Kian Keong Poh

Assessing aortic valve area in aortic stenosis by continuity equation: a novel approach using real-time three-dimensional echocardiography.

AIMS Two-dimensional echocardiographic (2DE) continuity-equation derived aortic valve area (AVA) in aortic stenosis (AS) relies on non-simultaneous measurement of left ventricular outflow tract (LVOT) velocity and geometric assumptions of LVOT area, which can amplify error, especially in upper septal hypertrophy (USH). We hypothesized that real-time three-dimensional echocardiography (RT3DE) can improve accuracy of AVA by directly measuring LVOT stroke volume (SV) in one window. METHODS AND RESULTS RT3DE colour Doppler and 2DE were acquired in 68 AS patients (74 +/- 12 yrs) prospectively. SV was derived from flow obtained from a sampling curve placed orthogonal to LVOT (Tomtec Imaging). Agreement between continuity-equation derived AVA by RT3DE (AVA(3D-SV)) and 2DE (AVA(2D)) and predictors of discrepancies were analysed. Validation of LVOT SV was performed by aortic flow probe in a sheep model with balloon inflation of septum to mimic USH. There was only modest correlation between AVA(2D) and AVA(3D-SV) (r = 0.71, difference 0.11 +/- 0.23 cm(2)). The degree of USH was significantly associated with difference in AVA calculation (r = 0.4, P = 0.005). In experimentally distorted LVOT geometry in sheep, RT3DE correlated better with flow probe assessment (r = 0.96, P < 0.001) than 2DE (r = 0.71, P = 0.006). CONCLUSION RT3DE colour Doppler-derived LVOT SV in the calculation of AVA by continuity equation is more accurate than 2D, including in situations such as USH, common in the elderly, which modify LVOT geometry.

Complementary Role of Multimodality Imaging in the Evaluation of Intracardiac Lymphoma in an HIV-Infected Man

A 52-year-old homosexual male presented with a 5-month history of anorexia and malaise, a 2-week history of night sweats, pleuritic chest pain, and worsening dyspnea on exertion. A transthoracic echocardiogram to evaluate the cause of his dyspnea revealed significant pericardial effusion with evidence of tamponade physiology, bulky mass (arrowheads) within the coronary sinus (parasternal long axis, Figure 1A, Movie I), and multiple large masses in the right atrium traversing the septum into the left atrium (subcostal, Figure 1B, Movie II). The left ventricular ejection fraction was estimated to be 50%. His blood count showed 5.2×103 white cells/cm3, 39.2% hematocrit, and 279×103 platelets …

MitraClip: Acute Thrombus Formation During Guide Insertion

Thrombus formation can occur during the mitraclip procedure and predispose patients to significant complications from thromboembolism. This case illustrates the need to be vigilant despite anticoagulation. The entire system had to be removed and re-prepared to remove the thrombus and prevent complications. In addition, increased anticoagulation had to be administered.