Search Results (172)

Background: Valve-sparing root replacement surgery is an alternative strategy for patients with aortic regurgitation with or without aortic root enlargement. A detailed understanding of the mechanisms of regurgitation and the morphology of the aortic root would be beneficial for predicting the feasibility and success of valve-sparing surgery. This is an exploratory study of the measurement of geometric height in 3D transesophageal echocardiography as a predictor of valve-sparing root replacement for aortic regurgitation. Methods: Transesophageal echocardiographic findings and long-term outcomes were compared in 124 patients undergoing either valve-sparing root replacement (VSRR group) or composite valve graft replacement (Bentall group) from September 2014 to March 2019. Results: The VSRR group was younger and had better left ventricular function than the Bentall group. Three-dimensional transesophageal echocardiography showed that geometric height was significantly larger in the VSRR group. In receiver-operating curve analysis, the cutoff values of geometric height for the feasibility of valve-sparing surgery were 15.9 mm and 19.8 mm in the tricuspid and bicuspid aortic valve, respectively. The overall survival was 98.6% and the freedom from reoperation rate was 89.7% at 5 years in the VSRR group. Conclusions: Appropriate patient selection and adequate GH may contribute to the success of VSSR and improve long-term outcomes. Full article

Background: The 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE) highlighted the essential role of multimodal imaging in the diagnostic algorithm of IE and its complications. Methods: We hereby report a case series of IE in which the diagnosis was confirmed or excluded by the use of multimodal imaging during the period between January 2024 and July 2024 at the Infectious Diseases Clinic, Perugia Hospital, Italy. Results: Six patients were retrospectively included. Prosthetic valve endocarditis (PVE) was suspected in four patients and native valve endocarditis (NVE) in two cases. In patients with prosthetic valves, 18F FDG-PET/CT was performed, except in one case (P1) where cardiac CTA was performed for suspicion of perigraft aneurysm. Patients underwent transesophageal echocardiography (TOE), which was diagnostic in two cases and inconclusive in the remaining cases. In case of inconclusive TOE, the use of multimodal imaging added a major criterion and allowed us to consider (from ‘rejected’ to ‘possible’) or confirm (from ‘possible’ to ‘definite’) the diagnosis of EI based on the 2023 Duke–ESC Criteria. In one case (P6), it was possible to exclude the diagnosis. For patients with diagnostic TOE, 18F FDG-PET/CT allowed for the enhancement of diagnostic accuracy, identifying the site of valve involvement and the extension of the infection to the device (cases P3 and P5, respectively). Conclusions: In clinical practice, the use of cardiac CTA and/or 18F FDG-PET/CT based on the latest ESC guidelines demonstrated a significant impact on the diagnosis and therapeutic management of IE. Full article

Background and Objectives: Studies have shown that inflammation markers can be used as prognostic tools in predicting acute ischemic stroke. In this study, we conducted a comparison of several inflammation scores in predicting left atrial thrombosis (LAT) in patients with ischemic stroke without AF. Materials and Methods: In this single-center, retrospective study, we included 303 consecutive patients with ischemic stroke. Each patient underwent a transesophageal echocardiography (TEE) examination within 10 days of admission to detect the presence of LAT. To identify independent predictors of LAT, we conducted a multivariate logistic regression analysis. Results: In total, 303 patients who had ischemic stroke were included in the analysis. LAT was detached in 34 patients at the time of the TEE examination. The patients were categorized into two groups based on their LAT status. The Prognostic Nutritional Index (PNI), HALP score, and C-reactive Protein–Albumin Ratio (CAR) were identified as statistically significant predictors of LAT. Based on the results of the multivariate regression analysis, the CAR emerged as the only independent predictor of LAT. Conclusions: Among several inflammation scores, the PNI, HALP, and CAR were statistically significant predictors of LAT in ischemic stroke patients without AF. CAR was identified as the optimal score for the prediction of LAT in patients with stroke and without AF. Full article

