bluuebunny/crossref_metadata_2025 huggingface dataset:
Should Patients Be Submitted to Coronary Arteriography After Echocardiographic Diagnosis of Idiopathic Dilated Cardiomyopathy?
Authors: BLOCH ANTOINE , MAYOR CHANTAL , JAUSSI ANDRES
Published: December 2007

Objectives: The present study was designed to determine if patients with an echocardiographic diagnosis of idiopathic dilated cardiomyopathy should be submitted to coronary arteriography. Background: Whether echocardiography allows distinction of idiopathic dilated cardiomyopathy from severe coronary heart disease remains controversial. Methods: A questionnaire was sent out to the members of the Swiss Society of Cardiology. In the first study 78 patients with an echocardiographic diagnosis of idiopathic dilated cardiomyopathy who had undergone coronary arteriography or had been followed‐up for > 5 years were investigated. In a second study, the echocardiograms of 50 patients with either idiopathic cardiomyopathy or severe coronary heart disease, all of whom had also undergone coronary arteriography, were reviewed by two independent echocardiographers without access to any complementary information. Result: The questionnaire revealed that one half of the Swiss cardiologists generally refer such patients for coronary arteriography. The first study showed that the diagnosis of idiopathic dilated cardiomyopathy was confirmed in all cases, in which the echocardiographer had been certain of the diagnosis (64/78 [82%]). In the uncertain cases (14 [18%]) coronary arteriography revealed 9 idiopathic cardiomyopathies, 3 coronary heart diseases, and 2 mixed etiologies. The second study showed that a correct diagnosis was achieved in 85% of cases. Furthermore, the echocardiographers were able to specify those patients with an uncertain diagnosis who would therefore require coronary arteriography. Conclusions: In the overwhelming majority of cases, echocardiography can distinguish idiopathic dilated cardiomyopathy from severe coronary heart disease. Coronary arteriography is only indicated when the echocardiographer is uncertain of the diagnosis. The routine and costly practice of coronary arteriography of these patients does not appear to be justified.
Reference Techniques for Left Ventricular Volume Measurement by Three‐Dimensional Echocardiography: Determination of Precision, Accuracy, and Feasibility
Authors: BELOHLAVEK MAREK , FOSTER STEPHEN M. , KINNICK RANDALL R. , GREENLEAF JAMES F. , SEWARD JAMES B.
Published: December 2007

The use of multiple in vitro reference methods to validate three‐dimensional (3‐D) echocardiographic techniques makes comparison difficult. In an attempt to establish a reference standard, we studied precision, accuracy, and feasibility of a true left ventricular (LV) volume measurement in six dog heart specimens using three techniques, called fluid, sheath, and cast. LV volumes ranged from 30 to 105 mL. Intraobserver variability was minimal in all combinations (1.26% to 2.8%) with a statistically insignificant tendency to higher values in the cast method. The cast method, however, exhibited significantly higher interobserver variability (5.78%) as compared to that ranging from 1.47% to 1.59% in the remaining two techniques. Regression analysis demonstrated high correlations among the three techniques assessed by 95% confidence limits and correlation coefficient (R2 > 0.98, P < 0.01). Mean differences among the techniques (0.12 to 1.08 mL) were not significant. The fluid technique was easy to perform. The sheath technique required some practice. The cast method was sensitive to accurate preparation of a gelatin mixture. We conclude that the fluid and sheath techniques are precise, accurate, and feasible. We recommend their use as reference standards in laboratory LV volume measurement. Validation 3‐D echocardiographic studies using either of these two techniques will be comparable. Although the accuracy of the cast technique is excellent, its lower precision makes it a second choice. It could be used in cases where an LV cavity cast is required and higher interobserver variability is acceptable.
Transthoracic Versus Transesophageal Two‐Dimensional Echo Doppler Determination of Flow Velocity in the Left Atrial Appendage
Authors: CARRANZA CÉSAR , ABUFHELE ALEJANDRO , CARTES FANNY , FORERO ALEJANDRO
Published: December 2007

The assessment of flow velocity (FV) in the left atrial appendage (LAA) by transesophageal echocardiography (TEE) has been reported to be a useful tool as a high risk marker for systemic emboli. The analysis of FV in LAA by transthoracic echocardiography (TTE) has not yet been validated. The purpose of this study was to compare FV measurements in the LAA by TEE and TTE in 30 consecutive patients (age 19–87 years, mean = 55) sent for echocardiographic study with the following diagnosis: stroke (11 patients), mitral stenosis (6 patients), congenital heart disease (4 patients), mitral prosthetic function assessment (2 patients), and other pathologies (7 patients). FV was measured at the outlet and mid‐portion of the LAA with TTE, from the apical two‐chamber view and with biplane TEE, from the longitudinal two‐chamber view. Satisfactory measurements were obtained with TTE from the outlet of the LAA in 96.7% and from the mid‐portion of the LAA in 90% of patients. One third of patients were in atrial fibrillation (AF) during the study. The mean FV in the outlet of the LAA was 32.7 ± 2.5 (SE) cm/sec with TTE and was 33.7 ± 3.04 (SE) cm/sec with TEE (r = 0.95). The mean FV in the mid‐portion of the LAA was 40.9 ± 3.3 and 42.7 ± 3.9 with TTE and TEE respectively (P = NS) (r = 0.95). There was no difference in the LAA FV determination by TTE and TEE in the subgroup with AF. TTE was able to detect FV < 30 cm/sec with a sensitivity of 88% and specificity of 81% and a positive predictive value of 84% compared with TEE.
Severe Aortic Coarctation in an Adult Without Left Ventricular Hypertrophy Nor Overt Collateral Channels
Authors: MANGION JUDY R. , POPOWSKI BARBARA E. , JOELSON JOHN M. , TIGHE DENNIS A.
Published: December 2007

