bluuebunny/crossref_metadata_2025 huggingface dataset:
Protective Effect of JTV519, A New 1,4‐Benzothiazepine Derivative, on Prolonged Myocardial Preservation
Authors: Hachida Mitsuhiro , Kihara Shinichirou , Nonoyama Masaki , Koyanagi Hitoshi
Published: August 2007

Abstract Background: JTV519 is know to protect cardiomyocytes from calcium overloading‐induced damage. The aim of this study was to investigate the potential protective effect of JTV519 on myocardium subjected to prolonged ischemia and the underlying mechanism of such protection. The effect of JTV519 was also compared with that of diltiazem, a 1,5‐ben‐zothiazepine derivative. Methods: Isolated rat hearts were randomly divided into three groups. Control hearts were arrested with histidine‐tryptophan‐ketoglutarat (HTK) cardio‐plegic solution alone. In the JTV519 group of hearts, cardiac arrest was achieved with JTV519 (10‐‐3 mmol/L) in the HTK solution. Hearts in the diltiazem group were arrested with diltiazem (0.5 mmol/L) in the HTK solution. All the hearts were then subjected to 6‐hour storage in HTK solution at 4°C. Results: After a 30‐minute reperfusion, the left ventricular developed pressure in the JTV519 and diltiazem groups were improved significantly compared with the control group. There was a significantly lower left ventricular end‐diastolic pressure level and higher recovery of coronary flow in the JTV519 group than in the control group. The postischemic intracellular calcium concentration was attenuated by adding JTV519 or diltiazem to HTK cardioplegia. Conclusion: As an adjunct to cardioplegia, JTV519 showed a significant protective effect on myocardium undergoing 6 hours of ischemia. The beneficial protective effects of JTV519 are correlated with its ability to inhibit the postischemic rise in intracellular calcium.
Partial Left Ventriculectomy (Batista Procedure) in the Treatment of Dilated Cardiomyopathy: Makati Medical Center Philippine Experience
Authors: Garcia Jorge M. , Barril Joseph , Manapat Adrian , Lopez Gary , Luna Benjamin
Published: August 2007

Abstract In the Philippines patients with end‐stage heart disease refractory to conventional medical and surgical treatment do not have alternative choices. More than 99% of the population cannot afford cardiac transplantation. Partial left ventriculectomy (PLV) is a surgical procedure that improves cardiac function and refractory congestive heart failure (CHF). Between October 1997 and February 1998 eight patients had PLV at the Makati Medical Center, Philippines. All patients had end‐stage dilated cardiomyopathy. Six patients had an id‐iopathic etiology, one was ischemic and one valvular. Seven of eight operations were done with the heart beating and all had transesophageal echo monitoring. An average of a 2‐cm reduction in the left ventricle diameter was achieved and ejection fraction improved in all cases. There were no operative deaths. There were three late deaths. Two patients died of refractory CHF and ventricular arrhythmias and one patient died of massive cerebral hemorrhage with coumadin therapy. The five survivors are all doing well with no CHF. Follow‐up two‐dimensional echo shows stable left ventricular (LV) size and improved ejection fraction. Our initial experience shows that PLV, at least in the short‐term, has beneficial effects in the treatment of end‐stage dilated cardiomyopathy and might become an alternative to cardiac transplantation.
Minimally lnvasive Coronary Artery Bypass Grafting: One‐Year Follow‐Up
Authors: Verkkala Kalervo , Voutilainen Sari , Jarvinen Antero , Keto Pekka , Voutilainen Petri , Salmenpera Markku
Published: August 2007

Abstract Background: Use of the minimally invasive direct coronary artery bypass grafting (MIDCAB) technique has been associated with excellent primary results, and sparing of resources has been assumed. There is, however, a limited amount of information available concerning the results of mid‐term follow‐up. The purpose of this study was to present 1‐year follow‐up results of our first 130 consecutive MIDCAB patients.

Methods: MIDCAB operations, defined as no sternotomy, no cardiopulmonary bypass, and no aortic manipulation were started in our clinic in February 1996. One hundred thirty patients requiring invasive treatment of coronary artery disease who were not suitable for percutaneous transluminal angioplasty were included in this series. The main outcome measures were mortality, the need for subsequent invasive treatment, and 1‐year NYHA classification.

Results: There was one hospital death, but during the first‐year follow‐up, four additional deaths occurred and three patients were reoperated on with conventional techniques. Five percutaneous transluminal coronary angioplasties (PTCAs) had to be performed, two because of anastomosic stenosis. Additionally, cardiac‐ or operation‐related symptoms caused a total of 27 hospital visits among 23 patients during the first‐year follow‐up. Angiographic left internal thoracic artery (LITA)‐left anterior descending artery (LAD) patency was 97.4% (37/38) (confidence interval [CI] ranged from 86.2% to 99.9%) at 3 months. After 1 year, 86.9% (113/130) of the patients were without symptoms. A clear improvement of the follow‐up results was observed to be associated with increased experience during the study period.

