bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Dobutamine Infusion on Mitral Regurgitation
Authors: SONODA MAKOTO , TAKENAKA KATSU , SAKAMOTO TSUGUYA , WATANABE FUMIYOSHI , NAKAJIMA YOSHIE , DONG YANG WEI , OMATA MASAO
Published: December 2007

Both intensity of mitral regurgitant murmur and color‐coded Doppler regurgitant signal area have been reported to correlate with the degree of regurgitation. To evaluate the relationship between the intensity of regurgitant murmur and severity of mitral regurgitation, phonocardiography, echocardiography, and Doppler ultrasound were performed in 18 patients with mitral regurgitation before and during dobutamine infusion. Mitral regurgitation was due to mitral valve prolapse with ruptured chordae tendineae in 8 patients, rheumatic change in 5 patients, and dilated cardiomyopathy in 5 patients. With intravenous dobutamine infusion, heart rate (77–103 beats/min), systolic blood pressure (119–144 mmHg), peak mitral regurgitant jet velocity (4.5–5.4 m/sec), intensity of mitral regurgitant murmur (to 201% of that before infusion in early systole) increased, while left ventricular end‐diastolic volume (124–102 mm), left ventricular end‐systolic volume (57–42 mm), mitral anular diameter (33–28mm), and color Doppler mitral regurgitant signal area (704–416 mm2) decreased (P < 0.05). Total (forward + backward) left ventricular stroke volume (66–61 mL/beat) showed no change. Dobutamine decreased mitral regurgitant flow/beat, regardless of etiology of mitral regurgitation, which was probably due to the decrease of left ventricular size and mitral annular diameter. Although total (forward + backward) left ventricular stroke volume was unchanged, dobutamine effectively increased forward left ventricular stroke volume by decreasing backward regurgitation. Mitral regurgitant murmur became louder despite the decrease of mitral regurgation, indicating the uselessness of auscultation in the grading of the severity of mitral regurgitation.
Cardiac Effects of Water Immersion in Healthy Volunteers
Authors: SMITH DONALD E. , KAYE ALAN D. , MUBAREK SAMEH K. , KUSNICK BARRY A. , ANWAR MUHAMMAD , FRIEDMAN INA M. , DEAN NOSSAMAN BOBBY
Published: December 2007

To evaluate cardiac chamber size and ejection fraction during head‐out immersion of patients in the semisitting position in neutral temperature water bath, 12 volunteers were studied using transthoracic echocardiography (TTE). In this open, controlled, prospective clinical study, left ventricular end‐systolic, end‐diastolic volumes, and ejection fraction were measured in 12 adult awake healthy volunteers using TTE with the patient in a semisitting position pre‐, during, and postimmersion in the Dornier extracorporeal shock wave lithotriptor water bath at 35°C. Left ventricular end‐diastolic volume significantly increased from an average of 96.0 ± 10.8 to 130 ± 19 cm3, P < 0.0001 and left ventricular end‐systolic volume increased from an average 38.9 ± 6.9 to 45.2 ± 8.0 cm3, P < 0.01. Left ventricular ejection fraction increased significantly from control to water immersion from 0.59 ± 0.1% to 0.65 ± 0.1% (P < 0.001). The results of this study demonstrate that water immersion in normal healthy volunteers significantly increases both left ventricular diastolic and systolic volume, and that there is a significant increase in left ventricular ejection fraction after water immersion, (e.g., bathing, lithotripsy). While this increased cardiac filling is well‐tolerated in most patients, it may not be well‐tolerated in some patients who have limited cardiac reserve, including patients with heart failure.
Evaluation of Right Ventricular Function During CABG
Authors: MISHRA MANISHA , SWAMINATHAN MADHAV , MALHOTRA RAJNEESH , MISHRA ANIL , TREHAN NARESH
Published: December 2007

The vulnerability of right ventricle (RV) to ischemic insult during cardiac surgery is being increasingly recognized. This study aims to evaluate right ventricular function by measuring hepatic venous flow (HVF) patterns using intraoperative transesophageal echocardiography (TEE), and to compare HVF with other conventional two‐dimensional echocardiographic and hemodynamic indices of RV performance. Patients undergoing coronary artery bypass grafting (CABG) were studied intraoperatively using a multiplane dual frequency 5/3.7‐MHz phased array transducer, a pulmonary artery catheter, and an arterial catheter. Peak velocities and time velocity integrals of HVF pattern were studied. Peak systolic‐diastolic ratio (S/D) of biphasic HVF and reverse flow ratio (% reverse flow/forward flow =% RF/FF) were also examined. Two‐dimensional echocardiographic measurements included: (1) transverse plane long‐axis (LA) and short‐axis (SA) planimetered areas expressed as ratios; LA maximum major and minor‐axis shortening fractions; (2) tricuspid annular plane systolic excursion (TAPSE) ratio. All data were obtained after induction of anesthesia (stage 1), after sternotomy (stage 2), aftercardiopulmonary bypass (CPB) (stage 3), and after sternal closure (stage 4). Pre‐CPB all 35 patients had biphasic HVF by Doppler. In 31 patients peak S/D ratio was > 1. After CPB, there was significant reduction in systolic forward flow (S wave), along with an increase in late systolic reverse flow (V wave) and an increase in % RF/FF. At this stage TAPSE ratio decreased (pre CPB 0.33 ± 0.12 vs post CPB 0.30 ± 0.11). There was simultaneous decrease in 2‐D long‐axis LA (pre CPB 0.52 ± 0.11 vs post CPB 0.31 ± 0.01) and max major axis LA (pre CPB 0.38 ± 0.06 vs post CPB 0.31 ± 0.11). Max major axis LA correlated significantly with changes in right atrial pressure (P < 0.05). Tricuspid annular motion diminished significantly at sternal closure. Hepatic systolic forward flow and TAPSE ratio can be an indirect measure of RV systolic functions in correlation with maximum major axis LA changes. Evaluation of HVF provides unique insight into right ventricular dynamics. It is an easy, safe, and sensitive method for assessing RV functions intraoperatively.
Assessment of Coronary Artery Fistula by Color Doppler Echocardiography
Authors: YANG YA , LI ZHIAN , WANG XINFANG
Published: December 2007