We describe an unusual case of periductal coarctation of the aorta in a 40‐year‐old patient presenting to the echocardiography laboratory for evaluation of a heart murmur. Subsequent clinical history revealed easy fatigability, dyspnea on exertion, and hypertension. Despite a lack of left ventricular hypertrophy, aortic coarctation was suggested by echocardiography. It was later confirmed to be severe by multiple additional imaging modalities, despite an absence of overt collateral arterial channels. The importance of echocardiography in the diagnosis of coarctation of the aorta and the management of this complicated patient is discussed.
Imaging in Cardiac Echinococcosis
Authors: BENNIS AHMED , BENNANI‐SMIRÉS C. , CHRAIBI N.
Published: December 2007

Cardiac echinococcosis is a rare disease. Its diagnosis is sometimes difficult and requires medical imaging such as echocardiography. An 18‐year‐old man with multiple cardiac hydatid cysts diagnosed by echocardiography and nuclear magnetic resonance is presented. The results from these imaging techniques are presented.
Identification of the Aortic Arch Branches Using Transesophageal Echocardiography
Authors: AGRAWAL GOPAL , LAMOTTE LANCE C. , NANDA NAVIN C. , PAREKH HEMAL H.
Published: December 2007

In this report we describe the technique used for identification of the individual aortic arch vessels using transesophageal echocardiography.
Echocardiographic Guidance for Endomyocardial Biopsy
Authors: DRURY JOHN H. , LABOVITZ ARTHUR J. , MILLER LESLIE W.
Published: December 2007

Endomyocardial biopsy is fundamental to the success of cardiac transplantation and can also provide important information for the diagnosis of primary and secondary myocardial pathology. Classically, endomyocardial biopsy procedures have utilized fluoroscopy to guide bioptome manipulation. However, echocardiographic guidance has many distinct advantages. We review our experience of 4301 echocardiography guided endomyocardial biopsy procedures. Our overall major complication rate was 0.4% with one right ventricular perforation and no procedure related mortality. These results compare favorably to traditional fluoroscopic techniques. Echocardiographic guidance for endomyocardial biopsy is safe, effective, and efficient.
Echocardiography in Percutaneous Balloon Mitral Valvuloplasty
Authors: ABASCAL VIVIAN M. , CHEN CHUNGUANG , PALACIOS IGOR F.
Published: December 2007

Percutaneous balloon valvuloplasty (BV) has been used successfully in recent years for the relief of mitral stenosis, and in many instances, as an alternative to cardiac surgery. This procedure requires precise evaluation of both valve morphology and function for preprocedure decision making and follow‐up of patients. Two‐dimensional (2‐D) echocardiography is a unique, noninvasive tool for evaluating morphologic characteristics of valve, subvalvular apparatus, and valve annular size. Doppler echocardiogarphy provides functional information on transvalvular flow velocity, which can be used to derive pressure gradient across valve and regurgitant flow. Mitral valve area can be either obtained from 2‐D echocardiography or derived from Doppler pressure half time. Echocardiography is currently the most widely used technique for assessing results of percutaneous BV. More recently, transesophageal echocardiography (TEE) has been used for the evaluation of patients undergoing percutaneous mitral BV in whom left atrial thrombus is suspected and for the intraoperative monitoring of the valvuloplasty procedure. In this article we discuss the advantages and limitations of both transthoracic echocardiography and TEE, its recent developments in monitoring the procedure, evaluation of immediate results and long term follow‐up after the valvuloplasty procedure, and its clinical utility in the selection of patients for percutaneous BV.
Pericardiocentesis Guided by Two‐Dimensional Echocardiography
Authors: CALLAHAN JOHN A. , SEWARD JAMES B.
Published: December 2007

Echodirected pericardiocentesis has become the method of choice for the initial treatment of clinically significant pericardial effusions since it was introduced into the regular practice at the Mayo Medical Center in April 1980. Between April 1980 and January 1, 1994, 610 consecutive two‐dimensional (2‐D) echodirected pericardiocenteses were performed at the Mayo Clinic. There have been no deaths in the series of consecutive cases. In the first 500 consecutive cases examined in detail, there were five serious complications and 18 nonthreatening complications. Echodirected pericardiocentesis is a safe, humane, and cost‐effective means of performing a pericardial tap. Excellent results have been obtained even with a large number of physician operators. This technique is well suited to the primary care setting. Physicians performing this procedure should be familiar with reading and performing 2‐D echocardiography. Qualified physicians can be trained, fairly easily, to perform echodirected pericardiocentesis.
Transesophageal Echocardiographic Evaluation of Patients Receiving Mechanical Assistance from Ventricular Assist Devices
Authors: DÁVILA‐ROMÁN VICTOR G. , BARZILAI BENICO
Published: December 2007

Ventricular assist devices (VADs) have been successfully used to provide circulatory support for patients with cardiogenic shock after cardiac surgery. Transesophageal echocardiography plays a vital role in the evaluation of patients on VAD support: it is used to verify the correct positioning of the VAD hardware; to diagnose complications, including intracardiac thrombus and tamponade; and to assess right and left ventricular function when VAD flow is decreased to determine the correct timing for weaning from the device. Future developments may allow us to prospectively identify patients with stunned but viable myocardium who would benefit the most from VAD support.
Doppler Evaluation of Left Ventricular Diastolic Inflow and Outflow Waveforms in Normal Subjects
Authors: VOON WEN‐CHOL , SHEU SHENG‐HSIUNG , HWANG YUH‐YAU
Published: December 2007

