bluuebunny/crossref_metadata_2025 huggingface dataset:
Echocardiographic Assessment of Adults with Tetralogy of Fallot
Authors: CHILD JOHN S.
Published: August 2007

Advances in medical and surgical management of congenital heart disease in the last three decades have resulted in a great many survivors to adulthood. Proper care requires intimate knowledge of the basic malformations and their surgical anatomy and results. Tetralogy of Fallot, the most common cyanotic malformation in adults, represents a spectrum from mild right ventricular outflow tract obstruction to complete pulmonary atresia. Evaluation of surgical residua and sequelae includes imaging of aortic‐to‐pulmonary arterial palliative shunts, detection of residual ventricular septal defect patch leaks or right ventricular outflow tract obstruction, definition of extracardiac conduit patency, and quantitation of ventricular function and valvular regurgitation. Refined echocardiographic imaging and hemodynamic definition is a mainstay in precise segmental anatomical and hemodynamic assessment. Transesophageal echocardiography is particularly important for intraoperative evaluation of surgical results. (ECHOCARDIOGRAPHY, Volume 10, November 1993)
Infected Myxomas:Report of a Case and Review of the Literature
Authors: VILACOSTA ISIDRE , ZAMORANO JOSÉ , RAMOS JOSÉ MANUEL , ROMÁN JOŚE ALBERTO SAN , CAMINO ASUNCIÓN , ROCA VICTOR , CASTAÑÓN JOSÉ , GIL MANUEL
Published: August 2007

Myxomas, the most common primary cardiac tumors, rarely become infected. This report describes a patient with a right atrial myxoma and a very unusual and life‐threatening complication: infection with resultant bacteremia. The few cases reported in the literature are reviewed. The relevance of transesophageal echocardiography (TEE) in the diagnosis and assessment of atrial masses is emphasized.
Horizontal Plane Transesophageal Echocardiography May Be False Negative for Large Tricuspid Vegetations
Authors: GUARNERI ERMINIA , TUNICK PAUL A. , KENNEDY JAMES T. , KRONZON ITZHAK
Published: August 2007

A 37‐year‐old man was admitted to the hospital with fever. Because of a history of intravenous drug abuse, and a picture consistent with septic pulmonary emboli, right‐sided endocarditis was suspected. However, transthoracic echocardiography did not reveal any vegetations. Transesophageal echocardiography was therefore done, and excellent visualization of the tricuspid valve with the horizontal plane view showed what appeared to be a normal tricuspid valve. However, the vertical plane image clearly showed a large tricuspid vegetation. This case illustrates the advantage of the biplane transesophageal transducer, as the diagnosis would have been missed with a standard single plane probe.

transesophageal echocardiography, tricuspid vegetation, biplane transesophageal echocardiography
Transesophageal Echocardiography and Concurrent Coronary Angiography for the Rapid Assessment of Papillary Muscle Rupture
Authors: KOZLOWSKI CHRISTOPHER M. , DOROGY MARK E.
Published: August 2007

Echocardiography with color flow imaging is valuable for identifying mechanical complications of myocardial infarction. Transesophageal echocardiography is useful for critically ill patients in whom transthoracic imaging is often insufficient. A case of papillary muscle rupture is presented in which transesophageal echocardiography was performed concurrently with coronary angiography. The detailed information obtained from two‐dimensional and color flow imaging eliminated the need for diagnostic right heart catheterization and left ventriculography. Transesophageal echocardiography used in this manner can facilitate expeditious surgical management.

papillary muscle, transesophageal echocardiography, myocardial infarction
A Study of the Heating of Plaque During an Intravascular Procedure
Authors: CHELLAIAH S.
Published: August 2007

In invasive techniques such as laser angioplasty and intravascular ultrasonography, there is a source of heat inside the vascular system that is being released/dissipated by the inserted device. In this article, the transfer of heat from this source to the plaque deposited on the walls of the artery has been studied numerically using two different models. The models consider the transient conduction and the absorption of heat through the plaque. The variation of thermophysical properties is also included in the analysis. It was found that the temperature distribution depends significantly on the type of plaque and the power level.

heat transfer, arterial plaque
Transesophageal Echocardiographic Findings in Complete Unilateral Anomalous Pulmonary Venous Connection of Right Lung to Right Atrium
Authors: SANYAL RAJAT S. , NANDA NAVIN C. , SNELL DERRY , FINCH ANA , LOUNGANI RAMESH R. , BLACKWELL GERALD G. , PACIFICO A.D.
Published: August 2007

Transesophageal echocardiographic findings in a patient with anomalous drainage of both right‐ sided pulmonary veins into the right atrium are described. The atrial septum was intact and the left‐ sided veins connected normally with the left atrium.

transesophageal echocardiography, partial anomalous pulmonary venous connection of the right pulmonary veins to the right atrium
Transient Hypertrophic Obstructive Cardiomyopathy During Pregnancy
Authors: ROSENBLATT JEFFREY A. , OSHER HAROLD L. , LAMBREW COSTAS T.
Published: August 2007

Hypertrophic obstructive cardiomyopathy (HOCM) is a primary myocardial disease with typical echocardiography features of asymmetric septal hypertrophy and evidence of left ventricular outflow tract obstruction. The natural history of HOCM is characterized by a slow progression of symptoms and a significant annual mortality rate. We report an unusual case of transient HOCM during pregnancy with evidence of total resolution postpartum.