Background and Objectives: In coronary artery bypass grafting (CABG) on pump, achieving optimal visualization is critical for surgical precision and safety. The use of blowers to clear the CABG anastomosis poses risks, including the formation of micro-embolic gas bubbles, which can be insidious and increase the risk of cerebral or myocardial complications. This retrospective study compares the effectiveness of the use of irrigation mist and CO₂ versus a direct CO₂ blower without irrigation in terms of visualization, postoperative fibrillation, and micro-embolic gas activity. Materials and Methods: The study involved 40 patients who underwent on-pump CABG, with 20 patients assigned to the irrigation mist and CO₂ group (ClearView™) and 20 to the direct CO₂ blower group. Primary outcomes included the quality of intraoperative visualization, the incidence of fibrillation at aortic de-clamping, and the presence of micro-embolic gas activity detected via transesophageal echocardiography (TEE) in the cardiac chambers. Results: Patients in the irrigation mist and CO₂ group experienced superior visualization and reduced tissue desiccation. Fibrillation at the time of aortic de-clamping occurred in two patients (10%) using the irrigation mist and CO₂, compared to eight patients (40%) using the direct CO₂ blower. Additionally, TEE monitoring revealed lower levels of micro-embolic gas activity in the irrigation mist and CO₂ group, indicating a potential reduction in gas embolization risk. Conclusions: The irrigation mist and CO₂ system not only provides enhanced visualization during CABG but also significantly reduces the incidence of fibrillation during aortic de-clamping and micro-embolic gas activity. These findings suggest improved patient safety and outcomes, highlighting the irrigation mist and CO₂ system as a potentially safer alternative to direct CO₂ blowing in the context of myocardial revascularization. Full article

Background/Objectives: The automatic left ventricle segmentation in transesophageal echocardiography (TEE) is of significant importance. In this paper, we constructed a large-scale TEE apical four-chamber view (A4CV) image dataset and proposed an automatic left ventricular segmentation method for the TEE A4CV based on the UNeXt deep neural network. Methods: UNeXt, a variant of U-Net integrating a multilayer perceptron, was employed for left ventricle segmentation in the TEE A4CV because it could yield promising segmentation performance while reducing both the number of network parameters and computational complexity. We also compared the proposed method with U-Net, TransUNet, and Attention U-Net models. Standard TEE A4CV videos were collected from 60 patients undergoing cardiac surgery, from the onset of anesthesia to the conclusion of the procedure. After preprocessing, a dataset comprising 3000 TEE images and their corresponding labels was generated. The dataset was randomly divided into training, validation, and test sets in an 8:1:1 ratio on the patient level. The training and validation sets were used to train the UNeXt, U-Net, TransUNet, and Attention U-Net models for left ventricular segmentation. The dice similarity coefficient (DSC) and Intersection over Union (IoU) were used to evaluate the segmentation performance of each model, and the Kruskal–Wallis test was employed to analyze the significance of DSC differences. Results: On the test set, the UNeXt model achieved an average DSC of 88.60%, outperforming U-Net (87.76%), TransUNet (85.75%, p < 0.05), and Attention U-Net (79.98%; p < 0.05). Additionally, the UNeXt model had a smaller number of parameters (1.47 million) and floating point operations (2.28 giga) as well as a shorter average inference time per image (141.73 ms), compared to U-Net (185.12 ms), TransUNet (209.08 ms), and Attention U-Net (201.13 ms). The average IoU of UNeXt (77.60%) was also higher than that of U-Net (76.61%), TransUNet (77.35%), and Attention U-Net (68.86%). Conclusions: This study pioneered the construction of a large-scale TEE A4CV dataset and the application of UNeXt to left ventricle segmentation in the TEE A4CV. The proposed method may be used for automatic segmentation of the left ventricle in the TEE A4CV. Full article

Significant advances in the diagnosis and treatment of congenital heart disease have transformed patient outcomes, leading to an expanding adult congenital heart disease population. Many of these adults require lifelong procedural interventions, frequently performed in catheterization labs under the guidance of echocardiography. This review explores the transesophageal echocardiographic aspect in key catheterization-based procedures. Full article