The measurements of the left ventricular inflow parameters do not necessarily reflect the measurements of the respective outflow ones. The A wave transit time from the mitral valve to the left ventricular outflow tract has been demonstrated to have a fair correlation with measures of the left ventricular late diastolic stiffness. We performed this study to obtain the normal patterns of the diastolic left ventricular outflow as well as inflow waveforms and to evaluate the roles of aging and other physiological parameters in their evolution. The study population consisted of 60 healthy subjects (aged 22–66 years). They were divided into three groups: group 1 (aged 20–34 years), group 2 (aged 35–49 years), and group 3 (aged 50–70 years). Pulse‐wave Doppler echocardiography was performed to get the patterns of diastolic left ventricular inflow and outflow waveforms. With aging, the peak velocity and velocity‐time integral of the transmitted transmitral E wave decreased, and those of the transmitted transmitral A wave increased with a progressive decrease in their ratio of transmitted transmitral E to A wave. The diastolic left ventricular inflows followed a similar aging course. There was no obvious aging trend in the A wave transit time from the mitral valve to the left ventricular outflow tract. Multiple linear regression analyses selected age as the most important determinant in the differences in most left ventricular inflow and outflow indices among normal subjects. Besides, heart rate had modest influences on some Doppler indices. This study confirms the age related changes in the left ventricular inflow waveforms and further establishes the concept that the diastolic left ventricular outflow waveforms are also significantly influenced by age and heart rate. Hence, both factors should be taken into account in interpreting the diastolic left ventricular outflow as well as inflow indices.
Low Incidence of Cerebrovascular Events in Patients with Incidental Atrial Septal Aneurysm
Authors: BURGER ANDREW J. , JADHAV PRAVEEN , KAMALESH MASOOR
Published: December 2007

Objectives: The purpose of our investigation was to describe the echocardiographic characteristics of an atrial septal aneurysm (ASA) and associated cardiac abnormalities, to determine whether any echocardiographic characteristics are associated with cerebrovascular events, and to compare the cerebrovascular risk of ASA when it is an isolated and incidental finding with ASA associated with other cardiac abnormalities and diagnostic indications, including a cardiac source of embolus. Methods: In 1605 consecutive patients referred for transesophageal echocardiography during open heart surgery, we identified 78 patients with ASA as an incidental finding (Group I). During the same period, this anomaly was found in 39 of 8014 consecutive patients referred to the echocardiographic laboratory for various diagnostic reasons (Group II). The frequency of cerebrovascular events and ASA characteristics was compared between these two groups. Results: A total of 117 patients with ASA was included in the study: 60 males and 57 females with a mean age of 66.7 ± 9.1 years. There were no significant differences in the echocardiographic characteristics of ASA or associated cardiac abnormalities between these two groups; no intracardiac or ASA associated thrombi were detected in either group. While only 6.4% of Group I had a clinical event, 23% of patients in Group II had a stroke or transient ischemic abnormality. Conclusions: The morphological characteristics of ASA and associated cardiac abnormalities do not distinguish patients at risk for cerebrovascular events. Although the presence of ASA may be a risk factor for embolic strokes, this risk is lower than previously thought.
Leiomyosarcoma of the Right Atrium Masked by a Covering Thrombus: Conflicting Results of Echocardiography and Transvenous Biopsy—In Favor of Echocardiography
Authors: AUERBACH ILAN , TENENBAUM ALEXANDER , FISMAN ENRIQUE Z. , SHEMESH JOSEPH , FEINMESER MEORA , HERZ YITZHAK , TRUJILLO ANA , MOTRO MICHAEL
Published: December 2007

A 62‐year‐old woman was admitted for the evaluation of pedal edema and ascitis. Echocardiography revealed a right atrial (RA) mass invading the interatrial septum and extending into the inferior vena cava (IVC). Contrast enhanced computerized tomography scan excluded extravascular involvement. An organized thrombus was diagnosed by transvenous endomyocardial biopsy. The patient was treated with continuous intravenous heparin, and died soon after from hepatic failure. Postmortem histologic examination revealed a leiomyosarcoma surrounded by a thrombus involving RA, IVC, and hepatic veins. Endomyocardial biopsy played a misleading role that affected patient's management.
Biological Effects of Ultrasound. The Perceived Safety of Diagnostic Ultrasound Within the Context of Ultrasound Biophysics: A Personal Perspective
Authors: MILLER MORTON W. , BRAYMAN ANDREW A.
Published: December 2007

This brief review addresses the issue of health and safety from exposure to diagnostic ultrasound. The exemplary historical record of diagnostic ultrasound exposures is coupled with great patient benefit. However, the power outputs of clinical devices have been increasing over the past decade such that inertial cavitation seems reasonably likely to occur if appropriate gas nuclei are present. The use of microbubble contrast agents for certain diagnostic procedures ensures a well nucleated system. Under such conditions, the use of low signal output levels and short exam times will decrease the chance of cavitation related bioeffects.
Harmonic Power Doppler Contrast Echocardiography: Preliminary Experimental Results
Authors: AGRAWAL DIPAK I. , MALHOTRA SANJAY , NANDA NAVIN C. , TRUFFA CLAUDIA CARVALHO , AGRAWAL GOPAL , THAKUR ABHASH C. , JAMIL FARRUKH , TAYLOR GREGG W. , BECHER HARALD
Published: December 2007

