bluuebunny/crossref_metadata_2025 huggingface dataset:
Noninvasive Transcutaneous Low Frequency Ultrasound Enhances Thrombolysis in Peripheral and Coronary Arteries
Authors: Siegel Robert J. , Atar Shaul , Fishbein Michael C. , Brasch Andrea V. , Peterson Thomas M. , Nagai Tomoo , Pal Dharmendra , Nishioka Toshihiko , Chae Jang‐Seong , Birnbaum Yochai , Zanelli Claudio , Luo Huai
Published: July 2003

Previous studies have shown that external ultrasound with low frequencies and high intensities can enhance thrombolytic drug‐induced clot dissolution during in vitro experiments. In this series of studies, we evaluated the efficacy of peripheral and coronary thrombolysis in vivo in animals by using noninvasive transcutaneous ultrasound combined with thrombolytic drugs (streptokinase and tPA) and/or microbubbles agents (dodecafluoropentane [DDFP] and perfluorocarbon‐exposed sonicated dextrose albumin [PESDA]). Thrombotic occlusions were induced in 74 rabbit iliofemoral arteries and 24 canine left anterior descending (LAD) coronary arteries in this in vivo study. By using the combination of transcutaneous ultrasound and streptokinase, the angiographic patency rate in rabbit iliofemoral arteries was higher (56%–100%) than with ultrasound (6%; P ≤ 0.0036) and streptokinase alone (6%; P ≤ 0.0012). Also, with transcutaneous ultrasound and microbubbles, the angiographic patency rates were 76%–100% as compared with ultrasound alone (0%, P ≤ 0.0003) or microbubbles alone (9%, P ≤ 0.0001). In the canine study of acute myocardial infarction, thrombolysis in myocardial infarction (TIMI) grade flow at 90 minutes in the tPA alone group was 0.92 ± 1.4 as compared with 2.42 ± 1.9 in the tPA plus transthoracic ultrasound group (P = 0.006). There was much improved reperfusion with tPA plus ultrasound as compared with tPA alone. In vivo animal studies demonstrate that noninvasive transcutaneous ultrasound can greatly enhance the effect of clot dissolution with thrombolytic drugs and/or microbubbles, and has the potential for clinical application as an adjunctive method to improve arterial thrombolysis.
Potential Use of Therapeutic Ultrasound in Ischemic Stroke Treatment
Authors: Behrens Stephan , Spengos Konstantinos , Daffertshofer Michael , Wirth Steffen , Hennerici Michael
Published: July 2003

Systemic treatment with rtPA approved for a 3‐hour window is the only established causal therapy for acute stroke in the United States and Canada. Thrombolytic therapy with rtPA demonstrated a small, although significantly reduced morbidity, in a limited number of highly selected patients. As recently shown, intraarterial application is favorable and opens the window of treatment up to 6 hours. The combination of ultrasound with thrombolytic agents may further enhance the potential benefit by means of enzymatic‐mediated thrombolysis, which has been demonstrated in different in vitro and in vivo experiments for an accelerated recanalization of occluded peripheral and coronary vessels. Whereas no or only small attenuation of ultrasound can be expected through skin and chest, intensity will be significantly attenuated if penetration of the skull is required. The transcranial penetration of ultrasound increases when the frequency is decreased to 20 kHz and may be transmitted through the skull transtemporally with tolerable attenuation up to 200 kHz. This results in efficacy in vitro with low intensities of 0.5–2.0 W/cm2 systemic treatment with rtPA approved for a 3‐hour window in the nonfocused ultrasound field. Application of ultrasound insonation increased rtPA‐mediated thrombolysis up to 20% in a static model; meanwhile, it enhanced the recanalization rate from 30%–90% in a flow model. In vitro results suggest that 1 MHz ultrasound with 0.5 W/cm2, established for diagnostic purposes, may already enhance rtPA– mediated thrombolysis. Before therapeutic ultrasound can be tested clinically in acute stroke, safety of transcranial exposure of the brain has to be confirmed. To date, animal experiments suggested no harm to the blood brain barrier or systemic heating with 2 W/cm2. This combined treatment is one perspective in optimizing therapy in acute stroke within the acute phase and may be applied easily with few limitations.
Augmentation of Ultrasound‐Induced Clot Disruption by Nongas‐Filled Microparticles
Authors: Birnbaum Yochai
Published: July 2003

The augmentation of ultrasound‐induced clot disruption by echocardiographic contrast microbubbles may be a direct mechanical erosive effect of the clot by the microparticles. To further assess this hypothesis, we evaluated the rate and extent of clot disruption by using external ultrasound and nongas‐filled microparticles (HAEMACCEL and HAES). Human blood clots were used in this in vitro study. The percent clot reduction using the combination of ultrasound and microparticles was dose dependent and significantly higher than that with microparticles alone.
Comparison of Two‐Dimensional Echocardiography and Pulsed Doppler Tissue Imaging during Dobutamine‐Atropine Stress Testing to Detect Coronary Artery Disease
Authors: Peteiro Jesús , Monserrat Lorenzo , Fabregas Ramón , Vázquez Jose Manuel , Calviño Ramon , Castro‐Beiras Alfonso
Published: July 2003

