bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement of Echocardiographic M‐Mode Detection of Ventricular Precontraction in the Wolff‐Parkinson‐White Syndrome by Transesophageal Atrial Pacing
Authors: PEHRSON STEEN , ESKILSSON JAN , PRIPP CARL‐MAGNUS , YUAN SHIWEN , BLOMSTRÖM PER
Published: December 2007

Background: The purpose of this study was to evaluate the accuracy of conventional M‐mode echo‐cardiography in localizing the site of the accessory pathway in 21 patients with overt Wolff‐Parkinson‐White (W‐P‐W) syndrome during sinus rhythm (SR) and during transesophageal atrial stimulation (TAS). Methods: The invasive electrophysiological study was used as a reference, and the results were compared with the pathway localization obtained through algorithmic interpretation of the 12‐lead electrocardiogram during SR. Echocardiographic left parasternal short‐axis recordings were performed during SR and TAS (100–120 beats/min). The shortest electromechanical interval measured at six different sites of the atrioventricular valve plane from the onset of the delta wave to the peak of the precontraction defined the pathway localization. Results: Correct localization of the accessory pathway with echocardiography could be attained in 14 patients during SR (14 of 21, or 66%). With the aid of TAS, correct pathway localization was achieved for an additional 2 patients, making a total of 16 patients (76%). During TAS, precontraction was enhanced in 63% of the patients. With the algorithmic electrocardiographic interpretation, the localization of the accessory pathway was correct in 13 of the 21 patients (62%). The differences were not significant. Conclusion: M‐mode echocardiography is a simple and readily available method for the identification of precontraction. The method is comparable to pathway localization through algorithmic ECG interpretation during SR. Transesophageal left atrial pacing during echocardiography can amplify the precontraction and thereby facilitate the interpretation of the wall motions.
Echocardiographic Diagnosis of Biventricular Thrombi in a Cocaine‐Induced Myocardial Infarction
Authors: GLADYS ESPÍNOLA‐ZAVALETA NILDA , VARGAS‐BARRÓN JESÚS , VÁZQUEZ‐NEIRA JAVIER , ROMERO‐CÁRDENAS ANGEL , KEIRNS CANDACE
Published: December 2007

We present the case of a patient with a biventricular myocardial infarction induced by cocaine and a large left and a smaller right ventricular apical thrombus. Serial multiplane transesophageal echocardiography was used to document the morphological course of the thrombi during anticoagulation therapy over a period of 6 weeks.
Alcohol‐ and Caffeine‐Induced Changes in Mitral Valve Echo Morphology and Auscultation in Healthy Females
Authors: FRIEDMAN KELLY LESLEE , BENDER ALYSE M. , LAX DANIELA , GOLDBERG STANLEY J.
Published: December 2007

Mitral valve prolapse (MVP) is a common cardiac valve abnormality that affects women more frequently than men. We have shown that mild dehydration induces echocardiographic signs of MVP in healthy females more frequently than in males. The present study investigated whether ethanol and caffeine, two commonly used substances, will induce changes in mitral leaflet morphology in normal subjects and whether these changes are gender dependent. Ten healthy volunteers were examined after ingesting 0.95 g/ kg ethanol at breath ethanol values of 0.025%± 0.005%, 0.050%± 0.005%, and 0.075% (peak) ± 0.005%, and at decreasing ethanol levels of 0.050%± 0.005% and 0.025%± 0.005%. Twelve healthy subjects were studied at 1.5, 3, and 4.5 hours after ingesting 5 mg/kg body weight of caffeine in a randomized, double‐blind, crossover manner. A significant increase in mitral valve shape index (MVSI) on apical four‐chamber view was documented in females following ethanol ingestion at all ethanol levels. These changes were accompanied by auscultatory findings characteristic of MVP. Decreased systemic vascular resistance, and afterload and increased heart rate, also occurred after ethanol ingestion. A significant increase in MVSI occurred on parasternal long axis in females at peak caffeine level; auscultatory findings characteristic of MVP also were documented. MVSI increased slightly on apical four‐chamber view in males; however, no male subject developed auscultatory MVP. Body mass index was significantly lower in females (20.8 ± 0.7 kg/m2) versus males (23.7 ± 0.3 kg/m2, P ± 0.05). All subjects lost weight after caffeine intake; afterload and contractility also were increased. This study documents that ethanol and caffeine, at concentrations similar to those present in social intake, induced significant echo changes in mitral leaflet morphology and auscultation suggestive of MVP in healthy females. These results suggest that in addition to apparent hydration state, recent ethanol or caffeine intake should be taken into consideration before making the diagnosis of MVP.
Abnormal Inflow Wave Propagation in Patients with Doppler Characteristics of Impaired Left Ventricular Relaxation
Authors: VOON WEN‐CHOL , SHEU SHENG‐HSIUNG
Published: December 2007

