Publications by authors named "Itzhak Kronzon"

161 Publications

A stepwise diagnostic approach to superior vena cava syndrome.

Eur Heart J Cardiovasc Imaging 2019 03;20(3):367

Department of Cardiovascular Medicine, Lenox Hill, Northwell, 100 E 77th Street, 2nd Floor, New York, NY, USA.

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http://dx.doi.org/10.1093/ehjci/jey185DOI Listing
March 2019

Cardiac tamponade from a fractured inferior vena cava filter.

Eur Heart J Cardiovasc Imaging 2019 May;20(5):590

Department of Cardiovascular Medicine, Lenox Hill Hospital, 100 E 77th Street, New York, NY, USA.

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http://dx.doi.org/10.1093/ehjci/jey227DOI Listing
May 2019

Mechanical prosthetic valve malfunction diagnosed by gated non-contrast computed tomography.

Eur Heart J Cardiovasc Imaging 2018 12;19(12):1428

Department of Cardiovascular Medicine, Lenox Hill Hospital, Northwell Health, 100 E 77th street, 2nd Floor, New York, NY, USA.

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http://dx.doi.org/10.1093/ehjci/jey124DOI Listing
December 2018

The role of percutaneous vacuum-assisted thrombectomy for intracardiac and intravascular pathology.

J Card Surg 2018 Oct 5;33(10):666-672. Epub 2018 Sep 5.

Department of Cardiovascular Medicine, Lenox Hill Hospital-Northwell Health, New York, New York.

Vacuum-assisted thrombectomy (VAT) is a mechanical suction device that can be deployed to aspirate thrombi in the heart and vascular system. Successful percutaneous aspiration of iliocaval, right heart, and pulmonary arterial thrombi have been reported, in addition to the debulking of intravascular and intracardiac masses and vegetations. VAT is indicated for patients who are poor surgical candidates and/or have a contraindication to thrombolysis. This review discusses the mechanism, current results, potential clinical indications, and limitations of VAT for iliocaval and intracardiac mass removal.
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http://dx.doi.org/10.1111/jocs.13806DOI Listing
October 2018

A standardized protocol to reliably visualize the left atrial appendage with intracardiac echocardiography: Importance of multiple imaging sites.

Echocardiography 2018 10 25;35(10):1635-1640. Epub 2018 Jul 25.

Department of Cardiovascular Medicine, Lenox Hill Hospital, Northwell Health, New York, New York.

Background: Currently, there is no accepted protocol for left atrial appendage (LAA) imaging with intracardiac echocardiography (ICE).

Objective: This study aimed to assess the utility of ICE to reliably visualize the entire cavity of the LAA and propose a specific procedural protocol to achieve the above objective.

Methods: We created a three-dimensional reconstruction of the LAA, using two-dimensional ICE sections obtained from three different location (the right atrium [RA], right ventricle inflow [RVI], and right ventricular outflow [RVOT]). We then compared the three-dimensional LAA reconstruction by ICE with one obtained by cardiac computed tomography angiography (CCTA) for morphological and volume differences.

Results: Three-dimensional reconstruction with ICE could reliably reproduce the LAA as visualized with CCTA but only when ICE sampling was performed from at least two catheter positions. There was no statistically significant difference between LAA volumes obtained with ICE and CCTA (P = 0.33). The contribution of each anatomical location to the total volume was 17% ± 16.6%, 74% ± 13.3%, and 33% ± 26% for RA, RVI, and RVOT, respectively.

Conclusion: In comparison with CCTA, the LAA can be reliably visualized in its entity by ICE, but only if multiple imaging positions (RA, RV inflow, and RVOT) are used.
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http://dx.doi.org/10.1111/echo.14104DOI Listing
October 2018

Tricuspid valve vegetectomy using percutaneous aspiration catheter.

Eur Heart J Cardiovasc Imaging 2018 06;19(6):709

Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, 100 East 77th St., 2nd Floor Noninvasive Cardiology, New York, NY 10075, USA.

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http://dx.doi.org/10.1093/ehjci/jey017DOI Listing
June 2018

Congenital Abnormalities of the Pericardium.

