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Sample records for left atrium transesophageal

  1. Mechanical discordance between left atrium and left atrial appendage

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    Arash Khamooshian

    2018-01-01

    Full Text Available During standard transesophageal echocardiographic examinations in sinus rhythm (SR patients, the left atrial appendage (LAA is not routinely assessed with Doppler. Despite having a SR, it is still possible to have irregular activity in the LAA. This situation is even more important for SR patients where assessment of the left atrium is often foregone. We describe a case where we encountered this situation and briefly review how to assess the left atrium and its appendage in such a case scenario.

  2. Malignant phyllodes tumor of the left atrium

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    Anupam Bhambhani

    2014-03-01

    Full Text Available Metastatic tumors to the heart usually involve right sided chambers. We report a rare case of malignant phyllodes tumor of breast with metastatic involvement of left atrium occurring through direct invasion from mediastinal micro-metastasis and presenting as a left atrial mass causing arrhythmia.

  3. Atlas-Based Mosaicing of Left Atrial 3-D Transesophageal Echocardiography Images

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    Mulder, Harriët W.; van Stralen, Marijn; Ren, Ben; Haak, Alexander; Viergever, Max A.; Bosch, Johan G.; Pluim, JPW

    Transesophageal echocardiography (TEE) is a promising imaging modality used to guide cardiac interventions, such as catheter ablation for the treatment of cardiac arrhythmias. These procedures rely on good visualization of the left atrium and pulmonary veins. To visualize these structures in a

  4. UFO in the Left Atrium: How to Capture Metal Debris Floating in the Left Atrium.

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    Fassini, Gaetano; Moltrasio, Massimo; Conti, Sergio; Biagioli, Viviana; Tondo, Claudio

    2016-06-01

    Electrophysiology procedures involving left atrium navigation are becoming more frequent, mostly due to the increase of atrial fibrillation ablation. Mapping catheters of different shapes and size as well as dedicated sheaths are mandatory tools for the accomplishment of procedural end point. Therefore, technical issues are expected, usually unrelated to significant risk. However, any accidental intra-atrial device loss of integrity implies a risk of cerebrovascular embolization. The lack of clear evidence on how to manage these events and the need for a quick solution complicate the scenario. We report an empirical solution in the case of debris floating in the left atrium. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  5. [Determination of residual mass in left ventricle by intraoperative transesophageal echocardiography after a giant and floating left atrial myxoma resection].

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    Kavakli, Ali Sait; Kavrut Ozturk, Nilgun

    2017-12-20

    Atrial myxoma is a benign tumor of the heart that occurs primarily in the left atrium. Floating or large left atrial myxomas frequently cause functional mitral stenosis, may also affect mitral valve structure and flow, and lead to mitral regurgitation. Systemic embolization occurs in around 30% of cases either from tumor fragmentation or complete tumor detachment hence it should be removed as soon as it is detected. Intraoperative transesophageal echocardiography has a vital importance in the surgery. After resection of myxoma, intraoperative transesophageal echocardiography must be performed to rule out residual mass. The case here reported is of a 48-year old female, who presented with giant and floating left atrial myxoma. Residue mass was detected with intraoperative transesophageal echocardiography in the left ventricle after the resection of myxoma. Subsequently, the residue mass was successfully removed. Complete resection must be required to prevent possible complications such as recurrence, embolization in atrial myxomas. Transesophageal echocardiography performed intraoperatively is vital importance to confirm that the myxoma is completely resected. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  6. Giant left atrium encountered during right-sided thoracentesis

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    Rashmi Advani

    Full Text Available Giant left atrium is an uncommon pathology to encounter during bedside chest ultrasound, but is an important structure to be aware of when considering thoracentesis. This cardiac structure could easily be mistaken for loculated pleural fluid. This case also supports growing evidence that expert users can safely perform thoracentesis without completely reversing therapeutic anticoagulation. Keywords: Giant left atrium, Thoracentesis, Rheumatic heart disease, Ultrasound

  7. Left Atrium Papillary Fibroelastomas: A Cause of Cerebral Emboli

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    A. G. Ciss

    2012-01-01

    Full Text Available Papillary fibroelastomas are cardiac benign tumours. Among the benign cardiac tumor, papillary fibroelastomas are reported second after myxomas. Most often diagnosed incidentally, papillary fibroelastomas may embolize to cerebral circulation. Valvular locations are predominant; location in left atrium is rare. In this paper, we present a case of papillary fibroelastoma located in left atrium with symptoms of cerebral embolization. Transoesophageal echocardiography diagnosed a mobile mass. The patient was treated with surgical resection without further embolic complication.

  8. Anatomic relationship between left coronary artery and left atrium in patients undergoing atrial fibrillation ablation.

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    Anselmino, Matteo; Torri, Federica; Ferraris, Federico; Calò, Leonardo; Castagno, Davide; Gili, Sebastiano; Rovera, Chiara; Giustetto, Carla; Gaita, Fiorenzo

    2017-07-01

    Atrial fibrillation transcatheter ablation (TCA) is, within available atrial fibrillation rhythm control strategies, one of the most effective. To potentially improve ablation outcome in case of recurrent atrial fibrillation after a first procedure or in presence of structural myocardial disease, isolation of the pulmonary veins may be associated with extensive lesions within the left atrium. To avoid rare, but potentially life-threatening, complications, thorough knowledge and assessment of left atrium anatomy and its relation to structures in close proximity are, therefore, mandatory. Aim of the present study is to describe, by cardiac computed tomography, the anatomic relationship between aortic root, left coronary artery and left atrium in patients undergoing atrial fibrillation TCA. The cardiac computed tomography scan of 21 patients affected by atrial fibrillation was elaborated to segment left atrium, aortic root and left coronary artery from the surrounding structures and the following distances measured: left atrium and aortic root; left atrium roof and aortic root; left main coronary artery and left atrium; circumflex artery and left atrium appendage; and circumflex artery and mitral valve annulus. Above all, the median distance between left atrium and aortic root (1.9, 1.5-2.1 mm), and between circumflex artery and left atrium appendage ostium (3.0, 2.1-3.4 mm) were minimal (≤3 mm). None of measured distances significantly varied between patients presenting paroxysmal versus persistent atrial fibrillation. The anatomic relationship between left atrium and coronary arteries is extremely relevant when performing atrial fibrillation TCA by extensive lesions. Therefore, at least in the latter case, preablation imaging should be recommended to avoid rare, but potentially life-threatening, complications with the aim of an as well tolerated as possible procedure.

  9. Right superior vena cava draining into the left atrium

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    Calcagni, Giulio; Sidi, Daniel; Bonnet, Damien [University Rene Descartes-Paris 5, Department of Paediatric Cardiology, Hopital Necker-Enfants Malades, Paris (France); Batisse, Alain [Institut de Puericulture et de Perinatalogie, Paris (France); Vouhe, Pascal [University Rene Descartes-Paris 5, Department of Paediatric Cardiac Surgery, Hopital Necker-Enfants Malades, Paris (France); Ou, Phalla [University Rene Descartes-Paris 5, Department of Paediatric Cardiology, Hopital Necker-Enfants Malades, Paris (France); University Rene Descartes-Paris 5, Department of Pediatric Radiology, Hopital Necker-Enfants Malades, Paris (France)

    2008-08-15

    The right superior vena cava draining into the left atrium is a rare malformation causing cyanosis and clubbing in patients in whom no other signs of congenital heart defect are present. Diagnosis may be difficult as cyanosis may be mild and the anomaly is not always easily detectable by echocardiography. For this reason we report a 13-month-old male in whom we confirmed the clinical and echocardiographic suspicion of anomalous drainage of the right superior vena cava using multidetector CT. This allowed successful surgical reconnection of the right superior vena cava to the right atrium. (orig.)

  10. VARIATION IN THE OPENINGS (OSTIA OF LEFT PULMONARY VEINS INTO THE LEFT ATRIUM: A CASE REPORT

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    Sesi

    2015-03-01

    Full Text Available During early embryonic development, absorption of pulmonary venous network by the left primitive atrial chamber results in opening of four pulmonary veins which drain independently into its chamber. The extent of absorption and hence, the number of pulmon ary veins which open into the left atrium, may vary. Here we report a variation in the opening of the Left upper (superior pulmonary vein into the Left atrium. A total of six openings observed

  11. Validation of semi-automatic segmentation of the left atrium

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    Rettmann, M. E.; Holmes, D. R., III; Camp, J. J.; Packer, D. L.; Robb, R. A.

    2008-03-01

    Catheter ablation therapy has become increasingly popular for the treatment of left atrial fibrillation. The effect of this treatment on left atrial morphology, however, has not yet been completely quantified. Initial studies have indicated a decrease in left atrial size with a concomitant decrease in pulmonary vein diameter. In order to effectively study if catheter based therapies affect left atrial geometry, robust segmentations with minimal user interaction are required. In this work, we validate a method to semi-automatically segment the left atrium from computed-tomography scans. The first step of the technique utilizes seeded region growing to extract the entire blood pool including the four chambers of the heart, the pulmonary veins, aorta, superior vena cava, inferior vena cava, and other surrounding structures. Next, the left atrium and pulmonary veins are separated from the rest of the blood pool using an algorithm that searches for thin connections between user defined points in the volumetric data or on a surface rendering. Finally, pulmonary veins are separated from the left atrium using a three dimensional tracing tool. A single user segmented three datasets three times using both the semi-automatic technique as well as manual tracing. The user interaction time for the semi-automatic technique was approximately forty-five minutes per dataset and the manual tracing required between four and eight hours per dataset depending on the number of slices. A truth model was generated using a simple voting scheme on the repeated manual segmentations. A second user segmented each of the nine datasets using the semi-automatic technique only. Several metrics were computed to assess the agreement between the semi-automatic technique and the truth model including percent differences in left atrial volume, DICE overlap, and mean distance between the boundaries of the segmented left atria. Overall, the semi-automatic approach was demonstrated to be repeatable within

  12. Anesthetic implications of total anomalous systemic venous connection to left atrium with left isomerism

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    Parimala Prasanna Simha

    2012-01-01

    Full Text Available Total anomalous systemic venous connection (TASVC to the left atrium (LA is a rare congenital anomaly. An 11-year-old girl presented with complaints of palpitations and cyanosis. TASVC with left isomerism and noncompaction of LV was diagnosed after contrast echocardiogram and computed tomography angiogram. The knowledge of anatomy and pathophysiology is essential for the successful management of these cases. Anesthetic concerns in this case were polycythemia, paradoxical embolism and rhythm abnormalities. The patient was successfully operated by rerouting the systemic venous connection to the right atrium.

  13. Percutaneous closure of a hemodynamically significant connection between the inferior vena cava and the left atrium.

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    Wiebe, Jens; Rixe, Johannes; Nef, Holger

    2015-10-01

    A connection between the inferior vena cava (IVC) and the left atrium (LA) can occur as a rare complication after surgical atrial septum defect (ASD) repair. We demonstrate the first case of a percutaneous closure of this connection. A 67-year-old female was admitted to hospital due to exertional dyspnea. A history of a surgical ASD repair in 1960 and 1966 with a residual shunt was already known. Transesophageal echocardiography and a CT scan revealed a hemodynamically significant drainage of the IVC into the LA. This connection was successfully closed percutaneously with an AMPLATEZR Duct Occluder I (St. Jude Medical, St. Paul, MN). Post-procedural CT-scan and transthoracic echocardiography demonstrated a stable position and there was also no evidence of a residual shunt. The patient reported a significant reduction of exertional dyspnea. Percutaneous closure of an IVC to LA connection in this case was safe and feasible. The decision about which device is optimal must be made on an individual basis. © 2015 Wiley Periodicals, Inc.

  14. Gadofosveset trisodium-enhanced magnetic resonance angiography of the left atrium-A feasibility study

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    Wagner, Moritz, E-mail: moritz.wagner@charite.d [Department of Radiology, Charite - University Hospital, Berlin (Germany); Rief, Matthias; Asbach, Patrick [Department of Radiology, Charite - University Hospital, Berlin (Germany); Vogtmann, Thomas [Department of Cardioloy and Angiology, Charite - University Hospital, Berlin (Germany); Huppertz, Alexander [Imaging Science Institute Charite Berlin, Berlin (Germany); Beling, Mark [Department of Cardioloy and Angiology, Charite - University Hospital, Berlin (Germany); Butler, Craig [Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (Canada); Laule, Michael [Department of Cardioloy and Angiology, Charite - University Hospital, Berlin (Germany); Warmuth, Carsten; Taupitz, Matthias; Hamm, Bernd; Lembcke, Alexander [Department of Radiology, Charite - University Hospital, Berlin (Germany)

    2010-08-15

    Aim: Imaging of the left atrium is regularly performed prior to pulmonary vein isolation. The aim of the study was to evaluate the feasibility of contrast-enhanced high-resolution magnetic resonance angiography (MRA) of the left atrium using the blood-pool contrast agent gadofosveset trisodium in comparison to noncontrast MRA. Materials and methods: Twenty consecutive patients were examined by free-breathing electrocardiogram-gated whole-heart MRA (reconstructed spatial resolution, 0.7 mm x 0.6 mm x 0.8 mm) with a noncontrast T2-prepared steady state free precession sequence (T2-prep SSFP) and a gadofosveset trisodium-enhanced inversion-recovery SSFP sequence (CE IR-SSFP). Contrast-to-noise ratio (CNR) of blood in the left atrium was determined. Depiction of the left atrium was rated by two radiologists in consensus. A cardiologist segmented the MR data sets and rated depiction of the left atrium. Results: Five of 20 patients had irregular breathing patterns with navigator efficiency less than 35% and were excluded from evaluation. CNR was significantly higher for CE IR-SSFP compared with T2-prep SSFP (18.4 {+-} 5.3 vs. 11.7 {+-} 3.5, p < 0.01). Depiction of the left atrium by T2-prep SSFP was rated as good in four patients, moderate in ten patients, and poor in one patient, whereas depiction of the left atrium by CE IR-SSFP was rated as excellent in nine patients, good in four patients, and moderate in two patients. CE IR-SSFP allowed for semiautomated segmentation of the left atrium in 15 patients, whereas T2-prep SSFP allowed for segmentation only in ten patients. Conclusion: Gadofosveset trisodium-enhanced MRA of the left atrium is feasible with significantly improved image quality compared to noncontrast MRA.

  15. Catheter localization in the left atrium using an outdated anatomic reference for guidance.

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    Koolwal, Aditya B; Barbagli, Federico; Carlson, Christopher R; Liang, David H

    2009-01-01

    We present a method for registering real-time ultrasound of the left atrium to an outdated, anatomic surface mesh model, whose shape differs from that of the anatomy. Using an intracardiac echo (ICE) catheter with mounted 6DOF electromagnetic position/orientation sensor (EPS), we acquire images of the left atrium and determine where the ICE catheter must be positioned relative to the surface mesh to generate similar, "virtual" ICE images. Further, we use an affine warping model to infer how the shape of the surface mesh differs from that of the atrium. Our registration and warping algorithm allows us to display EPS-sensorized catheters inside the surface mesh, facilitating guidance for left atrial procedures. By solving for the atrium-to-mesh warping parameters, we ensure that tissue contact in the anatomy is properly displayed as tissue contact in the mesh. After considering less than thirty seconds worth of ICE data, we are able to accurately localize EPS measurements within the surface mesh, despite surface mesh warpings of up to +/-20% along and about the principal axes of the left atrium. Further, because our estimation framework is iterative and continuous, our accuracy improves as new data is acquired.

  16. Transcatheter therapy in partially abnormal pulmonary venous return with additional drainage to the left atrium.

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    Luciano, Debora; Laux, Daniela; Boudjemline, Younes; Hascoët, Sébastien; Lusson, Jean-René; Sorensen, Clio; Ovaert, Caroline; Kreitmann, Bernard; Van Praagh, Richard; Fraisse, Alain

    2013-12-10

    A persistent anastomosis between the pulmonary veins that connect with the left atrium and the systemic vein that drains into the right atrium has occasionally been reported. We report characteristics and transcatheter therapy in partially abnormal pulmonary venous return with additional drainage to the left atrium. We retrospectively studied such patients in 5 institutions. Ten patients (6 girls) presented at a median age of 8 (0.1 to 54) years with 2 anatomic types: 8 vertical vein types with drainage of the left upper lobe to the innominate vein via a large vertical vein (left superior cardinal vein) and to the left atrium via the left upper pulmonary vein; and 2 scimitar vein (SV) types with drainage of the right middle and lower pulmonary veins into the inferior vena cava and to the left atrium via an anomalous connecting vein. Associated malformations were aortic coarctation (n=2) and secundum atrial septal defects (n=3). Two patients of the vertical vein type were operated. Transcatheter occlusion of the abnormal pulmonary venous return was performed in 7 cases, associated with occlusion of systemic arterial supply (n=2), secundum atrial septal closure (n=2), left upper pulmonary vein stenosis stenting (n=1), and coarctation stenting (n=1). Including previously published cases, 18 patients (13 vertical veins and 5 scimitar veins) underwent transcatheter repair. Patients over 40 years of age tend to be symptomatic at presentation (p=0.056). In partially abnormal pulmonary venous return with dual drainage, transcatheter therapy can be offered in the majority of patients. © 2013.

  17. A large tumour of the left atrium – A 10-year follow-up

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    Agnieszka M. Łebek-Szatańska

    2016-11-01

    Full Text Available Benign myxomas are the most common primary tumors in the left atrium of the heart, and they usually require urgent operative management. However, with the constant aging of the population and treatment of patients with severe concomitant diseases, an interesting question is the efficacy of the conservative approach. We present a case of a 75-year-old woman who was previously diagnosed with a left atrial myxoma, underwent an operation to resect it and then developed a recurrent tumor at the site of resection, which was found by control echocardiography 1.5 years later. She has been observed for over 10 years, as she repeatedly refused reoperation. In the setting of this example of a relatively favorable clinical course of left atrium myxoma, we discuss the current knowledge about the natural history of these tumors and the role of echocardiography in predicting their growth and complications.

  18. Pleomorphic rhabdomyosarcoma of the left atrium mimicking myxoma

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    Tanvi Aggarwal

    2016-01-01

    Full Text Available Primary rhabdomyosarcoma (RMS of the heart is a rare malignant tumor which has poor prognosis and survival despite surgery and adjuvant chemotherapy. The preoperative diagnosis is often difficult in view of nonspecific clinicoradiological findings. This report describes a case of a 60-year-old woman who was clinically diagnosed as left atrial myxoma. A diagnosis of pleomorphic RMS was made on histopathology after excision. Our case discusses the clinicopathological features and treatment options of cardiac RMS emphasizing the fact that histopathology and immunohistochemistry are essential to confirm the diagnosis of such an aggressive malignant tumor.

  19. Unexpected traumatic rupture of left atrium mimicking aortic rupture

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    Abdallah K Alameddine

    2014-01-01

    Full Text Available Left atrial (LA rupture is rare following blunt chest injury. We describe a case of blunt LA rupture that was treated surgically. This report is intended to alert practitioners for a need of a close multiple disciplinary collaborations among them for optimal management of patients with this type of trauma; because other non-cardiac injuries involving the head, abdomen, or extremities are considered covariates for in-hospital mortality. As in the present case, the patient eventually died from associated extrathoracic injuries. The diagnosis of LA rupture is by exclusion. However, the initial radiological reading may be misinterpreted, because this injury can easily be mistaking for an aortic rupture. The final reappraisal of the chest imaging studies should be interpreted by a skilled radiologist to avoid misdiagnosis. Subtle radiological features can help distinguish aortic thoracic injury as illustrated in this patient. These factors may be useful to the practicing surgeon in deciding surgical approach.

  20. Surgical repair of an aneurysm-like fistula connecting the left main coronary artery with the right atrium.

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    Tong, Guang; Sun, Zhongchan; Zhang, Weida

    2016-08-01

    Coronary fistula is defined as an anomalous connection between a coronary artery and any of the four chambers of the heart or any of its great vessels. A coronary fistula connecting the left main coronary artery to the right atrium is the most uncommon. In the present study, we report the surgical management of a very uncommon case of an aneurysm-like fistula connecting the left main coronary artery to the right atrium in a 2-year-old boy.

  1. Incremental Value of Three-Dimensional Transesophageal Echocardiography over the Two-Dimensional Technique in the Assessment of a Thrombus in Transit through a Patent Foramen Ovale.

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    Thind, Munveer; Ahmed, Mustafa I; Gok, Gulay; Joson, Marisa; Elsayed, Mahmoud; Tuck, Benjamin C; Townsley, Matthew M; Klas, Berthold; McGiffin, David C; Nanda, Navin C

    2015-05-01

    We report a case of a right atrial thrombus traversing a patent foramen ovale into the left atrium, where three-dimensional transesophageal echocardiography provided considerable incremental value over two-dimensional transesophageal echocardiography in its assessment. As well as allowing us to better spatially characterize the thrombus, three-dimensional transesophageal echocardiography provided a more quantitative assessment through estimation of total thrombus burden. © 2015, Wiley Periodicals, Inc.

  2. Intraoperative Transesophageal Echocardiography and Right Ventricular Failure After Left Ventricular Assist Device Implantation.

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    Silverton, Natalie A; Patel, Ravi; Zimmerman, Josh; Ma, Jianing; Stoddard, Greg; Selzman, Craig; Morrissey, Candice K

    2018-02-15

    To determine whether intraoperative measures of right ventricular (RV) function using transesophageal echocardiography are associated with subsequent RV failure after left ventricular assist device (LVAD) implantation. Retrospective, nonrandomized, observational study. Single tertiary-level, university-affiliated hospital. The study comprised 100 patients with systolic heart failure undergoing elective LVAD implantation. Transesophageal echocardiographic images before and after cardiopulmonary bypass were analyzed to quantify RV function using tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (S'), fractional area change (FAC), RV global longitudinal strain, and RV free wall strain. A chart review was performed to determine which patients subsequently developed RV failure (right ventricular assist device placement or prolonged inotrope requirement ≥14 days). Nineteen patients (19%) subsequently developed RV failure. Postbypass FAC was the only measure of RV function that distinguished between the RV failure and non-RV failure groups (21.2% v 26.5%; p = 0.04). The sensitivity, specificity, and area under the curve of an abnormal RV FAC (failure after LVAD implantation were 84%, 20%, and 0.52, respectively. No other intraoperative measure of RV function was associated with subsequent RV failure. RV failure increased ventilator time, intensive care unit and hospital length of stay, and mortality. Intraoperative measures of RV function such as tricuspid annular plane systolic excursion, tricuspid annular systolic velocity, and RV strain were not associated with RV failure after LVAD implantation. Decreased postbypass FAC was significantly associated with RV failure but showed poor discrimination. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Electro-anatomical mapping of the left atrium before and after cryothermal balloon isolation of the pulmonary veins

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    Y. van Belle (Yves); S.P. Knops (Simon); P. Janse (Petter); M. Rivero-Ayerza (Maximo); E. Jessurun; T. Szili-Torok (Tamas); L.J.L.M. Jordaens (Luc)

    2009-01-01

    textabstractIntroduction: The 28 mm cryoballoon catheter is a device used for pulmonary vein isolation (PVI). The aim of this study was to evaluate the extent of the ablation in the antral regions of the left atrium. Methods and Results: Eighteen patients with drug refractory, symptomatic,

  4. Transcranial Doppler to Detect Right to Left Communication: Evaluation Versus Transesophageal Echocardiography in Real Life.

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    Maillet, Alexandre; Pavero, Antoine; Salaun, Pierre; Pibourdin, Alexis; Skopinski, Sophie; Thambo, Jean-Benoit; Sibon, Igor; Constans, Joël; Boulon, Carine

    2018-01-01

    We compared transcranial Doppler (TCD) with transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) for the detection of right to left communication (RLC) in the heart. All patients explored from 2013 to 2016 in a vascular medicine unit to detect RLC by TCD were included. Right to left communication was detected by TCD monitoring for microembolic signals after intravenous injection of agitated 5% glucose and air. One hundred one patients were explored for RLC by TCD, 64 by TEE (not possible in 10, bubble injection in 51), and 93 by TTE because of unexplained stroke or arterial thrombosis (51 males, 50 females, age 51.0 ± 15.8 years) (bubble injection in 35). Fifty-three patients were positive after TCD (TEE: 4 negative, TTE: 7 negative). Of the negative patients after TCD, none was positive for TEE and 1 was positive for TTE with no evidence of patent foramen ovale. Transcranial Doppler was sensitive to detect RLC, even in patients with negative TTE or TTE. A negative TEE did not exclude RLC demonstrated by TCD. Transcranial Doppler might be proposed as first line to detect RLC.

  5. [Transesophageal echocardiography in perioperative period guiding the decision making during hemodynamic instability due to atrial fibrillation].

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    Pontes, João Paulo Jordão; Dos Santos, Aline Tonin; Salgado Filho, Marcello Fonseca

    2018-03-27

    Atrial fibrillation is the most common cardiac arrhythmia, which may occur during the perioperative period and lead to hemodynamic instability due to loss of atrial systolic function. During atrial fibrillation management, electrical cardioversion is one of the therapeutic options in the presence of hemodynamic instability; however, it exposes the patient to thromboembolic event risks. Transesophageal echocardiography is a diagnostic tool for thrombi in the left atrium and left atrial appendage with high sensitivity and specificity, allowing early and safe cardioversion. The present case describes the use of transesophageal echocardiography to exclude the presence of thrombi in the left atrium and left atrial appendage in a patient undergoing non-cardiac surgery with atrial fibrillation of unknown duration and hemodynamic instability. Male patient, 74 years old, hypertensive, with scheduled abdominal surgery, who upon cardiac monitoring in the operating room showed atrial fibrillation undiagnosed in preoperative electrocardiogram, but hemodynamic stability. During surgery, the patient showed hemodynamic instability requiring norepinephrine at increasing doses, with no response to heart rate control. After the end of the surgery, transesophageal echocardiography was performed with a thorough evaluation of the left atrium and left atrial appendage and pulsed Doppler analysis of the left atrial appendage with mean velocity of 45cm.s -1 . Thrombus in the left atrium and left atrial appendage and other cardiac causes for hemodynamic instability were excluded. Therefore, electrical cardioversion was performed safely. After returning to sinus rhythm, the patient showed improvement in blood pressure levels, with noradrenaline discontinuation, extubation in the operating room, and admission to the intensive care unit. In addition to a tool for non-invasive hemodynamic monitoring, perioperative transesophageal echocardiography may be valuable in clinical decision making. In

  6. Left Atrial Enlargement on Transthoracic Echocardiography Predicts Left Atrial Thrombus on Transesophageal Echocardiography in Ischemic Stroke Patients

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    James Anaissie

    2016-01-01

    Full Text Available Background. Transesophageal echocardiogram (TEE is superior to transthoracic echocardiogram (TTE in detecting left atrial thrombus (LAT, a risk factor for stroke, but is costly and invasive, carrying a higher risk for complications. Aims. To determine the utility of using left atrial enlargement (LAE on TTE to predict LAT on TEE. Methods. AIS patients who presented in 06/2008–7/2013 and underwent both TTE and TEE were identified from our prospective stroke registry. Analysis consisted of multivariate logistic regression with propensity score adjustment and receiver operating characteristic (ROC area under the curve (AUC analyses. Results. 219 AIS patients underwent both TTE and TEE. LAE on TTE was detected in 113 (51.6% of AIS patients. Patients with LAE on TTE had higher proportion of LAT on TEE (8.4% versus 1.0%, p=0.018. LAE on TTE predicted increased odds of LAT on TEE (OR=8.83, 95% CI 1.04–74.83, p=0.046. The sensitivity and specificity for LAT on TEE by LAE on TEE were 88.89% and 52.20%, respectively (AUC=0.7054, 95% CI 0.5906–0.8202. Conclusions. LAE on TTE can predict LAT detected on TEE in nearly 90% of patients. This demonstrates the utility of LAE on TTE as a potential screening tool for LAT, potentially limiting unneeded costs and complications associated with TEE.

  7. Left Atrial Enlargement on Transthoracic Echocardiography Predicts Left Atrial Thrombus on Transesophageal Echocardiography in Ischemic Stroke Patients.

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    Anaissie, James; Monlezun, Dominique; Seelochan, A; Siegler, James E; Chavez-Keatts, Maria; Tiu, Jonathan; Pineda, Denise; George, Alexander; Shaban, Amir; Abi Rafeh, Nidal; Schluter, Laurie; Martin-Schild, Sheryl; El Khoury, Ramy

    2016-01-01

    Background. Transesophageal echocardiogram (TEE) is superior to transthoracic echocardiogram (TTE) in detecting left atrial thrombus (LAT), a risk factor for stroke, but is costly and invasive, carrying a higher risk for complications. Aims. To determine the utility of using left atrial enlargement (LAE) on TTE to predict LAT on TEE. Methods. AIS patients who presented in 06/2008-7/2013 and underwent both TTE and TEE were identified from our prospective stroke registry. Analysis consisted of multivariate logistic regression with propensity score adjustment and receiver operating characteristic (ROC) area under the curve (AUC) analyses. Results. 219 AIS patients underwent both TTE and TEE. LAE on TTE was detected in 113 (51.6%) of AIS patients. Patients with LAE on TTE had higher proportion of LAT on TEE (8.4% versus 1.0%, p = 0.018). LAE on TTE predicted increased odds of LAT on TEE (OR = 8.83, 95% CI 1.04-74.83, p = 0.046). The sensitivity and specificity for LAT on TEE by LAE on TEE were 88.89% and 52.20%, respectively (AUC = 0.7054, 95% CI 0.5906-0.8202). Conclusions. LAE on TTE can predict LAT detected on TEE in nearly 90% of patients. This demonstrates the utility of LAE on TTE as a potential screening tool for LAT, potentially limiting unneeded costs and complications associated with TEE.

  8. Contrast-Based 3D/2D Registration of the Left Atrium: Fast versus Consistent

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    Matthias Hoffmann

    2016-01-01

    Full Text Available For augmented fluoroscopy during cardiac ablation, a preoperatively acquired 3D model of a patient’s left atrium (LA can be registered to X-ray images recorded during a contrast agent (CA injection. An automatic registration method that works also for small amounts of CA is desired. We propose two similarity measures: The first focuses on edges of the patient anatomy. The second computes a contrast agent distribution estimate (CADE inside the 3D model and rates its consistency with the CA as seen in biplane fluoroscopic images. Moreover, temporal filtering on the obtained registration results of a sequence is applied using a Markov chain framework. Evaluation was performed on 11 well-contrasted clinical angiographic sequences and 10 additional sequences with less CA. For well-contrasted sequences, the error for all 73 frames was 7.9 ± 6.3 mm and it dropped to 4.6 ± 4.0 mm when registering to an automatically selected, well enhanced frame in each sequence. Temporal filtering reduced the error for all frames from 7.9 ± 6.3 mm to 5.7 ± 4.6 mm. The error was typically higher if less CA was used. A combination of both similarity measures outperforms a previously proposed similarity measure. The mean accuracy for well contrasted sequences is in the range of other proposed manual registration methods.

  9. Hemangioma intra-atrial esquerdo Capillary-type cardiac hemangioma, in the left atrium

    Directory of Open Access Journals (Sweden)

    Adalberto Freire Sobrinho

    2005-12-01

    Full Text Available É apresentado o caso de paciente de 49 anos, sexo feminino, com ecocardiograma e cateterismo cardíaco mostrando massa intra-atrial esquerda, sugerindo mixoma, encaminhada para avaliação cardiológica devido à dispnéia. A paciente era ainda portadora de hepatoesplenomegalia esquistossomótica. Após preparo pré-operatório, que incluiu assistência hematológica, a paciente foi submetida a tratamento cirúrgico, com auxílio de circulação extracorpórea. Apresentou sangramento aumentado no pós-operatório imediato, melhorando após transfusão de plaquetas. O estudo anatomopatológico revelou tratar-se de hemangioma capilar benigno.A 49-year-old woman, whose echocardiography and hemodynamic study showed a mass in the left atrium suggestive of myxoma, was referred for cardiological evaluation because of dyspnea. She also had schistosomotic hepatosplenomegaly. After a preoperative evaluation with hematological assistance, the patient underwent surgery using a cardiopulmonary bypass. She suffered a hemorrhage in the immediate post-operative period, which improved after platelet transfusion. The histopathologic study showed a capillary-type cardiac hemangioma.

  10. [Value of two left atrium and pulmonary vein stereoscopic imaging reconstruction methods on guiding radiofrequency ablation for atrial fibrillation].

    Science.gov (United States)

    Tian, Y; Zhou, S; Yin, Y H; Zheng, Y X; Wang, R P; Liu, X Q; Liu, Z Q; Liu, Q F; Liu, W; Pang, J; Jiang, Z; Tian, L H; Huang, J; Yang, L

    2017-11-24

    Objective: To compare the value of two 3D imaging reconstruction methods for left atria and pulmonary vein on guiding the catheter ablation for atrial fibrillation (AF). Methods: From January 2014 to January 2017, a total of 100 drug refractory paroxysmal AF patients were divided into left atria direct angiography group ( n =50), and indirect angiography group ( n =50). 3D CARTO system was applied for mapping and guiding the ablation procedure. Patients assigned to direct angiography group were treated as follows: intraoperative puncture of atrial septum, inject contrast agent directly into the left atrium, conduct left atrial and pulmonary venous rotation angiography, reconstruct three-dimensional image, integrate the image into real-time X-ray system to facilitate circumferential pulmonary vein isolation. Patients assigned into the indirect angiography group were treated as follows: inject contrast agent through the right ventricle, conduct delayed rotation angiography of the left atria and pulmonary vein to guide circumferential pulmonary vein fixation and ablation. The left atrial and pulmonary venous image acquisition, the operation and X-ray exposure time, the success rate and the incidence of complication of the two groups were compared. The patients were followed up for 3-6 months. Results: General clinical characteristics of the two groups were similar(all P >0.05). Ablation was successful in all 100 patients. The operation time[(112.0±21.4)min vs. (134.0±24.3)min]and X-ray exposure time((10.7±4.7)min vs. (15.8±5.2)min)were significantly lower in direct angiography group than in indirect angiography group (both P guide the radiofrequency catheter ablation of paroxysmal atrial fibrillation by reconstruction 3D image of left atrium and pulmonary vein. Compared with indirect angiography group, direct angiography group can improve the imaging quality of left atrium and pulmonary vein, decrease the X-ray exposure time of the ablation procedure.

  11. Pain perception during esophageal warming due to radiofrequency catheter ablation in the left atrium.

    Science.gov (United States)

    Galeazzi, Marco; Ficili, Sabina; Dottori, Serena; Elian, Mohamed Abdelkader; Pasceri, Vincenzo; Venditti, Franco; Russo, Maurizio; Lavalle, Carlo; Pandozi, Angela; Pandozi, Claudio; Santini, Massimo

    2010-03-01

    We investigated the relationship among esophageal warming, pain perception, and the site of radiofrequency (RF) delivery in the left atrium (LA) during the course of catheter ablation of atrial fibrillation. Such a procedure in awake patients is often linked to the development of visceral pain and esophageal warming. As a consequence, potentially dangerous complications have been described. Twenty patients undergoing RF ablation in the LA were studied. An esophageal probe (EP) capable of measuring endoesophageal temperature (ET) was positioned before starting the procedure. The relative position of the EP and the tip of the ablator were evaluated through fluoroscopy imaging before starting each RF delivery, during which the highest value of the temperature was collected. After RF withdrawal, the patients were asked to define the intensity of the experienced pain by using a score index ranging from 0 (no pain) to 4 (pain requiring immediate RF interruption). The mean ET value during ablation was 39.59 +/- 4.71 degrees C. The EP proximity to the ablator's tip showed a high correlation with the development of the highest ET values (Spearman's rank correlation coefficient r = 0.49, confidence interval (CI) 0.55-0.41). Moreover, the highest values of pain intensity were reported when the RF was delivered to the atrial zones close to the EP projection (r = 0.50, CI 0.55-0.42) and when the highest ET levels were reached (r = 0.38, CI 0.30-0.45). Pain perception in LA ablation is significantly related to esophageal warming and is higher when the RF is delivered near the esophagus. It seems advisable to perform ET monitoring in sedated patients to avoid short- and long-term jeopardizing of the esophageal wall.

  12. Brain Abscess Associated with Isolated Left Superior Vena Cava Draining into the Left Atrium in the Absence of Coronary Sinus and Atrial Septal Defect

    International Nuclear Information System (INIS)

    Erol, Ilknur; Cetin, I. Ilker; Alehan, Fuesun; Varan, Birguel; Ozkan, Sueleyman; Agildere, A. Muhtesem; Tokel, Kursad

    2006-01-01

    A previously healthy 12-year-old girl presented with severe headache for 2 weeks. On physical examination, there was finger clubbing without apparent cyanosis. Neurological examination revealed only papiledema without focal neurologic signs. Cerebral magnetic resonance imaging showed the characteristic features of brain abscess in the left frontal lobe. Cardiologic workup to exclude a right-to-left shunt showed an abnormality of the systemic venous drainage: presence of isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect. This anomaly is rare, because only a few other cases have been reported

  13. Management issues during HeartWare left ventricular assist device implantation and the role of transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Sanjay Orathi Patangi

    2013-01-01

    Full Text Available Left ventricular assist devices (LVAD are increasingly used for mechanical circulatory support of patients with severe heart failure, primarily as a bridge to heart transplantation. Transesophageal echocardiography (TEE plays a major role in the clinical decision making during insertion of the devices and in the post-operative management of these patients. The detection of structural and device-related mechanical abnormalities is critical for optimal functioning of assist device. In this review article, we describe the usefulness of TEE for optimal perioperative management of patients presenting for HeartWare LVAD insertion.

  14. Endocardial left ventricle feature tracking and reconstruction from tri-plane trans-esophageal echocardiography data

    Science.gov (United States)

    Dangi, Shusil; Ben-Zikri, Yehuda K.; Cahill, Nathan; Schwarz, Karl Q.; Linte, Cristian A.

    2015-03-01

    Two-dimensional (2D) ultrasound (US) has been the clinical standard for over two decades for monitoring and assessing cardiac function and providing support via intra-operative visualization and guidance for minimally invasive cardiac interventions. Developments in three-dimensional (3D) image acquisition and transducer design and technology have revolutionized echocardiography imaging enabling both real-time 3D trans-esophageal and intra-cardiac image acquisition. However, in most cases the clinicians do not access the entire 3D image volume when analyzing the data, rather they focus on several key views that render the cardiac anatomy of interest during the US imaging exam. This approach enables image acquisition at a much higher spatial and temporal resolution. Two such common approaches are the bi-plane and tri-plane data acquisition protocols; as their name states, the former comprises two orthogonal image views, while the latter depicts the cardiac anatomy based on three co-axially intersecting views spaced at 600 to one another. Since cardiac anatomy is continuously changing, the intra-operative anatomy depicted using real-time US imaging also needs to be updated by tracking the key features of interest and endocardial left ventricle (LV) boundaries. Therefore, rapid automatic feature tracking in US images is critical for three reasons: 1) to perform cardiac function assessment; 2) to identify location of surgical targets for accurate tool to target navigation and on-target instrument positioning; and 3) to enable pre- to intra-op image registration as a means to fuse pre-op CT or MR images used during planning with intra-operative images for enhanced guidance. In this paper we utilize monogenic filtering, graph-cut based segmentation and robust spline smoothing in a combined work flow to process the acquired tri-plane TEE time series US images and demonstrate robust and accurate tracking of the LV endocardial features. We reconstruct the endocardial LV

  15. Repeatability and reproducibility of measurements obtained via two-dimensional speckle tracking echocardiography of the left atrium and time-left atrial area curve analysis in healthy dogs.

    Science.gov (United States)

    Osuga, Tatsuyuki; Nakamura, Kensuke; Lim, Sue Yee; Tamura, Yu; Kumara, Wickramasekara Rajapakshage Bandula; Murakami, Masahiro; Sasaki, Noboru; Morishita, Keitaro; Ohta, Hiroshi; Yamasaki, Masahiro; Takiguchi, Mitsuyoshi

    2013-06-01

    To evaluate left atrial phasic function in healthy dogs by means of 2-D speckle tracking echocardiography with time-left atrial area curve analysis and to assess repeatability and reproducibility of obtained measurements. 6 healthy Beagles. Each dog underwent echocardiography twice on different days (3 nonconsecutive examinations/d). Images were analyzed with offline software; area of the left atrium was automatically calculated in each frame throughout the cardiac cycle to derive time-left atrial area curves. Variables used to assess left atrial phasic function (total, passive, and active emptying area and emptying fractions and mean active and total emptying rates) were calculated. Agreement between variables measured via speckle tracking echocardiography and a manual tracing method was assessed with modified Bland-Altman analysis. Within-day and between-day coefficients of variation were determined. Mean ± SD total, passive, and active emptying fractions of the left atrium were 49.8 ± 3.5%, 277 ± 4.0%, and 30.5 ± 4.3%, respectively. Mean ± SD total and active emptying rates were 16.0 ± 2.5 cm(2)/s and 25.1 ± 4.9 cm(2)/s, respectively. Within-day and between-day coefficients of variation were canine patients.

  16. Transesophageal echo diagnosis of perioperative unusual transient left ventricular apical ballooning syndrome

    Directory of Open Access Journals (Sweden)

    Hugo Andrés Mantilla

    2016-01-01

    Full Text Available Stress cardiomyopathy, or Takotsubo syndrome, is a widely recognized cardiac pathology with a clinical presentation similar to acute coronary syndrome and related to physical or emotional stress. Perioperatively, it is challenging to identify it given the variety of forms and scenarios in which it can present. We describe a 22-year-old patient with an atypical presentation of Takotsubo syndrome during anesthesia induction, which highlights the usefulness of transesophageal echocardiography for the initial diagnosis.

  17. A fast slam approach to freehand 3-d ultrasound reconstruction for catheter ablation guidance in the left atrium.

    Science.gov (United States)

    Koolwal, Aditya B; Barbagli, Federico; Carlson, Christopher R; Liang, David H

    2011-12-01

    We present a method for real-time, freehand 3D ultrasound (3D-US) reconstruction of moving anatomy, with specific application towards guiding the catheter ablation procedure in the left atrium. Using an intracardiac echo (ICE) catheter with a pose (position/orientation) sensor mounted to its tip, we continually mosaic 2D-ICE images of a left atrium phantom model to form a 3D-US volume. Our mosaicing strategy employs a probabilistic framework based on simultaneous localization and mapping (SLAM), a technique commonly used in mobile robotics for creating maps of unexplored environments. The measured ICE catheter tip pose provides an initial estimate for compounding 2D-ICE image data into the 3D-US volume. However, we simultaneously consider the overlap-consistency shared between 2D-ICE images and the 3D-US volume, computing a "corrected" tip pose if need be to ensure spatially-consistent reconstruction. This allows us to compensate for anatomic movement and sensor drift that would otherwise cause motion artifacts in the 3D-US volume. Our approach incorporates 2D-ICE data immediately after acquisition, allowing us to continuously update the registration parameters linking sensor coordinates to 3D-US coordinates. This, in turn, enables real-time localization and display of sensorized therapeutic catheters within the 3D-US volume for facilitating procedural guidance. Copyright © 2011 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  18. Enlarged Right Atrium Falsely Interpreted as a Mediastinal Mass: A Case Report

    Directory of Open Access Journals (Sweden)

    Farid Zand

    2015-09-01

    Full Text Available Right atrial dilation due to left heart disease is a common complication among adults. The present review aimed to describe a case of massively dilated right atrium in a female patient presenting with valvular heart disease and no atrial fibrillation. The results of chest X-ray revealed a large opacity filling the lower right hemithorax, falsely interpreted as a mediastinal mass. During the transesophageal echocardiography, severe enlargement of the right atrium was detected, and open mitral and tricuspid valve replacements were performed successfully.

  19. Quantitative description of the 3D regional mechanics of the left atrium using cardiac magnetic resonance imaging

    International Nuclear Information System (INIS)

    Kuklik, P; Molaee, P; Ganesan, A N; Brooks, A G; Worthley, S G; Sanders, P; Podziemski, P

    2014-01-01

    The left atrium (LA) plays an important role in the maintenance of hemodynamic and electrical stability of the heart. One of the conditions altering the atrial mechanical function is atrial fibrillation (AF), leading to an increased thromboembolic risk due to impaired mechanical function. Preserving the regions of the LA that contribute the greatest to atrial mechanical function during curative strategies for AF is important. The purpose of this study is to introduce a novel method of regional assessment of mechanical function of the LA. We used cardiac MRI to reconstruct the 3D geometry of the LA in nine control and nine patients with paroxysmal atrial fibrillation (PAF). Regional mechanical function of the LA in pre-defined segments of the atrium was calculated using regional ejection fraction and wall velocity. We found significantly greater mechanical function in anterior, septal and lateral segments as opposed to roof and posterior segments, as well as a significant decrease of mechanical function in the PAF group. We suggest that in order to minimize the impact of the AF treatment on global atrial mechanical function, damage related to therapeutic intervention, such as catheter ablation, in those areas should be minimized. (paper)

  20. Preventive AF ablation in patients with mitral valve lesion and left atrium enlargement: 3-month follow-up results

    Directory of Open Access Journals (Sweden)

    A. V. Bogachev-Prokophiev

    2017-07-01

    Full Text Available Aim. Persistence or appearance of atrial fibrillation (AF after mitral valve surgery significantly reduces the number of excellent and good results in the long-term period. AF leads to heart failure and pulmonary hypertension and increases the risk of thromboembolic events and stroke. Drug strategies for prevention of new-onset AF in the postoperative period are well developed, while invasive methods are still under development and clinical trials. This study aims to evaluate the safety and efficacy of surgical prevention of atrial fibrillation in patients with left atrium enlargement and mitral valve (MV lesion at 3-month follow-up.Methods. Forty patients operated in our clinic over a period of 2015–2017 were included in the study. All patients had MV lesion and left atrial dilatation greater than 60 mm. All patients had a sinus rhythm at the time of the operation and no documented AF in the history. The mean age of the patients was 48.9±10.1 (23-69 years. All patients had indications for mitral valve surgery and were randomized into two groups. The first group included patients who underwent a concomitant preventive ablation procedure (n = 20. The second group included patients with isolated MV surgery (n = 20. Complications and heart rhythm were evaluated within 3 months after surgery.Results. Patients who underwent preventive ablation within 3 months after the surgery did not differ significantly in the number of complications as compared with the control. In the group of patients with preventive ablation, a higher freedom from AF in comparison with the group of patients with isolated MV surgery was observed: 95 vs. 40%, respectively. Conclusion. Preventive atrial fibrillation ablation in patients with mitral valve lesion and left atrium enlargement is a safe and effective procedure. Preventive ablation reduces the risk of atrial fibrillation by 1.6 times within 3-month follow-up.Received 24 April 2017. Accepted 28 June 2017.Funding: The

  1. Left atrial calcification in a hemodialysis patient with cor triatriatum.

    Science.gov (United States)

    Peces, R; Pobes, A; Rodriguez, M; Simarro, C; Iglesias, G; Simarro, E

    2000-05-01

    Myocardial calcification is a rare manifestation of abnormal calcium metabolism seen in some patients with chronic renal failure. This report describes the transesophageal echocardiographic and spiral computed tomography (CT) findings in a young hemodialysis female with severe secondary hyperparathyroidism. These findings included calcification of the multiperforated membrane of a cor triatriatum and the wall of the left atrium.

  2. The left atrium, atrial fibrillation, and the risk of stroke in hypertensive patients with left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Wachtell, K.; Devereux, R.B.; Lyle, P.A.

    2008-01-01

    The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study provided extensive data on predisposing factors, consequences, and prevention of atrial fibrillation (AF) in patients with hypertension and left ventricular (LV) hypertrophy. Randomized losartan-based treatment...

  3. A Combined Random Forests and Active Contour Model Approach for Fully Automatic Segmentation of the Left Atrium in Volumetric MRI

    Directory of Open Access Journals (Sweden)

    Chao Ma

    2017-01-01

    Full Text Available Segmentation of the left atrium (LA from cardiac magnetic resonance imaging (MRI datasets is of great importance for image guided atrial fibrillation ablation, LA fibrosis quantification, and cardiac biophysical modelling. However, automated LA segmentation from cardiac MRI is challenging due to limited image resolution, considerable variability in anatomical structures across subjects, and dynamic motion of the heart. In this work, we propose a combined random forests (RFs and active contour model (ACM approach for fully automatic segmentation of the LA from cardiac volumetric MRI. Specifically, we employ the RFs within an autocontext scheme to effectively integrate contextual and appearance information from multisource images together for LA shape inferring. The inferred shape is then incorporated into a volume-scalable ACM for further improving the segmentation accuracy. We validated the proposed method on the cardiac volumetric MRI datasets from the STACOM 2013 and HVSMR 2016 databases and showed that it outperforms other latest automated LA segmentation methods. Validation metrics, average Dice coefficient (DC and average surface-to-surface distance (S2S, were computed as 0.9227±0.0598 and 1.14±1.205 mm, versus those of 0.6222–0.878 and 1.34–8.72 mm, obtained by other methods, respectively.

  4. A case of a resected benign myxoma-like hemorrhagic cyst, which later recurred as undifferentiated pleomorphic sarcoma in the left atrium.

    Science.gov (United States)

    Kim, Eunju; Choi, Seo-Won; Min, Daniel; Kim, Sang Hoon; Yang, Woo-In; Moon, Jae Youn; Sung, Jung Hoon; Kim, In Jai; Lim, Sang-Wook; Cha, Dong-Hun; Moon, Byung; Cho, Sang-Ho; Kim, Won-Jang

    2017-04-01

    An intracardiac cystic mass is a rare type of mass found in the left atrium. The differential diagnosis of an intracardiac cystic mass includes hydatid cysts, bronchogenic cysts, intracardiac varices, and hemorrhages in some tumor types, including myxoma. We present the case of a 68-year-old woman who presented with episodic dyspnea. Transthoracic echocardiography (TTE) revealed the presence of a left atrial mass mimicking myxoma. However, in postoperative findings, it was determined that the mass was actually a hemorrhagic cyst. Eighteen months later, the patient presented with recurrent exertional dyspnea and TTE revealed the recurrence of a left atrial mass. Computed tomography showed that the mass extended into the right atrium, inferior vena cava, and coronary sinus. After re-operation, the final histological diagnosis was determined to be an undifferentiated pleomorphic sarcoma in the left atrium. An intracardiac hemorrhagic cyst was suspected during the operation of a benign-looking LA mass. As such, we recommend that other rare etiologies be considered and more biopsies be performed when possible.

  5. Computer-based automated left atrium segmentation and volumetry from ECG-gated coronary CT angiography data. Comparison with manual slice segmentation and ultrasound planimetric methods

    Energy Technology Data Exchange (ETDEWEB)

    Bauer, R.W.; Kraus, B.; Kerl, J.M.; Lehnert, T.; Vogl, T.J. [Universitaetsklinikum Frankfurt (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Bernhardt, D.; Vega-Higuera, F. [Siemens AG, Healthcare Sector, Forchheim (Germany). Computed Tomography; Ackermann, H. [Universitaetsklinikum Frankfurt (Germany). Inst. fuer Biostatistik und Mathematische Modellierung

    2010-12-15

    Purpose: Enlargement of the left atrium is a risk factor for cardiovascular or cerebrovascular events. We evaluated the performance of prototype software for fully automated segmentation and volumetry of the left atrium. Materials and Methods: In 34 retrospectively ECG-gated coronary CT angiography scans, the end-systolic (LAVsys) and end-diastolic (LAVdia) volume of the left atrium was calculated fully automatically by prototype software. Manual slice segmentation by two independent experienced radiologists served as the reference standard. Furthermore, two independent observers calculated the LAV utilizing two ultrasound planimetric methods ('area length' and 'prolate ellipse') on CTA images. Measurement periods were compared for all methods. Results: The left atrial volumes calculated with the prototype software were in excellent agreement with the results from manual slice segmentation (r = 0.97 - 0.99; p < 0.001; Bland-Altman) with excellent interobserver agreement between both radiologists (r = 0.99; p < 0.001). Ultrasound planimetric methods clearly showed a higher variation (r = 0.72 - 0.86) with moderate interobserver agreement (r = 0.51 - 0.79). The measurement period was significantly lower with the software (267 {+-} 28 sec; p < 0.001) than with ultrasound methods (431 {+-} 68 sec) or manual slice segmentation (567 {+-} 91 sec). Conclusion: The prototype software showed excellent agreement with manual slice segmentation with the least time consumption. This will facilitate the routine assessment of the LA volume from coronary CTA data and therefore risk stratification. (orig.)

  6. Left ventricular ejection fraction and left atrium diameter related to new-onset atrial fibrillation following acute myocardial infarction: a systematic review and meta-analysis.

    Science.gov (United States)

    Zeng, Rui-Xiang; Chen, Mao-Sheng; Lian, Bao-Tao; Liao, Peng-Da; Zhang, Min-Zhou

    2017-10-06

    New-onset atrial fibrillation (NOAF) occurs frequently in patients with acute myocardial infarction (AMI), and is associated with increased subsequent cardiovascular mortality. However, only a few studies directly evaluated the relationship of left ventricular ejection fraction (LVEF) or left atrium diameter (LAD) and NOAF following AMI. MEDLINE ® , EMBASE ® and the Cochrane Library were carried out to find studies until January 2017. Pooled mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate the value of LVEF and LAD in the prediction of NOAF after AMI. We performed sensitivity analyses to explore the potential sources of heterogeneity. Statistical analyses were carried out using the Revman 5.3. We included 10 qualifying studies comprising a total of 708 patients with NOAF and 6785 controls. Overall, decreased LVEF and increased LAD levels had a significant positive association with NOAF in patients with AMI. The MD in the LVEF levels between the patients with and those without NOAF was -4.91 units (95% Cl: -5.70 to -4.12), test for overall effect z-score = 12.18 ( p < 0.00001, I 2 = 35%). Moreover, in a subgroup analysis, the MD for LAD and NOAF was 2.55 units (95% Cl: 1.91 to 3.19), test for overall effect z-score = 7.80 ( p < 0.00001, I 2 = 57%). Our meta-analysis demonstrated that both decreased LVEF and increased LAD levels were associated with greater risk of NOAF following AMI.

  7. Impact of ECG gating in contrast-enhanced MR angiography for the assessment of the pulmonary veins and the left atrium anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Katoh, M.; Buecker, A.; Muehlenbruch, G.; Guenther, R.W.; Spuentrup, E. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum RWTH Aachen (Germany); Schauerte, P. [Medizinische Klinik 1, Universitaetsklinikum RWTH Aachen (Germany)

    2006-02-15

    Purpose: Implementation of ECG gating in contrast-enhanced MR angiography (ceMRA) for improved visualization of the pulmonary veins, the left atrium, and the thoracic vessels. Materials and Methods: CeMRA was performed on twelve patients with a history of recurrent atrial fibrillation for the purpose of an intra-individual comparison with and without ECG gating on a 1.5 Tesla MR system (Gyroscan Intera, Philips Medical Systems, Best, NL). Objective image quality parameters such as the signal-to-noise ratio (SNR) of the blood and the contrast-to-noise ratio (CNR) between the blood and myocardium or lung parenchyma were analyzed. The contour sharpness of the pulmonary veins, left atrium, ascending aorta, and pulmonary trunk was also measured. In addition, the artifact level was subjectively assessed by two observers blinded with respect to the sequence parameters. Statistically significant differences (p<0.05) between the procedures were analyzed using the Wilcoxon test and Pearson Chi-square test. Results: The use of ECG gating in ceMRA significantly reduced artifacts caused by cardiac motion and vessel pulsation. This in turn lead to a significant increase in the contour sharpness of the left atrium and the thoracic vessels. In addition, higher SNR and CNR were found using ECG-gated ceMRA compared to standard ceMRA. Conclusion: The use of ECG gating in ceMRA results in artifact-free and sharper delineation of the structures of the heart and thoracic vessels. (orig.)

  8. Mixoma gigante em átrio esquerdo: relato de caso Giant myxoma in the left atrium: case report

    Directory of Open Access Journals (Sweden)

    Marcos de Paula Vale

    2008-06-01

    Full Text Available Paciente de 63 anos, sexo feminino, com história de dispnéia, palpitação e precordialgia foi submetida a avaliação cardiológica. Ao exame físico mostrava-se sem anormalidades. O ecocardiograma mostrou grande massa em átrio esquerdo, sugerindo mixoma; confirmado pela tomografia e cateterismo. A paciente foi submetida a tratamento cirúrgico, com boa evolução pós-operatória. O estudo anatomopatológico confirmou o diagnóstico de mixoma. Neste artigo é apresentada revisão bibliográfica, bem como comentários enfatizando-se a dificuldade diagnóstica baseada nos sinais e sintomas, assim como o desenvolvimento de derrame pleural bilateral no pós-operatório, possivelmente relacionado ao mixoma.In this study is reported the case of a 63-year-old-woman with history of dyspnea, palpitations, and precordial pain who underwent cardiologic evaluation. The physical examination did not reveal abnormalities. The echocardiogram showed great mass in the left atrium, suggesting myxoma which was confirmed by tomography and catheterization. The patient underwent surgical treatment with a good postoperative evolution. The diagnosis of myxoma was confirmed by histopathologic study. In this study is included a bibliographic review and a comment emphasizing the diagnostic difficulty based on signs and symptoms, as well as the details about the development of bilateral pleural effusion possibly related to the myxoma.

  9. Transesophageal echocardiography in surgical management of pseudoaneurysm of mitral-aortic intervalvular fibrosa with aneurysms of right sinus of Valsalva and left main coronary artery

    Directory of Open Access Journals (Sweden)

    Shreedhar S Joshi

    2013-01-01

    Full Text Available Pseudoaneurysm of mitral-aortic intervalvular fibrosa (MAIVF is a rare complication associated with aortic and/or mitral valve surgery complicated by infective endocarditis. We report pseudoaneurysm of MAIVF in a young adult without overt cardiac disease or previous cardiac surgery. The patient had a rare combination of pseudoaneurysm of MAIVF impinging on anterior mitral leaflet causing moderate mitral regurgitation, right sinus of Valsalva aneurysm extending into interventricular septum, and left main coronary artery aneurysm. Transesophageal echocardiography helped in confirming the lesions, delineating the anatomy of all the lesions, and assessing the adequacy of surgical repair.

  10. Left atrium volume index is influenced by aortic stiffness and central pulse pressure in type 2 diabetes mellitus patients: a hemodynamic and echocardiographic study.

    Science.gov (United States)

    Zapolski, Tomasz; Wysokiński, Andrzej

    2013-03-04

    Left atrial volume index (LAVI) has recently emerged as a useful biomarker for risk stratification and risk monitoring in many clinical settings. Many hemodynamic factors such as preload and afterload have an effect on evaluating left atrium function. This study was performed to investigate the relationship between LAVI and aortic stiffness index (ASI) and selected markers characterizing hemodynamic state in patients with type 2 diabetes mellitus (DM2). The study population consisted of 100 patients (56 men, 44 women), 67.2 (±10.9) years old DM2, scheduled for routine coronary angiography. Standard transthoracic echocardiography was used to measure parameters needed for calculation of LAVI and ASI. During invasive procedures, central pulse pressure (CPP) in the ascendens aorta and left ventricle end-diastolic pressure (LVEDP) were recorded. Selected laboratory parameters were obtained, including lipidogram, serum uric acid, hs-CRP, fibrinogen, cTnT, myoglobin, BNP, HbA1C, creatinine, and GFR. Both LAVI and ASI were greater and CPP and LVEDP were markedly elevated in DM2 patients compared to controls. The independent predictors of LAVI were ASI (ß=0.331; p=0.011), CPP (ß=0.312; p=0.020), LVEDP (ß=0.381; p=0.006), HbA1C (ß=0.379; p=0.008), and BNP (ß=0,423; pDM2 patients.

  11. The Abundance of Epicardial Adipose Tissue Surrounding Left Atrium Is Associated With the Occurrence of Stroke in Patients With Atrial Fibrillation

    Science.gov (United States)

    Tsao, Hsuan-Ming; Hu, Wei-Chih; Tsai, Ping-Huang; Lee, Chao-Lin; Liu, Fang-Chun; Wang, Hsueh-Han; Lo, Li-Wei; Chang, Shih-Lin; Chao, Tze-Fan; Chen, Shih-Ann

    2016-01-01

    Abstract Epicardial adipose tissue (EAT) is positively associated with risk factors for cardiovascular disease, but the role of EAT in the development of atrial fibrillation (AF)-related stroke and its association with the anatomical and functional remodeling of the left atrium (LA) have not been elucidated. This was a comparative cross-sectional study. Twenty-seven patients with paroxysmal or persistent AF and cardioembolic stroke were selected and compared with 68 age- and sex-matched AF patients without stroke. In addition, 20 controls without a history of AF or stroke were included. The periatrial EAT and the structural and functional properties of the LA and left ventricle were evaluated using contrast-enhanced 64-slice multidetector computed tomography during sinus rhythm. Total EAT around the LA was significantly increased across the groups (control vs AF vs AF-related stroke, P EAT had a negative correlation with the dynamic function of the LA, LAA, and the HU ratio. After a multivariate analysis, increased EAT (P EAT was increased and was correlated with atrial dysfunction in patients with AF-related stroke. Hence, EAT assessment may potentially offer an incremental value for grading the risk of cardioembolic stroke in patients with AF. PMID:27057876

  12. Transesophageal echocardiographic guidance of transcatheter closure of the aortic valve in a patient with left ventricular assist device-related severe aortic regurgitation

    Directory of Open Access Journals (Sweden)

    Preetham R Muskala

    2017-04-01

    Full Text Available A 68-year-old man with a severe ischemic cardiomyopathy underwent left ventricular assist device (LVAD implantation (Heart Mate II device for destination therapy. He presented 49 months after LVAD implantation with worsening heart failure symptoms and new severe aortic regurgitation. Given high risk for both surgical and transcatheter aortic valve replacement, he was admitted for transcatheter closure of the aortic valve under transesophageal echocardiographic (TEE guidance. TEE imaging revealed severe aortic regurgitation (Fig. 1A and B and Videos 1 and 2. Under TEE and fluoroscopic guidance, a 25 mm Amplatzer cribriform atrial septal defect closure device was advanced across the aortic valve (Fig. 1C and D and Videos 3 and 4. Immediately after device deployment, TEE revealed a well-seated device with complete aortic valve closure and trivial aortic regurgitation (Fig. 2A, B, C and D and Videos 5, 6, 7 and 8. Subsequent transthoracic echocardiograms obtained from 74 to 172 days after the procedure revealed no residual aortic regurgitation. The patient awoke with diffuse urticaria 244 days after the procedure and died en route to the emergency department, presumably secondary to a systemic allergic reaction. De novo aortic regurgitation is increasingly recognized in patients with LVADs (1. TEE-guided transcatheter aortic valve closure is an option in these high-risk patients (2.

  13. Assessment of left atrial appendage function by transthoracic pulsed Doppler echocardiography: Comparing against transesophageal interrogation and predicting echocardiographic risk factors for stroke.

    Science.gov (United States)

    Wai, Shin Hnin; Kyu, Kyu; Galupo, Mary Joyce; Songco, Geronica G; Kong, William K F; Lee, Chi Hang; Yeo, Tiong Cheng; Poh, Kian Keong

    2017-10-01

    Transesophageal echocardiographic (TEE) findings of left atrial appendage (LAA) thrombus, spontaneous echo contrast (SEC), and LAA dysfunction are established risk factors of cardioembolic stroke. The semi-invasive nature of TEE limits its utility as a routine risk stratification tool. We aim to correlate TEE and transthoracic echocardiography (TTE) pulsed Doppler measurements of LAA flow velocities and use TTE measurements to predict TEE findings. We prospectively measured pulsed Doppler LAA flow velocities in 103 consecutive patients on TEE and TTE. There was a strong correlation between TEE and TTE LAA emptying velocity (LAA E) (r = .88, P TTE LAA E predicted the presence of thrombus or SEC independent of atrial fibrillation (AF). To predict the presence of thrombus or SEC, the optimal TTE LAA E cutoff was ≤30 cm/s in all patients (75% sensitive, 90% specific) and ≤31 cm/s in AF patients (80% sensitive, 79% specific). To predict LAA dysfunction (TEE E ≤ 20 cm/s), the optimal TTE LAA E cutoff was ≤27 cm/s (100% sensitive, 89% specific in all patients and 100% sensitive, 74% specific in AF patients). TTE assessment of LAA function is feasible and correlates well with the more invasive TEE method. It predicts the presence of thrombus, SEC, and LAA dysfunction on TEE. TTE LAA assessment has incremental value in thromboembolic risk stratification and should be utilized more frequently. © 2017, Wiley Periodicals, Inc.

  14. Routine18F-FDG PET/CT does not detect inflammation in the left atrium in patients with atrial fibrillation.

    Science.gov (United States)

    Lange, Philipp S; Avramovic, Nemanja; Frommeyer, Gerrit; Wasmer, Kristina; Pott, Christian; Eckardt, Lars; Wenning, Christian

    2017-08-01

    Increasing evidence supports a role of inflammation in the development of atrial fibrillation (AF). However, direct evidence of persistent inflammatory activity in the atria of AF patients is scarce. In this study, we used 18-Fluor-Deoxyglucose positron emission tomography computed tomography ( 18 F-FDG PET/CT) to determine atrial inflammation in patients with and without AF. Retrospectively, 18 F-FDG PET/CT scans were analyzed. 37 patients with a history of AF were compared to an age and sex matched control group with no history of AF. Standardized uptake values were obtained in the atrial walls, in the left ventricular wall, and in the right ventricular blood pool, respectively. Target to background ratios (TBR) were determined in the atrial and left ventricular walls and compared between the two groups. TBR values of the left atrial wall were slightly but not significantly higher in patients with AF (1.21 ± 0.27) compared to those without AF (1.14 ± 0.29; p = 0.85). Likewise, a weak but not significant difference was observed in signal intensities in the right atrial wall between patients in the AF (1.14 ± 0.45) and the control group (0.96 ± 0.2; p = 0.41). TBR values of the left ventricular myocardium did not differ between the groups; no significant correlation was found between the TBR in the left and right atrial wall and blood glucose levels. 18 F-FDG PET/CT performed under routine conditions did not detect a significant difference in inflammatory activity in the left or right atrium between patients with and without AF. Contrary to previous reports, these results therefore do not clearly support a role for ongoing atrial inflammation in patients with AF. Prospective clinical studies using myocardial glucose uptake suppression strategies may be helpful to clarify these issues.

  15. Diagnosing Paroxysmal Atrial Fibrillation in Patients With Ischemic Strokes and Transient Ischemic Attacks Using Echocardiographic Measurements of Left Atrium Function

    DEFF Research Database (Denmark)

    Skaarup, Kristoffer Grundtvig; Christensen, Hanne Krarup; Høst, Nis

    2016-01-01

    Twenty-five to 35 percentage of stroke cases are cryptogenic, and it has been demonstrated that paroxysmal atrial fibrillation (AF) is the causal agent in up to 25% of these incidents. The purpose of this study was to investigate if left atrial (LA) parameters have value for diagnosing paroxysmal...... AF in patients with ischemic stroke (IS) and transient ischemic attack (TIA). We retrospectively analyzed 219 patients who after acute IS or TIA underwent a transthoracic echocardiographic examination. Patients were designated as patients with paroxysmal AF if they had one or more reported incidents...... of AF before or after their echocardiographic examination. Patients in the paroxysmal AF group were significantly older and had higher CHA2DS2-VASc score than patients without paroxysmal AF (p

  16. Rotational X-ray angiography: a method for intra-operative volume imaging of the left-atrium and pulmonary veins for atrial fibrillation ablation guidance

    Science.gov (United States)

    Manzke, R.; Zagorchev, L.; d'Avila, A.; Thiagalingam, A.; Reddy, V. Y.; Chan, R. C.

    2007-03-01

    Catheter-based ablation in the left atrium and pulmonary veins (LAPV) for treatment of atrial fibrillation in cardiac electrophysiology (EP) are complex and require knowledge of heart chamber anatomy. Electroanatomical mapping (EAM) is typically used to define cardiac structures by combining electromagnetic spatial catheter localization with surface models which interpolate the anatomy between EAM point locations in 3D. Recently, the incorporation of pre-operative volumetric CT or MR data sets has allowed for more detailed maps of LAPV anatomy to be used intra-operatively. Preoperative data sets are however a rough guide since they can be acquired several days to weeks prior to EP intervention. Due to positional and physiological changes, the intra-operative cardiac anatomy can be different from that depicted in the pre-operative data. We present an application of contrast-enhanced rotational X-ray imaging for CT-like reconstruction of 3D LAPV anatomy during the intervention itself. Depending on the heart size a single or two selective contrastenhanced rotational acquisitions are performed and CT-like volumes are reconstructed with 3D filtered back projection. In case of dual injection, the two volumes depicting the left and right portions of the LAPV are registered and fused. The data sets are visualized and segmented intra-procedurally to provide anatomical data and surface models for intervention guidance. Our results from animal and human experiments indicate that the anatomical information from intra-operative CT-like reconstructions compares favorably with preacquired imaging data and can be of sufficient quality for intra-operative guidance.

  17. The Value of 3D Printing Models of Left Atrial Appendage Using Real-Time 3D Transesophageal Echocardiographic Data in Left Atrial Appendage Occlusion: Applications toward an Era of Truly Personalized Medicine.

    Science.gov (United States)

    Liu, Peng; Liu, Rijing; Zhang, Yan; Liu, Yingfeng; Tang, Xiaoming; Cheng, Yanzhen

    The objective of this study was to assess the clinical feasibility of generating 3D printing models of left atrial appendage (LAA) using real-time 3D transesophageal echocardiogram (TEE) data for preoperative reference of LAA occlusion. Percutaneous LAA occlusion can effectively prevent patients with atrial fibrillation from stroke. However, the anatomical structure of LAA is so complicated that adequate information of its structure is essential for successful LAA occlusion. Emerging 3D printing technology has the demonstrated potential to structure more accurately than conventional imaging modalities by creating tangible patient-specific models. Typically, 3D printing data sets are acquired from CT and MRI, which may involve intravenous contrast, sedation, and ionizing radiation. It has been reported that 3D models of LAA were successfully created by the data acquired from CT. However, 3D printing of the LAA using real-time 3D TEE data has not yet been explored. Acquisition of 3D transesophageal echocardiographic data from 8 patients with atrial fibrillation was performed using the Philips EPIQ7 ultrasound system. Raw echocardiographic image data were opened in Philips QLAB and converted to 'Cartesian DICOM' format and imported into Mimics® software to create 3D models of LAA, which were printed using a rubber-like material. The printed 3D models were then used for preoperative reference and procedural simulation in LAA occlusion. We successfully printed LAAs of 8 patients. Each LAA costs approximately CNY 800-1,000 and the total process takes 16-17 h. Seven of the 8 Watchman devices predicted by preprocedural 2D TEE images were of the same sizes as those placed in the real operation. Interestingly, 3D printing models were highly reflective of the shape and size of LAAs, and all device sizes predicted by the 3D printing model were fully consistent with those placed in the real operation. Also, the 3D printed model could predict operating difficulty and the

  18. Mechanical dyssynchrony of the left atrium during sinus rhythm is associated with history of stroke in patients with atrial fibrillation.

    Science.gov (United States)

    Ciuffo, Luisa; Inoue, Yuko Y; Tao, Susumu; Gucuk Ipek, Esra; Balouch, Muhammad; Lima, Joao A C; Nazarian, Saman; Spragg, David D; Marine, Joseph E; Berger, Ronald D; Calkins, Hugh; Ashikaga, Hiroshi

    2018-04-01

    We sought to evaluate the relationship between left atrial (LA) mechanical dyssynchrony and history of stroke or transient ischaemic attack (TIA) in patients with atrial fibrillation (AF). We hypothesized that mechanical dyssynchrony of the LA is associated with history of stroke/TIA independent of LA function and Cardiac failure, Hypertension, Age, Diabetes, Stroke/transient ischaemic attack (TIA), VAscular disease, and Sex category (CHA2DS2-VASc) score in patients with AF. We conducted a cross-sectional study of 246 patients with a history of AF (59 ± 10 years, 29% female, 26% non-paroxysmal AF) referred for catheter ablation to treat drug-refractory AF who underwent preablation cardiac magnetic resonance (CMR) in sinus rhythm. Using tissue-tracking CMR, we measured the LA longitudinal strain and strain rate in each of 12 equal-length segments in two- and four-chamber views. We defined indices of LA mechanical dyssynchrony, including the standard deviation of the time to the peak longitudinal strain (SD-TPS). Patients with a prior history of stroke or TIA (n = 23) had significantly higher SD-TPS than those without (n = 223) (39.9 vs. 23.4 ms, P stroke/TIA after adjusting for the CHA2DS2-VASc score, LA minimum index volume, and the peak LA longitudinal strain (P stroke/TIA more accurately than CHA2DS2-VASc score alone (c-statistics: 0.82 vs. 0.75, P stroke/TIA in patients with AF.

  19. Atrium-driven mitral annulus motion velocity reflects global left ventricular function and pulmonary congestion during acute biventricular pacing.

    Science.gov (United States)

    Frielingsdorf, Jürgen; Schmidt, Christoph; Debrunner, Marianne; Tavakoli, Reza; Genoni, Michele; Straumann, Edwin; Bertel, Osmund; Naegeli, Barbara

    2008-03-01

    The short-term effect of acute biventricular pacing on cardiac function in patients with chronic heart failure undergoing heart surgery is widely unknown. The present study was designed to determine whether mitral annular tissue Doppler imaging (TDI) is useful to predict acute changes in global systolic function determined by the continuous cardiac output method that was measured postoperatively during various pacing configurations in patients with depressed left ventricular (LV) function. TDI peak velocities of systolic (Sm), early diastolic (Em), and late diastolic (Am) mitral annular motion waves were measured in 17 patients (age 67 +/- 8 years, 10 male) with depressed LV systolic function (LV ejection fraction 120 ms undergoing temporary epicardial biventricular pacing after aortocoronary bypass and valve surgery. TDI velocities, QRS duration on surface electrocardiogram, cardiac index (CI), right atrial pressure, pulmonary artery pressure, and pulmonary capillary wedge (PCW) pressure were measured simultaneously during various pacing configurations (right atrial-biventricular, right atrial-LV, right atrial-right ventricular, atrial inhibited, and no pacing). Univariate linear regression analysis showed a good correlation between Am and CI (r = 0.53, P = .0001) determined in all pacing modes, a weak correlation between Sm and CI (r = 0.31, P = .017), and no correlation between Em and CI (r = 0.21, P = .074). Am > 6 cm/s predicted a CI of 2.5 L/min/m(2) or more with a sensitivity of 95% and a specificity of 30%. All TDI values correlated negatively with PCW (r = -0.53, P = .0001 for Sm; r = -0.34, P = .01 for Em; r = -0.50, P = .0001 for Am). Am greater than 6 cm/s predicted a PCW of 16 mm Hg or less with a specificity of 100% and a sensitivity of 34%. Mean values of TDI velocities and hemodynamic parameters were not significantly different between each pacing configuration. Peak Am mitral annular velocity correlates well with CI and PCW, respectively, thus

  20. Thromboembolic risk in atrial fibrillation: association between left atrium mechanics and risk scores. A study based on 3D wall-motion tracking technology.

    Science.gov (United States)

    Islas, Fabián; Olmos, Carmen; Vieira, Catarina; De Agustín, José A; Marcos-Alberca, Pedro; Saltijeral, Adriana; Almería, Carlos; Rodrigo, José L; García Fernández, Miguel A; Macaya, Carlos; Pérez de Isla, Leopoldo

    2015-04-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a significantly high risk of stroke and systemic embolism. The aim of our study was to assess the association between left atrium (LA) mechanics measured by 3D wall-motion tracking (3DWMT) technology and the most common thromboembolic risk scores (CHADS2, CHA2DS2-VASc). A total of 101 consecutive patients with permanent AF referred were included. Conventional bidimensional (2D) LA parameters, and LA mechanics by means of 3DWMT were studied. Association between LA 2D and 3DWMT parameters and both risk scores was evaluated as well as its correlation with every component of the score individually. Mean age was 78 ± 10 years. Mean CHADS2 was 2.7 ± 1.3 and mean CHA2DS2-VASc was 4.4 ± 1.7. Values of 2D and 3DWTM LA parameters were: 2D area 26.4 ± 9.7 cm(2) , 2D volume index 49.4 ± 10.1 mL/m(2) , 3DWMT left atrial emptying fraction (LAEF) 15.9 ± 8.4%, longitudinal strain 9.1 ± 4.5% and area strain 14.9 ± 8.8%. Linear regression analysis showed statistically significant correlation between LA longitudinal strain and LAEF with CHADS2 and CHA2DS2-VASc scores. For each 10% variation in longitudinal strain, CHADS2 and CHA2DS2-VASc scores change in 0.7 and 0.8 points, respectively. Left atrial longitudinal strain and emptying fraction assessed by 3D WMT technology have correlation with both CHADS2 and CHA2DS2-VASc scores. Each 10% of variation in longitudinal strain represents a 0.7 and 0.8 points change in those risk scores. LA mechanics evaluation might provide additional value to risk scores and could be considered to be a predictor of stroke in patients with AF. © 2014, Wiley Periodicals, Inc.

