bluuebunny/crossref_metadata_2025 huggingface dataset:
A COMPARISON OF INDUCTIVELY‐COUPLED PLASMA EMISSION SPECTROMETRY AND ATOMIC ABSORPTION SPECTROMETRY ANALYSIS ON STANDARD REFERENCE SILICATE MATERIALS AND CERAMICS
Authors: HATCHER H. , TITE M. S. , WALSH J. N.
Published: August 2007

Analyses by inductively coupled plasma atomic emission spectrometry and atomic absorption spectrometry of 22 ceramic standards and sherds are compared. Further data from analyses of one of the ceramic standards analysed by both methods are also discussed. The results show that for most major elements, the methods are comparable, but that use of common standards would be advisable if data from the two methods are to be compared.
THE POSSIBLE FRACTIONATION OF LEAD ISOTOPES IN ANCIENT METALLURGICAL PROCESSES
Authors: BUDD P. , POLLARD A. M. , SCAIFE B. , THOMAS R. G.
Published: August 2007

The possibility of lead isotope fractionation in ancient lead production is examined. Kinetic theory relating to isotopic fractionation in non‐equilibrium evaporation is considered and the feasibility of the alteration of lead isotope abundance ratios in ore roasting and smelting is assessed. Previous experimental work is shown to have been inconclusive and conclusions are drawn on the need for further research to quantify the possible extent of fractionation in practice.
OBSIDIAN IN THE MEDITERRANEAN AND THE NEAR EAST: A PROVENANCING SUCCESS STORY
Authors: WILLIAMS‐THORPE O.
Published: August 2007

Obsidian provenancing studies comprise one of the most productive and successful research programmes of archaeological science. Obsidian characterization has been successful because workable obsidian is homogeneous on a small scale, analysable by a large number of methods, and is restricted to a small number of mainly readily distinguishable geological sources. Analytical, dating, source, and trade studies within the western Mediterranean, central and eastern Europe, the Aegean, and Anatolia and the Near East during the last 30 years or so are reviewed. Research has shown that distributions are mainly separate in the four regions examined, and that obsidian was traded up to 900km in the prehistoric period. Publications on obsidian in the areas under review reached a peak of frequency in the later 1970s and 1980s, but have now decreased in number. This may reflect changing fashions in archaeometric studies, and a current lack of routine application of the provenancing methods developed.
SHRINES AND CERAMICS IN CHALCOLITHIC ISRAEL: THE VIEW THROUGH THE PETROGRAPHIC MICROSCOPE
Authors: GOREN Y.
Published: August 2007

The question of the nature of social and economic life in the Chalcolithic southern Levant has recently been the subject of increasing interest. Several archaeological sites and features in Israel have been interpreted as elements of religion. These include the shrines at En‐Gedi and Gilat and the Nahal Mishmar hoard. The results of petrographic analyses of the pottery assemblages of these three sites, as well as the ceramic cores of copper artefacts from Nahal Mishmar and additional sites, are presented. In light of these results some previous hypotheses are tested. Alternative suggestions are offered as to the role of these sites in the life of the inhabitants of the Chalcolithic southern Levant.
CHEMICAL ANALYSIS OF COPPER ALLOY TRADE METAL FROM A POST‐CONTACT HURON SITE IN ONTARIO, CANADA
Authors: HANCOCK R. G. V. , PAVLISH L. A. , FOX W. A. , LATTA M. A.
Published: August 2007

Fifty‐three copper‐based metal fragments, recovered from the Robitaille site in southcentral Ontario, were analysed by neutron activation to establish their chemical make‐up and to sort them by their trace elemental chemistries. Three different European copper samples, one brassy copper and 48 brass samples with five different chemistries were found. As few as eight trading actions may account for all of the recovered European metal fragments.
CYPRIOT BLACK‐ON‐RED WARE: TOWARDS A CHARACTERIZATION
Authors: BRODIE N. J. , STEEL L.
Published: August 2007

Chemical analysis of Early Iron Age sherds from Cyprus and the Levant using atomic absorption spectrometry shows that Black‐on‐Red ware was manufactured only in Cyprus. Two types of fabric are isolated, calcareous and non‐calcareous, and their technological significance discussed. The presence of trade links between the Cypriot sites of Kition and Amathus and sites in the Levant is suggested.
X‐RAY FLUORESCENCE ANALYSIS WITH SYNCHROTRON RADIATION ON THE INKS AND PAPERS OF INCUNABULA
Authors: MOMMSEN H. , BEIER TH. , DITTMANN H. , HEIMERMANN D. , HEIN A. , ROSENBERG A. , BOGHARDT M. , HANEBUTT‐BENZ E.‐M. , HALBEY H.
Published: August 2007

Non‐destructive X‐ray fluorescence analyses induced by white synchrotron radiation (SYXRF) have been performed on a page of the Gutenberg Bible and 21 other different single leaves printed in the years 1470 to 1500. Absolute elemental areal densities for the papers and the inks are reported. The known high Cu and Pb content in Gutenberg's ink is confirmed. The elemental compositions of the other inks, if measurable by XRF at all, are in general very low, governed only by a few additional elements and found to be not distinctive for a known printer. This will render an identification of the printer or printing offices by ink composition analysis in the period after 1470 difficult.
Clinical Results of Endarterectomy of the Right and Left Anterior Descending Coronary Arteries
Authors: Abrahamov Dan , Tamaris Miguel , Guru Veena , Fremes Steve , Christakis George , Bhatnagar Gopal , Sever Jeri , Goldman Bernard
Published: August 2007

