Despite many recent advances in three-dimensional (3D) transesophageal echocardiography (TEE) imagining, the process of orienting 3D TEE images is nonintuitive and uses assumptions based on idealized ...anatomy. Correlating two-dimensional TEE cross-sectional images to 3D reconstructions remains an additional challenge. In this article, we suggest the repurposing of the stitching artifact generated in 2-beat electrocardiogram-gated 3D TEE as a means of exactly orienting 3D images within a patient's unique anatomy. We demonstrate the application of this strategy to assess a normal mitral valve to localize scallops of mitral valve prolapse and to visualize typical left atrial appendage two-dimensional cuts in a 3D space. By taking command of stitching artifacts, cardiac imagers can successfully navigate the complex structures of the heart for optimal, individualized echocardiographic views.
The COVID‐19 pandemic has presented countless new challenges for healthcare providers including the challenge of differentiating COVID‐19 infection from other diseases. COVID‐19 infection and acute ...endocarditis may present similarly, both with shortness of breath and vital sign abnormalities, yet they require very different treatments. Here, we present two cases in which life‐threatening acute endocarditis was initially misdiagnosed as COVID‐19 infection during the height of the pandemic in New York City. The first was a case of Klebsiella pneumoniae mitral valve endocarditis leading to papillary muscle rupture and severe mitral regurgitation, and the second a case of Streptococcus mitis aortic valve endocarditis with heart failure due to severe aortic regurgitation. These cases highlight the importance of careful clinical reasoning and demonstrate how cognitive errors may impact clinical reasoning. They also underscore the limitations of real‐time reverse transcription‐polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2 testing and illustrate the ways in which difficulty interpreting results may also influence clinical reasoning. Accurate diagnosis of acute endocarditis is critical given that surgical intervention can be lifesaving in unstable patients.
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•RHD is a rare cause of severe valvular AS.•Rheumatic MS typically accompanies rheumatic AV disease.•2D and 3D echocardiography are essential in the assessment of rheumatic AS.•CCT ...has become crucial in planning therapeutic procedures for AS.
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•Individual cases of Watchman FLX DAT are scarce in literature.•The Watchman FLX has shown lower rates of DAT than the Watchman 2.0.•Thrombus formation is still possible in rare ...instances with the Watchman FLX.
Recent improvements in 3D TEE post processing rendering techniques referred to as TrueVue (Philips Medical Systems, Andover, MA, USA). It allows for novel photorealistic imaging of cardiac structures ...including left atrial appendage (LAA) and its closure devices. Here we present TrueVue images of the LAA prior to and after LAA exclusion/occlusion using various percutaneous and surgical techniques. TrueVue may improve delineation of LAA anatomy prior to occlusion as well as visualization of occluder device position within the LAA.
Infective endocarditis (IE) is a life‐threatening disease associated with in‐hospital mortality of nearly one in five cases. IE can destroy valvular tissue, which may rarely progress to aneurysm ...formation, most commonly at the anterior leaflet in instances of mitral valve involvement. We present a remarkable case of a patient with IE and a rare complication of a ruptured aneurysm of the posterior leaflet of the mitral valve. Two‐ and Three‐dimensional transesophageal echocardiography, intra‐operative videography, and histopathologic analysis revealed disruption at this unusual location–at the junction of the P2 and P3 scallops, surrounded by an annular abscess.
Partial anomalous pulmonary venous return (PAPVR) comprises a group of congenital cardiovascular anomalies associated with pulmonary venous flow directly or indirectly into the right atrium. Scimitar ...syndrome is a variant of PAPVR in which the right lung is drained by right pulmonary veins connected anomalously to the inferior vena cava. Surgery is the definitive treatment for scimitar syndrome. However, it is not always necessary as many patients are asymptomatic, have small left‐to‐right shunts, and enjoy a normal life expectancy without surgery. We report multimodality imaging in four adults with scimitar syndrome and the implications for management of this rare syndrome.
A 51‐year‐old man with Klippel–Feil syndrome (KFS) and immunodeficiency syndrome, status postintravenous immunoglobulin therapy, presented with shortness of breath. He was found to have severe aortic ...regurgitation in the setting of a trileaflet aortic valve with thickened leaflets and mild prolapse of the right coronary cusp with left ventricular dilation and borderline left ventricular ejection fraction. Although various cardiac anomalies have been described in KPS, otherwise unexplained severe aortic regurgitation has not been previously reported to the best of our knowledge. The patient underwent an uncomplicated surgical aortic valve replacement with a 25‐mm Medtronic Avalus pericardial tissue valve resulting in symptomatic improvement. Intra‐operative management and transesophageal echocardiography can be particularly challenging in KFS patients. We describe the first reported case of severe aortic regurgitation in KPS, review the cardiac anomalies associated with the syndrome, and highlight the clinical challenges in intra‐operative management of these patients.
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Precise LAA anatomy must be established for LAA occlusion device selection.
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We have developed the TUPLE maneuver, an acronym for “tilt up and turn left”.
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The TUPLE maneuver facilitates LAA ...device selection and intraprocedural guidance.
Advanced Imaging Techniques for Mitral Regurgitation Quien, Mary M.; Vainrib, Alan F.; Freedberg, Robin S. ...
Progress in cardiovascular diseases,
November-December 2018, 2018 Nov - Dec, 2018-11-00, Letnik:
61, Številka:
5-6
Journal Article
Recenzirano
Mitral regurgitation (MR) is one of the most commonly encountered valvular lesions in clinical practice. MR can be either primary (degenerative) or secondary (functional) depending on the etiology of ...MR and the pathology of the mitral valve (MV). Echocardiography is the primary diagnostic tool for MR and is key in determining this etiology as well as MR severity. While clinicians usually turn to 2 Dimensional echocardiography as first-line imaging, 3 Dimensional echocardiography (3DE) has continually shown to be superior in terms of describing MV anatomy and pathology. This review article elaborates on 3DE techniques, modalities, and advances in software. Furthermore, the article demonstrates how 3DE has reformed MR evaluation and has played a vital role in determining patient management.
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