bluuebunny/crossref_metadata_2025 huggingface dataset:
Left Ventricular Shape Deformation and Mitral Valve Prolapse in Chronic Pulmonary Hypertension
Authors: BURLESON KATHARINE O. , BLANCHARD DANIEL G. , KUVELAS TERI , DITTRICH HOWARD C.
Published: August 2007

Mitral valve prolapse (MVP) has been described in patients with right ventricular pressure or volume overload. The frequency of this phenomenon and its relationship to left ventricular shape and mitral valve annulus size, as well as its reversibility in chronic pulmonary hypertension, are poorly understood. We have observed an increased frequency of MVP in a patient population with chronic thromboembolic pulmonary hypertension that often resolves after thromboendarterectomy and reduction of pulmonary hypertension. To further evaluate the relationship between MVP and left ventricular shape in pulmonary hypertension, we studied 51 consecutive patients undergoing surgery for thromboembolic pulmonary hypertension. Echocardiographic features including interventricular septal position, as measured by an eccentricity index, left ventricular size, and several mitral valve annulus dimensions were evaluated prior to surgery and during the postoperative hospitalization period. The pulmonary artery systolic pressure was elevated for all patients prior to surgery, 87 ± 21 mmHg (mean ± SD). Twelve patients (23.5%) had MVP before surgery, which resolved in ten patients postoperatively. In addition, one patient whose pulmonary hypertension improved little, developed MVP postoperatively. Those patients with MVP had a greater pulmonary artery pressure preoperatively than those without MVP (102 ±19 vs 84 ±21 mmHg). The eccentricity index for those patients with MVP (1.68±0.2) was greater than for those with no MVP (1.53 ± 0.37). No significant differences were noted between groups with MVP and without MVP according to all mitral annulus dimensions or left ventricular chamber areas. Postoperatively, eccentricity index decreased significantly in both those with MVP and without MVP (1.29 ± 0.18 and 1.20 ± 0.15, respectively) as did pulmonary artery systolic pressure (67± 22 and 47 ± 13 mmHg, respectively). Mitral valve prolapse in chronic pulmonary hypertension occurs frequently and is noted particularly in those patients with the most severe pulmonary hypertension. It appears that deformation of the left ventricle is associated with echocardiographic MVP and that reduction of pulmonary hypertension reverses this deformation and allows for resolution of MVP.
Transesophageal Echocardiography in Candidates for Percutaneous Balloon Mitral Valvuloplasty
Authors: HAUSMANN DIRK , DANIEL WERNER G. , HEUBLEIN BERND , MÜGGE ANDREAS , ZICK RENATE , ENGEL HANS‐JÜRGEN , LICHTLEN PAUL R.
Published: August 2007

Prior to percutaneous balloon mitral valvuloplasty (PBMV), mitral valve morphology and the presence of left atrial thrombi are usually evaluated by transthoracic two‐dimensional and Doppler echocardiography (TTE). This study analyzes the impact of transesophageal echocardiography (TEE) in addition to TTE on the selection of candidates considered for PBMV for mitral stenosis. Seventy‐five patients with severe mitral stenosis who were considered as appropriate candidates for PBMV based on TTE findings were studied. In 19 (25%) patients, TEE revealed findings that were essential for PBMV but were missed by TTE: left atrial thrombi (n = 14; including 13 in left atrial appendage), right atrial thrombus (n = 1), incomplete cor triatriatum (n = 1) and mitral valve vegetation (n = 1). In two other patients, a left atrial thrombus had been suspected by TTE but could be excluded by TEE. TEE and TTE revealed similar scores of thickening, calcification, and mobility of the mitral valve. Compared to TTE, thickening of the subvalvular apparatus was graded lower using horizontal plane TEE due to shadowing by the mitral valve (echo score 1.8 ± 0.8 vs 1.4 ± 0.7; P < 0.05) whereas results from longitudinal plane TEE were similar to TTE findings. The data show that due to the high prevalence of left atrial thrombi, TEE should be performed in addition to TTE in all patients prior to PBMV.
Transesophageal Echocardiography Identification and Validation of Individual Tricuspid Valve Leaflets
Authors: MAXTED WILLIAM , NANDA NAVIN C. , KIM KEE‐SIK , ROYCHOUDHURY DEBASISH , PINHERIO LUIZ
Published: August 2007

The present study demonstrates the usefulness of transesophageal echocardiography in the identification of individual leaflets of the tricuspid valve. Validation was obtained by selecting patients with specific lesions involving individual tricuspid leaflets and correlating the transesophageal echocardiographic findings with surgery.
Noninvasive Estimation of Left Ventricular Max(dP/dt) from Aortic Flow Acceleration and Pulse Wave Velocity
Authors: SUGAWARA MOTOAKI , SENDA SHOICHI , KATAYAMA HIROSHI , MASUGATA HISASHI , NISHIYA TOMOHIKO , MATSUO HIROHIDE
Published: August 2007