Abstract In this study, we examined the clinical outcome of coronary endarterectomy. From 1990 to 1998, 4839 patients underwent surgical revascularization. Coronary artery bypass graft surgery (CABG) was performed alone on 4516 patients, was combined with right coronary artery endarterectomy (RCA‐E) in 242 patients, and was combined with left anterior descending coronary artery endarterectomy (LAD‐E) in 81 patients. An analysis of preoperative variables revealed a higher proportion of males (90.79'0 vs 80.2%, p < 0.001), of patients with low ejection fraction (< 35%; 4.69'0 vs 1.796, p < 0.001), and of three‐vessel disease (47.9% vs 3696, p < 0.001) in the RCA‐E versus the CABG patients. There was a higher proportion of unstable angina (51.9% vs 40.3%, p = 0.04) in the LAD‐E patients. The 30‐day mortality rate for CABG was 2% versus 2.5% for RCA‐E and 3.7% for LAD‐E (p = NS). Perioperative myocardial infarction (MI) rate for CABG was 3.49/0 versus 7.00/0 for RCA‐E (p < 0.001) and 4.996 for LAD‐E patients (p = NS). Postoperative low cardiac output syndrome was recorded in 11.596 of CABG, 18.6% of RCA‐E (p = 0.01), and 11.1% of LAD‐E (p = NS) patients. Predictors of postoperative bad outcome (death, MI, low cardiac output, cere‐brovascular accident) were preoperative intra‐aortic balloon pump, repeat operation, ejection fraction of < 350/, renal insufficiency, female gender, RCA‐E, and age over 70. Protective factors included the use of internal mammary artery, multiple arterial grafts, and warm cardioplegia. Actuarial analysis at 6, 12, and 24 months showed late mortality rates of 0.8%, 1.3%, and 2.19'0 for CABG; 1.2%, 3.7%, and 3.7% for RCA‐E; and 2.9%, 2.996, and 2.9% for LAD‐E, respectively. Late MI occurrence was 0.4%. 0.49/0, and 0.7% for CABG; 1.5%, 1.5%. and 2.7% for RCA‐E; and 0% for LAD‐E, respectively. Multivariate analysis found renal insufficiency, ejection fraction of < 3556, repeat operation, female gender, New York Heart Association functional class IV, and diabetes to be predictors for late adverse events (recurrence of angina, MI, and cardiac death), and RCA‐E was found to be a predictor of late MI. We conclude that the use of coronary endarterectomy to achieve complete revascularization in patients with diffuse distal coronary artery disease is a reasonable option, associated with a minimal addition in complication rates.
Dilated Cardiomyopathy: Changing PathophysiologicaI Concepts and Mechanisms of Dysfunction
Authors: Keulenaer Gilles W. De , Brutsaert Dirk L.
Published: August 2007

Abstract Experimental observations made over the past two decades have led to a profound shift in the conceptual paradigms about the syndrome of heart failure and dilated cardiomyopathy. As a consequence, heart failure is currently considered a complex disease and is not merely characterized by hemodynamic disturbances. It is now believed that the syndrome is governed and impelled by neurohormonal imbalances and intracardiac paracrine processes. The latter processes are mediated by activated cardiac endothelial cells and cytokines, creating a state of cardiac maladaption and leading to disease progression. Therapeutic interventions such as operative left ventricular volume reduction or mitral valve reconstruction should therefore no longer be solely interpreted in terms of hemodynamics (i.e., symptomatic improvements). Effects on neurohormonal, endothelial, and cytokine activities should be taken equally into account.
Echocardiographic Contrast Enhancement of Poor or Weak Continuous‐Wave Doppler Signals
Authors: HAGLER DONALD J. , CURRIE PHILIP J. , SEWARD JAMES B. , TAJIK A. JAMIL , MAIR DOUGLAS D. , RITTER DONALD G.
Published: August 2007

Echocardiography contrast enhancement of poor continuous‐wave Doppler signals was demonstrated with peripheral venous dye injections in a patient undergoing balloon pulmonary valvuloplasty. The use of intracardiac dye injections for contrast enhancement of poor or weak continuous‐wave Doppler signals also was demonstrated. Simultaneous continuous‐wave Doppler echocardiography, with dual‐catheter measurement of the outflow tract gradient during the echocardiographic contrast injections (indocy‐anine green dye and saline), confirmed the accuracy of the spectral signals obtained with contrast enhancement. These preliminary findings– that peripheral venous echocardiographic enhancement of weak or poor continuous‐wave Doppler signals can provide added information for evaluation of stenotic lesions, valvular regurgitation, and ventricular septal defect–are encouraging.
Annular Array Technology: Application to Cardiac Imaging
Authors: RYAN THOMAS , ARMSTRONG WILLIAM F. , FEIGENBAUM HARVEY
Published: August 2007

Annular array imaging combines desirable features of both phased‐array and mechanical transducer technology. Its major advantage is dual‐plane electronic focusing, which contributes to deeper penetration, improved lateral resolution, and a thinner tomographic slice. All of these features help to improve image quality in the majority of patients. Areas of improvement observed with annular array imaging in the clinical setting include increased depth of field, better endocardia1 definiton, greater detail of valvular structures, more accurate recording of intracardiac masses, and generally improved signal‐to‐noise ratio. These aspects of improved image quality make annular array technology an important advance in ultrasonic cardiac imaging.
Prediction of Intracardiac Pressures and Assessment of Ventricular Function with Doppler Echocardiography
Authors: SNIDER A. REBECCA
Published: August 2007

