bluuebunny/crossref_metadata_2025 huggingface dataset:
Doppler Color Flow Image Size: Dependence on Instrument Settings
Authors: STEWART WILLIAM J. , COHEN GERALD I. , SALCEDO ERNESTO E.
Published: August 2007

Doppler color flow imaging provides important qualitative information about the location and spatial distribution of intracardiac blood flow. However, the effect of instrument‐related variables on the size of color Doppler images requires further definition. Flow of a silicone particle solution was established in a tube or cylinder and scanned as color gain, pulse repetition frequency, depth, and transducer frequency were varied. The diameter of Doppler color flow images were measured during constant laminar or disturbed flow parallel to the ultrasound beam and during laminar flow perpendicular to the ultrasound beam. The diameter of color Doppler images of laminar flow perpendicular and parallel to the beam varied directly with color gain. Diameter varied inversely with transducer frequency for laminar flow parallel to the transducer and inversely with pulse repetition frequency for laminar flow perpendicular to the transducer. The diameter of laminar flow parallel to the transducer varied directly with the depth of the flow area below the transducer. The size of the color flow dropout of laminar flow exactly perpendicular to the ultrasound beam varied directly with transducer frequency and inversely with gain. During disturbed flow parallel to the transducer, the diameter of the image varied directly with gain and inversely with transducer frequency and pulse repetition frequency. Instrument settings have a significant impact on the size of color Doppler images. Understanding the effects of changes in these variables is important for reliable diagnostic use of Doppler color flow imaging. (ECHOCARDIOGRAPHY, Volume 8, May 1991)
A New Angled Transducer for Intraoperative Epicardial Echocardiography
Authors: MATSUWAKA RYOUSUKE , MATSUDA HIKARU , NAKANO SUSUMU , HIRATA NOBUAKI , NISHIMURA MOTONOBU , MITSUNO MASATAKA , KAWASHIMA YASUNARU
Published: August 2007

We tested a new angled transducer developed for intraoperative epicardial echocardiography in 42 patients. This small transducer, 70 × 20 × 15 mm in size, demonstrated superior operability and provided adequate two‐ or four‐chamber imaging from the apical approach, which may lead to high‐quality assessment with two‐dimensional Doppler flow imaging. (ECHOCARDIOGRAPHY, Volume 8, May 1991)
Spontaneous Left Ventricular Contrast Echoes in a Patient with Aortic Regurgitation
Authors: HUMBERT VERNON H. , KADIRESAN VENKATESH N.
Published: August 2007

We describe a patient with chronic aortic regurgitation and moderately severe left ventricular dysfunction whose echocardiographic study revealed striking clouds of smokelike blood billowing in discrete puffs from the area of the mitral inflow tract toward the cardiac apex early in each diastole. (ECHOCARDIOGRAPHY, Volume 8, May 1991)

We have described a case in which spontaneous contrast echoes developed consistently in the left ventricular inflow tract, swirled quickly to the cardiac apex, and were rapidly ejected through the aortic valve during the following systole in a patient with chronic aortic regurgitation. Although we cannot completely exclude transmitral passage of stagnant left atrial blood as the cause of this phenomenon, we believe that the spontaneous contrast echoes seen may have originated from precise direction of the regurgitant jet directly against the anterior mitral leaflet with slightly higher amplitude fluttering than commonly seen in this situation, resulting in sufficient fluid agitation adjacent the leaflet to create local mi‐crocavitations. This mechanism has previously been documented to occur in an in vitro model. The rarity with which this phenomenon occurs in the setting of a common clinical entity suggests that a critical interplay of multiple factors, some as yet unidentified, is necessary for its generation.
Transesophageal Echocardiographic Visualization of Leaflet Destruction in Two Patients with Suspected Endocarditis
Authors: ROUDAUT RAYMOND , DUPAS JEAN‐YVES , GOSSE PHILLIPE , DALLOCCHIO MODESTE
Published: August 2007

We report two cases of nonvegetant endocarditis, one with a perforated mitral valve aneurysm, the other with a perforated aortic leaflet. In both cases, the diagnosis of perforation was not made by transthoracic Doppler echocardiography but by transesophageal Doppler echocardiography. Transesophageal echocardiography is particularly useful in the context of nonvegetant endocarditis for a rapid diagnosis because an urgent surgical treatment may possibly be needed. (ECHOCARDIOGRAPHY, Volume 8, May 1991)
Left Ventricular Diastolic Function in Idiopathic Cardiomyopathy: Doppler Hemodynamic Correlations
Authors: VINE STEVEN J. LA
Published: August 2007

The left ventricular diastolic filling pattern in congestive cardiomyopathy is heterogeneous and may vary from a “rapid filling predominant pattern” to an “atrial filling predominant pattern.” The observed pattern of diastolic filling may depend on a complex interaction of factors including: left ventricular relaxation, left ventricular stiffness, external constraining forces, loading conditions, and heart rate. These factors appear to express themselves individually and collectively through alterations in the time course and extent of the transmitral pressure gradient. In this review, the physiological basis for each of these diastolic filling patterns is discussed based on previous clinical and experimental studies that either directly or indirectly address these issues. (ECHOCARDIOGRAPHY, Volume 8, March 1991)
Evaluation of Left Ventricular Filling in Dilated Cardiomyopathy Using Digitized M‐Mode Echocardiograms
Authors: RAHKO PETER S.
Published: August 2007