The Doppler method of obtaining left ventricular Max(dP/dt) proposed recently was based on the measurement of mitral regurgitation velocity. Since Max(dP/dt) is an isovolumic phase index, its use in cases of mitral regurgitation may be open to argument. However, we had proposed a noninvasive method of estimating left ventricular Max(dP/dt) based on different principles. In our method, Max(dP/dt) had been given by Max(dP/dt) = pcMax(du I dt), where p is the blood density, c is the pulse wave velocity, and u is the flow velocity in the aorta. We had derived the above equation theoretically, and confirmed its validity by animal experiments. In our previous study, we also applied our method in the clinical setting. The aortic flow velocity was measured by Doppler echocardiography, and the pulse wave velocity by mechanocardiography or Doppler echocardiography. pcMax(dufdt) obtained noninvasively was compared with Max(dP/dt) measured with a catheter‐tip micromanometer. We found an excellent correlation between pcMax(dufdt) and Max(dP I dt), and concluded that pcMax(du/dt) is useful in assessing noninvasively the contractile state of the left ventricle. Here, we summarize our method, review previous results, and report new results of the clinical application of our method.
Correlation of Echocardiographic Normalized Peak Rate of Left Ventricular Area Expansion With Radionuclide Peak Filling Rate
Authors: DOMANSKI MICHAEL J. , COLLERAN JOHN A. , CUNNION ROBERT E. , NANDA NAVIN C.
Published: August 2007

The purpose of this study was to determine whether normalized peak rate of left ventricular area expansion during diastole, as obtained from echocardiography using the parasternal short‐axis view, correlates well with left ventricular diastolic peak filling rate, as determined from radionuclide ventriculography. Normalized peak rate of area expansion, readily calculated from tracings of the ventricular endocardium on sequential echocardiographic image frames, can be measured rapidly, noninvasively, repeatedly, and without radiation exposure. The advent of automated edge detection systems that permit continuous, on line display of ventricular areas may further enhance the utility of this technique. Twenty‐four patients with and without regional wall‐motion abnormalities who had both echocardiography and radionuclide ventriculography as part of their clinical care were analyzed. Comparing normalized peak rate of area expansion with peak filling rate, the correlation coefficient was 0.86 (P < 0.001). These findings suggest that echocardiographically derived normalized peak area expansion measured in the parasternal short‐axis view is an excellent measure of global diatstolic function.
Automated Correlation of Intravascular Ultrasound Images with Angiography
Authors: GOWDA ASHOK , GOJER BERNARD , MOTAMEDI MASSOUD , DAVIS MICHAEL J. , FARRELL ROBERT W. , RASTEGAR SOHI , MILLER GERALD E. , KRONENBERG MARVIN W.
Published: August 2007

One limitation of intravascular ultrasound (IVUS) is the restriction to viewing one cross‐sectional image at a time. Computerized three‐dimensional reconstructions of IVUS images have been developed in an attempt to overcome this limitation. These algorithms, however, are limited by artifacts from catheter movements and rotation within large vessels. Consequently, this technique has been applied only to straight segments of small caliber vessels. Contrast angiography has long been the standard for vascular imaging. In order to take advantage of both contrast angiography and IVUS, we developed a computer procedure to automatically correlate IVUS images with their corresponding locations on contrast angiograms, and to display both images in a side by side format. Models of the aortic arch and aorto‐ileo‐femoral system were constructed with artificial plaques located at various sites. The models were filled with iodinated contrast media and radiographic images were obtained. Timed pull‐backs were performed in both models in order to obtain sets of serial cross‐sectional images. For each data set, a digitized set of 75 serial IVUS images and model angiographic images were loaded in the computer procedure. We then correlated at least one IVUS image containing a known landmark with its position on the model angiogram. The procedure then automatically displayed sequential ultrasound images along with their corresponding positions on the reference angiogram. We analyzed the error of this algorithm as a function of the number of correlation points used. The maximum error was 4 mm over a total pullback distance of 130 mm (relative error of 3%). This algorithm was subsequently used to correlate IVUS images obtained from the aortic arch of a patient with their corresponding positions on an aortogram. Our results demonstrate that computer‐based correlation of IVUS images with their corresponding positions on angiograms is accurate, may enhance the use of IVUS to assess vascular pathology, and provides an alternative to three‐dimensional reconstructions.
Papillary Muscle Rupture Following Myocardial Infarction
Authors: CHANDLER ARCHIE H. , NOMEIR A.M. , KITZMAN DALANE W.
Published: August 2007

Papillary muscle rupture is an uncommon, catastrophic complication of myocardial infarction that is potentially correctable if promptly diagnosed. Two cases are described in which the diagnosis of papillary muscle rupture was complicated by unusual initial presentations, absence of audible murmurs, and technically difficult, nondiagnostic transthoracic echocardiograms. In both cases, a high index of clinical suspicion for papillary muscle rupture led to transesophageal echocardiography and a rapid, definitive diagnosis. Since early surgery may be important in this disorder, a rapid, reliable diagnosis is essential and transesophageal echocardiography is the diagnostic procedure of choice.
Cost‐Benefit Analysis of Transesophageal Echocardiography in Cardiac Surgery
Authors: BENSON MATTHEW J. , CAHALAN MICHAEL K.
Published: August 2007

This article evaluates the costs and outcomes associated with TEE during and after cardiac surgery. The costs include the direct and indirect costs—the complications of TEE. The outcomes include the positive consequences or the benefits: money and lives saved. The article uses liberal (high) estimates of the direct and indirect costs of TEE and conservative (low) estimates of the benefits. The exact cost or benefit depends on the number of cases performed. The analysis shows that patients having surgery for congenital heart disease derive the greatest overall benefit: around $600 per case studied. Patients having valvular repair surgery derive the next greatest benefit: around $450 per case studied. In contrast patients having valve replacement have an overall cost of around $150 per case studied. Patients having surgery for coronary artery disease also derive an overall benefit: around $100‐$300 per case studied, depending upon assumptions regarding TEE's role in prevention of intraoperative strokes. This analysis indicates that the financial benefits of TEE are substantial and frequently outweigh costs in patients requiring cardiac surgery.
Left Ventricular Mass Estimation by Echocardiography
Authors: MUKHERJEE SANDIP K. , JAFFE COMRADE C.
Published: August 2007