This preliminary experimental study demonstrates the potential usefulness of harmonic power Doppler imaging in producing left ventricular myocardial opacification and demonstrating intra‐myocardial coronary vessels during contrast echocardiography using Levovist, a saccharide‐based contrast agent. The contrast effect was most dramatic when a vasodilator such as dipyridamole or nitroglycerin was used in conjunction with contrast injections of Levovist. No significant myocardial opacification was noted with B‐mode harmonic imaging alone.
Color Kinesis
Authors: BEDNARZ JAMES , VIGNON PHILIPPE , MOR‐AVI VICTOR , WEINERT LYNN , KOCH RICK , SPENCER KIRK , LANG ROBERTO M.
Published: December 2007

Color kinesis is a new echocardiographic technique that aids in the assessment of global and regional left ventricular performance during either systole or diastole. Color kinesis uses automated border detection technology based on backscatter data to display both the magnitude and timing of endocardial motion in real time. The color kinesis display superimposes a color overlay on the two‐dimensional echocardiographic image; the number of color pixels represents the magnitude of endocardial motion, while the different colors represent the timing of endocardial motion according to a predefined color scheme. Because color kinesis is an operator‐dependent technique, the steps involved in performing a technically adequate study will be reviewed as well as the pitfalls and technical limitations. The potential clinical applications of color kinesis will also be discussed.
Left Atrial Contribution to Left Ventricular Filling in Patients with Mitral Stenosis
Authors: OKI TAKASHI , IUCHI ARATA , TABATA TOMOTSUGU , YAMADA HIROTSUGU , MANABE KAZUYO , FUKUDA KAZUYO , ABE MIHO , FUKUDA NOBUO , ITO SUSUMU
Published: December 2007

We recorded transmitral and pulmonary venous flow velocities using transthoracic continuous‐wave and transesophageal pulsed Doppler echocardiography, respectively, in 36 patients with mitral stenosis who were in sinus rhythm to investigate the left atrial contribution to left ventricular filling in mitral stenosis. The mitral valve area was determined by transthoracic two‐dimensional short‐axis echocardiography. Patients were classified as having mild stenosis (± 1.5 cm2, n = 17) or moderate stenosis (< 1.5 cm2, n = 19). The mean pulmonary capillary wedge pressure and left atrial maximal diameter were significantly larger, and left atrial volume change during atrial contraction was significantly smaller in the moderate group than in the mild group. The percent left atrial contribution to left ventricular filling, estimated from the transmitral flow velocity, the peak atrial systolic velocity, and the percent ratio of left atrial systolic regurgitation to left atrial filling, estimated from the pulmonary venous flow velocity, were significantly lower in the moderate group than in the mild group. The percent left atrial contribution to left ventricular filling, the peak atrial systolic velocity, and the percent ratio of left atrial systolic regurgitation to left atrial filling were positively correlated with the mitral valve area and negatively correlated with the mean pulmonary capillary wedge pressure. These results suggest that the left atrial contribution to left ventricular filling in patients with mitral stenosis in sinus rhythm decreases as the severity of valve stenosis increases, and that analysis of the atrial systolic waves of the transmitral and pulmonary venous flow velocities provides important information for evaluation of left atrial systolic performance in patients with mitral stenosis.
Ventricular Septal Defect Masquerading as Severe Tricuspid Regurgitation
Authors: RICHARDS DAVID R. , COLON PERCY J. , OCHSNER JOHN L. , CHEIRIF JORGE
Published: December 2007

Two‐dimensional echocardiography (2‐D) is a useful technique for noninvasive evaluation cardiac structure, function, and hemodynamics; however, multiple factors may limit the technical adequacy of the 2‐D examination. In this article, we present the case of a ventricular septal defect to right atrial shunt, which was misinterpreted as severe tricuspid regurgitation secondary to severe pulmonary hypertension, despite the absence of right ventricular enlargement or hypertrophy. A transesophageal echocardiography (TEE) examination was performed to explain the discrepancy between the 2‐D and Doppler findings, the results of which are discussed, along with a review of the literature.
Three‐Dimensional Imaging Used for Virtual Dissection, Image Banking and Physical Replication of Anatomy and Physiology
Authors: MACLELLAN‐TOBERT SUSAN G. , BUITHIEU JEAN , BELOHLAVEK MAREK , BEHRENBECK THOMAS , GREENLEAF JAMES F. , EDWARDS WILLIAM D. , SEWARD JAMES B.
Published: December 2007

Historically, techniques of dissection have been used to aid in our understanding of human anatomy, physiology, and pathology. However, these techniques alter the structures and fine details being studied. New advances in computer technology, imaging equipment, data acquisition, processing, storage, and display now allow multidimensional imaging. Interactive computer programs can electronically display both static three‐dimensional and higher‐dimensional images that retain features such as motion, pressure, and temporal change. Multidimensional images can be reconstructed and manipulated using different holographic, stereolithographic, or interactive two‐dimensional displays. We describe the unique potential of multidimensional reconstruction, virtual dissection, and replication of cordiovascular structures using ultrasound data. Ultrasound technology has the advantage of depicting both anatomy and physiology. The ability to perform virtual dissection and surgery in the living patient without disruption of anatomy or physiology provides the clinician with a powerful new tool for diagnosis, teaching, and therapeutics.
Combined Interatrial and Intrapulmonary Shunting in Orthodeoxia Detected by Transesophageal Echocardiography
Authors: THAKUR ABHASH C , NANDA NAVIN C. , MALHOTRA SANJAY , MARTIN MICHELE B. ST. , JAMIL FARRUKH , AGRAWAL DIPAK , MAHESHWARI SANJAY , ABRAMS GARY A. , PATEL BIPIN
Published: December 2007

