Timothy G. Roche, Tyler S. Kaster, Rachel E Green, Yeung Yam, B. Chow
Background: Coronary computed tomographic angiography (CCTA) image quality is dependent on heart rate (HR). Beta blockers are commonly administered before CCTA to lower HR and minimize variability. However, contrast media may also impact upon HR and image quality. Since iso-osmolar contrast media induce less vasodilation, this may decrease a patient's sensation of heat, minimizing patient discomfort and improving HR control and variability. Objectives: The aim of the study was to compare the impact of contrast media selection in CCTA upon HR and image quality. Patients and Methods: A total of 173 patients undergoing CCTA between February and April 2011 were allocated to different contrast media (Iodixanol, Iohexol, and Iopamidol) in 2-week blocks. The groups were analyzed for differences in baseline characteristics, imaging parameters, image quality, HR, and HR variability. Patients were also surveyed for perception of heat. Results: Baseline HR was similar across the patients assigned to Iohexol, Iopamidol, and Iodixanol (65.3 ± 9.7, 66.9 ± 10.9, and 65.3 ± 13.3, respectively; P = NS). Compared to Iohexol and Iopamidol, Iodixanol use was associated with lower HR at the time of image acquisition and immediately after CCTA (53.2 ± 8.0 bpm, 56.3 ± 7.8 bpm, and 56.8 ± 6.5 bpm; P = 0.069 and P = 0.032). A greater proportion of patients achieved HR ≤ 55 beats per minute (bpm) with Iodixanol (63%) than with Iohexol (42%; P = 0.025) and Iopamidol (39%; P = 0.011). As was expected, Iodixanol (2.34 ± 2.02) was associated with a lower perception of heat than Iohexol (6.13 ± 1.89; P < 0.001) and Iopamidol (5.22 ± 2.10; P < 0.001). Image quality was similar in all three groups. Conclusions: Compared to Iohexol and Iopamidol, Iodixanol use was associated with a lower patient perception of heat and lower HR while maintaining similar contrast-to-noise and signal-to-noise ratios.
{"title":"Effects of contrast media selection upon heart rate and heat sensation during coronary computed tomographic angiography","authors":"Timothy G. Roche, Tyler S. Kaster, Rachel E Green, Yeung Yam, B. Chow","doi":"10.5812/acvi.20708","DOIUrl":"https://doi.org/10.5812/acvi.20708","url":null,"abstract":"Background: Coronary computed tomographic angiography (CCTA) image quality is dependent on heart rate (HR). Beta blockers are commonly administered before CCTA to lower HR and minimize variability. However, contrast media may also impact upon HR and image quality. Since iso-osmolar contrast media induce less vasodilation, this may decrease a patient's sensation of heat, minimizing patient discomfort and improving HR control and variability. Objectives: The aim of the study was to compare the impact of contrast media selection in CCTA upon HR and image quality. Patients and Methods: A total of 173 patients undergoing CCTA between February and April 2011 were allocated to different contrast media (Iodixanol, Iohexol, and Iopamidol) in 2-week blocks. The groups were analyzed for differences in baseline characteristics, imaging parameters, image quality, HR, and HR variability. Patients were also surveyed for perception of heat. Results: Baseline HR was similar across the patients assigned to Iohexol, Iopamidol, and Iodixanol (65.3 ± 9.7, 66.9 ± 10.9, and 65.3 ± 13.3, respectively; P = NS). Compared to Iohexol and Iopamidol, Iodixanol use was associated with lower HR at the time of image acquisition and immediately after CCTA (53.2 ± 8.0 bpm, 56.3 ± 7.8 bpm, and 56.8 ± 6.5 bpm; P = 0.069 and P = 0.032). A greater proportion of patients achieved HR ≤ 55 beats per minute (bpm) with Iodixanol (63%) than with Iohexol (42%; P = 0.025) and Iopamidol (39%; P = 0.011). As was expected, Iodixanol (2.34 ± 2.02) was associated with a lower perception of heat than Iohexol (6.13 ± 1.89; P < 0.001) and Iopamidol (5.22 ± 2.10; P < 0.001). Image quality was similar in all three groups. Conclusions: Compared to Iohexol and Iopamidol, Iodixanol use was associated with a lower patient perception of heat and lower HR while maintaining similar contrast-to-noise and signal-to-noise ratios.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126314689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Moaref, Firuzeh Abtahi, K. Aghasadeghi, S. Shekarforoush
