Helen Taussig Professor and director of pediatric cardiology Shelby Kutty presents, "How to Handle Incidental and Unusual Findings on Echocardiography” at #EuroEcho21, the annual congress of the European Association of Cardiovascular Imaging.
mhm. Good morning, everyone. This presentation will address the problem of unusual and incident lack of findings. It's organized as what you might see, how to identify what you're saying, what it could mean for the patient and what to do about it. To make this fun, I have entirely fabricated case periods, but the echo images I'm going to show a real, as are the clinical problems we face when the Echo shows the unexpected Billy good time since the 50th senior and fraternity house president at nearby favorite college. His friends brought him to the emergency department after he fell down the stairs and suffered chest contusions. The testing showed an unusual cardiac cigarette, so an echo was performed. This is echo, and it showed a true ventricular discordance, with the right atrium emptying into the left ventricle through a metal valve and the left atrium bending into the right ventricle to attract a spit valve as well as ventricle. Article discordance with embryology l looping, resulting in an anterior and left a Toyota arising from the right ventricle and the postseason, right? Would pulmonary artery arising from the left ventricle? Billy has congenitally corrected transposition of the great arteries. Some patients with CCG like billiard without centers, although one might worry that his fall might have been provoked. An orange By age 45. About one quarter of those patients with no additional cardiac defects have heart failure. Sentence. Progressive Titus negotiation, heart failure and arrhythmias can occur over time. I want to do about this. Regular outpatient surveillance is important, as recommended by the recent E, S C and SEC guidelines for adults with congenital heart disease Electrophysiology evaluation. Facing an ablation can be helpful surgical options in adults and not to be definitive but can address the associated physiologic burdens. Terry Tiki is a retired high school guidance counselor. Now 68 years old, Terry sought medical attention after she suddenly noted her heart was racing and he said, You review if it with the rapid ventricular response and Echo was arranged to evaluate her heart function and to exclude any structural problem. This is a record, and it shows the membrane in her left atrium denoted by this arrow. What she has is a core trio. Triton's sinister with no significant obstruction to Venus flow on color or balls. Tabla culture, right? Right. Um represents a spectrum from non obstructive to securely obstructive a lemon brains. The non obstructive ones are usually asymptomatic. The median age of diagnosis is 43 years in a house, and less than half are obstructive symptoms seems to have been brought on by a thread, and this may be pertinent for Mistake E as she presented the data, which may or may not have been caused by her order. I try them. What to do for her outpatient follow up is important. Arrhythmias need to be evaluated for and treated, and surgical resection is reserved for those with important obstructions. The pedigree is the 27 year old healthy postal worker. He recently learned that his sister Paula, has a micro speed aortic valve, and Nicole is obtained to see if Pete also has a bicuspid aortic valve. It turns out he has a normal trikus periodic valves, but a non obstructive symbiotic membrane was seen below the aortic valve in multiple echo views. There was no severe aortic stenosis and know aortic regurgitation be just typical in that this condition is often discovered. Incidentally, it can be isolated or associated with other defects. Those without obstruction not typically symptomatic and progression of surveys is slower in patients who are presenting a down good Now, What to do For patients like Pete, this is return for periodic evaluation and echo. We worry more as variants approach 50 Marjorie, but still can follow clinically so long as there is no envy. Hypertrophy development of significant European vegetation is an indication for surgical resection. Real estate agent dollar property Age 44 was on her feet all afternoon at an open house event when she began to experience substantial chest pain and shortness of breath. This result after sitting down for a few minutes. But she mentioned the incident to her primary care physician, an evaluation for possible cardiac causes, including an echo. You can see here that Paula has a normal left and right heart function and no chamber dilation. The right coronary artery was slightly dilated, and it was hard to see the left in its usual location. In fact, the left coronary arose from the main pulmonary artery. Here you see there lady in two d and color Doppler conforming, an anomalous left coronary artery from the pulmonary artery. Although it's possible to meet someone like Paula. The incident of discovery of the cup and the adult is very rare. A review of cases in adulthood found an average age of diagnosis. For 41 years. There was a remarkable female predominance and mostly symptomatic, with complaints such as angina, this nail palpitations and fatigue, how to manage and instantly discovered alcohol. And that out is debatable. Surgery to establish enduring Connery system is an accepted means for correcting this vision in symptomatic adults, often the concurrent placement of an ICD. But the repair or not, Al Capone is a significant threat, and close observation is advised. Mhm. Vicki volunteer is 19 healthy, and then she can get work. She waits tables at a restaurant near her home, hoping to earn a little extra money for Christmas gifts. This year, Wiki signed up for a Facebook pharmaceutical trial of reduced Map, a new biological, which shows promise for weight loss before receiving any dose of reduced map. The child protocol required an echo. This is Vicky Seco, and her envy Short axis image here shows an unusually opening mitral valve with two openings and color Doppler showing two jets of mild weather station Yeah, double office double valve is defined by two separate metamorphosis. It's supported by its own code and paralysis. Isolated. The MV can function normally and maybe clinically silent. However, the vast can deteriorate over time, so periodical surveillance is warranted. Well, repair may not become necessary, however. Indications for repair include progressive deterioration of malfunction that is unresponsive to medical management. Our final friend is Mr Frank Frederick, age 37, his assistant director for a large software developer. His company had a health fair, and even though Frank never had cardiac symptoms, his wife, Fawn, insisted that he gets his free CD that was often an affair. They see the short, complete right bundle branch block, and Frank's doctor ordered an echo. The echo is normal, except for the structure shown in a rose in the typical Ford and Paris stone long axis views. This is a dilated coronary Sinus, and the hype aristo only made shows There is a persistent left superior vena cava. Unless we see to see us represents the abnormal persistence of an embryologist vessel, which connects to the right atrium near the coronary Sinus. The prevalence is about .4% among healthy people, But can be up to 10% in patients with other continental heart defects. A dilated CS or an echo should always raise the suspicion of the left as we see, and the echo should serve as an adequate assessment for associated cardiac lesions if isolated. Finding reassurance is the appropriate management in summary. Incidentally, liquid findings are common and diverse, and there is important clinical questions. Some may require diligent for war because they may someday benefit from surgical or captured immediate intervention. Others require only reassurance. First steps in an incidental finding Sonic oh, are developing the skills to recognize them and understanding the implications and prognosis thanks to my colleagues to help with images and thank you for your attention, yeah.