Digital M‐mode echocardiography describes a characteristic alteration in the pattern of left ventricular filling when a dilated cardiomyopathy is present. The peak rates of early diastolic dimension change (dD/dt and dD/dt/D) are uniformly reduced but remain unchanged in time of occurrence (time to dD/dt). The rapid filling period is slightly shortened compared to normals, but the %AD taking place during rapid filling is not different than normals. This pattern is distinct from characteristic alterations seen in other cardiac diseases that have preserved systolic performance. While M‐mode indices of left ventricular filling may be altered by several factors, the most significant factors in dilated cardiomyopathy are the severity of systolic dysfunction and preload. Left‐sided conduction delays and associated right ventricular enlargement have no demonstrable effect on very early portions of diastole, but the conduction delay does prolong the rapid filling period and reduce the extent of filling during this period. Combined use of digitized M‐mode echocardiograms and Doppler analysis of transmitral flow may allow a more complete description of left ventricular filling in future studies. (ECHOCARDIOGRAPHY, Volume 8, March 1991)
Mechanism of Mitral Regurgitation in Dilated Cardiomyopathy
Authors: BRUSS JEFFREY , JACOBS LARRY E. , KOTLER MORRIS N.
Published: August 2007

Dilated cardiomyopathy is a condition characterized by chamber dilatation and impaired systolic function, resulting in the clinical manifestations of congestive heart failure. Mitral regurgitation occurs with varying frequency in dilated cardiomyopathy, and its detection depends on the diagnostic modality utilized. The presence of mitral regurgitation imposes an additional burden on the failing ventricle, and appears to be an independent prognostic indicator of mortality. The mechanism of mitral regurgitation in dilated cardiomyopathy is complex, controversial, and incompletely understood. The mitral apparatus consists of the left atrial wall, mitral annulus, mitral leaflets, chordae tendineae, papillary muscles, and left ventricular wall, and each of these components and the intimate interrelationship between these structures may contribute to the development of mitral regurgitation. Left atrial enlargement, reduced left atrial contractility, mitral leaflet retraction, abnormal vector of chordal tendineae pull, papillary muscle dysfunction (either asynergic contraction or malalignment), mitral annular dilatation, and changes in the size, shape, and function of the left ventricle have been suggested as possible mechanisms for the development of mitral regurgitation in dilated cardiomyopathy. The primary event in the development of mitral regurgitation appears to be left ventricular dilatation and dysfunction. Controversy persists as to whether the associated mechanism is annular dilatation, papillary muscle or free left ventricular wall dysfunction, or a combination of all, but recent echo‐Doppler studies reviewed in this article support the notion that annular dilatation is the predominant mechanism. Improved understanding of the mechanism of mitral regurgitation in dilated cardiomyopathy may lead to a more aggressive approach with regard to pharmacological therapy, thus impacting on survival in this group of patients. (ECHOCARDIOGRAPHY, Volume 8, March 1991)
Doppler Assessment of Diastolic Function in Cardiac Amyloidosis
Authors: KLEIN ALLAN L. , TAJIK A. JAMIL
Published: August 2007

The hallmark of cardiac amyloidosis is abnormal diastolic function secondary to amyloid infiltration of the ventricular walls, which accounts for the term “stiff heart syndrome.” The abnormal diastolic function has not yet been well characterized, however. Thus, we assessed left and right ventricular diastolic function in 53 patients with cardiac amyloidosis. We measured the left and right ventricular inflow and venous flow velocities with Doppler echocardiography and found a range of Doppler filling abnormalities. These abnormalities were dependent on the degree of amyloid infiltration of the heart as measured by mean left ventricular wall thickness. Patients with advanced cardiac amyloidosis (a wall thickness ≥15 mm) showed restriction, while patients with early cardiac amyloidosis (a wall thickness <15 mm) showed abnormal relaxation or normal filling. In another study, during a 13‐month follow‐up, patients with early cardiac amyloidosis showed Doppler patterns that evolved from abnormal relaxation through a normal stage, to an advanced stage of restrictive disease. We also have demonstrated the importance of left ventricular inflow variables in predicting the outcome of patients with cardiac amyloidosis. We conclude that Doppler echocardiography is useful in characterizing abnormal diastolic function in patients with cardiac amyloidosis. (ECHOCARDIOGRAPHY, Volume 8, March 1991)
Transesophageal Echocardiographic Mimicry of Cor Triatriatum
Authors: GOLDMAN ANTHONY P. , GLOVER MATTHEW U. , MICK WIL , BESSONE LOUIS , HIRO STEPHEN , PUPELLO DENNIS
Published: August 2007

In this report we describe the findings by transesophageal echocardiography of an intra‐atrial membrane highly suggestive of cor triatriatum. This linear echo density within the left atrium was found to be a fold within the left atrium at exploratory surgery.
Two‐Dimensional Echocardiographic Detection of Asymptomatic Pulmonary Thromboembolism
Authors: ZAIDI SARFRAZ J.
Published: August 2007

Asymptomatic pulmonary thromboembolism is a well‐known clinical entity. In this case, a routine two‐dimensional echocardiogram detected a thrombus in the right atrium. During the examination, it was seen to move into the right ventricle and across the pulmonic valve into the pulmonary artery. The patient remained completely asymptomatic. To my knowledge, this is the first case describing two‐dimensional echocardiographic demonstration of asymptomatic pulmonary thromboembolism.
Usefulness of Transesophageal Echocardiography for the Detection of Left Atrial Thrombi in Patients with Rheumatic Heart Disease
Authors: LIN SHOA‐LIN , HSU TSUI‐LEIH , LIOU JER‐YOUNG , CHEN CHEN‐HUAN , CHANG MAU‐SONG , CHIANG HUNG‐TING , CHEN CHUNG‐YIN
Published: August 2007