Conclusions MIDCAB operations, after some experience, can be performed with relatively good outcome. However, special attention should be directed to determination of correct anastomosic site and to avoiding anastomosic stenosis. We also recommend extended mobilization of the ITA and use of specific stabilizers.
Extended Follow‐Up After Atrial Repair for Transposition of the Great Arteries: A Younger Age at Surgery Improves Late Survival
Authors: Genoni Michele , Vogt Paul , von Segesser Ludwig , Seifert Burkhardt , Arbenz Urs , Jenni Rolf , Turina Marko
Published: August 2007

Abstract Background: Surgical treatment for transposition of the great arteries (TGA) usually involves anatomic repair, although atrial repair is used in cases with special coronary artery patterns. Methods: Records of all 239 patients surviving at least 30 days after atrial correction of TGA between 1962 and 1987 at the University Hospital in Zurich were reviewed. The mean length of follow‐up time was 13.7 years (median 14.9 years; range from 0.05 to 30.1 years). The average age at surgery was 45.7 months (range from 7 days to 24.4 years). One hundred twenty‐one patients had a simple TGA, whereas the remaining 118 had a complex TGA. Results:The surviving patients were in NYHAclassI at time of follow‐up. The most common reasons for death were systemic right ventricular dysfunction and sudden rhythm disturbances. There was a major risk for late cardiac event in patients over 3 years old at operation (p = 0.02) and also in patients with complex TGA (p = 0.03). However, date of surgery, previous surgery, or the postoperative requirement for a pacemaker did not greatly affect late cardiac mortality. Conclusions: Although the procedure of choice for TGA is the arterial switch operation, the promising findings of the current long‐term study, which reports the longest follow‐up to date, indicate that the atrial switch operation is a good alternative procedure for the rare cases where the use of arterial switch procedures is limited. (J Card Surg 1999;14:246–251)
Pentastarch Versus Albumin in Cardiopulmonary Bypass Prime: Impact on Blood Loss
Authors: Keyser Eric J. , Latter David A. , Morin Jean E. , Murshid Abdulelah A. , Denis France , de Varennes Benoit
Published: August 2007

Abstract Background: Albumin is commonly used as a volume expander in cardiopulmonary bypass (CPB) prime. Pentastarch, a low molecular weight hetastarch, may provide similar efficacy at decreased cost but is known to alter coagulation profiles. Infectious concerns forced the temporary withdrawal of albumin in our institution. Therefore we evaluated pentastarch as an alternative with regards to perioperative hemostasis and blood loss. Methods: One hundred consecutive adult patients undergoing first‐time aorto‐coronary bypass were given 750 mL of 10% pentastarch (represented as P in calculations) diluted in 1000 mL of Ringer's solution added in their CPB prime. A similar control group of 100 consecutive patients had received 200 mL of 25% albumin (represented as A in calculations) diluted in 1500 mL of Ringer's solution. Results: Postoperative prothrombin time (PT) was slightly higher with pentastarch (P: 14.9 ± 1.5 seconds, A: 14.2 ± 1.3 seconds, p = 0.003). Postoperative bleeding was also increased (P: 2337 ± 1242 mL, A: 1981 ± 1121 mL, p = 0.0341, mostly because of recirculated shed mediastinal blood (P: 834 ± 499 mL, A: 640 ± 388, p = 0.002) rather than lost pleural tube blood (P: 1503 ± 821 mL, A: 1341 ± 824 mL, p = 0.16). Overall net blood loss (P: 2014 ± 914 mL, A: 2061 ± 1015, p = 0.73) was similar. Blood‐product transfusion requirements and postoperative daily hematocrits did not differ. Conclusion: The diminished coagulability associated with this dose of pentastarch resulted in increased postoperative bleeding. However, with recirculation of shed mediastinal blood, there was no net increase in blood loss. In this setting, pentastarch may serve as a suitable alternative to albumin. (J Card Surg 1999; 14.279–286)
Echocardiography in the Diagnosis of Cardiac Tamponade
Authors: SAGAR KIRAN B. , WANN L. SAMUEL , KLOPEFENSTEIN H. SIDNEY
Published: August 2007

M‐mode echocardiography has a limited role in the diagnosis of cardiac tamponade. Right ventricular diastolic collapse observed on the two‐dimensional echocardiogram is both sensitive and specific for cardiac tamponade in the absence of pressure overload of the right ventricle. Right atrial collapse is a highly sensitive but less specific sign for cardiac tamponade. Both of these signs should be used with caution, however, taking into consideration the intravascular status and the state of the left Ventricular volume.
Congestive Cardiomyopathy: Doppler Echocardiographic Assessment of Structure and Function
Authors: LOUIE ERIC K.
Published: August 2007

Changing strategies in the treatment of congestive cardiomyopathies including new pharmacological agents, “physiological” dual‐chamber pacing, and cardiac transplantation have provided the impetus for finding diagnostic techniques that can better characterize and quantify the structure and function relationships in these diseases. Two‐dimensional echocardiography provides us with an excellent noninvasive tool for demonstrating the dilated hypocontractile left ventricle of congestive cardiomyopathy and contrasting it against other primary and secondary diseases of the left ventricle. Doppler echocardiographic quantitation of intracardiac blood flow‐velocities offers the potential to complement these anatomical studies with physiological information about disordered systolic and diastolic function in the congestive cardiomyopathies. The synthesis of these techniques should allow more precise prognostication and stratification of this varied and complex group of patients, which will have important implications for the diagnosis and treatment of congestive cardiomyopathies.
Natural History of Carotid Artery Disease as Assessed by Ultrasonic Techniques
Authors: LANGLOIS YVES , ROEDERER GHISLAINE O. , STRANDNESS D. EUGENE
Published: August 2007

