bluuebunny/crossref_metadata_2025 huggingface dataset:
Transesophageal Echocardiographic Identification of a Bicuspid Pulmonary Valve Associated with Congenitally Corrected Transposition of the Great Arteries
Authors: FINCH ANA D. , SNELL DERRY R. , SANYAL RAJAT S. , NANDA NAVIN C. , LOUNGANI RAMESH R.
Published: August 2007

We are reporting, for the first time, the echocardiographic identification of a bicuspid pulmonary valve associated with congenitally corrected transposition of the great arteries.
Retrieval of a Distal Right Pulmonary Artery Vegetative Embolus Under Transesophageal Echocardiographic Guidance
Authors: VAN TUONG B. , HALLDORSSON ARI , BAUCUM RALPH W. , RATTS THOMAS E. , GHALI JALAL K. , MOSLEY LAWRENCE E. , EGGERSTEDT JANE M. , HANLEY HENRY G.
Published: August 2007

Transesophageal echocardiography has proved to be a versatile and valuable diagnostic tool. It has successfully been used to guide valvuloplasties and intracardiac biopsies. However, there is no report in the literature that transesophageal echocardiography has previously been used to diagnose and guide the subsequent retrieval of a vegetative embolus from the distal right pulmonary artery. We report a case of tricuspid valve endocarditis with embolization in which transesophageal echocardiography was used to make the diagnosis and guide the retrieval of the vegetative embolism from the distal right pulmonary artery.
Echocardiographic Evaluation of Isolated Pulmonary Valve Disease in Adolescents and Adults
Authors: MULHERN KEVIN M. , SKORTON DAVID J.
Published: August 2007

Congenital pulmonary valve disease is often not discovered until adolescence or adulthood. Transthoracic two‐dimensional echocardiography can provide detailed information regarding right ventricular outflow anatomy, although images are often less satisfactory than those obtained in infants and children. The more recent addition of biplanar transesophageal echocardiography has enhanced our ability to image the right ventricular outflow tract, pulmonary valve, and pulmonary artery noninvasively. Pulsed and continuous‐wave Doppler estimates of subvalvular and transvalvular gradients have proved to be accurate. Doppler color flow mapping has proved useful in determining the location and direction of stenotic and regurgitant flow. With no accepted standard for comparison, quantification of regurgitation remains problematic. In many cases, echocardiography has replaced catheterization and angiography in the evaluation and long‐term follow‐up of congenital pulmonary valve disease before and after intervention.
Coarctation of the Aorta in the Adolescent and Adult:
Authors: CYRAN STEPHEN E.
Published: August 2007

The combination of two‐dimensional and continuous‐wave (CW) Doppler echocardiographic imaging forms the cornerstone of diagnostic imaging in pre‐ or postoperative coarctation of the aorta. Because of the frequent association of other congenital heart defects, e.g., bicuspid aortic valve, a segmental imaging approach with multiple image planes should be used. CW Doppler examination from the suprasternal notch should be utilized to assess the degree of obstruction at the coarctation site in all patients. This enhances diagnostic sensitivity. CW Doppler examination can also be applied throughout exercise. Such application allows detection of relative degrees of aortic obstruction following surgical repair of coarctation that may only manifest at elevated levels of cardiac output, e.g., exercise. It aids in the identification of individuals with exercise related systolic hypertension following “successful” coarctectomy and provides a rationale for treatment with beta blockade. The methodology for applying this relatively new technique is discussed.
Echocardiographic Guidance During Placement of the Buttoned Double‐Disk Device for Atrial Septal Defect Closure
Authors: MINICH L. LUANN , SNIDER A. REBECCA
Published: August 2007

The usefulness of two‐dimensional and Doppler echocardiography during buttoned double‐disk device closure of an atrial septal defect was evaluated in 20 consecutive patients at the time of interventional catheterization. Transesophageal echocardiography was used in 11 patients (ages 5 to 62 years, weights 20 to 91 kg). Because of the size of the available transesophageal echo probe, transthoracic echocardiography was used in the remaining 9 patients (ages 4 to 5.5 years, weights 14 to 21 kg). In the transesophageal echo group, 1 patient was found to have no atrial septal defect despite a previous diagnosis by transthoracic echocardiography, 3 patients had atrial septal defects too large for closure despite attempts in 2, and 7 patients had transesophageal echo guided device placement. All of these 7 patients had small residual shunts by color Doppler, 2 had unusual arm positions, and 2 had surgical removal of the device due to embolization to the pulmonary artery in 1 and failure to obtain close approximation of the occluder and counteroccluder in 1. In the transthoracic echo group, 2 patients had atrial septal defects too large for closure, 1 patient had no femoral venous access, and 6 patients had transthoracic echo guided device placement. All of these 6 patients had small residual shunts by color Doppler and 3 of the 6 had unusual arm positions. For atrial septal defect sizing, transesophageal echo measurements correlated with catheter balloon size more closely than did transthoracic echo measurements (r2 = 0.97 vs 0.86). Echocardiography was particularly useful for sizing the defect in two orthogonal views (n = 18), sizing total atrial septal length to determine maximum usable device size (n = 15), imaging septal rims (n = 19), determining effectiveness of balloon occlusion for sizing (n = 16), placement of occluder and counteroccluder (n = 15), detecting residual shunts (n = 15), and detecting unusual arm positions with or without new‐onset valve regurgitation (n = 5). Thus, echocardiographic imaging is an essential component of atrial septal defect closure during cardiac catheterization. (ECHOCARDIOGRAPHY, Volume 10, November 1993)
Left Ventricular Volume and Mass:Comparative Study of Two‐Dimensional Echocardiography and Ultrafast Computed Tomography
Authors: KURODA TOSHIO , SEWARD JAMES B. , RUMBERGER JOHN A. , YANAGI HIDEKIYO , TAJIK A. JAMIL
Published: August 2007

