TEE Images Research Articles

AngioVac Procedures: Integration of cardiac surgeon and anesthesiologist-led transesophageal echocardiography: A preliminary report

IntroductionThe AngioVac system is a novel, minimally invasive, endovascular technique used to evacuate intravascular or intracardiac vegetation or thrombus. Although most AngioVac procedures are currently performed by interventionalists, this innovative procedure has been gaining attention among the surgical and anesthesia communities. MethodsWe retrospectively reviewed all patients who underwent the AngioVac procedure performed by a cardiac surgeon between August 2019 and December 2022. Fellowship-trained cardiac anesthesiologists operated TEE to navigate the AngioVac cannula during the procedure. The stored TEE images were retrospectively reviewed and independently analyzed by two cardiac anesthesiologists with specific focus on TEE-guided navigation of the AngioVac cannula towards the aspiration target. ResultsEleven patients underwent the AngioVac procedure during the study period. In nine cases, the majority of the vegetation or thrombus was successfully aspirated. In two cases, incomplete aspiration was attributed to the mass burden being too large, firm, and chronic in etiology. Worsening tricuspid regurgitation (TR) was identified in three of the 11 cases. Intraoperative TEE provided the cardiac surgeon with simultaneous display of the AngioVac cannula shaft, its tip, and aspiration target, as well as real-time assessment of TR, facilitating the minute movements essential for successful outcomes. ConclusionsThis study details our experience and the effectiveness of the AngioVac system for treating soft, intracardiac vegetation or thrombus in a minimally invasive manner. Experienced cardiac anesthesiologists have the skillsets and knowledge to provide optimal live TEE imaging necessary for successful maneuvering of the AngioVac cannula.

Impact of interatrial septal thickness and interatrial conduction time on cryoballoon ablation outcome

Abstract Introduction Interatrial septal thickness (IAST) is an indirect measure of interatrial septal fat which is anatomic extension of epicardial fat. Interatrial conduction time (IACT) reflects altered conduction between atria. Both parameters are associated with left atrial (LA) fibrosis and atrial fibrillation (AF). However, limited data exist regarding the influence of IAST and IACT on the outcomes of cryoballoon ablation (CBA). In this study, we aimed to analyze possible effect of IAST and IACT on atrial tachyarrhythmia (ATA) free survival after CBA. Methods and results Sixty five patients (34/65, 52.3% male, 53.3±11.0 years old) undergoing first time CBA for pulmonary vein isolation were enrolled. Pre-procedural TEE images were analyzed and bicaval view was used to visualize SVC rim for IAST measurement (Figure 1). IACT was measured from the onset of surface P wave to atrial EGM recorded by distal coronary sinus electrode. After 3 months blanking period all anti-arrhythmic drugs were discontinued. Clinical endpoint was ATA recurrence including AF, flutter or tachycardia lasting more than 30 seconds. After 11.2±4.1 months of follow-up 8 patients (12.3%) had ATA recurrence. IAST (4.4±1.1 vs 3.3±0.6 mm, p=0.007) and LA volume index (37.4±8.0 vs 30.1±12.4 mL/m2, p=0.03) were greater in patients with ATA recurrence than those without. In contrast, patients with and without had similar IACT (85.8±31.1 vs 62.2±23.9 ms, p=0.10). Conclusion Pre-procedural measurement of IAST using TEE may provide prognostic information in CBA patients. Increased IAST was found to be associated with ATA recurrence after CBA based PVI and warrants further study.Interatrial septal thickness measurement

Complete region of interest reconstruction by fusing multiview deformable three-dimensional transesophageal echocardiography images.