Contrast transesophageal echocardiography was found useful in diagnosing combined interatrial and intrapulmonary right‐to‐left shunts in a patient presenting with orthodeoxia. This was done by separately examining the pulmonary veins and the interatrial septum during intravenous normal saline injections.
Three‐Dimensional Echocardiography of the Aortic Valve
Authors: KASPRZAK JAROSLAW D. , SALUSTRI ALESSANDRO , ROELANDT JOS R.T.C. , TEN CATE FOLKERT J.
Published: December 2007

Objectives: The purpose of our study was to assess the feasibility and potential clinical utility of three‐dimensional echocardiography for evaluation of the aortic valve. Background: The value of three‐dimensional echocardiographic assessment of the aortic valve has not been established yet. Methods: The study group comprised 32 patients (11 women, 21 men), mean age 56.1 (range 20–82). Seven morphologically normal valves, 5 homografts, 6 mechanical prostheses, and 14 valves of abnormal morphology were evaluated. Images were acquired during a routine multiplane transesophageal echocardiographic examination (rotational scan with 2° interval, respiration, and electrocardiogram [ECG] gating) and postprocessed off‐line. A selection of reconstructed cutplanes (anyplane mode) and volume‐rendered three‐dimensional views of aortic valve anatomy were analyzed by two observers and compared with two‐dimensional echocardiography findings. Results: The quality of reconstructions was scored excellent when permitting unrestricted assessment of aortic valve anatomy with optimized planimetric measurements (19 patients, 59%), adequate when aortic valve was partially visualized (7 patients, 22%), or inadequate when no assessment was possible (6 patients, 19%, including 5 with prosthetic valves). Three‐dimensional echocardiography provided additional information in ten (31%) patients as compared with the two‐dimensional echocardiographic findings. Conclusions. It can be concluded that three‐dimensional echocardiographic reconstruction of the aortic valve is feasible, with excellent or adequate quality in 81% of patients, more frequently in native than in prosthetic valves, P < 0.05. Morphologic information additional to that provided by two‐dimensional echocardiography is obtained in a significant proportion of patients.
Cardiac and Paracardiac Masses
Authors: SAMUEL WANN L. , SAMPSON CYNTHIA , LIU YU
Published: December 2007

The objective of this study was to compare the roles of echocardiography and magnetic resonance imaging (MRI) in the evaluation of patients suspected of having cardiac and paracardiac masses. Echocardiography is a widely available and useful technique for characterizing cardiac and paracardiac abnormalities but suffers from a limited field of view and restricted acoustic access to mediastinal structures. MRI is an alternative noninvasive imaging technique for investigation of these abnormalities. Fourteen consecutive patients suspected of having cardiac or paracardiac masses on echocardiography were referred for cardiac MRI. MRI gave more complete visualization in four patients with infiltrating lung tumors and in one patient with intracardiac metastases who had a technically inadequate echo. Echo showed a rapidly moving Chiari network not seen on MRI. Both echo and MRI were helpful in patients with hiatal hernias (2); lipomatous hypertrophy of the interatrial septum (2); left atrial myxoma (1); and calcified mitral annulus (3). We conclude that echocardiography and MRI should be used together to investigate patients with cardiac and paracardiac masses.
Transesophageal Pulsed Doppler Echocardiographic Study of Systolic Flow Velocity Patterns of the Pulmonary Vein in Patients with Atrial Fibrillation
Authors: OKI TAKASHI , IUCHI ARATA , TABATA TOMOTSUGU , YAMADA HIROTSUGU , MANABE KAZUYO , FUKUDA KAZUYO , ABE MIHO , FUKUDA NOBUO , ITO SUSUMU
Published: December 2007

We recorded pulmonary venous flow velocity in 27 patients with atrial fibrillation using trans‐esophageal pulsed Doppler echocardiography to investigate the cycle length‐dependent characteristics and background of early systolic reversal and second systolic forward waves. The study group consisted of 15 patients with mitral stenosis, 5 patients with left atrial myxoma, and 7 patients without underlying organic heart disease; they were compared with 20 normal controls in sinus rhythm. The mean pulmonary capillary wedge pressure was significantly greater in patients with mitral stenosis and left atrial myxoma than in normal controls and in patients with isolated atrial fibrillation. The mean peak velocity of the early systolic reversal wave was also significantly greater in patients with mitral stenosis and left atrial myxoma than in patients with isolated atrial fibrillation. The mean peak velocity of the second systolic forward wave was significantly lower in patients with mitral stenosis and left atrial myxoma than in controls and in patients with isolated atrial fibrillation. The preceding RR interval had significant negative correlations with the peak early systolic reversal velocity, left atrial pressure during closure of the mitral valve, and peak V wave height of the pulmonary capillary wedge pressure in patients with mitral stenosis and left atrial myxoma. In the same patient groups, the preceding RR interval had significant positive correlations with the peak second systolic forward velocity and amplitudes of the mitral annular and interatrial septal motions during ventricular systole. The variations in the peak velocities of the early systolic reversal and second systolic forward waves with the preceding RR interval were smaller in patients with more severe mitral stenosis. In conclusion, early systolic reversal waves of the pulmonary venous flow velocity reflect left atrial pressure, and the second systolic forward waves reflect left atrial filling. Both velocities vary with disease conditions or preceding RR intervals in atrial fibrillation.
Local Anesthetic‐Induced Methemoglobinemia During Transesophageal Echocardiography
Authors: MALHOTRA SANJAY , KOLDA MICHAL , NANDA NAVIN C.
Published: December 2007

