Image in Cardiology
Three-dimensional transesophageal echocardiography in the diagnosis of biological prosthetic valve thrombosis (and its resolution)
Ecocardiografia transesofágica tridimensional no diagnóstico de trombose de prótese valvular biológica (e respetiva resolução)
Juan Caro-Codón
, Teresa López-Fernández, Zorba Blázquez Bermejo, Jose Ruiz Cantador, Inés Ponz de Antonio, Mar Moreno Yangüela
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Serviço de Cardiologia, Hospital Universitario La Paz, Madrid, Spain
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Complete aortic coarctation of 16–11<span class="elsevierStyleHsp" style=""></span>mm in axial and longitudinal diameter; (C) tube graft interposed between the ascending and descending thoracic aorta.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Christian Ortega-Loubon, Salvatore Di Stefano, Ana Revilla, José Alberto San Román" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Christian" "apellidos" => "Ortega-Loubon" ] 1 => array:2 [ "nombre" => "Salvatore" "apellidos" => "Di Stefano" ] 2 => array:2 [ "nombre" => "Ana" "apellidos" => "Revilla" ] 3 => array:2 [ "nombre" => "José Alberto" "apellidos" => "San Román" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204916000325" "doi" => "10.1016/j.repce.2015.09.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000325?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000032?idApp=UINPBA00004E" "url" => "/08702551/0000003500000002/v1_201602130045/S0870255116000032/v1_201602130045/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Three-dimensional transesophageal echocardiography in the diagnosis of biological prosthetic valve thrombosis (and its resolution)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "127" "paginaFinal" => "129" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan Caro-Codón, Teresa López-Fernández, Zorba Blázquez Bermejo, Jose Ruiz Cantador, Inés Ponz de Antonio, Mar Moreno Yangüela" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Juan" "apellidos" => "Caro-Codón" "email" => array:1 [ 0 => "juancarocd@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Teresa" "apellidos" => "López-Fernández" ] 2 => array:2 [ "nombre" => "Zorba" "apellidos" => "Blázquez Bermejo" ] 3 => array:2 [ "nombre" => "Jose" "apellidos" => "Ruiz Cantador" ] 4 => array:2 [ "nombre" => "Inés" "apellidos" => "Ponz de Antonio" ] 5 => array:2 [ "nombre" => "Mar" "apellidos" => "Moreno Yangüela" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospital Universitario La Paz, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Ecocardiografia transesofágica tridimensional no diagnóstico de trombose de prótese valvular biológica (e respetiva resolução)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1262 "Ancho" => 2067 "Tamanyo" => 269757 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography demonstrating increased flow velocity across the mitral bioprosthesis (A), with prolongation of pressure half-time and elevated mean pressure gradient (B); two-dimensional transesophageal echocardiography showing marked thickening of two of the three mitral leaflets (C systolic frame, D diastolic frame).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 73-year-old woman presented to the emergency department with a two-month history of progressive dyspnea on exertion. Fifteen months earlier she had undergone mitral valve replacement with a bioprosthesis due to severe mitral regurgitation. Her postoperative treatment included antiplatelet therapy with aspirin and oral anticoagulation, but both medications were discontinued six months after the surgery. Transthoracic echocardiography showed prolongation of mitral pressure half-time suggestive of prosthesis dysfunction (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B, Video 1). Transesophageal echocardiography (TEE) revealed thickening of two of the three prosthetic mitral leaflets, with restricted mobility. The anterior leaflet opened normally, resulting in severe stenosis with a total effective area of 0.81 cm<span class="elsevierStyleSup">2</span> calculated by three-dimensional (3D) planimetry (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C and D, <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A–C, Videos 2–4). Diuretics, aspirin and anticoagulation were initiated and the patient was discharged home on day 3 with a presumptive diagnosis of prosthetic valve thrombosis. Follow-up TEE performed two months later showed normal thickness of the three leaflets with normal opening and an effective area of 1.7 cm<span class="elsevierStyleSup">2</span> assessed by 3D echocardiography (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D–F, <a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>, Videos 5 and 6). This case demonstrates the utility of 3D TEE to define the anatomy of the obstructed prosthesis and how the thrombus impairs leaflet function. In addition, it illustrates the potential benefit of maintaining antiplatelet therapy in patients with a bioprosthetic mitral valve and no other risk factors for thromboembolism, as recommended in the 2014 AHA/ACC guideline for the management of patients with valvular heart disease.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0045" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-06-30" "fechaAceptado" => "2015-10-16" "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0035" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia><elsevierMultimedia ident="upi0020"></elsevierMultimedia><elsevierMultimedia ident="upi0025"></elsevierMultimedia><elsevierMultimedia ident="upi0030"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary material" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1262 "Ancho" => 2067 "Tamanyo" => 269757 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography demonstrating increased flow velocity across the mitral bioprosthesis (A), with prolongation of pressure half-time and elevated mean pressure gradient (B); two-dimensional transesophageal echocardiography showing marked thickening of two of the three mitral leaflets (C systolic frame, D diastolic frame).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1082 "Ancho" => 1860 "Tamanyo" => 224262 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A–C) Baseline three-dimensional transesophageal echocardiography (3D TEE) images of the prosthesis as viewed from the left atrium (A, systole; B, diastole) and the left ventricle (C, diastole); 3D TEE confirms two-dimensional findings and improves anatomical characterization of the thrombosed bioprosthesis; (D–F) control 3D TEE after two months of antithrombotic treatment demonstrating normal prosthetic function, with normal opening of the three leaflets.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 696 "Ancho" => 1860 "Tamanyo" => 145033 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Follow-up two-dimensional transesophageal echocardiography showing normal flow velocity (A) and mean pressure gradient (B) across the mitral bioprosthesis.</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 642717 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 4 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 712378 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" ] "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 5 => array:5 [ "identificador" => "upi0015" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc3.mp4" "ficheroTamanyo" => 481309 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc3.m4v" "poster" => "mmc3.jpg" ] "flv" => array:5 [ "fichero" => "mmc3.flv" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 6 => array:5 [ "identificador" => "upi0020" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc4.mp4" "ficheroTamanyo" => 468375 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc4.m4v" "poster" => "mmc4.jpg" ] "flv" => array:5 [ "fichero" => "mmc4.flv" "poster" => "mmc4.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 7 => array:5 [ "identificador" => "upi0025" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc5.mp4" "ficheroTamanyo" => 429680 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc5.m4v" "poster" => "mmc5.jpg" ] "flv" => array:5 [ "fichero" => "mmc5.flv" "poster" => "mmc5.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 8 => array:5 [ "identificador" => "upi0030" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc6.mp4" "ficheroTamanyo" => 440846 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc6.m4v" "poster" => "mmc6.jpg" ] "flv" => array:5 [ "fichero" => "mmc6.flv" "poster" => "mmc6.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003500000002/v1_201602130045/S0870255116000020/v1_201602130045/en/main.assets" "Apartado" => array:4 [ "identificador" => "357" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Imagens em cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003500000002/v1_201602130045/S0870255116000020/v1_201602130045/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000020?idApp=UINPBA00004E" ]
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