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Background Evaluation of central venous pressure (CVP) by inferior vena cava (IVC) measurements is crucial in the management of patients with cardiogenic shock to optimize drugs therapy. IVC has a complex 3-dimensional (3D) shape but measurements used to estimate CVP remain based on 2-dimensional (2D) echocardiographic imaging. Purpose The aim of this study was to investigate the accuracy of CVP estimation by IVC size and collapsibility index obtained using 3D-echocardiography compared with 2D in patients with cardiogenic shock. Methods Eighty consecutive echocardiographic examinations performed in 33 patients (72 ± 15 years, left ventricular ejection fraction = 19 ± 10%) admitted for cardiogenic shock were prospectively included. Two and three-dimensional images of the IVC, performed at baseline and when CVP was ≤ 10 mmHg, were acquired simultaneous with invasive measurement of CVP, both at rest and during sniff test. 2D and 3D IVC diameters, 3D IVC area and collapsibility index (IVCCI) were assessed. The eccentricity index (EI) was computed from 3D data as the ratio of maximum over minimum IVC diameter. The cut-off value of 10 mmHg of CVP defined patient with euvolemia hemodynamic status. Results At rest, the IVC diameter averaged 23 ± 7 mm by 2D and 25 ± 8 × 19 ± 7 mm by 3D. IVC had an eccentric shape (EI = 1.3) that increased when CVP was ≤10 mmHg and during sniff test (P Fig. 1 ). Conclusions In patients with cardiogenic shock, IVCCI from area by 3D echocardiography is reproducible and accurate to evaluate CVP.

Free-floating thrombi in the right heart chambers is a rare phenomenon. Nearly 99% of detected cases are associated with the presence of proven pulmonary embolism. Its presence is associated with a poor outcome with a mortality between 27 to 44% according to studies. Despite the emergency of treatment, optimal management of free floating right heart thrombus remains controversial with no clear consensus. We present the case of a 84-year-old man hospitalised for acute decompensated heart failure. After an initial favourable evolution, a degradation of respiratory occurred with dyspnea and desaturation. A bedside transthoracic echocardiography showed a mobile serpiginous thrombus, 7cm size, moving to and across the tricuspid valve. A computed tomography of the chest demonstrated massive bilateral pulmonary embolism. After persistence of the thrombus and seven days of heparinotherapy, thrombolysis therapy was initiated. The thrombus disappeared 24h after thrombolysis. Without contra-indication, thrombolysis is a faster, readily available treatment for the management of floating thrombus in the right heart chambers associated with pulmonary embolism.

Free-floating thrombi in the right heart chambers is a rare phenomenon. Nearly 99% of detected cases are associated with the presence of proven pulmonary embolism. Its presence is associated with a poor outcome with a mortality between 27 to 44% according to studies. Despite the emergency of treatment, optimal management of free floating right heart thrombus remains controversial with no clear consensus. We present the case of a 84-year-old man hospitalised for acute decompensated heart failure. After an initial favourable evolution, a degradation of respiratory occurred with dyspnea and desaturation. A bedside transthoracic echocardiography showed a mobile serpiginous thrombus, 7cm size, moving to and across the tricuspid valve. A computed tomography of the chest demonstrated massive bilateral pulmonary embolism. After persistence of the thrombus and seven days of heparinotherapy, thrombolysis therapy was initiated. The thrombus disappeared 24h after thrombolysis. Without contra-indication, thrombolysis is a faster, readily available treatment for the management of floating thrombus in the right heart chambers associated with pulmonary embolism.

Introduction Aortic valve (AV) calcium quantification by cardiac Computed Tomography (cardiac CT) has been proposed as an alternative for AV stenosis quantification when echocardiography is uncertain. To limit X-ray radiation and cost, we developed an alternative AV calcium score based on 3D-transesophageal echocardiography (3D-TOE). Methods The study enrolled 29 patients referred for AV assessment (21 men and 8 women who were 78 ± 11 years old, average transaortic peak velocity was 4.18 ± 1.5 m/s and average mean transaortic gradient was 45 ± 18 mmHg). All patients underwent 3D-TOE and calcium score was derived from AV 3D full volume data using home-made region growing algorithm developed on MatLab® ( Fig. 2 ). Calcium score obtained with 3D-TOE was compared to AV calcium scoring obtained by cardiac CT. In patients referred for cardiac surgery, AV calcium scoring by CT was repeated on the explanted AV and calcium weight was obtained by pathology analysis. Results Calcium score by 3D-TOE (8877 ± 4024 AU) and CT (3155 ± 2360 AU) were fairly correlated (R = 0.88; P Fig. 1 ). Similar correlation was observed with CT calcium score on explanted AV (R = 0.89; P = 0.0014) and pathology data (R = 0.63; P = 0.0516). Inter-observer and intra-observer variability coefficients were 11% and 11%, respectively ( Fig. 1 , Fig. 2 ). Conclusion AV calcium load can be quantified using 3D-TOE. Excellent correlation was observed with AV calcium score obtained by CT.