In order to compare the diagnostic accuracy of two‐dimensional (2‐D) echocardiography and pulsed Doppler tissue imaging (pDTI) during dobutamine‐atropine stress testing (DAST) to detect significant coronary lesions, 41 patients underwent DAST (up to 40 μg/k/min of dobutamine with additional atropine during submaximal heart rate responses) and coronary angiography. Pulsed Doppler tissue sampling of territories corresponding to the left anterior descending (LAD), left circumflex (LCx), and right coronary arteries (RCAs) were performed in the apical four‐chamber plus aorta and two‐chamber apical views. The measurements were repeated at rest, at low dose (10 μg/k/min), and at peak stress. Pulsed DTI measurements included peak early systolic (Vs), peak early diastolic (Ve), and peak late diastolic (Va) velocities. Harmonic 2‐D echocardiography was recorded at rest, low dose, peak stress, and recovery, and compared with pDTI assessment. Positive 2‐D echocardiography was considered as infarction or ischemic response. The results were evaluated for the prediction of significant coronary stenosis (50% luminal narrowing). Feasibility of pDTI was 100%, 95%, and 98% for the LAD, the LCx, and RCA territories, respectively. At rest, Vs in territories supplied by arteries with coronary artery disease (CAD) (6.3 ± 2.0 cm/sec) was not different from those without (6.6 ± 2.1 cm/sec). Vs increased less in territories supplied by arteries with than without CAD (75 ± 107% vs 102 ± 69%, P = NS). Ve was lower in territories with CAD at rest (6.0 ± 2.1 cm/sec vs 8.2 ± 3.4 cm/sec, P < 0.0001) and low dose (7.2 ± 2.1 cm/sec vs 8.8 ± 3.6 cm/sec, P < 0.01), but similar at peak stress (7.6 ± 3.5 cm/sec vs 8.1 ± 3.3 cm/sec). Ve increase was similar in territories with (36 ± 74%) than without CAD (15 ± 6 4%). Va was similar at rest and low dose in territories with and without CAD (9.2 ± 2.7 cm/sec vs 9.1 ± 2.3 cm/sec and 10.9 ± 3.1 vs 10.3 ± 3.6 cm/sec, respectively), but lower at peak stress in territories with CAD (13.3 ± 4.6 cm/sec vs 15.3 ± 4.5 cm/sec, P = 0.05). The Va increase was lower in territories with CAD (43 ± 37% vs 77 ± 72%, P < 0.05). In a territory‐based analysis, a failure to achieve Vs ≥ 10.5 cm/sec at peak stress in the LAD and LCx, and ≥ 10.0 cm/sec in the RCA territory, was found to be the more accurate limit to detect CAD in the corresponding arteries: sensitivity (95% confidence intervals): 63% (55–71), P = NS vs 2‐D echocardiography: 59% (51–67); specificity 76% (68–84), P < 0.01 vs 2‐D echocardiography: 95% (89–100); and accuracy 69% (63–75), P = NS vs 2‐D echocardiography: 76% (70–82). Thus, pDTI is feasible during DAST but not more accurate than 2‐D echocardiography for the detection of significant CAD in a territory‐based study.
Normal Coronary Angiogram and Dobutamine‐Induced Left Ventricular Obstruction During Stress Echocardiography: A Higher Hemodynamic Responsiveness to Dobutamine
Authors: Christiaens Luc , Duplantier Cecile , Allal Joseph , Donal Erwan , Nanadoumgar Hoda , Barraine Robert , Coisne Damien
Published: July 2003

This study assessed the clinical or echographic factors predisposing to dynamic left ventricular obstruction (LVO) during dobutamine echocardiography (DE) in patients with angina‐like chest pain but without coronary artery disease (CAD). DE is an effective technique for the noninvasive diagnosis of underlying CAD. During DE, an LVO is not unusual in ischemic patients. Methods: DE (5–40 μg/kg/min) was performed in 52 consecutive patients with angina‐like chest pain and normal coronary angiogram. Mean (standard deviation) age was 61 ± 10 years (27 men, 25 women). Dobutamine‐induced LVO was defined as a new intracavitary flow acceleration of at least 3 msec in the left ventricle. Results: Dynamic LVO was observed during DE in 20 (38%) of the 52 patients and was not related to clinical or baseline echocardiographic parameters. The chronotropic response and the systolic blood pressure during DE were higher in the group with LVO (P < 0.03 and P < 0.05, respectively). Appearance of chest pain during the test was also more frequent when LVO occurred (P < 0.02). Conclusion: Dynamic LVO is common during DE in a population of patients with angina‐like chest pain without epicardial CAD and is associated with a higher hemodynamic responsiveness to dobutamine.
Left Ventricular Outflow Tract Obstruction After Myocardial Infarction Due to a Hyperdynamic Basal Septum
Authors: Landesman Keith A. , Sadaniantz Ara
Published: July 2003

Acquired left ventricular outflow (LVOT) obstruction may occur following mitral valve repair or replacement. We describe a case where following a large myocardial infarction the hyperdynamic basilar septum was the cause of LVOT.
Left Atrial Appendage Stenosis
Authors: Ha Jong‐Won , Chung Namsik , Hong Yoo‐Sun , Cho Bum‐Koo
Published: July 2003

We describe an unusual case with an anatomic narrowing at the opening of the left atrial appendage demonstrated by two‐dimensional color Doppler and continuous‐wave Doppler transesophageal echocardiography.
Investigation of Cystic Left Ventricular Masses with Echocardiography and Magnetic Resonance Imaging
Authors: Shaburishvili Tamaz , Khabeishvili George , Wann Samuel
Published: July 2003

We report on two patients who had cystic masses located in the left ventricle associated with findings of congestive heart failure. Both echocardiography and magnetic resonance imaging (MRI) were helpful in identifying features of these masses. Echocardiography was used to guide percutaneous transarterial catheter drainage of the mass in one patient.
Transesophageal Three‐Dimensional Echocardiographic Assessment of Left Main Coronary Artery Fistula
Authors: Nekkanti Rajasekhar , Nanda Navin C. , Angsingkar Kamlesh G. , Mukhtar Osman
Published: July 2003

