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Echocardiography in the Recognition and Management of Mechanical Complications of Acute Myocardial Infarction

Zhang, Robert S; Ro, Richard; Bamira, Daniel; Vainrib, Alan; Zhang, Lily; Nayar, Ambika C; Saric, Muhamed; Bernard, Samuel
PURPOSE OF REVIEW/OBJECTIVE:Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. RECENT FINDINGS/RESULTS:The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention.
PMID: 38526749
ISSN: 1534-3170
CID: 5644472

Quick Three-Dimensional Transesophageal Echocardiography of Left Atrial Appendage (LAA) Anatomy Using the LAA Multiview Technique

Vainrib, Alan; Saric, Muhamed
PMID: 38028389
ISSN: 2468-6441
CID: 5616882

Very Late Sinus of Valsalva Sequestration After Transcatheter Aortic Valve Implantation in Native Aortic Annuli [Case Report]

Ibrahim, Homam; Chaus, Adib; Staniloae, Cezar; Jilaihawi, Hasan; Vainrib, Alan; Alkhalil, Ahmad; Neuberger, Peter; Saric, Muhammad; Williams, Mathew
Coronary artery obstruction caused by sinus sequestration is well described after transcatheter aortic valve implantation in failed bioprosthetic valves, which usually occurs during or shortly after the transcatheter aortic valve implantation procedure. We report the presentation, management, and outcomes of 2 cases of very late sinus sequestration in native aortic annuli, which has not been described before to our knowledge. (Level of Difficulty: Advanced.).
PMID: 37954954
ISSN: 2666-0849
CID: 5611082

Left Atrial Appendage Tilt-Up-and-Turn-Left Maneuver: A Novel Three-Dimensional Transesophageal Echocardiography Imaging Maneuver to Characterize the Left Atrial Appendage and to Improve Transcatheter Closure Guidance [Case Report]

Hayes, Dena E; Bamira, Daniel; Vainrib, Alan F; Freedberg, Robin S; Aizer, Anthony; Chinitz, Larry A; Saric, Muhamed
• Precise LAA anatomy must be established for LAA occlusion device selection. • We have developed the TUPLE maneuver, an acronym for “tilt up and turn left”. • The TUPLE maneuver facilitates LAA device selection and intraprocedural guidance.
PMID: 37970485
ISSN: 2468-6441
CID: 5610832

The Double-Orifice Left Atrial Appendage: Multimodality and Virtual Transillumination Imaging [Case Report]

Rhee, David W; Aizer, Anthony; Chinitz, Larry A; Saric, Muhamed; Vainrib, Alan F
• LAA membranes are exceedingly rare with variable morphologies. • Thromboembolic risk with LAA membranes remains unknown. • Use of 3D TEE transillumination may assist in visualization and understanding.
PMID: 37614689
ISSN: 2468-6441
CID: 5599262

Device-Associated Thrombus with Watchman FLX Left Atrial Appendage Closure Device: A Report of Two Cases [Case Report]

Dhaduk, Nehal; Vainrib, Alan F; Bamira, Daniel; Ro, Richard; Aizer, Anthony; Chinitz, Larry; Saric, Muhamed
• Individual cases of Watchman FLX DAT are scare in literature. • The Watchman FLX has shown lower rates of DAT than the Watchman 2.0. • Thrombus formation is still possible in rare instances with the Watchman FLX.
PMID: 37396475
ISSN: 2468-6441
CID: 5538982

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.
PMID: 36680732
ISSN: 1534-3170
CID: 5405192

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.
PMID: 36174809
ISSN: 1097-6795
CID: 5334502

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.
PMID: 36198094
ISSN: 1540-8175
CID: 5356642

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
PMID: 36247374
ISSN: 2468-6441
CID: 5356652