Continued surveillance of asymptomatic patients with carotid artery disease is now feasible using accurate noninvasive tests that are safe and easily repeatable. A better understanding of the natural history of carotid artery disease will permit a more enlightened management of disease in these patients. It will be feasible to identify subsets of patients who will benefit from closer surveillance or prophylactic treatments. Our data support that it is sate to observe asymptomatic patients with noninvasive tests until disease has progressed beyond 80% diameter reduction or until the appearance of TIAs. As underlined in other studies, the high occurrence of cardiac events also supports the fact that we should adopt a more global approach in the care of these patients.
Application of Doppler Color Flow Mapping in the Assessment and the Evaluation of Congenital Heart Disease
Authors: RITTER SAMUEL B.
Published: August 2007

Summary and Future Directions

Doppler color flow mapping has proven to be a most valuable addition in the armamentarium of noninvasive cardiovascular technology. For the first time real‐time two‐dimensional imaging of morphology with spontaneous display of flow is provided for the cardiologist. It enhances both qualitative and quantitive observations and is seen as an invaluable adjunct in the complete noninvasive examination. Continued application and investigation of quantitative and semiquantitative aspects of Doppler color flow mapping as well as investigations in the new areas of fetal and intraoperative color flow will continue to grow and add to our information of cardiac morphology and physiology and a more complete understanding of the dynamics of congential heart disease.
Comparison of Transthoracic and Transesophageal Assessment of Prosthetic Valve Dysfunction
Authors: DANIEL LORRETTA B. , GRIGG LEEANNE E. , WEISEL RICHARD D. , RAKOWSKI HARRY
Published: August 2007

Transesophageal echocardiography has added another dimension to the assessment of prosthetic valve dysfunction with high‐resolution images that allow for more detailed structural evaluation of tissue and mechanical valves. This study is a retrospective analysis of 140 prosthetic valves (90 tissue, 50 mechanical) in the mitral (89), aortic (45), and tricuspid (6) position in 116 patients studied by transthoracic and transesophageal echocardiography techniques. Transesophageal echocardiography was consistently better than the transthoracic technique in the evaluation of structural abnormalities of tissue valves in the mitral and aortic positions with respect to leaflet thickening, prolapse, flail, and vegetations. With transesophageal echocardiography, five tissue mitral valve had flail leaflets that were not identified by the transthoracic technique. Transesophageal echocardiography was better than transthoracic in the detection, quantification, and localization of prosthetic mitral regurgitation. Physiological mitral regurgitation was detected in 31 valves by transesophageal echocardiography compared to seven by transthoracic technique. By transesophageal echocardiography, mitral regurgitation was paravalvular in 24% compared with 4% by transthoracic technique. Left atrial spontaneous contrast was seen in 42% of the patients with a mitral prosthesis detected only by transesophageal echocardiography. Six patients had left atrial or left atrial appendage thrombus and in five patients they were detected only by transesophageal echocardiography. We conclude that transesophageal echocardiography should be a complimentary test to transthoracic studies in patients with suspected prosthetic valve dysfunction or for the follow‐up of older tissue valves.
Intraoperative Echocardiographic Assessment of Global and Regional Myocardial Function
Authors: SIMON P. , MOHL W.
Published: August 2007

Intraoperative echocardiography is gaining increasing importance to the anesthesiologist and the surgeon in the management of high‐risk patients undergoing cardiac and major noncardiac surgery. It can provide for the noninvasive, immediate assessment of global left ventricular function, and its determinants; preload, afterload, and myocardial contractility. In addition, abnormalities of regional myocardial function, as a marker of myocardial ischemia, can be easily identified. With the advent of transesophageal echocardiography, this imaging technique can be more widely applied without interfering with the surgical procedure, not only increasing our ability to adequately monitor the patient, but also guiding our therapy and providing additional insights into the physiological and pathophysiological processes affecting the heart during surgery.
Comparative Studies of Angioscopy and Ultrasound for the Evaluation of Arterial Disease
Authors: SIEGEL ROBERT J. , FISHBEIN MICHAEL C. , CHAE JANG‐SEONG , HELFANT RICHARD H. , HICKEY ANN , FORRESTER JAMES S.
Published: August 2007

In this in vitro investigation, we studied the histopathological basis for intravascular ultrasound image interpretation and how this technique compares with fiberoptic angioscopy in assessing atherosclerosis. This article presents the sensitivity and specificity of these techniques in the recognition of arterial abnormalities. The relevance of these data in interventional therapeutic procedures and the clinical implications of intravascular imaging methods are also discussed.
Clinical Perspectives of Intravascular Ultrasound
Authors: ROELANDT J. , SERRUYS P.W. , TUCCILLO B. , GUSSENHOVEN W.J.
Published: August 2007

The history of intravascular ultrasound imaging, recent developments in catheter technology, and the initial in vivo experience are reviewed. Additionally, the article also discusses the potential applications of intravascular ultrasound imaging in coronary and peripheral arterial atherosclerosis, hypertension, pulmonary arterial disorders, valvular heart disease, aortic abnormalities, and in congenital heart disorders. Possible future directions are outlined.
Visualization of Mitral Valve Aneurysm by Transesophageal Echocardiography
Authors: SHAKUDO MASAHIRO , ENG ALVIN K. , APPLEGATE PATRICIA M. , BANSAL RAMESH C. , WONG MAYLENE , SHAH PRAVIN M.
Published: August 2007

