David C. McGiffin

Usefulness of transesophageal three-dimensional echocardiography in the identification of individual segment/scallop prolapse of the mitral valve.

We evaluated the potential usefulness of three‐dimensional (3D) transesophageal echocardiography (TEE) in assessing individual scallop/segment prolapse in 36 adult patients with mitral valve prolapse (MVP) undergoing surgical correction. Intraoperative 3D TEE correctly identified the location of scallop/segment prolapse in 34 of 36 patients (94%). However, in 6 of these patients 3D TEE images revealed more scallops or segments with prolapse than the surgeon noted intraoperatively. Prolapse of these areas was less prominent and this could possibly explain the lack of correlation with the surgical findings in these patients. In another 2 patients areas of prolapse seen by the surgeon were missed by 3D TEE because some of those scallops/segments could not be well imaged due to image “drop out” and artifacts. Thus, perfect correlation between 3D TEE and surgery was noted in 28 of 36 (78%) patients. Noncoaptation of the MV was also identified in 2 patients. The prolapsed area of posterior (n = 28 observations) and anterior (n = 9 observations) MV leaflets ranged from 1 cm2 to 9 cm2 (mean 3.50 cm2± 2.14) and 1.20 cm2 to 5.99 cm2 (mean 3.21 cm2± 1.33), respectively. Interobserver and intraobserver agreement for location and area of MVP was excellent (r = 0.97 and r = 0.99, respectively; all P values are <0.0001). In conclusion, 3D TEE is useful in identifying the location of MVP. It may also be potentially useful in assessing the extent of individual scallop/segment prolapse and identifying sites of MV noncoaptation. This information could aid the surgeon in deciding the extent of MV resection. (ECHOCARDIOGRAPHY, Volume 20, February 2003)

Initial Experience with Live/Real Time Three‐Dimensional Transesophageal Echocardiography

A new tool has been recently introduced to the echocardiography armamentarium, live/real time three‐dimensional (3D) transesophageal echocardiography (TEE). In these cases, we describe our initial experience in 13 patients studied intraoperatively and in the echocardiography suite. This important technology promises improved anatomic definition, diagnostic confidence, and novel views of the complicated cardiovascular pathology encountered in common clinical practice.

Device Related Infections: Are We Making Progress?

Abstractu2002 Infection was identified early in development of mechanical circulatory support devices (MCSDs) as an important cause of morbidity and mortality. Sepsis, infection of implanted pump components, and infections of percutaneous drivelines continue to limit survival and decrease quality of life for patients with a MCSD. This review examines five questions related to whether there has been progress in preventing or managing infection complications in patients with MCSDs. Have changes in patient selection, device design, and surgical implant techniques decreased the incidence of infection? Do smaller implanted blood pumps have a lower risk for infection than larger implanted blood pumps? Will fully implanted circulatory support systems have fewer infection complications than tethered MCSDs? Can optimal design of a driveline together with improvements in surgical techniques and care of the percutaneous driveline diminish the rate and consequences of driveline infections? Have improvements in the preoperative, intraoperative, and immediate postoperative management of patients with MCSDs decreased the risk of sepsis? Although infection remains an important problem for patients with MCSDs, there is evidence that we are making progress as described in this review. It is crucial that we continue. (J Card Surg 2010;25:478‐483)

Incremental Value of Three‐Dimensional Echocardiography Over Transesophageal Multiplane Two‐Dimensional Echocardiography in Qualitative and Quantitative Assessment of Cardiac Masses and Defects

