bluuebunny/crossref_metadata_2025 huggingface dataset:
Myocardial Drainage via Thebesian Veins: Demonstration by Contrast Enhanced Color Doppler
Authors: BECHER HARALD , BIBRA HELENE VON , SCHLIEF REINHARD , GELLER CHRISTOPH , GLÄNZER KILIAN , AUPPERLE BIRGIT , VETTER HANS
Published: August 2007

In order to increase the sensitivity of color Doppler imaging, 15 patients with ischemic heart disease were evaluated before and after intravenous injections of 10 mL SH U 508 (200 mg/mL). This new contrast agent contains stabilized microbubbles capable of transpulmonary passage and it is expected to enhance left ventricular flow display. After injection of SH U508, left ventricular filling and outflow were imaged in brighter colors and on wider areas than in the baseline study: the display of filling (percentageof thecross‐sectionalarea) increasedfrom 30%± 14% (mean value ± standard deviation) to 54%± 16%, P< 0.01, the display of outflow increased from 27%± 13% to45%± 15%, P< 0.01, respectively. In addition, color Doppler imaging with SH U 508 demonstrated single or multiple mosaic flow patterns, which were different from the flow areas in the inflow and outflow tracts. The additional flow areas were found during systole and diastole and originated from the apical myocardium in most of the patients. Further clinical and angiographic investigation revealed no evidence of coronary artery fistulas to the left ventricle. Color Doppler after intravenous injection of SH U 508 provides improved display of left ventricular filling and outflow. In addition, flow patterns are displayed that probably represent myocardial drainage by Thebesian veins. (ECHOCARDIOGRAPHY, Volume 8, September 1991)
Noninvasive Estimation of End‐Systolic Aortic Pressure in Children
Authors: IWAHARA MASAZUMI , BENSON LEE N. , FREEDOM ROBERT M.
Published: August 2007

To simplify the estimation of end‐systolic aortic pressure (Pes) noninvasively, a regression equation was derived from intra‐arterial measurements. Peak‐systolic (Pps), Pes, and diastolic aortic pressure (Pd), pulse pressure (Pp), heart rate, hemoglobin, body weight, and height were measured. Cardiac index and body surface area were calculated in 66 patients (17 with aortic runoff lesions, group I; 49 without lesions, group II) with various heart diseases without aortic stenosis (35 males, 31 females, mean age 4.6 years) during the course of diagnostic catheterization. Using a stepwise regression analysis, the following relationship was determined from the combined groups: Pes= 0.422*Pps+ 0.617*Pd+ 1.377. The correlation between Pes measured directly and Pes calculated from our formula was quite strong(r= 0.957, P= 0.0001), as was the correlations between each subgroup (r= 0.948, group I; r= 0.959, group II). The correlation between Pes calculated and that estimated using an indirect carotid pulse tracing method was also strong (r= 0.912, P= 0.0001, n= 31). This regression equation appears applicable to infants or children with aortic runoff lesions in whom it is difficult to measure Pes by noninvasive methods using the carotid pulse. (ECHOCARDIOGRAPHY, Volume 8, September 1991)
Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Pre‐ and Postoperative Echocardiography Findings in Three Unusual Cases
Authors: TULZER GERALD , NESSER HANS J. , HAMMERER IGNAZ
Published: August 2007

Diagnosis of anomalous left coronary artery from the pulmonary artery was prospectively established by color Doppler echocardiography in three patients. In two asymptomatic girls, aged 10 years and 5 years respectively, referred for evaluation of a murmur with normal ECG and chest X ray, two‐dimensional and pulsed‐Doppler examination showed no intracardiac abnormalities. Color flow mapping detected flow in a dilated right coronary artery and left coronary artery to pulmonary artery shunting. Color guided pulsed‐Doppler examination permitted further evaluation of coronary flow. Another child had a dilated cardiomyopathy with an echo‐dense anterolateral papillary muscle and mitral insufficiency. Postoperative echoes after subclavian to left coronary artery anastomosis and ligation of the left coronary artery at its origin showed residual high‐velocity shunting resulting in reoperation in one case and a moderate supravalvular pulmonic stenosis in another. These findings further emphasize the benefit of color Doppler echocardiography in the pre‐ and postoperative evaluation of anomalous left coronary artery. (ECHOCARDIOGRAPHY, Volume 8, September 1991)
Intraoperative Transesophageal Echocardiography of Ventricular Septal Defect
Authors: ROBERSON DAVID A. , MUHIUDEEN ISOBEL A. , CAHALAN MICHAEL K. , SILVERMAN NORMAN H. , HAAS GARY , TURLEY KEVIN
Published: August 2007

