bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Accessory Atrioventricular Pathways by Doppler Myocardial Imaging
Authors: Caso Pio , D'Andrea Antonello , Musto Carmine , Nardi Stefano , Cavallaro Ciro , Martiniello Alfonso Roberto , Vecchione Filippo , Mininni Nicola , Calabrò Raffaele , Sutherland George R.
Published: July 2003

Purpose: The use of electrophysiologic studies (EPS) for the localization of accessory atrioventricular connections in Wolff‐Parkinson‐White syndrome (WPW) requires accurate evaluation of the site of bypass tract insertion. Doppler myocardial imaging (DMI) is a new ultrasound technique that allows the detection of abnormal and early regional myocardial depolarization. The purpose of this study was to identify an abnormal pathway site in WPW patients. Methods: Twenty‐one patients with ventricular preexcitation were studied by DMI. Two‐dimensional color DMI, velocity maps, acceleration maps, and pulsed‐wave applications were used. A subsequent diagnostic EPS was performed. The results of EPS were taken as the gold standard diagnostic procedure. Radiofrequency catheter ablation therapy was then performed on all patients. Results: The anomalous pathway was detected by DMI in 16 (76%) of 21 patients (9 [90%] of 10 with left pathways and 7 [64%] of 11 with right pathways), with respect to results of the EPS. Pathway detection was better with pulsed‐wave DMI (76%) with its higher temporal resolution as compared with M‐mode velocity map (57%) and acceleration map (47%). In most of the patients with successful radiofrequency ablation, an immediate resolution of the abnormal ventricular depolarization occurred and was detectable by DMI. Conclusions: Our findings demonstrate the feasibility of DMI to assess the early ventricular contraction associated with atrioventricular accessory pathways. Therefore, DMI appears to be a clinically useful adjunct to noninvasive evaluation of abnormal myocardial depolarization in WPW and to evaluate the results after radiofrequency ablation, even though its accuracy is considerably better for left‐sided accessory pathways than for right‐sided ones.
Cross‐Sectional Multiplane Transesophageal Echocardiographic Measurements: Comparison with Standard Transthoracic Values Obtained in the Same Setting
Authors: Colombo Paolo C. , Municino Annamaria , Brofferio Alessandra , Kholdarova Lyudmila , Nanna Michele , Ilercil Arzu , Shirani Jamshid
Published: July 2003

Background: Several algorithms developed for cost‐effective use of transesophageal echocardiography (TEE) propose elimination of “screening” transthoracic echocardiographic (TTE) studies. Cross‐sectional measurements obtained by TTE (left atrial diameter [LAD], left ventricular internal dimensions in diastole and systole [LVIDd, LVIDs], septal and posterior wall thickness in diastole [VSTd, PWTd], LV end‐diastolic and end‐systolic volumes [LVEDV and LVESV], and LV ejection fraction [LVEF]) have not been standardized for TEE. Methods: Forty‐six patients (age 27 to 85 years, 60 ± 13 years, 25 [54%] women) underwent TEE and TTE studies. TTE was performed while the TEE probe was in place and the patient was still sedated. Standard TTE measurements were compared with corresponding TEE values obtained from mid‐esophageal and transgastric views. Results: Standard TTE measurements compared favorably with those obtained by TEE at the mid‐esophageal three‐chamber view for LAD (3.9 ± 0.6 cm vs 4.0 ± 0.7 cm, P = NS) and at the transgastric long‐axis view for LVIDd (4.6 ± 0.8 cm vs 4.7 ± 0.8 cm, P = NS), LVIDs (3.1 ± 0.9 cm vs 3.1 ± 0.9 cm, P = NS), and VSTd (0.95 ± 0.18 cm vs 0.98 ± 0.19 cm, P = NS). Biplane TTE and TEE measurements of LVEDV (106 ± 35 ml vs 112 ± 38 ml, P = NS), LVESV (37 ± 23 ml vs 37 ± 25 ml, P = NS), and LVEF (67 ± 14% vs 69 ± 14%, P = NS) also correlated closely. The negative predictive values of TEE measurements for excluding abnormal LAD, LVIDd, VSTd, PWTd, and LVEF as defined by TTE were 83%, 94%, 95%, 97%, and 97%, respectively. Conclusion: Cross‐sectional TEE measurements as obtained in this study are equivalent to standard TTE dimensions and provide reliable information that may facilitate interpretation of TEE studies in the absence of TTE information.
Prosthetic Aortic Valve Abscess Producing Total Right Coronary Artery Occlusion: Diagnosis by Transesophageal Three‐Dimensional Echocardiography
Authors: Horton Carl J. , Nanda Navin C. , Nekkanti Rajasekhar , Mukhtar Osman , McGiffin David
Published: July 2003

We present a patient with total right coronary artery occlusion produced by a prosthetic aortic valve abscess. The diagnosis was made by transesophageal three‐dimensional echocardiography.
Part II: Recent Advances in Myocardial Contrast Echocardiography. Clinical Experience in the Detection of Coronary Artery Disease with Myocardial Contrast Echocardiography
Authors: Villanueva Flordeliza S. , Porter Thomas R. , Xie Feng
Published: July 2003

Myocardial contrast enhancement following intravenous infusions or injections of perfluorocarbon‐containing microbubbles has now been observed consistently in humans. Currently, the major challenge facing us is interpreting accurately what we see. The myocardial contrast patterns we observe have, thus far, been shown to detect myocardial perfusion abnormalities during dipyridamole, adenosine, and dobutamine stress echocardiography. They also have been shown to detect zones of no reflow following coronary revascularization in patients with acute myocardial infarction. These preliminary data will require validation in larger multicenter clinical studies.
Microbubble‐Endothelial Cell Interactions as a Basis for Assessing Endothelial Function
Authors: Villanueva Flordeliza S. , Klibanov Alexander , Wagner William R.
Published: July 2003