Two patients with coronary artery fistula (CAF) were studied by color Doppler echocardiography, left coronary artery‐right ventricle fistula in a child and right coronary artery‐left ventricle fistula in an adult. Diagnosis was made by transthoracic echocardiography (TTE) and one adult by multiplane transesophageal echocardiography (TEE), respectively. The proximal dilated coronary artery, the course, and the drainage sites were demonstrated with color Doppler echocardiography in both patients.
Left Ventricular Diverticula and Aneurysms
Authors: COENE BALES AMY , SANDELSKI JOANNE , SARELI PINHAS , LANG ROBERTO M.
Published: December 2007

Congenital diverticula and aneurysms are extremely rare cardiac anomalies, in contrast to acquired ventricular outpouchings, which are relatively commonplace. The English language literature pertaining to congenital lesions in particular is somewhat sparse; in addition, a definitive classification scheme for these malformations is lacking. In this manuscript, we review the salient literature pertaining to congenital diverticula, congenital aneurysms, acquired true aneurysms, “aneurysms” of the membranous interventricular septum, and left ventricular pseudoaneurysms. This is performed with attention to the clinical and pathological characteristics, etiology (if known), prognosis, and suggested management of these lesions. Important echocardiographic features are delineated in the figure legends; however, the differentiation between these lesions often must be made on clinical grounds as well.
Phono‐Doppler Timing Relationships in Patients with a Fourth Heart Sound
Authors: VOON WEL‐CHOL , SHEU SHENG‐HSIUNG
Published: December 2007

Controversies exist about the timing relationship between the fourth heart sound and the ventricular inflow Doppler events. Besides, there has been no data about the timing relationship between the fourth heart sound and the ventricular outflow Doppler events. This study was designed to measure these phono‐Doppler timing relationships and to evaluate the influence of different Doppler modes on the timing relationship of the onset of the A wave. Twenty patients (61 ± 9 years, 18 males and 2 females) with an audible and recordable fourth heart sound were included. No matter on the pulsed Doppler wave trace or on the continuous‐wave trace, both the interval from the onset of the mitral A wave to the first vibration of the fourth heart sound and the interval from the peak velocity of the mitral A wave to the first vibration of the fourth heart sound differed significantly from zero (P < 0.001 for all). Nevertheless, the interval from the onset of the transmitted transmitral A wave to the first vibration of the fourth heart sound (0.4 ± 1.7 ms) was not significantly different from zero (P = 0.314). The pulsed wave data and the continuous wave data were significantly correlated. Differences in the Doppler modes do not seem to lead to obvious changes in the Doppler‐phono timing relationships.
Automated Left Ventricular Endocardial Border Detection Using Acoustic Quantification in Children
Authors: REIN AZARIA J.J.T. , TRACEY MEGAN , COLAN STEVEN D. , POLLAK ARTHUR , SANDERS STEPHEN P.
Published: December 2007

Objectives: The purpose of this study was to determine the reliability and accuracy of automated border detection using acoustic quantification in children. Background: Acoustic quantification has shown promise in adult patients as a method for on‐line estimation of left ventricular size and function. However, in children, the smaller ventricular size might magnify the importance of measurement error. Methods: We compared the cross‐sectional area and fractional area change of the left ventricle as measured on line by acoustic quantification with the area and fractional area change derived by hand‐digitizing the endocardial border of the left ventricle off line, both with and without the papillary muscles included in the left ventricular cavity. Results: The areas and area change fractions from the two methods were highly correlated, both with inclusion and exclusion of the papillary muscles for off‐line analysis. However, the regression slope was closer to unity when the papillary muscles were excluded from the left ventricular cavity during off‐line digitization of the endocardial border. Analysis of agreement between the two methods showed good agreement for area measurements and fair agreement for function measurements. The magnitude of the difference between the two methods for area measurement was directly proportional to the size of the ventricle. That is, the larger the ventricle the larger the difference between the area measurements by the two methods. Discussion: Automatic border detection using acoustic quantification appears to be an acceptable method for estimating the cross‐sectional area and fractional area change of the left ventricle in children.
Abnormal Ultrasonic Tissue Characterization of the Myocardium in Children Receiving Doxorubicin for Cancer Therapy
Authors: BIGRAS JEAN‐LUC , MCCRINDLE BRIAN W. , SHIBUYA KAZUHIKO , SMALLHORN JEFFREY F.
Published: December 2007