The accuracy and limitations of intraoperative two‐dimensional (2‐D) and color Doppler flow mapping transesophageal echocardiography (TEE) of ventricular septal defect (VSD), before and after cardiopulmonary bypass, were analyzed in 62 children. Twenty‐one patients had an isolated VSD, and 41 had a VSD plus additional cardiac anomalies. Two‐dimensional and color Doppler flow mapping TEE were performed with a miniaturized 5‐MHz single (transverse) plane transducer in the 51 of 62 patients weighing <20 kg. The remaining 11 were monitored using a single plane adult probe (n= 4) and a biplane (transverse plus longitudinal) probe (n= 7). Prebypass TEE provided a correct diagnosis in 57 of 62 cases (92%) and corrected an erroneous preoperative transthoracic echocardiographic diagnosis in three of 62 cases (5%). Single plane TEE diagnosis was erroneous in five patients: four with doubly‐committed subarterial VSD and one with multiple small apical muscular defects and pulmonary hypertension. Biplane TEE (transverse longitudinal) provided clear and complete imaging of the right ventricular outflow tract in all seven cases in whom it was used. Postbypass TEE showed absence of a hemodynamically significant residual VSD in 38 of 40 patients (95%) who underwent VSD patch closure, prospectively identified two of 40 with significant residual VSD, and accurately measured the color Doppler jet width of all residual VSDs. We conclude that hemodynamically significant VSDs can be identified immediately after cardiopulmonary bypass based on the width of the residual VSD color Doppler flow map jet. Therefore, 2‐D and color Doppler flow mapping TEE provide an accurate diagnosis in most cases of VSD but may miss doubly‐committed subarterial and apical muscular VSD unless biplane TEE is used. (ECHOCARDIOGRAPHY, Volume 8, November 1991)
Patterns of Flow Within the Dilated Cardiomyopathy Left Ventricle: Color Flow Doppler Observations
Authors: D'CRUZ IVAN A. , SHARAF IDRIS S.
Published: August 2007

Study of the pathways of intraventricular flow by pulsed Doppler and color flow Doppler has shown that, in normal individuals, a broad strong stream flows into the left ventricular chamber from the mitral annulus to the apex during early rapid and late (atrial) ventricular filling phases; in systole, a broad rapid stream from the apex to the aortic orifice is dominant. In dilated cardiomyopathy, flow velocities are slower, and the typical pattern is a circular type of diastolic flow along the lateral left ventricular wall toward the apex and then from the apex to the aortic orifice along the septum. The systolic flow pattern is also different in dilated cardiomyopathy; in addition to the flow along the septum toward the aortic orifice, some blood flows in a circular manner back to the apex along the lateral wall. An important aspect of abnormal flow patterns in dilated dysfunctional left ventricular chambers is their association with a tendency to thrombus formation. Thus, the pathophysiology of abnormal intraventricular flow patterns may have academic but also therapeutic implications. (ECHOCARDIOGRAPHY, Volume 8, March 1991)
Quantitative Stress Echocardiography
Authors: SHAPIRO SHELLEY M. , GINZTON LEONARD E.
Published: August 2007

Dramatic improvements in our ability to treat coronary artery disease have created the need to develop sensitive and specific noninvasive tests for diagnosing and assessing the severity of ischemic disease. The purpose of this review is to examine stress echocardiography and, in particular, quantitative stress echocardiography in this context. Methodology and technical aspects of performing and interpreting stress echocardiography are discussed, including the type of exercise performed, imaging and recording techniques, and methods for on‐line and off‐line analysis. Qualitative, semiquantitative, and quantitative approaches are compared and contrasted. In assessing quantitative stress echocardiography, the role of global measurements of left ventricular function including ejection fraction, peak systolic pressure to end‐systolic volume index ratio, as well as regional measurements including wall‐motion analysis and wall stress, are discussed. Pertinent literature using quantitative approaches is reviewed including those comparing quantitative stress echocardiography with other noninvasive modalities. Future directions for study are also addressed. We concluded that quantitative stress echocardiography has excellent sensitivity and specificity for diagnosing ischemic heart disease. It was useful in localizing lesions, defining multivessel disease, and predicting patients with poor prognosis postmyocardial infarction. Its reproducibility makes it a valuable technique in following patients noninvasively over time.
Quantification of Mitral Regurgitation: A Comparison of Transesophageal Echocardiography and Contrast Ventriculography
Authors: JACOBS LARRY E. , WERTHEIMER JOHN H. , KOTLER MORRIS N. , FANNING ROBERT , MEYEROWITZ COLIN , STRAUSS CLIFFORD S. , IOLI ALFRED W.
Published: August 2007

Transesophageal echocardiography (TEE) allows an unobscured view of the left atrium for the assessment of mitral regurgitation (MR). However, criteria for assessing MR by TEE have not been carefully validated. In order to determine and validate criteria for the assessment of MR severity, 65 clinically stable patients with a TEE color Doppler study and contrast ventriculography within a 2‐week period were identified. Maximal or peak mitral regurgitation jet area to left atrial area ratio (MR/LA) derived solely from TEE imaging had the best correlation to MR severity by contrast ventriculography (r = 0.89). Utilizing MR jet area without correction for LA size resulted in r = 0.72 to 0.75. Utilizing LA area data from transthoracic echocardiograms in a subset of 29 patients resulted in r = 0.77. Best sensitivity and specificity for the assessment of MR by TEE were obtained using the following criteria: Peak MR/LA of 0%‐9% predicts 0+ MR; 10%‐28% 1 + MR; 29%‐54% 2 + to 3 + MR; and >55% 4 + MR. Best sensitivity and specificity occurs for assessment of 0 + and 4 + MR. Considerable overlap in data occurs in the 1 + to 3 + MR range utilizing the above stated criteria. Peak MR/LA ratio derived from a single TEE view in which the MR jet is maximally imaged is the best determinant of MR severity.
Utility of Stress Echocardiography for Postinfarct Prognosis
Authors: VISSER C.A. , RES J. , JAARSMA W.
Published: August 2007

