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Objective: To evaluate the benefit of using three-dimensional transesophageal echocardiography (3DTEE) over conventional two-dimensional transesophageal echocardiography (2DTEE) in evaluation of various morphological features of atrial septal defect (ASD) and patent foramen ovale (PFO) during transcatheter closure. Methods: This is an observational cross sectional study including 115 patients (45 PFO and 70 ASD patients) who underwent 2D/3DTEE guided transcatheter closure from April 2019 to October 2021 in cardiology department, Tanta university hospital. Results: 70 ASD patients were divided into two groups; the pediatric age group (18 patients, mean age 9.05 ± 3.51 years) and the adult group (52 patients, mean age 39.3 ± 10.15 years). ASD morphology was simple in 12.9% and complex in 87.1% of patients, where 3DTEE was superior in the evaluation of posterior, infero posterior rims, fenestrated flimsy rims, aneurysm shape, orientation, and quality of its tissue. Procedural success was defined as complete defect closure with no complications. The procedure was successful in 68 and failed in 2 patients. 45 PFO patients were divided into two groups; the pediatric age group (14 patients, mean age 13.5 ± 3.25 years) and the adult group (31 patients, mean age 35.2 ± 4.5 years). PFO morphology was simple in 22.2% and complex in 77.8% of patients, where 3DTEE was superior in the evaluation of the exact PFO opening from the left atrium, additional fenestrations, aneurysm shape, orientation, and quality of its tissue. The procedure was successful in all patients. Conclusion: 3DTEE guided transcatheter ASD/PFO closure provides an additional value over conventional 2DTEE in assessment of complex ASD/PFO morphology.
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BACKGROUND: Diabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage (LAA), a small outpouch from the LA, is the most common location for thrombus formation in patients with AFib. HYPOTHESIS: In this study, we examined LAA remodeling differences between diabetic and nondiabetic patients with AFib. METHODS: This retrospective study analyzed data from 242 subjects subdivided into two subgroups of 122 with DM (diabetic group) and 120 without DM (nondiabetic group). The study group underwent real-time 3-dimensional transesophageal echocardiography (RT3DTEE) for AFib ablation, cardioversion, or LAA device closure. The LAA dimensions were measured using the "Yosefy rotational 3DTEE method." RESULTS: The RT3DTEE analysis revealed that diabetic patients display larger LAA diameters, D1-lengh (2.09 ± 0.50 vs 1.88 ± 0.54 cm, P = .003), D2-width (1.70 ± 0.48 vs 1.55 ± 0.55 cm, P = .024), D3-depth (2.21 ± 0.75 vs 1.99 ± 0.65 cm, P = .017), larger orifice areas (2.8 ± 1.35 and 2.3 ± 1.49 cm2 , P = .004), and diminished orifice flow velocity (37.3 ± 17.6 and 43.7 ± 19.5 cm/sec, P = .008). CONCLUSIONS: Adverse LAA remodeling in DM patients with AFib is characterized by significantly LAA orifice enlargement and reduced orifice flow velocity. Analysis of LAA geometry and hemodynamics may have clinical implications in thrombotic risk assessment and treatment of DM patients with AFib.
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Apéndice Atrial/fisiopatología , Fibrilación Atrial/fisiopatología , Remodelación Atrial/fisiología , Cardiomiopatías Diabéticas/fisiopatología , Anciano , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/cirugía , Cardiomiopatías Diabéticas/diagnóstico por imagen , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Cardioversión Eléctrica , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Implantación de Prótesis , Estudios Retrospectivos , Medición de Riesgo , Factores de RiesgoRESUMEN
INTRODUCTION: In functional mitral regurgitation (FMR), effective regurgitant orifice area (EROA) displays a dynamic pattern. The impact of dynamic changes of annulus dysfunction and leaflets tenting on phasic EROA was explored with real-time three-dimensional transesophageal echocardiography (RT3D-TEE). METHODS: RT3D-TEE was performed in 52 FMR patients and 30 controls. Mitral annulus dimensions and leaflets tenting were measured throughout systole (TomTec, Germany). Phasic EROA was measured by proximal isovelocity surface area (PISA) method. RESULTS: Mitral annulus had the minimal area and an oval shape with saddle configuration during early systole in controls, which enlarged and became round and flattened towards mid and late systole (P<0.05). In contrast, annulus in FMR was significantly larger, rounder and flatter (P<0.001), which further dilated and became more flattened at late systole (P<0.05 vs control). Leaflet tenting height in FMR decreased in mid systole and remains unchanged towards late systole. The leaflet tenting volume peaked at early and late systole with a mid-systolic trough in both FMR and controls. But tenting volume of patients with FMR was significantly larger than that of controls (all P<0.001 vs control in whole systole). Further analysis demonstrated that early tenting volume (ß value=0.053, P<0.05) was a predictor of early EROA, whereas late tenting volume (ß value=0.031, P<0.05) and late annular displacement velocity were predictors of late EROA. CONCLUSIONS: The early and late peak EROAs of FMR was primarily contributed by tenting volume at early systole and late systole respectively. These findings would be of value to consider in interventions aimed at reducing the severity of FMR.