This study was undertaken to define the accuracy of two‐dimensional echocardiography in the determination of left ventricular end‐diastolic and end‐systolic volumes, stroke volume, ejection fraction, and mass when compared to ultrafast cine computed tomography in the same 56 patients. Single‐plane and biplane modified Simpson's rule, single‐plane and biplane ellipsoidal formula, bullet formula (biplane only), and biapical Simpson's rule methods were utilized. Linear regression analysis showed the strongest correlation with the modified biplane Simpson's rule (mean r =0.897). In valvular heart disease (n=12) and dilated cardiomyopathy (n = 6), the mean correlation coefficients for all methods were high (r = 0.894 and 0.911, respectively). The mean correlation coefficient for all methods in patients with prior myocardial infarction (n=25) was relatively poor (r = 0.643). Intraobserver and interobserver variabilities for all methods were low (r= 0.980 and 0.965, respectively). It is concluded that calculations of left ventricular volumes and mass by two‐dimensional echocardiography are accurate and reproducible in patients with a global effect on the left ventricle and were less acceptable in patients with segmental (ischemic) left ventricular involvement. The best measurement technique is a modified biplane Simpson's rule.
Diagnosis of Accessory Mitral Valve Tissue by Transesophageal Echocardiography
Authors: WILLENS HOWARD J. , LEVY RALPH , PEREZ ANGEL
Published: August 2007

Accessory mitral valve tissue is a rare cause of intracardiac mass and subvalvular left ventricular outflow tract obstruction. The preoperative diagnosis of this congenital anomaly has been facilitated by transthoracic two‐dimensional and Doppler echocardiography. However, transthoracic two‐dimensional echocardiography cannot identify or correctly diagnose all cases of accessory mitral valve tissue. We report a patient in whom an intracardiac mass detected by transthoracic echocardiography was definitively diagnosed as accessory mitral valve tissue by transesophageal echocardiography.

accessory mitral valve tissue, subaortic stenosis, transesophageal echocardiography, intracardiac mass
Dynamic Three‐Dimensional Echocardiographic Imaging of Congenital Heart Defects in Infants and Children by Computer‐Controlled Tomographic Parallel Slicing Using a Single Integrated Ultrasound Instrument
Authors: FULTON DAVID R. , MARX GERALD R. , PANDIAN NATESA G. , ROMERO BARBARA A. , MUMM BERNARD , KRAUSS MICHAEL , WOLLSCHLÄGER HELMUT , LUDOMIRSKY ACHI , CAO QI‐LING
Published: August 2007

Three‐dimensional cardiac reconstruction generated from transesophageal interrogation can be performed using an integrated unit that captures, processes, and postprocesses tomographic parallel slices of the heart. This probe was used for infants and young children in the transthoracic position to evaluate the feasibility of producing three‐dimensional cardiac images with capability for realtime dynamic display. Twenty‐two infants and children (range 1 day–3.5 years) underwent image acquisition using a 16 mm 5 MHz 64 element probe placed over the precordium. Two infants were also imaged from the subcostal position. Data was obtained and stored over a single cardiac cycle after acceptable cardiac and respiratory gating intervals were met. The transducer was advanced in 0.5–1 mm increments over the cardiac structures using identical acquisition criteria. The images were reconstructed from the stored digital cubic format and could be oriented in any desired plane. In 9 of the 22 infants the images obtained were of optimal quality. The images obtained displayed normal cardiac structures emphasizing depth relationships as well as visualization of planes not generally demonstrated by two‐dimensional imaging. Several lesions were also depicted in a unique fashion using this technique. Though the method employed was limited by movement artifact and reconstruction time, the quality of the three‐dimensional display was excellent and enhanced by realtime demonstration. The transthoracic approach was successful in capturing sufficient data to create three‐dimensional images, which may have further application in more accurate diagnosis of complex cardiac abnormalities and generation of planes of view which could duplicate surgical visualization of a lesion. Further assessment of the technique in infants with congenital heart disease is warranted.

echocardiography, three‐dimensional echocardiography, three‐dimensional reconstruction, ultrasound, congenital heart disease
Diagnosis of Main‐Stem Pulmonary Thromboemboli by Transesophageal Echocardiography
Authors: FISHEL ROBERT SCOTT , MERLINO JOHN DAMIEN , FELNER JOEL MICHAEL
Published: August 2007

The aim of this report is to describe the usefulness of transesophageal echocardiography in the diagnosis of pulmonary emboli. A biplane transesophageal probe was used to examine the pulmonary artery in multiple views in three patients with suspected pulmonary emboli. The diagnosis of pulmonary emboli was made by transesophageal echocardiography in each of three patients when an echodense, circular or linear mass was seen in more than one view of the main or right pulmonary artery. In conclusion, our findings, coupled with previous case reports, suggest that transesophageal echocardiography should be considered in all critically inpatients with suspected pulmonary emboli.