  1. MDCT Evaluation of Left Atrium and Pulmonary Vein in the Patients with Atrial Fibrillation: Comparison with the Non-Atrial Fibrillation Group

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Won Jung; Choi, Eun Jeong; Ham, Soo Yeon; Oh, Yu Whan; Kim, Young Hoon [Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Yong, Hwan Seok [Korea University Guro Hospital, Seoul (Korea, Republic of); Yang, Kyung Sook [Korea University, Seoul (Korea, Republic of)

    2011-02-15

    The anatomy of the left atrium (LA) and the pulmonary veins (PVs) is important in planning and performing successful electrophysiologic ablation (EPA) for atrial fibrillation (Afib) patients. The authors estimated the findings of LA and PVs of Afib patients by MDCT, and compared these with the findings of LA and PVs of the non- Afib group using coronary CT angiography (CCTA). From September, 2009 to February, 2010, 91 Afib patients underwent PVCT (male: female = 72:19, mean age = 55.0-years-old) before EPA. At same time, 90 patients underwent CCTA (male: female = 73:17, mean age = 59.1- years-old). Two radiologists reviewed and analyzed all axial and 3D images of LA and PVs retrospectively with consensus. The average LA volumes of the Afib group(100.49 mm3) was larger than that of the non-Afib group (78.38 mm3) (p<0.05). The average lengths of the LA right wall in the Afib group (40.25 mm) was longer than that of the non-Afib group (37.3 mm) (p<0.05). The average distances between the PV ostium and first segmental bifurcation of the Lt superior PV (LSPV) and the RSPV were shorter in the Afib group (LSPV, 19.38 mm: RSPV, 11.49 mm) than in the non-Afib group (LSPV, 23.23 mm: RSPV, 14.25 mm) (p<0.05). There were higher incidences of anomalous branches such as ostial, accessory branches, or common ostia in the Afib group versus the non-Afib group (p<0.05). In Afib group, variable parameters of LA and PVs were obtained and estimated by MDCT, and there was statistically significant difference in the parameters of LA and PVs between Afib and non-Afib groups

  2. Volumetric and functional assessment of the left atrium in young competitive athletes without left ventricular hypertrophy: the MAGYAR-Sport Study.

    Science.gov (United States)

    Nemes, Attila; Domsik, Péter; Kalapos, Anita; Orosz, Andrea; Oszlánczi, Mónika; Török, László; Balogh, László; Márton, János; Forster, Tamás; Lengyel, Csaba

    2017-06-01

    Left atrial (LA) remodeling may be regarded as a physiologic adaptation to exercise conditioning. Three-dimensional speckle tracking echocardiography (3DSTE) is a new promising tool for volumetric and functional characterization of the LA. The present study was undertaken to assess adaptive changes in LA volumes and functional properties respecting cardiac cycle in young competitive athletes without left ventricular hypertrophy (LVH) by detailed 3DSTE assessment. The study group consisted of 20 young elite basketball and handball players (mean age: 28.1±10.1 years, 8 men) without LVH, their results were compared to 23 age- and gender-matched non-sportive healthy controls (mean age: 31.7±8.5 years, 11 men. All subjects had undergone standard transthoracic two-dimensional Doppler echocardiographic study with 3DSTE. Increased systolic maximum (66.5±13.6 mL vs. 38.5±8.6 mL, Pglobal (21.1±7.7% vs. 27.6±9.9%, P=0.02) and mean segmental (26.1±7.1% vs. 35.7±12.0%, P=0.003) peak LA strains proved to be significantly reduced in athletes as compared to controls. 3DSTE-derived increased cyclic LA volumes and specific alterations in LA functional properties could be demonstrated in young competing athletes which is most likely a physiologic consequence of a global cardiac adaptation to intensive and chronic training.

  3. Transesophageal echocardiography. 3. rev. and enl. ed.

    International Nuclear Information System (INIS)

    Lambertz, Heinz; Lethen, Harald

    2013-01-01

    The book on transesophageal echocardiography covers the following issues: Development of transesophageal echocardiography, technical advances; indications and contraindication for transesophageal echocardiography; systematic of the medical examination process; cardiac valves and valve prostheses; mitral and aortic valvuloplasty, TAVI and interventional treatment of mitral regurgitation; infectious endocarditis; one-way and effluence disturbances of the left and right ventricle; diseases of the thoracic aorta; undefined right ventricle enlargement; lung embolism, acute infarct complications; TEE during anesthesia and perioperative intensive medicine, cardiac sources of embolism; cardiac tumors, mediastinal lymph nodes; pericardiac diseases; congenital heart diseases in childhood and adulthood; catheter interventions and heart valve reconstruction; surgically corrected congenital cardiac defects; intracavitary versus transesophageal echocardiography; three-dimensional TEE; coronary diagnostics; ischemia and vitality diagnostics.

  4. Circumferential lesion formation around the pulmonary veins in the left atrium with focused ultrasound using a 2D-array endoesophageal device: a numerical study

    Energy Technology Data Exchange (ETDEWEB)

    Pichardo, Samuel; Hynynen, Kullervo [Imaging Research-Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room C713, Toronto, ON M4N 3M5 (Canada)

    2007-08-21

    Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia affecting humans. The electrical isolation by ablation of the pulmonary veins (PVs) in the left atrium (LA) of the heart has been proven as an effective cure of AF. The ablation consists mainly in the formation of a localized circumferential thermal coagulation of the cardiac tissue surrounding the PVs. In the present numerical study, the feasibility of producing the required circumferential lesion with an endoesophageal ultrasound probe is investigated. The probe operates at 1 MHz and consists of a 2D array with enough elements (114 x 20) to steer the acoustic field electronically in a volume comparable to the LA. Realistic anatomical conditions of the thorax were considered from the segmentation of histological images of the thorax. The cardiac muscle and the blood-filled cavities in the heart were identified and considered in the sound propagation and thermal models. The influence of different conditions of the thermal sinking in the LA chamber was also studied. The circumferential ablation of the PVs was achieved by the sum of individual lesions induced with the proposed device. Different scenarios of lesion formation were considered where ultrasound exposures (1, 2, 5 and 10 s) were combined with maximal peak temperatures (60, 70 and 80 {sup 0}C). The results of this numerical study allowed identifying the limits and best conditions for controlled lesion formation in the LA using the proposed device. A controlled situation for the lesion formation surrounding the PVs was obtained when the targets were located within a distance from the device in the range of 26 {+-} 7 mm. When combined with a maximal temperature of 70 {sup 0}C and an exposure time between 5 and 10 s, this distance ensured preservation of the esophageal structures, controlled lesion formation and delivery of an acoustic intensity at the transducer surface that is compatible with existing materials. With a peak

  5. Repair of recurrent pseudoaneurysm of the mitral-aortic intervalvular fibrosa: Role of transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Shreedhar S Joshi

    2014-01-01

    Full Text Available Pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF is a rare cardiac surgical condition. P-MAIVF commonly occurs as a complication of aortic and mitral valve replacement surgeries. The surgical trauma during replacement of the valves weakens the avascular mitral and aortic intervalvular area. We present a case of P-MAIVF recurrence 5 years after a primary repair. Congestive cardiac failure was the presenting feature with mitral and aortic regurgitation. In view of the recurrence, the surgical team planned for a double valve replacement. The sewing rings of the two prosthetic-valves were interposed to close the mouth of the pseudoaneurysm and to provide mechanical reinforcement of the MAIVF. Intra-operative transesophageal echocardiography (TEE helped in delineating the anatomy, extent of the lesion, rupture of one of the pseudoaneurysm into left atrium and severity of the valvular regurgitation. Post-procedure TEE confirmed complete obliteration of the pseudoaneurysm and prosthetic valve function.

  6. Cardiac shear-wave elastography using a transesophageal transducer: application to the mapping of thermal lesions in ultrasound transesophageal cardiac ablation

    Science.gov (United States)

    Kwiecinski, Wojciech; Bessière, Francis; Constanciel Colas, Elodie; Apoutou N'Djin, W.; Tanter, Mickaël; Lafon, Cyril; Pernot, Mathieu

    2015-10-01

    Heart rhythm disorders, such as atrial fibrillation or ventricular tachycardia can be treated by catheter-based thermal ablation. However, clinically available systems based on radio-frequency or cryothermal ablation suffer from limited energy penetration and the lack of lesion’s extent monitoring. An ultrasound-guided transesophageal device has recently successfully been used to perform High-Intensity Focused Ultrasound (HIFU) ablation in targeted regions of the heart in vivo. In this study we investigate the feasibility of a dual therapy and imaging approach on the same transesophageal device. We demonstrate in vivo that quantitative cardiac shear-wave elastography (SWE) can be performed with the device and we show on ex vivo samples that transesophageal SWE can map the extent of the HIFU lesions. First, SWE was validated with the transesophageal endoscope in one sheep in vivo. The stiffness of normal atrial and ventricular tissues has been assessed during the cardiac cycle (n=11 ) and mapped (n= 7 ). Second, HIFU ablation has been performed with the therapy-imaging transesophageal device in ex vivo chicken breast samples (n  =  3), then atrial (left, n= 2 ) and ventricular (left n=1 , right n=1 ) porcine heart tissues. SWE provided stiffness maps of the tissues before and after ablation. Areas of the lesions were obtained by tissue color change with gross pathology and compared to SWE. During the cardiac cycle stiffness varied from 0.5   ±   0.1 kPa to 6.0   ±   0.3 kPa in the atrium and from 1.3   ±   0.3 kPa to 13.5   ±   9.1 kPa in the ventricles. The thermal lesions were visible on all SWE maps performed after ablation. Shear modulus of the ablated zones increased to 16.3   ±   5.5 kPa (versus 4.4   ±   1.6 kPa before ablation) in the chicken breast, to 30.3   ±   10.3 kPa (versus 12.2   ±   4.3 kPa) in the atria and to 73.8   ±   13

  7. Can contrast-enhanced multi-detector computed tomography replace transesophageal echocardiography for the detection of thrombogenic milieu and thrombi in the left atrial appendage. A prospective study with 124 patients; Kann die kontrastmittelverstaerkte Mehrzeilen-Computertomografie die transoesophageale Echokardiografie bei der Detektion von thrombogenem Milieu und Vorhofohrthromben ersetzen? Eine prospektive Studie mit 124 Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Homsi, R.; Luetkens, J.A.; Schild, H.H.; Naehle, C.P. [Bonn Univ. (Germany). Dept. of Radiology; Nath, B. [SHG-KLliniken Voelklingen (Germany). Dept. of Medicine I - Cardiology; Schwab, J.O. [Bonn Univ. (Germany). Dept. of Medicine I - Cardiology

    2016-01-15

    To assess the diagnostic value of contrast-enhanced multi-detector computed tomography (MD-CT) for identifying patients with left atrial appendage (LAA) thrombus or circulatory stasis. 124 patients with a history of atrial fibrillation and/or cerebral ischemia (83 men, mean age 58.6 ± 12.4 years) and with a clinical indication for MD-CT of the heart and for transesophageal echocardiography (TEE) were included in the study. LAA thrombus or thrombogenic milieu was visually identified in TEE and MD-CT. In addition, MD-CT was analyzed quantitatively measuring the Hounsfield units (HU) of the left atrium (LA), the LAA and the ascending aorta (AA), and calculating the HU ratios LAA/AA (HU [LAA/AA]) und LAA/LA (HU [LAA/LA]). Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated. The prevalence of a thrombus or thrombogenic milieu as assessed by TEE was 21.8 %. The HU ratio was lower in patients with thrombus or thrombogenic milieu (HU [LAA/AA]: 0.590 ± 0.248 vs. 0.909 ± 0.141; p < 0.001 und HU [LAA/LA] 0.689 ± 0.366 vs. 1.082 ± 0.228; p < 0.001). For the diagnosis of thrombus or a thrombogenic milieu, visual analysis yielded a sensitivity of 81.5 %, a specificity of 96.9 %, a PPV of 87.5 % and a NPV of 95.2 %. By combining visual and quantitative analysis with one criterion being positive, the specificity decreased to 91.8 %, the sensitivity to 77.8 %, the PPV to 72.4 %, and the NPV to 94.9 %. Visual analysis of the LAA in the evaluation of thrombus or thrombogenic milieu yields a high NPV of 95.1 % and may especially be useful to rule out LAA thrombi in patients with contraindications for TEE. Additional calculation of HU ratios did not improve the diagnostic performance of MD-CT.

  8. Profound Obstructive Hypotension From Prone Positioning Documented by Transesophageal Echocardiography in a Patient With Scoliosis: A Case Report.

    Science.gov (United States)

    Abcejo, Arnoley S; Diaz Soto, Juan; Castoro, Courtney; Armour, Sarah; Long, Timothy R

    2017-08-01

    In a healthy 12-year-old female with scoliosis, prone positioning resulted in pressor-refractory cardiovascular collapse. Resumption of supine position immediately improved hemodynamics. Intraoperative transesophageal echocardiography (TEE) revealed a collapsed left atrium and biventricular failure. Repeat prone positioning resulted in a recurrence of hypotension. However, hemodynamic stabilization was restored and maintained by repositioning chest pads caudally. The patient successfully underwent a 6-hour scoliosis repair without perioperative morbidity. With this case, we aim to: (1) reintroduce awareness of this mechanical obstructive cause of reversible hypotension; (2) highlight the use of intraoperative TEE during prone hemodynamic collapse; and (3) suggest an alternative prone positioning technique if chest compression results in hemodynamic instability.

  9. A cooled intraesophageal balloon to prevent thermal injury during endocardial surgical radiofrequency ablation of the left atrium: a finite element study

    Energy Technology Data Exchange (ETDEWEB)

    Berjano, Enrique J [Center for Research and Innovation on Bioengineering, Valencia Polytechnic University, Camino de Vera s/n, 46022 Valencia (Spain); Hornero, Fernando [Cardiac Surgery Department, Valencia University General Hospital, Avd Tres Cruces s/n, 46014, Valencia (Spain)

    2005-10-21

    Recent clinical studies on intraoperative monopolar radiofrequency ablation of atrial fibrillation have reported some cases of injury to the esophagus. The aim of this study was to perform computer simulations using three-dimensional finite element models in order to investigate the feasibility of a cooled intraesophageal balloon appropriately placed to prevent injury. The models included atrial tissue and a fragment of esophagus and lung linked by connective tissue. The lesion depth in the esophagus was assessed using a 50 deg. C isotherm and expressed as a percentage of thickness of the esophageal wall. The results are as follows: (1) chilling the esophagus by means of a cooled balloon placed in the lumen minimizes the lesion in the esophageal wall compared to the cases in which no balloon is used (a collapsed esophagus) and with a non-cooled balloon; (2) the temperature of the cooling fluid has a more significant effect on the minimization of the lesion than the rate of cooling (the thermal transfer coefficient for forced convection); and (3) pre-cooling periods previous to RF ablation do not represent a significant improvement. Finally, the results also suggest that the use of a cooled balloon could affect the transmurality of the atrial lesion, especially in the cases where the atrium is of considerable thickness. (note)

  10. Antenatal and postnatal sonographic imaging findings of a single ventricle presenting as double outlet right ventricle with rudimentary left ventricle and single atrium

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    Donboklang Lynser

    2015-11-01

    Full Text Available Congenital heart disease is a major cause of morbidity and mortality. Single ventricle is a rare finding and usually of left ventricular morphology. We present here interesting antenatal and postnatal echocardiographic findings of a baby having a rare single ventricle of right ventricular morphology with double outlet. Antenatally we saw a large ventricular septal defect indistinguishable from a single ventricle with left to right ventricular ratio of 1:1. Postnatally we saw a single ventricle having the outlets for both the main pulmonary artery and aortic root. The left ventricle is collapse with a rudimentary morphology possibly due to changes in hemodynamics after birth and absent of outlet from it.

  11. [Diagnosis and evaluation of a patient with cor triatriatum using perioperative transesophageal echocardiography].

    Science.gov (United States)

    Kurazumi, Takuya; Suzuki, Takeshi; Morita, Yoshihisa; Masuda, Junich

    2014-03-01

    Cor triatriatum is a rare congenital cardiac anomaly accounting for only 0.1-0.4% of all congenital heart diseases usually diagnosed in infancy or childhood and rarely found in adults. It is characterized by fibromuscular membrane dividing the left atrium into two chambers. This congenital heart disease is reported to be frequently associated with variety of cardiac anomalies such as an atrial septal defect, anomalous pulmonary venous drainage, and persistent left superior vena cava. A woman with no cardiac history was admitted to the hospital due to acute heart failure and diagnosed as severe mitral regurgitation and cor triatriatum by pre-orerative transthoracic echocardiography. Emergency mitral valve plasty was undertaken because of the severity of mitral regurgitation without determining the detailed type of cor triatriatum. Thus, diagnosis of the type of cor triatriatum with perioperative transesophageal echocardiography (TEE) was required to establish correct cardiopulmonary bypass and determine the operative procedure. Perioperative TEE revealed that the type was Lucas-Schmidt- I A, and cardiopulmonary bypass was established safely. Operation was performed without any problems. The TEE skill of our anesthesiologists could contribute to the safe management of the cardiac surgery.

  12. Preferential streaming of the ductus venosus toward the right atrium is associated with a worse outcome despite a higher rate of invasive procedures in human fetuses with left diaphragmatic hernia.

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    Stressig, R; Fimmers, R; Schaible, T; Degenhardt, J; Axt-Fliedner, R; Gembruch, U; Kohl, T

    2013-12-01

    Preferential streaming of the ductus venosus (DV) toward the right atrium has been observed in fetuses with left diaphragmatic hernia (LDH). The purpose of this retrospective study was to compare survival rates to discharge between a group with preferential streaming of the DV toward the right heart and a group in which this abnormal flow pattern was not present. We retrospectively searched our patient records for fetuses with LDH in whom liver position, DV streaming and postnatal outcome information was available. 55 cases were found and divided into two groups: Group I fetuses exhibited abnormal DV streaming toward the right side of the heart; group II fetuses did not. Various prognostic and outcome parameters were compared. 62 % of group I fetuses and 88 % of group II fetuses survived to discharge (p = 0.032). Fetoscopic tracheal balloon occlusion (FETO) was performed in 66 % of group I fetuses and 23 % of group II fetuses (p = 0.003). Postnatal ECMO therapy was performed in 55 % of group I fetuses and 23 % of group II infants (p = 0.025). Moderate to severe chronic lung disease in survivors was observed in 56 % of the survivors of group I and 9 % of the survivors of group II (p = 0.002). Preferential streaming of the DV toward the right heart in human fetuses with left-sided diaphragmatic hernia was associated with a poorer postnatal outcome despite a higher rate of invasive pre- and postnatal procedures compared to fetuses without this flow abnormality. Specifically, abnormal DV streaming was found to be an independent predictor for FETO. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Serum levels of NT- pro ANP, BNP, NT-pro BNP and function of the left atrium in patients with heart failure and preserved ejection fraction after myocardial infarction

    Science.gov (United States)

    Shurupov, V.; Suslova, T.; Ryabov, V.

    2015-11-01

    The objective of our study was to evaluate the levels of natriuretic peptides in patients (pts) with heart failure with preserved ejection fraction (HFpEF) in 12 month after ST elevation myocardial infarction (STEMI) with a focus on the function of left atrium (LA) and left ventricular (LV) filling pressure. 55 pts were included in the study. 6-minute walk test was performed. Echo exam was performed by the diagnostic system VIVID 7. BNP in whole blood was determined using the Triage ® Meter BNP test. The serum levels of NT-pro BNP, NT-pro ANP («Biomedica», Austria) were determined in blood samples by enzyme-linked immune-sorbent assay (ELISA). LA volume index were differences (16.03±3.39 ml/m2; 25.36±8.26 ml/m2; 29.41±9.46 ml/m2 accordingly I, II, III class) depending on severity of HF. Well as E/E' ratio were differences (7.5±1.4; 9.8±5.1; 13.5±7.6 accordingly I, II, III class) depending on severity of HF. The LA volume index correlated with levels of NT-pro ANP (R=0.29; p=0.04), levels of NT-pro BNP (R=0.37; p=0.01), levels of BNP (R=0.51; p=0.0001). The LV filling pressure correlated with levels of NT-pro ANP (R=0.45; p=0.002), levels of NT-pro BNP (R=0.49; p=0.001), levels of BNP (R=0.37; p=0.01).

  14. Mechanical and substrate abnormalities of the left atrium assessed by 3-dimensional speckle-tracking echocardiography and electroanatomic mapping system in patients with paroxysmal atrial fibrillation.

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    Watanabe, Yoshikazu; Nakano, Yukiko; Hidaka, Takayuki; Oda, Noboru; Kajihara, Kenta; Tokuyama, Takehito; Uchimura, Yuko; Sairaku, Akinori; Motoda, Chikaaki; Fujiwara, Mai; Kawazoe, Hiroshi; Matsumura, Hiroya; Kihara, Yasuki

    2015-03-01

    Left atrial (LA) remodeling progresses to electrical remodeling, contractile remodeling, and subsequently structural remodeling. Little is known about the relationship between LA electrical and anatomical remodeling and LA mechanical function. We aimed to clarify the relationship between LA mechanical function using 3-dimensional speckle-tracking echocardiography (3D-STE) and LA electrical remodeling using an electroanatomic mapping system (CARTO 3) and to estimate atrial fibrillation (AF) substrate in patients with paroxysmal AF (PAF). A total of 52 patients with PAF (41 (79%) men; mean age 61 ± 11 years) undergoing their initial pulmonary vein isolation (PVI) were examined. The standard deviation of the time to peak strain in each LA segment (%SD-TPS) was analyzed as an index of LA dyssynchrony using 3D-STE before PVI. Contact LA bipolar voltage and activation maps were constructed during sinus rhythm before PVI using CARTO 3. The LA total activation time was measured and low-voltage zones (LVZs) were determined with a local bipolar electrogram amplitude of <0.5 mV. The patients were divided into those with an LVZ (LVZ group; n = 23) and those without an LVZ (non-LVZ group; n = 29). The %SD-TPS was significantly higher (14.1 ± 5.7 vs 8.0 ± 5.1; P=.0002) in the LVZ group than in the non-LVZ group and was an independent determinant of the LVZ (odds ratio 1.21; 95% confidence interval 1.04-1.49; P=.01). In addition, the LA total activation time was weakly correlated with the %SD-TPS. LA dyssynchrony and conduction delay exist in patients with PAF. The 3D-STE enabled noninvasive estimation of LA electrical remodeling and AF substrate. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  15. Early detection and efficient therapy of cardiac angiosarcoma due to routine transesophageal echocardiography after cerebrovascular stroke

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    Dirk Vogelgesang

    2008-08-01

    Full Text Available Dirk Vogelgesang1, Johannes B Dahm2, Holm Großmann3, Andre Hippe4, Astrid Hummel5, Christian Lotze6, Silke Vogelgesang71Practice of Cardiology, Greifswald, 2Practice of Cardiology, Goettingen, 3Department of Cardiovascular Surgery, Herzzentrum Karlsburg, 4Department of Neurology, 5Department of Cardiology, 6Department of Haematology and Oncology, 7Department of Pathology, University of Greifswald, Greifswald, GermanyAbstract: Primary malignant cardiac tumors (cardiac angiosarcomas are exceedingly rare. Since there are initially nonspecific or missing symptoms, these tumors are usually diagnosed only in an advanced, often incurable stage, after the large tumor mass elicits hemodynamic obstructive symptoms. A 59-year-old female presented with symptoms of cerebral ischemia. A computed tomography (CT scan showed changes suggestive of stroke. Transesophageal echocardiography revealed an inhomogeneous, medium-echogenic, floating mass at the roof of the left atrium near the mouth of the right upper pulmonary vein, indicative of a thrombus. At surgery, a solitary tumor was completely enucleated. Histologically, cardiac angiosarcoma was diagnosed. The patient received adjuvant chemotherapy and was free of symptoms and recurrence of disease at 14 months follow-up. Due to the fortuitous appearance of clinical signs indicative of stroke, cardiac angiosarcoma was diagnosed and effectively treated at an early, nonmetastatic, and therefore potentially curable stage. Although cardiac angiosarcoma is a rare disease, it should be taken into consideration as a potential cause of cerebral embolic disease.Keywords: cardiac angiosarcoma, stroke, embolism

  16. Acesso transeptal vertical ampliado em reoperações valvares mitrais com átrio esquerdo pequeno Extended vertical transseptal approach in mitral valve reoperation with a small left atrium

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    Walter Vosgrau Fagundes

    2004-03-01

    Full Text Available OBJETIVO: Avaliar a abordagem transeptal vertical ampliada em reoperações da valva mitral com átrio esquerdo pequeno. MÉTODO: De janeiro de 2001 a dezembro de 2002, 15 pacientes portadores de doença valvar mitral com indicação de reintervenção cirúrgica, átrio esquerdo pequeno (menor ou igual a 4,0 cm e fibrilação atrial crônica, foram submetidos à abordagem transeptal vertical ampliada da valva mitral. Nove pacientes (pt eram do sexo feminino. A idade variou de 22 a 48 anos. As indicações cirúrgicas foram: disfunção de prótese mitral (seis pt; insuficiência mitral (cinco pt e dupla lesão mitral (quatro pt. Três pacientes apresentavam insuficiência aórtica associada e um pt, insuficiência tricúspide. Nove (60% pacientes encontravam-se em ICC CF III da NYHA e seis (40%, em CF IV. RESULTADOS: A exposição do aparelho valvar mitral foi excelente. O tempo de circulação extracorpórea variou de 65 a 150 min (média = 95min. Foram implantadas próteses em todos os pacientes (15 mitrais, três aórticas e um tricúspide. A mortalidade hospitalar foi de 6,7%, com um óbito devido a baixo débito cardíaco e falência de múltiplos órgãos. Um (6,7% paciente apresentou broncopneumonia na fase hospitalar. Dez pacientes permaneceram com fibrilação atrial, três pt reverteram para ritmo sinusal e um evoluiu com ritmo juncional. A permanência hospitalar média foi de 8,2 dias. Doze (85,7% pacientes encontram-se em CF I e dois (14,3% em CF II. A curva atuarial de sobrevida é de 92,5 % em 22 meses de seguimento. CONCLUSÃO: A técnica cirúrgica empregada proporciona excelente visibilização do aparelho valvar mitral, com baixo índice de complicações.OBJECTIVE: To evaluate the efficacy of the extended vertical transseptal approach in mitral valve reoperation with a small left atrium. METHOD: From January 2001 to December 2002, 15 patients with previous mitral operations, small left atrium and atrial fibrillation

  17. [The application of Atricure bipolar radiofrequency system in ablation of different parts and different times of pig heart atrium and the analysis of transmural lesions].

    Science.gov (United States)

    Liu, Pei-sheng; Chen, Xin; Liu, Ming

    2010-12-15

    To analyze the transmural lesions of different parts of the pig heart atrium received different times of ablation applied with Atricure bipolar radiofrequency system. Six fresh (ex vivo timepig hearts with atrium preserved intact were used as the experimental objects and experimental groups were divided according to the ablation position. The Atricure bipolar radiofrequency system was applied in the ablation of the parts of the atrium, such as posterior wall of left atrium, anterior wall of left atrium, anterior wall of right atrium and posterior wall of left atrium close to mitral posterior ring. Ablate the position of the atrium lengthened about 2.0 cm with the same thickness with an interval of 0.5 cm for 4 times respectively, also recording the time of every ablation. For each part and each time of ablation, the ablated atrial tissue was preserved with 4% formaldehyde and 5% glutaraldehyde, and was sent for observation under light microscope and transmission electron microscope. The ablation time and lesion were analyzed statistically. In the same position of the atrium, ablation time decreased with the times of the ablation, in different position of the atrium with same time of ablation, time showed a positive proportion with the thickness of the atrium. Atricure bipolar radiofrequency system is very safe and efficient, also convenient for manipulation. With regard to the relatively thinner part of the atrium, such as posterior wall and anterior wall of left atrium, at least two times of ablation can ensure transmural lesion of the atrial tissue, but to the position of the atrium such as anterior wall of right atrium and posterior wall of left atrium close to mitral posterior ring, 3 to 4 times of ablation can ensure transmural lesion of the atrial tissue.

  18. Anomalía del retorno venoso sistémico Drenaje anómalo de la vena cava superior derecha a la aurícula izquierda: Revisión de la literatura y reporte de caso Anomalous systemic venous return. Anomalous drainage of the right superior vena cava into the left atrium: Review of literature and case report

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    Ríos Giovanny

    2012-06-01

    Full Text Available La anomalía total del retorno venoso sistémico tiene gran variedad de presentaciones; sin embargo, la patología de más baja frecuencia es el drenaje de vena cava superior derecha a la aurícula izquierda, hecho de peso para que en el mundo se reporten pocos casos. En la Fundación Clínica Abood Shaio se trató el caso de una paciente de seis años de edad con drenaje venoso total de cava superior derecha a la aurícula izquierda, mediante la técnica de movilización de cava superior y anastomosis cavo-atrial, y se obtuvieron buenos resultados. El caso es mención corresponde al número 21 en la literatura mundial.Total anomalous systemic venous return has a variety of presentations, being the drainage of right superior vena cava into the left atrium a low frequency condition. There are few reported cases in the world. In Shaio Clinic Foundation we have handled a case of total venous drainage of the right superior vena cava into the left atrium in a 6-year old girl, using the superior vena cava mobilization technique and cavo-atrial anastomosis, with good results. This case is reported as case number 21 in the world.

  19. Extension of adrenocortical carcinoma into the right atrium – echocardiographic diagnosis: A case report

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    Rozenman Yoseph

    2003-05-01

    Full Text Available Abstract Background Adrenocortical carcinoma is a rare, highly malignant tumor. Cardiac involvement of the tumor is very rare. Echocardiography facilitates the evaluation of the cardiac involvement of the tumor. Case Presentation We describe a patient with an adrenal tumor. Transthoracic echo showed its extension into the right atrium. Accordingly, a combined abdominal and cardiac operation was performed, monitored by transesophageal echocardiography. Conclusion This case highlights the importance of echocardiography in revealing the cardiac involvement by this tumor and in planning the operative procedure.

  20. Transesophageal echocardiography. 3. rev. and enl. ed.; Transoesophageale Echokardiografie. Lehrbuch und Altlas zur Untersuchungstechnik und Befundinterpretation

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    Lambertz, Heinz [ECHOECUCT-Akademie, Wiesbaden (Germany); Lethen, Harald (eds.) [Internistische Intensivmedizin, Wiesbaden (Germany). Innere Medizin/Kardiologie

    2013-02-01

    The book on transesophageal echocardiography covers the following issues: Development of transesophageal echocardiography, technical advances; indications and contraindication for transesophageal echocardiography; systematic of the medical examination process; cardiac valves and valve prostheses; mitral and aortic valvuloplasty, TAVI and interventional treatment of mitral regurgitation; infectious endocarditis; one-way and effluence disturbances of the left and right ventricle; diseases of the thoracic aorta; undefined right ventricle enlargement; lung embolism, acute infarct complications; TEE during anesthesia and perioperative intensive medicine, cardiac sources of embolism; cardiac tumors, mediastinal lymph nodes; pericardiac diseases; congenital heart diseases in childhood and adulthood; catheter interventions and heart valve reconstruction; surgically corrected congenital cardiac defects; intracavitary versus transesophageal echocardiography; three-dimensional TEE; coronary diagnostics; ischemia and vitality diagnostics.

  1. Clarifying the atrioventricular junctional anatomy in the setting of double outlet right atrium

    Science.gov (United States)

    Gupta, Saurabh Kumar; Gupta, Anunay; Ramakrishnan, Sivasubramanian; Anderson, Robert H

    2015-01-01

    Double outlet atrium is a rare cardiac anomaly wherein one of the atriums, most frequently the right atrium, opens into both the ventricles. Although seen more commonly in the setting of atrioventricular septal defect, this arrangement can also be found when one of the atrioventricular connections is atretic due to absence of the atrioventricular connection and the other atrioventricular valve straddles the muscular ventricular septum. It is the specific anatomy and connections of the atrioventricular junction that clarifies the situation and distinguishes between these two types of double outlet atrium. In this report, we present a case of double outlet right atrium co-existing with the absence of left atrioventricular connection. We then discuss the morphologic aspects of this interesting anomaly. PMID:26556972

  2. Transthoracic Echocardiography versus Transesophageal Echocardiography for Rupture Sinus of Valsalva Aneurysm

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    Dhawan, Ira; Malik, Vishwas; Sharma, Kamal Prakash; Makhija, Neeti; Pangasa, Neha

    2017-01-01

    We report a rare case of sinus of Valsalva aneurysm of both right and left coronary sinus (LCS), with perforation of the LCS opening into the left ventricle. The LCS aneurysm with its perforation was undiagnosed on transthoracic echocardiography emphasizing the role of transesophageal echocardiography in delineating the anatomy. PMID:28393788

  3. Multiplane Transesophageal Echocardiography for Multiclinical Dilemmas

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    Kamberi, Lulzim S.; Gorani, Daut R.; ?itaku, Hajdin R.; Selmani, Hamza H.; Beqiri, Arton I.; Mustafai, Ardian I.

    2011-01-01

    Introduction Transesophageal echocardiography was introduced 4 decades ago. Its use have had very limited clinical indication. Now it has become very useful clinical tool. Indications for its use are almost as indications for transthoracic echocardiography, especially to assess deeper cardiovascular structures. Transesophageal echocardiography is semi-invasive examination with small number of complications. Aim of the study To determine usefulness of transesophageal echocardiography in variou...

  4. Multiplane Transesophageal Echocardiography for Multiclinical Dilemmas

    Science.gov (United States)

    Kamberi, Lulzim S.; Gorani, Daut R.; Çitaku, Hajdin R.; Selmani, Hamza H.; Beqiri, Arton I.; Mustafai, Ardian I.

    2011-01-01

    Introduction Transesophageal echocardiography was introduced 4 decades ago. Its use have had very limited clinical indication. Now it has become very useful clinical tool. Indications for its use are almost as indications for transthoracic echocardiography, especially to assess deeper cardiovascular structures. Transesophageal echocardiography is semi-invasive examination with small number of complications. Aim of the study To determine usefulness of transesophageal echocardiography in various cardiac conditions based in our experience. Also to encourage use of transesophageal echocardiography as reliable examination. Methods All of the patients signed a Term of Free Informed Consent, approved from Ethics Committee. We enrolled 425 patients who have done TEE in last 5 years (2006-2010) by authors. Medical history and Clinical evaluation was carefully performed by expert cardiologists. Procedures were performed in two different centers using machines, PHILIPS iE33 and Siemens accuson CV 70, with equipment attached to a multi frequency 2.5 to 3.5 MHz for TTE and 7.0 MHz for TEE multiplane transducer. TEE were performed and images were obtained according to the standard recommandations. Results The results were analyzed by a standard method of descriptive statistics using Pivot Table of Excel Office 2007. Results. We have analyzed 425 transesophageal echocardiography . The examination of the thoracic aorta in severe hypertension patients was conducted in 96 cases; atrial fibrillation in 118; aortic dissection 49 cases, aortic stenosis was evaluated in 28 cases; finding of source of emboli 36 cases; suspicion for aneurysm of the thoracic aorta in 14 cases, 11 cases with suspected endocarditis; the type of intervention for mitral valve was evaluated in 28 cases. Interatrial septum abnormalities 37 cases; and miscellaneous 18 cases. No minor or mayor complications happened. Conlusion Transesophageal echocardiography can elucidate many dubious serious conditions

  5. Direct thrombolysis of multiple thrombi in both right and left heart atrium in a patient on extracorporeal membrane oxygenation support following urgent double-lung transplantation: a case report.

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    Pollert, Lukas; Prikrylova, Zuzana; Berousek, Jan; Mosna, Frantisek; Lischke, Robert

    2016-01-01

    Lung transplantation is considered an established treatment for patients with end-stage chronic respiratory failure. Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at high risk of death. Extracorporeal membrane oxygenation (ECMO) has been proposed as an alternative bridging strategy to mechanical ventilation. The shear stress created by the mechanical pumps causes changes in the hematological system in almost all patients treated with ECMO. An antithrombotic strategy to mitigate ECMO bleeding and thrombotic complications is necessary. The use of thrombolytic therapy is recommended for patients with acute symptomatic embolism with associated hypotension or shock. In this setting, the hemodynamic benefits of thrombolytic treatment far outweigh its bleeding risk. This case report describes a 32-year-old woman suffering from lymphangioleiomyomatosis, who underwent urgent double-lung transplantation. This patient was maintained on ECMO preoperatively, perioperatively, and postoperatively due to life-threatening hypoxemia caused by the progression of her pulmonary tissue damage. Multiple thrombi developed in the early postoperative period, in both right and left heart atria. Direct thrombolysis was successfully performed on the first postoperative day. According to the current published literature, direct thrombolysis of thrombi in both right and left atria in a patient supported on ECMO following urgent double-lung transplantation is an extremely rare treatment method. Even when taking into account all of the risks associated with thrombolysis and arteriovenous ECMO support, we found that this technique is very effective and, without a doubt, it saved the life of our patient.

  6. Direct thrombolysis of multiple thrombi in both right and left heart atrium in a patient on extracorporeal membrane oxygenation support following urgent double-lung transplantation: a case report

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    Pollert L

    2016-06-01

    Full Text Available Lukas Pollert,1 Zuzana Prikrylova,1 Jan Berousek,1 Frantisek Mosna,1 Robert Lischke2 1Department of Anaesthesiology and Intensive Care, 2nd Faculty of Medicine, 23rd Surgical Department, 1st Faculty of Medicine, Charles University in Prague and Motol University Hospital, Praha, Czech Republic Background: Lung transplantation is considered an established treatment for patients with end-stage chronic respiratory failure. Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at high risk of death. Extracorporeal membrane oxygenation (ECMO has been proposed as an alternative bridging strategy to mechanical ventilation. The shear stress created by the mechanical pumps causes changes in the hematological system in almost all patients treated with ECMO. An antithrombotic strategy to mitigate ECMO bleeding and thrombotic complications is necessary. The use of thrombolytic therapy is recommended for patients with acute symptomatic embolism with associated hypotension or shock. In this setting, the hemodynamic benefits of thrombolytic treatment far outweigh its bleeding risk.Case presentation: This case report describes a 32-year-old woman suffering from lymphangioleiomyomatosis, who underwent urgent double-lung transplantation. This patient was maintained on ECMO preoperatively, perioperatively, and postoperatively due to life-threatening hypoxemia caused by the progression of her pulmonary tissue damage. Multiple thrombi developed in the early postoperative period, in both right and left heart atria. Direct thrombolysis was successfully performed on the first postoperative day.Conclusion: According to the current published literature, direct thrombolysis of thrombi in both right and left atria in a patient supported on ECMO following urgent double-lung transplantation is an extremely rare treatment method. Even when taking into account all of the risks

  7. ABO blood groups: A risk factor for left atrial and left atrial appendage thrombogenic milieu in patients with non-valvular atrial fibrillation.

    Science.gov (United States)

    Fu, Yuan; Li, Kuibao; Yang, Xinchun

    2017-08-01

    Previous studies have identified ABO blood groups as predictors of thromboembolic diseases. In patients with atrial fibrillation (AF), however, potential association between ABO blood groups and the risk of left atrial (LA) and/or left atrial appendage (LAA) thrombogenic milieu (TM) has not been established. This is a retrospective case-control study that included 125 consecutive patients with non-valvular atrial fibrillation (NVAF) plus TM, as evidenced by transesophageal echocardiography (TEE) during a period from1 January 2010 to 31 December 2016. The controls were selected randomly from 1072 NVAF without TM at a 1:2 ratio. Potential association between ABO blood groups and TM was analyzed using multivariate logistic regression analysis. The risk of TM was higher in patients with blood group A (33.6% vs. 20.2% in non-A blood groups, P=0.005). After adjusting for age, sex, oral anticoagulant use, AF type and duration, and relevant functional measures (e.g., NT-pro BNP level, left atrium diameter, and left ventricular ejection fraction), blood group A remained associated with an increased risk of TM (OR=2.99, 95% CI 1.4-6.388, P=0.005). Blood group A is an independent risk factor for TM in NVAF patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Transesophageal echocardiography in NeoChord procedure

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    Pittarello Demetrio

    2015-01-01

    Full Text Available Background: Transapical off-pump mitral valve intervention with neochord implantation for degenerative mitral valve disease have been recently introduced in the surgical practice. The procedure is performed under 2D-3D transesophageal echocardiography guidance. Methods: The use of 3D real-time transesophageal echocardiography provides more accurate information than 2D echocardiography only in all the steps of the procedure. In particular 3D echocardiography is mandatory for preoperative assessment of the morphology of the valve, for correct positioning of the neochord on the diseased segment , for the final tensioning of the chordae and for the final evaluation of the surgical result. Result and Conclusion: This article is to outline the technical aspects of the transesophageal echocardiography guidance of the NeoChord procedure showing that the procedure can be performed only with a close and continuous interaction between the anesthesiologist and the cardiac surgeon.

  9. Feasibility of transesophageal echocardiography in birds without cardiac disease.

    Science.gov (United States)

    Beaufrère, Hugues; Pariaut, Romain; Nevarez, Javier G; Tully, Thomas N

    2010-03-01

    To establish a technique of transesophageal echocardiography (TEE) in birds without cardiac disease and describe the imaging planes obtained. Validation study. 18 birds including 3 pigeons (Columbia livia), 3 barred owls (Strix varia), 2 red-tailed hawks (Buteo jamaicensis), 1 goose (Anser anser), 1 mallard duck (Anas platyrhynchos), 1 Muscovy duck (Cairina moschata), 2 brown pelicans (Pelecanus occidentalis), 2 Hispaniolan Amazon parrots (Amazona ventralis), 2 red-fronted macaws (Ara rubrogenys), and 1 military macaw (Ara militaris). For each bird, anesthesia was induced and maintained by use of isoflurane. A pediatric, multiplane transesophageal ultrasound probe was passed into the esophagus and adjusted to the level of the heart for echocardiography. Probe positions were recorded via fluoroscopy, and associated imaging planes were described. TEE was performed successfully in all birds except the pelicans, 1 Hispaniolan Amazon parrot, and the red-fronted macaws. Five imaging planes of the heart were consistently viewed from 3 positions of the probe (identified as caudal, middle, and cranial positions relative to the cardiac silhouette). M-mode echocardiography of the left ventricle and the aortic root was performed. Color flow and spectral Doppler ultrasonographic images of in- and outflow regions were obtained. One Hispaniolan Amazon parrot died as a result of esophageal perforation. TEE examination of birds was feasible and provided a larger number of imaging planes with better resolution and details than those typically achieved via a transcoelomic approach. However, TEE should be performed with caution in psittacines.

  10. [Recurrent left atrial myxoma].

    Science.gov (United States)

    Moreno Martínez, Francisco L; Lagomasino Hidalgo, Alvaro; Mirabal Rodríguez, Roger; López Bermúdez, Félix H; López Bernal, Omaida J

    2003-01-01

    Primary cardiac tumors are rare. Mixomas are the most common among them; 75% are located in the left atrium, 20% in the right atrium, and the rest in the ventricles. The seldom appear in atrio-ventricular valves. Recidivant mixoma are also rare, appearing in 1-5% of all patients that have undergone surgical treatment of a mixoma. In this paper we present our experience with a female patient, who 8 years after having been operated of a left atrial mixoma, began with symptoms of mild heart failure. Transthoracic echocardiography revealed recurrence of the tumor, and was therefore subjected to a second open-heart surgery from which she recovered without complications.

  11. The analysis of transesophageal oxygen saturation photoplethysmography from different signal sources.

    Science.gov (United States)

    Mou, Ling; Gong, Quan; Wei, Wei; Gao, Bo

    2013-06-01

    The photoplethysmography (PPG) signals detected by transesophageal oximetry sensor toward aorta arch (AA), descending aorta (DA), and left ventricle (LV) under the guidance of transesophageal echocardiography (TEE) were investigated, and the effects of filter application on PPG signals were evaluated. Eleven cardiac surgical patients were involved. After anesthesia was induced, the TEE probe with a modified pulse oximetry sensor was inserted. Under the guidance of TEE, the AA PPG, DA PPG and LV PPG were detected respectively when ventilator was on and off. The mean alternating current (AC) amplitudes and direct current (DC) values of original and filtered PPG signals were measured. The ratio of AC and DC value (AC/DC) and ventilation-induced AC variations were calculated. Satisfactory PPG waveforms were obtained in all patients under the guidance of TEE. The AC amplitude in LV PPG was significant larger than in AA and DA PPG, and both AC/DC and ventilation-induced AC variation in LV PPG were significantly higher than in AA PPG or DA PPG either. There were no significant differences of AC amplitude between filtered and ventilation off PPG signals. The AC amplitudes and AC/DC toward LV are significantly higher than transesophageal oximeter toward AA or DA, and the effect of mechanical ventilation on transesophageal PPG can be obviously reduced by filtering techniques.

  12. Transesophageal Ultrasonography for Lung Cancer Staging

    DEFF Research Database (Denmark)

    Konge, Lars; Annema, Jouke; Vilmann, Peter

    2013-01-01

    Accurate mediastinal nodal staging is essential for patients with resectable non-small-cell lung cancer and is achieved by combined endobronchial ultrasound and transesophageal endoscopic ultrasound (EUS). Training requirements for EUS-guided fine-needle aspiration (FNA) for lung cancer staging...

  13. Serpentinous structure in the right atrium

    Directory of Open Access Journals (Sweden)

    Monish S Raut

    2017-01-01

    Full Text Available Thin, slender, filament like structure is common finding in right atrium echocardiographically. These structures generally represent embryological remnants like thebasian valve, eustachian valve and chiari network. Apart from these variants, they can also be initial finding of thrombotic process specially in the presence of central venous catheter. Early detection and removing the catheter can prevent further thromboembolism in such cases.

  14. New Engineering Principles in Atrium Smoke Management

    DEFF Research Database (Denmark)

    Valkvist, Morten Birk Sabroe

    A typical atrium smoke management setup was divided into characteristic flow regions; axisymmetric plume, ceiling jet/approach flow, rotation region and spill plume. A grid convergence study was conducted on each of the flow regions in order to determine the non-dimensional grid resolution required...

  15. Spectroscopic photoacoustic imaging of radiofrequency ablation in the left atrium

    NARCIS (Netherlands)

    S. Iskander-Rizk (Sophinese); P. Kruizinga (Pieter); A.F.W. van der Steen (Ton); G. van Soest (Gijs)

    2018-01-01

    textabstractCatheter-based radiofrequency ablation for atrial fibrillation has long-term success in 60-70% of cases. A better assessment of lesion quality, depth, and continuity could improve the procedure’s outcome. We investigate here photoacoustic contrast between ablated and healthy atrial-wall

  16. Investigating atrium in hot and humid climate and providing ...

    African Journals Online (AJOL)

    Atrium has thermal comfort space since the old time by two methods of greenhouse effect and chimney effect. Now these questions are raised: What impact does atrium have in terms of performance in reducing energy consumption in buildings and how is the performance of atrium in the hot and humid climate, and how it ...

  17. Ecocardiografia transesofágica e diagnóstico intraoperatório de veia cava superior esquerda persistente Ecocardiografía transesofágica y diagnóstico intraoperatorio de vena cava superior izquierda persistente Transesophageal echocardiography and intraoperative diagnosis of persistent left superior vena cava

    Directory of Open Access Journals (Sweden)

    Alexander Alves da Silva

    2009-12-01

    persistent left superior vena cava has an incidence of 0.5% in the normal population, but in patients with congenital cardiopathy its incidence ranges from 3% to 10%. The objective of this report was to present a case of intraoperative diagnosis with transesophageal echocardiography and to emphasize the importance of its routine use in surgical procedures for correction of congenital cardiopathies. CASE REPORT: This is a 16-year old male patient, ASA II, with a diagnosis of superior sinus venosus interatrial communication (IAC with partial anomalous drainage of the pulmonary veins scheduled for the surgical correction of the cardiopathy. After induction of general anesthesia, transesophageal echocardiography (TEE showed initially a dilation of the right cardiac chambers, a 17-mm superior sinus venosus IAC, anomalous drainage of the right superior pulmonary vein draining into the right superior vena cava (SVC, and dilation of the coronary sinus raising the possibility of persistent left superior vena cava. To confirm this suspicion, 10 mL of NS (works as a contrast in echocardiography were injected in the venous access of the left arm, and microbubbles crossing the coronary sinus were observed immediately afterwards confirming the diagnosis of persistent left superior vena cava. CONCLUSIONS: Routine intraoperative transesophageal echocardiography in patients with congenital cardiopathy is a fundamental auxiliary method, not only for the surgeon, often having direct influence on the surgical technique used, but also for the anesthesiologist, who can get useful information for the hemodynamic management of the patient.

  18. Transesophageal Echocardiography and Radiation-induced Damages.

    Science.gov (United States)

    Cottini, Marzia; Polizzi, Vincenzo; Pino, Paolo Giuseppe; Buffa, Vitaliano; Musumeci, Francesco

    2016-01-01

    The long-term sequelae of mantle therapy include, especially lung and cardiac disease but also involve the vessels and the organs in the neck and thorax (such as thyroid, aorta, and esophagus). We presented the case of 66-year-old female admitted for congestive heart failure in radiation-induced heart disease. The patient had undergone to massive radiotherapy 42 years ago for Hodgkin's disease (type 1A). Transesophageal echocardiography was performed unsuccessfully with difficulty because of the rigidity and impedance of esophageal walls. Our case is an extraordinary report of radiotherapy's latency effect as a result of dramatic changes in the structure of mediastinum, in particular in the esophagus, causing unavailability of a transesophageal echocardiogram.

  19. Utility of transesophageal electrocardiography to guide optimal placement of a transesophageal pacing catheter in dogs.

    Science.gov (United States)

    Sanders, Robert A; Chapel, Emily; Garcia-Pereira, Fernando L; Venet, Katherine E

    2015-01-01

    To determine if the transesophageal atrial (A) wave amplitude or ventricular (V) wave amplitude can be used to guide optimal positioning of a transesophageal pacing catheter in dogs. Prospective clinical study. Fourteen client owned healthy dogs with a median weight of 15.4 kg (IQR = 10.6-22.4) and a median age of 12 months (IQR = 6-12). Transesophageal atrial pacing (TAP) using a 6 Fr pacing catheter was attempted in dogs under general anesthesia. The pacing catheter was inserted orally into the esophagus to a position caudal to the heart. With the pulse generator set at a rate 20 beats/minute(-1) above the intrinsic sinus rate, the catheter was slowly withdrawn until atrial pacing was noted on a surface electrocardiogram (ECG). Then the catheter was withdrawn in 1 cm increments until atrial capture was lost. Minimum pacing threshold (MPT) and transesophageal ECG were recorded at each site. Amplitudes of the A and V waves on transesophageal ECG were then measured and their relationship to MPT was evaluated. TAP was achieved in all dogs. In 9/14 dogs the site of lowest overall MPT was the same as the site of maximal A wave deflection. In dogs with at least three data points, linear regression analysis of the relationship between the estimated site of the lowest overall MPT compared to estimated site of the maximal A and V waveform amplitudes demonstrated a strong correlation (R(2) = 0.99). Transesophageal ECG A and V waveforms were correlated to MPT and could be used to direct the placement of a pacing catheter. However, the technique was technically challenging and was not considered to be clinically useful to guide the placement of a pacing catheter. © 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

  20. Increased FDG uptake in the wall of the right atrium in people who participated in a cancer screening program with whole-body PET

    International Nuclear Information System (INIS)

    Fujii, Hirofumi; Ide, Michiru; Yasuda, Seiei; Takahashi, Wakoh; Shohtsu, Akira; Kubo, Atsushi

    1999-01-01

    The purpose of this study was to evaluate the characteristics of patients who showed increased FDG uptake in the wall of the right atrium. We have encountered 10 patients with increased activity in the wall of the right atrium among a total of 2,367 examinees who participated in our cancer screening program with whole-body PET. The mean age of these examinees was 62.9 yr, higher than that of the total population. All suffered from cardiac disorders, especially atrial fibrillation. FDG accumulated almost exclusively in the wall of the right atrium, whereas only slight activity was seen in the wall of the left atrium. Although the average size of the right atria was significantly enlarged, left atria were more severely dilated than right ones. Therefore overload does not seem to account for the FDG accumulation in the wall of the right atrium. In conclusion, the increased activity in the wall of the right atrium was a rare finding that was made in older people who suffered from cardiac disease. Although the mechanism of induction of the high metabolic state of glucose in the wall of the right atrium remains unclear, this unusual activity would be another false positive finding in cancer screening with whole-body FDG PET. (author)

  1. Cor triatriatum or divided atriums: which approach provides the better understanding?

    Science.gov (United States)

    Bharucha, Tara; Spicer, Diane E; Mohun, Timothy J; Black, David; Henry, G William; Anderson, Robert H

    2015-02-01

    It is frequent, in the current era, to encounter congenital cardiac malformations described in terms of "cor triatriatum". But can hearts be truly found with three atrial chambers? The morphological method, emphasised by Van Praagh et al, states that structures within the heart should be defined on the basis of their most constant components. In the atrial chambers, it is the appendages that are the most constant components, and to the best of our knowledge, hearts can only possess two appendages, which can be of either right or left morphology. The hearts described on the basis of "cor triatriatum", nonetheless, can also be analysed on the basis of division of either the morphologically right or the morphologically left atriums. In this review, we provide a description of cardiac embryology, showing how each of the atrial chambers possesses part of the embryological body, along with an appendage, a vestibule, a venous component, and a septum that separates them. We then show how it is, indeed, the case that the hearts described in terms of "cor triatriatum" can be readily understood on the basis of division of these atrial components. In the right atrium, it is the venous valves that divide the chamber. In the left atrium, it is harder to provide an explanation for the shelf that produces atrial division. We also contrast the classic examples of the divided atrial chambers with the vestibular shelf that produces supravalvar stenosis in the morphologically left atrium, showing that this form of obstruction needs to be distinguished from the fibrous shelves producing intravalvar obstruction.

  2. Thrombus-in-Transit Entrapped in a Partially Ligated Left Atrial Appendage

    Directory of Open Access Journals (Sweden)

    Farideh Roshanali

    2015-10-01

    Full Text Available A 54-year-old man referred to our center with Barlow’s disease and severe mitral regurgitation. He had atrial fibrillation (AF rhythm, with a mildly enlarged left atrium (LA. Transesophageal echocardiography (TEE showed no clot in the LA and LA appendage; there was only mild spontaneous echo contrast in the LA appendage. The patient underwent mitral valve repair and the Maze operation, during which the LA appendage was ligated with the double suture technique. He was discharged from the hospital in good condition and in sinus rhythm. He was recommended Warfarin and PT control.One month later, he returned with the complaint of vision loss twice in the left eye each time for a few seconds. The AF rhythm had returned.TEE demonstrated a fresh and mobile thrombus entrapped in the LA appendage with a small portion in the LA (Figures 1 and 2. Laboratory tests showed therapeutic international normalized ratio (INR. The patient refused re- operation.  Plavix was added to his medication, and he was discharged.

  3. Mediastinal lymphoma eroding the right atrium

    International Nuclear Information System (INIS)

    Saeed, S.; Mangi, S.A.; Ahmad, R.; Rashid, A.

    2013-01-01

    Primary cardiac tumours are an uncommon cause of intra-cardiac mass. Most common intra-cardiac mass is thrombus followed by infiltrating secondary cardiac tumours. These secondary tumours are more likely to invade the cardiac chambers when they arise from close vicinity of the heart. We report an unusual case of mediastinal lymphoma in a 55 years old lady presenting as an intra-cardiac mass in the right atrium, which was detected by a transthoracic echocardiogram and later confirmed with more specific modalities. (author)

  4. [Tapia's syndrome following transesophageal echocardiography during an open-heart operation: a case report].

    Science.gov (United States)

    Fujiwara, Satoru; Yoshimura, Hajime; Nishiya, Kenta; Oshima, Keiichi; Kawamoto, Michi; Kohara, Nobuo

    2017-12-27

    A 67-year-old man presented with hoarseness, dysarthria and deviation of the tongue to the left side the day after the open-heart operation under general anesthesia. Brain MRI demonstrated no causal lesion, and laryngoscope showed left vocal cord abductor palsy, so we diagnosed him with Tapia's syndrome (i.e., concomitant paralysis of the left recurrent and hypoglossal nerve). His neurological symptoms recovered gradually and improved completely four months after the onset. Tapia's syndrome is a rare condition caused by the extra cranial lesion of the recurrent laryngeal branch of the vagus nerve and the hypoglossal nerve, and mostly described as a complication of tracheal intubation. In this case, transesophageal echo probe has been held in the left side of the pharynx, so compression to the posterior wall of pharynx by the probe resulted in this condition, and to the best of our knowledge, this is the first report of Tapia's syndrome due to transesophageal echocardiography during an open-heart operation. This rare syndrome should be considered as a differential diagnosis of dysarthria and tongue deviation after a procedure associated with compression to the pharynx.

  5. The role of Multidetector CT in the evaluation of the left atrium and pulmonary veins anatomy before and after radio-frequency catheter ablation for atrial fibrillation. Preliminary results and work in progress.Technical note; Il ruolo della TC Multidetettore nella valutazione anatomica dell'atrio sinistro e delle vene polmonari prima e dopo ablazione percutanea con radiofrequenza della fibrillazione atriale. Risultati preliminari e work in progress

    Energy Technology Data Exchange (ETDEWEB)

    Centoze, Maurizio; Della Sala, Sabino Walter; Dalla Palma, Francesco [Azienda Provinciale per i servizi sanitari, Trento (Italy). Dipartimento di radiodiagnostica; Del Greco, Maurizio; Marini, Massimiliano [Ospedale S. Chiara, Trento (Italy). U.O. di cardiologia; Nollo, Giandomenico; Ravelli, Flavia [Trento Univ., Trento (Italy). Dipartimento di fisica

    2005-07-15

    Radio-frequency catheter ablation (RFCA) of the distal pulmonary veins is increasingly being used to treat recurrent or refractory atrial fibrillation that doesn't respond to pharmacologic therapy or cardioversion. Successful RFCA of atrial al fibrillation depends on the pre-procedural understanding of the complex anatomy of the distal pulmonary veins and the left atrium. Aim of this parer is to describe the technical main features that characterise the multidetector helical computed tomography in the evaluation of this anatomic region before and after RFCA procedure. The 3D post-processing techniques useful for pre-RFCA planning are straightforward. [Italian] La ablazione percutanea con radiofrequenza (RFCA) del tratto distale delle vene polmonari nella fibrillazione atriale, che non risponde al trattamento farmacologico e alla cardioversione elettrica, e una procedura in grande sviluppo. Il successo del trattamento dipende dalla comprensione della complessa anatomia delle vene polmonari e dell'atrio sinistro. Lo scopo di questo articolo e illustrare gli aspetti tecnici fondamentali che caratterizzano lo studio di questa regione anatomica con TC spirale multidetettore prima e dopo RFCA. Particolare risalto e stato rivolto alle tecniche di post-processing 3D estremamente utili nella pianificazione della procedura di ablazione.

  6. Intraoperative transesophageal echocardiography in congenital heart diseases surgery

    International Nuclear Information System (INIS)

    Ozores Suarez, Francisco Javier; Perez de Ordaz, Luis Bravo

    2010-01-01

    The intraoperative transesophageal echocardiography is very used in pediatric cardiovascular surgery. The aim of present paper was to determine its impact on the surgery immediate results after a previous experience of authors with this type of procedure

  7. Transesophageal echocardiography for cardiac thromboembolic risk assessment in patients with severe, symptomatic aortic valve stenosis referred for potential transcatheter aortic valve implantation.

    Science.gov (United States)

    Lenders, Guy D; Paelinck, Bernard P; Wouters, Kristien; Claeys, Marc J; Rodrigus, Inez E; Van Herck, Paul L; Vrints, Christiaan J; Bosmans, Johan M

    2013-05-15

    Stroke is a devastating complication after transcatheter aortic valve implantation (TAVI) and might partially be related to cardiac embolization. The aim of this single-center prospective study was to determine the incidence of intracardiac thrombi and left atrial spontaneous echo contrast (SEC), both known predictors of cardiac embolic stroke, in patients referred for potential TAVI. One hundred four consecutive patients with severe symptomatic aortic valve stenosis and at high or very high risk for surgery were included and underwent transesophageal echocardiography. In 11 patients (10.6%), intracardiac thrombi were detected, and 25 patients (24%) showed dense grade 2 SEC. Atrial fibrillation (p risk patients with severe aortic valve stenosis referred for potential TAVI is high and can accurately be detected using transesophageal echocardiography. Systematic thromboembolic evaluation using transesophageal echocardiography is thus recommended in patients referred for TAVI. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Structural and molecular pathology of the atrium in boxer arrhythmogenic right ventricular cardiomyopathy.

    Science.gov (United States)

    Vila, J; Pariaut, R; Moïse, N S; Oxford, E M; Fox, P R; Reynolds, C A; Saelinger, C

    2017-02-01

    To investigate the expression and distribution of desmosomal and gap junction proteins of the intercalated disc in the atria of boxers with arrhythmogenic right ventricular cardiomyopathy (ARVC). Nineteen control dogs and 13 boxers with histopathologically confirmed ARVC. Right and left atrial samples were examined using immunofluorescence and Western blots. The intercalated disc proteins investigated included total and phosphorylated connexin43 (Cx43 and pCx43), connexin45, connexin40, plakoglobin, plakophilin-2, desmoplakin, and N-cadherin. Histopathological changes characteristic of ARVC were present in the left or right atrium of 12 out of 13 boxers and were absent in all control dogs. When compared to the 19 control dogs, immunofluorescence analysis revealed a decrease in signal intensity for pCx43 and plakoglobin in the left (p = 0.03 and p = 0.014, respectively) and right atrium (p = 0.015 and p = 0.002, respectively) of affected boxers. Connexin43 and pCx43 Western blot band density was significantly decreased in the left (p = 0.025 and p = 0.027, respectively) and right atrium (p = 0.001 and p = 0.044, respectively) of affected boxers. Altered intercalated disc and gap junction proteins were identified in atrial myocardium of ARVC boxers, supporting atrial involvement as part of this disorder. Reduction in pCx43 in conjunction with histological changes could represent the substrate for atrial arrhythmias associated with ARVC. Furthermore, these findings detected in boxer dogs, lend support for the broader term, arrhythmogenic cardiomyopathy, as preferred nomenclature used to describe this disease in humans. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Intraoperative transesophageal echocardiography for pulmonary embolectomy without cardiopulmonary bypass.

    Science.gov (United States)

    Deleuze, P; Saada, M; De Paulis, R; Brochard, L; Mazzucotelli, J P; Rotman, N; Loisance, D Y; Cachera, J P

    1991-07-01

    This case report describes a patient with massive pulmonary embolism and acute circulatory failure in whom transesophageal echocardiography permitted the diagnosis of thrombi in the main pulmonary truncus and in the right branch and guided intraoperatively the surgical embolectomy performed under simple venous inflow occlusion because of a contraindication to heparin administration. Transesophageal echocardiography seems to be a very helpful technique to diagnose promptly massive pulmonary embolism and a very useful tool at the time of operation to guide the embolectomy.

  10. Rotational Angiography Based Three-Dimensional Left Atrial Reconstruction: A New Approach for Transseptal Puncture.

    Science.gov (United States)

    Koektuerk, Buelent; Yorgun, Hikmet; Koektuerk, Oezlem; Turan, Cem H; Gorr, Eduard; Horlitz, Marc; Turan, Ramazan G

    2016-02-01

    Rotational angiography is a well-known method for the three-dimensional (3-D) reconstruction of left atrium and pulmonary veins during left-sided atrial arrhythmia ablation procedures. In our study, we aimed to review our experience in transseptal puncture (TSP) using 3-D rotational angiography. We included a total of 271 patients who underwent atrial fibrillation ablation using cryoballoon. Rotational angiography was performed to get the three-dimensional left atrial and pulmonary vein reconstructions using cardiac C-arm computed tomography. The image reconstruction was made using the DynaCT Cardiac software (Siemens, Erlangen, Germany). The mean age of the study population was 61 ± 10 years. The indications for left atrial arrhythmia ablation were paroxysmal AF in 140 patients (52%) and persistent AF patients in 131 (48%) patients. The success rate of TSP using only rotational guidance was (264/271 patients, 97.4%). In the remaining seven patients, transesophageal guidance was used after the initial attempt due to thick interatrial septum in five patients and difficult TSP due to abnormal anatomy and mild pericardial effusion in the remaining two patients. Mean fluoroscopy dosage of the rotational angiography was 4896.4 ± 825.3 μGym(2). The mean time beginning from femoral vein puncture to TSP was 12.3 ± 5.5 min. TSP guided by rotational angiography is a safe and effective method. Our results indicate that integration of rotational angiographic images into the real-time fluoroscopy can guide the TSP during the procedure. © 2015 John Wiley & Sons Ltd.

  11. Case Report: Giant Right Atrium in Rheumatic Mitral Disease

    Directory of Open Access Journals (Sweden)

    Deniz Demir

    2014-06-01

    Full Text Available Dilation and hypertrophy of the atria occur in patients with valvular heart disease especially in mitral regurgitation, mitral stenosis or tricuspid abnormalities. Dilatation of the atriums which occurs slowly in time, becomes evident with ritim disturbances and embolic events. We report a case of an unusual giant right atrium in context of rheumatic mitral stenosis, mitral regurgitation, pulmonar hypertansion and severe tricuspid regurgitation in a 40-year-old man who underwent succesfull operations as mitral valve replacement, Maze-IV radiofrequency ablation, right atrium atrioplasty and De Vega anuloplasty. [J Contemp Med 2014; 4(2.000: 98-102

  12. Comparison of transcoelomic, contrast transcoelomic, and transesophageal echocardiography in anesthetized red-tailed hawks (Buteo jamaicensis).

    Science.gov (United States)

    Beaufrère, Hugues; Pariaut, Romain; Rodriguez, Daniel; Nevarez, Javier G; Tully, Thomas N

    2012-10-01

    To assess the agreement and reliability of cardiac measurements obtained with 3 echocardiographic techniques in anesthetized red-tailed hawks (Buteo jamaicensis). 10 red-tailed hawks. Transcoelomic, contrast transcoelomic, and transesophageal echocardiographic evaluations of the hawks were performed, and cineloops of imaging planes were recorded. Three observers performed echocardiographic measurements of cardiac variables 3 times on 3 days. The order in which hawks were assessed and echocardiographic techniques were used was randomized. Results were analyzed with linear mixed modeling, agreement was assessed with intraclass correlation coefficients, and variation was estimated with coefficients of variation. Significant differences were evident among the 3 echocardiographic methods for most measurements, and the agreement among findings was generally low. Interobserver agreement was generally low to medium. Intraobserver agreement was generally medium to high. Overall, better agreement was achieved for the left ventricular measurements and for the transesophageal approach than for other measurements and techniques. Echocardiographic measurements in hawks were not reliable, except when the left ventricle was measured by the same observer. Furthermore, cardiac morphometric measurements may not be clinically important. When measurements are required, one needs to consider that follow-up measurements should be performed by the same echocardiographer and should show at least a 20% difference from initial measurements to be confident that any difference is genuine.

  13. Inflammatory Myofibroblastic Tumor of the Right Atrium

    Directory of Open Access Journals (Sweden)

    Neerod K. Jha

    2010-01-01

    Full Text Available Cardiac inflammatory myofibroblastic tumor (IMT is a rare entity and is associated with distinct clinical, pathological and molecular features. The clinical behavior, natural history, biological potential, management and prognosis of such tumors are unclear. We present herewith an adolescent girl who presented with similar entity involving the junction of the right atrium and the inferior vena cava (IVC in association with thrombocytosis and IVC thrombosis leading to obstruction of blood flow. Diagnostic tools included imaging and immuno-histopathology studies. Surgical management included resection of the tumor and thrombo-embolectomy of the IVC under cardiopulmonary bypass. This case is unique due to association of complete obstruction of IVC caused by the strategic location of the tumor, thrombosis of vena cava and association of thrombocytosis. These features have not been reported yet in relation to the cardiac IMT. This report will help in better understanding and management of similar cases in terms of planning cannulation of femoral veins or application of total hypothermic circulatory arrest during cardiopulmonary bypass and prompt us to look for recurrence or metastasis during follow up using echocardiography and laboratory investigations. The possibility of IMT should be kept in the differential diagnosis of cardiac tumors especially in children and adolescents.

  14. Minimally invasive cardiac surgery and transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Ajay Kumar Jha

    2014-01-01

    Full Text Available Improved cosmetic appearance, reduced pain and duration of post-operative stay have intensified the popularity of minimally invasive cardiac surgery (MICS; however, the increased risk of stroke remains a concern. In conventional cardiac surgery, surgeons can visualize and feel the cardiac structures directly, which is not possible with MICS. Transesophageal echocardiography (TEE is essential during MICS in detecting problems that require immediate correction. Comprehensive evaluation of the cardiac structures and function helps in the confirmation of not only the definitive diagnosis, but also the success of surgical treatment. Venous and aortic cannulations are not under the direct vision of the surgeon and appropriate positioning of the cannulae is not possible during MICS without the aid of TEE. Intra-operative TEE helps in the navigation of the guide wire and correct placement of the cannulae and allows real-time assessment of valvular pathologies, ventricular filling, ventricular function, intracardiac air, weaning from cardiopulmonary bypass and adequacy of the surgical procedure. Early detection of perioperative complications by TEE potentially enhances the post-operative outcome of patients managed with MICS.

  15. Minimally invasive cardiac surgery and transesophageal echocardiography.

    Science.gov (United States)

    Jha, Ajay Kumar; Malik, Vishwas; Hote, Milind

    2014-01-01

    Improved cosmetic appearance, reduced pain and duration of post-operative stay have intensified the popularity of minimally invasive cardiac surgery (MICS); however, the increased risk of stroke remains a concern. In conventional cardiac surgery, surgeons can visualize and feel the cardiac structures directly, which is not possible with MICS. Transesophageal echocardiography (TEE) is essential during MICS in detecting problems that require immediate correction. Comprehensive evaluation of the cardiac structures and function helps in the confirmation of not only the definitive diagnosis, but also the success of surgical treatment. Venous and aortic cannulations are not under the direct vision of the surgeon and appropriate positioning of the cannulae is not possible during MICS without the aid of TEE. Intra-operative TEE helps in the navigation of the guide wire and correct placement of the cannulae and allows real-time assessment of valvular pathologies, ventricular filling, ventricular function, intracardiac air, weaning from cardiopulmonary bypass and adequacy of the surgical procedure. Early detection of perioperative complications by TEE potentially enhances the post-operative outcome of patients managed with MICS.

  16. Small, smooth, nonmobile cardiac myxoma detected by transesophageal echocardiography following recurrent cerebral infarction: a case report.

    Science.gov (United States)

    Saito, Yuki; Aizawa, Yoshihiro; Monno, Koyuru; Nagashima, Koichi; Kurokawa, Sayaka; Osaka, Shunji; Akimoto, Takayoshi; Kamei, Satoshi; Tanaka, Masashi; Hirayama, Atsushi

    2017-05-10

    Cardiac myxoma is known to cause repeated events of cerebral embolism. Soft and irregularly shaped myxomas with high mobility are associated with a higher occurrence of cerebral embolism. In contrast, nonmobile cardiac myxomas with a round regular shape are rarely considered to be a cause of cerebral embolism. In this case, we present a patient with recurrent cerebral embolism associated with a small and nonmobile cardiac myxoma of round regular shape. A 76-year-old Japanese man presented to our hospital with weakness in his right upper extremity. He had a history of right frontal lobe infarction in the previous month. T2-weighted magnetic resonance imaging revealed an area of hyperintensity in the left precentral gyrus, indicating acute cerebral infarction. Transthoracic echocardiography revealed normal left ventricular function and no abnormalities. However, transesophageal echocardiography showed a small and nonmobile left atrial tumor with round regular shape attached to the ostium secundum of the atrial septum. Based on these findings, we diagnosed recurrent cerebral infarction due to embolization caused by left atrial myxoma, and cardiac tumor extraction was performed on hospitalization day 36. The excised tumor measured 0.6 × 0.6 × 0.5 cm and was diagnosed as cardiac myxoma by histologic examination. Even small and nonmobile cardiac myxomas with a round regular shape may cause recurrent cerebral infarction. The diagnosis of this type of atrial myxoma is elusive and transesophageal echocardiography was an effective method of detection. In a clinical situation, this type of cardiac myxoma may be overlooked as a cause of cerebral infarction.

  17. The association between atrium electromechanical interval and pericardial fat.

    Directory of Open Access Journals (Sweden)

    Tze-Fan Chao

    Full Text Available OBJECTIVES: Pericardial fat (PCF may induce local inflammation and subsequent structural remodeling of the left atrium (LA. However, the adverse effects of PCF on LA are difficult to be evaluated and quantified. The atrial electromechanical interval determined by transthoracic echocardiogram was shown to be a convenient parameter which can reflect the process of LA remodeling. The goal of the present study was to investigate the association between the electromechanical interval and PCF. METHODS AND RESULTS: A total of 337 patients with mean age of 51.9 ± 9.0 years were enrolled. The electromechanical interval (PA-PDI defined as the time interval from the initiation of the P wave deflection to the peak of the mitral inflow A wave on the pulse wave Doppler imaging was measured for every patient. The amount of PCF was determined by multi-detector computed tomography. The PA-PDI interval was significantly correlated with the amount of PCF (r = 0.641, p value <0.001. Graded prolongation of PA-PDI interval was observed across 3 groups of patients divided according to the tertile values of PCF. The AUC for the PA-PDI interval in predicting an increased amount of PCF (third tertile was 0.796. At a cutoff value of 130 ms identified by the ROC curve, the sensitivity and specificity of PA-PDI interval in identifying patients with a highest tertile of PCF were 63.4% and 85.3%, respectively. CONCLUSIONS: The PA-PDI intervals were longer in patients with an increased amount of PCF. It may be a useful parameter to represent the degree of PCF-related atrial remodeling.

  18. Natural Orifice Transesophageal Endoscopic Surgery: State of the Art

    Directory of Open Access Journals (Sweden)

    João Moreira-Pinto

    2012-01-01

    Full Text Available The main goal of Natural Orifice Transluminal Endoscopic Surgery (NOTES is performing surgery avoiding skin incisions. Theoretical advantages of NOTES include decreased postoperative pain, reduction/elimination of general anesthesia, improved cosmetic outcomes, elimination of skin incision-related complications such as wound infections and hernias, and increased overall patient satisfaction. Although various forms of port creation to accomplish thoracic NOTES procedures have been proposed, transesophageal NOTES has been shown to be the most reliable one. The evolution of endoscopic submucosal transesophageal access resulted in the development of per-oral endoscopic myotomy (POEM, which had a fast transition to clinical practice. The authors present a review of the current state of the art concerning transesophageal NOTES, looking at its potential for diagnostic and therapeutic interventions as well as the hurdles yet to be overcome.

  19. Detection of left atrial thrombus by intracardiac echocardiography in patients undergoing ablation of atrial fibrillation.

    Science.gov (United States)

    Sriram, Chenni S; Banchs, Javier E; Moukabary, Talal; Moradkhan, Raman; Gonzalez, Mario D

    2015-09-01

    The role of intracardiac echocardiography (ICE) to detect thrombus within left atrium (LA) before atrial fibrillation (AF) ablation despite a recent transesophageal echocardiogram (TEE) is not well defined. We examined the prevalence of LA/left atrial appendage (LAA) thrombus using ICE immediately prior to AF ablation in patients in whom anticoagulation was not withheld. We analyzed 122 consecutive patients (62.6 ± 10.8 years, 90 males, CHA(2)DS(2) -VASc score 2.4 ± 1.5, persistent AF 29.5 %) who underwent an ICE-guided AF ablation 1 day after a negative (n = 120) or inconclusive (n = 2) TEE for LA thrombus. LA was imaged with ICE from the right atrium, coronary sinus, and right ventricular inflow tract (RVIT). ICE and TEE images were compared for LAA area, thrombus, and spontaneous echo contrast (SEC). LAA was adequately visualized in 99 and 100 % of patients with TEE and ICE, respectively. RVIT was the best ICE view for LAA visualization. The LAA 2-D-area measured by TEE was 4.9 ± 0.5 vs. 5 ± 0.5 cm(2) by ICE (P = NS). ICE identified a thrombus in seven patients with a previous negative TEE, leading to cancellation of ablation. It ruled out a thrombus in two patients with an inconclusive TEE. Thrombi were found in the LAA (n = 4), atrial septum (n = 2), and left superior pulmonary vein (n = 1). SEC during TEE was more frequent in patients with thrombus on ICE than those without (85.7 vs. 17.4 %; p = 0.03; positive predictive value 23.1 %, negative predictive value 98.9 %). The results of our staged imaging approach suggest that ICE has a complimentary value in re-screening the LA/LAA for thrombus after a recent negative or equivocal TEE. The presence of SEC during TEE increases the probability of finding a thrombus with ICE, which could potentially be dislodged during catheter manipulation.

  20. Daylighting in linear atrium buildings at high latitudes

    Energy Technology Data Exchange (ETDEWEB)

    Matusiak, Barbara

    1998-12-31

    This thesis proposes new criteria for visual comfort based on knowledge of visual perception and a method for estimating the modelling ability of light by using inter-reflection calculations. Simplified calculations are presented for the daylight factor in linear building structures, using the projected solid angle principle, for uniform sky and for CIE overcast sky conditions. The calculations are compared with experimental results. Simple diagrams are created based on calculations of the mean daylight factor in rooms adjacent to a narrow street. These diagrams and presented formulas and tables can be used as a simple design tool. Daylighting strategies for linear atrium buildings at high latitudes are developed and examined. These strategies are divided into three groups: (1) the atrium space and facades as light conductor/reflector, (2) the glass roof as a light conductor, and (3) light reflectors on the neighbouring roof. The atrium space and facade strategies are subdivided into passive and active. The strategies connected to the glazed roof includes different configurations of glazing: horizontal, single pitched, double pitched, and the use of laser cut panels and prismatic panels in the glazed roof. The shapes of reflectors on the neighbouring roof are a flat reflector, a parabolic reflector and a parabolic concentrator. Strategies from all three groups are examined on a physical model of scale 1:20 in the artificial sky of mirror box type. Simulations with artificial sun have also been done. The results from model studies are compared with computer simulations. All the active daylighting systems designed for use in the atrium space or on the atrium facades have a huge potential for use in atrium buildings. From the strategies connected with the glazed roof the negatively sloped glass is found to be the best alternative for glazed roofs at high latitudes. Among the roof reflectors, the flat one performs best. 82 refs., 122 figs., 27 tabs.