With application of the range ambiguity, a delay between the flow onset at both the mitral valve and the apex has been shown to be present in patients with a severely dilated and poorly contracting left ventricle and those with acute myocardial infarction with abnormal apical wall motion, but the delay has been absent in normal subjects. Nevertheless, whether there is a delay between the flow onset at both regions in the presence of impaired left ventricular relaxation remains unknown. This study was undertaken to evaluate the left ventricular inflow wave propagation in control subjects and patients with impaired left ventricular relaxation. Eighteen patients with normal systolic function and Doppler characteristics of impaired relaxation of the left ventricle and 17 age‐ and sex‐matched healthy control subjects were included. Range ambiguity was used to simultaneously record the phantom Doppler signals from the mitral valve region and the true ones from the apex. The inflow wave propagation velocity was derived from the inflow wave propagation distance divided by the time between the mitral valve and the apex. There was always some delay between the flow onset at both the mitral valve and the apex in both the controls and the patients (47 ± 13 msec vs 85 ± 19 msec, P < 0.001). The inflow wave propagation velocity was 160 ± 50 cm/sec and 90 ± 20 cm / sec in the control subjects and the patients, respectively (P < 0.001). Multiple linear regression analyses of the significantly correlated variables stepwisely selected the deceleration time of the E wave (R2= 0.53, P < 0.001) and age (R2= 0.06, P = 0.039) as the significant determinants of the left ventricular inflow wave propagation velocity. In conclusion, the application of the range ambiguity offers a new method of determining the left ventricular inflow wave propagation velocity, and Doppler characteristics of impaired left ventricular relaxation are associated with a slower inflow wave propagation from the mitral valve to the apex.
Automatic Border Detection for Assessment of Left Ventricular Diastolic Function Among Normal Neonates
Authors: TIGHE DENNIS A. , PAUL JAMES J. , POHL CHARLES A. , COOK JAMES R. , HUHTA JAMES C.
Published: December 2007

Doppler echocardiography is the standard noninvasive method to assess left ventricular (LV) diastolic function. Recently, automatic border detection (ABD), a method based on analysis of integrated ultrasonic backscatter, has been introduced permitting real‐time, on‐line assessment of LV diastolic function. A comparison of these methods in normal, full‐term neonates has not been performed. Therefore, the objectives of this study were to evaluate the usefulness of ABD in the assessment of LV diastolic function among normal neonates, to compare parameters obtained with the ABD method with standard Doppler‐derived indexes of diastolic function, and to assess the reproducibility of ABD measurements. We studied 17 consecutive normal neonates during natural sleep with both methods shortly after birth (mean 17.4 ± 3.9 h) and approximately 2 weeks later (mean 14.8 ± 2.2 days). An average of five consecutive cardiac cycles were performed. Similar to Doppler indexes, no significant change in any ABD parameter of diastolic function occurred between the early and later studies. A complete ABD study could be performed within 5 minutes. Mean interobserver variation for individual ABD measurements ranged from 0% to 11%. Compared with Doppler, rapid filling fraction was greater and atrial filling fraction was less with ABD. Regression analysis showed poor correlation of these parameters between methods, but their ratio by each method remained constant between studies. A similar poor correlation existed between peak E wave velocity by Doppler and peak rapid filling rate by ABD and between peak A wave velocity by Doppler and peak atrial filling rate by ABD. These differences may be explained by technical factors and different aspects of diastolic filling assessed by each method. This study indicated that ABD was a feasible and reproducible method compared with Doppler echocardiography for serial evaluation of LV diastolic function among neonates.
Novel Application of Tissue Doppler Imaging
Authors: KERUT EDMUND K.
Published: December 2007

Tissue Doppler imaging was used with transthoracic and transesophageal echocardiography to determine its clinical usefulness beyond visualization of ventricular wall motion. Thirteen novel applications were found: acoustically difficult transthoracic studies, thrombus, mitral chordal motion, shunt detection using saline contrast, spontaneous echo contrast, intra‐aortic balloon pump position and function, endocarditis (prosthetic and native), valve strands (prosthetic and native), mobile aortic atheroma, prosthetic valve motion, aortic valve motion in the presence of a calcified aortic annulus, systolic anterior motion of the mitral valve, and cardiac tumors. Tissue Doppler imaging directly affected the ability to make difficult diagnostic decisions with increased confidence and reduced the need for additional studies.
Three‐Dimensional Echocardiography
Authors: TANABE KAZUAKI , BELOHLAVEK MAREK , JAKRAPANICHAKUL DECHO , BAE RICHARD Y. , GREENLEAF JAMES F. , SEWARD JAMES B.
Published: December 2007

We developed a new, rapid (6 seconds) acquisition technique allowing collection of approximately six through nine apical rotational tomograms for three‐dimensional (3‐D) echocardiography. To justify an appropriate sampling density for precise and accurate measurement of chamber volumes in left ventricles with complicated shape, we designed a validation study in vitro using six canine heart specimens with irregular, asymmetric left ventricles with known volumes (28.5 to 104.3 ml; mean, 71.2 ml). The number of equally spaced slices were incrementally deleted from the original high resolution scans (48 slices) to 2 slices in 3‐D reconstruction. We created subgroups of 48‐ and 36‐, 24‐ and 16‐, 12‐ and 8‐, 6‐ and 4‐, and 3‐ and 2‐component slices to compare left ventricular (LV) volumes measured in 3‐D images with different slice resolution with the reference standard measured in the specimen. The accuracy and precision of LV volume were relatively constant in the subgroup of 4‐ and 6‐ through 36‐ and 48‐component slices. When the subgroup with 6‐ and 4‐component slices was used, the correlation was r = 0.991, P < 0.0001, root mean‐square percent error of 5.0%, bias of 0.5 ± 3.7 ml, and interobserver variability of 5.0%. With the reduction in component slices equal or less than three, the accuracy decreased significantly (root‐mean‐square percent error = 8.1% and bias = ‐2.0 ± 5.7 ml) compared with higher slice resolutions. This study demonstrated that 3‐D echocardiography using apical rotational techniques can accurately quantify LV volume in the canine heart specimens with irregular shapes with as few as 4–6 axial slices. The rapid 3‐D acquisition technique is therefore anticipated to yield precise and accurate LV volumetry.
Three‐Dimensional Echocardiographic Reconstruction of Atrial Membranes
Authors: SAMAL ADITYA K. , NANDA NAVIN C. , THAKUR ABHASH C. , AGGARWAL RAMESH , JAMIL FARRUKH , KAPUR GAURAV , AALURI SRINIVASA R. , MOURSI MOHAMMED , MCGIFFIN DAVID , KIRKLIN JAMES
Published: December 2007