transesophageal echocardiography, pulmonary embolus
Successful Withdrawal of Biventricular Assist Devices After Assessment of Left Ventricular Function by Transesophageal Echocardiography and Automatic Border Detection
Authors: FEINBERG MICHA S. , DAVILA‐ROMAN VICTOR G. , HOPKINS WILLIAM E. , SPRAY THOMAS L. , PEREZ JULIO E. , BARZILAI BENICO
Published: August 2007

A case of cardiogenic shock after mitral valve repair that was successfully treated with a ventricular assist device is reported. Evaluation of left ventricular function performed on line by serial trans‐esophgeal echocardiography (TEE) with automatic border detection (ABD) showed improvement in left ventricular function from day 2 to day 6 (fractional area change 7% at day 2; 38% at day 6). TEE with ABD is a promising new approach for online evaluation of ventricular function, and has a promising role in determining the timing for successful removal of mechanical assist devices after surgical intervention.
Quantitative Assessment of Normal and Stenotic Aortic Valve Using Transesophageal Three‐Dimensional Echocardiography
Authors: NANDA NAVIN C. , ROYCHOUDHURY DEBASISH , CHUNG SANG‐MAN , KIM KEE‐SIK , OSTLUND VICKI , KLAS BERTHOLD
Published: August 2007

The present study demonstrates the feasibility of transesophageal three‐dimensional reconstruction of normal, sclerotic, and stenotic aortic valves using a computed tomographic ultrasound system. The study also shows the potential clinical usefulness of this technique in delineating aortic valve morphology (extent and severity of valve thickening and calcification and size and number of cusps) and assessing aortic orifice areas by direct planimetry of the three‐dimensional images.
High Frequency Phenomena in Regurgitant Jets
Authors: ACAR PH. , DELOUCHE A. , BERREBI A. , DELOUCHE PH. , DUMEE PH. , DIEBOLD B.
Published: August 2007

Color Doppler echocardiography is accepted as a useful tool for evaluating valvular regurgitation but, so far, it does not allow for a precise quantification of the regurgitant volume since it is limited by the combination of velocity ambiguities, a limited resolution, and a low frame rate. The low frame rate is imposed by the sector angle, the packet size, the pulse repetition rate, the line density, and the sequential analysis of the ultrasound emissions. On the other hand, the images are supposed to depict pulsatile jets surrounded by high frequency pulsatile vortices. The present study was designed to search for the presence of high frequency phenomena in turbulent jets and to analyze the influence of the low frame rate on the jet images. An in vitro study using an aliasing‐free laser Doppler and a hydraulic model simulating intracardiac jets was carried out. An analysis of flow events with a high bandwidth (500 Hz) was conducted using M‐mode color displays of the velocities. It showed: (1) on the centerline, a slow propagation of the front of the jet, and low frequency velocity fluctuations (< 50 Hz); and (2) at the opposite, in the boundary layer of the jet, very rapid fluctuations with frequencies comprised between 50 and 500 Hz. On two‐dimensional color images of laser Doppler data, the size of the central laminar core appeared strongly modified by a decrease in frame rate up to the maximum one commonly used in color Doppler (30 frames / sec) as well by a decrease in line density. These data demonstrate that higher frame rate could improve the accuracy of ultrasound color Doppler flow mapping.
Endomyocardial Fibrosis with Unusual Patterns of Endocarditis and Pericarditis
Authors: AYMAN MOHAMED , RASHWAN MAGDY A. , ASHOUR SANAA , HASANEIN MAHMOUD M. , NANDA NAVIN C. , WINOKUR THOMAS S.
Published: August 2007

In this report of three patients with EMF, we report the unusual affection of the pericardium with echocardiographic epicardial thickening and pericardial inflammatory reaction, the presence of schistosomal granuloma in the pericardium, echocardiographic evidence of dense extensive fibrotic endocardial lesions, and microscopic evidences of an ongoing fibrotic process.
Echocardiography Practice Issues
Authors: GARDIN JULIUS M.
Published: August 2007

With the major changes in the delivery of medical care brought about by “health care reform,” the American Society of Echocardiography has become active in dealing with a variety of issues related to reimbursement, continuing quality improvement, training, examination, and certification outcomes research, and strengthening of relations with local societies. These efforts will undoubtedly continue to occupy a major role in the Society's agenda. The importance of cooperation among echocardiographers, sonographers, and other cardiac ultrasound professionals in ensuring the proper role of echocardiography in the practice of medicine cannot be overemphasized.
Doppler Echocardiography in Familial Hypertrophic Cardiomyopathy
Authors: DUBOURG OLIVIER , ISNARD RICHARD , HAGÈGE ALBERT , JONDEAU GUILLAUME , DESNOS MICHEL , SACREZ ANDRÉ , BOUHOUR JEAN BRIEUC , PELLENC PATRICK MESSNER , MILLAIRE ALAIN , FETLER LUC , GUICHENEY PASCAL , SCHWARTZ KETTY , KOMAJDA MICHEL
Published: August 2007