We describe a patient with a left main coronary artery fistula with an opening at the superior vena cava‐right atrial junction in whom three‐dimensional transesophageal echocardiography permitted more accurate assessment of the shape and size of the communication site than two‐dimensional transesophageal echocardiography.
Therapeutic Ultrasound, Part II*. High Intensity Focused Ultrasound: A Method of Hemostasis
Authors: Siegal Robert J. , Vaezy Shahram , Martin Roy , Crum Lawrence
Published: July 2003

Acoustic hemostasis is a new field of ultrasound research in which high intensity focused ultrasound (HIFU) is used to induce hemostasis in actively bleeding, injured solid organs and blood vessels. In animal studies, moderate to profuse bleeding from parenchymal and vascular injuries has been arrested within approximately 1 minute of HIFU application, even when a large dose of heparin was administered. Moreover, acoustic hemostasis has shown promise in cauterizing large regions of liver, providing a method for bloodless resectioning of abnormal tissue. Two distinct physical mechanisms of HIFU appear to contribute to hemostasis: (1) a thermal mechanism in which absorption of sound leads to temperature elevations, and (2) mechanical mechanisms (acoustic cavitation) in which gas and vapor‐filled voids oscillate with large displacement amplitudes. While the thermal mechanism results in a temperature increase in excess of 70°C in about 1 second, the mechanical mechanism appears to result in structural disruption of tissue and possible release of coagulation‐inducing tissue factors. Of utmost importance in further development of HIFU as a clinical tool is targeting and monitoring of the HIFU treatment. We have obtained initial success in integrating HIFU with ultrasound imaging so as to develop an image‐guided therapy system. Image‐guided acoustic hemostasis may provide a valuable method of hemostasis in surgical and prehospital settings with applications in trauma and elective surgery.
High Intensity Focused Ultrasound for the Treatment of Tumors
Authors: Ter Haar Gail R.
Published: July 2003

High intensity focused ultrasound (HIFU) is a technique that was first investigated in the 1940s as a potential method of destroying selective regions within the brain to aid neurobehavioral studies. A beam of ultrasound can be brought to a tight focus at a distance from its source, and if sufficient energy is concentrated within the focus, the cells lying within this focal volume are killed, whereas those lying elsewhere are spared. This is, therefore, a noninvasive method of producing selective and “trackless” tissue destruction in deep‐seated targets in the body without damage to overlying tissues. This technique is being investigated in a number of medical fields, including urology, ophthalmology, and oncology. The mechanism for cell killing is mainly thermal in origin. Renewal of interest in this technique is due to the availability of sophisticated medical imaging, which now allows the focal volume to be accurately targeted and also allows the tissue destruction to be monitored during treatment. The burgeoning field of HIFU focused ultrasound surgery (FUS) are reviewed in this article.
The Use of Ultrasound for Drug Delivery
Authors: Tachibana Katsuro , Tachibana Shunro
Published: July 2003

Ultrasound has been in use for the last three decades as a modality for diagnostic imaging in medicine. Recent studies have shown that nonthermal ultrasound energy could be applied for targeting or controlling drug release. This new concept of therapeutic ultrasound combined with drugs has induced interest in various medical fields. Enhanced effects of thrombolytic agents such as urokinase and TPA with acoustic energy have been demonstrated. Ultrasound transducer‐tipped catheters are being developed for treatment of cardiovascular diseases. Other devices with ultrasound transducers implanted in transdermal drug patches are also being evaluated for possible delivery of insulin through the skin. Echo contrast microbubbles could also be used to carry and release genes to various tissues and lesions. Chemical activation of drugs by ultrasound energy for treatment of cancers is another new field recently termed “sonodynamic therapy.” Various examples of ultrasound application are under investigation that could lead to revolutionary drug delivery systems of the future.
Delivery of Drugs with Ultrasound
Authors: Lindner Jonathan R. , Kaul Sanjiv
Published: July 2003

In this article we discuss the potential role of microbubbles, traditionally used as ultrasound contrast agents, for site‐specific drug delivery. To reach this goal, microbubbles capable of carrying a drug payload are being developed. To ensure that these microbubbles reach sufficient local concentration at disease sites, specific targeting for diseased tissues can be accomplished using several strategies. These strategies rely on either the intrinsic properties of microbubble shells or conjugation of monoclonal antibodies or other ligands to these shells that recognize antigens expressed in regions of disease. Site‐specific delivery of antiinflammatory, antineoplastic, and thrombolytic drugs with microbubbles can be further enhanced by the ability to locally destroy microbubbles within an acoustic field, thereby releasing drugs and improving drug efficacy without systemic adverse effects. In the case of thrombi, ultrasound‐mediated microbubble destruction also may facilitate the process of clot lysis. This review also will consider current limitations and technological advances required for the development of this field.
Ultrasound Gene Therapy: On the Road from Concept to Reality
Authors: Newman Christopher M. , Lawrie Allan , Brisken Axel F. , Cumberland David C.
Published: July 2003

The promise of gene therapy lies in the potential to ameliorate or cure conditions that are resistant to conventional therapeutic approaches. Progress in vascular and all other fields of gene therapy has been hampered by concerns over the safety and practicality of recombinant viral vectors and the inefficiency of current nonviral transfection techniques. This review summarizes the increasing evidence that exposure of eukaryotic cells to relatively modest intensity ultrasound, within the range emitted by diagnostic transducers, either alone or in combination with other nonviral techniques, can enhance transgene expression by up to several orders of magnitude over naked DNA alone. In combination with the flexibility and excellent clinical safety profile of therapeutic and diagnostic ultrasound, these data suggest that ultrasound‐assisted gene delivery has great promise as a novel approach to improve the efficiency of many forms of nonviral gene delivery.
Therapeutic Ultrasound for Gene Delivery
Authors: Porter Thomas R. , Xie Feng
Published: July 2003