Three‐dimensional echocardiographic findings in cor triatriatum sinister (sinistrum), cor triatriatum dexter, mitral supravalvular membrane, and atrial baffle are presented.
Visualization of Secundum Atrial Septal Defect Using Transthoracic Three‐Dimensional Echocardiography in Children
Authors: LU JEN‐HER , HSU TSUI‐LIEH , HWANG BETAU , WENG ZENG‐CHUNG
Published: December 2007

Background: The objective of this study was to evaluate the efficacy of quantitative measurements of secundum atrial septal defect (ASD) with dynamic transthoracic three‐dimensional (3–D) echocardiography. Methods: Twenty‐six patients (age, 13 months to 14 years; mean age, 37 months) with secundum ASDs underwent 3‐D echocardiographic imaging generated from transthoracic echocardiographic interrogation before surgery. Four specific cut planes were defined: four‐chamber view, transverse view, en face view from right and left atrial side. The images obtained from 16 patients clearly demonstrated all four defined cut planes for the quantitative measurement. Results: The defect sizing determined by the 3‐D images correlated well with surgical findings. These images may be interactively manipulated to optimize visualization of the defect to allow the cardiologist to perform transcatheter occlusion. A significant correlation was demonstrated to the limbic band tissue assessment by four‐chamber and transverse views. Unusual atrial structures such as muscle bands and the fore‐shortening of the en face view might induce biased measurements. Conclusions: The transthoracic approach was successful in capturing sufficient data to create 3‐D images, which can provide an accurate assessment of secundum ASD. The possibility of underestimation should always be taken into account with the en face view. Multiple cut planes were essential to ensure correct sizing for adequate selection of the occluder.
Traumatic Rupture of Atherosclerotic Plaque Producing Aortic Isthmus Dissection
Authors: SAMAL ADITYA K. , NANDA NAVIN C. , BIEDERMAN ROBERT W. W. , de SOUSA JOAO B. , JOHN ABRAHAM S. , NANDA ANIL , NANDA ANITA , McGIFFIN DAVID
Published: December 2007

Traumatic rupture of aortic isthmus atherosclerotic plaque resulting in dissection has not been documented through the use of either invasive or noninvasive diagnostic modalities. We describe an elderly patient in whom transesophageal echocardiography and three‐dimensional reconstruction of multiplane transesophageal two‐dimensional images clearly demonstrated the traumatic dissection to be due to rupture of a large atherosclerotic plaque located in the aortic isthmus. The patient had experienced blunt trauma to the chest from the impact of the steering wheel during an automobile accident.
Comparison of Left Ventricular Ejection Fraction Calculation Methods
Authors: WILSON DANIEL J. , NORTH NESHE , WILSON RICHARD A.
Published: December 2007

Left ventricular ejection fraction (LVEF) has been used for many years to assess left ventricular systolic function. Over time, patients may have LVEF measurements performed with the use of different imaging modalities. It is important for the clinician to appreciate how these different methods compare with each other. The purpose of this study was to determine the correlation among three such LVEF measurement methods: two echocardiographic methods (Teichholz and Quinones) and gated thallium three‐dimensional (3‐D) scintigraphic method. Eighteen patients underwent both echocardiographic and nuclear imaging studies. The nuclear and echo images were completed within 1 hour of each other. The Teichholz method resulted in consistently larger LVEF estimates but correlated well with the Quinones method (r = 0.88, SEE = 8.41). The Teichholz method did not correlate well with the gated thallium 3‐D method and again gave consistently larger estimates that were even higher than when compared with the Quinones method (r = 0.7, SEE = 12.6). The Quinones method and gated thallium 3‐D method correlated well (r = 0.87, SEE = 9.6) and gave a line of best fit close to the line of identity. In conclusion, the Teichholz method consistently overestimates LVEF compared with the Quinones and gated thallium 3‐D methods. The Quinones echocardiographic and gated thallium 3‐D methods appear to result in similar absolute LVEF measurements.
Posterior Mediastinal Bronchogenic Cyst Compressing Left Atrium
Authors: ELIAS SAID E. , D'CRUZ IVAN A.
Published: December 2007

The echocardiographic literature contains exceedingly few reports of mediastinal bronchogenic cyst; in most published cases of this entity, the cysts were imaged by computed tomography or magnetic resonance imaging. Because mediastinal bronchogenic cyst is little known as a cause of cardiorespiratory symptoms, we report such a case.
The Role of Echocardiography Doppler in Pulmonary Embolism
Authors: RIBEIRO ARY
Published: December 2007

The purpose of this review is to make a critical analysis of selected literature about the role of echo‐Doppler in suspected or proved venous thromboembolism and to address some issues about the potential use of echo‐Doppler in specific situations in patients with pulmonary embolism (PE). Echo‐Doppler is of great value in patients with suspected PE because many conditions that may be clinically mistaken for PE will be diagnosed. Echo‐Doppler should not be used alone to rule out the diagnosis of PE because the ability of the technique in proving the diagnosis of PE in a nonselected population is limited. Echo‐Doppler may be of value for diagnosis in selected subgroups of PE patients, mostly in scenarios like the emergency department or intensive care unit. Echo‐Doppler is valuable in the hemodynamic assessment of patients with PE, making possible a strategy for risk stratification of in‐hospital death in relation to the degree of right ventricle dysfunction at the time of diagnosis of acute PE. Echo‐Doppler is useful for serial assessment of patients with established diagnosis of chronic thromboembolic pulmonary hypertension. Echo‐Doppler may be useful in follow‐up of patients after a diagnosis of acute PE to enable early identification of patients with persistent pulmonary hypertension / right ventricle dysfunction.
Three‐Dimensional Echocardiography:
Authors: BRUINING NICO , ROELANDT JOS R. T. C. , GRUNST GERNOTH , BERLAGE THOMAS , WALDINGER JOHANNES , MUMM BERNHARD
Published: December 2007

