TY - JOUR
T1 - Pseudoaneurysms of the mitral-aortic intervalvular fibrosa
T2 - Dynamic characterization using transesophageal echocardiographic and Doppler techniques
AU - Afridi, Imran
AU - Apostolidou, Maria A.
AU - Saad, Robert M.
AU - Zoghbi, William A.
N1 - Funding Information:
From the Department of Medicine, Section of Cardiology, Baylor College of Medicine and Echocardiography Laboratory, The Methodist Hospital, Houston, Texas. Computational assistance was provided by the General Clinical Research Center, Clinical Database Management and Analysis System, funded by Grant RR-00350 from the Division of Research Resources, National Institutes of Health, Bethesda, Maryland. Manusclipt received March 9, 1994; revised manuscript received July 7, 1994, accepted July 20, 1994. Address for correspondence: Dr. William A. Zoghbi, Section of Cardiology, The Methodist Hospital, 6535 Fannin, F-905, Houston, Texas 77030.
PY - 1995/1
Y1 - 1995/1
N2 - Objectives. The aim of this study was to provide a detailed description of echocardiographic and Doppler features of pseudoaneurysms involving the mitral-aortic intervalvular fibrosa and to compare echocardiographic and aortographic findings. Background. Infection of the aortic valve may spread to the aortic annulus, resulting in ring abscesses or pseudoaneurysms, or both, of the intervalvular fibrosa, which can alter patient management and prognosis. Methods. The echocardiographic and Doppler findings of 20 patients with pseudoaneurysms or ring abscesses, or both, were reviewed and compared with surgical and aortographic results. Results. A total of 23 lesions were identified, of which 16 were intervalvular pseudoaneurysms, and 7 were ring abscesses. Transthoracic echocardiography detected 43% of the lesions, whereas transesophageal echocardiography identified 90% (p < 0.01). The most distinct feature of the pseudoaneurysms was marked pulsatility, with systolic expansion and diastolic collapse (mean systolic area [±SD] 4.1 ± 3.4 cm2 vs. diastolic mean area 1.8 ± 2.2 cm2, p < 0.05). Using color Doppler, two types were identified: unruptured pseudoaneurysms (n = 9), which communicated only with the left ventricular outflow tract and had a distinct flow pattern, and ruptured pseudoaneurysms (n = 7), which, in addition, communicated with the left atrium or aorta. Compared with pseudoaneurysms, ring abscesses were smaller and nonpulsatile and showed either no flow or continuous systolic and diastolic flow, the site of paravalvular aortic insufficiency. In 10 patients who underwent aortography, three lesions were identified, and findings were concordant with echocardiography. However, in seven patients aortographic findings were normal, whereas echocardiography identified intervalvular pseudoaneurysms, all of which were documented at operation. Conclusions. Intervalvular pseudoaneurysms are more frequently detected by transesophageal echocardiography than by aortography or transthoracic examination and exhibit distinct dynamic features and Doppler patterns that can further help characterize cavitary lesions in the aortic root and guide appropriate surgical intervention.
AB - Objectives. The aim of this study was to provide a detailed description of echocardiographic and Doppler features of pseudoaneurysms involving the mitral-aortic intervalvular fibrosa and to compare echocardiographic and aortographic findings. Background. Infection of the aortic valve may spread to the aortic annulus, resulting in ring abscesses or pseudoaneurysms, or both, of the intervalvular fibrosa, which can alter patient management and prognosis. Methods. The echocardiographic and Doppler findings of 20 patients with pseudoaneurysms or ring abscesses, or both, were reviewed and compared with surgical and aortographic results. Results. A total of 23 lesions were identified, of which 16 were intervalvular pseudoaneurysms, and 7 were ring abscesses. Transthoracic echocardiography detected 43% of the lesions, whereas transesophageal echocardiography identified 90% (p < 0.01). The most distinct feature of the pseudoaneurysms was marked pulsatility, with systolic expansion and diastolic collapse (mean systolic area [±SD] 4.1 ± 3.4 cm2 vs. diastolic mean area 1.8 ± 2.2 cm2, p < 0.05). Using color Doppler, two types were identified: unruptured pseudoaneurysms (n = 9), which communicated only with the left ventricular outflow tract and had a distinct flow pattern, and ruptured pseudoaneurysms (n = 7), which, in addition, communicated with the left atrium or aorta. Compared with pseudoaneurysms, ring abscesses were smaller and nonpulsatile and showed either no flow or continuous systolic and diastolic flow, the site of paravalvular aortic insufficiency. In 10 patients who underwent aortography, three lesions were identified, and findings were concordant with echocardiography. However, in seven patients aortographic findings were normal, whereas echocardiography identified intervalvular pseudoaneurysms, all of which were documented at operation. Conclusions. Intervalvular pseudoaneurysms are more frequently detected by transesophageal echocardiography than by aortography or transthoracic examination and exhibit distinct dynamic features and Doppler patterns that can further help characterize cavitary lesions in the aortic root and guide appropriate surgical intervention.
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U2 - 10.1016/0735-1097(94)00326-L
DO - 10.1016/0735-1097(94)00326-L
M3 - Article
C2 - 7798491
AN - SCOPUS:0028804556
SN - 0735-1097
VL - 25
SP - 137
EP - 145
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -