights and proven solutions to navigate the accreditation journey for others. Mirroring the IAC Standards and Guidelines for PTE accreditation, this review is divided into three pivotal sections as follows: (1) organization of a perioperative echocardiography service, including stakeholder engagement to facilitate the application for accreditation; (2) performance of examinations and reporting; and (3) instituting quality improvement strategies and establishing a robust program. The pursuit of accreditation in PTE is to transcend a mere compliance exercise. It signifies a dedication to excellence, continual growth, and, above all, to the well-being of patients.
Collapse
Affiliation(s)
- Mehran Ebadi-Tehrani
- Department of Anesthesiology and Pain Medicine, University of Michigan Medical School, Ann Arbor, MI.
| | - Richard Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Andrej Alfirevic
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Paul Kazanjian
- Department of Anesthesiology and Pain Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Karen Zimmerman
- Department of Anesthesiology and Pain Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Michael Mathis
- Department of Anesthesiology and Pain Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Alina Nicoara
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| |
Collapse
|
35
|
Kasai Y, Kasai J, Kitai T, Horita R, Morita J, Fujita T. Silent steam pop detected by transesophageal echocardiography for premature ventricular contractions originating from the aortomitral continuity. J Echocardiogr 2024; 22:61-62. [PMID: 37120477 PMCID: PMC10917827 DOI: 10.1007/s12574-023-00602-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/03/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Yuhei Kasai
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan.
| | | | - Takayuki Kitai
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Ryo Horita
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Junji Morita
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| |
Collapse
|
36
|
Verma R, Nwakoby A, Yanagawa B. Commentary: Papillary fibroelastoma resection-one and done? J Thorac Cardiovasc Surg 2024; 167:1098-1099. [PMID: 35989121 DOI: 10.1016/j.jtcvs.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Raj Verma
- Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Akachukwu Nwakoby
- Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada.
| |
Collapse
|
37
|
Karl R, Romano G, Marx J, Eden M, Schlegel P, Stroh L, Fischer S, Hehl M, Kühle R, Mohl L, Karck M, Frey N, De Simone R, Engelhardt S. An ex-vivo and in-vitro dynamic simulator for surgical and transcatheter mitral valve interventions. Int J Comput Assist Radiol Surg 2024; 19:411-421. [PMID: 38064021 PMCID: PMC10881771 DOI: 10.1007/s11548-023-03036-4] [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] [Received: 05/29/2023] [Accepted: 11/06/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE Minimally invasive mitral valve surgery (MIMVS) and transcatheter edge-to-edge repair (TEER) are complex procedures used to treat mitral valve (MV) pathologies, but with limited training opportunities available. To enable training, a realistic hemodynamic environment is needed. In this work we aimed to develop and validate a simulator that enables investigation of MV pathologies and their repair by MIMVS and TEER in a hemodynamic setting. METHODS Different MVs were installed in the simulator, and pressure, flow, and transesophageal echocardiographic measurements were obtained. To confirm the simulator's physiological range, we first installed a biological prosthetic, a mechanical prosthetic, and a competent excised porcine MV. Subsequently, we inserted two porcine MVs-one with induced chordae tendineae rupture and the other with a dilated annulus, along with a patient-specific silicone valve extracted from echocardiography with bi-leaflet prolapse. Finally, TEER and MIMVS procedures were conducted by experts to repair the MVs. RESULTS Systolic pressures, cardiac outputs, and regurgitations volumes (RVol) with competent MVs were 119 ± 1 mmHg, 4.78 ± 0.16 l min-1, and 5 ± 3 ml respectively, and thus within the physiological range. In contrast, the pathological MVs displayed increased RVols. MIMVS and TEER resulted in a decrease in RVols and mitigated the severity of mitral regurgitation. CONCLUSION Ex-vivo modelling of MV pathologies and repair procedures using the described simulator realistically replicated physiological in-vivo conditions. Furthermore, we showed the feasibility of performing MIMVS and TEER at the simulator, also at patient-specific level, thus providing new clinical perspectives in terms of training modalities and personalized planning.
Collapse
Affiliation(s)
- Roger Karl
- Ruprecht-Karls University of Heidelberg, Heidelberg, Germany.
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany.
- Department of Internal Medicine III, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.
| | - Gabriele Romano
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Josephin Marx
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Internal Medicine III, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Matthias Eden
- Department of Internal Medicine III, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Philipp Schlegel
- Department of Internal Medicine III, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Lubov Stroh
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Samantha Fischer
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Internal Medicine III, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Maximilian Hehl
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Internal Medicine III, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Reinald Kühle
- Clinic and Polyclinic for Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Lukas Mohl
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Internal Medicine III, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Raffaele De Simone
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Sandy Engelhardt
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Internal Medicine III, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| |
Collapse
|
38
|
Pyra P, Hadeed K, Guitarte Vidaurre A, Vincent R, Dulac Y, Chausseray G, Calvaruso DF, Acar P, Karsenty C. Usefulness of perioperative transoesophageal echocardiography during paediatric cardiac surgery. Arch Cardiovasc Dis 2024; 117:177-185. [PMID: 38272760 DOI: 10.1016/j.acvd.2023.12.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Paediatric transoesophageal echocardiography probes allow perioperative evaluation during paediatric congenital heart disease surgery. AIM To assess the usefulness of perioperative transoesophageal echocardiography in evaluating the severity of residual lesions, based on the type of congenital heart disease repaired in paediatric patients. METHODS A retrospective analysis was conducted on paediatric patients who underwent open-heart surgery at our tertiary centre over a four-year period. Perioperative transoesophageal echocardiography studies were performed, and residual lesions were classified as mild, moderate or severe. RESULTS Overall, 323 procedures involving 310 patients with a median age of 13.8 (0.07-214.4) months and a median weight of 8.2 (2-96) kg at intervention were enrolled in the study. Twenty-one (6.5%) residual lesions led to immediate reintervention: severe right ventricular outflow tract obstruction (n=12); severe aortic regurgitation (n=3); superior vena cava stenosis (n=2); moderate residual ventricular septal defect (n=2); severe mitral regurgitation (n=1); and severe mitral stenosis (n=1). Three (0.9%) neonates had ventilation difficulties caused by the transoesophageal echocardiography probe having to be removed, but experienced no sequelae. CONCLUSION Perioperative transoesophageal echocardiography is a safe procedure, providing information on severe residual lesions, leading to the immediate revision of several paediatric congenital heart disease cases.
Collapse
Affiliation(s)
- Pierrick Pyra
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France.
| | - Khaled Hadeed
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Aitor Guitarte Vidaurre
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Rémi Vincent
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Yves Dulac
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Gérald Chausseray
- Department of Paediatric Anaesthesiology, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Davide Felice Calvaruso
- Department of Congenital Cardiac Surgery, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Philippe Acar
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France
| | - Clément Karsenty
- Paediatric Cardiology Unit, Department of Paediatrics, Children's Hospital, Toulouse University Hospital, 31059 Toulouse, France; Inserm U1048, Institut des Maladies Métaboliques et Cardiovasculaires (Institute of Metabolic and Cardiovascular Diseases; I2MC), University of Toulouse, 31432 Toulouse, France
| |
Collapse
|
39
|
Dusonchet A, Varenne O, Puscas T, Saadi M, Hagege A, Calvet D, Mas J, Turc G. Does Atrial Septal Anatomy Still Matter in the Etiological Evaluation of Ischemic Stroke Beyond the Age of 60? J Am Heart Assoc 2024; 13:e031684. [PMID: 38353217 PMCID: PMC11010114 DOI: 10.1161/jaha.123.031684] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/14/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Patent foramen ovale (PFO) is causally associated with stroke in some patients younger than 60 years, especially when it is large or associated with an atrial septal aneurysm (ASA). After 60 years of age, this association is less well understood. We assessed the relationships between detailed atrial septal anatomy and the cryptogenic nature of stroke in this population. METHODS AND RESULTS We reviewed all patients aged 60 to 80 years admitted to our stroke center for ischemic stroke who underwent contrast echocardiography between 2016 and 2021. The atherosclerosis, small-vessel disease, cardiac pathology, other causes, and dissection (ASCOD) classification was used to reevaluate the etiological workup. Associations between cryptogenic stroke and (1) PFO presence or (2) categories of PFO anatomy (nonlarge PFO without ASA, nonlarge PFO with ASA, large PFO without ASA, and large PFO with ASA) were assessed using logistic regression. Among 533 patients (median National Institutes of Health Stroke Scale score=1), PFO was present in 152 (prevalence, 28.5% [95% CI, 24.9-32.5]). Compared with noncryptogenic stroke, cryptogenic stroke (n=218) was associated with PFO presence (44.5% versus 17.5%; P<0.0001). Among patients with a PFO, septal anatomy categories were associated with cryptogenic stroke (P=0.02), with a strong association for patients with both large PFO and ASA (38.1% versus 14.5%, P=0.002). CONCLUSIONS PFO presence remains strongly associated with cryptogenic stroke between 60 and 80 years of age. Large PFO, ASA, and their association were strongly associated with cryptogenic stroke in this age group. Our results support performing contrast echocardiography even after 60 years of age, although the optimal secondary prevention therapy in this population remains to be determined in randomized trials.