  1. Transesophageal echocardiography in patients with cryptogenic cerebral ischemia

    Directory of Open Access Journals (Sweden)

    Dreger Henryk

    2009-03-01

    Full Text Available Abstract Background In about one third of all patients with cerebral ischemia, no definite cause can be identified (cryptogenic stroke. In many patients with initially suspected cryptogenic stroke, however, a cardiogenic etiology can eventually be determined. Hence, the aim of this study was to describe the prevalence of abnormal echocardiographic findings in a large number of these patients. Method Patients with cryptogenic cerebral ischemia (ischemic stroke, IS, and transient ischemic attack, TIA were included. The initial work-up included a neurological examination, EEG, cCT, cMRT, 12-lead ECG, Holter-ECG, Doppler ultrasound of the extracranial arteries, and transthoracic echocardiography. A multiplane transeophageal echocardiography (TEE, including i.v. contrast medium application [Echovist], Valsalva maneuver was performed in all patients Results 702 consecutive patients (380 male, 383 IS, 319 TIA, age 18–90 years were included. In 52.6% of all patients, TEE examination revealed relevant findings. Overall, the most common findings in all patients were: patent foramen ovale (21.7%, previously undiagnosed valvular disease (15.8%, aortic plaques, aortic valve sclerosis, atrial septal aneurysms, regional myocardial dyskinesia, dilated left atrium and atrial septal defects. Older patients (> 55 years, n = 291 and patients with IS had more relevant echocardiographic findings than younger patients or patients with TIA, respectively (p = 0.002, p = 0.003. The prevalence rates of PFO or ASD were higher in younger patients (PFO: 26.8% vs. 18.0%, p = 0.005, ASD: 9.6% vs. 4.9%, p = 0.014. Conclusion A TEE examination in cryptogenic stroke reveals contributing cardiogenic factors in about half of all patients. Younger patients had a higher prevalence of PFO, whereas older patients had more frequently atherosclerotic findings. Therefore, TEE examinations seem indicated in all patients with cryptogenic stroke – irrespective of age – because of

  2. Antiarrhythmic Mechanisms of SK Channel Inhibition in the Rat Atrium

    DEFF Research Database (Denmark)

    Skibsbye, Lasse; Wang, Xiaodong; Axelsen, Lene Nygaard

    2015-01-01

    -clamping and two-electrode voltage-clamp was used to access INa and IK,ACh respectively. RESULTS: The SK channel inhibitor N-(pyridin-2-yl)-4-(pyridin-2-yl)thiazol-2-amine (ICA) exhibited antiarrhythmic effects. ICA prevented electrically induced runs of atrial fibrillation in the isolated right atrium and induced...

  3. Massively dilated right atrium masquerading as a mediastinal tumor

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    Thomas Schroeter

    2011-04-01

    Full Text Available Severe tricuspid valve insufficiency causes right atrial dilatation, venous congestion, and reduced atrial contractility, and may eventually lead to right heart failure. We report a case of a patient with severe tricuspid valve insufficiency, right heart failure, and a massively dilated right atrium. The enormously dilated atrium compressed the right lung, resulting in a radiographic appearance of a mediastinal tumor. Tricuspid valve repair and reduction of the right atrium was performed. Follow up examination revealed improvement of liver function, reduced peripheral edema and improved New York Heart Association (NYHA class. The reduction of the atrial size and repair of the tricuspid valve resulted in a restoration of the conduit and reservoir function of the right atrium. Given the chronicity of the disease process and the long-standing atrial fibrillation, there is no impact of this operation on right atrial contraction. In combination with the reconstruction of the tricuspid valve, the reduction atrioplasty will reduce the risk of thrombembolic events and preserve the right ventricular function.

  4. [Peculiarities of the transesophageal echocardiography in octogenarian patients].

    Science.gov (United States)

    Canale, Jesús M; Cardoza-Encinas, Rubén; Canale-Segovia, Andrés

    The growing trend in the absolute and relative number of elderly in the population scheme, the increasing prevalence of heart disease as people get older and the impressive technological development of ultrasound devices have all together recently contributed to promote an increasing number of transesophageal echocardiograms in older patients, however, the already published information about the distinguishing features of this diagnostic methodology in elderly patients is still scarce and seems to be insufficient. This review focuses on the already published methodological and diagnostic features related to the transesophageal echocardiography in the octogenarian -or even older patient- in order to show them in an orderly and systematic manner to provide elements that induce useful clinical criteria for the physician who attends patients in this age group in whom this diagnostic modality is now increasingly requested. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  5. Trans-esophageal echocardiography for tricuspid and pulmonary valves

    Directory of Open Access Journals (Sweden)

    Prabhu Mahesh

    2009-01-01

    Full Text Available Transesophageal echocardiography has been shown to provide unique information about cardiac anatomy, function, hemodynamics and blood flow and is relatively easy to perform with a low risk of complications. Echocardiographic evaluation of the tricuspid and pulmonary valves can be achieved with two-dimensional and Doppler imaging. Transesophageal echocardiography of these valves is more challenging because of their complex structure and their relative distance from the esophagus. Two-dimensional echocardiography allows an accurate visualization of the cardiac chambers and valves and their motion during the cardiac cycle. Doppler echocardiography is the most commonly used diagnostic technique for detecting and evaluating valvular regurgitation. The lack of good quality evidence makes it difficult to recommend a validated quantitative approach but expert consensus recommends a clinically useful qualitative approach. This review ennumerates probe placement, recommended cross-sectional views, flow patterns, quantitative equations including the clinical approach to the noninvasive quantification of both stenotic and regurgitant lesions.

  6. Atrial fibrillation: effects beyond the atrium?

    Science.gov (United States)

    Wijesurendra, Rohan S; Casadei, Barbara

    2015-03-01

    Atrial fibrillation (AF) is the most common sustained clinical arrhythmia and is associated with significant morbidity, mostly secondary to heart failure and stroke, and an estimated two-fold increase in premature death. Efforts to increase our understanding of AF and its complications have focused on unravelling the mechanisms of electrical and structural remodelling of the atrial myocardium. Yet, it is increasingly recognized that AF is more than an atrial disease, being associated with systemic inflammation, endothelial dysfunction, and adverse effects on the structure and function of the left ventricular myocardium that may be prognostically important. Here, we review the molecular and in vivo evidence that underpins current knowledge regarding the effects of human or experimental AF on the ventricular myocardium. Potential mechanisms are explored including diffuse ventricular fibrosis, focal myocardial scarring, and impaired myocardial perfusion and perfusion reserve. The complex relationship between AF, systemic inflammation, as well as endothelial/microvascular dysfunction and the effects of AF on ventricular calcium handling and oxidative stress are also addressed. Finally, consideration is given to the clinical implications of these observations and concepts, with particular reference to rate vs. rhythm control. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  7. [Quantification of mitral regurgitation by cine-MRI. Comparison with transesophageal echocardiography in 45 patients].

    Science.gov (United States)

    Ambrosi, P; Habib, G; Ferracci, A; Faugère, G; Luccioni, R; Bernard, P J

    1997-11-01

    Cine-MRI demonstrates the presence of mitral regurgitation by a signal void. This study was undertaken to assess the value of this method for quantification of mitral regurgitation in a population not excluding either patients with mitral valve prostheses or those with atrial fibrillation. The subjects included had a mean age of 59 years and were referred for transoesophageal echocardiography, either for assessment of valvular heart disease (38 patients), or for detection of atrial thrombosis before external electrical cardioversion (7 patients). Eight patients had mitral valve prostheses and 19 were in atrial fibrillation. Cine-MRI was performed within 12 days of the transoesophageal echocardiography study with a 1.5 tesla magnet, using a sequence of gradient echo in 3 parallel planes in the 4 chamber view. The regurgitation was quantified by MRI from the extension of the signal void in the left atrium. The transoesophageal Doppler echocardiographic criteria were the width of the regurgitant jet at its origin, the intensity of the regurgitation signal recorded by continuous wave Doppler and the extension of the jet within the left atrium. The quantification by degrees 1 to 4 did not differ by more than 1 degree between the 2 techniques in 43 of the 45 patients. Out of 4 left atrial thrombus detected by transoesophageal echocardiography, only 1 was visible by MRI. The authors concluded that quantification of mitral regurgitation by cine-MRI provides similar results to those obtained by transoesophageal echocardiography and that the correlation remains valid in cases of atrial fibrillation. However, Doppler echocardiography provides further valuable information for the clinician.

  8. Early morphogenesis of the sinuatrial region of the chick heart: a contribution to the understanding of the pathogenesis of direct pulmonary venous connections to the right atrium and atrial septal defects in hearts with right isomerism of the atrial appendages.

    Science.gov (United States)

    Männer, Jörg; Merkel, Nico

    2007-02-01

    The morphogenesis of the sinuatrial region of embryonic hearts is still not well understood. Current matters of dispute are the topogenesis of the future pulmonary vein orifice and the topogenesis of the primary atrial septum. We analyzed the development of the sinuatrial region in chick embryos ranging from Hamburger and Hamilton (HH) stage 14 to 25. Our study disclosed three features of sinuatrial development. First, the primitive atrium of the HH stage 16 chick embryo heart has a separate inflow component. This inflow component takes up the mouth of the confluence of the systemic veins (sinus venosus) as well as the future mouth of the common pulmonary vein (pulmonary pit). The left portion of the atrial inflow component becomes incorporated into the left atrium and its right portion becomes incorporated into the right atrium. Rightward growth of the sinuatrial fold separates the sinus venosus from the left atrium. Second, the pulmonary pit originally forms as a bilaterally paired structure. Its left and right portions are connected to the left and right portions of the atrial inflow component, respectively. Normally, only the left portion of the pulmonary pit deepens to form the common pulmonary vein orifice, whereas the right portion disappears. Third, the primary atrial septum of the chick heart is not formed at the original midline of the embryonic heart, but is formed to the left of the original midline. This finding is in accord with molecular data suggesting that the primary atrial septum derives from the left heart-forming field. Our findings shed new light on the pathogenesis of direct pulmonary venous connections to the right atrium and atrial septal defects in hearts with right isomerism of the atrial appendages.

  9. Left atrial appendage occlusion

    Directory of Open Access Journals (Sweden)

    Ahmad Mirdamadi

    2013-01-01

    Full Text Available Left atrial appendage (LAA occlusion is a treatment strategy to prevent blood clot formation in atrial appendage. Although, LAA occlusion usually was done by catheter-based techniques, especially percutaneous trans-luminal mitral commissurotomy (PTMC, it can be done during closed and open mitral valve commissurotomy (CMVC, OMVC and mitral valve replacement (MVR too. Nowadays, PTMC is performed as an optimal management of severe mitral stenosis (MS and many patients currently are treated by PTMC instead of previous surgical methods. One of the most important contraindications of PTMC is presence of clot in LAA. So, each patient who suffers of severe MS is evaluated by Trans-Esophageal Echocardiogram to rule out thrombus in LAA before PTMC. At open heart surgery, replacement of the mitral valve was performed for 49-year-old woman. Also, left atrial appendage occlusion was done during surgery. Immediately after surgery, echocardiography demonstrates an echo imitated the presence of a thrombus in left atrial appendage area, although there was not any evidence of thrombus in pre-pump TEE. We can conclude from this case report that when we suspect of thrombus of left atrial, we should obtain exact history of previous surgery of mitral valve to avoid misdiagnosis clotted LAA, instead of obliterated LAA. Consequently, it can prevent additional evaluations and treatments such as oral anticoagulation and exclusion or postponing surgeries including PTMC.

  10. The hemodynamic response to dopamine and nitroprusside following right atrium-pulmonary artery bypass (Fontan procedure).

    Science.gov (United States)

    Williams, D B; Kiernan, P D; Schaff, H V; Marsh, H M; Danielson, G K

    1982-07-01

    Cardiac output is critically dependent upon pulmonary vascular resistance after right atrium-pulmonary artery bypass (Fontan procedure), since there is no pulmonary ventricle in the circulation. Inotropic agents, including dopamine, may increase pulmonary vascular resistance and, therefore, might have an adverse effect on cardiac output. The present study determined the hemodynamic responses to dopamine and nitroprusside of 9 patients following right atrium-pulmonary artery bypass. Particular attention was given to effects on cardiac output (CI), pulmonary vascular resistance, and right atrial pressure (RAP). Baseline hemodynamic data were measured without drugs, with dopamine at 7.5 micrograms/kg/min, with sodium nitroprusside up to 5.0 micrograms/kg/min, and with a combination of dopamine, 7.5 micrograms/kg/min, and sodium nitroprusside, 1.0 micrograms/kg/min. Right and left atrial pressures (LAP), mean arterial blood pressure (BP), heart rate (HR), and CI were measured. Stroke volume index and pulmonary arteriolar resistance index were calculated. The increase in CI from baseline (1.98 +/- 0.86 liters per minute) was significant for infusions of dopamine (2.75 +/- 1.05, p less than 0.001), sodium nitroprusside (2.57 +/- 0.78, p less than 0.001), and both drugs (2.74 +/- 0.84, p less than 0.001). The increased CI was achieved primarily by a significant increase in HR with dopamine and by an increase in stroke volume index with sodium nitroprusside. With a similar increment in CI, the RAP was significantly decreased from baseline (21 +/- 4 torr) with sodium nitroprusside (15 +/- 3, p less than 0.001) but was unchanged with dopamine. Pulmonary arteriolar resistance index decreased significantly from baseline (375 +/- 230 dynes sec cm-5/m2) with sodium nitroprusside (169 +/- 132, p less than 0.001), and, interestingly, with dopamine as well (273 +/- 165, p less than 0.05). Both dopamine and sodium nitroprusside in these dosages have favorable effects on CI and

  11. Emerging Concepts in Transesophageal Echocardiography [version 1; referees: 3 approved

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    Cory Maxwell

    2016-03-01

    Full Text Available Introduced in 1977, transesophageal echocardiography (TEE offered imaging through a new acoustic window sitting directly behind the heart, allowing improved evaluation of many cardiac conditions. Shortly thereafter, TEE was applied to the intraoperative environment, as investigators quickly recognized that continuous cardiac evaluation and monitoring during surgery, particularly cardiac operations, were now possible. Among the many applications for perioperative TEE, this review will focus on four recent advances: three-dimensional TEE imaging, continuous TEE monitoring in the intensive care unit, strain imaging, and assessment of diastolic ventricular function.

  12. Primary malignant fibrous histiocytoma involving the left pulmonary vein presenting as a left atrial tumor

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    Saikat Bandyopadhyay

    2013-01-01

    Full Text Available A 35-year-old woman presented with 4 months history of progressively increasing intermittent dyspnea and hemoptysis. Transthoracic echocardiography revealed a loculated mass in the left atrium (LA. A provisional diagnosis of LA myxoma was made. Intraoperatively the tumor was found extending into and closely adherent to the left pulmonary vein and could not be completely cleared off from the pulmonary venous wall. The histopathological examination of the tumor revealed it to be a myxoid malignant fibrous histiocytoma.

  13. EXAMINATION OF ELECTROPHYSIOLOGICAL PARAMETERS OF THE ATRIUMS IN PATIENTS WITH LONG-TERM PERSISTENT FORM OF ATRIAL FIBRILLATION AND VALVULAR HEART DISEASE

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    A. A. Kulikov

    2017-01-01

    Full Text Available The study objective is to examine electrophysiological parameters of atrial myocardium, characteristics of atrioventricular conduction, and potential factors affecting recurrent atrial fibrillation (AF in patients with persistent and long-term persistent forms of AF prior to the Labirynth IIIB surgery with single-step correction of valvular heart disease.Materials and methods. The study included 100 adults (48 men, 52 women with persistent and long-term persistent forms of AF and different valvular heart diseases. Mean patient age was 59 years. Mean AF duration was 4 years. All patients were prescribed antiarrhythmic therapy but it proved ineffective. In 15 % of patients, restoration of the sinus rhythm was attempted through electrical cardioversion but long-term control of the sinus rhythm wasn’t achieved. All patients were diagnosed with organic pathology of the mitral valve. Also, in 80 % of patients, relative insufficiency of the tricuspid valve was detected. Chronic heart failure functional class per NYHA was III. Size of the left atrium was 5 cm, mean left ventricular ejection fraction was 61 %. All patients underwent electrical cardioversion. After successful restoration of the sinus rhythm, endocardial electrophysiology study (EES of the heart was performed. Then, correction of valvular pathologies and the Labyrinth IIIB surgery were performed. Results. Examination of refractoriness of different parts of the atriums has shown that effective refractory period (ERP of the atrioventricular node was minimal compared to other parts of the atriums. Maximal ERP duration was observed in the upper part of the right atrium. Therefore, in patients with long history of AF, heterogeneity of atrial myocardium ERP duration is observed. In 17 % of patients, atrial vulnerability was detected. The area of atrial vulnerability was always associated with ERP. Its duration in patients with atrial vulnerability was significantly higher.Conclusion. Long

  14. Right coronary fistula and aneurysm draining to the right atrium.

    Science.gov (United States)

    Pesonen, Erkki; Hochbergs, Peter

    2009-09-01

    In a 3-year-old boy, a continuous heart murmur was heard. The echocardiogram showed a dilated right coronary artery suggesting the existence of a coronary fistula. A more detailed echocardiogram when the patient was sedated revealed a fistula leading to a large aneurysm and further to the right atrium. The accidental dissection and thrombosis during the interventional heart catheterization resulted in a closure of the fistula. A continuous heart murmur and a dilated coronary artery are the hallmarks of coronary fistula. Anatomic details of coronary fistula might be possible to see in an echocardiogram. Interventional heart catheterization is usually an adequate treatment option.

  15. Simulation of Left Atrial Function Using a Multi-Scale Model of the Cardiovascular System

    Science.gov (United States)

    Pironet, Antoine; Dauby, Pierre C.; Paeme, Sabine; Kosta, Sarah; Chase, J. Geoffrey; Desaive, Thomas

    2013-01-01

    During a full cardiac cycle, the left atrium successively behaves as a reservoir, a conduit and a pump. This complex behavior makes it unrealistic to apply the time-varying elastance theory to characterize the left atrium, first, because this theory has known limitations, and second, because it is still uncertain whether the load independence hypothesis holds. In this study, we aim to bypass this uncertainty by relying on another kind of mathematical model of the cardiac chambers. In the present work, we describe both the left atrium and the left ventricle with a multi-scale model. The multi-scale property of this model comes from the fact that pressure inside a cardiac chamber is derived from a model of the sarcomere behavior. Macroscopic model parameters are identified from reference dog hemodynamic data. The multi-scale model of the cardiovascular system including the left atrium is then simulated to show that the physiological roles of the left atrium are correctly reproduced. This include a biphasic pressure wave and an eight-shaped pressure-volume loop. We also test the validity of our model in non basal conditions by reproducing a preload reduction experiment by inferior vena cava occlusion with the model. We compute the variation of eight indices before and after this experiment and obtain the same variation as experimentally observed for seven out of the eight indices. In summary, the multi-scale mathematical model presented in this work is able to correctly account for the three roles of the left atrium and also exhibits a realistic left atrial pressure-volume loop. Furthermore, the model has been previously presented and validated for the left ventricle. This makes it a proper alternative to the time-varying elastance theory if the focus is set on precisely representing the left atrial and left ventricular behaviors. PMID:23755183

  16. Simulation of left atrial function using a multi-scale model of the cardiovascular system.

    Directory of Open Access Journals (Sweden)

    Antoine Pironet

    Full Text Available During a full cardiac cycle, the left atrium successively behaves as a reservoir, a conduit and a pump. This complex behavior makes it unrealistic to apply the time-varying elastance theory to characterize the left atrium, first, because this theory has known limitations, and second, because it is still uncertain whether the load independence hypothesis holds. In this study, we aim to bypass this uncertainty by relying on another kind of mathematical model of the cardiac chambers. In the present work, we describe both the left atrium and the left ventricle with a multi-scale model. The multi-scale property of this model comes from the fact that pressure inside a cardiac chamber is derived from a model of the sarcomere behavior. Macroscopic model parameters are identified from reference dog hemodynamic data. The multi-scale model of the cardiovascular system including the left atrium is then simulated to show that the physiological roles of the left atrium are correctly reproduced. This include a biphasic pressure wave and an eight-shaped pressure-volume loop. We also test the validity of our model in non basal conditions by reproducing a preload reduction experiment by inferior vena cava occlusion with the model. We compute the variation of eight indices before and after this experiment and obtain the same variation as experimentally observed for seven out of the eight indices. In summary, the multi-scale mathematical model presented in this work is able to correctly account for the three roles of the left atrium and also exhibits a realistic left atrial pressure-volume loop. Furthermore, the model has been previously presented and validated for the left ventricle. This makes it a proper alternative to the time-varying elastance theory if the focus is set on precisely representing the left atrial and left ventricular behaviors.

  17. Left Ventricular Assist Device Insertion in a Patient With Biventricular Noncompaction Cardiomyopathy, Ebstein Anomaly, and a Left Atrial Mass: A Case Report.

    Science.gov (United States)

    Kumar, Nikhil; Troianos, Christopher A; Baisden, Joshua S

    2016-12-15

    In this report, we present the case of a patient with biventricular noncompaction cardiomyopathy, Ebstein anomaly, and a left atrial mass who required emergent placement of a left ventricular assist device. The noncompaction cardiomyopathy complicated the left ventricular assist device implantation procedure because the thickened, trabeculated myocardium made it difficult to place the inflow cannula. We discuss our perioperative management strategy, in which transesophageal echocardiography was used, to help the surgical team identify the proper cannula placement and provide a bridge to transplantation.

  18. The prognostic value of left atrial peak reservoir strain in acute myocardial infarction is dependent on left ventricular longitudinal function and left atrial size

    DEFF Research Database (Denmark)

    Ersboll, M; Andersen, Mads Jønsson; Valeur, N.

    2013-01-01

    BACKGROUND: Peak atrial longitudinal strain (PALS) during the reservoir phase has been proposed as a measure of left atrium function in a range of cardiac conditions, with the potential for added pathophysiological insight and prognostic value. However, no studies have assessed the interrelation ...

  19. The Prognostic Value of Left Atrial Peak Reservoir Strain in Acute Myocardial Infarction Is Dependent on Left Ventricular Longitudinal Function and Left Atrial Size

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Andersen, Mads J; Valeur, Nana

    2013-01-01

    BACKGROUND: Peak atrial longitudinal strain (PALS) during the reservoir phase has been proposed as a measure of left atrium function in a range of cardiac conditions, with the potential for added pathophysiological insight and prognostic value. However, no studies have assessed the interrelation ...

  20. Visualization of atrial septal aneurysm and patent foramen ovale by three-dimensional transesophageal echocardiography.

    Science.gov (United States)

    Najib, Mohammad Q; Ganji, Jhansi L; Chaliki, Hari P

    2016-12-01

    : Transesophageal echocardiography is frequently performed for further evaluation of sources of embolism and better evaluation of atrial septum in patients with cerebral ishemic events. Although two-dimensional transesophageal echocardiography can depict atrial septal aneurysm and patent foramen ovale, the full extent of the patent foramen ovale cannot be easily discerned in some cases. We describe a patient with transient cerebral ischemia where three-dimensional echocardiography provided incremental value when compared to two-dimensional transesophageal echocardiography in the assessment of atrial septal aneurysm and patent foramen ovale.

  1. Dose efetiva de sedação em ecocardiograma transesofágico: relação com idade, área de superfície e função do ventrículo esquerdo Dosis efectiva de sedación en ecografía transesofágica: relación con edad, área de superficie y función del VI Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function

    Directory of Open Access Journals (Sweden)

    Guilherme Moreira José

    2009-12-01

    ón de eyección del ventrículo izquierdo, estudiamos dos grupos: GA: 55%. En el análisis estadístico utilizamos el test de Kruskal-Wallis para correlación con edad y fracción de eyección del ventrículo izquierdo, y correlación lineal simple para área de superficie corporal. RESULTADOS: En el estudio de la edad, las dosis medias de sedación necesarias fueron significativamente menores en el G3 y G4 (p BACKGROUND: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case. OBJECTIVE: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction. METHODS: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml, meperidine 1 mg (1 ml and distilled water (7.5 ml. Four age groups were analyzed: G1: 65 years. Body surface area was calculated using the formula {[(height x 1000.725] x (weight0.425 x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: 55%. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area. RESULTS: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01. The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01. The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null. CONCLUSION: The mean dose of sedatives required was lower in older individuals and in those with left ventricular systolic dysfunction. No correlation with body surface area was found.

  2. Common Atrium with Unusual Electrocardiogram in Ellis-van Creveld Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Amit Kumar

    2015-01-01

    This report describes a case of common atrium with unusual electrocardiographic findings in a patient with EVC syndrome. This 17-year-old male of Indian origin born of a consanguineous marriage had short stature, genu valgum, polydactyly, gingival hypertrophy, multiple frenula, common atrium, and right axis deviation of QRS with clockwise depolarization in electrocardiogram.

  3. Intraoperative Diagnosis of Stanford Type A Dissection by Transesophageal Echocardiogram in a Patient Presenting for Renal Transplantation

    Directory of Open Access Journals (Sweden)

    William R. Hand

    2011-01-01

    Full Text Available A 48-year-old patient with hypertensive end-stage renal disease presented for cadaveric renal transplantation. On physical exam, a previously undocumented diastolic murmur was heard loudest at the left lower sternal border. The patient had a history of pericardial effusions and reported “a feeling of chest fullness” when lying flat. As such, a transesophageal echocardiogram (TEE was performed after induction of anesthesia to evaluate the pericardial space and possibly determine the etiology and severity of the new murmur. The TEE revealed a Stanford Type A aortic dissection. The renal transplant was cancelled (organ reassigned within region, and the patient underwent an urgent ascending and proximal hemiarch aortic replacement. This case demonstrates the importance of a thorough physical exam and highlights the utility of TEE for noncardiac surgical cases.

  4. What is Clinical Efficacy of Transesophageal Echocardiography in Patients With Cryptogenic Stroke?: A Critically Appraised Topic.

    Science.gov (United States)

    Christiansen, Michael E; Van Woerkom, Ryan C; Demaerschalk, Bart M; Wingerchuk, Dean M; O'Carroll, Cumara B

    2018-01-01

    Adults with cryptogenic stroke often undergo transesophageal echocardiogram (TEE) because this is the gold-standard for evaluation of potential proximal sources of emboli. The risks of performing this invasive test must be weighed against its clinical efficacy and limitations, determined by the rate of positive findings, and the impact on clinical outcome for the patient. To critically appraise current evidence regarding the rate of positive TEE findings in cryptogenic stroke patients, and analyze the implications of these findings on management decisions and outcomes. The objective was addressed through the development of a structured, critically appraised topic. We incorporated a clinical scenario, background information, a structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, and vascular neurology and cardiology content experts. TEE commonly identifies abnormalities, including aorta atherosclerosis in 51%, patent foramen ovale in 43%, and atrial septal aneurysm in 13% of patients. Findings such as left-sided chamber thrombus or intracardiac tumor that definitively warrant a change in management by guideline-supported use of anticoagulation are less common, occurring in ∼3% of patients. TEE identifies potential causal sources of embolus in patients with cryptogenic stroke that leads to changes in management and outcomes at least 3% of the time. Other findings, particularly aorta atherosclerosis, are identified much more commonly but the causal link to stroke is uncertain, thus changes in management in these cases is variable and data describing resulting outcomes are lacking.

  5. Left atrium in cardiac resynchronization therapy: Active participant or innocent bystander

    Directory of Open Access Journals (Sweden)

    Haitham A. Badran

    2017-10-01

    Conclusions: CRT induces LA anatomic, electrical, and structural reverse remodeling that could be assessed by conventional 2D echocardiography and 2D (ɛ strain imaging. LA dimension and volumes were independent predictors of response to CRT and can help in selection of candidates for it.

  6. Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Huo, Yan; Gaspar, Thomas; Pohl, Matthias

    2017-01-01

    Aims: To describe the extent and distribution of low voltage zones (LVZ) in a large cohort of patients undergoing ablation for paroxysmal and persistent atrial fibrillation (AF), and to explore baseline predictors of LVZ in these patients. Methods and results: Consecutive patients who underwent...... was present in 58 out of 292 patients with paroxysmal and 134 out of 247 persistent AF (P paroxysmal AF, 5 cm2 (IQR 3-18.6) vs. 12.1 cm2 (IQR 3.6-28.5), P = 0.026, respectively. In the multivariate analysis age (OR 1.07, 95%CI 1...... of LVZ. Conclusion: In a large cohort of patients undergoing ablation for AF, the prevalence of LVZ was higher and LVZ areas larger in patients with persistent as compared with paroxysmal AF. The most frequent localization of LVZ was anterior wall, septum and posterior wall. Presence of LVZ...

  7. Idiopathic Pulmonary Vein Thrombus Extending into Left Atrium: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Muhammad Asim Rana

    2016-01-01

    Full Text Available Pulmonary vein thrombosis (PVT is rather an uncommon condition which presents nonspecifically and is usually associated with lung malignancy and major pulmonary surgery. Rarely could no cause be found. It causes increased pulmonary venous pressure leading to pulmonary arterial vasoconstriction and subsequent pulmonary arterial hypertension and subsequently can cause cor pulmonale if not addressed in timely fashion. Other associated complications like peripheral embolization and stroke have also been reported. This case emphasizes the importance of maintaining high index of clinical suspicion especially when CT pulmonary angiogram is negative for pulmonary embolism.

  8. Hypnosis for sedation in transesophageal echocardiography: a comparison with midazolam.

    Science.gov (United States)

    Eren, Gulay; Dogan, Yuksel; Demir, Guray; Tulubas, Evrim; Hergunsel, Oya; Tekdos, Yasemin; Dogan, Murat; Bilgi, Deniz; Abut, Yesim

    2015-01-01

    Transesophageal echocardiography (TEE), being a displeasing intervention, usually entails sedation. We aimed to compare the effects of hypnosis and midazolam for sedation in TEE. A prospective single-blinded study conducted on patients scheduled for TEE between April 2011 and July 2011 at a university in Istanbul, Turkey. A total of 41 patients underwent sedation using midazolam and 45 patients underwent hypnosis. Patients were given the State-Trait Anxiety Inventory (STAI) test for anxiety and continuous performance test (CPT) for alertness before and after the procedure. The difficulty of probing and the overall procedure rated by the cardiologist and satisfaction scores of the patients were also documented. Anxiety was found to be less and attention more in the hypnosis group, as revealed by STAI and CPT test scores (P Hypnosis proved to be associated with positive therapeutic outcomes for TEE with regard to alleviation of anxiety and maintenance of vigilance, thus providing more satisfaction compared to sedation with midazolam.

  9. Esophageal Perforation due to Transesophageal Echocardiogram: New Endoscopic Clip Treatment

    Directory of Open Access Journals (Sweden)

    John Robotis

    2014-07-01

    Full Text Available Esophageal perforation due to transesophageal echocardiogram (TEE during cardiac surgery is rare. A 72-year-old female underwent TEE during an operation for aortic valve replacement. Further, the patient presented hematemesis. Gastroscopy revealed an esophageal bleeding ulcer. Endoscopic therapy was successful. Although a CT scan excluded perforation, the patient became febrile, and a second gastroscopy revealed a big perforation at the site of ulcer. The patient's clinical condition required endoscopic intervention with a new OTSC® clip (Ovesco Endoscopy, Tübingen, Germany. The perforation was successfully sealed. The patient remained on intravenous antibiotics, proton pump inhibitors and parenteral nutrition for few days, followed by enteral feeding. She was discharged fully recovered 3 months later. We clearly demonstrate an effective, less invasive treatment of an esophageal perforation with a new endoscopic clip.

  10. Cerebral embolism complicating left atrial myxoma: a case report.

    Science.gov (United States)

    Ihsen, Zairi; Hela, Mssaad; Khadija, Mzoughi; Zouhayer, Jnifene

    2016-01-01

    Cardiac myxoma are the most common benign primary cardiac tumors that can lead to many complications as described in literature. Here we report the case of a boy aged 11 that was referred for etiological diagnosis of ischemic stroke. Transthoracic echocardiography reveals a myxoma in the left atrium. Patient was referred to surgery. The diagnosis was confirmed and the mass was completely resected.

  11. Simulator-based Transesophageal Echocardiographic Training with Motion Analysis A Curriculum-based Approach

    NARCIS (Netherlands)

    Matyal, Robina; Mitchell, John D.; Hess, Philip E.; Chaudary, Bilal; Bose, Ruma; Jainandunsing, Jayant S.; Wong, Vanessa; Mahmood, Feroze

    Background: Transesophageal echocardiography (TEE) is a complex endeavor involving both motor and cognitive skills. Current training requires extended time in the clinical setting. Application of an integrated approach for TEE training including simulation could facilitate acquisition of skills and

  12. Diffuse Gallium-67 Accumulation in the Left Atrial Wall Detected Using SPECT/CT Fusion Images

    Directory of Open Access Journals (Sweden)

    Kohei Kotani

    2016-01-01

    Full Text Available Gallium-67 scintigraphy is useful for detecting active inflammation. We show a 66-year-old female patient with atrial fibrillation and diffuse thickening of the left atrial wall due to acute myocarditis, who presented diffuse abnormal accumulation of gallium-67 in the left atrium on single photon emission computed tomography/computed tomography (SPECT/CT fusion images. In the second gallium-67 scan 2 months after the first scintigraphy, the abnormal accumulation in the heart was no longer visible. Gallium-67 SPECT/CT images helped understanding the disease condition that temporary inflammation in the left atrium caused atrial fibrillation.

  13. Heart failure due to giant left atrial myxoma: a case report

    Directory of Open Access Journals (Sweden)

    Giuston Mendoza-Chuctaya

    2016-04-01

    Full Text Available Myxomas are frequent cardiac tumors that are mostly located in the left atrium. Their signs and symptoms are very varied and nonspecific, and depend on their behavior. We report the case of a 41-year-old female patient with a disease period of approximately 3 months, and a clinical picture suggesting heart failure characterized by respiratory difficulty at rest, chest pain, general malaise and edema on lower limbs. The EKG suggested left atrial growth, where transthoracic echocardiography was a key test for the diagnosis of a myxoma filling the entire left atrium, which was later excised by surgery and confirmed by pathological anatomy

  14. The Relationship between Left Atrial Mechanical Function and Functional Capacity in Mitral Stenosis

    Directory of Open Access Journals (Sweden)

    Mücahit Yetim

    2013-11-01

    Full Text Available Aim: In this study, left atrial functions of patients with rheumatic mitral stenosis and sinus rhythm, which was determined by transthorasic echocardiography, was compared with those of healhty subjects and the association of left atrial functions with functional capacity was investigated in subgroup analyses.   Material and methods: 32 patients with isolated rheumatic mitral stenosis (median age was 39.1±11  (group 1 and 20 patients in the control group ( median age was 37±8,2 (group 2 were enrolled to study. The average mitral valve area of patients was 1.1±0,3 cm2. When patients were divided according to New York Heart Association (NYHA classification ; 16 patients were NYHA 2 (Grup A and 16 patients were NYHA 3 (Grup B. There were not any asymptomatic patients and no patients were NYHA 4. Left atrium diameters, left atrium volume, left atrium fractional area change and left atrium ejection fractions  of patients in these groups were calculated.   Results: The demographic characteristics of patients is shown in table 1. Left atrium ejection fraction (LAEF and left atrium fractional area change (LAFAC that were determined echocardiographycally were significantly lower in patients with mitral stenosis (32 ± 5, 44 ± 3; p<0.001- 25 ± 11, 32 ± 6; p< 0.02.  When patients were divided according to New York Heart Association (NYHA classification ; 16 patients were NYHA 2 (Grup A and 16 patients were NYHA 3 (Grup B. There were not any asymptomatic patients and no patients were NYHA 4. The clinical and echocardiographic data of patients are shown in table 2. Despite of similar mitral valve area and average mitral gradient ,systolic pulmonary artery pressure was found to be higher in symptomatic group. But there was no difference between left atrial functions of the two groups.   Discussion: In this study we have shown that left atrial functions determined echocardiographically  can decline in patients with mitral stenosis but the

  15. Cardiac impairment evaluated by transesophageal echocardiography and invasive measurements in rats undergoing sinoaortic denervation.

    Directory of Open Access Journals (Sweden)

    Raquel A Sirvente

    Full Text Available BACKGROUND: Sympathetic hyperactivity may be related to left ventricular (LV dysfunction and baro- and chemoreflex impairment in hypertension. However, cardiac function, regarding the association of hypertension and baroreflex dysfunction, has not been previously evaluated by transesophageal echocardiography (TEE using intracardiac echocardiographic catheter. METHODS AND RESULTS: We evaluated exercise tests, baroreflex sensitivity and cardiovascular autonomic control, cardiac function, and biventricular invasive pressures in rats 10 weeks after sinoaortic denervation (SAD. The rats (n = 32 were divided into 4 groups: 16 Wistar (W with (n = 8 or without SAD (n = 8 and 16 spontaneously hypertensive rats (SHR with (n = 8 or without SAD (SHRSAD (n = 8. Blood pressure (BP and heart rate (HR did not change between the groups with or without SAD; however, compared to W, SHR groups had higher BP levels and BP variability was increased. Exercise testing showed that SHR had better functional capacity compared to SAD and SHRSAD. Echocardiography showed left ventricular (LV concentric hypertrophy; segmental systolic and diastolic biventricular dysfunction; indirect signals of pulmonary arterial hypertension, mostly evident in SHRSAD. The end-diastolic right ventricular (RV pressure increased in all groups compared to W, and the end-diastolic LV pressure increased in SHR and SHRSAD groups compared to W, and in SHRSAD compared to SAD. CONCLUSIONS: Our results suggest that baroreflex dysfunction impairs cardiac function, and increases pulmonary artery pressure, supporting a role for baroreflex dysfunction in the pathogenesis of hypertensive cardiac disease. Moreover, TEE is a useful and feasible noninvasive technique that allows the assessment of cardiac function, particularly RV indices in this model of cardiac disease.

  16. Evaluation of acute ischemic mitral regurgitation following cardiopulmonary bypass assessed by biplane transesophageal echocardiography.

    Science.gov (United States)

    Nakao, T; Fujimoto, K; Brodman, R F; Oka, Y

    1997-03-01

    The aim of this study was to evaluate pathogenesis and outcome of acute ischemic mitral regurgitation (MR) in patients undergoing coronary artery bypass grafting (CABG) using biplane transesophageal echocardiography (TEE). Biplane TEE was continuously monitored in a total of 96 patients who were scheduled for elective CABG surgery. Of 96 patients, 10 with no MR at stages 1 (after anesthetic induction but before skin incision) and 2 (after cardiopulmonary bypass [CPB] and decannulation) were excluded. In the remaining 86 patients with MR between stages 1 and 2, 45 (group A) had an increase in MR, and 41 (group B) had a decrease in MR. An increase in MR at stage 2 in group A was associated with a significant increase in annular diameter (p < 0.05), and pulmonary capillary wedge pressure (p < 0.01) compared with stage 1. A significant decrease in the left ventricular end-diastolic area (p < 0.01), end-systolic area (p < 0.05) and the mean wall motion abnormality score (WMA score) (p < 0.001) was observed at stage 2 compared with stage 1 in group B. In 16 of 17 patients (94%) with an increased WMA score in group A, a regional wall motion abnormality (RWMA) was detected in the right coronary artery (RCA) and/or left circumflex coronary artery (LCX) areas. In 7 patients in group A, MR increased continuously until stage 3 (after sternal closure) despite treatment. In 2 of these 7 patients, pulmonary venous systolic flow (PVSF) decreased during stage 2 and persisted to stage 3. The post operative course of these 2 patients was complicated with atrial fibrillation (AF). The increase in annular diameter and worsening in RWMA in RCA and/or LCX areas are associated with acute ischemic MR following CPB. The majority of acute ischemic MR cases were resolved by pharmacological intervention. Post operative AF was noted in 2 patients with acute ischemic MR associated with persistently decreased PVSF following CPB despite treatment.

  17. Overlay Technique for Transcatheter Left Atrial Appendage Closure.

    Science.gov (United States)

    Li, Shuang; Zhu, Mengyun; Lu, Yunlan; Tang, Kai; Zhao, Dongdong; Chen, Wei; Xu, Yawei

    2015-08-01

    The Overlay technique is popular in peripheral artery interventions, but not in coronary or cardiac structural procedures. We present an initial experience using three-episode overlays during a transcatheter left atrial appendage closure. The first overlay was applied to facilitate advancement of the delivery sheath into left atrium. The second overlay was used to navigate the advancement of prepped delivery system containing the compressed occluder into its optimal position in the left atrium. The third overlay facilitated the real-time deployment of the closure device. This case report demonstrates the effectiveness of the overlay technique in facilitating each step of the transcatheter left atrial appendage closure. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  18. Pulmonary vein tumor thrombosis and left atrial extension in lung carcinoma.

    Science.gov (United States)

    Koo, B C; Woldenberg, L S; Kim, K T

    1984-10-01

    A case of lung carcinoma extending into left atrium through a pulmonary vein and mimicking left atrial myxoma is presented. The localized enlargement of a pulmonary vein is seen as a possible CT sign of pulmonary vein tumor thrombosis. Computed tomography (CT) and echocardiography are complementary in the correct diagnosis of this condition.

  19. Functional Tricuspid Regurgitation Caused by Chronic Atrial Fibrillation: A Real-Time 3-Dimensional Transesophageal Echocardiography Study.

    Science.gov (United States)

    Utsunomiya, Hiroto; Itabashi, Yuji; Mihara, Hirotsugu; Berdejo, Javier; Kobayashi, Sayuki; Siegel, Robert J; Shiota, Takahiro

    2017-01-01

    Functional tricuspid regurgitation (TR) with a structurally normal tricuspid valve (TV) may occur secondary to chronic atrial fibrillation (AF). However, the clinical and echocardiographic differences according to functional TR subtypes are unclear. Therefore, characterization of functional TR because of chronic AF (AF-TR) remains undetermined. To investigate the prevalence of AF-TR, 437 patients with moderate to severe TR underwent 3-dimensional (3D) transesophageal echocardiography. TR severity was determined by the averaged vena contracta width on apical and parasternal inflow views. The prevalence of AF-TR was 9.2%, whereas that of functional TR because of left-sided heart disease was 45.3%. Clinical features of AF-TR included advanced age, female sex, greater right atrial than left atrial enlargement and lower systolic pulmonary artery pressure compared with left-sided heart disease-TR with sinus rhythm (all Pdisease-TR with sinus rhythm. On multivariable analysis, only the TV annular area in midsystole (coefficient, 0.059; 95% confidence interval, 0.041-0.078 per 100 mm 2 ; Pdisease-TR. Our results suggest that in patients with TR secondary to AF, TV annuloplasty should be effective because this entity has annular dilatation without leaflet deformation. © 2017 American Heart Association, Inc.

  20. Echocardiographic study of left atrial myxoma

    Directory of Open Access Journals (Sweden)

    Dalal J

    1979-01-01

    Full Text Available Four cases of left atrial myxoma were diagnosed pre-operatively by echocardiography. All cases showed characteristic echocardio-graphic features of variegated shadows behind the mitral valve in diastole and within the left atrium in systole. In two cases the my-xomas were surgically removed and confirmed on histology. In one case the post-operative echocardiogram showed complete dis-appearance of the abnormal shadows. Echocardiography is the most reliable method today for the diagnosis of a myxoma.

  1. Homeostatic Left Heart integration and disintegration links atrio-ventricular covariation's dyshomeostasis in Hypertrophic Cardiomyopathy.

    Science.gov (United States)

    Piras, Paolo; Torromeo, Concetta; Evangelista, Antonietta; Gabriele, Stefano; Esposito, Giuseppe; Nardinocchi, Paola; Teresi, Luciano; Madeo, Andrea; Schiariti, Michele; Varano, Valerio; Puddu, Paolo Emilio

    2017-07-24

    Left ventricle and left atrium are and have been practically always analyzed separately in common clinically and non-clinically oriented cardiovascular investigations. Both classic and speckle tracking echocardiographic data contributed to the knowledge about deformational impairments occurring in systo-diastolic differences. Recently new trajectory based approaches allowed a greater awareness about the entire left ventricle or left atrium revolution and on their deficiencies that take place in presence of hypertrophic cardiomyopathy. However, surprisingly, the concomitant function of the two left heart chambers has not been analyzed for their geometrical/mechanical relationship. For the first time we study here, by acquiring left ventricle and left atrial geometries on the same heartbeat, the trajectory attributes of the entire left heart treated as a whole shape and the shape covariation of its two subunits. We contrasted healthy subjects with patients affected by hypertrophic cardiomyopathy. We found impaired left heart trajectory mainly in terms of orientation and size. More importantly, we found profound differences in the direction of morphological covariation of left ventricle and left atrium. These findings open to new perspectives in pathophysiological evaluation of different diseases by allowing the appreciation of concomitant functioning of both left heart whole geometry and of its two chambers.

  2. Novel, multimodal approach for basic transesophageal echocardiographic teaching.

    Science.gov (United States)

    Mitchell, John D; Mahmood, Feroze; Bose, Ruma; Hess, Philip E; Wong, Vanessa; Matyal, Robina

    2014-06-01

    Web and simulation technology may help in creating a transesophageal echocardiography (TEE) curriculum. The authors discuss the educational principles applied to developing and implementing a multimodal TEE curriculum. The authors modified a pilot course based on principles for effective simulation-based education. Key curricular elements were consistent with principles for effective simulation-based education: (1) clear goals and carefully structured objectives, (2) conveniently accessed, graduated, longitudinal instruction, (3) a protected and optimal learning environment, (4) repetition of concepts and technical skills, (5) progressive expectations for understanding and skill development, (6) introduction of abnormalities after understanding of normal anatomy and probe manipulation is achieved, (7) live learning sessions that are customizable to meet learner needs and individualized proctoring in skill sessions, (8) use of multiple approaches to teaching, (9) regular and relevant feedback, and (10) application of performance and compliance measures. Fifty-five learners participated in a curriculum with web-based modules, live teaching, and simulation practice between August 2011 and May 2013. It is possible to develop and implement an integrated, multimodal TEE curriculum supported by educational theory. The authors will explore the transferability of this approach to intraoperative TEE on live patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Accuracy assessment of fluoroscopy-transesophageal echocardiography registration

    Science.gov (United States)

    Lang, Pencilla; Seslija, Petar; Bainbridge, Daniel; Guiraudon, Gerard M.; Jones, Doug L.; Chu, Michael W.; Holdsworth, David W.; Peters, Terry M.

    2011-03-01

    This study assesses the accuracy of a new transesophageal (TEE) ultrasound (US) fluoroscopy registration technique designed to guide percutaneous aortic valve replacement. In this minimally invasive procedure, a valve is inserted into the aortic annulus via a catheter. Navigation and positioning of the valve is guided primarily by intra-operative fluoroscopy. Poor anatomical visualization of the aortic root region can result in incorrect positioning, leading to heart valve embolization, obstruction of the coronary ostia and acute kidney injury. The use of TEE US images to augment intra-operative fluoroscopy provides significant improvements to image-guidance. Registration is achieved using an image-based TEE probe tracking technique and US calibration. TEE probe tracking is accomplished using a single-perspective pose estimation algorithm. Pose estimation from a single image allows registration to be achieved using only images collected in standard OR workflow. Accuracy of this registration technique is assessed using three models: a point target phantom, a cadaveric porcine heart with implanted fiducials, and in-vivo porcine images. Results demonstrate that registration can be achieved with an RMS error of less than 1.5mm, which is within the clinical accuracy requirements of 5mm. US-fluoroscopy registration based on single-perspective pose estimation demonstrates promise as a method for providing guidance to percutaneous aortic valve replacement procedures. Future work will focus on real-time implementation and a visualization system that can be used in the operating room.

  4. Malignant inferior vena cava obstruction involving right atrium. Palliative treatment with self expandable metallic stent

    International Nuclear Information System (INIS)

    Shao Guoliang; Wang Jianhua; Zhou Kangrong; Yan Zhiping

    2001-01-01

    Objective: To investigate the safety and efficacy of placement of self-expandable metallic stent within right atrium and inferior vena cava (ICV) in patients with malignant ICV obstruction involving right atrium. Methods: There were 5 male patients with advanced hepatocellular carcinoma, aged from 42 to 65 years (mean 56.3 years). The malignancies invaded right atrium and ICV simultaneously, and caused obstruction of ICV. These patients presented symptoms and signs of obstruction of ICV such as hepatomegaly, ascites, edema of lower extremities. 'Z' type stainless steel stents (7.5-10.0 cm in length and 2.5 cm in diameter) were selected for these patients. Part (1.0-3.0 cm in length) of stent was placed in right atrium and the rest was in ICV. Results: All of stents were placed successfully and obstructed ICV reopened. The symptoms of obstruction of ICV relieved or disappeared. There were no recurrence of symptoms of obstruction of ICV and any cardiac complication related to placement of stents in follow-up period (67-188 days). Conclusion: Placement of self-expandable metallic stent within right atrium and ICV in treatment of patients with malignant ICV obstruction involving right atrium is one of the safe and effective methods

  5. Diagnostic accuracy of transesophageal echocardiogram for the detection of patent foramen ovale: a meta-analysis.

    Science.gov (United States)

    Mojadidi, Mohammad Khalid; Bogush, Nikolay; Caceres, Jose Diego; Msaouel, Pavlos; Tobis, Jonathan M

    2014-07-01

    Patent foramen ovale (PFO) is a remnant of the fetal circulation present in 20% of the population. Right-to-left shunting (RLS) through a PFO has been linked to the pathophysiology of stroke, migraine with aura, and hypoxemia. While different imaging modalities including transcranial Doppler, intra-cardiac echo, and transthoracic echo (TTE) have often been used to detect RLS, transesophageal echo (TEE) bubble study remains the gold standard for diagnosing PFO. The aim of this study was to determine the relative accuracy of TEE in the detection of PFO. A systematic review of Medline, using a standard approach for meta-analysis, was performed for all prospective studies assessing accuracy of TEE in the detection of PFO using confirmation by autopsy, cardiac surgery, and/or catheterization as the reference. Search results revealed 3105 studies; 4 met inclusion criteria. A total of 164 patients were included. TEE had a weighted sensitivity of 89.2% (95% CI: 81.1-94.7%) and specificity of 91.4% (95% CI: 82.3-96.8%) to detect PFO. The overall positive likelihood ratio (LR+) was 5.93 (95% CI: 1.30-27.09) and the overall negative likelihood ratio (LR-) was 0.22 (95% CI: 0.08-0.56). While TEE bubble study is considered to be the gold standard modality for diagnosing PFO, some PFOs may still be missed or misdiagnosed. It is important to understand the limitations of TEE and perhaps use other highly sensitive screening tests, such as transcranial doppler (TCD), in conjunction with TEE before scheduling a patient for transcatheter PFO closure. © 2013, Wiley Periodicals, Inc.

  6. Changes in Mitral Annular Geometry after Aortic Valve Replacement: A Three-Dimensional Transesophageal Echocardiographic Study

    Science.gov (United States)

    Mahmood, Feroze; Warraich, Haider J.; Gorman, Joseph H.; Gorman, Robert C.; Chen, Tzong-Huei; Panzica, Peter; Maslow, Andrew; Khabbaz, Kamal

    2014-01-01

    Background and aim of the study Intraoperative real-time three-dimensional transesophageal echocardiography (RT-3D TEE) was used to examine the geometric changes that occur in the mitral annulus immediately after aortic valve replacement (AVR). Methods A total of 35 patients undergoing elective surgical AVR under cardiopulmonary bypass was enrolled in the study. Intraoperative RT-3D TEE was used prospectively to acquire volumetric echocardiographic datasets immediately before and after AVR. The 3D echocardiographic data were analyzed offline using TomTec® Mitral Valve Assessment software to assess changes in specific mitral annular geometric parameters. Results Datasets were successfully acquired and analyzed for all patients. A significant reduction was noted in the mitral annular area (-16.3%, p <0.001), circumference (-8.9% p <0.001) and the anteroposterior (-6.3%, p = 0.019) and anterolateral-posteromedial (-10.5%, p <0.001) diameters. A greater reduction was noted in the anterior annulus length compared to the posterior annulus length (10.5% versus 62%, p <0.05) after AVR. No significant change was seen in the non-planarity angle, coaptation depth, and closure line length. During the period of data acquisition before and after AVR, no significant change was noted in the central venous pressure or left ventricular end-diastolic diameter. Conclusion The mitral annulus undergoes significant geometric changes immediately after AVR Notably, a 16.3% reduction was observed in the mitral annular area. The anterior annulus underwent a greater reduction in length compared to the posterior annulus, which suggested the existence of a mechanical compression by the prosthetic valve. PMID:23409347

  7. Importance of adequately performed Valsalva maneuver to detect patent foramen ovale during transesophageal echocardiography.

    Science.gov (United States)

    Rodrigues, Ana Clara; Picard, Michael H; Carbone, Aime; Arruda, Ana Lúcia; Flores, Thaís; Klohn, Juliana; Furtado, Meive; Lira-Filho, Edgar B; Cerri, Giovanni G; Andrade, José L

    2013-11-01

    Transesophageal echocardiography (TEE) plays an important role in evaluating cardioembolic sources of emboli. The identification of a patent foramen ovale (PFO) is reportedly improved with TEE compared with transthoracic echocardiography (TTE), but the Valsalva maneuver during TEE may be difficult or suboptimal. The aim of this study was to assess the efficacy of the Valsalva maneuver for PFO diagnosis using TEE compared with TTE by evaluating patients with ischemic stroke referred for echocardiography. Only patients able to perform the Valsalva maneuver during TTE were included; efficacy was defined by a 20 cm/sec decrease in transmitral E velocity. A PFO was judged present when microbubbles of agitated intravenous saline were seen in the left chambers within three cycles after right atrial opacification. Of 108 patients (mean age, 55 ± 15 years; 61 men), 48 (44%) were judged to have PFOs by TEE and/or TTE. In 36 patients (33% of the total, 75% of those with PFOs), microbubbles were observed both by TEE and TTE, in seven patients only during TTE, and in five patients only during TEE. In patients able to satisfactorily perform the Valsalva maneuver during TEE, 22 PFOs were found, and two shunts (9%) were missed, whereas in patients unable to perform this maneuver, 26 PFOs were observed, with five shunts missed (19%) (P TTE, either the echocardiographic window was suboptimal or the shunt was small. An adequate Valsalva maneuver is crucial for diagnosis of PFO; most patients with stroke may be screened using TTE with contrast and the Valsalva maneuver, with TEE indicated in case of suboptimal transthoracic images. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  8. Transesophageal echocardiographic evaluation of native aortic valve area: utility of the double-envelope technique.

    Science.gov (United States)

    Maslow, A D; Mashikian, J; Haering, J M; Heindel, S; Douglas, P; Levine, R

    2001-06-01

    To assess the accuracy of aortic valve area (AVA) calculations using the continuity equation with data obtained from the double envelope (DE) (simultaneously obtained left ventricular outflow tract [V1]) and aortic valve [V2] velocities) during intraoperative transesophageal echocardiography (TEE). Prospective study; measurements were performed on-line. University hospital. Cardiac and noncardiac surgical patients (n = 75) with recent aortic valve assessment (AVA was measured by the continuity equation using the DE technique (DE/TEE) and by planimetry (PL/TEE). Left ventricular outflow tract diameter was obtained from midesophageal views, whereas subvalvular (V1) and valvular (V2) velocities were obtained simultaneously using continuous-wave Doppler from transgastric views. V1 was also obtained using pulsed-wave Doppler. Measurements were compared with AVA obtained preoperatively by the Gorlin equation during cardiac catheterization (G/CATH) or by transthoracic echocardiography using the traditional continuity equation (C/TTE) (nonsimultaneously obtained V1 and V2). A DE was obtained in 73 of 75 patients (97%). Four patients had atrial fibrillation at the time of the examination, whereas the rest were in sinus rhythm. PL/TEE was performed in 54 of 71 patients with sinus rhythm (76%). Agreement was good between DE/TEE and G/CATH (mean bias, 0.02 cm(2) [SD, 0.24 cm(2)]), and C/TTE (mean bias, -0.05 cm(2) [SD, 0.16 cm(2)]). Agreement was not as good between PL/TEE and G/CATH (mean bias, -0.07 cm(2) [SD, 0.28 cm(2)]) and C/TTE (mean bias, -0.13 cm(2) [SD, 0.30 cm(2)]). V1 obtained by pulsed-wave Doppler and with DE closely agreed (mean bias, 0.01 m/sec [SD, 0.05 m/sec]). TEE evaluation of native AVA using the DE technique is feasible and in good agreement with that obtained by C/TTE and G/CATH. Compared with DE/TEE, PL/TEE did not agree as well. Use of DE/TEE should simplify the continuity equation and may minimize errors resulting from beat-to-beat variability in

  9. Left atrial volume and function in patients following ST elevation myocardial infarction and the association with clinical outcome

    DEFF Research Database (Denmark)

    Lønborg, Jacob Thomsen; Engstrøm, Thomas; Møller, Jacob Eifer

    2013-01-01

    The left atrium (LA) transfers blood to the left ventricle in a complex manner. LA function is characterized by passive emptying (LA passive fraction), active emptying (LA ejection fraction), and total emptying (LA fractional change). Despite this complexity, the clinical relevance of the LA is b...

  10. Isolated tear in left atrial appendage due to blunt trauma chest: A rare case report

    OpenAIRE

    Salooja, Manpreet S.; Singla, Manender; Srivastava, Anupam; Mukherjee, Kishore C.

    2013-01-01

    Blunt traumatic cardiac rupture is associated with a high mortality rate. Motor vehicle accidents account for most cardiac ruptures, but crush injury is relatively rare. We describe a case of a 72-year-old man who had the left atrial appendage ruptured through blunt trauma due to a fall from scooter. Simple suture repair of the atrial appendage was achieved after clamping the base of the left atrium to control the bleeding. He recovered without complication. Traumatic injury to left atrial ap...

  11. Systematic analysis of gene expression differences between left and right atria in different mouse strains and in human atrial tissue.

    Directory of Open Access Journals (Sweden)

    Peter C Kahr

    Full Text Available BACKGROUND: Normal development of the atria requires left-right differentiation during embryonic development. Reduced expression of Pitx2c (paired-like homeodomain transcription factor 2, isoform c, a key regulator of left-right asymmetry, has recently been linked to atrial fibrillation. We therefore systematically studied the molecular composition of left and right atrial tissue in adult murine and human atria. METHODS: We compared left and right atrial gene expression in healthy, adult mice of different strains and ages by employing whole genome array analyses on freshly frozen atrial tissue. Selected genes with enriched expression in either atrium were validated by RT-qPCR and Western blot in further animals and in shock-frozen left and right atrial appendages of patients undergoing open heart surgery. RESULTS: We identified 77 genes with preferential expression in one atrium that were common in all strains and age groups analysed. Independent of strain and age, Pitx2c was the gene with the highest enrichment in left atrium, while Bmp10, a member of the TGFβ family, showed highest enrichment in right atrium. These differences were validated by RT-qPCR in murine and human tissue. Western blot showed a 2-fold left-right concentration gradient in PITX2 protein in adult human atria. Several of the genes and gene groups enriched in left atria have a known biological role for maintenance of healthy physiology, specifically the prevention of atrial pathologies involved in atrial fibrillation, including membrane electrophysiology, metabolic cellular function, and regulation of inflammatory processes. Comparison of the array datasets with published array analyses in heterozygous Pitx2c(+/- atria suggested that approximately half of the genes with left-sided enrichment are regulated by Pitx2c. CONCLUSIONS: Our study reveals systematic differences between left and right atrial gene expression and supports the hypothesis that Pitx2c has a functional

  12. Atorvastatin can ameliorate left atrial stunning induced by radiofrequency ablation for atrial fibrillation.

    Science.gov (United States)

    Xie, Ruiqin; Yang, Yingtao; Cui, Wei; Yin, Hongning; Zheng, Hongmei; Zhang, Jidong; You, Ling

    2017-09-01

    The objective of this study was to study the functional changes of the left atrium after radiofrequency ablation treatment for atrial fibrillation and the therapeutic effect of atorvastatin. Fifty-eight patients undergoing radiofrequency ablation for atrial fibrillation were randomly divided into non-atorvastatin group and atorvastatin group. Patients in the atorvastatin group were treated with atorvastatin 20 mg p.o. per night in addition to the conventional treatment of atrial fibrillation; patients in the non-atorvastatin group received conventional treatment of atrial fibrillation only. Echocardiography was performed before radiofrequency ablation operation and 1 week, 2 weeks, 3 weeks, and 4 weeks after operation. Two-dimensional ultrasound speckle tracking imaging system was used to measure the structural indexes of the left atrium. Results indicated that there was no significant change for indexes representing the structural status of the left atrium within a month after radiofrequency ablation (P > 0.05); however, there were significant changes for indexes representing the functional status of the left atrium. There were also significant changes in indexes reflecting left atrial strain status: the S and SRs of atorvastatin group were higher than those of non-atorvastatin group (P radiofrequency ablation of atrial fibrillation.

  13. Anomlus pulmonary venous return aaccompanied by normal superior pulmonary veins in the left upper lobe: A case report

    International Nuclear Information System (INIS)

    Kim, Dong Eon; Kang, Min Jin; Lee, Ji Hae; Bae, Kyung Eun; Kim, Jae Hyung; Kang, Tae Kyung; Kim, Soung Hee; Kim, Ji Young; Jeong, Myeong Ja; Kim, Soo Hyun

    2017-01-01

    Partial anomalous pulmonary venous return is a rare congenital pulmonary venous anomaly, in which some of the pulmonary veins drain into the systemic circulation rather than the left atrium. Many variants of partial anomalous pulmonary venous return have been reported. We present a rare type of partial anomalous pulmonary venous return in which the anomalous left upper lobe pulmonary vein drained into the left innominate vein via the vertical vein, accompanying the left upper lobe pulmonary vein in the normal location

  14. Anomlus pulmonary venous return aaccompanied by normal superior pulmonary veins in the left upper lobe: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Eon; Kang, Min Jin; Lee, Ji Hae; Bae, Kyung Eun; Kim, Jae Hyung; Kang, Tae Kyung; Kim, Soung Hee; Kim, Ji Young; Jeong, Myeong Ja; Kim, Soo Hyun [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2017-08-15

    Partial anomalous pulmonary venous return is a rare congenital pulmonary venous anomaly, in which some of the pulmonary veins drain into the systemic circulation rather than the left atrium. Many variants of partial anomalous pulmonary venous return have been reported. We present a rare type of partial anomalous pulmonary venous return in which the anomalous left upper lobe pulmonary vein drained into the left innominate vein via the vertical vein, accompanying the left upper lobe pulmonary vein in the normal location.

  15. Investigation on Smoke Movement and Smoke Control for Atrium in Green and Sustainable Buildings

    DEFF Research Database (Denmark)

    Fang, Lui; Nielsen, Peter V.; Brohus, Henrik

    exhaust effectiveness; atrium smoke filling process and its time constant; pre-stratification and detection ; airflow for smoke control between the atrium and communicating space; sprinkler effect, etc. This report was written as a work report of my stay at the department of civil engineering of Aalborg...... conservation into account. Architectural and building design, electrical and mechanical systems, and building management have to be upgraded. However, there are problems in dealing with fire safety, especially in complying with the existing prescriptive fire codes. A hot argument is that smoke control system...... such as axisymmetric plume, wall plume, corner plume and balcony spill plume in this report. As many large space buildings such as cinema, sports arenas containing the sloping floor are designed to meet the function and aesthetic requirement. The smoke movement in atrium with sloping floor is also discussed...

  16. Atrium-specific ion channels in the zebrafish-A role of Iin atrial repolarization

    DEFF Research Database (Denmark)

    Skarsfeldt, M A; Bomholtz, S H; Lundegaard, P R

    2018-01-01

    reaction, we assessed the expression level of atrium-specific potassium channels. The functional role of these channels was studied by patch clamp experiments on isolated atrial and ventricular cardiomyocytes and by optical mapping of explanted adult zebrafish hearts. Finally, surface ECGs were recorded...... to establish possible in vivo roles of atrial ion channels. RESULTS: In isolated adult zebrafish hearts, we identified the expression of kcnk3, kcnk9, kcnn1, kcnn2, kcnn3, kcnj3 and kcnj5, the genes that encode the atrium-specific K2P, KCa2.x and Kir3.1/4 (KACh) ion channels. The electrophysiological data...... indicate that the acetylcholine-activated inward-rectifying current, IKACh,plays a major role in the zebrafish atrium, whereas K2P3.1/9.1 and KCa2.x channels do not appear to be involved in regulating the action potential in the zebrafish heart. CONCLUSION: We demonstrate that the acetylcholine...

  17. The Linguistic and Cultural Interpretation of Dissonant Heritage: the ATRIUM Cultural Route

    Directory of Open Access Journals (Sweden)

    Sandra Nauert

    2017-06-01

    Full Text Available The European Cultural Route ATRIUM (Architecture of Totalitarian Regimes in Europe's Urban Memory deals with dissonant heritage, referring to a contrast of meaning and value systems between the past and the present. The route will be examined within the framework of a set of communication strategies for cultural routes. This short paper will look at some linguistic aspects related to the ATRIUM route and its ‘dissonant heritage’. By analysing some examples of existing promotional approaches related to this particular heritage, it will outline some considerations for a communicative strategy appropriate to the overall narrative structure of the ATRIUM cultural route, with special regard to a bottom-up constructivist approach.

  18. Intraoperative transesophageal echocardiography assessment of right atrial myxoma resulting in a change of the surgical plan

    Directory of Open Access Journals (Sweden)

    Sathish Kumar Dharmalingam

    2014-01-01

    Full Text Available Transesophageal echocardiography (TEE is an important diagnostic tool. It provides structural and functional assessment of cardiac structures which can improve the overall outcome of the patient. We present a case with right atrial myxoma in which TEE helped to find the attachment of the mass so that overall surgical plan was changed.

  19. Evaluation of prosthetic heart valves by transesophageal echocardiography: problems, pitfalls, and timing of echocardiography

    NARCIS (Netherlands)

    van den Brink, Renee B. A.

    2006-01-01

    Transesophageal echocardiography (TEE) is especially suitable for examination of prosthetic valves because of the proximity of the esophagus to the heart and absence of interference with lungs and ribs. This article reviews normal and abnormal morphologic characteristics of prosthetic valves such as

  20. Three-dimensional transesophageal echocardiography in the evaluation of aortic valve destruction by endocarditis

    NARCIS (Netherlands)

    Nemes, Attila; Lagrand, Wim K.; McGhie, Jackie S.; ten Cate, Folkert J.

    2006-01-01

    Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. The aim of this study was to demonstrate the clinical usefulness of 3-dimensional transesophageal echocardiography for the spatial assessment of aortic valve endocarditis. This case showed severe

  1. Off-pump atrial septostomy with thoracoscopic scissors under transesophageal echocardiography guidance

    Directory of Open Access Journals (Sweden)

    Raj R Benedict

    2013-01-01

    Full Text Available Selected children with congenital heart defects undergoing palliative closed heart procedures require a cardiopulmonary bypass (CPB run only for the purpose of creating an inter-atrial communication. We report a simple technique of atrial septostomy using thoracoscopy scissors under transesophageal echocardiography guidance without the need for CPB.

  2. Manual Skill Acquisition During Transesophageal Echocardiography Simulator Training of Cardiology Fellows : A Kinematic Assessment

    NARCIS (Netherlands)

    Matyal, Robina; Montealegre-Gallegos, Mario; Mitchell, John D.; Kim, Han; Bergman, Remco; Hawthorne, Katie M.; O'Halloran, David; Wong, Vanessa; Hess, Phillip E.; Mahmood, Feroze

    2015-01-01

    Objective: To investigate whether a transesophageal echocardiography (TEE) simulator with motion analysis can be used to impart proficiency in TEE in an integrated curriculum-based model. Design: A prospective cohort study. Setting: A tertiary-care university hospital. Participants: TEE-naive

  3. Daylighting and Cooling of Atrium Buildings in Warm Climates: Impact of the Top-Fenestration and Wall Mass Area.

    Science.gov (United States)

    Atif, Morad Rachid

    1992-01-01

    Sun-lighting and daylighting contribute greatly to the aesthetic value of an atrium. However, today's atria are often found either over-lit with extensive cooling loads, or under-lit requiring increased artificial lighting loads. The increase of the top-glazing area increases the cooling loads and decreases the lighting loads. The increase of the mass in the atrium walls decreases the maximum atrium temperature and the cooling loads. Furthermore, the mass distribution and its reflectance affect the lighting levels at the atrium floor. The purpose of this study is to investigate the simultaneous impact of the top-fenestration and the mass and reflectance of atrium walls on the cooling and daylighting performance of atria in warm climates. It attempts to determine the optimum top-fenestration for efficient daylighting and low cooling loads. The daylighting performance was evaluated through illumination measurements in physical models in a sky simulator. The cooling performance was evaluated using the software TRNSYS 13.1. Two types of top-fenestration were tested: horizontal and vertical south-facing, each with three alternate areas. The variations of the atrium walls included materials (standard frame and heavyweight concrete) and percentage and reflectance of the solid area. Two and four-story atria were considered, each with square and linear configuration. The performance was evaluated for three warm climates. The optimum top-fenestration for efficient daylighting was determined. The daylighting prediction algorithm was extended to include the effective reflectance of the atrium walls. The increase of mass in the atrium walls significantly decreased the atrium temperature range, the maximum atrium temperature, and the cooling loads. This impact decreased from horizontal to vertical south-facing top-glazing. The vertical south-facing top-glazing and, to a lesser degree, the reduction of the glazed atrium cover by 50% had more cooling benefits than increasing the

  4. Effect of lateral body position on transesophageal echocardiography images and the association with patient characteristics: A prospective observational study

    Science.gov (United States)

    Mita, Norikatsu; Kuroda, Masataka; Saito, Shigeru; Miyoshi, Sohtaro

    2015-01-01

    Background: Changes in heart position are occasionally observed on the transesophageal echocardiography (TEE) image screen after changing the body position from supine to lateral, although the magnitude of change in cardiac position varies individually. We hypothesized that this variation is associated with certain patient characteristics and evaluated how lateral positioning affects visualization of the heart on TEE and whether the magnitude of change in the heart position correlates with patient characteristics. Methods: Fifty-three lung resection patients were enrolled. Two angle and two length parameters (ΔθTV, ΔθAP, ΔLTV, and ΔLAP) were defined to describe location change of the lateral tricuspid annulus and right ventricular apex on the TEE image between supine and lateral position. The correlation coefficients were calculated between these four parameters and patient characteristics, including age, body mass index (BMI), epicardial fat thickness, and pulmonary function variables. Results: The ΔθTV correlated positively and inversely with BMI in both right and left lateral patients (right: r = 0.6365, P = 0.0034; left: r = −0.6616, P < 0.0001, respectively). In left lateral patients, the ΔθTV correlated inversely with epicardial fat thickness (r = −0.4879, P = 0.0182), and the ΔLAP correlated positively with the forced vital capacity percent predicted (r = 0.5736, P = 0.0082). Conclusions: Lateral body positioning affects cardiac visualization on TEE, and the BMI, epicardial fat thickness, and pulmonary function moderate this effect. PMID:26139732

  5. Smoke Movement in an Atrium with a Fire with Low Rate of Heat Release

    DEFF Research Database (Denmark)

    Nielsen, Peter V.; Brohus, Henrik; Petersen, A. J.

    2008-01-01

    Results from small-scale experiments on smoke movement in an atrium are given, both with and without a vertical temperature gradient, and expressions for the smoke movement are developed on the basis of these experiments. Comparisons with a general analytical expression used for calculating...... the height to the location of the smoke layer are given. Furthermore, the paper discusses the air movement in a typical atrium exposed to different internal and external heat loads to elaborate on the use of the "flow element" expressions developed for smoke movement from a fire with a low rate of heat...

  6. Focal FDG Activity in the Region of Right Atrium: Coregistered CT Identifies Three Benign Etiologies.

    Science.gov (United States)

    Meka, Murali; Depuey, E Gordon; Bhargava, Peeyush

    2008-01-01

    We present the whole body FDG PET-CT images on 3 different patients with benign focal activity in the region of the right atrium. Co-registered CT correctly identified the cause of focal FDG activity as: right atrial appendage, lipomatous hypertrophy of the interatrial septum, and catheter-related activity. Although all these have been reported separately in the literature, we are presenting them together to emphasize the importance of recognizing the benign causes of FDG uptake in the region of right atrium and the role of co-registered CT in improving the accuracy and specificity of the FDG PET.

  7. Left atrial leiomyosarcoma as cause of heart failure

    International Nuclear Information System (INIS)

    Valdes Martin, Alexander

    2012-01-01

    The case of a 26 year-old patient with diagnosis of heart failure and presence of a mobile echogenic mass without calcification attached to the posterolateral area of the left atrium was reported. She underwent surgery and tissue examination evidenced a high-grade heart leiomyosarcoma. Postoperative course was satisfactory and her clinical state was rigorously monitored by oncology and heart specialists in the institution

  8. Anatomic characterization of cavotricuspid isthmus by 3D transesophageal echocardiography in patients undergoing radiofrequency ablation of typical atrial flutter.

    Science.gov (United States)

    Regoli, François; Faletra, Francesco; Marcon, Serena; Leo, Laura Anna; Dequarti, Maria Cristina; Caputo, Maria Luce; Conte, Giulio; Moccetti, Tiziano; Auricchio, Angelo

    2018-01-01

    Radiofrequency ablation (RFA) is the treatment of choice of cavotricuspid isthmus (CTI)-dependent atrial flutter. Procedural time is highly variable due to anatomical structures. This study aimed to characterize CTI anatomy by transesophageal 3D echocardiography imaging (3D-TEE) to identify anatomic structures related to longer ablation time. Thirty-one consecutive patients (mean age 67.3 ± 11.5 years, 22 males) underwent CTI-ablation procedure. Before ablation, TEE was performed and 3D-TEE images were acquired to evaluate CTI anatomy qualitatively as well as perform measures of CTI morphological features. The electrophysiologist performing RFA was blinded to 3D-TEE data. Bidirectional block of CTI was achieved in all patients without procedural complications after a median ablation time of 11 (IQR 7-14) min. Patients with RFA time ≥11 min (Group 2) presented lower left ventricular ejection fraction (51.1 ± 17.0 vs. 59.5 ± 6.6%, P 3D-TEE imaging is extremely helpful in qualitative and quantitative evaluation of CTI anatomy in patients undergoing RFA for symptomatic typical atrial flutter. Detection of a deep right atrial pouch was found to be associated with significantly prolonged CTI ablation time to achieve bidirectional block. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  9. Role of transesophageal echocardiography in surgical retrieval of embolized amplatzer device and closure of coronary–cameral fistula

    Directory of Open Access Journals (Sweden)

    Bhupesh Kumar

    2017-01-01

    Full Text Available Congenital coronary artery fistula is an uncommon anomaly. Transcatheter coil embolization or Amplatzer vascular plug device closure of fistula is often done in symptomatic patients with safe accessibility to the feeding coronary artery. Embolization of Amplatzer vascular plug device is rare. We report an 11-year-old male child who presented to us with increasing shortness of breath for 7 years. He had a history of Amplatzer vascular plug device closure of right coronary–cameral fistula 8 years back. Echocardiography demonstrated a dilated aneurysmal right coronary artery with turbulent jet entering into the right ventricle (RV and device embolized into the left pulmonary artery (LPA. Cardiac catheterization eventually confirmed the diagnosis. Surgical closure of fistula and retrieval of device was done using cardiopulmonary bypass. Intraoperatively transesophageal echocardiogram helped in localizing fistula opening in the RV below the anterior leaflet of tricuspid valve, continuous monitoring to prevent further distal embolization of the device during surgical handling, and assessment of completeness of repair of the fistula and LPA following retrieval of the device.

  10. Usefulness of intraoperative transesophageal echocardiography for evaluation of circumflex coronary artery fistula with ruptured aneurysm draining into coronary sinus.

    Science.gov (United States)

    Sawai, Toshiyuki; Nakahira, Junko; Minami, Toshiaki

    2015-12-01

    A coronary artery aneurysm (CAA) is defined as dilatation of a coronary artery to a diameter >1.5 times that of the adjoining normal coronary artery. Giant CAAs with a diameter ≥ 50 mm are quite rare. Coronary artery fistulas are also uncommon, and affected patients require prompt diagnosis and treatment. Coronary angiography is the most common method of diagnosing coronary artery fistulas; however, transesophageal echocardiography (TEE) can also be a key intraoperative tool. In the present report, we describe the case of an 83-year-old man urgently admitted to our hospital with pericardial tamponade. Enhanced computed tomography and coronary angiography revealed a bulging left main and circumflex artery that was connected to a 50-mm diameter CAA. Emergency intraoperative TEE clearly showed a CAA with a surrounding hematoma, bulging circumflex artery, and a fistulous connection to the coronary sinus; the fistulous vessel contained a thrombus. Surgical repair was successful. This case demonstrates that CAA can rupture because of spontaneous closure of a thrombus-containing fistula and that intraoperative TEE could help to clearly identify the location of the CAA and fistulous connection.