Echocardiographic determination of left ventricular mass provides prognostic information that is independent of blood pressure. This prognostic information has a graded and continuous relationship with outcome, and is independent of traditional risk factors. This article addresses the prognostic and clinical utility of echocardiography for detection of left ventricular mass. Recommendations will be offered regarding the use of echocardiography for screening in select individuals.
Changes of Left Ventricular Diastolic Filling After Sublingual Nitroglycerin in Determining the Severity of Coronary Artery Disease
Authors: VASKELYTE JOLANTA V. , NAVICKAS RAMUNAS S. , KINDURIS SARUNAS J.
Published: August 2007

The aim of the study was to evaluate the left ventricular (LV) diastolic filling (DF) in patients with 1, 2, and 3 vessel and left main (LM) coronary artery disease (CAD) and to determine the response of LV DF to nitroglycerin in age‐matched patient groups. The study covers 74 patients with CAD including ten patients with 1 vessel CAD, ten patients with 2 vessel CAD, 43 patients with 3 vessel CAD, and 11 patients with LM CAD who underwent Doppler echocardiographic measurements of early (E) and late (A) diastolic transmitral velocities, their ratio (E/A) and deceleration time (DT) of E before and after sublingual administration of 0.5 mg nitroglycerin. Baseline studies did not reveal any significant differences in E, A, and DT between groups. Baseline E/A ratio differed between 1, 2, and 3 vessel and LM CAD patients (1.07 ± 0.10; 0.89 ± 0.07; 0.87 ± 0.05 vs 0.67 ± 0.06, P < 0.05). After nitroglycerin, significant differences in E between 1 vessel CAD and all the remaining groups, also between 2 and 3 vessel CAD and LM CAD patient groups (50.1 ± 2.4 cm/sec vs 39.6 ± 2.6; 38.4 ± 1.8; 30.2 ± 3.3 cm/sec and 39.6 ± 2.6; 38.4 ± 1.8 cm/sec vs 30.2 ± 3.3 cm/sec, respectively) were observed. A velocity did not differ significantly between the groups, DT differed between 1 vessel CAD and LM CAD patients (162.2 ± 14.6 msec vs 117.0 ± 12.1 msec), differences in E/A ratio appeared between 1 vessel and the remaining groups (1.13 ± 0.10 vs 0.72 ± 0.08; 0.70 ± 0.05 and 0.55 ± 0.07). Thus, Doppler LV DF indices, except E/A ratio, were not sensitive in reflecting the severity of CAD. Therefore, nitroglycerin resulted in more marked decrease of LV DF indices in patients with more severe CAD and in revealing differences between patients with 1, 2, and 3 vessel and LM CAD. These data suggest that a nitroglycerin Doppler test may be proposed for the assessment of the severity of CAD.
Echocardiographic Detection of a Congenital Diverticulum of the Right Ventricular Outflow Tract
Authors: MEYER KARLA B. , FYFE DEREK A.
Published: August 2007

Congenital diverticula of the right ventricle are extremely rare and may be life threatening. The ultrasound demonstration and recognition of such an abnormality and the important differential features are discussed.
Pulmonary Venous Flow Pattern in Severe Aortic Regurgitation with Diastolic‐Systolic Mitral Regurgitation Detected by Transesophageal Echocardiography
Authors: YLINEN TIMO , MICHALOWSKI ZENON , SÜRIG MANFRED , KLEMPT HANS‐WERNER
Published: August 2007

The pulmonary venous flow patterns of two patients with severe aortic regurgitation (AR) (one with 2+diastolic, 2+/3+systolic mitral regurgitation (MR), the other with minimal diastolic and 1+/2+ systolic MR) was examined with TEE. A reduced systolic forward flow and an accentuated diastolic reversal flow were found in each case, irrespective of the amount of MR. According to the first impression it could perhaps be possible to judge the amount of AR on the basis of the VTI measurement of the pulmonary venous flow pattern.
Strategy of Diagnostic Imaging Before and After PTCA
Authors: PIRELLI SALVATORE , DANZI GIAN BATTISTA , MASSA DARIA , PICCALO GIACOMO , FALETRA FRANCESCO , CAMPOLO LUIGI , VITA CLAUDIO DE
Published: August 2007

It is now widely accepted that percutaneous transluminal coronary angioplasty (PTCA) is an effective nonsurgical technique for achieving coronary revascularization. Exercise electrocardiography remains the standard procedure for functional evaluation before, early, and late after angioplasty because of its availability, safety, and limited cost. The drawback of exercise testing is its low specificity and the fact that the attainment of diagnostically useful data requires a level of exercise that substantially increases myocardial oxygen demand. Exercise thallium imaging has been shown to be highly predictive of restenosis and adverse events after angioplasty, but it is possible that myocardial perfusion may not return to normal immediately after successful revascularization. Stress echocardiography has many practical advantages over scanning tests, as result of its lower cost, shorter imaging time, and the absence of radiation exposure. Dipyridamole echocardiography testing (DET) is an exercise‐independent method of evaluating patients who have to undergo coronary angioplasty. Before PTCA, DET allows the clinician to localize the site and extent of myocardial ischemia anatomically. Early after a successful procedure, DET identifies a group at high risk for the late recurrence of symptoms. Late after PTCA, DET is more accurate than exercise electrocardiography in detecting restenosis or disease progression. In asymptomatic patients with exercise‐induced ST depression, DET has the same good diagnostic accuracy as thallium scintigraphy. For these reasons, as well as because of its noninvasive nature and availability, DET should be considered an attractive option for the evaluation of patients after anatomically successful angioplasty.
Application and Perspectives of Transesophageal Stress Echocardiography Using Monoplane and Biplane Instruments
Authors: HOFFMANN RAINER , FLACHSKAMPF FRANK A. , HANRATH PETER
Published: August 2007