Clinical signs and symptoms of coronary artery disease are predated in decades by endothelial dysfunction, an aberration in the vascular lining that permits the development and propagation of atherosclerotic lesions and vasomotor dysfunction in the arterial circulation. These ultimately lead to acute and chronic coronary ischemic syndromes. Other pathophysiologic scenarios encountered in clinical cardiology practice, such as cardiac transplant rejection and the period following coronary angioplasty or cardiac surgery, also are associated with endothelial dysfunction. Endothelial dysfunction parallels coronary risk factors and is potentially reversible, rendering early identification of the phenomenon a clinically important endpoint. Current methods for detecting endothelial dysfunction are limited, however. Myocardial contrast echocardiography using microbubbles targeted to bind to cell surface markers uniquely expressed by dysfunctional endothelial cells may offer an approach to the noninvasive detection of endothelial disease using clinical ultrasound imaging techniques. This article will discuss the concept of targeted ultrasound imaging and present preliminary studies in this area as applied to endothelial assessment. Potential applications to other disease states, both diagnostic and therapeutic, also are discussed.
Acute Cardiac Effects of Nicotine in Healthy Young Adults
Authors: Jolma Catherine D. , Samson Ricardo A. , Klewer Scott E. , Donnerstein Richard L. , Goldberg Stanley J.
Published: July 2003

Background: Nicotine is known to have many physiologic effects. The influence of nicotine delivered in chewing gum upon cardiac hemodynamics and conduction has not been well‐characterized. Methods: We studied the effects of nicotine in nonsmoking adults (6 male, 5 female; ages 23–36 years) using a double‐blind, randomized, cross‐over study. Subjects chewed nicotine gum (4 mg) or placebo. After 20 minutes (approximate time to peak nicotine levels), echocardiograms and signal‐averaged electrocardiograms (SAECG) were obtained. After 40 minutes, subjects were again given nicotine gum or placebo in cross‐over fashion. Standard echocardiographic measurements were made from two‐dimensional images. We then calculated end‐systolic wall stress (ESWS), shortening fraction (SF), systemic vascular resistance (SVR), velocity for circumferential fiber shortening corrected for heart rate (Vcfc), stroke volume, and cardiac output. P wave and QRS duration were measured from SAECG. Results: Significant differences (P < 0.05) from control or placebo were found for ESWS, mean blood pressure, cardiac output, SVR, heart rate, and P wave duration. No significant changes were seen in left ventricular ejection time (LVET), LV dimensions, SF, contractility (Vcfc), or QRS duration. Conclusions: These results suggest that nicotine chewing gum increases afterload and cardiac output. Cardiac contractility does not change acutely in response to nicotine gum. Heart rate and P wave duration are increased by chewing nicotine gum.
Dynamic Left Ventricular Outflow Tract Obstruction in the Setting of Acute Anterior Myocardial Infarction: A Serious and Potentially Fatal Complication?
Authors: Hrovatin Enzo , Piazza Rita , Pavan Daniela , Mimo Renata , Macor Franco , Dall'Aglio Vittorio , Burelli Claudio , Cassin Matteo , Canterin Francesco Antonini , Brieda Marco , Vitrella Giancarlo , Gilberto Cattarini , Nicolosi Gian Luigi
Published: July 2003

Dynamic left ventricular outflow tract (LVOT) obstruction was thought to be a hallmark of hypertrophic obstructive cardiomyopathy, especially in those cases with isolated asymmetric septal hypertrophy and systolic anterior motion (SAM) of the mitral valve. Recently, several authors described the occurrence of a dynamic LVOT obstruction during acute coronary insufficiency in ventricles without significant myocardial hypertrophy. The LVOT gradient was reported to disappear following resolution of the ischemic syndrome. Furthermore, it was reported that LVOT obstruction in the setting of acute myocardial infarction could predispose to cardiac rupture. We describe four cases with acute anterior myocardial infarction complicated with a dynamic LVOT obstruction documented by transthoracic Doppler echocardiogram. The detection of the dynamic LVOT obstruction allowed us to optimize the pharmacological treatment in each case. In spite of therapy, two of our patients worsened progressively to fatal cardiogenic shock and cardiac rupture. In conclusion, the development of a LVOT obstruction during acute anterior myocardial infarction has to be considered a serious and potentially fatal complication.
Doppler‐Derived Mitral and Pulmonary Venous Flow Variables Are Predictors of Pulmonary Hypertension in Dilated Cardiomyopathy
Authors: Dini Frank Lloyd , Nuti Rossella , Barsotti Luca , Baldini Umberto , Dell'Anna Rita , Micheli Giovanni
Published: July 2003