We report a case of methemoglobinemia that occurred following topical benzocaine spray to the throat, leading to cancellation of the transesophageal echocardiography (TEE) procedure. Since the condition is potentially fatal, increased awareness of this disorder should result in its early recognition and treatment. (ECHOCARDIOGRAPHY, Volume 15, February 1998)
Clinical‐Echocardiographic Correlation of Myocardial Infarction with Extension to Right Chambers
Authors: VARGAS‐BARRÓN JESÚS , ESPINOLA‐ZAVALETA NILDA , ROMERO‐CARDENAS ANGEL , SIMON‐RUIZ SILVINO , KEIRNS CANDACE , PEÑA‐DUQUE MARCO , RIJLAARSDAM MARÍA , LUPI‐HERRERA EULO
Published: December 2007

In order to determine the transesophageal echocardiographic characteristics in patients with acute myocardial infarction of right ventricle and establish the relationship between these findings, the clinical condition, and their prognostic value, 38 patients consecutively admitted to the Instituto Nacional de Cardiología with a diagnosis of acute left ventricular myocardial infarction with extension to right ventricle and/or atrium were retrospectively studied. Of the left ventricular infarctions, 37 were posteroinferior and one anterior. Significant elevations of CPK and DHL were found in 35. In 30 patients (78%) electrocardiographic evidence of extension of infarction to the right ventricle was found, and in 3, evidence of right atrial infarction. Twenty‐one patients presented clinical data compatible with right ventricular infarction. In 19, cardiac rhythm and atrioventricular conduction disturbances were documented. Coronary angiograms practiced on 34 patients demonstrated single‐vessel (right coronary) disease in 12, affection of two vessels in 14, and lesions in three or more in 6. Coronary arteries presented no significant lesions in two cases. With TEE, alterations of right ventricular segmental mobility were demonstrated in all patients, and in 6, alterations of right atrial mobility as well. As respects the ventricular wall movement index, 68.5% had total scores (RV + LV) of 7lt;5. The other 31.5% had scores ≤ 5. In 26%, the right ventricular wall movement index was ≤ 4. The RVDD/LVDD ratio was 1 or less in 30 patients (78%) and > 1 in only 8 (22%). The conclusions from these findings are that: (1) TEE is an excellent diagnostic means of identifying right ventricular and/or atrial infarction; and (2) a relationship exists between the magnitude of right ventricular damage and a wall movement index of 5 or more or an RV/LV diastolic diameter ratio > 1:postinfarction hemodynamic deterioration is significantly greater and the incidence of intrahospitalary complications higher.
Experimental Right Atrial Ischemia and Its Response to Stimulation with Dobutamine
Authors: ROMERO‐CÁRDENAS ANGEL , VARGAS‐BARRÓN JESÚS , ESPINOLA‐ZAVALETA NILDA , MUÑIZ‐GARCÍA ARTURO , PEÑA‐DUQUE MARCO , MARTÍNEZ‐SÁNCHEZ CARLOS , KEIRNS CANDACE , RIJLAARSDAM MARÍA , ROSAS‐PERALTA MARTÍN , LUPI‐HERRERA EULO
Published: December 2007

In order to analyze the repercussion of experimental isolated selected right atrial ischemia on the hemodynamics of both ventricles, we investigated the response of atrial myocardium with administration of dobutamine and evaluated the utility of transesophageal echocardiography (TEE) with Doppler in the examination of alterations produced by atrial ischemia. Ten dogs were studied with normal, diminished, and increased cardiac output with ligation of the visible atrial branches of the right coronary artery. Right atrial wall movement and peak A wave velocity of tricuspid flow registered by TEE decreased (P < 0.05). The amplitude of the right atrial A wave decreased in hemodynamic recordings (P < 0.05). No significant modifications occurred in right ventricular wall movement nor in pressures registered in right or left ventricles or cardiac output. Seventy‐five minutes after atrial ischemia was induced dobutamine was administered. In dogs with incomplete ligations of atrial circulation, right atrial wall movement improved (P < 0.001), and the amplitude of the peak A wave velocity of tricuspid flow increased. In dogs with complete coronary ligation, administration of the medication produced no improvement of these variables. The findings indicate that it is possible to produce selective right atrial ischemia manifested by diminished wall movement, a diminished atrial component of tricuspid flow in TEE, and decreased amplitude of the A wave in atrial pressure recordings. The localized hemodynamic changes produced by right atrial ischemia are not related to variations in venous return when right ventricular function is normal. Apparently isolated right atrial damage from ischemia does not affect ventricular function if these remain healthy. The recuperation of atrial contractility can be demonstrated with dobutamine. Transesophageal echocardiography is a very useful technique for studying right atrial ischemia and infarction.
Transesophageal Echocardiographic Study of Right Atrial Myocardial Infarction and Myocardial Viability
Authors: VARGAS‐BARRÓN JESÚS , ROMERO‐CÁRDENAS ANGEL , ESPINOLA‐ZAVALETA NILDA , PEÑA‐DUQUE MARCO , MARTINEZ‐SANCHEZ CARLOS , ELADIO ORTIZ‐SOLIS JOSE , KEIRNS CANDACE , RIJLAARSDAM MARÍA , LUPI‐HERRERA EULO
Published: December 2007