Although high‐risk patients following myocardial infarct are usually identified in the acute stage by clinical assessment and determination of left ventricular function at rest, a significant percentage of infarct patients with increased risks, i.e., presence of residual myocardial ischemia, remain undetected at discharge. Since the yield of adequate images for interpretation stress echocardiograms has been significantly improved with digital technology, stress echocardiography has become a truly practical technique to identify these patients. Presence of remote asynergy, i.e., asynergy not directly adjacent to the infarcted area and supposed to be related to another vascular region, directly following cessation of dynamic exercise appears to be highly related to multivessel disease and an unfavorable follow‐up period. Treadmill electrocardiographic findings, however, appeared to be of limited value in this respect. Furthermore, the echocardiographic ejection fraction was also a poor predictor. The versatility of the technique, lack of injections, or radiation hazard, and the relatively low cost will undoubtedly increase the application of stress echocardiography for postinfarct stratification.
Clinical Usefulness of Biplane Transesophageal Echocardiography
Authors: DECOODT PIERRE , KACENELENBOGEN RAYMOND , BAR JEAN‐PAUL , SALMON KARIN , PEPERSTRAETE BÉATRICE , VERBEET THIERRY , TELERMAN MICHEL
Published: August 2007

The clinical usefulness of biplane color Doppler transesophageal echocardiography is illustrated by the results obtained in 300 successive examinations. The additional contribution of the newer longitudinal plane was judged significant or major in 64% of the cases. The method was useful mainly for intraoperative examinations, assessment of native valvular disease, prosthetic valve evaluation, search for tumors, and assessment of endocarditis, congenital heart disease, and aortic disease. In contrast, the longitudinal plane option was not contributory in 68% of the cases of thromboembolism. Typically, the technique aided in the evaluation of mitral valve insufficiency and the detection of paraprosthetic leaks. Lesions located at the level of the ascending aorta, the left and right ventricular outflow tracts, and the interatrial septum were also visualized best. The limitations of the method were negligible and the duration of the examination was not significantly increased in comparison to the monoplane method. When available, biplane transesophageal echocardiography seems to be preferred in most clinical settings.
Diagnosis of Contained Aortic Rupture by Transesophageal Echocardiography
Authors: OBARSKI TIMOTHY P. , ROGERS PAUL J. , ROSS JESSICA A. , DUFF STEPHEN B.
Published: August 2007

Hematogenous seeding is the most common mechanism for the development of peripheral arterial infections. Echocardiography, and especially transesophageal echocardiography, has played an increasingly important role in the diagnosis of aortic pathology. Rupture of an aortic aneurysm is difficult to diagnose antemortem, and requires a high index of suspicion and a rapid diagnosis if surgery is to be beneficial. We present a case of a ruptured aortic aneurysm secondary to seeding from B. fragilis bacteremia suspected by transesophageal echocardiography and confirmed by surgical exploration. The two‐dimensional echocardiographic and color flow Doppler findings are described and differentiated from those seen in an aortic dissection.
Thrombolytic Treatment of an Acute Anterior Myocardial Infarction Based Upon Echocardiography and in the Absence of Electrocardiographic Criteria
Authors: EISENBERG JOEL D.
Published: August 2007

Tissue plasminogen activator was administered intravenously to a patient with clinical features of, but without electrocardiographic criteria for, an acute myocardial infarction. The ultimate treatment decision was based upon echocardiographic findings diagnostic for an anteroseptal myocardial infarction. Subsequent coronary angiography demonstrated a severe proximal, but patent left anterior descending stenosis. The patient is now asymptomatic 3 months following thrombolytic therapy and coronary angioplasty.
Echocardiographic Long‐Term Evaluation of Percutaneous Balloon Mitral Valvotomy
Authors: CASTILLO JOSE MARIA DEL , MIYAHIRA NELSON , ZULIANI MARIA FERNANDA M. , MANGIONE JOSE ARMANDO , ARIE SIGUEMITUZO
Published: August 2007

Percutaneous balloon mitral valvotomy (BMV) is an alternative therapeutic method for patients with mitral stenosis. We studied 62 patients (56 females, mean age 36.4 years) who underwent balloon mitral valvotomy. Five patients were pregnant and in New York Heart Association Functional Class IV. Doppler echocardiographic studies were performed prior to the procedure, and at 7 days, 6 months, 12 months, and 24 months after the procedure. We studied the following parameters: echo‐score by the sum of valvular mobility, thickening, and calcification, and subvalvular disease, graded from 1 to 4; and mitral valve area (MVA) and mitral pressure gradient (MPG) by Doppler echocardiography. The patients were separated into two groups: group I with an echo‐score 8 (40 patients), and group II with an echo‐score 9 (22 patients). Mitral valve area and MPG were compared with hemodynamics through the correlation coefficient and linear regression. Comparison between groups I and II was performed using the unpaired Student's t‐test. Follow‐up of MVA and MPG was analyzed by analysis of variance. The Student's t‐test did not show any significant difference between MVA and MPG before balloon mitral valvotomy. There was significant decrease of MVA in group II (P<0.01) in the last three studies. There was significant increase in MPG in group II (P<0.01) in every postvalvotomy study. The analysis of variance of group I showed statistical increase of the MVA, and significant decrease of the MPC after BMV. The analysis of variance of group II showed significant increase in MVA and significant decrease in MPG between the pre‐ and the first postvalvotomy study. There was significant decrease (P<0.01) in MVA, and increase in MPG in the three postvalvotomy studies. Complications included mitral regurgitation, residual interatrial communication, pericardial effusion due to an atrial wall perforation, and peripheral embolization. Atrial fibrillation did not significantly alter the results of BMV. Results were considered positive when MVA was>1.5 cm2 and area increase was>25%. Patients with an echo‐score 8 (group I) benefit from BMV, with a positive predictive value > 78%. In pregnant patients the symptomatology was alleviated by BMV, without any signs of fetal compromise.
Intravascular Ultrasound Imaging of Arterial Wall Architecture
Authors: GE JUNBO , ERBEL RAIMUND , GÖRGE GÜNTER , GERBER THOMAS , BRENNECKE RÜDIGER , SEIDEL INGO , REICHERT TORSTEN , MEYER JÜRGEN
Published: August 2007

