Transesophageal Echocardiographic Screening for Structural Heart Interventions
Ro, Richard; Bamira, Daniel; Bernard, Samuel; Vainrib, Alan; Ibrahim, Homam; Staniloae, Cezar; Williams, Mathew R; Saric, Muhamed
PURPOSE OF REVIEW/OBJECTIVE:Percutaneous structural interventions have provided patients with an effective therapeutic option, and its growth has been aided by echocardiography. We describe the vital role that transesophageal echocardiography (TEE) plays in screening patients prior to their procedure. RECENT FINDINGS/RESULTS:A multimodality imaging approach is employed by the valve team, but TEE plays a unique role in diagnosis and planning. Utilization of all TEE views and features such as biplane, 3D imaging, and multiplanar reconstruction ensures accurate assessment of the structural lesion of interest. The role of TEE remains essential in the planning of structural interventions, and these studies should be performed in a systematic and comprehensive manner.
Recommendations for Special Competency in Echocardiographic Guidance of Structural Heart Disease Interventions: From the American Society of Echocardiography
Little, Stephen H; Rigolin, Vera H; Garcia-Sayan, Enrique; Hahn, Rebecca T; Hung, Judy; Mackensen, G Burkhard; Mankad, Sunil; Quader, Nishath; Saric, Muhamed
Transcatheter therapies for structural heart disease continue to grow at a rapid pace, and echocardiography is the primary imaging modality used to support such procedures. Transesophageal echocardiographic guidance of structural heart disease procedures must be performed by highly skilled echocardiographers who can provide rapid, accurate, and high-quality image acquisition and interpretation in real time. Training standards are needed to ensure that interventional echocardiographers have the necessary expertise to perform this complex task. This document provides guidance on all critical aspects of training for cardiology and anesthesiology trainees and postgraduate echocardiographers who plan to specialize in interventional echocardiography. Core competencies common to all transcatheter therapies are reviewed in addition to competencies for each specific transcatheter procedure. A core principle is that the length of interventional echocardiography training or achieved procedure volumes are less important than the demonstration of procedure-specific competencies within the milestone domains of knowledge, skill, and communication.
A Case Report of Cardiac Arrest After Intravenous Administration of Sulfur Hexafluoride (Lumason®) Ultrasound Enhancing Agent
Arnouk, Serena; Huynh, Quy; Saric, Muhamed; Papadopoulos, John
Ultrasound enhancing agents (UEAs) are medications that enable clear visualization of ultrasound images. While large studies have demonstrated the safety of these agents, case reports of life-threatening reactions temporally associated with their use have been published and reported to the Food and Drug Administration. Current literature describes the most serious adverse reactions due to UEAs to be allergic in nature; however, embolic phenomena may play a role as well. Here, we report a case of unexplained cardiac arrest following the administration of sulfur hexafluoride (Lumason®) in an adult inpatient undergoing echocardiography where resuscitative efforts were ultimately unsuccessful, and review possible mechanisms of cardiac arrest based on prior published literature.
Apical Aneurysms and Mid-Left Ventricular Obstruction in Hypertrophic Cardiomyopathy
Sherrid, Mark V; Bernard, Samuel; Tripathi, Nidhi; Patel, Yash; Modi, Vivek; Axel, Leon; Talebi, Soheila; Ghoshhajra, Brian B; Sanborn, Danita Y; Saric, Muhamed; Adlestein, Elizabeth; Alvarez, Isabel Castro; Xia, Yuhe; Swistel, Daniel G; Massera, Daniele; Fifer, Michael A; Kim, Bette
BACKGROUND:Apical left ventricular (LV) aneurysms in hypertrophic cardiomyopathy (HCM) are associated with adverse outcomes. The reported frequency of mid-LV obstruction has varied from 36% to 90%. OBJECTIVES/OBJECTIVE:The authors sought to ascertain the frequency of mid-LV obstruction in HCM apical aneurysms. METHODS:The authors analyzed echocardiographic and cardiac magnetic resonance examinations of patients with aneurysms from 3 dedicated programs and compared them with 63 normal controls and 47 controls with apical-mid HCM who did not have aneurysms (22 with increased LV systolic velocities). RESULTS:]; P = 0.004). Complete emptying occurs circumferentially around central PMs that contribute to obstruction. Late gadolinium enhancement was always brightest and the most transmural apical of, or at the level of, complete emptying. CONCLUSIONS:The great majority (95%) of patients in the continuum of apical aneurysms have associated mid-LV obstruction. Further research to investigate obstruction as a contributing cause to apical aneurysms is warranted.