hypertrophic cardiomyopathy, pregnancy, idiopathic hypertrophic subaortic stenosis, two‐dimensional echocardiography, Doppler echocardiography
Quantification of Left Ventricular Dimensions On Line with Biplane Transesophageal Echocardiography and Lateral Gain Compensation
Authors: DÁVILA‐ROMÁN VICTOR G. , CARDONA HIRAM , FEINBERG MICHA , PEREZ JULIO E. , BARZILAI BENICO
Published: August 2007

To determine the feasibility and accuracy of biplane transesophageal echocardiography (TEE) with automatic boundary detection (ABD) for the estimation of left ventricular areas, we examined 19 consecutive patients with the use of this technique. In addition, we evaluated the utility of lateral gain compensation (LGC) to improve the online tracking of the ABD algorithm on the lateral endocar‐dial‐blood boundary of the echocardiographic image. The transverse plane short‐axis TEE view and the longitudinal plane two chamber TEE view were used for the analysis. A semiquantitative estimate (in degrees) of the endocardial circumference, in which the boundary was correctly identified and tracked on line, improved from a mean of 198o to 360o with LGC (P < 0.001). Results of comparisons of offline and online biplane TEE cavity areas revealed excellent correlations of values for the 16 patients (84%) in whom adequate transverse plane short‐axis images were obtained (r values> 0.9 at systole and diastole). The correlation was also excellent (r values > 0.9) in the nine patients in whom longitudinal plane two‐chamber views adequate for ABD analysis were obtained at systole and diastole. LGC significantly improved the accuracy of endocardial detection and tracking, which otherwise would be limited due to the anisotropic properties of the myocardium. Thus, ABD during biplane TEE may be feasible in a significant number of patients and accurately reflects left ventricular areas when compared with offline methods.

transesophageal echocardiography, LV areas
Cardiac Abnormalities in One Case of Maple Syrup Urine Disease
Authors: ECKERD JOHN M. , HANSEN JAMES
Published: August 2007

Classic Maple Syrup Urine Disease is a rare and serious metabolic disorder caused by inability to metabolize leucine, valine, and isoleucine properly. Accumulation of branched chain ketoacids leads to impairment of all vital organs, including the heart. Corrected QT index is prolonged during the early stages of the disorder. Quantitative Doppler demonstrates abnormalities in ventricular compliance and relaxation characteristics.

Maple Syrup Urine Disease, myocardial diseases, echocardiography, Doppler, long QT syndrome
Embolic Accident Following Heparin Therapy for a Left Ventricular Clot Diagnosed by TEE:
Authors: AMUCHASTEGUI LUIS MARIA , AMUCHASTEGUI MARCOS , MOREYRA EDUARDO , SALOMONE OSCAR
Published: August 2007

There are few data available on the incidence of embolic events inpatients with systemic anticoagulation. We describe a 40‐year‐old woman in congestive heart failure who was shown by transesophageal echocardiography to have an apical thrombus in the left ventricle without concomitant aneurysm. The patient was started on heparin immediately after the diagnosis was established. Twelve hours later she developed an embolic cerebrovascular accident. We believe that heparin dislodged the thrombus as occurs occasionally with thrombolytic agents used in the treatment of acute myocardial infarction.

transesophageal echocardiography, paradoxical embolization with heparin treatment, left ventricular thrombus
Redundant Mitral Valve Simulating an Intracardiac Mass on Transesophageal Echocardiography
Authors: WILLENS HOWARD J. , CHAKKO SIMON , LEVY RALPH , BAUERLEIN E. JOSEPH , KESSLER KENNETH M.
Published: August 2007

Cardiac ultrasound is a useful diagnostic modality for the evaluation of cardiac masses and tumors. However, normal cardiac structures and normal variants can mimic masses with both transthoracic echocardiography and transesophageal echocardiography. We report two patients in whom a redundant mitral leaflet simulated cardiac tumor attached to the mitral valve by transesophageal echocardiography. (ECHOCARDIOGRAPHY, Volume 11, May 1994)
Quantitative Assessment of Lumen Area Stenosis by Doppler Echocardiography and Application of Continuity Equation
Authors: YAMAGISHI MASAKAZU , NAKATANI SATOSHI , MIYATAKE KUNIO
Published: August 2007

Assessment of luminal stenosis plays a central role in the clinical decision makings for patients with heart diseases. To examine the role of Doppler echocardiography in the measurement of stenotic areas, we attempted to determine the mitral valve area and coronary artery stenosis by Doppler technique with a continuity equation. Mitral valve area was determined as a product of aortic or pulmonic annular cross‐sectional area and the ratio of time velocity integral of aortic or pulmonic flow to that of the mitral stenotic jet. Mitral valve area determined at catheterization by Gorlin's formula was used as a gold standard. In the determination of coronary artery stenosis, flow velocity at the site prior to the stenotic lesion and that of stenosis was measured by catheter‐tipped Doppler flowmeter (3‐Fr, 20 MHz). The severity of the stenosis was calculated from the ratio of time‐velocity integrals from prestenotic and stenotic segments. In 41 patients with mitral valve stenosis, valve area determined by continuity equation method correlated well with catheterization measurements irrespective the presence of aortic regurgitation (r = 0.91, y = 0.84x + 0.15, P < 0.01). Of 20 patients with coronary artery disease, flow velocity both at the stenosis and prior to the stenosis could be determined in 13 patients examined. Under these conditions, coronary artery stenosis determined by continuity equation varied from 21%–76%. When these values were compared with those determined by biplane cineangiography, there was good correlation between them (r = 0.83, y=0.92x – 0.45, P < 0.01). These results demonstrate that Doppler‐derived luminal area stenosis is applicable to assess the severity of the stenotic lesions, providing further information which cannot be obtained by the conventional methods, although several limitations should further be resolved. (ECHOCARDIOGRAPHY, Volume 11, May 1994)
Transesophageal Echocardiography During Radiofrequency Ablation of Left‐Sided Free Wall Atrioventricular Accessory Pathways in Wolff‐Parkinson‐White Syndrome
Authors: SARNOSKI JOSEPH , BAJWA TANVIR , DESHPANDE SANJAY , SCHMIDT DONALD H. , GAL RAMI
Published: August 2007