Transesophageal stress echocardiography has been reported to have a high sensitivity and specificity for noninvasive identification and assessment of coronary artery disease. Its advantage is the virtually never obstructed acoustic window on the heart yielding superior image quality in almost all patients. Pharmacological stress as well as simultaneous atrial pacing—attaching electrodes to the echoscope—have been applied as stress modalities. Both transesophageal stress echocardiography modalities have been shown to be well tolerated, safe, and feasible in most patients. These promising initial experiences led to clinical application of this method for preoperative risk evaluation, for detection of restenosis after PTCA, and for evaluation of hibernating myocardium. This technique was also successful for evaluation of stress induced changes of transmitral and pulmonary venous flow in patients with left ventricular hypertrophy and coronary artery disease. Although all studies published so far were performed with monoplane technique, the sensitivity for detection of one‐vessel and, even more so, multivessel disease was high. However, apical and basal wall‐motion abnormalities may go undetected using monoplane equipment. The advent of biplane transesophageal imaging enables the visualization of more ventricular segments. Future studies will show to which degree biplane transesophageal stress echocardiography improves the diagnostic accuracy.
Preimplantation Echo Doppler Evaluation of VVI Versus DDD Pacing
Authors: SOUSSOU ADEL ISSA , HELMY MOHAMED GAMAL , GUINDY RAMEZ RAOUF
Published: August 2007

This study was carried out to select before permanent pacemaker implantation patients with complete atrioventricular block (CHB) who would benefit best from DDD pacing, and to determine the optimal atrioventricular delay (AVD) for each of those patients. This was achieved with the aid of Doppler echo‐cardiography. The effect of different AVDs on both the systolic and diastolic function of the normal and failing heart was also delineated in this study. Methods: Thirty patients with CHB and normal sinoatrial function were selected, with no age or sex predilection. These patients were categorized into three equal groups: groups A, B, and C with normal left ventricular (LV) systolic and diastolic function, LV diastolic dysfunction, and LV systolic dysfunction, respectively. For each patient, systolic and diastolic function was calculated utilizing echo Doppler during CHB, temporary VDD pacing with different AVDs, and temporary VVI pacing with a rate matching that during VDD mode. Temporary VDD mode of pacing was performed utilizing a temporary bipolar ventricular lead for ventricular pacing and an esophageal lead for atrial sensing to trigger ventricular pacing. Results: Qualitatively the most obvious change in the pattern of LV filling as AVD is increased in the three groups, is the earlier occurrence of active atrial filling A wave due to progressive approximation of the ECG P wave toward the previous QRS. As the AV interval is increased, the following changes occur: (a) A wave occurs progressively earlier with superimposition onto the early filling E wave resulting in a progressive increase in its velocity (VA), its FVI, and its percent atrial contribution (% AC); (b) the three times diastolic filling time (DFT), mitral valve opening to Q wave (MVO‐Q), and closure (Q‐MVC) progressively shorten; (c) since DFT decreases, less passive filling occurs early during diastole, thus E.FVI decrease with longer AV intervals; (d) the ratios VE/VA and FVI E/A decrease subsequently to the previous described changes. Compared to CHB, percent ejection fraction (% EF) was not significantly changed during VVI pacing. Percent EF increased significantly during VDD in comparison to VVI pacing modes. Percent EF was highest at optimal AVD and decreased as this AVD increased or decreased. The cardiac output (CO) increment during VDD in comparison to VVI pacing modes differed much among the three groups. In group A, a 10.29% increase in CO was seen when comparing VDD pacing (with optimal AVD) with that of VII one; in group B, this increment was much greater and reached 29.48%; in group C it reached 23.68%. For the optimal AVD, it was in group A between 100 and 150 msec; group B, mostly 125 msec; and group C, entirely 100 msec. Conclusion: This article describes an echocardiographic method that might be helpful in the selection of appropriate pacing mode when the absolute benefit of DDD pacing might not be otherwise apparent.
Transthoracic Echo‐Doppler Appearances of Perforation of a Bicuspid Aortic Valve by Bacterial Endocarditis
Authors: D'CRUZ IVAN A. , FEGHALI NASSIF T.
Published: August 2007

The echo‐Doppler diagnosis of aortic valve perforation has seldom been made before. We describe a combination of findings in a patient with severe aortic regurgitation following endocarditis of a bicuspid aortic valve, which suggests the presence of aortic cusp perforation: (A) discontinuity of cusp contour in parasternal long‐axis view; (B) emergence of aortic regurgitant jet through a cusp rather than between the two cusps; (C) fine flutter of a cusp, but not on the free apposed edges; (D) severe aortic regurgitation without flail cusp motion, following bacterial endocarditis.
A Suprasternal Approach to Assess the Proximal Coronary Arteries in Infants and Children
Authors: ZIELINSKY PAULO , FILHO RAUL IVO ROSSI , HATEM DOMINGOS , BARRA MARINEZ , YORDI LUIZ MARIA
Published: August 2007