Background: Cardiac involvement in Systemic Sclerosis (SSc) is a major risk factor for death. The aim of this study was to evaluate strain-based measures of the right ventricular (RV) systolic function in SSc patients without pulmonary hypertension. Objectives: The aim of this study was to assess strain-based measures of the RV systolic function in patients with SSc without pulmonary hypertension. Materials and Methods: Thirty-eight consecutive SSc patients (mean age = 48.1 ± 13 years) with normal pulmonary artery pressure and left ventricular ejection fraction and 27 healthy subjects (mean age = 53.2 ± 10 years) were investigated. The RV systolic strain and strain rate were assessed using standard echocardiography with tissue Doppler imaging (TDI) and compared with the results of the healthy subjects. Results: In the SSc patients, the RV strain (- 19 ± 10 vs. - 25 ± 4 %; P = 0.004) and the systolic strain rate (- 1.3 ± 0.5 vs. - 1.5 ± 0.3, s-1; P = 0.03) were significantly lower than those in the control group. Conclusions: This study indicated that the RV systolic strain and strain rate can be used to detect early RV systolic dysfunction in SSc patients without pulmonary hypertension. These parameters may be useful for the provision of a more adequate management of SSc patients.
背景:心脏受累于系统性硬化症(SSc)是死亡的主要危险因素。本研究的目的是评估无肺动脉高压的SSc患者右心室收缩功能的应变测量。目的:本研究的目的是评估无肺动脉高压的SSc患者RV收缩功能的应变测量。材料与方法:连续38例肺动脉压、左室射血分数正常的SSc患者(平均年龄48.1±13岁)和27例健康者(平均年龄53.2±10岁)进行研究。采用标准超声心动图结合组织多普勒成像(TDI)评估左心室收缩应变和应变率，并与健康受试者进行比较。结果:在SSc患者中，RV菌株(- 19±10 vs - 25±4%;P = 0.004)和收缩应变率(- 1.3±0.5 vs - 1.5±0.3,s-1;P = 0.03)显著低于对照组。结论:本研究提示右心室收缩应变和应变率可用于无肺动脉高压SSc患者早期右心室收缩功能障碍的检测。这些参数可能有助于对SSc患者进行更充分的管理。
{"title":"Right ventricular strain and strain rate in patients with systemic sclerosis without pulmonary hypertension","authors":"A. Moaref, Firuzeh Abtahi, K. Aghasadeghi, S. Shekarforoush","doi":"10.5812/acvi.20735","DOIUrl":"https://doi.org/10.5812/acvi.20735","url":null,"abstract":"Background: Cardiac involvement in Systemic Sclerosis (SSc) is a major risk factor for death. The aim of this study was to evaluate strain-based measures of the right ventricular (RV) systolic function in SSc patients without pulmonary hypertension. Objectives: The aim of this study was to assess strain-based measures of the RV systolic function in patients with SSc without pulmonary hypertension. Materials and Methods: Thirty-eight consecutive SSc patients (mean age = 48.1 ± 13 years) with normal pulmonary artery pressure and left ventricular ejection fraction and 27 healthy subjects (mean age = 53.2 ± 10 years) were investigated. The RV systolic strain and strain rate were assessed using standard echocardiography with tissue Doppler imaging (TDI) and compared with the results of the healthy subjects. Results: In the SSc patients, the RV strain (- 19 ± 10 vs. - 25 ± 4 %; P = 0.004) and the systolic strain rate (- 1.3 ± 0.5 vs. - 1.5 ± 0.3, s-1; P = 0.03) were significantly lower than those in the control group. Conclusions: This study indicated that the RV systolic strain and strain rate can be used to detect early RV systolic dysfunction in SSc patients without pulmonary hypertension. These parameters may be useful for the provision of a more adequate management of SSc patients.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124667581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Beigel, J. Tress, Louise Jane Thomson, D. Luthringer, A. Shturman, A. Trento, R. Siegel
Introduction: While primary malignant tumors of the heart are rare, angiosarcomas are the most common cardiac malignant tumors. Case Presentation: We describe a 23-year-old woman who presented with a right atrial mass, which was discovered to be a cardiac angiosarcoma. We demonstrate the use of several noninvasive imaging modalities along with pathology confirmation for the definitive and comprehensive diagnosis of a cardiac angiosarcoma, a rare entity by itself. Conclusions: With the increasing availability of noninvasive imaging techniques, the diagnosis of angiosarcomas can be made at earlier stages. If angiosarcomas are left untreated, their prognosis is very poor. Therapeutic options include surgical excision, chemotherapy, radiation therapy, and heart transplantation or a combination of these.
