Faculty Bibliography

BACKGROUND:The role of three-dimensional transesophageal echocardiography (3DTEE) vs multidetector computed tomography (MDCT) in aortic annular sizing has been poorly defined in patients undergoing transcatheter aortic valve replacements (TAVR). We set to determine the correlation between 3DTEE and MDCT in measuring the aortic annulus prior to TAVR. METHODS:In an observational, retrospective study, we compared aortic annular areas measured by MDCT and 3DTEE in TAVR patients. The aortic annular area was measured by planimetry of images obtained by MDCT pre-TAVR and by intra-TAVR TEE using 3D rendering of the aortic annulus followed by planimetry. Our primary outcome was degree of correlation between mean aortic annulus area by 3DTEE and MDCT. RESULTS:. There was a strong positive linear correlation between aortic annular area measurements obtained from these two modalities with mild relative underestimation by 3DTEE (ρ=.833). This relationship can be estimated using the predictive formula: [Formula: see text] CONCLUSIONS: Three-dimensional transesophageal echocardiography measurements have a high degree of correlation with MDCT measurements and thus can assist in proper valve prosthesis selection for TAVR. Our study thus supports use of 3DTEE as a reasonable alternative imaging modality in patients undergoing TAVR.

Snow shoveler's infarction is the phenomenon of increased incidence of myocardial infarction (MI) in the days following a snow storm. Followingheavy snowfall, public awareness of snow- shoveling-induced MI is heightened by news cover- age. We report a case of show-shoveling-induced chest pain with ECG changes concerning for MI. Emergent angiography revealed normal coronary arteries and apical ballooning consistent with ta- kotsubo cardiomyopathy (TCM). TCM, a transient cardiomyopathy, is often clinically indistinguishable from MI and is often induced by emotional/ physical stress. In conclusion, TCM is an alternative diagnosis to MI in patients presenting with chest pain after a period of heavy snowfall.