In vitro and in vivo studies using perfluorocarbon‐exposed sonicated dextrose albumin (PESDA) microbubbles to enhance gene delivery are reviewed. In vitro studies show PESDA binds to oligonucleotides and that ultrasound can be used to deposit these nucleotides. In addition, in vitro studies show that drug release from microspheres is dependent on ultrasound transmission frequency as well as pulsed or continuous application. Early in vivo studies confirm that ultrasound in combination with microbubbles can be used to facilitate gene deposition. However, the role of ultrasound targeting gene delivery remains to be determined.
Gene Delivery Using Ultrasound Contrast Agents
Authors: Unger Evan C. , Hersh Evan , Vannan Mani , McCreery Thomas
Published: July 2003

With the human genome product and continuing advances in molecular biology many therapeutic genes have been discovered. In the cardiovascular system, gene therapy has the potential to improve myocardial vascularization and ameliorate congestive heart failure. For successful development of clinical gene therapy, however, effective gene delivery vectors are needed. Ultrasound contrast agents can be used to develop new, more effective vectors for gene delivery. Ultrasound contrast agents lower the threshold for cavitation by ultrasound energy. Using physical properties of microbubbles and coating materials, genetic drugs have been incorporated into ultrasound contrast agents. Genebearing microbubbles can be injected IV and ultrasound energy applied to the target region. As the microbubbles enter the region of insonation, the microbubbles cavitate, locally releasing DNA. Cavitation also likely causes a local shockwave that improves cellular uptake of DNA. With transthoracic ultrasound, using commercially available diagnostic ultrasound system and an IV injection of gene‐bearing microbubbles, high levels of transgene expression are observed in the insonated region of the myocardium. This new technology using microbubbles and ultrasound for gene delivery merits further study and development.
SHU 508 A (Levovist)‐Enhanced Doppler Echocardiography Improves the Assessment of Valvular Heart Disease
Authors: Lepper Wolfgang , Franke Andreas , Von Bibra Helene , Becher Harald , Holz Kerstin , Näbauer M. , Vered Zvi , Hoffmann Rainer , Flachskampf Frank A. , Hanrath Peter
Published: July 2003

Objective: To investigate whether intravenous injection of SHU 508 A improves the diagnostic accuracy of Doppler echocardiography in the assessment of valvular pathologies. Methods and Results: One hundred and twenty‐five consecutive patients with valvular pathology (aortic stenosis, n = 48; aortic regurgitation, n = 20; mitral stenosis, n = 21; and mitral regurgitation, n = 36) and diagnostically insufficient Doppler signal were enrolled in this multicenter study. The severity of valvular pathology was graded on a four‐point scale using unenhanced and contrast‐enhanced Doppler echocardiography as well as cardiac catheterization. Agreement with cardiac catheterization findings increased from 63% using the unenhanced examination to 73% using the contrast‐enhanced Doppler examination. Grading was possible in all patients using SHU 508 A, whereas the unenhanced Doppler examination remained inconclusive in six patients. The weighted kappa coefficient between contrast‐enhanced Doppler and cardiac catheterization for all diagnoses was 0.76 as compared to 0.68 between unenhanced Doppler and cardiac catheterization. Agreement was especially improved in aortic stenosis (kappa 0.69 unenhanced vs 0.81 contrast‐enhanced) and in aortic regurgitation (kappa 0.45 unenhanced vs 0.75 contrast‐enhanced). Patients with mitral stenosis and mitral regurgitation experienced less improvement. Conclusions: In case of an inconclusive unenhanced Doppler echo study, the administration of a left heart contrast agent should be considered. SHU 508 A is especially useful in improving the severity grading of aortic stenosis and aortic regurgitation, while grading of mitral stenosis and mitral regurgitation is less improved.
Dobutamine Stress Echocardiography Response of Asymptomatic Patients with Diabetes
Authors: Coisne Damien , Donal Erwan , Torremocha Florence , Christiaens Luc , Allal Joseph
Published: July 2003

Aims: This study investigated the role of dobutamine stress echocardiography for the silent diagnosis of myocardial ischemia in a diabetic population. Results from the stress test were compared between diabetic and nondiabetic groups. Methods: Forty‐nine diabetics and 63 consecutive nondiabetics underwent dobutamine stress echocardiography between April and December 1999, to check for new regional wall‐motion abnormalities. A single operator, using the same echograph with tissue harmonic imaging in each case, performed all the examinations, using the same techniques. Results: Significant coronary artery disease was detected in 9% of asymptomatic diabetics. Dynamic left ventricular obstruction was observed in 59% of the diabetic population and only 22% in the nondiabetic population. One patient suffered an adverse event (fast atrial fibrillation) during the stress test. Cardiac frequency at the beginning and end of the stress test differed significantly between the two populations. Conclusion: Dobutamine stress echocardiography allows for detection of silent myocardial ischemia. In the diabetic population, we describe, for the first time under dobutamine infusion, a great number of dynamic left ventricular obstructions.
Flail Aortic Valve and Acute Aortic Regurgitation Due to Spontaneous Localized Intimal Tear of Ascending Aorta
Authors: Ha Jong‐Won , Chang Byung‐Chul , Lee Dong‐Il , Chun Kook‐Jin , Rim Se‐Joong , Chung Namsik , Cho Seung‐Yun
Published: July 2003

