Biernacka, Katarzyna

Demkow, Marcin

Kalińczuk, Łukasz

Mintz, Gary S

Rudziński, Piotr Nikodem

Skotarczak, Wiktor

Via Medica Journals

947w w w . j o u r n a l s . v i a m e d i c a . p l / k a r d i o l o g i a _ p o l s k aCorrespondence to: Piotr Nikodem Rudziński,  MD, PhD,National Institute of Cardiology,Alpejska 42,  04–628 Warszawa, Poland,phone: +48 505 794 691,e-mail: piotr.rudzinski@ikard.plCopyright by the Author(s), 2022DOI: 10.33963/KP.a2022.0177Received:  April 20, 2022Accepted:  July 25, 2022Early publication date:  July 29, 2022  C L I N I C A L  V I G N E T T ELarge field-of-view intravascular ultrasound for periprocedural cross-sectional assessment of right ventricular outflow tract anatomy offering a detailed tomographic perspectiveWiktor Skotarczak1, Piotr Nikodem Rudziński1, Łukasz Kalińczuk1, Katarzyna Biernacka2, Gary S Mintz2,  Marcin Demkow11 National Institute of Cardiology, Warszawa, Poland2Cardiovascular Research Foundation, New York, NY, United StatesA 35-year-old male born with tetralogy of Fallot with total surgical correction at the age of 3 years and reoperation at the age of 15 years with homograft insertion in the right ventricular outflow tract (RVOT) was admitted due to deterioration in exercise tolerance and arrhythmia. Echocardiography showed severe pulmonary insufficiency and stenosis (pres-sure half-time of 89 ms with maximal/mean gradient of 67/44 mm Hg). Pulmonary regur-gitant volume measured in cardiac magnetic resonance was 13 ml with a regurgitant frac-tion of 16% and a substantially increased right ventricular end-diastolic volume (219 ml/m2). Multi-slice computed tomography (MSCT) angiography (384-row SOMATOM® Definition Flash, Dual Source, SIEMENS, Forchheim, Germany) showed diffusely calcified and nar-rowed RVOT with minimal lumen cross-sec-tional area (CSA) of 1.89 cm2 measured in systole (Figure 1, panels 3 and 4). Lumen CSAs measured in systole at the proximal and distal references were 2.99 and 3.15 cm2, respective-ly (Figure 1, panels 1 and 7) with calculated stenosis area of 40% (1.89 cm2/3.07 cm2). Given our recent experiences documenting a unique 60-mm periprocedural tomograph-ic imaging perspective offered by a Vision PV035 10 MHz intravascular ultrasound (IVUS, Philips North America Corporation, Andover, MA, US), novel imaging instrumentation was used to verify its diagnostic performance in the highly calcified RVOT (Figure 1, panel 3, white arrow indicates the transducer location) [1–4]. Intravascular ultrasound cross-sectional visualization measured lumen dimensions that corresponded closely with those made in angio-MSCT (Figure 1, the lower row). Contrast-free cross-sectional imaging using a large field of view IVUS is feasible even in highly calcified RVOT anatomy, offering an understanding of the target zone anatomy and its dimensions that are crucial for plan-ning transcatheter intervention.Article informationConflict of interest: None declared.Funding: None.Open access: This article is available in open access under Creative Common Attribution-Non-Commer-cial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially. For commercial use, please contact the journal office at kardiologiapolska@ptkardio.pl.948K A R D I O L O G I A  P O L S K Aw w w . j o u r n a l s . v i a m e d i c a . p l / k a r d i o l o g i a _ p o l s k aREFERENCES1. Kalińczuk Ł, Stokłosa P, Dąbrowski M, et al. Nonuniform expansion of the LOTUS Edge intra-annular transcatheter aortic valve seen on intra-vascular ultrasound as a mechanism of prosthesis-patient mismatch. Kardiol Pol. 2021; 79(2): 203–204, doi: 10.33963/KP.15752, indexed in Pubmed: 33463988.2. Kalińczuk Ł, Chmielak Z, Zieliński K, et al. Intravascular ultrasound on-line guidance during transcatheter valve replacement for native aortic stenosis or failed bioprosthesis. Kardiol Pol. 2020; 78(7-8): 762–765, doi: 10.33963/KP.15307, indexed in Pubmed: 32329320.Figure 1. Baseline RVOT anatomy in: angio-MSCT (panel 1: longitudinal and cross-sectional views seen in the upper and middle row, respec-tively), angiography (panel 2: corresponding longitudinal view), and parallel IVUS (panel 3: cross-sectional view). Corresponding relevant dimensions of RVOT lumen measured in angio-MSCT and parallel IVUS cross-sections presented are in the lower rowAbbreviations: angio-MSCT, multi-slice computed tomography angiography; IVUS, intravascular ultrasound; RPA, right pulmonary artery;  RV, right ventricle; RVOT, right ventricular outflow tract 3. Kalińczuk Ł, Świerczewski M, Skotarczak W, et al. Intravascular ultrasound for transcatheter pulmonary valve replacement. Kardiol Pol. 2020; 78(11): 1174–1175, doi: 10.33963/kp.15534, indexed in Pubmed: 32735403.4. Kalińczuk Ł, Biernacka K, Rużyłło W, et al. First-in-man intravascular ultrasound guidance of percutaneous pulmonary valve implantation. Cardiol J. 2020; 27(2): 202–203, doi: 10.5603/CJ.2020.0044, indexed in Pubmed: 32463110.

Large field-of-view intravascular ultrasound for periprocedural cross-sectional assessment of right ventricular outflow tract anatomy offering detailed tomographic perspective

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Large field-of-view intravascular ultrasound for periprocedural cross-sectional assessment of right ventricular outflow tract anatomy offering detailed tomographic perspective

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