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J Ultrasound Med 2021 Apr 22. Epub 2021 Apr 22.

Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.

Objectives: Transcranial Doppler ultrasound (TCD) is noninvasive and highly sensitive and specific for the diagnosis of patent foramen ovale (PFO). We evaluated the diagnostic implications of the TCD with a saline agitation test as a routine work-up for ischemic stroke patients.

Methods: A TCD bubble study was performed in all consecutive ischemic stroke patients as a routine work-up. Read More

Ann Card Anaesth 2021 Apr-Jun;24(2):253-255

Department of Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India.

A 5-year-old child with L posed great arteries, large subpulmonic ventricular septal defect (VSD), atrial septal defect (ASD), and a large patent ductus arteriosus (PDA) with mild isthmic narrowing was scheduled for surgical correction. Intraoperatively, it was a case of anatomically corrected malposition of great arteries. Due to abnormal positioning of great vessels, the isthmus was ligated instead of the large PDA. Read More

Ann Card Anaesth 2021 Apr-Jun;24(2):234-237

Department of Interventional Radiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.

We report a case of 44-year-old female patient with congenital heart disease, ostium secundum atrial septal defect (ASD) with moderate mitral regurgitation for minimally invasive ASD repair along with mitral valve repair. Venous cannulations were performed through right internal jugular vein and right femoral vein (RFV) and arterial cannulation was accomplished through right femoral artery. Intraoperative transesophageal echocardiography (TEE) could not visualize venous cannula through RFV. Read More

Ann Card Anaesth 2021 Apr-Jun;24(2):163-171

Department of CVTS, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Background: Effective regurgitant orifice area (EROA) can be represented by 3D echocardiographic vena contracta cross-sectional area (3D-VCA) as a reference method for the quantification of mitral regurgitation (MR) without making any geometrical assumptions. EROA can also be derived from 3D PISA technique with a hemispherical (HS) or hemielliptical (HE) assumption of the proximal flow convergence. However, it is not clear whether HS-PISA and HE-PISA has better agreement with 3D-VCA. Read More

ASAIO J 2021 Apr 19. Epub 2021 Apr 19.

From the Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.

We describe a technique for insertion of the Impella RP device that does not require fluoroscopy. Venous cannulation was performed via the superior vena cava and femoral vein percutaneously. After right atriotomy, the Impella RP is percutaneously inserted and advanced to the right atrium under transesophageal echocardiography guidance. Read More

Clin Nucl Med 2021 Apr 21. Epub 2021 Apr 21.

From the Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital Division of Cardiology, Department of Pediatrics Department of Radiology, Nationwide Children's Hospital Department of Surgery, The Ohio State University College of Medicine, Columbus, OH.

Abstract: A 15-year-old girl with a history of complex congenital heart disease and prior pulmonary valve replacement presented with suspected endocarditis. PET/CT imaging with 18F-FDG was performed to evaluate the potential presence of intracardiac vegetations after previously inconclusive findings from CT angiography, transthoracic echocardiography, and transesophageal echocardiography. PET/CT detected heterogeneous, asymmetric, increased 18F-FDG uptake in the region of the pulmonary valve prosthesis, typical for infection, and confirmed diagnosis of bacterial infective endocarditis. Read More

BMJ Case Rep 2021 Apr 21;14(4). Epub 2021 Apr 21.

Department of Cardiology, St Vincent Hospital, Worcester, Massachusetts, USA.

Paradoxical coronary artery embolism is often an underdiagnosed cause of acute myocardial infarction (MI). It should always be considered in patient with acute MI and a low risk profile for atherosclerotic coronary artery disease. We describe a patient with simultaneous acute saddle pulmonary embolism (PE) and acute ST segment elevation MI due to paradoxical coronary artery embolism. Read More

Cureus 2021 Mar 19;13(3):e13996. Epub 2021 Mar 19.

Cardiology, Overlook Medical Center, Summit , USA.