Ultrasonic tissue characterization by integrated backscatter is a sensitive tool to detect myocardial changes related to specific diseases. Cardiotoxicity related to doxorubicin use is well known and remains a major concern. To determine if ultrasonic tissue characterization of the myocardium is abnormal in patients receiving doxorubicin, we studied the myocardium of pediatric patients receiving doxorubicin by a real‐time integrated backscatter (IB) imaging system. Three values of IB parameters were averaged from the left ventricular posterior wall at the level of the tip of the mitral valve. In addition to standard echo parameters, we obtained the following IB parameters: peak, nadir, cyclic variation (CV), end‐diastole, heart‐rate corrected delay of nadir (Delayc), and the ratio of CV over end‐diastole. IB parameters were normalized as Z scores from multiple linear regression equations including echo wall thickness and functional indices from a normal control group of 72 children. We evaluated 27 patients at a median age of 11.6 years (1.6 years to 20.3 years) and median time of 1.7 m (2 days to 7.2 years) after a mean cumulative dose of doxorubicin of 188 ± 120 mg/m2 for treatment of neoplasm. Mean (± SD) Z scores for IB variables were as follows: zPeak 0.15 ± 1.07, P = 0.47; zNadir 0.41 ± 1.16, P = 0.08; zCV ‐0.49 ± 0.95, P = 0.01; zEnd‐diastole 0.17 ± 0.94, P = 0.38; zDelayc 0.33 ± 0.80, P = 0.06, and zCV/Peak ‐0.59 ± 1.06, P = 0.009. This study shows that ultrasonic IB of the myocardium of children receiving doxorubicin is abnormal and is independent of the cumulative dosage of doxorubicin or the amount of time since the last dose.
Hemodynamic Predictors of Atherosclerosis in the Thoracic Aorta
Authors: SUKERNIK MIKHAIL R. , WEST OSCAR D. , CHITTIVELU BABU , VANDERBUSH ERIC J. , FRANCIS CHARLES K.
Published: December 2007

We sought to identify atherosclerotic plaques and measured flow parameters in the descending aorta (DA) of 83 consecutive patients (40 years and older) studied with transesophageal echocardiography. Patients with atherosclerotic plaques in the DA were older (68 ± 10 vs 58 ± 12 years [P = 0.0001]), had a higher proportion of spontaneous echo contrast in the DA (15/46 [33%] vs 3 of 37 [8%] P = 0.02), had larger aortic diameters (2.52 ± 0.35 vs 2.37 ± 0.36 cm [P = 0.06]), had a lower maximal velocity in the DA (54.2 ± 21.5 vs 73.8 ± 33.0 cm/sec [P = 0.02]), and had a lower calculated maximal shear rate (SR) (88.0 ± 37.6 vs 129.0 ± 67.0 sec−1 [P = 0.002]). There was no significant difference between groups with respect to sex, hypertension, diabetes, total cholesterol, and smoking. In multivariate analysis only age (P = 0.002) and maximal SR (P = 0.03) were identified as independent predictors of atherosclerosis in the DA. We conclude that low SR is associated with aortic atherosclerosis.
Multiplane Transesophageal Echocardiography with Dobutamine in Patients with Biventricular Inferior Myocardial Infarction
Authors: ESPINOLA‐ZAVALETA NILDA , VARGAS‐BARRÓN JESÚS , ROMERO‐CÁRDENAS ANGEL , BIALOSTOZKY DAVID , ALEXANDERSON ERICK , MARTINEZ‐SANCHEZ CARLOS , PEÑA‐DUQUE MARCO , KEIRNS CANDACE , RIJLAARSDAM MARÍA , LUPI‐HERRERA EULO
Published: December 2007

The purpose of this study was to evaluate the alterations of ventricular wall movement in patients with acute posteroinferior myocardial infarction with extension to right cavities with multiplane transesophageal echocardiography (TEE), as well as the utility of dobutamine with this technique to analyze myocardial viability. Nine men with a mean age of 51 years fulfilled the inclusion criteria. Myocardial TEE was performed in all the men 72 hours after the acute event with long‐ and short‐axis transgastric images of both ventricles under basal conditions and with dobutamine infusions of 5 and 10 μg/kg per minute. Results were compared with myocardial perfusion findings obtained with Tc‐99m Sestamibi SPECT. Left ventricular myocardial viability was demonstrated in 28 of 45 altered segments with dobutamine stress myocardial TEE and Tc‐99m Sestamibi SPECT. Right ventricular myocardial viability was identified in 27 of 30 altered segments with dobutamine stress myocardial TEE in transgastric short and long axes, and with Tc‐99m Sestamibi SPECT in 23 of 25 segments only in short‐axis images. Multiplane TEE provided excellent image resolution and better definition of endocardial and epicardial borders, which facilitated detailed evaluation of ventricular segmental wall movement. Infusion of low doses of dobutamine made it possible to identify viable tissue in both ventricles, and results were comparable to those of nuclear medicine.
Can the Extent of Change of the Left Ventricular Doppler Inflow Pattern During the Valsalva Maneuver Predict an Elevated Left Ventricular End‐Diastolic Pressure?
Authors: BRUNNER‐La ROCCA HANS‐PETER , HELENA ATTENHOFER CHRISTINE , JENNI ROLF
Published: December 2007

Background: The objective of this study was to determine whether analysis of changes in the transmitral filling pattern during the Valsalva maneuver improves the diagnostic accuracy to noninvasively detect an elevated left ventricular end‐diastolic pressure (LVEDP). Methods: We prospectively compared the diagnostic accuracy of the mitral flow velocity indexes at baseline with those obtained during the Valsalva maneuver to detect an elevated LVEDP in 50 patients with coronary artery disease. Results: Moderate correlations were found between LVEDP (mean, 11.8 ± 6.2 mmHg) and deceleration time (r = 0.49), isovolumetric relaxation time (r = 0.52), and the E/A ratio (r = 0.48). There was a strong correlation (r = 0.73) between LVEDP and the percentile decrease in the E/A ratio during the Valsalva maneuver. Discriminant analysis showed that a decrease in E/A ratio during the Valsalva maneuver by ± 40% detected an elevated LVEDP with a sensitivity of 77% and a specificity of 94%, resulting in a diagnostic accuracy of 88%. In 11 patients, the constellation of pseudonormalization (normal E/A ratio and elevated LVEDP) was present. This could be identified in 73% with a diagnostic accuracy of 87%. Conclusions: For a comprehensive assessment of diastolic dysfunction by Doppler echocardiography, combined analysis of the E/A ratio at baseline and during the Valsalva maneuver should be performed routinely as an easy method of increasing diagnostic accuracy and uncovering pseudonormalization.
Volumetric Holography of Cardiac Defects in Humans
Authors: VANNAN MANI A. , PANDIAN NATESA G. , DALTON MICHAEL N. , SCHWARTZ STEVEN L. , MUMM BERNHARD , CAO QI‐LING
Published: December 2007

