Two- and Three-Dimensional Transesophageal Echocardiography for Aortic Valve Aneurysms on the Right Coronary Cusp

2013 ◽  
Vol 116 (4) ◽  
pp. 784-787 ◽  
Author(s):  
Masataka Kuroda ◽  
Akihito Takemae ◽  
Toshikazu Takahashi ◽  
Norikatsu Mita ◽  
Shin Kagaya ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transesophageal Echocardiography ◽  
Three Dimensional ◽  
Coronary Cusp ◽  
The Right ◽  
Right Coronary Cusp

scholarly journals P1526 Updated prevalence of lambls excrescences using the latest three-dimensional transesophageal echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Takahashi ◽  
K Kusunose ◽  
S Hayashi ◽  
S Morita ◽  
Y Torii ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Transesophageal Echocardiography ◽  
Severe Aortic Stenosis ◽  
Cryptogenic Stroke ◽  
Three Dimensional ◽  
Poor Quality ◽  
Prosthetic Valves ◽  
And Gender ◽  
Right Coronary Cusp

Abstract Background Lambl’s excrescences (LEs), filiform strands that occur at sites of cardiac valves, have been suggested the cause cryptogenic stroke. The diagnosis is primarily based upon the echocardiographic study, but conventional two-dimensional transthoracic echocardiography has limitation to detect such as small strands. Latest three dimensional-transesophageal echocardiography (3D-TEE) have high-resolution images with many slices, so small structures are able to be clearly visible and detected. Purpose The aim of this study was to assess the prevalence of LEs using the latest 3D-TEE images. Methods We retrospectively reviewed consecutive 140 patients who underwent 3D-TEE from November 2018 to May 2019. Forty-seven patients were excluded due to unmeasurable, such as mitral valve prolapse, severe aortic stenosis, prosthetic valves and poor-quality images. We carefully evaluated the mitral and aortic valve leaflets in order to find mobile string structure (diameter <1 mm and length 1–20 mm) in each cardiac cycle. Total analyzed images were over 50 slices per one patient. Results Among 93 patients, 83 patients (89%) was detected the presence of LEs. No difference in age and gender were found between patients with LEs and patients without LEs. Of the total 83 patients, there were 35 patients with strands on mitral valve, 32 patients with strands on aortic valve, and 16 patients with strands on both valves. Distribution of LEs at each valve leaflet were shown in Figure. Right coronary cusp of aortic valve (42%) and P2 of mitral valve (35%) were high prevalence among leaflets. Conclusions 3D-TEE provides an update prevalence of LEs. The prevalence of LEs might be potentially high in the real world. Abstract P1526 Figure.

scholarly journals Automatic Aortic Valve Cusps Segmentation from CT Images Based on the Cascading Multiple Deep Neural Networks

2022 ◽  
Vol 8 (1) ◽  
pp. 11
Author(s):  
Gakuto Aoyama ◽  
Longfei Zhao ◽  
Shun Zhao ◽  
Xiao Xue ◽  
Yunxin Zhong ◽  
...  
Keyword(s):  
Neural Networks ◽  
Aortic Valve ◽  
Deep Neural Networks ◽  
Spatial Configuration ◽  
Ct Images ◽  
Anatomical Landmarks ◽  
Strong Correlations ◽  
Coronary Cusp ◽  
The Right ◽  
Right Coronary Cusp

Accurate morphological information on aortic valve cusps is critical in treatment planning. Image segmentation is necessary to acquire this information, but manual segmentation is tedious and time consuming. In this paper, we propose a fully automatic aortic valve cusps segmentation method from CT images by combining two deep neural networks, spatial configuration-Net for detecting anatomical landmarks and U-Net for segmentation of aortic valve components. A total of 258 CT volumes of end systolic and end diastolic phases, which include cases with and without severe calcifications, were collected and manually annotated for each aortic valve component. The collected CT volumes were split 6:2:2 for the training, validation and test steps, and our method was evaluated by five-fold cross validation. The segmentation was successful for all CT volumes with 69.26 s as mean processing time. For the segmentation results of the aortic root, the right-coronary cusp, the left-coronary cusp and the non-coronary cusp, mean Dice Coefficient were 0.95, 0.70, 0.69, and 0.67, respectively. There were strong correlations between measurement values automatically calculated based on the annotations and those based on the segmentation results. The results suggest that our method can be used to automatically obtain measurement values for aortic valve morphology.

scholarly journals Nonsurgical Management of a Papillary Fibroelastoma of the Aortic Valve