Doppler echocardiography has had a profound influence on the clinical practice of cardiology. With the use of the modified Bernoulli equation, Doppler echocardiography provides a noninvasive technique for calculating intracardiac pressures. Compared to invasive measurements, the Doppler estimates of intracardiac pressures are accurate and reproducible. By the evaluation of intracardiac blood flow, Doppler echocardiography provides a technique for the evaluation of ventricular performance that is independent of ventricular geometry. This application of the Doppler technique is in its infancy and much investigative work is needed to correlate the invasive and noninvasive measurements of ventricular function and to determine the effect of factors such as heart rate, loading conditions, and cardiac drugs on the Doppler indexes of function. In the future, it is very likely that Doppler color flow mapping techniques will provide additional information on ventricular emptying and filling patterns that will be important in the noninvasive assessment of cardiac function.
Coarctation of the Aorta: Quantitative Analysis by Transesophageal Echocardiography
Authors: STERN HEIKO , ERBEL RAIMUND , SCHREINER GERHARD , HENKEL BERND , MEYER JURGEN
Published: August 2007

Transesophageal echocardiography and standard two‐dimensional echocardiography were performed in 15 patients with suspected coarctation of the aorta. Aortic diameters and crosssectional areas were determined by means of TEE and compared with clinical findings and catheterization data. The isthmus of the aorta could be imaged in all patients using TEE, but in only seven patients using standard suprasternal echocardiography. Compared with controls, aortic diameters were narrowed in 9 of 15 patients, and cross‐sectional areas were reduced in 13 of 15. There was a satisfactory correlation between TEE data and angiographic and hemodynamic data. TEE is a promising method of a diagnosing and quantifying coarctation of the aorta, and is more sensitive than conventional two‐dimensional and Doppler echocardiography.
Role of Transesophageal Echocardiography in Percutaneous Balloon Mitral Valvuloplasty
Authors: CHAN KWAN‐LEUNG , MARQUIS JEAN‐FRANCOIS , ASCAH CATHERINE , MORTON BRIAN , BAIRD MICHAEL
Published: August 2007

Echocardiography is useful in the selection of patients for percutaneous balloon mitral valuuloplasty, which is an effective treatment in suitable patients with rheumatic mitral stenosis. Transesophageal echocardiography appears superior to precordial echocardiography in this role because transesophageal echocardiography is not only reliable in the assessment of mitral valvular morphology but also more sensitive in the detection of left atrial thrombi and mitral regurgitation. Transesophageal echocardiography can be used in guiding the proper positioning of the catheters during the dilatation procedure. Complications of balloon mitral valvuloplasty such as torn mitral leaflets or atrial septal defects can also be diagnosed reliably by transesophageal echocardiography. Thus, transesophageal echocardiography should be an integral part of balloon mitral valvuloplasty.
Intraoperative Monitoring of Regional Wall Motion Abnormalities for Detecting Myocardial Ischemia by Transesophageal Echocardiography
Authors: HONG YONG‐WOO , ORIHASHI KAZUMASA , OKA YASU
Published: August 2007

Transesophageal two‐dimensional echocardiography has been used for intraoperative monitoring of regional wall motion of the left ventricle. Regional wall motion abnormality is a sensitive indicator of myocardial ischemia and the use of two‐dimensional transesophageal echocardiography may have a substantial advantage for early detection of myocardial infarction and thus for initiating timely and appropriate therapy in preventing postoperative myocardial ischemia. With an expected increase in the use of intraoperative transesophageal echocardiography for monitoring regional wall motion, we described the practical aspects of transesophageal echocardiography: (1) insertion technique of transesophageal echocardiographic probe; (2) the technique for obtaining an optimal short‐axis view of the left ventricle; and (3) the method for evaluating regional wall‐motion abnormality and myocardial ischemia. Regional wall motion abnormality is best monitored at the mid‐papillary muscle level where all three coronary arteries meet. In obtaining this view, the transesophageal echocardiographic probe was found to be predominantly located in the stomach. Failure in obtaining short‐axis view of the left ventricle at this level occurred in patients with left ventricular dilatation or obesity. Because of the anatomical reason, the echocardiographic transducer cannot reach a proper plane. In anesthetized patients, air can be pushed into the stomach during induction and may disturb the visualization. The pitfalls in examining regional wall motion abnormalities include: (1) shifting of the center of left ventricular contraction; (2) inadequate direction of the scanning plane; and (3) paradoxical septal movement. Three cases are presented to demonstrate the usefulness of transesophageal echocardiography in managing coronary artery surgical patients.
Percutaneous Intracoronary Ultrasound Imaging: Initial Applications in Patients
Authors: HODGSON JOHN M. , GRAHAM SUSAN P. , SHEEHAN HELEN , SAVAKUS ADAM D.
Published: August 2007

This study was designed to evaluate the feasibility and potential clinical utility of intracoronary ultrasound imaging in patients using a 5.5 F synthetic aperture array, over‐a‐wire ultrasound catheter. Thirty patients underwent percutaneous intracoronary (n = 22) or peripheral (n = 8) ultrasound imaging at the time of cardiac catheterization. Ultrasound images were compared to simultaneous digital angiograms. Correlation between ultrasonic and angiographic estimation of coronary diameters was good (r = 0.80). Morphological analysis of ultrasound images obtained in patients revealed a pattern consistent with mild‐to‐minimal atherosclerosis, as defined by prior in vitro studies. In 15 patients, imaging was performed during intracoronary infusion of vasoactive medications (papaverine 15 mg, nitroglycerine 100 μgm, and acetylcholine 2 × 10−5 or 2 × 10−6M). These medications were also infused during continuous intracoronary Doppler catheter monitoring of velocity and pressure, thus allowing calculation of volume flow and coronary resistance indices. Serial determination of ultrasound‐derived epicardial vessel cross‐sectional area demonstrated no change (−1 ± 1%) after papaverine, an 8 ± 2% increase after nitroglycerine, and a 9 ± 3% decrease after acetylcholine. Calculated resistance fell 53 ± 4% after acetylcholine and 60 ± 3% after papaverine. Preliminary in vitro studies using a combination angioplasty balloon/ultrasound catheter demonstrated the ability to visualize vessel dilation in real time. We conclude that intravascular ultrasound imaging will be useful for dimensional and morphological characterization of vascular disease, for beat‐to‐beat monitoring of vasomotion, and potentially as a real‐time adjunct to therapeutic interventions.
Real‐Time Intracardiac Two‐Dimensional Echocardiography: An Experimental Study of In Vivo Feasibility, Imaging Planes, and Echocardiographic Anatomy
Authors: SCHWARTZ STEVEN L. , PANDIAN NATESA G. , KUSAY BRENDA S. , KUMAR ROHIT , WEINTRAUB ANDREW , KATZ SARAH E. , ARONOVITZ MARK
Published: August 2007