We have previously described a method to develop holograms that does not entail the presence of laser light source in the clinical environment. Although we have demonstrated the feasibility of holography from cardiac ultrasound data to depict normal and abnormal cardiac anatomy in experimental studies, the ability of holography from ultrasound data to image structural cardiac anomalies in patients is not known. In this exploratory study, we addressed the question of whether it was possible to image cardiac pathology by holography in patients with mitral valve disease, atrial septal defects, and ventricular aneurysms. Parallel, tomographic echocardiographic data obtained during transesophageal echocardiography were used to generate holograms of cardiac disorders. Holographic three‐dimensional (3‐D) reproduction contains up to 1024 by 1024 pixels and full gray scale in each of the individual slices. Holograms of cardiac defects depicted their true spatial location, which not only enhanced the anatomic appreciation of the defect itself, but also revealed the depth and the relationship of the structures in proximity of the defect. Thus, 3‐D imaging of cardiac anomalies by volumetric multiplexed holography is feasible.
Follow‐Up of an Unresectable Hemangioma in the Heart
Authors: CHRISSOS DIMITRIOS N. , AGELOPOULOS NICOLAOS G. , GARYFALLOS DIMITIRIOS J. , STERGIOPOULOU POLYXENI D.
Published: December 2007

We present the case of a patient with a hemangioma, a benign heart tumor, that is revealed incidentally during cardiac catheterization. The patient had coexisting coronary artery disease. This rare tumor remained unchanged in size, and the patient has been asymptomatic for a period of 20 years.
Multiple Local Recurrent Myxoma
Authors: ETXEBESTE JON , ARRILLAGA MANUEL , BASURTO JOSE , GONZALEZ JOSE , ANDRACA LEYRE , ORTIZ DE SALAZAR ALVARO
Published: December 2007

Cardiac myxomas, usually considered benign tumors, occasionally pursue an aggressive clinical course. The recurrence of sporadic myxomas is much less frequent than that of complex or familial myxomas (1–3% vs. 22% vs. 12%, respectively). We report a case of sporadic myxoma with multiple local recurrence in the left atrium diagnosed by transesophageal two‐dimensional echocardiography 4 years after the first excision.
Echocardiographic and Clinical Predictors of Mortality in Chronic Chagas' Disease
Authors: RODRIGUEZ‐SALAS LUIS A. , KLEIN EDURADO , ACQUATELLA HARRY , CATALIOTI FRANCO , DAVALOS VICENTE , RAMON GOMEZ‐MANCEBO JOSE , GONZALEZ HECTOR , BOSCH FERNANDO , JOSE PUIGBO JUAN
Published: December 2007

Background:In a prospective epidemiological study of chronic Chagas' disease, several clinical and echocardiographic variables were analyzed as predictors of mortality. Methods: Among 960 subjects seropositive for Chagas' disease who were examined between June 1981 and June 1992, 283 had echocardiograms.Results:During a mean follow‐up period of 48.3 ± 36.4 months (range, 1–156 months), 108 subjects died. Echocardiographic end‐diastolic and ‐systolic left ventricular internal dimensions, fractional shortening, radius‐to‐thickness ratio, left ventricular mass, mitral E‐point septal separation, and 17 other nonechocardiographic variables were predictors of death on univariate analysis (P < 0.001 for each). On stepwise multiple regression analysis of 215 subjects, significant risk covariates in a Cox model analysis were clinical group (P < 0.0001), M‐mode echocardiographic E‐point septal separation of 22 mm (P = 0.003), presence of first‐ or second‐degree heart block (P = 0.003), chest radiologic cardiothoracic ratio ≤ 0.55 (P = 0.012), presence of electrocar‐diographic ST segment elevation on precordial leads (P = 0.014), age ≤ 56 years (P = 0.028), and presence of right bundle‐branch block (P = 0.045). Patients with an apical aneurysm on two‐dimensional echocardiography had an increased mortality (Chi‐square = 11.5, P < 0.001).Conclusions:Echocardiography is a valuable tool to assess the risk of death in prospective studies on chronic Chagas' heart disease.
Magnetic Resonance Imaging in Chronic Chagas' Disease
Authors: ALCIDES BOCCHI EDIMAR , KALIL ROBERTO , BACAL FERNANDO , de LOURDES HIGUCHI MARIA , MENEGHETTI CLAUDIO , MAGALHÃES ALVARO , BELOTTI GIOVANNI , RAMIRES JOSÉ A.F.
Published: December 2007

