Intra-procedural imaging of the left atrial appendage: Implications for closure with the AmplatzerTM cardiac plug

Objectives: To evaluate intra-procedural imaging with transesophageal echocardiography and angiography during left atrial appendage occlusion using the Amplatzer&#8482; Cardiac Plug with regard to sizing and final device shape. Methods: Left atrial appendage ostium dimensions and diameter at a depth of 10 mm from the ostium were measured by transesophageal echocardiography (0-180°) and angiography (RAO 30° - Cranial 20°) in consecutive patients undergoing left atrial appendage occlusion using the ACP with an oversizing strategy of 10-20% relative to the baseline measurements. After delivery, ACP dimensions were measured and device shape was assessed. Results: Twenty-seven consecutive patients underwent successful uncomplicated left atrial appendage closure with Amplatzer&#8482; Cardiac Plug. We found a significant difference between the largest and smallest left atrial appendage diameter measured with transesophageal echocardiography (22.3 ± 4.2 vs. 18.1 ± 4.1 mm, p <0.001). By the end of the procedure (by angiography), ACP had an optimal shape in 17 patients (63%), a strawberry-like shape in 7 patients (26%), and a square-like shape in 3 patients (11%). ACP was oversized on average by 1.5±2.7 and 3.3±2.3mm compared to transesophageal echocardiography and angiography, respectively. The final shape of the device was not significantly associated with the degree of oversizing. Conclusions: We found a considerable variability in the assessment of the left atrial appendage, using transesophageal echocardiography and angiography. The degree of Amplatzer&#8482; Cardiac Plug expansion within the left atrial appendage and the final shape of the device were not associated with the degree of oversizing

Evaluación de la función y sincronía de la contracción ventricular en pacientes con enfermedad de Chagas en estadio de latencia

Objetivo: Comparar la función ventricular izquierda y la sincronía de la contracción ventricular en un grupo de sujetos con enfermedad de Chagas en estadio de latencia respecto a un grupo de individuos control. Método: Se realizó un estudio prospectivo, transversal, comparativo y no aleatorio de la función ventricular izquierda (FVI) y la sincronía de la contracción ventricular (SCV) en 36 personas con serología positiva de enfermedad de Chagas (18 varones y 18 mujeres) cuya edad promedio fue de 15 ± 5 años. Los hallazgos se compararon respecto a un grupo de 23 voluntarios considerados normales (11 varones y 12 mujeres) con edad promedio de 28 ± 5 años. La FVI y la SCV fueron evaluadas mediante la modalidad de imagen denominada ventriculografía radioisotópica en equilibrio (VRIE). Para comparar las poblaciones se utilizó la prueba estadística t de Student para muestras independientes, y se consideró un valor de significancia de p < 0.05. Resultados: Los parámetros utilizados para evaluar la FVI y la SCV en los sujetos con serología positiva para enfermedad de Chagas no fueron diferentes desde el punto de vista estadístico a los calculados para los sujetos control. Sin embargo, aunque la contracción es homogénea, el tiempo promedio en que se realiza la contracción del ventrículo derecho (VD) y del ventrículo izquierdo (VI) sí es menor estadísticamente respecto al grupo de sujetos control. Conclusiones: En estadios clínicamente incipientes de la enfermedad de Chagas no se detectaron anormalidades en la FVI ni signos de asincronía interventricular o intraventricular. Es necesario realizar el seguimiento de la población estudiada con índices que permitan identificar anormalidades en el sistema nervioso autónomo

Multiplanar transesophageal echocardiography for the evaluation and percutaneous management of ostium secundum atrial septal defects in the adult

The purpose of this paper is to review the usefulness of multiplanar transesophageal echocardiography before, during and after percutaneous transcatheter closure of secundum atrial septal defects. Transesophageal echocardiography imaging techniques, including their role in patient selection, procedural guidance and immediate assessment of technical success and complications are described and discussed in this review. Percutaneous transcatheter closure is indicated for ostium secundum atrial septal defects of less than 40 mm in maximal diameter. The defect must have a favorable anatomy, with adequate rims of at least 5 mm to anchor the prosthesis. Transesophageal echocardiography plays a critical role before the procedure in identifying potential candidates for percutaneous closure and to exclude those with unfavorable anatomy or associated lesions, which could not be addressed percutaneously. Transesophageal echocardiography is also important during the procedure to guide the deployment of the device. After device deployment, the echocardiographer must assess the device (integrity, position and stability), residual shunt, atrio-ventricular valve regurgitation, obstruction to systemic or venous return and pericardial effusion, in order to determine procedural success and diagnose immediate complications