Background: Transseptal puncture (TSP) is a critical step in electrophysiological (EP) procedures, as a misdirected TSP can result in life-threatening complications. Although TSP is predominantly performed under fluoroscopic guidance in EP procedures, transesophageal echocardiography (TEE) offers more precision and certainty in the localization of the transseptal needle at the interatrial septum. Despite the widespread use of TSP, evidence supporting the added value of TEE-guided TSP in EP procedures remains limited. This study evaluates the impact of additional TEE guidance on TSP-associated complications during EP procedures. Methods: This study enrolled patients who underwent left atrial or left ventricular procedures with TSP, performed either without (fluoroscopy group) or with additional TEE guidance (TEE group), at the University Heart Center Ulm, Germany. Results: A total of 932 patients were included: 443 in the TEE group (mean age 68.1 ± 11.8 years, 40.6% female) and 489 in the fluoroscopy group (mean age 68.8 ± 11.0 years, 38.2% female). The mean number of transseptal accesses per patient was 1.18 ± 0.38 in the TEE group and 1.14 ± 0.34 in the fluoroscopy group (p = 0.101). Pericardial tamponade occurred significantly less in the TEE group (0.5%) than in the fluoroscopy group (1.8%; p = 0.046). Logistic regression revealed a 91.8% lower risk of pericardial tamponade with TEE-guided TSP compared to fluoroscopy guidance alone. The overall TEE complication rate was low (0.9%). Conclusions: TEE guidance during TSP significantly reduces the risk of pericardial tamponade in EP procedures, indicating that TSP should be performed with additional sonographic guidance to increase patient safety. Full article

Background: Transesophageal echocardiography (TEE) is a vital diagnostic tool in clinical practice, particularly in transcatheter interventions where it aids in both pre-operative planning and intra-operative guidance. Traditional TEE probes often require general anesthesia due to patient discomfort. However, the development of miniaturized TEE probes presents a promising alternative, enabling routine examinations and interventions with minimal sedation. This study evaluates the feasibility of performing a complete 2D/4D TEE protocol with the new 4D mini-TEE probe in the echocardiography department and its application in transcatheter interventions. Methods: This is a retrospective study that included 30 consecutive patients from two high-volume European hospitals (Interbalkan Medical Center, Thessaloniki, Greece, and Rennes University, France) that underwent TEE or transcatheter interventions. The new 4D mini-TEE 9VT-D probe (GE Healthcare) was utilized. The quality of the images and the tolerance of the probe were assessed in the cath lab during interventions and in the echocardiography department during routine TEE examinations. Results: Direct comparison of the 4D mini-TEE probe with the standard 6VT-D probe confirmed the excellent image quality of this new pediatric probe. Most of the patients required minimal sedation or local oropharyngeal anesthesia, with satisfactory tolerance reported. Most of the transcatheter procedures did not require general anesthesia and intubation, resulting in shorter procedural time. Both 2D and 4D imaging modalities offered adequate intra-operative guidance for transcatheter procedures. Conclusions: The 4D mini-TEE probe delivers exceptional imaging capabilities for routine examinations and transcatheter interventions without needing sedation. Its use reduces esophageal trauma and the need for general anesthesia, enhancing patient comfort and safety. Full article

Two-dimensional transthoracic echocardiography (2D TTE) and two-dimensional transesophageal echocardiography (2D TEE) are regarded as the main imaging techniques for the assessment of degenerative mitral valve regurgitation (DMVR). However, describing the complex morphology of DMVR with 2D TTE and 2D TEE remains at the very least challenging. Three-dimensional (3D) TEE is an ideal technique for illustrating the extremely variable morphology of DMVR, providing images of unparalleled quality in terms of anatomical detail. In this review, we describe the key role of 3D TEE in various morphological scenarios that reflect everyday experiences in an echocardiographic laboratory. We also discuss the growing role of 3D TEE in mitral valve (MV) transcatheter edge-to-edge repair (TEER) and new modalities such as photorealistic and transparent displays, surface rendering parametric color maps, new algorithms for MVR quantification, and the potential role of new mini-TEE probes in adult patients with DMVR. Full article