This report describes the transesophageal echocardiographic findings of acute severe aortic regurgitation resulting from localized transverse intimal tear of ascending thoracic aorta which could not be suspected as a cause of flail aortic valve preoperatively. In patients with chest pain and acute aortic regurgitation associated with flail aortic valve, localized intimal tear of aorta should be considered as a possible cause of flail aortic valve.
Aortic Transsection After Blunt Chest Trauma
Authors: Tsoukas Atahanasios , Stathoulopoulos Athanasios , Tsatsoulis Panagiotis , Geranios Agelos , Pavlakis Emmanouel , Athanasopoulou Alexandra , Papaeliou Ioannis
Published: July 2003

We report a case of an 18‐year‐old female who developed an extensive hemothorax after blunt chest trauma. Transesophageal echocardiography (TEE) showed transsection of the aorta at the level of the isthmus and turbulent flows in several places around the aorta. We discuss the contribution of TEE for detecting traumatic injuries to the thoracic aorta.
Transesophageal Color Doppler Three‐Dimensional Echocardiographic Detection of Prosthetic Aortic Valve Dehiscence: Correlation with Surgical Findings
Authors: Mukhtari Osman , Horton Carl J. , Nanda Navin C. , Aaluri Srinivasa R. , Pacifico Albert
Published: July 2003

Three‐dimensional echocardiography is being used with increasing frequency to evaluate cardiac function and structure. We present two cases of prosthetic aortic valve endocarditis where threedimensional transesophageal echocardiography correlated with the intraoperative surgical findings of prosthetic dehiscence and communication with an abscess cavity. When compared with two‐dimensional transesophageal echocardiography, three‐dimensional echocardiography was more accurate in defining the exact site of dehiscence and communication with an abscess cavity. The echocardiographic images were oriented as a clockface watch to conform to the surgeon's visualization of the aortic root as viewed from the right side of the patient.
Systemic Venous Abnormalities: Embryologic and Echocardiographic Considerations
Authors: Tacy Theresa A. , Silverman Norman H.
Published: July 2003

The echocardiographic diagnosis of systemic venous anomalies often is rendered difficult by the variety of lesions that exist. An understanding of the embryologic processes that result in these lesions is essential for accurate identification, since these lesions often are not obvious on routine echocardiographic examination. Standard echocardiographic views may demonstrate some lesions, whereas many require modified views to outline the abnormal systemic venous anatomy. This paper reviews the basic embryologic processes of the development of the normal and abnormal systemic venous system, as well as the echocardiographic identification of these major systemic venous malformations.
Cross‐Sectional Echocardiographic Assessment of Atrioventricular Septal Defect: Basic Morphology and Preoperative Risk Factors
Authors: Smallhorn Jeffrey F.
Published: July 2003

Accurate evaluation of an atrioventricular septal defect is readily achieved by echocardiography. A sound understanding of the basic morphology and associated lesions is key to this approach. This article first details the features that are common to all hearts with an atrioventricular septal defect, irrespective of the presence or absence of an interatrial or interventricular communication. These common features are: (1) inlet outlet disproportion; (2) absence of the atrioventricular muscular septum; (3) abnormal position of the left ventricular papillary muscles; (4) abnormal configuration of the atrioventricular valves and, (5) cleft in the left atrioventricular valve. These are all predicated by a sprung atrioventricular junction. Second, is a detailed outline of the associated risk factors that must be identified by the echocardiographer prior to presenting the patient for surgical management, with the most important ones being abnormalities of the left atrioventricular valve and left ventricular outflow tract obstruction. Indeed, in this current era it is rarely necessary to perform other investigations prior to surgical repair.
Three‐Dimensional Echocardiography of the Atrial Septum
Authors: Marx Gerald R. , Sherwood Megan C. , Fleishman Craig , Van Praagh Richard
Published: July 2003

This article details the important contribution of three‐dimensional echocardiography for catheterization device closure of secundum atrial septal defects. Aspects presented include three‐dimensional echocardiographic application in preselection of patients and in selection of the type and size of the atrial septal occluder devices. Unique three‐dimensional echocardiographic imaging planes are shown that depict the size and shape of the defect, the important rim tissue surrounding the defect, and the images that demonstrate successful device placement. Details of the acquisition phase, digital reformatting, and the eventual rendering of standard three‐dimensional echocardiographic imaging planes of the atrial septum are shown. Three‐dimensional echocardiography not only provides important additional information, but also enhances understanding of standard twodimensional studies.
Echocardiography of Serous Effusions Adjacent to the Heart
Authors: D'Cruz Ivan A. , Kanuru Narendra
Published: July 2003

Sonolucent spaces in close proximity to the heart are common in routine clinical echocardiographic practice, yet apart from pericardial effusions have received little attention. These clear spaces can represent left or right pleural effusions, ascites, pericardial cysts, or unusual diaphragmatic hernias. All these entities have typical echocardiographic features, including location, size, shape, and anatomic relationships to contiguous structures. In addition, loculated pericardial effusions, with or without associated tamponade, have to be considered in the differential diagnosis. In this brief review, we discuss and illustrate these various types of juxtacardiac sonolucencies.
The Effect of Kidney Transplant on Cardiac Function: An Echocardiographic Perspective
Authors: Sahagún‐Sánchez Guillermo , Espinola‐Zavaleta Nilda , Lafragua‐Contreras Magdalena , Chávez Pedro Yánac , Gómez‐Núñez Nelly , Keirns Candace , Romero‐Cardenas Angel , Pérez‐Grovas Héctor , Acosta Jaime Herrera , Vargas‐Barrón Jesús
Published: July 2003

