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Cardiac Masses
Published in Takahiro Shiota, 3D Echocardiography, 2020
Sonia Velasco del Castillo, Miguel Angel García-Fernández
Sometimes fat surrounding the tricuspid annulus can simulate a pathological mass (Figure 19.27). The moderator band is a prominent muscle trabeculation only present in the right ventricle. It is visualized near the apex as a thick echodense band from the interventricular septum to the base of the anterior papillary muscle. It is most visible when the right ventricle is dilated, acquiring a more unfolded morphology. It should not be confused with an apical thrombus.
Abnormal Four-Chamber View
Published in Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan, Problem-Based Obstetric Ultrasound, 2019
Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan
The following is a checklist for scanning the fetal heart: Check abdominal situs. This is imperative to understand the left and right of the fetus and ensure that the fetal heart and stomach are on the fetal left side.The fetal heart points to the left side with the majority of the heart lying in the left chest.The heart occupies a third of the chest area.There are four chambers with symmetrical ventricles and atria.The moderator band is identified and indicates the right ventricle.There are two A-V valves opening and closing (cineloop helps) and their point of attachment to the interventricular septum shows an offset with the tricuspid valve being closer to the apex when compared to the mitral valve.The septum is intact (preferably checked with the septum horizontally oriented).
Thorax
Published in David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings, McMinn’s Concise Human Anatomy, 2017
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings
Conducting system - the impulse for cardiac contraction begins in a small specialised area of pale heart muscle cells, the sinoatrial (SA) node, located superiorly in the right atrium just beside the entry of the superior vena cava (Fig.5.9) where the superior end of the sulcus terminalis meets the atrial appendage. From there the impulse spreads through the cardiac muscle of the atria and reaches a specialised area of large pale muscle cells, the atrioventricular (AV) node, located in the lower part of the interatrial septum. The conduction continues through specialised myocardial cells, known as Purkinje fibres, from the AV node into the interventricular septum as the AV bundle of His, passing through the fibrous cushion before splitting into the left and right bundles and passing on the respective sides of the interventricular septum. These pass to the apex of the heart from where the wave of depolarisation that causes muscle contraction spreads across the ventricular walls. Within each ventricle several branches have been described passing from the main bundles. These have been referred to as moderator bands and they ensure that the wave of depolarisation is widely distributed, especially to the papillary muscles, so they contract at exactly the same time as the apex. However, only the one seen in the right ventricle is commonly referred to as the moderator band (or septomarginal trabeculum). These specialised tissues form the conducting or conduction system of the heart.
Prevalence and diagnostic value of extra-left ventricle echocardiographic findings in transthyretin-related cardiac amyloidosis
Published in Amyloid, 2022
Gianluca Di Bella, Francesco Cappelli, Roberto Licordari, Paolo Piaggi, Mariapaola Campisi, Diego Bellavia, Fabio Minutoli, Luca Gentile, Massimo Russo, Cesare de Gregorio, Federico Perfetto, Anna Mazzeo, Calogero Falletta, Francesco Clemenza, Giuseppe Vita, Scipione Carerj, Giovanni Donato Aquaro
Transthoracic colour Doppler echocardiography (ECHO) was performed using commercial ultrasound machines (Vivid 7 or Vivid 9, GE Ultrasound, Horten, Norway) equipped with a phased-array adult cardiology transducer. Parasternal short-axis views at the basal, mid and apical LV levels, short-axis view of the aortic valve and standard apical views (four-chamber, two-chamber, five-chamber and LV outflow long-axis) were acquired. The measurement of left ventricular septal thickness in tele-diastole was made avowing structures like moderator band, false tendon and trabecular structure of both ventricles. All conventional measurements were acquired according to the recommendations of the American Society of Echocardiography and the European Association of Cardiovascular Imaging [18–19].
Transcatheter tricuspid valve repair and replacement: a landscape review of current techniques and devices for the treatment of tricuspid valve regurgitation
Published in Expert Review of Cardiovascular Therapy, 2021
Kusha Rahgozar, Edwin Ho, Ythan Goldberg, Mei Chau, Azeem Latib
For annular-reshaping devices and transcatheter tricuspid valve replacement, pre-procedural MSCT or CMR are required, with MSCT most often used. These imaging modalities allow for accurate assessment of the tricuspid annulus morphology, the surrounding structures and potential hazards, vascular access, and the landing zone geometry within the right ventricle. For accurate assessment of the tricuspid annulus detailed measurement of the annular area, annular perimeter, and maximal anteroposterior and septolateral diameters should be obtained. The presence of sufficient annular tissue should be confirmed as this is essential for specific annuloplasty devices (Cardioband). On evaluation of vascular access, the size of the IVC at the right atrial-IVC junction plane and at the level of the first hepatic vein are important for certain devices (heterotopic caval valve implantation). For devices that anchor into tissue within right ventricle, assessment of the landing zone geometry within the right ventricular septal free wall should be performed. The presence of any prominent moderator bands, significant trabeculations, and large papillary muscles should be accounted for as these structures may potentially hinder successful device navigation and implantation. Finally, an accurate mapping of essential structures surrounding the tricuspid valve should be created, with the locations of the atrioventricular node, right bundle of His, and right coronary artery all carefully noted.
Interventional therapies for relief of obstruction in hypertrophic cardiomyopathy: discussion and proposed clinical algorithm
Published in Hospital Practice, 2018
Srihari S Naidu, Jason Jacobson, Sei Iwai, Tanya Dutta, Wilbert S Aronow, Angelica Poniros, Ramin Malekan, David Spielvogel, Julio A Panza
Alcohol septal ablation proceeds initially with temporary pacemaker placement, due to the 5–10% incidence of complete heart block that can develop post-procedure. While traditionally these were placed via the femoral vein, our recent experience has modified these to be externalized screw-in active fixation leads via the right internal jugular vein, thereby allowing the device to stay in longer, encourage ambulation while in hospital, and avoid accrued pacemaker complications such as effusion or tamponade. Care must be taken to place the lead at the apical septum, so that it is far removed from any area of septal ablation, which might affect pacemaker capture thresholds. Once the pacemaker is placed, it is set at a low rate, usually 40 beats/min, as back-up pacing. Baseline echo views are then obtained. This includes the parasternal long axis view, and apical 2, 3, 4, and 5 chamber views. The purpose of these views are to determine the level of opacification and wall motion of all relevant walls, including any area ethanol may inadvertently travel to. This includes the mid-septum, moderator band and free wall of the right ventricle, papillary muscles, and the anterior wall, posterior wall and apex of the left ventricle. The 3 and 5 chamber views are utilized to obtain outflow tract gradients.