Mitral valve disease is a common heart disease in dogs. The aim of this study was to describe the cases of dogs that underwent mitral valve repair via a V-clamp device and to provide long-term follow-up data on cardiac function after mitral valve repair. Four dogs with mitral valve regurgitation who experienced coughing and dyspnea underwent surgical mitral valve repair between December 2023 and March 2024. The patients were evaluated via transthoracic and transesophageal echocardiography. Echocardiography revealed mitral valve leaflet regurgitation. Mitral valve repair was performed under general anesthesia using a V-clamp device introduced through an introducer wire guide. Echocardiography was conducted at baseline and during the six-month follow-up. Blood analysis results after surgical repair were normal. Follow-up echocardiography revealed no complications related to the procedure, with all dogs demonstrating improved respiratory signs and quality of life after repair. No adverse reactions were reported after surgery. A V-clamp device was used to repair mitral valve regurgitation in four dogs. Mitral valve repair via a V-clamp device is another treatment option for mitral valve disease in dogs. Full article

Infective endocarditis (IE) is a disease associated with significant morbidity and mortality. It is more commonly caused by Gram-positive cocci, but Gram-positive bacilli may seldom cause the disease. Listeria monocytogenes is an aerobic Gram-positive coccobacillus and a foodborne and opportunistic pathogen most commonly causing gastrointestinal infections, even though bacteremia, sepsis, meningitis, and fetal infections may also occur. Listeria IE has rarely been described, with most reports being case reports or case series. Thus, the characteristics of this disease remain largely unknown. This systematic review aimed to present all published Listeria IE studies and describe their characteristics. A search of PubMed, Scopus, and the Cochrane Library for studies providing information on epidemiology, clinical findings, treatment, and outcome of Listeria IE cases was performed. A total of 54 studies containing data from 62 patients were included. Among all patients, 64.5% were male; the median age was 69 years. Among all patients, 54.8% had a history of a prosthetic valve. The aortic valve was the most commonly affected, followed by the mitral. Fever, heart failure, and embolic phenomena were the most commonly encountered clinical findings. The only isolated species was L. monocytogenes. Antimicrobial resistance was relatively low for aminopenicillins and aminoglycosides, the most commonly used antimicrobials for treating L. monocytogenes IE. Surgery was performed in 27.4% of patients. Mortality was 37.1%. Patients who survived were more likely to have had a prosthetic valve, to have necessitated transesophageal echocardiography for the diagnosis, to have mitral valve IE, and to have had surgical management; however, no factor was identified in a multivariate logistic regression model as an independent factor for overall mortality. Full article

Cardiac hemangiomas are rare and often misdiagnosed due to their nonspecific clinical presentations. We report a case of a 70-year-old man presenting with chills and cold sweats, initially suspected of having infective endocarditis based on echocardiographic findings of a mobile mass on the mitral valve. Laboratory results showed leukocytosis and elevated C-reactive protein, but blood cultures were negative. Transesophageal echocardiography later revealed a well-defined mass with characteristics suggestive of a tumor. Surgical excision confirmed the diagnosis of hemangioma. Postoperative recovery was uneventful, with no mitral regurgitation. This case highlights the importance of considering cardiac tumors in the differential diagnosis of intracardiac masses. Full article

Background: Transesophageal echocardiography (TEE) is mandatory before transvenous lead extraction (TLE), but its usefulness remains underestimated. This study aims to describe the broad range of TEE findings in TLE candidates, as well as their influence on procedure complexity, major complications (MCs) and long-term survival. Methods: Preoperative TEE was performed in 1191 patients undergoing TLE. Results: Lead thickening (OR = 1.536; p = 0.007), lead adhesion to heart structures (OR = 2.531; p < 0.001) and abnormally long lead loops (OR = 1.632; p = 0.006) increased the complexity of TLE. Vegetation-like masses on the lead (OR = 4.080; p = 0.44), lead thickening (OR = 2.389; p = 0.049) and lead adhesion to heart structures (OR = 6.341; p < 0.001) increased the rate of MCs. The presence of vegetations (HR = 7.254; p < 0.001) was the strongest predictor of death during a 1-year follow-up period. Conclusions: TEE before TLE provides a lot of important information for the operator. Apart from the visualization of possible vegetations, it can also detect various forms of lead-related scar tissue. Build-up of scar tissue and the presence of long lead loops are associated with increased complexity of the procedure and risk of MCs. Preoperative TEE performed outside the operating room may have an impact on the clinical decision-making process, such as transferring potentially more difficult patients to a more experienced center or having the procedure performed by the most experienced operator. Moreover, the presence of masses or vegetations on the leads significantly increases 1-year and all-cause mortality. Full article