Mitral valve rupture secondary to ischemic papillary muscle necrosis is rare in the contemporary era due to improved revascularization techniques. However, when it does occur, prompt diagnosis and urgent surgical intervention can be lifesaving. A 69-year-old male with morbid obesity, hypothyroidism, and a family history of coronary artery disease presented to the hospital with chest pain and dyspnea that began five hours prior. Read More

Monaldi Arch Chest Dis 2021 Apr 21. Epub 2021 Apr 21.

Cardiac Rehabilitation Division, ICS Maugeri IRCCS, Gattico-Veruno.

Paravalvular regurgitation (PVR) is a serious complication after surgical valve replacement. Echocardiography is the gold standard technique to assess the severity of PVR with an integrated approach. A 48-year-old male underwent aortic valve replacement due to infective endocarditis (IE). Read More

J Cardiothorac Vasc Anesth 2021 Mar 21. Epub 2021 Mar 21.

Department of Anesthesiology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano 380-8582, Japan.

Echocardiography 2021 Apr 18. Epub 2021 Apr 18.

Department of Cardiology, Shandong University Qilu Hospital, Jinan, China.

The aim of this research was to compare the sensitivity and positive predictive value of contrast transcranial Doppler (c-TCD), contrast transthoracic echocardiography (c-TTE), and contrast transesophageal echocardiography (c-TEE), to determine the best method for diagnosing patent foramen ovale (PFO) and to provide a reference for the further improvement of clinical practice. We investigated 161 patients who suffered from migraines, cryptogenic stroke, TIA, and cerebral infarction of unknown cause. All patients underwent transcatheter examination, and the results of the right heart catheterization (RHC) were considered the gold standard for PFO diagnosis. Read More

Open Med (Wars) 2021 3;16(1):361-366. Epub 2021 Mar 3.

Department of Cardiology, Zhongda Hospital of Southeast University, Nanjing, 210009, China.

Objective: To investigate the risk factors of left atrial appendage thrombus (LAAT) in patients with non-valvular atrial fibrillation (AF).

Methods: We collected the clinical data of patients with non-valvular AF who underwent transesophageal echocardiography (TEE) at the Zhongda Hospital of Southeast University between January 2016 and June 2019. The patients were divided into two groups, LAAT and non-LAAT. Read More

Heart Lung Circ 2021 Apr 15. Epub 2021 Apr 15.

Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.

Background: Long-term predictors of recurrent mitral regurgitation (MR) after mitral valve plasty (MVP) remain to be elucidated. This study sought to determine the prognostic factors of recurrent MR during long-term follow-up after MVP, by analysing findings of three-dimensional transoesophageal echocardiography (TEE) conducted after MVP.

Methods: This study analysed 207 patients who underwent MVP for A2 and/or P2 prolapse and received TEE before discharge. Read More

J Cardiothorac Vasc Anesth 2021 Mar 6. Epub 2021 Mar 6.

Division of Cardiothoracic Surgery, Department of Surgery, University of California San Diego, San Diego, CA.

BMC Cardiovasc Disord 2021 Apr 17;21(1):189. Epub 2021 Apr 17.

Department of Anesthesiology, Medical Faculty, RWTH University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany.

Background: Resuscitation using a percutaneous mechanical circulatory support device (iCPR) improves survival after cardiac arrest (CA). We hypothesized that the addition of inhaled nitric oxide (iNO) during iCPR might prove synergistic, leading to improved myocardial performance due to lowering of right ventricular (RV) afterload, left ventricular (LV) preload, and myocardial energetics. This study aimed to characterize the changes in LV and RV function and global myocardial work indices (GWI) following iCPR, both with and without iNO, using 2-D transesophageal echocardiography (TEE) and GWI evaluation as a novel non-invasive measurement. Read More

Indian Heart J 2021 Mar-Apr;73(2):228-230. Epub 2021 Jan 29.

Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.

The prognostic value of atrial thrombi (AT) among elective patients with atrial fibrillation (AF) referred for a rhythm control strategy is unclear. In this study, clinical variables were correlated with the presence of AT and long term survival among 205 patients submitted to transesophageal echocardiography before elective AF cardioversion or ablation. Atrial thrombi were present in 7. Read More

Int J Cardiovasc Imaging 2021 Apr 17. Epub 2021 Apr 17.