Intravascular ultrasound (IVUS) is a promising new technique for assessing vascular morphology and structure. Controversy exists whether the three‐layer appearance of the arterial wall correctly reflects the histologic structures of the intima, media, and adventitia. We performed an experimental study to clarify the three‐layer appearance. The vessel wall architecture was analyzed by IVUS on eight different kinds of plastic cylinders, 24 normal blood vessels from pigs, and 59 human arterial segments. A distinct three‐layer appearance was observed on all the plastic cylinders when the ultrasound beam was perpendicular to the wall. A three‐layer appearance was also seen in the arterial wall, in the muscular (iliac, femoral artery) and elastic types (aorta), when the echo beam was perpendicular to the vessel wall. The three‐layer pattern was even observed on the arterial wall when the intima was removed. Furthermore, the removed intima itself provided a three‐layer image. Histologic examination showed that there was no correspondence between the IVUS three‐layer appearance and the intima, media, and adventitia. Moreover, we also performed IVUS on nine patients who suffered from aortic dissection. Intravascular ultrasonic visualization of the dissected intima showed a distinct three‐layer pattern. The pattern disappeared when: (1) the echo beam was not perpendicular to the vessel wall; (2) there was connective tissue around the vessel wall; (3) there was arterial wall calcification; or (4) the vessel wall was too thick or the distance between the ultrasound transducer and the vessel wall was too large. We conclude that the three‐layer pattern in IVUS images seems to not represent the histologic intima, media, and adventitia, but results from the reflection of echo beam at the border zones.
The Improved Yield of Transesophageal Echocardiography Over Transthoracic Echocardiography in Patients with Neurological Events is Largely Due to the Detection of Aortic Protruding Atheromas
Authors: TUNICK PAUL A. , KRONZON ITZHAK
Published: August 2007

It is important to determine what, if any, the added contribution of transesophageal echocardiography is to the evaluation of patients with unexplained strokes and transient ischemic attacks. Transesophageal echocardiography was performed in 283 consecutive patients over an 8‐month period. The reason for referral in 63 of these patients was unexplained stroke or transient ischemic attack. These 63 studies were evaluated for the presence of lesions that could be etiologic in these patients, including protruding aortic atheromas, spontaneous echo contrast, atrial septal aneurysms, and atrial clots. The transesophageal and transthoracic techniques were compared. The main finding was that there were 23 abnormal findings that might have been responsible for stroke or transient ischemic attacks seen on transesophageal echocardiography, which were not visualized on transthoracic echocardiography. Transthoracic echocardiography was false negative in 19 (30%) of 63 patients. None of the protruding aortic arch atheromas seen on transesophageal echocardiography were diagnosed with transthoracic echocardiography. Transesophageal echocardiography is indicated in the evaluation of patients with unexplained strokes and transient ischemic attacks, and the added yield of this technique is largely due to the finding of protrvding aortic arch atheromas.
Three‐Dimensional and Four‐Dimensional Transesophageal Echocardiographic Imaging of the Heart and Aorta in Humans Using a Computed Tomographic Imaging Probe
Authors: PANDIAN NATESA G. , NANDA NAVIN C. , SCHWARTZ STEVEN L. , FAN POHOEY , CAO QI‐LING , SANYAL RAJAT , HSU TSUI‐LIEH , MUMM BERNARD , WOLLSCHLÄGER HELMUT , WEINTRAUB ANDREW
Published: August 2007

We evaluated the clinical applicability of a prototype tomographic transesophageal echocardiographic (TEE) system, which not only provides conventional TEE images but also three‐dimensional tissue reconstruction and four‐dimensional display capabilities. The probe was used in 16 patients in the echocardiographic laboratory, intensive care unit, and the operating room. The instrument is a 5‐MHz, 64‐element, phased array unit mounted on a sliding carriage within a casing. After appropriate probe placement within the esophagus, the probe is straightened, a balloon surrounding the probe is inflated, and data acquisition begun with ECG and respiration gating. With computer controlled transducer movement at 1‐mm increments, a complete cardiac cycle is recorded at each tomographic level. These are processed using a dedicated four‐dimensional software, and displayed as a dynamic three‐dimensional tissue image of the heart. We were able to see the dynamic motion of the ventricles and all the valves in the four‐dimensional format. In addition to four‐dimensional display, we were able to cut and visualize the heart in dynamic mode in any desired plane and also in multiple planes. Patients tolerated the procedure well. We conclude that this tomographic four‐dimensional approach, which does not require tedious off‐line processing, can easily be performed in patients and has a strong clinical potential.
Visualization of Mitral Valve Tunnel Aneurysm by Transesophageal Echocardiography
Authors: RENTOUKAS ELIAS , KREMASTINOS DIMITRIOS T. , MATSAKAS EVAGELOS , KOLETTIS THEOFILOS M. , TOUTOUZAS PAVLOS
Published: August 2007

We report the echocardiographic findings in a patient with a mitral valve aneurysm, probably occurring as a complication of aortic valve endocarditis. Transesophageal echocardiography showed a tunnel‐shaped aneurysm of the atrial side of the anterior mitral leaflet, expanding in systole and collapsing in diastole. Transesophageal echocardiography is a useful diagnostic tool for the evaluation of mitral valve pathology.
Pitfalls in the Echo‐Doppler Diagnosis of Hypertrophic Cardiomyopathy
Authors: MOVSOWITZ HERMAN D. , MOVSOWITZ COLIN , JACOBS LARRY E. , KOTLER MORRIS N.
Published: August 2007