Background: We studied the correlation among cardiac magnetic resonance imaging (MRI), gallium‐67 myocardial uptake, and right ventricular endomyocardial biopsy results in chronic Chagas' disease. To our knowledge, this represents the first attempt to correlate the histological findings with cardiac MRI and gallium‐67 myocardial uptake for noninvasive diagnosis of inflammatory activity associated with Chagas' disease. Methods: Ten male patients with cardiomyopathy secondary to Chagas' disease were studied (mean age, 47.7 ± 7 years; congestive heart failure New York Heart Association [NYHA] functional class II [two patients], III [six patients], and IV [two patients]; and mean echocardiographic left ventricular [LV] ejection fraction [EF], 36 ± 6%). The patients underwent right ventricular endomyocardial biopsy, cardiac MRI, and gallium‐67 myocardial uptake testing. The results of this group were compared with those of a control group of patients with idiopathic dilated cardiomyopathy who were matched in age (mean age, 46 ± 10 years), LV function (mean echocardiographic EF, 30 ± 4%), and NYHA classification (one patient in class II, five patients in class III, and one patient in class IV). Results: All patients with Chagas' disease showed higher signal intensity on MRI after the administration of gadolinium. The intensity of the septal signal changed from 0.90 ± 0.11 to 1.56 ± 0.19 (P < 0.001). In the control group, there was no difference in signal intensity with gadolinium (mean septal intensity, 0.94 ± 0.12 before and 0.99 ± 0.15 after; NS). On biopsy, eight chagasic patients had evident signs of myocarditis, and two patients had borderline evidence myocarditis. However, only one patient in the control group had a histological diagnosis of borderline myocarditis. Gallium‐67 cardiac uptake was positive for myocardial inflammatory process in seven chagasic patients and borderline in one. On the other hand, only one patient in the control group had an uptake that was positive for inflammation, and one had a borderline result. Conclusions: In conclusion, the data from this study strongly suggest that myocarditis is frequently found in Chagas' disease. Cardiac MRI appears to be an accurate and alternative method for the diagnosis of inflammatory process associated with Chagas' disease.
Mid‐Term Results of Dual‐Chamber Pacing in Children with Hypertrophic Obstructive Cardiomyopathy
Authors: ALDAY LUIS E. , BRUNO EVA , MOREYRA EDUARDO , AMUCHASTEGUI LUIS M. , JUANEDA ERNESTO , MAISULS HECTOR
Published: December 2007

Background: Permanent dual‐chambered pacing (DDD) is an alternative to surgical treatment in patients with severe hypertrophic obstructive cardiomyopathy (HOCM) who do not have a satisfactory response to medical treatment. Methods: Five children with severe HOCM still symptomatic despite medical treatment underwent permanent DDD pacing and were followed for 21 ± 9.7 months. Results: All patients improved their functional class. Doppler echocardiographic studies showed an early reduction of the left ventricular outflow tract gradient from 66 ± 40 to 40 ± 20 mmHg (P < 0.05) and to 30 ± 11 mmHg (P < 0.05 and NS for comparison with the baseline and the early post‐DDD pacing gradients, respectively) at mid‐term follow‐up. There was no evidence of left ventricular systolic dysfunction, and the results of left ventricular filling studies ruled out deleterious effects on diastolic function. Doppler echocardiography played a key role in the initial and subsequent assessment of these patients. Conclusions: Permanent DDD pacing is a reasonable alternative to surgery in children with HOCM who are still symptomatic despite medical therapy.
Left Ventricular Systolic Function in a Population Sample of Elderly Men
Authors: ANDRÉN BERTIL , LIND LARS , HEDENSTIERNA GÖRAN , LITHELL HANS
Published: December 2007

Background: The present study was designed to evaluate the usefulness and discriminatory power of different echocardiographic indices of left ventricular (LV) systolic function in a healthy screening sample of 584 men who were 70 years old. Methods: Ejection fraction (EF), fractional shortening (FS), stroke index (SI), left ventricular diameter in systole (LVESD), and cardiac index (CI) were evaluated, in addition to LV wall motion score and atrioventricular plane displacement (AVPD). Results: Subjects with hypertension or coronary heart disease (CHD), but not those with diabetes mellitus, showed impairments in EF, FS, LVESD, AVPD, and LV wall motion scores compared with the healthy subjects in the sample (P < 0.01–0.001). SI and CI findings in those with hypertension or CHD were, however, no different from those in the healthy group. The index of LV systolic function that discriminated best between diseased and healthy subjects was LV wall motion score, being correlated with EF, LVESD, and AVPD but only poorly with SI and CI. SI evaluated with use of the Teichholz formula was correlated to LV end‐diastolic diameter (r = 0.72, P < 0.0001), whereas the corresponding correlation between SI measured with Doppler (aortic flow) and LVEDD was weak. The difference between the Teichholz and Doppler evaluations of SI was dependent on LV end‐diastolic diameter (r = 0.51, P < 0.001) but not on LV systolic function. An index, the systolic two‐dimensional index, which takes into account both the longitudinal motion (AVPD) and movement along the short axis (LVESD) during systole, was suggested by the formula AVPD + 5/LVESD. Conclusions: Impaired LV systolic function was found in both elderly men with hypertension and those with CHD. SI was normal in these groups, however, although overestimated when measured with the Teichholz formula in this population with a large proportion of subjects with LV dilatation. AVPD appears to be applicable in the present population, and a new systolic index consisting of LVESD and AVPD is suggested for the evaluation of LV systolic function in two dimensions.
Hemodynamic Comparison by Doppler Echocardiography of Valves in the Aortic Position
Authors: PETEIRO JESUS , CAMPOS VICENTE , VALLE JOSE , ALVAREZ NEMESIO , CASTRO‐BEIRAS ALFONSO
Published: December 2007