Transesophageal (TEE) and transthoracic (TTE) echocardiograms were performed in 110 patients with rheumatic heart disease to evaluate the usefulness of these methods for the detection of left atrial thrombi. TEE was better than TTE for detecting left atrial thrombi (21 vs 9). The thrombi not detected by TTE were in the left atrial appendage in ten and over the left atrial posterior wall in two. Patients with left atrial thrombi had significantly smaller mitral valve area (P < 0.01) and greater left atrial dimension (P < 0.05) than those without. All patients with left atrial thrombi had atrial fibrillation. Thirty‐one patients underwent surgical intervention and 13 were found to have left atrial thrombi. TEE detected left atrial thrombi in all 13 patients with a sensitivity of 100%, specificity of 100%, and accuracy of 100%, while TTE detected left atrial thrombi in only nine of these 13 patients with a sensitivity of 69.2%, specificity of 100%, and accuracy of 87.1%. Thus, TEE is superior to TTE for the detection of left atrial thrombi, especially for those thrombi located in the left atrial appendage and along the left atrial posterior wall.
Application of Echocardiographic Color Flow Doppler Mitral Regurgitation to the Diagnosis of Acute Cardiac Transplant Rejection
Authors: FAN POHEY , KIRKLIN JAMES K. , NAFTEL DAVID C. , BOURGE ROBERT C. , NANDA NAVIN C. , HSIUNG MING C. , WHITE‐WILLIAMS CONNIE , SMITH SHIRLEY
Published: August 2007

Numerous noninvasive techniques have been examined for the detection of acute rejection following cardiac transplantation, but none has proven sufficiently sensitive to replace the endomyocardial biopsy. A prospective study was performed in 92 heart transplant patients in order to test the hypothesis that mitral regurgitant ratio by two‐dimensional echocardiography with Doppler flow mapping could detect moderate or severe acute allograft rejection. There were 82 rejection episodes identified, of which 40% were associated with mitral regurgitation by echo‐Doppler at the beginning of the episode. With augmentation of immunosuppression during a rejection episode, there was a progressive fall in the degree of mitral incompetence (P = 0.03). The sensitivity of color Doppler studies in identifying rejection was low (60% of all rejection episodes had no associated mitral incompetence at the beginning of the episode), but the likelihood of rejection progressively increased with higher degrees of mitral regurgitation (P < 0.01), approaching 60% when the echo‐Doppler regurgitant ratio exceeded 15%. Echo‐Doppler studies do not provide sufficient sensitivity to be useful as a screening technique for acute cardiac rejection, but high or increasing echocardiographic mitral regurgitant ratio is predictive of acute rejection and should indicate prompt endomyocardial biopsy.
Spontaneous Regression of Cardiac Tumors
Authors: ORTIZ JUAREZ , MAGALHãES HELIO PEREIRA , DE SOUZA ALBINO MALTA , SILVA CARLOS E.S.
Published: August 2007

The authors report a case of an asymptomatic 3‐day‐old baby with multiple biventricular tumors detected 2 years ago by echocardiography. In spite of the major anatomical anomaly, no functional abnormality was found. There was no outflow tract obstruction and, therefore, an expectant and noninterventional approach was recommended. Serial echocardiographic follow‐up revealed spontaneous and progressive regression of the tumors. Today the child remains asymptomatic and only three small masses persist.
Hemodynamic Determinants of Echocardiographically‐Derived Indices of Left Ventricular Filling
Authors: ZILE MICHAEL R.
Published: August 2007

Noninvasive techniques have made it easy to detect abnormalities in the pattern of left ventricular diastolic filling. Abnormalities in diastolic filling patterns have been identified in a wide variety of cardiac disorders and are sensitive, early indicators of myocardial disease. However, changes in noninvasive indices of left ventricular diastolic filling are caused not only by pathological processes but also by several physiological determinants. The purpose of this review is to describe the measurements used to quantitate diastolic function, define the physiological and pathological determinants of these measurements, and discuss the use of these measurements in the diagnosis and treatment of cardiac disease.
Physical Basis for the Mitral Velocity Curve in Assessing Mitral Valve Area and Left Ventricular Diastolic Function
Authors: THOMAS JAMES D.
Published: August 2007

The temporal pattern of blood velocity through the mitral valve is used to assess mitral valve area and ventricular diastolic function. In routine empirical implementation, it is often assumed in mitral stenosis that mitral valve area alone determines the pressure half‐time, while in assessing diastolic function, the effects of the mitral valve are often ignored. Clearly these situations cannot be completely separated: chamber properties and mitral valve impedance affect ventricular filling in both cases. In this review, a unified approach to the analysis of mitral inflow patterns is presented. Through theoretical analysis, computer simulation, in vitro modeling, and clinical data, it is shown that mitral acceleration varies directly with the atrioventricular pressure difference early in diastole and inversely with the inertance of blood within the mitral apparatus. Similarly, mitral deceleration rate is directly proportional to the effective area of the mitral valve and inversely related to the net compliance of the atrium and ventricle. In the setting of mitral stenosis, this means that the mitral pressure half‐time is inversely proportional to mitral valve area (as commonly implemented clinically), but also directly related to net chamber compliance and the square root of the initial transmitral pressure difference. In evaluation of diastolic function, this explains the steep mitral deceleration observed in restrictive cardiomyopathies. An appreciation of the physical issues governing ventricular filling should warn of potential pitfalls in the Doppler evaluation of mitral valve area and ventricular function, as well as suggest more quantitative approaches based on these principles.
The Natural History of Left Ventricular Filling Abnormalities: Assessment by Two‐Dimensional and Doppler Echocardiography
Authors: APPLETON CHRISTOPHER P. , HATLE LIV K.
Published: August 2007