This article describes the transesophageal echocardiographic findings in a patient with pathologically proven mitral valve aneurysm. This aneurysm probably occurred as a complication of aortic valve endocarditis. Transesophageal echocardiography showed a saccular structure attached to the left atrial side of the anterior mitral leaflet with systolic expansion and diastolic collapse, and its orifice was visualized with excellent resolution. Transesophageal echocardiography is a useful diagnostic tool for evaluation of mitral valve aneurysm.
Transvaginal Doppler Ultrasonography in Early Pregnancy: Blood Flow Development in the Umbilical Cord
Authors: FUNK A. , JÖRN H. , FENDEL H.
Published: August 2007

The umbilical arterial and venous blood flow of 60 pregnancies between the sixth and fifteenth week of gestation was investigated using Doppler ultrasound technology. Although fetal heart activity was detected from the fifth week, umbilical arterial blood flow was not identified until the sixth week, and venous flow was not seen until the seventh week. The characteristics of the Doppler velocity waveform changed significantly as gestation progressed. Initially, the waveform showed a short flat systolic component without diastolic flow. Systole gradually increased in duration and peaked. The diastolic component increased and became continuous at 14 weeks. After the fourteenth week, the velocity waveform did not differ greatly from those of later gestation. Arterial blood flow changes evidenced by a serial decline in the pulsatility index presumably reflects decreasing resistance of the embryonic and fetal placental vessels associated with maturation of the fetoplacental unit.
Fetal and Maternal Velocimetry in High Risk Pregnancies for the Assessment of Adverse Perinatal Outcome
Authors: GRAMELLINI D. , FOLLI M. C. , SACCHINI C. , STERBINI M. P. , LOMBARDO A. , MERIALDI A.
Published: August 2007

Pulsed‐Doppler ultrasound assessment of blood flow was performed simultaneously in the fetal middle cerebral artery, umbilical artery, and uteroplacental vessels to verify the incidence of velocimetric abnormalities, as well as their predictive value towards adverse perinatal outcome. Eighteen normal pregnancies and 32 complicated pregnancies (intrauterine growth retardation, pregnancy‐induced hypertension, chronic hypertension and pre‐eclampsia) have been examined between 30th and 40th week of gestation. Waveform abnormalities were detected even in the control group, more frequently in the cerebral artery (11.1%) and umbilical artery (5.5%) than in uteroplacental arteries. Umbilical artery abnormalities were found in intrauterine growth retardation, pregnancy‐induced hypertension, and preeclampsia; while the highest number of anomalous Doppler waveforms in the middle cerebral artery was seen in 71.4% of patients with pregnancy‐induced hypertension. Pathological umbilical artery patterns have shown a diagnostic accuracy of 62% in identifying adverse perinatal outcome. Both middle cerebral artery and uteroplacental vessels demonstrated a diagnostic accuracy of 58%. The false positive rate is 6% for the umbilical artery, 8% for the middle cerebral artery, and 0% for uteroplacental vessels, contrary to current methods of fetal surveillance (such as nonstress test, contraction stress test and biophysical profile), which have a false‐positive rate ranging from 30% to 70%.
Assessment of the Main Fetal Cerebrovascular Areas by Ultrasound Color‐Coded Doppler
Authors: ARBEILLE Ph. , MONTENEGRO N. , TRANQUART F. , BERSON M. , RONCIN A. , POURCELOT L.
Published: August 2007

The color flow mapping method makes it possible to identify small vessels presently not detected on B‐mode imaging. The main cerebral arteries of normal human fetuses, anterior, middle, and posterior arteries, were investigated by color‐coded Doppler in 45 normal pregnancies. The Pourcelot index R was calculated at different stages of the pregnancy. The values of R (anterior cerebral artery), R (middle cerebral artery), and R (posterior cerebral artery) were compared in each fetus. No significant differences were found when comparing all of the R (anterior cerebral artery) and R (middle cerebral artery) or the R (anterior cerebral artery) and R (middle cerebral artery) at the same gestational age. On the contrary, for each fetus, at any gestational age, the R (anterior cerebral artery) and the R (middle cerebral artery) indices were significantly different (P < 0.01); the index in the middle cerebral artery was higher than that of the anterior cerebral artery. The same difference was observed when comparing R (posterior cerebral artery) and R (middle cerebral artery). The index of the middle cerebral artery was significantly higher than that of the posterior cerebral artery (P < 0.001). On the other hand, no significant difference was found between R (anterior cerebral artery) and R (posterior cerebral artery) at any gestational age (P = 0.4).
Effects of Indomethacin on Resting Cerebral Hemodynamic and During Suctioning in Preterm Neonates
Authors: SALIBA E. , AUTRET E. , ARBEILLE Ph. , GOLD F. , POURCELOT L. , LAUGIER J.
Published: August 2007

The effect of therapeutic doses of indomethacin versus a placebo on cerebral hemodynamics was studied in nine preterm infants using Doppler ultrasound. Three doses of indomethacin (0.2 mg/kg) induced a significant decrease in the mean frequency compared to the placebo. Heart rate, blood pressure, transcutaneous carbon dioxide tension, and transcutaneous oxygen tension remained stable throughout the study. The changes in mean frequency occurred rapidly and were sustained at significantly diminished levels for at least 1 hour. All infants were mechanically ventilated, and the increase of mean frequency secondary to suctioning was significantly attenuated after each dose of indomethacin as compared to the placebo. The results confirmed that infusion of indomethacin caused a reduction in cerebral blood flow, probably by vasoconstriction of cerebral vessels. Indomethacin also seemed to attenuate the cerebrovascular response to hypercapnia induced by endotracheal suctioning. Even so, and because of the alteration of resting cerebral hemodynamics, we do not support the recommendation that indomethacin should be used prophylactically to prevent patent ductus arterious or periventricular intraventricular hemorrhage.
Transesophageal Echocardiographic Identification of Atrial Septal Aneurysm
Authors: ZBOYOVSKY KAREN L. , NANDA NAVIN C. , JAIN HANS
Published: August 2007