The authors propose a two‐dimensional echocardiographic approach to demonstrate the origin and proximal course of the coronary arteries in children, which could be called “suprasternal right anterior oblique cut”. The important feature disclosed by this new view, but not by the classic parasternal short‐axis cut, is the spatial relationship between the origin of the coronary arteries, the aortic root, and the ascending aorta. The knowledge of this anatomical feature may be of surgical significance in the setting of congenital heart diseases, such as tetralogy and transposition or acquired coronary diseases, such as Kawasaki's syndrome. The suprasternal right anterior oblique cut was obtained by rotating the transducer counterclockwise, with slight anterior tilting, from the classic long‐axis view of the aorta, for imaging the left coronary artery. The left coronary artery arises as a main trunk from the upper portion of the left coronary sinus, passes behind the pulmonary trunk and beneath the left atrial appendage for a few millimeters up to the point of bifurcation. Because of the orientation of the ultrasound beam, the left coronary is shown between the right pulmonary artery and the left atrial appendage in this cut. To assess the right coronary artery, the transducer was slightly deviated to the right and further rotated counterclockwise, while very carefully tilted anteriorly. Fifty consecutive children (29 males, 21 females), with a mean age of 5.4 ± 4.1 years, were evaluated from May to July 1992, in order to demonstrate the feasibility of the proposed approach. The left coronary artery was disclosed in 100% of cases, and the right in 76%. The 12 patients in which the right coronary artery was not visualized were significantly older than the group in which both coronary arteries were demonstrated (P < 0.001). It was concluded that the suprasternal right anterior oblique two‐dimensional echocardiographic cut for demonstration of the coronary arteries in children is easy to perform, reproducible, and allows the assessment of anatomical features not disclosed by the classic approach.
Two‐Dimensional Echocardiographic Identification of Peripheral Coronary Artery Ectasia in an Adult
Authors: TIGHE DENNIS A. , HARPER KATHLEEN A. , SHNIDER REED , KALMBACH MARIANNE , RIFKIN ROBERT D.
Published: August 2007

Coronary artery aneurysms (ectasia) have been reported to be present in up to 4.9% of patients undergoing coronary angiography. In children with Kawasaki's disease or coronary arteriovenous fistula, the transthoracic two‐dimensional echocardiographic findings associated with peripheral vessel aneurysms have been previously described. Echocardiographic imaging of peripheral coronary artery segments in the adult is difficult and to date only imaging of large, proximal coronary artery aneurysms has been reported. We report a case of an adult patient with angiographically documented extensive right coronary artery ectasia in which peripheral vessel aneurysms were identified with transthoracic echocardiography.
Echocardiographic Evaluation of Adult Postoperative Congenital Heart Disease
Authors: CHILD JOHN S.
Published: August 2007

Diagnostic and surgical advances have resulted in a large and growing population of adult patients with congenital heart disease. Proper care of these individuals requires knowledge of the original defects as well as the multitude of variations on surgical intervention for those lesions. Most complex congenital cardiac malformations amenable to “biventricular repair” are cyanotic and include a mixture of septal defects, obstructive and regurgitant valvular, subvalvular, or supravalvular lesions, and malposition of the cardiac chambers and great arteries. Whether they reach adulthood unoperated largely depends upon the balance of pulmonary blood flow. Examples of anatomical substrates that are usually candidates for “biventricular repair” include conotruncal abnormalities such as tetralogy of Fallot, transposition complexes of the great arteries, double‐outlet right or left ventricle, and truncus arteriosus. “Biventricular repair” results in two well formed functional ventricles with a subpulmonic ventricle and a subaortic ventricle that are able to provide a circulation in series without admixture of venous and systemic blood. A unifying theme includes patch closure of a ventricular septal defect and reconstitution of ventricular‐to‐pulmonary arterial blood flow.
Echocardiographic Postoperative Assessment of Patients with Transposition of the Great Arteries
Authors: MAHONEY LARRY T. , KNOEDEL DIANA L. , SKORTON DAVID J.
Published: August 2007

Successful surgical repair during childhood of complete transposition of the great arteries has resulted in a group of patients in adult life with complicated cardiac anatomy and physiology. It is imperative that cardiologists providing care for these patients have an understanding of the surgical procedures involved in redirecting the systemic and pulmonary venous returns at either the atrial level or great artery level. Echocardiography provides an excellent means for assessing newly created anatomical abnormalities; residual associated congenital heart defects; and ventricular function.
Lipomatous Hypertrophy of Interatrial Septum
Authors: REDDY PUNURU J.M. , MISSRI JOSÉ , JAGJIVAN B. , CLARK BERNARD A.
Published: August 2007

Transthoracic and transesophageal echocardiography were utilized to diagnose a patient with lipomatous hypertrophy of the interatrial septum (LHIS). The role of other imaging techniques including computerized tomography (CT) and magnetic resonance imaging (MRI) for differentiating it from other interatrial masses is discussed.
Infarct Related Intramyocardial Dissection
Authors: TIGHE DENNIS A. , RAICHLEN JOEL S. , PAUL JAMES J.
Published: August 2007