In 281 patients, we used Doppler echocardiography to compare the hemodynamic performance of different aortic prosthetic valves at three postoperative stages and investigated the value of the continuity equation in diagnosing aortic prosthetic obstruction. A baseline study was performed in 163 patients, a 5 ± 2‐month follow‐up study was performed in 103 patients, and a 15 ± 5‐month follow‐up study was performed in 65 patients. From baseline to the second study, left ventricular diastolic diameter, heart rate, and maximum (MG) and mean Doppler‐derived gradient (MeG) decreased significantly, and left ventricular shortening fraction, systolic blood pressure, stroke volume, and prosthetic valvular area (PVA) increased significantly. No changes were found between the second and third studies. Thus, noninvasive hemodynamic values at the time of follow‐up are reported in 171 patients: 86 with Björk‐Shiley Monostrut, 27 with Carbomedics, 11 with Medtronic‐Hall, 18 with Hancock modified, and 29 with Toronto valve bioprosthesis. Patients implanted with the Toronto had a larger prosthetic size (Monostrut 23 ± 2 mm, Carbomedics 23 ± 3 mm, Medtronic‐Hall 23 ± 2 mm, Hancock 23 ± 2 mm, Toronto 25 ± 2 mm, P < 0.01) despite a similar body surface area. MeG and MG were lower (MeG [in mmHg] Monostrut 12 ± 5, Carbomedics 14 ± 6, Medtronic‐Hall 19 ± 6, Hancock 11 ± 4, Toronto 7 ± 5; P < 0.01 between Toronto and all others), and PVA was greater (Monostrut 2.0 ± 0.7 cm2, Carbomedics 1.8 ± 0.8 cm2, Medtronic‐Hall 1.6 ± 0.7 cm2, Hancock 1.7 ± 0.5 cm2, Toronto 2.2 ± 0.9 cm2; P < 0.01 between Toronto and Carbomedics, Medtronic‐Hall, and Hancock), even compared with the same sizes in the other valves. A PVA of 0.9 cm2 or less and MeG of 28 mmHg or more identified prosthetic obstruction with 100% sensitivity and 99% specificity. Hemodynamics change significantly from the early to the late postoperative state. The Toronto valve stentless porcine bioprostheses performs hemodynamically better than other valves. PVA measurement using the continuity equation may accurately identify prosthetic obstruction.
Clinical Validation of Digital Image Compression Levels for Fetal Echocardiograms for Telemedicine
Authors: FYFE DEREK A. , EMGE FRED , JOHNSON GREGORY , McCAFFREY FRANCIS , LUTEN WILLIAM , COUSE DOUG , SCHRUM ALAN
Published: December 2007

Background: Digital telephone transmission of dynamic fetal echocardiographic sequences requires wide bandwidths. To reduce the transmission of nonessential information present in echocardiographic images, compression algorithms have been used and validated for adult echocardiography. The level of compression that retains all diagnostic clinical information must be determined and validated for fetal echocardiographic studies. The purpose of this study was to validate levels of image compression that are diagnostic for fetal echocardiography. Methods: Twenty previously recorded fetal echocardiograms representing two normal and 18 congenitally abnormal hearts were looped, digitized, and compressed at differing ratios. Images were reviewed in a blinded manner by four experts. Images were scored for diagnosis, diagnostic quality, and technical quality. Results: Forty‐four images were viewed. Experts correctly diagnosed 87% of images. There were no images of unacceptable diagnostic quality at a compression ratio of 300 (0%) and 2% at compression, ratio of 600:1. Conclusions: Digital image compression of 300:1 was diagnostic for fetal congenital heart diseases with a variety of defects using cine‐looped images. These data support the use of compressed fetal images for telephone transmission with a low bandwidth.
Right‐to‐Left Shunt Through a Ventricular Septal Defect During Sedated Sleep
Authors: MIYAKE TOSHIHARU , YOKOYAMA TATSUO , FUKUHARA HITOO
Published: December 2007

A 10‐month‐old infant with Down's syndrome developed cyanosis due to a right‐to‐left shunt through a ventricular septal defect during sedated sleep induced for echocardiography. During cardiac catheterization, arterial oxygen saturation decreased, and arterial carbon dioxide concentration increased. Various echocardiographic parameters during sedated and natural sleep were compared. It was considered that hypoventilation caused by the narrowed upper airway was induced by sedated sleep. We conclude that the influence of sedatives should be considered in the estimation of echocardiographic data if an infant with Down's syndrome has a ventricular septal defect with pulmonary hypertension.
Benzocaine‐Induced Methemoglobinemia Complicating Transesophageal Echocardiography
Authors: McGRATH PAUL D. , MOLONEY JOHN F. , RIKER RICHARD R.
Published: December 2007

Methemoglobinemia is a rare but potentially serious complication occurring after the administration of the anesthetic agent benzocaine. We describe the findings and subsequent treatment of a patient who developed this complication after the use of benzocaine during the course of transesophageal echocardiography.
A Case of Ruptured Mitral Valve Aneurysm Complicating Long‐Standing Aortic Regurgitation
Authors: MATSUMURA NORIHIKO , FUJIMOTO SHINICHI , NAKANO HIROSHI , MIZUNO REIKO , NEGORO KENSUKE , YAMAMOTO YUTA , YABUTA MATAHIRO , NONAKA HIDERO , DOHI KAZUHIRO
Published: December 2007

A 53‐year‐old man with aortic regurgitation was admitted to our hospital because of fever. A diagnosis of ruptured mitral valve aneurysm was made by Doppler echocardiography. Aortic regurgitant flow along the anterior mitral leaflet may have predisposed to mitral valve endocarditis, aneurysm formation, and its rupture.
Transesophageal Echocardiographic Diagnosis of Right‐Sided Aortic Arch
Authors: NANDA NAVIN C. , SAMAL ADITYA K. , BAKIR STEVE , MOURSI MOHAMMED , THAKUR ABHASH C. , AGGARWAL RAMESH , SINGH SATINDER , SOTO BENIGNO , CERFOLIO ROBERT , McGIFFIN DAVID C.
Published: December 2007

