Cardiac magnetic resonance imaging for assessment of mitral stenosis before and after percutaneous balloon valvuloplasty in comparison to two- and three-dimensional echocardiography.
- 作者列表："Abdelaziz HM","Tawfik AM","Abd-Elsamad AA","Sakr SA","Algamal AM
BACKGROUND:The experience with cardiac magnetic resonance (CMR) in mitral stenosis (MS) is limited in contrast to mitral regurgitation. PURPOSE:To compare CMR versus 2D and 3D transthoracic (TTE) and 3D transesophgeal (TEE) echocardiography in assessment of rheumatic MS before and after percutaneous balloon mitral valvuloplasty (PBMV). MATERIAL AND METHODS:Twenty consecutive symptomatic patients with MS were evaluated prospectively and independently by CMR, TTE, and TEE pre-PBMV, and by CMR and TTE post-PBMV. Mitral valve area (MVA) was assessed by CMR planimetry, TTE and TEE planimetry, and pressure half time (PHT). Further assessment included trans-mitral velocity, mitral regurgitation (MR), and left atrial (LA) volume. RESULTS:PBMV was successful in 18 patients and failed in two patients (one with MVA <1.5 cm2, one developed severe MR). Pre-PBMV and MVA by CMR, 2D TTE, biplane, 3D TTE, 3D TEE, and PHT were 1.16, 1.16, 1.10, 1.02, 1.05, and 0.99 cm2, respectively. Post-PBMV, a significant increase in MVA was observed (2.15, 2.06, 2.07, 2.04, and 2.03 cm2, respectively). High agreement was observed between CMR and echocardiography before and after PBMV, except for PHT method. CMR significantly underestimated trans-mitral velocity and gradients compared to echocardiography (P<0.001). Before PBMV, mild MR was observed in 11, 12, and 19 patients by 2D TTE, 3D TTE, and CMR. After PBMV, MR was observed in all patients (19 mild, one severe) by all modalities. Echocardiography significantly underestimated LA volume compared to CMR (P<0.001). LA volume decreased significantly after PBMV (P<0.001). CONCLUSION:CMR provides comprehensive assessment of several parameters in MS patients before and after intervention. Agreement with echocardiography is acceptable.
背景: 与二尖瓣反流相比，心脏磁共振 (CMR) 在二尖瓣狭窄 (MS) 中的经验有限。 目的: 比较经皮球囊二尖瓣成形术 (PBMV) 前后经胸 (TTE) 和3D经食管 (TEE) 超声心动图对风湿性MS的评价。 材料和方法: 20名连续有症状的MS患者通过CMR、TTE和TEE在PBMV前以及通过CMR和TTE在PBMV后进行前瞻性独立评估。通过CMR平面测量、TTE和TEE平面测量以及压力半时间 (PHT) 评估二尖瓣面积 (MVA)。进一步评估包括跨二尖瓣速度、二尖瓣反流 (MR) 和左心房 (LA) 体积。 结果: PBMV成功18例，失败2例 (1例MVA <1.5 cm2 cm2，1例出现重度MR)。CMR、2D TTE、双平面、3D TTE、3D TEE和PHT的预PBMV和MVA分别为1.16、1.10、1.02、1.05和0.99 cm2 cm2。PBMV后，观察到MVA的显著增加 (分别为2.15、2.06、2.07、2.04和2.03-cm2)。除PHT法外，PBMV前后CMR与超声心动图的一致性较高。与超声心动图相比，CMR显著低估了经二尖瓣速度和梯度 (P<0.001)。在PBMV之前，通过2D TTE、3D TTE和CMR在11、12和19名患者中观察到轻度MR。在PBMV后，通过所有方式在所有患者 (19例轻度，1例重度) 中观察到MR。与CMR相比，超声心动图显著低估LA体积 (P<0.001)。PBMV后LA体积显著下降 (P<0.001)。 结论: CMR提供了MS患者干预前后几个参数的综合评估。与超声心动图相符。
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.