While three-dimensional transesophageal echocardiography (3D TEE) has been increasingly used for assessing cardiac anatomy and function, it still suffers from a limited field of view (FoV) of the ultrasound transducer. Therefore, it is difficult to examine a complete region of interest without moving the transducer. Existing methods extend the FoV of 3D TEE images by mosaicing multiview static images, which requires synchronization between 3D TEE images and electrocardiogram (ECG) signal to avoid deformations in the images and can only get the widened image at a specificphase. This work aims to develop a novel multiview nonrigid registration and fusion method to extend the FoV of 3D TEE images at different cardiac phases, avoiding the bias toward the specifically chosenphase. A multiview nonrigid registration and fusion method is proposed to enlarge the FoV of 3D TEE images by fusing dynamic images captured from different viewpoints sequentially. The deformation field for registering images is defined by a collection of affine transformations organized in a graph structure and is estimated by a direct (intensity-based) method. The accuracy of the proposed method is evaluated by comparing it with two B-spline-based methods, two Demons-based methods, and one learning-based method VoxelMorph. Twenty-nine sequences of in vivo 3D TEE images captured from four patients are used for the comparative experiments. Four performance metrics including checkerboard volumes, signed distance, mean absolute distance (MAD), and Dice similarity coefficient (DSC) are used jointly to evaluate the accuracy of the results. Additionally, paired t-tests are performed to examine the significance of theresults. The qualitative results show that the proposed method can align images more accurately and obtain the fused images with higher quality than the other five methods. Additionally, in the evaluation of the segmented left atrium (LA) walls for the pairwise registration and sequential fusion experiments, the proposed method achieves the MAD of (0.07 ± 0.03) mm for pairwise registration and (0.19 ± 0.02) mm for sequential fusion. Paired t-tests indicate that the results obtained from the proposed method are more accurate than those obtained by the state-of-the-art VoxelMorph and the diffeomorphic Demons methods at the significance level of 0.05. In the evaluation of left ventricle (LV) segmentations for the sequential fusion experiments, the proposed method achieves a DSC of (0.88 ± 0.08), which is also significantly better than diffeomorphic Demons at the 0.05 level. The FoVs of the final fused 3D TEE images obtained by our method are enlarged around two times compared with the originalimages. Without selecting the static (ECG-gated) images from the same cardiac phase, this work addressed the problem of limited FoV of 3D TEE images in the deformable scenario, obtaining the fused images with high accuracy and good quality. The proposed method could provide an alternative to the conventional fusion methods that are biased toward the specifically chosenphase.

Transcatheter Edge to Edge Mitral Valve Repair (MitraClip) Step by Step Guide

Surgical mitral valve repair has been the gold standard treatment for severe degenerative mitral regurgitation. However, a segment of patient population is considered too high risk for surgery because of their age and/or comorbidities.Catheter-based interventions have been developed during the last decade to address mitral regurgitation in high surgical risk patients. MitraClip System (Abbott Vascular, Santa Clara, CA, USA) is FDA approved in high risk patients with primary or secondary mitral regurgitation who meet certain criteria. This article touches briefly on indications for transcatheter edge to edge mitral valve repair (TEER) and focuses on describing procedural steps to perform TEER usig MitraClip device. These steps include preoperative assessment and planning using TEE images, transseptal access to mitral valve, introducing transseptal sheath, steerable guide catheter (SGC), and clip delivery system (CDS), crossing the mitral valve, grasping the leaflets in desired location, and deployment. Procedural steps are also demonstrated in a brief video. Surgical mitral valve repair has been the gold standard treatment for severe degenerative mitral regurgitation. However, a segment of patient population is considered too high risk for surgery because of their age and/or comorbidities.Catheter-based interventions have been developed during the last decade to address mitral regurgitation in high surgical risk patients. MitraClip System (Abbott Vascular, Santa Clara, CA, USA) is FDA approved in high risk patients with primary or secondary mitral regurgitation who meet certain criteria. This article touches briefly on indications for transcatheter edge to edge mitral valve repair (TEER) and focuses on describing procedural steps to perform TEER usig MitraClip device. These steps include preoperative assessment and planning using TEE images, transseptal access to mitral valve, introducing transseptal sheath, steerable guide catheter (SGC), and clip delivery system (CDS), crossing the mitral valve, grasping the leaflets in desired location, and deployment. Procedural steps are also demonstrated in a brief video.

TEE image quality improvement with our devised probe cover.