This study assessed whether Doppler‐derived mitral and pulmonary venous flow parameters were predictors of pulmonary artery hypertension in patients with left ventricular dysfunction. Doppler echocardiographic examinations were performed in patients (n= 100) with dilated cardiomyopathy in sinus rhythm either symptomatic or asymptomatic before and after optimized therapy with ACE inhibitors, diuretics, and vasodilators. In case of weak or poor Doppler signals, measurable tricuspid regurgitation and pulmonary venous flow tracings were obtained after intravenous administration of 2.5 grams of Levovist at 400 mg/ml. At baseline, left ventricular ejection fraction was 30%± 7% and pulmonary artery systolic pressure was 48 ± 14 mmHg. At the follow‐up study carried out after 6 ± 2 months, reversibility of pulmonary artery hypertension was apparent only in those patients exhibiting favorable changes of mitral flow curve from the restrictive or pseudonormal to impaired relaxation pattern (53 ± 7 mmHg vs 38 ± 8 mmHg; P < 0.0001). Numerous variables correlated significantly with pulmonary artery systolic pressure at baseline, while the correlations were generally weaker at the follow‐up study. The closest correlations were found with E wave deceleration rate (r= 0.73) at baseline and with the systolic fraction of pulmonary venous flow forward peak velocities (r=−0.67) at follow‐up. The stepwise regression model showed that the E wave deceleration rate and the degree of mitral regurgitation were the strongest independent predictors of pulmonary hypertension at baseline, while the ratio between pulmonary venous flow reverse and mitral wave velocities at atrial systole and ejection fraction added minor contributions, leading to a cumulative r value of 0.81. The systolic fraction was the strongest at the follow‐up study, with minor contributions provided by the E wave deceleration rate and the left atrial dimension index, leading to a cumulative r value of 0.71.
Color M‐Mode Flow Propagation Velocity Versus Conventional Doppler Indices in the Assessment of Diastolic Left Ventricular Function in Patients on Chronic Hemodialysis
Authors: Chamoun Antonio J. , Xie Tianrong , Trough Marti , Esquivel‐Avila Jose , Carson Richard , DeFilippi Christopher , Ahmad Masood
Published: July 2003

Background and Objective: Color M‐mode flow propagation velocity (Vp) has been reported as a preload‐independent measure of diastolic function. To study the effects of loading conditions on diastolic function assessment in patients on chronic hemodialysis, we measured Vp and conventional Doppler indices pre‐ and posthemodialysis. Methods: Twenty hemodialysis patients with normal systolic function underwent measurement of Vp, early filling velocity (E), its deceleration time (DT), atrial contraction velocity (A), isovolumic relaxation time (IVRT), and pulmonary atrial flow reversal velocity (PFR) pre‐ and posthemodialysis. Twelve healthy controls underwent these same measurements. Results: Hemodialysis patients had significantly slower Vp at baseline than normal controls, while E/A, DT, IVRT, and pulmonary flow reversal were not significantly different. E, IVRT, and PFR were affected by hemodialysis, while color M‐mode flow propagation velocities, A, and DT were not. Conclusions: Color M‐mode flow propagation velocity seems to be a preload‐independent measure of diastolic function in chronic hemodialysis patients in whom isolated diastolic dysfunction appears prevalent.
Viability of Hypokinetic Segments: Influence of Tethering from Adjacent Segments
Authors: Chia Karin K.M. , Picard Michael H. , Skopicki Hal A. , Hung Judy
Published: July 2003

Hypokinetic myocardium is presumed to be reversibly dysfunctional. However, hypokinetic segments do not necessarily improve after revascularization since their outcome can be influenced by tethering effects of adjacent myocardium. To assess whether hypokinetic segments improve following revascularization, 24 patients underwent resting and dobutamine stress echocardiography (DSE), with a total of 420 (20 per patient) myocardial segments studied pre‐ and postrevascularization. One hundred fifty‐five hypokinetic segments were identified prerevascularization. Postrevascularization, only 57% of these segments improved in wall motion, while 43% showed no improvement or worsening of wall motion. Low dose (5–10 μg/kg/min) DSE identified correctly 57 (65%) of 88 segments that improved, and falsely predicted improvement in 26 (39%) of 67 segments that ultimately did not improve postrevascularization. Of the hypokinetic segments that did not improve, 90% were adjacent to at least one severely hypokinetic or akinetic segment as compared with 73% of the segments that improved following revascularization (P = 0.009). Sixty‐five percent of all true positive DSE responses were adjacent to at least one akinetic or severely hypokinetic segment, while 87% of all false negative DSE responses were adjacent to at least one akinetic or severely hypokinetic segment (P = 0.03). In conclusion, myocardial segments found to be hypokinetic do not necessarily improve after revascularization. This may be related to tethering influences of adjacent segments, which have a contrasting level of function.
Prenatal Role of the Ductus Arteriosus in Absent Pulmonary Valve Syndrome
Authors: Yeager Scott B. , Van Der Velde Mary E. , Waters Brenda L. , Sanders Stephen P.
Published: July 2003

Absent pulmonary valve with ventricular septal defect is associated with ductal agenesis and markedly dilated main and branch pulmonary arteries. The less common variant with intact ventricular septum generally exhibits a patent ductus and smaller branch pulmonary arteries, and may be associated with tricuspid atresia. We identified 7 patients with the prenatal diagnosis of absent pulmonary valve, 5 with ventricular septal defect (Group 1) and 2 with an intact ventricular septum (Group 2). Imaging, color Doppler, and pulsed‐Doppler recordings were analyzed. The branch and main pulmonary arteries were measured and expressed as a ratio with the descending aorta. Pulmonary regurgitation time (PRT) and diastolic acceleration time (DAT) were derived, and DAT/PRT was calculated to characterize diastolic pulmonary flow. Group 1 patients all had a large ventricular septal defect, normal biventricular size and function, and dilated main and branch pulmonary arteries. Group 2 patients had dilated main but smaller branch pulmonary arteries, moderate right ventricular dilation with severe dysfunction, and limited or absent tricuspid inflow. Group 1 demonstrated shorter acceleration time and earlier peak velocity, resulting in a smaller DAT/RT ratio. We speculate that free communication between the fetal aorta and the ventricles may limit atrial inflow and elevate diastolic pressure, affecting cardiac output, ventricular function, and atrioventricular valve development. With an intact ventricular septum, these physiologic and anatomic repercussions are limited to the right ventricle, but with a ventricular septal defect, both ventricles would experience similar consequences and cardiac performance could be critically impaired.
Intracardiac Echocardiography During Catheter‐Based Procedures: Ultrasound System, Examination Technique, and Image Presentation
Authors: Zanchetta Mario , Rigatelli Gianluca , Pedon Luigi , Zennaro Marco , Onorato Eustaquio , Maiolino Pietro
Published: July 2003