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Antonino M. Grande ◽  
Nicoletta Castiglione ◽  
Adelaide Iervolino ◽  
Francesco Nappi ◽  
Antonio Fiore
Keyword(s):  
Aortic Valve ◽  
Standard Of Care ◽  
Surgical Excision ◽  
Papillary Fibroelastoma ◽  
Surgical Removal ◽  
Nonsurgical Management ◽  
Asymptomatic Patients ◽  
Coronary Cusp ◽  
The Right ◽  
Right Coronary Cusp

We report the case of a 63-year-old woman who had an incidental echocardiographic diagnosis of papillary fibroelastoma (PFE) of the right coronary cusp of the aortic valve. The patient was informed about the embolic risk due to the pedunculated mass located on the aortic valve but she refused the proposed surgical removal. She was followed up yearly, and each follow-up included an echocardiographic evaluation of the mass. The lady is taking lysine acetylsalycilate 160 mg daily, and after more than 19 years later, she does not complain any symptoms or complications as a result of possible embolic episodes. If on one hand, our report is provocative for PFE nonsurgical management; on the other, we do believe that in symptomatic patients PFE located in the left heart chambers, the standard of care remains surgical excision after diagnosis. Anyway, our analysis shows that further data in this issue are needed in asymptomatic patients, and surgical indication should be proposed considering carefully the risk-benefit balance.

Easy Placement of Annular Sutures during Minimally Invasive Aortic Valve Replacement

2017 ◽  
Vol 12 (3) ◽  
pp. 227-229 ◽  
Author(s):  
Toshinori Totsugawa ◽  
Arudo Hiraoka ◽  
Kentaro Tamura ◽  
Hidenori Yoshitaka ◽  
Taichi Sakaguchi
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Surgical Field ◽  
Coronary Cusp ◽  
Hemodynamic Performance ◽  
The Right ◽  
Right Coronary Cusp

Placing annular sutures at the right coronary cusp is difficult during minimally invasive aortic valve replacement. We propose the partial everting mattress method, whereby a prosthetic valve is implanted ina supra-annular position at the left coronary and noncoronary cusps, with pledgets on the left ventricular side, but in an intra-annular position at the right coronary cusp, with pledgets on the aortic side. Needles can be grasped in forehand pass at all three coronary cusps. Our method enables easy placement of annular stitches even in the small surgical field, without adversely influencing the hemodynamic performance of the prosthesis.

scholarly journals Pre-anesthesia clinic: skip it or not? A case report

2019 ◽  
pp. 221-224
Author(s):  
Amr Abdullah ◽  
Amir Fouad ◽  
Ahmed Mamdouh Esmat ◽  
Ali Elhefnawy
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Incidental Finding ◽  
Previous History ◽  
Mobile Mass ◽  
History Of ◽  
Total Knee ◽  
Coronary Cusp ◽  
The Right ◽  
Right Coronary Cusp

We present a rare case of papillary fibroelastoma (PFE) of the aortic valve diagnosed after being referred from a pre-anesthesia clinic. This patient presented in preanesthesia clinic for assessment prior to right total knee replacement. Along with other investigations, echocardiography was ordered as the patient had a previous history of ischemic heart disease with angioplasty. There was no previous echocardiogram (ECHO) in the patient records. An incidental finding of a sclerotic aortic valve with highly mobile mass was seen attached to the right coronary cusp on the aortic side with same echogenicity as the valve. Based on this rare finding, the patient was referred to an interventional cardiac center prior to an elective orthopedic surgery.Citation: Abdullah A, Fouad A, Esmat AM, Elhefnawy A, Adeel S. Pre-anesthesia clinic: skip it or not? A case report. Anaesth. pain & intensive care 2019;23(2):221-224

scholarly journals P1305 Rare complication of a frequent disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Boeangiu ◽  
E Stoica ◽  
M Anton ◽  
C Maresiu ◽  
C Margineanu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Rare Complication ◽  
Left Ventricular ◽  
Benign Condition ◽  
Coronary Cusp ◽  
The Right ◽  
Right Coronary Cusp