Virtual reality (VR) is one of the latest developments in cardiac three‐dimensional (3‐D) ultrasound. A VR heart model linked to 3‐D echocardiographic image datasets provides the observers spatial information regarding a 3‐D image dataset and prevents the “lost in space effect” in difficult and relevant coupled diseases when integrated into 3‐D reconstruction software. Standardized echocardiographic views can be selected within the integrated developed VR heart model, and this is the first step to automatic 3‐D computations with minimal operator interaction. VR heart models open exciting opportunities in the field of teaching echocardiographic cardiology, diagnosis, and examinable states.
Transvascular Imaging
Authors: BRUCE CHARLES J , PACKER DOUGLAS L , SEWARD JAMES B.
Published: December 2007

Background: Transvascular imaging is defined as the acquisition of anatomic and functional information of structures lying beyond the confines of a vascular conduit within which the imaging device resides. Interrogating structures surrounding the vascular conduit is the subject of this feasibility study using a novel underblood, phased array ultrasound‐tipped catheter. Methods: An intravascular catheter (10‐F, 3.2‐mm‐diameter, four‐way articulation) tipped with a 5.5‐ to 10‐MHz frequency agile, vector phased array transducer with full Doppler capability (Sequoia, Acuson) was used. The imaging transducer has a wide range of tissue penetration (2 mm to >10 cm from the lens). The catheter was introduced via an 11‐Fr femoral venous sheath into the inferior and superior vena cavae and right heart chambers. As the catheter was advanced, attention was directed to visualization of structures surrounding the vessel in which the catheter resided. Results: From the cavae and femoral vein the thoracic, abdominal and femoral arteries could be easily imaged. Anatomy that was visualized included the liver, hepatic veins, gallbladder, and mesenteric vessels. Normal and pathological anatomy and Doppler physiology could be readily appreciated. Doppler (i.e., pulsed‐ and continuous‐wave, color flow, and tissue Doppler) fostered unique transvascular physiological hemo‐dynamic and flow assessment. Conclusion: Transvascular imaging is feasible in human subjects using this 10‐Fr catheter tipped with a 5.5‐ to 10 MHz vector phased array transducer. Intravascular navigation to a desired location within the body and the performance of diagnostic or therapeutic procedures at a remote site under direct ultrasound visualization are possible. Full Doppler capability extends the concept of transvascular hemodynamic and physiological assessment.
Three‐Dimensional Echocardiographic Assessment of Lambl's Excrescences on the Aortic Valve
Authors: SAMAL ADITYA K. , NANDA NAVIN , THAKUR ABHASH C. , KUMAR NARAYAN VIRENJAN , OCAK OZLEM , YU LEE TAO , VOROS SZILARD , JINDAL AJAY , WINOKAR THOMAS S.
Published: December 2007

The present case reports demonstrate the incremental value of three‐dimensional echocardiography over multiplane transesophageal two‐dimensional imaging in the assessment of Lambl's excrescences (strands) involving the aortic valve.
Assessment of Left Ventricular Systolic Function Using Color‐Coded Tissue Doppler Echocardiography
Authors: GORCSAN JOHN
Published: December 2007

Tissue Doppler echocardiography can be used to measure myocardial velocity data by using the Doppler shift data of ultrasound waves. Two methods have recently been described to calculate velocity data: pulsed tissue Doppler and color‐coded tissue Doppler. This article focuses on color‐coded tissue Doppler data to evaluate left ventricular systolic function. Technical considerations and validation studies are reviewed. Potential clinical applications of color‐coded tissue Doppler are presented, including dobutamine stress echocardiography, assessment of left ventricular ejection dynamics using mitral annular velocity, and tissue Doppler assessment of cardiac transplant rejection.
Regional Left Ventricular Diastolic Dysfunction Evaluated by Pulsed‐Tissue Doppler Echocardiography
Authors: ANGEL GARCIA‐FERNANDEZ MIGUEL , AZEVEDO JOSÉ , MORENO MAR , BERMEJO JAVIER , MORENO RAUL
Published: December 2007

Pulsed‐wave Doppler tissue imaging (DTI) allows the examination of regional wall motion at a very high temporal resolution and therefore constitutes an excellent technique for assessing diastolic motion of left ventricular walls. Regional relaxation has been well characterized in normal subjects using this technique, and physiological time intervals and motion wave profiles are described. In an experimental model of acute ischemia, local relaxation impairment was observed showing highly characteristic local diastolic abnormalities. Interestingly, these findings took place before any decrease in systolic motion was recordable. In a prospective clinical study, noninvasive regional DTI parameters were compared with coronary angiography to assess the feasibility and clinical value of the technique; the diagnostic accuracy is discussed in detail. Also, the association between regional diastolic parameters and global regional function as assessed by Doppler analysis of transmitral left ventricular filling flow was studied, stressing the impact of regional diastolic function on overall ventricular performance. Finally, the diagnostic role of pulsed‐wave DTI on stress testing, identification of myocardial viability, and microvascular angina is reviewed.
Tissue Doppler to Assess Diastolic Left Ventricular Function
Authors: GARCIA MARIO J. , THOMAS JAMES D.
Published: December 2007