{"title":"Multimodality imaging of a cardiac angiosarcoma","authors":"R. Beigel, J. Tress, Louise Jane Thomson, D. Luthringer, A. Shturman, A. Trento, R. Siegel","doi":"10.5812/acvi.20252","DOIUrl":"https://doi.org/10.5812/acvi.20252","url":null,"abstract":"Introduction: While primary malignant tumors of the heart are rare, angiosarcomas are the most common cardiac malignant tumors. Case Presentation: We describe a 23-year-old woman who presented with a right atrial mass, which was discovered to be a cardiac angiosarcoma. We demonstrate the use of several noninvasive imaging modalities along with pathology confirmation for the definitive and comprehensive diagnosis of a cardiac angiosarcoma, a rare entity by itself. Conclusions: With the increasing availability of noninvasive imaging techniques, the diagnosis of angiosarcomas can be made at earlier stages. If angiosarcomas are left untreated, their prognosis is very poor. Therapeutic options include surgical excision, chemotherapy, radiation therapy, and heart transplantation or a combination of these.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126226634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Ranjbar, M. Karvandi, S. Hassantash, M. Foroughi
Background: How can mathematics help us to understand the mechanism of the cardiac motion? The best known approach is to take a mathematical model of the fibered structure and insert it into a more-or-less complex model of a cardiac architecture. Objectives: We provide a new mathematical tool by introducing the notions strains, which are two-by-two and three-by-three matrices. Materials and Methods: Using motion and deformation echocardiographic data, force vectors of myocardial samples were estimated by MATLAB software, interfaced in the echocardiograph system. Dynamic orientation contraction (through the cardiac cycle) of every individual myocardial fiber could be created by adding together the sequential steps of the multiple fragmented sectors of that fiber. Results: Myocardial fibers initiate from the posterior basal region of the heart, continue through the left ventricular free wall, reach the septum, loop around the apex, ascend, and end at the superior-anterior edge of the left ventricle. Conclusions: These studies will enable physicians to diagnose and follow up many cardiac diseases when this software is interfaced within echocardiographic machines.
{"title":"How to construct a 3D mathematical/computer model of the left ventricle","authors":"S. Ranjbar, M. Karvandi, S. Hassantash, M. Foroughi","doi":"10.5812/acvi.20628","DOIUrl":"https://doi.org/10.5812/acvi.20628","url":null,"abstract":"Background: How can mathematics help us to understand the mechanism of the cardiac motion? The best known approach is to take a mathematical model of the fibered structure and insert it into a more-or-less complex model of a cardiac architecture. Objectives: We provide a new mathematical tool by introducing the notions strains, which are two-by-two and three-by-three matrices. Materials and Methods: Using motion and deformation echocardiographic data, force vectors of myocardial samples were estimated by MATLAB software, interfaced in the echocardiograph system. Dynamic orientation contraction (through the cardiac cycle) of every individual myocardial fiber could be created by adding together the sequential steps of the multiple fragmented sectors of that fiber. Results: Myocardial fibers initiate from the posterior basal region of the heart, continue through the left ventricular free wall, reach the septum, loop around the apex, ascend, and end at the superior-anterior edge of the left ventricle. Conclusions: These studies will enable physicians to diagnose and follow up many cardiac diseases when this software is interfaced within echocardiographic machines.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132669444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Dilated cardiomyopathy (DCM) is the leading cause of heart failure and arrhythmia. Case Presentation: A 47-year-old male, diagnosed with dilated cardiomyopathy, died due to heart failure. During the screening of his family members, his 17-year-old daughter and 9-year-old son also had dilated cardiomyopathy. Another daughter had died suddenly at the age of 12 years. Conclusions: We herein describe 3 patients with dilated cardiomyopathy developing in the father, daughter, and son of the same family and justify the importance of the screening test as an important tool for identifying families affected by familial dilated cardiomyopathy.
