scholarly journals Prevalence of pericardial late gadolinium enhancement in patients after cardiac surgery: clinical and histological correlation

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
R Martinez ◽  
A-G Pavon ◽  
D Arangalage ◽  
S Colombier ◽  
S Rotman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Late Gadolinium Enhancement ◽  
Clinical Signs ◽  
Short Axis ◽  
Short Axis View ◽  
Histological Findings ◽  
Gadolinium Enhancement ◽  
Duration Of Surgery ◽  
Hematoxylin And Eosin ◽  
Axis View

Abstract Funding Acknowledgements Type of funding sources: None. Background Opening of the pericardial sack during cardiac surgery induce usually, a mild inflammatory reaction. Late gadolinium enhancement of the pericardium (pLGE) still has been observed on cardiovascular magnetic resonance (CMR) in patients even long-time after cardiac surgery suggesting ongoing pericardial inflammation. Clinical relevance and histological correlation are unknown. We present a study evaluating the prevalence of pLGE and correlating it to clinical and histological findings. Materials and Methods 185 patients after cardiac surgery underwent CMR on a 1.5 or 3.0 T system. Presence (LGE+) or absence (LGE-) of pLGE was rated by 2 independent operators blinded to clinical characteristics. In case of discordance a third observer served as referee. Information on clinical symptoms were obtained at the time of CMR or from medical records. A pericardial biopsy was performed in 4 patients who underwent a second cardiac surgical intervention after CMR. Results Mean time between CMR and cardiac surgery was 158 ± 110 months. Pericardial LGE was observed in 83 patients (38%), two independent observers agreed in 73 (89%). The presence of LGE was not significant correlated to the type (p = 0.812) or duration of surgery (p = 0.734), nor the use of intrapericardial foreign material (p = 0.534). Two biopsies in LGE + patients showed mild inflammation and calcification, one biopsy in a LGE + patient showed the presence of fibrosis without inflammation while one biopsy in a LGE – patient was negative for inflammation. None of patients presented clinical signs for an active pericarditis. Discussion Presence of pericardial LGE is frequent in patient after cardiac surgery, however without clinical features of pericarditis. The CMR findings appear to be histologically correlated to the presence of fibrosis or mild chronic inflammation which remains to be confirmed in a larger patient population. Figure 1: Basal ventricular short axis view in LGE sequences showing the presence of LGE of the pericardium (Panel A, yellow arrows) compatible with mild inflammation present in histological findings, shown by the presence of T lymphocytes CD3+ (Panel B) and the presence of fibrin (Panel C) : (hematoxylin and eosin) and (Panel D) : (FAOG). Mid-ventricular short axis view in LGE sequences showing the presence of LGE of the pericardium (Panel E, yellow arrows), which is compatible with histological findings, showing the presence of granulomatous inflammation in a fibrinous pericardium (Panel F,H) : (hematoxylin and eosin) and (Panel G) : (fils polarized). Visible granuloma (Panel F).

Aortic valve regurgitation

2021 ◽  
pp. 181-190
Author(s):  
Julien Magne ◽  
Patrizio Lancellotti
Keyword(s):  
Aortic Valve ◽  
Transoesophageal Echocardiography ◽  
Correct Identification ◽  
Short Axis ◽  
Short Axis View ◽  
Valve Regurgitation ◽  
Chamber View ◽  
Imaging Tool ◽  
Line Imaging ◽  
Axis View

Transthoracic echocardiography (TTE) is the first-line imaging tool to assess aortic valve (AV), aorta, and subsequent aortic regurgitation (AR). The parasternal long-axis view is classically used to measure the left outflow tract, the aortic annulus, and the aortic sinuses. Leaflet thickening and morphology can be visualized from this window as well as from the parasternal short-axis view and the apical five-chamber view. Nevertheless, 2D TTE may be limited and not enabling correct identification of the anatomy and causes of AR. In this situation, 3D echocardiography and cardiac magnetic resonance (CMR) could provide better delineation of the AV morphology. In some cases, transoesophageal echocardiography (TOE) could be required, more particularly for assessing the aortic root dimensions.

Echocardiographic two-dimensional view of the pulmonary valve in infants: the high transsternal view

2015 ◽  
Vol 26 (4) ◽  
pp. 790-792
Author(s):  
Miguel A. Granados ◽  
Leticia Albert ◽  
Belén Toral
Keyword(s):  
Older Patients ◽  
Pulmonary Valve ◽  
Thymus Gland ◽  
Age Group ◽  
Short Axis ◽  
Two Dimensional ◽  
Short Axis View ◽  
Axis View

AbstractNeonates and small infants have unique characteristics that make it possible to obtain echocardiographic views that are inaccessible in older patients. A high transsternal approach through the cartilaginous sternum and the thymus gland allows visualisation of a short-axis view of the pulmonary valve. This view should be included as part of routine protocols for echocardiographic examinations performed in this age group.

scholarly journals Natural evolution of cardiac sarcoidosis in an asymptomatic patient: a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Ganna Degtiarova ◽  
Olivier Gheysens ◽  
Johan Van Cleemput ◽  
Wim Wuyts ◽  
Jan Bogaert
Keyword(s):  
Computed Tomography ◽  
Late Gadolinium Enhancement ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Clinical Signs ◽  
Steroid Treatment ◽  
Lung Pathology ◽  
Gadolinium Enhancement ◽  
18F Fdg

Abstract Background Sarcoidosis is a multi-organ granulomatous disease of unknown aetiology. Adverse outcome related with cardiac involvement, makes early diagnosis of cardiac sarcoidosis crucial. Case summary In a 55-year-old man presenting with recurrent pulmonary infections, computed tomography (CT) showed several enlarged mediastinal lymph nodes and no lung pathology. Subsequent mediastinoscopy revealed the diagnosis of sarcoidosis. Further screening for organ involvement showed multifocal cardiac involvement both on cardiac magnetic resonance (CMR) and 18-F-fluorodeoxyglucose-positron emission tomography-computed tomography (18F-FDG PET-CT). Because of the lack of functional deterioration and clinical symptoms, no steroid treatment was initiated and regular follow-up of cardiac abnormalities was performed by CMR. Unremarkable progression of cardiac involvement during the first 2 years of follow-up turned into a dramatic involvement after 4 years, with the increase in the number and size of lesions at late gadolinium enhancement (LGE) CMR. Late gadolinium enhancement areas matched the regions of strongly increased 18F-FDG uptake. For the first time, the patient started complaining on shortness of breath, electrocardiography showed an atrioventricular block Grade 1. Cardiac biomarkers and cardiac function were still preserved. Steroid treatment was started. Although an electrophysiology study was negative, Holter monitoring showed ventricular arrhythmia. Cardioverter-defibrillator was implanted. Discussion This case shows the progression of cardiac sarcoidosis on CMR in an asymptomatic untreated patient over a 4-year period, and rises the awareness of possible severe cardiac damage even in the absence of clinical signs of cardiac involvement. Combination of PET and CMR is appealing to better understand the evolution of cardiac sarcoidosis and may help in the management of such patients.

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