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Post Heart Transplant Echocardiographic Evaluation

Cardiac transplantation remains the gold standard therapy for patients with end-stage heart failure that is refractory to optimal medical therapy (American College of Cardiology/American Heart Association stage D heart failure). Since the first cardiac transplantation in 1967, considerable advances in immunosuppressive therapy have led to improved long-term survival, with recent reports of 1-year survival rates after heart transplantation of almost 90% and a conditional half-life of…

Extracorporeal Membrane Oxygenation, Impella, and Other Circulatory Mechanical Support

Acknowledgment Stephen N. Palmer, PhD, ELS, contributed to the editing of the manuscript. Mechanical Circulatory Support Mechanical circulatory support (MCS) refers to nonpharmacologic cardiac assist systems that provide hemodynamic support in the treatment of patients with cardiogenic shock. Temporary MCS is used as a bridge to myocardial recovery, durable MCS, and heart transplantation or to provide time for clinical decision making. Despite having been in use…

Systematic Echocardiographic Approach to Left Ventricular Assist Device Therapy

As the population ages, the prevalence of heart failure continues to escalate. Heart failure with reduced ejection fraction (HFrEF) comprises approximately 50% of the admission diagnoses for heart failure. The American College of Cardiology/American Heart Association categorizes heart failure into four stages labeled A to D. Patients with stage D heart failure have the worst outcomes. Clinically, they have persistent symptoms despite optimal doses of guideline-directed…

Vacuum Extraction of Intracardiac Masses

The management of intracardiac masses is clinically challenging. Much of the difficulty arises from the fact that it is often difficult to describe the precise character and location of cardiac masses by current imaging techniques. Possible causes of intracardiac masses typically include tumor, thrombus, vegetation, or foreign body. Therefore, traditional management of cardiac masses often has included a trial of anticoagulation and eventual surgical embolectomy. However,…

Echocardiography-Guided Biopsy of Intracardiac Masses

Endomyocardial biopsy (EMB) is a commonly performed procedure for the evaluation of cardiac tissue for transplant monitoring ( Video 173.1 ), myocarditis, drug toxicity, cardiomyopathy, and secondary cardiac involvement by systemic diseases and for diagnosis of cardiac masses. , This chapter discusses only the role of EMB of cardiac masses. Although lesion morphology and location often suggest a diagnosis, histologic evaluation is required before the initiation…

Periprosthetic Leaks

Paravalvular regurgitation (PVR) is a serious and underdiagnosed problem of prosthetic valves. It occurs in 7% to 17% of surgical mitral prosthetic valves and 2% to 10% of aortic prosthetic valves. Approximately 74% of PVR occur in the first year after implantation. Anatomic risk factors for development of PVR include history of endocarditis, significant mitral annular calcification, corticosteroid use, and presence of mechanical prosthetic valves. Although…

Echocardiographic Imaging of Left Atrial Appendage Occlusion

Atrial fibrillation (AF) is the most common cardiac arrhythmia in the world, affecting more than 3 million people in the United States alone. AF is defined as a supraventricular tachyarrhythmia characterized by uncoordinated atrial activation and consequent deterioration of mechanical atrial function. The incidence of AF in the United States is projected to increase to 7.56 million by 2050 as the population ages. AF may be…

Transcatheter Closure of Cardiac Pseudoaneurysms

Left ventricular (LV) pseudoaneurysm is a rare but serious complication of myocardial infarction (MI), cardiac surgery, trauma, and infection. Medical treatment alone is frequently not effective and is associated with as much as 50% mortality. Until recently, the recommended treatment was surgical closure. These surgeries carried high risk because of abnormal hemodynamics, necrotic substrates, and the comorbidities of these patients. Recently, transcatheter closure has been shown…

Atrial and Ventricular Septal Defect Closure

Atrial Septal Defect Closure Aside from the bicuspid aortic valve, an atrial septal defect (ASD) is the most common congenital cardiac anomaly in adults with an approximate prevalence of 1 per 1000 individuals. This chapter focuses on echocardiographic imaging during ASD closure. Embryology, classification, diagnosis, and hemodynamic significance of ASDs are discussed in detail in the congenital heart disease section of this book. Briefly, there are…

Transcatheter Valve-in-Valve Implantation

Surgical valve replacement is frequently required in patients with severe native valve disorders not amenable to valve repair. Until recently, valve replacement invariably required open-heart surgery with cardiopulmonary bypass. This major surgery was associated with morbidity, mortality, long hospital stays, and disability. The surgical prosthetic valves commonly used are less than perfect, and the long-term results are still suboptimal. Most prosthetic valves that are surgically implanted…