Kidney transplant (KT) resolves many of the cardiac abnormalities associated with chronic kidney failure (CKF). This study analyzed cardiac alterations of kidney failure and their modification with transplant. Thirteen patients in CKF underwent conventional echocardiograms, dobutamine stress echocardiograms, and injection of contrast to examine perfusion before KT and 3 months after transplant. Nine patients had evidence of left ventricular hypertrophy and six had evidence of diastolic dysfunction. Wall thickness, left ventricular mass, and mass index diminished after KT; only two patients continued to manifest hypertrophy. Left ventricular systolic diameters and volumes diminished at 3 months, and diastolic diameters after 4 months. Left ventricular fractional shortening and ejection fraction increased 3 months after transplant. At the end of the study, only two patients continued to show diastolic dysfunction. Dobutamine echocardiograms showed no segmental wall‐movement abnormalities. Myocardial perfusion was normal before and after transplant. The results suggest that KT diminishes hypertrophy and improves left ventricular systolic and diastolic function. Echocardiography provides valuable information for detection and follow‐up of cardiac abnormalities in patients with kidney disease. Evaluation of segmental wall movement and myocardial perfusion aid in demonstrating that our studied patients with CKF had no indirect signs of coronary artery disease.
Left Ventricular Apex to Descending Aorta Valved Conduit: Description of Transthoracic and Transesophageal Echocardiographic Findings in Four Cases
Authors: Kerut Edmund Kenneth , Hanawalt Curtis , Everson Charles T. , Frank Robert A. , Giles Thomas D.
Published: July 2003

Patients with critical aortic stenosis and a “porcelain” aorta are at an increased risk for complications with aortic cross‐clamping during valve replacement. To our knowledge, this is the first report of both transthoracic and transesophageal echocardiographic findings of the left ventricle to the descending aorta (LVDA) valved conduit. We present results of four patients in whom this procedure was performed for critical aortic stenosis, who also had a porcelain aorta. “Normal” echo and Doppler findings, along with those of development of a regurgitant valve within the conduit, are presented.
Doppler Velocimetry in Superior Vena Cava Provides Useful Information on the Right Circulatory Function in Patients with Congestive Heart Failure
Authors: Ghio Stefano , Recusani Franco , Sebastiani Roberta , Klersy Catherine , Raineri Claudia , Campana Carlo , Lanzarini Luca , Gavazzi Antonello , Tavazzi Luigi
Published: July 2003

Background: Although flow velocities curves recorded with pulsed‐wave Doppler in systemic vein are known to provide functional data on the right circulatory function, little information is available on the relationship between right heart filling dynamics and right ventricular function. Methods: Consecutive patients with chronic heart failure due to severe systolic left ventricular dysfunction and in sinus rhythm underwent echocardiography and right heart catheterization. In the initial part of the study, the hemodynamic correlates of different flow velocity patterns recorded into the superior vena cava were evaluated in 120 patients. The accuracy of the prediction of different right heart hemodynamic profiles by means of the different venous flow patterns was then prospectively tested in a subsequent series of 86 patients. Results: The venous flow pattern was closely related to right heart hemodynamics. A normal Doppler pattern identified patients with normal right heart hemodynamics (sensitivity 86%, specificity 78%); a “predominant systolic wave” pattern identified patients with a reduced thermodilution‐derived right ventricular ejection fraction (<30%) and normal or slightly elevated right atrial pressure (≤8 mmHg) (sensitivity 69%, specificity 81%); a “predominant diastolic wave” pattern identified patients with a reduced right ventricular ejection fraction (<30%) and elevated right atrial pressure (>8 mmHg) (sensitivity 52%, specificity 95%). The observed and the predicted hemodynamic profiles turned out to be concordant in 80% of patients. Conclusions: The analysis of the flow velocity pattern into the superior vena cava is a useful tool to estimate the extent of the right circulatory impairment in patients with congestive heart failure.
Spatial and Temporal Analysis of Left Ventricular Filling Flow Propagation in Hypertensive Patients Before and After Regression of Myocardial Hypertrophy with Alacepril Therapy
Authors: Nobuoka Sachihiko , Nagashima Junzo , Hatano Seiji , Fujimaki Rikiya , Saito Kenichi , Tokuoka Shinichi , Ando Hiroyasu , Miyake Fumihiko
Published: July 2003

The purpose of this study was to assess the clinical significance of spatial and temporal analysis of left ventricular (LV) filling‐flow propagation using color M‐mode Doppler echocardiography before and after regression of LV hypertrophy in patients with hypertension. Seven patients with hypertensive LV hypertrophy were studied. Echocardiographic and Doppler examinations were performed both before and after 6 months administration of alacepril. LV mass index (LVMI), LV flow propagation velocity (FPV), and the maximal early transmitral flow velocity (E) were measured. LVMI, FPV, and FPV/E ratio were compared to before and after administration of alacepril. In addition, the correlation between LVMI and FPV/E ratio was evaluated. Results showed that LVMI was significantly decreased (P < 0.05) and the FPV/E ratio was significantly increased (P < 0.05) after treatment with alacepril. There was no significant change in FPV. In addition, there was a significant negative correlation between LVMI and the FPV/E ratio (r =−0.662, P < 0.001). The present study indicates that the FPV/E ratio could be a useful noninvasive parameter to assess the diastolic dysfunction associated with LV hypertrophy in patients with hypertension.
Echocardiographic Study of Patients with Congenital Heart Disease and Infective Endocarditis
Authors: Gómez‐Núñez Nelly , Vargas‐Barrón Jesus , Espinola‐Zavaleta Nilda , Romero‐Cárdenas Angel , Hernández‐Reyes Pablo , Keirns Candace , Roldán Francisco Javier , Vázquez‐Antona Clara
Published: July 2003