While Doppler echocardiography has become the gold standard for the diagnosis of hypertrophic cardiomyopathy, there are many pitfalls in its use. Some of these pitfalls are technical in nature resulting from inadequate image quality, incorrect transducer angulation, and improper equipment settings. Other pitfalls relate to the diversity and heterogeneity in defining hypertrophic cardiomyopathy and to the host of disorders that may mimic it by echocardiography. The pattern and extent of ventricular hypertrophy, systolic anterior motion of the mitral valve, andDoppler determination of left ventricular outflow tract obstruction, diastolic dysfunction, and mitral regurgitation are discussed, as are wall‐motion abnormalities and myocardial echo reflectivity. While these echocardiographic features of hypertrophic cardiomyopathy are nonspecific when seen in isolation, their combined presence in the appropriate clinical setting makes the diagnosis likely.
Pitfalls in the Echo‐Doppler Diagnosis of Prosthetic Valve Disorders
Authors: ZABALGOITIA MIGUEL , GARCIA MARY
Published: August 2007

Assessment of artificial heart valves is a classic example of pitfalls in Doppler and color flow echocardiography. These limitations should be analyzed in the context of the most common clinical conditions associated with prosthetic valve dysfunction, that is, assessment of stenosis, regurgitation, endocarditis, and source of emboli. Estimation of the mean transvalvular gradient in addition to valve areas may avoid potential problems of over‐ or underestimation of stenotic lesions. The combination of acoustic attenuation, acoustic shadowing, and jet(s) eccentricity makes accurate grading of prosthetic regurgitation difficult and often frustrating. Reverberations and side lobe are frequent artifacts that decrease the ability of two‐dimensional echocardiography to identify endocarditis‐induced lesions such as vegetations and abscesses, as well as potential sources of emboli such as thrombus and atrial septal abnormalities. Transesophageal echocardiography has provided a new window in the evaluation of prosthetic cardiac valve function. With this approach, high frequency, high resolution transducers greatly improve the quality of ultrasound and color flow Doppler images that result in a higher diagnostic yield. In patients with suspected mitral prosthesis malfunction, transesophageal echocardiography is the method of choice. Contrast study during the transesophageal examination increases the sensitivity to detect potential sources of emboli such as patent foramen ovale. The improvement in diagnostic accuracy may allow one to avoid further diagnostic tests and, in selected patients, it may facilitate optimal timing of a surgical intervention.
The Increasing Role of Transesophageal Echocardiography in Unexplained Cerebral Ischemia
Authors: LABOVITZ ARTHUR J.
Published: August 2007

Cerebrovascular disease is a leading cause of morbidity and mortality in the United States. A significant number of cerebral infarctions are due to a cardiac source of embolus. Transesophageal echocardiography (TEE) is being used with increasing frequency to study patients with potential cardiac causes of cerebral ischemia. TEE has a higher sensitivity for detecting left atrial and left atrial appendage thrombi and for visualizing abnormalities of the atrial septum such as patent foramen ovale and aneurysm. Abnormalities of the aorta and native and prosthetic valves can now be clearly identified by TEE. Preliminary data suggest that TEE may influence clinical management in patients with unexplained stroke.
Neurologists' Perspective in the Evaluation of Ischemic Stroke
Authors: GOMEZ CAMILO R. , TULYAPRONCHOTE ROEKCHAI
Published: August 2007

The evaluation of victims of ischemic stroke has evolved over the last few years, primarily as a result of the introduction of innovative, sensitive, and informative diagnostic procedures. The role of the neurologist appears to have been redefined as one in which the identification of the presumptive cause and mechanism of the stroke is one of the primary responsibilities. The trend towards classification of patients into stroke subtypes, based upon etiology and pathogenesis, has led to ashift in care to a more etiology‐specific approach. The inclusion of results of ancillary tests in the criteria utilized for stroke subtype classification has expanded the neurologists' ability to ascertain the presumptive etiology of many strokes that in the past were considered of unknown etiology. This has also resulted in an apparent increase in the proportion of ischemic strokes presumably due to cardiogenic embolism. The impact oftransesophageal echocardiography upon changes in the presumptive etiology of ischemic stroke is illustrated, underscoring the future collaboration of neurologists and cardiologists in the evaluation of victims of presumed cardiogenic ischemic stroke.
Pericardiocentesis Guided By Two‐Dimensional Contrast Echocardiography
Authors: CHIANG HUNG‐TING , LIN MIKE
Published: August 2007

The clinical application of two‐dimensional contrast echocardiography to pericardiocentesis was investigated in 20 patients with pericardial effusion. Multiple views were obtained to determine the ideal needle entry route. During pericardiocentesis, after 5 to 10 mL of pericardial fluid was withdrawn, 3 to 5 mL of agitated saline solution was injected through the exploring needle into the pericardium and a cloud of echoes indicated the needle's position. Contrast echoes were observed in all 20 patients. The procedure was performed smoothly in all patients except two (10%): the exploring needle was inserted into the right atrium in one patient and into the right ventricle in the other patient. The former promptly underwent a surgical drainage procedure, and the latter a second pericardiocentesis successfully guided by contrast echocardiography. The pericardial fluid was simply, safely, and successfully aspirated in the other 18 patients. We conclude that two‐dimensional contrast echocardiography is valuable for locating needle position, thus facilitating successful pericardiocentesis in clinical practice.
Reliability of Doppler Color Flow Mapping in the Identification and Localization of Multiple Ventricular Septal Defects
Authors: SPEVAK PHILIP J. , MANDELL VALERIE S. , COLAN STEVEN D. , VAN DER VELDE MARY E. , JONAS RICHARD A. , LOCK JAMES E. , SANDERS STEPHEN P.
Published: August 2007