This study reports our initial experience in performing radiofrequency ablations (RFA) of Wolff‐Parkinson‐White accessory pathways in the lateral wall of the left ventricle with monitoring and guidance provided by transesophageal echocardiography (TEE). Fifty RFA procedures were performed in 48 patients. TEE was used to detect underlying heart disease (in nine patients), monitor coronary sinus catheterization (in 15 patients), guide atrial transseptal catheterization (in 29 procedures), help position the RFA catheter's tip, and evaluate for possible complications in all patients. The study suggests that TEE may help to guide electrophysiologists during their initial experience with RFA procedures.
Obstruction of Left Atrial Filling by a Large Descending Thoracic Aortic Aneurysm Detected by Pulsed Doppler Echocardiography
Authors: SADANIANTZ ARA , PYNE CHRISTOPHER T.
Published: August 2007

We describe the echocardiographic findings of extrinsic compression of the left atrium by a large aneurysm of the descending aorta. Pulsed Doppler echocardiography demonstrated increased velocity at the junction of left atrium and pulmonary vein suggesting obstruction of left atrial filling.
Spontaneous Echo Contrast in a Polycythemic Patient with a Ventricular Septal Defect
Authors: HUTCHISON STUART J. , TAK TAHIR , MATTHEWS SAJEN , CHANDRARATNA P. ANTHONY N.
Published: August 2007

We describe the unusual case of spontaneous echo contrast (SEC) and thrombus occurring in a 23‐year‐old male with a ventricular septal defect (VSD), Eisenmenger's complex, and severe polycythemia. The contrast effect was faintly seen by transthoracic echocardiography, and was seen clearly by transesophageal echocardiography. The SEC was present in all four cardiac chambers and was particularly obvious in the left ventricle (LV). In addition, there was a large thrombus in the LV. The velocity across the VSD was 1 ml sec. The patient's hematocrit was 74%. The platelet count was normal and total proteins were 8.9 gm%. The widespread SEC may be related to rheologic abnormalities related to the secondary polycythemia and, perhaps, became more obvious due to the moderate LV dysfunction.
Evaluation of Postinfarction Viable Myocardium at Jeopardy by Dobutamine Echocardiography and Myocardial Contrast Echocardiography
Authors: GALIUTO LEONAKDA , MARCHESE ALFREDO , CAVALLARI DANIELA , ILICETO SABINO , RIZZON PAOLO
Published: August 2007

Both myocardial contrast echocardiography (MCE), obtained by intracoronary injection of sonicated Ioxaglate, and dobutamine echocardiography (DE) were performed before and after percutaneous transluminal coronary angioplasty (PTCA) in a patient with recent myocardial infarction, an occluded infarct related artery (IRA) and collateral flow. An opposite response to low and high dose dobutamine (increase and decrease in regional contractility, respectively) suggested the presence of viable myocardium at jeopardy in the infarcted area. This myocardial area was exclusively perfused by collateral circulation (demonstrated by MCE) supplied by an angiographically normal left coronary artery. After PTCA, right coronary artery flow was re‐established and angiographically demonstrated collateral flow disappeared. MCE showed a normal right coronary artery perfusion bed and relevant overlap areas after left coronary MCE injection. Dobutamine echocardiography performed after PTCA demonstrated persistence of viability, but disappearence of myocardial ischemia.
Transesophageal Echocardiography Findings of an Infected Quadricuspid Aortic Valve with an Anomalous Coronary Artery
Authors: FINCH ANA , OSMAN KHIDIR , KIM KEE‐SIK , NANDA NAVIN C. , WILLMAN BERT , SOTO BENIGNO , KIRKLIN JAMES K.
Published: August 2007

We describe a patient with severe aortic regurgitation in whom transesophageal echocardiography coupled with cardiac catheterization and pathological examination confirmed the diagnosis of a quadricuspid aortic valve, anomalous coronary artery, and aneurysm of the noncoronary sinus of Valsalva.
Model‐Based Estimation of Vascular Parameters:
Authors: ANGELSEN B.A.J. , AAKHUS S. , RABBEN S.I. , TORP H.G.
Published: August 2007

Left ventricular performance depends not only on myocardial state, but also on the properties of the systemic arterial tree. These properties can be assessed from recordings of aortic root pressure and flow by the use of appropriate vascular models. Noninvasive estimates of aortic root pressure and flow can be obtained by the combined use of calibrated external subclavian artery pulse tracing and Doppler echocardiography. With recent advances in computer technology, estimation of model parameters are thus accessible in the clinical setting. We discuss the suitability of different parametric vascular models together with methods for adapting these models to the measured aortic root pressure. We compared the results obtained with simple vascular models (three‐component modified Windkessel models) with those of five‐component models. The simpler models gave less accurate approximation of the measured pressure waveform, but for a representative set of aortic root pressure and flow data, the simpler models provided adequate estimates of the peripheral arterial resistance, the total arterial compliance, and the proximal aortic area compliance. Furthermore, the simpler models are robust for measurement noise with simple estimation algorithms. Distal arterial pressure and flow waveforms are more oscillatory, and for these the five‐component model has more robust estimation schemes with more accurate estimated parameters. Hence, we conclude that for clinical noninvasive assessment of aortic vascular properties, the simpler three‐component models provide adequate information. For assessment of the peripheral arteries with large oscillations in the flow, the three‐component models can give more than 10% error in the compliance estimate and more complex models can be appropriate.
High Quality Stress Echocardiography Using Simultaneous Transesophageal Echocardiographic Imaging and Atrial Pacing
Authors: KAMP OTTO , DE COCK CAREL C. , VISSER GEES A.
Published: August 2007