Doppler indices of left ventricular (LV) filling have been used traditionally for the assessment of LV diastolic function. In many circumstances, however, the interpretation of these indices is difficult because they respond to alterations of different physiological variables such as preload, relaxation, and heart rate. A typical example of their limitation is seen in patients with abnormal LV relaxation and increased preload compensation, who often present a “pseudonormal” LV filling pattern. Thus, there is a need for noninvasive indices of diastolic function capable of discriminating the effects of relaxation and preload. Tissue Doppler echocardiography (TDE) is available in most modern cardiac ultrasound imaging systems. TDE can be used to obtain regional myocardial velocities during isovolumic relaxation, early filling, and atrial systole with high spatial and temporal resolution. This article discusses the complementary role, limitations, and future challenges of TDE in the study of diastolic function.
Tissue Doppler Echocardiography
Authors: SUTHERLAND GEORGE R. , KUKULSKI TOMASZ , VOIGHT JENS UWE , D'HOOGE JAN
Published: December 2007

The use of color‐coded tissue Doppler echocardiography has resulted in rapid technological advances in the evaluation of cardiac function. This article describes some of these exciting new advances, including curved M‐mode analysis and strain rate imaging. Data from studies in animals and humans are presented to demonstrate the potential clinical use of this new echocardiographic diagnostic tool.
Factors of Importance to Doppler Indexes of Left Ventricular Filling in 50‐Year‐Old Hypertensive Persons
Authors: KANGRO TOOMAS , HENRIKSEN EGIL , JONASON TOMMY , RINGQVIST IVAR
Published: December 2007

Altered left ventricular (LV) diastolic filling has been shown in subjects with hypertension. Age is a major determinant of Doppler indexes of LV diastolic filling; therefore, a group of subjects of uniform age should preferably be chosen, if other determinants of diastolic LV filling are to be studied. A limited body of data is available regarding Doppler indexes of LV filling in hypertensive persons of a similar age. We therefore evaluated 26 hypertensive subjects (13 women and 13 men) 50 years old by Doppler echocardiography. The peak velocity of early diastolic filling (E wave), the peak velocity of atrial filling (A wave), the early‐to‐atrial peak velocity (E/A) ratio, and the deceleration time of early velocity were measured. The peak E wave velocity was 0.76 ± 0.11 versus 0.62 ± 0.13 m/s (P < 0.005), and the E/A ratio was 1.11 ± 0.24 versus 0.93 ± 0.23 (P < 0.05) in hypertensive women and men, respectively. The peak A wave velocity was increased and the E/A ratio was decreased in both hypertensive women and men compared with healthy 50‐year‐old subjects. In multivariate analyses, LV diameter, body mass index, and gender correlated with the E/A ratio in hypertensive persons. It is concluded that there is a significant difference in Doppler LV filling indexes between 50‐year‐old hypertensive women and men. LV diameter, gender, and body mass index are independent determinants of LV diastolic inflow in similarly aged hypertensive persons.
Echocardiographic Diagnosis of Subacute Ventricular Wall Rupture Complicating Acute Myocardial Infarction
Authors: MARCÌ MARCELLO , AJELLO ABELE , DI FRANCESCO MICHELE , MARINA FLORESTA AGATA , LOJACONO FRANCESCA , BATTAGLIA ANTONINO
Published: December 2007

Rupture of ventricular wall is one of the most threatening complications of acute myocardial infarction. As a rule, it is rapidly lethal, and a precise diagnosis is seldom possible. On the contrary, in the so‐called subacute ruptures (about one third of all cases), patients can survive for several hours, allowing time for diagnosis and immediate surgical intervention. We report here the case of one patient with subacute cardiac rupture who was diagnosed with echocardiography and successfully treated with pericardiocentesis and surgery.
Acute Myocardial Infarction During Transesophageal Echocardiography
Authors: AL MOUSSARIH ABDALLAH , DOUARD HERVE , LAFITTE STEPHANE , PAUL BROUSTET JEAN , ROUDAUT RAYMOND
Published: December 2007

We describe the occurrence of acute myocardial infarction during transesophageal echocardiography (TEE) in a patient with atrial fibrillation and underestimated angina. Such a case has not been previously reported in the literature. This case illustrates one of the possible complications of TEE, leading us to suggest systematic sedation in patients with angina in whom TEE is envisaged.
Diagnosis and Management of Complicated Left Atrial Mural Endocarditis
Authors: GRIGOROV VLADIMIR , GOLDBERG LEONARD , MANGA PRAVIN , PATEL NALIN
Published: December 2007

Mural endocarditis that involves the left atrial wall is rare. We report on the transesophageal findings in a patient with left atrial mural endocarditis and discuss its recognition, complications, and treatment.
Echocardiography in Minimally Invasive Direct Coronary Artery Bypass
Authors: KASLIWAL RAVI , MITTAL SANJAY , SHRIVASTAVA SAMEER , MISHRA YUGAL , MALHOTRA RAJNEESH , KANOJIA AJAY , TREHAN NARESH , KRONZON ITZHAK
Published: December 2007

Minimally invasive direct coronary artery bypass (MIDCAB) is a recently developed, less‐invasive alternative to standard bypass surgery. MIDCAB is performed through a small incision (2–3 inches) on the beating heart without the use of cardiopulmonary bypass or cardioplegia. It is associated with less trauma and a shorter hospital stay than conventional surgery. Transesophageal echocardiography helps in patient selection by detecting protruding aortic atheromas (PATHs), which are associated with a high risk of stroke during typical cardiopulmonary bypass. MIDCAB may be the technique of choice in patients with PATHs. Intraoperative echocardiography can detect wall motion abnormalities and helps in determining intraoperative myocardial ischemia and the postoperative prognosis. Duplex study of the internal mammary arteries is helpful in evaluating coronary anastomosis patency. Characteristically, a patent coronary anastomosis demonstrates a high diastolic flow fraction, with a ratio between peak diastolic and peak systolic flow velocity of > 1.
Assessment of Right Ventricular and Right Atrial Systolic and Diastolic Performance Using Automated Border Detection
Authors: SPENCER KIRK T. , GARCIA MARIA J. , WEINART LYNN , VIGNON PHILIPPE , LANG ROBERTO
Published: December 2007