The traditional transthoracic and transesophageal echocardiographic examination have proven to be useful imaging tools for studying cardiac morphology, pathology, and function. Recently, catheter‐based ultrasound transducers have been available for intravascular ultrasonic imaging. We supposed that echocardiographic examination performed from within the heart itself can provide useful information about cardiac structure and function, especially in settings where transthoracic or transesophageal echocardiography may be technically difficult to perform or poorly tolerated by the patient. To explore this concept, we performed intracardiac echocardiography in vivo in 22 dogs using both 5‐MHz and 20‐MHz transducers. High‐quality images were obtained in all animals. Using the higher frequency transducer, detailed images with only a limited depth of field were obtained. With the 5‐MHz transducer, a comprehensive cardiac examination was feasible from within the right atrium and inferior vena cava. We were able to visualize the great vessels, all cardiac valves, and cardiac chambers in a multitude of imaging planes. Alterations in ventricular function were instantly recognized. Color Doppler capabilities allowed visualization of flow abnormalities as well. We conclude that intracardiac echocardiography is feasible and could be potentially useful in certain clinical situations. With further research and development, this technique may have an important clinical impact in cardiac therapy and diagnosis.
Directions for the Use of Intracardiac High‐Frequency Ultrasound Scanning for Monitoring Pediatric Interventional Catheterization Procedures
Authors: SAHN DAVID J.
Published: August 2007

Intravascular and intracardiac ultrasound imaging using high‐frequnecy ultrasound catheters has a number of potential applications in pediatric cardiology. This article reviews the current difficulties associated with interventional procedures for congenital heart lesions, the feasibility of intravascular ultrasound imaging in children, and its potential applications.
Pitfalls in the Display of Color Doppler Jet Areas: Combined Variability Due to Doppler Angle, Frame Rate, and Scanning Direction
Authors: UTSUNOMIYA TOSHINORI , OGAWA TOSHIO , KING S. WILLIAM , SUNADA ERIC , LOBODZINSKI SLAWOMIR M. , HENRY WALTER L. , GARDIN JULIUS M.
Published: August 2007

The Doppler color jet area depicting a regurgitant or shunt lesion may be useful in estimating its severity. However, color jet area may be affected by technical factors. We studied the combined effects of Doppler angle, frame rate, and scanning direction on the Doppler color jet area of a free jet with 10‐mL injection. Results: (1) Angle effects: color flow area was 11.7 ± 2.0 cm2 at a Doppler angle of 20°, and 2.3 ± 1.2 cm2 at an angle of 60°, when other parameters were kept constant (frame rate=12 frames/sec, reverse scanning direction). (2) Frame rate effects: with other parameters kept constant (Doppler angle = 20°, reverse scanning direction), color flow area was 11.7 ± 2.0 cm2 at a rate of 12 frames/sec and 6.5 ± 1.8 cm2 at 6 frames/sec. (3) Scanning direction effects: with other parameters kept constant (Doppler angle=20°, frame rate = 9 frames/sec), color flow area was 7.3 ± 1.1 cm2 with scanning in the reverse direction, and 20.5 ± 1.6 cm2 with scanning in the forward direction. (4) Combined effects: In our in vitro studies, the maximum color flow area was 20.5 ± 1.6 cm2, and the minimum area was 1.5 ± 0.2 cm2 (nearly twelve‐fold). Conclusions: Doppler color jet area correlated inversely with Doppler angle (P<0.01) and directly with frame rate (P<0.01). Color jet area was increased in the forward (following flow), compared with the reverse (against flow) scanning direction (P<0.01). These machine factors must be considered clinically in quantitating color Doppler jet area.
Transesophageal Biplane Echocardiographic Imaging: Technique, Planes, and Clinical Usefulness
Authors: NANDA NAVIN C. , PINHEIRO LUIZ , SANYAL RAJAT S. , STOREY OCTAVIA
Published: August 2007

The technique of examination, imaging planes, and the clinical utility of transesophageal biplane echocardiography are described.
The Role of Doppler Echocardiography in the Diagnosis, Follow‐Up, and Management of Ventricular Septal Defects
Authors: ANDRADE JOSE L.
Published: August 2007

The defects of the ventricular septum have received special attention from investigators working in echocardiography. The method showed an incomparable capability to identify all the morphological features of the defects. The increasing improvement in definition of transducers associated with conventional and color Doppler contributed significantly to the reliability to detect most of the defects. The great majority of associated lesions can be easily identified and serial examinations allow prediction of which defect may become smaller or even close spontaneously as well as which have acquired deleterious changes in the heart. Several authors have shown very good statistical correlations between echocardiographic indices and hemodynamic parameters in patients with this type of defect. Doppler echocardiography has become an invaluable tool in the diagnosis and follow‐up of ventricular septal defect reducing the need for cardiac catheterization and helping management of these patients. (ECHOCARDIOGRAPHY, Volume 8, July 1991)
Fenestrated Aneurysm of the Mitral Valve
Authors: BEHNAM RAMSEY , BOMMER WILLIAM
Published: August 2007

