Project description:Prosthetic valve complications are not uncommon after valve replacement. In this paper we report a female patient who presented with aortic prosthetic valve endocarditis and echocardiographic appearance of periaortic abscess. After 6 weeks of antibiotic therapy, echocardiographic examination revealed resolution of abscess cavity and replacement with a clear blood-filled anechoic sac. Diagnosis was made by cardiac computed tomography, which showed a left ventricular outflow tract (LVOT) pseudoaneurysm rather than an abscess, located just below the sewing ring of the prosthetic aortic valve. We assumed that either resolution of thrombus in LVOT pseudoaneurysm following effective warfarin therapy or clearance of infective content in pseudoaneurysm after co-administered antibiotics gave rise to change in echocardiographic characteristics in the perivalvular area.
Project description:We present a case of a pseudoaneurysm arising from the left ventricular outflow tract/aortic root as a complication of aortic valve surgery. A 45-year-old Nigerian female presented to our institution's emergency department with chest discomfort. She had three bioprosthetic aortic valve replacements in the preceding year at an outside institution for aortic regurgitation and wanted a second opinion on remaining surgical options. The learning points relevant to this case are as follows: (1) Recognizing potential complications postmultiple valve surgeries, (2) screening patients for chronic infections and rheumatologic conditions that can contribute to failed valve surgeries.
Project description:IntroductionMultiple algorithms based on 12-lead ECG measurements have been proposed to identify the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT) locations from which ventricular tachycardia (VT) and frequent premature ventricular complex (PVC) originate. However, a clinical-grade machine learning algorithm that automatically analyzes characteristics of 12-lead ECGs and predicts RVOT or LVOT origins of VT and PVC is not currently available. The effective ablation sites of RVOT and LVOT, confirmed by a successful ablation procedure, provide evidence to create RVOT and LVOT labels for the machine learning model.MethodsWe randomly sampled training, validation, and testing data sets from 420 patients who underwent successful catheter ablation (CA) to treat VT or PVC, containing 340 (81%), 38 (9%), and 42 (10%) patients, respectively. We iteratively trained a machine learning algorithm supplied with 1,600,800 features extracted via our proprietary algorithm from 12-lead ECGs of the patients in the training cohort. The area under the curve (AUC) of the receiver operating characteristic curve was calculated from the internal validation data set to choose an optimal discretization cutoff threshold.ResultsThe proposed approach attained the following performance: accuracy (ACC) of 97.62 (87.44-99.99), weighted F1-score of 98.46 (90-100), AUC of 98.99 (96.89-100), sensitivity (SE) of 96.97 (82.54-99.89), and specificity (SP) of 100 (62.97-100).ConclusionsThe proposed multistage diagnostic scheme attained clinical-grade precision of prediction for LVOT and RVOT locations of VT origin with fewer applicability restrictions than prior studies.
Project description:The high accuracy of multidetector-row computed tomography (MDCT) in evaluating prosthetic valve disorders has been confirmed. This, we believe, is the 1st report of the use of MDCT to detect and evaluate left ventricular outflow tract (LVOT) pseudoaneurysms in patients who have undergone aortic valve replacement with prosthetic valves. We used MDCT to scan 21 such patients, 3 of whom had a small pseudoaneurysm in the LVOT. Each pseudoaneurysm projected away from the LVOT and had a narrow neck that was located just below the sewing ring of the prosthetic aortic valve. One pseudoaneurysm was not thrombotic, 1 was partially thrombotic, and 1 was completely thrombotic. One of these had gone undetected earlier on transthoracic echocardiography.We consider MDCT to be superior to echocardiography in the detection of LVOT pseudoaneurysms in patients who have undergone aortic valve replacement with prosthetic valves. We publicize our results in the hope that larger studies will be undertaken in order to investigate the prevalence and clinical implications of our findings.
Project description:Innocent left ventricular outflow tract (LVOT) membranes are a rare entity and found incidentally on echocardiography. The authors report a case of innocent LVOT membrane in a patient who was admitted with ischaemic stroke. Initial transthoracic echocardiography showed a possible valvular vegetation which was thought to be the cause of embolic stroke. Anticoagulation with coumadin and antibiotics were started. Subsequent Transesophageal echocardiography showed that it was more consistent with innocent LVOT membrane and not vegetation. Anticoagulation and antibiotics were discontinued, and on a follow-up over 5 years later, the membrane was stable in size and location without any complications.
Project description:Surgical and rarely transcatheter aortic valve replacement can be complicated by intracardiac fistula. Transcatheter closure of those shunts has been previously reported with favorable results. We describe a case of percutaneous closure of left ventricular outflow tract-to-left atrium fistula after surgical aortic valve replacement using an Amplatzer Vascular Plug II. (Level of Difficulty: Advanced.).