3D transesophageal echocardiography in TAVR

Recently, there has been an increasingly minimalistic approach to transcatheter aortic valve replacement (TAVR), with most procedures now performed under conscious sedation without real time transesophageal echocardiography (TEE) guidance. Proponents of echo should not feel discouraged by this; it is the initial insights that were gained with procedural TEE during the early years of TAVR that have allowed the procedure's gradual maturation and sophistication. Experienced centers that have promoted extensive TAVR TEE programs continue to maximize the benefits of echocardiography in both procedural planning and execution. Critical to this is the understanding of 3D TEE, allowing the annulus to be sized accurately, relevant neighboring anatomy defined, and complications flagged. This review will outline the current application of 3D TEE in TAVR and discuss challenges and opportunities for 3D echocardiography in this field.     

Anticoagulation for coexisting bioprosthetic aortic valve thrombosis and anticoagulant-related bleeding: “A double edge sword”

The choice of anticoagulant agents for newly implanted bioprosthetic valve varies significantly, particularly in the presence of postoperative atrial fibrillation with increasing use of nonvitamin K oral anticoagulation (NOACs) in recent years. We reported a challenging case with a coexisting bioprosthetic aortic valve thrombosis and significant anticoagulant-related bleeding. Clinical management strategy and brief literature review were presented.     

Echocardiographic diagnosis of permanent pacemaker lead malposition in the left ventricle: A case study

Inadvertent endocardial lead malposition is recognized as a rare incident which is usually underreported and if recognized during implantation can be easily corrected. This phenomenon is caused by the ventricular lead unintentionally crossing a pre-existing patent foremen ovale, septal defects (atrial or ventricular) or directly from the aorta via an accidental subclavian puncture resulting in the lead implanting into the left ventricle. While this is a rare occurrence we report, the incidental finding of pacemaker lead malposition during a routine follow-up transthoracic echocardiogram and the benefits of three-dimensional transesophageal echocardiography in this patient prior to lead extraction.     

经食管三维超声心动图系统的成像显示方法

经食管三维超声心动图作为一种新的影像技术，进行了心脏结构的立体重建，本文对我院研制的经食管三维超声心动图系统中设置的成像方式，显示方法及设计原理进行了介绍，临床应用表明，本系统设计的成像显示方法能清晰显示各种正常和异常心脏结构的三维图像，为心脏形态学研究和临床心脏病诊断提供了帮助。     

Assessment of left atrial appendage function by transesophageal echocardiography in patients two weeks after acute coronary syndromes

Background For many years in ischemic heart disease, ventricles rather than atria received attention so not much is known about left atrial function in left ventricular ischemia. Objective Our study aimed to evaluate left atrial appendage (LAA) function by means of biplane transesophageal echocardiography in patients ten days after acute coronary syndromes (ACS). Methods The study was performed on 16 adult patients (65.9±9.9 years old) in whom transesophageal echocardiography was done 10 days after ACS. The following left atrial appendage (LAA) planimetric parameters were analyzed: LAA transversal dimension, LAA longitudinal dimension,LAA maximal area, and LAA minimal area. LAA ejection fraction was calculated and analyzed. The following LAA Doppler parameters were analyzed: the peak LAA emptying and the peak LAA filling velocities. The control group consisted of 14 patients (43±14.6 years old) without cardiovascular diseases. Results Both LAA longitudinal dimension and LAA transversal dimension were significantly higher in patients with ACS than in control patients. The same was observed for LAA maximal area. Also LAA ejection fraction was higher in patients with ACS . LAA minimal area did not differ in the patients in either group. LAA peak emptying flow (LAAE) and LAA peak filling flow (LAAF) were significantly higher in patients of the study group than of the control group. Conclusion Our study shows that two weeks after acute coronary syndrome LAA as a reservoir as well as a pump works at a higher level than it does in the control group. (J Geriatr Cardiol 2005; 2(4):198-201)     

Usefulness of Intraprocedural Pulmonary Venous Flow for Predicting Recurrent Mitral Regurgitation and Clinical Outcomes After Percutaneous Mitral Valve Repair With the MitraClip

Objectives

The aim of this study was to determine the prognostic value of pulmonary venous (PV) flow during MitraClip implantation.

Transesophageal echocardiography in NeoChord procedure

Background:

Transapical off-pump mitral valve intervention with neochord implantation for degenerative mitral valve disease have been recently introduced in the surgical practice. The procedure is performed under 2D-3D transesophageal echocardiography guidance.

Methods:

The use of 3D real-time transesophageal echocardiography provides more accurate information than 2D echocardiography only in all the steps of the procedure. In particular 3D echocardiography is mandatory for preoperative assessment of the morphology of the valve, for correct positioning of the neochord on the diseased segment, for the final tensioning of the chordae and for the final evaluation of the surgical result.

Result and Conclusion:

This article is to outline the technical aspects of the transesophageal echocardiography guidance of the NeoChord procedure showing that the procedure can be performed only with a close and continuous interaction between the anesthesiologist and the cardiac surgeon.     

基于经食管超声心动图数据的左心耳3D打印模型准确性研究

目的：应用经食管超声心动图数据重建并打印左心耳3D模型并分析其准确性。方法：选取于医院就诊并接受三维经食管超声心动图（3D-TEE）及心脏增强CT检查的患者20例,对其3D-TEE 左心耳数据进行后处理并使用软质类橡胶材料打印3D实体模型,测量左心耳模型的开口长径、短径、深度并进行解剖分型评估,将其与3D-TEE、CT的结果进行对比。结果：3D模型组与3D-TEE组的左心耳开口长径、开口短径、深度差异均无统计学意义（均P >0.05）,组间ICC分别为0.97、0.98、0.98;CT组的左心耳开口长径、开口短径、深度测值均大于3D-TEE组（均P <0.05）,组间ICC分别0.91、0.88、0.90。3D模型组与CT组在左心耳评估形态、分叶差异均无统计学意义（均P >0.05）;Kappa值分别为0.86、0.91（均P <0.05）。3D-TEE组与CT组在左心耳评估形态、分叶差异均无统计学意义（均P >0.05）;Kappa值分别为0.71、0.81（均P <0.05）。结论：基于经食管超声数据左心耳3D打印模型的测量径线可准确还原其数据源;与3D-TEE相比,左心耳3D模型在评估形态及分叶方面与CT重建一致性更高。     

Flail aortic valve and acute aortic regurgitation due to spontaneous localized intimal tear of ascending aorta

This report describes the transesophageal echocardiographic findings of acute severe aortic regurgitation resulting from localized transverse intimal tear of ascending thoracic aorta which could not be suspected as a cause of flail aortic valve preoperatively. In patients with chest pain and acute aortic regurgitation associated with flail aortic valve, localized intimal tear of aorta should be considered as a possible cause of flail aortic valve.