Familial hypertrophic cardiomyopathy (HCM) has been poorly studied, although it may represent 50% of all HCM. We studied 346 subjects belonging to 20 unrelated families. Patients were considered affected in view of left ventricular (LV) wall thickness. One hundred twenty‐seven adults were considered affected, id est. had a left ventricular wall thickness (LVWT) > 13 mm, whereas 123 had a LVWT > 15 mm, suggesting that the cut‐off value is usually not critical. Within affected patients, 95% had an asymmetrical HCM (interventricular septum/left posterior wall thickness > 1.3 mm), whereas 84% had a ratio > 1.5. Distribution of the affected patients according with Maron's classification are in keeping with published studies about sporadic forms. Doppler derived isovolumetric relaxation time was prolonged in HCM (105 ± 23 vs 88 ± 16 msec, P < 0.001), and the ratio peak velocity of A wave over peak velocity of E wave was significantly lower in affected individuals (0.99 ± 0.56 vs 0.83 ± 0.46, P < 0.05). None of the 24 children studied (10 ± 3 years) were considered affected according to echocardiographic criteria. Conclusion: Echocardiography is the obligatory first step during genetic study for recognizing familial HCM. It allows classification in adults but not in children. Doppler estimate ofdiastolic function may be helpful in the future to recognize genetically affected subjects with normal or subnormal echocardiographic examination.
Transesophageal Echocardiographic Study of Ebstein's Anomaly
Authors: VARGAS‐BARRON JESUS , RIJLAARSDAM MARIA , ROMERO‐CARDENAS ANGEL , ESPINOLA‐ZAVALETA NILDA , MANRIQUE‐RINCON FRANSCISCO , KEIRNS CANDACE
Published: August 2007

Twenty‐four adults with Ebstein's anomaly were studied using transesophageal echocardiography (TEE) with color Doppler. Transesophageal and transgastric images in transverse and longitudinal planes made it possible to study wall attachments and anomalous insertions of the three tricuspid leaflets. Transesophageal imaging allows estimation of functional and atrialized right venticle as well as wall thickness and mobility. A semiquantitative estimate of tricuspid regurgitation and identification of associated flow defects were performed with color‐coded Doppler. In 22 of the 24 patients, interatrial shunts were documented; there were three cases with a ventricular septal defect and in three cases, mild hypoplasia of the right ventricular outflow tract; one with hypoplasia of the pulmonary artery. One patient had an associated patent ductus arteriosus. It is concluded that TEE with a biplanar probe provides information that complements that of transthoracic studies in the diagnostic evaluation of patients with Ebstein's anomaly.
The First International Stress Echo Symposium
Authors: PICANO EUGENIO , DISTANTE ALESSANDRO
Published: August 2007

The First International Stress Echo Symposium (held in Pisa, Italy on January 12‐14, 1993) was a good occasion for old and new friends to come to Pisa to discuss their work and plan future ventures.
The Role of Transesophageal Echocardiography in the Management of Patients with Acute and Chronic Pulmonary Thromboembolism
Authors: LENGYEL MARIA
Published: August 2007

Acute and chronic pulmonary thromboembolism carry high mortality. The role of transesophageal echocardiography (TEE), however, has not been well delineated in patients with suspected pulmonary thromboembolism. The aim of the present study was to demonstrate the value of TEE in patients with various clinical manifestations of pulmonary thromboembolic disease. Twelve patients—ten males and two females, age 47–85 years—are presented in whom central pulmonary thromboembolism was found by TEE. Six patients were referred for breathlessness and had moderate to severe pulmonary hypertension (PH) with (3) or without (1) right atrial thrombus or had right heart dilatation (1) or right ventricular myxoma (1) on transthoracic echocardiography (TTE). Thrombolysis (2), surgery (2), and heparin (2) treatment was performed without angiography. All but one patient recovered. Six patients had severe PH by TTE, one of them had a right atrial thrombus. Angiography was done in five patients in whom surgery was considered. Pulmonary thromboendarterectomy was successfully performed in two patients, it was contraindicated in two patients for advanced age or severe left ventricular dysfunction, both patients died during follow‐up, and two patients were waiting for surgery. In conclusion: TEE has a definite role in the management of patients with acute pulmonary thromboembolism or in pulmonary embolism associated with right‐sided intracardiac masses and in the selection of patients with PH for pulmonary thrombo‐endarterectomy.
Pulmonary Venous Flow as Assessed by Doppler Echocardiography
Authors: MEIJBURG HUUB W. J. , VISSER CEES A.
Published: August 2007

During the past few years Doppler assessment of pulmonary venous flow has gained increasing interest. The growing experience with the use of transesophageal echocardiography, the approach that nearly always yields registrations adequate for quantitative analysis, has markedly contributed in this respect. The Doppler‐derived pulmonary venous flow pattern can be regarded as a measure of left atrial inflow and it augments the clinical significance of Doppler transmitral flow in the evaluation of diastolic left ventricular function. This article summarizes physiological background, possible applications, and limitations of Doppler echocardiography of pulmonary venous flow in clinical cardiology.
Pulmonary Venous Flow and Correlates in Patients with Aortic Stenosis
Authors: PETEIRO JESUS , REDONDO FRANCISCO , PASALODOS JAVIER , CASTRO ALFONSO
Published: August 2007

In order to determine the value of pulmonary venous flow (PVF) pulsed Doppler measurements in assessing filling pressures in aortic stenosis (AS), we studied 20 patients by transthoracic and transesophageal echocardiography and catheter examination. Peak systolic PVF correlated with pulmonary capillary wedge pressure (PCWP) (r =‐0.67, P < 0.01), the ratio of peak systolic to diastolic PVF correlated with PCWP (r =‐0.68, P < 0.01) and left ventricular end‐diastolic pressure (r =‐0.51, P < 0.01). Peak systolic PVF < 40 cm / sec was highly sensitive and specific in the detection of PCWP ≥ 15 mmHg (100% and 84%, respectively). Correlations between PVF and pulsed Doppler transmitral indices were also found (r = 0.66 between peak systolic to diastolic PVF and peak late transmitral velocity, P < 0.01); however, PVF indices predicted filling pressures better than Doppler transmitral indices. In conclusion PVF indices are accurate predictors of high filling pressures in AS patients.
Mitral Annular Calcification Mimicking an Intracardiac Mass
Authors: PRASAD NIRAJ K. , ALAM MOSIN , ROSMAN HOWARD S. , SILVERMAN NORMAN A.
Published: August 2007

