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ABSTRACT: Background and Objectives: The purpose of this study was to evaluate the usefulness of transesophageal echocardiography during the implantation of the CoreValve percutaneous aortic prosthesis and the influence of the learning curve in its indications. Methods: From April 2008 to January 2010, 53 patients were treated for symptomatic severe aortic stenosis with a CoreValve percutaneous aortic prosthesis. Transesophageal echocardiography was performed during the procedure for two reasons: if a discrepancy between the measures of the aortic annulus arose before the implantation and to provide visualization if a complication occurred during the procedure. Patients were divided in to two groups based on the learning curve (group I:the first 25 patients, group II: all of the subsequent patients). Results: Thirty-six transesophageal echocardiographies were performed on 28 patients (53%).In 15 cases the indication was to assist us in determining the proper sized prosthesis, and in the other 21 cases it was performed due to a complication during the procedure. The numbers of intraprocedure transesophageal echocardiographies were similar in both learning-curve groups, (64% in group I vs. 71% in group II, P = 0.56) but the proportion of the studies indicated by serious complications was significantly lower in the second period of the learning curve (67% in group I vs. 17% in group II, P < 0.05). Conclusions: In our experience, transesophageal echocardiography was very useful in more than one-half of the patients during the implantation of the CoreValve percutaneous aortic prosthesis. After overcoming the learning curve, its indication due to serious procedure-related complications decreased significantly. © 2011 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions 07/2012; · 2.29 Impact Factor
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ABSTRACT: Purpose: We aimed to analyze the feasibility of two-dimensional speckle-tracking echocardiography (2DSTE) in evaluating myocardial strain in consecutive, nonselected patients in daily clinical practice. Methods: Strain analysis using 2DSTE was attempted in 59 consecutive patients: 24 patients with severe aortic stenosis, 28 patients with dilated cardiomyopathy, and 7 healthy controls. The analysis was done by four expert echocardiographers and one cardiology resident. Results: It was possible to obtain reliable data for radial strain in 175 of 354 segments (49%), circumferential strain in 192 of 354 segments (54%), and longitudinal strain in 319 of 354 segments (90%). Experienced echocardiographers felt assessment of radial and circumferential strain was appropriate in more segments than did the cardiology resident (57% and 58% vs. 23% and 40%, respectively, P < 0.01). Conclusion: Longitudinal strain analysis with 2DSTE is feasible in most segments, but the radial and circumferential strain evaluation was only feasible in approximately half of the patients.
Echocardiography 06/2012; 29(8):923-6. · 1.24 Impact Factor
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ABSTRACT: Atrial septal defect (ASD) is one of the most common congenital heart diseases. Nowadays, percutaneous closure is considered the treatment of choice in most of secundum ASDs. Assessment of the defect and procedure monitoring have been usually performed by angiographic balloon-sizing and/or two-dimensional (2D) transesophageal echocardiography. However, in complex ASDs these techniques might be inaccurate.
From January 2009 to January 2011 all adult patients with complex ASDs submitted for percutaneous closure were selected. Those defects, where shunts were present through a device previously implanted on the atrial septum or through multiperforated septums, were considered complex ASDs. Two-dimensional transesophageal echocardiography and real time three-dimensional (3D) echocardiography were performed simultaneously during the percutaneous closure procedure. Number of orifices, relationships between the defect, catheter, and device, as well as residual shunt were assessed.
Seven patients were included. Five patients had a multiperforated septum and in two cases the defect in the septum was through a previously implanted device. In all cases, 3D echocardiography was superior to 2D echocardiography in relation to the assessment of the relationship between the defect and the catheter or the device. Mechanisms responsible for residual shunts through a device were also better assessed by 3D echocardiography.
Three-dimensional echocardiography is a safe and useful technique when monitoring percutaneous closure of ASDs, showing relevant advantages over 2D echocardiography.
Echocardiography 04/2012; 29(6):729-34. · 1.24 Impact Factor
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Dolores Mesa Rubio,
José Suárez de Lezo Cruz Conde,
Manuel Pan Alvarez-Osorio,
Martin Ruiz Ortiz, Mónica Delgado Ortega,
Maria del Carmen León del Pino,
Francisco Toledano Delgado,
Jose Segura Saint-Gerons,
Soledad Ojeda Pineda,
Daniel Garcia Fuertes,
Manuel Crespín Crespín,
Simona Espejo,
Rusel Ysamat
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ABSTRACT: To compare the measurements of the aortic annulus obtained with various imaging techniques in patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation, and to determine the grade of agreement between the predicted size of the prosthesis for each technique, and the size of the finally implanted valve.
The aortic annulus was measured in 40 patients treated by transcatheter aortic valve implantation (CoreValve aortic valve) with transthoracic (TTE) and transesophageal echocardiography (TEE), 64-slice tomography, and angiography. A large valve was implanted when annulus was >23 mm and a small one if it was ≤23 mm. If the size of the prosthesis predicted by several techniques was not the same in one case, we selected the size in which more techniques presented agreement. Forty aortic valves, 26 small and 14 large, were implanted percutaneously. The best correlation was obtained with TTE and TEE (r = 0.93, P < 0.001). The correlation of TTE and TEE with angiography also was good (r = 0.58, P < 0.001 and r = 0.53, P < 0.001, respectively). Correlations between these techniques and computed tomography were poor (P = NS for all comparisons). The best agreement between estimated aortic annulus and implanted valve size was obtained with transtoracic and TEE (κ= 0.88 and 0.76).
