Using biplane transesophageal echocardiography and the concept of three dimensional transthoracic echocardiography,we performed three dimensional reconstruction of transesophageal images of various clinicopathologic c...Using biplane transesophageal echocardiography and the concept of three dimensional transthoracic echocardiography,we performed three dimensional reconstruction of transesophageal images of various clinicopathologic cases,including atrial septal defect,mitral stenosis,mitral valve prolapse and pulmonary stenosis.The hardware equipments and image processing flow chart of three dimensional reconstruction of transesophageal echocardiographic images are described. Our present study indicates that three dimensional reconstruction of transesophageal echocardiographic images could display multi-regional three dimensional structures of heart and great vessels,including superior vena cava,ascending aorta,right ventricular outflow tract, pulmonary artery and left heart,with clear,visual and stereoscopic imaging.The regional structures could be displayed at different levels of stereo-anatomic-sec-tions and in different orientations of rotating stereo-images,which could provide accurate three dimensional anatomical information for cardiac stereo-morphological study and definition of spatial location and size of cardiac abnormalities.展开更多
Background: Aortic stenosis (AS) is caused by either age-related degeneration of aortic valve or congenital malformation of aortic cusps. Severe aortic valve stenosis is a clinically emerging diagnosis in the current ...Background: Aortic stenosis (AS) is caused by either age-related degeneration of aortic valve or congenital malformation of aortic cusps. Severe aortic valve stenosis is a clinically emerging diagnosis in the current world. The three cardinal signs of severe AS are dyspnea, syncope, and angina. Transcatheter aortic valve implantation is one of the safe and effective methods for treating severe aortic valve stenosis, and an alternative to surgery in high-risk patients. Aortic valve calcification and changes after TAVI were specifically assessed by computed tomography. Excessive aortic valve calcification is related to procedural complications. A possible consequence is obstruction of coronary ostia. Heavy calcification of the aortic valve and surrounding structure is an important risk factor for coronary obstruction, heart block, and embolization during aortic valve implantation (TAVI). Here we present a case of an elderly old man, where critical ostial left main coronary artery (LMCA) disease was caused by shifting of a calcium speck rather than obstruction with native leaflet. He was successfully rescued by an emergent CABG. Methods and Results: This is a case of a 69-year-old man with severe calcific aortic stenosis and single-vessel CAD who underwent TAVI with a relatively unremarkable course. Notably, his pre-operative TAVI angiography showed no LMCA stenosis. But 10 days later he presented to the ER with acute myocardial infarction with peak high-intensity troponins, diffuse ST changes, and cardiogenic shock. Urgent coronary angiography and intravascular ultrasound showed critical LMCA stenosis caused by a speck of calcium externally abating the vessel. He underwent emergency coronary artery bypass grafting;intraoperative TEE confirmed the etiology. He had an uneventful postoperative course and was successfully weaned off vasoactive medications. Conclusion: This case illustrates that obstruction of coronary ostia could be a possible complication of TAVI. Calcium distribution should factor in TAVI versus surgical candidacy. Calcium shifting should be watched closely during valve deployment, post-TAVI coronary angiogram should be considered if shifting was significant or suspected to compromise coronary arteries.展开更多
文摘Using biplane transesophageal echocardiography and the concept of three dimensional transthoracic echocardiography,we performed three dimensional reconstruction of transesophageal images of various clinicopathologic cases,including atrial septal defect,mitral stenosis,mitral valve prolapse and pulmonary stenosis.The hardware equipments and image processing flow chart of three dimensional reconstruction of transesophageal echocardiographic images are described. Our present study indicates that three dimensional reconstruction of transesophageal echocardiographic images could display multi-regional three dimensional structures of heart and great vessels,including superior vena cava,ascending aorta,right ventricular outflow tract, pulmonary artery and left heart,with clear,visual and stereoscopic imaging.The regional structures could be displayed at different levels of stereo-anatomic-sec-tions and in different orientations of rotating stereo-images,which could provide accurate three dimensional anatomical information for cardiac stereo-morphological study and definition of spatial location and size of cardiac abnormalities.
文摘Background: Aortic stenosis (AS) is caused by either age-related degeneration of aortic valve or congenital malformation of aortic cusps. Severe aortic valve stenosis is a clinically emerging diagnosis in the current world. The three cardinal signs of severe AS are dyspnea, syncope, and angina. Transcatheter aortic valve implantation is one of the safe and effective methods for treating severe aortic valve stenosis, and an alternative to surgery in high-risk patients. Aortic valve calcification and changes after TAVI were specifically assessed by computed tomography. Excessive aortic valve calcification is related to procedural complications. A possible consequence is obstruction of coronary ostia. Heavy calcification of the aortic valve and surrounding structure is an important risk factor for coronary obstruction, heart block, and embolization during aortic valve implantation (TAVI). Here we present a case of an elderly old man, where critical ostial left main coronary artery (LMCA) disease was caused by shifting of a calcium speck rather than obstruction with native leaflet. He was successfully rescued by an emergent CABG. Methods and Results: This is a case of a 69-year-old man with severe calcific aortic stenosis and single-vessel CAD who underwent TAVI with a relatively unremarkable course. Notably, his pre-operative TAVI angiography showed no LMCA stenosis. But 10 days later he presented to the ER with acute myocardial infarction with peak high-intensity troponins, diffuse ST changes, and cardiogenic shock. Urgent coronary angiography and intravascular ultrasound showed critical LMCA stenosis caused by a speck of calcium externally abating the vessel. He underwent emergency coronary artery bypass grafting;intraoperative TEE confirmed the etiology. He had an uneventful postoperative course and was successfully weaned off vasoactive medications. Conclusion: This case illustrates that obstruction of coronary ostia could be a possible complication of TAVI. Calcium distribution should factor in TAVI versus surgical candidacy. Calcium shifting should be watched closely during valve deployment, post-TAVI coronary angiogram should be considered if shifting was significant or suspected to compromise coronary arteries.
