The role of 'halo sign' for the accurate quantification of atrial septal defect size with 3D TEE.
“光环信号” 在3D TEE准确定量房间隔缺损大小中的作用。
- 作者列表："Aggeli C","Apostolou I","Dimitroglou Y","Toutouzas K","Vavuranakis M","Latsios G","Tsiamis E","Lerakis S","Tousoulis D
:In patients undergoing percutaneous closure of secundum atrial septal defect, the device selection is decided based on three-dimensional transesophageal echocardiography (3D TEE) measurements and two-dimensional balloon stretched diameter measurements; more importantly balloon sizing. The purpose of the study was to assess whether in patients with "halo-sign", defined as increased tissue thickness at the edge of the ASD rims, there is an agreement between 3D TEE and 2D balloon stretched diameter aiming to avoidance of balloon sizing. Forty consecutive patients who underwent closure of a single, without complex anatomy ASD were included. 3D and 2D TEE datasets were acquired and analyzed offline. Planimetry was used to calculate circumference derived diameter of ASD from 3D datasets. Patients were classified according to the presence of the "halo sign" and the agreement between circumference derived diameter and balloon stretched diameter was examined. Forty consecutive patients who underwent closure of a single, without complex anatomy ASD were included. 3D and 2D TEE datasets were acquired and analyzed offline. Planimetry was used to calculate circumference derived diameter of ASD from 3D datasets. Patients were classified according to the presence of the "halo sign" and the agreement between circumference derived diameter and balloon stretched diameter was examined. Higher correlation and lower median absolute difference between 3D TEE measurements and 2D stretched balloon diameter was found in patients with "halo sign". In patients with the "halo sign" mean diameter difference was non-significant. On the contrary statistically significant difference was found in patients without the "halo sign". Significant difference was also found when comparing mean difference in the two patient groups. ASD sizing by 3D echocardiography, is accurate in patients with halo sign and it correlates well with the balloon sizing method. This study justifies further investigation concerning the reliability of 3D imaging for the selection of the ASD device size with a view to avoid balloon sizing, decrease procedural time and thus simplify the procedure.
: 在接受继发孔型房间隔缺损经皮封堵术的患者中，器械选择基于三维经食管超声心动图 (3D TEE) 测量和二维球囊拉伸直径测量; 更重要的是球囊尺寸。该研究的目的是评估在具有 “光晕征” (定义为ASD边缘处的组织厚度增加) 的患者中，3D TEE和2D球囊拉伸直径之间是否存在一致，以避免球囊尺寸。连续纳入40例接受单一闭合，无复杂解剖结构ASD的患者。获取3D和2D TEE数据集并离线分析。平面测量法用于计算来自3D数据集的ASD的周长导出直径。根据 “晕征” 的存在对患者进行分类，并检查周长导出直径和球囊拉伸直径之间的一致性。连续纳入40例接受单一闭合，无复杂解剖结构ASD的患者。获取3D和2D TEE数据集并离线分析。平面测量法用于计算来自3D数据集的ASD的周长导出直径。根据 “晕征” 的存在对患者进行分类，并检查周长导出直径和球囊拉伸直径之间的一致性。在具有 “光晕征” 的患者中发现3D TEE测量与2D拉伸球囊直径之间的相关性较高且中值绝对差异较低。在 “晕征” 患者中，平均直径差异不显著。相反，在没有 “光环征” 的患者中发现统计学显著差异。当比较两个患者组中的平均差异时，也发现显著差异。3D超声心动图测量ASD在晕征患者中是准确的，并且它与球囊测量方法很好地相关。本研究证明了关于3D成像的可靠性的进一步研究，以选择ASD装置尺寸，从而避免气球尺寸，减少程序时间，从而简化程序。
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.