A detailed understanding of the anatomic structures of both atria is mandatory for successful catheter‐based interventional techniques. Some of the drawbacks of transthoracic and transesophageal echocardiography can be overcome by intracardiac echocardiography (ICE). We present our ICE experience based on 70 out of 186 patients who were included in a multicenter registry of transcatheter interatrial communication closures. The ultrasound catheter was a 9‐Fr, 9 MHZ monoplane probe (Ultra ICE catheter) compatible with the motor drive unit and imaging console of the Clear View Ultra. Four slice selections in the axial plane and only one in the sagittal plane were needed in order to obtain a comprehensive guide to ICE interrogation. Their intracardiac ultrasound imaging presentation is an essential and nontrivial step. The anatomic coordinate system was maintained identical to a tomographic imaging plane as follows: Left/right and anterior/posterior in the axial planes and superior/inferior and anterior/posterior in the sagittal plane. In order to identify the imaging coordinates, two specific anatomic landmarks were used. The first one was the crista terminalis (at 10 o′clock) and the second one was the right atrial auricle (at 12 o′clock). Once the ultrasound images were orientated, their interpretation and spatial reconstruction were straightforward. In conclusion, a standardized ICE examination allows for a comprehensive evaluation of the right atrial anatomy and may be helpful in guiding therapeutic catheter‐based interventions. The major clinical advantages of ICE include optimal contrast between soft‐tissue structures, limited fluoroscopic exposure time, and good patient acceptance, thus avoiding general anesthesia.
Left‐Sided Endocarditis in Intravenous Drug Users: A Case Report and Review of the Literature
Authors: Seghatol Frank , Grinberg Isaac
Published: July 2003

We report a case of staphylococcus endocarditis of the mitral and aortic valves in an intravenous drug user (IVDU) complicated by abscess of the aortic root and aorto‐left atrial fistula. Interestingly, the tricuspid valve was free of vegetation. Infective endocarditis in IVDUs more commonly involves right‐sided valves; left‐sided endocarditis is rare, indicates severe disease, or is a postmortem finding. This case illustrates the need for considering left‐sided valve endocarditis in IVDU with septicemia, even if the tricuspid valve shows no evidence of vegetation.
Very Large Pericardial Effusion Attributable to Minoxidil: Resolution Without Drainage of Fluid
Authors: Shirwany Arsalan , D'Cruz Ivan A. , Munir Ahmad
Published: July 2003

A 52‐year‐old man with a history of chronic hypertension presented with worsening dyspnea and leg edema. He had been on minoxidil for 10 years. The cardiac silhouette was markedly enlarged. Echocardiography and computed tomography showed a large pericardial effusion. His cardiac status was stable and he was in no cardiorespiratory distress. No attempt was made to drain the fluid. Minoxidil was discontinued, and a month later, the effusion had virtually disappeared. Cessation of minoxidil administration and conservative management may suffice, even though the pericardial effusion is large.
Reversible Left Ventricular Function After Tricuspid Valve Replacement for a Patient with Congenital Isolated Severe Tricuspid Regurgitation
Authors: Hung Ming‐Jui , Kuo Li‐Tang , Wang Chao‐Hung , Cherng Wen‐Jin
Published: July 2003

We describe the case of a 30‐year‐old man presenting with congenital, isolated severe tricuspid regurgitation due to posterior leaflet dysfunction. An impaired left ventricular ejection fraction and restrictive filling pattern were noted, recovering after tricuspid valve replacement. The left ventricular dysfunction, reversible in this case, may have been the result of right ventricular volume overload, resulting in ventricular septal paradox.
Echocardiographic Diagnosis of Apical Hypertrophic Cardiomyopathy with Optison Contrast
Authors: Patel Jagruti , Michaels Jeremy , Mieres Jennifer , Kort Smadar , Mangion Judy R.
Published: July 2003

We describe a case of obstructive apical hypertrophic cardiomyopathy in a 61‐year‐old Caucasian female with a history of chest pain syndrome. The patient was referred to the echo lab by her nuclear cardiologist, who was impressed by her abnormal stress nuclear perfusion scan that showed marked increased uptake of radioisotope at the left ventricular (LV) apex. The patient had deep negative T waves on her electrocardiogram similar to those originally described in the Japanese population. Transthoracic echocardiography with native harmonic imaging was suboptimal for visualizing LV segments. Therefore, 0.5 cc of Optison contrast was given intravenously, with repeat transthoracic imaging confirming the diagnosis. The patient and her family were referred for additional genetic testing and cardiovascular workup.
Transesophageal Echocardiographic Identification of Right Vertebral Artery
Authors: Ahmed Sujood , Nanda Navin C. , Manchikalapudi Partha , Nekkanti Rajasekhar , Yousif Abdalla M.
Published: July 2003