This case illustrates the usefulness of biplane transesophageal echocardiography in the diagnosis of an atrial septal aneurysm, which in some views, mimicked a mass lesion in the left atrium. (ECHOCARDIOGRAPHY, Volume 8, July 1991)
Cardiac Ultrasound: Its Role in the Recognition and Management of Fetal Heart Disease
Authors: GIDDING SAMUEL S. , HUHTA JAMES C.
Published: August 2007

This article briefly reviews the role of ultrasound scanning in the diagnosis and management of fetal cardiac disease. Currently, the potential exists for the accurate identification of a wide range of cardiac defects and for the diagnosis and successful management of many cardiac rhythm disturbances. Considerable benefit is derived for families with previously affected children when a normal fetal cardiac ultrasound report can be provided. (ECHOCARDIOGRAPHY, Volume 8, July 1991)
Echocardiography Segmental Approach to Complex Congenital Heart Disease in the Neonate
Authors: HAGLER DONALD J.
Published: August 2007

A segmental echocardiographic approach to complex congenital heart disease in the neonate allows accurate and precise assessment of intracardiac, as well as extracardiac, anomalies. Determination of abnormalities of atrial and visceral situs, as well as the cardiac situs, provides a fundamental background for the echocardiographic examination. Subsequently, a segmental approach allows precise determination of abnormalities of atrioventricular and ventricular great artery connections. Recent echocardiographic advances including high‐frequency (7.5 and 10 MHz) and color flow imaging capabilities have dramatically improved our ability to accurately define abnormalities of anatomy and connection in the neonate. These advances now have expanded our previous echocardiographic criteria and allow application of the echocardiographic segmental approach to characterize complex congenital heart disease in the neonate. (ECHOCARDIOGRAPHY, Volume 8, July 1991)
Echocardiographic Examination of the Aortic Arch: Anomalies Presenting in the Neonatal Period
Authors: HUMES RICHARD A. , FAROOKI ZIA Q.
Published: August 2007

Congenital anomalies of the aortic arch that present in the first 30 days of life include clinically significant lesions such as coarctation of the aorta and interruption of the aortic arch. Other anomalies of aortic arch position may present as part of a larger congenital complex. Knowledge of the embryology and anatomy of these structures is essential to the understanding of this class of defects. A systematic and careful two‐dimensional echocardiographic examination of the arch structures from suprasternal and high parasternal views should reveal the anatomy. A careful Doppler examination using pulsed‐ and continuous‐wave Doppler, as well as color flow imaging, is used to delineate the presence and severity of obstructive lesions. This review discusses the anatomy and echocardiographic techniques that may be used to demonstrate this group of lesions. Noninvasive echocardiographic examination of the aortic arch complex in the neonate should be sufficient to make the diagnosis of most aortic arch anomalies. (ECHOCARDIOGRAPHY, Volume 8, July 1991)
Transesophageal Echocardiography for Congenital Heart Disease
Authors: FYFE DEREK A. , KLINE CHARLES H.
Published: August 2007

Surface echocardiographic imaging of small children is routinely successful in defining anatomical details and Doppler flow patterns with even the most complex congenital cardiac malformations. However, in larger children or adults, imaging is frequently limited. A recent expansion of the role of echocardiography is intraoperative epicardial imaging. Epicardial and postoperative imaging, however, have significant limitations. To avoid some of these limitations, transesophageal echocardiography has increasingly been used in the arena of congenital heart disease. The more recent development of small sized gastroscopic probes has allowed transesophageal echocardiographic assessment of congenital heart disease in children down to newborn size. As detailed studies of individual lesions are reported, it has become clear that the mere presence of a congenital heart defect is not an indication for transesophageal echocardiography in most children if imaging can be accomplished by surface examination. However, transesophageal echocardiography may be indicated for the intraoperative or postoperative assessment of that defect, particularly when repair has been difficult or is known to be associated with significant residual abnormalities. Cardiac structures encountered with horizontal and vertical imaging plane transducers have been described and should be completely familiar to the examining echocardiographer. (ECHOCARDIOGRAPHY, Volume 8, September 1991)
Corrected Transposition of the Great Arteries, Common Atrioventricular Valve, and Dextrocardia
Authors: RYLAARSDAM MARÍA , ZABAL CARLOS , ROMERO ANGEL , BUENDÍA ALFONSO , ATTIE FAUSE
Published: August 2007

Corrected transposition of the great arteries with a common atrioventricular valve is a rare congenital anomaly. In the presence of two well‐defined, atrioventricular valves, cross‐sectional echocardiography is the method of choice for the diagnosis of this cardiac defect. The presence of a common atrioventricular valve can be a limitation of the method. Angiocardiography provides additional information for the diagnosis. (ECHOCARDIOGRAPHY, Volume 8, September 1991)
Transesophageal Color Doppler Flow Mapping of Iatrogenic Left‐to‐Right Interatrial Shunting After Percutaneous Transluminal Mitral Valvotomy
Authors: CHEN CHEN‐HUAN , LIN SHOA‐LIN , YIN WEI‐HSIAN , LIOU JER‐YOUNG , HSU TSUI‐LIEH , TING CHIH‐TAI , CHANG MAU‐SONG , CHIANG BENJAMIN N.
Published: August 2007