Our hypothesis was that our devised transesophageal echocardiography probe cover with the capacity for pinpoint suction would improve image quality. Prospective cohort study. Single tertiary medical center. Patients undergoing surgery requiring intraoperative transesophageal echocardiography. Suctioning with inserted orogastric tube. Changes in image quality with suctioning were assessed by 2 methods. In method #1, investigators categorized the quality of all acquired images on a numeric scale based on each investigator's impression (1: very poor, 2: poor, 3: acceptable, 4: good, and 5: very good). In method #2, the reproducibility of the left ventricular fraction area change (LV FAC) was assessed, assuming that improved transgastric midpapillary short-axis view image quality would yield better LV FAC reproducibility. With method #1, for midesophageal views, 26.5%, 70.5%, and 3.0% of images showed improved, the same, and worsened image quality, respectively. For transgastric views, 55.3%, 43.3%, and 1.4% showed improved, the same, and worsened image quality, respectively. For deep transgastric views, 60.0%, 38.0%, and 2.0% showed improved, the same, and worsened image quality, respectively. With method #2, the presuction group had an ICC of 0.942 (95% CI: 0.91, 0.965). The postsuction group had an ICC of 0.988 (95% CI: 0.981, 0.993). Our investigation validates the potential image quality improvement withour devised TEE probe cover. However, its clinical validity needs to be confirmed by further studies.

Direct 3D ultrasound fusion for transesophageal echocardiography

BackgroundReal-time three-dimensional transesophageal echocardiography (3D TEE) has been increasingly used in clinic for fast 3D analysis of cardiac anatomy and function. However, 3D TEE still suffers from the limited field of view (FoV). It is challenging to adopt conventional multi-view fusion methods to 3D TEE images because feature-based registration methods tend to fail in the ultrasound scenario, and conventional intensity-based methods have poor convergence properties and require an iterative coarse-to-fine strategy. MethodsA novel multi-view registration and fusion method is proposed to enlarge the FoV of 3D TEE images efficiently. A direct method is proposed to solve the registration problem in the Lie algebra space. Fast implementation is realized by searching voxels on three orthogonal planes between two volumes. Besides, a weighted-average 3D fusion method is proposed to fuse the aligned images seamlessly. For a sequence of 3D TEE images, they are fused incrementally. ResultsQualitative and quantitative results of in-vivo experiments indicate that the proposed registration algorithm outperforms a state-of-the-art PCA-based registration method in terms of accuracy and efficiency. Image registration and fusion performed on 76 in-vivo 3D TEE volumes from nine patients show apparent enlargement of FoV (enlarged around two times) in the obtained fused images. ConclusionsThe proposed methods can fuse 3D TEE images efficiently and accurately so that the whole Region of Interest (ROI) can be seen in a single frame. This research shows good potential to assist clinical diagnosis, preoperative planning, and future intraoperative guidance with 3D TEE.

Comparison of pulmonary vein sizing by transesophageal echocardiogram and by direct angiogram