{"title":"Is screening imaging necessary in dilated cardiomyopathy?","authors":"L. Dubey","doi":"10.5812/acvi.19681","DOIUrl":"https://doi.org/10.5812/acvi.19681","url":null,"abstract":"Introduction: Dilated cardiomyopathy (DCM) is the leading cause of heart failure and arrhythmia. Case Presentation: A 47-year-old male, diagnosed with dilated cardiomyopathy, died due to heart failure. During the screening of his family members, his 17-year-old daughter and 9-year-old son also had dilated cardiomyopathy. Another daughter had died suddenly at the age of 12 years. Conclusions: We herein describe 3 patients with dilated cardiomyopathy developing in the father, daughter, and son of the same family and justify the importance of the screening test as an important tool for identifying families affected by familial dilated cardiomyopathy.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123259296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kiavar, N. Aslanabadi, A. Alizadehasl, Ahmad Ahmadzadeh Pournaky, A. Hashemi, R. Salehi, Mitra Chitsazan, S. Nourbakhsh, M. Esfahani
Background: Patients with severe refractory cardiac angina who are not candidates for any form of invasive treatment and are already on optimal medical therapy have few therapeutic options. Enhanced external counter pulsation (EECP) offers an alternative palliative and possibly therapeutic option for these patients. EECP achieves this by inducing hemodynamic effects much similar to those of the intraaortic balloon pump. Objectives: We sought to further evaluate these therapeutic effects, especially on the basis of echocardiographic data. Patients and Methods: Thirty-two patients who had severe refractory angina despite full anti-ischemic medication and were poor candidates for invasive procedures were evaluated. After undergoing 35 sessions of EECP, the patients were followed up for 6 months for adverse events, change in quality of life, severity of the remaining symptoms according to the Canadian Cardiovascular Society (CCS) classification, and echocardiographic changes. Results: After receiving standard EECP treatment regimen, the patients showed a marked increase in quality of life scores; a significant decrease in left ventricular (LV) end-diastolic volume index after 6 months (P = 0.045), in tandem with an increase in the LV myocardial performance index (P = 0.04) with no significant change in the LV ejection fraction; and a significant decrease in the CCS scores (P = 0.01). In addition, physical performance measures, including time to unset of angina during the exercise test, were significantly increased. Conclusions: EECP is a useful and low-risk additive therapeutic option in patients with end-stage and non-responsive angina symptoms who are receiving optimal medical conventional treatments and are not good candidates for invasive procedures. This treatment can induce some positive remodeling in the LV.