In the present study, we compared three‐dimensionally (3‐D) reconstructed images with multiplane two‐dimensional (2‐D) transesophageal echocardiographic (TEE) images in 17 patients with various cardiac masses and defects. To overcome the problem of making measurements from 3‐D reconstructed images, we carefully “dissected” the 3‐D dataset using paraplane and anyplane 2‐D sections, which were then used to obtain the maximum sizes of the cardiac masses and defects. Of the 15 vegetations and 9 abscesses detected by 3‐D TEE in 7 patients, only 8 (53%) vegetations and 4 (44%) abscesses were detected by multiplane 2‐D TEE (P < 0.02). Also, the exact anatomical location, shape, geometry, and extent of various cardiac masses and defects were more clearly delineated by 3‐D than 2‐D TEE. The maximum dimensions of cardiac masses and defects were larger by 3‐D than by 2‐D TEE in 17 (89%) of the 19 lesions available for comparison (P < 0.002). In addition, 3‐D TEE correlated more closely than 2‐D TEE when compared to surgical measurements in three patients in whom they were available. Thus, it would appear that in several instances, the exact size of the cardiac lesion could only be assessed by analysis of the 3‐D volumetric dataset. Out preliminary study has demonstrated the superiority of transesophageal 3‐D reconstruction over multiplane 2‐D TEE in both qualitative and quantitative assessment of various cardiac mass lesions and pathological defects.

Usefulness of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in the Characterization of Ventricular Septal Defects in Adults

In this report, we present 12 patients (range 14–76 years, mean 40 ± 22.7 years) who underwent surgical repair of a ventricular septal defect (VSD). Location, size, and surrounding anatomy of the VSD were assessed prior to intervention in all patients with live/real time three‐dimensional transthoracic echocardiography (3DTTE). In 9 patients, measurements of maximum dimension, circumference, and area by 3DTTE correlated well with the same measurements from intraoperative three‐dimensional transesophageal echocardiographic (3DTEE) reconstruction. 3DTTE measurement of maximum dimension of VSDs also agreed well with maximum dimension by surgery in 10 patients. Live/real time 3DTTE accurately defined VSD location, size, and surrounding anatomy in all patients studied by us. VSD characterization by live 3DTTE agreed well with surgery descriptions and 3DTEE measurements.

Live three-dimensional transthoracic echocardiographic delineation of ventricular septal rupture following myocardial infarction.

We present an elderly patient with ventricular septal rupture following myocardial infarction in whom live three‐dimensional transthoracic echocardiography allowed comprehensive noninvasive assessment of the location, shape, and size of the septal defect, which could be clearly visualized en face from both left and right ventricular aspects.

Transesophageal Two- and Three-Dimensional Echocardiographic Diagnosis of Combined Left Ventricular Pseudoaneurysm and Ventricular Septal Rupture

Two‐ (2‐D) and three‐dimensional (3‐D) transesophageal echocardiography (TEE) were useful in making the diagnosis of combined left ventricular pseudoaneurysm and ventricular septal rupture in an elderly patient presenting with mediastinitis and worsening heart failure following coronary artery bypass graft surgery. The diagnosis was not suspected clinically. Three‐dimensional TEE served to increase the confidence level with which the diagnosis of this combined lesion was made. Additionally, 3‐D TEE proved superior to 2‐D TEE in assessing the size of the left ventricular rupture site.

Echocardiography Diagnosis of a Stenotic Double Orifice Parachute Mitral Valve with a Single Papillary Muscle

We present the case of a patient with a single papillary muscle that is supporting both orifices of a stenotic double orifice mitral valve. With the use of both transthoracic and transesophageal echocardiography, we were able to prospectively define this entity, which was confirmed at surgery.

Transesophageal three-dimensional echocardiographic assessment of left ventricular pseudoaneurysm.

We report an adult patient with a left ventricular pseudoaneurysm following an acute myocardial infarction in whom three‐dimensional (3‐D) transesophageal echocardiography (TEE) delineated clearly not only the location but also the size and shape of the rupture site. The size of the rupture site measured by 3‐D TEE correlated well with the surgical measurements. Three‐dimensional images also showed a localized superior distortion of the lateral aspect of the mitral annulus and left atrial wall produced by the pseudoaneurysm. The resulting severe mitral regurgitation practically disappeared after repair and decompression of the pseudoaneurysm.

Hemolysis after mitral valve repair.

Hemolysis is a potential complication of mitral valve repair. We report a case of hemolytic anemia after mitral valve repair successfully treated with re‐repair, and review the literature on reoperation after failure of mitral valve repair with associated hemolysis. doi: 10.1111/jocs.12060 (J Card Surg 2013;28:129–132)