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein (PV) anatomy and sizing is important to know before performing PV isolation. This information is conventionally obtained by angiography or by CT scan. Aim We undertook this study to identify and measure the PVs during TEE studies and validate these against angiography. Method 17 consecutive patients due to undergo PV isolation for paroxysmal atrial fibrillation were analysed. Using TEE, the PVs were visualised (Upper panel) as follows: i) From the mid-esophageal four chamber view, the chamber probe was turned to the right at 110-130º for the bicaval view, where the RSPV was seen entering the left atrium adjacent to the SVC. ii) At 0º the SVC was imaged in its short axis, and the probe advanced till the interatrial septum was seen. The angle was changed to 30º to visualise the right inferior PV (RIPV). iii) From the two chamber view (70-90º), the probe was turned to the left and withdrawn to display the left superior PV (LSPV) entering the left atrium parallel to the appendage.iv) Keeping the LSPV in focus, the angle was changed to 135º and the probe advanced till the AV groove, where the left inferior PV (LIPV) was visualised. After transseptal puncture, each PV was cannulated. The PV angiograms were performed in several projections to obtain the best PV profile (lower panel). Using electronic callipers, each PV was measured within 1 cm of its entry into the left atrium, after having received all tributaries. Those PVs were considered for analysis which were measured by both TEE and angiography. The paired ‘T’ test was used to compare the PV diameters by TEE and angiography and the Bland Altman analysis was done to see the level of agreement. Results Of a total of 68 PVs, 62 could be adequately visualised by TEE and 50 by angiography. These 50 PVs were measured using both methods. The diameters of the PVs measured by TEE and angiography were not statistically different by the paired t test; LSPV14 ± 1.8 mm v/s 14.4 ± 2.1 mm; RSPV 13 ± 1.8 mm v/s 14.6 ± 3.5 mm; LIPV 11.9 ± 2.1 vs 13.2 ± 2.8 mm and RIPV 10.5 ± 2.7 vs 12.1 ± 2.9 mm. Bland Altman analysis showed most PV sizes estimated by TEE and angiography lay within limits of agreement. Conclusions A majority of PVs can be visualised by TEE using a defined protocol. TEE is a good technique to visualise and assess the size of PVs, avoiding the need for contrast medium and radiation. Abstract Figure. TEE and angiographic images of PVs

3D ECHOCARDIOGRAPHIC ASSESSMENT OF MITRAL ANNULAR DIMENSIONS AND RISK OF MITRAL STENOSIS AFTER TRANSCATHETER MITRAL VALVE REPAIR

Post procedural mitral stenosis (PPMS) is associated with adverse outcomes in subjects undergoing transcatheter mitral valve repair (TMVR). We hypothesized that smaller mitral annular dimensions would be associated with increased risk of PPMS. 3D TEE images previously acquired in 49 subjects

Semiautomatic Estimation of Device Size for Left Atrial Appendage Occlusion in 3-D TEE Images.

Left atrial appendage (LAA) occlusion is used to reduce the risk of thromboembolism in patients with nonvalvular atrial fibrillation by obstructing the LAA through a percutaneously delivered device. Nonetheless, correct device sizing is complex, requiring the manual estimation of different measurements in preprocedural/periprocedural images, which is tedious and time-consuming and with high interobserver and intraobserver variability. In this paper, a semiautomatic solution to estimate the required relevant clinical measurements is described. This solution starts with the 3-D segmentation of the LAA in 3-D transesophageal echocardiographic images, using a constant blind-ended model initialized through a manually defined spline. Then, the segmented LAA surface is aligned with a set of templates, i.e., 3-D surfaces plus relevant measurement planes (manually defined by one observer), transferring the latter to the unknown situation. Specifically, the alignment is performed in three consecutive steps, namely: 1) rigid alignment using the LAA clipping plane position; 2) orientation compensation using the circumflex artery location; and 3) anatomical refinement through a weighted iterative closest point algorithm. The novel solution was evaluated in a clinical database with 20 volumetric TEE images. Two experiments were set up to assess: 1) the sensitivity of the model's parameters and 2) the accuracy of the proposed solution for the estimation of the clinical measurements. Measurement levels manually identified by two observers were used as ground truth. The proposed solution obtained results comparable to the interobserver variability, presenting narrower limits of agreement for all measurements. Moreover, this solution proved to be fast, taking nearly 40 s (manual analysis took 3 min) to estimate the relevant measurements while being robust to the variation of the model's parameters. Overall, the proposed solution showed its potential for fast and robust estimation of the clinical measurements for occluding device selection, proving its added value for clinical practice.

Three-dimensional mitral valve reconstruction based on TEE images

Three-dimensional mitral valve reconstruction based on TEE images

Signal dropout correction-based ultrasound segmentation for diastolic mitral valve modeling.