Background/Objective: Whether left atrial appendage thrombus (LAAT) in patients with atrial fibrillation (AF) on chronic anticoagulation significantly increases cardiovascular risk is unknown. This study aimed to assess LAAT prevalence and its predictive role in cardiovascular events among consecutive anticoagulated patients with AF admitted for electrical cardioversion. Methods: This prospective study included 500 patients. The primary outcome was LAAT on transesophageal echocardiography. Patients were followed up for a median of 1927.5 (interquartile range 1004–2643) days to assess cardiovascular events. Results: LAAT was detected in 65 (13%) patients. No significant differences in stroke, transient ischemic attack, systemic thromboembolic events, or myocardial infarction prevalence were observed between patients with AF with and without LAAT. Hospitalization for heart failure (HF) was more frequent in patients with LAAT than in those without LAAT; however, the effect of LAAT on HF hospitalization was not statistically significant. Patients with LAAT had a significantly higher risk of cardiovascular death than those without LAAT. LAAT and greater left atrial (LA) diameter were associated with higher rates of cardiovascular death. The independent HF hospitalization predictors were greater LA diameter, lower left ventricular ejection fraction (LVEF), and estimated glomerular filtration rate (eGFR). Conclusions: Patients with AF who received anticoagulation therapy showed a high prevalence of LAAT. LAAT and greater LA diameter were associated with significantly higher rates of cardiovascular death. LAAT, greater LA diameter, lower LVEF, and lower eGFR were associated with poor prognosis in anticoagulated patients with AF and were predictors of disease severity. Full article

Genetic factors play a significant role in the pathogenesis of mitral valve diseases, including mitral valve prolapse (MVP) and mitral valve regurgitation. Genes like Fibrillin-1 (FBN1), Filamin A (FLNA), matrix metalloproteinase 2 (MMP2), and SRY-box transcription factor 9 (SOX9) are known to influence mitral valve pathology but knowledge of the exact mechanism is far from clear. Data regarding serum parameters, transesophageal echocardiography, and genetic and histopathologic parameters were investigated in 54 patients who underwent cardiovascular surgery for mitral valve regurgitation. The possible association between Fibrillin-1, Filamin A, MMP2, and SOX9 gene expressions was checked in relationship with the parameters of systemic inflammatory response. The mRNA expression levels (RQ—relative quantification) were categorized into three distinct groups: low (RQ < 1), medium/normal (RQ = 1–2), and high (RQ > 2). Severe fibrosis of the mitral valve was reflected by high expression of FBN1 and low expression of MMP2 (p < 0.05). The myxoid degeneration level was associated with the mRNA expression level for FBN1 and a low lymphocyte-monocyte ratio was associated with an increased mRNA expression of FBN1 (p < 0.05). A high number of monocytes was associated with high values of FBN1 whereas the increase in the number of lymphocytes was associated with high levels of MMP2. In addition, we observed that the risk of severe hyalinization was enhanced by a low mRNA expression of FLNA and/or SOX9. In conclusion, a lower FLNA mRNA expression can reflect the aging process that is highlighted in mitral valve pathology as a higher risk for hyalinization, especially in males, that might be prevented by upregulation of the SOX9 gene. FBN1 and MMP2 influence the inflammation-related fibrotic degeneration of the mitral valve. Understanding the genetic base of mitral valve pathology can provide insights into disease mechanisms, risk stratification, and potential therapeutic targets. Full article