Characteristics of transesophageal color Doppler flow mapping of iatrogenic left‐to‐right interatrial shunts were assessed in 58 patients, 1 to 994 days after percutaneous transluminal mitral valvotomy. Transesophageal color Doppler flow mapping detected 22 cases of interatrial shunt whereas transthoracic two‐dimensional echocardiography visualized only five interatrial septal defects. Five types of color Doppler flow patterns of interatrial shunts were found: type 1, a bluish jet passing through the interatrial septum into the right atrium with a small bluish proximal flow in the left atrium (50%); type 2, a bluish jet passing through the interatrial septum into the right atrium without a proximal flow (13.6%); type 3, a predominant bluish proximal flow in the left atrium passing through the interatrial septum with minimal flow entering into the right atrium (18.2%); type 4, an “en face” bluish jet in the right atrium (4.5%); and type 5, a “wall jet” with proximal flow adhering to and entering into the interatrial septum (13.6%). Oximetry demonstrated increased pulmonary‐to‐systemic flow ratio (range 1.07 to 3.32) in 11 patients (50%), which was significantly correlated with the maximal jet area derived from colorDoppler flow mapping (r= 0.80, P= 0.001). Thus, transesophageal color Doppler flow mapping is useful in detection of left‐to‐right interatrial shunts after percutaneous transluminal mitral valvotomy, and recognition of the variable types of color flow mapping may further help identify these atypical interatrial shunts. (ECHOCARDIOGRAPHY, Volume 8, November 1991)
Transesophageal Echocardiography with Color Doppler During Interventional Catheterization
Authors: VELDE MARY E. VAN DER , PERRY STANTON B. , SANDERS STEPHEN P.
Published: August 2007

Echocardiography has been used during interventional cardiac catheterization for guidance of the procedure and assessment of results. However, limited echocardiographic windows and logistical difficulties make conventional echocardiography during interventional catheterization impractical and of limited value. Transesophageal echocardiography (TEE) with Doppler color flow mapping is more useful than conventional echocardiography for guidance of interventional catheterizations. Device closure of congenital atrial and ventricular septal defects (ASDs and VSDs) and of postoperative residual interatrial and interventricular communications, balloon valvuloplasty, and Brockenbrough atrial septal puncture with ASD creation have been performed under combined fluoroscopic and TEE guidance. Transesophageal echocardiography can be performed continuously throughout the procedure, allowing simultaneous fluoroscopic and echocardiographic assessment of catheter position. Localization of individual device arms during transcatheter device closure of ASDs and VSDs is easier and more accurate when TEE is used, resulting in a lower incidence of incorrect device positioning. Doppler color flow mapping is used to determine number, location, and size of defects, to detect residual shunts after device closure, and to assess valve insufficiency after balloon valvuloplasty and other procedures. Combined TEE and fluoroscopic guidance of interventional procedures, with echocardiographic assessment of results, reduces the amount of radiation and contrast used during the procedure, allowing performance of additional interventional procedures during the same catheterization. Transesophageal echocardiography is indicated during interventional procedures in which simultaneous Doppler color flow mapping and precise localization of catheter, balloon, and/or device position will result in a higher success rate and decreased morbidity. (ECHOCARDIOGRAPHY, Volume 8, November 1991)
Transesophageal Echocardiographic Imaging of the Pulmonary Veins
Authors: PINHEIRO LUIZ , NANDA NAVIN C. , JAIN HANS , SANYAL RAJAT
Published: August 2007

This report focuses on the technical aspects of the assessment of pulmonary veins using biplane transesophageal echocardiography, taking into account their spatial anatomical orientation and relationship to neighboring structures. This is aimed at increasing the echocardiographer's ability to visualize the proximal segments of all four pulmonary veins. (ECHOCARDIOGRAPHY, Volume 8, November 1991)
Left Ventricular to Right Atrial Septal Defect Secondary to Blunt Thoracic Trauma Diagnosed by Transesophageal Echocardiography
Authors: WILSON VANCE E. , KIRSCH MARVIN M. , STARKEY THOMAS D. , ARMSTRONG WILLIAM F.
Published: August 2007

A case report is presented of a 58‐year‐old man who developed a new holosystolic murmur 4 months after a high‐speed motor vehicle accident. Cardiac catheterization demonstrated a left‐to‐right shunt at the right atrial level. Intraoperative transesophageal echocardiography (TEE) identified and localized a discrete atrioventricular septal defect associated with a shunt from the left ventricle to the right atrium without tricuspid regurgitation, findings that were confirmed after surgical exploration. TEE is recommended for patients with a heart murmur and a history of blunt cardiac trauma, may permit early diagnosis, and may allow surgical repair in selected patients without pre‐operative catheterization. (ECHOCARDIOGRAPHY, Volume 8, May 1991)
Comparison of Noninvasive Measures of Contractility in Dilated Cardiomyopathy
Authors: ROMAN MARY J. , DEVEREUX RICHARD B.
Published: August 2007