Cardiol Clin 2017 Nov;35(4):601-614

Department of Cardiovascular Medicine, Lenox Hill Hospital, Northwell Health, 100 East 77th Street, New York, NY 10075, USA. Electronic address:

Congenital abnormalities of the pericardium are a rare group of disorders that include congenital absence of the pericardium, pericardial cysts, and diverticula. These congenital defects result from alterations in the embryologic formation and structure of the pericardium. Although many cases are incidentally found, they can present as symptomatic, life-threatening disease. Owing to their rarity, many cases are inappropriately diagnosed. Alterations in the embryologic formation and structure may result in the formation of these congenital abnormalities. We review the presentation, diagnosis, and management of congenital absence of the pericardium, pericardial cysts, and diverticula. A summary of multimodality imaging features is provided.
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http://dx.doi.org/10.1016/j.ccl.2017.07.012DOI Listing
November 2017

Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions.

Curr Cardiol Rep 2017 09 6;19(10):102. Epub 2017 Sep 6.

Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA.

Purpose Of Review: With an increasing number of interventional procedures performed for structural heart disease and cardiac arrhythmias each year, echocardiographic guidance is necessary for safe and efficient results. The purpose of this review article is to overview the principles of intracardiac echocardiography (ICE) and describes the peri-interventional role of ICE in a variety of structural heart disease and electrophysiological interventions.

Recent Findings: Both transthoracic (TTE) and transesophageal echocardiography have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with transesophageal echocardiography (TEE). Limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs, and a learning curve for new operators. Data supports the use of ICE in guiding device closure of interatrial shunts, transseptal puncture, and electrophysiologic procedures. This paper reviews the more recent reports that ICE may be used for primary guidance or as a supplement to TEE in patients undergoing left atrial appendage (LAA) closure, interatrial shunt closure, transaortic valve implantation (TAVI), percutaneous mitral valve repair (PMVR), paravalvular leak (PVL) closure, aortic interventions, transcatheter pulmonary valve replacement (tPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) closure. ICE imaging technology will continue to expand and help improve structural heart and electrophysiology interventions.
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http://dx.doi.org/10.1007/s11886-017-0902-6DOI Listing
September 2017

Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis.

Eur Heart J 2018 04;39(15):1224-1245

Imperial College London, London, United Kingdom.

The VARC (Valve Academic Research Consortium) for transcatheter aortic valve replacement set the standard for selecting appropriate clinical endpoints reflecting safety and effectiveness of transcatheter devices, and defining single and composite clinical endpoints for clinical trials. No such standardization exists for circumferentially sutured surgical valve paravalvular leak (PVL) closure. This document seeks to provide core principles, appropriate clinical endpoints, and endpoint definitions to be used in clinical trials of PVL closure devices. The PVL Academic Research Consortium met to review evidence and make recommendations for assessment of disease severity, data collection, and updated endpoint definitions. A 5-class grading scheme to evaluate PVL was developed in concordance with VARC recommendations. Unresolved issues in the field are outlined. The current PVL Academic Research Consortium provides recommendations for assessment of disease severity, data collection, and endpoint definitions. Future research in the field is warranted.
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http://dx.doi.org/10.1093/eurheartj/ehx211DOI Listing
April 2018

Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis: An Expert Statement.

J Am Coll Cardiol 2017 Apr;69(16):2067-2087

Imperial College London, London, United Kingdom.

The VARC (Valve Academic Research Consortium) for transcatheter aortic valve replacement set the standard for selecting appropriate clinical endpoints reflecting safety and effectiveness of transcatheter devices, and defining single and composite clinical endpoints for clinical trials. No such standardization exists for circumferentially sutured surgical valve paravalvular leak (PVL) closure. This document seeks to provide core principles, appropriate clinical endpoints, and endpoint definitions to be used in clinical trials of PVL closure devices. The PVL Academic Research Consortium met to review evidence and make recommendations for assessment of disease severity, data collection, and updated endpoint definitions. A 5-class grading scheme to evaluate PVL was developed in concordance with VARC recommendations. Unresolved issues in the field are outlined. The current PVL Academic Research Consortium provides recommendations for assessment of disease severity, data collection, and endpoint definitions. Future research in the field is warranted.
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http://dx.doi.org/10.1016/j.jacc.2017.02.038DOI Listing
April 2017

Hopscotch technique: A novel method for percutaneous closure of paravalvular leaks.