  11. Implementation of real-time three-dimensional transesophageal echocardiography for mitral balloon valvuloplasty.

    Science.gov (United States)

    Eng, Marvin H; Salcedo, Ernesto E; Kim, Michael; Quaife, Robert A; Carroll, John D

    2013-11-15

    Transthoracic (TTE) and intracardiac echocardiography (ICE) have both been established as modalities for imaging guidance in mitral balloon valvuloplasty (MBV). Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) improves depth resolution, characterization of pathology and visualization of interventional catheters and devices. Three-dimensional imaging should enhance catheter navigation but improvements in procedural outcomes are not easily quantified. Using time from transseptal puncture to balloon inflation, procedure time and radiation exposure as surrogates for improvements linked to image guidance, we describe our early experience in implementing RT3D-TEE during MBV, a prototypical left-sided structural intervention. Using a dedicated interventional procedures database, we reviewed the clinical and procedural variables of 70 consecutive cases of MBV utilizing either RT3D-TEE or TTE combined with ICE from 12/2004 to 4/2009. The clinical characteristics of both groups were well matched and there was no difference in mean gradient reduction or complication rates. Fluoroscopy times (TTE/ICE 26.7 ± 5.6 min. vs. RT3D-TEE 23.3 ± 6 min. P = 0.02) and radiation dose-area product (TTE/ICE 216.2 ± 96.6 vs. RT3D-TEE 171.5 ± 63.9) were lower with the RT3D-TEE cohort. Time from 1st transseptal puncture attempt to 1st balloon inflation was found to be lower in the RT-3DTEE cohort (TTE/ICE 36 ± 8 min vs. 28 ± 8 min P <0.01) CONCLUSION: RT3D-TEE is associated with expedited transseptal puncture and balloon catheter navigation as reflected in the decreased transseptal to balloon time. RT3D-TEE is associated with less reliance on fluoroscopic navigation as compared to using TTE/ICE. This series demonstrates the feasibility and advantages of implementing RT3D-TEE for MBV. Copyright © 2013 Wiley Periodicals, Inc.

  12. a case of persistent left superior vena cava detected by post-contrast CT scan

    International Nuclear Information System (INIS)

    Sasaki, Fumio; Koga, Sukehiko; Takeuchi, Akira; Hattori, Yoshinobu; Ino, Akio

    1983-01-01

    A case of persistent left superior vena cava and large anastomosis between double superior vena cava was incidentally detected by post-contrast CT scans. This abnormal vein did not connect to the right atrium via coronary sinus. The usefulness for the diagnosis of post-contrast CT scans and RI venography should be emphasized. (author)

  13. “Anomalous right pulmonary artery left atrial fistula”: Growth in vain

    Directory of Open Access Journals (Sweden)

    Vishal Kumar Jain

    2015-12-01

    Full Text Available We report a case of direct communication between the right pulmonary artery and the left atrium; a rare cause of central cyanosis in 10 year old boy, emphasizing the role of multislice computed tomography scanner in delineating the complex vascular abnormality over more invasive conventional angiography.

  14. Rupture of sinus of Valsalva aneurysm into both right atrium and ...

    African Journals Online (AJOL)

    A young man had a congenital sinus of Valsalva aneurysm originating from the right coronary sinus, complicated by fistulas draining into both right atrium and right ventricle, as well as a congenitally abnormal aortic valve with mild aortic insufficiency. His dramatic clinical presentation, with the sudden appearance of severe ...

  15. Anomalous muscle bundle in the right atrium; Implication to trans atrial device closure

    Directory of Open Access Journals (Sweden)

    Saji Philip

    2017-09-01

    Full Text Available Intracavitary muscle bands or aberrant bands have been well described in all four chambers of the heart but rarely seen thick muscular band crossing right atrium. We report a case of devisable secundum atrial septal defect with an intra-atrial anomalous muscular band, crossing right atrial wall to the rim of the secundum atrial septal defect warranting surgical closure.

  16. Optimisation of Heating Energy Demand and Thermal Comfort of a Courtyard-Atrium Dwelling

    NARCIS (Netherlands)

    Taleghani, M.; Tenpierik, M.; Dobbelsteen, A.

    2013-01-01

    In the light of energy reduction, transitional spaces are recognised as ways to receive natural light and fresh air. This paper analyses the effects of courtyard and atrium as two types of transitional spaces on heating demand and thermal comfort of a Dutch low-rise dwelling, at current and future

  17. Thrombus Development on a Transseptal Sheath in the Right Atrium Before Electrical Pulmonary Vein Isolation

    Directory of Open Access Journals (Sweden)

    Nieves Romero-Rodriguez

    2008-02-01

    Full Text Available We describe the case of a patient who developed a thrombus on the transseptal sheath in the right atrium before transseptal puncture for circumferential pulmonary vein isolation for paroxysmal atrial fibrillation treatment. The use of intracardiac echocardiography allowed to its identification and probably prevented the patient from suffering a serious thromboembolic complication.

  18. Three-dimensional echocardiography of normal and pathologic mitral valve: a comparison with two-dimensional transesophageal echocardiography

    NARCIS (Netherlands)

    Salustri, A.; Becker, A. E.; van Herwerden, L.; Vletter, W. B.; ten Cate, F. J.; Roelandt, J. R.

    1996-01-01

    This study was done to ascertain whether three-dimensional echocardiography can facilitate the diagnosis of mitral valve abnormalities. The value of the additional information provided by three-dimensional echocardiography compared with two-dimensional multiplane transesophageal echocardiography for

  19. [Surgical treatment for pseudoaneurysm of the sinus of valsalva ruptured into the right atrium after mycotic right coronary artery aneurysm repair;report of a case].

    Science.gov (United States)

    Hirai, Hidekazu; Sasaki, Yasuyuki; Hosono, Mitsuharu; Bito, Yasuyuki; Nakahira, Atsushi; Suehiro, Yasuo; Kaku, Daisuke; Miyabe, Makoto; Suehiro, Shigefumi

    2015-02-01

    A 67-year-old man was admitted to our hospital by ambulance after syncope due to complete A-V block. He had received surgical treatment for mycotic aneurysm of the right coronary artery 3 months before, with patch plasty of the right sinus of Valsalva and bypass grafting to the right coronary artery (RCA) as well as the left anterior descending branch. Computed tomography revealed pseudoaneurysm of the right Valsalva sinus of about 8 cm in diameter and a shunt flow to the right atrium. The previous bypass graft to RCA had been occluded due to compression by the aneurysm. As he was in a shock state, emergency operation was performed. Cardiopulmonary bypass was first established, and after the rectal temperature reached to 26 degrees centigrade, the chest was opened. The pseudoaneurysm burst out when the sternum was re-opened. Under circulatory arrest, the ascending aorta was clamped, and then the circulation was resumed. The previous bovine pericardium patch repairing the Valsalva sinus was detached due to infection, and mural thrombus and pus were observed in the aneurysm. At the bottom of the aneurysm, a fistula connected to the right atrium was found. Debridement around the aneurysm was performed as much as possible. The defect of the Valsalva sinus was repaired with a Dacron patch immersed in gentian violet. The postoperative course was uneventful without any recurrence of infection.

  20. Echocardiographic assessment of left atrial size in patients with end-stage renal disease.

    Science.gov (United States)

    Koçinaj, Dardan; Gashi, Masar; Berisha, Merita; Koçinaj, Allma; Ramadani, Naser; Korça, Hajrije

    2009-01-01

    Cardiac disease is the most common cause of death in patients with end-stage renal disease. It is assumed that the high rate of cardiovascular mortality is related to accelerated atherosclerosis. Patients with chronic renal insufficiency have an increased prevalence of coronary artery disease, silent myocardial ischaemia, complex ventricular arrhythmias, atrial fibrillation, left ventricular hypertrophy, annular mitral and aortic valve calcification, and enlargement of the left atrium, than patients with normal renal function. It is also well known that haemodialysis is associated with cardiovascular structural changes and rapid fluctuations in electrolyte levels. In this study, we sought to estimate left atrial size by means of echocardiography and to determine any correlations between different echocardiographic measurements in patients with end-stage renal disease. We analysed data from 123 patients who were on regular haemodialysis, by means of traditional transthoracic echocardiographic examination. The usual statistical parameters, correlations and the Student's t-test were performed, with levels of significance of p < 0.01 and p < 0.05. The most presented age group was 60 to 69 years old, with a predomination of females (56.1%). We found dilated left atrium in 26.02% of the study patients and a high statistical correlation between different methods of measurement and calculated volumes of the left atrium. Evaluation of left atrial size should be determined by several different measurements, and left atrial enlargement should be seen as a risk factor for advancing disease.

  1. The assessment of left atrial function in hypertrophic cardiomyopathy using an ultrafast computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Karikomi, Masahito (Chiba Univ. (Japan). School of Medicine)

    1994-06-01

    Ultrafast computed tomography was performed in 22 patients with hypertrophic cardiomyopathy (HCM) and 8 normal subjects to evaluate left atrial function. The area-time curve of the left atrium was obtained from the long axial view and analyzed. The diminishing fraction of the left atrial area from passive atrial emptying to atrial diastasis in HCM was significantly less than that in normal subjects (17.4[+-]6.3% vs 23.0[+-]6.8%, p<0.05). The maximum area, filling fraction, time to peak diminishing rate, peak diminishing rate, time to 50% of peak diminishing rate, and diminishing fraction at the time of peak diminishing rate in HCM did not differ significantly from those in normal subjects. No indices differed between symptomatic patients with HCM and asymptomatic patients with HCM. In conclusion, the contraction of the left atrium is increased and a compensatory mechanism is at work in response to the impairment of left ventricular early diastolic filling, which does not affect the conduit function of the left atrium. It is suggested that the left atrial function in HCM may well be altered before symptom is present. (author).

  2. Three-dimensional analysis of the left atrial appendage for detecting paroxysmal atrial fibrillation in acute ischemic stroke.

    Science.gov (United States)

    Tanaka, Koji; Koga, Masatoshi; Sato, Kazuaki; Suzuki, Rieko; Minematsu, Kazuo; Toyoda, Kazunori

    2014-12-01

    Atrial fibrillation impairs left atrial appendage function and the thrombus formation in the left atrial appendage is a major cause of cardioembolic stroke. To evaluate the association between the volume of the left atrial appendage measured by real-time three-dimensional transesophageal echocardiography and presence of paroxysmal atrial fibrillation in patients with cerebral infarction or transient ischemic attack. Real-time three-dimensional transesophageal echocardiography was performed to measure left atrial appendage end-diastolic and end-systolic volumes to calculate left atrial appendage ejection fraction. Patients with normal sinus rhythm at the time of real-time three-dimensional transesophageal echocardiography were divided into groups with and without paroxysmal atrial fibrillation. Volumetric data were corrected with the body surface area. Of 146 patients registered, 102 (29 women, 72·2 ± 10·7 years) were normal sinus rhythm at the examination. In 23 patients with paroxysmal atrial fibrillation, left atrial appendage end-diastolic volume (4·78 ± 3·00 ml/m(2) vs. 3·14 ± 2·04 ml/m(2), P = 0·003) and end-systolic volume (3·10 ± 2·47 ml/m(2) vs. 1·39 ± 1·56 ml/m(2), P analysis, all these parameters were independently associated with paroxysmal atrial fibrillation after adjusting for sex, age, diabetes mellitus, and previous stroke. Left atrial appendage volumetric analysis by real-time three-dimensional transesophageal echocardiography is a promising method for detecting paroxysmal atrial fibrillation in acute cerebral infarction or transient ischemic attack. © 2014 The Authors. International Journal of Stroke © 2014 World Stroke Organization.

  3. Kids in the atrium: comparing architectural intentions and children's experiences in a pediatric hospital lobby.

    Science.gov (United States)

    Adams, Annmarie; Theodore, David; Goldenberg, Ellie; McLaren, Coralee; McKeever, Patricia

    2010-03-01

    The study reported here adopts an interdisciplinary focus to elicit children's views about hospital environments. Based at the Hospital for Sick Children (SickKids), Toronto, the research explores the ways in which designers and patients understand and use the eight-storey lobby, The Atrium, a monumental addition constructed in 1993. It is a public place that never closes; hundreds of children pass through the namesake atrium every day. Combining methodological approaches from architectural history and health sociology, the intentions and uses of central features of the hospital atrium are examined. Data were collected from observations, focused interviews, and textual and visual documents. We locate the contemporary atrium in a historical context of building typologies rarely connected to hospital design, such as shopping malls, hotels and airports. We link the design of these multi-storey, glass-roofed spaces to other urban experiences especially consumption as normalizing forces in the everyday lives of Canadian children. Seeking to uncover children's self-identified, self-articulated place within contemporary pediatric hospitals, we assess how the atrium--by providing important, but difficult-to-measure functions such as comfort, socialization, interface, wayfinding, contact with nature and diurnal rhythms, and respite from adjacent medicalized spaces--contributes to the well-being of young patients. We used theoretical underpinnings from architecture and humanistic geography, and participatory methods advocated by child researchers and theorists. Our findings begin to address the significant gap in understanding about the relationship between the perceptions of children and the settings where their healthcare occurs. The study also underlines children's potential to serve as agents of architectural knowledge, reporting on and recording their observations of hospital architecture with remarkable sophistication. 2009 Elsevier Ltd. All rights reserved.

  4. Echocardiographic predictors of left atrial appendage thrombus formation.

    Science.gov (United States)

    Ayirala, Srilatha; Kumar, Simi; O'Sullivan, David M; Silverman, David I

    2011-05-01

    Although transesophageal echocardiography is the definitive test for the detection of left atrial (LA) appendage thrombus, transthoracic echocardiography has yet to prove useful for the determination of increased risk for LA appendage thrombus formation. The authors hypothesized that higher LA volume and/or lower left ventricular ejection fraction (LVEF) might prove valuable as markers of increased risk for LA appendage thrombus formation and tested this hypothesis in a consecutive retrospective series of patients with atrial fibrillation undergoing both transthoracic and transesophageal echocardiography. Three hundred thirty-four consecutive patients with atrial fibrillation undergoing transesophageal echocardiography for the detection of LA appendage thrombus were studied. Anticoagulation status, CHADS(2) scores, and echocardiographic parameters were catalogued. The relationship between the presence of LA appendage thrombus and covariates was analyzed using binary logistic regression. LA appendage thrombus was detected in 52 patients (15.6%). A higher CHADS(2) score (odds ratio, 1.45; P LA volume index (odds ratio, 1.02; P = .018), and lower LVEF (odds ratio, 1.02; P = .05) were significant predictors of LA appendage thrombus formation. LA appendage thrombus was not seen in patients with CHADS(2) scores ≤ 1, LVEFs > 55%, and a LA volume indexes LA volume index ≤ 1.5 produced 100% sensitivity for the presence of LA appendage thrombus. The presence of LA appendage thrombus is related to both clinical and echocardiographic variables. Although no single echocardiographic variable discriminated between the presence and absence of LA thrombus, a normal LVEF and normal LA volume index were associated with the absence of LA appendage thrombus formation. For patients with atrial fibrillation with CHADS(2) scores ≤ 1, normal left ventricular systolic function and normal LA volume in combination may be a useful measure for the identification of patients at low risk

  5. Left atrial myxoma, ruptured chordae tendinae causing mitral regurgitation and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Bhupesh Kumar

    2014-01-01

    Full Text Available Mitral regurgitation is uncommon with left atrial myxoma. The echocardiographic assessment of presence of mitral regurgitation and its severity are impaired by the presence of left atrial myxoma. We describe an uncommon association of left atrial myxoma with coronary artery disease and mitral regurgitation. MR was reported as mild on pre-operative transthoracic echocardiography but found to be severe due to ruptured chordae tendinae during intra-operative transesophageal echocardiography, which lead to change in the surgical plan to mitral valve replacement in addition to excision of myxoma.

  6. Transesophageal Echocardiographically-Confirmed Pulmonary Vein Thrombosis in Association with Posterior Circulation Infarction.

    LENUS (Irish Health Repository)

    Kinsella, Justin A

    2010-01-01

    Pulmonary venous thromboembolism has only been identified as a cause of stroke with pulmonary arteriovenous malformations\\/fistulae, pulmonary neoplasia, transplantation or lobectomy, and following percutaneous radiofrequency ablation of pulmonary vein ostia in patients with atrial fibrillation. A 59-year-old man presented with a posterior circulation ischemic stroke. \\'Unheralded\\' pulmonary vein thrombosis was identified on transesophageal echocardiography as the likely etiology. He had no further cerebrovascular events after intensifying antithrombotic therapy. Twenty-eight months after initial presentation, he was diagnosed with metastatic pancreatic adenocarcinoma and died 3 months later. This report illustrates the importance of doing transesophageal echocardiography in presumed \\'cardioembolic\\' stroke, and that potential \\'pulmonary venous thromboembolic\\' stroke may occur in patients without traditional risk factors for venous thromboembolism. Consideration should be given to screening such patients for occult malignancy.

  7. Cardiac magnetic resonance imaging has limited additional yield in cryptogenic stroke evaluation after transesophageal echocardiography.

    Science.gov (United States)

    Liberman, Ava L; Kalani, Rizwan E; Aw-Zoretic, Jessie; Sondag, Matthew; Daruwalla, Vistasp J; Mitter, Sumeet S; Bernstein, Richard; Collins, Jeremy D; Prabhakaran, Shyam

    2017-12-01

    Background The use of cardiac magnetic resonance imaging is increasing, but its role in the diagnostic work-up following ischemic stroke has received limited study. We aimed to explore the added yield of cardiac magnetic resonance imaging to identify cardio-aortic sources not detected by transesophageal echocardiography among patients with cryptogenic stroke. Methods A retrospective single-center cohort study was performed from 01 January 2009 to 01 March 2013. Consecutive patients who had both a stroke protocol cardiac magnetic resonance imaging and a transesophageal echocardiography preformed during a single hospitalization were included. All cardiac magnetic resonance imaging studies underwent independent, blinded review by two investigators. We applied the causative classification system for ischemic stroke to all patients, first blinded to cardiac magnetic resonance imaging results; we then reapplied the causative classification system using cardiac magnetic resonance imaging. Standard statistical tests to evaluate stroke subtype reclassification rates were used. Results Ninety-three patients were included in the final analysis; 68.8% were classified as cryptogenic stroke after initial diagnostic evaluation. Among patients with cryptogenic stroke, five (7.8%) were reclassified due to cardiac magnetic resonance imaging findings: one was reclassified as "cardio-aortic embolism evident" due to the presence of a patent foramen ovale and focal cardiac infarct and four were reclassified as "cardio-aortic embolism possible" due to mitral valve thickening (n = 1) or hypertensive cardiomyopathy (n = 3). Overall, findings on cardiac magnetic resonance imaging reduced the percentage of patients with cryptogenic stroke by slightly more than 1%. Conclusion Our stroke subtype reclassification rate after the addition of cardiac magnetic resonance imaging results to a diagnostic work-up which includes transesophageal echocardiography was very low. Prospective studies

  8. Measurements of cardiac output obtained with transesophageal echocardiography and pulmonary artery thermodilution are not interchangeable

    DEFF Research Database (Denmark)

    Møller-Sørensen, H; Graeser, K; Hansen, K L

    2014-01-01

    BACKGROUND: Echocardiography is increasingly becoming an integrated tool for circulatory evaluation in the intensive care unit and the operating room. Therefore, it is imperative to know the reproducibility of measurements obtained by echocardiography. In this study, a comparison of cardiac output...... (CO) measurements obtained with transesophageal echocardiography (TEE) and pulmonary artery catheter (PAC) thermodilution (TD) was carried out to test the precision, accuracy and trending ability of CO measurements obtained with TEE. METHODS: Twenty-five patients completed the study. Each patient...

  9. Left Atrial Thrombus Causing Stroke and Syncope: Does Size Matters?

    Directory of Open Access Journals (Sweden)

    Surender Deora

    2014-01-01

    Full Text Available Left atrium thrombus is seen in patients with rheumatic heart disease, severe mitral stenosis and/or atrial fibrillation, but is usually immobile and located in left atrial appendage. Freely mobile thrombus is rarely seen, and the size may vary from few millimeters to centimeters. The clinical presentation varies from presyncope or syncope in a small well organized thrombus to transient ischemic attacks or stroke in large poorly organized thrombus. Management includes urgent surgical removal of thrombus with underlying valvular correction and anticoagulation.

  10. Incremental value of three-dimensional transesophageal echocardiography over two-dimensional transesophageal echocardiography in the assessment of Lambl's excrescences and nodules of Arantius on the aortic valve.

    Science.gov (United States)

    Dumaswala, Bhavin; Dumaswala, Komal; Hsiung, Ming Chon; Quiroz, Luis David Meggo; Sungur, Aylin; Escanuela, Maximilliano German Amado; Mehta, Kruti; Oz, Tugba Kemaloglu; Bhagatwala, Kunal; Karia, Nidhi M; Nanda, Navin C

    2013-09-01

    In this retrospective study, we identified 7 cases where Lambl's excrescences were identified by two-dimensional transesophageal echocardiography (2DTEE) and also had live/real time three-dimensional transesophageal echocardiography (3DTEE) studies available for comparison. We subsequently assessed them for the presence of Lambl's excrescences (LE) and nodules of Arantius (NA) on the aortic valve. After their identification, we qualitatively and quantitatively organized our findings by number, cusp location, measurements, and orientation if applicable. A greater number of LE was found by 3DTEE than 2DTEE (19 vs. 11, respectively). In all 3DTEE studies, their cusp attachment site, their x-, y-, and z-axis measurements, and orientation were clearly visualized and described. Only 3DTEE studies provided confident visualization of the cusp attachment sites. Similarly, a greater number of NA was found by 3DTEE than 2DTEE (21 vs. 5, respectively). The triad of NA was visualized in all 3DTEE studies and each was described using its x-, y-, and z- axis measurements. Only three 2DTEE studies provided reliable identification of the NA. In conclusion, we present further evidence of the incremental value of 3DTEE over 2DTEE in the qualitative and quantitative assessment of cardiac structures including LE and NA on the aortic valve. © 2013, Wiley Periodicals, Inc.

  11. Evaluation of right atrium-to-right ventricle diameter ratio on computed tomography pulmonary angiography: Prediction of adverse outcome and 30-day mortality.

    Science.gov (United States)

    Oz, Ibrahim Ilker; Altınsoy, Bülent; Serifoglu, Ismail; Sayın, Rasit; Buyukuysal, Mustafa Cagatay; Erboy, Fatma; Akduman, Ece Isin

    2015-12-01

    The aim of this study was to examine the association between right atrium (RA) and right ventricle (RV) diameters on computed tomography (CT) pulmonary angiography in response to acute pulmonary embolism (APE), in addition to 30-day mortality and adverse outcomes in patients with APE. This retrospective study was accepted by the institutional ethics committee. From January 2013 to March 2014, 79 hospitalized adult patients with symptomatic APE were included. Inclusion criteria were a CT pulmonary angiography positive for pulmonary embolism, availability of patient records, and a follow-up of at least 30 days. A review of patient records and images was performed. The maximum diameters of the heart chambers were measured on a reconstructed four-chamber heart view, and the vascular obstruction index was calculated on CT pulmonary angiography. There were statistically significant relationships in both the RA/RV diameter ratio and the RV/left ventricle (LV) diameter ratio between patients with and without adverse outcomes (prights reserved.

  12. Aqueous leaf extract of Averrhoa carambola L. (Oxalidaceae reduces both the inotropic effect of BAY K 8644 on the guinea pig atrium and the calcium current on GH3cells

    Directory of Open Access Journals (Sweden)

    Carla M. L. Vasconcelos

    Full Text Available It was previously showed that aqueous leaf extract (AqEx of Averrhoa carambola depresses the guinea pig atrial inotropism. Therefore, experiments were carried out on guinea pig left atrium and on pituitary GH3 cells in order to evaluate the effect of AqEx on the cellular calcium influx. The atrium was mounted in an organ chamber (5 mL, Tyrode, 27 ± 0.1 ºC, 95 % O2, 5 % CO2, stretched to 10 mN, and paced at 2 Hz (0.5 ms, 400 V and GH3 cells were submitted to a whole cell voltage clamp configuration. In the atrium, the AqEx (1500 µg/mL shifted to the right the concentration-effect curve of the positive inotropic effect produced by (± BAY K 8644, an L-type calcium channel agonist. The AqEx increased EC50 (concentration required to promote 50% of the maximum effect of the inotropic effect of BAY K 8644 from 7.8 ± 0.38 to 115.1 ± 0.44 nM (N = 3; p < 0.05. In GH3 cells assayed with 500 µg/mL of AqEx, the L-type calcium inward current declined 30 % (from 282 to 190 pA. Nevertheless, the extract did not change the voltage correspondent to the peak current. These data suggest that, at least in part, the negative inotropic effect of AqEx on the guinea pig atrium is due to a reduction of the L-type calcium current.

  13. Angiosarcoma of the Right Atrium Presenting as Syncope and Hemorrhagic Pericardial Tamponade

    Directory of Open Access Journals (Sweden)

    V. G. Sams

    2012-01-01

    Full Text Available Angiosarcoma of the heart is a rare malignancy that can present in many ways. It is an important diagnosis to consider in patients presenting with otherwise unexplained tamponade-type symptoms. Here we present a case of a young male who presented with hemorrhagic tamponade and underwent resection of a large angiosarcoma of the right atrium. In this case, we describe the rare presentation of angiosarcoma with its diagnostic approaches, hospital course, clinical management, and discussion.

  14. Renal Angiomyolipoma with Fatty Thrombus Extending to the Right Atrium: An Exceptional Presentation

    Directory of Open Access Journals (Sweden)

    Yassine Nouira

    2013-01-01

    Full Text Available This paper reports the case of 34-year-old woman who presented with bilateral renal angiomyolipomas (AMLs. On the right side, there was a large AML with a fatty thrombus extending to the right atrium. The treatment consisted of right nephrectomy and complete thrombectomy with extracorporeal circulation and right atriotomy. Postoperatively, the patient was septic and died on postoperative day 7 because of septic shock.

  15. Il patrimonio scomodo del Novecento europeo nel progetto Atrium a Forlì

    Directory of Open Access Journals (Sweden)

    Elena Pirazzoli

    2013-09-01

    Full Text Available Il Novecento ha lasciato tracce difficili nelle città d'Europa. I regimi che si sono succeduti hanno trasformato urbanisticamente e architettonicamente l'intero territorio e oggi è complesso relazionarsi con questi segni. Il progetto europeo Atrium - Architecture of Totalitarian Regimes in Urban Managements si propone di valorizzare, con attenta cura e senza intenti mistificatori, proprio il “patrimonio scomodo” di 11 paesi dell'Europa del sud.

  16. Atypical leiomyoma arising in a hepatic vein with extension into the inferior vena cava and right atrium

    International Nuclear Information System (INIS)

    Dunlap, H.J.; Udjus, K.

    1990-01-01

    We report an atypical leiomyoma arising in a hepatic vein and extending into the inferior vena cava and right atrium in a fourteen year old boy. US, CT and MRI facilitated diagnosis and removal of this tumor. (orig.)

  17. Researching for sustained translation from site cluster permeability into building courtyard and interior atrium

    Science.gov (United States)

    Teddy Badai Samodra, FX; Defiana, Ima; Setyawan, Wahyu

    2018-03-01

    Many previous types of research have discussed the permeability of site cluster. Because of interaction and interconnected attribute, it will be better that there is its translation into lower context such as building and interior scale. In this paper, the sustainability design performance of both similar designs of courtyard and atrium are investigated continuing the recommendation of site space permeability. By researching related literature review and study through Ecotect Analysis and Ansys Fluent simulations, the pattern transformation and optimum courtyard and atrium design could comply the requirement. The results highlighted that the air movement from the site could be translated at the minimum of 50% higher to the building and indoor environment. Thus, it has potency for energy efficiency when grid, loop, and cul-de-sac site clusters, with 25% of ground coverage, have connectivity with building courtyard compared to the atrium. Energy saving is higher when using low thermal transmittance of transparent material and its lower area percentages for the courtyard walls. In general, it was more energy efficient option as part of a low rise building, while the courtyard building performed better with increasing irregular building height more than 90% of the difference.

  18. Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism. The Filiale Echocardiographie de la Société Française de Cardiologie.

    Science.gov (United States)

    Laperche, T; Laurian, C; Roudaut, R; Steg, P G

    1997-07-01

    Atherosclerotic lesions of the aortic arch are potential sources of arterial embolism. Mobile thrombi in the aortic arch in young patients without diffuse atherosclerosis have been reported recently, but such cases remain exceptional. We describe a series of young patients with unexplained arterial embolism in whom transesophageal echocardiography detected mobile aortic arch thromboses. Transesophageal echocardiography files collected between 1991 and 1995 in French academic cardiology centers were reviewed to identify patients who fulfilled the following criteria: (1) an arterial embolic event in the preceding weeks; (2) a mobile pedunculated aortic arch thrombosis, defined as an echogenic mass protruding into the lumen of the aorta and inserted on the aortic arch; and (3) absence of obvious diffuse aortic atherosclerosis or of aortic debris on transesophageal echocardiography. Twenty-three cases were identified from 27 855 examinations. Thromboses were located on the horizontal aorta (n = 4), near the ostium of the left subclavian artery (n = 5), or on the concavity of the posterior segment of the aortic arch (in the isthmus) (n = 14). The insertion site was a small atherosclerotic plaque in 21 patients. The remaining aortic wall always appeared normal or mildly atherosclerotic. The mean age of the patients was 45 +/- 8.4 years (range, 26 to 61 years). All patients were treated with intravenous heparin after the diagnosis of aortic arch thrombosis, and surgical removal of the thrombosis was performed in 10 patients in whom histological examination confirmed an atherosclerotic process at the site of insertion of the thrombosis. The prognosis was mainly influenced by embolic events. Thromboses of the aortic arch appear to be a variant form of aortic atherosclerotic disease associated with arterial embolism in young patients.

  19. The utility of atrial pacing for identifying the electrical breakthrough sites between the left atrium and pulmonary veins

    Directory of Open Access Journals (Sweden)

    Shinya Sugiura, MD

    2017-04-01

    Conclusions: This pacing method may help to identify whether EBSs are located in the anterior Lt.PVs. Improved recognition of EBSs through pacing from different sites would be helpful for achieving PV isolation.

  20. Transesophageal echocardiography (TEE) vs. transthoracic echocardiography (TTE) in assessing cardio-vascular sources of emboli in patients with acute ischemic stroke.

    Science.gov (United States)

    Blum, Arnon; Reisner, Shimon; Farbstein, Yakov

    2004-09-01

    Transesophageal echocardiography (TEE) is a valuable tool in the evaluation of ischemic stroke patients. However, the real clinical impact of additional TEE data remains to be defined. Our purpose was to evaluate the impact of TEE on the management of patients at low risk for cardiogenic embolism. We studied 68 patients (57+/-10 years old) with ischemic stroke at low-risk for cardiogenic embolism. Each patient underwent bilateral carotid ultrasound Doppler study, trans-thoracic echocardiography (TTE) and TEE in order to find out left atrial spontaneous echo contrast or intracavitary thrombi, communication or aneurysm of the inter-atrial septum, ventricular septal defect, patent foramen ovale, and the presence of intra-aortic atherosclerotic plaques or thrombi. In 28 out of 68 patients TEE found an abnormal lesion that has not been detected by TTE: there were 23 diffuse (>5mm) atherosclerotic atheromas in the aortic arch, 5 patent foramen ovale (PFO) lesions, 3 left atrial thrombi, 1 ventricular septal defect (VSD), and 1 atrial septal defect (ASD). 6 patients had more than 1 finding. These findings changed the management, and all 28 patients started to be treated with Coumadine instead of Aspirin. Patients with PFO were sent to close the shunt with a patch. In half of the patients TEE (but not TTE) found a significant lesion that changed our policy of management. None of these lesions were detected by TTE. It seems that TEE is mandatory in the evaluation of patients with acute ischemic stroke.

  1. Transesophageal Echocardiography and Laryngeal Mask Airway for Placement of Permanent Central Venous Catheter in Cancer Patients with Radiographically Unidentifiable SVC-RA Junction: Effectiveness and Safety

    Directory of Open Access Journals (Sweden)

    Jong-Hau Hsu

    2007-09-01

    Full Text Available In patients who require a permanent central venous catheter (PCVC, the usual aim is to put the catheter tip at the superior vena cava and right atrium (SVC-RA junction. However, there is no study regarding how to guide the positioning of the catheter tip when the SVC-RA junction cannot be identified on chest radiograph. The objectives of this prospective study were: (1 to investigate the incidence and etiologies of radiographically undetermined SVC-RA junctions in cancer patients undergoing PCVC implantation; and (2 to evaluate the feasibility, effectiveness and safety of combined transesophageal echocardiography (TEE and laryngeal mask airway (LMA to guide the positioning of catheters during implantations in patients without this radiographic landmark. Over a 1-year study period, 83 consecutive patients with oncologic diseases who required implantation of a PCVC in a tertiary center were screened. Their preoperative chest radiographs were examined by radiologists to identify the presence of the SVC-RA junction. Patients without a radiographically identifiable SVC-RA junction were classified as cancer-related or cancer-unrelated in terms of etiology. For patients without this landmark, we used TEE with a pediatric biplane transducer and a LMA under intravenous general anesthesia during PCVC implantation to guide the positioning of the catheter tip at the SVC-RA junction. We found that in 16% (13/83 of patients, the SVC-RA junction could not be identified on radiograph. Among the 13 patients, only three (23% had cancer-related etiologies. In all of the 13 patients, the LMA was successfully placed after the TEE transducer was inserted. No episode of air leak from the LMA was found during surgery. All had the catheter tip positioned in the anatomic SVC-RA junction under TEE guidance. In conclusion, 16% of cancer patients requiring PCVC implantation had no identifiable SVC-RA junction on chest radiograph and most causes were cancer-unrelated. In

  2. Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus : Case report

    Directory of Open Access Journals (Sweden)

    Ziyab K. Sarfaraz

    2017-08-01

    Full Text Available The anomalous origin of the right coronary artery from the left coronary sinus is a rare congenital disorder and can often result in sudden death upon initial presentation. We report a 19-year-old male patient who was referred to the Sultan Qaboos University Hospital, Muscat, Oman, in 2015 with multiple episodes of exertional angina. He was diagnosed as having an anomalous right coronary artery arising from the left coronary sinus following an intraoperative transesophageal echocardiogram. An unroofing ostioplasty of the anomalous right coronary artery was successful. Details of the surgical management of this anomaly are discussed.

  3. Fixed volume particle trace emission for the analysis of left atrial blood flow using 4D Flow MRI.

    Science.gov (United States)

    Gaeta, Stephen; Dyverfeldt, Petter; Eriksson, Jonatan; Carlhäll, Carl-Johan; Ebbers, Tino; Bolger, Ann F

    2018-04-01

    4D Flow MRI has been used to quantify normal and deranged left ventricular blood flow characteristics on the basis of functionally distinct flow components. However, the application of this technique to the atria is challenging due to the presence of continuous inflow. This continuous inflow necessitates plane-based emission of particle traces from the inlet veins, leading to particles that represents different amounts of blood, and related quantification errors. The purpose of this study was to develop a novel fixed-volume approach for particle tracing and employ this method to develop quantitative analysis of 4D blood flow characteristics in the left atrium. 4D Flow MRI data were acquired during free-breathing using a navigator-gated gradient-echo sequence in three volunteers at 1.5T. Fixed-volume particle traces emitted from the pulmonary veins were used to visualize left atrial blood flow and to quantitatively separate the flow into two functionally distinct flow components: Direct flow=particle traces that enter and leave the atrium in one heartbeat, Retained flow=particle traces that enter the atrium and remains there for one cardiac cycle. Flow visualization based on fixed-volume traces revealed that, beginning in early ventricular systole, flow enters the atrium and engages with residual blood volume to form a vortex. In early diastole during early ventricular filling, the organized vortical flow is extinguished, followed by formation of a second transient atrial vortex. Finally, in late diastole during atrial contraction, a second acceleration of blood into the ventricle is seen. The direct and retained left atrial flow components were between 44 and 57% and 43-56% of the stroke volume, respectively. In conclusion, fixed-volume particle tracing permits separation of left atrial blood flow into different components based on the transit of blood through the atrium. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. In Vivo Evaluations of a Phased Ultrasound Array for Transesophageal Cardiac Ablation

    Science.gov (United States)

    Jaiswal, Devina; Werner, Jacob; Park, Eun-Joo; Francischelli, David; Smith, Nadine Barrie

    2010-03-01

    Atrial fibrillation is one of the most common arrhythmias that affects over 2.2 million Americans each year. Catheter ablation, one of the effective treatments, has shown high rate of success in treating paroxysmal atrial fibrillation. Currently, radiofrequency which is being used for catheter ablation is an invasive procedure. Measurable morbidity and significant costs and time are associated with this modality of treatment of permanent or persistent atrial fibrillation. In order to address these issues, a transesophageal ultrasound applicator for noninvasive cardiac ablation was designed, developed and evaluated. The ultrasound energy delivered by the phased array was used to create a lesion in the myocardial tissue. Various factors, simulation results of transducer arrays, current transesophageal medical devices, and throat anatomy, were considered while designing a phased ultrasound transducer that can be inserted into the esophagus. For this research, a two-dimensional sparse phased array with flat tapered elements was fabricated and evaluated in in vivo experiments. Five pigs were anesthetized; the array was passed transesophagealy and positioned over the heart. An operating frequency of 1.6 MHz and 8˜15 minutes of array operation resulted in both single and multiple lesions on atrial and ventricular myocardium. The average size of lesions was 5.1±2.1 mm in diameter and 7.8±2.5 mm in length. Experimental results indicate that the array delivered sufficient power to produce ablation at the focal point while not grossly damaging the tissue surrounding the area of interest. These results demonstrate a potential application of the ultrasound applicator for noninvasive transesophageal cardiac surgery in atrial fibrillation treatment.

  5. [Multiplane transesophageal echocardiography and adenosine in the study of coronary blood reserve].

    Science.gov (United States)

    Galati, A; Coletta, C; Ricci, R; Zingales, L D; Richichi, G; Carunchio, A; Ceci, V

    1995-12-01

    Coronary blood reserve is the capacity of coronary vessels to vasodilate and thereby to increase the blood flow, when the heart needs more energy. However, when a coronary stenosis occurs, the capacity to vasodilate is reduced or completely diminished. It is then necessary to use all the tools useful in evaluating the functional conditions of the coronary vessels. Above all, the intracoronary Doppler technique is used to measure the velocity of blood flow. Our purpose was to evaluate a non-invasive tool "Multiplane Transesophageal Echocardiography" in the study of velocity of the anterior descendent artery before and after adenosine infusion. At first, we studied 28 patients (pts), which we divided in two groups: Group A, 18 pts 59.38 +/- 8.23 mean age, 15 M. and 3 F., with anterior descending disease; Group B 10 pts, 59.20 +/- 8.48 mean age, 7 M. and 3 F, without significant stenosis (> 75%). Echocardiography examinations were performed with a 5 MHz multiplane probe, connected to a 1000 Hewlett Parkard echocardiography. Before the test, Diazepam 1 mg i.v. and Lidocaine spray were administered to the patients. We introduced the transesophageal probe and after choosing the best position of the aortic short axis view, we studied the anterior descending artery and measured the maximum and mean diastolic and sistolic velocities (V.MAX D., V.MN.D., V.MAX S., V.MN.S.). Transesophageal echocardiography allowed us to study the anterior descending artery in 95% of pts. There were no side effects, except for one pt affected by severe bradicardia. In Group B there was an increase of the diastolic and sistolic velocity after adenosine infusion, resulting twice greater they the rest values. The adenosine/rest velocities ratios were statistically significant (V.MAX D. p < 0.02) (V.MN.D. p < 0.03). Our results demonstrated an higher capacity of the Multiplane Transesophageal Echocardiography in studiing coronary blood reserve. We used adenosine, as a vasodilator drug, because of

  6. Esophageal Perforation: A Rare Complication of Transesophageal Echocardiography in a Patient with Asymptomatic Esophagitis

    Directory of Open Access Journals (Sweden)

    Kabir Ahmed

    2012-12-01

    Full Text Available Transesophageal echocardiography (TEE is a commonly used procedure in patients with suspected endocarditis. A rare but dreadful complication of this procedure is perforation of the esophagus. We report the case of an elderly female with multiple comorbidities, who presented with polyarticular septic arthritis. TEE was performed to rule out endocarditis. Though the standard procedure protocol was followed, she developed esophageal perforation. It was managed with esophageal stenting but she developed multiorgan failure and did not survive. This case highlights the potential of severe morbidity and mortality associated with TEE. Appropriate screening must be done and high-risk individuals must be identified before such procedures are attempted.

  7. Transesophageal echocardiographic evaluation of an intraoperative retrograde acute aortic dissection: case report

    Directory of Open Access Journals (Sweden)

    Reiter Charles G

    2006-04-01

    Full Text Available Abstract Background We report an intraoperative retrograde dissection of the aorta and its subsequent evaluation by transesophageal echocardiography (TEE. Case presentation A 78 year old woman with an ascending aortic aneurysm without dissection and coronary artery disease was brought to the operating room for aneurysm repair and coronary artery bypass grafting. After initiation of cardiopulmonary bypass through a femoral artery cannula, aortic dissection was noted and subsequently imaged by TEE. Conclusion Retrograde aortic dissection through the femoral artery is life-threatening. Intraoperative TEE can be used to diagnose this uncommon event, and should be considered after initiation of bypass.

  8. Detection of Right Heart Emboli by Transesophageal Echocardiography in Cement Implantation Syndrome in an Elderly Patient

    Directory of Open Access Journals (Sweden)

    Ching-Hung Chen

    2008-09-01

    Full Text Available Femoral fractures are common and lethal among elderly patients. The elderly suffer more perioperative risks because of their complicated medical conditions and poor physical reserves. During cemented arthroplasty surgery in the elderly, unstable hemodynamic changes are frequently noted when the cement and prosthesis are inserted. Transesophageal echocardiography (TEE allows rapid perioperative diagnosis and management of hemodynamic changes. We report an elderly patient with paroxysmal atrial fibrillation, in whom a huge serpentine embolus was noted by TEE. Although cardiovascular collapse was encountered during cemented hip arthroplasty surgery, the patient was successfully resuscitated and the related perioperative risk was managed by TEE application.

  9. Role of perioperative transesophageal echocardiography in the management of adolescent truncus arteriosus: Rare case report

    Directory of Open Access Journals (Sweden)

    P S Nagaraja

    2015-01-01

    Full Text Available Truncus arteriosus (TA is a rare congenital heart disease defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. The truncal valve in majority of the cases is tricuspid though quadricuspid and bicuspid valves have been reported. Patients with TA typically have a large nonrestrictive sub truncal ventricular septal defect. Survival of these infants beyond 1-year is uncommon. Here, we report a unique case of 12-year-old female patient with persistent TA who underwent surgical repair by using transesophageal echocardiography as a monitoring device during the perioperative management.

  10. Giant right coronary artery aneurysm with unusual physiology: Role of intraoperative transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    David M Orozco

    2012-01-01

    Full Text Available A 65-year-old woman presented with a history of dyspnea and atypical chest pain. She was diagnosed with a non-ST-segment elevation myocardial infarction due to a giant right coronary artery aneurysm. After a failed percutaneous embolization, she was scheduled for right coronary artery aneurysm resection, posterior descending artery revascularization and mitral valve repair. During the induction of anesthesia and institution of mechanical ventilation, the patient suffered cardiovascular collapse. The transesophageal echocardiographic examination revealed tamponade physiology owing to compression of the cardiac chambers by the unruptured aneurysm, which resolved with the sternotomy. The surgery was carried out uneventfully.

  11. Association Between Left Atrial Compression And Atrial Fibrillation: A Case Presentation And A Short Review Of Literature.

    Science.gov (United States)

    Ahmed, Niloy; Carlos, Morales-Mangual; Moshe, Gunsburg; Yitzhak, Rosen

    2016-01-01

    This case report describes a patient who developed palpitations and chest pain and was found to be in atrial fibrillation, which was likely due to the presence of an extra-cardiac mass. This was compressing the left atrium. The mass was related to small cell carcinoma, which decreased significantly in size after chemotherapy. Resolution of the atrial fibrillation correlated temporally with reduction in the size of the mass and alleviation of the left atrial compression.

  12. Left atrio-vertebral ratio: A new computed-tomography measurement to identify left atrial dilation.

    Science.gov (United States)

    Baque-Juston, Marie; Volondat, Manuelle; Fontas, Eric; Roger, Coralie; Brunner, Philippe; Padovani, Bernard; Chevallier, Patrick

    2016-01-01

    Left cardiac chambers dilation, interstitial lung changes and pleural effusions are the characteristics of cardiogenic pulmonary oedema on computed tomography (CT) of the chest but mensuration of the left atrial size is not routinely performed. Cardiac chambers normal dimensions are known to be proportional to the patient's build and anthropomorphic data but adjustment of chambers dimensions to available elements seen on the axial CT images has never been evaluated before. Our objective was to use data easily available on axial images to directly scale the left atrium. We chose to divide the left atrial diameter by the thoracic vertebral diameter, using the latter as a body-mass indicator. As a preliminary study, we aimed to evaluate the range of values of this left atrio-vertebral ratio (LAVR) by comparing patients suffering from cardiogenic pulmonary oedema with patients free of cardiac disease. We hypothesized that if the difference of values in these two populations of patients was significant enough, this ratio would be relevant and could be used as a quick criterion in different clinical situations. Two radiologists reviewed CT scans of 32 of patients free of cardiac disease and 40 patients in acute cardiac failure. The maximum diameter of the left atrium at the level of the right inferior pulmonary vein was divided by the vertebral transverse diameter to generate a left atrio-vertebral ratio. Receiver operating characteristic curves identified the threshold associated with pulmonary oedema. The mean LAVR was 1.85 ± 0.27 in asymptomatic patients and 2.48 ± 0.35 in patients with pulmonary oedema. A LAVR of 2.1 yielded 85% sensitivity and 88% specificity for the diagnosis of cardiogenic pulmonary oedema. LAVR is a simple new measure directly scaling the left atrial diameter to the anthropomorphic characteristics of the patient. In our series, a ratio above 2.1 is strongly associated with cardiogenic pulmonary oedema indirectly suggesting left atrial dilation

  13. Pacing Lead-Induced Granuloma in the Atrium: A Foreign Body Reaction to Polyurethane

    Directory of Open Access Journals (Sweden)

    Shinagawa Yoko

    2013-01-01

    Full Text Available We described a case of an 82-year-old male who presented with a granuloma entrapping the polyurethane-coated pacing lead at the site of contact on the atrium. He had been paced for 8 years without symptoms or signs suggestive of an allergic reaction to the pacemaker system and died from thrombosis of the superior mesenteric artery and heart failure. A histological examination of the nodule showed an incidental granuloma with multinucleated giant cells. No granuloma was found in the heart or the lung.

  14. Robotic-assisted excision of a left ventricular thrombus.

    Science.gov (United States)

    Lutz, Charles J; Bhamidipati, Castigliano M; Ford, Brant; Swartz, Mike; Hauser, Michael; Kyobe, Moses; Dilip, Karikehalli

    2007-09-01

    : Left ventricular thrombus is a rare entity usually associated with myocardial infarction. The daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, Calif) offers excellent visualization of the mitral subvalvular apparatus and should provide an effective means to excise a left ventricular mass. : A 34-year-old man presented to an outside institution with fever of unknown origin and ulcerative colitis. As part of this workup, he underwent a transthoracic echocardiogram and subsequently a transesophageal echocardiogram that showed a 2-cm left ventricular apical pedunculated mass. He was referred to our institution for excision of this ventricular mass. Because of the pedunculated nature of the mass, he was deemed a candidate for a robotic-assisted minimally invasive approach. : The patient underwent successful robotic-assisted excision of a left ventricular mass. Total robotic time was 15 minutes. Pathology revealed that the mass was a left ventricular thrombus. The patient experienced an uneventful recovery and was discharged home in 4 days. : Left ventricular mass excision can be safely performed with the daVinci Surgical System. The daVinci Surgical System offers excellent visualization of the entire left ventricular cavity.

  15. Isolated left-sided partial anomalous pulmonary venous connection in a child.

    Science.gov (United States)

    Onan, İsmihan Selen; Sen, Onur; Gökalp, Selman; Onan, Burak

    2017-09-01

    Isolated left-sided partial anomalous pulmonary venous connection with intact interatrial septum is a rare diagnosis in childhood. In these cases, a vertical vein drains the left upper pulmonary lobe into the brachiocephalic vein and finally to the right atrium. Surgical treatment is performed to prevent right ventricular failure and pulmonary artery disease in advanced age. In this report, the rare entity of isolated left-sided anomalous pulmonary venous connection in a 14-year-old girl and successful minimally invasive surgery without cardiopulmonary bypass are described.

  16. Left atrial myxoma complicated with multi-system embolization.

    Science.gov (United States)

    Zhang, Ren-Dan; Zeng, Zhi-Huan; Zheng, Jian-Yi; Li, Tu-Di; Zhao, Yan-Qun; Liu, Yu-Hong; Yao, Yu-Si

    2017-09-05

    Atrial myxoma accounts for approximately 50% of all cardiac tumors. The majority of myxomas are located in the left atrium and present variable clinical manifestation. A young man was transferred to our hospital with sudden onset of resting pain, pallor and numb in right leg. An atrial mobile mass was detected by transthoracic echocardiography. Anticoagulant and antithrombotic therapy were administered, a timely surgery was performed and the mass was confirmed as a myxoma. The patient did not discharge any discomfort post-operation. For patients with atrial myxoma, early diagnosis is essential, anticoagulant or antithrombotic therapy and surgery have a great importance to prevent further embolism.

  17. Left atrial rupture due to blunt thoracic trauma.

    Science.gov (United States)

    Akar, İlker; İnce, İlker; Aslan, Cemal; Çeber, Mehmet; Kaya, İlker

    2015-07-01

    Blunt traumatic cardiac rupture is rare and associated with high mortality. The most popular theory of cardiac rupture after blunt thoracic trauma is rapid deceleration with disruption of the atria from their connections to the vena cava and pulmonary veins. In cases with both massive hemothorax and hemopericardium, injury can usually originate from the heart and/or major vessels. Surgical approach through the median sternotomy can provide convenience to repair the defect. In this article, successful treatment with median sternotomy of a 33-year-old male case with a rupture of the left atrium after blunt thoracic trauma was reported.

  18. Customized CT angiogram planning for intraoperative transesophageal echography-guided endovascular exclusion of thoracic aorta penetrating ulcer.

    Science.gov (United States)

    Piazza, Michele; Lupia, Mario; Grego, Franco; Antonello, Michele

    2015-04-01

    The technique is demonstrated in a 78-year-old man; the preoperative CT angiogram showed a descending thoracic aorta ulcer of 5.9 cm in maximum diameter and 3.8 cm longitudinal extension. A ZTEG-2P-36-127-PF (Cook Medical) single tubular endograft was planned to be deployed. From the preoperative CT angiogram we planned to land 4.7 cm above the midline of the descending thoracic aorta ulcer and 8.0 cm below. In the operating room, under radioscopic vision the centre of the transesophageal echography probe was used as marker to identify the correspondent midline of the descending thoracic aorta ulcer and a centimeter-sized pigtail catheter in the aorta was used to calculate the desired length above and below the ulcer midline. The endograft was introduced and placed in the desired position compared to the transesophageal echography probe and the catheter; under transesophageal echography vision the graft was finally deployed. The CT angiogram at 1 month showed the correct endograft position, descending thoracic aorta ulcer exclusion with no signs of endoleak. In selected cases, this method allows planning in advance safe stent graft positioning and deployment totally assisted by transesophageal echography, with no risk of periprocedural contrast-related renal failure and reduced radiation exposure for the patient and operators. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  19. Computational prediction of proarrhythmogenic effect of the V241F KCNQ1 mutation in human atrium.

    Science.gov (United States)

    Imaniastuti, Riski; Lee, Hyun Seung; Kim, Nari; Youm, Jae Boum; Shim, Eun Bo; Lim, Ki Moo

    2014-09-01

    Genetic factors play an important role in the pathogenesis of atrial flutter (AF). Although mutation in KCNQ1 has been widely correlated with AF, the mechanism by which mutation promotes AF remains poorly understood. The purpose of this study was to investigate the proarrhythmic effect of V241F KCNQ1 mutation in human atrium using the electrophysiological model of human atrium. Using 2D and 3D cardiac electrophysiological models that incorporate the Courtemanche human atrial model, we simulated electrical conduction through atrial tissue and compared spiral wave dynamics under the wild-type and V241F KCNQ1 conditions. In 2D and 3D simulation, V241F KCNQ1 showed a stable and persistent wave without spiral break-up, whereas the wild-type wave was less stable, resulting in early self-termination. According to the results, we concluded that compared to the wild type, the electrical activity of the V241F KCNQ1 mutation is more likely to sustain spiral wave. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. [Endoscopic approach to ventricular atrium for biopsy of pineal region tumour: case report].

    Science.gov (United States)

    Hernández-León, Odalys; Rodríguez-Villalonga, Olga Lidia; Pérez-Nogueira, Frank Reinaldo; Guillén-Cánovas, Evelio José; Alvarez-Toledo, Nilo; Lemus-Saraceni, Agustín

    2014-01-01

    The usual endoscopic approach in the management of pineal region tumours consists of inserting the scope into the frontal horn of the lateral ventricle and advancing it through the foramen of Monro into the third ventricle. We report the case of a patient with a pineal tumour on whom we used an endoscopic approach through the ventricular atrium to obtain a biopsy by opening the choroidal fissure. This young 25-year-old man presented with headache and double vision. Papilloedema and Parinaud's syndrome were found on physical examination. Cranial magnetic resonance revealed a pineal mass and hydrocephalus. We initially performed a third ventriculostomy and a tumour biopsy through a frontal burr hole. The tissue sample was not useful for pathological diagnosis and we decided to perform a second endoscopic biopsy. The endoscopic approach to pineal region masses, reaching the ventricular atrium through a parietal burr hole and opening the choroidal fissure, makes it possible to take a biopsy using a single endoscopic approach without needing to cross other ventricular structures. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  1. EFFECTS OF AEROBIC TRAINING ON THE CARDIOMYOCYTES OF THE RIGHT ATRIUM OF MICE

    Directory of Open Access Journals (Sweden)

    Vanessa Gonçalves Coutinho de Oliveira

    Full Text Available ABSTRACT Introduction: Polypeptide hormones (natriuretic peptides, NPs are secreted by the cardiac atria and play an important role in the regulation of blood pressure. Objective: To evaluate the effects of aerobic training on the secretory apparatus of NPs in cardiomyocytes of the right atrium. Methods: Nine-month-old mice were divided in two groups (n=10: control group (CG and trained group (TG. The training protocol was performed on a motor treadmill for 8 weeks. Systolic blood pressure was measured at the beginning of the experiment (9 months of age and at moment of the sacrifice (11 months of age. Electron micrographs were used to quantify the following variables: the quantitative density and area of NP granules, the relative volumes of the mitochondria, endoplasmic reticulum, and Golgi complex and the relative volume of euchromatin in the nucleus and the number of pores per 10 µm of the nuclear membrane. The results were compared by Student's t test (p< 0.05. Results: The cardiomyocytes obtained from TG mice showed increased density and sectional area of secretory granules of NP, higher relative volume of endoplasmic reticulum, mitochondria, and Golgi complex compared with the CG mice. Furthermore, the quantitative density of nuclear pores and the relative volume of euchromatin in the nucleus were significantly higher compared with the CG mice. Conclusion: Aerobic training caused hypertrophy of the secretory apparatus in the cardiomyocytes of right atrium, which could explain the intense synthesis of natriuretic peptides in trained mice with respect to the untrained mice.

  2. Computer Simulation Investigation on the Effect of Channelled and Unchannelled Screens on Smoke Contamination in Atriums Upper Balconies

    Directory of Open Access Journals (Sweden)

    Nasif Mohammad Shakir

    2014-07-01

    Full Text Available This paper performed the effect of installing channel screen on smoke contamination in the presence of 0.5 m deep down stand in a fire compartment. The results are then compared with smoke contamination occurrence when the channel screens were removed. The results showed that there will be 96% increase in upper balconies smoke contamination in an atrium when no channel screens at fire compartment opening are used. This work provides new correlation obtained from numerical study which can predict the smoke contamination height in upper balconies of the atrium in the presence of 0.5 m down stand and no channel screens. The proposed correlation will be useful design tool for building designer to design safe shopping malls (atrium.

  3. Assessment of left atrial volume and function in patients with permanent atrial fibrillation

    DEFF Research Database (Denmark)

    Agner, Bue F Ross; Kühl, Jørgen Tobias; Linde, Jesper James

    2014-01-01

    Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with substantial morbidity and mortality. AF is associated with enlargement of the left atrium (LA), and the LA volume has important prognostic implications for the disease. The objective of the study was to determine how ...... measurements of LA volume and function obtained by transthoracic echocardiography (TTE), cardiac magnetic resonance (CMR), and 320-slice multi-detector computed tomography (MDCT) correlate in patients with permanent AF....

  4. Autosynchronized systolic unloading during left ventricular assist with a centrifugal pump.

    Science.gov (United States)

    Kono, Satoshi; Nishimura, Kazunobu; Nishina, Takeshi; Yuasa, Sadatoshi; Ueyama, Koji; Hamada, Chikuma; Akamatsu, Teruaki; Komeda, Masashi

    2003-02-01

    The purpose of this study was to investigate how the inflow cannulation site of the left ventricular assist system with a centrifugal pump would influence cardiac function on failing heart models. In 10 sheep, a left ventricular assist system was instituted by an outflow cannula in the descending aorta, two inflow cannulas in the left atrium and the left ventricle, and connecting those cannulas to a magnetically suspended centrifugal pump. A conductance catheter and a tipped micromanometer for monitoring the pressure-volume loop were also inserted into the left ventricle. Myocardial oxygen consumption was directly measured. Heart failure was induced by injection of microspheres into the left main coronary artery. The assist rate was varied from 0% to 100% at each inflow cannulation site. The pump flow with left ventricular cannulation increased during the systolic phase and decreased during the diastolic phase, whereas it was constant with left atrial cannulation. Ejection fraction with left atrial cannulation decreased as the assist rate increased, whereas that with left ventricular cannulation was maintained up to 75% assist. The external work with left atrial cannulation decreased gradually as the assist rate increased, whereas the external work with left ventricular cannulation did not decrease until the assist rate reached 75%. The myocardial oxygen consumption in both cannulations decreased proportionally as the assist rate increased; they were significantly less with left ventricular cannulation at the 100% assist rate than with left atrial cannulation. Left ventricular cannulation during left ventricular assistance maintains ejection fraction and effectively reduces oxygen consumption.

  5. Fibrin glue on an aortic cusp detected by transesophageal echocardiography after valve-sparing aortic valve replacement: a case report.

    Science.gov (United States)

    Nakahira, Junko; Ishii, Hisanari; Sawai, Toshiyuki; Minami, Toshiaki

    2015-03-07

    Fibrin glue is used commonly during cardiac surgery but can behave as an intracardiac abnormal foreign body following surgery. There have been few such cases reported, and they were typically noticed only because of the resulting catastrophic cardiac conditions, such as valvular malfunction. We report a case where, for the first time, transesophageal echocardiography was used to detected fibrin glue that was adherent to the ventricular side of a patient's aortic valve immediately after aortic declamping. A 45-year-old Japanese man with Marfan syndrome underwent an aortic valve-sparing operation to treat moderate aortic valve regurgitation resulting from enlargement of his right coronary cusp. Fibrin glue was lightly applied to the suture line between the previous and new grafts. Transesophageal echocardiography performed prior to weaning from the cardiopulmonary bypass revealed mild aortic valve regurgitation in addition to a mobile membranous structure attached to the ventricular side of his aortic valve. It was identified as fibrin glue. We resolved the regurgitation by removing the fibrin glue and repeating the aortic cusp plication. The patient had no complications during recovery. Fibrin glue can act as an intracardiac foreign body and lead to a potentially fatal embolism. We demonstrated the use of transesophageal echocardiography to detect a fibrin glue-derived intracardiac abnormal foreign body and to confirm its removal. To the best of our knowledge, this is the first case where fibrin glue adherent to the aortic valve was detected by transesophageal echocardiography. These findings demonstrate the importance of using transesophageal echocardiography during cardiac surgery that involves using biological glues.

  6. Numerical investigation on the effect of balcony open and solid upstand on smoke contamination in atrium balconies

    Science.gov (United States)

    Mutafi, M. A.; Nasif, M. S.; Pao, W.; Ismail, F. B.

    2017-10-01

    Atrium is a modern architectural design of buildings that has an open space at the middle and contains several floors. In atrium structure the smoke due to fire can easily flow through the open spaces and causes smoke contamination. CFD simulation using fire dynamic simulator (FDS) software is conducted in this work, to investigate the effect of balcony open upstand on smoke contamination in atrium’s balconies and compare it with balconies with solid upstand. It was found that in case of open upstand, the smoke contamination occurrence decreased inside the balcony comparing with balconies with solid upstand.

  7. Descending aortic mechanics and atrial fibrillation: a two-dimensional speckle tracking transesophageal echocardiography study.

    Science.gov (United States)

    Teixeira, Rogério; Monteiro, Ricardo; Dinis, Paulo; Santos, Maria José; Botelho, Ana; Quintal, Nuno; Cardim, Nuno; Gonçalves, Lino

    2017-04-01

    Vascular mechanics assessed with two-dimensional speckle tracking echocardiography (2D-STE) could be used as a new imaging surrogate of vascular stiffening. The CHA 2 DS 2 -VASc score is considered accurate as an estimate of stroke risk in non-valvular AF, although many potential stroke risk factors have not been included in this scoring method. The purpose of this research is to study the feasibility of evaluating vascular mechanics at the descending aorta in non-valvular AF patients using transesophageal 2D-STE and to analyze the association between descending aortic mechanics and stroke. We prospectively recruited a group of 44 patients referred for a transesophageal echocardiogram (TEE) in the context of cardioversion for non-valvular AF. A short-axis view of the descending aorta, one to two centimeters after the aortic arch was selected for the vascular mechanics assessment with the 2D-STE methodology. The vascular mechanics parameters analyzed were circumferential aortic strain (CAS) and early circumferential aortic strain rate (CASR). A clinical assessment was performed with focus on the past stroke history and the CHA 2 DS 2 -VASc score. The mean age of our cohort was 65 ± 13 years and 75% were men; AF was known for 2.8 ± 2.5 years and it was considered paroxystic in 41% of cases. Waveforms adequate for measuring 2D-STE were present in 85% of the 264 descending aortic wall segments. The mean CAS was 3.5 ± 1.2% and the mean CASR was 0.7 ± 0.3 s -1 . The inter- and intra-observer variability for aortic mechanics was considered adequate. The median CHA 2 DS 2 VASc score was 2 (2-3). As the score increased we noted that both the CAS (r = -0.38, P = 0.01) and the CASR (r = -0.42, P mechanics assessed with transesophageal 2D-STE.

  8. Blood pressure levels, left ventricular mass and function are correlated with left atrial volume in mild to moderate hypertensive patients.

    Science.gov (United States)

    Milan, A; Caserta, M A; Dematteis, A; Naso, D; Pertusio, A; Magnino, C; Puglisi, E; Rabbia, F; Pandian, N G; Mulatero, P; Veglio, F

    2009-11-01

    Arterial hypertension is associated with an increased risk of atrial fibrillation (AF), and leads to a pronounced increase in morbidity and mortality. Left atrial volume (LAV) is an important prognostic marker in the older populations. The aim of our study was to identify the clinical and echocardiographic determinants of LAV in middle-aged (R(2)=0.19, P<0.001) and LAV were increased in essential hypertensive patients with left ventricular hypertrophy (LVH), and patients with enlarged LAV showed lower systolic and diastolic function and an increased LVMI. The LAVi is dependent on blood pressure levels and anthropometric variables (age and BMI). Further structural (LVMI) and functional (systolic and diastolic) variables are related to the LAVi; LVMI is the most important variable associated with LAV in mild to moderate essential hypertensive adult patients. These findings highlight the importance of left atrium evaluation in adult, relatively young, essential hypertensive patients.

  9. Incremental Value of Live/Real Time Three-Dimensional over Two-Dimensional Transesophageal Echocardiography in the Assessment of Atrial Septal Pouch.

    Science.gov (United States)

    Elsayed, Mahmoud; Hsiung, Ming C; Meggo-Quiroz, L David; Elguindy, Mostafa; Uygur, Begum; Tandon, Rohit; Guvenc, Tolga; Keser, Nurgul; Vural, Mustafa G; Bulur, Serkan; Chahwala, Jugal R; Abtahi, Firoozeh; Nanda, Navin C

    2015-12-01

    An atrial septal pouch (ASP) results from partial fusion of the septum primum and the septum secundum, and depending on the site of fusion, the pouch can be left-sided (LASP) or right-sided (RASP). LASPs have been described in association with thrombi found in patients admitted with acute strokes, raising awareness of its potential cardioembolic role, especially in those with no other clearly identifiable embolic source. We retrospectively studied 39 patients in whom the presence of an ASP had been identified by three-dimensional transesophageal echocardiography (3DTEE) and who had a two-dimensional transesophageal echocardiogram (2DTEE) performed during the same clinical encounter. The incremental value provided by 3DTEE over 2DTEE included the detection of six ASPs not found by 2DTEE; the detection of two ASPs in the same subject (in four patients) not identified by 2DTEE; larger ASP measurements of length and height in over 80% of the cases; and measurement of the ASP width (elevational axis) for the calculation of the area of the ASP opening, because of its unique capability to view the pouch en face. In addition, the volume of ASP and of the echogenic masses contained in the ASP (four of 39 patients) could be calculated by 3DTEE, which is a superior parameter of size characterization when compared to individual dimensions. One of these patients who presented with ischemic stroke diagnosed by magnetic resonance imaging had a large (>2 cm) mass in a LASP, with echolucencies similar to those seen in thrombi and associated with clot lysis and resolution. This mass completely disappeared on anticoagulant therapy lending credence that it was most likely a thrombus. There was no history of stroke or any other type of embolic event in the other three patients with masses in ASP. In conclusion, this retrospective study highlights the incremental value of 3DTEE over 2DTEE in the comprehensive assessment and characterization of ASPs, which can aid in the clarification of

  10. Noninvasive diagnosis of suspected severe pulmonary embolism. Trans-esophageal echocardiography vs spiral CT

    International Nuclear Information System (INIS)

    Pruszczyk, P.; Torbicki, A.; Pacho, R.

    1998-01-01

    Patients with pulmonary embolism (PE) and echocardiographic signs of right ventricular over-lead have worse prognosis and may be require aggressive therapy. Unequivocal confirmation of PE is required before thrombolysis or embolectomy. This study compares the value of trans-esophageal echocardiography (TEE) and spiral CT (sCT) in direct visualization of pulmonary artery thrombo-emboli in patients with suspected PE and echocardiographic signs of right ventricular over-lead. Because of high prevalence of bilateral central pulmonary thrombo-emboli in patients with hemo-dynamically significant PE, both sCT and TEE allow its definitive confirmation in most cases. Thrombi reported by sCT distally to lobar arteries should be interpreted with caution. (author)

  11. Successful thrombectomy of a stuck mechanical prosthetic mitral valve guided by perioperative transesophageal echocardiography and cinefluoroscopy

    Directory of Open Access Journals (Sweden)

    Paulo César Gobert Damasceno Campos

    2009-03-01

    Full Text Available We describe the case of a 53-year-old man with past history of rheumatic valvular disease who developed acute decompensated heart failure due to thrombosis of his mechanical mitral valve prosthesis. The diagnosis was established after a combined and complementary approach of echocardiography and cinefluoroscopy. Because of the severe heart failure at presentation, the patient was taken to surgery. The intraoperative transesophageal echocardiography was critical to guide a successful thrombectomy procedure. Postoperative pathological findings revealed the presence of thrombus and fibrotic tissue (pannus in the surgical specimens removed from the valve. The success of this case and the treatment choice are supported by the most recent literature data on prosthetic valve thrombosis. We highlight the use of three diagnostic approaches in our patient: echocardiography, cinefluoroscopy and pathology.

  12. In-vivo continuous monitoring of mixed venous oxygen saturation by photoacoustic transesophageal echocardiography (Conference Presentation)

    Science.gov (United States)

    Li, Li; Subramaniam, Balachundhar; Aguirre, Aaron D.; Andrawes, Michael N.; Tearney, Guillermo J.

    2016-02-01

    Mixed venous oxygen saturation (SvO2), measured from pulmonary arteries, is a gold-standard measure of the dynamic balance between the oxygen supply and demand in the body. In critical care, continuous monitoring of SvO2 plays a vital role in early detection of circulatory shock and guiding goal-oriented resuscitation. In current clinical practice, SvO2 is measured by invasive pulmonary artery catheters (PAC), which are associated with a 10% risk of severe complications. To address the unmet clinical need for a non-invasive SvO2 monitor, we are developing a new technology termed photoacoustic transesophageal echocardiography (PA-TEE). PA-TEE integrates transesophageal echocardiography with photoacoustic oximetry, and enables continuous assessment of SvO2 through an esophageal probe that can be inserted into the body in a minimally invasive manner. We have constructed a clinically translatable PA-TEE prototype, which features a mobile OPO laser, a modified ultrasonography console and a dual-modality esophageal probe. Comprised of a rotatable acoustic array detector, a flexible optical fiber bundle and a light-integrating acoustic lens, the oximetric probe has an outer diameter smaller than 15 mm and will be tolerable for most patients. Through custom-made C++/Qt software, our device acquires and displays ultrasonic and photoacoustic images in real time to guide the deployment of the probe. SvO2 is calculated on-line and updated every second. PA-TEE has now been used to evaluate SvO2 in living swine. Our findings show that changing the fraction of oxygen in the inspired gas modulates SvO2 measured by PA-TEE. Statistic comparison between SvO2 measurements from PA-TEE in vivo the gold-standard laboratorial analysis on blood samples drawn from PACs will be presented.

  13. Anomalous left-to-right shunting communication between the ascending aorta and right pulmonary artery in a dog.

    Science.gov (United States)

    Scollan, Katherine; Salinardi, Brenda; Bulmer, Barret J; Sisson, D David

    2011-06-01

    Anomalies of conotruncal septation are rare in dogs and uncommon in humans. Congenital conotruncal defects most commonly reported in veterinary medicine include aorto-pulmonary window and persistent truncus arteriosus. We report a case of an anomalous vessel connecting the ascending aorta to the right pulmonary artery causing left-to-right shunting, left-sided volume overload, and pulmonary overcirculation. Transesophageal echocardiography, cardiac catheterization, and contrast-enhanced computed tomography assisted in the diagnosis and facilitated the surgical correction of the anomalous vessel. The authors hypothesize this defect represents an unusual anomalous vessel connecting the ascending aorta to the right pulmonary artery. Copyright © 2011 Elsevier B.V. All rights reserved.

  14. A novel innominate vein-to-common atrium fenestration at Fontan completion.

    Science.gov (United States)

    Mir, Thomas S; Arndt, Florian; von Samson, Patrick; Philipp, Lisa; Schnegg, Clivia; Mueller, Götz; Dodge-Khatami, Ali

    2010-05-01

    With the hypothesis of low thromboembolic risk and higher late postoperative spontaneous closure, a new fenestration technique during extracardiac total cavopulmonary connection was attempted. From 2008 to 2009, 14 consecutive patients received an innominate vein-common atrium 5-mm Gore-Tex (W.L. Gore and Associates, Flagstaff, AZ) graft fenestration. Monitoring was performed by contrast bubble echocardiography at hospital discharge and up to 6 months postoperatively. The technique proved safe and reproducible, did not add to surgical difficulty or time, and provided reliable fenestration of up to at least 3 weeks, with a high rate of spontaneous closure during intermediate follow-up. Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. A сase of obstruction of SVC-right atrium appendage anastomosis after procedure Warden

    Directory of Open Access Journals (Sweden)

    Е. А. Связов

    2017-04-01

    Full Text Available The analysis of a 6-year patient’s medical history after correction of congenital heart disease (partial anomalous drainage of the right superior pulmonary vein into the superior vena cava complicated by obstruction of the anastomosis between the SVC and the appendage right atrium is presented. The article discusses the stages of diagnosis and patient management features, as well as the choice of treatment.Received 12 December 2016. Accepted 14 February 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Svyazov E.A.: data analysis, article writing and editing. Podoksenov A.U.: article editing. Varvarenko V.I.: implantation of the stent-graft in superior vena cava.Martsinkevich G.I.: echocardiographic examination of the patient before and after endograft implantation, article editing. Krivoshchyokov E.V.: organizational work and referral of the patient to endovascular treatment, article editing.

  16. Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus

    Directory of Open Access Journals (Sweden)

    Preetham R Muskula

    2017-04-01

    Full Text Available An 84-year-old man presented 5 years after bioprosthetic mitral valve replacement with three months of worsening dyspnea on exertion. A new mitral stenosis murmur was noted on physical examination, and an electrocardiogram revealed newly recognized atrial fibrillation. Severe mitral stenosis (mean gradient = 13 mmHg was confirmed by transthoracic echocardiography. Transesophageal echocardiography revealed markedly thickened mitral bioprosthetic leaflets with limited mobility, and a massive left atrial thrombus (>4 cm in diameter (Fig. 1A, B, C, D and Videos 1, 2, 3 and 4. Intravenous heparin was initiated, and 5 days later, he was taken to the operating room for planned redo mitral valve replacement and left atrial thrombus extraction. Intraoperative transesophageal echocardiography revealed near-complete resolution of the bioprosthetic leaflet thickening, and a mean mitral gradient of only 3 mmHg (Fig. 2A, B, C and Videos 5, 6 and 7. The patient underwent resection of the massive left atrial thrombus (Fig. 2D but did not require redo mitral valve replacement. He was initiated on heparin (and transitioned to warfarin early in the post-operative period, with complete resolution of dyspnea on exertion at 3-month follow-up. Bioprosthetic valve thrombosis is increasingly recognized as a cause of early prosthetic valve dysfunction (1, 2. This case illustrates that bioprosthetic valve thrombosis may occur years after valve replacement; therefore, any deterioration in a patient’s clinical status (new-onset dyspnea, heart failure or atrial fibrillation warrants a thorough evaluation of the bioprosthetic valve with transesophageal echocardiography. In this case, initiation of anticoagulation obviated the need for redo mitral valve replacement.

  17. Plant Atrium System for Food Production in NASA's Deep Space Habitat Tests

    Science.gov (United States)

    Massa, Gioia D.; Simpson, Morgan; Wheeler, Raymond M.; Newsham, Gerald; Stutte, Gary W.

    2013-01-01

    In preparation for future human exploration missions to space, NASA evaluates habitat concepts to assess integration issues, power requirements, crew operations, technology, and system performance. The concept of a Food Production System utilizes fresh foods, such as vegetables and small fruits, harvested on a continuous basis, to improve the crew's diet and quality of life. The system would need to fit conveniently into the habitat and not interfere with other components or operations. To test this concept, a plant growing "atrium" was designed to surround the lift between the lower and upper modules of the Deep Space Habitat and deployed at NASA Desert Research and Technology Studies (DRATS) test site in 2011 and at NASA Johnson Space Center in 2012. With this approach, no-utilized volume provided an area for vegetable growth. For the 2011 test, mizuna, lettuce, basil, radish and sweetpotato plants were grown in trays using commercially available red I blue LED light fixtures. Seedlings were transplanted into the atrium and cared for by the. crew. Plants were then harvested two weeks later following completion of the test. In 2012, mizuna, lettuce, and radish plants were grown similarly but under flat panel banks of white LEDs. In 2012, the crew went through plant harvesting, including sanitizing tlie leafy greens and radishes, which were then consumed. Each test demonstrated successful production of vegetables within a functional hab module. The round red I blue LEDs for the 2011 test lighting cast a purple light in the hab, and were less uniformly distributed over the plant trays. The white LED panels provided broad spectrum light with more uniform distribution. Post-test questionnaires showed that the crew enjoyed tending and consuming the plants and that the white LED light in 2012 provided welcome extra light for the main HAB AREA.

  18. Variability of the Left Atrial Appendage in Human Hearts.

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    Rafał Kamiński

    Full Text Available Atrial fibrillation increases the risk of thrombus formation. It is commonly responsible for cerebral stroke whereas less frequently for pulmonary embolism. The aim of the study was to describe the morphology of the left atrial appendage in the human heart with respect to sex, age and weight. Macroscopic examination was carried out on 100 left appendages taken from the hearts of the patients aged 18-77, both sexes. All hearts preserved in 4% water solution of formaldehyde carried neither marks of coronary artery disease nor congenital abnormalities. Three axes of appendage orientation were performed. After the appendage had been cut off, morphological examination was performed in long and perpendicular axes. Measurements of the appendages were taken from anatomical specimens and their silicone casts. We classified the left atrial appendage into 4 morphological groups according to the number of lobes. Most left atrial appendages in female population were composed of 2 lobes. In the male group typically 2 or 3-lobed appendages were observed. The mean left atrial appendage orifice ranged from 12.0 to 16.0 mm and the most significant difference in the orifices between males and females was observed in LAA type 2 (about 3.3 mm. A smaller orifice and narrower, tubular shape of the LAA lobes could explain a higher risk of thrombus formation during nonvalvular atrial fibrillation in women. Knowledge of anatomical variability of the LAA helps diagnose some undefined echoes in the appendage during transesophageal echocardiographic examination.