We describe a transesophageal technique for identifying the origin and precervical course of the right vertebral artery with the probe positioned in the upper esophagus. The technique was successful in 9 of 11 patients in whom it was attempted.
Cavitation versus Degassing: In Vitro Study of the Microbubble Phenomenon Observed During Echocardiography in Patients with Mechanical Prosthetic Cardiac Valves
Authors: Girod Grégoire , Jaussi Andres , Rosset Cédric , De Werra Philippe , Hirt Félix , Kappenberger Lukas
Published: July 2003

Background: With the advent of second harmonic imaging in echocardiography, microbubbles have been observed during opening and closure of mechanical prosthetic valves. The single phenomenon of cavitation, an extremely short event described in the literature, cannot explain the persistence of microbubbles during several hundred milliseconds. Therefore, in vitro we reproduced two distinct phenomena created by a local depression occurring during the closure and/or opening of prosthetic valves: Cavitation and degassing. Methods: We used a water circuit system enriched with CO2 that passes through a Venturi tube in order to create variable pressure gradients. Three types of observations were performed: (1) the dimensions of the bubbles as a function of pressure, (2) calibration of the echocardiograph, and (3) comparison and illustrations of the difference between bubble formation by cavitation (vaporization) and degassing (liberation of CO2). Results: According to the different pressures exerted, the dimensions of the bubbles only vary by several microns, not measurable in practice. Second, the calibration of the echocardiograph reveals that the dimensions of the bubbles measured by ultrasound are greater by a factor of 1.75. Finally, the observed cavitation is a short phenomenon (several milliseconds) and happens under a great local pressure gradient. The degassing produces microbubbles lasting up to as long as > 1 second under much lower pressure. Conclusion: This in vitro study suggests that microbubbles observed during several hundred milliseconds after the opening of prosthetic cardiac valves are the result of degassing of CO2 in blood rather than a cavitation phenomenon as suggested in the literature.
Clinical Utility of Low Dose Dobutamine Echocardiography in Regional Myocardial Viability Detection Before and After Surgical Revascularization
Authors: Moreno Juan Batista González , Beltrán Alvaro , Pouso Jorge , Ortiz Antonio , Lado Mario , Galain Gustavo , Filgueira Luis , Scola Ramón , Bigalli Daniel , Brusich Daniel , De Lilla Adriana , Di Paola Nenufar , Firpi Laura , Besada Enrique
Published: July 2003

Seventy‐eight consecutive patients (mean 63 ± 10 years, 79.5% men) with a history of myocardial infarction and indication of coronary artery bypass grafting (CABG) were studied with low dose dobutamine stress echocardiography (DSE) before (DSE 1) and at 3‐month follow‐up (DSE 2) to evaluate its clinical utility in the detection of viable myocardium. We determined the expected utilities of global patients (P; n = 67) and coronary territories (T; n = 126) with the classic strategy: DSE 1 and results of a rest follow‐up echocardiogram (REST 2) and applying them to a complementary strategy that submitted false positives (Fp) and false negatives (Fn) results to DSE 2. Assigned utilities in each node of the decision tree were maximal (1.0), submaximal (0.75), and intermedium (0.50) using the folding method as a mathematical model. Results: Global P and T expected utilities when performing DSE 1 were 0.84 and 0.89, respectively for positive viability; 0.85 and 0.82, respectively; and for negative viability 0.83 and 0.82, respectively. The expected utilities with the decision of performing a DSE 2 to Fp were 0.74 and 0.76, respectively (viability was detected in 66% of P and in 58% of T) and 0.47 and 0.45, respectively, as applied to Fn. Conclusions: Low dose DSE results in high clinical utility by finding viable or scar myocardium before CABG as well as when discordant results are found in follow‐up, particularly with Fp.
Prognostic Value of Dobutamine Echocardiography in Patients with Intermediate Coronary Lesions at Angiography
Authors: Ciaroni Stefano , Bloch Antoine , Hoffmann Jacques Lars , Bettoni Marco , Fournet Dominique
Published: July 2003

The prognostic value of dobutamine echocardiography (DOBU‐ECHO) in patients with intermediate coronary lesions has not been described in the literature. The aim of this study was to determine the prognostic value of DOBU‐ECHO in patients presenting with coronary lesions smaller than 50% at angiography. Ninety‐four consecutive patients were analyzed and followed‐up for 64 ± 7 months (range: 12 to 75 months). All patients presented with coronary lesions between ≥ 30% and < 50% of the luminal diameter of at least one major epicardial vessel. The patient population was divided into two groups: Those with a positive DOBU‐ECHO (n = 23) and those with a negative DOBU‐ECHO (n = 71). The number of coronary lesions did not differ between the two groups. The patients with a positive DOBU‐ECHO result were more likely than those in the negative group to have a family history of coronary artery disease or suffer from hypertension or a dyslipidemia. During the follow‐up period, 13 cardiac events occurred (1 cardiac death, 5 myocardial infarctions, 2 unstable anginas, and 5 myocardial revascularizations), 11 (47.8%) of which occurred in patients with positive DOBU‐ECHO. The annual incidence for a cardiac event was 7.9% per year in the positive DOBUECHO group and 0.5% per year in the negative DOBU‐ECHO group (P < 0.001). This incidence remained significant for spontaneous cardiac events, such as cardiac death, myocardial infarction, and unstable angina (5.8% per year vs 0.2% per year; P < 0.001). Conclusions. In patients with angiographically confirmed intermediate coronary lesions, a positive DOBU‐ECHO is an additional risk factor for the onset of a cardiac event, whereas a negative DOBU‐ECHO can be used to define patients with a low cardiac risk.
An Early Predictor of Left Ventricular Remodeling After Reperfused Anterior Acute Myocardial Infarction: Ratio of Peak E Wave Velocity/Flow Propagation Velocity and Mitral E Wave Deceleration Time
Authors: Ueno Yoshiki , Nakamura Yasuyuki , Kinoshita Masahiko , Fujita Tamotsu , Sakamoto Taizou , Okamura Hiroshi
Published: July 2003