Catheter Cardiovasc Interv 2017 Apr 7;89(5):944-950. Epub 2017 Feb 7.

North Shore LIJ Health System, Lenox Hill Heart and Vascular Institute of New York, New York.

Objectives: To describe the feasibility and safety of the Hopscotch Technique, a novel method to close paravalvular leaks.

Background: Successful closure of paravalvular leaks requires the complete seal of irregular defects, frequently interrupted by remaining sutures or tissue that converts a large defect into a complex series of contiguous smaller defects. Successful treatment with devices placed in a single space is impossible with constrained appearance and significant residual leak; therefore, new techniques to deploy smaller devices in the correct location are needed.

Methods: We retrospective analyzed all the patients with mitral PVLs undergoing percutaneous closure with the Hopscotch technique from November 2011 to January 2016.

Results: Sixteen procedures were performed in 15 patients (median age 66-year-old, 67% male, STS 3.9%), most of them with biological prostheses (73%). Mean PVL size was 12.5 mm located in the lateral position. Percutaneous transapical access was the final approach in nine procedures and success of the procedure was achieved in 12. Usually, the technique was performed by 1 Hopscotch crossing/jump; however, complex procedures requiring 2 or 3 crossings were utilized in 4 patients, even possible between aortic and mitral leaks along the aortic-mitral continuity. Residual mitral paravalvular regurgitation of ≤mild was achieved in 93% of procedures.

Conclusions: The Hopscotch technique is feasible and safety for patients with mitral paravalvular leak when boundaries prevent full device expansion. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ccd.26854DOI Listing
April 2017

Acute Pericarditis.

Prog Cardiovasc Dis 2017 Jan - Feb;59(4):349-359. Epub 2016 Dec 10.

Lenox Hill Heart and Vascular Institute of New York, New York, NY, United States. Electronic address:

Acute pericarditis is an acute inflammatory disease of the pericardium, which may occur in many different disease states (both infectious and non-infectious). Usually the diagnosis is based on symptoms (chest pain, shortness of breath), electrocardiographic changes (ST elevation), physical examination (pericardial friction rub) and elevation of cardiac biomarkers. It may occur in isolation or be associated with an underlying inflammatory disorder. In routine clinical practice, acute pericarditis can be associated with myocarditis due to their overlapping etiologies.
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http://dx.doi.org/10.1016/j.pcad.2016.12.001DOI Listing
May 2017

Aortic dissection mimicking a massive pulmonary embolism.

Eur Heart J Cardiovasc Imaging 2016 Oct 1;17(10):1145. Epub 2016 Jul 1.

Department of Cardiovascular Disease, Northwell Health System, Lenox Hill Hospital, 100 East 77th Street, New York, NY, USA.

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http://dx.doi.org/10.1093/ehjci/jew137DOI Listing
October 2016

Utilization of electroanatomical mapping in the diagnosis of cardiac amyloidosis.

Eur Heart J Cardiovasc Imaging 2016 Sep 25;17(9):1035. Epub 2016 May 25.

Department of Cardiovascular Disease, Lenox Hill Hospital, 100 East 77th Street-2nd Floor, New York, NY 10075, USA.

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http://dx.doi.org/10.1093/ehjci/jew109DOI Listing
September 2016

Right Atrial Vacuum-Assisted Thrombectomy: Single-Center Experience.

J Invasive Cardiol 2016 May;28(5):196-201

Hackensack University Medical Center, 30 Prospect Avenue, 5 Main, Room 5640, Hackensack, NJ 07601 USA.

Background: Right heart thrombus in the absence of structural heart disease, atrial fibrillation, or intracardiac catheter is rare. It typically represents a thrombus migrating from the venous system to the lung, known as thrombi-in-transit, and can lead to a life-threatening pulmonary embolism. The optimal therapy for thrombi-in-transit remains controversial. We report our experience using percutaneous removal of right heart thrombus using vacuum aspiration.

