bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis of Coronary Artery Disease in Patients with Permanent Cardiac Pacemaker by Dobutamine Stress Echocardiography or Exercise Thallium‐201 Myocardial Tomography
Authors: Ciaroni Stefano , Bloch Antoine , Albrecht Laurette , Vanautryve Bernadette
Published: July 2003

This study evaluated the use of dobutamine stress echocardiography and exercise thallium‐201 myocardial computed tomography (CT) in the diagnosis of coronary artery disease (CAD) in patients with permanent transvenous pacemaker with the electrode implanted in the right ventricle (RV). Twenty‐nine consecutive patients with pacemaker underwent dobutamine stress echocardiography, exercise thallium‐201 myocardial CT, and coronary arteriography over a period of 8 ± 1 days. None of these patients had suffered a myocardial infarction (MI). The cardiac rhythm of every patient was electrically paced during echocardiography and tomography. Sixteen (55%) patients showed CAD on angiography (stenosis ≥ 50% of the luminal diameter of a major epicardial vessel). The detection sensitivity for CAD was 94% for the tomography and 88% for the echocardiography (P = NS). The difference between the sensitivities of the two techniques in detecting CAD based on the affected coronary artery was not statistically significant. Of the 13 patients without CAD, tomography showed a positive result in nine cases, i.e., a specificity of 31%, whereas echocardiography showed a positive result in only one case, i.e., a specificity of 92% (P < 0.01). Exercise thallium‐201 myocardial computed tomography produces an increased rate of false‐positive results in patients with permanent transvenous cardiac pacemaker (PCP) implanted in the right ventricle (RV). Dobutamine stress echocardiography can thus be used to reduce considerably the level of false‐positive results in these patients and still retain a detection sensitivity for CAD equal to that of myocardial tomography.
Evaluation of Ventricular Septal Defect Repair Using Intraoperative Transesophageal Echocardiography: Frequency and Significance of Residual Defects in Infants and Children
Authors: Yang Song‐Gui , Novello Rita , Nicolson Susan , Steven James , Gaynor J. William , Spray Thomas L. , Rychik Jack
Published: July 2003

Intraoperative transesophageal echocardiography (IOTEE) is commonly used to assess for residual defect and the need to return to bypass after repair of ventricular septal defect (VSD). The frequency and significance of residual septal defects as noted on IOTEE has not been well defined. We evaluated the frequency of residual VSD via IOTEE and the relationship between size of a residual VSD and rate of reoperation. In addition, we looked at the relationship between the presence of a residual VSD via IOTEE and the presence of residual VSD at follow‐up transthoracic echocardiography (TTE). Residual VSD was measured via the largest width of the Doppler color jet diameter originating at the left ventricular septal surface. Of the 294 patients evaluated with IOTEE after VSD repair, one‐third had a residual defect by IOTEE Doppler color flow mapping. Two‐thirds of these defects closed spontaneously on TTE by the time of hospital discharge. There was no difference in frequency of residual VSD between simple (VSD closure alone, n = 90) and complex (VSD with associated lesions, n = 204) repair. Return to bypass with immediate reoperation was undertaken in nine patients, all of whom had significant shunt via oximetry (Qp/Qs > 1.5:1.0). All had residual VSD color jet diameters > 3 mm. Seven patients had residual color jet equal to 3 mm; however, hemodynamic studies did not reveal a significant shunt and none of these had reoperation. Seven patients with no VSD or < 3 mm residual VSD via had late reoperation to close residual VSD at 4 days to 5 months after initial operation. These were due to patch dehiscence or development of an “intramural” VSD in patients with conotruncal anomaly. A residual defect on IOTEE color Doppler measuring ≥ 4 mm predicts the need for immediate reoperation, while a 3 mm defect may be significant and requires additional intraoperative hemodynamic evaluation. The majority of small defects noted on IOTEE are not present at discharge TTE. Patients with conotruncal defect repair should be followed closely for development of late significant “intramural” defects.
Aortic Valve Endocarditis Due to Staphylococcus Capitis
Authors: Kamalesh Masoor , Aslam Shamaila
Published: July 2003

Native valve endocarditis due to Staphylococcus capitis is uncommon and is usually managed conservatively with good outcome. Of the nine previously reported cases there has been only one mortality. We report a case of native aortic valve endocarditis due to S capitis in an elderly diabetic that had a fatal outcome despite appropriate therapy with antibiotics. A review the literature is also presented.
Transesophageal Echocardiographic Diagnosis of Thrombus in Accessory Lobes of the Left Atrial Appendage
Authors: Vargas‐Barrón Jesús , Espinola‐Zavaleta Nilda , Roldán Francisco Javier , Romero‐Cárdenas Angel , Keirns Candace , Vázquez‐Antona Clara
Published: July 2003