Several studies have demonstrated that the ratio of peak E wave velocity/flow propagation velocity (E/FPV) using color M‐mode Doppler echocardiography and the mitral E wave deceleration time make it possible to estimate left ventricular filling pressure. Recent studies have indicated that deceleration time can predict left ventricular dilation after acute myocardial infarction. The purpose of this study was to determine whether the early assessment of deceleration time and E/FPV could predict left ventricular dilation after acute myocardial infarction. We studied 55 patients with first anterior acute myocardial infarction who underwent successful coronary angioplasty by two‐dimensional (2‐D) Doppler echocardiography within 12 hours and at 1 and 6 months after reperfusion. Patients were divided into three groups according to deceleration time and E/FPV immediately after reperfusion: (1) restrictive filling (deceleration time < 140 msec and E/FPV ≥ 2.0), (2) elevated filling pressure (deceleration time ≥ 140 msec and E/FPV ≥ 2.0), (3) and normal filling pressure (deceleration time ≥ 140 msec and E/FPV < 2.0). The end‐diastolic volume index (EDVI) was similar in the three groups immediately after reperfusion. EDVI in the groups with restrictive filling and elevated filling pressure was significantly greater than that in the group with normal filling pressure at 6 months (93 ± 11 and 89 ± 16 vs 59 ± 11 ml/m2, respectively; P < 0.0001). E/FPV shows a better correlation with the change in EDVI at 6 months than deceleration time (r = 0.77; P < 0.0001 and r =− 0.46; P < 0.001, respectively). The early measurement of E/FPV provides a simple and accurate means for predicting left ventricular dilation after acute myocardial infarction.
Intraoperative Echocardiography and Minimally Invasive Cardiac Surgery
Authors: Shanewise Jack S. , Zaffer Rashid , Martin Randolph P.
Published: July 2003

The term minimally invasive cardiac surgery encompasses a number of different techniques, each with its own rationale, origin, and development, but all focusing on limiting the physiologic trespass of cardiac surgery on the patient. In this article, we discuss the application of intraoperative echocardiography to three types of these procedures: Offpump coronary artery bypass graft (OPCABG) surgery, valvular surgery through limited thoracic incisions, and port‐access heart surgery.
Intraoperative Transesophageal Echocardiography with a Special Focus on a Patient Undergoing Advanced Robotic‐Assisted Procedures
Authors: Sorrell Vincent L. , Rajeev Angampally G. , Nifong L.W. , Chu F.V. , Chitwood Walter R.
Published: July 2003

Intraoperative echocardiography (IOE) has earned a major role in surgical decision‐making and helps the cardiac surgeon decide and proceed with appropriate intervention based on the visualized pathology. With the advent of minimally invasive surgical techniques and robotic‐assisted operations, more emphasis and dependence has been placed on IOE. We describe our experience with IOE during mitral valve repair at our center, which is one of the pioneer centers for these telemanipulation techniques.
Thoracic Aortic Disease: Endovascular Stents
Authors: Kahn Ronald A. , Konstadt Steven
Published: July 2003

Aortic disease is a serious, often life‐threatening condition. The keys to instituting appropriate therapy in diseases of the aorta include accurate and rapid diagnosis and anatomical assessment. Endovascular aortic repair is a new alternative to conventional surgical approaches. Because arterial rupture is a risk of this procedure, appropriate facilities for resuscitation must be present during the procedure. This paper reviews the important aspects of aortic anatomy, echocardiographic imaging of the thoracic aorta, aortic pathology, endovascular surgery, and the role of echocardiography in the evaluation of the surgical outcome.
Volume Reduction Surgery for End‐Stage Ischemic Heart Disease
Authors: Shiota Takahiro , McCarthy Patrick M.
Published: July 2003

The Dor procedure, or infarction excision surgery, was first used in 1984. It is a surgical treatment option for patients with end‐stage ischemic heart failure. In a recently published multicenter study that included a total of 439 patients, average ejection fraction increased from 29 ± 10% to 39 ± 12% after surgery. In our experience, the overall survival rate 18 months after surgery is 89%, and the preoperative mortality rate is 6.6%. These results are similar to the previous reports from Dor′s group, which confirmed the certain value of the surgery. Echocardiography, including intraoperative transesophageal echocardiography, plays an important role in clarifying cardiac anatomies, absolute left ventricular (LV) volumes, ejection fraction, and mitral regurgitation in patients with ischemic heart failure undergoing this surgery. With the development of ultrasound and computer technology, three‐dimensional echocardiography may be preferred when evaluating the surgical results, including determination of absolute LV volumes. Communication between experienced cardiac surgeons and echocardiographers in the operating room is essential for successful outcomes and reliable evaluation of the surgery.
The Relationship Between Left Ventricular Shape and QT Interval Dispersion
Authors: Harjai Kishore J. , Samal Aditya , Shah Mehul , Edupuganti Ravindra , Nunez Eduardo , Pandian Natesa G.
Published: July 2003