Methods: Patients with right atrial mass who were hemodynamically stable and underwent vacuum thombectomy using the AngioVac system (AngioDynamics) at our institution were included in this analysis. Between December 2012 and August 2014, a total of 7 patients (2 men, 5 women) with a mean age of 51.5 years (range, 20-83 years) underwent right atrial thrombectomy. Data during the procedure and follow-up period were collected and analyzed.

Results: All patients were hemodynamically stable before the procedure. The procedure was considered successful in 6 patients. All patients survived through hospitalization. No periprocedural bleeding, stroke, or myocardial infarction occurred. One patient developed cardiogenic shock after the procedure that required extracorporeal membrane oxygenation support for <24 hours. There was no recurrent venous thromboembolism at a mean follow-up of 9 months.

Conclusion: Vacuum-assisted thrombectomy can be a potential treatment option for hemodynamically stable patients with large right-sided intracardiac thrombus who are not surgical candidates.
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May 2016

Persistent anomaly complicating pacemaker placement.

Eur Heart J Cardiovasc Imaging 2016 Jul 29;17(7):731. Epub 2016 Apr 29.

Lenox Hill Heart and Vascular Institute, Lenox Hill Hospital, 100 E 77th Street, 2nd Floor, Noninvasive Cardiology, New York, NY 10075, USA

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http://dx.doi.org/10.1093/ehjci/jew059DOI Listing
July 2016

Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism.

J Am Soc Echocardiogr 2016 Jan;29(1):1-42

University of New Mexico Health Sciences Center, Albuquerque, New Mexico.

Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
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http://dx.doi.org/10.1016/j.echo.2015.09.011DOI Listing
January 2016

Novel Percutaneous Apical Exclusion of a Left Ventricular Pseudoaneurysm After Complicated Transapical Transcatheter Aortic Valve Replacement.

JACC Cardiovasc Interv 2015 Dec;8(14):e227-8

Hackensack University Medical Center and the Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey. Electronic address:

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http://dx.doi.org/10.1016/j.jcin.2015.06.032DOI Listing
December 2015

Transcatheter Therapies for the Treatment of Valvular and Paravalvular Regurgitation in Acquired and Congenital Valvular Heart Disease.

J Am Coll Cardiol 2015 Jul;66(2):169-83

Lenox Hill Heart and Vascular Institute of New York-Hofstra School of Medicine, New York, New York.

Transcatheter therapies in structural heart disease have evolved tremendously over the past 15 years. Since the introduction of the first balloon-expandable valves for stenotic lesions with implantation in the pulmonic position in 2000, treatment for valvular heart disease in the outflow position has become more refined, with newer-generation devices, alternative techniques, and novel access approaches. Recent efforts into the inflow position and regurgitant lesions, with transcatheter repair and replacement technologies, have expanded our potential to treat a broader, more heterogeneous patient population. The evolution of multimodality imaging has paralleled these developments. Three- and 4-dimensional visualization and concomitant use of novel technologies, such as fusion imaging, have supported technical growth, from pre-procedural planning and intraprocedural guidance, to assessment of acute results and follow-up. A multimodality approach has allowed operators to overcome many limitations of each modality and facilitated integration of a multidisciplinary team for treatment of this complex patient population.
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http://dx.doi.org/10.1016/j.jacc.2015.05.034DOI Listing
July 2015

Congenital defects of the pericardium: a review.

Eur Heart J Cardiovasc Imaging 2015 Aug 23;16(8):821-7. Epub 2015 May 23.