We present two patients with atypical mitral annular calcification. In both instances, the annular calcification presented as a mass localized to the atrioventricular junction. In one instance, there was a mobile element of the mass which resulted in an embolic stroke. In conclusion, atypical mitral annular calcification can mimic an intracardiac mass. It is usually recognized by its typical location and echocardiographic characteristics.
Incremental Value of Three‐Dimensional Echocardiography Over Transesophageal Multiplane Two‐Dimensional Echocardiography in Qualitative and Quantitative Assessment of Cardiac Masses and Defects
Authors: NANDA NAVIN C. , RAHMAN SAYED MOHAMMED ABD‐EL , KHATRI GAJENDRA , AGRAWAL GOPAL , EL‐SAYED ADEL A. , HASSANIAN HASSAN A. SHEHATA , KAMRAN MOHAMMAD , KIRKLIN JAMES , McGIFFIN DAVID C. , HOLMAN WILLIAM L. , PACIFICO ALBERT D.
Published: August 2007

In the present study, we compared three‐dimensionally (3‐D) reconstructed images with multiplane two‐dimensional (2‐D) transesophageal echocardiographic (TEE) images in 17 patients with various cardiac masses and defects. To overcome the problem of making measurements from 3‐D reconstructed images, we carefully “dissected” the 3‐D dataset using paraplane and anyplane 2‐D sections, which were then used to obtain the maximum sizes of the cardiac masses and defects. Of the 15 vegetations and 9 abscesses detected by 3‐D TEE in 7 patients, only 8 (53%) vegetations and 4 (44%) abscesses were detected by multiplane 2‐D TEE (P < 0.02). Also, the exact anatomical location, shape, geometry, and extent of various cardiac masses and defects were more clearly delineated by 3‐D than 2‐D TEE. The maximum dimensions of cardiac masses and defects were larger by 3‐D than by 2‐D TEE in 17 (89%) of the 19 lesions available for comparison (P < 0.002). In addition, 3‐D TEE correlated more closely than 2‐D TEE when compared to surgical measurements in three patients in whom they were available. Thus, it would appear that in several instances, the exact size of the cardiac lesion could only be assessed by analysis of the 3‐D volumetric dataset. Out preliminary study has demonstrated the superiority of transesophageal 3‐D reconstruction over multiplane 2‐D TEE in both qualitative and quantitative assessment of various cardiac mass lesions and pathological defects.
Temporality in Ultrasound‐Induced Cell Lysis In Vitro
Authors: AZADNIV MITRA , DOIDA YUKIO , MILLER MORTON W. , BRAYMAN ANDREW A. , MELTZER RICHARD S.
Published: August 2007

To test the hypothesis that the full extent of in vitro cell lysis due to ultrasound becomes evident with time lapse following insonation, human erythrocytes (2% hematocrit) in autologous plasma were mixed with Albunex®, a pulse echo contrast agent, and exposed to 1‐MHz, continuous‐wave ultrasound (US) (5 W/cm2 SPTA intensity) for 60 seconds while in a rotating (200 rpm) dialysis membrane vessel. Exposed and sham‐exposed samples were subsequently assayed for hemolysis colorimetrically, either immediately or after a delay of 3 hours. Hemolysis was dependent on the interval between US exposure and assay, with significantly greater lysis evident with delayed assay. There was also temporality in lytic yield with sample number, i.e., with time postpreparation of the blood sample, US‐induced cell lysis decreased. The temporality of lytic yield was eliminated by maintenance at ice water temperatures, or by waiting about 1 hour before beginning treatments. The collective data indicate that the full extent of US‐induced cell lysis is not evident upon assay immediately after insonation, and that with time postpreparation and preinsonation, erythrocytes may undergo changes in sensitivity to US.
Autumatic Border Detection to Assess Right Ventricular Function Following Surgical Treatment of Thromboembolic Pulmonary Hypertension
Authors: RASMUSSEN CHARLES M. , DYER DANIEL , WHEELER KAREN , DONAGHEY LINDA , KWAN OI LING , DITTRICH HOWARD C.
Published: August 2007

Automatic border detection (ABD) has been developed as a potentially useful means for evaluating ventricular function on line in an automatic fashion. Its success with tracking left ventricular function is established, but little is known about its ability to assess right ventricular (RV) function. Accordingly, 20 patients with severe pulmonary hypertension due to chronic thromboembolic disease underwent standard two‐dimensional echocardiography and imaging with ABD before and after pulmonary thromboendarterectomy to correct pulmonary hypertension. ABD‐derived results were compared to manually planimetered RV areas calculated from the apical four‐chamber view. Doppler tricuspid regurgitant velocity fell significantly with surgery from 4.4 ± 0.6 to 2.9 ± 0.7 m / sec (P < 0.001). The mean values for RV areas derived by manual planimetry and ABD were similar, as was fractional area shortening, which improved significantly with surgery (manual 0.24 ± 0.01 preoperative vs 0.31 ± 0.11 postoperative, P < 0.05; and ABD 0.19 ± 0.05 preoperative vs 0.32 ± 0.15 postoperative, P < 0.001). There was, however, very little correlation between the individual values for ABD versus manually derived RV areas and fractional area shortening, with the best correlation being the RV end‐diastolic areas after surgery (y = 0.684x + 7.9, r = 0.564, P = 0.01). These results demonstrate that both manually planimetered RV areas and those determined by ABD can adequately follow changes in ventricular function over time. However, variability within each technique may prevent direct comparison of the absolute values of the two techniques.
Ultrasonic Evaluation of the Abdominal Aorta
Authors: BLUTH EDWARD I. , LoCASCIO LLOYD
Published: August 2007