Left ventricular geometry is suspected to affect heterogeneity of myocardial repolarization; therefore, it is plausible but unproven that increased sphericity of the left ventricle is associated with greater QT interval dispersion. In 60 patients with dilated cardiomyopathy with left ventricular ejection fraction ≤ 30%, we found that spherical distortion of the left ventricle was associated with increased QT dispersion, implying increased heterogeneity of myocardial repolarization.
How Can Coronary Flow Reserve Be Altered by Severe Aortic Stenosis?
Authors: Nemes Attila , Forster Tamás , Varga Albert , Vass Andrea , Borthaiser Angela , Pálinkás Attila , Csanády Miklós
Published: July 2003

The coronary flow reserve, a well‐known characteristic of the distensibility of the coronary arteries, can be measured by means of dipyridamole stress transesophageal echocardiography. This study compared the coronary flow reserve in patients with normal coronary arteries with aortic stenosis (Group 1), in patients with normal coronary arteries without aortic stenosis (Group 2), and in patients with significant left anterior descending coronary artery disease (Group 3). Patients and Methods: Groups 1 and 2 were comprised of 21 patients each, while Group 3 was comprised of 37 patients. Transesophageal stress echocardiography was carried out according to a standard protocol, with a vasodilator stimulus of dipyridamole in a dose of 0.56 mg/kg over 4 minutes. The coronary flow reserve was calculated as the ratio of posthyperemic to basal peak (CFR) and mean (mean CFR) diastolic flow velocities. Results: The left ventricular mass and left ventricular mass index were significantly higher in Group 1 than in Groups 2 and 3. The coronary flow reserve and the posthyperemic mean diastolic flow velocities were significantly lower, while the resting mean diastolic flow velocities were significantly higher in Groups 1 and 3 than in Group 2. Conclusions: In patients with aortic stenosis and a normal coronary angiogram, the coronary flow reserve is significantly lower, similarly as in the case of significant left anterior descending coronary artery disease. In severe aortic stenosis with left ventricular hypertrophy, stress transesophageal echocardiography is unable to distinguish between the drop in coronary flow reserve caused by a vascular or a myocardial component, and therefore, not suitable for the selection of patients with significant coronary artery disease, even in cases of left anterior descending coronary artery disease.
Relation of Vasodilator Response of the Brachial Artery to Inflammatory Markers in Patients with Coronary Artery Disease
Authors: Kang Seok‐Min , Chung Namsik , Kim Ji‐Young , Koo Bon‐Kwon , Choi Donghoon , Jang Yangsoo , Cho Seung‐Yun
Published: July 2003

Endothelial dysfunction of the coronary artery is closely related to elevated levels of systemic inflammatory markers and cardiovascular events in patients with coronary artery disease (CAD). We hypothesized that patients with CAD may have a higher risk of endothelial dysfunction of the peripheral artery than patients without evidence of CAD, and that endothelial dysfunction of the peripheral artery also may be related to elevated levels of inflammatory markers. Using high resolution ultrasound, we assessed the brachial vasodilator response to reactive hyperemia (endothelium‐dependent) and sublingual nitroglycerin (endothelium‐independent). As inflammatory markers, serum C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR) levels, and lipid profiles were measured in patients with CAD (n = 30, 16 male and 14 female) and normal subjects without evidence of CAD (n = 45, 23 male and 22 female). Patients with CAD (Group II) showed a significantly reduced endothelium‐dependent vasodilation as compared with normal subjects (Group I) (4.4 ± 3.6 vs 7.4 ± 6.1%, P < 0.05). However, endothelium‐independent vasodilation was not significantly different between the two groups (7.7 ± 7.1 vs 9.7 ± 8.0%, P > 0.05). In Group II, CRP level was inversely related to endothelium‐dependent vasodilation (r =−0.398, P = 0.029). In contrast, ESR level was not significantly associated to endothelium‐dependent vasodilation (r =−0.113, P = 0.552). On multivariate analysis, CRP and low density lipoprotein cholesterol levels were significant independent predictors of a blunted endothelium‐dependent vasodilation in Group II. Our study showed that elevated CRP level was associated with blunted endothelium‐dependent vasodilation of the brachial artery in patients with CAD. Thus, identification of elevated CRP levels combined with demonstration of endothelial dysfunction of the brachial artery may have a possible clinical application for the detection of high risk CAD patients.
Strain Rate Imaging: An In Vitro “Validation” Study Using a Physiologic Balloon Model Mimicking the Left Ventricle
Authors: Hashimoto Ikuo , Mori Yoshiki , Rusk Rosemary A. , Davies Crispin H. , Li Xiaokui , Mack Gordon K. , Sahn David J.
Published: July 2003

Background: Strain rate imaging (SRI) can be implemented from digital ultrasound loops of tissue Doppler imaging (TDI) data and is performed as an autocorrelation solution of the distance between intramyocardial targets. As such, it should have better resolution along longer distances of wall segments that are imaged at the length of individual ultrasound scan lines. Methods: We used a new left ventricular double‐balloon phantom with a tissue‐mimicking gel between the walls. Mounted in a water bath and connected to a pulsatile flow pump at four‐stroke volume (30–50 ml/beat), the high frame rate, digital, multiple two‐dimensional/tissue/TDI loops of balloon wall motion were recorded using a GE VingMed system FiVe (3.5 MHz phased array transducer), with the model scanned longitudinally from the apex. The strain rate (SR) values were measured at the apex and the lateral wall using an offline measurement program, and mean SR values for every 100 msec were calculated by averaging three determinations at each point. The excursions of the apex and lateral wall also were measured directly by high speed digital video imaging, and consecutive velocity profiles were calculated every 100 msec. A total of 40 data points for four‐stroke volumes were analyzed. Results: While our balloon model had enough gel targets between the walls to produce a good mimic of myocardial speckle with walls that thickened and thinned, samples immediately across the apex and apex SR values (Hz) varied substantially. In contrast, systematic signals could be obtained from lines imaged >15° from the true apex and crossing a longer length of myocardium. At the lateral wall, there was a close correlation between the video velocities and SR values, as well as a close overlap of the phasic patterns. Conclusions: SRI produces more reliable data from wall segments parallel to scan lines.
Hypovolemia‐Induced Reversible Severe Mitral Regurgitation Due to Left Ventricular Outflow Tract Obstruction
Authors: Rosen Boaz , Kriwisky Michael , Rozenman Yoseph , Harpaz David
Published: July 2003