Three-dimensional ultrasound segmentation of mitral valve (MV) at diastole is helpful for duplicating geometry and pathology in a patient-specific dynamic phantom. The major challenge is the signal dropout at leaflet regions in transesophageal echocardiography image data. Conventional segmentation approaches suffer from missing sonographic data leading to inaccurate MV modeling at leaflet regions. This paper proposes a signal dropout correction-based ultrasound segmentation method for diastolic MV modeling. The proposed method combines signal dropout correction, image fusion, continuous max-flow segmentation, and active contour segmentation techniques. The signal dropout correction approach is developed to recover the missing segmentation information. Once the signal dropout regions of TEE image data are recovered, the MV model can be accurately duplicated. Compared with other methods in current literature, the proposed algorithm exhibits lower computational cost. The experimental results show that the proposed algorithm gives competitive results for diastolic MV modeling compared with conventional segmentation algorithms, evaluated in terms of accuracy and efficiency.

A novel software program for detection of potential air emboli during cardiac surgery.

BackgroundRisks associated with air emboli introduced during cardiac surgery have been highlighted by reports of postoperative neuropsychological dysfunction, myocardial dysfunction, and mortality. Presently, there are no standard effective methods for quantifying potential emboli in the bloodstream during cardiac surgery. Our objective was to develop software that can automatically detect and quantify air bubbles within the ascending aorta and/or cardiac chambers during cardiac surgery in real time.FindingsWe created a software algorithm (“Detection of Emboli using Transesophageal Echocardiography for Counting, Total volume, and Size estimation”, or DETECTS™) to identify and measure potential emboli present during cardiac surgery using two-dimensional ultrasound. An in vitro experiment was used to validate the accuracy of DETECTS™ at identifying and measuring air emboli. An experimental rig was built to correlate the ultrasound images to high definition camera images of air bubbles created in water by an automatic bubbler system. There was a correlation between true bubble size and the size reported by DETECTS™ in our in vitro experiment (r = 0.76). We also tested DETECTS™ using TEE images obtained during cardiac surgery, and provide visualization of the software interface.ConclusionsWhile monitoring the heart during cardiac surgery using existing ultrasound technology and DETECTS™, the operative team can obtain real-time data on the number and volume of potential air emboli. This system will potentially allow de-airing techniques to be evaluated and improved upon. This could lead to reduced air in the cardiac chambers after cardiopulmonary bypass, possibly reducing the risk of neurological dysfunction following cardiac surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-7120-13-3) contains supplementary material, which is available to authorized users.

Procedural Guidance Using Advance Imaging Techniques for Percutaneous Edge-to-Edge Mitral Valve Repair

The complexity of structural heart disease interventions such as edge-to edge mitral valve repair requires integration of multiple highly technical imaging modalities. Real time imaging with 3-dimensional (3D) echocardiography is a relatively new technique that first, allows clear volumetric imaging of target structures such as the mitral valve for both pre-procedural diagnosis and planning in patients with degenerative or functional mitral valve regurgitation. Secondly it provides intra-procedural, real-time panoramic volumetric 3D view of structural heart disease targets that facilitates eye-hand coordination while manipulating devices within the heart. X-ray fluoroscopy and RT 3D TEE images are used in combination to display specific targets and movement of catheter based technologies in 3D space. This integration requires at least two different image display monitors and mentally fusing the individual datasets by the operator. Combined display technology such as this, allow rotation and orientation of both dataset perspectives necessary to define targets and guidance of structural disease device procedures. The inherently easy concept of direct visual feedback and eye-hand coordination allows safe and efficient completion of MitraClip procedures. This technology is now merged into a single structural heart disease guidance mode called EchoNavigator(TM) (Philips Medical Imaging Andover, MA). These advanced imaging techniques have revolutionized the field of structural heart disease interventions and this experience is exemplified by a cooperative imaging approach used for guidance of edge-to-edge mitral valve repair procedures.