Noninvasive assessment of right ventricular (RV) function is important clinically, but current techniques have limitations. Acoustic quantification (AQ) is an automated endocardial border detection technique that allows continuous determination of RV and right atrial (RA) area waveforms and may be useful for the assessment of RA and RV systolic and diastolic performance. Fifty patients (10 normal, 40 with RV pathology) were studied. Signal‐averaged RA and RV AQ area waveforms were obtained and analyzed to compute parameters of diastolic and systolic function. All groups demonstrated significant diastolic dysfunction on the RA AQ waveform as manifested by a reduced percentage of passive atrial emptying and increased dependence on active atrial emptying. Abnormalities of diastolic performance were noted in all subgroups on RV AQ analysis as evidenced by a reduction in the percentage of ventricular filling occurring during early diastole and an increased contribution from active atrial contraction. This study demonstrates the feasibility of using automated analysis of signal‐averaged RA and RV area waveforms for the evaluation of RV systolic and diastolic performance. This technique identified significant systolic and diastolic dysfunction in four groups of commonly seen right heart pathologies including biventricular heart failure, pulmonary hypertension, pressure and volume overloaded RVs, and biventricular hypertrophy.
Transpharyngeal Echocardiographic Diagnosis of Carotid Bulb and Left Internal Carotid Artery Stenosis
Authors: NANDA NAVIN C. , GOMEZ CAMILO R. , KUMAR NARAYAN VIRENJAN , KADIMI SRINATH , TERRY JOHN B. , TULYAPRONCHOTE ROEKCHAI , THAKUR ABHASH C. , OCAK OZLEM , JINDAL AJAY , YU LEE TAO
Published: December 2007

We report a patient in whom we were able to make an accurate diagnosis of left carotid bulb and left internal carotid artery stenosis by carefully and slowly withdrawing the probe from the esophagus into the pharynx.
Aortic Stenosis
Authors: NAQVI TASNEEM Z. , SIEGEL ROBERT J.
Published: December 2007

Noninvasive assessment of aortic valve area by echocardiography has become the standard of practice over the past few years. The advent of transesophageal echocardiography (TEE) has provided a new method for the assessment of aortic valve area (AVA) using planimetry by two‐dimensional imaging. Clear visualization of the anatomy of the valve, as well as accuracy of AVA assessment, makes TEE an invaluable tool for the evaluation of aortic valve stenosis. TEE is especially helpful in clinical settings when there is a discrepancy between the AVA obtained by transthoracic echocardiography and cardiac catheterization. TEE is particularly helpful in the assessment of the aortic valve during intraoperative echocardiography. This review discusses the techniques, imaging planes, and details for assessing AVA by TEE. The role of TEE in AVA assessment is described, with specific clinical case examples cited.
Echocardiographic Criteria in Selection of Patients for Percutaneous Mitral Commissurotomy
Authors: GARBARZ ERIC , IUNG BERNARD , CORMIER BERTRAND , VAHANIAN ALEC
Published: December 2007

The purpose of this report is to review the role of echocardiography in the selection of patients for percutaneous mitral commissurotomy (PMC). Echocardiography has become the standard for the assessment of the severity of mitral stenosis and of its consequences. PMC is usually performed only in patients with a valve area of < 1.5 cm2, whereas pulmonary hypertension or spontaneous echo contrast in the left atrium may lead to intervention in patients with few symptoms. The next step of the echocardiographic evaluation is to eliminate contraindications: left atrial thrombosis (by the systematic performance of a transesophageal examination before PMC), mitral regurgitation ≥ 2/4, severe aortic valve disease, mixed tricuspid valve disease, and massive or bicommissural calcification. Finally, echocardiography allows the classification of patients into different anatomic groups for prognostic consideration. There is controversy regarding the best echo score system in the prediction of the results of PMC. Scores using a global evaluation of the valve anatomy are the most widely used, whereas more recently, scores taking into account the uneven distribution of the disease have had promising preliminary results. Overall, echo scores are useful criteria for selecting candidates for PMC, but they should be considered together with the other clinical and procedural variables. Thus, echocardiography has an important role in the selection of patients for PMC, as well as for the guidance of the procedure, the evaluation of the results, and surveillance.
Delayed Recovery of Diastolic Function in Patients with Suspected Acute Myocarditis as Assessed with Doppler Echocardiography
Authors: HUNG MING‐JUI , WANG CHAO‐HUNG , CHERNG WEN‐JIN
Published: December 2007

Pulsed‐wave Doppler echocardiography was performed repeatedly in two women (24 and 23 years old) who had clinically suspected acute myocarditis. Systolic function recovered earlier than diastolic function in both cases. Although left ventricular diastolic dysfunction has been demonstrated in lymphocytic myocarditis, this difference in the rates of systolic and diastolic function recovery after acute myocarditis has not been previously described. The slower recovery of the diastolic function might be related to the slower resolution of the infiltrated myocardium. We also discuss the contribution of echocardiography to the difference in the rates of cardiac function recovery after acute myocarditis.
Transesophageal Three‐Dimensional Echo Assessment of Sinus Venosus Atrial Septal Defect
Authors: NANDA NAVIN C. , ANSINGKAR KAMLESH , ESPINAL MIGUEL , JINDAL AJAY , PURI VIRENDER , AALURI SRINIVASA , MUKHTAR OSMAN , YU LEE TAO , SAMAL ADITYA K. , BHAMBORE MAHESH M. , PACIFICO ALBERT D.
Published: December 2007