Ultrasound is a very accurate and cost‐effective method for evaluating the aorta and identifying abdominal aortic aneurysms. It is also valuable for following aneurysms for expansion. In the future, the use of color flow Doppler imaging may further prevent the risk of rupture by identifying specific high risk flow patterns.
Imaging Modalities in the Diagnosis of Acute Aortic Dissection
Authors: SCHNEIDER MANFRED , MÜGGE ANDREAS , DANIEL WERNER G.
Published: August 2007

The management of patients with acute aortic dissection requires a rapid diagnosis and precise information about the localization and extent of the dissection. Four imaging techniques are currently available to diagnose aortic dissection: aortography; contrast‐enhanced computerized tomography (CECT); magnetic resonance imaging (MRI); and transesophageal echocardiography (TEE). All of these techniques have their specific advantages and inherent limitations. Recent studies have demonstrated that MRI may best provide a comprehensive and detailed evaluation of the thoracic aorta, therefore proposing this technique as a “new gold standard” in the diagnosis of acute aortic dissection. TEE, however, may be the best alternative technique, as it combines high sensitivity and specificity with high practicality. The practicality is particularly important in hemodynamically unstable patients in whom a rapid bedside imaging modality is required. CECT might be necessary in selected cases in whom TEE fails to provide a definite diagnosis. Aortography may be necessary in patients in whom clinical signs are suggestive of organ ischemia and in whom coronary anatomy needs to be delineated before operation.
Supine Bicycle Exercise Echocardiography
Authors: JAUSSI ANDRES , SAVCIC MILOS , DELABAYS ALAIN , KAPPENBERGER LUKAS
Published: August 2007

Background: Exercise echocardiography (EE) is being used increasingly as an investigative technique now that dynamic images can be captured digitally. Its equivalent reliability with scintigraphic methods has been demonstrated in a hospital setting. This study analyzes its impact on daily practice. Materials and Methods: Standardized progressive stress was produced by supine bicycle ergometry. Echocardiographic images of complete cardiac cycles were obtained in standard apical and parasternal short‐axis views before, during, and after maximum effort, and digitized for simultaneous analysis of synchronized images at rest and during exercise. Two hundred sixteen patients (175 men and 41 women; mean age 58 ± 10 years) were studied. Results: Image quality was suboptimal in 4 cases. In the remaining 212 cases, ischemia was detected in 91 cases, and the test was negative in 114 cases and doubtful in 7 cases. Control by selective coronary angiography, as indicated by the clinical situation, was performed in 52 cases. In this particular group, EE showed 87% sensitivity, which is significantly higher than the 59% recorded for conventional exercise testing (P > 0.0001). Conclusions: EE by bicycle ergometer in the supine position is a valid, noninvasive investigative technique that can be used in an outpatient situation (feasibility 95%) since it is readily available. Its value appears to be greatest in cases in which exercise ECG is not conclusive. A negative result enables the initial cardiologist to reassure the patient immediately, which has been demonstrated in the literature to have favorable prognostic value.
Transesophageal Three‐Dimensional Echocardiographic Assessment of Normal and Stenosed Coronary Arteries
Authors: El‐Rahman Sayed Mohammed Abd , KHATRI GAJENDRA , NANDA NAVIN , AGRAWAL GOPAL , NANDA ANITA , NANDA ANIL , McGIFFIN DAVID C. , KIRKLIN JAMES K. , PACIFICO ALBERT D. , LI ZHI‐AN , WANG XIN‐FANG
Published: August 2007

We describe our preliminary experience in assessing normal and stenosed coronary arteries using transesophageal three‐dimensional echocardiography (3‐D echo) in 27 adult patients. Multiplane transesophageal two‐dimensional images of the coronary arteries (20 left, 3 right, 3 both left and right, and 1 posterior descending) were first acquired in the TomTec computer in 3° sequential increments, from 0° to 180°, and then 3‐D reconstruction was performed. The entire left main (LMC, measuring 0.5 to 1.7 cm, mean 1.0 cm) as well as variable lengths of proximal or both proximal and middle segments of the left anterior descending (LAD, measuring 0.2 to 2.5 cm, mean 0.8 cm) and circumflex (LCX, measuring 0.2 to 2.8 cm, mean 0.9 cm) coronary arteries together with some of their branches could be visualized in 3‐D in 22 of 23 patients. In the remaining patient, the LMC was absent, and both LAD and LCX could be visualized in 3‐D as having separate but adjacent origins from the left sinus of Valsalva (proven by angiography). In two patients, long segments of interventricular and great cardiac veins were also visualized accompanying the LAD and LCX, respectively. The right coronary artery (RCA, measuring 0.7 to 3.0 cm, mean 1.9 cm) was also successfully delineated in 3‐D in all six patients in whom an attempt was made to visualize it during echo examination. Using the transgastric approach, a long (1.8 cm) segment of the posterior descending branch (PDA) of RCA was imaged in one patient. In addition, nine significantly stenotic lesions (> 50% lumen diameter) were identified by 3‐D in eight patients involving LMC (1), proximal LAD (1), mid LAD (1), proximal LCX (2), proximal RCA(3), and mid PDA (1). Eight of these 9 lesions were confirmed by coronary angiography. The remaining lesion (mid PDA) could not be confirmed since the patient did not undergo angiography. Our preliminary study demonstrates the usefulness of transesophageal 3‐D echo not only in delineating normal coronary arteries but also diagnosing significant atherosclerotic stenosis in these vessels.
Microembolism in Carotid Artery Disease
Authors: SIEBLER MARIO , SITZER MATTHIAS , ROSE GEORG , STEINMETZ HELMUTH
Published: August 2007

