Quantitative three-dimensional echocardiographic analysis of the bicuspid aortic valve and aortic root: A single modality approach.
- 作者列表："Levack MM","Mecozzi G","Jainandunsing JS","Bouma W","Jassar AS","Pouch AM","Yushkevich PA","Mariani MA","Jackson BM","Gorman JH 3rd","Gorman RC
BACKGROUND:Patients with bicuspid aortic valves (BAV) are heterogeneous with regard to patterns of root remodeling and valvular dysfunction. Two-dimensional echocardiography is the standard surveillance modality for patients with aortic valve dysfunction. However, ancillary computed tomography or magnetic resonance imaging is often necessary to characterize associated patterns of aortic root pathology. Conversely, the pairing of three-dimensional (3D) echocardiography with novel quantitative modeling techniques allows for a single modality description of the entire root complex. We sought to determine 3D aortic valve and root geometry with this quantitative approach. METHODS:Transesophageal real-time 3D echocardiography was performed in five patients with tricuspid aortic valves (TAV) and in five patients with BAV. No patient had evidence of valvular dysfunction or aortic root pathology. A customized image analysis protocol was used to assess 3D aortic annular, valvular, and root geometry. RESULTS:Annular, sinus and sinotubular junction diameters and areas were similar in both groups. Coaptation length and area were higher in the TAV group (7.25 ± 0.98 mm and 298 ± 118 mm2 , respectively) compared to the BAV group (5.67 ± 1.33 mm and 177 ± 43 mm2 ; P = .07 and P = .01). Cusp surface area to annular area, coaptation height, and the sub- and supravalvular tenting indices did not differ significantly between groups. CONCLUSIONS:Single modality 3D echocardiography-based modeling allows for a quantitative description of the aortic valve and root geometry. This technique together with novel indices will improve our understanding of normal and pathologic geometry in the BAV population and may help to identify geometric predictors of adverse remodeling and guide tailored surgical therapy.
背景: 二叶式主动脉瓣 (BAV) 患者在根部重塑和瓣膜功能障碍的模式方面存在异质性。二维超声心动图是主动脉瓣功能障碍患者的标准监测方式。然而，辅助计算机断层扫描或磁共振成像通常是表征主动脉根部病理的相关模式所必需的。相反，三维 (3D) 超声心动图与新型定量建模技术的配对允许对整个根复合体进行单一模态描述。我们试图用这种定量方法确定3D主动脉瓣和根部几何形状。 方法: 对5例三尖瓣主动脉瓣 (TAV) 和5例BAV患者进行食管实时三维超声心动图检查。没有患者有瓣膜功能障碍或主动脉根部病变的证据。使用定制的图像分析协议来评估3D主动脉环、瓣膜和根部几何形状。 结果: 两组的环状、窦道和窦道交界直径和面积相似。TAV组的接合长度和面积 (分别为7.25 ± 0.98mm和298 ± 118平方毫米mm) 高于BAV组 (5.67 ± 1.33mm和177 ± 43平方毫米mm; P = .07和p = .01)。组间尖尖表面积至环形面积、接合高度以及瓣下和瓣上帐篷指数无显著差异。 结论: 基于单一模态三维超声心动图的建模允许对主动脉瓣和根部几何形状进行定量描述。这项技术和新的指数将提高我们对BAV人群正常和病理几何形状的理解，并可能有助于确定不利重塑的几何预测因子，并指导定制的手术治疗。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.