Collapse
Affiliation(s)
- Antoine Dusonchet
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
| | - Olivier Varenne
- Department of CardiologyHôpital Cochin, AP‐HP, Université Paris CitéParisFrance
| | - Tania Puscas
- Department of CardiologyHôpital Européen Georges Pompidou, AP‐HP, Université Paris CitéParisFrance
| | - Malika Saadi
- Department of CardiologyHôpital Cochin, AP‐HP, Université Paris CitéParisFrance
| | - Albert Hagege
- Department of CardiologyHôpital Européen Georges Pompidou, AP‐HP, Université Paris CitéParisFrance
| | - David Calvet
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
| | - Jean‐Louis Mas
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
| |
Collapse
|
40
|
Sinclair De Frías J, Olivero L, Fleissner Z, Burns J, Chadha R, Moreno Franco P. Intraoperative vascular air embolism and intracardiac thrombosis complicating liver transplantation: a case report. J Med Case Rep 2024; 18:59. [PMID: 38368412 PMCID: PMC10874554 DOI: 10.1186/s13256-024-04376-8] [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] [Received: 05/16/2023] [Accepted: 01/11/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for intracardiac thrombus and vascular air embolism during orthotopic liver transplantation, this report presents the first documentation of their simultaneous occurrence in this surgical setting. CASE PRESENTATION This case report outlines the clinical course of a 60-year-old white female patient with end-stage liver disease complicated by portal hypertension, ascites, and hepatocellular carcinoma. The patient underwent orthotopic liver transplantation and encountered concurrent intraoperative complications involving intracardiac thrombus and vascular air embolism. Transesophageal echocardiography revealed the presence of air in the left ventricle and a thrombus in the right atrium and ventricle. Successful management ensued, incorporating hemodynamic support, anticoagulation, and thrombolytic therapy, culminating in the patient's discharge after a week. CONCLUSIONS This report highlights the potential for simultaneous intraoperative complications during orthotopic liver transplantation, manifesting at any phase of the surgery. It underscores the critical importance of vigilant monitoring throughout orthotopic liver transplantation to promptly identify and effectively address these rare yet potentially catastrophic complications.
Collapse
Affiliation(s)
| | - Lorenzo Olivero
- Department of Critical Care, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA
| | | | - Justin Burns
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ryan Chadha
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - Pablo Moreno Franco
- Department of Critical Care, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA.
| |
Collapse
|
41
|
Yao PC, Fei ZT, Chen M, Mo BF, Zhang R, Yang YL, Sun J, Wang QS, Li YG. Incidence, impact and predictors of residual device patency after left atrial appendage closure with the LACbes device. Int J Cardiol 2024; 397:131640. [PMID: 38065326 DOI: 10.1016/j.ijcard.2023.131640] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/09/2023] [Accepted: 12/03/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND The residual device patency (RDP) after left atrial appendage closure (LAAC) with the LACbes device has not been specifically explored in atrial fibrillation (AF) patients. This study aims to explore the incidence, impact and predictors of RDP detected by cardiac computed tomography angiography (CCTA) post LAAC. METHODS AF patients implanted with the LACbes device were prospectively enrolled. CCTA device surveillance was performed at 3 months post-procedure. Major adverse events (MAEs), including stroke/transient ischemic attack, major bleeding and all-cause death, were evaluated. RESULTS Among 141 patients with CCTA surveillance, 56 (39.7%) showed no visible leak and 85 (60.3%) showed RDP. During the median follow-up of 443 [232, 706] days, the presence of RDP was not associated with an increased risk of MAEs (adjusted hazard ratio [HR]: 4.07, 95% confidence interval [CI]: 0.49-34.24, p = 0.196), while peri-device leak (PDL) at the lobe was associated with heightened risks of MAEs (adjusted HR: 6.85, 95% CI: 1.62-28.89, p = 0.009). In patients with PDL at the lobe, antiplatelet after 6 months (HR: 0.20, 95% CI: 0.05-0.91, p = 0.038) was independent protective predictor of MAEs. Besides, current smoking (odds ratio [OR]: 7.52, 95% CI: 2.68-21.08, p < 0.001) and maximum diameter of LAA orifice (OR: 1.16, 95% CI: 1.00-1.34, p = 0.048) were independent predictors of PDL at the lobe. CONCLUSIONS Presence of PDL at the device lobe detected by CCTA at 3-month post LAAC with LACbes is associated with unfavorable prognosis in AF patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03788941.