Abnormal high intensity transient signals detectable with transcranial Doppler (TCD) sonography have been associated with formed cerebral microembolism. Using long‐term TCD monitoring, these clinically silent microembolic events can be observed in patients with cerebrovascular disease. Downstream of high grade internal carotid artery (ICA) stenosis, they occur significantly more frequently in neurologically symptomatic than in asymptomatic patients. Although the occurrence ofmicroemboli is random, the individual rate underlies circadian fluctuations and seems to decline within the first weeks after an ischemic event. Pathoanatomic work suggests that luminal ulcer and thrombosis of the stenosed ICA are the major sources of microemboli. Thus, by tapping into an important pathomechanism, the detection of clinically silent cerebral microembolism appears to provide paraclinical evidence of “unstable carotid artery disease” and may help to evaluate more specific treatment strategies.
Carotid Endarterectomy and Intraoperative Emboli Detection
Authors: ACKERSTAFF ROB G.A. , JANSEN CEES , MOLL FRANS L.
Published: August 2007

Carotid endarterectomy (CEA) performed with continuous transcranial Doppler (TCD) monitoring provides a unique opportunity to determine the number of cerebral microemboli and to relate their occurrence to the surgical technique. The purpose of this study was to assess in CEA the impact of cerebral microembolism on clinical outcome and brain morphology. We also evaluated the influence of the audible TCD signal on the surgeon and his/her technique. In a prospective series of 301 endarterectomies, brain function was monitored with electroencephalography and TCD ultrasonography. Preoperative and intraoperative risk factors were entered in a logistic regression analysis program to assess their correlation with cerebral outcome. To evaluate the impact of cerebral microembolism on brain morphology, we compared preoperative and postoperative magnetic resonance (MR) images of the brain in a subgroup of 40 patients. Microemboli (> 10) observed during the dissection phase of the operation were related to intraoperative (P < 0.002) and postoperative (P < 0.02) cerebral complications. Microemboli that occurred during shunting were also related to intraoperative complications (P < 0.007). Finally, the phenomenon of > 10 microemboli during dissection was significantly (P < 0.005) related to new hyperintensive lesions on the postoperative T2‐weighted MR images. The presence of microembolism (> 10) during the dissection phase of carotid endarterectomy shows a statistically significant relationship with perioperative cerebral complications and with new ischemic lesions on MR images of the brain. Microembolism during shunting is also related to intraoperative complications. Surgeons can be guided by the audio Doppler and emboli signals by changing their technique, which may result in a decline of the intraoperative stroke rate.
Emboli and Neuropsychological Outcome Following Cardiopulmonary Bypass
Authors: STUMP DAVID A. , KON NEAL A. , ROGERS ANNE T. , HAMMON JOHN W.
Published: August 2007

The dramatic decline in mortality related to cardiac surgery has resulted in over 330,000 surgeries involving cardiopulmonary bypass (CPB) being performed yearly in the United States. Although few patients die as a result of cardiac surgery, over two thirds of the patients demonstrate evidence of acute neuropsychological dysfunction postoperatively. The potential mechanisms contributing to post‐CPB neuropsychological deficits are many, but two major inter‐related etiologic factors, hypoperfusion and emboli, are suggested as the probable culprits. If embolism is the cause of the deficits, increasing cerebral perfusion would deliver more emboli and increase the amount and severity of injury. Conversely, if hypoperfusion is the cause of the injury, then decreasing brain blood flow to minimize embolic delivery would increase the likelihood of perfusion injury. By monitoring the carotid arteries of patients undergoing coronary artery bypass graft surgery, we have determined the frequency and quantity of embolic signals that occur during CPB. Although we have not been able to determine the nature of the embolus, gaseous or solid, we have demonstrated a relationship between the overall embolic load and the probability of having NP dysfunction.
7.5‐MHz Pediatric Phased Array Transesophageal Endoscope
Authors: Jr. PIEL JOSEPH E. , LEWANDOWKSI ROBERT S. , LORRAINE PETER W. , SMITH L. SCOTT , SHIOTA TAKAHIRO , SAHN DAVID J.
Published: August 2007

This work extends the clinical benefits of phased array transesophageal echocardiography with high detail and contrast resolution to include neonatal patients. We have built several prototype, 64‐element, 7.5‐MHz phased array transducers housed in 6.2‐mm endoscope shafts for use with commercially available imaging systems. The acoustic design is standard, but the miniaturized packaging of the electrical connections was quite challenging. The endoscopes demonstrate very good structural resolution and excellent sensitivity for color flow imaging and continuous‐wave Doppler. They have been used on patients as small as 1.9 kg, frequently as an anatomical guide during catheter‐based interventions and during congenital heart surgery. Array test data and representative clinical studies are shown.
Design of Control‐Group Conditions in Clinical Trials of Behavioral Interventions
Authors: Lindquist Ruth , Wyman Jean F. , Talley Kristine M.C. , Findorff Mary J. , Gross Cynthia R.
Published: August 2007

Purpose

: To review considerations in the design of placebo (attention) control conditions for community‐based clinical trials of health behavior change interventions and to provide practical strategies for the design of control conditions.