Selected Abstracts of the TEEPGI 2014 Workshop

ABSTRACT Mitral valve perforation is most commonly due to infective endocarditis. Iatrogenic mitral valve perforation following aortic valve replacement has not been described previously. A 57 years male patient presented with complaints of progressive dyspnea on exertion and occasional palpitations. A preoperative diagnosis of severe aortic stenosis, sclerodegenerative aortic valve with normal left ventricle function was made on transthoracic echocardiography. A coronary angiogram showed single vessel disease involving proximal left anterior descending artery causing 80% stenosis. The patient was planned for aortic valve replacement (AVR) and CABG. Pre bypass TEE showed bicuspid aortic valve, thick, calcified, severe aortic stenosis and normal left ventricle systolic function. Mitral valve was morphologically normal with mild central mitral regurgitation jet. Patient underwent CABG and AVR under cardiopulmonary bypass support. Post CPB TEE examination showed 2 jets of mitral regurgitation in midesophageal aortic long-axis view (Fig. 1). There was a mild central MR jet and an additional mild MR jet from the body of anterior mitral leaflet. Transgastric short axis view showed turbulence in the region of A1 scallop of anterior mitral leaflet. We present the intraoperative TEE images of the patient with a discussion on the role of TEE in detection of mitral valve perforation and surgical decision making.

Abstract 18610: Left Atrial Thrombus Formation After the Left Atrial Appendage Exclusion With a Novel Endoepicardial Suture Device (LARIAT®)

Introduction: There is no data reported on the occurrence of left atrial (LA) thrombus after LA appendage (LAA) closure with Lariat suture ligation device. We intend to identify the incidence and describe the clinical course of LA thrombi after Lariat procedure. Methods: We performed a multicenter observational study including all patients who underwent Lariat LAA exclusion. Patients underwent routine post-procedural TEE at approximately 1, 3 and 12 months follow-up. Additional TEEs were obtained as deemed necessary clinically. All patients in whom a LA thrombus was detected on TEE images were included in the study. Demographic characteristics, procedural variables, time of detection of LA thrombus were noted. Clinical course including duration of anticoagulation, serial TEEs and complications during follow up were recorded and analyzed. Results: Of the 1056 patients who underwent Lariat procedure, 8 patients (6 males; 2 females) were found to have a LA thrombus (0.007%). Median age, median CHADS2 score, median CHADS-Vasc score and median HASBLED score were 76 years, 3.5, 4.5 and 3 respectively. LA thrombus was detected after median interval of 36 days (IQR 32.5 -262.5). Thrombus was seen in close proximity of the LAA remnant in all patients. It was identified on the first follow-up TEE in all but one. In 1 patient 1.5 cm LA thrombus was seen at 427 days with prior TEEs being clear. Mean diameter of LA thrombus was 1.14 cm ± 0.3. Dabigatran was initiated in 2 patients and warfarin in the rest. After a median duration of 190 days (IQR 86-367.5), resolution of LA thrombus was observed in 7/8 patients. In 1 patient (on warfarin), there was a significant reduction in the size of the thrombus in the first and only TEE obtained 60 days after detection. In 1 patient on dabigatran, delayed resolution of thrombus was seen (occurring at 228days after detection). No embolic events were seen in any of the patients. Conclusion: Incidence of LA thrombus is rare after LARIAT LAA exclusion and can be safely managed with oral anticoagulation without any active intervention.

A study of location of coronary artery ostia in transcatheter aortic valve implantation procedure using three dimensional echocardiography

Objective To study the the feasibility of real-time 3D transesophageal echocardiography (RT-3D TEE) in measuring the distance between the coronary artery ostia and the aortic annulus.Methods RT-3D TEE image of aortic root was collected intraoperatively in 18 cases who were refered to our center for transcatheter aortic valve implantation.The aortic annulus was reconstructed and the height of the annulus (H) was generated.Meanwhile RT-3D TEE and MDCT was used to determine the left coronary artery ostia-aortic annulus distance (E-LAA,C-LAA) and the right coronary artery ostia-aortic annulus distance (E-RAA,C-RAA).Results The display rate of right coronary artery was 94.4％ (17/18),with the left coronary artery 88.9％ (16/18) on the RT-3D TEE imaging.The height of the annulus(H) was lower than the distance between the coronary artery ostia and the aortic annulus(P ＜0.05).No statistically significant differences was found in the parameters of the distance between the coronary artery ostia and the aortic annulus between RT-3D TEE and MDCT (P ＞0.05).Conclusions RT-3D TEE imaging can display and measure the distance between the coronary artery ostia and the aortic annulus. Key words: Echocardiography, transesophageal; Coronary vessel; Aortic valve stenosis

Fully automatic segmentation of the mitral leaflets in 3D transesophageal echocardiographic images using multi-atlas joint label fusion and deformable medial modeling.