Doppler and two‐dimensional echocardiography are being increasingly used for the indirect assessment of left ventricular (LV) diastolic function. In this article the alterations in LV filling patterns that occur in patients with LV diastolic function are reviewed in the context of echocardiographic findings. A progression of LV filling abnormalities is presented in the sequential “stages” in which we believe they occur in most cardiac disease states. Patient symptoms, hemodynamics, pulmonary venous flow velocities, and left atrial function associated with the different LV filling patterns are also discussed.
Transesophageal Echocardiography with a Single‐Plane Probe
Authors: GADASALLI SURESH N. , SARNOSKI JOSEPH S. , KUBOTA JAMES , SCHMIDT DONALD H. , GAL RAMI
Published: August 2007

The literature suggests that during transesophageal echocardiography (TEE), a short‐axis view can be obtained in the gastric position using a single‐plane probe. Recently, we have found that a long‐axis apical display of the heart can be achieved by placing the tip of the probe in the fundus of the stomach. In a 3‐month period, we attempted to obtain this view in 54 consecutive patients. Twelve of the patients had TEE done under general anesthesia, while the other 42 patients had the procedure performed under sedation with midazolam at hospital bedside or as an outpatient. The long‐axis transgastric view was obtained in 51 of the 54 patients (94%). The image quality was graded subjectively as good in 39 (72%) and fair in the other 12 patients (22%). This view helped to establish the diagnosis in eight patients (15%) and to increase the level of confidence about the accuracy of the diagnosis in 23 (43%) other patients. Four patients' findings are described. We conclude that the new long‐axis transgastric view is easy to obtain, does not add much time to the usual TEE study, does not add to the low complication rate of TEE, and may help to interrogate the distal structures of the heart.
Does Cardiac Function Modify Left Heart Opacification with Transpulmonary Echo Contrast Agents?
Authors: VÖLLER HEINZ , SCHRÖDER KLAUS , SPIELBERG CHRISTOPH , UHRIG ALEXANDER , WILKENSHOFF URSULA , DISSMANN RÜDIGER , SCHLIEF REINHARD , SCHRÖDER ROLF
Published: August 2007

Dependence of left heart opacification on ventricular function was evaluated for the new transpulmonary echo enhancing agent (SH U 508‐A. The contrast agent was injected intravenously in 5 patients with normal cardiac function (ejection fraction [EF] > 60% and echocardiographic left ventricular end‐diastolic diameter [LVED] < 56 mm) and in five patients with pathological ventricular function (EF < 40%, LVED > 65 mm). A concentration of 400 mg/mL with dosages of 5, 9, and 16 mL was used in all patients. The visually assessed signal enhancement as well as the videodensitometrically determined peak intensity and duration of signal enhancement did not differ significantly between the two patient groups, while the transit times were markedly prolonged in patients with impaired ventricular function. No significant alteration was found for systemic blood pressure and heart rate. Side effects were transitory and dose related. The noninvasive nature of the procedure and the absence of hemodynamic effects make repeated studies of left ventricular performance with SH U 508‐A in patients with varied hemodynamic status possible.
Comparison of Color Flow Imaging and Peripheral Venous Saline Contrast During Transesophageal Echocardiography to Evaluate Right‐to‐Left Shunt at the Atrial Level
Authors: WAGGONER ALAN D. , DÁVILA‐ROMÁN VÍCTOR G. , HOPKINS WILLIAM E. , PÉREZ JULIO E. , BARZILAI BENICO
Published: August 2007

Intravenous injections of agitated saline (contrast) are used to identify right‐to‐left atrial shunt during transesophageal echocardiography (TEE). Color flow imaging (CFI) with TEE can be used to detect left‐to‐right atrial shunt but its application to detect right‐to‐left shunt is not known. We performed CFI and contrast during TEE in 72 patients for detection of right‐to‐left shunt. Frame‐by‐frame review of CFI demonstrated discrete laminar jets of the left side of the atrial septum at the lower or upper margin of the fossa ovalis (FO) in 41 (57%) of 72; only 22 had positive contrast. Timing of shunts was late diastolic or early systolic and not related to pulmonary venous inflow. The length of the FO at end‐systole was greater in those with positive CFI compared to negative CFI (13.5 ± 5 vs 11 ± 4 mm, P = 0.02). CFI was positive for right‐to‐left shunt in ten of 14 with atrial septal aneurysms. Contrast was positive for right‐to‐left shunt in 29 (40%) of 72; all but six had positive CFI. The degree of left atrial opacification was minimal in 19 and moderate to severe in ten. FO size was greater in positive versus negative contrast (14 ± 4 vs 11 ± 5 mm, P = 0.02). Contrast was positive for shunt in ten of 14 with septal aneurysms. Thus, right‐to‐left atrial shunt more often occurs with increased FO size and septal aneurysms. TEE with CFI is extremely sensitive for timing and localization of atrial right‐to‐left shunt, but the degree of right‐to‐left shunt is best assessed with contrast.
Left Brachiocephalic Vein Mimicking an Aortic Dissection on Transesophageal Echocardiography
Authors: APPELBE ALAN F. , OLSON SHARI , BIBY LLOYD D. , CURLING PATRICK E. , MARTIN RANDOLPH P.
Published: August 2007

Transesophageal echocardiography has gained widespread acceptance for the diagnosis of aortic dissection; however, little attention has been paid to the pitfalls that may be encountered. The left brachiocephalic vein can mimic a localized aortic dissection. The features that distinguished this vein from an aortic dissection are: the lack of the characteristic oscillating motion of an intimal flap; the pattern of flow within the vein; the tubular nature of the vein is seen using the sagittal imaging plane; and an injection of agitated saline into a left arm vein will show contrast enhancement of the left brachiocephalic vein.
Influence of Jet Impingement on Color Doppler Parameters of Aortic Regurgitation
Authors: REIMOLD SHARON C. , ATKINSON CHRIS M. , F° BRAULIO LUNA , LEE RICHARD T.
Published: August 2007