Aneurysms of the cardiac valves remain rare. In this report, we describe the first case of a left ventricular to mitral valve aneurysm to left atrial shunt through a fenestrated aneurysm of the mitral valve diagnosed and successfully repaired under the guidance of transesophageal echocardiography. The transesophageal echocardiography provided substantial additional data to the transthoracic echocardiography, and was valuable in planning the surgical approach. Transesophageal echocardiography should be considered when clear‐cut transthoracic echocardiographic interpretation cannot be made in patients with mitral regurgitation. (ECHOCARDIOGRAPHY, Volume 8, September 1991)
A Common Color Flow Doppler Finding in the Mitral Regurgitation of Acute Rheumatic Fever
Authors: ZUCKER NILI , GOLDFARB BENJAMIN L. , ZALZSTEIN ELYAHU , SILBER HAIM , ROVNER MAYA , GOLDBRAICH NAOMI , WANDERMAN KENNETH L.
Published: August 2007

Between October 1986 and May 1991, 19 patients with acute rheumatic fever who were hospitalized in the Department of Pediatrics at Soroka Medical Center underwent echocardiographic color flow Doppler examination. Five patients had an echocardiographic picture of mitral valve prolapse, with or without leaflet thickening, and one had a flail anterior leaflet. Six had mitral valve thickening without prolapse, and seven patients had an echocardiographically normal appearing mitral valve. All 19 patients had a posterolaterally directed jet of mitral regurgitation demonstrated on color flow Doppler. All patients had echocardiographically normal aortic valves. However, mild aortic regurgitation was noted in eight of them. The posterolateral jet of mitral insufficiency in acute rheumatic fever may be the most common echo‐Doppler finding in this condition. (ECHOCARDIOGRAPHY, Volume 8, November 1991)

Summary and Conclusions
Comparison of Transesophageal to Transthoracic Color Doppler Echocardiography in the Identification of Intracardiac Mycotic Aneurysms in Infective Endocarditis
Authors: KAN MEE‐NIN , CHEN YING‐TSUNG , LEE ANDREW YING‐SIU
Published: August 2007

We report on cases of mycotic aneurysms in a group of 14 patients with infective endocarditis, all of whom were evaluated with transthoracic (TTE) and transesophageal (TEE) color Doppler echocardiography. Four mycotic aneurysms were found, one each in the left ventricular outflow tract, the right coronary sinus of Valsalva, the anterior mitral leaflet, and the atrial septum. With TTE, only three of four cases of mycotic aneurysms could be detected. Utilizing TEE, however, all were detected and their connections with the heart chambers or great vessels could be readily and clearly depicted, especially those in the atrial septum and mitral leaflet. We are of the opinion that TEE is superior to TTE in the identification and detailed analysis of mycotic aneurysms complicating infective endocarditis. In addition, we feel that echocardiography may help evaluate the progress of the disease, the location and direction of infection, and the extent of involvement of the mycotic aneurysms, providing useful information for guiding surgical intervention. (ECHOCARDIOGRAPHY, Volume 8, November 1991)
Role of Prenatal Echocardiography in the Study of Hypertrophic Cardiomyopathy in the Fetus
Authors: ZIELINSKY PAULO
Published: August 2007

The increased incidence of hypertrophic cardiomyopathy in children of diabetic mothers has already been demonstrated, but its prenatal diagnosis has not yet been extensively studied. The purpose of this prospective study was to evaluate the frequency, severity, and echocardiography features of fetal hypertrophic cardiomyopathy in a population with several indications for prenatal echocardiography. From March 1987 to April 1991,283 fetuses were submitted to comprehensive prenatal echocardiography, including M‐mode measurements, cross‐sectional imaging, Doppler studies, and color flow mapping. One hundred seventy‐six were pregnancies complicated by previous or gestational diabetes. The diagnosis of disproportionate septal hypertrophy was made in 39 fetuses (mean septal thickness 7.12 ±1.6 mm), at a mean gestational age of 32 weeks. Diabetes mellitus was present in 36 of these pregnancies (92.3%). In four cases, nonimmune hydrops was detected. A systolic anterior motion of the mitral valve was present in three fetuses, but only one showed a gradient across the left ventricular outflow tract. Postnatal echocardiography examination in 27 babies did not show false positivity. In ten cases, spontaneous regression of the septal hypertrophy was shown. There were three neonatal deaths, unrelated to the myocardial disease. We concluded that transient hypertrophic cardiomyopathy is a frequent entity, especially when associated with diabetes during gestation, being a potential cause for nonimmune hydrops. Fetal echocardiography is the method of choice for its prenatal diagnosis and should always be indicated in diabetic mothers. (ECHOCARDIOGRAPHY, Volume 8, November 1991)
Transgastric Ultrasonography: A New Approach for Imaging the Abdominal Structures and Vessels
Authors: CHOUINARD MARK D. , PINHEIRO LUIZ , NANDA NAVIN C. , SANYAL RAJAT S.
Published: August 2007