Lenox Hill Hospital, 100 East 77th Street, 2nd Floor Non-invasive Cardiology, New York, NY 10075, USA

Pericardial defects are a rare disorder that can be characterized as acquired or congenital. Congenital defects can be further characterized by location and size of the defect, e.g. left- or right-sided and partial or complete absence of the pericardium. While physical examination and electrocardiogram are not diagnostic, chest radiographs and echocardiography have findings that should alert the clinician to the absence of the pericardium as a possible diagnosis. Despite its limitations with visualizing the normal pericardium in areas of minimal adipose, cardiac magnetic resonance is currently the gold standard for diagnosing the congenital absence of the pericardium. Patients have a similar life expectancy to those without pericardial defects; however in certain cases, herniation and strangulation of cardiac chambers can be life threatening and lead to sudden cardiac death. Treatment is tailored to the patient's symptoms, presentation, and the size and location of the defect.
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http://dx.doi.org/10.1093/ehjci/jev119DOI Listing
August 2015

Successful first-in-man percutaneous transapical-transseptal Melody mitral valve-in-ring implantation after complicated closure of a para-annular ring leak.

EuroIntervention 2014 Dec;10(8):968-74

Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute, North Shore/LIJ Health System, New York, NY, USA.

Aims: Transcatheter techniques can theoretically be applied to the treatment of para-annular ring (PAR) leaks. Little is known about their potential application and resultant complications in such cases. We describe the first-in-man percutaneous transapical-transseptal Melody valve-in-ring (ViR) implantation after a complication from percutaneous PAR leak closure.

Methods And Results: A 49-year-old woman, at high operative risk, presented with congestive heart failure secondary to severe para-ring/extravalvular regurgitation two months after bypass surgery and mitral ring annuloplasty. Successful percutaneous closure of the leak was performed using an AMPLATZER Vascular Plug IV. One month later, she developed haemolysis with severe PAR regurgitation, through and around the device. After device retrieval and placement of an AMPLATZER Muscular VSD occluder, the patient developed severe intravalvular regurgitation. Completely percutaneous, transseptal delivery of a Melody ViR was performed over a transapical-transseptal, arteriovenous rail. Echocardiography revealed trivial residual regurgitation through the implanted valve with mild transvalvular gradients.

Conclusions: Percutaneous closure of mitral PAR leaks after ring annuloplasty in the high-risk patient is feasible (proof-of-concept), particularly when the leak is para-ring/extravalvular. Potential complications include severe intravalvular mitral regurgitation caused by disruption of the mitral apparatus and/or ring deformation during device deployment, which can be successfully treated via percutaneous transapical-transseptal ViR implantation.
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http://dx.doi.org/10.4244/EIJV10I8A164DOI Listing
December 2014

A constrained heart: a case of sudden onset unrelenting chest pain.

Circulation 2014 Oct;130(18):1625-31

From the Lenox Hill Hospital, North Shore LIJ Health System, New York, NY.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.114.011410DOI Listing
October 2014

Percutaneous transapical access: current status.

EuroIntervention 2014 Sep;10 Suppl U:U84-9

Lenox Hill Heart and Vascular Institute of New York, North Shore LIJ Health System, New York, USA.

Percutaneous transapical access provides a direct route to many cardiac structures difficult to reach with conventional interventional approaches. With recent developments of new technologies in structural heart disease, there has been an increasing interest in the use of transapical access for cardiac interventions. Meticulous planning, careful access and closure techniques are essential. Development of novel imaging technologies and dedicated closure devices are warranted to allow a greater number of operators to successfully adopt percutaneous transapical access and further reduce complication rates. This article is an overview of the current status and utility of percutaneous transapical access with focus on multimodality imaging, technique and potential complications of this approach.
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http://dx.doi.org/10.4244/EIJV10SUA12DOI Listing
September 2014

Footprints of cardiac mechanical activity as expressed in lung Doppler signals.

Echocardiography 2015 Mar 5;32(3):407-10. Epub 2014 Aug 5.

B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; EchoSense Ltd., Haifa, Israel.

Aims: To determine the diagnostic information contained in cardiac pulsatile pressure waves as expressed in the Doppler signals recorded over the right lung.

Methods And Results: The pulsatile characteristics of the pulmonary vascular system were studied by means of the novel pulse Doppler technology in 38 control volunteers, 31 patients with atrial fibrillation (AF) and 7 patients with atrial flutter. The Doppler velocity waveforms recorded were interpreted in relation to the cardiac cycle mechanical events that generate them: Ventricular systole (S), diastole (D) and presystolic left atrial contraction (A). It was demonstrated that in all cases of AF, wave-A was absent. With longer diastole a high frequency velocity waves were visible. It is assumed that they represent the atrial mechanical fibrillation. In the patients with atrial flutter, the single A-wave was replaced by a waveform termed F, the frequency of which exactly matched that of the flutter wave on the ECG. The F-wave had both a positive and negative component.