In order to determine the effects of dobutamine on right atrial wall movement, two groups were studied using transesophageal echocardiography. Group A included six patients without ischemic heart disease. Group B included six patients with infarction of the inferior wall of both ventricles and abnormal wall movement of the right atrium. In group A, an increase in the amplitude of right atrial movement was observed with dobutamine at doses of 5 and 10 μ/kg per minute. In group B, infusion of dobutamine did not modify wall akinesis in three patients with right atrial infarction; in the remaining three, alterations of segmental atrial movement were evident, and their responses to dobutamine were related to the patency of right atrial coronary branches. The following conclusions were reached: (1) dobutamine has a positive inotropic effect on atrial myocardium; (2) right atrial ischemia appears in the echocardiogram as altered segmental or global wall movement; (3) dobutamine can be used in the evaluation of atrial myocardial viability.
Echocardiographic Aspects of Restrictive Cardiomyopathy
Authors: FERNANDO GUADALAJARA JOSE , VERA‐DELGADO ADOLFO , GASPAR‐HERNANDEZ JORGE , GALVAN‐MONTIEL OLGA , HUERTA‐HERNANDEZ DAVID
Published: December 2007

Background and Methods: We studied 17 patients with restrictive cardiomyopathy; eight had biventricular restriction (type A), four had left ventricular restriction (type B), and five had only right ventricular restriction (type C). Results: Type A disease was characterized by pulmonary and systemic venous congestion. The restrictive pattern was found in the inlet of both ventricles. Both atria were enormous, with small or normal‐size ventricles. Differential diagnosis included constrictive pericarditis and systolic pump dysfunction. Type B restriction disease was characterized by venous pulmonary congestion, pulmonary hypertension, and important dilatation of the left atrium and right cavities with a small or normal‐size left ventricle; the restrictive pattern was found only in the affected left ventricle. Conclusions: The clinical picture resembles that of rheumatic mitral valve disease with right ventricular failure. Type C disease had restriction only in the inlet of right ventricle, with giant right atrium, systemic venous hypertension with low flow, and normal pressure of pulmonary artery and left heart. Differential diagnosis included Ebstein's anomaly of tricuspid valve. The etiology of type A disease was amyloid, endomyocardial fibrosis of ventricles and idiopathic interstitial fibrosis. Asymmetric types were always caused by Davies' disease.
Serial Doppler Gradients Are Predictive of Future Bioprosthetic Valve Degeneration
Authors: PRASAD NIRAJ K. , ALAM MOHSIN , ROSMAN HOWARD S. , FARHA AMJAD , SILVERMAN NORMAN A.
Published: December 2007

Doppler echocardiography and color flow imaging are helpful techniques in evaluating the functional status of a bioprosthetic valve. The aim of this study was to determine whether serial Doppler gradients are predictive of future bioprosthetic valve degeneration. We performed serial echo‐Doppler studies over a 6‐year period (1988–1994) on 228 patients who had undergone mitral (n = 112) or aortic (n = 116) bioprosthetic valve implantation between 1973 and 1994. Thirtynine mitral prostheses and 30 aortic prostheses became dysfunctional and required reoperation. A serial rise in mean gradient of 5 mmHg or more across the mitral valve and 25 mmHg or more across the aortic valve was significantly associated with increased valve degeneration (odds ratio 3.40 and 16.11 and 95% confidence intervals 1.31 and 8.80 and 13.6 and 72.13 for the mitral and aortic valve, respectively). Both aortic and mitral valves began to degenerate after 8 years. Serial echo‐Doppler studies showed a rise in transvalvular gradients around the same time. Closer evaluation for prosthetic valve dysfunction should be considered in patients 8 or more years status post surgery, especially those with high transvalvular gradients.
Normal Values in Children for Myocardial Ultrasonic Tissue Characterization by Integrated Backscatter
Authors: SHIBUYA KAZUHIKO , BIGRAS JEAN‐LUC , McCRINDLE BRIAN W. , NEWMAN ALICE , SMALLHORN JEFFREY F.
Published: December 2007

Normal values in adults for ultrasonic tissue characterization by integrated backscatter have been reported previously and subsequently applied to patients with specific diseases. Factors influencing integrated backscatter values in a pediatric population are not clearly defined. To obtain normal values for myocardial ultrasonic integrated backscatter in a pediatric population, we studied 72 children with normal cardiac anatomy using an ultrasonic integrated backscatter imaging system. The parameters measured were at peak, nadir, and end‐diastole in eight different regions with two different settings: fixed and variable. We subsequently calculated cyclic variation, the ratios of cyclic variation to end‐diastole and to peak. Age ranged from 1 day to 17.4 years (median 4.4 years). More than 90% of data curves from the two regions in the left ventricular posterior wall in long‐axis view had normal patterns, whereas more than 50% of curves for the other regions had abnormal patterns. Comparing the two posterior wall positions, there were no differences in cyclic variation between the two regions, with little effect of setting. Less effect of regions and settings was noted for the ratios of cyclic variation to end‐diastole or peak. There was no relation between backscatter variables and age, gender, or height, and some variables correlated weakly with body surface area. The assessment of integrated backscatter in children is optimal with interrogation of the left ventricular posterior wall imaged in the long‐axis view. More stable estimates are obtained when the cyclic variation is related to the peak or end‐diastolic value.
Free‐Floating Ball Thrombus in Left Atrium
Authors: NAGARAJA KAMALAKAR KADALIVENKATA , JAISHANKAR SADASIVAN , VENKATESWARA RAO CHAGANTI , SESHAGIRI RAO DAMERA , PEDDESWARA RAO PALLEM , LAXMI NARASIMHA KAPARDHI PANNALA , RAJAGOPAL PRABHALA
Published: December 2007