For the first time, the feasibility of using transgastric ultrasonography to examine the abdominal vasculature and organs has been demonstrated. An illustrative case report details how this approach was utilized in a patient following abdominal aortic aneurysm resection, in whom surface ultrasonography was not feasible. The diagnostic potential of this new approach is discussed. Possible modifications to improve the technique and to facilitate the examination in a wider range of patients are also suggested. Further studies are needed to better define the technique and role of transgastric ultrasonography in the evaluation of the abdominal aorta and its branches and other abdominal structures. (ECHOCARDIOGRAPHY, Volume 8, May 1991)
Regurgitant Volume Estimation in Patients with Mitral Regurgitation: Initial Studies Using the Color Doppler “Proximal Isovelocity Surface Area” Method
Authors: UTSUNOMIYA TOSHINORI , DOSHI RAJEN , PATEL DHARMENDRA , NGUYEN DAT , MEHTA KAPIL , GARDIN JULIUS M.
Published: August 2007

Doppler color flow mapping of a proximal isovelocity surface area (PISA), calculated from a blue‐red aliasing radius, has been shown in vitro to be accurate for estimating volume flow rate across a narrowed orifice. Volume flow rate (in cm3/sec) can be calculated as PISA (in cm2) x aliasing velocity (in cm/sec). This method has advantages over other color Doppler approaches in that PISA‐derived volume flow rate calculations appear to be independent of machine parameter settings and orifice shape. We evaluated the clinical applicability of the PISA method in 49 patients with native valve mitral regurgitation (MR). Color Doppler flow mapping was performed at color aliasing velocities of 54–72 cm/sec. Twenty‐four patients were excluded because a color aliasing radius was not clearly seen: 20 of these 24 patients had mild MR. In the remaining 25 patients, the ratio of maximum regurgitant jet area‐to‐left atrial area, as well as the regurgitant stroke volume estimated using the time‐velocity integral method, were compared to regurgitant stroke volume calculated from the PISA method. Maximum PISA was calculated using a formula derived from previous in vitro studies: PISA = 8.05 × r2, where r is the maximum color Doppler aliasing radius in the apical four‐chamber view. Regurgitant stroke volume using the PISA method was calculated as 8.05 × r2× V × MRTVI/MRPFV, where V is the aliasing velocity, MRTVI is the time‐velocity integral of the MR jet from continuous‐wave Doppler, and MRPFV is the peak velocity of the MR jet on the continuous‐wave Doppler recording. Calculated regurgitant stroke volume using the PISA method correlated well with the ratio of maximum MR jet area‐to‐left atrial area (r = 0.84, P < 0.01), and fairly well with the regurgitant stroke volume calculated using the time‐velocity integral method (r = 0.77, P < 0.05). We conclude that in patients with moderate or severe native valve MR, the color Doppler PISA method is useful for estimating regurgitant stroke volume.
Histologically Confirmed Cholesterol Atheroemboli with Identification of the Source by Transesophageal Echocardiography
Authors: KOPPANG JOYCE R. , NANDA NAVIN C. , COGHLAN H. CECIL , SANYAL RAJATSUBRA
Published: August 2007

Cholesterol embolization may occur after catheter manipulation of the descending aorta in patients with diffuse atherosclerosis. A clinical diagnosis of cholesterol embolism after manipulation of the descending aorta is suspected by the presence of systemic atheroemboli. Transesophageal echocardiography (TEE) is an excellent technique for detecting atheromatous plaques of the aorta. TEE is becoming more commonly used in the work‐up of cerebrovascular events but we suggest its scope should be broadened to include patients with suspected intra‐aortic atherosclerotic disease prior to cardiac catheterization. The findings at TEE would help alert the clinician to use extreme caution if an invasive aortic procedure was felt to be essential. Our patient illustrates the constellation of clinical findings in atheroembolic disease that occurred after cardiac catheterization with biopsy confirmation of cholesterol emboli. TEE revealed several large protruding atheromatous plaques of the descending aorta that were most probably responsible for the systemic manifestations of renal insufficiency and digital infarctions.
Vascular Ultrasound: A Radiologist Perspective
Authors: FOLEY W. DENNIS
Published: August 2007

Color Doppler flow imaging (CDFI) is an evolutionary technical development that has considerably improved the diagnostic efficacy and clinical role of vascular ultrasound. The appropriate use of CDFI rests on an understanding of the instrumentation, factors affecting image quality and artifact, as well as the pathophysiology of the central and peripheral circulation. The modality has reached a relative plateau of performance. In this review, applications of CDFI for studies of the neck, abdomen, and extremities are evaluated.
Magnetic Resonance Imaging of Peripheral Vascular Disease
Authors: MOHIADDIN RAAD H.
Published: August 2007

Peripheral vascular disease is a term often used to describe the manifestation of atherosclerosis below the bifurcation of the abdominal aorta. Peripheral atherosclerosis is a major cause of morbidity in the developed countries and 2% of adults in late middle age have intermittent claudication, which is severe enough in some patients to warrant hospital admission. The disease produces problems either by reducing blood flow or by the release of emboli from ulcerated plaques. The morphology and composition of arterial segments containing atheroma is of considerable importance. Plaques of different morphology have different effects on the arterial wall, such as the potential for thrombosis and the effect of arterial spasm. The lipid content may also affect the propensity for fissuring, ulceration, and thrombosis. In addition to discrete atherotic lesions, a localized and generalized sclerosis occurs. Sclerosis, or stiffness, can be demonstrated in experimental disease in animals and in man, and regression leads to reduced stiffness. Magnetic resonance imaging promises a comprehensive assessment of peripheral atherosclerosis noninvasively and without the use of ionizing radiation. Atheroma can be imaged directly, its size can be measured, its shape can be described, its lipid content can be assessed, and its effects upon vascular hemodynamics can be studied. In addition, arterial compliance, pulse wave velocity, and the pattern of flow within the vessel can be studied. It is thus a potential tool not only for the detection of disease but also for studying its natural history, risk factors, and the effects of pharmacological or surgical interventions.
Assessing Prosthetic Heart Valve Function
Authors: ROUDAUT RAYMOND , GOSSE PHILIPPE , DALLOCCHIO MODESTE
Published: August 2007