Background: Infective endocarditis (IE) occurs with significant frequency in patients with congenital heart disease. The complications leading to increased morbidity and mortality may be detected by echocardiographic examination. This study was undertaken in order to identify echocardiographic findings that influence the outcome of patients with congenital heart disease and IE. Methods: Twenty‐five patients with an average age of 28 years were selected and divided into two groups according to evolution. Group I included patients who survived the infectious process, while Group II included patients who died during hospitalization or after release. Results: Aortic valve disease was the most frequent anomaly. The clinical finding of most relevance for evolution during hospitalization was heart failure. Acute kidney failure and multiple organ failure from sepsis were the most common complications in patients who died. Echocardiograms established the diagnosis in all cases. Transesophageal studies revealed all periaortic abscesses. Conclusions: Echocardiography makes it possible to identify and evaluate complications associated with elevated morbidity and mortality in patients with congenital heart disease and IE.
Evaluation of the Response to Pharmacological Stress in Chronic Aortic Regurgitation
Authors: Espinola‐Zavaleta Nilda , Gómez‐Núñez Nelly , Chávez Pedro Yánac , Sahagun‐Sánchez Guillermo , Keirns Candace , Casanova José Miguel , Romero‐Cárdenas Angel , Roldán Francisco Javier , Vargas‐Barrón Jesús
Published: July 2003

We evaluated the hemodynamic response of patients with chronic aortic regurgitation and decreased ejection fraction (EF), mean value ± SD (37 ± 9), to dobutamine stress echocardiography (DSE). Eleven patients were studied with DSE. Nine patients were in New York Heart Association (NYHA) Class II and two in NYHA Class III. Ten patients received medical treatment in the only other periodic evaluation. With DSE in nine patients, a significant decrease in left ventricular enddiastolic and end‐systolic diameters (LVEDD and LVESD) as well as LV end‐diastolic and endsystolic volumes (LVEDV and LVESV) was documented in comparison to resting values. EF and fractional shortening (FS) improved significantly with DSE. Systolic wall stress (SWS) and pulmonary arterial systolic pressure (PASP) did not change. Average follow‐up was 6.7 months. Three patients underwent valve replacement with mechanical prostheses. Two of them are in NYHA Class I and the other died of LV failure 3 days after surgery. One patient deteriorated beyond surgical treatment and was in NYHA Class II. The other seven patients remain in NYHA Class II and await valve replacement. In patients with chronic aortic regurgitation and depressed EF, the variables relevant to myocardial reserve appear to be EF, FS, LVEDD, LVESD, LVEDV, and LVESV.
Power Doppler Dual‐Frame Triggering of Myocardial Contrast Echocardiography: A Quantitative Video Intensity Analysis
Authors: Kolias Theodore J. , Avelar Erick , Bradsher Kristi , Cermak Lisa , Armstrong William F. , Vannan Mani A.
Published: July 2003

Aim: The purpose of this study was to define the pattern of myocardial contrast observed during triggered dual‐frame power Doppler imaging. Methods and Results: Ten patients with no previous history of myocardial infarction underwent a continuous intravenous infusion of Optison at 0.5 ml/min. Triggered, sequential dual‐frame power Doppler imaging was performed from an apical four‐chamber view using a prototype Acuson Sequoia imaging system. The average triggering interval was once every four cardiac cycles, and the average interval between sequential frames was 50 msec. Video intensity analysis was performed in five myocardial regions of interest, and the percent decrease in video intensity of the destruction frames in each region of interest was determined by subtracting the destruction frame video intensity from the fill frame video intensity. The percent decrease in video intensity varied significantly by myocardial location (P < 0.001), with greater destruction seen in the apical than in the basal regions. Conclusion: This preliminary study demonstrates that power Doppler dual‐frame triggering produces nonuniform decreases in video intensity, which likely represent nonuniform microbubble destruction. These results have important implications for the interpretation of myocardial perfusion patterns using this technique.
Changes in Local Wall Thickness Correlate with Pathologic Lesion Size Following Radiofrequency Catheter Ablation: An Intracardiac Echocardiographic Imaging Study
Authors: Ren Jian‐Fang , Callans David J. , Schwartzman David , Michele John J. , Marchlinski Francis E.
Published: July 2003

Introduction: High‐resolution intracardiac echocardiographic (ICE) imaging can accurately assess wall thickness during radiofrequency (RF) catheter ablation procedures. This study investigated the correlation of changes in wall thickness at the ablation site with pathologic lesion size. Methods and Results: ICE image‐guided 31 RF applications (30–50 W, up to 120 sec) were performed in five anesthetized closed chest swine (n = 5, body weight 35–60 kg). Twenty‐four lesions were delivered in the right and left atria with standard RF; seven lesions were delivered in the left ventricle (LV) with irrigated (30–40 ml/min) RF. Wall thickness and tissue echo density measured by ICE imaging (preand 1‐minute post‐RF delivery) with increased focal echo density following RF deployment in the atria (4.5 ± 1.5 vs 2.3 ± 1.0 mm pre‐RF) and the LV (9.8 ± 2.3 vs 6.8 ± 2.2 mm pre‐RF; P < 0.01). The observed changes in wall thickness (ΔWT) following ablation in the LV were greater than in the atria (3.0 ± 1.4 vs 2.2 ± 1.2 mm; P < 0.05). A significant correlation between ΔWT and lesion depth (ventricular: r = 0.85, P < 0.05; atrial: r = 0.82, P < 0.01) was demonstrated at all ablation sites. Local wall thickness measured post‐RF also significantly correlated with lesion depth (r = 0.89, P < 0.01), especially with that of transmural lesions (r = 0.95, n = 23, P < 0.001) at atrial and LV sites. Conclusion: Therapeutic RF ablation results in mural swelling and increased echo density. These changes can be detected by ICE imaging and correlate with pathologic lesion size. ICE imaging may be useful in online quantification of lesion size, especially for transmural lesions during clinical catheter ablation procedures.
Transthoracic Color Doppler Echocardiography: A New Way to Diagnose Coronary Artery Disease
Authors: Saraste Markku , Mikkola Jorma , Hartiala Jaakko
Published: July 2003

