Version 1
: Received: 14 July 2023 / Approved: 19 July 2023 / Online: 19 July 2023 (12:05:13 CEST)
Version 2
: Received: 24 September 2023 / Approved: 26 September 2023 / Online: 27 September 2023 (14:24:14 CEST)
How to cite:
Elhakim, A.; Karkour, K.; Sauter, P.; Rode, M.; Elhakim, M.; Radke, P.; Saad, M. The Role of Endosongraphy in Cardiology: Clinical Applications. Preprints2023, 2023071290. https://doi.org/10.20944/preprints202307.1290.v2
Elhakim, A.; Karkour, K.; Sauter, P.; Rode, M.; Elhakim, M.; Radke, P.; Saad, M. The Role of Endosongraphy in Cardiology: Clinical Applications. Preprints 2023, 2023071290. https://doi.org/10.20944/preprints202307.1290.v2
Elhakim, A.; Karkour, K.; Sauter, P.; Rode, M.; Elhakim, M.; Radke, P.; Saad, M. The Role of Endosongraphy in Cardiology: Clinical Applications. Preprints2023, 2023071290. https://doi.org/10.20944/preprints202307.1290.v2
APA Style
Elhakim, A., Karkour, K., Sauter, P., Rode, M., Elhakim, M., Radke, P., & Saad, M. (2023). The Role of Endosongraphy in Cardiology: Clinical Applications. Preprints. https://doi.org/10.20944/preprints202307.1290.v2
Chicago/Turabian Style
Elhakim, A., Peter Radke and Mohamed Saad. 2023 "The Role of Endosongraphy in Cardiology: Clinical Applications" Preprints. https://doi.org/10.20944/preprints202307.1290.v2
Abstract
Background: Ultrasonography in medicine allows real time “dynamic” assessment of structure where the procedure takes place. This feature and design could be more advantageous than radiological “static” view imaging. Thus, it is the convincing imaging tool for many structural cardiovascular and gastrointestinal interventions. Technically, the image resolution for Endosonography (EUS) is noticeably higher than that of transesophageal echocardiography (TOE). The benefits of investigating the cardiovascular structures using this high-resolution endoscope are unknown. Clinical applications: We present clinical applications of incidentally diagnosed cardiovascular structures, which demonstrated during routine gastrointestinal endosonographic procedures. These diagnoses could influence changes in management strategies. Discussion: The introduction of high resolution endosonography (EUS) in cardiology allows "panoramic" and “dynamic” real-time assessment of cardiovascular structures with an accurate definition of the variable cardiovascular anatomy. Using this advantage during routine gastrointestinal procedures allows for the early detection of asymptomatic cardiac pathologies and accompanying diseases, prevents double investigations for patients and operators, eliminates the risk of esophageal trauma, highlights interdisciplinary teamwork benefits, and could facilitate in the future the indications for cardiac-based structural procedures, which could influence management strategies with improved safety, efficacy, and economic outcomes. Conclusion: The introduction of endosonography (EUS) in cardiology provide high-resolution real-time assessments of cardiovascular anatomy. Thus, it can be used for early detections of variable cardiovascular pathologies during routine gastrointestinal procedures.