The incremental value of three‐dimensional echocardiography over transesophageal multiplane two‐dimensional imaging in the assessment of sinus venosus atrial septal defect is demonstrated in the present study.
Characteristics of SonoVue™
Authors: SCHNEIDER MICHEL
Published: December 2007

The advances made by ultrasonography in the last decade, in parallel with the development of ultrasound contrast agents, have opened a wide range of potential breakthroughs in the field of ultrasound imaging. SonoVue™ is a new echocontrast agent made of microbubbles stabilized by phospholipids and containing sulphur hexafluoride (SF6), an innocuous gas. The suspension of the microbubbles is stable over the time following reconstitution. The bubble concentration of SonoVue™ is between 100 and 500 million per ml. The mean bubble diameter is 2.5 μm and more than 90% of the bubbles are smaller than 8 μm. Following intravenous injection, the bubble suspension is submitted to pressure increases. SF6, a high molecular weight gas with low solubility in water, was selected since laboratory tests showed that it confers to the bubbles a good resistance to pressure changes as those that occur in the left ventricle, in the pulmonary capillaries, or in the coronary circulation. The high bubble concentration, combined with a favorable size distribution profile, provides SonoVue™ with a strong echogenicity. SonoVue™ shows a peak in the backscatter coefficient at about 3 MHz. With regard to the gas contained in the bubbles, its pharmacokinetics have been assessed during a study in human volunteers. Following intravenous administration of 0.3 ml/kg of SonoVue™ (i.e., approximately ten times the imaging dose), the blood level curve showed a distribution half‐life of about 1 minute and an elimination half‐life of about 6 minutes. More than 80% of the administered gas is exhaled via the lungs after 11 minutes. Extensive studies in animals and humans have confirmed the outstanding safety profile of this second generation contrast agent and its capability in providing a clinically useful ultrasound signal enhancement for the evaluation of cardiac function and extracardiac vessel abnormalities. Thanks to the long persistence of SF6 microbubbles, SonoVue™ is also potentially useful in the assessment of myocardial perfusion, as well as microcirculatory disorders.
Imaging of Myocardial Perfusion with SonoVue™ in Patients with a Prior Myocardial Infarction
Authors: LINDNER JONATHAN R. , WEI KEVIN , KAUL SANJIV
Published: December 2007

Myocardial contrast echocardiography (MCE) is an evolving noninvasive imaging technique that can be used to assess regional myocardial perfusion. MCE relies upon the detection of nonlinear ultrasound signal from gas‐filled microbubbles during their microvascular transit, resulting in tissue opacification. Provided that the relation between myocardial microbubble concentration and video intensity (VI) is within the linear range, VI measured from any myocardial region reflects the relative tissue concentration of microbubbles, which is influenced by three factors: (1) microbubble concentration in blood; (2) the myocardial blood volume fraction; and (3) microbubble destruction that occurs within the ultrasound beam. In this article, we discuss how these three factors may influence myocardial perfusion information provided by MCE and highlight the importance of image processing. In order to illustrate these concepts, we examine data obtained during perfusion imaging in patients with prior myocardial infarction using intermittent harmonic imaging at various ultrasound pulsing intervals (PIs) during bolus and continuous venous infusions of a second‐generation microbubble agent (SonoVue™). Our results suggest that evaluation of resting perfusion is most accurate when both myocardial blood volume and blood velocity are assessed. This information is provided only with continuous infusions of microbubbles during imaging protocols that vary the ultrasound PI.
Load‐Independent Indices of Left Ventricular Function Using Automated Border Detection
Authors: III JOHN GORCSAN
Published: December 2007

Echocardiographic automated border detection is the ability to assess left ventricular (LV) cross‐sectional cavity areas and volumes on line. This capability has enabled the use of LV pressure‐volume relationships as a means to determine LV function in a manner relatively independent of loading conditions. This discussion reviews previous validation studies in animal models and humans using LV cross‐sectional area as a surrogate for LV volume and the clinical applications of LV pressure‐area relations. Applications of arterial pressure as a substitute for LV ejection pressure to assess pressure‐area relations are also reviewed, along with the use of pressure‐area relations to assess right ventricular performance. Last, preload‐adjusted maximal power as an alternative load‐insensitive means to determine LV performance is discussed.
Echocardiography in the Emergency Department
Authors: CORRALL C. JAMES , CORDELL WILLIAM H. , TRIPPI JAMES A.
Published: December 2007

Echocardiography performed in the emergency department must adapt to this new setting for noninvasive diagnostic testing. Emergency physicians require echocardiography to provide rapid diagnosis in life‐threatening emergencies. New initiatives are being proposed by emergency physicians in the delivery of this test. Cardiologists now use echocardiography in the emergency‐department to make the diagnosis of heart disease earlier and with greater accuracy.
Long‐Term Value of Stress Echocardiography in the Triage of Patients with Atypical Chest Pain Presenting to the Emergency Department
Authors: III PERCY J. COLON , CHEIRIF JORGE
Published: December 2007