Abstract Introduction Splenic abcess represents a rare complication of left-sided infective endocarditis. Unlike splenic infarction, which is a more benign condition, splenic abcess requires rapid diagnosis and treatment as its course can be fatal. We present the case of a 52- year old male, with diabetes and hypertension, admitted for shortness of breath and fever in the past two months. Clinical examination revealed respiratory distress, tachypnea, diastolic murmur on the left sternal border. Baseline laboratory investigations showed elevated inflammation markers, leukocytosis and thrombocytosis. Enterococcus faecalis was isolated from the hemocultures. Transthoracic echocardiography revealed a dilated left ventricle (LV), with preserved LV ejection fraction, with severe aortic regurgitation due to valve destruction. A large (11mm diameter) vegetation-like structure attached to the ventricular side of the right coronary cusp, protruding into the left ventricular outflow tract was identified. Further evaluation by transoesopahgeal echocardiography did not identify other lesions, except for secondary moderate mitral regurgitation, with intact mitral leaflets. Dual antibiotic therapy with Ampicilin and Gentamycin was initiated. Surgery was planned after infection control. The first three days were uneventful, with rapid resolution of fever and inflammatory markers, but on the fourth day, the patient developed severe abdominal pain, with its focal point in the left hypochondrium. Contrast abdominal CT was performed and large multiple subcapsular lesions were identified. These findings, correlated with the symptomatology, suggested embolic splenic abcess and infarction. The patient successfully underwent laparoscopic splenectomy, but soon after he developed sepsis with respiratory failure and neurological deterioration (with normal CT scan) and was admitted to the intensive care unit, where he was intubated and mechanically ventilated. Consensus after discussions between cardiology, cardiac surgery and neurology services was to immediately replace the aortic valve, given the inability to otherwise control the infection. Intraoperative images were consistent with perforation of the right coronary cusp. During hospitalization in the ICU following cardiac surgery, the patient was extubated and his neurological function markedly improved. Repeated TTE and TEE showed normal prosthetic valve function and resolution of mitral regurgitation. The patient continued to improve clinically until his discharge. Conclusions We presented a case of a rare pathogenic entity- splenic abscess and infarction- due to systemic embolization from infective aortic valve endocarditis. Multidisciplinary teamwork was required between cardiologist, intensive care specialist, neurologist, infectionist, general surgeon and cardiac surgeon. Splenectomy was performed before valve replacement, a treatment-course characteristic in the occurrence of these rare cases.

scholarly journals Aortic Annular Sizing Using Novel Software in Three-Dimensional Transesophageal Echocardiography for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 751
Author(s):  
Chanrith Mork ◽  
Minjie Wei ◽  
Weixi Jiang ◽  
Jianli Ren ◽  
Haitao Ran
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transesophageal Echocardiography ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Meta Analysis ◽  
Three Dimensional ◽  
Minimum Diameter ◽  
Transcatheter Aortic Valve ◽  
Mean Differences

(1) Background: We performed this study to evaluate the agreement between novel automated software of three-dimensional transesophageal echocardiography (3D-TEE) and multidetector computed tomography (MDCT) for aortic annular measurements of preprocedural transcatheter aortic valve replacement (TAVR); (2) Methods: PubMed, EMBASE, Web of Science, and Cochrane Library (Wiley) databases were systematically searched for studies that compared 3D-TEE and MDCT as the reference standard for aortic annular measurement of the following parameters: annular area, annular perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter. Meta-analytic methods were utilized to determine the pooled correlations and mean differences between 3D-TEE and MDCT. Heterogeneity and publication bias were also assessed. Meta-regression analyses were performed based on the potential factors affecting the correlation of aortic annular area; (3) Results: A total of 889 patients from 10 studies were included in the meta-analysis. Pooled correlation coefficients between 3D-TEE and MDCT of annulus area, perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter measurements were strong 0.89 (95% CI: 0.84–0.92), 0.88 (95% CI: 0.83–0.92), 0.87 (95% CI: 0.77–0.93), 0.87 (95% CI: 0.77–0.93), 0.79 (95% CI: 0.64–0.87), and 0.75 (95% CI: 0.61–0.84) (Overall p < 0.0001), respectively. Pooled mean differences between 3D-TEE and MDCT of annulus area, perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter measurements were −20.01 mm2 ((95% CI: −35.37 to −0.64), p = 0.011), −2.31 mm ((95% CI: −3.31 to −1.31), p < 0.0001), −0.22 mm ((95% CI: −0.73 to 0.29), p = 0.40), −0.47 mm ((95% CI: −1.06 to 0.12), p = 0.12), −1.36 mm ((95% CI: −2.43 to −0.30), p = 0.012), and 0.31 mm ((95% CI: −0.15 to 0.77), p = 0.18), respectively. There were no statistically significant associations with the baseline patient characteristics of sex, age, left ventricular ejection fraction, mean transaortic gradient, and aortic valve area to the correlation between 3D-TEE and MDCT for aortic annular area sizing; (4) Conclusions: The present study implies that 3D-TEE using novel software tools, automatically analysis, is feasible to MDCT for annulus sizing in clinical practice.

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