  19. ARE LEFT HANDED SURGEONS LEFT OUT?

    OpenAIRE

    SriKamkshi Kothandaraman; Balasubramanian Thiagarajan

    2012-01-01

    Being a left-handed surgeon, more specifically a left-handed ENT surgeon, presents a unique pattern of difficulties.This article is an overview of left-handedness and a personal account of the specific difficulties a left-handed ENT surgeon faces.

  20. Сlinical features of left atrial myxoma in comorbidity with active lung tuberculosis

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    M. Yu. Kolesnyk

    2016-12-01

    Full Text Available The symptoms and syndromology of myxomas with clinical features of a rare comorbidity – lung tuberculosis and left atrial myxoma in a 69-old year woman, are described in the article. The description includes the clinical history, transesophageal echocardiography findings, pathomorphological characteristics of myxoma, also photoillustrations of tumor’s macro- and microstructures. The analysis reflects the troubles in differential diagnosis of the clinical case due to non-specific symptoms of both diseases. The discussion provides the information about the possible pathophysiological link between myxoma and tuberculosis and the role of interleukin6 inthis process.

  1. Siblings with Idiopathic Left Atrial Appendage Ostial Stenosis and Cor Triatriatum.

    Science.gov (United States)

    Okada, Seigo; Ishiguchi, Yukiko; Moritoh, Yuji; Shohi, Mayuko; Nakagawa, Naomi; Okamoto, Kengo; Kamada, Masahiro

    2016-07-01

    Isolated left atrial appendage (LAA) ostial stenosis is a very rare entity found coincidentally in adults by transesophageal echocardiography. A 3-month-old healthy infant was suspected as having cor triatriatum. His brother had a history of surgical treatment of cor triatriatum. A cardiac catheterization revealed a narrowed ostium of the LAA and confirmed the echocardiographic diagnosis of isolated LAA ostial stenosis. This is the first pediatric case of idiopathic LAA ostial stenosis. The siblings called our attention to the differential diagnosis and the etiopathogenesis between LAA ostial stenosis and cor triatriatum. © 2016, Wiley Periodicals, Inc.

  2. Persistent left superior vena cava with absent right superior vena cava: image findings

    International Nuclear Information System (INIS)

    Araujo Junior, Cyrillo Rodrigues de; Carvalho, Tarcisio Nunes; Fraguas Filho, Sergio Roberto; Costa, Marlos Augusto Bitencourt; Jacob, Beatriz Mahmud; Machado, Marcio Martins; Teixeira, Kim-Ir-Sen Santos; Ximenes, Carlos Alberto

    2003-01-01

    Persistent left superior vena cava absent right superior vena cava is a rare anomaly, with less than 150 cases reported in the literature. Congenitally persistent left superior vena cava is the most common variant of systemic venous return to the heart, resulting embryologically from failure of the left anterior cardinal vein to become obliterated. Its incidence varies from 0.3% in patients with otherwise normal heart to 4.3% in patients with congenital heart disease. In the majority of the patients, a right superior vena cava is present as well, but rarely the right anterior cardinal vein degenerates resulting in the absence of the normal right superior vena cava. The blood from the right side is carried by the persistent left superior vena cava to the right atrium through the coronary sinus. We report the case of a patient with a persistent left superior vena cava and absence of right superior vena cava identified by chance during a chest radiograph and computed tomography examination for investigation of chronic pulmonary obstructive disease. The patient had no congenital heart disease and the blood from the right side was drained by the persistent left superior vena cava into the right atrium through the coronary sinus. (author)

  3. Sudden onset congestive heart failure with a continuous murmur: ruptured sinus of Valsalva aneurysm complicated by anomalous origin of the left coronary artery.

    Science.gov (United States)

    Seto, Arnold H; Hermer, Alan; Kern, Morton

    2008-01-01

    Ruptured sinus of Valsalva aneurysm is an unusual cause for congestive heart failure, and anomalous coronary arteries have rarely been found in association. A 47-year-old man developed sudden onset heart failure due to a ruptured noncoronary sinus of Valsalva fistula to the right atrium. Coronary angiography revealed an anomalous left coronary artery arising from the right coronary sinus, limiting percutaneous options for repair. We review the incidence, complications, and management of sinus of Valsalva aneurysms and anomalous left coronary arteries.

  4. Successful Resuscitation of Maternal Cardiac Arrest With Disseminated Intravascular Coagulation Guided by Rotational Thromboelastometry and Transesophageal Echocardiography: A Case Report.

    Science.gov (United States)

    Brown, Hannah; Barrett, Helen L; Lee, Julie; Pincus, Jason M; Kimble, Rebecca M; Eley, Victoria A

    2017-10-26

    We present a case of maternal cardiac arrest during an elective cesarean delivery. Transesophageal echocardiography identified a large pulmonary artery mass, and guided resuscitation efforts. After return of spontaneous circulation, the patient developed disseminated intravascular coagulation with massive hemorrhage. Blood product selection and volume replacement were guided by rotational thromboelastometry and transesophageal echocardiography, respectively. Correction of coagulopathy was observed clinically and confirmed by rotational thromboelastometry. The patient fully recovered without neurological deficit.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  5. A Giant Left Atrial Myxoma Neovascularized from the Right Coronary Artery

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    Demet Menekse Gerede

    2015-01-01

    Full Text Available Myxomas are benign and the most common tumors of the cardiac muscle (Reynen, 1995. They are predominantly located in the left atrium. Clinical manifestations may vary according to the localization and the size of the myxoma. On the other hand, imaging of a myxoma by contrast dye during coronary angiography is a rare sign, which displays the vascular supply of the tumor. Here, we report the case of a 51-year-old man presenting with presyncope and palpitations due to a giant left atrial myxoma having its vascular supply from the right coronary artery (RCA.

  6. Comparison of four echocardiographic methods to determine left atrial size in dogs

    DEFF Research Database (Denmark)

    Höllmer, Miriam; Willesen, Jakob; Tolver, Anders

    2016-01-01

    breeds, 88 healthy dogs and 88 dogs with myxomatous mitral valve disease of different disease severity. METHODS: The left apical four- and two-chamber views were used to measure LA volumes. The right parasternal short-axis view at the level of the heart base was used to measure the LA/Ao ratio. RESULTS......OBJECTIVES: To compare a linear and three volume-based two-dimensional echocardiographic methods for measuring LA size: left atrium to aorta ratio (LA/Ao ratio), biplane area-length, biplane modified Simpson and monoplane area-length. ANIMALS: One hundred seventy-six client-owned dogs of different...

  7. Atrial myocardium derives from the posterior region of the second heart field, which acquires left-right identity as Pitx2c is expressed.

    Science.gov (United States)

    Galli, Daniela; Domínguez, Jorge N; Zaffran, Stephane; Munk, Andrew; Brown, Nigel A; Buckingham, Margaret E

    2008-03-01

    Splanchnic mesoderm in the region described as the second heart field (SHF) is marked by Islet1 expression in the mouse embryo. The anterior part of this region expresses a number of markers, including Fgf10, and the contribution of these cells to outflow tract and right ventricular myocardium has been established. We now show that the posterior region also has myocardial potential, giving rise specifically to differentiated cells of the atria. This conclusion is based on explant experiments using endogenous and transgenic markers and on DiI labelling, followed by embryo culture. Progenitor cells in the right or left posterior SHF contribute to the right or left common atrium, respectively. Explant experiments with transgenic embryos, in which the transgene marks the right atrium, show that atrial progenitor cells acquire right-left identity between the 4- and 6-somite stages, at the time when Pitx2c is first expressed. Manipulation of Pitx2c, by gain- and loss-of-function, shows that it represses the transgenic marker of right atrial identity. A repressive effect is also seen on the proliferation of cells in the left sinus venosus and in cultured explants from the left side of the posterior SHF. This report provides new insights into the contribution of the SHF to atrial myocardium and the effect of Pitx2c on the formation of the left atrium.

  8. Rapid growth of left atrial myxoma after radiofrequency ablation.

    Science.gov (United States)

    Rubio Alvarez, José; Martinez de Alegria, Anxo; Sierra Quiroga, Juan; Adrio Nazar, Belen; Rubio Taboada, Carola; Martinez Comendador, José Manuel

    2013-01-01

    Atrial myxoma is the most common benign tumor of the heart, but its appearance after radiofrequency ablation is very rare. We report a case in which an asymptomatic, rapidly growing cardiac myxoma arose in the left atrium after radiofrequency ablation. Two months after the procedure, cardiovascular magnetic resonance, performed to evaluate the right ventricular anatomy, revealed a 10 × 10-mm mass (assumed to be a thrombus) attached to the patient's left atrial septum. Three months later, transthoracic echocardiography revealed a larger mass, and the patient was diagnosed with myxoma. Two days later, a 20 × 20-mm myxoma weighing 37 g was excised. To our knowledge, the appearance of an atrial myxoma after radiofrequency ablation has been reported only once before. Whether tumor development is related to such ablation or is merely a coincidence is uncertain, but myxomas have developed after other instances of cardiac trauma.

  9. Left atrial spindle cell sarcoma – Case report

    Directory of Open Access Journals (Sweden)

    Nihar Mehta

    2012-07-01

    Full Text Available Primary spindle cell sarcoma of the left atrium is an extremely rare tumour. Surgical excision is the mainstay of treatment since it responds poorly to chemotherapy or radiotherapy. In spite of all the treatment, the prognosis remains poor due to inadvertent delay in diagnosis, few therapeutic options and propensity to metastasize. We present a 47-year-old male who underwent a surgical excision of a left atrial mass in February 2010. It was proved to be a high-grade spindle cell sarcoma on histopathology. He presented again in October 2010 with recurrence of the tumour for which he was re-operated. However, the tumour recurred again within one month, to which the patient succumbed.

  10. Isolated persistent left-sided superior vena cava, giant coronary sinus, atrial tachycardia and heart failure in a child

    Directory of Open Access Journals (Sweden)

    Nagaraja Moorthy

    2013-09-01

    Full Text Available Persistence of a left-sided superior vena cava (PLSVC with absent right superior vena cava (isolated PLSVC is a very rare venous malformation and commonly associated with congenital heart disease or alterations of the cardiac situs. We describe an unusual case of a young boy presenting with persistent atrial tachycardia and congestive heart failure. He was detected to have unexplained grossly dilated right atrium, right ventricle with systolic dysfunction and a giant coronary sinus (CS. The dilated CS closely mimicked a pseudo cor-triatriatum on echocardiography. Contrast echocardiography from both arms revealed opacification of the CS before the right atrium. Bilateral upper limb venography confirmed the presence of absent right SVC and isolated persistent left SVC draining into the giant coronary sinus.

  11. Mechanisms of recurrent aortic regurgitation after aortic valve repair: predictive value of intraoperative transesophageal echocardiography.

    Science.gov (United States)

    le Polain de Waroux, Jean-Benoît; Pouleur, Anne-Catherine; Robert, Annie; Pasquet, Agnès; Gerber, Bernhard L; Noirhomme, Philippe; El Khoury, Gébrine; Vanoverschelde, Jean-Louis J

    2009-08-01

    The aim of the present study was to examine the intraoperative echocardiographic features associated with recurrent severe aortic regurgitation (AR) after an aortic valve repair surgery. Surgical valve repair for AR has significant advantages over valve replacement, but little is known about the predictors and mechanisms of its failure. We blindly reviewed all clinical, pre-operative, intraoperative, and follow-up transesophageal echocardiographic data of 186 consecutive patients who underwent valve repair for AR during a 10-year period and in whom intraoperative and follow-up echo data were available. After a median follow-up duration of 18 months, 41 patients had recurrent 3+ AR, 23 patients presented with residual 1+ to 2+ AR, and 122 had no or trivial AR. In patients with recurrent 3+ AR, the cause of recurrent AR was the rupture of a pericardial patch in 3 patients, a residual cusp prolapse in 26 patients, a restrictive cusp motion in 9 patients, an aortic dissection in 2 patients, and an infective endocarditis in 1 patient. Pre-operatively, all 3 groups were similar for aortic root dimensions and prevalence of bicuspid valve (overall 37%). Patients with recurrent AR were more likely to display Marfan syndrome or type 3 dysfunction pre-operatively. At the opposite end, patients with continent AR repair at follow-up were more likely to have type 2 dysfunction pre-operatively. After cardiopulmonary bypass, a shorter coaptation length, the degree of cusp billowing, a lower level of coaptation (relative to the annulus), a larger diameter of the aortic annulus and the sino-tubular junction, the presence of a residual AR, and the width of its vena contracta were associated with the presence of AR at follow-up. Multivariate Cox analysis identified a shorter coaptation length (odds ratio [OR]: 0.8, p = 0.05), a coaptation occurring below the level of the aortic annulus (OR: 7.9, p < 0.01), a larger aortic annulus (OR: 1.2, p = 0.01), and residual aortic regurgitation

  12. Image-based flow modeling in a two-chamber model of the left heart

    Science.gov (United States)

    Vedula, Vijay; Seo, Jung-Hee; Shoele, Kourosh; George, Richard; Younes, Laurent; Mittal, Rajat

    2014-11-01

    Computational modeling of cardiac flows has been an active topic of discussion over the past decade. Modeling approaches have been consistently improved by inclusion of additional complexities and these continue to provide new insights into the dynamics of blood flow in health and disease. The vast majority of cardiac models have been single-chamber models, which have typically focused on the left or right ventricles, and in these models, the atria are modeled in highly simplistic ways. However, the left atrium acts as a mixing chamber and works with the left ventricle in a highly coordinated fashion to move the blood from the pulmonary veins to the aorta. The flow dynamics associated with this two-chamber interaction is not well understood. In addition, the flow in the left atrium has by itself significant clinical implications and our understanding of this is far less than that of the left ventricle. In the current study, we use 4D CT to create a physiological heart model that is functionally normal and use an experimentally validated sharp-interface immersed boundary flow solver to explore the atrio-ventricular interaction and develop insights into some of the questions addressed above. This research is supported by the U.S. National Science Foundation through NSF Grants IOS-1124804 and IIS-1344772. Computational resources are provided in part through the NSF XSEDE grants TG-CTS100002 and TG-CTS130064.

  13. The effect of transesophageal echocardiography in the surgical treatment of tetralogy of Fallot.

    Science.gov (United States)

    Wang, L-C; Li, S-K; Zhu, F-T; Bian, T; Wang, H-Y

    2018-04-01

    To investigate the effect of transesophageal echocardiography (TEE) in the surgical treatment of tetralogy of Fallot. 98 patients with tetralogy of Fallot received and cured by Zhengzhou Cardiovascular Hospital (Zhengzhou No. 7 People's Hospital) from January 2015 to January 2017 were selected as the study objects. All patients were examined by TEE before surgery, and the pulmonary artery index (PAI) and pulmonary vein index (PVI) were measured, so as to analyze the effect of TEE in the surgical treatment of tetralogy of Fallot. Among the 98 patients, 12 patients were diagnosed with intensive care unit (ICU) retention, 23 patients were diagnosed with respirator assisted respiration extension, 8 patients were diagnosed with low cardiac output syndrome, and 10 patients were diagnosed with respiratory tract infection, which indicated that TEE could diagnose conditions after radical operation of tetralogy of Fallot. The calculation results showed that the PAI was (171.37±58.39) mm2/m2 and the PVI was (282.46±54.37) mm2/m2. The Pearson correlation analysis showed that the correlation between them was good (r=0.821, ptetralogy of Fallot. TEE can predict the occurrence of respirator assisted respiration extension, ICU retention and low cardiac output syndrome of patients after radical surgery by evaluating the PAI and PVI of patients with tetralogy of Fallot.

  14. Transesophageal echocardiography simulation is an effective tool in teaching psychomotor skills to novice echocardiographers.

    Science.gov (United States)

    Sohmer, Benjamin; Hudson, Christopher; Hudson, Jordan; Posner, Glenn D; Naik, Viren

    2014-03-01

    Performance of transesophageal echocardiography (TEE) requires the psychomotor ability to obtain interpretable echocardiographic images. The purpose of this study was to determine the effectiveness of a simulation-based curriculum in which a TEE simulator is used to teach the psychomotor skills to novice echocardiographers and to compare instructor-guided with self-directed online delivery of the curriculum. After institutional review board approval, subjects inexperienced in TEE completed an online review of TEE material prior to a baseline pre-test of TEE psychomotor skills using the simulator. Subjects were randomized to two groups. The first group received an instructor-guided lesson of TEE psychomotor skills with the simulator. The second group received a self-directed slide presentation of TEE psychomotor skills with the simulator. Both lessons delivered identical information. Following their respective training sessions, all subjects performed a post-test of their TEE psychomotor skills using the simulator. Two assessors rated the TEE performances using a validated scoring system for acquisition of images. Pre-test TEE simulator scores were similar between the two instruction groups (9.0 vs 5.0; P = 0.28). The scores in both groups improved significantly following training, regardless of the method of instruction (P psychomotor skills. There was no difference in improvement between the different modalities of instruction. Further research will examine the need for a faculty resource for a curriculum in which a simulator is used as an adjunct.

  15. Integration of trans-esophageal echocardiography with magnetic tracking technology for cardiac interventions

    Science.gov (United States)

    Moore, John T.; Wiles, Andrew D.; Wedlake, Chris; Bainbridge, Daniel; Kiaii, Bob; Trejos, Ana Luisa; Patel, Rajni; Peters, Terry M.

    2010-02-01

    Trans-esophageal echocardiography (TEE) is a standard component of patient monitoring during most cardiac surgeries. In recent years magnetic tracking systems (MTS) have become sufficiently robust to function effectively in appropriately structured operating room environments. The ability to track a conventional multiplanar 2D TEE transducer in 3D space offers incredible potential by greatly expanding the cumulative field of view of cardiac anatomy beyond the limited field of view provided by 2D and 3D TEE technology. However, there is currently no TEE probe manufactured with MTS technology embedded in the transducer, which means sensors must be attached to the outer surface of the TEE. This leads to potential safety issues for patients, as well as potential damage to the sensor during procedures. This paper presents a standard 2D TEE probe fully integrated with MTS technology. The system is evaluated in an environment free of magnetic and electromagnetic disturbances, as well as a clinical operating room in the presence of a da Vinci robotic system. Our first integrated TEE device is currently being used in animal studies for virtual reality-enhanced ultrasound guidance of intracardiac surgeries, while the "second generation" TEE is in use in a clinical operating room as part of a project to measure perioperative heart shift and optimal port placement for robotic cardiac surgery. We demonstrate excellent system accuracy for both applications.

  16. Front-end receiver electronics for a matrix transducer for 3-D transesophageal echocardiography.

    Science.gov (United States)

    Yu, Zili; Blaak, Sandra; Chang, Zu-yao; Yao, Jiajian; Bosch, Johan G; Prins, Christian; Lancée, Charles T; de Jong, Nico; Pertijs, Michiel A P; Meijer, Gerard C M

    2012-07-01

    There is a clear clinical need for creating 3-D images of the heart. One promising technique is the use of transesophageal echocardiography (TEE). To enable 3-D TEE, we are developing a miniature ultrasound probe containing a matrix piezoelectric transducer with more than 2000 elements. Because a gastroscopic tube cannot accommodate the cables needed to connect all transducer elements directly to an imaging system, a major challenge is to locally reduce the number of channels, while maintaining a sufficient signal-to-noise ratio. This can be achieved by using front-end receiver electronics bonded to the transducers to provide appropriate signal conditioning in the tip of the probe. This paper presents the design of such electronics, realizing time-gain compensation (TGC) and micro-beamforming using simple, low-power circuits. Prototypes of TGC amplifiers and micro-beamforming cells have been fabricated in 0.35-μm CMOS technology. These prototype chips have been combined on a printed circuit board (PCB) to form an ultrasound-receiver system capable of reading and combining the signals of three transducer elements. Experimental results show that this design is a suitable candidate for 3-D TEE.

  17. Real-time compounding of three-dimensional transesophageal echocardiographic volumes: the phantom study.

    Science.gov (United States)

    Gao, Gang; Reddy, Kiran; Ma, Yingliang; Rhode, Kawal S

    2009-01-01

    3D ultrasound has attracted considerable interest in recent years as a low cost, mobile and real-time imaging modality for interventional cardiac applications. However, the low image quality and small field of view have been two major barriers preventing 3D ultrasound from being widely accepted as a solution to the guidance of cardiac interventions. By using the 3D transesophageal echographic (TEE) probe, it is possible to acquire images with better quality compared to the images acquired from traditional transthoracic probe (TTE). However, the 3D TEE volume has even smaller field of view and is insufficient to cover the whole geometry of the heart. Previously, we have developed a technique to compound 3D TTE volumes in real-time. In this study, we extend this technique to compound 3D TEE volumes by using an electromagnetic tracking system. In this pilot study, two different types of phantoms were used to evaluate our technique. The results suggest our method is accurate and efficient. The compounding error is approximately 2.5mm.

  18. Manual Skill Acquisition During Transesophageal Echocardiography Simulator Training of Cardiology Fellows: A Kinematic Assessment.

    Science.gov (United States)

    Matyal, Robina; Montealegre-Gallegos, Mario; Mitchell, John D; Kim, Han; Bergman, Remco; Hawthorne, Katie M; O'Halloran, David; Wong, Vanessa; Hess, Phillip E; Mahmood, Feroze

    2015-12-01

    To investigate whether a transesophageal echocardiography (TEE) simulator with motion analysis can be used to impart proficiency in TEE in an integrated curriculum-based model. A prospective cohort study. A tertiary-care university hospital. TEE-naïve cardiology fellows. Participants underwent an 8-session multimodal TEE training program. Manual skills were assessed at the end of sessions 2 and 8 using motion analysis of the TEE simulator's probe. At the end of the course, participants performed an intraoperative TEE; their examinations were video captured, and a blinded investigator evaluated the total time and image transitions needed for each view. Results are reported as mean±standard deviation, or median (interquartile range) where appropriate. Eleven fellows completed the knowledge and kinematic portions of the study. Five participants were excluded from the evaluation in the clinical setting because of interim exposure to TEE or having participated in a TEE rotation after the training course. An increase of 12.95% in post-test knowledge scores was observed. From the start to the end of the course, there was a significant reduction (pcardiology fellows can be complemented with kinematic analyses to objectify acquisition of manual skills during simulator-based training. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Diagnostic value of harmonic transthoracic echocardiography in native valve infective endocarditis: comparison with transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Embil John M

    2007-05-01

    Full Text Available Abstract Background Although echocardiography has been incorporated into the diagnostic algorithm of patients with suspected infective endocarditis (IE, systematic usage in clinical practice remains ill defined. To determine the diagnostic accuracy of detecting vegetations using harmonic transthoracic echocardiography (hTTE as compared to transesophageal echocardiography (TEE in patients with an intermediate likelihood of native valve IE. Methods Between 2004 and 2005, 36 consecutive inpatients with an intermediate likelihood of disease were prospectively evaluated by hTTE and TEE. Results Of 36 patients (21 males with a mean age of 57 ± 15 years, range 32 to 86 years, 19 patients had definite IE by TEE. The sensitivity for the detection of vegetations by hTTE was 84%, specificity of 88%, positive predictive value (PPV of 89% and negative predictive value (NPV of 82%. The association between hTTE and TTE interpretation for the presence and absence of vegetations were high (kappa = 0.90 and 0.85 respectively. Conclusion In patients with an intermediate likelihood of native valve IE, TTE with harmonic imaging provides diagnostic quality images in the majority of cases, has excellent concordance with TEE and should be recommended as the first line test.

  20. Simultaneous Epicardial and Noncontact Endocardial Mapping of the Canine Right Atrium: Simulation and Experiment

    Science.gov (United States)

    Sabouri, Sepideh; Matene, Elhacene; Vinet, Alain; Richer, Louis-Philippe; Cardinal, René; Armour, J. Andrew; Pagé, Pierre; Kus, Teresa; Jacquemet, Vincent

    2014-01-01

    Epicardial high-density electrical mapping is a well-established experimental instrument to monitor in vivo the activity of the atria in response to modulations of the autonomic nervous system in sinus rhythm. In regions that are not accessible by epicardial mapping, noncontact endocardial mapping performed through a balloon catheter may provide a more comprehensive description of atrial activity. We developed a computer model of the canine right atrium to compare epicardial and noncontact endocardial mapping. The model was derived from an experiment in which electroanatomical reconstruction, epicardial mapping (103 electrodes), noncontact endocardial mapping (2048 virtual electrodes computed from a 64-channel balloon catheter), and direct-contact endocardial catheter recordings were simultaneously performed in a dog. The recording system was simulated in the computer model. For simulations and experiments (after atrio-ventricular node suppression), activation maps were computed during sinus rhythm. Repolarization was assessed by measuring the area under the atrial T wave (ATa), a marker of repolarization gradients. Results showed an epicardial-endocardial correlation coefficients of 0.80 and 0.63 (two dog experiments) and 0.96 (simulation) between activation times, and a correlation coefficients of 0.57 and 0.46 (two dog experiments) and 0.92 (simulation) between ATa values. Despite distance (balloon-atrial wall) and dimension reduction (64 electrodes), some information about atrial repolarization remained present in noncontact signals. PMID:24598778

  1. Condrossarcoma mixóide de átrio direito Right atrium myxoid chondrosarcoma

    Directory of Open Access Journals (Sweden)

    Cláudio Ribeiro da Cunha

    2008-03-01

    Full Text Available Relatamos o caso de uma paciente de 46 anos, cor branca, hipertensa há 20 anos, com suspeita de endocardite infecciosa. Foi realizado ecocardiograma transtorácico, o qual levou à hipótese de mixoma de átrio direito. A paciente foi submetida à cirurgia, observando-se massa tumoral de aspecto muco-gelatinoso friável. A massa foi submetida a congelação para exame anatomopatológico, com laudo sugestivo de tumor maligno mesenquimal. Foi realizado exame imunohistoquímico compatível com condrossarcoma mixóide. A paciente evoluiu com remissão espontânea do quadro após ressecção completa da neoplasia. Realizou acompanhamento ambulatorial por 14 meses, sem apresentar sinais de recidiva do tumor.We report a case of a 46 years-old woman, Caucasian, with hypertension and a primary dianosis of infectious endocarditis. A transthoracic echocardiogram was performed suggesting right atrium myxoma. The patient was submitted to surgery, which found a tumor mass with a jelly-like exterior. The mass was sent to anatomo-pathological analysis which diagnosed a myxoid chondrosarcoma tumor. After surgical resection, the patient achieved complete recovery with no signs of recidivation after 14 months.

  2. Simultaneous epicardial and noncontact endocardial mapping of the canine right atrium: simulation and experiment.

    Directory of Open Access Journals (Sweden)

    Sepideh Sabouri

    Full Text Available Epicardial high-density electrical mapping is a well-established experimental instrument to monitor in vivo the activity of the atria in response to modulations of the autonomic nervous system in sinus rhythm. In regions that are not accessible by epicardial mapping, noncontact endocardial mapping performed through a balloon catheter may provide a more comprehensive description of atrial activity. We developed a computer model of the canine right atrium to compare epicardial and noncontact endocardial mapping. The model was derived from an experiment in which electroanatomical reconstruction, epicardial mapping (103 electrodes, noncontact endocardial mapping (2048 virtual electrodes computed from a 64-channel balloon catheter, and direct-contact endocardial catheter recordings were simultaneously performed in a dog. The recording system was simulated in the computer model. For simulations and experiments (after atrio-ventricular node suppression, activation maps were computed during sinus rhythm. Repolarization was assessed by measuring the area under the atrial T wave (ATa, a marker of repolarization gradients. Results showed an epicardial-endocardial correlation coefficients of 0.80 and 0.63 (two dog experiments and 0.96 (simulation between activation times, and a correlation coefficients of 0.57 and 0.46 (two dog experiments and 0.92 (simulation between ATa values. Despite distance (balloon-atrial wall and dimension reduction (64 electrodes, some information about atrial repolarization remained present in noncontact signals.

  3. Simultaneous epicardial and noncontact endocardial mapping of the canine right atrium: simulation and experiment.

    Science.gov (United States)

    Sabouri, Sepideh; Matene, Elhacene; Vinet, Alain; Richer, Louis-Philippe; Cardinal, René; Armour, J Andrew; Pagé, Pierre; Kus, Teresa; Jacquemet, Vincent

    2014-01-01

    Epicardial high-density electrical mapping is a well-established experimental instrument to monitor in vivo the activity of the atria in response to modulations of the autonomic nervous system in sinus rhythm. In regions that are not accessible by epicardial mapping, noncontact endocardial mapping performed through a balloon catheter may provide a more comprehensive description of atrial activity. We developed a computer model of the canine right atrium to compare epicardial and noncontact endocardial mapping. The model was derived from an experiment in which electroanatomical reconstruction, epicardial mapping (103 electrodes), noncontact endocardial mapping (2048 virtual electrodes computed from a 64-channel balloon catheter), and direct-contact endocardial catheter recordings were simultaneously performed in a dog. The recording system was simulated in the computer model. For simulations and experiments (after atrio-ventricular node suppression), activation maps were computed during sinus rhythm. Repolarization was assessed by measuring the area under the atrial T wave (ATa), a marker of repolarization gradients. Results showed an epicardial-endocardial correlation coefficients of 0.80 and 0.63 (two dog experiments) and 0.96 (simulation) between activation times, and a correlation coefficients of 0.57 and 0.46 (two dog experiments) and 0.92 (simulation) between ATa values. Despite distance (balloon-atrial wall) and dimension reduction (64 electrodes), some information about atrial repolarization remained present in noncontact signals.

  4. Hepatic vein and inferior vena caval thrombus extending into the right atrium: A rare complication of amoebic liver abscess

    International Nuclear Information System (INIS)

    Rehman, S.; Alvi, A.R.

    2010-01-01

    Amoebic liver abscess is an endemic in developing countries but few cases of associated vascular complications have been reported. The authors report a very rare vascular complication of hepatic veins and inferior vena caval (IVC) thrombosis extending into the right atrium in a young male with large amoebic liver abscess. Optimal result was achieved with early diagnosis on CT scan, percutaneous drainage of abscess, intravenous metronidazole, peri-operative anticoagulation, sternotomy and thrombectomy. (author)

  5. Analysis and prediction of daylighting and energy performance in atrium spaces using daylight-linked lighting controls

    International Nuclear Information System (INIS)

    Chow, Stanley K.H.; Li, Danny H.W.; Lee, Eric W.M.; Lam, Joseph C.

    2013-01-01

    Highlights: ► Daylight-linked lighting control and energy performance for atrium is studied. ► Field measurement of automatic dimming control shows 93% energy saving. ► Field measurement of manual on–off control shows 95% energy saving. ► Atrium illuminance is correlated with daylight factor for energy saving prediction. - Abstract: In subtropical Hong Kong, a certain amount of electricity is used to create visually comfortable interior spaces through electric lighting, which is the second major electricity-consuming item in commercial buildings, accounting for 20–30% of total electricity use. The burning of fossil fuels for electricity generation has many adverse effects on the environment. Daylighting is an important and useful strategy for enhancing visual comfort and reducing the need for the electricity consumed by light fittings. The rational use of daylight through tools such as photoelectric lighting controls can effectively reduce buildings’ electricity consumption and the related pollutants and greenhouse gas emissions. Daylighting design techniques are often best demonstrated via field measurements that provide reliable operational and energy performance data for establishing design guidelines. An atrium provides an environmentally controlled indoor public space that introduces daylight into the hearts of large buildings. In circulation areas such as corridors, people expect the way ahead to be sufficiently lit and daylight-linked lighting controls can deliver excellent energy savings. This paper presents the daylighting and energy performance of an atrium space using daylight-linked lighting controls. The cost, energy and environmental issues related to various daylight illuminances are estimated and design implications are discussed

  6. Higher levels of serum fibrin-monomer reflect hypercoagulable state and thrombus formation in the left atrial appendage in patients with acute ischemic stroke.

    Science.gov (United States)

    Okuyama, Hidenobu; Hirono, Osamu; Liu, Ling; Takeishi, Yasuchika; Kayama, Takamasa; Kubota, Isao

    2006-08-01

    It is sometimes difficult to make a diagnosis of cardioembolic stroke in the stroke care unit, because of the splashing and vanishing of the intracardiac source of the emboli on transesophageal echocardiography. Serum fibrin-monomer (FM) is a new marker for coagulation activity that is useful for identifying older individuals at increased risk of ischemic stroke. Two hundred and four patients with acute ischemic stroke were examined for serum coagulation and fibrinolytic activity on admission, and underwent transesophageal echocardiography within 7 days of onset. Serum levels of FM was significantly higher in patients with left atrial appendage (LAA) thrombus formation (n=24) than in those with no thrombus (88+/-52 vs 14+/-9 microg/ml, pvs 8+/-5 microg/ml, pstroke.

  7. Use of the Amplatzer ASD Occluder for Closing a Persistent Left Vertical Vein

    International Nuclear Information System (INIS)

    Zanchetta, Mario; Zennaro, Marco; Zecchel, Roberto; Mancuso, Daniela; Pedon, Luigi

    2009-01-01

    We report the case of a very large anomalous connection of the veins draining the upper lobe of the left lung to both the left-sided vertical vein and the left atrium, associated with mild rheumatic mitral valve stenosis, in which the atrial septum was intact and the remaining venous system, including the coronary sinus, was otherwise normal (a variant of Lutembacher's syndrome). In order to abolish the left-to-right shunting, a transcatheter approach to close this venous structure was successfully attempted using an Amplatzer ASD Occluder device. The technical aspects and the alternative options of performing a procedure with a device for a purpose outside the scope of its approved label are discussed.

  8. Etiologic significance of enlargement of the left atrial appendage in adults

    International Nuclear Information System (INIS)

    Green, C.E.; Kelley, M.J.; Higgins, C.B.

    1982-01-01

    Fifty-one patients were divided into two groups: 20 patients with proven rheumatic mitral valve disease (RMVD) and 31 patients with left atrial enlargement (LAE) of a nonrheumatic etiology. The latter group included patients with ischemic papillary muscle dysfunction, mitral valve prolapse, and congestive cardiomyopathy. Radiographic studies showed that enlargement of the left atrial appendage (LAAE) was present in 18 of 20 rheumatics but in only one of 31 nonrheumatics. There was no direct relationship between enlargement of the LAA and radiographic or echocardiographic left atrial size, degree of pulmonary venous hypertension (PVH), or presence of atrial fibrillation. It is postulated that rheumatic influammation of the LAA allows it to dilate out of proportion to the body of the left atrium. In the adult patient with radiographic findings of PVH, LAAE is a valuable and specific radiographic sign of rheumatic mitral valve disease

  9. Persistent left superior vena cava leads to catheter malposition during PICC Port placement.

    Science.gov (United States)

    Konstantinou, Evangelos A; Mariolis Sapsakos, Theodoros D; Katsoulas, Theodoros A; Velecheris, Dimitrios; Tsitsimelis, Dimitrios; Bonatsos, Gerasimos

    2016-03-09

    We present a case of peripherally inserted central catheter (PICC) port placement where the catheter had been malpositioned to the persistent left superior vena cava. Despite the obvious elevation of the P-wave signaling proximity of the catheter tip to the sinus node, the catheter was not in the desired location within the superior vena cava or the right atrium, because of the presence of a persistent left superior vena cava. Computed tomography was used in order to locate the catheter. The catheter was located in the persistent left superior vena cava. Malpositioning of the catheter in the persistent left superior vena cava occurs in 0.3%-0.5% of patients. The catheter was subsequently removed.

  10. The Left Atrio-Vertebral Ratio: a new simple means for assessing left atrial enlargement on Computed Tomography.

    Science.gov (United States)

    Montillet, Marie; Baqué-Juston, Marie; Tasu, Jean-Pierre; Bertrand, Sandra; Berthier, Frédéric; Zarqane, Naïma; Brunner, Philippe

    2018-03-01

    The purpose of this study is to describe a new method to quickly estimate left atrial enlargement (LAE) on Computed Tomography. Left atrial (LA) volume was assessed with a 3D-threshold Hounsfield unit detection technique, including left atrial appendage and excluding pulmonary venous confluence, in 201 patients with ECG-gated 128-slice dual-source CT and indexed to body surface area. LA and vertebral axial diameter and area were measured at the bottom level of the right inferior pulmonary vein ostium. Ratio of LA diameter and surface on vertebra (LAVD and LAVA) were compared to LA volume. In accordance with the literature, a cutoff value of 78 ml/m 2 was chosen for maximal normal LA volume. 18% of LA was enlarged. The best cutoff values for LAE assessment were 2.5 for LAVD (AUC: 0.65; 95% CI: 0.58-0.73; sensitivity: 57%; specificity: 71%), and 3 for LAVA (AUC: 0.78; 95% CI: 0.72-0.84; sensitivity: 67%; specificity: 79%), with higher accuracy for LAVA (P=0.015). Inter-observer and intra-observer variability were either good or excellent for LAVD and LAVA (respective intraclass coefficients: 0.792 and 0.910; 0.912 and 0.937). A left atrium area superior to three times the vertebral area indicates LAE with high specificity. • Left atrial enlargement is a frequent condition associated with poor cardiac outcome. • Left atrial enlargement is highly time-consuming to diagnose on CT. • The left atrio-vertebral ratio quickly assesses left atrial enlargement. • A left atrial area > three times vertebral area is highly specific.

  11. Impact of transesophageal echocardiography on management in patients with suspected cardioembolic stroke.

    Science.gov (United States)

    Khariton, Yevgeniy; House, John A; Comer, Lynn; Coggins, Tina R; Magalski, Anthony; Skolnick, David G; Good, Thomas H; Main, Michael L

    2014-12-15

    Transesophageal echocardiography (TEE) is frequently performed in patients with acute ischemic cerebrovascular events to exclude a cardioembolic source. We aimed to determine the clinical impact of TEE on management. This is a retrospective single-center study of 1,458 consecutive patients hospitalized with acute ischemic stroke or transient ischemic attack who underwent TEE for evaluation of a suspected cardioembolic cause. Significant TEE findings were determined for each patient as recorded on the TEE report. The medical record was reviewed for baseline, clinical, and demographic variables and to determine whether significant management changes occurred as a result of the TEE findings. Potential significant changes in management included initiation of anticoagulation, placement of a patent foramen ovale (PFO) closure device, initiation of antibiotic therapy for endocarditis, surgical PFO closure, other cardiac surgery, and coil embolization of a pulmonary arteriovenous malformation. A significant change in management occurred in 243 patients (16.7%); 173 (71%) underwent treatment for PFO with a percutaneous PFO closure device (n = 100), initiation of chronic systemic anticoagulation (n = 68), or surgical PFO closure (n = 5). Additional findings leading to a change in management included endocarditis (n = 20), aortic arch atheroma (n = 14), intracardiac thrombus (n = 13), pulmonary arteriovenous malformation (n = 2), aortic valve fibroelastoma (n = 2), other valve masses (n = 4), and miscellaneous causes (n = 15). In conclusion, in patients with suspected cardioembolic stroke, TEE findings led to a change in management in 16.7% of patients. Of these, most (71%) were directed at prevention of subsequent paradoxical emboli in patients with PFO. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Transesophageal echocardiography screening in subjects with a first cerebrovascular ischemic event.

    Science.gov (United States)

    Young, Kate C; Benesch, Curtis G

    2011-11-01

    Our goal was to develop decision guides to predict the presence of a high-risk source of embolus and to predict a change in management following transesophageal echocardiography (TEE) in subjects who present with a first cerebral ischemic event. We conducted a retrospective review of subjects age ≥18 years who underwent TEE after a first ischemic event and were admitted to our stroke service between 2004 and 2007 (n = 287). A high-risk source of embolus and a change in clinical management (including medication changes or subsequent testing) were analyzed as separate endpoints, using multivariate techniques and receiver operating characteristic curves. We found that 14.3% of the subjects had a high-risk source, and an additional 61.3% had a potential (or low-risk) source of embolus. Increasing age and no history of diabetes mellitus were independently associated with a high-risk source of embolus. TEE would be recommended for nondiabetic individuals age ≥66 years (sensitivity, 68%; specificity, 76%). The area under the curve (AUC) for detecting a high-risk source was 0.773. TEE results changed medications or clinical management in 30.3% of the subjects. Current smokers were less likely to undergo a change in management. The AUC was uninformative (0.56) for predicting changes in management. Subjects presenting with a first ischemic event age ≥66 years may benefit from TEE. Although changes in management occurred in at least 30% of our cohort, no factors that predicted a change in management better than chance alone could be identified. Copyright © 2011 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Avoiding transthoracic echocardiography and transesophageal echocardiography for patients with variable body mass indexes in infective endocarditis

    Directory of Open Access Journals (Sweden)

    Robert Sogomonian

    2016-04-01

    Full Text Available Background: Echocardiography has been a popular modality used to aid in the diagnosis of infective endocarditis (IE with the modified Duke criteria. We evaluated the necessity between the uses of either a transthoracic echocardiography (TTE or transesophageal echocardiography (TEE in patients with a body mass index (BMI greater than or equal to 25 kg/m2 and less than 25 kg/m2. Methods: A single-centered, retrospective study of 198 patients between 2005 and 2012 diagnosed with IE based on modified Duke criteria. Patients, required to be above age 18, had undergone an echocardiogram study and had blood cultures to be included in the study. Results: Among 198 patients, two echocardiographic groups were evaluated as 158 patients obtained a TTE, 143 obtained a TEE, and 103 overlapped with TEE and TTE. Out of these patients, 167 patients were included in the study as 109 (65% were discovered to have native valve vegetations on TEE and 58 (35% with TTE. TTE findings were compared with TEE results for true negatives and positives to isolate valvular vegetations. Overall sensitivity of TTE was calculated to be 67% with a specificity of 93%. Patients were further divided into two groups with the first group having a BMI ≥25 kg/m2 and the subsequent group with a BMI <25 kg/m2. Patients with a BMI ≥25 kg/m2 who underwent a TTE study had a sensitivity and specificity of 54 and 92%, respectively. On the contrary, patients with a BMI < 25 kg/m2 had a TTE sensitivity and specificity of 78 and 95%, respectively. Conclusions: Patients with a BMI <25 kg/m2 and a negative TTE should refrain from further diagnostic studies, with TEE strong clinical judgment is warranted. Patients with a BMI ≥ 25 kg/m2 may proceed directly to TEE as the initial study, possibly avoiding an additional study with a TTE.

  14. Transesophageal electrophysiological evaluation of children with a history of supraventricular tachycardia in infancy.

    Science.gov (United States)

    Blaufox, Andrew D; Warsy, Irfan; D'Souza, Marise; Kanter, Ronald

    2011-12-01

    Supraventricular tachycardia (SVT) presenting in the neonatal period may resolve by 1 year of age. Predicting which patients require therapy beyond 1 year of age is desirable. Pediatric electrophysiology databases from two institutions were reviewed for patients with a history of infant SVT who underwent transesophageal electrophysiology study (TEEPS) after initial SVT and before 2 years of age. All patients were tested off medications and followed for clinical recurrence. Forty-two patients presented with SVT at median age of 4 days (0-300 days). Initial control was achieved with one drug in 31 patients and multiple drugs in 11 patients. Prior to TEEPS, nine patients had clinical recurrence in the first year of life after initial control had been previously achieved. For all patients, TEEPS was performed, without complications, at median 13 months (9-22 months) of age and at median of 13 months (6-22 months) following the initial SVT episode. SVT was inducible in 27/42: 8 atrio-ventricular nodal reentry tachycardia (AVNRT) and 19 atrio-ventricular reciprocating tachycardia (AVRT). Inducibility was not associated with age at presentation, age at TEEPS, ventricular dysfunction at presentation, presence of structural congenital heart disease, number of drugs required to initially control SVT, or SVT recurrence after initial control. Of 15 not inducible at TEEPS, none had known SVT recurrence off medications at median follow-up of 27 months (6-37 months). In conclusion, among patients having SVT in early infancy, (1) TEEPS results are not associated with clinical variables, (2) non-inducibility is a good indicator of lack of clinical recurrence at intermediate follow-up, and (3) AVNRT may be more prevalent in infancy than previously reported.

  15. Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery: A Large Cohort Study

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    Wouter W. Jansen Klomp

    2017-01-01

    Full Text Available The aim of this study was to investigate the impact of perioperative screening with modified transesophageal echocardiography (A-View method. We compared, in consecutive patients who underwent cardiac surgery between 2006 and 2014, 30-day mortality and in-hospital stroke incidence, operated either with perioperative modified TEE screening (intervention group or only with conventional TEE screening (control group. Of the 8,605 study patients, modified TEE was applied in 1,391 patients (16.2%. Patients in the intervention group were on average older (71 versus 68 years, p<0.001 and more often females (31.0% versus 28.0%, p<0.001 and had a higher predicted mortality (EuroSCORE I: 5.9% versus 4.0%, p<0.001. The observed 30-day mortality was 2.2% and 2.5% in both groups, respectively, with multivariable and propensity-score adjusted relative risks (RRs of 0.70 (95% CI: 0.50–1.00, p=0.05 and 0.67 (95% CI: 0.45–0.98, p=0.04. In-hospital stroke was 2.9% and 2.1% in both groups, respectively, with adjusted RRs of 1.03 (95% CI: 0.73–1.45 and 1.01 (95% CI: 0.71–1.43. In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening.

  16. Avoiding transthoracic echocardiography and transesophageal echocardiography for patients with variable body mass indexes in infective endocarditis.

    Science.gov (United States)

    Sogomonian, Robert; Alkhawam, Hassan; Vyas, Neil; Jolly, JoshPaul; Nguyen, James; Moradoghli Haftevani, Emma A; Al-Khazraji, Ahmed; Ashraf, Amar

    2016-01-01

    Echocardiography has been a popular modality used to aid in the diagnosis of infective endocarditis (IE) with the modified Duke criteria. We evaluated the necessity between the uses of either a transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) in patients with a body mass index (BMI) greater than or equal to 25 kg/m(2) and less than 25 kg/m(2). A single-centered, retrospective study of 198 patients between 2005 and 2012 diagnosed with IE based on modified Duke criteria. Patients, required to be above age 18, had undergone an echocardiogram study and had blood cultures to be included in the study. Among 198 patients, two echocardiographic groups were evaluated as 158 patients obtained a TTE, 143 obtained a TEE, and 103 overlapped with TEE and TTE. Out of these patients, 167 patients were included in the study as 109 (65%) were discovered to have native valve vegetations on TEE and 58 (35%) with TTE. TTE findings were compared with TEE results for true negatives and positives to isolate valvular vegetations. Overall sensitivity of TTE was calculated to be 67% with a specificity of 93%. Patients were further divided into two groups with the first group having a BMI ≥25 kg/m(2) and the subsequent group with a BMI TTE study had a sensitivity and specificity of 54 and 92%, respectively. On the contrary, patients with a BMI TTE sensitivity and specificity of 78 and 95%, respectively. Patients with a BMI TTE should refrain from further diagnostic studies, with TEE strong clinical judgment is warranted. Patients with a BMI ≥ 25 kg/m(2) may proceed directly to TEE as the initial study, possibly avoiding an additional study with a TTE.

  17. Paravalvular Regurgitation after Transcatheter Aortic Valve Replacement: Comparing Transthoracic versus Transesophageal Echocardiographic Guidance.

    Science.gov (United States)

    Hayek, Salim S; Corrigan, Frank E; Condado, Jose F; Lin, Shuang; Howell, Sharon; MacNamara, James P; Zheng, Shuai; Keegan, Patricia; Thourani, Vinod; Babaliaros, Vasilis C; Lerakis, Stamatios

    2017-06-01

    Transcatheter aortic valve replacement (TAVR) is increasingly being performed in cardiac catheterization laboratories using transthoracic echocardiography (TTE) to guide valve deployment. The risk of paravalvular regurgitation (PVR) remains a concern. We retrospectively reviewed 454 consecutive patients (mean age, 82 ± 8; 58% male) who underwent transfemoral TAVR at Emory Healthcare from 2007 to 2014. Two hundred thirty-four patients underwent TAVR in the cardiac catheterization laboratory with TTE guidance (TTE-TAVR; mean Society of Thoracic Surgeons score, 10%), while 220 patients underwent the procedure in the hybrid operating room with transesophageal echocardiography (TEE) guidance (TEE-TAVR; mean Society of Thoracic Surgeons score, 11%). All patients received an Edwards valve (SAPIEN 55%, SAPIEN-XT 45%). Clinical and procedural characteristics, echocardiographic parameters, and incidence of PVR were compared. The incidence of at least mild PVR at discharge was comparable between TTE-TAVR and TEE-TAVR (33% vs 38%, respectively; P = .326) and did not differ when stratified by valve type. However, in the TTE-TAVR group, there was a higher incidence of second valve implantation (7% vs 2%; P = .026) and postdilation (38% vs 17%; P TTE-TAVR was associated with PVR-related events: the combined outcome of mild PVR at discharge, intraprocedural postdilation, and second valve insertion (odds ratio = 1.58; 95% CI, 1.01-2.46). There were no significant differences in PVR at 30 days, 6 months, and 1 year between the two groups. TTE-TAVR in a high-risk group of patients was associated with increased incidence of intraprocedure PVR-related events, although it was not associated with higher rates of PVR at follow-up. Multicenter randomized trials are required to confirm the cost-effectiveness and safety of TTE-TAVR. Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  18. Significance of transesophageal echocardiography in the evaluation of aortic valve stenosis

    Directory of Open Access Journals (Sweden)

    Prcović Biljana

    2010-01-01

    Full Text Available Background/Aim. Transesophageal echocardiography (TEE is a relatively new diagnostic method offering better resolution of cardiac anatomy than the conventional transthoracal two-dimensional echocardiography (TTE. Clinical indications for TEE have been expanding, thus the technique as a diagnostic procedure is used in numerous cardiac diseases such as endocarditis, congenital heart defect, aortic dissection, prosthetic valves dysfunction, as well as in calculation of aortic valve surface in aortic stenosis. The aim of the study was to prove TEE as a more precise method in determination of the level of seriousness of aortic valve stenosis. Methods. All the patients went through TTE and TEE. Evaluating of the aortic valve surface was performed by the use of Gorlin's formula in TTE while it was planimetric in TEE examination. Results. Comparative analysis of all parameters obtained by TTE and TEE showed a difference between them. All the parameters values except that for surface area of the aortic valve orifice confluence were higher in TEE than in TTE examination, but no difference was statistically significant (p > 0.05; t-test for a dependant specimens. By the use of the TTE method, the size of aortic orifice stenosis was 1.22 ± 0.54 cm2, and by the TEE method it was 1.08 ± 0.54 cm2. Conclusion. Multiplain TEE is reliable in quantification of an aortic valve area in patients with aortic stenosis. It offers useful clinical information, particularly in patients with non-adequate evaluation with TTE, as well as in seriously ill patients or those with a confirmed valvular defect.

  19. Transthoracic Echocardiography to Assess Aortic Regurgitation after TAVR: A Comparison with Periprocedural Transesophageal Echocardiography.

    Science.gov (United States)

    Goncalves, Alexandra; Nyman, Charles; Okada, David R; Singh, Avinainder; Swanson, Jeffrey; Cheezum, Michael; Steigner, Michael; Di Carli, Marcelo; Solomon, Scott; Shah, Pinak B; Bhatt, Deepak L; Shook, Douglas; Blankstein, Ron

    We aimed to compare periprocedural transesophageal echocardiography (TEE) with postprocedural transthoracic echocardiography (TTE) for the diagnosis of aortic regurgitation (AR). TEE and TTE images of 163 transcatheter aortic valve replacement (TAVR) patients (mean age 81 ± 8 years; 56% men) were reviewed separately and blinded to each other as well as to all clinical data. The median time between TEE during TAVR (TEE/TAVR) and TTE was 4 days (IQR 2-10 days). After TAVR, 48% of the patients had at least trace AR by TEE, 56% by angiography and 67% by TTE. The majority of AR was paravalvular (78%). More patients were classified with mild-to-moderate AR by TTE than by TEE (44 vs. 22%, p TTE which was not at TEE/TAVR, both systolic and diastolic blood pressure (SBP and DBP) were significantly higher during TTE than during TEE (mean ΔSBP = 9 ± 4 mm Hg and mean ΔDBP = 6 ± 2 mm Hg, p TTE were found among patients with no AR or among those who had AR in both studies. At a median follow-up of 185 days (IQR 39-424 days), the overall mortality was 17%, but this was not associated with the presence of AR on TTE or TEE. Patients' hemodynamic conditions may result in underdiagnosis of paravalvular regurgitation in periprocedural TEE. Our findings suggest that a postprocedural evaluation for AR by TTE could serve as a reasonable alternative to TEE for the evaluation of AR. © 2016 S. Karger AG, Basel.

  20. Diagnosis of malignancy of adult mediastinal tumors by conventional and transesophageal echocardiography.

    Science.gov (United States)

    Zhou, Wei-Wei; Wang, Hong-Wei; Liu, Nan-Nan; Li, Jing-Jing; Yuan, Wei; Zhao, Rui; Xiang, Liang-Bi; Qi, Miao

    2015-04-20

    Transesophageal echocardiography (TEE) is a well-established method for detecting and diagnosing heart tumors. In contrast, its role in assessing the presence, growth and evidence of malignant tumors originating from mediastinal sites remains unclear. The aim of this study was to compare the diagnostic impact of TEE and transthoracic echocardiography (TTE) for determining the localization, growth and malignancy of adult mediastinal tumors (MTs). In a prospective and investigator-blinded study, we evaluated 144 consecutive patients with MT lesions to assess the diagnostic impact of TEE and TTE for detecting the presence of tumors spreading both inside and outside of the heart and for determining infiltration and invasion using pathological examination results as a reference. All tumor lesions were diagnosed and carefully evaluated by biopsy. Biopsy revealed malignant tumors in 79 patients and benign tumors in 65 patients. When compared to histological findings, TEE predicted malignancy from the presence of tumors spreading both inside and outside of the heart and from infiltration and invasion in 49/79 patients (62.0%). TTE predicted malignancy in only 8/79 patients (10.1%, P TTE visualized tumor lesions in 110 patients (76.4%) and was less effective at detecting MT lesions (P TTE and TEE could detect anterior MTs and adequately verified MTs (P > 0.05); TEE detected medium MTs better than TTE (P TTE for predicting the localization and growth of MTs as well as for accessing evidence of tumor malignancy. TTE and TEE were able to detect anterior MTs; TEE was able to detect medium MT better than TTE.

  1. Factors of Formation of Various Types of Left Ventricular Diastolic Filling in Adolescents with Myocardium Pathology

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    L.F. Bogmat

    2016-08-01

    Full Text Available Objective: to study the main components of the formation of impaired left ventricular diastolic filling in adolescents with myocardial pathology. Materials and methods. The study involved 110 adolescents with myocardial pathology aged 13–18 years, of which 40 — with heart rhythm disorder, 40 — with dysplastic cardiomyopathy, 30 — with primary hypertension. Morphological and functional parameters of the heart were studied using ultrasound according to standard procedure. Left ventricular diastolic function has been studied in the pulsed wave Doppler mode with transmitral flow mapping from the apical access of four-chambered heart. For an adequate assessment of left ventricular diastolic function and detection of its earliest disorders, adolescents underwent tests with isometric exercise. Based on these results, adolescents were divided in terms of the E/A ratio. In order to identify common latent factors that explain the correlation between indicators, we have used the factor analysis, namely, the principal component analysis. All statistical procedures were performed using application packages Statgraphics Centurion. Results. On the initial stages of formation of diastolic dysfunction of the left ventricular myocardium in adolescents, a significant role is played by a number of factors, which can be conditionally defined as the geometric, functional and neurohumoral factors consistently included in the pathological process. Thus, during the formation of left ventricular diastolic dysfunction type 1, the number one is neurohumoral factor, namely, the activation of the sympathoadrenal system, then peripheral vascular tone is being involved in the pathological process, and, consequently, a geometric factor — changing the sizes of the left atrium. In the formation of left ventricular diastolic dysfunction type 2, the process consistently involves the renin-angiotensin system, namely, renin, a functional factor is presented by the indices

  2. Infective endocarditis in the elderly in the era of transesophageal echocardiography: clinical features and prognosis compared with younger patients.

    Science.gov (United States)

    Werner, G S; Schulz, R; Fuchs, J B; Andreas, S; Prange, H; Ruschewski, W; Kreuzer, H

    1996-01-01

    Advanced age is considered to be associated with a more severe prognosis in infective endocarditis (IE), which is relevance in view of a change in epidemiology of the disease with an increasing proportion of elderly people. We wanted to examine whether in the era of improved diagnostic sensitivity for IE by transesophageal echocardiography the clinical course in elderly persons would be still more severe than in younger patients. During the period from 1989 to 1993, 104 patients with 106 episodes of IE were treated at our university hospital. Three groups were compared: group A with 28 patients younger than 50 years, group B with 58 patients aged 50 to 70, and group C with 20 patients older than 70. Transesophageal echocardiography was performed in 78% of the patients; it was not performed in 22% of the patients with a conclusive transthoracic examination. The patients were followed up for an average of 25 months after the diagnosis. No significant differences were observed among the age groups with respect to the possible source of infection, the frequency of positive blood cultures, and the type of infective organisms. Elderly patients more often had predisposing valvular conditions (eg, degenerative and calcified lesions and prosthetic valves), which decreased the sensitivity of transthoracic echocardiography to 45% as compared with 75% in group A. Transesophageal echocardiography improved the diagnostic yield by 45% in group C and by 47% in group B. Vegetations were smaller in group C and B as compared with group A, whereas other echocardiographic characteristics were similar. Fever and leukocytosis were less frequent in group C (55% and 25%, respectively) than in group A (82% and 61%, respectively). The interval between the onset of symptoms and the diagnosis of IE was similar in all groups. Elderly patients underwent surgical therapy as frequently (65%) as the other groups. The 1-year survival in group C (26%) was comparable with that in group A (22%) and

  3. [Consensus on Perioperative Transesophageal Echocardiography of the Brazilian Society of Anesthesiology and the Department of Cardiovascular Image of the Brazilian Society of Cardiology].

    Science.gov (United States)

    Salgado-Filho, Marcello Fonseca; Morhy, Samira Saady; Vasconcelos, Henrique Doria de; Lineburger, Eric Benedet; Papa, Fabio de Vasconcelos; Botelho, Eduardo Souza Leal; Fernandes, Marcelo Ramalho; Daher, Maurício; Bihan, David Le; Gatto, Chiara Scaglioni Tessmer; Fischer, Cláudio Henrique; Silva, Alexander Alves da; Galhardo Júnior, Carlos; Neves, Carolina Baeta; Fernandes, Alexandre; Vieira, Marcelo Luiz Campos

    Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  4. Comparison of left atrial size and function in hypertrophic cardiomyopathy and in Fabry disease with left ventricular hypertrophy.

    Science.gov (United States)

    Saccheri, María Cristina; Cianciulli, Tomás Francisco; Challapa Licidio, Wilde; Lax, Jorge A; Beck, Martín A; Morita, Luis A; Gagliardi, Juan A

    2018-02-19

    Fabry disease (FD) and hypertrophic cardiomyopathy (HCM) are two diseases with a different pathophysiology, both cause left ventricular hypertrophy (LVH) and myocardial fibrosis. Although remodeling and systolic dysfunction of the left atrium (LA) are associated with atrial fibrillation and stroke in HCM, changes in the size and function of the LA have not been well studied in FD with LVH. The following groups were studied prospectively, and their respective findings compared: 19 patients with non-obstructive HCM (Group I), 20 patients with a diagnosis of Fabry cardiomyopathy (Group II), and 20 normal subjects matched for sex and age (Group III). Left ventricular mass index was measured using Devereux' formula, left atrial volume with Simpson's biplane method and left atrial mechanical function, including strain and strain rate, was measured using the speckle tracking technique. Strain and strain rate of the reservoir were measured during the three phases: reservoir (SR S), passive conduit (SR E) and atrial contraction (SR A). Patients with HCM had a larger left atrial volume than patients with FD (48.16 ± 14.3 mL/m 2 vs 38.9 ± 14.9 mL/m 2 respectively, P cardiomyopathy, affecting the three phasic functions of the LA. Although in patients with HCM left atrial volume is larger than in patients with FD, both disorders exhibit severe decrease in left atrial function. These findings should be considered, given the potentially serious complications that can occur with the two diseases. © 2018 Wiley Periodicals, Inc.

  5. Evaluation of left atrial functions in children with chronic renal failure.

    Science.gov (United States)

    Demirpençe, Savaş; Güven, Barış; Meşe, Timur; Serdaroğlu, Erkin; Yılmazer, Murat Muhtar; Firuzan, Esin; Tavlı, Vedide

    2014-05-01

    One-quarter of deaths in children with chronic renal failure is due to cardiovascular complications. Conventional echocardiographic methods are insufficient for evaluating systolic functions in children with chronic renal failure. The aim of the present study was to investigate cardiac functions in children with chronic renal failure by evaluating left atrial volume and functions. The present cross-sectional observational study included 44 children undergoing dialysis, 16 children with chronic renal failure but not yet on dialysis, and 20 healthy control subjects. Transthoracic echocardiography was performed for all children. Variables regarding to left ventricle and atrium (left atrial systolic force, left atrial systolic force index, left atrial volume, left ventricular mass index, and relative wall thickness) were measured using two-dimensional and M-mode echocardiography. Left atrial systolic force index was negatively correlated with systolic blood pressure and left ventricular mass (p=0.01, r=0.266 and p=0.02, r=0.347, respectively). However, it was positively correlated with both early and late diastolic mitral inflow velocity (r=0.518, p=0.001 and r=0.828, p=0.001, respectively). There were no significant difference among the groups in terms of left atrial systolic force index and left atrial volume. However, left atrial systolic force index was higher in children with chronic renal failure but not yet on dialysis. Left atrial systolic force was negatively correlated with systolic blood pressure and left ventricular mass. These findings suggested that evaluating left atrial systolic force and left atrial volume were useful to determine diastolic dysfunction and the necessity of dialysis in patient with chronic renal failure.

  6. Pitx2 prevents susceptibility to atrial arrhythmias by inhibiting left-sided pacemaker specification.

    Science.gov (United States)

    Wang, Jun; Klysik, Elzbieta; Sood, Subeena; Johnson, Randy L; Wehrens, Xander H T; Martin, James F

    2010-05-25

    Atrial fibrillation (AF), the most prevalent sustained cardiac arrhythmia, often coexists with the related arrhythmia atrial flutter (AFL). Limitations in effectiveness and safety of current therapies make an understanding of the molecular mechanism underlying AF more urgent. Genome-wide association studies implicated a region of human chromosome 4q25 in familial AF and AFL, approximately 150 kb distal to the Pitx2 homeobox gene, a developmental left-right asymmetry (LRA) gene. To investigate the significance of the 4q25 variants, we used mouse models to investigate Pitx2 in atrial arrhythmogenesis directly. When challenged by programmed stimulation, Pitx2(null+/-) adult mice had atrial arrhythmias, including AFL and atrial tachycardia, indicating that Pitx2 haploinsufficiency predisposes to atrial arrhythmias. Microarray and in situ studies indicated that Pitx2 suppresses sinoatrial node (SAN)-specific gene expression, including Shox2, in the left atrium of embryos and young adults. In vivo ChIP and transfection experiments indicated that Pitx2 directly bound Shox2 in vivo, supporting the notion that Pitx2 directly inhibits the SAN-specific genetic program in left atrium. Our findings implicate Pitx2 and Pitx2-mediated LRA-signaling pathways in prevention of atrial arrhythmias.

  7. Generative Retrieval Improves Learning and Retention of Cardiac Anatomy Using Transesophageal Echocardiography.

    Science.gov (United States)

    Kleiman, Amanda M; Forkin, Katherine T; Bechtel, Allison J; Collins, Stephen R; Ma, Jennie Z; Nemergut, Edward C; Huffmyer, Julie L

    2017-05-01

    Transesophageal echocardiography (TEE) is a valuable monitor for patients undergoing cardiac and noncardiac surgery as it allows for evaluation of cardiovascular compromise in the perioperative period. It is challenging for anesthesiology residents and medical students to learn to use and interpret TEE in the clinical environment. A critical component of learning to use and interpret TEE is a strong grasp of normal cardiovascular ultrasound anatomy. Fifteen fourth-year medical students and 15 post-graduate year (PGY) 1 and 2 anesthesiology residents without prior training in cardiac anesthesia or TEE viewed normal cardiovascular anatomy TEE video clips; participants were randomized to learning cardiac anatomy in generative retrieval (GR) and standard practice (SP) groups. GR participants were required to verbally identify each unlabeled cardiac anatomical structure within 10 seconds of the TEE video appearing on the screen. Then a correctly labeled TEE video clip was shown to the GR participant for 5 more seconds. SP participants viewed the same TEE video clips as GR but there was no requirement for SP participants to generate an answer; for the SP group, each TEE video image was labeled with the correctly identified anatomical structure for the 15 second period. All participants were tested for intermediate (1 week) and late (1 month) retention of normal TEE cardiovascular anatomy. Improvement of intermediate and late retention of TEE cardiovascular anatomy was evaluated using a linear mixed effects model with random intercepts and random slopes. There was no statistically significant difference in baseline score between GR (49% ± 11) and SP (50% ± 12), with mean difference (95% CI) -1.1% (-9.5, 7.3%). At 1 week following the educational intervention, GR (90% ± 5) performed significantly better than SP (82% ± 11), with mean difference (95% CI) 8.1% (1.9, 14.2%); P = .012. This significant increase in scores persisted in the late posttest session at one month

  8. Long-term prognostic value of transesophageal atrial pacing stress echocardiography.

    Science.gov (United States)

    Płońska, Edyta; Kasprzak, Jarosław D; Kornacewicz-Jach, Zdzisława

    2005-07-01

    The aim of our study was to evaluate the long-term prognostic value of transesophageal atrial pacing stress echocardiography (TAPSE) for the prediction of cardiovascular events (myocardial infarction) and mortality at 10-year follow-up. TAPSE was applied as a diagnostic modality in 93 consecutive patients (mean age 45 +/- 8 years) who were diagnosed for the cause of chest pain. Long-term follow-up data were obtained from 87 (94%) patients with a mean duration of follow-up of 92 +/- 4 months. Stress echocardiography was performed using TAPSE with a mean pacing rate of 142 +/- 18/min. Predefined cardiac events occurred during the follow-up period in 45 (52%) patients, including 24 (28%) with hard end points: 10 (12%) with nonfatal myocardial infarction and 17 who died (events overlap). Positive result of TAPSE was found in 47 (54%) patients and among those with positive TAPSE result, 16 died (94% of total mortality) and 21 had a hard event (death or infarction-88% of total prevalence). Survival free from hard events was noted in 37 (92%) patients with negative TAPSE and only in 26 (55%) of those with positive TAPSE ( P = .001). Independent predictive factors for mortality were TAPSE positivity (relative risk with 95% confidence interval [RR/CI] = 39.6 [36.3-42.9], P = .0006) and diabetes (RR/CI = 10.2 [8.6-11.8], P = .0026). Independent predictive factors for myocardial infarction were diabetes (RR/CI = 8.1 [6.3-9.9], P = .0186) and significant coronary stenosis in angiography (RR/CI = 9.0 [6.8-11.2], P = .0479). Independent predictive factors for death or nonfatal myocardial infarction were TAPSE positivity (RR/CI = 12.3 [11.1-13.3], P = .0001) and diabetes (RR/CI = 7.0 [5.8-8.2], P = .0018). Positive TAPSE result carries long-term prognostic information regarding mortality and risk of myocardial infarction that can be used to identify patients requiring more aggressive treatment. Negative TAPSE allows highly accurate definition of low-risk population with

  9. A giant myxoma originating from the aortic valve causing severe left ventricular tract obstruction: a case report and literature review.

    Science.gov (United States)

    Prifti, Edvin; Ademaj, Fadil; Kajo, Efrosina; Baboci, Arben

    2015-04-16

    The left ventricular localization of a myxoma is very rare, usually arising from the interventricular septum close to the left ventricular outflow tract, the mitral valve, the ventricular wall and extremely rarely the aortic valve. A 13-year-old male was admitted due to dyspnea and angina. Transesophageal echocardiography revealed left ventricular outflow tract obstruction with a mean gradient of 58 mmHg, and a mobile mass measuring 65×25 mm originating from the ventricular surface of the aortic valve was identified. The patient underwent urgent surgical excision and aortic valve replacement. Histopathological examination of the mass confirmed the diagnosis of a myxoma. In conclusion, a myxoma originating from the aortic valve remains a very rare localization. Total resection associated with aortic valve replacement seems to offer an excellent outcome.

  10. Value of systolic pulmonary venous flow reversal and color Doppler jet measurements assessed with transesophageal echocardiography in recognizing severe pure mitral regurgitation

    NARCIS (Netherlands)

    Pieper, E. P.; Hellemans, I. M.; Hamer, H. P.; Ravelli, A. C.; Cheriex, E. C.; Tijssen, J. G.; Lie, K. I.; Visser, C. A.

    1996-01-01

    We evaluated the value of color and pulsed Doppler transesophageal echocardiographic parameters and of V waves in estimating the severity of mitral regurgitation (MR) in 62 consecutive patients (38 men and 24 women, aged 39 to 80 years) with angiographically proven chronic pure MR (15 grade I/II, 47

  11. A Front-End ASIC with Receive Sub-array Beamforming Integrated with a 32 × 32 PZT Matrix Transducer for 3-D Transesophageal Echocardiography

    NARCIS (Netherlands)

    Chen, C.; Chen, Z.; Bera, Deep; Raghunathan, S.B.; ShabaniMotlagh, M.; Noothout, E.C.; Chang, Z.Y.; Ponte, Jacco; Prins, Christian; Vos, H.J.; Bosch, Johan G.; Verweij, M.D.; de Jong, N.; Pertijs, M.A.P.

    2017-01-01

    This paper presents a power-and area-efficient front-end application-specific integrated circuit (ASIC) that is directly integrated with an array of 32 × 32 piezoelectric transducer elements to enable next-generation miniature ultrasound probes for real-time 3-D transesophageal echocardiography.

  12. Isolated persistent left superior vena cava: A case report and its clinical implications

    Directory of Open Access Journals (Sweden)

    Samarjit Bisoyi

    2017-01-01

    Full Text Available The venous anomaly of a persistent left superior vena cava (PLSVC affects 0.3%-0.5% of the general population. PLSVC with absent right superior vena cava, also termed as "isolated PLSVC," is an extremely rare venous anomaly. Almost half of the patients with isolated PLSVC have cardiac anomalies in the form of atrial septal defect, endocardial cushion defects, or tetralogy of Fallot. Isolated PLSVC is usually innocuous. Its discovery, however, has important clinical implications. It can pose clinical difficulties with central venous access, cardiothoracic surgeries, and pacemaker implantation. When it drains to the left atrium, it may create a right to left shunt. In this case report, we present the incidental finding of isolated PLSVC in a patient who underwent aortic valve replacement. Awareness about this condition and its variations is important to avoid complications.

  13. A Case of Left Atrial Myxoma Whose Initial Symptom Was Finger Ischemic Symptom.

    Science.gov (United States)

    Yamashita, Maho; Eguchi, Kazuo; Ogawa, Masaya; Takahashi, Kan; Nagai, Michiaki; Shimpo, Masahisa; Misawa, Yoshio; Kario, Kazuomi

    2018-01-01

    We experienced a 45-year-old Japanese man who was transferred to our hospital complaining of acute onset of pain and pallor in the right lower limb. Two years earlier, he had complained of repetitive pain at rest and pallor in the left third and fourth fingers. The physical exam and angiography demonstrated occlusion of finger arteries, however we could not reach final diagnosis. Acute arterial occlusive disease in the right lower limb was suspected. Transthoracic echocardiography demonstrated a gross tumor in the left atrium, which suggested left atrial myxoma. An emergency tumorectomy was successfully conducted. Pathologically, the fragile tumor and resultant thrombosis could have caused the patient's peripheral circulatory failure at least two years prior to this episode. A rigorous systemic survey is important even when the ischemic symptom is localized in peripheral circulation.

  14. Types of Diastolic Dysfunction of the Left Ventricle in Adolescents with Myocardial Pathology

    Directory of Open Access Journals (Sweden)

    L.F. Bogmat

    2014-05-01

    Full Text Available In adolescents with myocardial pathology during isometric tests we detected three types of diastolic dysfunction of the left ventricle (LV of the heart, depending on E/A ratio. The most pronounced signs of diastolic filling disorders were detected in the third group of patients, as evidenced: by a tendency to increase isovolumic relaxation time, a significant increase of slowing down time of the first phase of left ventricular filling, reduced LV filling rate both in the first phase of the passive filling and the second phase of active LV filling, increasing E/A ratio of more than 2, significant dilation of the left atrium, as well as positive increase in diastolic reserve that confirms deeper diastolic dysfunction in these adolescents compared with other subgroups.

  15. A Large Left Ventricle Myxoma: Presenting with Epigastric Pain and Weight Loss

    Directory of Open Access Journals (Sweden)

    Solmaz Fakhari

    2016-01-01

    Full Text Available Cardiac myxomas are the most common benign tumors found in the heart. They usually appear in the left atrium. Those originating from the left ventricle (LV are rare. Although clinical presentation may vary, dyspnea and embolism are the most commonly reported symptoms. In the present case study, a 27-year-old woman with a large myxoma originating from the left ventricular free wall is studied. She had atypical complaints, mainly epigastric discomfort, nausea, vomiting, and anorexia. She was hospitalized for acute abdomen, but subsequent investigations revealed a large myxoma that fully filled the LV and severely compromised the flow of the aortic and mitral valves. After successful emergency tumor resection, all symptoms disappeared. The uncommon presentation caused by these tumors is discussed in this study.

  16. Plain radiographic diagnosis of thrombosis of left atrial appendage in mitral valve disease

    International Nuclear Information System (INIS)

    Matsuyama, S.; Watabe, T.; Kuribayashi, S.

    1983-01-01

    Conventional posteroanterior chest radiographs of 42 patients with mitral valve disease who had had surgery were analyzed, and particular attention was directed to the presence or absence of the convexity of the left lower midcardiac border (left artrial segment). The flatness or concavity of this segment, despite other evidence of left atrial enlargement, was observed in six (60%) of 10 patients who had left atrial thrombosis, and in three (9%) of 32 patients who did not have thrombosis (false positive diagnosis). Four of the 10 patients who had left atrial thrombosis did not show this finding on the radiographs (false negative diagnosis). One of these four had a thrombus only against the posterior wall of the body of the left atrium. Therefore, the accuracy in the diagnosis of thrombosis of the left atrial appendage was 66.7% (six of nine) for patients who had thrombosis of the appendage. Standard chest radiographs are important in the evaluation of the patient with thrombosis of the left atrial appendage

  17. [Surface ECG characteristics of right and left atrial flutter].

    Science.gov (United States)

    Rostock, Thomas; Konrad, Torsten; Sonnenschein, Sebastian; Mollnau, Hanke; Ocete, Blanca Quesada; Bock, Karsten; Spittler, Raphael; Huber, Carola; Theis, Cathrin

    2015-09-01

    Atrial tachycardia in virtually all areas of both atria has become more important in the clinical management of patients with previous complex atrial fibrillation ablation. Accurate interpretation of surface electrocardiogram (ECG) characteristics is of paramount importance to localize the origin of atrial tachycardia, particularly for planning interventional treatment. This article highlights the ECG features of different types of right and left atrial tachycardia. Typical right atrial flutter through the cavotricuspid isthmus conducts septally in a cranial direction and demonstrates sawtooth-like flutter waves which start negative in II, III and aVF and then show a steep slope upwards to the isoelectric line. The flutter rate typically ranges between 240-250 beats/min. In contrast, right atrial flutter in a clockwise rotation, flutter around the vena cava inferior or superior and around a scar (e.g. after cardiac surgery) show positive or biphasic flutter waves (lower or upper loop reentry). Left atrial flutter waves (e.g. around the mitral valve or around the pulmonary veins) are very heterogeneous and are typically positive in V1 as the left atrium is located in the posterior mediastinum. Specific knowledge of flutter wave morphology in surface ECG facilitates planning and performance of the ablation strategy.

  18. [Ischemic stroke induced by a left atrial myxoma].

    Science.gov (United States)

    Hatayama, Sayaka; Ogata, Toshiyasu; Okawa, Masakazu; Higashi, Toshio; Inoue, Tooru; Takano, Koichi; Minematsu, Noritoshi; Tashiro, Tadashi; Sakata, Noriyuki

    2012-10-01

    We reported a case of ischemic stroke induced by a left atrial myxoma. A 76-year-old man was found unconscious and transferred to the emergency ward in our hospital. He experienced consciousness disturbance, motor dominant aphasia, and severe right hemiparesis. His neurological and radiological findings indicated that he had ischemic stroke and was eligible to undergo intravenous thrombolysis. Alteplase was administrated 155 min after the onset of stroke. Intracerebral hemorrhage was not seen 24h after thrombolysis. A tumor in the left atrium was detected on transthoracic echocardiography, and this finding suggested that the tumor was a myxoma. Although cardiac surgery was scheduled, hemorrhagic transformation was found on day 11, which made us postpone the surgery. After the hemorrhage was disappeared, the tumor was resected by open-heart surgery and it was confirmed to be a myxoma. Neither his neurological symptom nor intracerebral hemorrhage was not deteriorated after the operation. Thrombolytic treatment seemed a safe option for ischemic stroke caused by left atrial myxoma. However, we should carefully monitor the extent of anticoagulation therapy because hemorrhagic transformation might alter the timing of surgery for tumor resection.

  19. A Novel Mapping System for Panoramic Mapping of the Left Atrium: Application to Detect and Characterize Localized Sources Maintaining Atrial Fibrillation.

    Science.gov (United States)

    Honarbakhsh, Shohreh; Schilling, Richard J; Dhillon, Gurpreet; Ullah, Waqas; Keating, Emily; Providencia, Rui; Chow, Anthony; Earley, Mark J; Hunter, Ross J

    2018-01-01

    This study sought to use a novel panoramic mapping system (CARTOFINDER) to detect and characterize drivers in persistent atrial fibrillation (AF). Mechanisms sustaining persistent AF remain uncertain. Patients undergoing catheter ablation for persistent AF were included. A 64-pole basket catheter was used to acquire unipolar signals, which were processed by the mapping system to generate wavefront propagation maps. The system was used to identify and characterize potential drivers in AF pre- and post-pulmonary vein (PV) isolation. The effect of ablation on drivers identified post-PV isolation was assessed. Twenty patients were included in the study with 112 CARTOFINDER maps created. Potential drivers were mapped in 19 of 20 patients with AF (damage to the basket and noise on electrograms was present in 1 patient). Thirty potential drivers were identified all of which were transient but repetitive; 19 were rotational and 11 focal. Twenty-six drivers were ablated with a predefined response in 22 of 26 drivers: AF terminated with 12 and cycle length slowed (≥30 ms) with 10. Drivers with rotational activation were predominantly mapped to sites of low-voltage zones (81.8%). PV isolation had no remarkable impact on the cycle length at the driver sites (138.4 ± 14.3 ms pre-PV isolation vs. 137.2 ± 15.2 ms post-PV isolation) and drivers that had also been identified on pre-PV isolation maps were more commonly associated with AF termination. Drivers were identified in almost all patients in the form of intermittent but repetitive focal or rotational activation patterns. The mechanistic importance of these phenomena was confirmed by the response to ablation.

  20. Enlargement of the left atrium is associated with increased infiltration of immune cells in patients with atrial fibrillation who had undergone surgery

    Directory of Open Access Journals (Sweden)

    Takeshi Yamashita, MD

    2015-04-01

    Conclusions: In the patients with AF, LA enlargement was associated not only with the increase in the extent of interstitial fibrosis but also with the changes in the LA component cells, including an increase in number of immune cells resident in tissues.

  1. Crude extract and purified components isolated from the stems of Tinospora crispa exhibit positive inotropic effects on the isolated left atrium of rats

    DEFF Research Database (Denmark)

    Praman, Siwaporn; Mulvany, Michael J.; Williams, David E.

    2013-01-01

    -butanol soluble material was concentrated and dried under reduced pressure and lyophilized to obtain a crude powder (Tinospora crispa extract). The active components of Tinospora crispa extract were separated by column chromatography and preparative HPLC. The effects and mechanisms of the n-butanol extract...

  2. Clinical application of percutaneous balloon mitral valvuloplasty in patients with rheumatic mitral stenosis and left atrial thrombi

    International Nuclear Information System (INIS)

    Chen Junzhu; Zhang Furong; Tao Qianmin; Cheng Guanchang; Zheng Liangrong; Zhu Jianhua

    2002-01-01

    Objective: To evaluate safety and effect of percutaneous balloon mitral valvuloplasty (PBMV) for patients with rheumatic mitral stenosis and left atrial thrombi. Methods: PBMV was performed in 27 patients with rheumatic mitral stenosis and left atrial thrombi. 19 cases of left atrial fresh thrombi revealed by trans-esophageal echocardiography (TEE) received warfarin orally for 3-6 months before PBMV. Results: PBMV was successful in all cases of mitral stenosis and left atrial thrombi. Left atrial fresh thrombi was completely resolved in 9 cases and became smaller chronic organized thrombi in 10 cases after warfarin anticoagulation treatment among 19 cases of left atrial fresh thrombi revealed by TEE. In 5 cases of left atrial chronic organized thrombi shown only transthoracic echocardiography and without anticoagulation treatment, one case had cerebral embolism. No complication occurred in other cases. Conclusions: The study showed that patients with rheumatic mitral stenosis and atrial fibrillation should have routine TEE. PBMV for rheumatic mitral stenosis with left atrial thrombi after anticoagulation treatment is safe and effective

  3. An integrated software system for quality assurance-related kappa coefficient analysis of intraoperative transesophageal echocardiography interpretive skills.

    Science.gov (United States)

    Rafferty, T; Edwards, B; Judd, J; Swamy, V; Workman, R; Lippmann, H; Harris, S; Cohen, I; Prokop, E; Ezekowitz, M

    1993-10-01

    This report describes the development of a quality assurance-oriented integrated software system designed for an anesthesiology-based intraoperative transesophageal echocardiography service. Entry data include patient and operation demographics, two-dimensional echocardiographic, saline-contrast, and color flow/pulsed Doppler assessments of the heart and great vessels, presented in a defined sequence. A statistical analysis component (kappa coefficient analysis) allows for comparison of intraoperative real-time interpretations with laboratory interpretations made by experienced full-time echocardiographers on a field-by-field basis. This provides a means of quantifying expertise in each individual aspect of the patient examination sequence. We believe that such self-appraisal data are essential for delineating the status and tracking the progress of service being provided.

  4. A rare case of classical Hodgkin's lymphoma in the setting of a newly diagnosed left atrial myxoma

    Science.gov (United States)

    Bolanos, Alexander Javier; Dibu, George; Burke, Floyd W; Klodell, Charles T; Li, Ying; Rand, Kenneth H; Lucas, Alexandra Rose

    2015-01-01

    We report a rare case of left atrial myxoma with concomitant classical Hodgkin's lymphoma in a 36-year-old woman with a non-significant medical history and 4 months of progressively worsening palpitations, dyspnoea on exertion, chest discomfort and fatigue. Outpatient echocardiography revealed functional mitral valve stenosis as a result of a large left atrial cardiac mass. Preoperative thoracic imaging revealed an anterior mediastinal mass with associated lymphadenopathy. The patient underwent successful resection of the anterior mediastinal mass and left atrial mass. Surgical pathology revealed myxoma in the left atrium and classical Hodgkin's lymphoma in the anterior mediastinum. Thus the patient was diagnosed with early-stage classical Hodgkin's lymphoma. This clinical vignette emphasises the importance of a comprehensive diagnostic evaluation in the setting of a newly discovered atrial tumour. PMID:26516250

  5. Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Murdoch, Dale, E-mail: dale_murdoch@health.qld.gov.au [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia); McAulay, Laura [The Prince Charles Hospital, Brisbane (Australia); Walters, Darren L. [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia)

    2014-11-15

    Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy.

  6. Successful surgical osteoplasty of the left main coronary artery with concomitant mitral valve replacement and tricuspid annuloplasty

    Directory of Open Access Journals (Sweden)

    Ujjwal Kumar Chowdhury

    2017-01-01

    Full Text Available A 50-year-old woman with rheumatic heart disease, mitral stenosis, and critical isolated left main ostial stenosis was successfully treated by mitral valve replacement, tricuspid annuloplasty, and surgery of left main osteoplasty and is reported for its rarity. Notable clinical findings included an intermittently irregular pulse, blood pressure of 100/70 mmHg, cardiomegaly, a diastolic precordial thrill, a mid-diastolic murmur without presystolic accentuation that was loudest at the mitral area. Chest radiograph revealed cardiomegaly with a cardiothoracic ratio of 0.7 due to enlarged right atrium, right ventricle with a straightened left heart border and evidence of pulmonary hypertension. The investigation shows that surgical reconstruction of the left main coronary artery is safe and effective for the treatment.

  7. Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

    International Nuclear Information System (INIS)

    Murdoch, Dale; McAulay, Laura; Walters, Darren L.

    2014-01-01

    Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy

  8. The effect of aerobic continuous training and detraining on left ventricular structure and function in male students

    Directory of Open Access Journals (Sweden)

    Mahdiabadi Javad

    2017-04-01

    Full Text Available Purpose. Regular exercise training induces cardiac physiological hypertrophy. The aim of this study was to determine the effect of aerobic continuous training and a detraining period on left ventricular structure and function in non-athlete healthy men. Material. Ten untrained healthy male students (aged 18-22 years were volunteered and participated in countryside continuous jogging programme (3days/week, at 70% of Maximum Heart Rate for 45 min, 8-weeks and four weeks detraining afterwards. M-mode, 2-dimensional, colour and Doppler transthoracic echocardiography were performed, during resting conditions, before and after the training and after detraining period. Results. Using t-test, we found significant difference in end systolic diameter and the posterior wall thickness, percentage shortening and ejection fraction after eight weeks training compared to before training. It was found no significant difference in end diastolic diameter, interventricular septum thickness, left atrium diameter, aortic root diameter, heart rate, systolic and diastolic blood pressures. Following four weeks detraining after training, compared with eight weeks of training was a significant difference in end diastolic diameter, percentage shortening and ejection fraction and no significant difference in end systolic diameter, posterior wall thickness, interventricular septum thickness, left atrium diameter, aortic root diameter, heart rate, systolic and diastolic blood pressures. Conclusions. In general, eight-week aerobic continuous training and a detraining period can affect left ventricular structure and function.

  9. The advantages of live/real time three-dimensional transesophageal echocardiography during assessments of pulmonary stenosis.

    Science.gov (United States)

    Kemaloğlu Öz, Tuğba; Özpamuk Karadeniz, Fatma; Akyüz, Şükrü; Ünal Dayı, Şennur; Esen Zencirci, Aycan; Atasoy, Işıl; Ösken, Altuğ; Eren, Mehmet

    2016-04-01

    This report sought to compare live/real-time three-dimensional transesophageal echocardiography (3D-TEE) with two-dimensional transesophageal echocardiography (2D-TEE) and to determine whether there are advantages to using 3D-TEE on patients with pulmonary stenosis (PS). Sixteen consecutive adult patients (50 % male and 50 % female; mean age 33 ± 13.4 years) with PS and indications of TEE were prospectively enrolled in this study. Following this, initial 2D-TEE and 3D-TEE examinations were performed, and 3D-TEE images were analyzed using an off-line Q-lab software system. Finally, the 2D-TEE and 3D-TEE findings were compared. In the present study, 3D-TEE allowed us to obtain the en face views of pulmonary valves (PVs) in all but one patient. While this patient was without a PV due to a previous tetralogy of Fallot operation, we could detect the type of PV in the other 15 (93.7 %) patients by using 3D-TEE. Due to poor image quality, the most stenotic area was not measurable in only one (6.2 %) of the patients. In eight (50 %) of the patients, severity and localization of stenosis were more precisely determined with 3DTEE than with 2D-TEE. The PVs' maximal annulus dimensions were found to be significantly larger when they were measured using 3D modalities. This study provides evidence of the incremental value of using 3D-TEE rather than 2D-TEE during assessments of PS, specifically in cases where special conditions (pregnancy, pulmonary regurgitation, and concomitant atrial septal defects) cause recordings of the transvalvular peak gradient to be inaccurate. Therefore, 3D-TEE should be used as a complementary imaging tool to 2D-TEE during routine echocardiographic examinations.

  10. Diagnostic Accuracy of Transthoracic Echocardiography for Infective Endocarditis Findings Using Transesophageal Echocardiography as the Reference Standard: A Meta-Analysis.

    Science.gov (United States)

    Bai, Anthony D; Steinberg, Marilyn; Showler, Adrienne; Burry, Lisa; Bhatia, R Sacha; Tomlinson, George A; Bell, Chaim M; Morris, Andrew M

    2017-07-01

    Echocardiography is important for the diagnosis of infective endocarditis (IE), for which transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE). A systematic review and meta-analysis of observational studies was performed with the objective of evaluating diagnostic properties of TTE, with transesophageal findings of IE as the reference standard in patients with suspected IE. The literature search yielded 377 unique articles, of which 16 met the inclusion criteria. The 16 studies included 2,807 patients, of whom 793 (28%) had vegetations on TEE. For detecting vegetations, harmonic TTE had sensitivity of 61% (95% CI, 45%-75%) and specificity of 94% (95% CI, 85%-98%) with a negative likelihood ratio (NLR) of 0.42 (95% CI, 0.26-0.61). NLR for harmonic TTE can be improved by including only patients without prosthetic valves (NLR = 0.36; 95% CI, 0.22-0.55) or by having strict criteria for conclusively negative results on TTE (NLR = 0.17; 95% CI, 0.10-0.28). In the setting of patients without prosthetic valves, harmonic TTE had likelihood ratios of 0.14 (95% CI, 0.09-0.23) for a conclusively negative result, 0.66 (95% CI, 0.53-0.81) for an indeterminate result, and 14.60 (95% CI, 3.37-70.40) for a positive result. Modern harmonic TTE still has the potential to miss many vegetations detected on TEE. When limited to patients without prosthetic valves, a conclusively negative TTE under optimal view greatly decreases likelihood of IE. All other transthoracic results are not useful for ruling out IE, and subsequent TEE is almost always required. Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  11. Posterior non-ischemic left ventricular aneurysm. Report of 2 surgical cases.

    Science.gov (United States)

    Lioulias, A G; Kokotsakis, J N; Skouteli, E A T; Boulafendis, D G

    2002-12-01

    Posterior non-ischemic left ventricular aneurysms are unusual aneurysms of different etiology that develop adjacent to the mitral valve annulus causing mitral regurgitation and progressive heart failure. Surgical correction is mandatory and involves repair of the aneurysm along with repair or replacement of the mitral valve. Two cases of posterior non-ischemic left ventricular aneurysms are reported. Both patients were females (19 and 9 years old) and they presented with symptoms of progressive heart failure. Definite diagnosis was made with transesophageal echocardiography (TEE) and confirmed with left ventriculography. Both patients were successfully treated by surgery. The first patient underwent repair of the aneurysm from inside the left ventricle and mitral valve replacement. The second patient had resection of the aneurysm through an extracardiac route. Both patients are in NYHA class 1, 5 and 4 years respectively after their operation with no evidence of mitral valve dysfunction. Posterior non-ischemic left ventricular aneurysms can securely be diagnosed by TEE and angiocardiography. Surgical treatment is mandatory in order to forestall potential life threatening cardiovascular events and should be tailored to the operative findings.

  12. Multimodality Cardiac Imaging for the Assessment of Left Atrial Function and the Association With Atrial Arrhythmias

    DEFF Research Database (Denmark)

    Olsen, Flemming Javier; Bertelsen, Litten; de Knegt, Martina Chantal

    2016-01-01

    Several cardiac imaging modalities are able to visualize the left atrium (LA) and, therefore, allow for quantification of both structural and functional properties of this cardiac chamber. In echocardiography, only the maximal LA volume is included in the assessment of diastolic function at the c......Several cardiac imaging modalities are able to visualize the left atrium (LA) and, therefore, allow for quantification of both structural and functional properties of this cardiac chamber. In echocardiography, only the maximal LA volume is included in the assessment of diastolic function...... atrial fibrillation, which will be a point of focus in this review. Pivotal cardiac magnetic resonance imaging studies have revealed high correlation between LA fibrosis and risk of atrial fibrillation recurrence after catheter ablation, and subsequent multimodality imaging studies have uncovered...... an inverse relationship between LA reservoir function and degree of LA fibrosis. This has sparked an increased interest into the application of advanced imaging modalities, including both speckle tracking echocardiography and tissue tracking by cardiac magnetic resonance imaging. Even though increasing...

  13. The feasibility of substituting left atrial wall strain for flow velocity of left atrial appendage.

    Science.gov (United States)

    Miyoshi, Akihito; Nakamura, Yoichi; Kazatani, Yukio; Ito, Hiroshi

    2017-07-28

    Non-valvular atrial fibrillation (NVAF) is frequently complicated by thromboembolism. Left atrial appendage (LAA) flow is a predictor of LAA thrombosis. LAA flow is measured by transesophageal echocardiography (TEE), which is a semi-invasive diagnostic tool. Recently, speckle-tracking methods have been adapted for the evaluation of local cardiac function. We hypothesised that if we could determine LAA wall motion utilising a speckle tracking technique, we could non-invasively analyse LAA flow. Sixty-three NVAF patients including 38 with chronic atrial fibrillation (CAF), 14 with paroxysmal AF (PAF) and 11 with atrial flutter (AFL) were enrolled in this study. Normal sinus rhythm (NSR) patients with non-thromboembolic cerebral infarction were also included. Immediately after obtaining a 2D movie of the LAA through the aortic oblique short axis view by transthoracic echocardiography, LAA flow velocity was measured by TEE. Mean strains between the posterior and anterior walls were measured using a speckle-tracking technique. Ten patients exhibited a thrombus and 11 had spontaneous echo contrast (SEC) in the auricle. Mean strain value was similar between CAF and PAF, although LAA flow velocity for CAF was significantly reduced compared with PAF (median value 13.7 cm/s versus 36.1 cm/s, p = reduced compared with NSR patients (median value 1.52% versus 3.17%, p = .00181). Furthermore, mean strain was correlated with LAA flow velocity (R = 0.399, R2 = 0.1595, p = .000615). LAA wall strain identified via speckle-tracking methods may presage LAA peak flow velocity. This technique may contribute to stratification of thrombosis risks in the LAA.

  14. Effects of trypan blue on the action of adrenergic agonists in the guinea-pig isolated atrium.

    Science.gov (United States)

    Mahmoudian, M; Ziai, S A

    1998-01-01

    It has been reported that trypan blue, a diazo dye with polyamphipathic structure, can inhibit the coupling of receptors to G-proteins. The present study was carried out to investigate the effect of trypan blue on the actions of adrenoceptor agonists in the guinea-pig atrium. Trypan blue (10 and 100 microM) antagonized the positive inotropic effects of isoprenaline and dobutamine by shifting their concentration-response curves to the right. With the selective beta 2-adrenoceptor agonist, salbutamol, there was a reduction of response in the presence of trypan blue. Therefore, we concluded that trypan blue diminish the response to beta-adrenoceptor agonists possibly via decoupling receptors from Gs. Trypan blue and similar agents, due to their unique mode of action, can be used as tools for the investigation of the mechanism of receptor-G protein coupling in the whole tissue preparation.

  15. Cardiac Rupture of the Junction of the Right Atrium and Superior Vena Cava in Blunt Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    Chun Sung Byun

    Full Text Available Cardiac rupture following blunt thoracic trauma is rarely encountered, since it commonly causes death at the scene. With advances in critical care, blunt cardiac rupture has been successfully treated with well-organized team approach including an emergency physician, anesthesiologist, and cardiac surgeon. We encountered a patient with blunt cardiac rupture of the junction of the superior vena cava and right atrium that extended 7 cm to the right ventricular junction. The patient was successfully resuscitated after a closed thoracostomy and pericardiocentesis with fluid loading. Cardiac injury was repaired via mid-sternotomy without cardiopulmonary bypass. The patient recovered without complications and was discharged on the 7th day after surgery.

  16. A successful insertion of PICC in patient with cardiac angiosarcoma and neoplasty of right atrium and pacemaker: A case report.

    Science.gov (United States)

    Liu, Bing; Sun, Wenyan; Wang, Kai

    2017-12-01

    Primary cardiac angiosarcoma is a rare tumor and the common treatment is surgical resection followed by chemotherapy. Peripherally inserted central venous catheters (PICCs) are widely used in cancer patients and ultrasound-guided PICC insertion could improve success rate especially in patient with abnormal anatomy structure. Reports about PICCs being placed in patient who had suffered from the cardiac angiosarcoma and neoplasty of right atrium with an ipsilateral cardiac permanent pacemaker are rarely.After patient's informed consent, we present a case of the successful insertion of PICC into a patient with the ipsilateral cardiac disease with a pacemaker placement, which has not been previously reported. This report highlights PICC could be used in patient with cardiac disease with a pacemaker placement for chemotherapy. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  17. A successful insertion of PICC in patient with cardiac angiosarcoma and neoplasty of right atrium and pacemaker

    Science.gov (United States)

    Liu, Bing; Sun, Wenyan; Wang, Kai

    2017-01-01

    Abstract Introduction: Primary cardiac angiosarcoma is a rare tumor and the common treatment is surgical resection followed by chemotherapy. Peripherally inserted central venous catheters (PICCs) are widely used in cancer patients and ultrasound-guided PICC insertion could improve success rate especially in patient with abnormal anatomy structure. Reports about PICCs being placed in patient who had suffered from the cardiac angiosarcoma and neoplasty of right atrium with an ipsilateral cardiac permanent pacemaker are rarely. After patient's informed consent, we present a case of the successful insertion of PICC into a patient with the ipsilateral cardiac disease with a pacemaker placement, which has not been previously reported. Conclusions: This report highlights PICC could be used in patient with cardiac disease with a pacemaker placement for chemotherapy. PMID:29390474

  18. Left atrial function in heart failure with impaired and preserved ejection fraction.

    Science.gov (United States)

    Fang, Fang; Lee, Alex Pui-Wai; Yu, Cheuk-Man

    2014-09-01

    Left atrial structural and functional changes in heart failure are relatively ignored parts of cardiac assessment. This review illustrates the pathophysiological and functional changes in left atrium in heart failure as well as their prognostic value. Heart failure can be divided into those with systolic dysfunction and heart failure with preserved ejection fraction (HFPEF). Left atrial enlargement and dysfunction commonly occur in systolic heart failure, in particular, in idiopathic dilated cardiomyopathy. Atrial enlargement and dysfunction also carry important prognostic value in systolic heart failure, independently of known parameters such as left ventricular ejection fraction. In HFPEF, there is evidence of left atrial enlargement, impaired atrial compliance, and reduction of atrial pump function. This occurs not only at rest but also during exercise, indicating significant impairment of atrial contractile reserve. Furthermore, atrial dyssynchrony is common in HFPEF. These factors further contribute to the development of new onset or progression of atrial arrhythmias, in particular, atrial fibrillation. Left atrial function is an integral part of cardiac function and its structural and functional changes in heart failure are common. As changes of left atrial structure and function have different clinical implications in systolic heart failure and HFPEF, routine assessment is warranted.

  19. Numerical investigations of buoyancy-driven natural ventilation in a simple three-storey atrium building and thermal comfort evaluation

    International Nuclear Information System (INIS)

    Hussain, Shafqat; Oosthuizen, Patrick H.

    2013-01-01

    The numerical investigations of buoyancy-driven natural ventilation and thermal comfort evaluation in a simple three-storey atrium building as a part of the passive ventilation strategy was undertaken using a validated Computational Fluid Dynamic (CFD) model. The Reynolds Averaged Navier–Stokes (RANS) modeling approach with the SST-k–ω turbulence model and the discrete transfer radiation model (DTRM) was used for the numerical investigations. The steady-state governing equations were solved using a commercial solver FLUENT©. Various flow situations of the buoyancy-driven natural ventilation in the building during day and night time were examined. The numerical results obtained for the airflow rates, airflow patterns and temperature distributions inside the building are presented in this paper. Using the numerical results, the well-known thermal comfort indices PMV (predicted mean vote) and PPD (predicted percentage of dissatisfied) were calculated for the evaluation of the thermal comfort conditions in the occupied regions of the building. It was noticed that thermal conditions prevailing in the occupied areas of the building as a result of using the buoyancy-driven ventilation were mostly in comfort zone. From the study of the night time ventilation, it was found that hot water (80 °C) circulation (heated by solar collectors during daytime) along the chimney walls during night time and heat sources present in the building can be useful in inducing night ventilation airflows in the building as a part of the passive ventilation strategy. -- Highlights: • A simple three-storey atrium building. • Numerical modeling of buoyancy-driven ventilation flow in the building. • Effect of solar intensity and geographical location on ventilation. • CFD predictions were used to calculate thermal comfort indices. • Evaluation of thermal comfort conditions for the occupants

  20. Left atrial volume index

    DEFF Research Database (Denmark)

    Poulsen, Mikael K; Dahl, Jordi S; Henriksen, Jan Erik

    2013-01-01

    To determine the prognostic importance of left atrial (LA) dilatation in patients with type 2 diabetes (T2DM) and no history of cardiovascular disease.......To determine the prognostic importance of left atrial (LA) dilatation in patients with type 2 diabetes (T2DM) and no history of cardiovascular disease....

  1. Split-bolus single-phase cardiac multidetector computed tomography for reliable detection of left atrial thrombus. Comparison to transesophageal echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Staab, W.; Zwaka, P.A.; Sohns, J.M.; Schwarz, A.; Lotz, J. [University Medical Center Goettingen Univ. (Germany). Inst. for Diagnostic and Interventional Radiology; Sohns, C.; Vollmann, D.; Zabel, M.; Hasenfuss, G. [Goettingen Univ. (Germany). Dept. of Cardiology and Pneumology; Schneider, S. [Goettingen Univ. (Germany). Dept. of Medical Statistics

    2014-11-15

    Evaluation of a new cardiac MDCT protocol using a split-bolus contrast injection protocol and single MDCT scan for reliable diagnosis of LA/LAA thrombi in comparison to TEE, optimizing radiation exposure and use of contrast agent. A total of 182 consecutive patients with drug refractory AF scheduled for PVI (62.6% male, mean age: 64.1 ± 10.2 years) underwent routine diagnostic work including TEE and cardiac MDCT for the evaluation of LA/LAA anatomy and thrombus formation between November 2010 and March 2012. Contrast media injection was split into a pre-bolus of 30 ml and main bolus of 70 ml iodinated contrast agent separated by a short time delay. In this study, split-bolus cardiac MDCT identified 14 of 182 patients with filling defects of the LA/LAA. In all of these 14 patients, abnormalities were found in TEE. All 5 of the 14 patients with thrombus formation in cardiac MDCT were confirmed by TEE. MDCT was 100% accurate for thrombus, with strong but not perfect overall results for SEC equivalent on MDCT.

  2. Concomitant lipomatous hypertrophy and left atrial mass: Distinguishing benign from malignant.

    Science.gov (United States)

    Kleiman, Amanda M; Harding, Lindsay M; Bechtel, Allison J

    2018-02-11

    Masses in and near the interatrial septum may be either benign or malignant. The most common mass near the interatrial septum is lipomatous atrial septal hypertrophy (LASH). LASH can be present in patients with intracardiac malignancies, myxomas, lipomas, or other cardiac masses. It is important to recognize the transesophageal echocardiography (TEE) characteristics of these pathologies to arrive at an accurate diagnosis with an appropriate plan for intraoperative resection. At the authors' institution, patients have been referred for surgery due to a finding of significant LASH masquerading as a left atrial myxoma. In challenging cases, TEE offers a thorough evaluation of the interatrial septum to delineate between multiple intracardiac masses. © 2018 Wiley Periodicals, Inc.

  3. Thrombosed cor triatriatum sinistrum mimicking left atrial mass and causing unilateral pulmonary edema.

    Science.gov (United States)

    Gonzalez Lengua, Carlos A; Kumar, Pirkash; Cham, Matthew; Sanz, Javier

    2016-01-01

    46 year old female with history of progressive shortness of breath for 3 years associated with recurrent right lung infiltrates and hemoptisis. A computed tomography of the chest showed a left atrial mass suggestive of atrial myxoma confirmed with transesophageal echocardiogram. Contrary with findings from a dedicated EKG gated cardiac computed tomography suggestive of cor triatriatum with associated thrombus and less likely a neoplasm; findings later on confirmed during surgery. Cardiac CT offers superior spatial resolution and multi-planar image reconstructions, allowing improved characterization of cardiac structures and cardiac masses compared to other traditional cardiovascular imaging modalities. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  4. Persistent left superior vena cava with thrombus formed in the catheter lumen 4 h after dialysis catheter placed.

    Science.gov (United States)

    Kawasaki, Tomoki; Tanaka, Hiroyuki; Oba, Miki; Takada, Megumi; Tanaka, Haruna; Suda, Shin

    2018-02-17

    Persistent left superior vena cava (PLSVC) is one of the most common thoracic venous anomaly and rarely noticed, because it is asymptomatic. However, for nephrologists, it is frequent enough to be encountered while placing hemodialysis catheters through the jugular vein. We report the case of 66-year-old patient with PLSVC presenting intrinsic thrombosis formation 4 h after dialysis catheter placed. Dialysis catheter was placed in the left internal jugular vein without resistance and any complication. PLSVC was detected after dialysis catheter insertion. We decided to remove the catheter, because the patient has other veins in which the catheter can be placed. When it was removed 4 h after catheter placing, thrombus was recognized in the catheter lumen. Transesophageal echocardiography was performed and no thrombus formation was observed in the heart chamber. For patients with PLSVC, if there were other veins in which the catheter can be placed, catheter replacement should be considered.

  5. Nonbacterial thrombotic endocarditis associated with cancer of unknown origin complicated with thrombus in the left auricular appendage: case report

    Directory of Open Access Journals (Sweden)

    Morinaga Yukiko

    2011-02-01

    Full Text Available Abstract A 63-year-old man was admitted to our hospital with a complaint of right lateroabdominal pain. He was diagnosed with metastatic colon cancer, and then developed multiple brain embolic infarctions 7 days after admission. Transesophageal echocardiography showed that mobile, echo-dense masses were attached to the anterior and posterior mitral valve leaflet. Furthermore, there was a thrombus in the left auricular appendage despite sinus rhythm. These findings led to a diagnosis of suspected infectious endocarditis with subsequent multiple brain infarctions. The patient's general condition worsened and he died 13 days after admission. An autopsy was performed, and, while poorly differentiated cancer was observed in multiple organs, no primary tumor could be identified. Histological analysis showed that the masses of the mitral valve consisted mainly of fibrin without bacteria or oncocytes. This patient was therefore diagnosed with nonbacterial thrombotic endocarditis associated with cancer of unknown origin complicated with thrombus in the left auricular appendage.

  6. Anatomy and Physiology of Left Ventricular Suction Induced by Rotary Blood Pumps.

    Science.gov (United States)

    Salamonsen, Robert Francis; Lim, Einly; Moloney, John; Lovell, Nigel Hamilton; Rosenfeldt, Franklin L

    2015-08-01

    This study in five large greyhound dogs implanted with a VentrAssist left ventricular assist device focused on identification of the precise site and physiological changes induced by or underlying the complication of left ventricular suction. Pressure sensors were placed in left and right atria, proximal and distal left ventricle, and proximal aorta while dual perivascular and tubing ultrasonic flow meters measured blood flow in the aortic root and pump outlet cannula. When suction occurred, end-systolic pressure gradients between proximal and distal regions of the left ventricle on the order of 40-160 mm Hg indicated an occlusive process of variable intensity in the distal ventricle. A variable negative flow difference between end systole and end diastole (0.5-3.4 L/min) was observed. This was presumably mediated by variable apposition of the free and septal walls of the ventricle at the pump inlet cannula orifice which lasted approximately 100 ms. This apposition, by inducing an end-systolic flow deficit, terminated the suction process by relieving the imbalance between pump requirement and delivery from the right ventricle. Immediately preceding this event, however, unnaturally low end-systolic pressures occurred in the left atrium and proximal left ventricle which in four dogs lasted for 80-120 ms. In one dog, however, this collapse progressed to a new level and remained at approximately -5 mm Hg across four heart beats at which point suction was relieved by manual reduction in pump speed. Because these pressures were associated with a pulmonary capillary wedge pressure of -5 mm Hg as well, they indicate total collapse of the entire pulmonary venous system, left atrium, and left ventricle which persisted until pump flow requirement was relieved by reducing pump speed. We suggest that this collapse caused the whole vascular region from pulmonary capillaries to distal left ventricle to behave as a Starling resistance which further reduced right

  7. Radionuclide detection and differential diagnosis of left-to-right cardiac shunts by analysis of time-activity curves

    International Nuclear Information System (INIS)

    Kim, Ok-Hwa

    1986-01-01

    The noninvasive nature of the radionuclide angiocardiography provided a useful approach for the evaluation of left-to-right cardiac shunts (LRCS). While the qualitative information can be obtained by inspection of serial radionuclide angiocardiograms, the quantitative information of radionuclide angiocardiography can be obtained by the analysis of time-activity curves using advanced computer system. The count ratios method and pulmonary-to-systemic flow ratio (QP/QS) by gamma variate fit method were used to evaluate the accuracy of detection and localization of LRCS. One hundred and ten time-activity curves were analyzed. There were 46 LRCS (atrial septal defects 11, ventricular septal defects 22, patent ductus arteriosus 13) and 64 normal subjects. By computer analysis of time-activity histograms of the right atrium, ventricle and the lungs separately, the count ratios modified by adding the mean cardiac transit time were calculated in each anatomic site. In normal subjects the mean count ratios in the right atrium, ventricle and lungs were 0.24 on average. In atrial septal defects, the count ratios were high in the right atrium, ventricle and lungs, whereas in ventricular septal defects the count ratios were higher only in the right ventricle and lungs. Patent ductus arteriosus showed normal count ratios in the heart but high count ratios were obtained in the lungs. Thus, this count ratios method could be separated normal from those with intracardiac or extracardiac shunts, and moreover, with this method the localization of the shunts level was possible in LRCS. Another method that could differentiate the intracardiac shunts from extracardiac shunts was measuring QP/QS in the left and right lungs. In patent ductus arteriosus, the left lung QP/QS was hight than those of the right lung, whereas in atrial septal defects and ventricular septal defects QP/QS ratios were equal in both lungs. (J.P.N.)

  8. Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of primary cardiac malignant fibrous histiocytoma.

    Science.gov (United States)

    Gok, Gulay; Elsayed, Mahmoud; Thind, Munveer; Uygur, Begum; Abtahi, Firoozeh; Chahwala, Jugal R; Yıldırımtürk, Özlem; Kayacıoğlu, İlyas; Pehlivanoğlu, Seçkin; Nanda, Navin C

    2015-07-01

    We describe a case of primary cardiac malignant fibrous histiocytoma where live/real time three-dimensional transesophageal echocardiography added incremental value to the two-dimensional modalities. Specifically, the three-dimensional technique allowed us to delineate the true extent and infiltration of the tumor, to identify characteristics of the tumor mass suggestive of its malignant nature, and to quantitatively assess the total tumor burden. © 2015, Wiley Periodicals, Inc.

  9. The importance of integrated left atrial evaluation: From hypertension to heart failure with preserved ejection fraction.

    Science.gov (United States)

    Beltrami, Matteo; Palazzuoli, Alberto; Padeletti, Luigi; Cerbai, Elisabetta; Coiro, Stefano; Emdin, Michele; Marcucci, Rossella; Morrone, Doralisa; Cameli, Matteo; Savino, Ketty; Pedrinelli, Roberto; Ambrosio, Giuseppe

    2017-12-28

    Functional analysis and measurement of left atrium are an integral part of cardiac evaluation, and they represent a key element during non-invasive analysis of diastolic function in patients with hypertension (HT) and/or heart failure with preserved ejection fraction (HFpEF). However, diastolic dysfunction remains quite elusive regarding classification, and atrial size and function are two key factors for left ventricular (LV) filling evaluation. Chronic left atrial (LA) remodelling is the final step of chronic intra-cavitary pressure overload, and it accompanies increased neurohormonal, proarrhythmic and prothrombotic activities. In this systematic review, we aim to purpose a multi-modality approach for LA geometry and function analysis, which integrates diastolic flow with LA characteristics and remodelling through application of both traditional and new diagnostic tools. The most important studies published in the literature on LA size, function and diastolic dysfunction in patients with HFpEF, HT and/or atrial fibrillation (AF) are considered and discussed. In HFpEF and HT, pulsed and tissue Doppler assessments are useful tools to estimate LV filling pressure, atrio-ventricular coupling and LV relaxation but they need to be enriched with LA evaluation in terms of morphology and function. An integrated evaluation should be also applied to patients with a high arrhythmic risk, in whom eccentric LA remodelling and higher LA stiffness are associated with a greater AF risk. Evaluation of LA size, volume, function and structure are mandatory in the management of patients with HT, HFpEF and AF. A multi-modality approach could provide additional information, identifying subjects with more severe LA remodelling. Left atrium assessment deserves an accurate study inside the cardiac imaging approach and optimised measurement with established cut-offs need to be better recognised through multicenter studies. © 2017 John Wiley & Sons Ltd.

  10. Percutaneous occlusion of left atrial appendage with the Amplatzer Cardiac PlugTM in atrial fibrillation.

    Science.gov (United States)

    Montenegro, Márcio José; Quintella, Edgard Freitas; Damonte, Aníbal; Sabino, Hugo de Castro; Zajdenverg, Ricardo; Laufer, Gustavo Pinaud; Amorim, Bernardo; Estrada, André Pereira Duque; Armas, Cristian Paul Yugcha; Sterque, Aline

    2012-02-01

    Atrial fibrillation is associated with embolic strokes that often result in death or disability. Effective in reducing these events, anticoagulation has several limitations and has been widely underutilized. Over 90% of thrombi identified in patients with atrial fibrillation without valvular disease originate in the left atrial appendage, whose occlusion is investigated as an alternative to anticoagulation. To determine the feasibility of percutaneous occlusion of the left atrial appendage in patients at high risk of embolic events and limitations to the use of anticoagulation. We report our initial experience with Amplatzer Cardiac Plug™ (St. Jude Medical Inc., Saint Paul, Estados Unidos) in patients with nonvalvular atrial fibrillation. We selected patients at high risk of thromboembolism, major bleeding, contraindications to the use or major instability in response to the anticoagulant. The procedures were performed percutaneously under general anesthesia and transesophageal echocardiography. The primary outcome was the presence of periprocedural complications and follow-up program included clinical and echocardiographic review within 30 days and by telephone contact after nine months. In five selected patients it was possible to occlude the left atrial appendage without periprocedural complications. There were no clinical events in follow-up. Controlled clinical trials are needed before percutaneous closure of the left atrial appendage should be considered an alternative to anticoagulation in nonvalvular atrial fibrillation. But the device has shown to be promissory in patients at high risk of embolism and restrictions on the use of anticoagulants.

  11. Left heart catheterization

    Science.gov (United States)

    Catheterization - left heart ... to help guide the catheters up into your heart and arteries. Dye (sometimes called "contrast") will be ... in the blood vessels that lead to your heart. The catheter is then moved through the aortic ...

  12. Ecocardiografía transesofágica en pacientes pediátricos Transesophageal echocardiography in pediatric patients

    Directory of Open Access Journals (Sweden)

    Francisco Javier Ozores Suárez

    2007-12-01

    Full Text Available La ecocardiografía transesofágica es un procedimiento semiinvasivo que brinda una segunda ventana para la exploración del corazón. El médico que lo realiza debe recibir formación en ecocardiografía transtorácica y realizar entrenamiento en intubación esofágica. En el paciente pediátrico tiene gran importancia la preparación previa al examen y especialmente los aspectos anestésicos y psicológicos. A los pacientes con peso de 3 kg o más se les colocan sondas pediátricas; por debajo de este peso debe utilizarse sondas de tipo neonatal. La ecocardiografía transesofágica en niños está indicada en el transoperatorio de cirugía cardiovascular e igualmente durante ciertos procedimientos de cateterismo intervencionista y en el diagnóstico de patología cardiovascular cuando hay deficiente ventana acústica transtorácica. Durante la realización de este procedimiento debe monitorizarse al paciente adecuadamente, tener en cuenta las contraindicaciones absolutas para su ejecución y actuar con la gentileza que exige el paciente pediátrico. En Cuba el uso de este proceder está muy poco extendido, por lo que los médicos no se encuentran familiarizados con la técnica. Se hace una revisión de los aspectos relevantes relacionados con este proceder.Transesophageal echocardiography is a semiinvasive procedure offering a second window to heart exploration. The specialist performing it should receive training in transthoracic echocardiography and esophageal intubation. In the pediatric patient, it is very important the preparation previous to the examination and, specially, the anesthetic and psychological aspects. Pediatric probes are used in patients weighing 3 kg or over. Neonatal probes are placed in children under this weight. Transesophageal echocardiography in children is indicated in the transoperative of cardiovascular surgery, and during certain procedures of interventional catheterization as well as in the diagnosis of

  13. Right atrium positioning for exposure of right pulmonary veins during off-pump atrial fibrillation ablation.

    Science.gov (United States)

    Suwalski, Grzegorz; Emery, Robert; Mróz, Jakub; Kaczejko, Kamil; Gryszko, Leszek; Cwetsch, Andrzej; Skrobowski, Andrzej

    2017-06-01

    Concomitant surgical ablation of atrial fibrillation (AF) is recommended for patients undergoing off-pump coronary revascularization in the presence of this arrhythmia. Achievement of optimal visualization of pulmonary veins while maintaining stable haemodynamic conditions is crucial for proper completion of the ablation procedure. This study evaluates the safety and feasibility of right atrial positioning using a suction-based cardiac positioner as opposed to compressive manoeuvres for exposure during off-pump surgical ablation for AF. Thirty-four consecutive patients underwent pulmonary vein isolation, ganglionated plexi ablation and left atrial appendage occlusion during off-pump coronary artery bypass grafting. Right atrial suction positioning was used to visualize right pulmonary veins. Safety and feasibility end points were analysed intraoperatively and in the early postoperative course. In all patients, right atrial positioning created optimal conditions to complete transverse and oblique sinus blunt dissection, correct placement of a bipolar ablation probe, detection and ablation of ganglionated plexi and conduction block assessment. In all patients, this entire right-sided ablation procedure was completed with a single exposure manoeuvre. Feasibility end points were achieved in all study patients. This report documents the safety and feasibility of right atrial exposure using a suction-based cardiac positioner to complete ablation for AF concomitant with off-pump coronary revascularization. This technique may be widely adopted to create stable haemodynamic conditions and optimal visualization of the right pulmonary veins. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  14. [Transitory transesophageal atrial electric stimulation. Preliminary report on 19 cases and considerations on the method, indications and results (author's transl)].

    Science.gov (United States)

    Pistolese, M; Richichi, G; Catalano, V; Boccadamo, R

    1975-01-01

    Literature provides sufficient evidence that transitory electric stimulation via esophagus (SATE) - after the first positive experimental attempts on dogs - can be applied to man with a simple, rapid and harmless method. The study covers 19 patients subjected to high frequency transesophageal atrial stimulation by way of a bipolar electrode inserted through a nasogastric tube and connected to an external generator capable of producing tension impulses. Said impulses are variable up to 150 volts, lasting 2.5 microsec. with a frequency of up to 450/min. The 19 patients can be divided into 2 groups. The first including 15 patients on which SATE was effected for diagnostic purposes: in coronary deficiency (8 patients), in the disease of sinus node (3 patients), and lastly in the research for the A-V-block latent in 4 patients with acute post-infarctual A-V-block which regressed during the immediate clinical course of the illness. The other group includes 4 patients in which the atrial stimulation indication was the treatment of rapid, paroxysmic atrial rhythms, inaffected by drugs. By using impulses of 25-30 volts, the AA. have obtained a stable stimulation.

  15. Characterization of the syndrome of UGI bleeding from a Mallory-Weiss tear associated with transesophageal echocardiography.

    Science.gov (United States)

    Cappell, Mitchell S; Dass, Kathleen; Manickam, Palaniappian

    2014-10-01

    To quantitatively describe the syndrome of Mallory-Weiss tears associated (MWa) with antecedent transesophageal echocardiography (TEE) as a distinct syndrome. Cases of MWa were identified by comprehensive, computerized literature search via PubMed and review of textbooks and monographs on TEE and gastroenterology. Statistical comparison of 17 identified MWa cases versus previously published series of 73 cases of Mallory-Weiss tears unassociated with TEE (MWu) was performed. A new illustrative case is also currently reported. Comparison between these two groups revealed the following: MWa patients were significantly older (67.1 vs. 52.6 years, p = .0002, assuming equal variance), likely due to MWa patients having preexisting cardiovascular disease for which the TEE was indicated. The two groups had similar sex distributions (60 vs. 76% male, p = .32). MWa patients were significantly, more frequently anticoagulated at the time of bleeding (90.9 vs. 9.6%, p syndrome: (1) tear associated with hiatal hernia, (2) presentation with severe, fatal UGI bleeding, and (3) no anticoagulation during bleeding episode. Patients with MWa represent a distinct clinical subset from patients with MWu, with significantly older mean age, more frequent concomitant anticoagulation, and higher mortality. They also tend to have more severe bleeding. These characteristics are important in clinically managing this syndrome.

  16. A Prototype PZT Matrix Transducer With Low-Power Integrated Receive ASIC for 3-D Transesophageal Echocardiography.

    Science.gov (United States)

    Chen, Chao; Raghunathan, Shreyas B; Yu, Zili; Shabanimotlagh, Maysam; Chen, Zhao; Chang, Zu-yao; Blaak, Sandra; Prins, Christian; Ponte, Jacco; Noothout, Emile; Vos, Hendrik J; Bosch, Johan G; Verweij, Martin D; de Jong, Nico; Pertijs, Michiel A P

    2016-01-01

    This paper presents the design, fabrication, and experimental evaluation of a prototype lead zirconium titanate (PZT) matrix transducer with an integrated receive ASIC, as a proof of concept for a miniature three-dimensional (3-D) transesophageal echocardiography (TEE) probe. It consists of an array of 9 ×12 piezoelectric elements mounted on the ASIC via an integration scheme that involves direct electrical connections between a bond-pad array on the ASIC and the transducer elements. The ASIC addresses the critical challenge of reducing cable count, and includes front-end amplifiers with adjustable gains and micro-beamformer circuits that locally process and combine echo signals received by the elements of each 3 ×3 subarray. Thus, an order-of-magnitude reduction in the number of receive channels is achieved. Dedicated circuit techniques are employed to meet the strict space and power constraints of TEE probes. The ASIC has been fabricated in a standard 0.18-μm CMOS process and consumes only 0.44 mW/channel. The prototype has been acoustically characterized in a water tank. The ASIC allows the array to be presteered across ±37° while achieving an overall dynamic range of 77 dB. Both the measured characteristics of the individual transducer elements and the performance of the ASIC are in good agreement with expectations, demonstrating the effectiveness of the proposed techniques.

  17. Architecture of fibrin network inside thrombotic material obtained from the right atrium and pulmonary arteries: flow and location matter.

    Science.gov (United States)

    Mazur, Piotr; Sobczyński, Robert; Ząbczyk, Michał; Babiarczyk, Paulina; Sadowski, Jerzy; Undas, Anetta

    2013-01-01

    Pulmonary embolectomy is a treatment option in selected patients with high-risk pulmonary embolism (PE). Efficiency of thrombus degradation in PE largely depends on the architecture of its fibrin network, however little is known about its determinants. We present the case of a 56-year-old woman with high-risk PE and proximal deep-vein thrombosis, whose thrombotic material removed during embolectomy from the right atrium and pulmonary (lobar and segmental) arteries has been studied using scanning electron microscopy (SEM). SEM images showed that distally located thrombi are richer in densely-packed fibrin fibers and contain more white cells and less erythrocytes than the proximal ones and the atrial thrombus. Fibrin fibers alignment along the flow vector was observed in the thrombi removed from high-velocity flow pulmonary arteries, and not in the atrial thrombus. The content of denser fibrin network and platelet aggregates was increased in segmental thromboemboli. Our findings describe the relation between thrombus architecture and location, and might help to elucidate thrombus resistance to anticoagulant therapy in some PE patients.

  18. Latest generation of unipolar and bipolar steroid eluting leads: long-term comparison of electrical performance in atrium and ventricles.

    Science.gov (United States)

    Cornacchia, D; Fabbri, M; Puglisi, A; Moracchini, P; Bernasconi, M; Nastasi, M; Menozzi, C; Mascioli, G; Marotta, T; de Seta, F

    2000-07-01

    One hundred and seventy-three patients, mean age 74 years permanently paced with 123 atrial (53 unipolar, 70 bipolar) and 143 ventricular (73 unipolar, 70 bipolar) pacing leads were included in this study. The pacing leads were recent generation low surface area steroid eluting leads from one manufacturer: leads with silicone and polyurethane insulation were studied, and they were combined with generations of one pacemaker family from the same manufacturer permitting identical measurements to be made over a follow-up of 2 years. Pacing threshold was measured using pulse duration at a fixed voltage of 1.5 V: peak to peak P and R wave amplitude and pacing impedance at 2.5 V and 0.5 ms were all measured using the manufacturer's standard programmer. Although many significant differences, in the parameters measures, existed between atrium and ventricle and unipolar and bipolar configurations, none was felt to be of clinical significance. These data permit the physician to choose the lead type with regard to sensing performance and long-term lead integrity.

  19. Adrenocortical carcinoma with extension to the inferior vena cava and right atrium: 20-month-old girl with TP53 mutation

    Directory of Open Access Journals (Sweden)

    Terry L. Levin, MD

    2015-01-01

    Full Text Available A 20-month-old female presented with respiratory distress and a right adrenal mass extending into the inferior vena cava and right atrium. The mass was initially thought to be neuroblastoma. Pathology later revealed adrenocortical carcinoma. Inferior vena cava extension is far more common in adrenocortical carcinoma than neuroblastoma, and its presence should prompt clinical and laboratory evaluation for an adrenocortical tumor. The genetic findings in TP53 associated with this disease are discussed.

  20. Giant congenital aneurysm of the appendix of the left auricle; an entity potentially lethal

    International Nuclear Information System (INIS)

    Perafan, Sergio; Ascione, Giovanny; Parra, Luis E; Jimenez, Luz S

    2004-01-01

    The case of a 22 years old female patient who at 16 years of age suffered a closed thoracic trauma during a car accident is reported. She underwent surgery under extra corporeal circulation with femoro-femoral cannulation with the diagnosis of rupture of the left atrium. a large aneurysm of the left auricle without evidence of heart trauma, pericardial leakage or hemo pericardium, was found. The surgeon decided not to perform surgery on the aneurysm and to withdraw the extra corporeal circulation, proceeding to suture the patient, who was released with the recommendation of performing additional studies in order to consider the handling of the aneurysm. Six years later she is sent to our institution with the diagnosis of cerebral embolism with left hemiparesis, and a giant partially thrombosed left auricle aneurysm. With a diagnosis of an embolizing partially thrombosed aneurysm of the left auricle she underwent surgery under extracorporeal circulation in order to resect it. The case with the intraoperative findings and the surgical technique are described. Different manifestations and expressions of this potentially lethal rare entity are detailed, concluding that it is imperative to resect surgically the aneurysm once it has been diagnosed

  1. Size of Left Cardiac Chambers Correlates with Cerebral Microembolic Load in Open Heart Operations

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    Elena Z. Golukhova

    2010-01-01

    Full Text Available Background. Microemboli are a widely recognized etiological factor of cerebral complications in cardiac surgery patients. The present study was aimed to determine if size of left cardiac chambers relates to cerebral microembolic load in open heart operations. Methods. Thirty patients participated in the study. Echocardiography was performed in 2-3 days before surgery. A transcranial Doppler system was used for registering intraoperative microemboli. Results. Preoperative left atrium and left ventricular end-systolic and end-diastolic sizes significantly correlated with intraoperative microembolic load (s=0.48, 0.57 and 0.53, s≺.01, resp.. The associations between left ventricular diameters and number of cerebral microemboli remained significant when cardiopulmonary bypass time was included as a covariate into the analysis. Conclusions. The present results demonstrate that increased size of left heart chambers is an influential risk factor for elevated cerebral microembolic load during open heart operations. Mini-invasive surgery and carbon dioxide insufflation into wound cavity may be considered as neuroprotective approaches in patients with high risk of cerebral microembolism.

  2. The effect of 8-week aerobic interval training and a detraining period on left ventricular structure and function in non-athlete healthy men

    Directory of Open Access Journals (Sweden)

    Abbasali Gaeini

    2012-02-01

    Full Text Available Background: Exercise plays an important role to improve cardiovascular performance. The purpose of this study was to determine the effect 8wk of aerobic cyclic training and a detraining period on left ventricular structure and function in non-athlete healthy men.Materials and Method: In this research, ten male non-athlete students were volunteered and participated in a 8- week running program (3days/week, at 70% of Maximum Heart Rate and 4 weeks detraining afterwards. In each session, cyclic running was done in 5 nine-minute stages and there was a four-minute inactive rest among them.Results: Using echocardiography, there was a significant difference in interventricular septal thickness, percent of rapid shortening and percent of ejection fraction after 8 weeks training compared to before training. It was found no significant difference end-diastolic and end-systolic dimensions, posterior wall thickness, left atrium diameter, aortic root thickness, heart rate, systolic and diastolic blood pressures. There was a significant difference in end-systolic dimension, intervntricular septal thickness, left atrium diameter, percent of rapid shortening and ejection fraction following 4-week detraining after training compared to 8-week.Conclusion: Eight-week aerobic cyclic training and a detraining period can effect on left ventricle structure and function

  3. Hypoplastic left heart syndrome

    Directory of Open Access Journals (Sweden)

    Thiagarajan Ravi

    2007-05-01

    Full Text Available Abstract Hypoplastic left heart syndrome(HLHS refers to the abnormal development of the left-sided cardiac structures, resulting in obstruction to blood flow from the left ventricular outflow tract. In addition, the syndrome includes underdevelopment of the left ventricle, aorta, and aortic arch, as well as mitral atresia or stenosis. HLHS has been reported to occur in approximately 0.016 to 0.036% of all live births. Newborn infants with the condition generally are born at full term and initially appear healthy. As the arterial duct closes, the systemic perfusion becomes decreased, resulting in hypoxemia, acidosis, and shock. Usually, no heart murmur, or a non-specific heart murmur, may be detected. The second heart sound is loud and single because of aortic atresia. Often the liver is enlarged secondary to congestive heart failure. The embryologic cause of the disease, as in the case of most congenital cardiac defects, is not fully known. The most useful diagnostic modality is the echocardiogram. The syndrome can be diagnosed by fetal echocardiography between 18 and 22 weeks of gestation. Differential diagnosis includes other left-sided obstructive lesions where the systemic circulation is dependent on ductal flow (critical aortic stenosis, coarctation of the aorta, interrupted aortic arch. Children with the syndrome require surgery as neonates, as they have duct-dependent systemic circulation. Currently, there are two major modalities, primary cardiac transplantation or a series of staged functionally univentricular palliations. The treatment chosen is dependent on the preference of the institution, its experience, and also preference. Although survival following initial surgical intervention has improved significantly over the last 20 years, significant mortality and morbidity are present for both surgical strategies. As a result pediatric cardiologists continue to be challenged by discussions with families regarding initial decision

  4. Patent Foramen Ovale in Patients with Cerebral Infarction: A Transesophageal Echocradigraphy Study

    Science.gov (United States)

    Petty, George W.; Khandheria, Bijoy K.; Chu, Chu-Pin; Sicks, JoRean D.; Whisnant, Jack P.

    1997-01-01

    Patent foramen ovale was detected in 37 patients (32%). Mean age was similar in those with (60 years) and those without (64 years) PFO. Patent foramen ovale was more frequent among men (39%) than women (20%, P=.03). Patients with PFO had a lower frequency of atrial fibrillation, diabetes me!litus, hypertension, and peripheral vascular disease compared with those without PFO. There was no difference in frequency of the following characteristics in patients with PFO compared with those without PFO: pulmonary embolus, chronic obstructive pulmonary disease, pulmonary hypertension, peripheral embolism, prior cerebral infarction, nosocomial cerebral infarction, Valsalva maneuver at the time of cerebral infarction, recent surgery, or hemorrhagic transformation of cerebral infarction. Patent foramen ovale was found in 22 (40%) of 55 patients with infarcts of uncertain cause and in 15 (25%) of 61 with infarcts of known cause (cardioembolic, 21%; large vessel atherostenosis, 25%; lacune, 40%) (P=.08). When the analysis was restricted to patients who underwent Valsalva maneuver, PFO with right to left or bidirectional shunt was found in 19 (50%) of 38 patients with infarcts of uncertain cause and in 6 (20%) of 30 with infarcts of known cause (P=.Ol). Conclusion: Although PFO was over-represented in patients with infarcts of uncertain cause in our and other studies, it has a high frequency among patients with cerebral infarction of all types. The relation between PFO and stroke requires further study.

  5. Transesophageal Contrast Echocardiography is Not Always the Gold Standard Method in the Identification of a Patent Foramen Ovale: A Clinical Case

    OpenAIRE

    Lunetta, Monica; Costa, Francesco; Gattuta, Marcello La; Novo, Salvatore

    2015-01-01

    In the embryo, Eustachian valve is a crescent-shaped membrane extending from the lower margin of the inferior vena cava and the ostium of the coronary sinus into the right atrium toward fossa ovalis and tricuspid valve. At birth, after the functional closure of the foramen ovale, the Eustachian valve loses its function, reducing to an embryo remnant. According to growing evidence, a persistent Eustachian valve is a frequent finding in patients with a patent foramen ovale (PFO). By directing t...

  6. Quantitative Modeling of the Mitral Valve by Three-Dimensional Transesophageal Echocardiography in Patients Undergoing Mitral Valve Repair: Correlation with Intraoperative Surgical Technique.

    Science.gov (United States)

    Calleja, Anna; Poulin, Frédéric; Woo, Anna; Meineri, Massimiliano; Jedrzkiewicz, Sean; Vannan, Mani A; Rakowski, Harry; David, Tirone; Tsang, Wendy; Thavendiranathan, Paaladinesh

    2015-09-01

    Mitral valve (MV) repair is the procedure of choice for patients with degenerative MV disease (DMVD) with severe mitral regurgitation. The aim of this study was to identify specific quantitative MV parameters from preoperative three-dimensional (3D) transesophageal echocardiography that are associated with the length of the mitral annuloplasty band implanted and the performance of leaflet resection in patients with DMVD undergoing MV repair. Ninety-four patients (mean age, 60 ± 11 years; 68% men) referred for MV surgery with adequate-quality preoperative 3D transesophageal echocardiographic studies were retrospectively identified. Parametric maps of the MV were generated using semiautomated MV modeling software. Annular and valvular parameters were measured and indexed to body surface area. The implanted annuloplasty band size and leaflet resection were determined on the basis of surgical reports. Three-dimensional annular circumference correlated best (r = 0.74) with the implanted annuloplasty band length and remained an independent predictor on multivariate linear regression analysis. A third of our cohort (n = 33) had posterior leaflet resection. On receiver operating characteristic curve analysis, P2 segment length ≥ 20 mm (area under the curve, 0.86; sensitivity, 88%; specificity, 74%) and P2 leaflet area ≥ 3.4 cm(2) (area under the curve, 0.84; sensitivity, 85%; specificity, 74%) best discriminated the need for leaflet resection. In DMVD, quantitative 3D annular circumference obtained from semiautomatically generated parametric maps of the MV from 3D transesophageal echocardiographic data was associated with the surgically implanted annuloplasty band length, while P2 leaflet length ≥ 20 mm and area ≥ 3.4 cm(2) were associated with the performance of leaflet resection. These parameters should be further investigated for preoperative planning in patients with DMVD undergoing MV repair. Copyright © 2015 American Society of Echocardiography

  7. Comparison between transthoracic and transesophageal echocardiography in screening for infective endocarditis in patients with Staphylococcus aureus bacteremia.

    Science.gov (United States)

    Wong, D; Keynan, Y; Rubinstein, E

    2014-11-01

    Echocardiography is an important diagnostic tool in evaluating a patient with Staphylococcus aureus bacteremia (SAB) for diagnosing infective endocarditis (IE). We sought to compare the utility of transthoracic echocardiography (TTE) with transesophageal echocardiography (TEE) in screening for IE in patients with SAB. We performed a retrospective chart review of 285 adult patients from two tertiary care hospitals with at least one positive blood culture for S. aureus between 2010 and 2012. Patients who underwent echocardiography were divided into two groups: TTE (screened with TTE only) and TEE (screened with both TTE and TEE). The demographic factors and clinical outcomes were compared between the groups. Of the 285 charts reviewed, 213 (74.7 %) patients were screened with echocardiography: 183 (85.9 %) were screened with TTE alone and 30 (14.1 %) were screened with both TTE and TEE. TEE disclosed more cases of definite IE than TTE (8 [26.7 %] vs. 22 [12.0 %], p = 0.046). The TEE group had higher mortality than the TTE group (15 [50.0 %] vs. 43 [23.5 %], p = 0.004). In patients with definite IE, mortality was higher in the TEE group than in the TTE group (6 [75.0 %] vs. 6 [27.3 %], p = 0.034). TEE discovered additional findings that were missed by TTE in 36.7 % of cases and refuted the findings of TTE in 13.3 % of cases. We do not support the routine use of TEE in patients with uncomplicated SAB. High-risk patients in which IE is a serious consideration should undergo investigation with TEE.

  8. Macro- and micromechanical remodelling in the fish atrium is associated with regulation of collagen 1 alpha 3 chain expression.

    Science.gov (United States)

    Keen, Adam N; Fenna, Andrew J; McConnell, James C; Sherratt, Michael J; Gardner, Peter; Shiels, Holly A

    2018-03-28

    Numerous pathologies lead to remodelling of the mammalian ventricle, often associated with fibrosis. Recent work in fish has shown that fibrotic remodelling of the ventricle is 'reversible', changing seasonally as temperature-induced changes in blood viscosity alter haemodynamic load on the heart. The atrial response to varying haemodynamic load is less understood in mammals and completely unexplored in non-mammalian vertebrates. To investigate atrial remodelling, rainbow trout were chronically cooled (from 10 ± 1 to 5 ± 1 °C) and chronically warmed (from 10 ± 1 to 18 ± 1 °C) for a minimum of 8 weeks. We assessed the functional effects on compliance using ex vivo heart preparations and atomic force microscopy nano-indentation and found chronic cold increased passive stiffness of the whole atrium and micromechanical stiffness of tissue sections. We then performed histological, biochemical and molecular assays to probe the mechanisms underlying functional remodelling of the atrial tissue. We found cooling resulted in collagen deposition which was associated with an upregulation of collagen-promoting genes, including the fish-specific collagen I alpha 3 chain, and a reduction in gelatinase activity of collagen-degrading matrix metalloproteinases (MMPs). Finally, we found that cooling reduced mRNA expression of cardiac growth factors and hypertrophic markers. Following long-term warming, there was an opposing response to that seen with cooling; however, these changes were more moderate. Our findings suggest that chronic cooling causes atrial dilation and increased myocardial stiffness in trout atria analogous to pathological states defined by changes in preload or afterload of the mammalian atria. The reversal of this phenotype following chronic warming is particularly interesting as it suggests that typically pathological features of mammalian atrial remodelling may oscillate seasonally in the fish, revealing a more dynamic and plastic atrial

  9. Left Ventricular Assist Devices

    Directory of Open Access Journals (Sweden)

    Khuansiri Narajeenron

    2017-04-01

    Full Text Available Audience: The audience for this classic team-based learning (cTBL session is emergency medicine residents, faculty, and students; although this topic is applicable to internal medicine and family medicine residents. Introduction: A left ventricular assist device (LVAD is a mechanical circulatory support device that can be placed in critically-ill patients who have poor left ventricular function. After LVAD implantation, patients have improved quality of life.1 The number of LVAD patients worldwide continues to rise. Left-ventricular assist device patients may present to the emergency department (ED with severe, life-threatening conditions. It is essential that emergency physicians have a good understanding of LVADs and their complications. Objectives: Upon completion of this cTBL module, the learner will be able to: 1 Properly assess LVAD patients’ circulatory status; 2 appropriately resuscitate LVAD patients; 3 identify common LVAD complications; 4 evaluate and appropriately manage patients with LVAD malfunctions. Method: The method for this didactic session is cTBL.

  10. When to use femoral vein injection for diagnosis of patent foramen ovale-Effect of a persistent eustachian valve on right atrial flow patterns during contrast transesophageal echocardiography.

    Science.gov (United States)

    Koh, Tat W

    2017-05-01

    Contrast echocardiography using agitated saline injected into the antecubital vein is the most common method used for the diagnosis of patent foramen ovale. We describe a case whereby the presence of a persistent eustachian valve and a "negative contrast sign" during contrast transesophageal echocardiography raised suspicion of a false-negative result. Femoral vein injection of contrast successfully demonstrated a patent foramen ovale. Femoral vein injection should be considered if this scenario is recognized because the eustachian valve directs blood preferentially from the inferior vena cava toward the interatrial septum and this route may prove to be more reliable. © 2017, Wiley Periodicals, Inc.

  11. Echocardiographic guidance and monitoring of left atrial appendage closure with AtriClip during open-chest cardiac surgery.

    Science.gov (United States)

    Contri, Rachele; Clivio, Sara; Torre, Tiziano; Cassina, Tiziano

    2017-10-01

    Left atrial appendage (LAA) closure prevents thromboembolic risk and avoids lifelong anticoagulation due to atrial fibrillation (AF). Nowadays, AtriClip, a modern epicardial device approved in June 2010, allows external and safe closure of LAA in patients undergoing cardiac surgery during other open-chest cardiac surgical procedures. Such a surgical approach and its epicardial deployment differentiates LAA closure with AtriClip from percutaneous closure techniques such as Watchman (Boston Scientific, Marlborough, MA, USA), Lariat (SentreHEART Inc., Redwood City, CA, USA), and Amplatzer Amulet (St. Jude Medical, St. Paul, MN, USA) device procedures. AtriClip positioning must consider perioperative transesophageal echocardiography (TEE) to confirm LAA anatomical features, to explore the links with neighboring structures, and finally to assess its successful closure. We report a sequence of images to document the role of intraoperative TEE during an elective aortic valve replacement and LAA external closure with AtriClip. © 2017, Wiley Periodicals, Inc.

  12. Left Main Coronary Artery Compression following Melody Pulmonary Valve Implantation: Use of Impella Support as Rescue Therapy and Perioperative Challenges with ECMO

    Directory of Open Access Journals (Sweden)

    Erica D. Wittwer

    2014-01-01

    Full Text Available The purpose of this case is to describe the complex perioperative management of a 30-year-old woman with congenital heart disease and multiple resternotomies presenting with pulmonary homograft dysfunction and evaluation for percutaneous pulmonary valve replacement. Transvenous, transcatheter Melody valve placement caused left main coronary artery occlusion and cardiogenic shock. An Impella ventricular assist device (VAD provided rescue therapy during operating room transport for valve removal and pulmonary homograft replacement. ECMO support was required following surgery. Several days later during an attempted ECMO wean, her hemodynamics deteriorated abruptly. Transesophageal and epicardial echocardiography identified pulmonary graft obstruction, requiring homograft revision due to large thrombosis. This case illustrates a role for Impella VAD as bridge to definitive procedure after left coronary occlusion and describes management of complex perioperative ECMO support challenges.

  13. Left Atrial trajectory impairment in Hypertrophic Cardiomyopathy disclosed by Geometric Morphometrics and Parallel Transport

    Science.gov (United States)

    Piras, Paolo; Torromeo, Concetta; Re, Federica; Evangelista, Antonietta; Gabriele, Stefano; Esposito, Giuseppe; Nardinocchi, Paola; Teresi, Luciano; Madeo, Andrea; Chialastri, Claudia; Schiariti, Michele; Varano, Valerio; Uguccioni, Massimo; Puddu, Paolo E.

    2016-10-01

    The analysis of full Left Atrium (LA) deformation and whole LA deformational trajectory in time has been poorly investigated and, to the best of our knowledge, seldom discussed in patients with Hypertrophic Cardiomyopathy. Therefore, we considered 22 patients with Hypertrophic Cardiomyopathy (HCM) and 46 healthy subjects, investigated them by three-dimensional Speckle Tracking Echocardiography, and studied the derived landmark clouds via Geometric Morphometrics with Parallel Transport. Trajectory shape and trajectory size were different in Controls versus HCM and their classification powers had high AUC (Area Under the Receiving Operator Characteristic Curve) and accuracy. The two trajectories were much different at the transition between LA conduit and booster pump functions. Full shape and deformation analyses with trajectory analysis enabled a straightforward perception of pathophysiological consequences of HCM condition on LA functioning. It might be worthwhile to apply these techniques to look for novel pathophysiological approaches that may better define atrio-ventricular interaction.

  14. Fully automated left ventricular contour detection for gated radionuclide angiography, (1)

    International Nuclear Information System (INIS)

    Hosoba, Minoru; Wani, Hidenobu; Hiroe, Michiaki; Kusakabe, Kiyoko.

    1984-01-01

    A fully automated practical method has been developed to detect the left ventricular (LV) contour from gated pool images. Ejection fraction and volume curve can be computed accurately without operater variance. The characteristics of the method are summarized as follows: 1. Optimal design of the filter that works on Fourier domain, can be achieved to improve the signal to noise ratio. 2. New algorithm which use the cosine and sine transform images has been developed for the separating ventricle from atrium and defining center of LV. 3. Contrast enhancement by optimized square filter. 4. Radial profiles are generated from the center of LV and smoothed by fourth order Fourier series approximation. The crossing point with local threshold value searched from the center of the LV is defined as edge. 5. LV contour is obtained by conecting all the edge points defined on radial profiles by fitting them to Fourier function. (author)

  15. Prevention of Cerebral Embolism Progression by Emergency Surgery of the Left Atrial Myxoma

    Directory of Open Access Journals (Sweden)

    Syuichi Tetsuka

    2015-01-01

    Full Text Available A 21-year-old woman developed left hemiparesis during work and was hospitalized. Her National Institutes of Health Stroke Scale score was 4. Hyperintense areas in the left basal ganglia, corona radiata, and cortex of the temporal lobe were found by brain diffusion-weighted magnetic resonance imaging, indicating acute cerebral infarction. Echocardiography showed a giant mass of diameter 7 × 4 cm in the left atrium. Therefore, she was diagnosed with cerebral embolism due to a left atrial myxoma. Currently, thrombolytic therapy may continue to be effective because the embolic source may be composed of tumor tissue itself. In case of atrial myxoma, we considered that the use of tPA as emergency treatment in all patients with infarction by atrial myxoma may be questioned. Thus, cardiac tumor extraction was performed the next day after hospitalization without thrombolytic therapy. The excised myxoma measured 7 × 6 × 4 cm. The patient recovered and her neurological symptoms also improved. Furthermore, her National Institutes of Health Stroke Scale score improved to 0. Thirteen days after admission, the patient was discharged from our hospital. Cardiac myxoma is often associated with a high risk of embolic episodes, which emphasizes the need for prompt surgical excision as soon as the diagnosis is confirmed.

  16. Left atrial deformation: Useful index for early detection of cardiac damage in chronic mitral regurgitation.

    Science.gov (United States)

    Cameli, M; Incampo, E; Mondillo, S

    2017-12-01

    In chronic mitral regurgitation (MR) left atrium is one of the first cardiac structures that is involved in remodeling and ultrastructural changes for a progressive volume overload. Severe left atrial (LA) dilation on echocardiography and new onset of atrial fibrillation in asymptomatic patients with preserved Left Ventricular (LV) function, appeared as a Class IIb recommendation for consideration for surgical mitral valve repair in the actual guidelines. However, before atrial dilatation and dysfunction, several ultrastructural changes appear in the atrial muscle tissue that are difficult to identify with the standard echocardiography. Speckle tracking echocardiography (STE) can analyze LA function: it has been showed that it can indirectly identify structural tissue modifications from excessive atrial effort in the early stages of MR up to the full depression of atrial function in the late stages where there are advanced ultrastructural alterations. This review aims to summarize current knowledge on the role of atrial strain identifying early structural alterations of the atrial tissue in the rising stages of MR considering that Left Atrial Peak Longitudinal Strain (PALS) considered useful parameter for a more extensive evaluation of MR patients.

  17. Left atrial strain: a new predictor of thrombotic risk and successful electrical cardioversion

    Directory of Open Access Journals (Sweden)

    Cátia Costa

    2016-06-01

    Full Text Available Background: Left atrial deformation (LAD parameters are new markers of atrial structural remodelling that seem to be affected in atrial fibrillation (AF and atrial flutter (AFL. This study aimed to determine whether LAD can identify patients with a higher risk of thrombosis and unsuccessful electrical cardioversion (ECV. Methods: Retrospective study including 56 patients with AF or AFL undergoing ECV, with previous transthoracic (TTE and transoesophageal echocardiography (TEE studies. Echocardiographic parameters analysed were as follows: left ventricle function, left atrium (LA dimensions, LAD parameters (positive and negative strain peaks, left atrial appendage (LAA filling and emptying velocities and the presence of thrombi. Strain values were analysed according to thrombotic risk and success of ECV. Results: Lower mean values of peak-positive strain (PPS in patients with prothrombotic velocities (<25 cm/s and a higher incidence of thrombi in LAA were observed compared with those with normal velocities. Multivariate analysis revealed PPS normalised by LA maximum volume indexed by body surface area (BSA to be associated with prothrombotic risk (odds ratio 0.000 (95% CI: 0.000–0.243, P 0.017, regardless of CHADs2VASC score. Peak-negative strain normalised by LA volumes indexed by BSA were associated with unsuccessful ECV. Conclusions: Atrial deformation parameters identify AF and AFL patients with a high risk of thrombosis and unsuccessful ECV. Therefore, these new parameters should be included in anticoagulation management and rhythm vs rate control strategies.

  18. Long-term survival of quiescent left atrial myxoma in an elderly patient.

    Science.gov (United States)

    Kay, Jay F L; Chow, Wing Hing

    2002-01-01

    Left atrial myxoma, if left untreated, is inexorably progressive and usually fatal. The classical management of this disease is prompt surgical removal. However, there may be exceptions to this traditional dogma. The authors report an 85-year-old man who presented with features of chronic obstructive airway disease and congestive heart failure 15 years previously. Auscultation of the heart showed a pansystolic murmur. Two-dimensional echocardiography revealed a nonobstructive, calcified, and well circumscribed mass in the left atrium, with a pedicle attached to the interatrial septum. Because the patient refused high-risk cardiac surgery related to his comorbidity, he was managed medically with a bronchodilator, diuretics, and digoxin. There have been no features of embolism or intracardiac obstruction, and serial echocardiography demonstrates no disease progression over this long period of time. This case illustrates that calcified left atrial myxoma may exhibit a quiescent phase. Tumor calcification, slow growth potential, and the absence of intracardiac obstruction may correlate with a better outcome in the elderly patient. (c)2002 CVRR, Inc.

  19. Exercise and cardiovascular outcomes in hypertensive patients in relation to structure and function of left ventricular hypertrophy: the LIFE study

    DEFF Research Database (Denmark)

    Boman, Kurt; Gerdts, Eva; Wachtell, Kristian

    2009-01-01

    (P = 0.016); and larger left atrium (P = 0.006). Systolic variables did not differ. In Cox regression analysis, physically active compared with sedentary patients had lower risk of primary composite endpoint [odds ratio (OR): 0.42, 95% confidence interval (CI): 0.26-0.68, P cardiovascular......BACKGROUND: Exercise lowers blood pressure and improves cardiovascular function, but little is known about whether exercise impacts cardiovascular morbidity and mortality independent of left ventricular hypertrophy (LVH) and LV geometry. DESIGN: Observational analysis of prospectively obtained...... (never exercise), intermediate (30 min twice/week). During 4.8-year follow-up, 105 patients suffered the primary composite endpoint of myocardial infarction (MI), stroke, or cardiovascular death. MI occurred in 39, stroke in 60, and cardiovascular death in 33 patients. RESULTS: Sedentary individuals (n...

  20. Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

    Directory of Open Access Journals (Sweden)

    Król Wojciech

    2016-12-01

    Full Text Available Enlargement of the left atrium is perceived as a part of athlete’s heart syndrome, despite the lack of evidence. So far, left atrial size has not been assessed in the context of exercise capacity. The hypothesis of the present study was that LA enlargement in athletes was physiological and fitness-related condition. In addition, we tried to assess the feasibility and normal values of left atrial strain parameters and their relationship with other signs of athlete’s heart. The study group consisted of 114 international-level rowers (17.5 ± 1.5 years old; 46.5% women. All participants underwent a cardio-pulmonary exercise test and resting transthoracic echocardiography. Beside standard echocardiographic measurements, two dimensional speckle tracking echocardiography was used to assess average peak atrial longitudinal strain, peak atrial contraction strain and early left atrial diastolic longitudinal strain. Mild, moderate and severe left atrial enlargement was present in 27.2°%, 11.4% and 4.4% athletes, respectively. There were no significant differences between subgroups with different range of left atrial enlargement in any of echocardiographic parameters of the left ventricle diastolic function, filling pressure or hypertrophy. A significant correlation was found between the left atrial volume index and maximal aerobic capacity (R > 0.3; p < 0.001. Left atrial strain parameters were independent of atrial size, left ventricle hypertrophy and left ventricle filling pressure. Decreased peak atrial longitudinal strain was observed in 4 individuals (3.5%. We concluded that LA enlargement was common in healthy, young athletes participating in endurance sport disciplines with a high level of static exertion and was strictly correlated with exercise capacity, therefore, could be perceived as another sign of athlete’s heart.

  1. Mixoma atrial esquerdo múltiplo: relato de caso Multiple left atrial myxoma: case report

    Directory of Open Access Journals (Sweden)

    José Carlos Dorsa Vieira Pontes

    2011-09-01

    Full Text Available Os tumores primários cardíacos são infrequentes, apresentando incidência entre 0,001% a 0,2%, com características histológicas benignas em 75% dos casos. Os mixomas correspondem a aproximadamente 50% dessas neoplasias. Quanto à localização, 75 a 80% dos mixomas estão no átrio esquerdo, 18% no átrio direito, e mais raramente nos ventrículos. Relatamos o caso de um paciente em classe funcional (CF IV New York Heart Association (NYHA e diagnóstico anatomopatológico pós-operatório de mixoma multilobular originário na parede posterior atrial esquerda. À avaliação clínica no 3º mês pós-operatório se encontrava em CF I NYHA e a ecocardiográfica com ausência de massas intracardíacas.Primary cardiac tumors are infrequent, with an incidence between 0.001% and 0.2%, mostly comprising benign histological characteristics in 75% of these cases. Myxomas account for approximately 50% of these neoplasms. As regards location, 75-80% of myxomas are in the left atrium, 18% in the right atrium, and more rarely in the ventricles. We report a case of a patient in functional class (FC IV New York Heart Association (NYHA and postoperative histological diagnosis of multilobular myxoma originating in the posterior left atrial wall. Clinical evaluation 3 months after surgery suggested NYHA functional class I and echocardiographic absence of intracardiac masses.