Fifty‐four percent of left atrial appendages have two lobes. The number ranges from one to four lobes. We describe three patients with accessory lobes of the left atrial appendage studied with multiplanar transesophageal echocardiography (TEE). In one patient there was evidence of thrombi in the accessory lobe.
Interventricular Septal Hydatid Cyst
Authors: Kurtoglu Nuri , Ermeydan Cem , Akdemir Ramazan , Basaran Yelda , Dindar İsmet
Published: July 2003

In this report we describe an unusual case of cardiac echinococcus located in the interventricular septum invaded by a cystic mass. It was demonstrated by using transthoracic echocardiography (TTE) and confirmed with magnetic resonance imaging (MRI). Surgical excision (cystopericystectomy) was performed on the patient as a curative therapy. Early recurrence was observed despite additional medical therapy with albendazole.
Fibrotic Aortic Stenosis in a Patient with Dwarfism
Authors: Huang Wen Ying , Nanda Navin C. , Miller Andrew , Aaluri Srinivasa Reddy , McGiffin David C. , Reddy Vishnu , Yesilbursa Dilek , Kottakota Radhika J.
Published: July 2003

In this report, we present an adult patient with dwarfism who had severe aortic stenosis with markedly thickened fibrotic valve leaflets without calcification. These findings were well demonstrated by both two‐ and three‐dimensional transesophageal echocardiography and confirmed at surgery and by pathological examination.
Blood Flow Assessment by Ultrasound‐Induced Destruction of Echocontrast Agents Using Harmonic Power Doppler Imaging: Which Parameters Determine Contrast Replenishment Curves?
Authors: Köster Jörg , Schlosser Thomas , Pohl Christoph , Lentz Christoph , Lohmaier Stefan , Veltmann Christian , Kuntz‐Hehner Stefanie , Omran Heyder , Lüderitz Berndt , Becher Harald , Tiemann Klaus
Published: July 2003

Objective: To evaluate the feasibility of flow determinations by contrast replenishment using harmonic power Doppler imaging (H‐PDI). Background: The application of indicator dilution principles on contrast echocardiography is limited by numerous methodical problems. Recently, a new method was introduced that relies on ultrasound‐mediated microbubble destruction and evaluation of the contrast replenishment. Methods: Definity, a perfluorocarbon‐derived contrast agent under development, was continuously infused into a steady flow phantom and H‐PDI registrations were performed within a silicone tube (d = 8 mm). Replenishment interval between destruction and imaging frame was varied from 0.04–2 seconds. Nonlinear curve fitting was performed using an exponential mathematical model. Results: Strong linear correlation between contrast dose and maximum signal intensity as well as between flow and the slope variable β of the replenishment curve was found for all settings (r > 0.96). Maximum signal intensity and contrast replenishment rate were found to be a function of emission power and were significantly influenced by depth and focus position. Conclusion: The feasibility of flow assessment using replenishment curves obtained by H‐PDI was demonstrated. However, in experimental conditions, flow analysis was severely influenced by ultrasound system settings and imaging conditions such as emission power, sound field geometry, and investigation depth. For a clinical use of this promising approach, algorithms that take specific system settings and imaging conditions into account have to be found. Imaging modalities that enable a most homogeneous scan field are best suited for the assessment of contrast replenishment.
A Recurrent Right Heart Thrombus in a Patient with Behçet's Disease
Authors: Dincer Irem , Dandachi Rabih , Atmaca Yusuf , Erol Cetin , Caglar Nail , Oral Dervis
Published: July 2003

We report the case of a patient who was admitted to the immunology unit of our medical facility. The patient had a history of recurrent oral ulcers, low‐grade fever, weight loss, and fatigue. Echocardiographic examination revealed a right ventricular mass that was initially thought to be a myxoma in an unusual location, and the patient was sent to surgery. Surgery revealed the mass to be a thrombus. After 5 months of anticoagulation therapy, the patient was readmitted to our institution with the same complaints, and a right atrial thrombus was found on echocardiographic examination. After a careful reevaluation of the patient's history and episodes of recurrent oral and genital ulcers, as well as the papulopustular lesions found on his first admission to hospital, Behçet's disease was diagnosed. The patient received thrombolytic therapy with a regression of thrombus, and continued with immunosuppressive and anticoagulation therapy. Five months later, echocardiographic examination showed complete disappearance of thrombus.
Transesophageal Echocardiographic Findings of an Intracavitary Cardiac Metastasis from a Neuroendocrine Thymic Carcinoma
Authors: Mukhtar Osman , Miller Andrew , Nanda Navin C. , Aaluri Srinivasa R. , Reddy Vishnu V. B. , Cerfolio Robert J. , Kottakota Radhika J.
Published: July 2003