Taking Command of 3D Stitching Artifacts: From an Annoyance to an Easy Tool for Navigating 3D Transesophageal Echocardiography
Maidman, Samuel D; Bamira, Daniel; Ro, Richard; Vainrib, Alan F; Saric, Muhamed
Despite many recent advances in three-dimensional (3D) transesophageal (TEE) imagining, the process of orienting 3D TEE images is nonintuitive and uses assumptions based on idealized anatomy. Correlating two-dimensional (2D) TEE cross-sectional images to 3D reconstructions remains an additional challenge. Here, we suggest the repurposing of the stitching artifact generated in 2-beat ECG-gated 3D TEE as a means of exactly orienting 3D images within a patient's unique anatomy. In this article, we demonstrate this application of this strategy to assess a normal mitral valve (MV), to localize scallops of mitral valve prolapse and to visualize typical left atrial appendage 2D cuts in a 3D space. By taking command of stitching artifacts, cardiac imagers can successfully navigate the complex structures of the heart for optimal, individualized echocardiographic views.
Isolated Left Ventricular Apical Hypoplasia: A Very Rare Congenital Anomaly Characterized by Multimodality Imaging and Invasive Testing
Maidman, Samuel D; Salerno, William D; Halpern, Dan G; Donnino, Robert; Saric, Muhamed
Bacterial endocarditis with AACEK (HACEK) organisms [Case Report]
Kuohn, Lindsey R; Ro, Richard; Bamira, Daniel; Vainrib, Alan; Freedberg, Robin; Galloway, Aubrey; Williams, Mathew R; Saric, Muhamed
INTRODUCTION/BACKGROUND:Gram-negative organisms of the AACEK group, formerly known as HACEK, rarely cause endocarditis. CASE SERIES/METHODS:We present three cases of bacterial endocarditis, involving native and prosthetic valves, caused by AACEK organisms. In two patients, Cardiobacterium hominis was the responsible organism, and in a third, Aggregatibacter aphrophilus was implicated. A dental source of infection was identified in two patients, and in all three patients, the presentation of endocarditis was subacute. DISCUSSION/CONCLUSIONS:This case series highlights the indolent nature of infection with the AACEK organisms. It also demonstrates the crucial role of multimodality imaging, especially transesophageal echocardiography, in the diagnosis of AACEk endocarditis of both native and prosthetic valves, and in delineating the extent of abscess in those with prosthetic valve infection.
Multimodality Imaging of Caval and Coronary Sinus Venous Anomalies [Case Report]
Liebman, Jordan; Bamira, Daniel; Ro, Richard; Vainrib, Alan F; Small, Adam J; Donnino, Robert; Saric, Muhamed
Mitral Valve-in-Ring Leaflet Thrombosis: A Multimodality Imaging Primer [Case Report]
Hayes, Dena E; Bamira, Daniel; Vainrib, Alan F; Staniloae, Cezar; Jilaihawi, Hasan; Williams, Mathew; Saric, Muhamed
Biatrial drainage of right superior vena cava with left superior vena cava: A diagnostic conundrum [Case Report]
Bhansali, Suneet; Cohen, Roi B; Halpern, Dan; Saharan, Sunil; Saric, Muhamed; Kumar, T K Susheel; Mosca, Ralph S