189
Side-branch evaluation by main-vessel OCT
10. Suter Y, Schoenenberger AW, Toggweiler S, Jamshidi P, Resink T, Erne P. Intravascular ultrasound-based left main coronary artery assessment: comparison between pullback from left anterior descending and circumflex arteries. J Invasive Cardiol 2009;21:457 –60. 11. Tu S, Xu L, Ligthart J, Xu B, Witberg K, Sun Z et al. In vivo comparison of arterial lumen dimensions assessed by co-registered three-dimensional (3D) quantitative coronary angiography, intravascular ultrasound and optical coherence tomography. Int J Cardiovasc Imaging 2012;28:1315 –27. 12. Tu S, Holm NR, Christiansen EH, Reiber JH. First presentation of 3-dimensional reconstruction and centerline-guided assessment of coronary bifurcation by fusion of X-ray angiography and optical coherence tomography. JACC Cardiovasc Interv 2012;5: 884 –5. 13. Tu S, Jing J, Holm NR, Onsea K, Zhang T, Adriaenssens T et al. In vivo assessment of bifurcation optimal viewing angles and bifurcation angles by three-dimensional (3D) quantitative coronary angiography. Int J Cardiovasc Imaging 2012;28:1617 –25. 14. Di Mario C, Madretsma S, Linker D, The SH, Bom N, Serruys PW et al. The angle of incidence of the ultrasonic beam: a critical factor for the image quality in intravascular ultrasonography. Am Heart J 1993;125(2 Pt 1):442 –8. 15. Chae JS, Brisken AF, Maurer G, Siegel RJ. Geometric accuracy of intravascular ultrasound imaging. J Am Soc Echocardiogr 1992;5:577 –87. 16. Wang T, Wieser W, Springeling G, Beurskens R, Lancee CT, Pfeiffer T et al. Intravascular optical coherence tomography imaging at 3200 frames per second. Opt Lett 2013;38:1715 – 7.
IMAGE FOCUS
doi:10.1093/ehjci/jeu201 Online publish-ahead-of-print 9 October 2014
.............................................................................................................................................................................
Synovial sarcoma invades the left atrium: visualization with three-dimensional trans-oesophageal echocardiography Imaad Razzaque, Bijoy K. Khandheria, Renuka Jain, Suhail Allaqaband, and Khawaja Afzal Ammar* Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, #840, Milwaukee, WI 53215, USA
* Corresponding author. Tel: +1 414 649 3909; fax: +1 414 649 3551, Email: [email protected]
A 36-year-old male presented with right hemiplegia and aphasia. Computed tomography imaging showed showered infarcts with multi-organ involvement including left carotid filling defect and left upper lung mass encasing the left upper pulmonary vein (Panels A and B). Trans-thoracic echocardiogram revealed a left atrial mass oscillating into the left ventricle. Two-dimensional trans-oesophageal echocardiogram (TEE) demonstrated a large mass originating from the left upper pulmonary vein going into the left atrium and left ventricle (Panels C and D; Supplementary data online, Videos S1 and S2). Threedimensional (3D) TEE revealed relative anatomy of surrounding structures, including left atrial appendage, septum and tricuspid valve in greater detail. Panel E and Supplementary data online, Video S3 are a view of the tumour projecting outward from the left upper pulmonary vein while oscillating into the left ventricle, previously only viewable in the operating theatre by the surgeon. Core biopsies obtained from the mass illustrated highly mitotic spindles consistent with synovial sarcoma (Panel F, top arrow) with interspersed capillaries (Panel F, bottom arrow). Diagnosis was confirmed using fluorescence in situ hybridization demonstrating translocation t(X,18), seen in synovial carcinoma. There are no previous case reports of synovial sarcoma invading into the heart visualized with 3D TEE. Synovial sarcoma is a rare, aggressive, malignant tumour accounting for nearly 14% of all sarcomas with origination from lung or pleura. This case demonstrates the unique ability of 3D TEE in visualization of the tumour originating from the left upper pulmonary vein in a fashion otherwise available only to the surgeon in the operating theatre. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from http://ehjcimaging.oxfordjournals.org/ by guest on March 23, 2016