Left ventricular performance is usually quantified by ejection phase indices such as ejection fraction, cardiac output, and fractional shortening. The load‐dependence of these measures may result in inaccurate estimation of intrinsic myocardial contractility in states of chronic pressure or volume overload. End‐systolic and stress‐shortening relations have been proposed as measures of contractile state insofar as they are theoretically independent of preload and incorporate afterload. This article examines the behavior of these relations in response to changes in loading conditions and contractile state and reviews their application utilizing noninvasive methodology, particularly in the setting of dilated cardiomyopathy. (ECHOCARDIOGRAPHY, Volume 8, March 1991)
A Physiological Approach to Drug Therapy in Dilated Cardiomyopathy
Authors: MARCUS RICHARD H. , LANG ROBERTO M. , NEUMANN ALEX , BOROW KENNETH M.
Published: August 2007

Cardiac ultrasound imaging can be used in conjunction with calibrated external pulse recordings to provide detailed information regarding cardiovascular hemodynamics. This review establishes a physiological framework for the echo‐Doppler assessment of cardiac mechanics, left ventricular energetics, and ventriculo‐systemic vascular coupling in patients with dilated cardiomyopathy. The section on cardiac mechanics concerns the evaluation of overall cardiac performance and its individual determinants. Particular emphasis is placed upon the use of noninvasive methodology to identify the relative contributions of altered loading conditions and intrinsic myocardial contractility to cardiac performance. The noninvasive evaluation of left ventricular energetics is based oh the physiological premise that myocardial oxygen consumption is a function of three major determinants, i.e., heart rate, contractility, and the integral of left ventricular systolic load (or wall stress). Following a brief discussion of the vascular properties that determine the relationship between pressure and flow in the systemic circulation, noninvasive methods for determination of systemic vascular resistance and arterial compliance are described. At the end of each section, practical clinical applications of these techniques to the evaluation and management of patients with dilated cardiomyopathy are presented. (ECHOCARDIOGRAPHY, Volume 8, March 1991)
Two‐Dimensional Echocardiography in Myocardial Amyloidosis
Authors: PICANO EUGENIO , PINAMONTI BRUNO , FERDEGHINI EZIO M. , LANDINI LUIGI , SLAVICH GIANNI , ORLANDINI ANDRÉS , MARINI CECILIA , LATTANZI FABIO , CAMERINI FULVIO
Published: August 2007

Two‐dimensional echocardiography is the best means of identifying early cardiac amyloid infiltration and gauging its subsequent progression. The early asymptomatic phase is characterized on echocardiography by a mild‐to‐moderate increase in left ventricular and/or right ventricular wall thicknesses. The distinctive combination of low electrocardiography voltage and increase in left ventricular mass on the echocardiogram, both compatible with substantial amyloid infiltration, is valuable in diagnosis and appears to indicate the severity of the disease. Other ancillary but common findings are left atrial dilatation, a small pericardial effusion, thickening of cardiac valves, papillary muscles, and interatrial septum. Finally, there is a peculiar texture of myocardial walls, with highly refractile areas that are typical, although not specific, of myocardial amyloidosis and can also be quantitatively described by digital image analysis techniques. The echocardiography appearance of amyloidosis can closely mimic several other diseases. Asymmetric hypertrophy of the septum due to amyloid deposition may occur, simulating hypertrophic cardiomyopathy. The granular sparkling of myocardial walls is also found in myocarditis with severe fibrosis, and it is quite common in hypertrophic cardiomyopathy, as well as in other infiltrative diseases of the myocardium. It is not uncommon that the echocardiography examination represents a turning point in the work‐up of the patient, briskly orienting the clinician towards the correct diagnostic pathway. However, the likelihood of the car‐diologist‐echocardiographer to successfully and prospectively identify myocardial amyloidosis is substantially higher if all the clinical and electrocardiographic information is reviewed at the time of the echocardiographic examination. (ECHOCARDIOGRAPHY, Volume 8, March 1991)
Intraoperative Color Doppler Assessment in Valve Repair Surgery
Authors: MAURER GERALD , CZER LAWRENCE S.C.
Published: August 2007

Intraoperative color Doppler recordings, obtained either from the epicardial or transesophageal approach, offer real‐time information about the presence and severity of mitral regurgitation at the time of surgery. The technique allows instantaneous evaluation of mitral and tricuspid repair and may offer important information about the postoperative outcome. (ECHOCARDIOGRAPHY, Volume 8, March 1991)
Right Atrial Compression by a Hepatic Cyst
Authors: HENNESSEY LAWRENCE R. , BROVIAC JOHN W. , EISENBERG JOEL D.
Published: August 2007

Adult polycystic kidney disease is often associated with cystic liver disease, but diaphragmatic herniation and compression of the right atrium by a hepatic cyst is a previously unreported finding. This case describes a patient with adult polycystic kidney disease and chronic renal failure who presented with chest pain, and was initially suspected to have had uremic pericarditis. Echocardiography revealed this surprising finding. The patient improved with symptomatic treatment. A review of adult polycystic kidney disease and polycystic liver disease is presented.
Prolonged Duration of Acute Aortic Insufficiency Detected by Doppler Echocardiography
Authors: POPOVIC ALEKSANDAR D. , NESKOVIC ALEKSANDAR N. , PAVLOVSKI KOCO , MANGOVSKI LJUPCO
Published: August 2007

A case of infective endocarditis of the aortic valve with severe acute aortic insufficiency is presented. Doppler echocardiography on admission revealed the presence ofdiastolic mitral regurgitation, which is considered to be the Doppler sign of acute aortic insufficiency. At subsequent studies 1 and 2 months later, diastolic mitral regurgitation was still present. This finding demonstrates that the pathophysiology of acute aortic insufficiency can persist over 2 months.
The Neonatal Transitional Circulation: A Combined Noninvasive Assessment
Authors: ALENICK D. SCOTT , HOLZMAN IAN R. , RITTER SAMUEL B.
Published: August 2007