Collapse
Affiliation(s)
- Peng-Cheng Yao
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen-Tao Fei
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mu Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bin-Feng Mo
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Li Yang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qun-Shan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
42
|
Alkhouli M, Makkar A, Freeman JV, Ellis CR, Shah AP, Gada H, Coylewright M, Lo M, Agarwal H, Lakkireddy D. Amulet Occluder Implantation in Patients With Failed Prior Left Atrial Appendage Occlusion: EMERGE LAA Insights. JACC Cardiovasc Interv 2024; 17:457-459. [PMID: 38355277 DOI: 10.1016/j.jcin.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024]
|
43
|
Hasami NA, Li WWL, Smith T, Verhagen AFTM, Ko K, Heijmen RH. Asymptomatic esophageal perforation discovered after elective cardiac surgery: the importance of clinical awareness. J Cardiothorac Surg 2024; 19:44. [PMID: 38310294 PMCID: PMC10837856 DOI: 10.1186/s13019-024-02551-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 01/28/2024] [Indexed: 02/05/2024] Open
Abstract
Transesophageal echocardiography (TEE) has become an indispensable part of cardiothoracic surgery at present and is considered to be a safe procedure, rarely associated with complications. However, TEE may cause serious and life threatening complications, as presented in this case report. We describe a patient who developed an empyema after elective cardiac surgery due to an esophageal perforation caused by TEE, without any clinical symptoms. Risk factors for TEE-related complications, identified in recent literature, will be discussed as well as the remarkable absence of clinical symptoms in this particular patient.
Collapse
Affiliation(s)
- N A Hasami
- Department of Cardiothoracic Surgery, RadboudUMC, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - W W L Li
- Department of Cardiothoracic Surgery, RadboudUMC, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - T Smith
- Department of Cardiothoracic Surgery, RadboudUMC, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - A F T M Verhagen
- Department of Cardiothoracic Surgery, RadboudUMC, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - K Ko
- Department of Cardiothoracic Surgery, RadboudUMC, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - R H Heijmen
- Department of Cardiothoracic Surgery, RadboudUMC, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| |
Collapse
|
44
|
Poulsen CFB, Munk K, Wang T, Damkjaer M. Transesophageal echocardiography of cardiac function in Nile crocodiles - A novel tool for assessing complex hemodynamic patterns. Comp Biochem Physiol A Mol Integr Physiol 2024; 288:111564. [PMID: 38135145 DOI: 10.1016/j.cbpa.2023.111564] [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] [Received: 09/22/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The crocodilian heart is unique among reptiles with its four-chambered structure and complete intracardiac separation of pulmonary and systemic blood flows and pressures. Crocodiles have retained two aortic arches; one from each ventricle, that communicate via Foramen of Panizza, immediately distally from the aortic valves. Moreover, crocodiles can regulate vascular resistance in the pulmonary portion of the right ventricular outflow tract (RVOT). These unique features allow for a complex regulation of shunting between the pulmonary and systemic circulations. Studies on crocodile shunting have predominantly been based on invasive measurements, but here we report on the use of echocardiography. METHODS Experiments were performed on seven pentobarbital anaesthetized juvenile Nile crocodiles (length and mass of 192 ± 13 cm and 26 ± 5 kg, respectively). Echocardiographic imaging was performed using a transesophageal (TEE) approach. All images were EKG-gated. RESULTS We obtain excellent views of cardiac structures and central vasculature through the esophagus. Standard imaging planes were defined for both long- and short axis views of the left ventricle and truncus arteriosus. For the RV, only a short axis view could be obtained. Color Doppler was used to visualize flow. Pulsed waved Doppler for measuring flow profiles across the atrioventricular valves, in the two RVOTs and the left ventricular outflow tract. Shunting across the Foramen of Panizza could be visualized and gated to the EKG. CONCLUSION TEE can be used to image the unique features of the crocodile heart and allow for in-vivo imaging of the complex shunting hemodynamics, including timing of cardiac shunts.