Organizing Constructs

: A well‐designed control condition is an essential component of a clinical trial to foster the unambiguous interpretation of study findings.

Methods

: Pitfalls in the design of control conditions in clinical trials of behavioral interventions are identified and strategies to address them are offered. Types of control conditions that have been used in fall prevention trials are described, along with their strengths and weaknesses. The control condition used in the recent fall evaluation and prevention program (FEPP) was designed to overcome limitations of previous trial designs; it is provided to illustrate how to apply specific design principles.

Conclusions

: Pitfalls in the design of behavioral intervention studies may be avoided with the application of sound design principles. The FEPP active control condition can be used as a model in the design of future studies.
The Influence of Caregiver Mastery on Depressive Symptoms
Authors: Sherwood Paula R. , Given Barbara A. , Given Charles W. , Schiffman Rachel F. , Murman Daniel L. , Von Eye Alexander , Lovely Mary , Rogers Lisa R. , Remer Sandy
Published: August 2007

Purpose

: The purpose of this study was to explore how the relationship between care recipients' problem behaviors and caregivers' depressive symptoms varies as a function of caregiver mastery, controlling for the effects of caregiver age, gender, and relationship to the care recipient in caregivers of people with primary malignant brain tumor (PMBT).

Design

: A cross‐sectional design was used to gather data via telephone interviews from 95 caregivers of people with primary malignant brain tumor, recruited from 2003 to 2004 from a brain tumor treatment center, two national support groups, and a statewide cancer registry.

Methods

: Measures for the study included the Neuropsychiatric Inventory‐Questionnaire, Caregiver Mastery, and the Center for Epidemiologic Studies–Depression. A stepwise regression procedure was used to evaluate potential moderating and mediating relationships.

Findings

: Data did not indicate that caregiver mastery was a moderating variable. The analysis showed caregiver mastery as a partial mediator, with both a direct effect of care recipients' problem behaviors on caregivers' depressive symptoms and an indirect effect through caregiver mastery. Concerning the indirect effect, care recipients' problem behaviors were related to lower levels of caregiver mastery, which in turn were related to more depressive symptoms in caregivers.

Conclusions

: Findings showed a link between care recipients' problem behaviors and caregivers' depressive symptoms, a relationship that has not been well established in oncology. This association indicates one mechanism through which problem behaviors in the care recipient might lead to caregiver depressive symptoms.
Workplace Violence Among Iraqi Hospital Nurses
Authors: AbuAlRub Raeda Fawzi , Khalifa Mohammed F. , Habbib Mohammed Bakir
Published: August 2007

Purpose

: To investigate (a) the occurrence and frequency of physical workplace violence among Iraqi hospital nurses as well as the complaints and responses of nurses to such violence; (b) measures and policies in the workplace to deal with violence; and (c) factors that contribute to the workplace violence and the strategies to prevent them from Iraqi nurses' perspective.

Design and Methods

: A descriptive exploratory survey was used. The structured interview technique was used for collecting data from a purposive sample of 116 Iraqi nurses. An adapted version of the original instrument that was developed by the International Labor Office (ILO), the International Council of Nurses (ICN), the World Health Organization (WHO), and the Public Services International (PSI) on Workplace Violence in the Health Sector was used.

Results

: Forty‐nine of 116 participants reported that they have been physically attacked at work. Few employers had specific policies on workplace violence.

Conclusions

: The results of the study indicated the importance of adopting hospital policies for dealing with incidents of violence and legislation to subject aggressors to judicial punishment.
Immortal hepatic stellate cell lines: useful tools to study hepatic stellate cell biology and function?
Authors: Herrmann Jens , Gressner Axel M. , Weiskirchen Ralf
Published: August 2007

Introduction

General aspects of immortal HSC

Immortalized murine HSC lines

Immortalized rat HSC lines

Immortalized human HSC lines

Qualities of primary and immortalized HSC

Conclusions

At the cellular level, the activation and transdifferentiation of quiescent hepatic stellate cells (HSC) into myofibroblasts is the key process involved in hepatic fibrogenesis that is associated with an increased and altered deposition of extracellular matrix components in the liver. The temporal sequence of molecular events associated with stellate cell activation turned out to be appropriately mimicked when HSC isolated from normal livers are cultured on uncoated plastic surface. Therefore, cultured primary cells isolated from rodents and human beings are common in vitro models in investigations addressing these issues of hepatic stellate biology and function. However, the limited supply, cost‐effective isolation procedure and the ever growing need have resulted in efforts to establish immortalized stellate cell lines having the advantage of virtually unlimited access. They allow rapid screening for disease‐associated factors and restrict the necessary number of animal experiments. From the first description of an immortal HSC line in 1986, a huge number of studies were conducted with these established cell lines. However, differences in morphology, growth characteristics and anomalies of chromosome number and structure make the applications of these models questionable. Here, we summarize the history and cellular characteristics of respective cell lines and discuss the differences of continuous HSC lines and their primary counterparts.