We describe a hypertensive patient who developed profound cardiogenic shock after treatment with nitrates and diuretics. Echocardiography revealed a marked left ventricular outflow tract obstruction with severe mitral regurgitation that were reversible after aggressive fluid therapy.
Paroxysmal Ventricular Tachycardia Due to Interventricular Hydatid Cyst
Authors: Sağkan Olcay , Köşşüş Adnan , Demirağ Mustafa Kemal , Dursun Ýhsan , Bahadir Hakan , Yazící Mustafa , Keçeligil H. Tahsin
Published: July 2003

A 35‐year‐old male patient with palpitations and mild lightheadedness was admitted to our clinic. Short‐lasting paroxysmal ventricular tachycardia was diagnosed following 12‐lead electrocardiography (ECG). A mass that included two‐thirds of the interventricular septum and the left ventricular cavity was seen by two‐dimensional echocardiography and magnetic resonance imaging (MRI). Specific hemagglutination tests for hydatid cyst were positive. The mass was excised, and the patient had a septoplasty operation to repair the remaining septal defect. He is currently being followed and reports no complaints. No evidence of arrhythmia was noted in 24‐hour ambulatory ECG monitoring.
Anomalous Right Coronary Artery from the Main Pulmonary Artery in a Patient with Double‐Chambered Right Ventricle
Authors: Joseph Thomas , Raccuglia Stephanie , Kort Smadar , Oviasu Felix , Mangion Judy R.
Published: July 2003

We describe a rare case of double‐chambered right ventricle (DCRV) in a 32‐year‐old female presenting to the echocardiography lab for evaluation of congenital heart disease. We identified a unique constellation of findings, including the DCRV, a perimembranous ventricular septal defect, aortic valve prolapse, patent foramen ovale, and an anomalous right coronary artery coming off the main pulmonary artery. To the best of our knowledge, this is the first reported case describing the association of an anomalous right coronary artery coming off the main pulmonary artery in a patient with DCRV.
Transesophageal Echocardiographic Detection of Left Vertebral Artery Origin Stenosis
Authors: Aaluri Srinivasa , Miller Andrew P. , Nanda Navin C. , Orr Sean C. , Nekkanti Rajasekhar S. , Gomez Camilo R.
Published: July 2003

We discuss the case of a patient with stroke in whom severe stenosis at the origin of the left vertebral artery was identified by transesophageal echocardiography and subsequently confirmed with conventional angiography.
Intraoperative Transesophageal Echocardiography in Valve Replacement Surgery
Authors: Rosenhek Raphael , Binder Thomas , Maurer Gerald
Published: July 2003

Transesophageal echocardiography (TEE) is applied widely during heart valve replacement surgery. Intraoperative TEE (IOTEE) is used to formulate the surgical plan, assess cardiac function, and evaluate surgical outcome. This review describes the methodology of IOTEE, focusing on its role in valve replacement surgery. Specific aspects, such as its role in surgical decision making, selection of the prosthetic model and size, detection and quantification of paravalvular leaks, outflow tract obstruction, and acute prosthetic valve obstruction, are discussed. Furthermore, a description of the value of IOTEE in newer procedures, such as port access surgery, is presented.
New Technology and Methodologies for Intraoperative, Perioperative, and Intraprocedural Monitoring of Surgical and Catheter Interventions for Congenital Heart Disease
Authors: Rice Mary J. , McDonald Robert W. , Li Xiaokui , Shen Irving , Ungerleider Ross M. , Sahn David J.
Published: July 2003

We review the new technology and methods available for support of intraoperative and intraprocedural imaging in the catheterization laboratory for surgical and interventional catheterization procedures in the treatment of congenital heart disease. The methods reviewed include miniaturized probes and new ways of using them perioperatively for cardiac imaging from transesophageal, substernal, and intracardiac imaging locations. The smaller and more versatile the probes, the better adapted they will be in providing methods to improve the outcomes in babies born with serious forms of congenital heart disease.
Intraoperative Epicardial Coronary Artery Imaging: Rationale, Methods, and Applications
Authors: Xing Yan‐Qiu , Khabbaz Kamal R. , Karia Darshak , Robinson Davida A. , Weintraub Andrew , De Castro Stefano , Pandian Natesa G.
Published: July 2003

Epicardial coronary imaging using high frequency (7–12 MHz) ultrasound probes could aid the surgeon performing coronary artery bypass procedures by localizing the coronary artery segments underneath epicardial fat, identifying the site of coronary stenosis to be bypassed, evaluating the integrity of distal coronary artery, assessing the efficacy of anastomosis, and detecting anastomotic complications. While an ideal coronary imaging probe is yet to be developed, early clinical experience with vascular imaging probes applied on the coronary vessels suggests that epicardial coronary artery imaging could enhance the optimum performance of coronary interventions. Fabrication of a flexible high frequency probe that could be applied not only on the arteries on the anterior surface of the heart but also on the lateral and posterior surfaces could facilitate development of newer surgical procedures as well.