In vitro studies have demonstrated that the characteristics of a color Doppler jet are influenced by a number of factors including jet eccentricity and jet impingement. To explore the relationship of jet impingement and aortic regurgitant color Doppler jet parameters, jet area, width, and length were measured from apical echocardiographic views of 84 patients 4 ± 11 days prior to catheterization and compared to angiographic grade. An impinging color jet contacted the interventricular septum or mitral valve beneath the aortic valve in the imaging plane and a nonimpinging jet did not contact the septum or mitral valve in the imaging plane. As expected, the percentage of patients with impinging jets increased with aortic regurgitation angiographic grade. Neither left ventricular chamber dimensions nor the presence of an aortic prosthesis significantly influenced the color Doppler variables. For a given angiographic grade of aortic regurgitation, impinging jets were associated with larger color Doppler jet widths (P < 0.05) and areas (P = 0.001) than nonimpinging jets. The color Doppler area and length increased significantly with angiographic grade for nonimpinging jets (P < 0.05) but not for impinging jets. Impinging jets are associated with larger color Doppler widths and areas than nonimpinging jets for a given grade of aortic regurgitation, possibly because of the effect of jet deflection toward an adjacent wall. Jet impinging should be considered when using color Doppler techniques to evaluate aortic regurgitation.
Intraventricular Systolic Flow Mapping in Hypertrophic Cardiomyopathy
Authors: NIHOYANNOPOULOS PETROS , KARATASAKIS GEORGE , JOSHI JAYSHREE , GILLIGAN DAVID , OAKLEY CELIA M.
Published: August 2007

Ninety‐two consecutive patients with hypertrophic cardiomyopathy were studied with pulsed and continuous‐wave Doppler and color flow imaging to assess the intraventricular systolic flow profile from apex to base and compare it with that obtained in normals and in patients with aortic stenosis and systemic hypertension. Hypertrophic cardiomyopathy patients had higher intraventricular blood flow velocities (cm/sec) from apex to base compared with normals and aortic stenosis and systemic hypertension patients (apex: 41.5 ± 17.3 vs 24 ± 1.9,26.1 ± 2.9, and 26.4 ± 3.3; papillary muscles: 95.4 ± 66.5 vs 41.9 ± 4.9, 46.2 ± 3.4, and 46.4 ± 5.7; outflow tract: 249.3 ± 176.2 vs 66.9 ± 8.4, 64.1 ± 10.8, and 66 ± 9.5, respectively) (P < 0.001). Eighty‐six (93%) hypertrophic cardiomyopathy patients showed an abnormal intraventricular systolic color flow pattern at one or more sites but none of the patients with aortic stenosis or systemic hypertension or normal controls. Of those, 65 (71%) showed one or more variant (mosaic) flow, all of whom had intraventricular gradients, while 75 showed abnormal aliased flow at a site other than the subaortic area. It is concluded that patients with hypertrophic cardiomyopathy often exhibit an abnormal spatial distribution of the intraventricular systolic flow velocity profile compared with normals and patients with secondary forms of ventricular hypertrophy that can readily be recognized with color flow imaging. This could improve the sometimes difficult separation of hypertrophic cardiomyopathy patients from secondary hypertrophy.
Use of Color Doppler Ultrasound in the Diagnosis and Treatment of Iatrogenic Subclavian Artery Pseudoaneurysm
Authors: BEARD DAVID C. , PINHEIRO LUIZ , NANDA NAVIN C.
Published: August 2007

Pseudoaneurysms resulting from inadvertent cannulation of the subclavian artery are rare, with only three prior cases reported in the English literature. Generally, they have required surgical correction. We present a case of a right subclavian artery pseudoaneurysm resulting from an unsuccessful attempt at cannulation of the right internal jugular vein by the middle approach. In this patient, successful closure of the pseudoaneurysm was accomplished with prolonged manual compression guided by vascular ultrasound and Doppler color flow imaging.
Doppler Echocardiographic Assessment of the Bjork‐Shiley Monostrut Valve Prosthesis in the Aortic Position
Authors: PETEIRO JESUS , HIDALGO RICARDO , APARICI MANUEL , BARBA JOAQUIN , MARTINEZ DIEGO
Published: August 2007