  2. Left Ventricular Pseudoaneurysm Perceived as a Left Lung Mass

    Directory of Open Access Journals (Sweden)

    Ugur Gocen

    2013-02-01

    Full Text Available Left ventricular pseudo-aneurysm is a rare complication of aneurysmectomy. We present a case of surgically-treated left ventricular pseudo-aneurysm which was diagnosed three years after coronary artery bypass grafting and left ventricular aneurysmectomy. The presenting symptoms, diagnostic evaluation and surgical repair are described. [Cukurova Med J 2013; 38(1.000: 123-125

  3. Cor Triatriatum Sinister Identified after New Onset Atrial Fibrillation in an Elderly Man

    Directory of Open Access Journals (Sweden)

    Ignacio A. Zepeda

    2014-01-01

    Full Text Available A 73-year-old man with new onset atrial fibrillation with rapid ventricular response underwent transthoracic echocardiography that revealed an echogenic linear structure along the left atrium, suggestive of cor triatriatum sinister (CTS. CTS was confirmed with transesophageal echocardiography which demonstrated a proximal accessory atrium receiving pulmonary venous flow separated from a distal true atrium by a fibromuscular membrane with a large fenestration allowing flow between the chambers. In CTS, the left atrium is divided into proximal and distal chambers by a fenestrated fibromuscular septum. This cardiac anomaly accounts for 0.1% of cases of congenital heart disease and rarely presents in adults. CTS is primarily diagnosed with echocardiography and is associated with left atrial enlargement and development of atrial fibrillation. Treatment options depend on size of the communication between proximal and distal chambers, the gradient across the membrane, and the position of pulmonary veins. In some instances, surgical resection of the membrane that divides the left atrium is warranted.

  4. Platypnea-orthodeoxia syndrome in the right lateral decubitus position: a case report.

    Science.gov (United States)

    Tsuzuki, Ippei; Iigaya, Kamon; Matsubara, Takashi; Takagi, Shunsuke; Inohara, Taku; Ohgino, Yasuyuki; Imafuku, Toshio

    2017-04-12

    Platypnea-orthodeoxia syndrome is a rare syndrome characterized by dyspnea and hypoxia when the patient is sitting or standing. Here we report a case of platypnea-orthodeoxia syndrome caused by a right hemidiaphragmatic elevation with giant liver cyst that triggered a right-to-left shunt through the patent foramen ovale. This case report is the first presentation of a case secondary to hemidiaphragmatic elevation with giant liver cyst. In addition to this, a malposition of the pacemaker lead could be associated with platypnea-orthodeoxia syndrome in this case. A 91-year-old Japanese woman presented to our hospital with hypoxia of unknown origin. Severe hypoxia and cyanosis were observed only in the right lateral decubitus position. A chest X-ray and computed tomography scan revealed right hemidiaphragmatic elevation, which was probably compressing the right atrium. A transesophageal echocardiogram showed a compressed right atrium and shunt blood flow in both directions: from the left to the right atrium and vice versa. The shunt flow was exacerbated by postural changes from the left to the right lateral decubitus. A transesophageal echocardiogram also confirmed compression of the right atrium due to giant liver cyst and a malposition of the pacemaker lead abnormally placed in the left atrium through patent foramen ovale. We concluded that the cause of hypoxia was platypnea-orthodeoxia syndrome with right-to-left interatrial shunt through patent foramen ovale. Surgical closure of patent foramen ovale was not performed due to the age of our patient, surgical difficulties, and failure to obtain informed consent. For these reasons she was discharged after receiving medical advice about her posture. Platypnea-orthodeoxia syndrome is rare and difficult to diagnose. The present case suggests that hypoxia due to postural changes should be considered a differential diagnosis of platypnea-orthodeoxia syndrome.

  5. Abnormal positioning of multiple abdominal organs with anomalous direct drainage of hepatic vein into the right atrium in a post operative omphalocele patient: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Hyun, Su Jeong; Cho, Bum Sang; Kim, Sung Jin; Lee, Seung Young; Kang, Min Ho; Yi, Kyung Sik [Chungbuk National Univ. Hospital, Cheongju (Korea, Republic of)

    2012-10-15

    An omphalocele is a rare congenital anomaly in which the infant's intestines protrude through the navel. Additional anomalies that are associated with omphalocele remain present in as many as 50% of cases, and these anomalies vary greatly from patient to patient. However, the persistent anomalies or abnormal position of the abdominal organs in post operative omphalocele patients have not reported previously. Herein, we report the case of an omphalocele patient with abnormal positioning of the liver, spleen and both kidneys, as well as abnormal drainage of the hepatic vein into the right atrium, which was found during a routine, postoperative follow-up computed tomography scan.

  6. Cardiac Aspergilloma: A Rare Case of a Cardiac Mass Involving the Native Tricuspid Valve, Right Atrium, and Right Ventricle in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Christina S. Chen-Milhone

    2018-01-01

    Full Text Available Aspergillus can cause devastating opportunistic infections in immunocompromised patients. Rarely does this fungus invade the heart, and when it does, survival is especially poor despite optimal medical and surgical treatment. We report a case of cardiac aspergilloma with involvement of the tricuspid valve and both the right atrium and ventricle found on a transthoracic echocardiogram in an immunocompromised patient after developing atrial fibrillation with rapid ventricular rate. The findings from this case suggest that early clinical suspicion is critical in early diagnosis and thus early treatment.

  7. Depth-resolved registration of transesophageal echo to x-ray fluoroscopy using an inverse geometry fluoroscopy system

    Energy Technology Data Exchange (ETDEWEB)

    Hatt, Charles R. [Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Tomkowiak, Michael T.; Dunkerley, David A. P.; Slagowski, Jordan M. [Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Funk, Tobias [Triple Ring Technologies, Inc., Newark, California 94560 (United States); Raval, Amish N. [Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53792 (United States); Speidel, Michael A., E-mail: speidel@wisc.edu [Departments of Medical Physics and Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States)

    2015-12-15

    Purpose: Image registration between standard x-ray fluoroscopy and transesophageal echocardiography (TEE) has recently been proposed. Scanning-beam digital x-ray (SBDX) is an inverse geometry fluoroscopy system designed for cardiac procedures. This study presents a method for 3D registration of SBDX and TEE images based on the tomosynthesis and 3D tracking capabilities of SBDX. Methods: The registration algorithm utilizes the stack of tomosynthetic planes produced by the SBDX system to estimate the physical 3D coordinates of salient key-points on the TEE probe. The key-points are used to arrive at an initial estimate of the probe pose, which is then refined using a 2D/3D registration method adapted for inverse geometry fluoroscopy. A phantom study was conducted to evaluate probe pose estimation accuracy relative to the ground truth, as defined by a set of coregistered fiducial markers. This experiment was conducted with varying probe poses and levels of signal difference-to-noise ratio (SDNR). Additional phantom and in vivo studies were performed to evaluate the correspondence of catheter tip positions in TEE and x-ray images following registration of the two modalities. Results: Target registration error (TRE) was used to characterize both pose estimation and registration accuracy. In the study of pose estimation accuracy, successful pose estimates (3D TRE < 5.0 mm) were obtained in 97% of cases when the SDNR was 5.9 or higher in seven out of eight poses. Under these conditions, 3D TRE was 2.32 ± 1.88 mm, and 2D (projection) TRE was 1.61 ± 1.36 mm. Probe localization error along the source-detector axis was 0.87 ± 1.31 mm. For the in vivo experiments, mean 3D TRE ranged from 2.6 to 4.6 mm and mean 2D TRE ranged from 1.1 to 1.6 mm. Anatomy extracted from the echo images appeared well aligned when projected onto the SBDX images. Conclusions: Full 6 DOF image registration between SBDX and TEE is feasible and accurate to within 5 mm. Future studies will focus on

  8. 15. Sensitivity in visualizing vegetations in cardiac lead-induced endocarditis: A comparative study between transesophageal vs. transthoracic echocardiography

    Directory of Open Access Journals (Sweden)

    A. AlFagih

    2016-07-01

    Full Text Available Despite advancement in sterile cardiac device implantation techniques, wound infections and/or bacteremia remain a significant problem. The presence of a vegetation in lead-induced endocarditis (LIE is a critical factor that determines the management. Transthoracic (TTE and Transesophageal (TEE Echocardiography are two different cardiac modalities that are used for the detection of lead vegetation. However, it is not yet clear which of the two has the highest diagnostic accuracy. We aim to identify which of the two has the highest sensitivity. In addition, we aim to correlate the existence of a vegetation with blood and wound culture results. We conducted a chart review in 113 patients whom underwent lead extraction at Prince Sultan Cardiac Center in Saudi Arabia during the period of Jan, 2002 to Jul, 2015. Six patients underwent lead extraction twice, increasing the number to be a total of 119 cases. Out of the study cohort, we include 38 patients who had both TTE and TEE done prior to lead extraction. Data regarding TTE, TEE, as well as blood and wound cultures were collected from echocardiography and microbiology lab reports using a well-structured case report form.Of the study population, 21 patients (55.3% had lead vegetations visualized either by TTE or TEE. Nineteen patients had vegetations detected by TEE, compared to 6 patients only when TTE was used. The sensitivity of TEE and TTE were 90.5% (CI: 69.6–98.8% and 28.5% (95% CI: 11.3–52.1%, respectively. Blood and wound culture results showed that in the presence of a vegetation, blood cultures were positive in 55% of the cases (P = 0.036 while only 44.4% of those with vegetations had a positive wound culture (P = 0.347. TEE has higher sensitivity in detecting vegetations compared to TTE in LIE. The presence of a vegetation is more likely to be associated with a positive blood culture than a positive wound culture. Further studies ought to measure the accuracy of different

  9. Computational Analysis of Pumping Efficacy of a Left Ventricular Assist Device according to Cannulation Site in Heart Failure with Valvular Regurgitation.

    Science.gov (United States)

    Heikhmakhtiar, Aulia Khamas; Lim, Ki Moo

    2016-01-01

    Mitral valve regurgitation (MR) causes blood to flow in two directions during contraction of the left ventricle (LV), that is, forward into the aorta and backward into the left atrium (LA). In aortic valve regurgitation (AR), leakage occurs from the aorta into the LV during diastole. Our objective is to analyze the contribution of a left ventricular assist device (LVAD) to MR and AR for the following two different cannulation sites: from the LA to the aorta (LAAO) and from the LV to the aorta (LVAO). Using a computational method, we simulated three ventricular conditions (normal [HF without valvular regurgitation], 5% MR, and 5% AR) in three groups (control [no LVAD], LAAO, and LVAO). The results showed that LVAD with LAAO cannulation is appropriate for recovery of the MR heart, and the LVAD with LVAO cannulation is appropriate for treating the AR heart.

  10. Why Dora Left

    DEFF Research Database (Denmark)

    Gammelgård, Judy

    2017-01-01

    The question of why Dora left her treatment before it was brought to a satisfactory end and the equally important question of why Freud chose to publish this problematic and fragmentary story have both been dealt with at great length by Freud’s successors. Dora has been read by analysts, literary...... critics, and not least by feminists. The aim of this paper is to point out the position Freud took toward his patient. Dora stands out as the one case among Freud’s 5 great case stories that has a female protagonist, and reading the case it becomes clear that Freud stumbled because of an unresolved...... problem toward femininity, both Dora’s and his own. In Dora, it is argued, Freud took a new stance toward the object of his investigation, speaking from the position of the master. Freud presents himself as the one who knows, in great contrast to the position he takes when unraveling the dream. Here he...

  11. Non-compact left ventricle/hypertrabeculated left ventricle

    International Nuclear Information System (INIS)

    Restrepo, Gustavo; Castano, Rafael; Marmol, Alejandro

    2005-01-01

    Non-compact left ventricle/hypertrabeculated left ventricle is a myocardiopatie produced by an arrest of the normal left ventricular compaction process during the early embryogenesis. It is associated to cardiac anomalies (congenital cardiopaties) as well as to extracardial conditions (neurological, facial, hematologic, cutaneous, skeletal and endocrinological anomalies). This entity is frequently unnoticed, being diagnosed only in centers with great experience in the diagnosis and treatment of myocardiopathies. Many cases of non-compact left ventricle have been initially misdiagnosed as hypertrophic myocardiopatie, endocardial fibroelastosis, dilated cardiomyopatie, restrictive cardiomyopathy and endocardial fibrosis. It is reported the case of a 74 years old man with a history of chronic arterial hypertension and diabetes mellitus, prechordial chest pain and mild dyspnoea. An echocardiogram showed signs of non-compact left ventricle with prominent trabeculations and deep inter-trabecular recesses involving left ventricular apical segment and extending to the lateral and inferior walls. Literature on this topic is reviewed

  12. Negative inotropic effect of carbachol and interaction between acetylcholine receptor-operated potassium channel (K.ACh channel) and GTP binding protein in mouse isolated atrium--a novel methodological trial.

    Science.gov (United States)

    Okada, Muneyoshi; Noma, Chihiro; Yamawaki, Hideyuki; Hara, Yukio

    2013-01-01

    Interaction between acetylcholine receptor-operated potassium channel (K.ACh channel) and GTP binding protein was examined by an immunoprecipitation-Western blotting system in mouse isolated atrium. The carbachol-induced negative inotropic action in indomethacin-pretreated mouse atrium was significantly inhibited by a K.ACh channel blocker, tertiapin or atropine. Kir3.1 K.ACh channel (Kir3.1) was immunoprecipitated with a mouse anti-Kir3.1 antibody. Coprecipitating Gβ with Kir3.1, detected by Western blotting, was significantly augmented by carbachol. Atropine, but not tertiapin, significantly inhibited the carbachol-induced coprecipitating Gβ with Kir3.1. The data indicate that immunoprecipitation with Kir3.1 and Western blotting of Gβ system is a useful method for assessing interaction between K.ACh channel and GTP binding protein in mouse atrium.

  13. Left Atrial Appendage: Physiology, Pathology, and Role as a Therapeutic Target

    Directory of Open Access Journals (Sweden)

    Damiano Regazzoli

    2015-01-01

    Full Text Available Atrial fibrillation (AF is the most common clinically relevant cardiac arrhythmia. AF poses patients at increased risk of thromboembolism, in particular ischemic stroke. The CHADS2 and CHA2DS2-VASc scores are useful in the assessment of thromboembolic risk in nonvalvular AF and are utilized in decision-making about treatment with oral anticoagulation (OAC. However, OAC is underutilized due to poor patient compliance and contraindications, especially major bleedings. The Virchow triad synthesizes the pathogenesis of thrombogenesis in AF: endocardial dysfunction, abnormal blood stasis, and altered hemostasis. This is especially prominent in the left atrial appendage (LAA, where the low flow reaches its minimum. The LAA is the remnant of the embryonic left atrium, with a complex and variable morphology predisposing to stasis, especially during AF. In patients with nonvalvular AF, 90% of thrombi are located in the LAA. So, left atrial appendage occlusion could be an interesting and effective procedure in thromboembolism prevention in AF. After exclusion of LAA as an embolic source, the remaining risk of thromboembolism does not longer justify the use of oral anticoagulants. Various surgical and catheter-based methods have been developed to exclude the LAA. This paper reviews the physiological and pathophysiological role of the LAA and catheter-based methods of LAA exclusion.

  14. LEFT VENTRICULAR NON-COMPACTION: AN EXAMPLE OF A RARE DISEASE IN CLINICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    O. V. Gaysyonok

    2017-01-01

    Full Text Available Objective: to describe the clinical case of a rare heart disease – left ventricular non-compaction.Materials and methods. Patient G., 1948, was hospitalized in connection with complaints of fluctuations in blood pressure, heart failure, discomfort in the heart, dizziness, headaches. The patient underwent the following general examination: general and biochemical blood tests, electrocardiography, Holter ECG monitoring, treadmill test, echocardiography, color duplex scanning of neck vessels, ultrasound of the thyroid and kidneys, chest X-ray.Results. Based on the history, complaints, clinical picture of the disease, objective and instrumental examination data, a clinical diagnosis was made: left ventricular non-compaction. One of the main diagnostic methods that allowed to verify the diagnosis was echocardiographic study: the structure of the myocardium of the lower-apical section of a two-layered one, with the presence of a noncompact layer (with intertabercular breaks, in relation to the compact as 2:1; a small extension of the left atrium; small hypokinesia in the lower-upper segment of the LV, without a decrease in the LVEF (PV = 73 %.Conclusion. This clinical case is interesting because the disease, concealed under the guise of rheumacarditis in an era when ultrasonic methods of examining the heart were not available in clinical practice, has now been diagnosed in the conduct of a reference echocardiographic study. Despite the fact that this disease belongs to rare nosology, it can occur in any age group and can often be asymptomatic.

  15. Experimental Assessment of the Hydraulics of a Miniature Axial-Flow Left Ventricular Assist Device

    Science.gov (United States)

    Smith, P. Alex; Cohn, William; Metcalfe, Ralph

    2017-11-01

    A minimally invasive partial-support left ventricular assist device (LVAD) has been proposed with a flow path from the left atrium to the arterial system to reduce left ventricular stroke work. In LVAD design, peak and average efficiency must be balanced over the operating range to reduce blood trauma. Axial flow pumps have many geometric parameters. Until recently, testing all these parameters was impractical, but modern 3D printing technology enables multi-parameter studies. Following theoretical design, experimental hydraulic evaluation in steady state conditions examines pressure, flow, pressure-flow gradient, efficiency, torque, and axial force as output parameters. Preliminary results suggest that impeller blades and stator vanes with higher inlet angles than recommended by mean line theory (MLT) produce flatter gradients and broader efficiency curves, increasing compatibility with heart physiology. These blades also produce less axial force, which reduces bearing load. However, they require slightly higher torque, which is more demanding of the motor. MLT is a low order, empirical model developed on large pumps. It does not account for the significant viscous losses in small pumps like LVADs. This emphasizes the importance of experimental testing for hydraulic design. Roderick D MacDonald Research Fund.

  16. [Left-handedness and health].

    Science.gov (United States)

    Milenković, Sanja; Belojević, Goran; Kocijancić, Radojka

    2010-01-01

    Hand dominance is defined as a proneness to use one hand rather than another in performing the majority of activities and this is the most obvious example of cerebral lateralization and an exclusive human characteristic. Left-handed people comprise 6-14% of the total population, while in Serbia, this percentage is 5-10%, moving from undeveloped to developed environments, where a socio-cultural pressure is less present. There is no agreement between investigators who in fact may be considered a left-handed person, about the percentage of left-handers in the population and about the etiology of left-handedness. In the scientific literature left-handedness has been related to health disorders (spine deformities, immunological disorders, migraine, neurosis, depressive psychosis, schizophrenia, insomnia, homosexuality, diabetes mellitus, arterial hypertension, sleep apnea, enuresis nocturna and Down Syndrome), developmental disorders (autism, dislexia and sttutering) and traumatism. The most reliable scientific evidences have been published about the relationship between left-handedness and spinal deformities in school children in puberty and with traumatism in general population. The controversy of other results in up-to-now investigations of health aspects of left-handedness may partly be explained by a scientific disagreement whether writing with the left hand is a sufficient criterium for left-handedness, or is it necessary to investigate other parameters for laterality assessment. Explanation of health aspects of left-handedness is dominantly based on Geschwind-Galaburda model about "anomalous" cerebral domination, as a consequence of hormonal disbalance.

  17. Evaluation of aspirin therapy on intracardiac thrombi using indium-111-oxine platelet scintigraphy, two-dimentional echocardiography and left ventriculography

    International Nuclear Information System (INIS)

    Shibuya, Masanori; Irino, Tadayoshi; Yoshioka, Toshiharu; Sugimoto, Tsuyoshi; Tsuji, Kazuo; Naka, Masashi; Arai, Hidekazu.

    1984-01-01

    Left ventriculography (LVG), two-dimensional echocardiography (2-DE) and indium-111-oxine platelet scintigraphy were performed in five patients with intracardiac thrombi. Thrombi were visible in 7 sites (5 in the ventricle and 2 in the atrium) by platelet scintigraphy, in 4 sites (3 in the ventricle and 1 in the atrium) by 2-DE, and in 4 sites (4 in the ventricle) by LVG. When aspirin was administered to the patients, platelet scintigraphy had become negative for thrombi in 5 sites and false-negative for them in 2 sites. However, thrombi were detected in 6 sites after the withdrawal of aspirin. On the other hand, thrombi were detected in 4 sites by 2-DE, irrespective of the administration of aspirin. Indium-111-oxine platelet scintigraphy has proved to not only have higher sensitivity for detecting thrombi but also to be capable of observing the coagulation status of platelets on the thrombi. It is therefore considered very helpful in assessing anticoagulation therapy. (Namekawa, K)

  18. Clinical impact of quantitative left atrial vortex flow analysis in patients with atrial fibrillation: a comparison with invasive left atrial voltage mapping.

    Science.gov (United States)

    Lee, Jung Myung; Hong, Geu-Ru; Pak, Hui-Nam; Shim, Chi Young; Houle, Helene; Vannan, Mani A; Kim, Minji; Chung, Namsik

    2015-08-01

    Recently, left atrial (LA) vortex flow analysis using contrast transesophageal echocardiography (TEE) has been shown to be feasible and has demonstrated significant differences in vortex flow morphology and pulsatility between normal subjects and patients with atrial fibrillation (AF). However, the relationship between LA vortex flow and electrophysiological properties and the clinical significance of LA vortex flow are unknown. The aims of this study were (1) to compare LA vortex flow parameters with LA voltage and (2) to assess the predictive value of LA vortex flow parameters for the recurrence of AF after radiofrequency catheter ablation (RFCA). Thirty-nine patients with symptomatic non-valvular AF underwent contrast TEE before undergoing RFCA for AF. Quantitative LA vortex flow parameters were analyzed by Omega flow (Siemens Medical Solution, Mountain View, CA, USA). The morphology and pulsatility of LA vortex flow were compared with electrophysiologic parameters that were measured invasively. Hemodynamic, electrophysiological, and vortex flow parameters were compared between patients with and without early recurrence of AF after RFCA. Morphologic parameters, including LA vortex depth, length, width, and sphericity index were not associated with LA voltage or hemodynamic parameters. The relative strength (RS), which represents the pulsatility power of LA, was positively correlated with LA voltage (R = 0.53, p = 0.01) and LA appendage flow velocity (R = 0.73, p vortex flow analysis, especially RS, correlated well with LA voltage. Decreased pulsatility strength in the LA was associated with recurrent AF. LA vortex may have incremental value in predicting the recurrence of AF.

  19. What Is Transesophageal Echocardiography?

    Science.gov (United States)

    ... addition to transthoracic (tranz-thor-AS-ik) echo (TTE), the most common type of echo. If TTE pictures don't give doctors enough information, they ... and its blood vessels. In general, transthoracic echo (TTE) is the first echo test used to diagnose ...

  20. Exertional Angina Due To Fused Aortic Bioprosthesis During Left Ventricular Assist Device Support: Two Cases and Review of the Literature.

    Science.gov (United States)

    Bonios, Michael J; Selzman, Craig H; Gilbert, Edward M; McKellar, Stephen H; Koliopoulou, Antigoni; Strege, Jennifer L; Nativi, Jose N; Fang, James C; Stehlik, Josef; Drakos, Stavros G

    We present the case of two patients with idiopathic dilated cardiomyopathy and moderate aortic valve regurgitation that were treated with a bioprosthetic valve at the time of the left ventricular assist device (LVAD) implantation. A few months later, patients revealed partial recovery in the left ventricle systolic function. Both patients, during the LVAD turndown protocol, reported the onset of chest pain. The transthoracic echocardiography revealed the presence of a new transaortic pressure gradient. We confirmed the presence of a fused bioprosthetic valve by further performing a transesophageal echocardiogram and a left and right heart catheterization. Replacement of aortic valve at the time of an LVAD implantation constitutes a challenging case. Although a mechanical valve is contraindicated due to the increased thromboembolic risk, selecting a bioprosthetic valve increases the risk of valve leaflets fusion. The consequences of this phenomenon should be acknowledged in LVAD patients undergoing aortic valve replacement with a bioprosthetic, especially under the view of LVAD explantation for those revealing myocardial recovery under mechanical unloading.

  1. Myxoma of the Left Ventricle

    Science.gov (United States)

    Novoa, José; Delgado, Antonio; Alonso, Ana

    2014-01-01

    This report concerns a 69-year-old woman who presented with an asymptomatic myxoma in the left ventricle. The tumor was successfully excised. We provide a very brief review of 72 other published cases of surgically treated left ventricular myxoma. PMID:25120392

  2. Left ventricular hypertrophy in athletes.

    Science.gov (United States)

    Douglas, P S; O'Toole, M L; Katz, S E; Ginsburg, G S; Hiller, W D; Laird, R H

    1997-11-15

    Left ventricular wall thickness >1.3 cm, septal-to-posterior wall ratios > 1.5, diastolic left ventricular size >6.0 cm, and eccentric or concentric remodeling are rare in athletes. Values outside of these cutoffs in an athlete of any age probably represent a pathologic state.

  3. The Left-Handed Writer.

    Science.gov (United States)

    Bloodsworth, James Gaston

    Contrary to the beliefs of many, right-handedness is not a single factor existing in almost all people, with a few exceptions termed left-handed: neither extreme exists independently of the other. During the first 4 years of life there is a period of fluctuation between right and left-handed dominance. Statistics and findings vary in determining…

  4. Two Lefts in Latin America?

    DEFF Research Database (Denmark)

    Christensen, Steen Fryba

    In this working paper I list five researchers' categorizations of the Latin American left in power (april 2006) in a schematic form. The most important criteria for the categorizations are given.......In this working paper I list five researchers' categorizations of the Latin American left in power (april 2006) in a schematic form. The most important criteria for the categorizations are given....

  5. A Giant Left Atrial Myxoma

    Directory of Open Access Journals (Sweden)

    Medhat F. Zaher

    2014-01-01

    Full Text Available Atrial myxomas are the most common primary cardiac tumors. Patients with left atrial myxomas generally present with mechanical obstruction of blood flow, systemic embolization, and constitutional symptoms. We present a case of an unusually large left atrial myxoma discovered incidentally in a patient with longstanding dyspnea being managed as bronchial asthma.

  6. Does desflurane alter left ventricular function when used to control surgical stimulation during aortic surgery?

    Science.gov (United States)

    Eyraud, D; Benmalek, F; Teugels, K; Bertrand, M; Mouren, S; Coriat, P

    1999-08-01

    Although desflurane is commonly used to control surgically induced hypertension, its effects on left ventricular (LV) function have not been investigated in this clinical situation. The purpose of the present study was to evaluate the LV function response to desflurane, when used to control intraoperative hypertension. In 50 patients, scheduled for vascular surgery, anesthesia was induced with sufentanil 0.5 microg/kg, midazolam 0.3 mg/kg and atracurium 0.5 mg/kg. After tracheal intubation, anesthesia was maintained with increments of drugs with controlled ventilation (N2O/O2=60/40%) until the start of surgery. A 5 Mhz transesophageal echocardiography (TEE) probe was inserted after intubation. Pulmonary artery catheter and TEE measurements were obtained after induction (to)(control value), at surgical incision (t1) if it was associated with an increase in systolic arterial pressure (SAP) greater than 140 mmHg (hypertension) and after control of hemodynamic parameters by administration of desflurane (return of systolic arterial pressure to within 20% of the control value) (t2) in a fresh gas flow of 31/ min. Sixteen patients developed hypertension at surgical incision. SAP was controlled by desflurane in all 16 patients. Afterload assessed by systemic vascular resistance index (SVRI), end-systolic wall-stress (ESWS) and left-ventricular stroke work index (LVSWI) increased with incision until the hypertension returned to post-induction values with mean end-tidal concentration of 5.1+/-0.7% desflurane. No change in heart rate, cardiac index, mean pulmonary arterial pressure, stroke volume, end-diastolic and end-systolic cross-sectional areas, fractional area change and left ventricular circumferential fiber shortening was noted when desflurane was added to restore blood pressure. This study demonstrates that in patients at risk for cardiac morbidity undergoing vascular surgery, desflurane is effective to control intraoperative hypertension without fear of major

  7. Left-handedness and health

    Directory of Open Access Journals (Sweden)

    Milenković Sanja

    2010-01-01

    Full Text Available Hand dominance is defined as a proneness to use one hand rather than another in performing the majority of activities and this is the most obvious example of cerebral lateralization and an exclusive human characteristic. Left-handed people comprise 6-14% of the total population, while in Serbia, this percentage is 5-10%, moving from undeveloped to developed environments, where a socio-cultural pressure is less present. There is no agreement between investigators who in fact may be considered a left-handed person, about the percentage of left-handers in the population and about the etiology of left-handedness. In the scientific literature left-handedness has been related to health disorders (spine deformities, immunological disorders, migraine, neurosis, depressive psychosis, schizophrenia, insomnia, homosexuality, diabetes mellitus, arterial hypertension, sleep apnea, enuresis nocturna and Down Syndrome, developmental disorders (autism, dislexia and sttutering and traumatism. The most reliable scientific evidences have been published about the relationship between left-handedness and spinal deformities in school children in puberty and with traumatism in general population. The controversy of other results in up-to-now investigations of health aspects of left-handedness may partly be explained by a scientific disagreement whether writing with the left hand is a sufficient criterium for left-handedness, or is it necessary to investigate other parameters for laterality assessment. Explanation of health aspects of left-handedness is dominantly based on Geschwind-Galaburda model about 'anomalous' cerebral domination, as a consequence of hormonal disbalance. .

  8. Left ventricular wall stress compendium.

    Science.gov (United States)

    Zhong, L; Ghista, D N; Tan, R S

    2012-01-01

    Left ventricular (LV) wall stress has intrigued scientists and cardiologists since the time of Lame and Laplace in 1800s. The left ventricle is an intriguing organ structure, whose intrinsic design enables it to fill and contract. The development of wall stress is intriguing to cardiologists and biomedical engineers. The role of left ventricle wall stress in cardiac perfusion and pumping as well as in cardiac pathophysiology is a relatively unexplored phenomenon. But even for us to assess this role, we first need accurate determination of in vivo wall stress. However, at this point, 150 years after Lame estimated left ventricle wall stress using the elasticity theory, we are still in the exploratory stage of (i) developing left ventricle models that properly represent left ventricle anatomy and physiology and (ii) obtaining data on left ventricle dynamics. In this paper, we are responding to the need for a comprehensive survey of left ventricle wall stress models, their mechanics, stress computation and results. We have provided herein a compendium of major type of wall stress models: thin-wall models based on the Laplace law, thick-wall shell models, elasticity theory model, thick-wall large deformation models and finite element models. We have compared the mean stress values of these models as well as the variation of stress across the wall. All of the thin-wall and thick-wall shell models are based on idealised ellipsoidal and spherical geometries. However, the elasticity model's shape can vary through the cycle, to simulate the more ellipsoidal shape of the left ventricle in the systolic phase. The finite element models have more representative geometries, but are generally based on animal data, which limits their medical relevance. This paper can enable readers to obtain a comprehensive perspective of left ventricle wall stress models, of how to employ them to determine wall stresses, and be cognizant of the assumptions involved in the use of specific models.

  9. Isolated right atrial appendage (RAA) rupture in blunt trauma--a case report and an anatomic study comparing RAA and right atrium (RA) wall thickness.

    Science.gov (United States)

    Figueiredo, Adoniram M; Poggetti, Renato S; Quintavalle, Fabio G; Fontes, Belchor; Dalva, Moise; Younes, Riad N; Jatene, Fabio B; Birolini, Dario

    2007-02-15

    Heart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The determinant factors, and the incidence of isolated heart chambers rupture remains undetermined. Isolated rupture of the right atrium appendage (RAA) is very rare, with 8 cases reported in the reviewed literature. The thin wall of the RAA has been presumed to render this chamber more prone to rupture in blunt trauma. To report a case of isolated RAA rupture in blunt trauma, and to compare right atrium (RA) and RAA wall thickness in a necropsy study. The thickness of RA and RAA wall of hearts from cadavers of fatal penetrating head trauma victims was measured. Our case of isolated RAA rupture is presented. The main findings of the 8 cases reported in the literature, and the findings of our case, were organized in a table. The comparison of the data showed that wall thickness of the RAA (0.53 +/- 0.33 mm) was significantly thinner than that of RA (1.11 +/- 0.42 mm) (p < 0.05). In all these 9 cases of isolated RAA rupture, cardiac tamponade occurred, RAA rupture was diagnosed intraoperatively and sutured, and the patients survived. Main mechanisms hypothesized for heart chamber rupture include mechanical compression coincident with phases of cardiac cycle, leading to high hydrostatic pressure inside the chamber. Published series include numerous cases of RA rupture, and only a few cases of RAA rupture. Thus, our data suggests that wall thickness is not a determinant factor for RA or RAA rupture in blunt trauma.

  10. Isolated right atrial appendage (RAA rupture in blunt trauma – a case report and an anatomic study comparing RAA and right atrium (RA wall thickness

    Directory of Open Access Journals (Sweden)

    Jatene Fabio B

    2007-02-01

    Full Text Available Abstract Background Heart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The determinant factors, and the incidence of isolated heart chambers rupture remains undetermined. Isolated rupture of the right atrium appendage (RAA is very rare, with 8 cases reported in the reviewed literature. The thin wall of the RAA has been presumed to render this chamber more prone to rupture in blunt trauma. Objective To report a case of isolated RAA rupture in blunt trauma, and to compare right atrium (RA and RAA wall thickness in a necropsy study. Methods The thickness of RA and RAA wall of hearts from cadavers of fatal penetrating head trauma victims was measured. Our case of isolated RAA rupture is presented. The main findings of the 8 cases reported in the literature, and the findings of our case, were organized in a table. Result The comparison of the data showed that wall thickness of the RAA (0.53 ± 0.33 mm was significantly thinner than that of RA (1.11 ± 0.42 mm (p Comments In all these 9 cases of isolated RAA rupture, cardiac tamponade occurred, RAA rupture was diagnosed intraoperatively and sutured, and the patients survived. Main mechanisms hypothesized for heart chamber rupture include mechanical compression coincident with phases of cardiac cycle, leading to high hydrostatic pressure inside the chamber. Published series include numerous cases of RA rupture, and only a few cases of RAA rupture. Conclusion Thus, our data suggests that wall thickness is not a determinant factor for RA or RAA rupture in blunt trauma.

  11. Isolated right atrial appendage (RAA) rupture in blunt trauma – a case report and an anatomic study comparing RAA and right atrium (RA) wall thickness

    Science.gov (United States)

    Figueiredo, Adoniram M; Poggetti, Renato S; Quintavalle, Fabio G; Fontes, Belchor; Dalva, Moise; Younes, Riad N; Jatene, Fabio B; Birolini, Dario

    2007-01-01

    Background Heart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The determinant factors, and the incidence of isolated heart chambers rupture remains undetermined. Isolated rupture of the right atrium appendage (RAA) is very rare, with 8 cases reported in the reviewed literature. The thin wall of the RAA has been presumed to render this chamber more prone to rupture in blunt trauma. Objective To report a case of isolated RAA rupture in blunt trauma, and to compare right atrium (RA) and RAA wall thickness in a necropsy study. Methods The thickness of RA and RAA wall of hearts from cadavers of fatal penetrating head trauma victims was measured. Our case of isolated RAA rupture is presented. The main findings of the 8 cases reported in the literature, and the findings of our case, were organized in a table. Result The comparison of the data showed that wall thickness of the RAA (0.53 ± 0.33 mm) was significantly thinner than that of RA (1.11 ± 0.42 mm) (p < 0.05). Comments In all these 9 cases of isolated RAA rupture, cardiac tamponade occurred, RAA rupture was diagnosed intraoperatively and sutured, and the patients survived. Main mechanisms hypothesized for heart chamber rupture include mechanical compression coincident with phases of cardiac cycle, leading to high hydrostatic pressure inside the chamber. Published series include numerous cases of RA rupture, and only a few cases of RAA rupture. Conclusion Thus, our data suggests that wall thickness is not a determinant factor for RA or RAA rupture in blunt trauma. PMID:17302990

  12. Arrhythmias are not to blame for all cardiac syncope patients: left atrial myxoma causing syncope in a middle-aged man.

    Science.gov (United States)

    Rajani, Ali Raza; Muaz, Reem Naif; Govindaswamy, Pushpa Rani; Mian, Muhammad Hamid

    2015-04-15

    A 47-year-old man presented with a history of syncope that lasted for 3 min and was not accompanied by jerky movement of limbs or incontinence. After regaining consciousness, he felt generalised weakness. There was no history of chest pain or palpitation. ECG showed normal sinus rhythm. All blood investigations were normal. Transthoracic echocardiography showed a large multilobulated echo dense mass in the left atrium. The mass was prolapsing through the mitral valve during diastole. Transoesophageal echocardiography verified these findings and also showed the stalk of the mass attached to the interatrial septum near the fossa ovalis. The mass was highly suggestive of myxoma. The patient underwent surgical resection of the mass and histopathology confirmed the diagnosis of left atrial myxoma. 2015 BMJ Publishing Group Ltd.

  13. Left atrial and ventricular function during dobutamine and glycopyrrolate stress in healthy young and elderly as evaluated by cardiac magnetic resonance

    DEFF Research Database (Denmark)

    Ahtarovski, Kiril A; Iversen, Kasper K; Lønborg, Jacob T

    2012-01-01

    The aim of this study is to describe phasic volume changes of the left atrium (LA) in healthy young and elderly subjects at rest and during pharmacological stress (PS). LA maximum size is related to cardiovascular mortality. LA has passive, active, and conduit function for left ventricular (LV......) filling. We hypothesized that changes in LV compliance from normal aging are reflected in LA volume changes and that PS will augment these differences. We enrolled twenty young (20-30 yr) and twenty elderly (60-70 yr) healthy subjects and measured their LV and LA volumes by cardiac magnetic resonance...... imaging at rest and during dobutamine and glycopyrrolate stress. We identified LA minimum, maximum, and middiastolic volumes and the volume before atrial contraction. LA emptying volumes were calculated as LA passive and active emptying volumes and LA conduit volume. We also calculated LV peak filling...

  14. Left atrial thrombus predicts transient ischemic attack in patients with atrial fibrillation.

    Science.gov (United States)

    Stoddard, Marcus F; Singh, Pradeep; Dawn, Buddhadeb; Longaker, Rita A

    2003-04-01

    Atrial fibrillation (AF) is widely accepted as a direct cause of cardioembolic stroke from left atrial (LA) thrombus formation. However, the relationship between LA thrombus and transient ischemic attack (TIA) in patients with AF is less well established. Two hundred sixty-one adult patients (mean age 66 +/- 11 years, 220 men and 41 women) with AF undergoing transesophageal echocardiography (TEE) were prospectively followed up for TIA (mean duration 30.3 +/- 20.6 months). LA thrombus was present in 18% (n = 46) and LA spontaneous echocardiographic contrast in 50% (n = 131) of the group. Nineteen of 261 patients had TIA during follow-up. Multivariate logistic regression showed congestive heart failure (CHF) as the only predictor of TIA when a model of clinical variables was constructed (odds ratio [OR] 2.7, P =.04). Age, sex, hypertension, and use of warfarin or aspirin were not predictors. When TEE variables were added to the model, LA thrombus became the only predictor of TIA (OR 7.7, P =.0001). Survival free of TIA (Kaplan-Meier) was significantly less (P =.0001) in patients with LA thrombus compared with those without, and the annual TIA event rate was 9.2% per year versus 1.9% per year (P likely thromboembolic mechanism for TIA from LA thrombus in patients with AF.

  15. Velocity encoded cardiovascular magnetic resonance to assess left atrial appendage emptying

    Directory of Open Access Journals (Sweden)

    Muellerleile Kai

    2012-06-01

    Full Text Available Abstract Background The presence of impaired left atrial appendage (LAA function identifies patients who are prone to thrombus formation in the LAA and therefore being at high risk for subsequent cardioembolic stroke. LAA function is typically assessed by measurements of LAA emptying velocities using transesophageal echocardiography (TEE in clinical routine. This study aimed at evaluating the feasibility of assessing LAA emptying by velocity encoded (VENC cardiovascular magnetic resonance (CMR. Methods This study included 30 patients with sinus rhythm (n = 18 or atrial fibrillation (n = 12. VENC-CMR velocity measurements were performed perpendicular to the orifice of the LAA. Peak velocities were measured of passive diastolic LAA emptying (e-wave in all patients. Peak velocities of active, late-diastolic LAA emptying (a-wave were assessed in patients with sinus rhythm. Correlation and agreement was analyzed between VENC-CMR and TEE measurements of e- and a-wave peak velocities. Results A significant correlation and good agreement was found between VENC-CMR and TEE measurements of maximal e-wave velocities (r = 0.61, P  Conclusions The assessment of active and passive LAA emptying by VENC-CMR is feasible. Further evaluation is required of potential future clinical applications such as risk stratification for cardioembolic stroke.

  16. Neurological manifestations of atrio-esophageal fistulas from left atrial ablation.

    Science.gov (United States)

    Finsterer, J; Stöllberger, C; Pulgram, T

    2011-10-01

    Left atrial ablation (LAAB) is carried out as an alternative treatment of atrial fibrillation refractory to conservative measures. An increasingly recognized complication of LAAB is an atrio-esophageal fistula (AEF). Neurological manifestations usually dominate the presentation of an AEF and result from cardiac embolism of thrombi, transgressed esophageal contents, or air. AEFs have been reported after LAAB in 52 patients (23 men, age 35-76 years), described in 24 publications, so far. AEFs manifest clinically on the average 17 days (3-38 days) after ablation. Neurological manifestations include embolic strokes (n = 30), seizures (n = 9), transitory-ischaemic attacks (n = 6), coma (n = 6), or psychiatric abnormalities (n = 5). Imaging studies of the cerebrum most frequently show multiple embolic strokes or air embolism. The diagnosis is made upon thoracic computed tomography with contrast media. An act of swallowing, trans-esophageal echocardiography, gastroscopy, or esophageal stenting must be avoided not to enlarge the shunt. The only expedient therapy is surgical closure of the fistula, but even then, the prognosis is poor with a mortality of 71%. AEFs should be suspected if there is a history of LAAB followed by fever, thoracic pain, postprandial cerebral strokes, seizures, coma, or confusion with a latency of days to 5 weeks after ablation. Diagnostic work-up must avoid measures, which enlarge the fistula. Treatment is surgical exclusively. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.

  17. Left atrial endocarditis as a rare complication of mitral valve endocarditis: a clinical case

    Directory of Open Access Journals (Sweden)

    Hamadanchi Ali

    2012-11-01

    Full Text Available Abstract Background Infective Endocarditis (IE is considered as a multifaceted problem in every aspect from etiology and presentation to diagnosis and management. Early recognition of this disease and especially its complications, remain a critical task for the cardiologist. Atrial endocarditis is a rare and sometimes unrecognized complication of mitral valve endocarditis. Case presentation We present a 48 year-old male patient who was admitted to our clinic because of recent onset of malaise, fever, jaundice and peripheral edema. Important physical findings were peripheral stigmata of IE in addition to holosystolic murmur over the left sternal border. Transthoracic and transesophageal echocardiophy revealed a severe eccentric MR due to a flailed posterior mitral valve caused by IE. The presence of atrial septal endocarditis caused by jet streaming was also observed. Blood culture was positive for streptococcus oralis and antibiotic therapy was immediately initiated. Considering the large burden of infective tissue, the patient was planned for an early surgical intervention. A minimally invasive resection of the atrial mass, direct closure of the defect, resection of the diseased portions of mitral leaflets and implantation of a biological mitral valve prosthesis was performed. Intra-operative and histological findings confirmed provisional diagnosis by echocardiography. Conclusions Together with comprehensive echocardiographic evaluation, attention should be placed on mural vegetations and excluded among all cases of mitral valve endocarditis, particularly those with severe eccentric regurgitant jets.

  18. Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking

    Directory of Open Access Journals (Sweden)

    Lisi Matteo

    2009-02-01

    Full Text Available Abstract Background The role of speckle tracking in the assessment of left atrial (LA deformation dynamics is not established. We sought to determine the feasibility and reference ranges of LA longitudinal strain indices measured by speckle tracking in a population of normal subjects. Methods In 60 healthy individuals, peak atrial longitudinal strain (PALS and time to peak longitudinal strain (TPLS were measured using a 12-segment model for the left atrium. Values were obtained by averaging all segments (global PALS and TPLS and by separately averaging segments measured in the two apical views (4- and 2-chamber average PALS and TPLS. Results Adequate tracking quality was achieved in 97% of segments analyzed. Inter and intra-observer variability coefficients of measurements ranged between 2.9% and 5.4%. Global PALS was 42.2 ± 6.1% (5–95° percentile range 32.2–53.2%, and global TPLS was 368 ± 30 ms (5–95° percentile range 323–430 ms. The 2-chamber average PALS was slightly higher than the 4-chamber average PALS (44.3 ± 6.0% vs 40.1 ± 7.9%, p Conclusion Speckle tracking is a feasible technique for the assessment of longitudinal myocardial LA deformation. Reference ranges of strain indices were reported.

  19. Left atrial dysfunction in type 2 diabetes mellitus: insights from cardiac MRI

    Energy Technology Data Exchange (ETDEWEB)

    Graca, Bruno; Donato, Paulo; Caseiro-Alves, Filipe [University of Coimbra, Faculty of Medicine, Coimbra (Portugal); Coimbra' s Hospital Centre and University, Medical Imaging Department, Coimbra (Portugal); Joao Ferreira, Maria [University of Coimbra, Faculty of Medicine, Coimbra (Portugal); Coimbra' s Hospital Centre and University, Cardiology Department, Coimbra (Portugal); Gomes, Leonor [University of Coimbra, Faculty of Medicine, Coimbra (Portugal); Coimbra' s Hospital Centre and University, Endocrinology Department, Coimbra (Portugal); Castelo-Branco, Miguel [University of Coimbra, Faculty of Medicine, Coimbra (Portugal)

    2014-11-15

    The left atrium (LA) modulates left ventricular filling through reservoir, conduit and booster pump functions. Only limited data exist on LA involvement in type 2 diabetes mellitus (DM2). This study sought to assess LA function in asymptomatic DM2 with cardiac MRI. We hypothesized that cardiac MRI can detect LA dysfunction in asymptomatic DM2. Forty-five patients with asymptomatic DM2 and 24 normoglycaemic controls were studied. MRI cine imaging was performed to measure LA maximal and minimal volumes. A flow-sensitive phase-contrast gradient-echo sequence was used for flow measurements perpendicular to the orifice of the mitral valve, to quantify active LA stroke volume. LA total, passive and active emptying volumes and fractions were calculated. LA reservoir function, namely LA total ejection fraction, was significantly greater in controls compared to patients with DM2 (62.2 ± 5.2 vs 57.0 ± 7.6 %, P = 0.004). LA passive ejection fraction was also greater in the controls (26.2 ± 9.5 vs 16.1 ± 11.0 %, P < 0.001). Regarding parameters of LA booster pump function, LA active ejection fraction was not significantly different between groups. DM2 was demonstrated to be an independent determinant of LA function. Cardiac MRI enables the detection of LA dysfunction in asymptomatic DM2, characterized by a reduction in LA reservoir and conduit functions. (orig.)

  20. Segmentation of Fetal Left Ventricle in Echocardiographic Sequences Based on Dynamic Convolutional Neural Networks.

    Science.gov (United States)

    Yu, Li; Guo, Yi; Wang, Yuanyuan; Yu, Jinhua; Chen, Ping

    2017-08-01

    Segmentation of fetal left ventricle (LV) in echocardiographic sequences is important for further quantitative analysis of fetal cardiac function. However, image gross inhomogeneities and fetal random movements make the segmentation a challenging problem. In this paper, a dynamic convolutional neural networks (CNN) based on multiscale information and fine-tuning is proposed for fetal LV segmentation. The CNN is pretrained by amount of labeled training data. In the segmentation, the first frame of each echocardiographic sequence is delineated manually. The dynamic CNN is fine-tuned by deep tuning with the first frame and shallow tuning with the rest of frames, respectively, to adapt to the individual fetus. Additionally, to separate the connection region between LV and left atrium (LA), a matching approach, which consists of block matching and line matching, is used for mitral valve (MV) base points tracking. Advantages of our proposed method are compared with an active contour model (ACM), a dynamical appearance model (DAM), and a fixed multiscale CNN method. Experimental results in 51 echocardiographic sequences show that the segmentation results agree well with the ground truth, especially in the cases with leakage, blurry boundaries, and subject-to-subject variations. The CNN architecture can be simple, and the dynamic fine-tuning is efficient.

  1. Left main percutaneous coronary intervention.

    Science.gov (United States)

    Teirstein, Paul S; Price, Matthew J

    2012-10-23

    The introduction of drug-eluting stents and advances in catheter techniques have led to increasing acceptance of percutaneous coronary intervention (PCI) as a viable alternative to coronary artery bypass graft (CABG) for unprotected left main disease. Current guidelines state that it is reasonable to consider unprotected left main PCI in patients with low to intermediate anatomic complexity who are at increased surgical risk. Data from randomized trials involving patients who are candidates for either treatment strategy provide novel insight into the relative safety and efficacy of PCI for this lesion subset. Herein, we review the current data comparing PCI with CABG for left main disease, summarize recent guideline recommendations, and provide an update on technical considerations that may optimize clinical outcomes in left main PCI. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. Left bundle-branch block

    DEFF Research Database (Denmark)

    Risum, Niels; Strauss, David; Sogaard, Peter

    2013-01-01

    The relationship between myocardial electrical activation by electrocardiogram (ECG) and mechanical contraction by echocardiography in left bundle-branch block (LBBB) has never been clearly demonstrated. New strict criteria for LBBB based on a fundamental understanding of physiology have recently...

  3. Dabigatran for left ventricular thrombus

    Directory of Open Access Journals (Sweden)

    Satishkumar Kolekar

    2015-09-01

    Dabigatran is a reversible direct thrombin inhibitor and currently approved for the prevention of thromboembolic episodes in non-valvar atrial fibrillation. This case demonstrates possible thrombolytic properties of dabigatran in resolution of left ventricular thrombus.

  4. Apraxia in left-handers.

    Science.gov (United States)

    Goldenberg, Georg

    2013-08-01

    In typical right-handed patients both apraxia and aphasia are caused by damage to the left hemisphere, which also controls the dominant right hand. In left-handed subjects the lateralities of language and of control of the dominant hand can dissociate. This permits disentangling the association of apraxia with aphasia from that with handedness. Pantomime of tool use, actual tool use and imitation of meaningless hand and finger postures were examined in 50 consecutive left-handed subjects with unilateral hemisphere lesions. There were three aphasic patients with pervasive apraxia caused by left-sided lesions. As the dominant hand is controlled by the right hemisphere, they constitute dissociations of apraxia from handedness. Conversely there were also three patients with pervasive apraxia caused by right brain lesions without aphasia. They constitute dissociations of apraxia from aphasia. Across the whole group of patients dissociations from handedness and from aphasia were observed for all manifestations of apraxia, but their frequency depended on the type of apraxia. Defective pantomime and defective tool use occurred rarely without aphasia, whereas defective imitation of hand, but not finger, postures was more frequent after right than left brain damage. The higher incidence of defective imitation of hand postures in right brain damage was mainly due to patients who had also hemi-neglect. This interaction alerts to the possibility that the association of right hemisphere damage with apraxia has to do with spatial aptitudes of the right hemisphere rather than with its control of the dominant left hand. Comparison with data from right-handed patients showed no differences between the severity of apraxia for imitation of hand or finger postures, but impairment on pantomime of tool use was milder in apraxic left-handers than in apraxic right-handers. This alleviation of the severity of apraxia corresponded with a similar alleviation of the severity of aphasia as

  5. Left ventricular apical ballooning syndrome

    International Nuclear Information System (INIS)

    Rahman, N.; Tai, J.; Soofi, A.

    2007-01-01

    The transient left ventricular apical ballooning syndrome, also known as Takotsubo cardiomyopathy, is characterized by transient left ventricular dysfunction in the absence of obstructive epicardial coronary disease. Although the syndrome has been reported in Japan since 1990, it is rare in other regions. Rapid recognition of the syndrome can modify the diagnostic and therapeutic attitude i.e. avoiding thrombolysis and performing catheterization in the acute phase. (author)

  6. Left Main Coronary Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Hossein Doustkami

    2016-07-01

    Full Text Available Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. The most common cause of coronary artery aneurysms is atherosclerosis. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of the coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgically or pharmacologically. We herein report a case of left main coronary artery aneurysm in a 72-year-old man with a prior history of hypertension presenting to our hospital because of unstable angina. The electrocardiogram showed ST-segment depression and T-wave inversion in the precordial leads. All the data of blood chemistry were normal. Echocardiography showed akinetic anterior wall, septum, and apex, mild mitral regurgitation and ejection fraction of 45%. Coronary angiography revealed a saccular aneurysm of the left main coronary artery with significant stenosis in the left anterior descending, left circumflex, and right coronary artery. The patient immediately underwent coronary artery bypass grafting and ligation of the aneurysm. At six months’ follow-up, he remained asymptomatic.

  7. Right colon cancer: Left behind.

    Science.gov (United States)

    Gervaz, P; Usel, M; Rapiti, E; Chappuis, P; Neyroud-Kaspar, I; Bouchardy, C

    2016-09-01

    Prognosis of colon cancer (CC) has steadily improved during the past three decades. This trend, however, may vary according to proximal (right) or distal (left) tumor location. We studied if improvement in survival was greater for left than for right CC. We included all CC recorded at the Geneva population-based registry between 1980 and 2006. We compared patients, tumor and treatment characteristics between left and right CC by logistic regression and compared CC specific survival by Cox models taking into account putative confounders. We also compared changes in survival between CC location in early and late years of observation. Among the 3396 CC patients, 1334 (39%) had right-sided and 2062 (61%) left-sided tumors. In the early 1980s, 5-year specific survival was identical for right and left CCs (49% vs. 48%). During the study period, a dramatic improvement in survival was observed for patients with left-sided cancers (Hazard ratio [HR]: 0.42, 95% confidence interval [CI]: 0.29-0.62, p colon cancer patients, those with right-sided lesions have by far the worse prognosis. Change of strategic management in this subgroup is warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Predictors for cardiac resynchronization therapy response: the importance of QRS morphology and left ventricular lead position.

    Science.gov (United States)

    Lin, Haiyan; Zhou, Ying; Xu, Geng

    2014-01-01

    Although cardiac resynchronization therapy (CRT) is a well-established treatment for a subset of patients with chronic heart failure, a considerable proportion of eligible patients still fail to benefit from this treatment. The aim of this study was to identify potential independent predictors for being a responder to CRT. A single-center, retrospective analysis was conducted in 193 consecutive patients with heart failure and wide QRS complex who successfully underwent CRT device implantation from January 2006 to October 2012. Clinical characteristics, left ventricular lead position (LV-Ps), electrocardiography and echocardiography were evaluated before and 12 months after CRT. Response to CRT was defined as an absolute increase of ≥ 5% in left ventricular ejection fraction (LVEF) compared with baseline at 12 months after CRT implantation without heart failure rehospitalization or any cause of death. There were 132 responders (68%) and 61 nonresponders (32%). By univariate logistic analysis, the presence of non-left bundle branch block (non-LBBB) and QRS duration, chronic atrial fibrillation (AF), history of ventricular tachycardia (VT), degree of tricuspid regurgitation and left atrium dimension (LAD) at baseline, ΔQRS duration, and LV-Ps were associated with predicting a response to CRT. However, on multivariate analysis, only optimal LV-Ps and presence of non-LBBB remained independently predictive for a CRT response, with an odds ratio of 2.53 (95% confidence interval [CI]: 1.13-5.66, P = 0.023), 0.15(95% CI: 0.05-0.45, P = 0.001), respectively. Kaplan-Meier analysis revealed that patients with nonoptimal LV-Ps or non-LBBB morphology had a significantly higher rate of mortality or heart failure rehospitalization as compared with those with optimal LV-Ps or LBBB morphology (P < 0.05).

  9. Aphasia following left thalamic hemorrhage

    International Nuclear Information System (INIS)

    Makishita, Hideo; Miyasaka, Motomaro; Tanizaki, Yoshio; Yanagisawa, Nobuo; Sugishita, Morihiro.

    1984-01-01

    We reported 7 patients with left thalamic hemorrhage in the chronic stage (from 1.5 months to 4.5 months), and described language disorders examined by Western Aphasia Battery (WAB) and measured cerebral blood flow by single photon emission CT. Examination of language by WAB revealed 4 aphasics out of 7 cases, and 3 patients had no language deficit. The patient with Wernicke's aphasia showed low density area only in the left posterior thalamus in X-ray CT, and revealed severe low blood flow area extending to left temporal lobe in emission CT. In the case with transcortical sensory aphasia, although X-ray CT showed no obvious low density area, emission CT revealed moderate low flow area in watershed area that involved the territory between posterior cerebral and middle cerebral arteries in the left temporooccipital region in addition to low blood flow at the left thalamus. In one of the two patients classified as anomic aphasia, whose score of repetition (8.4) was higher than that of comprehension (7.4), emission CT showed slight low flow area at the temporo-occipital region similarly as the case with transcortical sensory aphasia. In another case with anomic aphasia, scored 9 on both fluensy and comprehension subtests and 10 on repetition, there was wide low density area all over the left thalamus and midline shift to the right in X-ray CT, and emission CT showed severe low blood flow in the same region spreading widely toward the cerebral surface. On the other hand, in all of the 3 patients without aphasia, emission CT showed low flow region restricted to the left thalamus. (J.P.N.)

  10. Optimized guidance of percutaneous edge-to edge repair of the mitral valve using real-time 3-D transesophageal echocardiography.

    Science.gov (United States)

    Altiok, Ertunc; Becker, Michael; Hamada, Sandra; Reith, Sebastian; Marx, Nikolaus; Hoffmann, Rainer

    2011-08-01

    Percutaneous edge-to-edge repair with the MitraClip device has been shown to allow effective treatment of mitral regurgitation. It is mainly guided by transesophageal echocardiography while fluoroscopic guidance is of less importance. The impact of real-time three-dimensional transesophageal echocardiography (RT 3-D TEE) for guidance of this complex interventional procedure has not been evaluated. In 28 high-surgical risk patients with moderate or severe mitral regurgitation (mean age 67 ± 10 years; 15 male), 2-D and RT 3-D TEE were used for the guidance of percutaneous edge-to-edge mitral valve repair using the MitraClip device. We performed a structured analysis to compare information and guidance capacity provided by RT 3-D TEE compared to 2-D TEE. RT 3-D TEE was found to provide advantages in 9 of 11 steps of the percutaneous mitral repair procedure. The advantages related to optimized definition of the transseptal puncture site, improved guidance of the clip delivery system towards the mitral valve, precise positioning of the clip delivery system simultaneously in anterior-posterior and lateral-medial direction above the mitral valve considering mitral valve scallops A2 and P2 and valvular regurgitation jet position, adjustment of the opened clip-arms perpendicular to the commissural line, visualization of the clip position relative to the valvular orifice and of the remaining regurgitant jet after clip closure from atrial as well as ventricular views providing double orifice images and thereby allowing confirmation or rejection of clip position in medial-lateral direction. RT 3-D TEE was inferior to 2-D TEE for leaflet grasping and analysis of leaflet insertion. In complex interventional edge-to-edge repair with the MitraClip device requiring optimal spatial information RT 3-D TEE allows improved guidance of the procedure. RT 3-D TEE guidance compared with 2-D TEE guidance alone resulted in greater operator confidence to adequately perform the procedure.

  11. Pre-operative Tei Index does not predict left ventricular function immediately after mitral valve repair

    Directory of Open Access Journals (Sweden)

    Chirojit Mukherjee

    2012-01-01

    Full Text Available Echocardiographic assessment of systolic left ventricular (LV function in patients with severe mitral regurgitation (MR undergoing mitral valve (MV repair can be challenging because the measurement of ejection fraction (EF or fractional area change (FAC in pathological states is of questionable value. The aim of our study was to evaluate the usefulness of the pre-operative Tei Index in predicting left ventricular EF or FAC immediately after MV repair. One hundred and thirty patients undergoing MV repair with sinus rhythm pre- and post-operatively were enrolled in this prospective study. Twenty-six patients were excluded due to absence of sinus rhythm post-operatively. Standard transesophageal examination(IE 33,Philips,Netherlands was performed before and after cardiopulmonary bypass according to the guidelines of the ASE/SCA. FAC was determined in the transgastric midpapillary short-axis view. LV EF was measured in the midesophageal four- and two-chamber view. For calculation of the Tei Index, the deep transgastric and the midesophageal four-chamber view were used. Statistical analysis was performed with SPSS 17.0. values are expressed as mean with standard deviation. LV FAC and EF decreased significantly after MV repair (FAC: 56±12% vs. 50±14%, P<0.001; EF: 58±11 vs. 50±12Έ P<0.001. The Tei Index decreased from 0.66±0.23 before MV repair to 0.41±0.19 afterwards (P<0.001. No relationship between pre-operative Tei Index and post-operative FAC or post-operative EF were found (FAC: r=−0.061, P=0.554; EF: r=−0.29, P=0.771. Conclusion: Pre-operative Tei Index is not a good predictor for post-operative FAC and EF in patients undergoing MV repair.

  12. Left Atrial Appendage Closure Guided by Integrated Echocardiography and Fluoroscopy Imaging Reduces Radiation Exposure.

    Directory of Open Access Journals (Sweden)

    Christiane Jungen

    Full Text Available To investigate whether percutaneous left atrial appendage (LAA closure guided by automated real-time integration of 2D-/3D-transesophageal echocardiography (TEE and fluoroscopy imaging results in decreased radiation exposure.In this open-label single-center study LAA closure (AmplatzerTM Cardiac Plug was performed in 34 consecutive patients (8 women; 73.1±8.5 years with (n = 17, EN+ or without (n = 17, EN- integrated echocardiography/fluoroscopy imaging guidance (EchoNavigator® [EN]; Philips Healthcare. There were no significant differences in baseline characteristics between both groups. Successful LAA closure was documented in all patients. Radiation dose was reduced in the EN+ group about 52% (EN+: 48.5±30.7 vs. EN-: 93.9±64.4 Gy/cm2; p = 0.01. Corresponding to the radiation dose fluoroscopy time was reduced (EN+: 16.7±7 vs. EN-: 24.0±11.4 min; p = 0.035. These advantages were not at the cost of increased procedure time (89.6±28.8 vs. 90.1±30.2 min; p = 0.96 or periprocedural complications. Contrast media amount was comparable between both groups (172.3±92.7 vs. 197.5±127.8 ml; p = 0.53. During short-term follow-up of at least 3 months (mean: 8.1±5.9 months no device-related events occurred.Automated real-time integration of echocardiography and fluoroscopy can be incorporated into procedural work-flow of percutaneous left atrial appendage closure without prolonging procedure time. This approach results in a relevant reduction of radiation exposure.ClinicalTrials.gov NCT01262508.

  13. Left Atrial Appendage Closure Guided by Integrated Echocardiography and Fluoroscopy Imaging Reduces Radiation Exposure

    Science.gov (United States)

    Balzer, Jan; Eickholt, Christian; Petersen, Margot; Kehmeier, Eva; Veulemans, Verena; Kelm, Malte; Willems, Stephan; Meyer, Christian

    2015-01-01

    Aims To investigate whether percutaneous left atrial appendage (LAA) closure guided by automated real-time integration of 2D-/3D-transesophageal echocardiography (TEE) and fluoroscopy imaging results in decreased radiation exposure. Methods and Results In this open-label single-center study LAA closure (AmplatzerTM Cardiac Plug) was performed in 34 consecutive patients (8 women; 73.1±8.5 years) with (n = 17, EN+) or without (n = 17, EN-) integrated echocardiography/fluoroscopy imaging guidance (EchoNavigator® [EN]; Philips Healthcare). There were no significant differences in baseline characteristics between both groups. Successful LAA closure was documented in all patients. Radiation dose was reduced in the EN+ group about 52% (EN+: 48.5±30.7 vs. EN-: 93.9±64.4 Gy/cm2; p = 0.01). Corresponding to the radiation dose fluoroscopy time was reduced (EN+: 16.7±7 vs. EN-: 24.0±11.4 min; p = 0.035). These advantages were not at the cost of increased procedure time (89.6±28.8 vs. 90.1±30.2 min; p = 0.96) or periprocedural complications. Contrast media amount was comparable between both groups (172.3±92.7 vs. 197.5±127.8 ml; p = 0.53). During short-term follow-up of at least 3 months (mean: 8.1±5.9 months) no device-related events occurred. Conclusions Automated real-time integration of echocardiography and fluoroscopy can be incorporated into procedural work-flow of percutaneous left atrial appendage closure without prolonging procedure time. This approach results in a relevant reduction of radiation exposure. Trial Registration ClinicalTrials.gov NCT01262508 PMID:26465747

  14. Echocardiography-based hemodynamic management of left ventricular diastolic dysfunction: a feasibility and safety study.

    Science.gov (United States)

    Shillcutt, Sasha K; Montzingo, Candice R; Agrawal, Ankit; Khaleel, Maseeha S; Therrien, Stacey L; Thomas, Walker R; Porter, Thomas R; Brakke, Tara R

    2014-11-01

    Patients with left ventricular diastolic dysfunction (LVDD) are at increased risk of postoperative adverse events. The primary aim of this study was to evaluate the safety and feasibility of using echocardiography-guided hemodynamic management (EGHEM) during surgery in subjects with LVDD compared to conventional management. The feasibility of using echocardiography to direct a treatment algorithm and clinical outcomes were compared for safety between groups. Subjects were screened for LVDD by preoperative transthoracic echocardiography (TTE) and randomized to the conventional or EGHEM group. Subjects in EGHEM received hemodynamic management based on left ventricular filling patterns on transesophageal echocardiography (TEE). Primary outcomes measured were the feasibility to obtain TEE images and follow a TEE-based treatment algorithm. Safety outcomes also compared the following clinical differences between groups: length of hospitalization, incidence of atrial fibrillation, congestive heart failure (CHF), myocardial infarction, cerebrovascular accident, transient ischemic attack and renal failure measured 30 days postoperatively. Population consisted of 28 surgical subjects (14 in conventional group and 14 in EGHEM group). Mean subject age was 73.4 ± 6.7 years (36% male) in conventional group and 65.9 ± 14.4 years (36% male) in EGHEM group. Procedures included orthopedic (conventional = 29%, EGHEM 36%), general (conventional = 50%, EGHEM = 36%), vascular (conventional = 7%, EGHEM = 21%), and thoracic (conventional = 14%, EGHEM = 7%). There was no statistically significant difference in adverse clinical events between the 2 groups. The EGHEM group had less CHF, atrial fibrillation, and shorter length of stay. Echocardiography-guided hemodynamic management of patients with LVDD during surgery is feasible and may be a safe alternative to conventional management. © 2014, Wiley Periodicals, Inc.

  15. Obstructive Thrombosis of Left-Sided Mechanical Heart Valves: Clinical Profile and Thrombolytic Therapy.

    Science.gov (United States)

    Chandrakasu, Arumugam; Jayachandran, Avinash; Gopinath Nayar, Pradeep; Meyyappan, Chokkalingam; Narayan, Ganesh; Basha Abdul Bari, Ahamed; Johnson Samuel, Prince

    2017-05-01

    Thrombosis of a mechanical prosthetic heart valve is a potentially life-threatening complication associated with a high mortality. Although thrombolytic therapy has been considered highly beneficial in this situation, very few studies have been conducted to monitor the effectiveness of such thrombolytic therapy among Asian populations. Hence, the study aim was to evaluate the clinical profile, efficacy and safety of the thrombolytic agent streptokinase (SK) in patients with obstructive thrombosis of a left-sided mechanical heart valve. Patients (n = 30) with left-sided mechanical heart valve thrombosis (LSMHVT) who had been managed with SK during the past four years were included in this retrospective study. Clinical features such as presenting symptoms based on NYHA functional class, prosthetic valve position, oral anticoagulant compliance, International Normalized Ratio (INR) and imaging methods including fluoroscopy, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were evaluated. In addition, the effectiveness and complications of SK were analyzed. The majority of patients presented with advanced NYHA class (III and IV, each 40%). Obstructive thromboses were observed at the mitral prosthesis in 70% of cases, at the aortic prosthesis in 27%, and at both valves in 3%. All patients underwent TTE, but fluoroscopy was used more often than TEE. Despite compliance with oral anticoagulation therapy, a sub-therapeutic INR was observed in 40% of cases at the time of presentation. Overall, thrombolysis was successful in 80% of patients using intravenous SK, with 100% success in patients in NYHA classes I-III and 42% for NYHA class IV. Moreover, embolic complications occurred in only a small number of patients. In patients with obstructive thrombosis of LSMHVT, intravenous SK was effective and should be considered as first choice in patients in NYHA classes I-III, and as an acceptable alternative in those in NYHA class IV.

  16. Body surface localization of left and right atrial high-frequency rotors in atrial fibrillation patients: a clinical-computational study.

    Science.gov (United States)

    Rodrigo, Miguel; Guillem, María S; Climent, Andreu M; Pedrón-Torrecilla, Jorge; Liberos, Alejandro; Millet, José; Fernández-Avilés, Francisco; Atienza, Felipe; Berenfeld, Omer

    2014-09-01

    Ablation is an effective therapy in patients with atrial fibrillation (AF) in which an electrical driver can be identified. The aim of this study was to present and discuss a novel and strictly noninvasive approach to map and identify atrial regions responsible for AF perpetuation. Surface potential recordings of 14 patients with AF were recorded using a 67-lead recording system. Singularity points (SPs) were identified in surface phase maps after band-pass filtering at the highest dominant frequency (HDF). Mathematical models of combined atria and torso were constructed and used to investigate the ability of surface phase maps to estimate rotor activity in the atrial wall. The simulations show that surface SPs originate at atrial SPs, but not all atrial SPs are reflected at the surface. Stable SPs were found in AF signals during 8.3% ± 5.7% vs. 73.1% ± 16.8% of the time in unfiltered vs. HDF-filtered patient data, respectively (P surface HDF rotors by reducing the effect of the atrial electrical activity occurring at different frequencies. Torso surface SPs representing HDF rotors during AF were reflected at specific areas corresponding to the fastest atrial location. Phase analysis of surface potential signals after HDF filtering during AF shows reentrant drivers localized to either the left atrium or the right atrium, helping in localizing ablation targets. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  17. Cardiac leiomyosarcoma, a case report

    DEFF Research Database (Denmark)

    Andersen, Rikke; Kristensen, Bjarne W; Gill, Sabine

    2013-01-01

    In this case report we present the history of a patient admitted with recurrent pulmonary edema. Transesophageal chocardiography showed a tumour in the left atrium, occluding the ostium of the mitral valve and mimicking intermittent mitral stenosis. Cardiac surgery followed by pathological...... examination revealed that the tumour was a leiomyosarcoma. Images from the echocardiography as well as the pathological findings are shown and discussed. The present case report illustrates that atrial tumors comprise also sarcomas, suggesting the use of careful, rapid diagnostic procedures and treatment...

  18. Negative inotropic and chronotropic effects on the guinea pig atrium of extracts obtained from Averrhoa carambola L. leaves

    Directory of Open Access Journals (Sweden)

    Vasconcelos C.M.L.

    2005-01-01

    Full Text Available It has been reported that star fruit can lead to a fatal outcome in uremic patients. The intoxication syndrome consists of hiccups, mental confusion, dizziness, and vomiting. On the other hand, folk medicine uses teas and infusions of carambola leaves to treat headache, vomiting, cough, insomnia, and diabetes. This motivated us to determine if Averrhoa carambola can act on the contractility and automaticity of the guinea pig heart. We measured the atrial isometric force in stimulated left atria and determined the chronotropic changes in spontaneously beating right atria. The carambola leaf extracts (1.5 mg/ml abolished the contractile force in a concentration-dependent manner. Among the crude, methanolic, ethanolic, aqueous, and acetic extracts, the aqueous one was the most potent (EC50 = 520 ± 94 µg/ml; flavonoids and tannins are the main constituents; Na+ and K+ contents in 1.0 mg/ml of aqueous extract were 0.12 ± 0.016 and 1.19 ± 0.15 mM, respectively. The aqueous extract abolished the positive Bowditch staircase phenomenon and reduced the inotropic response to CaCl2 (0.17-8.22 mM, events that are dependent on the cellular Ca2+ inward current. The adrenergic, muscarinic or opioid membrane receptors do not seem to participate in the mechanism of action of the cardioactive substance(s. In spontaneously beating atria, the aqueous extract promoted a negative chronotropic effect that was antagonized by 0.1 µM isoproterenol bitartrate. With this agonist, the EC50 of the aqueous extract increased from 133 ± 58 to 650 ± 100 µg/ml. These data regarding the effect of A. carambola on guinea pig atrial contractility and automaticity indicate an L-type Ca2+ channel blockade.

  19. Fully automatic segmentation of the mitral leaflets in 3D transesophageal echocardiographic images using multi-atlas joint label fusion and deformable medial modeling.

    Science.gov (United States)

    Pouch, A M; Wang, H; Takabe, M; Jackson, B M; Gorman, J H; Gorman, R C; Yushkevich, P A; Sehgal, C M

    2014-01-01

    Comprehensive visual and quantitative analysis of in vivo human mitral valve morphology is central to the diagnosis and surgical treatment of mitral valve disease. Real-time 3D transesophageal echocardiography (3D TEE) is a practical, highly informative imaging modality for examining the mitral valve in a clinical setting. To facilitate visual and quantitative 3D TEE image analysis, we describe a fully automated method for segmenting the mitral leaflets in 3D TEE image data. The algorithm integrates complementary probabilistic segmentation and shape modeling techniques (multi-atlas joint label fusion and deformable modeling with continuous medial representation) to automatically generate 3D geometric models of the mitral leaflets from 3D TEE image data. These models are unique in that they establish a shape-based coordinate system on the valves of different subjects and represent the leaflets volumetrically, as structures with locally varying thickness. In this work, expert image analysis is the gold standard for evaluating automatic segmentation. Without any user interaction, we demonstrate that the automatic segmentation method accurately captures patient-specific leaflet geometry at both systole and diastole in 3D TEE data acquired from a mixed population of subjects with normal valve morphology and mitral valve disease. Copyright © 2013 Elsevier B.V. All rights reserved.

  20. Guidelines of the Indian Association of Cardiovascular and Thoracic Anaesthesiologists and Indian College of Cardiac Anaesthesia for perioperative transesophageal echocardiography fellowship examination

    Directory of Open Access Journals (Sweden)

    Kanchi Muralidhar

    2016-01-01

    Full Text Available During current medical care, perioperative transesophageal echocardiography (TEE has become a vital component of patient management, especially in cardiac operating rooms and in critical care medicine. Information derived from echocardiography has an important bearing on the patient′s outcome. The Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA has promoted the use of TEE during routine clinical care of patients undergoing cardiac surgery. An important mission of IACTA is to oversee training and certify anesthesiologists in the perioperative and intensive care use of TEE. The provision of "Fellowship" is by way of conducting IACTA - TEE fellowship (F-TEE examination. This has been done annually for the past 7 years using well-established curriculums by accredited national and international societies. Now, with the transformation and reconstitution of IACTA education and research cell into the newly formed Indian College of Cardiac Anaesthesia, F-TEE is bound to meet international standards. To ensure that the examinations are conducted in a transparent and foolproof manner, the guideline committee (formulated in 2010 of IACTA has taken the onus of formulating the guidelines for the same. These guidelines have been formally reviewed and updated since 2010 and are detailed here to serve as a guide to both the examinee and examiner ensuring standardization, efficiency, and competency of the IACTA F-TEE certification process.

  1. Usefulness of three-dimensional transesophageal echocardiography for diagnosis of hemolytic anemia due to inverted internal felt strip after surgery for aortic dissection.

    Science.gov (United States)

    Oda, Takeshi; Yasunaga, Hiroshi; Zaima, Yasuyuki; Arimura, Akiko; Imai, Shinichi; Kanamoto, Ryo; Fukuda, Hayato; Nakamura, Eiji; Tashiro, Hideki; Aoyagi, Shigeaki

    2017-04-01

    Felt strips are widely used for reinforcement of the aortic stump in surgery for aortic dissection (AD). Postoperative hemolytic anemia (HA) due to an inverted internal felt strip at the aortic stump fixation for AD is extremely rare. A 70-year-old woman underwent ascending aorta replacement for acute type A AD, where both proximal and distal anastomotic sites were reinforced with Teflon felt strips. A week later, macroscopic hematuria and HA emerged. Three-dimensional transesophageal echocardiography (3D-TEE) demonstrated that the proximal inner felt strip turned up and protruded into the aortic inner lumen. At redo surgery, which was performed 2 weeks after the initial surgery, the findings of 3D-TEE were confirmed, and the inverted internal felt strip was replaced with a bovine pericardial strip. The findings of HA disappeared immediately after the second surgery. 3D-TEE is a very informative, valuable modality for accurate diagnosis that leads to a safe surgery.