Arkansas Children's Hospital, Little Rock, AR, USA.

Current guidelines for adults with atrial switch repair recommend baseline cardiovascular magnetic resonance (CMR) for assessment of ventricular size and function, systemic and venous baffle obstruction and leaks, and valvular function. It also recommends transthoracic echocardiography (TTE) for outpatient follow up. Many such patients with implanted cardiac devices may need cardiac computed tomography (CCT) when CMR is not feasible. Read More

BMJ Case Rep 2021 Apr 16;14(4). Epub 2021 Apr 16.

Cardiology, St James Hospital, Dublin, Ireland.

A 78-year man with severe aortic stenosis awaiting elective surgical aortic valve replacement presented with worsening New York Heart Association IV shortness of breath. Despite appropriate heart failure treatment, he deteriorated and developed cardiogenic shock and cardiorenal syndrome which progressed despite inotropic support. A non-contrast-gated CT coronary angiogram was arranged in light of acute renal failure which revealed a bicuspid aortic valve. Read More

J Cardiothorac Vasc Anesth 2021 Mar 10. Epub 2021 Mar 10.

Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia.

Objectives: Quantification of the tricuspid annulus (TA) is an important factor in determining the requirement for tricuspid annuloplasty in cardiac surgery. Three-dimensional echocardiography (3DE) has shown that the TA is biplanar with an antero-posterior longaxis and septo-lateral shortaxis, and that the commonly used 2D TEE (two-dimensional transesophageal echocardiography) four-chamber view (4ChV) underestimates the true TA longaxis. The authors hypothesized that the use of multiple 2D TEE TA views could attain greater TA long-axis measurements and smaller TA short-axis measurements than the 4ChV, and that the 4ChV has a significant but inconsistent bias relative to the maximal TA diameter measured by these views. Read More

Anesth Analg 2021 May;132(5):1400-1409

From the Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium.

Background: Assessing diastolic dysfunction is essential and should be part of every routine echocardiography examination. However, clinicians routinely observe lower mitral annular velocities by transesophageal echocardiography (TEE) under anesthesia than described by awake transthoracic echocardiography (TTE). It would be important to know whether this difference persists under constant loading conditions. Read More

Ultrasound J 2021 Apr 15;13(1):22. Epub 2021 Apr 15.

Division of Emergency Ultrasound, Department of Emergency Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.

Background: Pericardial effusion is a known complication of post-open cardiac surgery which can progress to life-threatening cardiac tamponade. Classical signs of tamponade such as hypotension and pulsus paradoxus are often absent. Diagnosing acute cardiac tamponade with transthoracic echocardiography (TTE) can be challenging in post-cardiac surgical patients due to distorted anatomy and limited scanning windows by the presence of surgical dressings or scar. Read More

J Microsc Ultrastruct 2021 Jan-Mar;9(1):18-25. Epub 2020 Nov 9.

Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.

Introduction: is a Gram-positive, catalase- and oxidase-negative, microaerophilic, nonmotile bacteria species rarely associated with human infections such as arthritis, bacteremia, endocarditis, and meningitis. The bacteria are also often confused with streptococci species or treated as a contaminant.

Patients And Methodology: We conducted a retrospective, observational cohort study on all patients with isolates in blood samples from July 2010 to June 2019. Read More

Kardiologiia 2021 Mar 30;61(3):71-76. Epub 2021 Mar 30.

Scientific Medical Research Center of Cardiology, Moscow, Russia.

Aim    To develop a new, modified protocol for transesophageal atrial electric stimulation (TEAES), which would significantly enhance the diagnostic value of stress echocardiography and reduce the duration of the test in patients with ischemic heart disease (IHD).Material and methods    This study included 101 patients (80 men and 21 women aged 55±9 years) with suspected or documented diagnosis of IHD who were divided into two homogenous groups. Group 1 (51 patients) underwent stress echocardiography (stress-EchoCG) according to a standard protocol (SP) for TEAES and group 2 (50 patients), underwent stress-EchoCG according to a modified protocol (MP). Read More

J Thorac Dis 2021 Mar;13(3):1886-1898

Consultant in Anaesthetics and Intensive Care, The Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.