Until now, transthoracic echocardiography (TTE) has had the capability to visualize only the proximal portions of the main coronary arteries. However, we noticed that transthoracic color Doppler echocardiography has marked potential to visualize flow in the coronary arteries. In clinical cases we tested whether this method is useful for visualizing stenoses and flow even in peripheral branches of the coronaries. This article presents two illustrative clinical cases. In our experience, transthoracic color Doppler echocardiography is very suitable for clinical use.
Dynamic Intraventricular Obstruction in Acute Myocardial Infarction
Authors: Sanchez Daniel San Román , Medina Olga , Jimenez Francisco , Rodriguez Juan Carlos , Nieto Vicente
Published: July 2003

Transient left ventricular dynamic obstruction (TLVO) is an infrequent complication in acute myocardial infarction (AMI). Its hallmark is a new systolic murmur associated with hemodynamic worsening. An echocardiogram is necessary for diagnosis. We report on two cases, both of which had a good outcome. Serial echocardiograms showed that enhanced contractility of the basal left ventricular segments obstructed cardiac ejection by means of mitral valve systolic anterior movement in the left ventricular outflow tract. In both cases, the intraventricular gradient remained for several days and subsequently disappeared. The understanding of this mechanism is useful for management of this clinical problem.
Mild Thickening of the Aortic Wall: Subtle Intramural Hematoma?
Authors: Mansour Moussa , Berkery William , Kozlowski Lisa , Widell Jared , Obeid Anis
Published: July 2003

Recently published criteria for the diagnosis of intramural hematoma (IMH) of the ascending aorta by transesophageal echocardiogram (TEE) include the presence of a crescent‐shaped thickening of the aortic wall of more than 7 mm with an echolucent space. We report a patient whose clinical presentation suggested aortic dissection but whose TEE failed to meet the conventional criteria for such a diagnosis. TEE showed a uniform intimal thickening suspicious of IMH but less than 7 mm in thickness and with no echofree space. One week later, the patient developed frank aortic dissection. Conclusion: IMH can present with a subtle echo appearance. The diagnosis should not be totally discounted in the absence of a 7‐mm crescentic wall thickness and an echofree space if the clinical presentation is suggestive of dissection.
Unusually Located Left Atrial Papillary Fibroelastoma with Probable Embolization to the Spinal Cord
Authors: Friedman Gary R. , Pappas Thomas W. , Colangelo Robert , Tunick Paul A. , Freedberg Robin S. , Scholes John V. , Kronzon Itzhak
Published: July 2003

This report presents a patient with flaccid paraplegia, most probably secondary to embolization from a left atrial papillary fibroelastoma. The unique location of the tumor, attached to the ridge in the left atrium between the left atrial appendage and pulmonary vein, was well documented on transesophageal echocardiography, and the diagnosis was confirmed by histopathology. Although benign, these tumors may develop in all four cardiac chambers and result in pulmonary or systemic embolization. Paraplegia is a rare embolic complication.
Recurrent Cerebral Embolism and Impending Detachment of a Previous Nonmobile Left Atrial Thrombus Following Initiation of Anticoagulant Therapy in a Patient with Nonvalvular Atrial Fibrillation
Authors: Fang Ber‐Ren , Kuo Li‐Tang
Published: July 2003

A 65‐year‐old female with nonvalvular atrial fibrillation who presented with a transient ischemic attack was admitted to our hospital. Transesophageal echocardiography (TEE) revealed a nonmobile thrombus attached to the wall of the left atrial appendage. She suffered from a new episode of syncope on the 8th day following initiation of anticoagulant therapy. Follow‐up TEE indicated not only that the left atrial (LA) thrombus decreased in size but also that the previous nonmobile thrombus became mobile and showed impending detachment. Urgent surgery was subsequently performed to remove the LA thrombus, and the patient recovered uneventfully. In conclusion, anticoagulant therapy may precipitate partial fragmentation or partial detachment of LA thrombus.
Reptilian Echocardiography: Insights into Ontogeny and Phylogeny?
Authors: Sklansky Mark S. , Levy Denis J. , Elias William T. , Morris Patrick , Grossfeld Paul D. , Kashani Iraj A. , Shaughnessy Robin D. , Rothman Abraham
Published: July 2003

We describe the echocardiographic findings in a large reptile‐the carpet python. If ontogeny recapitulates phylogeny, the study of reptilian hearts may provide insights into human cardiac development. In addition, the reptilian heart has unique structural and physiological adaptations that may broaden our perspective on evolutionary cardiac adaptation.
Identification of Cardiac Abnormal Structures with Harmonic Power Doppler Contrast Echocardiography
Authors: Tani Tomoko , Tanabe Kazuaki , Katayama Minako , Yagi Toshikazu , Konda Toshiko , Yamamuro Atsushi , Takagi Tsutomu , Nagai Kunihiko , Shiratori Kenichi , Morioka Shigefumi
Published: July 2003

We describe two cases in which echocardiographic image enhancement with an intravenous contrast agent using harmonic power Doppler (HPD) imaging established the diagnosis of abnormal structures in the left ventricle (LV).