Doppler echocardiography is being used increasingly in the follow‐up of patients with valvular heart prostheses because it provides unique hemodynamic information about flow through prosthetic valves. A baseline checkup about 3 months after implantation is now recommended. We therefore now supply eachpatient with an identity and follow‐up card for each particular prosthesis.
Bedside Cardiac Catheterization Using Transesophageal Echocardiographic Guidance
Authors: KOENIG PETER R. , ROSSI ANTHONY , RITTER SAMUEL B.
Published: August 2007

We describe for the first time the use of transesophageal echocardiography to guide cardiac catheterization performed at the bedside in the pediatric cardiac intensive care unit. The procedure was performed on a 2.6‐kg infant with ventricular and atrial septal defects after repair of coarctation of the aorta. Poor hemodynamic status prevented obtaining the required hemodynamic information from cardiac catheterization in the cardiac catheterization laboratory. Transesophageal echocardiography provided cardiac and vascular imaging, which helped guide catheter placement where the small size of the infant and the extensive thoracic postoperative bandages prevented obtaining the echocardiographic information from other windows.
The Use of Transesophageal Echocardiography to Evaluate the Effectiveness of Patent Ductus Arteriosus Ligation
Authors: WANG KUO‐YANG , HSIEH KAI‐SHENG , YANG MING‐WEN , LIN CHUNG‐YUAN , KANG LIU , KUO SU‐MIN
Published: August 2007

The ligation of patent ductus arteriosus (PDA) is a comparatively easy operation, but some complications are possible. The most common complication is incomplete ligation of the PDA; others include inadvertent ligation of the descending aorta or left pulmonary artery, transient rise in systemic blood pressure and increased left ventricular afterload, and acute right heart failure due to pulmonary hypertension. The completeness of the PDA ligation is usually determined only by the operating physician's experience, including the use of an esophageal stethoscope or a finger on the lesion to feel for vibration. These methods sometimes fail to detect an incomplete ligation. With transesophageal echocardiography (TEE), we have monitored the entire course of the PDA ligation directly without interrupting the surgical procedure, and precisely determined the completeness of the ligation. We also expect that TEE will enable us to avoid other complications as well.
Coronary Artery Shape and Flow Changes Induced by Myocardial Bridging
Authors: ERBEL RAIMUND , RUPPRECHT HANS‐JÜRGEN , GE JUNBO , GERBER THOMAS , GÖRGE GÜNTER , MEYER JÜRGEN
Published: August 2007

Changes in coronary shape and blood flow induced by myocardial bridging were analyzed in a 56‐year‐old patient with symptoms of unstable angina after the exclusion of other heart disease. Coronary angiography demonstrated a 1.8‐cm long myocardial bridge in the middle part of the left anterior descending coronary artery. In systole, an eccentric compression of the artery occurred, resulting in a stenosis that occupied 86% of the diameter and 96% of the area. Intraluminal ultrasound was performed with a 20‐MHz transducer in a 4.8‐Fr catheter sheath (Boston Scientific Corp.) connected to an ultrasound console (Diasonics Inc.). A side saddle catheter was introduced into the left anterior descending coronary artery via a giant guiding catheter. A circular shape with typical systolic pulsation was seen in the proximal part of the artery (maximal and minimal diameters 3.6 mm and 3.5 mm, respectively). Distally an eccentric compression of the coronary artery was visualized, decreasing one diameter from 3.0 to 2.6 mm, whereas the orthogonal diameter remained constant at 3.3 mm. The myocardial bridge compressed 160°–180° of the circumference of the artery, leading to a change from a circular to an elliptical arterial shape. A delayed relaxation of the bridging was demonstrated. Only the proximal part of the vessel in the muscle bridge could be passed. Coronary flow was measured using a Doppler 3‐Fr 20‐MHz catheter (Millar Instruments Inc.) using a pulse repetition rate of 62.5 kHz. Coronary flow velocity was calculated in the proximal part of the left anterior descending coronary artery before and after intracoronary injection of 10 mg papaverine. Phasic coronary flow velocity increased from 14 to 21 cm/sec and mean flow from 6 to 13.5 cm/sec, yielding an estimated flow reserve of 1.5 and 2.2, respectively (normal > 3.0). Thus, intravascular and Doppler ultrasound are useful techniques for analyzing the effect of myocardial bridging on changes in coronary shape and blood flow. An eccentric compression of the coronary artery was visualized with delayed relaxation. Coronary flow reserve was reduced. Further studies in larger patient populations are necessary to demonstrate whether reduction of coronary flow reserve is, in general, related to delayed relaxation in diastole.
Echocardiographic Detection of Acute Myocardial Ischemia During Percutaneous Transluminal Coronary Angioplasty
Authors: HERREGODS MARIE‐CHRISTINE , VANDEPLAS ANNE , VROLIX MATTHIAS , De SCHEERDER IVAN , PIESSENS JAN , AUBERT ANDRÉ , De GEEST HILAIRE
Published: August 2007