The purpose of this study was to compare Doppler color flow mapping with angiography and surgical observation for detection of multiple ventricular septal defects (VSDs). Only patients with elevated pulmonary ventricular pressure were included. Among 137 patients with VSDs, 38 multiple defects were identified in 25 patients echocardiographically, 34 multiple defects in 24 patients angiographically, and 21 multiple defects in 17 patients surgically. Using surgical observation as the reference standard, the sensitivity of echocardiography for identifying patients with multiple VSDs was 17 of 17 (100%) and for angiography 15 of 17 (88%). The sensitivity of echocardiography for identifying all multiple VSDs seen at operation was 19 of 21 (90%) and of angiography was also 19 of 21 (90%). In many patients, use of both techniques may no longer may necessary. (ECHOCARDIOGRAPHY, Volume 10, November 1993)
Routine Use of Transesophageal Echocardiography and Color Flow Imaging in the Evaluation and Treatment of Children with Congenital Heart Disease
Authors: BENHEIM ALAN , KARR SHARON S. , SELL JEFFREY E. , MIDGLEY FRANK M. , HOLLEY DEIDRE , MARTIN GERARD R.
Published: August 2007

We reviewed our experience with transesophageal echocardiography (TEE) and color flow imaging in 157 consecutive patients with known or suspected heart disease to ascertain the impact of this technology on patient care. TEE was performed for diagnostic purposes (22/157), during interventional cardiac catheterizations (13/157), and during operative procedures (122/157). Diagnostic studies were performed after transthoracic echocardiography (TTE) in 21 of 22 patients. TEE was performed because TTE was inconclusive (15/21) or failed to provide sufficient detail of an abnormality (6/21). TEE detected an abnormality in 6 of 15 inconclusive TTEs. TEE was helpful during interventional cardiac catheterizations, particularly during umbrella closure of septal defects and in patients with complex venous and atrial anatomy undergoing transseptal puncture. TEE studies performed before cardiac operations significantly changed the diagnosis in only 5 of 122 (4%) patients, but the information changed the surgical approach in 4 of 5 of these patients. Postoperative TEE assessment more frequently changed care and resulted in further surgical management in 9 of 122 (7%) or a change in medical management in 6 of 122 (5%) patients. TEE was discontinued because of complications before studies were completed in only 4 of 157 (3%) patients. TEE and color flow imaging is a useful adjunct to care of children with known or suspected congenital heart disease. (ECHOCARDIOGRAPHY, Volume 10, November 1993)
DEEPAK K. PARASHARA, M.D.1
Authors: JACOBS LARRY E. , LEDLEY GARY S. , YAZDANFAR SHAHRIAR , OLINE JOHN , KOTLER MORRIS N.
Published: August 2007

The precise diagnosis of the presence of significant left main coronary artery disease has profound prognostic and therapeutic implications. Coronary cineangiography has shown to be imprecise and inaccurate to determine the percent stenosis of the left main coronary artery. We report a case with significant left main coronary artery disease in whom coronary cineangiography was in discordance with the clinical data and intravascular ultrasonography. Based on the intravascular ultrasound findings, the patient underwent coronary artery bypass graft surgery. Therefore, the intravascular ultrasonography may be the procedure of choice for assessing indeterminant left main coronary artery lesions by coronary angiography.

intravascular ultrasound, left main coronary artery, coronary cineangiography
Utility of In Vivo, Intracardiac Two‐Dimensional Echocardiography in the Assessment of Myocardial Risk Area and Myocardial Dyssynergy During Coronary Occlusion and Reperfusion
Authors: SCHWARTZ STEVEN L. , KUSAY BRENDA S. , PANDIAN NATESA G. , ARONOVITZ MARK , KONSTAM MARVIN A. , SALEM DEEB N.
Published: August 2007

We have previously reported the potential use of intracardiac echocardiography (ICE) in a variety of clinical settings, including detection of pericardial effusion, intracardiac masses, congenital cardiac defects, and during simulated balloon valvuloplasty. The utility of intracardiac ultrasound imaging of the left ventricle (LV) inpatients with coronary disease needs to be further explored. We performed this study with the purpose of evaluating risk area and regional wall‐motion abnormalities produced by ischemia using ICE. Ten episodes of ischemia were produced by transiently occluding the left anterior descending coronary artery in five dogs. ICE was performed with a modified 5‐MHz transesophageal echocardiographic probe placed in the right atrium. Continuous short‐axis images of the LV were obtained before, during, and after coronary occlusion. Risk area was defined using myocardial contrast echocardiography. In all cases, ICE provided high resolution images of the LV. Risk area and regional wall‐motion abnormalities were readily detected. There was good correlation between the risk area (x) and extent of dyssynergy (y), defined by the equation y = 0.76x + 6.38 (r = 0.80, P < 0.01). We conclude that ICE provides potentially useful information concerning regional LV dysfunction, and, when combined with myocardial contrast echocardiography, area at risk. This technique may be useful during interventional procedures once a catheter‐based ultrasound transducer with adequate depth of field to provide images of the entire LV can be developed.