Conclusion: The lung Doppler signals contain distinct signatures typical of arrhythmias such as AF and atrial flutter that can be used for both diagnosis and to gain insight into the nature of the phenomena.
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http://dx.doi.org/10.1111/echo.12689DOI Listing
March 2015

Percutaneous complete repair of failed mitral valve prosthesis: simultaneous closure of mitral paravalvular leaks and transcatheter mitral valve implantation - single-centre experience.

EuroIntervention 2015 Mar;10(11):1336-45

Lenox Hill Heart and Vascular Institute - North Shore/LIJ Health System, New York, NY, USA.

Aims: Structural deterioration and paravalvular leak (PVL) are complications associated with surgically implanted prosthetic valves, historically requiring reoperation. We present our experience of complete transcatheter repair of a degenerated mitral bioprosthesis.

Methods And Results: From March 2012 to October 2012, we reviewed consecutive, high-risk surgical patients (n=5) who underwent transcatheter repair of a failed mitral bioprosthesis with severe paravalvular regurgitation (PVR). Manufacturer valve sizes ranged from 27 to 33 mm, regurgitation (n=1), stenosis (n=1), or both (n=3). Percutaneous transapical and transseptal access were achieved with PVL closure performed transapically. An arteriovenous rail was created for transseptal delivery of a Melody valve. All patients had successful PVL closure with no residual PVR. Valve-in-valve (ViV) implantation was successful in four patients. Overall, mean transvalvular mitral gradient was 11.2 mmHg pre-procedure which improved to 5 mmHg post-procedure. Improvement of NYHA Class ≥2 was achieved in all patients (19±3 months). One patient had controlled Melody valve embolisation which required emergent surgical replacement. Inner valve diameter was 26 mm, too large for Melody valve implantation.

Conclusions: Complete transcatheter repair of a degenerated mitral bioprosthesis with PVR can be performed in the high-risk patient. Accurate measurement is necessary prior to intervention, with concern for embolisation among the larger valve sizes (>31 mm).
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http://dx.doi.org/10.4244/EIJY14M05_01DOI Listing
March 2015

Semiautomated detection and quantification of aortic plaques from three-dimensional transesophageal echocardiography.

J Am Soc Echocardiogr 2014 Jul 24;27(7):758-66. Epub 2014 Apr 24.

Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.

Background: Aortic atherosclerosis is a risk factor for cerebrovascular events. Two-dimensional transesophageal echocardiographic quantification of descending aortic plaques is time-consuming and underestimates plaque burden. The aim of this study was to assess the feasibility and accuracy of a novel semiautomated program that uses three-dimensional (3D) transesophageal echocardiography to identify and quantify aortic plaque severity as determined by plaque thickness, volume, and number. The relationship between maximum plaque thickness and volume was also examined.

Methods: Descending aortic 3D transesophageal echocardiographic images from 58 patients were analyzed for plaque thickness, volume, and number using semiautomated custom software. The reference standard was manual assessment by an expert reader using 3D multiplanar reconstructions. Agreement and κ values were calculated to determine the program's accuracy against the reference standard. Correlation and bias were examined using linear regression and Bland-Altman statistics. Pearson's correlation was used to examine the relationship between maximum plaque thickness and volume.

Results: Analysis was possible in all patients. Overall agreement for the absolute presence or absence of plaque per patient was 95%. Agreement regarding the number of plaques per patient and plaque severity was high at 95% and 85%, respectively. Plaque volume was slightly underestimated by the program compared with manual measurements. The correlation between plaque thickness and volume was 0.56.