{"title":"Is there any positive remodeling after enhanced external counter pulsation in patients with severe refractory angina?","authors":"M. Kiavar, N. Aslanabadi, A. Alizadehasl, Ahmad Ahmadzadeh Pournaky, A. Hashemi, R. Salehi, Mitra Chitsazan, S. Nourbakhsh, M. Esfahani","doi":"10.5812/acvi.20798","DOIUrl":"https://doi.org/10.5812/acvi.20798","url":null,"abstract":"Background: Patients with severe refractory cardiac angina who are not candidates for any form of invasive treatment and are already on optimal medical therapy have few therapeutic options. Enhanced external counter pulsation (EECP) offers an alternative palliative and possibly therapeutic option for these patients. EECP achieves this by inducing hemodynamic effects much similar to those of the intraaortic balloon pump. Objectives: We sought to further evaluate these therapeutic effects, especially on the basis of echocardiographic data. Patients and Methods: Thirty-two patients who had severe refractory angina despite full anti-ischemic medication and were poor candidates for invasive procedures were evaluated. After undergoing 35 sessions of EECP, the patients were followed up for 6 months for adverse events, change in quality of life, severity of the remaining symptoms according to the Canadian Cardiovascular Society (CCS) classification, and echocardiographic changes. Results: After receiving standard EECP treatment regimen, the patients showed a marked increase in quality of life scores; a significant decrease in left ventricular (LV) end-diastolic volume index after 6 months (P = 0.045), in tandem with an increase in the LV myocardial performance index (P = 0.04) with no significant change in the LV ejection fraction; and a significant decrease in the CCS scores (P = 0.01). In addition, physical performance measures, including time to unset of angina during the exercise test, were significantly increased. Conclusions: EECP is a useful and low-risk additive therapeutic option in patients with end-stage and non-responsive angina symptoms who are receiving optimal medical conventional treatments and are not good candidates for invasive procedures. This treatment can induce some positive remodeling in the LV.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116472229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I have read "Echocardiographic Assessment of Left Ventricular Twisting and Untwisting Rate in Normal Subjects by Tissue Doppler and Velocity Vector Imaging: Comparison of Two Methods" with great interest and congratulate the authors on their comprehensive and very balanced overview of recent studies on the left ventricular (LV) deformation analysis (1). However, there are three incorrect aspects that in my opinion needs clarification. Frist, the authors calculated the LV rotation by integrating the rotational velocity, determined from the DTI velocities of the septal and lateral regions, and correcting [R (t)] for the LV radius over time. R (t) is incorrect in Equation 1; it should be improved to:
{"title":"Echocardiographic assessment of left ventricular twisting and untwisting rate in normal subjects by tissue doppler and velocity vector imaging: Comparison of two methods","authors":"M. Karvandi","doi":"10.5812/acvi.18612","DOIUrl":"https://doi.org/10.5812/acvi.18612","url":null,"abstract":"I have read \"Echocardiographic Assessment of Left Ventricular Twisting and Untwisting Rate in Normal Subjects by Tissue Doppler and Velocity Vector Imaging: Comparison of Two Methods\" with great interest and congratulate the authors on their comprehensive and very balanced overview of recent studies on the left ventricular (LV) deformation analysis (1). However, there are three incorrect aspects that in my opinion needs clarification. Frist, the authors calculated the LV rotation by integrating the rotational velocity, determined from the DTI velocities of the septal and lateral regions, and correcting [R (t)] for the LV radius over time. R (t) is incorrect in Equation 1; it should be improved to:","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117192133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Darko Angjushev, Marija Kotevska-Angjushev, M. Lazarevski
Introduction: The Eustachian valve (EV) remnant, when present in adults, is usually rudimentary. However, in echocardiographic examinations, it may appear as a mobile long structure in the right atrium, and it rarely protrudes into the right ventricle. When it is quite large, the EV remnant could be misdiagnosed as a right atrial tumor, thrombus, or vegetation. Case Presentation: An 83-year-old patient was referred to the surgical ward for the excision of a gastric adenocarcinoma. In the course of preoperative assessment, transthoracic echocardiography showed a right atrial mobile filamentous mass that was protruding into the right ventricle. Differential diagnosis included a tumor or thrombus. After a precise evaluation through multiple views, the mass was demonstrated to be a giant EV, 7.3 cm in length. Conclusions: The giant EV remnant can persist in adults and is often diagnosed incidentally via echocardiography. Transthoracic echocardiography is a reliable noninvasive method for the diagnosis of the EV remnant and could help avoid its misdiagnosis as a tumor or thrombus. Nevertheless, sometimes transesophageal echocardiography is necessary to confirm the diagnosis or to demonstrate the existence of an additive clot on it.