The combination of transesophageal atrial pacing and transesophageal echocardiography (TEE) provides an alternative stress echocardiographic technique capable of assessing pacing‐induced wall‐motion abnormalities and ischemia‐induced mitral regurgitation. The rationale for combining pacing with TEE resulted from experiences with inadequate transthoracic stress studies in up to 15% of the patients and second, from failure of transesophageal atrial pacing with a single lead in another 15% of the patients. Simultaneous TEE and transesophageal atrial pacing was performed in 90 consecutive patients using continuous short‐axis monitoring obtained at papillary muscle level. All but one patient had good image quality at rest and during pacing. No complications occurred, in five patients (6%) pacing had to be discontinued prematurely because of discomfort. Early atrio‐ventricular Wenckebach block occurred in eight patients (9%). In 83 patients (92%) coronary artery angiography was performed. Sensitivity for assessment of suspected coronary artery disease was 83%, and specificity 94%. Multivessel disease in patients with prior myocardial infarction was assessed with sensitivity of 77%, and specificity of 100%. In 6 of 25 patients (24%) new or increasing mitral regurgitation after induction of wall‐motion abnormalities was observed. In conclusion, TEE in conjunction with atrial pacing is feasible, safe, and an alternative echocardiographic stress technique, capable of detecting wall‐motion abnormalities and changes in mitral regurgitation. Because of its semi‐invasive nature, only patients with a poor transthoracic window are candidates.
Misleading Echo‐Doppler Findings in Prolapsing Right Atrial Myxoma
Authors: ZEPPELLINI ROBERTO , GHENO GIUSEPPE , CUCCHINI FRANCESCO
Published: August 2007

In patients with prolapsing right atrial myxoma, paradoxical ventricular septal motion and right chamber dilatation have been observed. The abnormal septal motion has been ascribed to concomitant severe tricuspid regurgitation. Frame‐by‐frame analysis of echo‐Doppler tracings in one case allows an alternative explanation: the septal motion abnormality and the hepatic vein flow pattern are mainly due to hemodynamic effects of tumor movements during the cardiac cycle.
Transesophageal Echocardiographic Detection of Sinus of Valsalva Dissection
Authors: MAXTED WILLIAM , SANYAL RAJATSUBHRA , NANDA NAVIN C. , KIM KEE SIK , ROYCHOUDHURY DEBASISH , FINCH ANA , HOLMAN WILLIAM
Published: August 2007

We describe a left sinus of Valsalva dissection diagnosed by transesophageal echocardiography and confirmed at surgery. A dissection of the left sinus of Valsalva has not been previously reported.
Is Cardiac Catheterization Necessary in the Era of Echocardiography?
Authors: MISSRI JOSE
Published: August 2007

Definitive evaluation of cardiovascular disease is traditionally accomplished by cardiac catheterization. Advances in transthoracic and transesophageal Doppler echocardiography provides an accurate and cost‐effective approach when compared to cardiac catheterization. Recent data suggests that for most adult patients with aortic or mitral valve disease, Doppler echocardiographic data enables the clinician to make the same decision reached with catheterization data. Echo and Doppler studies are useful in guiding certain therapeutic interventional procedures, and in the diagnosis of aortic dissection, mechanical complications of myocardial infarction, and in identifying aortic atheromas as a potential source of embolism. Future research will need to demonstrate that not only is echocardiography cost‐effective, but that it will change the outcome of the patient.
Precordial Three‐Dimensional Echocardiography With a Rotational Imaging Probe
Authors: ROELANDT JOS , SALUSTRI ALESSANDRO , MUMM BERNARD , VLETTER WIM , BEKKERING LEO , BRUINING NICO
Published: August 2007

We report our initial experience with a precordial hand‐held transducer assembly allowing computer controlled acquisition of cardiac images for dynamic three‐dimensional tissue reconstruction in adult patients. A commercially available transducer and imaging system were used and its video output interfaced with the three‐dimensional reconstruction unit. For this feasibility study, 20 patients in sinus rhythm and with good image quality were examined. The dynamic motion of the valves and ventricles was visualized in three‐dimensional formats as well as relationships of complex pathology. Although the acquisition time in patients in sinus rhythm is relatively short, the reconstruction time is still too long and requires an experienced and dedicated operator. However, with further developments in computer technology dynamic three‐dimensional echocardiography will undoubtedly become an integral if not the principal part of our routine echocardiographic examination in the future.
Left Ventricular Lipoma by Transesophageal and in Vitro Echocardiographic Studies
Authors: MEHTA RAJEN K. , NANDA NAVIN C. , OSMAN KHIDIR , KIM KEE‐SIK , ROYCHOUDHURY DEBASISH , WINOKUR THOMAS S. , PACIFICO ALBERT
Published: August 2007