Due to its potential benefits and increased patient satisfaction minimal invasive cardiac surgery (MICS) is rapidly gaining in popularity. These procedures are not without challenges and require careful planning, pre-operative patient assessment and excellent intraoperative communication. Assessment of patient suitability for MICS by a multi-disciplinary team during pre-operative workup is desirable. Read More

Ann Biomed Eng 2021 Apr 9. Epub 2021 Apr 9.

James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA.

Ischemic mitral regurgitation (IMR) is a prevalent cardiac disease associated with substantial morbidity and mortality. Contemporary surgical treatments continue to have limited long-term success, in part due to the complex and multi-factorial nature of IMR. There is thus a need to better understand IMR etiology to guide optimal patient specific treatments. Read More

Int J Cardiovasc Imaging 2021 Apr 9. Epub 2021 Apr 9.

Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Denizer caddesi, Cevizli Kavsagi, Kartal, 34865, Istanbul, Turkey.

Three-dimensional transesophageal echocardiography (3D-TEE) provides detailed images of prosthetic valve thrombosis (PVT). However, data regarding PVT localization patterns based on 3D-TEE and their association with clinical findings among various bileaflet mitral prosthetic valve brands is lacking. The locations of thrombi were classified into 4 groups according to hinge and annulus involvement based on 3D-TEE: ring-like PVT involving entire mitral annulus (type-1), PVT involving peri-hinge(s) region and extends through some part of the annulus (type-2), PVT involving mitral annulus without involving hinge(s) region (type-3), and PVT involving only (peri)hinge(s) area (type-4). Read More

J Neurosurg Anesthesiol 2021 Apr 8. Epub 2021 Apr 8.

Departments of Anaesthesia and Intensive Care Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Fluid imbalance is common after aneurysmal subarachnoid hemorrhage and negatively impacts clinical outcomes. We compared intraoperative goal-directed fluid therapy (GDFT) using left ventricular outflow tract velocity time integral (LVOT-VTI) measured by transesophageal echocardiography with central venous pressure (CVP)-guided fluid therapy during aneurysm clipping in aneurysmal subarachnoid hemorrhage patients.

Methods: Fifty adults scheduled for urgent craniotomy for aneurysm clipping were randomly allocated to 2 groups: group G (n=25) received GDFT guided by LVOT-VTI and group C (n=25) received CVP-guided fluid management. Read More

Am J Case Rep 2021 Apr 9;22:e930510. Epub 2021 Apr 9.

Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan.

BACKGROUND Left atrial appendage (LAA) ostial stenosis is a rare cardiac condition usually identified by transesophageal echocardiography (TEE). LAA ostial stenosis can be classified into 2 types: one is idiopathic and the other is a complication after incomplete surgical LAA ligation. The former one is even rarer and only 12 cases have previously been reported. Read More

JACC Cardiovasc Imaging 2021 Apr;14(4):797-808

Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address:

Objectives: This study was designed to compare the clinical and echocardiographic characteristics, management, and outcomes of severe atrial functional mitral regurgitation (AFMR) to primary mitral regurgitation (PMR).

Background: AFMR remains poorly defined clinically.

Methods: Consecutive patients who underwent transesophageal echocardiography at our institution between 2011 and 2018 for severe mitral regurgitation with preserved left ventricular function were screened. Read More

JACC Cardiovasc Imaging 2021 Apr;14(4):782-793

Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA. Electronic address:

Objectives: The aim of this study was to assess mitral valve (MV) remodeling and strain in patients with secondary mitral regurgitation (SMR) compared with primary MR (PMR) and normal valves.

Background: A paucity of data exists on MV strain during the cardiac cycle in humans. Real-time 3-dimensional (3D) echocardiography allows for dynamic MV imaging, enabling computerized modeling of MV function in normal and disease states. Read More