Dissecting intramyocardial hematoma is a rare mechanical complication of acute myocardial infarction (MI). We describe four patients who sustained an acute inferior / inferoposterior MI, developed a new pansystolic murmur, and hemodynamically deteriorated in the first week following infarction. Two‐dimensional echocardiography identified a complex rupture that dissected across the inferior portion of the interventricular septum, tunneled through right ventricular (RV) myocardium, and reentered the cavity of the RV. Color flow Doppler was particularly valuable in identifying the serpiginous course of the dissections as well as the entry and exit points. Cardiac catheterization demonstrated markedly increased right heart filling pressures, multivessel coronary artery disease, and evidence of the ventricular septal rupture. One patient died prior to surgery, and the other three expired within 24 hours of attempted surgical repair. We conclude that intramyocardial dissection is a complication of inferior / inferoposterior MI that can be rapidly diagnosed by echocardiography.
Tricuspid Valve Aneursym Formation in a Child with Suspected Endocarditis
Authors: MIGA DANIEL E. , MEYER KARLA B. , FYFE DEREK A.
Published: August 2007

Aneurysms of the aortic and mitral valve are a known complication of infective endocarditis in adults. We report an unusual case of tricuspid valve endocarditis in a child with resultant aneurysm formation as its presenting finding after a brief clinical course.
Doppler Echocardiography During Pregnancy
Authors: CAMPOS ORLANDO
Published: August 2007

Despite continuous improvements in diagnostic cardiology techniques, echocardiography remains the cornerstone for noninvasive cardiovascular assessment of the pregnant woman with heart disease or suspected cardiac abnormality. Reversible physiological cardiac remodeling of pregnancy associated with changes in valve patency or transvalvular flow pattern can be suitably assessed by the complementary use of quantitative pulsed‐ and continuous Doppler and qualitative color Doppler technology. These techniques are also useful for a better understanding of the pathophysiology of the hemodynamic consequences of fixed valve stenosis during pregnancy with respect to the labile nature of gradients resulting from variable loading conditions as occurs during pregnancy. Recent and specific areas of clinical use including cardiac output estimation, contrast echocardiography minimizing radioscopy during cardiac catheterization, and transesophageal echocardiography for selection of patients with mitral stenosis suitable for percutaneous catheter valvotomy illustrate the large spectrum of capabilities of this versatile method during pregnancy.
Thoracic Aortic Aneurysms
Authors: GOLDSTEIN STEVEN A. , LINDSAY JOSEPH
Published: August 2007

This article describes the evolving role of echocardiography for the detection and evaluation of thoracic aortic aneurysms. A brief summary of the clinical, anatomical, and pathological features of the etiologic categories of thoracic aneurysms is presented. The advantages and limitations of echocardiography and its comparison with other techniques (computed tomographic scanning, magnetic resonance imaging, and aortography) are discussed.
Transesophageal Echocardiography in the Evaluation of Aortic Trauma
Authors: ROSENZWEIG BARRY P. , GUARNERI ERMINIA
Published: August 2007

Transesophageal echocardiography (TEE) is superior to other imaging techniques for the diagnosis of aortic trauma. It can accurately, rapidly, and safely diagnose life‐threatening conditions such as aortic rupture, pseudoaneurysm, traumatic aortic dissection, and intramural hematoma. TEE is useful for the diagnosis and prevention of iatrogenic aortic trauma induced by cardiovascular surgery, intraaortic procedures, and cardiopulmonary resuscitation.
On‐Line Myocardial Tissue Characterization with a New Commercially Produced Software
Authors: KATES MARC A. , MEZA MARIO F. , MEHRA MANDEEP R. , VENTURA HECTOR O. , REVALL SUSAN , D'SA ALWYN , MURGO JOSEPH P. , CHEIRIF JORGE
Published: August 2007

Myocardial tissue characterization has been performed using various ultrasonic techniques, one of which is the cyclic variation of integrated backscatter, a method that analyzes the acoustic properties of the myocardium using backscattered radiofrequency signals to provide information about myocardial structure and function. Previous studies using prototype equipment have demonstrated a reduction in the cardiac cycle variation of integrated backscatter in various pathologic states. Recently, a commercially produced software package that allows online analysis of cyclic variation of integrated backscatter has been made available for testing by various investigators. To evaluate this new commercially produced software, we compared integrated backscatter results in three groups of patients: a control group; an end‐stage cardiomyopathy group; and a heart transplant recipient group. Integrated backscatter of the septum and posterior walls in the parasternal long axis and 12, 3, 6, and 9 o'clock regions in the short axis was performed using a commercially produced program (Hewlett‐Packard Sonos 1500). In the control group, the mean cyclic variation of integrated backscatter was 5.04 ± 1.60 dB in the septum and did not significantly vary from the rest of the regions studied. In comparison, cyclic variation of integrated backscatter in every region studied was reduced in the cardiomyopathy and heart transplant groups. Intraobserver variability, interobserver variability, and reproducibility over a 3‐month interval was found to be 6.5%, 5.7%, and 7.5%, respectively. These results indicate that: (1) online analysis of cardiac cyclic variation of integrated backscatter is possible utilizing commercially produced software; (2) results obtained are consistent with a low intraobserver and interobserver variability and are reproducible over time; and (3) as observed in the comparison between the transplant and control groups, this information may detect changes in cardiac structure even in the absence of changes in function.
Relationship Between Intravascular Hemolysis and Bright Sparkling Echoes Detected by TEE in the Vicinity of Mechanical Mitral Prosthesis
Authors: LABBÉ LAURENT , ROUDAUT RAYMOND , LORIENT‐ROUDAUT MARIE‐FRANÇOISE , LABBÉ THIERRY , BONNET JACQUES
Published: August 2007