In order to determine the standard Doppler hemodynamic characteristics of the Bjork‐Shiley monostrut aortic prosthesis and the value of the continuity equation to calculate the prosthetic valvular area, we performed Doppler echocardiographic study in 106 stable patients with this prosthesis and in 7 patients with suspicion of aortic Bjork‐Shiley dysfunction. We measured maximum and mean Doppler gradients, prosthetic valvular area using the continuity equation, and degree of aortic regurgitation. The maximum and mean Doppler gradients in the 106 stable patients ranged from 9.5 to 51 mmHg (X̄= 28.9 ± 11 mmHg) and from 2 to 24 mmHg (X̄= 12.7 ± 5.2 mmHg), respectively. Maximum Doppler gradients > 45 mmHg and mean Doppler gradients > 20 mmHg occurred only in size 23 or smaller. No patient had a mean Doppler gradient > 25 mmHg. We found significant differences between sizes 25 and 27 (P < 0.01) and 21 and 25 (P < 0.01), but not between sizes 19, 21, and 23, or 23 and 25. There was significant difference in Doppler prosthetic valvular area between each valve size. The correlation coefficient between the prosthetic size and the echo‐Doppler valvular area was 0.89 according to a lineal equation (SEE = 16). We could demonstrate mild aortic regurgitation in 25 cases (24%). The Doppler‐derived prosthetic valvular area was < 0.38 cm2 in two patients with obstruction and > 2 cm2 in three patients with regurgitation alone. We conclude that high pressure gradients can be observed through the smallest sizes of the Bjork‐Shiley monostrut aortic prostheses. Mild aortic regurgitation is a common finding. Our values are suggested as a reference for comparison in the case of suspected Bjork‐Shiley valve dysfunction. The Doppler‐derived prosthetic valvular area may be useful in patients with dysfunction of this prosthesis, especially to differentiate obstruction and regurgitation from regurgitation alone.
Assessment of Aortic Regurgitation by Transesophageal Echocardiography: Correlation with Angiographic Determination
Authors: MEYEROWITZ COLIN B. , JACOBS LARRY E. , KOTLER MORRIS N. , WERTHEIMER JOHN H. , IOLI ALFRED , JANZER SEAN , CHANDRASEKARAN KRISHNASWAMY
Published: August 2007

Transthoracic echocardiographic studies have shown that color Doppler mapping of the aortic regurgitation (AR) jet correlated well with the severity of regurgitation as assessed by contrast aortography. The present study was performed to assess whether these parameters could be similarly applied to measurements determined by transesophageal echocardiography (TEE). In order to determine and validate criteria for the assessment of AR severity, 39 clinically stable patients with a TEE color Doppler study and contrast aortography within a 2‐week period were identified. The ratio of the jet area (JA) to left ventricular diastolic area (LVDA) had the best correlation to AR severity as determined by contrast aortography (r = 0.89). Jet length, JA, the ratio of jet width to the width of the left ventricular outflow tract and jet width had r values of 0.88, 0.88, 0.83, and 0.84, respectively. The best sensitivity and specificity for the assessment of AR by TEE were obtained as follows: JA/LVDA ratio of 0%‐7% predicts 0‐1 + AR; 8%‐20% 2‐3 + AR, and > 20% 4 + AR. Of the three patients miscategorized, none was misgraded by more than one angiographic grade of AR. Jets that measure more than 6 cm in length or have an area of > 10 cm2 have a 100% sensitivity and specificity for diagnosing 4 + AR. In the present study the ratio of JA to LVDA area correlates best with AR severity as determined by angiography.
Mobility of the Intimal Flap and Thrombus Formation in Aortic Dissection: A Transesophageal Echocardiographic Study
Authors: ROUDAUT RAYMOND , CHEVALIER JEAN‐MICHEL , BARBEAU PASCAL , EGLOFF PHILIPPE , GOSSE PHILIPPE , DALLOCCHIO MODESTE
Published: August 2007

The mechanisms of the motion of the intimal flap and of thrombus formation in acute or chronic aortic dissection are not definitively elucidated. Transesophageal echocardiography seems to be a technique of choice to analyze the flow in the true and false lumina. Twenty‐one consecutive patients were studied in order to define the mobility of the intimal flap, the color Doppler flow patterns, the presence of spontaneous echocardiographic contrast, and thrombus formation at different levels of the aorta. The results suggest that clotted false lumen is more often seen in chronic aortic dissection at the level of the descending thoracic aorta. However, thrombosed false lumen in the aortic arch is suggestive of a retrograde aortic dissection. In cases of complete obliteration of the false lumen, the differentiation between aortic dissection and aortic ectasia with mural thrombus may be extremely difficult.
Meta‐Analysis of Positive Blood Cultures During Transesophageal Echocardiography
Authors: ROUDAUT RAYMOND , LARTIGUE MARIE‐CLAIRE , DARTIGUES JEAN‐FRANCOIS , GUILLO PASCAL , GOSSE PHILIPPE , DALLOCCHIO MODESTE
Published: August 2007

We have reviewed ten prospective studies of bacteremia with transesophageal echocardiography (TEE) in 720 patients. The incidence of TEE related positive culture is low, and general recommendation for antibiotic prophylaxis during TEE is not warranted.
Echocardiography in the Management of Single Ventricle:
Authors: WILLIAMS ROBERTA G.
Published: August 2007

Echocardiography contributes to the management of patients with single ventricle by providing an initial comprehensive evaluation in fetal and neonatal life. This allows planning of the initial surgical palliation, usually without the need for cardiac catheterization. Serial surveillance for problems such as subaortic stenosis, valvar insufficiency, or complications of the mitral palliation aids in planning for the timing and type of subsequent surgical procedures. Evaluation of single ventricle size, shape, and mass provides some indication of risk for a Fontan procedure. Transesophageal echocardiography provides an excellent window for the evaluation of the interatrial baffle for shunts, thrombi, or occlusion in the early postoperative period. Later, studies of ventricular and valve function help to direct medical management such as afterload reduction and diuretic therapy.
Tumor‐Like Mitral Annular Calcification with Central Liquefaction
Authors: KAUTZNER JOSEF , VONDRÁČEK VLADIMÍR , JIRÁSEK ADAM , BĚLOHLÁVEK MAREK
Published: August 2007

Calcification of the mitral annulus is a degenerative process, which occurs mainly in older patients. Rarely, an extensive mitral annular calcification (MAC) with central liquefaction was reported. We report the case of extension of MAC into the adjacent left ventricular posterior wall along with central liquefaction and posterior mitral leaflet displacement in a 63‐year‐old woman. The abnormal size of the MAC and unusual echo density of pasty material inside made a correct diagnosis difficult and intracardiac tumor was suspected. Thus, similar uncommon clinical presentation of MAC should be considered in the differential diagnosis of intracardiac masses.
Myocardial Contrast Echocardiography:
Authors: CHEIRIF JORGE , NARKIEWICZ‐JODKO JOANNA B. , BRAVENEC JOSEPH S. , D'SA ALWYN , QUIÑONES MIGUEL A. , MICKELSON JUDITH K.
Published: August 2007