We present the transesophageal echocardiographic findings in two adult patients with right‐sided aortic arch: one without dissection and the other with traumatic aortic injury (dissection). In both patients, the branching pattern was the left common carotid artery and then the right common carotid artery, followed by the right and left subclavian arteries. The technique for the diagnosis of this anomaly and the identification of adjacent vascular structures using contrast echocardiography is described. Three‐dimensional reconstruction of the aortic arch also was performed in both patients.
Simple Way to Resolve the Range Ambiguity
Authors: VOON WEN‐CHOL , SHEU SHENG‐HSIUNG , WU JUNG‐CHOU
Published: December 2007

Purpose: The purpose of this study was to test the hypothesis that with the range gate fixed, random adjustment of the pulse repetition frequency will offer a rapid and accurate way to avoid misinterpretation of range ambiguity. Background: Traditionally, to avoid the misdiagnosis of Doppler artifacts caused by range ambiguity, time must be spent on checking the flow patterns in the calculated phantom range gates. Methods: Twenty‐four patients (mean age 64 ± 15 years, 15 men and nine women) with mitral regurgitation were included in the study. Pulsed Doppler evaluation was performed with sample volume initially at the shallow left ventricle and then, along the direction of ultrasonic beam, at the calculated range gate distal to the mitral valve to search for the high velocity Doppler signal. The highest velocity scale was initially selected. After detection of high velocity signal, the velocity scale was lowered to achieve the lower pulse repetition frequency. Results: For all patients, a high velocity regurgitant Doppler signal could be recorded both distal to the mitral valve and at the shallow left ventricle. Such signal persisted at the range gate distal to the mitral valve but disappeared at the range gate at the shallow left ventricle after manual adjustment of the velocity scale. The sensitivity, specificity, and accuracy of disappearance of the high velocity Doppler signal after adjustment of the pulse repetition frequency for confirmation of a phantom phenomenon are 100%, 100%, and 100%, respectively. Conclusions: Without the necessity of exact information about the pulse repetition frequency used, random adjustment of the pulse repetition frequency for the selected gate range is a rapid and exact method for initial differentiation of in situ from phantom signal in pulsed Doppler echocardiography.
Noninvasive Assessment of Regional and Global Myocardial Contractility in Normal Control Subjects and in Patients with Dilated Cardiomyopathies
Authors: DOMANSKI MICHAEL J. , FOLLMAN DEAN , KRAVITZ MARSHA , MIRSKY ISRAEL
Published: December 2007

The aim of the present study was to develop a new noninvasive approach for the assessment of regional and global myocardial contractility without the need for pharmacological intervention to alter load. Thirty‐four healthy adults and five adults with dilated cardiomyopathy (DCM) were studied. Patients with diabetes mellitus and hyperthyroidism were eliminated from the study. The remainder underwent echocardiography, sphygmomanometric blood pressure determination, and carotid pulse tracings. Left ventricular cross section in the parasternal long‐axis four‐ and two‐chamber views was divided into 20 segments. Associated measurements of end‐systolic pressure and left ventricular ejection time enabled shortening, shortening rate, and ejection fraction / afterload relationships to be determined. A discriminant analysis showed that the ejection fraction / afterload relationship in patients with DCM differed substantially from that of control subjects and was the most sensitive in this regard. Endocardial shortening, mid‐wall shortening, and ejection fraction / afterload relationships demonstrated linearity or nonlinearity for control subjects. This study thus permits the assessment of contractility in individual subjects without the need for drug interventions because load alteration stems from the variation of wall stress from base to apex in the left ventricle. More importantly, the approach may be applied to patients with segmental abnormalities of contractile function.
Left Ventricular Diastolic Function in a Population Sample of Elderly Men
Authors: ANDRÉN BERTIL , LIND LARS , HEDENSTIERNA GÖRAN , LITHELL HANS
Published: December 2007

Background and Methods: Echocardiography with Doppler has been widely used to assess left ventricular (LV) diastolic function. Interpretation of the diastolic indices that are derived, however, is confounded by the effects of physiological aging on the LV diastolic function. In this study, the usefulness of different Doppler‐derived indices of LV diastolic function was assessed in elderly subjects by using data from a health screening survey of 584 men aged 70 years. Results: The index of early versus late transmitral blood flow, the E / A ratio, was found to be reduced in the apparently healthy subgroup (n = 195) of the population (0.96 ± 0.25) compared with previous data from middle‐aged subjects. However, E / A ratios similar to those in the apparently healthy subjects were found in subjects with coronary heart disease (CHD), hypertension, and diabetes mellitus. Only subjects with systolic dysfunction (ejection fraction < 40%) showed a significantly decreased E / A ratio (0.79 ± 0.21, P < 0.05) compared with the apparently healthy subjects. Isovolumic relaxation time (IVRT) was, however, significantly prolonged in subjects with CHD or hypertension compared with the apparently healthy subjects (139 ± 32, 127 ± 25, and 118 ± 21 milliseconds, respectively; P < 0.01), whereas the E wave deceleration times (DT) were alike in both apparently healthy and unhealthy subjects. The diastolic and systolic components of the pulmonary venous blood flow were alike in apparently healthy and unhealthy subjects. Left atrial size was increased in all patients with disease, possibly indicating increased preload. Conclusion: In this population sample of elderly men, the commonly used E / A ratio did not distinguish between apparently healthy subjects and those with cardiovascular diseases such as CHD or hypertension, which are known to be associated with LV diastolic dysfunction in the middle‐aged population. IVRT appeared to be the most sensitive of the Doppler‐derived indices of LV diastolic function used in the present study, but for this variable, the differences between apparently healthy subjects and unhealthy subjects were small. Thus, the age‐associated changes in LV compliance appear to override the impact of these disorders on indices of LV diastolic function in elderly populations.
Right Ventricular Dysfunction Secondary to Myocardial Ischemia Provoked by Stress Testing
Authors: OBEID ANIS I. , BATTAGLIA JOSEPH , LOZNER EUGENE
Published: December 2007