The significance of abnormal bright and sparkling echoes in patients with mechanical mitral prosthetic valves (MMPV) has yet to be established. In the present study, the incidence of this phenomenon and its relationship with hemolysis was evaluated. Thirty‐five consecutive patients with MMPV, each examined by transesophageal echocardiography (TEE), were divided into four groups: (1) no bright echoes (n = 11 patients); (2) minor echoes (+) (n = 11 patients); (3) moderate echoes (++) (n = 7 patients); and (4) numerous echoes (+++) (n = 6 patients). Hemolysis was evaluated from assays of serum haptoglobin, serum lactic dehydrogenase (LDH) and hydrobutyric dehydrogenase (HDH), plasma hemoglobin, indirect bilirubin, and LDH1 and LDH2 isoenzymes. Serum haptoglobin was significantly lower in the patients with bright echoes (0.17 vs 0.63; P < 0.05). In patients with (++) and (+++) bright echoes, the plasma hemoglobin levels and indirect bilirubin levels were significantly higher than the levels found in those patients with minor echoes or with no echoes. These results suggest that bright echoes in patients with MMPV are related to intravascular hemolysis, and the more intense the echo the more severe the hemolysis. Furthermore, there was a higher incidence of bright echoes in the patients with bileaflet prosthetic valves than in those fitted with the Björk valve (84.6% vs 22%).
Echocardiographic Evaluation of Common Atrioventricular Canal Defects
Authors: GEVA TAL , AYRES NANCY A. , PIGNATELLI RICARDO H. , GAJARSKI ROBERT J.
Published: August 2007

An accurate echocardiographic evaluation of common atrioventricular canal (CAVC) requires indepth knowledge of the wide spectrum of morphological and physiological variations in this group of anomalies. In order to evaluate the incidence and morphological distribution of AV canal defects in a large series of patients and to define a systematic approach to the echocardiographic examination, we reviewed the echocardiograms of 206 consecutive patients with CAVC studied at Texas Children's Hospital over a 32‐month period. The complete form of CAVC was most common (68.4%) and presented at an earlier age (mean ± SD: 1.6 ± 2.4 months). A partial AV canal (ostium primum atrial septal defect [ASD]) was found in 42 patients (20.4%) and their age at presentation was higher (9.2 ± 10 months). Twenty‐three patients (11.2%) had a transitional AV canal. Down syndrome was diagnosed in 34% of patients, the majority of whom (79%) had a complete CAVC. Associated malformations were found in 46% of patients: anomalies of the conotruncus were most frequent (18%), followed by secundum ASD (14.1%), anomalous pulmonary venous connection (11.2%), and heterotaxy syndrome (11.2%). Subaortic obstruction and mitral stenosis were less common. The AV canal was unbalanced in 14.1% of patients, with the right ventricular dominant form being more common than the left ventricular dominant form (10.7% and 3.4%, respectively). Based on our experience, we developed a systematic, segment‐by‐segment approach to the echocardiographic examination in infants with CAVC. Together with detailed anatomical information, Doppler evaluation provides crucial hemodynamic information that allows planning of surgical repair.
Isolation of the Left Innominate Artery
Authors: BORNEMEIER RENEE ADAMS , RAMACIOTTI CLAUDIO
Published: August 2007

Isolation of the left innominate artery is a rare anomaly associated with a right aortic arch. Presented here is a case of a 3‐day‐old infant with an isolated innominate artery along with d‐transposition of the great arteries, and a ductal‐dependent circulation. These two lesions have not previously been reported together.
Histologic Studies of Brain Microemboli in Humans and Dogs After Cardiopulmonary Bypass
Authors: BROWN WILLIAM R. , MOODY DIXON M. , CHALLA VENKATA R. , STUMP DAVID A.
Published: August 2007

Emboli become lodged in the brains of patients undergoing cardiopulmonary bypass (CPB) and can cause death, stroke, or more subtle neurological and neuropsychological deficits. Using a specialized vascular stain (for alkaline phosphatase) in autopsy tissues from the brains of patients who underwent CPB shortly before death, we found large numbers of microemboli. All of these microemboli contain lipid, some contain small birefringent particles, and some may contain aluminum or silicon. Within a few weeks after CPB, most of the microemboli had disappeared from the brain tissues, but some persisted for at least 6 months. After several days, the endothelial cells of some of the vessels containing microemboli showed subtle damage in the form of loss of alkaline phosphatase reactivity, and some vessels appeared to be degenerating. Sometimes the surrounding neuropil also showed degeneration. Since skin and muscle biopsies can be readily obtained before, during, and after CPB, we investigated their suitability as surrogate tissues for brain; however, they were unsuitable because they had so few microemboli. By injecting microspheres into dogs at various times during CPB, we have investigated the timing of the production of microemboli. We are also exploring the use of rat brains to trap microemboli from the injected blood of patients undergoing CPB.
A Case of Cardiac Amyloidosis Presenting with Mid‐to Late Diastolic Retrograde Flow from the Left Atrium to the Pulmonary Vein
Authors: OKI TAKASHI , FUKUDA NOBUO , IUCHI ARATA , TABATA TOMOTSUGU , MANABE KAZUYO , KAGEJI YOSHIMI , SASAKI MIWA , YAMADA HIROTSUGU , ITO SUSUMU
Published: August 2007