3. Farooq V, Serruys PW, Heo JH, Gogas BD, Okamura T, Gomez-Lara J et al. New insights into the coronary artery bifurcation hypothesis-generating concepts utilizing 3-dimensional optical frequency domain imaging. JACC Cardiovasc Interv 2011;4: 921 –31. 4. Koo BK, Waseda K, Kang HJ, Kim HS, Nam CW, Hur SH et al. Anatomic and functional evaluation of bifurcation lesions undergoing percutaneous coronary intervention. Circ Cardiovasc Interv 2010;3:113 –9. 5. Suarez de Lezo J, Medina A, Martin P, Novoa J, Pan M, Caballero E et al. Predictors of ostial side branch damage during provisional stenting of coronary bifurcation lesions not involving the side branch origin: an ultrasonographic study. EuroIntervention 2012; 7:1147 –54. 6. Di Mario C, Iakovou I, van der Giessen WJ, Foin N, Adrianssens T, Tyczynski P et al. Optical coherence tomography for guidance in bifurcation lesion treatment. EuroIntervention 2010;6(Suppl. J):J99 –J106. 7. Karanasos A, Tu S, van der Linden M, van Weenen S, Ligthart J, Regar E. Online 3-dimensional rendering of optical coherence tomography images for the assessment of bifurcation intervention. Can J Cardiol 2012;28:759e1 –3. 8. Sawada T, Shite J, Negi N, Shinke T, Tanino Y, Ogasawara D et al. Factors that influence measurements and accurate evaluation of stent apposition by optical coherence tomography. Assessment using a phantom model. Circ J 2009;73:1841 –7. 9. Oviedo C, Maehara A, Mintz GS, Tsujita K, Kubo T, Doi H et al. Is accurate intravascular ultrasound evaluation of the left circumflex ostium from a left anterior descending to left main pullback possible? Am J Cardiol 2010;105:948 –54.
Side-branch evaluation by main-vessel OCT
10. Suter Y, Schoenenberger AW, Toggweiler S, Jamshidi P, Resink T, Erne P. Intravascular ultrasound-based left main coronary artery assessment: comparison between pullback from left anterior descending and circumflex arteries. J Invasive Cardiol 2009;21:457 –60. 11. Tu S, Xu L, Ligthart J, Xu B, Witberg K, Sun Z et al. In vivo comparison of arterial lumen dimensions assessed by co-registered three-dimensional (3D) quantitative coronary angiography, intravascular ultrasound and optical coherence tomography. Int J Cardiovasc Imaging 2012;28:1315 –27. 12. Tu S, Holm NR, Christiansen EH, Reiber JH. First presentation of 3-dimensional reconstruction and centerline-guided assessment of coronary bifurcation by fusion of X-ray angiography and optical coherence tomography. JACC Cardiovasc Interv 2012;5: 884 –5. 13. Tu S, Jing J, Holm NR, Onsea K, Zhang T, Adriaenssens T et al. In vivo assessment of bifurcation optimal viewing angles and bifurcation angles by three-dimensional (3D) quantitative coronary angiography. Int J Cardiovasc Imaging 2012;28:1617 –25. 14. Di Mario C, Madretsma S, Linker D, The SH, Bom N, Serruys PW et al. The angle of incidence of the ultrasonic beam: a critical factor for the image quality in intravascular ultrasonography. Am Heart J 1993;125(2 Pt 1):442 –8. 15. Chae JS, Brisken AF, Maurer G, Siegel RJ. Geometric accuracy of intravascular ultrasound imaging. J Am Soc Echocardiogr 1992;5:577 –87. 16. Wang T, Wieser W, Springeling G, Beurskens R, Lancee CT, Pfeiffer T et al. Intravascular optical coherence tomography imaging at 3200 frames per second. Opt Lett 2013;38:1715 – 7.
IMAGE FOCUS
doi:10.1093/ehjci/jeu201 Online publish-ahead-of-print 9 October 2014
.............................................................................................................................................................................