{"title":"A giant eustachian valve protruding into the right ventricle: A case report","authors":"Darko Angjushev, Marija Kotevska-Angjushev, M. Lazarevski","doi":"10.5812/acvi.18786","DOIUrl":"https://doi.org/10.5812/acvi.18786","url":null,"abstract":"Introduction: The Eustachian valve (EV) remnant, when present in adults, is usually rudimentary. However, in echocardiographic examinations, it may appear as a mobile long structure in the right atrium, and it rarely protrudes into the right ventricle. When it is quite large, the EV remnant could be misdiagnosed as a right atrial tumor, thrombus, or vegetation. Case Presentation: An 83-year-old patient was referred to the surgical ward for the excision of a gastric adenocarcinoma. In the course of preoperative assessment, transthoracic echocardiography showed a right atrial mobile filamentous mass that was protruding into the right ventricle. Differential diagnosis included a tumor or thrombus. After a precise evaluation through multiple views, the mass was demonstrated to be a giant EV, 7.3 cm in length. Conclusions: The giant EV remnant can persist in adults and is often diagnosed incidentally via echocardiography. Transthoracic echocardiography is a reliable noninvasive method for the diagnosis of the EV remnant and could help avoid its misdiagnosis as a tumor or thrombus. Nevertheless, sometimes transesophageal echocardiography is necessary to confirm the diagnosis or to demonstrate the existence of an additive clot on it.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125038384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mitral valve prolapse (MVP) syndrome refers to the combination of various symptoms and clinical findings associated with MVP (1). Mitral tissue Doppler imaging (TDI) represents the left ventricular (LV) systolic function. It is a good surrogate for diastolic function and can overcome the limitation of the mitral inflow, which is highly dependent on the left atrial (LA) volume (2). In this article, Alizadehasl A et al. (3) demonstrated that the Sm wave was prominent in the MVP group compared to the normal control group. Moreover, Em was lower and Am showed a higher tendency. An increased E/Em implies elevated LA volume and LV end-diastolic pressure. Taken together with these findings, all of the other TDI findings in this investigation consistently indicated diastolic dysfunction in the patients with the MVP syndrome. Diastolic dysfunction in the MVP syndrome is well understood by increased rigidity and a decreased ability for relaxation because of increased preload, positive sympathetic feedback, and a higher proportion of fibrin in the myocardium (4). With respect to the high Sm wave, the myocardial hypermobility appeared to be a result of increased sympathetic nervous system activity and increased blood volume due to the mitral regurgitation flow. In addition, decreased coronary blood flow and structural disarray near the MVP site resulted in a decreased response to exercise compared to that in the normal subjects. However, the major focus of this investigation is the correlation between TDI and MVP. Is there a correlation between the prolapsed site and the lateral Sm wave, or does the degree of prolapse and mitral regurgitation impact the Sm wave? According to a previous investigation, high spike systolic velocity was selectively seen on the posterolateral mitral annulus, which has low resistance compared with the anteroseptal mitral annulus interacting with the right ventricle (5). Correlation between the prolapsed site and the degree of mitral prolapse and a prominent Sm wave has never been investigated. Moreover, the clinical implication of the prominent Sm wave observed in patients with MVP has never been studied from the aspect of a further treatment strategy and prognosis. Based on the observations in this article, future investigations providing further perspectives on the issues are warranted.