Background: Quantitative assessment of myocardial perfusion by myocafdial contrast echocardiography has been made possible by the use of custom‐made off‐line video‐intensity programs. A standardized program that could be used by all investigators would improve the reproducibility of results and enhance its clinical utility. Methods and Results: The purpose of this study was to determine if the assessment of myocardial perfusion by contrast echocardiography using a new commercially available, quantitative on‐line software program correlates with an off‐line custom‐made video‐intensity program previously validated by our laboratory and with radiolabeled microspheres, under various experimental myocardial perfusion conditions. Two of the measured myocardial contrast echocardiographic parameters (peak intensity, area under the time‐intensity curve [area]) correlated well among on‐line and off‐line methods and radiolabeled microspheres, especially when the data were “normalized” by comparing percent change from baseline or a ratio of ischemic to nonischemic myocardium. The third myocardial contrast echocardiographic parameter examined, half‐time of the peak intensity on the washout limb of the curve (t1/2), correlated only when the percent change from baseline was compared between the two methods or when the off‐line method was compared with radiolabeled microspheres. Conclusion: The results of this investigation add further support to the potential use of myocardial contrast echocardiography to evaluate serial changes in myocardial perfusion. Whether using the off‐line or on‐line analysis system, it is important that: (1) multiple regions of interest are examined during a single injection: (2) no log compression or postprocessing is performed on the returning ultrasound signal to avoid distortion of the acquired data; and (3) myocardial translation and rotation are corrected with an internal reference system.
The Differentiation Between Restrictive Cardiomyopathy and Constrictive Pericarditis:
Authors: MERTENS LUC L. , DENEF B. , De GEEST H.
Published: August 2007

The differentiation between constrictive pericarditis and restrictive cardiomyopathy remains a difficult problem for clinical cardiologists. Recent advances in imaging techniques and the understanding of diastolic function have created a new diagnostic approach to this problem. In this article we will summarize the recent advances in the understanding of the pathophysiology of both disorders and how this is reflected mainly in the use of flow imaging techniques, such as Doppler echocardiography and radionuclide angiography. Combined with the advances in the radiological imaging of the pericardium by means of computed tomography and magnetic resonance imaging, an integrated approach to the differential diagnostic problem is proposed and an algorithm for clinical use has been designed.
Echocardiographic Assessment of Atrial Septal Defects
Authors: STAFFEN ROBERT N. , DAVIDSON WILLIAM R.
Published: August 2007

Echocardiography has become the method of choice for the assessment of patients with a known or suspected atrial septal defect. The majority of patients with defects can be identified by this method. In patients with inconclusive transthoracic studies, transesophageal echocardiography is useful for identification or exclusion of a defect. Echocardiography is useful for quantification of left‐to‐right shunting, identification of associated anomalies, and estimation of pulmonary pressures. Cardiac catheterization can be reserved for patients who require measurement of pulmonary vascular resistance, those who have a significant risk of coronary artery disease, and those with complex congenital heart disease.
An Unusual Complication During a Transesophageal Echocardiographic Procedure in a Patient with Left Ventricular Pseudoaneurysm
Authors: SASTRY B.K.S. , KRISHNA REDDY N. , VENKATESHWAR REDDY G. , RATNAKER K.S. , JAISHANKAR S. , RAJU B.S.
Published: August 2007

Transesophageal echocardiography (TEE) is a safe semiinvasive procedure with almost negligible mortality. We report a death during TEE procedure in a patient with unsuspected left ventricular pseudoaneurysm.

transesophageal echocardiography, pseudoaneurysm
Color Flow Doppler in the Diagnosis of Double‐Chambered Right Ventricle:
Authors: III C. OSBORNE SHULER , WIENECKE MATTHEW M. , FYFE DEREK A.
Published: August 2007

The purpose of this study was to evaluate the demographic and echocardiographic data of patients diagnosed with double‐chambered right ventricle and attempt to explain a perceived rise in the incidence. Definition: Double‐chambered right ventricle (DCRV) is a division of the right ventricle into two chambers by a hypertrophied muscle bundle. Methods: The medical records of patients diagnosed withDCRV were reviewed, and demographic, echocardiographic, and catheterization data were tabulated. Annual incidence of DCRV, based on year of birth, was compared to yearly detection rate, based on year of DCRV diagnosis. To evaluate the influence of color flow Doppler on the frequency of diagnosis of DCRV, demographics of patients born prior to September 1986 (when utilization of color Doppler began in our institution) were compared to those born after that date. Results: Despite an unchanged annual incidence of DCRV, yearly detection rate of this lesion rose significantly following the introduction of color flow Doppler to our institution (September 1986). DCRV was diagnosed earlier and was accompanied by earlier catheterization, which also showed lower right ventricular body gradients after September 1986. Associated anomalies, both cardiac and noncardiac, in our population differed from those reported in previous series. Conclusion: This study infers that the advent of color flow Doppler significantly enhanced the diagnosis of DCRV in our pediatric patients and led to a perceived rise in incidence.

double‐chambered right ventricle, anomalous right ventricular muscle bundles
Quadricuspid Aortic Valve Diagnosed by Multiplane Transesophageal Echocardiography
Authors: PATEL JAYANT N. , OSMAN KHIDIR , NANDA NAVIN C. , HENDERSON BRIAN , SANYAL RAJAT S. , FINCH D.
Published: August 2007