Transcatheter Mitral Valve Replacement

Mitral valve (MV) disease is the most prevalent form of valvular disease worldwide. Moderate to severe and severe native mitral regurgitation (MR) are the most prevalent forms of significant valvular disease in the developed countries. In 2006, it was estimated that moderate to severe and severe MR are approximately 20 times more prevalent than severe aortic stenosis (AS) in the United States ( Fig. 167.1 ),…

Percutaneous Mitral Edge-to-Edge Repair

Acknowledgments The authors gratefully acknowledge Julia Grapsa, MD, PhD; Ilias D. Koutsogeorgis, MD; Petros Nihoyannopoulos, MD; and Ferande Peters, MD, who were the authors of this chapter in the previous edition. The percutaneous mitral edge-to-edge repair is based on the principle of surgical edge-to-edge repair, also known as the Alfieri technique, introduced in 1991 by the Italian surgeon Ottavio Alfieri, who successfully treated a patient with…

Mitral Valve Balloon Valvuloplasty

Mitral stenosis (MS) is the most common form of rheumatic valve disease and produces significant disability, particularly in young and middle-aged adults. , Patients with severe MS usually develop fatigue, heart failure, atrial fibrillation, and thromboembolism. Of the many causes of MS, rheumatic mitral stenosis (RMS) remains the most common, usually presenting in patients between the ages 20 and 40 years, several years after an attack…

Evaluation of Patients Undergoing Transcatheter Aortic Valve Replacement

Acknowledgments We thank Drs. Linda D. Gillam, Konstantinos Koulogiannis, and Leo Marcoff for their contributions to the previous edition of this chapter. Transcatheter aortic valve replacement (TAVR) has emerged as a new option for the treatment of patients with severe symptomatic aortic stenosis (AS). Although initially approved for patients considered inoperable or at greatly increased risk for surgical aortic valve replacement (SAVR), recent clinical trials have…

Incidental Noncardiovascular Findings on Echocardiography

Acknowledgments The authors would like to thank Drs. Itzhak Kronzon, Robert J. Siegel, Hezzy Shmueli, and Neil L. Coplan for their contributions to the previous editions this chapter. Heart and Pericardium There are many well-described typical cardiac tumors (both primary and metastatic to the heart) that are discussed elsewhere in this text. However, intra- and extracardiac masses can present in various ways, requiring close attention on…

Cocaine

Acknowledgment The authors wish to acknowledge the late Ronald G. Victor, MD, PhD, for his creative insight, mentorship, and focus without which a seminal work of research that greatly contributed to this publication would not be possible. Cocaine use is a leading cause of cardiovascular disease in young adults in the United States. The National Survey on Drug Use and Health in 2008 estimated that there…

Pregnancy and the Heart

During normal pregnancy, the maternal cardiovascular system undergoes significant hemodynamic changes to ensure an uncomplicated pregnancy and a healthy fetus. Evaluation of these changes needs precise and safe diagnostic modalities. Echocardiography is the modality of choice to evaluate cardiac structure and function in pregnant women. Transthoracic echocardiography (TTE) is noninvasive and safe; does not involve radiation; is easily available, affordable, and portable; and can provide accurate…

Cardiotoxic Effects of Cancer Therapy

Cardiac toxicity by chemotherapeutic drugs was first described more than 50 years ago after the introduction of daunomycin, an anthracycline, as an antimitotic agent. The early recognition of heart failure as a side effect of anthracyclines led oncologists to limit the cumulative dose of chemotherapy and prompted them to find a method to serially monitor the occurrence of left ventricular dysfunction (LVD). Initially, endomyocardial biopsy and…

Human Immunodeficiency Virus

Cardiovascular manifestations of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) have been reported since the early years of the pandemic. Before the introduction of highly active antiretroviral therapy (HAART), many of the cardiovascular findings resulted from immunosuppression and direct myocardial infection. Common examples of these findings include myocardial and pericardial disease, cardiac tumors, and dilated cardiomyopathy (DCM; Box 159.1 ). With the advent of…

Sickle Cell Disease

Sickle cell disease (SCD) is an autosomal recessive disease that affects millions of people worldwide and approximately 1 in 500 African Americans and 1 in 1200 Hispanic Americans. It is caused by a β-globin gene mutation, resulting in systemic complications caused by vaso-occlusive episodes and hemolysis. Cardiopulmonary complications have surfaced as leading causes of morbidity and premature mortality, with a median life span of 45 years…