This case report presents the unusual characteristics of a neuroendocrine thymic carcinoma that probably has metastasized to the left side of the interatrial septum from a primary thymic site.
Noninvasive Right and Left Heart Catheterization: Taking the Echo Lab Beyond an Image‐Only Laboratory
Authors: Sorrell Vincent L. , Reeves William C.
Published: July 2003

The assessment of cardiovascular hemodynamics is an extremely important component of managing patients with cardiac diseases. For years, this has been accomplished primarily through the use of right and left heart catheters placed within the cardiac chambers. Since this is an invasive technique, it should only be used when necessary; patient discomfort, infections, and overall risks for physicians would be reduced if noninvasive methods were utilized when available. Echocardiography (echo) provides the greatest ability to determine cardiovascular hemodynamics noninvasively, but requires the utmost precision and care to avoid misinterpretation. When used correctly, echocardiographic modalities provide an even greater assessment of the cardiac patient than invasive techniques. A safer and more comprehensive interpretation is available, and thus, echo should be considered the modality of choice—the new gold standard.
Intracardiac Echocardiography: Current Uses and Future Directions
Authors: Foster Gary P. , Picard Michael H.
Published: July 2003

Advances in transducer technology have enabled development of catheter‐based ultrasound imaging devices that produce very high resolution images of vessels and cardiac structures. Although the majority of clinical use has been in the evaluation of the coronary and peripheral vasculature, a broad spectrum of cardiac applications continue to develop, including evaluations of the ventricles, valves, and great vessels, as well as the guidance of electrophysiological procedures. Specifically, introduction of the ultrasound catheter into the heart results in dynamic, real‐time images for assessment and quantitation of ventricular systolic function, severity of valve stenosis, and extent of regurgitant orifices. The intracardiac applications have the potential to become the gold standard for quantitation of valve dynamics and a critical tool in the ICU for prolonged monitoring of cardiac physiology.
Transesophageal Echocardiographic Assessment of Coronary Stenosis: A Decade of Experience
Authors: Biederman Robert W. W. , Sorrell Vincent L. , Nanda Navin C. , Voros Szilard , Thakur Abhash C.
Published: July 2003

Coronary artery imaging is routinely obtained invasively at cardiac catheterization through coronary angiography. This remains the gold standard, but with advances in ultrasound technology, electron beam computed tomography, and magnetic resonance imaging, newer noninvasive methodologies are achieving greater success at imaging the coronary anatomy. This review is meant to highlight the important accomplishments from transesophageal echocardiographic (TEE) investigations that have studied the coronary arteries. The specific technique for optimally imaging the coronaries with high frequency transducers, color and conventional Doppler, in addition to contrast‐enhanced methods, will be analyzed. Importantly, this article serves as a reminder to echocardiographers and cardiologists that excellent, clinically relevant information of the coronary arteries can be obtained routinely during TEE. This technique is part of the trend noted by the other authors in this special edition; that is, echocardiography is becoming the gold standard of the new millennium for many diagnostic areas, even coronary angiography.
Echocardiographic Evaluation of Valvular Stenosis: The Gold Standard for the Next Millennium?
Authors: Popović Aleksander D. , Stewart William J.
Published: July 2003

Over the past decade, utilization of cardiac catheterization for preoperative hemodynamic assessment of patients with mitral and aortic stenosis has steadily decreased. The reason for this trend is the use of echocardiography, which is emerging as a gold standard for clinical characterization of valvular lesions. Since cardiac catheterization is an invasive procedure that is associated with a significant percentage of complications, echocardiographic evaluation of patients with valvular stenosis is safer and more cost‐effective. In the next millennium, echocardiography will probably completely replace the use of catheterization for hemodynamic assessment of the severity of mitral and aortic stenosis.
Influence of Ejection Fraction and Valvular Regurgitation on the Accuracy of Aortic Valve Area Determination
Authors: Berglund Hans , Kim Chong‐Jin , Nishioka Toshihiko , Luo Huai , Siegel Robert J.
Published: July 2003