This case report describes a patient with a known left ventricular mass which was documented by transthoracic echocardiography and which had not changed in size after anticoagulation. The mass was characterized as fatty tumor or hemorrhagic by cardiovascular magnetic resonance imaging study, and surgical removal of the mass was performed. Transesophageal echocardiogram was performed intraoperatively. The tumor appeared homogenous with no echolucencies or echodensities and an overall bright echotexture. In vitro ultrasound studies done using similar instrument gain settings showed the lipoma specimen to have a much brighter appearance than a myxoma. This finding may be helpful in differentiating a lipoma from other left ventricular masses such as myxoma or thrombus.
Myocardial Viability: Nuclear Medicine Versus Stress Echocardiography
Authors: MARZULLO PAOLO , PARODI OBERDAN , SAMBUCETI GIANMARIO , REISENHOFER BARBARA , GIMELLI ALESSIA , GIORGETTI ASSUERO , BARTOLI MONICA , L'ABBATE ANTONIO
Published: August 2007

The failure of nonimaging techniques in the identification of myocardial viability has promoted the clinical application of radioisotopic and echocardiographic methods. Unfortunately, none of these techniques provides, per se, a 100% predictive accuracy and only few studies have been based on the postoperative improvement in regional wall motion, the absolute “gold standard” for myocardial viability. The recent thallium‐201 protocols (reinjection, late redistribution, rest studies) have provided nuclear cardiology with a cell membrane integrity image able to unmask viable myocardium in more than 85% of viable segments. Sestamibi has been introduced as a nonrecirculating flow tracer able to detect transient ischemia as well as thallium‐201. Its main limit, a high sensitivity to intermediate reductions in coronary blood flow, determines a high incidence of false positive studies. Positron emission tomography allows the evaluation of regional myocardial blood flow and metabolism. The marker of viable myocardium is the mismatch between reduced blood flow and normal or increased uptake of 18‐F fluorodeoxyglucose. This technique allows the detection of viable tissue in most segments showing improved postoperative function. In our experience, applying a multiparametric approach, rest thallium‐201 scan, rest sestamibi, dobutamine, and dipyridamole echocardiography showed a sensitivity and a specificity of 86%, 75%, 82%, 75% and 92%, 84%, 92%, and 89%, respectively, in the detection of residual viability. The main advantages of thallium‐201 are reproducibility and standardization; those of stress echo are low cost and availability. In patients with severely depressed ventricular function, positron emission tomography retains a primary role when compared to thallium‐201 and stress echocardiography.
Transesophageal Echocardiographic Analysis of the Systolic Pattern of the Anterior Mitral Leaflet in Patients with Flat Chest
Authors: OKI TAKASHI , FUKUDA NOBUO , TABATA TOMOTSUGU , IUCHI ARATA , TANIMOTO MASATO , MANABE KAZUYO , KAGEJI YOSHIMI , SASAKI MIWA , ITO SUSUMU
Published: August 2007

Transesophageal echocardiography was conducted to determine the systolic pattern of the anterior mitral leaflet in patients with flat chest, and to differentiate it from that associated with mitral valve prolapse. The fronto‐sagittal index (an index of chest flattening) was determined in 50 subjects using chest radiographs, and was used to classify them into a flat chest group (index < 0.38, n= 28) and a normal chest group (index ≥ 0.38, n= 22). We then used transesophageal echocardiography to examine the anterior leaflet in these subjects. A significant positive correlation was observed between the fronto‐sagittal index and the short‐to long‐axis diameter ratio of the left ventricle in all patients. These parameters, and the left atrial dimension were lower in the flat than the normal chest group. The clear zone area of the anterior leaflet during mid‐to late‐systole was significantly larger in the flat chest group. However, no intergroup differences existed in the rough zone area of the anterior leaflet or in the middle scallop area of the posterior leaflet. Mitral regurgitation was observed in 20 and 12 subjects in the flat and normal chest groups, respectively. The maximum mitral regurgitant area did not differ between the two groups. The clear zone area of the anterior leaflet increased significantly following inhalation of amyl nitrite in 22 subjects of both groups, but the other areas did not increase. The mitral regurgitant area decreased or disappeared after amyl nitrite at a similar rate in each group. Thus, the decrease in the antero‐posterior dimension of the thorax in subjects with flat chest affects the systolic pattern of the clear zone of the anterior leaflet more than that of the rough zone of the anterior leaflet or the posterior leaflet. This systolic pattern in such patients differs from that associated with mitral valve prolapse.
Doppler Characteristics of Coronary Blood Flow in Infantile Hypertrophic Cardiomyopathy with Cardiac Tamponade
Authors: SELIEM MOHAMED A. , PALILEO MAE
Published: August 2007

The co‐existence of severe hypertrophic cardiomyopathy and massive pericardial effusion is a rare combination that may lead to a significant decrease in diastolic cardiac filling with marked hemodynamic compromise. We present a unique case where both conditions co‐existed in an infant leading to marked diastolic cardiac dysfunction. It was possible to image the prominent epicardial coronary arteries and assess the coronary blood flow before and after pericardiocentesis using transthoracic two‐dimensional Doppler echocardiography. With large pericardial effusion, there was a significant reduction in coronary blood flow during systole, which increased after pericardiocentesis. The exact mechanism for such phenomenon is only speculative.
Early Prenatal Echocardiographic Diagnosis of Cantrell Pentology with Hypoplastic Right Heart Syndrome
Authors: SELIEM MOHAMED A. , MANASRA KHADER , MIGUEL RICHARD SAN , PALILEO MAE R.
Published: August 2007