intracardiac echocardiography, intravascular ultrasound, ischemia, coronary artery disease
Nonsurgical Creation of a Pericardial Window: Identification by Echocardiography
Authors: CHOW WING‐HING , CHOW TSUN‐CHEUNG , YIP ALEX S.B. , CHEUNG KING‐LOONG
Published: August 2007

A patient is described who has recurrent pericardial effusion and in whom a pericardial window created by balloon dilatation was directly identified by echocardiography. Echocardiography represents an additional useful means for confirming the immediate success of the procedure.

pericardial effusion, balloon dilatation, echocardiography
Discrepancies Between Doppler‐ and Catheter‐Derived Gradients in Aortic Prosthetic Valves:
Authors: SHAMMAS RONNY L. , MEHTA PRABODH M. , REEVES WILLIAM C.
Published: August 2007

Doppler‐ and catheter‐derived gradients have correlated well in patients with native aortic valvular stenosis. This relationship, however, is less certain in the presence of prosthetic aortic valves. We report a case with prosthetic aortic valve in which the echocardiogram suggested significant mechanical valve stenosis. The patient had no evidence of prosthetic valve dysfunction during cardiac catheterization. We conclude that Doppler‐derived gradients across prosthetic aortic valves should be correlated with the patient's clinical condition and supplemented by additional noninvasive and invasive data obtained during cardiac catheterization when warranted.

prosthetic aortic valves, Doppler, cardiac catheterization
Transesophageal Color Flow Echocardiographic Evaluation of Supravalve Mitral Ring in an Adult Patient
Authors: ASCIONE LUIGI , CASO PIO , LEVA FRANCESCO DE , SCHERILLO MARINO , GIANTURCO PAOLA , MININNI NICOLA
Published: August 2007

Supravalve mitral ring (SVMR) is an extremely rare form of congenital left ventricular inflow obstruction in which a left atrial membrane causes an obstruction keeping the left atrium from emptying into the left ventricle. Cardiac catheterization and angiography are not reliable means to diagnose this lesion. Transthoracic echocardiography (TTE) has proved to be the most sensitive tool for diagnosis of this form of left ventricular inflow obstruction; however, its diagnostic accuracy has been recently questioned. We report the complementary roles of TTE and transesophageal echocardiography in a case of SVMR in an adult patient. (ECHOCARDIOGRAPHY, Volume 11, May 1994)
New Method for Quantitatively Determining Aortic Regurgitant Volume Using Doppler Color Flow Imaging:
Authors: YOSHIDA YUTAKA , MOSCARELLI ELENA , TANOUCHI JUN , MASUYAMA TOHRU , HORI MASATSUGU , KAMADA TAKENOBU , KITABATAKE AKIRA
Published: August 2007

We have developed a method to provide the two‐dimensional distribution of blood flow velocity and the blood flow volume rate in the ascending aorta from the cross‐sectional Doppler color flow image. Regional blood flow velocities were determined by converting color intensities of the cross‐sectional Doppler color flow image into the corresponding flow velocities with the correction with the spatial ultrasound beam incident angle. The spatial ultrasound beam incident angle was estimated from the geometric characteristics of the color flow image contour. The method was validated in a steady flow model circuit comparing the calculated flow volume rates by the method with those simultaneously measured by an electromagnetic flowmeter. We performed an open chest dog experiment and calculated the blood flow volume rate at the ascending aorta before and after the aortic regurgitation was made. The calculated ejection flow volume rate and regurgitant volume were validated by the comparison with those simultaneously measured by an electromagnetic flowmeter. Based on these data, we can conclude that the current method provides accurate measurements of regurgitant volume as well as ejection flow volume rate in the ascending aorta. (ECHOCARDIOGRAPHY, Volume 11, May 1994)
Limitations in the Applicability of the Simplified Bernoulli Relation to Aortic Stenosis
Authors: CAREY RONALD F. , HERMAN BRUCE A.
Published: August 2007

Transvalvular pressure gradients (TPG) may be directly measured by invasive catheterization of the heart or indirectly estimated by echocardiography through Doppler measurement of fluid velocity. A significant body of work has recently shown that pressure recovery distal to the point of maximum velocity must be taken into account in the evaluation of aortic flows. Supported by this new work, conceptual arguments are presented here that challenge the common computation of pressure gradient across a restricting orifice from measurements of maximum fluid velocity, V. We argue that ideal, quasi‐steady flow proximal to and highly dissipative flow distal to the orifice are inappropriate simplifications. Rather, the relationship, TPG ≃K× V2, which frequently provides an acceptable estimate of TPG for values of K near 4, should be viewed as an empirical estimate of pressure drop due to loss mechanisms. Calculations of energy losses using one particular flow model demonstrate this. Such a reorientation in the interpretation of Doppler data provides critical insights into valve and patient variations, which heretofore have been assigned to measurement uncertainties. Based upon this analysis, the Food and Drug Administration's Office of Device Evaluation now asks that the coefficient K be determined in vitro for new prosthetic heart valves prior to human implantation.
Reproducibility of Transmitral Pulsed Doppler Parameters of Left Ventricular Filling During Dobutamine Stress Test
Authors: EL‐SAID EL‐SAID M. , RIJSTERBORGH HANS , ROELANDT JOS R.T.C. , VLETTER WIM B. , FIORETTI PAOLO M. , LINKER DAVID T.
Published: August 2007