We present the cases of two patients, aged 59 and 85 years, who were evaluated with stress echocardiography for chest pain. Both patients developed dramatic echocardiographic findings consisting of severe right ventricular enlargement and hypokinesis, as well as enlargement of the right atrium at relatively low‐level exercise. One patient collapsed with severe sinus bradycardia, junctional rhythm, ST elevation in the inferior leads, marked hypotension, and neck vein congestion. The other patient developed staggering and symptoms of hypoperfusion. In both patients, correction of critical proximal right coronary artery stenosis by angioplasty resulted in complete resolution of the right ventricular dysfunction on repeat stress testing. We conclude that in some patients, stress‐induced myocardial ischemia may involve primarily the right ventricle with little or no evidence of ischemic changes in the left ventricle. An assessment of right ventricular function should be included in stress echocardiographic studies.
Transnasal Transesophageal Stress Echocardiography
Authors: SPENCER KIRK T. , THURN JOHN , BEDNARZ JAMES , LINDER GERALD S. , CONNOR BRIAN , LANG ROBERTO M.
Published: December 2007

Exercise echocardiography is a widely used modality for the noninvasive assessment of coronary artery disease. However, limitations exist inherent to the acquisition of transthoracic echocardiographic images. Although transesophageal echocardiography has been used during pacing or pharmacological stress, its use during exercise stress testing has not been clinically feasible due to the large probe size. Recently, a miniaturized transesophageal probe was developed, and we sought to test the feasibility of using this probe during graded treadmill exercise testing. Normal subjects were studied with transnasal echocardiography during upright treadmill exercise testing. The transnasal probe was passed in 13 of the 15 subjects. Excellent‐quality monoplane two‐dimensional echocardiographic images were obtained in all patients in the upright position. During exercise treadmill testing, high quality clinically useful echocardiographic images of the left ventricular short axis could be maintained. We conclude that transnasal transesophageal stress echocardiography may offer a new modality for the exercise assessment of ischemic heart disease.
Spontaneous Echo Contrast in Purulent Pericardial Effusion due to Non‐Gas‐Forming Organisms
Authors: HUNG MING‐JUI , WANG CHAO‐HUNG , LIU DAH‐WEL , CHERNG WEN‐JIN
Published: December 2007

We present the case of a 55‐year‐old man who developed massive pericardial effusion with tamponade within a 5‐day period. During transthoracic two‐dimensional echocardiographic examination, spontaneous echo contrast was visualized in pericardial effusion. A diagnosis of polymicrobial pyopericarditis was made when urgent pericardiocentesis revealed a significantly foul odor and purulent fluid that grew a culture of aerobes. After surgical drainage and appropriate antimicrobial therapy, this patient's pyopericarditis resolved. It was suggested that spontaneous echo contrast in pericardial effusion could be induced by non‐gas‐forming pyogenic cells.
Thoracic Aortic Aneurysm Presenting as Pulmonary Vein Stenosis
Authors: HUNLEY STEPHEN O. , REEVES WILLIAM C. , WILLIAMS MARK J. , CAMPBELL JULIE , SORRELL VINCENT L.
Published: December 2007

We present the case of a 66‐year‐old woman presenting with pulmonary vein stenosis with a large descending thoracic aortic aneurysm. Pulmonary vein stenosis is a rare condition and can be caused by extrinsic compression, as well as by inflammatory diseases, congenital anomalies and related surgical repair, tuberculosis, and pulmonary veno‐occlusive disease. With obstruction to pulmonary vein flow, the velocity increases and becomes continuous. The finding of turbulent antegrade flow in the left atrium through the use of transthoracic color flow Doppler and pulsed‐Doppler warrants further investigation to evaluate known causes of pulmonary vein stenosis. We believe this is the first reported case of a patient with an aortic aneurysm causing pulmonary vein stenosis.
Improvement in Endocardial Border Delineation Using Tissue Harmonic Imaging
Authors: BECHER HARALD , TIEMANN KLAUS , SCHLOSSER THOMAS , POHL CHRISTOPH , NANDA NAVIN C. , AVERKIOU MICHALAKIS A. , POWERS JEFF , LÜDERITZ BERNDT
Published: December 2007

Background and Methods: For years, tissue has been assumed to be a linear medium in diagnostic ultrasound applications; thus, no backscattered signals in the second harmonic band are expected in harmonic imaging without the injection of a contrast agent. However, it has been shown that a useful tissue image is formed even without a contrast agent. The aim of this study was to evaluate whether this tissue harmonic image provided improved visualization of endocardial borders. Fifty‐six adult patients with various heart diseases were investigated using conventional two‐dimensional echocardiography and tissue harmonic imaging. In 30 of these patients, the left ventricular endocardial borders were well defined in the standard parasternal and apical views using conventional two‐dimensional echocardiography. In the remaining 26 patients, delineation of endocardial borders was not possible in at least two segments. The equipment used was an ATL HDI‐3000 diagnostic system equipped with harmonic imaging. Results: In all 56 patients, the myocardium and valves could be imaged with tissue harmonic imaging. Harmonic recordings were sharper and contained fewer clutter artifacts than conventional recordings. Most striking was the enhancement of left ventricular endocardial borders. In the 26 patients with incomplete delineation of left ventricular endocardial borders, wall motion could be evaluated in 290 of 312 (93%) segments with tissue harmonic imaging compared with only 168 of 312 (54%) segments with conventional echocardiography (P < 0.001). Conclusions: Tissue harmonic imaging improves image quality and can be used to enhance the definition of left ventricular endocardial borders. These findings can be explained by the nonlinear propagation of ultrasound within the tissue, which results in distortion of the transmitted signal and, thus, harmonic generation.