Pentology of Cantrell is a complex syndrome involving the thoracic and abdominal walls, the diaphragm, and the heart. We report a case of that syndrome diagnosed early in pregnancy (16 weeks gestation) by fetal echocardiogram. The fetus had a severe form of hypoplastic right heart syndrome. Early diagnosis of such complex cardiac anatomy together with other severe anatomical malformations is important in planning the surgical intervention. It also shows the intimate relationship between the developmental anatomy and physiology of the fetal heart.
Subvalvular Aortic Membrane Masquerading as Valvular Aortic Stenosis
Authors: FORMAN DANIEL E. , NÚÑEZ BORIS D. , KEIGHLEY CRAIG S. , COMSTOCK CINDY A. , DIVER DAN J. , JOHNSON ROBERT G. , DOUGLAS PAMELA S. , MANNING WARREN J.
Published: August 2007

Discrete subvalvular aortic membrane is an unusual cause of left ventricular outflow tract obstruction. While commonly presenting during childhood, one quarter of the individuals are asymptomatic in childhood but remain vulnerable to progressive outflow tract obstruction as well as bacterial endocarditis in adulthood. Unfortunately, because the condition is so uncommon in adults, the diagnosis of subvalvular membrane is often missed or delayed. We recently had the opportunity to care for an adult patient who finally had subvalvular membrane identified as the cause of a left ventricular outflow obstruction, only after a protracted series of diagnostic investigations. Pitfalls in the noninvasive and invasive diagnosis of this condition are reviewed.
Doppler Color Flow Echocardiography
Authors: MARX GERALD R.
Published: August 2007

Doppler color flow imaging has become indispensable in the diagnosis and management of patients with congenital heart disease. Certain defects may not be possible, or may be very difficult to diagnose by two‐dimensional echocardiography alone. Such examples include multiple ventricular septal defects, anomalous pulmonary venous connection, coronary artery malformations, and the hypertensive patent ductus arteriosus. Additionally, color flow Doppler echocardiography significantly provides additional information, and reduces the time for fetal and transesophageal echocardiographic studies. Doppler color flow imaging has become an essential part of the echocardiographic examination. Experience has broadened the use of this important technological advance, with anticipation of an ever expanding future for its clinical application.
Transesophageal Echocardiography in Myocardial Ischemia
Authors: KOZÀKOVÀ MICHAELA , PALOMBO CARLO , PITTELLA GIUSEPPE , DISTANTE ALESSANDRO
Published: August 2007

This article reviews established as well as emerging fields in the application of transesophageal echocardiography (TEE) in the investigation of myocardial ischemia. TEE already has a well defined and established role in stress echocardiography in patients with poor transthoracic acoustic window, and in the detection of intraoperative myocardial ischemia in cardiac and noncardiac surgery. The evaluation of right ventricular ischemia and infarction and the assessment of coronary flow reserve (CFR) are relatively new fields in the application of TEE and the potential of this technique has not yet been fully evaluated. The evidence collected and reviewed in this article is still preliminary but it presupposes a significant role of TEE in the diagnosis and pathophysiological assessment of myocardial ischemia.
Ambient Fluid Velocity Influences Proximal Isovelocity Surface Area Calculations
Authors: BOYLE GERARD J. , BRODER JONATHAN D. , Van AUKER MICHAEL D. , ETTEDGUI JOSE A. , CAPE EDWARD G.
Published: August 2007

Background: Recent reports have described a simplified mass balance equation designed to predict volumetric flow rate through regurgitant and shunt orifices. The proximal isovelocity surface area (PISA) technique relies on the assumption that constant velocity surfaces (isovels) that are hemispheric in shape can be constructed proximal to the orifice, and flow passing through these surfaces must also pass through the orifice by conservation of mass. The method has been validated in simplified in vitro models, but these models have been symmetric in design and do not consist of ambient crossflows that are found in the beating heart. This study addressed the hypothesis that ambient crossflow will affect the validity of the PISA method. Methods and Results: An in vitro model was designed to test the effect of crossflowing streams on the PISA calculation while maintaining control of volumetric flow through the orifice. PISA predicted flows showed a good correlation but overestimated actual flows by 10%–110% (Y = 2.16X‐118, r = 0.96). Addition of low flow data slightly reduced the overestimation (Y = 1.89X‐55.2, r = 0.97). Only under high output state conditions (high orifice and crossing flows) was good agreement found (Y = 0.92X + 9.78, r = 0.95). Conclusions: The presence of crossflowing streams in the vicinity of PISA images will distort the converging flow and its image in such a way that the simplified PISA theory may correlate with true flow but only rarely produces true agreement. Only when competing factors fortuitously cancel does the PISA method appear to be accurate. Since PISA images are readily obtained in patients and since the method has received extensive attention in the literature, systematic derivation of correction factors accounting for crossflow is indicated. In the meantime, caution should be exercised when interpreting PISA images in the presence of crossflowing streams.
Clinical Potential of Three‐Dimensional Echocardiography in Endocarditis
Authors: PANDIAN NATESA G. , CAO QI‐LING , VOGEL MICHAEL , LUDOMIRSKI ACHI , SCHWARTZ STEVEN L.
Published: August 2007

