A 3-dimensional transoesophageal echocardiography perspective of mitral valve abscess

An 85-year-old female with history of dementia presented with concern for severe sepsis and was found to have methicillin sensitive staphylococcus aureus bacteremia complicated by atrial fibrillation.For further workup,a transoesophageal echocardiography(TOE)was obtained.The study revealed a large echogenic density with multiple echolucent areas within the finding.There was evidence of blood flow in these echolucent areas based on color flow imaging.This mass was intermittently protruding into the left ventricle causing a function mitral stenosis.The collective findings on echocardiography,in context of bacteremia,were highly suggestive of mitral valve abscess(Figure 1).

Patient selection for transcatheter aortic valve replacement:A combined clinical and multimodality imaging approach

Transcatheter aortic valve replacement(TAVR) has been validated as a new therapy for patients affected by severe symptomatic aortic stenosis who are not eligible for surgical intervention because of major contraindication or high operative risk. Patient selection for TAVR should be based not only on accurate assessment of aortic stenosis morphology, but also on several clinical and functional data. Multi-Imaging modalities should be preferred for assessing the anatomy and the dimensions of the aortic valve and annulus before TAVR. Ultrasounds represent the first line tool in evaluation of this patients giving detailed anatomic description of aortic valve complex and allowing estimating with enough reliability the hemodynamic entity of valvular stenosis. Angiography should be used to assess coronary involvement and plan a revascularization strategy before the implant. Multislice computed tomography play a central role as it can give anatomical details in order to choice the best fitting prosthesis, evaluate the morphology of the access path and detect other relevant comorbidities. Cardiovascular magnetic resonance and positron emission tomography are emergent modality helpful in aortic stenosis evaluation. The aim of this review is to give an overview onTAVR clinical and technical aspects essential for adequate selection.

Accuracy of three-dimensional quantification of left ventricular function using magnetic sensor acquisition: a dynamic in vitro model

Objective To evaluate the accuracy of a three-dimensional (3D) magnetic position sensor system in the quantification of ventricular stroke volumes in a dynamic model.Methods A latex balloon model of the left ventricle was suspended in a water bath connected to a pump producing 10 different pulsatile stroke volumes (15-65mi/beat). Scanning was performed using a 5.0 mHz transducer mounted with a Flock of Birds (FOB) magnetic receiver (GE System Five). The probe was scanned to sweep continuously across and over the balloon volume over 3 - 7 seconds. Digital loops were stored on magneto-optical disks and reviewed retrospectively using 3D Echopac software (GE)based on Simpson's method and compared with a two-dimensional (2D) biplane area-length method (1/2L x R) measurements at end systole and end diastole. Both 3D and 2D derived stroke volumes were compared with the reference stroke volume calculated by direct measurement of balloon capacity.Results There was an improved correlation between 3D stroke volume and reference stroke volume ( y = 0.91 x + 0.41, r = 0.97, SEE = 2.83 ml, P = 0.0001 ) compared to 2D stroke volume and reference stroke volume (y=0.49x+8.68, r=0.87, SEE=3.87 ml, P=0.0011, difference between 2D and 3D P＜0.003).Conclusion 3D magnetic FOB scanning is practical, accurate and should facilitate assessment of left ventricular function.