The usefulness of multiplane transesophageal echocardiography in the diagnosis of quadricuspid aortic valve is described.

quadricuspid aortic valve, multiplane transesophageal echocardiography
Influence of Variable Loading Conditions on Pulsed Doppler Indices of Left Ventricular Ejection Dynamics
Authors: LU CHUNZENG , NICOLOSI GIAN L. , BURELLI CLAUDIO , CASSIN MATTEO , ZARDO FABIO , BRIEDA MARCO , CERVESATO EUGENIO , ZANUTTINI DOMENICO
Published: August 2007

To investigate the influence of changes in loading conditions on Doppler echocardiography determination of left ventricular ejection dynamics (peak aortic flow velocity and mean acceleration), pulsed Doppler was performed on 20 patients from apical 5‐chamber view. Doppler aortic flow velocity curves and hemodynamic values (left ventricular pressure, wedge pressure, and cardiac output) and the first derivative of ventricular pressure (dPIdt) by tip‐transducer catheter were simultaneously recorded at baseline and during intravenous infusion of nitroglycerin as well as at baseline and immediately following left ventriculography. During nitroglycerin infusion, the hemodynamic values were reduced and peakdPIdt remained constant, Doppler aortic peak velocity and mean acceleration decreased significantly compared with baseline (0.87 ± 0.11 mlsec vs 1.01 ± 0.14 mlsec and 8.86 ± 1.68 ml sec2 vs 10.17 ± 1.88 mlsec2 respectively; bothP < 0.001). After ventriculography, the hemodynamic values increased and peak dPIdt was still constant, Doppler aortic peak velocity and mean acceleration increased significantly compared with baseline (1.15 ± 0.17 mlsec vs 0.98 ± 0.16 mlsec and 11.44 ± 2.06 mlsec2 vs 9.79 ± 1.88 mlsec2 respectively;both P < 0.001). In conclusion, left ventricular ejection dynamics, as evaluated by pulsed Doppler echocardiography, is modified by mild changes in loading conditions. Therefore, when serially evaluating the inotropic state of the left ventricle by the Doppler aortic flow velocity pattern, the potential influence of loading conditions should be takeninto account.
Transthoracic and Transesophageal Echocardiographic Study of Pulmonary Autograft Valve in Aortic Position
Authors: ANDRADE ALEXANDRA , VARGAS‐BARRON JESUS , ROMERO‐GARDENAS ANGEL , URREA MIGUEL , RIJLAARSDAM MARIA , KEIRNS CANDACE , MOLINA JAVIER
Published: August 2007

Eleven patients who underwent pulmonary valve autograft to aortic position with placement of bovine pericardial prosthesis in pulmonary position were studied with echocardiography. The etiology of aortic valvuloplasty as determined by anatomopathological examination was rheumatic in five, degenerative in four, and congenital in two. Important mitral stenosis coexisted in two patients, and during the same operation as the Ross surgery, a mitral valvuloplasty with Carpentier ring was practiced on one and an open mitral commissurotomy on the other. Transthoracic echocardiography, which helped to confirm the viability of the surgery by determining the diameters of the semilunar valve rings and quantifying the severity of the aortic valve lesions, was performed on all patients before surgery and repeated 3 months later. Transesophageal echocardiograms were practiced on nine patients during the surgical procedure and repeated after 6 months on seven. The latter technique aided in immediate postoperative evaluation, and repetition at 6 months served to explore the ventricular infundibuli and evaluate pulmonary valve performance in aortic position. In conclusion, transthoracic and transesophageal echocardiography provide a practical and valuable means of investigating the pre‐, trans‐ and postoperative conditions of patients undergoing Ross surgery. (ECHOCARDIOGRAPHY, Volume 11, May 1994)
Dynamic Three‐Dimensional Echocardiography:
Authors: PANDIAN NATESA G. , ROELANDT JOS , NANDA NAVIN C. , SUGENG LISSA , CAO QI‐LING , AZEVEDO JOSE , SCHWARTZ STEVEN L. , VANNAN MANI A. , LUDOMIRSKI ACHI , MARX GERALD , VOGEL MICHAEL
Published: August 2007

In this article, we will attempt to review basic requirements for three‐dimensional reconstruction, methods of cavity reconstruction, approaches to gray scale tissue‐depiction displays, and current clinical experience, and also present some directions for future development. (ECHOCARDIOGRAPHY, Volume 11, May 1994)
Quantitative Evaluation of Left Ventricular Systolic Function by Doppler Echocardiography Techniques
Authors: LOUTFI HASSAN , NISHIMURA RICK A.
Published: August 2007

Doppler echocardiography provides the ability to measure blood flow velocities noinvasively. These blood flow velocities can be used to obtain powerful hemodynamic information about systolic contractility of the left ventricle, which in the past could only be determined from invasive cardiac catheterization or cumbersome pulse recordings. Volumetric flow rates can be measured using the hydraulic principle of flow through a rigid tube, providing a measurement of stroke volume and cardiac output. The rate of the left ventricular pressure rise derived from a mitral regurgitation velocity curve provides a nonejection phase index of systolic contractility. Acceleration time can be obtained from an ascending aortic velocity and is an indicator of maximum myocardial force. Systolic time intervals can now be quickly and accurately obtained from the standard Doppler tracings. These quantitative measurements of the status of the left ventricle are accurate, reproducible, and should be incorporated into the routine noninvasive assessment of patients with cardiac disease. (ECHOCARDIOGRAPHY, Volume 11, May 1994)