All lesions associated with endocarditis are three dimensional (3‐D). Transthoracic and trans‐esophageal echocardiographic techniques, while highly useful in endocarditis, yield only two‐dimensional (2‐D) data. The newly evolving method of 3‐D echocardiography that provides volume and surface rendered reconstructions could be helpful in endocarditis. The clinical feasibility of 3‐D echocardiography and its ability to display valvular and other cardiac structures have been recently demonstrated. Early experience suggests that vegetations, damaged valves, and other abnormalities could be delineated well by this method in viewing projections unavailable by current clinical techniques. Ongoing refinements in data acquisition, image processing, and display are likely to make 3‐D echocardiography a clinically valuable tool, aiding in enhanced diagnostic appraisal of disorders such as endocarditis, and in making therapeutic decisions.
Has Transesophageal Echocardiography Changed the Approach to Patients with Suspected or Known Infective Endocarditis?
Authors: LIU FENGQI , GE JUNBO , KUPFERWASSER IRI , MEYER JÜRGEN , MOHR‐KAHALY SUSANNE , ROHMANN SVEN , ERBEL RAIMUND
Published: August 2007

Infective endocarditis is still a great clinical challenge. Its diagnosis is difficult to establish, and mortality has remained around 30%. Early diagnosis and optimal treatment are crucial fo prognosis improvement. Echocardiography plays an indispensable role in the management of this disease, especially with the recently introduced approach, transesophageal echocardiography (TEE). TEE can overcome the limitations of transthoracic echocardiography (TTE) and is superior to TTE in almost every way in providing earlier and more information for the diagnosis and treatment of infective endocarditis. TEE detects valve vegetations with much higher sensitivity and specificity than TTE. It can demonstrate smaller vegetations in the early stage of the disease and vegetations on atypical locations (e.g., mitral valve annulus), and provides detailed characterization of vegetations (e.g., location, size, mobility, and changes during treatment). Such information is of great prognostic value and may help in selecting proper treatment. TEE is more sensitive for detecting complications, such as mitral valve perforation, abscess, and subaortic complications, which respond poorly to medicine and for which timely surgery may be the best treatment. For those with prosthetic valve endocarditis, TEE is especially useful because TTE is greatly limited by the acoustic shadow of prostheses. Both positive and negative results of TEE examination are valuable for confirming or excluding infective endocarditis. TEE also plays a unique role in intraoperative monitoring and can assess surgical results before the chest is closed. TEE has become an invaluable tool for the diagnosis and management of patients with suspected or known infective endocarditis.
Echocardiographic Assessment of Vegetations in Patients with Infective Endocarditis
Authors: MÜGGE ANDREAS , DANIEL WERNER G.
Published: August 2007

Today, echocardiography is the most important technique next to clinical findings and blood cultures in the diagnosis of infective endocarditis. The sensitivity of echocardiography, particularly the transesophageal approach, for detection of vegetations and endocarditis related valvular destructions is high. In addition, echocardiographic findings may have some prognostic implications. The size and mobility of vegetations stratifies endocarditis patients into a high risk group for arterial embolism. In particular, mobile vegetations attached to the mitral valve with a maximal diameter > 10 mm may be prone to embolic events. Furthermore, increase in size of vegetations during antimicrobial treatment may identify patients with no, or at least a prolonged, healing process. Also, a lack of increase in the echo density of vegetations under adequate antibiotic treatment may indicate a poor healing process and may necessitate more aggressive management. The demonstration of paravalvular abscesses by echocardiography, particularly by transesophageal echocardiography, identifies a subgroup of patients who will need urgent cardiac surgery before widespread tissue destruction has occurred.
Criteria for the Diagnosis of Endocarditis and the Role of Echocardiography
Authors: DODDS G. ALFRED , DURACK DAVID T.
Published: August 2007

When infective endocarditis is a diagnostic possibility, echocardiography permits noninvasive imaging of cardiac structures. As involvement of the endocardium is a sine qua non of endocarditis, echocardiography may assist in its diagnosis by demonstrating such involvement. The ability of echocardiography to detect the intracardiac manifestations of infective endocarditis has continued to improve, especially with the introduction of transesophageal imaging. This article will discuss some of the echocardiographic findings in endocarditis and elucidate the incorporation of these findings in the new Duke criteria for the diagnosis of endocarditis.
Role of Transesophageal Echocardiography in Right‐Sided Endocarditis
Authors: ROMÁN JOSÉ A. SAN , VILACOSTA ISIDRE
Published: August 2007

Investigations performed over the last few years support the invaluable usefulness of transesophageal echocardiography in the diagnosis of left‐sided endocarditis. Whether this can be applied to right‐sided endocarditis remains speculative. Patients at risk of having right‐sided endocarditis can be classified into three different and well‐defined groups: (1) intravenous drug abusers; (2) patients with pacemakers; and (3) patients with congenital heart diseases. In this article, we review the different value of transesophageal echocardiography in right‐sided endocarditis depending on the subset of patients considered.
Complementary Role of MRI in Infectious Endocarditis
Authors: VILACOSTA ISIDRE , GÓMEZ JORGE
Published: August 2007

The usefulness of magnetic resonance for imaging of cardiac structures is well established. In this study, we evaluated the role of this technique in the diagnosis of perivalvular extension of infectious endocarditis. Our initial experience and the few case reports in the literature show that magnetic resonance imaging can complement echocardiography in the assessment of periannular extension of infectious endocarditis.
Detection of Abdominal Aortic Aneurysm During Routine Echocardiography
Authors: SCHWARTZ KENNETH V. , RASHKOW ANDREW M. , AKELLA MOHAN S.
Published: August 2007

