Jose Luis Rodrigo

Tricuspid annular plane systolic excursion inaccuracy to assess right ventricular function in patients with previous tricuspid annulopasty

OBJETIVESnThe clinical and prognostic usefulness of tricuspid annular plane systolic excursion (TAPSE) is well established. However, the ability of TAPSE to assess right ventricular (RV) function in patients with previous tricuspid valve annulopasty is controversial. This study examined the TAPSE suitability in patients with previous tricuspid valve annuloplasty using right ventricular fractional area change (RVFAC) as reference method.nnnMETHODSnWe retrospectively analyzed 53 patients who underwent tricuspid valve annuloplasty at our hospital between 2013 and 2016. TAPSE and RVFAC were obtained in preoperative and postoperative periods using standard methodology.nnnRESULTSnMean age was 68±12years and 34 patients (64.1%) were women. TAPSE decreased significantly after surgery in comparison with pre-surgical values (17±4.2 Vs 12.9±4.1mm, p<0.001). On the contrary, RVFAC did not change significantly after surgery (37±9.2 Vs 36.2.9, p=0.25). The correlation between RVFAC and TAPSE was better in the preoperative (r=0.63, p<0.0001) than in the postoperative period (r=0.38, P=0.005). Good intra- and interobserver agreement for TAPSE and RVFAC was obtained, with intraclass correlation coefficients of 0.97 and 0.92 for TAPSE; and 0.90 and 0.85 for RVFAC, respectively.nnnCONCLUSIONSnThese findings suggest that TAPSE is not suitable after tricuspid valve annuloplasty and it leads to an underestimation of RV systolic function. It seems to be appropriate to rely on echocardiographic parameters of global RV function such as RVFAC in this context.

Descending Aorta Rupture During Transcatheter Aortic Valve Replacement

A 88-year-old woman with a permanent VDD pacemaker and severe aortic stenosis underwent elective transcatheter aortic valve replacement because of high surgical risk (logistic Euroscore of 35.3%). Aortic valve area was 0.5 cm2, mean gradient was 86 mmu2009Hg, and left ventricular ejection fraction was 64% on transthoracic echocardiography. Aortic annulus sizing was 23.5 and 23.7 mm by transesophageal echocardiography and multidetector computed tomography, respectively. Femoral and iliac arteries evaluated by angiography and computed tomography were straight with mild calcification and had adequate internal diameters. Great tortuosity of the aorta was also observed in computed tomography, with the presence of a double angle in the descending thoracic aorta and a very pronounced curve in the distal part of the aortic arch (Figure 1). The procedure took place via right transfemoral access with the use of a percutaneous closure device. A self-expandable 29-mm Core Valve prosthesis (Medtronic, Inc., Minneapolis, MN) was advanced, encountering a high resistance at the level of the distal part of the aortic arch that precluded the progress. When advancement …

Atypical pericardial cyst location: the role of multimodality imaging.

An 85-year-old woman with symptoms of polymyalgia rheumatica underwent chest X-ray which disclosed a rounded opacity in the upper half of the left hemithorax, adjacent to the cardiac silhouette ( Panel A , white arrow). Chest computed tomographic scan revealed the presence of a 7 × 4 × 6 cm thin-walled homogeneous lesion, …

Mycotic pseudoaneurysm of the ascending aorta.

A 49-year-old man consulted for progressive dyspnoea and bilateral lower extremity oedema. His history included a hospital admission because of a multi-resistant Escherichia coli septicaemia 3 years before. Transthoracic echocardiography revealed a calcified mass adjacent to the aortic root ( Panel A ). Transoesophageal echocardiogram showed a large ascending aorta pseudoaneurysm originating at the level of Valsalva sinuses, and communicating with the anterior aspect of the aortic …

Pulmonary Vein Stenosis Assessed by Three‐Dimensional Transesophageal Echocardiography

Figure 1. A. Color Doppler showing a turbulent blood flow in the LUPV. B. Increased peak velocity documented with continuous-wave Doppler. C. Three-dimensional transesophageal echocardiogram showing the LUPV stenosis (arrow) by direct en face visualization from the left atrium. D. Planimetry at the level of the LUPV stenosis by multiplanar review (MPR) mode. LA = left atrium; LAA = left atrial appendage; LUPV = left upper pulmonary vein.