Synovial sarcoma invades the left atrium: visualization with three-dimensional trans-oesophageal echocardiography Imaad Razzaque, Bijoy K. Khandheria, Renuka Jain, Suhail Allaqaband, and Khawaja Afzal Ammar* Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, #840, Milwaukee, WI 53215, USA
* Corresponding author. Tel: +1 414 649 3909; fax: +1 414 649 3551, Email: [email protected]
A 36-year-old male presented with right hemiplegia and aphasia. Computed tomography imaging showed showered infarcts with multi-organ involvement including left carotid filling defect and left upper lung mass encasing the left upper pulmonary vein (Panels A and B). Trans-thoracic echocardiogram revealed a left atrial mass oscillating into the left ventricle. Two-dimensional trans-oesophageal echocardiogram (TEE) demonstrated a large mass originating from the left upper pulmonary vein going into the left atrium and left ventricle (Panels C and D; Supplementary data online, Videos S1 and S2). Threedimensional (3D) TEE revealed relative anatomy of surrounding structures, including left atrial appendage, septum and tricuspid valve in greater detail. Panel E and Supplementary data online, Video S3 are a view of the tumour projecting outward from the left upper pulmonary vein while oscillating into the left ventricle, previously only viewable in the operating theatre by the surgeon. Core biopsies obtained from the mass illustrated highly mitotic spindles consistent with synovial sarcoma (Panel F, top arrow) with interspersed capillaries (Panel F, bottom arrow). Diagnosis was confirmed using fluorescence in situ hybridization demonstrating translocation t(X,18), seen in synovial carcinoma. There are no previous case reports of synovial sarcoma invading into the heart visualized with 3D TEE. Synovial sarcoma is a rare, aggressive, malignant tumour accounting for nearly 14% of all sarcomas with origination from lung or pleura. This case demonstrates the unique ability of 3D TEE in visualization of the tumour originating from the left upper pulmonary vein in a fashion otherwise available only to the surgeon in the operating theatre. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from http://ehjcimaging.oxfordjournals.org/ by guest on March 23, 2016
3. Farooq V, Serruys PW, Heo JH, Gogas BD, Okamura T, Gomez-Lara J et al. New insights into the coronary artery bifurcation hypothesis-generating concepts utilizing 3-dimensional optical frequency domain imaging. JACC Cardiovasc Interv 2011;4: 921 –31. 4. Koo BK, Waseda K, Kang HJ, Kim HS, Nam CW, Hur SH et al. Anatomic and functional evaluation of bifurcation lesions undergoing percutaneous coronary intervention. Circ Cardiovasc Interv 2010;3:113 –9. 5. Suarez de Lezo J, Medina A, Martin P, Novoa J, Pan M, Caballero E et al. Predictors of ostial side branch damage during provisional stenting of coronary bifurcation lesions not involving the side branch origin: an ultrasonographic study. EuroIntervention 2012; 7:1147 –54. 6. Di Mario C, Iakovou I, van der Giessen WJ, Foin N, Adrianssens T, Tyczynski P et al. Optical coherence tomography for guidance in bifurcation lesion treatment. EuroIntervention 2010;6(Suppl. J):J99 –J106. 7. Karanasos A, Tu S, van der Linden M, van Weenen S, Ligthart J, Regar E. Online 3-dimensional rendering of optical coherence tomography images for the assessment of bifurcation intervention. Can J Cardiol 2012;28:759e1 –3. 8. Sawada T, Shite J, Negi N, Shinke T, Tanino Y, Ogasawara D et al. Factors that influence measurements and accurate evaluation of stent apposition by optical coherence tomography. Assessment using a phantom model. Circ J 2009;73:1841 –7. 9. Oviedo C, Maehara A, Mintz GS, Tsujita K, Kubo T, Doi H et al. Is accurate intravascular ultrasound evaluation of the left circumflex ostium from a left anterior descending to left main pullback possible? Am J Cardiol 2010;105:948 –54.