Left atrial (LA) ball thrombus is a rare disorder. These ball thrombi are generally associated with mitral stenosis, and the restricted mitral orifice encloses the free‐floating thrombus in the LA. There is a potential for fatal systemic emboli or mitral value orifice occlusion that may result in sudden death. We report the case of a patient with tight rheumatic mitral stenosis in whom a ball thrombus was observed to bounce and rebound off the walls of LA on echocardiography. After the patient received anticoagulant therapy for 1 month, the thrombus was not found at surgery.
Mobilization of a Bacterial Vegetation Visualized During Transesophageal Echocardiography
Authors: HANSEN FLEMMING , CHRISTENSSON ANDERS , LECEROF HARRY
Published: December 2007

In this report, we describe visualization during transesophageal echocardiography of an embolus leaving the heart from the mitral valve of a patient with infective endocarditis.
Advances in Pharmacological Cardiac Stress Testing
Authors: CROUSE LINDA
Published: December 2007

In less than a decade, the use of stress echocardiography has grown dramatically, with both exercise and, for patients unable to exercise adequately, pharmacological stressors, such as dobutamine. A new pharmacological stress agent, arbutamine, administered using a closed‐loop computerized feedback system, has recently received approval by the Food and Drug Administration for use with echocardiography and radionuclide myocardial perfusion imaging. This system offers safety and accuracy in echocardiography comparable to the use of dobutamine and promises a number of advantages in terms of ease of use and reductions in personnel and time. A catecholamine specifically designed as a pharmacological stress agent, arbutamine increases heart rate, cardiac contractility, and systolic blood pressure with more balanced chronotropic and inotropic effects than dobutamine. The arbutamine delivery system includes a prefilled syringe of the agent, automatic dosing based on the patient's heart rate response, continuous monitoring of heart rate and blood pressure, a printout of test results, and safety features such as visual and audible warnings and automatic discontinuation of drug after an alarm. The accuracy, safety, convenience, and cost of the arbutamine closed‐loop system are likely to make it an attractive agent for echocardiographic diagnosis.
Diagnosis of Partial Anomalous Pulmonary Venous Connection with Intact Interatrial Septum by Echocardiography
Authors: TIGHE DENNIS A. , THOMAS NADINE V.L. , HAFER JESSE G. , ROUSOU JOHN A. , ENGELMAN RICHARD M. , ANENE CHARLES A. , FERNANDEZ EUGENE , RIFKIN ROBERT D.
Published: December 2007

This case illustrates the complementary use of transthoracic echocardiography and transesophageal echocardiography in the diagnosis of partial anomalous pulmonary venous connection. The transthoracic echocardiogram suggested the presence of anomalous pulmonary venous return by demonstrating right heart volume overload and evidence of an intact atrial septum. Transesophageal echocardiography was required to confirm these findings and provide a firm anatomic diagnosis before surgery. This case also emphasizes that a high degree of clinical suspicion for this condition should occur in situations in which apparent right heart volume overload is otherwise unexplained.
Spontaneous Obstruction of Interatrial Communication in Infants with Atrioventricular Valve Atresia or Stenosis in the Neonatal Period
Authors: SELIEM MOHAMED A. , SHAHAB RANA A.K. , PALILEO MAE
Published: December 2007

Background and Methods: The objective of this serial echocardiographic study was to document the critical size of the interatrial communication in infants with atrioventricular valve atresia, with which spontaneous obstruction is most likely to occur. Spontaneous obstruction of interatrial communication (patent foramen ovale) has been reported to occur in infants with atrioventricular valve atresia or severe stenosis. Atrial septostomy or septectomy therefore may be considered during initial palliation of these infants. Serial two‐dimensional Doppler echocardiographic examinations were performed on 11 newborn infants with complex cyanotic congenital cardiac lesions for whom Fontan procedure was contemplated. These newborn infants had either mitral or tricuspid valve atresia or severe stenosis other than hypoplastic left heart syndrome. The size of the foramen ovale was measured from the subcostal frontal, long‐axis oblique, and parasagittal views. Conventional Doppler and color flow mapping of the interatrial shunt also was obtained on each patient. Results: The size of the foramen ovale was 5 mm in nine patients at birth. Five of these patients underwent Blalock‐Taussig shunt in the neonatal period for severely restricted pulmonary blood flow. In three patients, surgery was postponed due to severe systemic (noncardiac) disease. One patient underwent the hemi‐Fontan procedure without a previous shunt. In all nine patients, the foramen ovale remained the same size or became progressively smaller beyond the neonatal period, and atrial septectomy was performed in five patients after initial palliation. In the remaining two patients (who underwent Blalock‐Taussig shunt as initial palliation), the foramen ovale measured ≤ 10 mm at birth and became progressively larger on subsequent follow‐up studies. Atrial septectomy was not necessary in these patients. In the first nine patients, Doppler technique did not detect any obstructive pattern during the first 2–4 weeks of life, after which it became progressively obstructive (i.e., > 2 m / sec and nonphasic). Conclusions: In newborn infants with either atrioventricular valve atresia or severe stenosis, the interatrial communication, which may not appear restrictive by Doppler at birth, becomes progressively obstructed beyond the neonatal period. If the size of the communication is < 10 mm in diameter, as measured by two‐dimensional echocardiography, atrial septectomy should be performed as an integral part of any initial palliation to protect the pulmonary vascular bed for subsequent successful Fontan repair.