The usefulness of echocardiography and Doppler for the detection of acute myocardial ischemia was evaluated during right coronary artery occlusion in 20 patients. The echocardiographic findings were compared with the occurrence of chest pain, and to electrocardiographs and hemodynamic changes obtained during percutaneous transluminal coronary angioplasty. Our results confirm that, even in the case of small segmental myocardial ischemia, two‐dimensional echocardiography is superior to all other measured parameters. In contrast, Doppler examination of transmitral flow is not sensitive enough for the detection of such small segmental myocardial ischemia induced by right coronary artery occlusion.
Reproducibility of Myocardial Contrast Echocardiography in Human Studies
Authors: MUDRA HARALD , KLAUSS VOLKER , MEISSNER OLIVER , METZ JONAS , ZWEHL WERNER , THEISEN KARL
Published: August 2007

Experimental and clinical studies were performed to assess the ability of myocardial contrast echocardiography for quantitation of regional myocardial blood flow. To evaluate whether myocardial contrast echocardiography is a reproducible technique in humans, 18 nonselected patients undergoing coronary angiography were studied. A total of 107 intracoronary injections into either the left or the right coronary artery were analyzed by computer assisted videodensitometry for peak intensity, contrast decay half‐time, and area under the curve. By means of these parameters intraobserver, interobserver, and interinjection variability were determined. Intraobserver measurements showed lowest variability with correlation coefficients of 0.83 for contrast decay half‐time, 0.93 for peak intensity, and 0.95 for area under the curve. Mean percent error varied between 6.8% (peak intensity) and 11.2% (area under the curve). The correlation coefficients for interobserver variability ranged from 0.73 for area under the curve to 0.97 for peak intensity. Mean percent error revealed a range between 7.5% for peak intensity and 19% for area under the curve. For interinjection variability, the correlation coefficient for contrast decay half‐time was lower (0.56) than for peak intensity (0.73) and area under the curve (0.84). Mean percent error were higher than for intraobserver and interobserver variability (range 24.1% to 34.2%). Thus, intraobserver and interobserver variability for parameters derived from time‐intensity curves after intracoronary injection of echo contrast agent in humans are sufficient and comparable to data from animal studies. Interinjection variability, however, showed a higher mean percent error. These interinjection differences have to be taken into account, if comparative measurements before and after interventions are performed.
Transthoracic Echocardiography for Evaluation of Hypertensive Heart Disease
Authors: DELLSPERGER KEVIN C.
Published: August 2007

Systemic arterial hypertension is a common malady in the United States, with as many as 58 million persons having a diagnosis of hypertension. Left ventricular hypertrophy (LVH), which develops as a response to the elevated afterload, may be viewed as necessary and protective. However, many recent studies have demonstrated that significant abnormalities of the coronary circulation occur with LVH. These include impaired vasodilator reserve, altered autoregulation, increased tendency to ventricular arrhythmias, and increased infarct size. In addition, adverse effects directly on cardiac muscle which includes decreased contractility, and altered diastolic function may also be present. Therefore, the presence or absence of LVH may predict outcome in addition to hypertension alone. In this review I will discuss potential advantages and disadvantages of each transthoracic echocardiographic method of measuring LV mass. I will also discuss the controversy surrounding serial measurements of LV mass with antihypertensive therapies.
Coronary Artery Disease in Women:
Authors: GORDON ELLEN E.I.
Published: August 2007

In the United States, coronary artery disease (CAD) kills equal numbers of men and women, and is the leading cause of death in women. Except at the oldest ages, the prevalence of disease is lower in women than in men. This low prevalence decreases the accuracy of all noninvasive testing methods, making the noninvasive diagnosis of CAD in women more difficult. Perhaps because of this increased difficulty in diagnosis and the prognosis of women with angina has been perceived to be “benign”, invasive testing has been used less often in women. Since the morbidity and mortality are greater in women compared with men with manifest CAD (i.e., myocardial infarction and coronary artery bypass grafting), an understanding of the strengths and limitations of noninvasive testing in women is critical. Due to the lower prevalence of CAD in women, symptoms of CAD (i.e., chest pain) and noninvasive tests (graded exercise treadmill) are less reliable with lower positive predictive values. Recent studies suggest using imaging techniques to improve the diagnostic sensitivity and specificity of noninvasive testing. This article will review the current literature regarding noninvasive diagnosis of CAD in women, including the use of stress echocardiography and thallium imaging in women. Detailed statistical descriptions of study populations are necessary so that study results can be accurately applied and interpreted in the general population.
Role of Papillary Muscle Dysfunction in the Pathogenesis of Mitral Regurgitation in Myocardial Infarction:
Authors: TASHIRO HIDEKI , KOYANAGI SAMON , TAKESHITA AKIRA
Published: August 2007

To elucidate the pathogenesis of mitral regurgitation (MR) after myocardial infarction (MI), the incidence of papillary muscle dysfunction (PMD), mitral annular size, and the extent of wall‐motion abnormalities were examined in 81 patients with previous MI by two‐dimensional echocardiography and real‐time two‐dimensional Doppler flow imaging. The prevalence of pathological MR was lower in patients with anterior MI (36%) than in those with inferior (65%) or anterior and inferior MI (88%) (P < 0.01 vs anterior MI group). The incidence of PMD in patients with MR in the anterior MI group (15%) was lower than that in the inferior (50%, P < 0.01) or anterior and inferior MI group (43%, P < 0.05). The mitral annular dimension in patients with MR was significantly greater than in those without MR, but it was similar among the three groups. The extent of wall‐motion abnormality correlated significantly with the area of MR jet in the anterior MI group (y = 3.1x + 15.5, r = 0.52, P < 0.01) and in the inferior MI group (y = 8.3x + 32.7, r = 0.57, P < 0.01). However, the slope of this relationship was significantly steeper in the inferior MI group than in the anterior MI group (P < 0.05). These results indicated that the degree of MR with inferior MI was greater than with anterior MI for a given MI area. PMD may play an important role in the higher prevalence and greater degree of MR in inferior MI.