Transesophageal Echocardiograph Findings in Patients with Cardiovascular Disorders at Al-Thawrah General Hospital, Sana’a, Yemen

ABSTRACT Objectives: To determine the frequency distribution of different cardiovascular disorders and to describe their associated morphological abnormalities by transesophageal echocardiography among patients referred to the Transesophageal Echocardiography Laboratory of Al-Thawrah General Hospital, Sana’a, in the period 2009– 2011. Methods: This was a retrospective descriptive study of 856 patients with suspected cardiovascular disorders and referred for transesophageal echocardiography over a two-year period. Data about patients’ sex, their refer- ral site and transesophageal echocardiography findings were collected and analyzed according to the type of cardiovascular disorders, valvular affections and lesions, complications and recommended treatments. Results: Of the 856 patients, 63.4% were females and 36.6% were males. The majority of patients diagnosed by transesophageal echocardiography (82.4%) were referred from outpatient departments. Rheumatic heart dis- ease was the most frequent cardiovascular disorder (87.1%), followed by tricuspid valve lesions (62.8%), of which 54% (329/606) were tricuspid regurgitation and 62.6% (114/182) were aortic valve regurgitation. Re- garding the type of valvular lesions detected, mitral valve disease was the most frequent, being found in 69.2% (214/309) of patients. Regarding the severity of valvular lesions, 73.1% (19/26) of mitral valve stenosis cases were severe while 83.3% (35/62) of aortic stenosis cases were mild. Moderate pulmonary hypertension was seen mostly secondary to rheumatic heart disease. The majority of cardiovascular disorder patients (33.6%; 284/844) were recommended for balloon mitral valvotomy. Mitral valve surgery was the most frequently per- formed surgical intervention for affected valves of patients with cardiovascular disorders; being used for the treatment of 31.4% (80/255) of valvular lesions. Conclusions: Transesophageal echocardiography revealed that rheumatic heart disease is the most frequent cardiovascular disorder among Yemeni patients and poses a major health problem. In addition, a high propor- tion of patients with cardiovascular disorders have valvular lesions of the mild degree that require surgical in- tervention

Registration of 3D trans-esophageal echocardiography to X-ray fluoroscopy using image-based probe tracking

Two-dimensional (2D) X-ray imaging is the dominant imaging modality for cardiac interventions. However, the use of X-ray fluoroscopy alone is inadequate for the guidance of procedures that require soft-tissue information, for example, the treatment of structural heart disease. The recent availability of three-dimensional (3D) trans-esophageal echocardiography (TEE) provides cardiologists with real-time 3D imaging of cardiac anatomy. Increasingly X-ray imaging is now supported by using intra-procedure 3D TEE imaging. We hypothesize that the real-time co-registration and visualization of 3D TEE and X-ray fluoroscopy data will provide a powerful guidance tool for cardiologists. In this paper, we propose a novel, robust and efficient method for performing this registration. The major advantage of our method is that it does not rely on any additional tracking hardware and therefore can be deployed straightforwardly into any interventional laboratory. Our method consists of an image-based TEE probe localization algorithm and a calibration procedure. While the calibration needs to be done only once, the GPU-accelerated registration takes approximately from 2 to 15. s to complete depending on the number of X-ray images used in the registration and the image resolution. The accuracy of our method was assessed using a realistic heart phantom. The target registration error (TRE) for the heart phantom was less than 2. mm. In addition, we assess the accuracy and the clinical feasibility of our method using five patient datasets, two of which were acquired from cardiac electrophysiology procedures and three from trans-catheter aortic valve implantation procedures. The registration results showed our technique had mean registration errors of 1.5-4.2. mm and 95% capture range of 8.7-11.4. mm in terms of TRE. © 2011 Elsevier B.V