The aortic annulus measurements obtained by TTE, TEE, and angiography correlated well, while tomography correlated poorly with other techniques. The imaging techniques that showed the best agreement between estimated aortic annulus size and implanted aortic valve size were TTE and TEE.
Echocardiography 04/2011; 28(4):388-96. · 1.24 Impact Factor
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ABSTRACT: To compare clinical and echocardiographic characteristics of the hyper-responders to cardiac resynchronization therapy (CRT) with the rest of patients.
We included 80 consecutive patients treated with CRT. The follow up was 19 (14) months. Patients were considered hyper-responder if they had an ejection fraction of left ventricle (LVEF) ≥ 50% after follow up.
Twelve (15%) patients were considered hyper-responders. Their baseline clinical characteristics were similar to the rest except that there were fewer males in the group of hyper-responders. In these patients, basal left ventricle diastolic diameter was 64 (7) mm and the systolic was 55 (6) mm versus 75 (8) mm and 66 (9) mm respectively, p < 0.05. The basal area of mitral regurgitation in the hyper-responders was 3.1 (1.8) cm(2) versus 6.4 (5.5) cm(2), p < 0.05.
Hyper-responder patients are often women with less dilated left ventricle and reduced severity of mitral regurgitation assessed by echocardiography.
Medicina Clínica 03/2011; 137(3):108-10. · 1.38 Impact Factor
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Revista Espa de Cardiologia 02/2009; 62(1):85. · 2.53 Impact Factor
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ABSTRACT: Stroke is a high morbimortality disease. In young patients, as many as 40% of acute strokes have no clearly identifiable cause (cryptogenic stroke) and this group of patients had until now limited therapeutic possibilities. However, transesophagical echocardiography (TEE) is changing patient management.
We studied 100 consecutive patients aged 55 years old or less with cryptogenic stroke. TEE was performed in all of them.
TEE was normal in 49 patients while in 51 patients it showed any abnormality: patent foramen ovale (PFO) was found in 29 patients, isolated atrial septal aneurysm (ASA) in 1 patient, PFO and ASA in 12 patients, 5 patients had a cardiac mass and in 4 patients we found severe aortic atherosclerotic plaques. Therefore, TEE showed a cardiac source of stroke in 51% of patients. We changed patient management in 46 patients (90.2% of patients with abnormal TEE), indicating percutaneous treatment in 38 patients, surgery in 3 patients and anticoagulant therapy in 5 patients.
TEE found a cardiac cause of stroke in 51% of young patients with cryptogenic stroke. These findings led to change the therapeutic management in 47% of patients. TEE seems to be a useful technique in young patients with cryptogenic stroke.
Medicina Clínica 04/2008; 130(7):241-5. · 1.38 Impact Factor
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ABSTRACT: To study the efficacy and safety of an oral anticoagulation protocol for the treatment of nonvalvular atrial fibrillation, based on scientific associations' recommendations, in unselected patients seen in daily clinical practice.
The study included all consecutive patients with permanent nonvalvular atrial fibrillation who attended two outpatient cardiology clinics between February 1, 2000 and February 1, 2002. They were treated according to an anticoagulation protocol based on Spanish Society of Cardiology and American College of Cardiology/American Heart Association/European Society of Cardiology guidelines. Patients were followed up prospectively for major events, such as death, stroke, transient ischemic attack, peripheral embolism and severe hemorrhage, which were recorded by treatment group.
A total of 624 patients were included in the study. Those receiving anticoagulation therapy (n=425; 68%) more frequently had hypertension, diabetes and previous embolism as well as a greater number of cardioembolic risk factors (P< .001). Overall, 93% of non-anticoagulated patients received platelet aggregation inhibitors (92% received aspirin). After a median follow-up of 21 months, the probability of an embolic event was lower in anticoagulated patients (0.81% vs 14.04%; P< .001), as was all-cause mortality (3.27% vs 6.42%; P=.003). However, there was no significant difference in the probability of severe bleeding (2.75% vs 2.93%; P=.96). Results were unchanged after adjustment for age, sex, and previous embolic events.
Oral anticoagulation therapy for nonvalvular atrial fibrillation implemented according to scientific associations' recommendations is effective and safe in daily clinical practice.
Revista Espa de Cardiologia 08/2006; 59(7):688-95. · 2.53 Impact Factor
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ABSTRACT: The treatment of infective endocarditis has undergone significant change within the last few years. The aim of this study was to evaluate the clinical features and prognosis of infective endocarditis over both the short and long term in patients who are not intravenous drug users.
We carried out a prospective study of 222 consecutive patients who were diagnosed with infective endocarditis between 1987 and June 2001 at two centers.
Their mean age was 48 (19) years, with 145 (65%) being male. Overall, 154 (69%) had native valve endocarditis and 68 (31%) had prosthetic valve endocarditis. In 61 patients (27%), no predisposing heart disease was found. Staphylococci were the causal microorganisms in 37% of cases (81 patients), and streptococci, in 35% (78 patients). Some 48% of patients underwent surgery during the active disease phase. Overall, inpatient mortality was 17% (39 cases); a significant decrease had occurred in recent years, from 25% in 1989-1995 to 12% in 1996-2001 (P<.01). In addition, the percentage undergoing early elective surgery had increased between the two periods, from 22% to 32% (P<.05). During a follow-up of 60 (48) months, 15 patients (8%) needed late cardiac surgery and 18 (10% of the whole series) died. The 6-year survival rate was 72% overall, and 80% in those who survived the active disease phase.
Short- and long-term prognoses for patients with infective endocarditis appear to have improved over recent years at our hospitals.
Revista Espa de Cardiologia 10/2005; 58(10):1188-96. · 2.53 Impact Factor
