Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques最新文献

Cardiovascular magnetic resonance imaging (CMR) has received extensive validation for the assessment of valvular heart disease (VHD) and offers an accurate and direct method for the quantification of aortic regurgitation (AR). According to the current guidelines, CMR represents a useful second-line investigation in patients with poor acoustic windows or when echocardiography is inconclusive, for example, in cases of multiple or eccentric aortic jets. Without ionizing radiation exposure, CMR provides in-depth information not only on the severity degree of AR, providing a precise quantification of regurgitant volume and fraction, but also on cardiac structure and function, being recognized as the gold standard for the assessment of heart chamber size and systolic function. CMR allows a free choice of cardiac imaging planes and provides further information on the myocardium, thanks to the tissue characterization ability offered by several sequences, such as the late gadolinium enhancement technique. The possibilities offered by CMR become even more interesting in the context of mixed and multiple VHD, where the echocardiographic assessments often encounter difficulties in the quantification of each single valve lesion. The current scientific data support a greater expansion of CMR in this field, thanks to its additional advantages for the diagnosis, risk stratification, and to guide treatment. This review investigates the current CMR techniques and protocols in AR, with special insights into the evaluation of mixed aortic valve disease and multiple VHD including AR.

Many cases of total anomalous pulmonary venous return (TAPVR) present with life-threatening pulmonary venous obstruction within hours following delivery. As a result, prenatal detection represents an important approach to optimizing outcome. Unfortunately, TAPVR remains one of the most challenging major forms of congenital heart disease to detect prenatally; most cases elude diagnosis until postnatal life, despite the widespread recognition of multiple fetal two-dimensional (2D) and color Doppler sonographic markers. This commentary demonstrates that even the 2D and color Doppler appearance of pulmonary venous drainage to the left atrium may be seen in cases of TAPVR. Accordingly, we describe, for the first time, a novel color Doppler fetal sonographic marker to rule out TAPVR.

Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent complete (apneas) and partial (hypopneas) upper airway events, causing intermittent hypoxemia and sleep fragmentation. It significantly impacts the cardiovascular system, increasing the morbidity and mortality associated with various complications. Therefore, employing appropriate echocardiographic methods to assess myocardial function in OSAS patients is crucial. It can facilitate early clinical intervention, enhance the quality of life, and potentially extend patients’ survival.

Iatrogenic aortic dissection (IAD) is a life-threatening condition, primarily caused by arterial cannulation during cardiopulmonary bypass (CPB) in cardiac surgeries. Transesophageal echocardiography (TEE) is the first-line diagnostic tool in the acute setting, but the presence of several artifacts can easily lead to misinterpretation. A 55-year-old man underwent coronary artery bypass grafting and implantation of central veno-arterial extracorporeal membrane oxygenation (V-A ECMO). TEE revealed what appeared to be an intimal dissection flap in the aortic arch and descending thoracic aorta, raising concerns for an IAD, which was not confirmed by computed tomographic angiography. This case highlights the pitfalls and limitations of echocardiography in the diagnosis of IAD, especially in settings with complex flow patterns such as during CPB or V-A ECMO.

This case highlights the use of multimodality imaging in the diagnosis and management of chronic constrictive pericarditis (CP) in a 37-year-old male with a history of T-wave inversions on electrocardiogram (ECG). The patient underwent adenosine stress cardiac magnetic resonance (CMR) due to suspicion of coronary artery disease (CAD). CMR revealed findings suggestive of chronic CP, including pericardial thickening and septal shudder, with computed tomography (CT) confirming the presence of pericardial calcification. The diagnosis was established through the combination of CMR and CT imaging. The patient underwent a successful pericardiectomy. This case emphasizes the crucial role of CMR and CT in diagnosing and guiding the management of CP.