Keywords
Endosonographic ultrasound; transesophageal echocardiography; left atrial appendage thrombus; mitral and aortic valve; left ventricle
Subject
Medicine and Pharmacology, Cardiac and Cardiovascular Systems
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received:
27 September 2023
Commenter:
Abdelrahman Elhakim
Commenter's Conflict of Interests:
Author
Comment:
I added a new chapter EUS-Guided Cardiovascular Interventions In the last years, endoscopic EUS has been evolving in gastroenterology from a diagnostic to interventional based procedure [28].On the other side, to our information, EUS in cardiology as diagnostic or therapeutic tool is still poorly discussed or rarely used in daily clinical practice. Due to the proximity of the posterior mediastinum to esophagus and EUS design, cardiovascular structures can be technically accessed by EUS. It could provide real-time sampling to confirm diagnosis of rare primary cardiac tumors instead of open-heart surgery in high-risk patients. In animal models, samples of the coronaries, atria, ventricles, and valvular apparatus with no major adverse events are reported in isolated cases [29].In daily clinical practice, there are little case reports in the literature of EUS usage as diagnostic tool to assess cardiovascular structures in high risk non operable patients. A case report of a 65-year-old female cardiac CT revealed a right-sided cardiac tumor with signs of invasion of the interatrial septum, superior and inferior caval veins, and liver parenchyma. An attempt of radiological guided puncture and biopsy was unsuccessful.Thus, a second attempt of EUS-guided transesophageal puncture was performed without any adverse events as follow: A linear echoendoscope was introduced in the middle thoracic esophagus, and a solid hypoechoic mass depending on the atrial right wall was observed. The lesion was punctured with a 22-gauge needle (Expect, Boston Scientific, Natick, Mass) with smooth to-and-fro movements. On-site cytopathology results confirmed the diagnosis of cardiac angiosarcoma [30]. Another case of 26-year-old male presented with recent-onset shortness of breath. Cardiac magnetic resonance imaging showed a large, infiltrative mass with post-contrast enhancement in the right atrium with pericardial extension. Linear EUS showed a large mass (8×8cm) within the right atrium along with diffusely thickened inferior and posterior.25G core needle (Acquire, Boston Scientific Co, Massachusetts, United States) from the posterior pericardium with two smooth to-and-fro movements. On-site cytopathology results confirmed the diagnosis of cardiac angiosarcoma [31]. Furthermore, a case of successful EUS-guided transesophageal pericardial cyst drainage has been reported [32]. Moreover, two case reports of Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) of left atrial masses has been successfully performed in which cardiac surgery was hazardous due to the comorbidity or previous surgical interventions. The cytopathology confirmed the diagnosis of a Burkitt lymphoma and a synovial sarcoma [33]. These findings suggest the possibility that in selected cases, linear endosonography can be used as a minimally invasive technique for intracardiac tumor diagnostics. While the reports are exciting, these are anecdotal cases, and more studies are required to assess the safety and efficacy of such interventions.
Commenter: Abdelrahman Elhakim
Commenter's Conflict of Interests: Author
EUS-Guided Cardiovascular Interventions
In the last years, endoscopic EUS has been evolving in gastroenterology from a diagnostic to interventional based procedure [28].On the other side, to our information, EUS in cardiology as diagnostic or therapeutic tool is still poorly discussed or rarely used in daily clinical practice. Due to the proximity of the posterior mediastinum to esophagus and EUS design, cardiovascular structures can be technically accessed by EUS. It could provide real-time sampling to confirm diagnosis of rare primary cardiac tumors instead of open-heart surgery in high-risk patients. In animal models, samples of the coronaries, atria, ventricles, and valvular apparatus with no major adverse events are reported in isolated cases [29].In daily clinical practice, there are little case reports in the literature of EUS usage as diagnostic tool to assess cardiovascular structures in high risk non operable patients. A case report of a 65-year-old female cardiac CT revealed a right-sided cardiac tumor with signs of invasion of the interatrial septum, superior and inferior caval veins, and liver parenchyma. An attempt of radiological guided puncture and biopsy was unsuccessful.Thus, a second attempt of EUS-guided transesophageal puncture was performed without any adverse events as follow: A linear echoendoscope was introduced in the middle thoracic esophagus, and a solid hypoechoic mass depending on the atrial right wall was observed. The lesion was punctured with a 22-gauge needle (Expect, Boston Scientific, Natick, Mass) with smooth to-and-fro movements. On-site cytopathology results confirmed the diagnosis of cardiac angiosarcoma [30]. Another case of 26-year-old male presented with recent-onset shortness of breath. Cardiac magnetic resonance imaging showed a large, infiltrative mass with post-contrast enhancement in the right atrium with pericardial extension. Linear EUS showed a large mass (8×8cm) within the right atrium along with diffusely thickened inferior and posterior.25G core needle (Acquire, Boston Scientific Co, Massachusetts, United States) from the posterior pericardium with two smooth to-and-fro movements. On-site cytopathology results confirmed the diagnosis of cardiac angiosarcoma [31]. Furthermore, a case of successful EUS-guided transesophageal pericardial cyst drainage has been reported [32]. Moreover, two case reports of Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) of left atrial masses has been successfully performed in which cardiac surgery was hazardous due to the comorbidity or previous surgical interventions. The cytopathology confirmed the diagnosis of a Burkitt lymphoma and a synovial sarcoma [33]. These findings suggest the possibility that in selected cases, linear endosonography can be used as a minimally invasive technique for intracardiac tumor diagnostics. While the reports are exciting, these are anecdotal cases, and more studies are required to assess the safety and efficacy of such interventions.