{"title":"Tissue doppler imaging of S wave in mitral valve prolapse syndrome","authors":"Kim In-cheol, Kim Hyungseop","doi":"10.5812/acvi.20271","DOIUrl":"https://doi.org/10.5812/acvi.20271","url":null,"abstract":"Mitral valve prolapse (MVP) syndrome refers to the combination of various symptoms and clinical findings associated with MVP (1). Mitral tissue Doppler imaging (TDI) represents the left ventricular (LV) systolic function. It is a good surrogate for diastolic function and can overcome the limitation of the mitral inflow, which is highly dependent on the left atrial (LA) volume (2). In this article, Alizadehasl A et al. (3) demonstrated that the Sm wave was prominent in the MVP group compared to the normal control group. Moreover, Em was lower and Am showed a higher tendency. An increased E/Em implies elevated LA volume and LV end-diastolic pressure. Taken together with these findings, all of the other TDI findings in this investigation consistently indicated diastolic dysfunction in the patients with the MVP syndrome. Diastolic dysfunction in the MVP syndrome is well understood by increased rigidity and a decreased ability for relaxation because of increased preload, positive sympathetic feedback, and a higher proportion of fibrin in the myocardium (4). With respect to the high Sm wave, the myocardial hypermobility appeared to be a result of increased sympathetic nervous system activity and increased blood volume due to the mitral regurgitation flow. In addition, decreased coronary blood flow and structural disarray near the MVP site resulted in a decreased response to exercise compared to that in the normal subjects. However, the major focus of this investigation is the correlation between TDI and MVP. Is there a correlation between the prolapsed site and the lateral Sm wave, or does the degree of prolapse and mitral regurgitation impact the Sm wave? According to a previous investigation, high spike systolic velocity was selectively seen on the posterolateral mitral annulus, which has low resistance compared with the anteroseptal mitral annulus interacting with the right ventricle (5). Correlation between the prolapsed site and the degree of mitral prolapse and a prominent Sm wave has never been investigated. Moreover, the clinical implication of the prominent Sm wave observed in patients with MVP has never been studied from the aspect of a further treatment strategy and prognosis. Based on the observations in this article, future investigations providing further perspectives on the issues are warranted.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130595662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The conus artery is usually the first branch of the right coronary artery (RCA) and passes around the right ventricular outflow tract. Objectives: To examine whether it is possible to visualize the conus artery in multi-slice computed tomography (CT). Patients and Methods: In 79 consecutive patients (aged 56 ± 12.9 years; 13 women), 64-slice CT was performed due to a suspicion of coronary artery disease. The standard protocol for scanning with retrospective gating was used for all the patients. Results: It was possible to visualize the conus artery in coronary CT angiography in 64 (81%) patients. The course of the conus artery in the right ventricle was commonly in the outflow tract direction. The conus artery was visualized at a distance of 33.2 ± 16.3 mm. The average diameter of the conus artery was 2.3 ± 0.8 mm. The conus artery most frequently originated from the first segment of the right coronary artery (53%) and directly from the aorta (37.9%). In the rest of the cases, there was a common trunk for both vessels (CA/RCA). Conclusions: In most cases, the conus artery can be visualized in cardiac CT. A description of the conus artery should be a part of the standard clinical coronary CT angiography description.
{"title":"Conus artery in coronary CT angiography","authors":"A. Młynarska, R. Młynarski, M. Sosnowski","doi":"10.5812/acvi.19641","DOIUrl":"https://doi.org/10.5812/acvi.19641","url":null,"abstract":"Background: The conus artery is usually the first branch of the right coronary artery (RCA) and passes around the right ventricular outflow tract. Objectives: To examine whether it is possible to visualize the conus artery in multi-slice computed tomography (CT). Patients and Methods: In 79 consecutive patients (aged 56 ± 12.9 years; 13 women), 64-slice CT was performed due to a suspicion of coronary artery disease. The standard protocol for scanning with retrospective gating was used for all the patients. Results: It was possible to visualize the conus artery in coronary CT angiography in 64 (81%) patients. The course of the conus artery in the right ventricle was commonly in the outflow tract direction. The conus artery was visualized at a distance of 33.2 ± 16.3 mm. The average diameter of the conus artery was 2.3 ± 0.8 mm. The conus artery most frequently originated from the first segment of the right coronary artery (53%) and directly from the aorta (37.9%). In the rest of the cases, there was a common trunk for both vessels (CA/RCA). Conclusions: In most cases, the conus artery can be visualized in cardiac CT. A description of the conus artery should be a part of the standard clinical coronary CT angiography description.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122407760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：