Objective: To determine the feasibility of detecting abdominal aortic aneurysms (AAAs) in the elderly by adding abdominal screening to a standard echocardiographic study. Methods: Prospective consecutive screening was performed on 250 patients (men over 55 years and women over 65 years) referred for standard echocardiography. After completion of the standard echocardiographic exam, abdominal aortic diameter was measured using the echocardiographic transducer. Results: Adequate aortic images were obtained in 216 patients. Thirteen aneurysms (ranging from 3.3–6.6 cm in diameter, nearly equally divided between men and women) were found. Conclusions: Screening of the abdomen in elderly men and women presenting for echocardiographic examination results in a significant yield of AAAs. This simple procedure should be added to the standard echocardiographic examination in the older population.
Atrial Mechanical Function Before and After Electrical or Amiodarone Cardioversion in Atrial Fibrillation
Authors: Amuchastegui Luis Maria , Cravero Cecilia , SALOMONE OSCAR , AMUCHASTEGUI MARCOS
Published: August 2007

In some patients with atrial fibrillation (AF), it has been suggested that left atrial mechanical dysfunction can develop after successful electrical cardioversion, justifying postcardioversion anticoagulant treatment. The purpose of this study was to investigate differences in left atrial appendage peak flow velocities and the incidence of left atrial spontaneous echo contrast in patients with AF before and after electrical cardioversion or intravenous amiodarone, studied using transesophageal echocardiography (TEE) and pulsed Doppler. We performed a control TEE in 7 patients in the electrical group and 6 in the amiodarone group, with no significant clinical differences between both groups. A second TEE was performed immediately in the 7 patients with successful electrical cardioversion. The peak flow velocities in the appendage before and after the procedure were: filling 43.3 ± 22 vs 27.7 ± 28 cm/sec (P = 0.01) and emptying 35.5 ± 22 vs 23.6 ± 17 cm/sec (P = 0.01), respectively. The spontaneous echo contrast increased in 4 of the 7 patients. In 4 patients of the amiodarone group, the peak flow velocities in the appendage during AF and within the first 24 hours after restoration of sinus rhythm were: filling 37.4 ± 12 vs 37.8 ± 18 cm/sec and emptying 36.4 ± 18 vs 35.9 ± 18 cm/sec, respectively (P = NS). There was no change in spontaneous echo contrast. In conclusion, patients with AF reverted to sinus rhythm using amiodarone did not show changes in left atrial mechanical function; however, patients with electrical cardioversion showed mechanical dysfunction. Further investigations on the effects of amiodarone and other drugs on the mechanical function of the atria are needed to determine if patients reverted pharmacologically require antico‐agulation post reversion.
Prosthetic Aortic Valve Thrombosis Detected by Doppler Echocardiography
Authors: OTAŠVIĆ PETAR , POPOVIĆ ALEKSANDAR D. , NEŠKOVIĆ ALEKSANDAR N. , BOŠKOVIĆ DEJAN
Published: August 2007

Thrombosis of the prosthetic valve is a highly lethal medical emergency that requires immediate diagnosis and prompt therapy. Establishing the diagnosis may be difficult, despite numerous physical, echocardiographic, fluoroscopic, and angiographic signs, which have been described. We report a case of prosthetic aortic valve thrombosis diagnosed by Doppler echocardiography.
A Form Fruste of Shone's Complex Diagnosed by Transesophageal Echocardiography
Authors: PATEL JANMEJAY J. , ROSS JOHN J. , CHANDRASEKARAN KRISHNASWAMY
Published: August 2007

Shone's complex is a developmental complex of parachute mitral valve, supravalvular ring of the left atrium, subaortic stenosis, and coarctation of the aorta. Little clinical experience has been accumulated since the original description by Shone et al. This may be due to underrecognition of the condition by transthoracic echocardiography (TTE). We describe a forme fruste of Shone's complex which is definitively diagnosed only after precise demonstration of the anatomy by transesophageal echocardiography (TEE). Demonstration of these abnormalities by TEE was of little clinical significance in our patient, but may be important in others in whom prior TTE has been suboptimal.
Transesophageal Color Doppler Echocardiographic Diagnosis of Cardiac Rupture Following Acute Myocardial Infarction
Authors: RAO ARUN , GARIMELLA SATYA , NANDA NAVIN C. , CHUNG SANG‐MAN
Published: August 2007

This report describes a case of cardiac rupture following acute myocardial infarction accurately diagnosed by transesophageal color Doppler echocardiography, which showed a very narrow transmural tract from the left ventricle into the pseudoaneurysm cavity. Such a small, slitlike rupture would most likely have been missed by an otherwise routine transesophageal examination, and we stress the importance of color Doppler interrogation in its accurate diagnosis.
Noninvasive Evaluation of Aortic Valve Anatomy
Authors: SANDERS STEPHEN P. , MORRIS SIMONDS HILARY , JAMESON SUSAN M.
Published: August 2007

Although aortic valve anatomy is three‐dimensionally complex, careful echocardiographic investigation can yield surgically relevant information. The promise of intravascular and transesophageal imaging is in yielding the raw data of sufficient resolution to make the three‐dimensional reconstruction clinically meaningful. (ECHOCARDIOGRAPHY, Volume 13, May 1996)
Rupture of Aortic Dissection During Attempted Transesophageal Echocardiography
Authors: KRISTENSEN STEEN DALBY , IVARSEN HANNE RAMLOV , EGEBLAD HENRIK
Published: August 2007

Transesophageal echocardiography (TEE) provides a rapid and accurate diagnosis in patients with dissection of the thoracic aorta. The procedure is considered to be safe. We report a case where rupture of a dissecting thoracic aneurysm occurred during attempted TEE in a patient, who had been clinically stable for 1 week. TEE was performed because aortic valve endocarditis was suspected, and the procedure did not include close surveillance of the blood pressure. Careful manipulation of the probe, adequate sedation, monitoring, and treatment of acute rises in blood pressure was recommended in patients with even a slight suspicion of dissection undergoing TEE.