Collapse
Affiliation(s)
- Christian F B Poulsen
- Department of Cardiology, Aalborg University Hospital, Denmark; Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Kim Munk
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tobias Wang
- Department of Zoophysiology, Aarhus University, Aarhus, Denmark. https://twitter.com/Tobias_Wang_AU
| | - Mads Damkjaer
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark.
| |
Collapse
|
45
|
Maddali MM, Al Maskari SN, Al Aamri I. Postoperative Left Atrial Shunt in a Child with Ventricular Septal Defect Repair. J Cardiothorac Vasc Anesth 2024; 38:582-585. [PMID: 38052692 DOI: 10.1053/j.jvca.2023.11.017] [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] [Received: 10/13/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Mohan Madan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
| | | | - Is'haq Al Aamri
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman
| |
Collapse
|
46
|
Teran F, West FM, Jelic T, Taylor L, Jafry ZM, Burns KM, Owyang CG, Emt CC, Abella BS, Andrus P. Resuscitative transesophageal echocardiography in emergency departments in the United States and Canada: A cross-sectional survey. Am J Emerg Med 2024; 76:164-172. [PMID: 38086182 DOI: 10.1016/j.ajem.2023.11.041] [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] [Received: 07/05/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Over the past two decades, transesophageal echocardiography (TEE) has been used with increasing frequency to evaluate critically ill patients outside of traditional settings. The purpose of this study was to characterize the number of programs, users, practice characteristics, training and competency requirements and barriers for the current use of resuscitative transesophageal echocardiography (TEE) in Emergency Departments (EDs) in the United States and Canada. METHODS A closed internet-based, cross-sectional, point-prevalence survey was administered via email to 120 program directors of emergency ultrasound fellowships (EUSF) and 43 physicians from EDs without EUSF from the United States and Canada. RESULTS Ninety-eight percent of surveyed participants responded. Twenty percent of respondents reported having active resuscitative TEE programs. The majority of participating hospitals (70%) were academic centers with residency programs. A total of 33 programs reported using resuscitative TEE in their ED and of those, 82% were programs with EUSF. Most programs performing TEE (79%) had less than five attending physicians performing TEE. Evaluation of patients during resuscitation from cardiac arrest (100%) and post-arrest care (76%) are the two most frequent indications for TEE in the ED. The most common core elements of resuscitative TEE protocols used are: assessment of left ventricular (LV) systolic function (97%), assessment of right ventricular (RV) function (88%), evaluation of pericardial effusion / tamponade (52%). All programs reported using formal didactics in their training programs, 94% reported using high-fidelity simulation, and 79% live scanning of patients. Financial concerns were the most common barrier use of TEE in the ED (58%), followed by maintenance of equipment (30%), and credentialing/privileges (30%). CONCLUSIONS This study provides a snapshot of the practice of resuscitative TEE in EDs in the United States and Canada revealing the existence of 33 programs using this emerging modality in the care of critically ill patients.
Collapse
Affiliation(s)
- Felipe Teran
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Frances Mae West
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Thomas Jefferson University, Pennsylvania, PA, USA
| | - Tom Jelic
- Department of Emergency Medicine, University of Winnipeg, Manitoba, MB, Canada
| | - Lindsay Taylor
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Zan M Jafry
- Department of Emergency Medicine, Loma Linda University, CA, USA
| | - Katharine M Burns
- Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Clark G Owyang
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Joan and Stanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Claire Centeno Emt
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin S Abella
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phillip Andrus
- Department of Emergency Medicine, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| |
Collapse
|
47
|
Grant MC, Salenger R, Lobdell KW. Perioperative hemodynamic monitoring in cardiac surgery. Curr Opin Anaesthesiol 2024; 37:1-9. [PMID: 38085877 DOI: 10.1097/aco.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
PURPOSE OF REVIEW Cardiac surgery has traditionally relied upon invasive hemodynamic monitoring, including regular use of pulmonary artery catheters. More recently, there has been advancement in our understanding as well as broader adoption of less invasive alternatives. This review serves as an outline of the key perioperative hemodynamic monitoring options for cardiac surgery. RECENT FINDINGS Recent study has revealed that the use of invasive monitoring such as pulmonary artery catheters or transesophageal echocardiography in low-risk patients undergoing low-risk cardiac surgery is of questionable benefit. Lesser invasive approaches such a pulse contour analysis or ultrasound may provide a useful alternative to assess patient hemodynamics and guide resuscitation therapy. A number of recent studies have been published to support broader indication for these evolving technologies. SUMMARY More selective use of indwelling catheters for cardiac surgery has coincided with greater application of less invasive alternatives. Understanding the advantages and limitations of each tool allows the bedside clinician to identify which hemodynamic monitoring modality is most suitable for which patient.