Conclusions: The results of this study demonstrate that semiautomated plaque analysis of 3D transesophageal echocardiographic descending aortic data sets is feasible and accurate in determining plaque severity as measured by plaque thickness, volume, and number. This methodology allows the standardization of plaque quantification, which will improve its utility in clinical trials. A greater understanding of the importance of plaque thickness versus volume is needed.
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http://dx.doi.org/10.1016/j.echo.2014.03.003DOI Listing
July 2014

Guidance of post myocardial infarction ventricular septal defect and pseudoaneurysm closure.

Curr Cardiol Rep 2014 Mar;16(3):456

Non Invasive Cardiology, Lenox Hill Hospital, 100 E 77th St. 2E, New York, NY, 10075, USA.

Left ventricular pseudoaneurysm and ventricular septal defect are rare but devastating complications of myocardial infarction. With medical treatment alone, the majority of patients will die from these complications. Until recently, the recommended treatment was surgical closure. These surgeries carried extreme risk due to abnormal hemodynamics, necrotic substrates and the comorbidities of these patients. Recently, trans-catheter closure was shown to be an acceptable alternative to open surgical intervention. 3D echocardiography identifies the location, size, and shape of the defect and can assess, guide, and follow up the closure procedure.
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http://dx.doi.org/10.1007/s11886-013-0456-1DOI Listing
March 2014

CT angiography-fluoroscopy fusion imaging for percutaneous transapical access.

JACC Cardiovasc Imaging 2014 Feb 8;7(2):169-77. Epub 2014 Jan 8.

Department of Cardiovascular Medicine, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore/Long Island Jewish Health System, New York, New York. Electronic address:

Objectives: The aim of this proof-of-principle study is to validate the accuracy of fusion imaging for percutaneous transapical access (TA).

Background: Structural heart disease interventions, including TA, are commonly obtained under fluoroscopic guidance, which lacks important spatial information. Computed tomographic angiography (CTA)-fluoroscopy fusion imaging can provide the 3-dimensional information necessary for improved accuracy in planning and guidance of these interventions.

Methods: Twenty consecutive patients scheduled for percutaneous left ventricular puncture and device closure using CTA-fluoroscopy fusion guidance were prospectively recruited. The HeartNavigator software (Philips Healthcare, Best, the Netherlands) was used to landmark the left ventricular epicardium for TA (planned puncture site [PPS]). The PPS landmark was compared with the position of the TA closure device on post-procedure CTA (actual puncture site). The distance between the PPS and actual puncture site was calculated from 2 fixed reference points (left main ostium and mitral prosthesis center) in 3 planes (x, y, and z). The distance from the left anterior descending artery at the same z-plane was also assessed. TA-related complications associated with fusion imaging were recorded.

Results: The median (interquartile range [IQR]) TA distance difference between the PPS and actual puncture site from the referenced left main ostium and mitral prosthesis center was 5.00 mm (IQR: 1.98 to 12.64 mm) and 3.27 mm (IQR: 1.88 to 11.24 mm) in the x-plane, 4.48 mm (IQR: 1.98 to 13.08 mm) and 4.00 mm (IQR: 1.62 to 11.86 mm) in the y-plane, and 5.57 mm (IQR: 3.89 to 13.62 mm) and 4.96 mm (IQR: 1.92 to 11.76 mm) in the z-plane. The mean TA distance to the left anterior descending artery was 15.5 ± 7.8 mm and 22.7 ± 13.7 mm in the x- and y-planes. No TA-related complications were identified, including evidence of coronary artery laceration.

Conclusions: With the use of CTA-fluoroscopy fusion imaging to guide TA, the actual puncture site can be approximated near the PPS. Moreover, fusion imaging can help maintain an adequate access distance from the left anterior descending artery, thereby, potentially reducing TA-related complications.
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http://dx.doi.org/10.1016/j.jcmg.2013.10.009DOI Listing
February 2014

Isolated accessory mitral valve: identification and anatomic description using 3D transesophageal echocardiography.

Eur Heart J Cardiovasc Imaging 2014 May 14;15(5):596. Epub 2013 Nov 14.

Department of Cardiovascular Disease, Non-Invasive Cardiology, Lenox Hill Hospital, 100 East 77th Street, 2nd Floor, New York, NY 10075, USA.

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http://dx.doi.org/10.1093/ehjci/jet230DOI Listing
May 2014
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