A patient of cardiac amyloidosis was found to have mid‐to late diastolic retrograde flow from the left atrium (LA) to the pulmonary vein. Congo‐red staining was positive for amyloid in the rectal tissue. M‐mode and two‐dimensional echocardiograms revealed symmetric hypertrophy and typical speckled pattern of the left ventricle (LV). The LV pressure curve showed a dip and plateau configuration during diastole, and end‐diastolic pressure was 28 mmHg. In addition, the LV pressure was high at mid‐diastole, surpassing the pulmonary capillary wedge pressure from mid‐to late diastole. The transmitral flow velocity revealed “restrictive” pattern, and the pulmonary venous flow velocity showed retrograde flow from the LA to the pulmonary vein during mid‐diastole and atrial systole. It is suggested that recording of the pulmonary venous flow velocity by transesophageal pulsed Doppler echocardiography is useful for understanding the mechanism of the development of pulmonary congestion or edema.
Mediastinal Tumor Presenting as Expanding Aortic Aneurysm Diagnosed by Transesophageal Echocardiography
Authors: MICALI ILIANA D. , JACOBS LARRY E. , IOLI ALFRED , KOTLER MORRIS N.
Published: August 2007

This article describes a patient with suspected expanding ascending aortic aneurysm in whom trans‐esophageal echocardiography appropriately determined the presence of a mediastinal soft tissue mass and visualized compression of the superior vena cava.
The Usefulness of Transesophageal Echocardiography in the Surgical Management of Older Children with Subaortic Stenosis
Authors: SHARMA SHIVA , STAMPER TERESA , DHAR PRADIP , EMGE FREDERICK , BAILEY JAMES , KANTER KIRK , WILLIAMS WILLIS , FYFE DEREK
Published: August 2007

Subaortic stenosis is a complex lesion that often presents in older children and adolescents. A clear depiction of the lesion is required for optimization of surgery. Due to the large size of these patients, is not always possible from surface echocardiography. Intraoperative multiplane echocardiography (MTEE) has been performed at our institute in older children for several different congenital heart lesions including many patients with subaortic stenosis. A retrospective analysis of our experience with MTEE in patients with subaortic stenosis was performed to assess its usefulness in the preoperative diagnosis and postoperative assessment of repair. Our results show that intraoperative MTEE was useful preoperatively by correcting or confirming suspected diagnosis, and giving additional details of the lesion in many patients. Postoperatively, MTEE was highly useful in the assessment of repair. We strongly recommend the use of intraoperative MTEE in older children and adolescents with subaortic stenosis.
Predictors of Functional Performance in Community‐Dwelling People with COPD
Authors: Wall Mary Patricia
Published: August 2007

Purpose

: To identify physiologic, well‐being, and coping resource predictors of functional performance in community‐dwelling people with COPD.

Design

: A cross‐sectional, correlational design was used with a convenience sample of 119 people who received care in a private pulmonary medicine practice.

Methods

: Participants were recruited in person, completed the study instruments at home, and returned the instruments to the researcher by mail. Pulmonary function test results were obtained from medical records. Univariate, bivariate, and multiple regression analyses were performed.

Findings

: Several bivariate correlations were robust, particularly among the well‐being and coping resource variables, but none were large enough to indicate multicollinearity. Four proposed predictors (depression, severity of pulmonary disease, age, and gender) explained 46.3% of the variance in functional performance.

Conclusions

: Functional performance was influenced by both physiologic and negative well‐being factors. Because of the potential influence of depression on adherence to medical regimen, attention to both physical and mental health is necessary for maintaining optimal health and functioning in these chronically ill people.
Bone loss in the ovariectomized baboonPapio ursinus: densitometry, histomorphometry and biochemistry
Authors: Mas I. Dal , Biscardi A. , Schnitzler C. M. , Ripamonti U.
Published: August 2007

To develop a non‐human primate model of systemic bone loss after ovariectomy, 24 ovariectomized (OVX) and eight control (non‐OVX) female baboonsPapio ursinuswere investigated over a period of 48 months using bone mineral density (BMD), iliac crest bone histomorphometry, bone turnover markers, and variables of calcium metabolism. Lumbar spine (L1–L4) BMD measured by dual energy X‐ray absorptiometry (DXA) decreased in OVX animals in the first 12 months (−7.6%) and showed a slow trend towards recovery after 24 months. Controls showed a slow increase in spinal BMD over 4 years (+9.7%). Total hip BMD decreased slowly up to 48 months in all animals (OVX −12.6%versuscontrols −10%); this indicated that OVX had a limited effect on total hip BMD. Forearm BMD did not change. The significant decrease in trabecular bone volume (TBV) of the iliac crest from baseline to 12 months was followed by some recovery. Microarchitectural deterioration of trabecular bone in OVX animals was demonstrated by a decline in trabecular number and an increase in trabecular spacing. These changes were also evident on sections of whole vertebrae, proximal femora and iliac crests. Changes in iliac TBV reflected spinal but not hip BMD changes in the OVX animals. Static and dynamic histomorphometric variables indicated that bone turnover was increased for 36 months following OVX. Controls showed no changes in histomorphometric variables. Bone specific alkaline phosphatase (ALPs) in OVX animals remained elevated throughout the study; osteocalcin (OC) was significantly elevated only at 6 and 12 months, and deoxypyridinoline (Pyr‐D) was elevated at 12 months but declined after 24 months. ALPs was thus more sensitive to the long‐term effects of OVX than were OC or Pyr‐D. Controls showed no changes in bone turnover markers. This study showed consistent deleterious changes in lumbar BMD, bone histomorphometry with microarchitectural deterioration together with altered biochemical markers of bone turnover in the first 12 months after OVX. Since these changes resemble those in post‐menopausal women, the non‐human primatePapio ursinusis suitable for the study of bone loss in post‐menopausal women.