The aim of this study was to investigate the reproducibility of transmitral Doppler parameters of left ventricular filling in subjects undergoing dobutamine stress and to estimate threshold values, which can be used as a reference to detect significant changes in Doppler measurements from baseline to peak dobutamine in an individual patient. The study groups included 11 male volunteers and 26 patients with coronary artery disease. Intra‐and interobserver tests were performed on 14 randomly selected tracings. The random variation of measurements (beat‐to‐beat variations plus random observer error) was estimated at baseline and peak dobutamine both in normals and patients. The parameters studied were: peak early (E) and atrial (A) filling velocities and their ratio (ElA), early filling acceleration (E‐AC) and deceleration (E‐DC) rates, and diastolic time‐velocity integral (TVI). Intra‐and interobserver mean differences were generally small (lt; 5%) with the largest found in the interobserver differences in E‐AC (12%) and TVI (7%). The random variation of measurements at baseline were similar in normals and patients with the smallest (lt; 5%) variation in E and the largest in E‐AC (12%) and El A (8%). There was a significant (P lt; 0.01) increase in the coefficient of variation from baseline to peak dobutamine for E (4.5% vs 7.6%), E‐AC (11% vs 14.8%), and E‐DC (6.5% vs 9.3%) in the patient group. The threshold values were calculated based on the random variation in a single patient and with the assumption that 3, 5, or 8 beats were analyzed at both instances. Conclusions: When Doppler evaluation of left ventricular filling is used during dobutamine stress, the following points should be considered: (1) peak E has the smallest variability among Doppler indices that assess early filling phase; (2) the variability of Doppler measurements of early filling increases with stress intervention in patients with CAD; (3) increasing the number of beats averaged from 3–8 reduces the threshold needed to decide significant differences in Doppler measurements between baseline and peak dobutamine by more than the half.
Transesophageal Echocardiography in Pericardial Disease and Tamponade
Authors: KRONZON ITZHAK , TUNICK PAUL A. , FREEDBERG ROBIN S.
Published: August 2007

While most pericardial disorders can be imaged by transthoracic echocardiography, transesophageal echocardiography may be required in those cases where pericardial pathology is clinically suspected, but cannot be imaged adequately with transthoracic echocardiography. Transesophageal echocardiography is especially helpful in patients after heart or chest surgery, with cardiac compression by a loculated pericardial hematoma, in patients with dissection, endocarditis, or interatrial shunting associated with pericardial effusion, inpatients with pericardial tumors, and in the differential diagnosis between constrictive pericarditis and restrictive cardiomyopathy.
Transthoracic Real‐Time Three‐Dimensional Echocardiography Using the Rotational Scanning Approach for Data Acquisition
Authors: LUDOMIRSKY ACHI , VERMILION ROGER , NESSER JOHACHIM , MARX GERALD , VOGEL MICHAEL , DERMAN RICHARD , PANDIAN NATESA
Published: August 2007

Transthoracic real‐time three‐dimensional echocardiography using the rotational scanning approach for data acquisition became a feasible modality for cardiac imaging during the last 4 years. Several attempts for reconstruction of the heart have been made using different methods. In this study we evaluate the data acquisition using the rotational approach from the transthoracic window. Thirty‐five children with congenital heart disease were enrolled in the study. All of them underwent complete two‐dimensional and Doppler echocardiogram followed by three‐dimensional reconstruction using rotational image acquisition. The rotational approach enabled us to acquire good data from subcostal, apical, and suprasternal notch positions by rotating the transducer from 0o‐180o. Novel views of the atrioventricular valve, semilunar valve, atrial, and ventricular septi were established by spatial plane imaging from the three‐dimensional echocardiography. This reconstruction enables spatial imaging of cardiac structures and deficiencies. Three‐dimensional echocardiography will enhance the understanding of complex congenital heart disease.
Left Ventricular Outflow Tract Obstruction Defined by Active Three‐Dimensional Echocardiography Using Rotational Transthoracic Acquisition
Authors: FYFE DEREK A. , LUDOMIRSKY ACHI , SANDHU SATINDER , DHAR PRADIP K. , SILBERBACH MICHAEL , SAHN DAVID J.
Published: August 2007

A rotational data acquisition system was used to create three‐dimensional images from thoracic and subxiphoid echocardiography windows in children with various types of subaortic stenosis. Thirteen patients, ranging in age from 2 days to 17 years, were examined. Subaortic obstruction was caused by a discrete fibrous ridge in six patients, hypertrophic cardiomyopathy in two patients, subaortic tunnel in two patients, and septal malalignment, restrictive VSD, and abnormal suture placement each in one patient. Unique views could be obtained equivalent to surgical or autopsy dissections, and allowed more complete understanding of morphology than conventional imaging techniques.
Enhanced Comprehension of Dynamic Cardiovascular Anatomy By Three‐Dimensional Echocardiography With the Use of Mixed Shading Techniques
Authors: CAO QI‐LING , PANDIAN NATESA G. , AZEVEDO JOSE , SCHWARTZ STEVEN L. , VOGEL MICHAEL , FULTON DAVID , MARX GERALD
Published: August 2007

Advances in ultrasound instrumentation and computer technology provide us an opportunity to develop methods to perform three‐dimensional echocardiography in patients. Optimal methods of displaying three‐dimensional images are critical for the perception of depth and distances. We examined the utility of various shading techniques in volume‐rendered three‐dimensional images in 22 patients with a variety of cardiac defects. Distance coding, gray level gradient shading, texture shading, and mixtures of these shading techniques were used. Our observations suggest that the mixture of shading techniques portray the dynamic three‐dimensional anatomy better than a single type of shading. Appropriate mix of shadings could provide dynamic three‐dimensional echocardiograms of clinical utility.