Collapse
Affiliation(s)
- Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Rawn Salenger
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kevin W Lobdell
- Sanger Heart & Vascular Institute, Advocate Health, Charlotte, North Carolina, USA
| |
Collapse
|
48
|
Medellin S, Burbano-Vera N, Alfirevic A. Obstructed Supramitral Inflow: Cor Triatriatum Sinister Presentation in Adulthood. J Cardiothorac Vasc Anesth 2024; 38:576-580. [PMID: 38072717 DOI: 10.1053/j.jvca.2023.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 07/11/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 01/27/2024]
Abstract
Cor triatriatum is a rare congenital heart defect that occurs when a fibromuscular membrane divides the atrium into two chambers, which may impair blood flow to the ventricle. When it does, the symptoms usually manifest during infancy or early childhood. In this E-challenge, though, the case of a 40-year-old man is reviewed whose symptoms of shortness of breath progressed over the years and were attributed to the diminished mitral valve inflow due to the restricted cor triatriatum sinister associated with pulmonary hypertension, tachycardia-bradycardia syndrome, and atrial fibrillation. Despite routine preoperative evaluation, intraoperative transesophageal echocardiography was used to more accurately evaluate cor triatriatum sinister's morphology, hemodynamic significance, and associated anomalies.
Collapse
Affiliation(s)
- Sara Medellin
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH.
| | - Nelson Burbano-Vera
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH; Department of Pediatric Anesthesiology, Section of Pediatric Cardiac Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Andrej Alfirevic
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| |
Collapse
|
49
|
Rigatelli G, Zuin M. Differences and similarities in interatrial shunts management. Eur J Intern Med 2024; 120:25-28. [PMID: 38072687 DOI: 10.1016/j.ejim.2023.12.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/11/2023] [Accepted: 12/05/2023] [Indexed: 02/06/2024]
Abstract
Atrial septal defects (ASD) and Patent foramen ovale (PFO) represent the most common congenital heart diseases (CHD) adulthood. These two clinical entities, having different embryological origin, as well as clinical manifestations, clinical course and treatment must be carefully distinguished. Right heart failure and pulmonary hypertension are considered the major determinants of morbidity and mortality in ASD. Conversely, new pathophysiology concepts have been raised in the management of PFO as left atrium cardiopathy. New diagnostic tools, including cardiac magnetic resonance and intracardiac echocardiography have joint transthoracic and transesophageal echocardiography in the diagnostic definition of both ASD and PFO as well as in guiding their percutaneous closure. Moreover, several innovations have been developed in the field of percutaneous ASD and PFO closure devices including new evidence supporting the safety and efficacy of device-based closure. Aim of the present review is to present review we provided and update overview on ASD and PFO, focusing on the novel concepts regarding their pathophysiological and therapeutic aspects.
Collapse
Affiliation(s)
- Gianluca Rigatelli
- Interventional Cardiology Unit, Ospedali Riuniti Padova Sud, Monselice, Padova, Italy.
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| |
Collapse
|
50
|
Arriola-Montenegro J, Tandon R, Shaffer A, Nijjar PS. Ventricular septal defect following mitral valve replacement. Eur J Cardiothorac Surg 2024; 65:ezae029. [PMID: 38290788 DOI: 10.1093/ejcts/ezae029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/01/2024] Open
Abstract
Mitral valve surgery (MVS), with repair preferred to replacement, is a common procedure for the treatment of severe primary mitral regurgitation related to leaflet prolapse. Structural complications after MVS include left ventricular outflow obstruction, paravalvular leak and atrial septal defect. Intraoperative transoesophageal echocardiography and predischarge transthoracic echocardiography (TTE) specifically screen for these complications. Ventricular septal defect (VSD), a known complication after aortic valve surgery, is rarely reported after MVS. Recently, unsuccessful valvuloplasty prior to replacement was suggested as a risk factor. We present such a case and explore mechanisms with advanced cardiac imaging. In this case, the patient was found to have an elongated membranous septum that likely predisposed her to septal injury. Finally, we provide guidance on specific transoesophageal/transthoracic echocardiography views to avoid a missed diagnosis.
Collapse
Affiliation(s)
| | - Rishabh Tandon
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Andrew Shaffer
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| |
Collapse
|