  2. Warden repair for superior sinus venosus atrial septal defect and anomalous pulmonary venous drainage in children: Anesthesia and transesophageal echocardiography perspective

    Directory of Open Access Journals (Sweden)

    Neelam Aggarwal

    2016-01-01

    Full Text Available Objective: Review of intraoperative anesthetic challenges and the role of transesophageal echocardiography in children with sinus venosus atrial septal defect and partial anomalous pulmonary venous drainage undergoing Warden repair. Design: A retrospective observational case series. Methodolgy: Pediatric patients who underwent Warden repair between October 2011-September 2015 were recruited. Their preoperative clinical details, anesthetic techniques, intraoperative TEE findings and postoperative events were recorded from the medical records. The categorical variables and the continuous variables were expressed as number (percentages and mean ΁ SD respectively. Results: A total of 35 patients were operated for Warden repair during the study period. Anesthesia was induced with the aim to prevent any fall in pulmonary vascular resistance. The right internal jugular vein was cannulated under ultrasound guidance using a short length cannula to monitor right superior vena cava pressure. Intraoperative TEE revealed the drainage of PAPVC high into RSVC in 22 patients. Persistent LSVC was found in 9 patients. After repair, TEE imaging detected a high gradient at Warden anastomotic site in 5 patients and 3 of them required revision of surgery. Rerouted pulmonary veins required surgical correction in 2 patients in view of obstruction. None of them had pulmonary venous and SVC obstruction in the postoperative period. Conclusion: The primary aim of anesthesia is to avoid any fall in PVR. Right IJV cannulation can be beneficial. The intraoperative TEE can help in delineating the anatomy of lesion and detecting anastomotic site obstruction.

  3. Left Activism, Succour and Selfhood

    DEFF Research Database (Denmark)

    Hughes, Celia Penelope

    2014-01-01

    an interchange of motherhood, domesticity, far-left politics, and close female friendship. The article will show how the women's epistolary friendship offers intimate insight into female self-fashioning at a breakthrough social and political moment in 1970s Britain. As they reflected on some of the key political...

  4. Limb ischemia, an alarm signal to a thromboembolic cascade - renal infarction and nephrectomy followed by surgical suppression of the left atrial appendage.

    Science.gov (United States)

    Caraşca, Cosmin; Borda, Angela; Incze, Alexandru; Caraşca, Emilian; Frigy, Attila; Suciu, HoraŢiu

    2016-01-01

    We present the case of a 55-year-old male with mild hypertension and brief episodes of paroxysmal self-limiting atrial fibrillation (AF) since 2010. Despite a small cardioembolic risk score, CHA2DS2-Vasc=1 (Congestive heart failure, Hypertension, Age=75, Diabetes melitus, prior Stroke), the patient is effectively anticoagulated using acenocumarol. In December 2014, he showed signs of plantar transitory ischemia, for which he did not address the doctor. In early January 2015, he urgently presented at the hospital with left renal pain, caused by a renal infarction, diagnosed by computed tomography (CT) angiography. Left nephrectomy was performed with pathological confirmation. He was discharged with effective anticoagulation treatment. Within the next two weeks, he suffered a transitory ischemic event and a stroke, associated with right sided hemiparesis. On admission, AF was found and converted to sinus rhythm with effective anticoagulation - international normalized ratio (INR) of 2.12. Transthoracic echocardiography detected no pathological findings. Transesophageal echocardiography showed an expended left atrial appendage (LAA) with a slow blood flow (0.2 m÷s) and spontaneous echocontrast. Considering these clinical circumstances, surgical LAA suppression was decided on as a last therapeutic resort. Postoperative evolution was favorable; the patient is still free of ischemic events, one year post-intervention. Some morphological and hemodynamic characteristics of LAA may add additional thromboembolic risk factors, not included in scores. Removing them by surgical LAA suppression may decrease the risk of cardioembolic events. Intraoperative presence of thrombus makes it an indisputable proof.

  5. Left atrial dilatation in systolic heart failure: a marker of poor prognosis, not just a buffer between the left ventricle and pulmonary circulation.

    Science.gov (United States)

    Rossi, A; Dini, F L; Agricola, E; Faggiano, P; Benfari, G; Temporelli, P L; Cucco, C; Scelsi, L; Vassanelli, C; Ghio, S

    2018-02-23

    The relation between systolic pulmonary pressure (sPAP) and left atrium in patients with heart failure (HF) is unclear. Diastolic dysfunction, expressed as restrictive mitral filling pattern (RMP), and functional mitral regurgitation (FMR) are associated with both LA enlargement and increased sPAP. We aimed to evaluate whether atrial dilation might modulate the consequences of RMP and FMR on the pulmonary circulation of patients with HF with reduced ejection fraction (HFrEF). 1256 HFrEF patients were retrospectively recruited in four Italian centers. Left ventricular (LVD) and atrial (LAD) diameters were measure by m-mode, and EF were measured. RMP was defined as E-wave deceleration time lower than 140 ms. FMR was quantitatively measured. sPAP was evaluated based on maximal tricuspid regurgitant velocity and estimated right atrial pressure. Final study population was formed by 1005 patients because of unavailability of sPAP in 252 patients. Mean EF was 33 ± 3, 35% had RMP, 67% had mild, and 26% moderate-to-severe FMR. 69% of patients had increased sPAP. A significant association was observed between sPAP and EF, RMP, FMR, and LAD (p < 0.0001 for all). At multivariate analysis, LAD was positively associated with sPAP (p < 0.0001) independently of EF, RMP, and FMR. Analogously, LAD (p < 0.05) was associated with more severe symptoms and worse prognosis after adjustment for LV function and FMR. LA dilation was positively associated with sPAP independently of EF, RMP, and FMR. This highlights that LA size should be considered a marker of the severity of the disease.

  6. Association of Preoperative Right and Left Ventricular Diastolic Dysfunction With Postoperative Atrial Fibrillation in Patients Undergoing Lung Surgery: A Prospective Observational Study.

    Science.gov (United States)

    Mita, Norikatsu; Kuroda, Masataka; Miyoshi, Sohtaro; Saito, Shigeru

    2017-04-01

    To clarify the relationship between right and left ventricular (RV and LV) diastolic function and postoperative atrial fibrillation (POAF). The early effects of major lung surgery on cardiac function in the intraoperative period during lung surgery were evaluated, using transesophageal echocardiography. Single-center prospective observational study. A public hospital. Patients undergoing elective lobectomy with lymph node dissection for lung cancer (n = 116). Transesophageal echocardiography examination was performed under general anesthesia before skin incision (preoperative) and after chest closure (postoperative). According to measured echocardiographic variables, ventricular systolic and diastolic functions were classified at each time point. Of the 116 patients, 24 (20.7%) experienced POAF. Preoperative RV and LV diastolic dysfunction were more common in patients with POAF than in those without POAF (58.3 v 28.3%, p = 0.008; 54.2 v 19.6%, p = 0.001, respectively). Among patients without preoperative diastolic dysfunction, a small number developed RV and LV diastolic dysfunction immediately after surgery (9.2% and 16.5%, respectively) and these distributions were comparable between patients with POAF and those without POAF. RV systolic dysfunction was observed in 6.5% of patients immediately after surgery and was not related to the occurrence of POAF. Multivariate analysis revealed older age, chronic obstructive pulmonary disease (COPD), and preoperative biventricular diastolic dysfunction as risk factors for POAF. Preoperative biventricular diastolic dysfunction, as well as older age and COPD, are associated with POAF in patients undergoing lobectomy. Major lung surgery has minimal early effects on postoperative systolic and diastolic functions. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Left ventricular diastolic performance of left ventricular hypertrophy

    Energy Technology Data Exchange (ETDEWEB)

    Ikezono, Tohru; Ozaki, Masaharu; Yamagishi, Takashi; Shimizu, Tatsuro; Furutani, Yuji; Kusukawa, Reizo

    1987-02-01

    To study left ventricular diastolic performance in different forms of left ventricular hypertrophy, ECG gated cardiac blood pool scan was performed in 11 patients with hypertrophic nonobstructive cardiomyopathy (HCM) and in 19 patients with hypertension (HT), and left ventricular volume curve (LVVC) was analyzed and compared with those of 13 normal subjects (N). Ejection fraction (EF) and early filling volume ratio (the ratio of volume increment of 100 msec later than the zero point in the first derivative of LVVC to the end diastolic volume) (%EFV) were computed from LVVC. Peak ejection rate (PER) and peak filling rate (PFR) were obtained from the first derivative of LVVC. Peak ejection acceleration (PEA) and peak filling acceleration (PFA) were calculated from the second derivative of LVVC. EF, PER and PEA did not show any difference between these 3 groups. PFR was lower in HT (2.6 +- 0.5) compared with those in HCM (3.0 +- 0.5) (p < 0.05) and in N (3.4 +- 0.5) (p < 0.001), but the %EFV in HCM (4.9 +- 1.8) was lower than those in HT (6.9 +- 1.9) (p < 0.01) and in N (11.4 +- 1.4) (p < 0.001). Moreover, PFA in HCM (27.9 +- 7.2) was increased than those in HT (20.2 +- 5.4) (p < 0.01) with no differences between HCM and N (29.4 +- 8.1). Significant correlation was observed between PFR and PFA (Y = 0.06X + 1.4. r = 0.856. p < 0.001). These result indicate that, in HCM, reduced increase in early left ventricular volume is compensated by a greater filling acceleration. In contrast, there is no compensation by filling acceleration in HT.

  8. Increased cardiac alpha-myosin heavy chain in left atria and decreased myocardial insulin-like growth factor (Igf-I) expression accompany low heart rate in hibernating grizzly bears.

    Science.gov (United States)

    Barrows, N D; Nelson, O L; Robbins, C T; Rourke, B C

    2011-01-01

    Grizzly bears (Ursus arctos horribilis) tolerate extended periods of extremely low heart rate during hibernation without developing congestive heart failure or cardiac chamber dilation. Left ventricular atrophy and decreased left ventricular compliance have been reported in this species during hibernation. We evaluated the myocardial response to significantly reduced heart rate during hibernation by measuring relative myosin heavy-chain (MyHC) isoform expression and expression of a set of genes important to muscle plasticity and mass regulation in the left atria and left ventricles of active and hibernating bears. We supplemented these data with measurements of systolic and diastolic function via echocardiography in unanesthetized grizzly bears. Atrial strain imaging revealed decreased atrial contractility, decreased expansion/reservoir function (increased atrial stiffness), and decreased passive-filling function (increased ventricular stiffness) in hibernating bears. Relative MyHC-α protein expression increased significantly in the atrium during hibernation. The left ventricle expressed 100% MyHC-β protein in both groups. Insulin-like growth factor (IGF-I) mRNA expression was reduced by ∼50% in both chambers during hibernation, consistent with the ventricular atrophy observed in these bears. Interestingly, mRNA expression of the atrophy-related ubiquitin ligases Muscle Atrophy F-box (MAFBx) and Muscle Ring Finger 1 did not increase, nor did expression of myostatin or hypoxia-inducible factor 1α (HIF-1α). We report atrium-specific decreases of 40% and 50%, respectively, in MAFBx and creatine kinase mRNA expression during hibernation. Decreased creatine kinase expression is consistent with lowered energy requirements and could relate to reduced atrial emptying function during hibernation. Taken together with our hemodynamic assessment, these data suggest a potential downregulation of atrial chamber function during hibernation to prevent fatigue and dilation

  9. Medline Plus

    Full Text Available ... The four chambers of the heart are the right atrium, the right ventricle, the left atrium, and the left ventricle. ... which bring blood from the body to the right atrium, the pulmonary artery, which transports blood from ...

  10. Mudança de conduta cirúrgica motivada pela ecocardiografia transesofágica intraoperatória Cambio de conducta quirúrgica motivada por la ecocardiografía transesofágica intraoperatoria Changes in surgical conduct due to the results of intraoperative transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Alexander Alves da Silva

    2010-04-01

    ón.BACKGROUND AND OBJECTIVES: Transesophageal echocardiography (TEE is extremely useful in surgeries like valvuloplasty, of the thoracic aorta, and correction of congenital cardiopathies. The low degree of invasiveness and the capacity to aggregate information that can change the course of the surgery are among the advantages of TEE. The objective of this report was to present a case in which the surgical conduct was changed due to a new diagnosis provided by intraoperative transesophageal echocardiography, and to emphasize the importance of using the transesophageal echo in surgeries to correct congenital cardiopathies. CASE REPORT: A 28-year old female, ASA II, with a history of dyspnea progressing from medium to small efforts was referred by another department for elective surgical correction of stenosis of the pulmonary valve diagnosed by transthoracic echocardiography. Intraoperative transesophageal echocardiography showed patent foramen ovale, infundibular stenosis of the right ventricular outlet, and perimembranous subaortic interventricular communication (IVC of 0.4 cm with left to right shunt. After beginning ECC, the above mentioned diagnoses were confirmed and the surgery included closure of the foramen ovale and IVC, and resection of the infundibular stenosis. Intraoperative intercurrences were not observed and the patient was intubated when she was transferred to the intensive care unit. CONCLUSIONS: Transesophageal echocardiography is extremely useful in patients undergoing surgical correction of congenital cardiopathies because, besides helping the hemodynamic management, it can provide new information capable of improving the final result of the surgery.

  11. Producing The New Regressive Left

    DEFF Research Database (Denmark)

    Crone, Christine

    This thesis is the first comprehensive research work conducted on the Beirut based TV station, an important representative of the post-2011 generation of Arab satellite news media. The launch of al-Mayadeen in June 2012 was closely linked to the political developments across the Arab world...... members, this thesis investigates a growing political trend and ideological discourse in the Arab world that I have called The New Regressive Left. On the premise that a media outlet can function as a forum for ideology production, the thesis argues that an analysis of this material can help to trace...... the contexture of The New Regressive Left. If the first part of the thesis lays out the theoretical approach and draws the contextual framework, through an exploration of the surrounding Arab media-and ideoscapes, the second part is an analytical investigation of the discourse that permeates the programmes aired...

  12. A novel method to estimate blood flow velocity in the left atrial appendage using enhanced computed tomography: role of Hounsfield unit density ratio at two distinct points within the left atrial appendage.

    Science.gov (United States)

    Yasuoka, Ryobun; Kurita, Takashi; Kotake, Yasuhito; Akaiwa, Yuzuru; Hashiguchi, Naotaka; Motoki, Koichiro; Yamamoto, Hiromi; Kobuke, Kazuhiro; Iwanaga, Yoshitaka; Hirano, Yutaka; Miyazaki, Shunichi

    2017-07-01

    Low blood flow velocity in the left atrial appendage (LAA) indicates a high risk of thromboembolism. Although transesophageal echocardiography (TEE) has been the standard method with which to evaluate the LAA blood flow velocity, a clinically noninvasive method is desired. We hypothesized that the ratio of the Hounsfield unit (HU) density at two distinct points within the LAA represents the blood flow velocity in the LAA. We retrospectively investigated 60 consecutive patients with atrial fibrillation (paroxysmal type, n = 29) who underwent enhanced computed tomography (CT) and TEE. The peak emptying flow velocity in the LAA (LAAPV) was evaluated using TEE. HU density was measured at proximal and distal sites of the LAA (LAAp and LAAd) on CT images. The LAAd/LAAp ratio was correlated with the LAAPV (P velocity of the LAA can be estimated by the HU density ratio at distal and proximal sites within the LAA. Our method might be a feasible substitution for TEE to discriminate patients with a reduced LAAPV.

  13. Atrial Septal Aneurysm and Patent Foramen Ovale as Risk Factors for Cryptogenic Stroke in Patients Less Than 55 Years of Age: A Study using Transesophageal Echocardiography

    Science.gov (United States)

    Cabanes, L.; Mas, J. L.; Cohen, A.; Amarenco, P.; Cabanes, P. A.; Oubary, P.; Chedru, F.; Guerin, F.; Bousser, M. G.; deRecondo, J.

    1993-01-01

    Background and Purpose: An association between atrial septal aneurysm and embolic events has been suggested. Atrial septal aneurysm has been shown to be associated with patent foramen ovale and,.in some reports, with mitral valve prolapse. These two latter cardiac disorder; have been identified as potential risk factors for ischemic stroke. The aim of this prospective study was to assess the role of atrial septal aneurysm as an independent risk factor for stroke, especially for cryptogenic stroke. Methods: We studied the prevalence of atrial septal aneurysm, patent foramen ovale, and mitral valve prolapse in 100 consecutive patients stroke who underwent extensive etiological investigations. We compared these results with those in a control group of 50 consecutive patients. The diagnosis of atrial septal aneurysm and patent foramen ovale relied on transesophageal echocardiography with a contrast study and that of mitral valve prolapse, on two-dimensional transthoracic echocardiography. Results: Stepwise logistic regression analysis showed that atrial septal aneurysm (odds ratio, 4.3; 95% confidence interval, 1.3 to 14.6; P=.01) and patent foramen ovale (odds ratio, 3.9; 95% confidence interval, 1.5 to 10; P=.003) but not mitral valve prolapse were significantly associated with the diagnosis of cryptogenic stroke. The stroke odds of a patient with both atrial septal aneurysm and patent foramen ovale were 33.3 times (95% confidence interval, 4.1 to 270) the stroke odds of a patient with neither of these cardiac disorders. For a patient with atrial septal aneurysm of >lo-mm excursion, the stroke odds were approximately 8 times the stroke odds of a patient with atrial septal aneurysm of stroke and that their association has a marked synergistic effect. Atrial septal aneurysms of >lo-mm excursion are associated with a higher risk of stroke. (Stroke. 1993;24:1865-1873.) KEY WORDS aneurysm echocardiography foramen ovale, patent mitral valve prolapse o young adults

  14. Atrial Septal Aneurysm and Patent Foramen Ovale as Risk Factors for Cryptogenic Stroke in Patients Less Than 55 Years of Age: A Study using Transesophageal Echocardiography

    Science.gov (United States)

    Cabanes, L.; Mas, J. L.; Cohen, A.; Amarenco, P.; Cabanes, P. A.; Oubary, P.; Chedru, F.; Guerin, F.; Bousser, M. G.; deRecondo, J.

    1993-01-01

    Background and Purpose: An association between atrial septal aneurysm and embolic events has been suggested. Atrial septal aneurysm has been shown to be associated with patent foramen ovale and,.in some reports, with mitral valve prolapse. These two latter cardiac disorder; have been identified as potential risk factors for ischemic stroke. The aim of this prospective study was to assess the role of atrial septal aneurysm as an independent risk factor for stroke, especially for cryptogenic stroke. Methods: We studied the prevalence of atrial septal aneurysm, patent foramen ovale, and mitral valve prolapse in 100 consecutive patients ischemic stroke who underwent extensive etiological investigations. We compared these results with those in a control group of 50 consecutive patients. The diagnosis of atrial septal aneurysm and patent foramen ovale relied on transesophageal echocardiography with a contrast study and that of mitral valve prolapse, on two-dimensional transthoracic echocardiography. Results: Stepwise logistic regression analysis showed that atrial septal aneurysm (odds ratio, 4.3; 95% confidence interval, 1.3 to 14.6; P=.01) and patent foramen ovale (odds ratio, 3.9; 95% confidence interval, 1.5 to 10; P=.003) but not mitral valve prolapse were significantly associated with the diagnosis of cryptogenic stroke. The stroke odds of a patient with both atrial septal aneurysm and patent foramen ovale were 33.3 times (95% confidence interval, 4.1 to 270) the stroke odds of a patient with neither of these cardiac disorders. For a patient with atrial septal aneurysm of >lo-mm excursion, the stroke odds were approximately 8 times the stroke odds of a patient with atrial septal aneurysm of stroke and that their association has a marked synergistic effect. Atrial septal aneurysms of >lo-mm excursion are associated with a higher risk of stroke. (Stroke. 1993;24:1865-1873.) KEY WORDS aneurysm echocardiography foramen ovale, patent mitral valve prolapse o young adults

  15. Vena contracta analysis by color Doppler three-dimensional transesophageal echocardiography shows geometrical differences between prolapse and pseudoprolapse in eccentric mitral regurgitation.

    Science.gov (United States)

    Berdejo, Javier; Shiota, Maiko; Mihara, Hirotsugu; Itabashi, Yuji; Utsunomiya, Hiroto; Shiota, Takahiro

    2017-05-01

    Evaluation of eccentric mitral regurgitation (MR) remains extremely difficult and the role played by its etiology, functional or degenerative, is not well understood. This study aimed to demonstrate the value of three-dimensional transesophageal echocardiography (3DTEE) in the evaluation of eccentric MR identifying geometric differences in the vena contracta area between functional and degenerative etiologies. We studied 61 patients with eccentric MR (30 functional and 31 degenerative). Regurgitant orifice area was determined by the two-dimensional proximal isovelocity surface area (2DPISA) and the 3DTEE methods. The ratio between maximum and minimum lengths of the vena contracta was calculated in each patient. Effective regurgitant orifice area by the 2DPISA method was smaller than that estimated by 3DTEE (0.56±0.21 vs 0.72±0.25 cm 2 ). A better correlation between both methods was seen in degenerative mitral regurgitation (DMR; r=.83), with a mean underestimation of 8.2% by the 2DPISA method. A much worse correlation was found in functional mitral regurgitation (FMR; r=.39), where a mean underestimation by the 2DPISA method of 29.1% was observed. There was a more elongated and curved vena contracta in FMR compared to that in DMR (length ratio: 3.4±1.0 vs 2.2±0.7, Pechocardiography identifies a more elongated regurgitant orifice in eccentric FMR compared to that in eccentric DMR. This difference may explain the greater underestimation of effective regurgitant orifice area by the 2DPISA method in FMR. High-quality 3DTEE analysis of vena contracta area would be a highly recommended alternative. © 2017, Wiley Periodicals, Inc.

  16. Influence of the Quantity of Aortic Valve Calcium on the Agreement Between Automated 3-Dimensional Transesophageal Echocardiography and Multidetector Row Computed Tomography for Aortic Annulus Sizing.

    Science.gov (United States)

    Podlesnikar, Tomaz; Prihadi, Edgard A; van Rosendael, Philippe J; Vollema, E Mara; van der Kley, Frank; de Weger, Arend; Ajmone Marsan, Nina; Naji, Franjo; Fras, Zlatko; Bax, Jeroen J; Delgado, Victoria

    2018-01-01

    Accurate aortic annulus sizing is key for selection of appropriate transcatheter aortic valve implantation (TAVI) prosthesis size. The present study compared novel automated 3-dimensional (3D) transesophageal echocardiography (TEE) software and multidetector row computed tomography (MDCT) for aortic annulus sizing and investigated the influence of the quantity of aortic valve calcium (AVC) on the selection of TAVI prosthesis size. A total of 83 patients with severe aortic stenosis undergoing TAVI were evaluated. Maximal and minimal aortic annulus diameter, perimeter, and area were measured. AVC was assessed with computed tomography. The low and high AVC burden groups were defined according to the median AVC score. Overall, 3D TEE measurements slightly underestimated the aortic annulus dimensions as compared with MDCT (mean differences between maximum, minimum diameter, perimeter, and area: -1.7 mm, 0.5 mm, -2.7 mm, and -13 mm 2 , respectively). The agreement between 3D TEE and MDCT on aortic annulus dimensions was superior among patients with low AVC burden (AVC burden (≥3,025 arbitrary units). The interobserver variability was excellent for both methods. 3D TEE and MDCT led to the same prosthesis size selection in 88%, 95%, and 81% of patients in the total population, the low, and the high AVC burden group, respectively. In conclusion, the novel automated 3D TEE imaging software allows accurate and highly reproducible measurements of the aortic annulus dimensions and shows excellent agreement with MDCT to determine the TAVI prosthesis size, particularly in patients with low AVC burden. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  17. Transcatheter closure of large atrial septal defects with deficient aortic or posterior rims using the "Greek maneuver". A multicenter study.

    Science.gov (United States)

    Thanopoulos, Basil D; Dardas, Petros; Ninios, Vlasis; Eleftherakis, Nicholaos; Karanasios, Evangelos

    2013-10-09

    We report a modification ("Greek maneuver") of the standard atrial septal defect (ASD) closure technique using the Amplatzer septal occluder (ASO) to facilitate closure of large ASDs with deficient aortic or posterior rims. 185 patients (median 10.8, range 3 to 52 years) with large ASDs (mean diameter 26±7 mm, range 20-40 mm) with a deficient aortic (134 patients) or posterior (51 patients) rim underwent catheter closure with the ASO using the "Greek maneuver" under transesophageal guidance. The Greek maneuver is applied when protrusion of the aortic edge of the deployed left disk of the device in to the right atrium is detected by echo. To circumvent this left disk is recaptured and the whole delivery system is pushed inward and leftward into the left atrium where the left disk and the 2/3 of right disk are simultaneously released. This maneuver forces the left disk to become parallel to the septum preventing the protrusion of the device into the right atrium. The ASO was successfully implanted and was associated with complete closure in 175/185 (95%) of the patients. There were no early or late complications related to the procedure during a follow-up period ranging from 6 months to 7 years. The "Greek maneuver" is a simple quite useful trick that facilitates closure of large ASDs associated with or without deficient aortic or posterior rims. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  18. Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients

    DEFF Research Database (Denmark)

    Bang, Casper; Gerdts, Eva; Aurigemma, Gerard P

    2013-01-01

    Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatation...

  19. A case with double-chambered right ventricle and left ventricular-right atrial communication (Gerbode defect): potential pitfall for Eisenmenger syndrome.

    Science.gov (United States)

    Gur, Demet Ozkaramanli; Gur, Ozcan; Goksuluk, Huseyin; Oral, Dervis

    2012-09-01

    The ventricular septal defect (VSD) can rarely be associated with other malformations such as double-chambered right ventricle (DCRV) in which hypertrophied muscle bundles divide the right ventricle into two chambers causing progressive obstruction (Mao et al., Asia Pac J Thorac Cardiovasc Surg 5:14-17, 1996). Most VSDs close spontaneously by apposition of the tricuspid leaflets, but the process is rarely disrupted, resulting in communication between left ventricle and right atrium called Gerbode defect [Cho et al., J Cardiovasc Ultrasound 19(3):148-151, 2011]. Hence, the Gerbode defect involves potential misinterpretation of its high-velocity shunt as pulmonary hypertension. Here we present a case with DCRV and Gerbode defect initially misdiagnosed to have Eisenmenger syndrome.

  20. Advanced Age Attenuates Left Ventricular Filling Efficiency Quantified Using Vortex Formation Time: A Study of Octogenarians With Normal Left Ventricular Systolic Function Undergoing Coronary Artery Surgery.

    Science.gov (United States)

    Pagel, Paul S; Dye, Lonnie; Boettcher, Brent T; Freed, Julie K

    2018-03-07

    Blood flow across the mitral valve during early left ventricular (LV) filling produces a 3-dimensional rotational fluid body, known as a vortex ring, that enhances LV filling efficiency. Diastolic dysfunction is common in elderly patients, but the influence of advanced age on vortex formation is unknown. The authors tested the hypothesis that advanced age is associated with a reduction in LV filling efficiency quantified using vortex formation time (VFT) in octogenarians undergoing coronary artery bypass graft (CABG) surgery. Observational study. Veterans Affairs medical center. After institutional review board approval, octogenarians (n = 7; 82 ± 2 year [mean ± standard deviation]; ejection fraction 56% ± 7%) without valve disease or atrial arrhythmias undergoing CABG were compared with a younger cohort (n = 7; 55 ± 6 year; ejection fraction 57% ± 7%) who were undergoing coronary revascularization. None. All patients were monitored using radial and pulmonary arterial catheters and transesophageal echocardiography. Peak early LV filling (E) and atrial systole (A) blood flow velocities and their corresponding velocity-time integrals were obtained using pulse-wave Doppler echocardiography to determine E/A, atrial filling fraction (β), and E wave deceleration time. Pulse-wave Doppler also was used to measure pulmonary venous blood flow during systole and diastole. Mitral valve diameter (D) was calculated as the average of major and minor axis lengths obtained in the midesophageal LV bicommissural and long-axis transesophageal echocardiography imaging planes, respectively. VFT was calculated as 4 × (1 - β) × SV/(πD 3 ), where SV is the stroke volume measured using thermodilution. Systemic and pulmonary hemodynamics, LV diastolic function, and VFT were determined during steady-state conditions 30 minutes before cardiopulmonary bypass. A delayed relaxation pattern of LV filling (E/A 0.81 ± 0.16 v 1.29 ± 0.19, p = 0.00015; β 0.44 ± 0.05 v 0.35 ± 0.03, p = 0

  1. High plasma human atrial natriuretic peptide and reduced transthoracic left atrial appendage wall-motion velocity are noninvasive surrogate markers for assessing thrombogenesis in patients with paroxysmal atrial fibrillation.

    Science.gov (United States)

    Yoshida, Naoyasu; Okamoto, Mitsunori; Hirao, Hidekazu; Suenari, Kazuyoshi; Nanba, Kiyomi; Uchida, Mio; Yamazato, Ryo; Watari, Yuichiro; Fukuda, Yukihiro; Ueda, Hironori

    2014-09-01

    The clinical relevance of examining human atrial natriuretic peptide (HANP) or left atrial appendage (LAA) wall-motion velocity during sinus rhythm in paroxysmal atrial fibrillation (AF) patients has not been clearly elucidated. The subjects were 38 patients with paroxysmal AF who underwent transesophageal and transthoracic echocardiography during sinus rhythm. The presence of spontaneous echocontrast (SEC) was examined with transesophageal echocardiography and LAA wall-motion velocity (LAAWV) was measured with transthoracic tissue Doppler echocardiography. Plasma HANP was measured within 3 hours after echocardiography. Human atrial natriuretic peptide ranged from 12 to 106 pg/mL with an average of 43 ± 24 pg/mL and had a significant correlation with LAAWV (r = -0.57) or LAA flow velocity (r = -0.41). HANP was significantly higher in patients with SEC than in patients without SEC (64 ± 29 vs. 34 ± 15 pg/mL, P = 0.008) and LAAWV was significantly lower in patients with SEC than in patients without SEC (13 ± 5 vs. 20 ± 5 cm/sec, P = 0.002). HANP >44 pg/mL had a sensitivity of 73% and specificity of 89% for diagnosing SEC. SEC was more frequently observed (73%) in patients with HANP >44 pg/mL and/or LAAWV velocity (P velocity may be noninvasive surrogate markers for assessing left atrial thrombogenesis during sinus rhythm in paroxysmal AF patients. © 2013, Wiley Periodicals, Inc.

  2. Role of surface electrocardiogram precordial leads in localizing different anatomic sites of ectopic atrial tachycardia arising from lower right atrium in pediatric population.

    Science.gov (United States)

    Allam, Lamyaa Elsayed; Ahmed, Rania Samir; Ghanem, Mazen Tawfik

    2018-01-01

    The study was designed to examine P wave morphology (PWM) in precordial leads (V 1 -V 6 ) during ectopic atrial tachycardia (EAT) originating from low right atrium (RA) to identify the anatomic sites of these foci in children. Twenty-three consecutive pediatric patients (56% females, mean age 8.5 ± 2.5) with EAT originating from the low RA underwent detailed atrial endocardial activation mapping and radiofrequency ablation. PWM during EAT was analyzed using standard 12-lead ECG in relation to successful ablation sites in RA. Ectopic atrial tachycardia originated from coronary sinus ostium (CSo) in 12 patients, nonseptal tricuspid annulus (TA) in five, lower crista terminalis (CT) in three and lower free wall in three. In lead V 1 , PWM showed a positive pattern during EAT originating from CSo (8/12) [91.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), 100% negative predictive value (NPV)]. A negative pattern was observed in EAT originating from lower free wall (1/3) and nonseptal TA (5/5) [50% sensitivity, 100% specificity, 100% PPV, 75% NPV], while isoelectric pattern was in EAT originating from lower CT (3/3) [100% sensitivity, 100% specificity, 100% PPV, 100% NPV]. In leads V 3 -V 6 , PWM showed a negative pattern in at least two consecutive leads during EAT from CSo (12/12), nonseptal TA (5/5) and lower free wall (3/3) while it was positive in EAT originating from lower CT (3/3) [100% sensitivity, 95% specificity, 75% PPV and 100% NPV]. P wave morphology in precordial leads can help differentiate the anatomic sites of EAT from lower RA with high PPVs and NPVs. © 2017 Wiley Periodicals, Inc.

  3. A purely functional Imaging based approach for transcortical resection of lesion involving the dominant atrium: Towards safer, imaging-guided, tailored cortico-leucotomies.

    Science.gov (United States)

    Frati, Alessandro; Pesce, Alessandro; D'Andrea, Giancarlo; Fraschetti, Flavia; Salvati, Maurizio; Cimatti, Marco; Esposito, Vincenzo; Raco, Antonino

    2018-04-01

    The Dominant Atrium (DA) is a crossroad of eloquent white matter bundles difficult to preserve with a standard "anatomical" approach. The aim of this work is to evaluate the results of a cohort of patients who underwent surgery with the aid of a purely functional MRI and DTI-based approach. 43 patients suffering from lesions involving the DA have been included in the final cohort and studied in regards to quality of life (KPS); a special attention was lent on the incidence of new or worsening of preexisting neurological deficits, with a focus on motor, visual and speech disturbances after the surgical treatment. Patient, surgery and lesion-related data were recorded to identify the relationships with outcome. Eloquent areas fMRI and the course of Arcuate Fasciculus (AF), Inferior frontooccipital fasciculus (IFOF), Optic radiation (OR) and corticospinal tract (CST) have been investigated with preoperative MRI sequences and DTI reconstruction. The final cohort consisted of 43 patients, 19 males and 24 females; average age was 56.8 years. We recorded 9 transient and 3 permanent postoperative deficits, only one of those was caused by an edema interference with DTI reconstruction. Preoperative functional status, histology and volume of the lesion proved to be independent factors affecting results. A purely functional surgical approach to the DA provided promising preliminary results. A direct DTI-fMRI visualization of the eloquent structures proximal to DA allows surgeon to conceive an ultra-precise and "tailored" cortico-leucotomy for an optimal exposure of the lesion. Copyright © 2018 Elsevier Ltd. All rights reserved.

  4. Left ventricular diastolic filling with an implantable ventricular assist device: beat to beat variability with overall improvement

    Science.gov (United States)

    Nakatani, S.; Thomas, J. D.; Vandervoort, P. M.; Zhou, J.; Greenberg, N. L.; Savage, R. M.; McCarthy, P. M.

    1997-01-01

    OBJECTIVES: We studied the effects of left ventricular (LV) unloading by an implantable ventricular assist device on LV diastolic filling. BACKGROUND: Although many investigators have reported reliable systemic and peripheral circulatory support with implantable LV assist devices, little is known about their effect on cardiac performance. METHODS: Peak velocities of early diastolic filling, late diastolic filling, late to early filling ratio, deceleration time of early filling, diastolic filling period and atrial filling fraction were measured by intraoperative transesophageal Doppler echocardiography before and after insertion of an LV assist device in eight patients. A numerical model was developed to simulate this situation. RESULTS: Before device insertion, all patients showed either a restrictive or a monophasic transmitral flow pattern. After device insertion, transmitral flow showed rapid beat to beat variation in each patient, from abnormal relaxation to restrictive patterns. However, when the average values obtained from 10 consecutive beats were considered, overall filling was significantly normalized from baseline, with early filling velocity falling from 87 +/- 31 to 64 +/- 26 cm/s (p assistance produced significant beat to beat variation in filling indexes, but overall a normalization of deceleration time as well as other variables. CONCLUSIONS: With LV assistance, transmitral flow showed rapidly varying patterns beat by beat in each patient, but overall diastolic filling tended to normalize with an increase of atrial contribution to the filling. Because of the variable nature of the transmitral flow pattern with the assist device, the timing of the device cycle must be considered when inferring diastolic function from transmitral flow pattern.

  5. Rebuilding the US Health Left

    Directory of Open Access Journals (Sweden)

    Victor W. Sidel, MD

    2010-02-01

    Full Text Available With this issue Social Medicine begins a series of invited papers on the topic: “Rebuilding the US Health Left.” In this editorial we will outline our vision for this series. We undertake this project aware that our good friend and mentor, Dr. Walter Lear, one of the leading health activists of the 20th century, lies critically ill. Walter was the creator and custodian of the US Health Left Archives, a collection that is now with the University of Pennsylvania library. The collection reminds us of the important role left health care workers played in US history throughout the 20th century. They advocated for a national health program (Committee on the Costs of Medical Care, Physicians Forum, Medical Care Section/APHA, HealthPAC, Physicians for a National Health Program, National Physicians Alliance, provided international solidarity (American Soviet Medical Society, international brigades during the Spanish Civil War, Central American Solidarity Movement, Committee to Help Chilean Health Workers, Doctors for Global Health, traced the connections between disease and social class (Sigerist Circle, Spirit of 1848, APHA, fought for workers’ health (Councils for Occupational Safety and Health; Occupational Health and Safety Section, APHA participated in anti-war movements (Medical Committee for Human Rights, Physicians for Social Responsibility, International Physicians for the Prevention of Nuclear War, created new models of health care delivery (Health Cooperatives, Prepaid Health Maintenance Organizations, Community Health Centers, National Health Service Corps, Free Clinics, were central to the struggle for women’s rights (Planned Parenthood, Physicians for Reproductive Choice and Health, supported the civil rights movement both in medicine and in the broader society (National Medical Association, Medical Committee for Human Rights, played key roles in the movement for gay rights (ACT-UP, Gay & Lesbian Medical Association, Lesbian, Gay

  6. Left ventricular outflow track obstruction and mitral valve regurgitation in a patient with takotsubo cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Yin Wu

    2015-12-01

    Full Text Available Introduction: Takotsubo cardiomyopathy (TCM can be complicated by left ventricular outflow tract (LVOT obstruction and severe acute mitral regurgitation (MR, leading to hemodynamic instability in an otherwise benign disorder. Despite the severity of these complications, there is a paucity of literature on the matter. Because up to 20–25% of TCM patients develop LVOT obstruction and/or MR, it is important to recognize the clinical manifestations of these complications and to adhere to specific management in order to reduce patient morbidity and mortality. We report the clinical history, imaging, treatment strategy, and clinical outcome of a patient with TCM that was complicated with severe MR and LVOT obstruction. We then discuss the pathophysiology, characteristic imaging, key clinical features, and current treatment strategy for this unique patient population. Case report: A postmenopausal woman with no clear risk factor for coronary artery disease (CAD presented to the emergency department with chest pain after an episode of mental/physical stress. Physical examination revealed MR, mild hypotension, and pulmonary vascular congestion. Her troponins were mildly elevated. Cardiac catheterization excluded obstructive CAD, but revealed severe apical hypokinesia and ballooning. Notably, multiple diagnostic tests revealed the presence of severe acute MR and LVOT obstruction. The patient was diagnosed with TCM complicated by underlying MR and LVOT obstruction, and mild hemodynamic instability. The mechanism of her LVOT and MR was attributed to systolic anterior motion of the mitral valve (SAM, which the transesophageal echocardiogram clearly showed during workup. She was treated with beta-blocker, aspirin, and ACE-I with good outcome. Nitroglycerin and inotropes were discontinued and further avoided. Conclusions: Our case illustrated LVOT obstruction and MR associated with underlying SAM in a patient with TCM. LVOT obstruction and MR are severe

  7. Left atrial appendage closure using AMPLATZER™ devices: A large, multicenter, Italian registry.

    Science.gov (United States)

    Berti, Sergio; Santoro, Gennaro; Brscic, Elvis; Montorfano, Matteo; Vignali, Luigi; Danna, Paolo; Tondo, Claudio; D'Amico, Gianpiero; Stabile, Amerigo; Saccà, Salvatore; Patti, Giuseppe; Rapacciuolo, Antonio; Poli, Arnaldo; Golino, Paolo; Magnavacchi, Paolo; De Caterina, Alberto; Meucci, Francesco; Pezzulich, Bruno; Rezzaghi, Marco; Stolcova, Miroslava; Tarantini, Giuseppe

    2017-12-01

    Left atrial appendage occlusion (LAAO) has been proven to be effective for stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF). We aim to assess the safety and efficacy of LAAO by AMPLATZER™ devices in a large, multicenter, single-nation cohort of NVAF patients at high-risk of stroke and bleeding. From December 2008 to April 2015 613 NVAF patients (75.1±8.0years, 62.5% male) underwent LAAO in 15 Italian centers by AMPLATZER™ devices. There were no restrictions on any personal/institutional protocols with respect to indications, pre-procedural planning, device implantation, drug therapy and follow-up. All the baseline characteristics, imaging, procedural and follow-up data were collected in a single dataset. AMPLATZER™ devices were successfully implanted in 95.4% of cases. Major complications occurred during 38 procedures (6.2%) and included more frequently major bleeding (3.3%) and pericardial tamponade (2.0%). At a mean follow-up of 20months, the overall annual rates of stroke and thromboembolic events, including those periprocedural, was 1.67% and 2.90%, respectively, consisting in a reduction in the rate of stroke and TIA of 66% compared with the risk-based expectation. Among the 218 patients undergoing transesophageal echocardiography at 6months of follow-up, device thrombosis was present in 1.8% of the patients whilst a significant or mild to moderate peri-device leak was found in 0.5% and 11.9% of cases, respectively. In this large, multicenter, single-nation study, LAAO with the AMPLATZER™ devices showed high procedural success, early safety and mid-term efficacy for the prevention of NVAF-related thromboembolism. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Preliminary design of the internal geometry in a minimally invasive left ventricular assist device under pulsatile-flow conditions.

    Science.gov (United States)

    Smith, P Alex; Wang, Yaxin; Metcalfe, Ralph W; Sampaio, Luiz C; Timms, Daniel L; Cohn, William E; Frazier, O H

    2018-03-01

    A minimally invasive, partial-assist, intra-atrial blood pump has been proposed, which would unload the left ventricle with a flow path from the left atrium to the arterial system. Flow modulation is a common strategy for ensuring washout in the pump, but it can increase power consumption because it is typically achieved through motor-speed variation. However, if a pump's performance curve had the proper gradient, flow modulation could be realized passively. To achieve this goal, we propose a pump performance operating curve as an alternative to the more standard operating point. Mean-line theory was employed to generate an initial set of geometries that were then tested on a hydraulic test rig at ~20,000 r/min. Experimental results show that the intra-atrial blood pump performed below the operating region; however, it was determined that smaller hub diameter and longer chord length bring the performance of the intra-atrial blood pump device closer to the operating curve. We found that it is possible to shape the pump performance curve for specifically targeted gradients over the operating region through geometric variations inside the pump.

  9. Considerations in cardio-oncology: Multiple mobile left-sided cardiac thrombi in chemotherapy-induced cardiomyopathy.

    Science.gov (United States)

    Minamishima, Toshinori; Matsushita, Kenichi; Morikubo, Hiromu; Isaka, Aoi; Matsushita, Noriko; Endo, Hidehito; Kubota, Hiroshi; Sakata, Konomi; Satoh, Toru; Yoshino, Hideaki

    2017-07-01

    With advances in cancer chemotherapy, the importance of the new clinical discipline of cardio-oncology, which is concerned with the cardiac effects of chemotherapy, is increasing. Herein we describe the case of a 48-year-old woman with a history of breast cancer who presented with symptoms of heart failure due to chemotherapy-induced cardiomyopathy. Treatment for the patient's breast cancer had included surgery and chemotherapy with anthracyclines and trastuzumab. Echocardiography revealed multiple mobile thrombi in the left ventricle and atrium. In addition, brain magnetic resonance imaging revealed small acute cerebral infarctions due to embolization. Given the high risk of re-embolization, surgical thrombectomy was performed. Thus far, there are no standardized therapeutic guidelines for left-sided cardiac thrombi and the optimal treatment remains contentious. Although this patient was managed successfully with surgical thrombectomy, patients should be managed individually, taking into consideration embolization, bleeding, and surgical risks. With further improvements in cancer chemotherapy, there may be an increase in the incidence of complications such as multiple cardiac thrombi. From the cardio-oncology standpoint, we propose close interactions between cardiologists and oncologists for the optimal care of cancer patients. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  10. Syndrome of hypoplasic left ventricle, Description of a clinical case with survival after carrying out of Norwood technique

    International Nuclear Information System (INIS)

    Velasco B, Ana M; Lince V, Rafael; Zapata S, Jorge A and others

    2003-01-01

    A clinical case of a 72 hours newborn patient admitted to the pediatric intensive care unit for reduced cardiac output syndrome showing anuria, metabolic acidosis and respiratory distress, is reported. Mechanical ventilation, inotropic support and continuous prostaglandin e1 infusion were initiated. The echocardiogram showed hypoplasia of the left ventricle. The Norwood procedure stage i under extracorporeal circulation with deep hypothermia and circulatory arrest, was performed at the 6th day of life. During the early postoperative period, the patient developed hypoxaemia and pulmonary hypertension, which improved with controlled hyperventilation and vasodilatation therapy. Other complications were clinical sepsis and abstinence syndrome, which resolved with medical management. The patient was extubated on the sixth postoperative day. Subsequent echocardiograms showed tricuspid valve regurgitation, right ventricular dysfunction with dilation and an organized thrombus in the left atrium. These improved with diuretics, dopamine, milrinone and heparin. The patient was discharged after 32 days of the surgery without signs of congestive heart failure. This case is important, given the high mortality rate of this pathology. The Norwood procedure proved to be a palliative strategy versus the ortotopic cardiac transplant in newborns, because of the difficulty in finding donators at this age and the immunosuppressive therapy complications. This represents a great advance in the Colombian pediatric cardiology because until recent years these patients did not have any other surgical alternative

  11. [Biatrial vs. isolated left atrial cryoablation for the treatment of long-lasting permanent atrial fibrillation. Midterm recurrence rate].

    Science.gov (United States)

    Gualis, Javier; Castaño, Mario; Martínez-Comendador, Jose Manuel; Marcos, Jose Miguel; Martín, Carlos; Estévez-Loureiro, Rodrigo; Gómez-Plana, Jesús; Martín, Elio; Otero, Javier

    2016-01-01

    The long-term results of cryomaze in patients with longstanding persistent atrial fibrillation during concomitant surgical procedures are still uncertain. Between 2006 and 2011, 150 consecutive patients with associated long-lasting permanent atrial fibrillation and associated heart disease underwent heart surgery were treated by biatrial Cox-Maze (63 patients) or by isolated endocardial or epicardial left atrial cryoablation (83 patients) concomitantly. The results at 3 years in these groups were compared with clinical monitoring, electrocardiography, 24-hour Holter, and echocardiography with measurement of the transmitral A wave at 1, 6 and 12 months and annually thereafter in all patients. Patients undergoing Cox-Maze IV ablation presented rates of freedom from atrial fibrillation of 97, 94, 89, 80 and 54% at 1, 6, 12, 24 and 36 months, respectively. In the 12-month follow-up, these differences were significant (p<.05). The independent risk factors of atrial fibrillation recurrence was isolated ablation of left atrium. Atrial fibrillation by cryothermia ablation had a high success rate before 2 years postoperatively. Recurrence of atrial fibrillation increased thereafter regardless of the technique used, although it was more intense and developed earlier in cases of monoatrial ablation. For the treatment of other long-lasting permanent atrial fibrillation cardiac surgery-associated pathology, an aggressive biatrial treatment with Cox maze ablation should be performed. Copyright © 2015 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  12. The left atrial septal pouch as a risk factor for stroke: A systematic review.

    Science.gov (United States)

    Strachinaru, Mihai; Castro-Rodriguez, Jose; Verbeet, Thierry; Gazagnes, Marie-Dominique

    2017-04-01

    The left atrial septal pouch (LASP) is formed by incomplete fusion of the septum primum and septum secundum, leaving a cavity open towards the left atrium, but without interatrial shunting. There is no recommendation concerning strategy in the presence of a LASP, especially in the setting of stroke. The aim of this review was to determine whether the LASP could be incriminated as the aetiology of a stroke. We included all pertinent publications on the subject, and calculated hazard ratios for ischaemic stroke and cryptogenic stroke. There were only five case-control studies concerning the LASP, involving 516 stroke patients and 779 controls. Overall LASP prevalence was 21%, with a slightly higher prevalence in the cryptogenic stroke group (26%), but this difference was not statistically significant (P=0.27). In a random-effects meta-analysis, there was no difference between controls and patients with ischaemic stroke (hazard ratio 1.20, 95% confidence interval 0.96-1.53; P=0.14). Cryptogenic stroke appeared more frequently in patients with LASP (hazard ratio 1.53, 95% confidence interval 1.07-2.24; P=0.02), but this was driven by only one severely underpowered study. The published case reports demonstrated that thrombus formation inside the pouch can occur in the presence of major predisposing factors. The LASP can be a site for thrombus formation, leading to embolic events, but its presence does not correlate with an increased incidence of stroke. Associated factors should be taken into consideration in the setting of stroke. Further studies are necessary to validate a possible relationship with cryptogenic stroke. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Right and left ventricular ejection fraction at rest and during exercise assessed with radionuclide angiocardiography

    International Nuclear Information System (INIS)

    Dahlstroem, J.A.

    1982-01-01

    Right (RVEF) and left ventricular ejection fraction (LVEF) assessed with radionuclide angiocardiography were compared to simultaneously obtained catheterization results at rest and during exercise in patients with pulmonary hypertension and ischemic heart disease. Blood pool imaging was performed with red blood cells (RBC) labelled with 99 Tcsup(m) in vivo as this method gave more stable 99 Tcsup(m) levels in blood compared to 99 Tcsup(m)-labelled human serum albumin and because it was more convenient than labelling RBC in vitro. RVEF measured with first pass (FP) technique and equilibrium (EQ) technique correlated well at rest, r = 0.86, and during exercise, r = 0.91. The FP technique had the best reproducibility and reference values at rest were 49+-5 per cent increasing with exercise. When 99 Tcsup(m) and 133 Xe were compared to assess RVEF with FP technique, the correlation was good, r = 0.88. LVEF assessed with EQ technique and a fixed end-diastolic region of interest was very reproducible at rest and during exercise; reference values at rest were 56+-8 per cent increasing with exercise. In 10 patients with pulmonary hypertension significant negative correlations were found between RVEF assessed with FP technique and pressures in pulmonary artery and right atrium. Abnormal RVEF was found in all patients with right ventricular disfunction. In 22 patients with recent myocardial infarction measurements of LVEF detected left ventricular disfunction better than did measurement of pulmonary artery diastolic pressure. During effort angina in another 10 patients all had abnormal LVEF and abnormal hemodynamics. By combining ejection fraction and stroke volume, ventricular volumes were calculated at rest and during exercise. (author)

  14. Distinctive left-sided distribution of adrenergic-derived cells in the adult mouse heart.

    Directory of Open Access Journals (Sweden)

    Kingsley Osuala

    Full Text Available Adrenaline and noradrenaline are produced within the heart from neuronal and non-neuronal sources. These adrenergic hormones have profound effects on cardiovascular development and function, yet relatively little information is available about the specific tissue distribution of adrenergic cells within the adult heart. The purpose of the present study was to define the anatomical localization of cells derived from an adrenergic lineage within the adult heart. To accomplish this, we performed genetic fate-mapping experiments where mice with the cre-recombinase (Cre gene inserted into the phenylethanolamine-n-methyltransferase (Pnmt locus were cross-mated with homozygous Rosa26 reporter (R26R mice. Because Pnmt serves as a marker gene for adrenergic cells, offspring from these matings express the β-galactosidase (βGAL reporter gene in cells of an adrenergic lineage. βGAL expression was found throughout the adult mouse heart, but was predominantly (89% located in the left atrium (LA and ventricle (LV (p<0.001 compared to RA and RV, where many of these cells appeared to have cardiomyocyte-like morphological and structural characteristics. The staining pattern in the LA was diffuse, but the LV free wall displayed intermittent non-random staining that extended from the apex to the base of the heart, including heavy staining of the anterior papillary muscle along its perimeter. Three-dimensional computer-aided reconstruction of XGAL+ staining revealed distribution throughout the LA and LV, with specific finger-like projections apparent near the mid and apical regions of the LV free wall. These data indicate that adrenergic-derived cells display distinctive left-sided distribution patterns in the adult mouse heart.

  15. Left-handed Children in Singapore.

    Science.gov (United States)

    Gan, Linda

    1998-01-01

    Used teacher questionnaires to examine incidence of left-handedness in nearly 2,800 Singaporean children, racial differences in this left-handed population, and educational provisions in preschool and primary school. Findings indicated that 7.5% of preschoolers and 6.3% of primary children were left-handed, with a higher proportion being Chinese…

  16. The Left-Handed: "Their Sinister" History.

    Science.gov (United States)

    Costas, Elaine Fowler

    The history of left-handedness can provide teachers and parents a better understanding of left-handed children and give those children more pride in their difference. No child should be made to feel that he or she is abnormal because of using the left hand, although some specific instruction for these students is necessary in handwriting. Many…

  17. Flavoured Dark Matter moving left

    Science.gov (United States)

    Blanke, Monika; Das, Satrajit; Kast, Simon

    2018-02-01

    We investigate the phenomenology of a simplified model of flavoured Dark Matter (DM), with a dark fermionic flavour triplet coupling to the left-handed SU(2) L quark doublets via a scalar mediator. The DM-quark coupling matrix is assumed to constitute the only new source of flavour and CP violation, following the hypothesis of Dark Minimal Flavour Violation. We analyse the constraints from LHC searches, from meson mixing data in the K, D, and B d,s meson systems, from thermal DM freeze-out, and from direct detection experiments. Our combined analysis shows that while the experimental constraints are similar to the DMFV models with DM coupling to right-handed quarks, the multitude of couplings between DM and the SM quark sector resulting from the SU(2) L structure implies a richer phenomenology and significantly alters the resulting impact on the viable parameter space.

  18. Prosthesis-patient mismatch after transcatheter aortic valve implantation: impact of 2D-transthoracic echocardiography versus 3D-transesophageal echocardiography.

    Science.gov (United States)

    da Silva, Cristina; Sahlen, Anders; Winter, Reidar; Bäck, Magnus; Rück, Andreas; Settergren, Magnus; Manouras, Aristomenis; Shahgaldi, Kambiz

    2014-12-01

    To investigate the role of 2D-transthoracic echocardiography (2D-TTE) and 3D-transesophageal echocardiography (3D-TEE) in the determination of aortic annulus size prior transcatheter aortic valve implantation (TAVI) and its' impact on the prevalence of patient prosthesis mismatch (PPM). Echocardiography plays an important role in measuring aortic annulus dimension in patients undergoing TAVI. This has great importance since it determines both eligibility for TAVI and selection of prosthesis type and size, and can be potentially important in preventing an inadequate ratio between the prosthetic valvular orifice and the patient's body surface area, concept known as prosthesis-patient mismatch (PPM). A total of 45 patients were studied pre-TAVI: 20 underwent 3D-TEE (men/women 12/8, age 84.8 ± 5.6) and 25 2D-TTE (men/women 9/16, age 84.4 ± 5.4) in order to measure aortic annulus diameter. The presence of PPM was assessed before hospital discharge and after a mean period of 3 months. Moderate PPM was defined as indexed aortic valve area (AVAi) ≤ 0.85 cm(2)/m(2) and severe PPM as AVAi < 0.65 cm(2)/m(2). Immediately post-TAVI, moderate PPM was present in 25 and 28 % of patients worked up using 3D-TEE and 2D-TTE respectively p value = n.s) and severe PPM occurred in 10 % of the patients who underwent 3D-TEE and in 20 % in those with 2D-TTE (p value = n.s). The echocardiographic evaluation 3 months post-TAVI showed 25 % moderate PPM in the 3D-TEE group compared with 24 % in the 2D-TTE group (p value = n.s) and no cases of severe PPM in the 3DTEE group comparing to 20 % in the 2D-TTE group (p = 0.032). Our results indicate a higher incidence of severe PPM in patients who performed 2DTTE compared to those performing 3DTEE prior TAVI. This suggests that the 3D technique should replace the 2DTTE analysis when investigating the aortic annulus diameter in patients undergoing TAVI.

  19. TU-F-BRF-04: Registration of 3D Transesophageal Echocardiography and X-Ray Fluoroscopy Using An Inverse Geometry X-Ray System

    Energy Technology Data Exchange (ETDEWEB)

    Speidel, M; Hatt, C; Tomkowiak, M; Raval, A [University of Wisconsin, Madison, WI (United States); Funk, T [Triple Ring Technologies, Inc., Newark, CA (United States)

    2014-06-15

    Purpose: To develop a method for the fusion of 3D echocardiography and Scanning-Beam Digital X-ray (SBDX) fluoroscopy to assist with catheter device and soft tissue visualization during interventional procedures. Methods: SBDX is a technology for low-dose inverse geometry x-ray fluoroscopy that performs digital tomosynthesis at multiple planes in real time. In this study, transesophageal echocardiography (TEE) images were fused with SBDX images by estimating the 3D position and orientation (the “pose”) of the TEE probe within the x-ray coordinate system and then spatially transforming the TEE image data to match this pose. An initial pose estimate was obtained through tomosynthesis-based 3D localization of points along the probe perimeter. Position and angle estimates were then iteratively refined by comparing simulated projections of a 3D probe model against SBDX x-ray images. Algorithm performance was quantified by imaging a TEE probe in different known orientations and locations within the x-ray field (0-30 degree tilt angle, up to 50 mm translation). Fused 3D TEE/SBDX imaging was demonstrated by imaging a tissue-mimicking polyvinyl alcohol cylindrical cavity as a catheter was navigated along the cavity axis. Results: Detected changes in probe tilt angle agreed with the known changes to within 1.2 degrees. For a 50 mm translation along the source-detector axis, the detected translation was 50.3 mm. Errors for in-plane translations ranged from 0.1 to 0.9 mm. In a fused 3D TEE/SBDX display, the catheter device was well visualized and coincident with the device shadow in the TEE images. The TEE images portrayed phantom boundaries that were not evident under x-ray. Conclusion: Registration of soft tissue anatomy derived from TEE imaging and device imaging from SBDX x-ray fluoroscopy is feasible. The simultaneous 3D visualization of these two modalities may be useful in interventional procedures involving the navigation of devices to soft tissue anatomy.

  20. Renal resistive index by transesophageal and transparietal echo-doppler imaging for the prediction of acute kidney injury in patients undergoing major heart surgery.

    Science.gov (United States)

    Regolisti, Giuseppe; Maggiore, Umberto; Cademartiri, Carola; Belli, Loredana; Gherli, Tiziano; Cabassi, Aderville; Morabito, Santo; Castellano, Giuseppe; Gesualdo, Loreto; Fiaccadori, Enrico

    2017-04-01

    Acute kidney injury (AKI) following major heart surgery (MHS) is associated with early decrease in renal blood flow and worsened prognosis. Doppler-derived renal resistive index (RRI), which reflects renal vascular resistance, may predict the development of AKI in patients undergoing MHS. We studied 60 consecutive patients (mean age 69.5 years, range 30-88, 41 males) undergoing MHS. We measured RRI, both at the renal sinus and intraparenchymally, by transesophageal echo-Doppler ultrasound (TE-ED us ) at anesthesia induction and at the end of surgery in all patients. Additionally, we measured RRI by external transparietal echo-Doppler ultrasound (TP-ED us ) at the following time points: anesthesia induction, end of surgery, 4 and 24 h from cardiopulmonary bypass (CPB) start. We also measured serum neutrophil gelatinase associated lipocalin (NGAL) at the same time points. AKI [serum creatinine (sCr) increase ≥0.3 mg/dl vs. baseline within 72 h] developed in 23/60 (38.3 %) patients, with two requiring dialysis. Systemic hemodynamic parameters were similar in the patients who developed AKI (AKI+) and in those who did not (AKI-). Intraparenchymal RRI at end-surgery was significantly higher in AKI+ compared to AKI- patients, both at TE-ED us and TP-ED us (TE-ED us mean difference, p = 0.004; TP-ED us mean difference, p = 0.013; difference between TE-ED us and TP-ED us results, p = 0.066), although the predictive performance was limited with both methods (area under the curve [AUC] of the receiver-operator characteristics: 0.71 and 0.70 for TE-ED us and TP-ED us , respectively). Serum NGAL values were higher in AKI + than in AKI- patients (anesthesia induction, p = 0.037; end-surgery, p = 0.007; 4 h from CPB start, p = 0.093; 24 h from CPB start, p = 0.024. However, combining RRI with serum NGAL at end-surgery did not provide a clear-cut advantage in predicting AKI. In patients undergoing MHS, increased echo-Doppler ultrasound-derived RRI at end

  1. Prospective randomized trial of transthoracic echocardiography versus transesophageal echocardiography for assessment and guidance of transcatheter closure of atrial septal defects in children using the Amplatzer septal occluder.

    Science.gov (United States)

    Bartakian, Sergio; El-Said, Howaida G; Printz, Beth; Moore, John W

    2013-09-01

    This study sought to determine whether transthoracic echocardiography (TTE) can provide safety and efficacy equivalent to transesophageal echocardiography (TEE) for assessment and guidance of transcatheter atrial septal defect (ASD) closure in pediatric patients. We performed a prospective randomized trial of ASD closure using the Amplatzer septal occluder (ASO) from March 2008 to April 2012. Inclusion criteria were isolated secundum ASD, age 2 to 18 years, and adequate TTE windows. Forty patients were enrolled and randomized to either TEE or TTE. In the TEE group, we used "stop flow" balloon sizing to determine device size. In the TTE group, we used the average ASD diameter times 1.2 (scaled). Patients were followed up to 1 year. Patient general and hemodynamic characteristics were similar in both groups. Procedural success was 100% in both groups. The average TEE stop flow diameter was similar to the scaled TTE diameter (15.35 ± 4.62 mm vs. 16.57 ± 5.47 mm; p = 0.46). Device size (16.0 ± 4.94 mm vs. 16.37 ± 5.05 mm, p = 0.82) and ratio of device to defect size (1.0 ± 0.06 vs. 0.99 ± 0.03, p = 0.52) were also similar. Total procedure (70.6 ± 22.98 min vs. 51.1 ± 17.61 min, p = 0.005), room (126.8 ± 28.41 min vs. 95.7 ± 20.53 min, p = 0.0004), and fluoroscopy (13.6 ± 6.17 min vs. 8.9 ± 8.45 min, p = 0.007) times were all significantly shorter in the TTE group. Neither group had significant complications during the procedure nor in follow-up. Rates of shunt resolution were similar between groups. This study suggests that in selected pediatric patients, use of TTE is as efficacious and safe as TEE for assessment and guidance of ASD occlusion using the ASO. TTE also may offer the additional safety benefit of reduced fluoroscopy exposure. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. Compression syndrome of the left renal vein

    Energy Technology Data Exchange (ETDEWEB)

    Justich, E.

    1982-04-01

    Severe compression of the left renal vein produces a pressure gradient between it and the inferior vena cava and results in changes in haemodynamics. The cause of the narrowing is usually the aorta, less commonly the superior mesenteric artery. Compression of the left renal vein may be responsible for a number of abnormalities such as primary varicoceles, primary varices of the ovarian, renal, pelvic and ureteric veins on the left, the more frequent occurrence of unilateral renal vein thrombosis on the left and the development of renovascular hypertension. One hundred and twenty-three selective phlebograms of the left renal vein and CT examinations of this structure in a further 87 patients acting as a control group were carried out. The significance of compression of the left renal vein as an aetiological factor in the development of the above mentioned abnormalities is discussed.

  3. Prognostic value of left atrial function in systemic light-chain amyloidosis: a cardiac magnetic resonance study.

    Science.gov (United States)

    Mohty, Dania; Boulogne, Cyrille; Magne, Julien; Varroud-Vial, Nicolas; Martin, Sylvain; Ettaif, Hind; Fadel, Bahaa M; Bridoux, Frank; Aboyans, Victor; Damy, Thibaud; Jaccard, Arnaud

    2016-09-01

    Cardiac involvement in systemic light-chain amyloidosis (AL) imparts an adverse impact on outcome. The left atrium (LA), by virtue of its anatomical location and muscular wall, is commonly affected by the amyloid process. Although LA infiltration by amyloid fibrils leads to a reduction in its pump function, the infiltration of the left ventricular (LV) myocardium results in diastolic dysfunction with subsequent increase in filling pressures and LA enlargement. Even though left atrial volume (LAV) is an independent prognostic marker in many cardiomyopathies, its value in amyloid heart disease remains to be determined. In addition, few data are available as to the prognostic value of LA function in systemic AL. Using cardiac magnetic resonance (CMR), the current study aims to assess the prognostic significance of the maximal LAV and total LA emptying fraction (LAEF) in patients with AL. Fifty-four consecutive patients (age 66 ± 10 years, 59% males) with confirmed systemic AL and mean LV ejection fraction of 60 ± 12% underwent CMR. As compared with patients with no or minimal cardiac involvement (Mayo Clinic [MC] stage I), those at moderate and high risk (MC stages II and III) had significantly larger indexed maximal LAV (36 ± 15 vs. 46 ± 13 vs. 52 ± 19 mL/m(2), P = 0.03) and indexed minimal LAV (20 ± 6 vs. 34 ± 11 vs. 44 ± 17 mL/m(2), P 16% (37 ± 11 vs. 94 ± 4%, P = 0.001). In multivariate analysis, lower LAEF remained independently associated with a higher risk of 2-year mortality (HR = 1.08 per 1% decrease, 95% CI: 1.02-1.15, P = 0.003). In patients with systemic AL, LAEF as assessed by CMR is associated with NYHA functional class, MC stage, myocardial LGE and 2-year mortality. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  4. Multiplicativity of left centralizers forcing additivity

    Directory of Open Access Journals (Sweden)

    Mohammad Sayed Tammam El-Sayiad

    2014-01-01

    Full Text Available A multiplicative left centralizer for an associative ring R is a map satisfying T(xy = T\\(xy for all x,y in R. T is not assumed to be additive. In this paper we deal with the additivity of the multiplicative left centralizers in a ring which contains an idempotent element. Specially, we study additivity for multiplicative left centralizers in prime and semiprime rings which contain an idempotent element.

  5. Anarchy, socialism and a Darwinian left.

    Science.gov (United States)

    Clarke, Ellen

    2006-03-01

    In A Darwinian left Peter Singer aims to reconcile Darwinian theory with left wing politics, using evolutionary game theory and in particular a model proposed by Robert Axelrod, which shows that cooperation can be an evolutionarily successful strategy. In this paper I will show that whilst Axelrod's model can give support to a kind of left wing politics, it is not the kind that Singer himself envisages. In fact, it is shown that there are insurmountable problems for the idea of increasing Axelrodian cooperation within a welfare state. My surprising conclusion will be that a Darwinian left worthy of the name would be anarchistic.

  6. What is Beyond Right/Left?

    DEFF Research Database (Denmark)

    Dyrberg, Torben Bech

    2009-01-01

    The article looks at New Labour's move beyond right/left in the mid/late 1990s, which is an occasion to spell out the nature of right/left and what it means for democracy. In contrast to both defenders and critics of this move I argue in the first part that right/left is not an empty label bound up...... right/left. I argue that the new hegemonic orientation is that of front/back, which designs political renewal as a response to the social changes cutting across the outdated lines of contestation of partisan politics. The democratic problem of this move lies in squeezing politics between technocratic...

  7. Left atrial systolic force in hypertensive patients with left ventricular hypertrophy: the LIFE study

    DEFF Research Database (Denmark)

    Chinali, M.; Simone, G. de; Wachtell, K.

    2008-01-01

    In hypertensive patients without prevalent cardiovascular disease, enhanced left atrial systolic force is associated with left ventricular hypertrophy and increased preload. It also predicts cardiovascular events in a population with high prevalence of obesity. Relations between left atrial...... with larger left ventricular diameter and higher left ventricular mass index (both P hypertrophy was greater (84 vs. 64%; P ..., transmitral peak E velocities and peak A velocities; and lower E/A ratio (all P hypertrophy, but normal left ventricular chamber systolic function with increased...

  8. Mixoma em átrio esquerdo associado a doença arterial coronariana obstrutiva Left atrial myxoma associated with obstructive coronary artery disease

    Directory of Open Access Journals (Sweden)

    Ronaldo Altenburg Odebrecht Curi Gismondi

    2007-01-01

    Full Text Available Descrevemos o caso de um paciente de 67 anos, portador de doença arterial coronariana obstrutiva, o qual, em avaliação pré-operatória para cirurgia de herniorrafia inguinal, realizou ecocardiograma demonstrando um volumoso tumor em átrio esquerdo, móvel, não-obstrutivo, com pedículo proveniente da veia pulmonar superior direita. O paciente realizou cineangiocoronariografia com ventriculografia esquerda, evidenciando lesão obstrutiva grave em terço médio da artéria descendente anterior, moderada em terço proximal da artéria circunflexa, no local de saída do primeiro ramo marginal, e coronária direita com lesão não-obstrutiva em terço distal. Havia, ainda, disfunção ventricular esquerda moderada. O paciente foi então submetido a cirurgia para retirada do tumor e revascularização do miocárdio. O exame histopatológico mostrou tratar-se de um mixoma.We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the preoperative survey for inguinal herniorraphy surgery, discovered, by a two-dimensional echocardiogram, a tumor in left atrium, mobile, non-obstructive. The patient underwent a cineangiocoronariography showing severe stenosis in the left anterior descending artery, moderate stenosis in the left circumflex artery, near the origin of the first marginal branch, and a non-obstructive plaque in the right coronary artery. There was also moderate left ventricular dysfunction. After that, the patient has gone coronary artery bypass surgery and resection of the left atrial tumor. The histological exam revealed that the tumor was, in fact, a myxoma.

  9. Left Paraduodenal Hernia: An Autopsy Case

    DEFF Research Database (Denmark)

    Omland, Silje Haukali; Hougen, Hans Petter

    2011-01-01

    We present a case of a left paraduodenal hernia diagnosed at autopsy. A left paraduodenal hernia is an internal hernia of congenital origin due to the abnormal rotation of the midgut during embryonic development. Internal hernias are a rare cause of intestinal obstruction, with the paraduodenal...

  10. Left ventricular hypertrophy, geometric patterns and clinical ...

    African Journals Online (AJOL)

    Background: Left ventricular hypertrophy can be due to various reasons including hypertension. It constitutes an increased cardiovascular risk. Various left ventricular geometric patterns occur in hypertension and may affect the cardiovascular risk profile of hypertensive subjects. Methods: One hundred and eighty eight ...

  11. Leptogenesis with left-right domain walls

    Indian Academy of Sciences (India)

    the scale of left-right symmetry breaking. Keywords. Leptogenesis; baryogenesis; domain walls; left-right symmetry. PACS Nos 12.10.Dm; 98.80.Cq; 98.80.Ft. Explaining the observed baryon asymmetry of the Universe within the framework of gauge theories and the standard Big Bang cosmology remains an open problem.

  12. On establishing coreference in Left Dislocation constructions ...

    African Journals Online (AJOL)

    The phenomenon of left dislocation (LD) has received relatively little attention in the generative literature. In Government & Binding theory and early versions of Minimalist Syntax, the left-dislocated expression is conventionally taken to be base-generated in its sentence-initial surface position and the resumptive pronoun in ...

  13. A new clinical sign probably associated to left hemiplegia with left hemineglect syndrome: the crossed legs.

    Science.gov (United States)

    Bazan, Rodrigo; Fernandes, Thiago; Braga, Gabriel; Luvizutto, Gustavo; Resende, Luiz

    2014-06-01

    To describe a new clinical sign associated with left unilateral neglect syndrome (UNS) in patients with ischemic stroke. Head computed tomography (CT) and National Institute of Health Stroke Scale were obtained in 150 patients with ischemic stroke. Those with right cerebral vascular lesions, left hemiplegia and right leg persistently crossed over the left were submitted to specific tests for UNS. The tests were also applied to 30 patients with right cerebral vascular lesions, left hemiplegia but without crossed legs. From 9 patients with persistent tendency to cross the right leg over the left, UNS was detected in 8. One patient died before the clinical tests were applied. Of the 30 patients without the crossed legs, 20 had normal clinical tests for UNS and 10 had minimal alterations, not sufficient for the diagnosis of UNS. The right leg crossed over the left may represent a new neurological semiotic sign associated with left hemiplegia and left UNS.

  14. Left ventricular outflow tract obstruction following repair of pneumococcal mitral annular abscess.

    Science.gov (United States)

    Charney, R; Schwinger, M E; Brodman, R; Spindola-Franco, H; Levine, E; Moser, S

    1993-04-01

    An unusual case of a mitral annular abscess caused by Streptococcus pneumoniae was diagnosed by transesophageal echocardiography. The patient underwent surgical resection of the abscess and developed outflow tract obstruction. This is an unusual complication of the surgical procedure. The outflow tract obstruction may have been due to anterior displacement of the mitral valve by the abscess.

  15. Social aspects of left-handedness

    Directory of Open Access Journals (Sweden)

    Belojević Goran

    2010-01-01

    Full Text Available Throughout human history left-handedness has been considered as sinful. It has been associated with the devil, weakness, female gender, unhealthiness, evil, something that has to be turned to a “good” - right side by force. Left-handedness is being more and more acceptable at rational level, but in everyday life it is still considered to be unusual if someone writes with the left hand. Lessening of the number of lefthanders is associated with ageing. There are about 13% lefthanders among people in twenties and less than 1% lefthanders among those in eighties. This finding may be explaned with more pronounced socio-cultural pressure on left-handed people in the past, compared to nowadays. On the other hand, this may also support the hypothesis about a reduced life span of lefthanded people. With cross-exercising of left-handedness, certain typical characteristics and behavioral patterns appear in these people. This was a sort of provoked behavior and an attack on the integrity of an emotional attitude toward oneself. Stuttering may also appear as a consequence of unsuccessful cross-exercising of left-handedness. The hypothesis about left-handedness as an advantage is supported with the reports about relatively more lefthanders in some specific groups such as: mathematicians, sculptors, architects, painters, musicians, actors, tennis players, as well as famous army commanders and rulers.

  16. Left ventricular performance during triggered left ventricular pacing in patients with cardiac resynchronization therapy and left bundle branch block

    DEFF Research Database (Denmark)

    Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard

    2016-01-01

    PURPOSE: To assess the acute effect of triggered left ventricular pacing (tLVp) on left ventricular performance and contraction pattern in patients with heart failure, left bundle branch block (LBBB), and cardiac resynchronization therapy (CRT). METHODS: Twenty-three patients with pre-implant QRS...... complex >150 ms, QRS complex narrowing under CRT, and sinus rhythm were included ≥3 months after CRT implantation. Echocardiographic assessment of left ventricular ejection fraction (LVEF), global peak systolic longitudinal strain (GLS), and contraction pattern by 2D strain was performed during intrinsic......V pacing. CONCLUSIONS: The acute effect of tLVp on LV systolic function and contraction pattern is significantly lower than the effect of BiV pacing and not different from intrinsic conduction in patients with LBBB and CRT....

  17. Motion of left atrial appendage as a determinant of thrombus formation in patients with a low CHADS2 score receiving warfarin for persistent nonvalvular atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Ono Koji

    2012-12-01

    Full Text Available Abstract Background The aim of this study was to define the independent determinants of left atrial appendage (LAA thrombus among various echocardiographic parameters measured by Velocity Vector Imaging (VVI in patients with nonvalvular atrial fibrillation (AF receiving warfarin, particularly in patients with a low CHADS2 score. Methods LAA emptying fraction (EF and LAA peak longitudinal strain were measured by VVI using transesophageal echocardiography in 260 consecutive patients with nonvalvular persistent AF receiving warfarin. The patients were divided into two groups according to the presence (n=43 or absence (n=217 of LAA thrombus. Moreover, the patients within each group were further divided into subgroups according to a CHADS2 score ≤1. Results Multivariate logistic regression analysis showed that LAAEF was an independent determinant of LAA thrombus in the subgroup of 140 with a low CHADS2 score. Receiver operating characteristics curve analysis showed that an LAAEF of 21% was the optimal cutoff value for predicting LAA thrombus. Conclusions LAA thrombus formation depended on LAA contractility. AF patients with reduced LAA contractile fraction (LAAEF ≤21% require strong anticoagulant therapy to avoid thromboembolic events regardless of a low CHADS2 score (≤1.

  18. Feasibility of rapid and automated importation of 3D echocardiographic left ventricular (LV) geometry into a finite element (FEM) analysis model.

    Science.gov (United States)

    Verhey, Janko F; Nathan, Nadia S

    2004-10-08

    Finite element method (FEM) analysis for intraoperative modeling of the left ventricle (LV) is presently not possible. Since 3D structural data of the LV is now obtainable using standard transesophageal echocardiography (TEE) devices intraoperatively, the present study describes a method to transfer this data into a commercially available FEM analysis system: ABAQUS. In this prospective study TomTec LV Analysis TEE Software was used for semi-automatic endocardial border detection, reconstruction, and volume-rendering of the clinical 3D echocardiographic data. A newly developed software program MVCP FemCoGen, written in Delphi, reformats the TomTec file structures in five patients for use in ABAQUS and allows visualization of regional deformation of the LV. This study demonstrates that a fully automated importation of 3D TEE data into FEM modeling is feasible and can be efficiently accomplished in the operating room. For complete intraoperative 3D LV finite element analysis, three input elements are necessary: 1. time-gaited, reality-based structural information, 2. continuous LV pressure and 3. instantaneous tissue elastance. The first of these elements is now available using the methods presented herein.

  19. Feasibility of rapid and automated importation of 3D echocardiographic left ventricular (LV geometry into a finite element (FEM analysis model

    Directory of Open Access Journals (Sweden)

    Nathan Nadia S

    2004-10-01

    Full Text Available Abstract Background Finite element method (FEM analysis for intraoperative modeling of the left ventricle (LV is presently not possible. Since 3D structural data of the LV is now obtainable using standard transesophageal echocardiography (TEE devices intraoperatively, the present study describes a method to transfer this data into a commercially available FEM analysis system: ABAQUS©. Methods In this prospective study TomTec LV Analysis TEE© Softwa