The purpose of this study was to assess the use of stress echocardiography in the triage of patients presenting to the emergency department with atypical chest pain. We hypothesized that a negative stress echocardiogram would identify patients with a very low risk for future cardiac events, thus reducing the requirement for unnecessary hospitalizations. Stress testing was performed in 105 patients presenting with atypical chest pain, no prior history of coronary artery disease, a nondiagnostic electrocardiogram (ECG), negative serial creatine phosphokinase level at 0 and 4 hours, and baseline normal echocardiagrams. Cardiac stress was invoked using an exercise protocol in 75 (71%) patients and intravenous dobutamine in 30 (29%) patients, with ECG and echocardiography results analyzed separately. Cardiac events (myocardial infarction, coronary revascularization, and cardiac death) were noted in 7 (7%) patients with a mean follow‐up of 2.8 ± 1.3 years. Univariate analysis identified five predictors of future cardiac events, but only stress‐induced wall motion abnormalities were found to be predictive with multivariate analysis. Kaplan‐Meier estimate of cumulative event‐free survival for cardiac events at 3 years was 99% for a negative stress echocardiogram (no stress‐induced wall motion abnormalities) compared with 95% for stress ECG (< 1‐mm ST segment depression). The event‐free rate of a positive stress echocardiogram and stress ECG was 25% and 63%, respectively. We conclude that stress echocardiography can be performed safely in patients presenting with atypical chest pain. A negative stress echocardiogram carries an excellent 3‐year prognosis and thus identifies patients who may forgo hospital admission and further cardiovascular workup.
Regional Diastolic Function in Microvascular Angina Studied by Pulsed‐Wave Doppler Tissue Imaging
Authors: MORENO RAÚL , GARCÍ‐FERNÁNDEZ MIGUEL‐ANGEL , MORENO MAR , BERMEJO JAVIER , ORTEGA ANA , SARNAGO FERNANDO , DELCÁN JUAN‐LUIS
Published: December 2007

Objectives: Diastolic dysfunction is an early finding during myocardial ischemia. However, regional diastolic function has not been studied in patients with microvascular angina (MA). The purpose of this study was to assess the regional diastolic function in patients with MA through use of the new echocardiographic technique, pulsed‐wave Doppler tissue imaging (DTI). Methods: Regional diastolic function was studied by DTI in 81 myocardial segments of seven patients with MA and in 54 segments of six healthy control subjects. Results: Myocardial segments in patients with MA had, in comparison with controls, an increased regional isovolumetric relaxation time (126 ± 34 vs 99 ± 34 msec, P < 0.0001), a higher e/a ratio (1.1 ± 0.7 vs 0.8 ± 0.3, P = 0.0048), and a lower peak velocity of the late diastolic wave a (6.9 ± 2.9 vs 8.4 ± 1.7 cm/msec, P = 0.0009). Moreover, peak velocity of systolic wave s was higher in patients with MA (5.8 ± 1.4 vs 5.3 ± 1.2 cm/msec, P = 0.0424). Conclusions: Patients with MA have an impaired regional diastolic function (an increased regional isovolumetric relaxation time and a lower a wave) and a higher velocity of the regional systolic wave s. These findings may have physiopathological implications.
Right Atrial Thrombi and Depressed Right Atrial Appendage Function After Cardioversion of Atrial Fibrillation
Authors: OMRAN HEYDER , JUNG WERNER , MACCARTER DEAN , SCHIMPF RAINER , RABAHIEH RAMI , SCHUMACHER BURGHARD , WOLPERT CHRISTIAN , BECHER HARALD , LÜDERITZ BERNDT
Published: December 2007

Background: It has been shown that cardioversion of atrial fibrillation may result in left atrial chamber and appendage dysfunction and cause new thrombi in the left atrium. The aim of this prospective study was to investigate right atrial appendage function and assess the incidence of new right atrial thrombi after electrical cardioversion. Methods: Transthoracic echocardiography was performed in 25 patients 4 h before and at 24 h and 7 days after electrical cardioversion to determine right and left atrial mechanical function (internal atrial defibrillation, n = 16; external electrical cardioversion, n = 9), as assessed by peak A wave velocities derived from the transtricuspid and transmitral velocity profiles. In addition, transesophageal echocardiography was performed 4 h before and 24 h after cardioversion to evaluate postcardioversion thrombus formation in the right and left atrial chambers and to assess right and left atrial appendage function. The degree of spontaneous echo contrast was noted, and peak emptying velocities of the appendages were measured before and after cardioversion. Results: Peak emptying velocities of both the right atrial appendage (mean ± SD, 0.23 ± 0.1 vs 032 ± 0.11 m/sec; P = 0.02) and the left atrial appendage (0.3 ± 0.15 vs 0.4 ± 0.15 m/sec; P = 0.01) were significantly lower 24 h after cardioversion compared with 4 h before cardioversion, respectively. The degree of spontaneous echo contrast increased in the left atrium after cardioversion from 1.0 ± 1.2 to 1.9 ± 2.1 (P = 0.02), and in the right atrium, it increased from 0.8 ± 1.1 io 1.2 ± 1.1 (P = 0.1) after cardioversion. Peak A wave transtricuspid velocity increased from 0.26 ± 0.05 m/sec at 24 h to 0.38 ± 0.06 m/sec (P = 0.001) after 7 days; respective values for transmitral peak A wave velocity were 0.39 ± 0.15 and 0.54 ± 0.16 m/sec (P = 0.009). No thrombi were found in either the right or left atrium before cardioversion. In two patients, new thrombi in the right atrium were detected 24 h after internal atrial defibrillation. Thrombi were located at the superior rim of the fossa ovalis in both patients with patent foramen ovale. Another patient had developed a thrombus in the left atrial appendage. Conclusions: Electrical cardioversion may not only cause left atrial chamber and appendage dysfunction and left atrial thrombi but also lead to depressed right atrial appendage function and the generation of new thrombi in the body of the right atrium.