Dramatic changes occur in the circulation of the newborn during the transition from fetal to neonatal life. Closure of the foramen ovale and ductus arteriosus, decrease in pulmonary vascular resistance, and improvement in right ventricular compliance are among these changes. These physiologicalanatomical events were characterized by means of two‐dimensional, Doppler and color flow echocardiography. Forty‐five full‐term infants (22 male, 23 female) were studied at a mean age of 4.2 hours (T1), 25.5 hours (T2), 49.8 hours (T3), and 73.8 hours (T4) by two‐dimensional, Doppler and color flow echocardiography. At T1, T2, T3, and T4, the ductus arteriosus was patent by color flow echocardiography in 100%, 34%, 22%, and 11%, respectively. Conversely, patency of the ductus by Doppler alone was detected in 100% (T1), 13% (T2, T3), and 11% (T4). Reversal of flow in the descending aorta, reflective of diastolic ductal filling, was not sensitive in detecting ductal patency (T1 50%, T2 3%, T3 and T4 O%). The patency of the foramen ovale was noted to decrease over the course of the study. Right ventricular compliance was quantitatively assessed by pulsed‐Doppler diastolic properties (E‐to‐A ratio). This changed significantly from T1 to T4 (0.90 to 0.97) reflecting improving compliance of the right ventricle. The ratio of acceleration to ejection time, a Doppler estimation measure of pulmonary vascular resistance, increased from 0.28 to 0.33 (T1 to T4) reflecting a decrease in pulmonary vascular resistance. The incidence of tricuspid regurgitation detected by color flow mapping was 100% throughout the course of the study in multiple views. In comparison, tricuspid regurgitation detected by Doppler interrogation without color flow guidance was only present in 94% (T1), 53% (T2), 52% (T3), and 33% (T4) of infants studied. Timing of foramen ovale and ductus arteriosus closure can be determined noninvasively with great sensitivity. Changes in right ventricular compliance and pulmonary vascular resistance can also be assessed noninvasively. The presence of tricuspid regurgitation was appreciated best by use of color flow mapping. Echocardiography is a useful tool in assessing the neonatal transitional circulation.
Experimental Studies to Define the Geometry of the Flow Convergence Region: Laser Doppler Particle Tracking and Color Doppler Imaging
Authors: SHANDAS ROBIN , GHARIB MOREY , LIEPMANN DORIAN , SHIOTA TAKAHIRO , SAHN DAVID J.
Published: August 2007

The color flow convergence method for calculating volume flow through regurgitant or forward flow restrictive orifices has gained significant interest and a number of in vitro studies have suggested that this method is accurate, even in pulsatile models. Clinical application of the method over a wide range of conditions will require improved understanding of the effect of orifice size, flow geometry, and flow rate on the flow convergence geometry. In this study, we performed laser particle tracking investigations to allow visualization of streamlines into stenotic orifices. These streamlines are theoretically perpendicular to the isovelocity surfaces used for flow convergence calculations. We compared those observations to color flow map, flow convergence images obtained with a Toshiba 160A for orifices 5 to 15 mm2 with flow rates of 1.5 to 9.7 L/min. Our results show that for large orifices, low flow rates, and/or low pressure gradients, more oblique streamlines in the velocity of the orifice correspond to nonhemispherical, but more elliptical, flow convergence geometries. This can be corrected for by using lower Nyquist limits and calculating flow convergence at greater distances from the orifice. Under high flow and high gradient conditions, increased Nyquist limits and shorter aliasing radii are more suitable. Our studies yield insights into flow convergence geometry and yield corrective procedures to improve volume flow calculation.
Clinical Applicability of Echocardiographically Detected Regional Wall‐Motion Abnormalities Provoked by Upright Treadmill Exercise
Authors: CROUSE LINDA J. , KRAMER PAUL H.
Published: August 2007

Exercise electrocardiography is the time‐honored screening test for coronary artery disease but has serious limitations in many patient subgroups. A number of adjunctive modalities have been coupled to exercise ECG to increase the diagnostic accuracy of noninvasive testing, including thallium scintigraphy and gated blood pool radioventriculography. Exercise echocardiography has more recently emerged as a tool that can detect exercise‐induced regional wall‐motion abnormalities as an indicator of provoked myocardial ischemia. While there are conceptual advantages to performing echocardiography during maximal exercise, we have found that regional wall‐motion analysis performed with echocardiograms obtained before and immediately after upright treadmill exercise allows highly accurate prediction of the extent and distribution of coronary artery disease as detected by angiography. This monograph summarizes our experience with this form of exercise echocardiography in three important patient groups: (1) patients being screened for the presence or absence of coronary artery disease; (2) patients who have undergone previous coronary artery bypass surgery and who are being evaluated for graft failure and/or progression of native‐vessel disease; and (3) patients who have undergone coronary angioplasty and are at risk for restenosis and/or progression of disease. We believe, based on our experience and that of other investigators, that exercise echocardiography is a uniquely valuable tool in these and other patients for assessing the status of the coronary vascular anatomy. Not only can the presence or absence of obstructive disease be assessed, but the extent and distribution of disease can be accurately predicted, and other, noncoronary causes of chest pain such as aortic stenosis, mitral valve prolapse, hypertrophic cardiomyopathy, and pericardial disease can readily be identified.