The Pivotal Role of Three-Dimensional Transesophageal Echocardiography in Non-Coronary Intervention Procedures

The recent availability of real-time 3-dimensional (3D) transesophageal echocardiography (TEE) can drive forward the diagnostic capability of ultrasound imaging. Real time 3D TEE has evolved into the imaging modality of choice when it comes to percutaneous interventions, as in many cases it serves as the ‘eyes of the operator’ to evaluate, guide, and assess the results of the procedures in the catheterization laboratory. Moreover, it has been shown to provide additional insight into the anatomical, morphological and hemodynamic status. Up to date, real time 3D TEE has been integrated into the following percutaneous non-coronary procedures: closure of atrial or ventricular defects, aortic valve replacement, paravalvular leak occlusion, mitral valve repair with clips, and more recently left atrial appendage occlusion with use of closure devices. Further technological advancements will lead to more accurate and wider use of this imaging technique

Advantages of Real-Time Three-Dimensional Echocardiography Over Two-Dimensional Echocardiography

Over the last fifty-years conventional two-dimensional (2D) echocardiography has served as a valuable clinical adjunct for the diagnosis and management of cardiovascular disease. However, the echocardiologist was expected to mentally reconstruct the complex structure of myocardium, resulting in geometrical assumptions which in turn could underestimate the validity of clinical findings

Late Tricuspid Regurgitation as a Result of Rheumatic Tricuspid Disease in a Patient With Prosthetic Mitral Valve. Combined Two-Dimensional and Real-Time Three-Dimensional Transthoracic Echocardiographic Assessment

We herein present the case of a 65-year-old lady with late tricuspid regurgitation 15 years after successful mitral valve replacement due to severe mitral stenosis of rheumatic origin. She presented to our department complaining of fatigue which worsened over the last 6 months. Transthoracic echocardiographic examination including both 2D and real time 3D modalities revealed severe tricuspid regurgitation and the patient was scheduled for tricuspid annuloplasty. A propos with this case, a brief review of the literature is provided highlighting the key points of this topic

Echocardiographic Findings in Carcinoid Syndrome

A 57-year-old Caucasian female was referred to our Cardiology department due to hypertension, flushing, and diarrhea. She had a medical history of hypertension and paroxysmal atrial fibrillation. On physical examination, the patient had a heart rate of 70 bpm and a respiratory rate of 12 breaths/min. Her temperature was 37°C and her blood pressure was 120/80 mmHg. Cardiac examination revealed a left parasternal holosystolic murmur, and a palpable right ventricular heave. Lung auscultation was unremarkable. From the initial biochemical exam she had no specific abnormalities. The ECG showed sinus rhythm, negative T-waves in leads III, V1-5. The transthoracic echocardiography study revealed a left ventricle with normal size and normal systolic function and dilatation of the left atrium, whereas the right cardiac chambers were dilated with thickened, immobile leaflets of the tricuspid and pulmonic valve, leading to malcoaptation and severe tricuspid and pulmonic regurgitation. (Figures 1-5) The clinical and echocardiographic findings raised the suspicion of carcinoid heart disease. Abdominal CT demonstrated hepatic metastases and the patient was treated with chemotherapy and with the somatostatin analog octreotide... (excerpt

Echocardiographic imaging of tricuspid and pulmonary valve abnormalities in primary ovarian carcinoid tumor

Carcinoid is a rare malignancy originating from enterochromaffin cells and is clinically characterized by flushing, diarrhea and bronchospasm, due to secretion of vasoactive substances. A dreaded complication is carcinoid heart disease, which mainly affects right cardiac chambers, resulting in thickened, immobile and retracted tricuspid and pulmonary valves. In the current report, a case of a 60-year old female presenting with symptoms of right heart failure is described. Transthoracic two-dimensional and real-time three-dimensional echocardiography findings, as well as biochemical markers, including pro-BNP and NT-pro-BNP, were consistent with carcinoid syndrome. The histological diagnosis of carcinoid was confirmed after surgical resection of an ovarian mass

Quantitative analysis of left atrial function in asymptomatic patients with b-thalassemia major using real-time three-dimensional echocardiography

<p>Abstract</p> <p>Background</p> <p>There is strong evidence that left atrial (LA) size is a prognostic marker in a variety of heart diseases. Recently, real-time three-dimensional echocardiography (RT3DE) has been reported as a useful tool for studying the phasic changes of the left atrial volumes. The aim of this study was to investigate the performance of the left atrium in beta-thalassemic patients with preserved left ventricular ejection fraction (EF) and no iron overload, using RT3DE.</p> <p>Methods</p> <p>Twenty-eight asymptomatic b-thalassemic patients (32.2 ± 4.3 years old, 17 men) who were on iron chelating therapy, as well as 20 age- and sex-matched healthy controls underwent transthoracic RT3DE. The patient group had normal echocardiographic systolic and diastolic indices, while there was no myocardial iron disposition according to MRI. Apical full volume data sets were obtained and LA volumes were measured at 3 time points of the cardiac cycle: (1) maximum volume (LAmax) at end-systole, just before mitral valve opening; (2) minimum volume (LAmin) at end-diastole, just before mitral valve closure; and (3) volume before atrial active contraction (LApreA) obtained from the last frame before mitral valve reopening or at time of the P wave on the surface electrocardiogram. From the derived values, left atrial active and passive emptying volumes, as well as the respective emptying fractions were calculated.</p> <p>Results</p> <p>Left ventricular EF (59.2 ± 2.5% patients vs. 60.1 ± 2.1% controls), E/A, E/E' were similar between the two groups. Differences in the LAmax, LAmin and LApreA between b-thalassemic patients and controls were non-significant, LAmax:(35.5 ± 13.4 vs 31.8 ± 9.8)cm³, LAmin:(16.0 ± 6.0 vs. 13.5 ±4.2)cm³, and LApreA:(25.4 ± 9.8 vs. 24.3 ± 7.2)cm³. However, left atrial active emptying fraction was reduced in the patient group as compared to the healthy population (34.3 ± 16.4% vs. 43.2 ± 11.4%, p < 0.05).</p> <p>Conclusion</p> <p>RT3DE may be a novel technique for the evaluation of LA function in asymptomatic patients with b-Thalassemia Major. Among three-dimensional volumes and indices, left atrial active emptying fraction may be an early index of LA dysfunction in the specific patient population.</p

Cardiac Masses: The Role of Cardiovascular Imaging in the Differential Diagnosis

Cardiac masses are space occupying lesions within the cardiac cavities or adjacent to the pericardium. They include frequently diagnosed clinical entities such as clots and vegetations, common benign tumors such as myxomas and papillary fibroelastomas and uncommon benign or malignant primary or metastatic tumors. Given their diversity, there are no guidelines or consensus statements regarding the best diagnostic or therapeutic approach. In the past, diagnosis used to be made by the histological specimens after surgery or during the post-mortem examination. Nevertheless, evolution and increased availability of cardiovascular imaging modalities has enabled better characterization of the masses and the surrounding tissue. Transthoracic echocardiography using contrast agents can evaluate the location, the morphology and the perfusion of the mass as well as its hemodynamic effect. Transesophageal echocardiography has increased spatial and temporal resolution; hence it is superior in depicting small highly mobile masses. Cardiac magnetic resonance and cardiac computed tomography are complementary providing tissue characterization. The scope of this review is to present the role of cardiovascular imaging in the differential diagnosis of cardiac masses and to propose a step-wise diagnostic algorithm, taking into account the epidemiology and clinical presentation of the cardiac masses, as well as the availability and the incremental value of each imaging modality