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.

Intraoperative Echocardiographic Images of Right Ventricular Outflow Tract Sarcoma

A rare case of right ventricular outflow tract (RVOT) primary spindle cell sarcoma with intraoperative TEE images is reported below. Primary tumors of the heart are uncommon and most are benign. Seventy-five percent of benign tumors are myxomas, which are most common in the left atrium. Primary malignant tumors of the heart are rare, and their diagnosis is usually delayed. They are reported mainly as a single case and occasionally as a small series.1–8 Both malignant and benign tumors have been reported in the RVOT,4,9–10 The specific signs and symptoms produced by cardiac tumors are related more to their anatomic location than to their histologic type.

Application of the real-time three-dimensional transesophageal echocardiography in the quantification of aortic anuulus diameter in patients with aortic stenosis

Objective To investigate the application of real-time three-dimensional transesophageal echocardiography (RT-3D TEE) in quantification of the aortic anuulus diameter in patients with severe aortic stenosis.Methods RT-3D TEE image of aortic root was get perioperatively in 65 patients with sever aortic valve stenosis during the surgery procedure.The aortic annulus was reconstructed in the quantitative analysis software to generate the parameters of 3-dimensional area based aortic anuulus diameter(3D-AAAD) and 3-dimensional circumference based aortic anuulus diameter(3D-C-AAD).The parameters was compared with intraoperative aortic anuulus diameter(IO-AAD),which was get by the standard cylindrical valve sizer.Results The three dimensional form of the aortic annulus was related to the number of the valves.The value of 3D-C AAD and 3D-A-AAD were (22.4 ± 2.1) mm,(23.4 ± 1.9) mm,no significant difference could be detected between them and the IO-AAD (P ＜ 0.05).The 3D-C-AAD had a better agreements with IO-AAD than 3D-A-AAD.Conclusions RT-3D TEE can reconstruct the three dimensional sharp of aortic anuulus,and can be used as quantitative tools to calculate its diameter. Key words: Echocardiography; Aortic valve stenosis; Aorta

A comparison between size of the occluder device and two-dimensional transoesophageal echocardiographic sizing of the ostium secundum atrial septal defect : cardiovascular topics

Transcatheter closure of a secundum atrial septal defect (ASD II) has become an effective alternative for surgical treatment. In this study we evaluated the correlation between the two-dimensional transoesophageal echocardiographic (2D TEE) sizing of ASDs and the actual diameter of occluders in patients undergoing device closure. The records of 54 patients who underwent transcatheter ASD closure were reviewed. ASD characteristics and maximum defect diameter were evaluated using preprocedure 2D TEE images. Appropriate device size was determined by the balloon sizing method, which measures the balloon occlusive diameter (BOD) via TEE and fluoroscopy. ASD closure was performed under continuous TEE monitoring using the Amplatzer occluder in all patients. The mean of the TEE-derived maximum defect diameter was significantly lower than the mean of the BOD (17.8 ± 4.5 vs 22.1 ± 5.1 mm; p < 0.001) and the mean size of the implanted occluder device (17.8 ± 4.5 vs 23.3 ± 5.1 mm; p < 0.001). However, a good correlation was found between the TEE-derived defect size and the BOD (BOD = 0.898 × TEE defect size + 6.212, R = 0.824; p < 0.001) and between the TEE measurement and the final size of the implanted Amplatzer (device size = 0.928 × TEE defect size + 6.853, R = 0.822; p < 0.001). 2D TEE may provide a good equation to predict the BOD or the size of the occluder device; however, further studies are needed to investigate whether it is feasible to perform transcatheter ASD occlusion without balloon sizing.