Objective: To examine the influence of left ventricular dysfunction, aortic regurgitation, and mitral regurgitation on commonly used methods for aortic valve area (AVA) determination. Background: Each method for AVA determination has its inherent limitations. Methods: AVA determinations by transesophageal echocardiography (TEE) using planimetry, transthoracic echocardiography (TTE) with application of the continuity equation, and cardiac catheterization applying the Gorlin formula were performed in 74 patients with aortic stenosis. The severity of the aortic stenosis was defined by consensus of at least two methods. Over‐ or underestimation of AVA associated with ejection fraction, aortic regurgitation, mitral regurgitation, or severity of the aortic stenosis for each method in relation to the other two methods was assessed. Results: Mean AVAs were 1.05 ± 0.51 by TEE, 1.06 ± 0.51 by TTE, and 1.08 ± 0.53 by cardiac catheterization. An overestimation of the severity of the aortic stenosis by the Gorlin formula in patients with moderate‐to‐severe aortic regurgitation as compared to TEE‐derived data was found (P = 0.014). A similar trend of overestimation by catheterization in comparison with the TTE data was found. In the context of moderate‐to‐severe mitral regurgitation, AVA determination by TTE overestimated the degree of aortic stenosis as compared to TEE (P = 0.011) and cardiac catheterization (P = 0.023). Conclusions: Overall mean AVA did not differ between methods, suggesting that these three methods are equally accurate in a nonselected clinical patient group. However, in the presence of significant aortic regurgitation, the two echocardiographic methods appear more accurate. Our observation of an overestimation of the severity of aortic stenosis by TTE in the presence of moderate‐to‐severe mitral regurgitation indicates that this possibility should be accounted for in clinical decisions based on TTE determinations of AVA.
Real‐Time Three‐Dimensional Echocardiography in Assessment of Heart Disease
Authors: Ahmad Masood
Published: July 2003

Echocardiography has progressed at an impressive pace in the last decade. A plethora of new techniques, including tissue‐Doppler imaging, harmonic imaging, contrast echocardiography, digital‐stress echocardiography, and three‐dimensional (3‐D) echocardiography, have altered our diagnostic strategies for managing patients with heart disease. Until recently, 3‐D echocardiography was looked upon as a time‐consuming and tedious procedure, making it more a research interest than a diagnostic tool. The introduction of real‐time three‐dimensional (RT–3‐D) echocardiography has made possible dynamic diagnostic/therapeutic assessments while the procedure is performed. At The University of Texas Medical Branch in Galveston, Texas, our more than 2 years of experience with RT–3‐D suggests that this technique will play an important role in diagnosing and managing patients with heart disease.
Myocardial Contrast Echocardiography: A New Gold Standard for Perfusion Imaging?
Authors: Porter Thomas R. , Cwajg Jucyléa
Published: July 2003

Recent developments have permitted myocardial contrast echocardiography (MCE) to become a new method of noninvasively assessing myocardial perfusion in humans. Preliminary studies of myocardial perfusion imaging during adenosine, dipyridamole, and dobutamine stress echocardiography have shown excellent agreement with either radionuclide uptake or quantitative angiography. This article reviews the recent advances in microbubble technology, ultrasound imaging, and myocardial physiology that have made contrast echocardiography a potential new gold standard for perfusion imaging in the new millennium.
Can the Proximal Isovelocity Surface Area Method Calculate Stenotic Mitral Valve Area in Patients with Associated Moderate to Severe Aortic Regurgitation? Analysis Using Low Aliasing Velocity of 10% of the Peak Transmitral Velocity
Authors: Ikawa Hiroshi , Enya Eiichi , Hirano Yutaka , Uehara Hisakazu , Ozasa Yoshihisa , Yamada Satoru , Ishikawa Kinji
Published: July 2003

To assess the ability of the proximal isovelocity surface area (PISA) method to accurately measure the stenotic mitral valve area (MVA), and to assess whether aortic regurgitation (AR) affects the calculation, we compared the accuracy of the PISA method and the pressure half‐time (PHT) method for determining MVA in patients with and without associated AR by using two‐dimensional echocardiographic planimetry as a standard. The study population consisted of 45 patients with mitral stenosis. Seventeen of the 45 patients had associated moderate‐to‐severe AR. The PISA method was performed using low aliasing velocity (AV) of 10% of the peak transmitral velocity, which provided the most accurate estimation of MVA when compared with planimetry. The maximal radius r of the PISA was measured from the orifice to blue‐red aliasing interface. Using the PISA method, MVA was calculated as (2πr2) ×θ/ 180 × AV/Vmax, where θ was the inflow angle formed by mitral leaflets, AV was the aliasing velocity (cm/sec), and Vmax was the peak transmitral velocity (cm/sec). MVA by the PISA method correlated well with planimetry both in patients with AR (r = 0.90, P < 0.001, SEE = 0.17 cm2) and without AR (r = 0.92, P < 0.001, SEE = 0.16 cm2). However, MVA by the PHT method did not correlate as well with planimetry (r = 0.57, P < 0.05, SEE = 0.37 cm2) in patients with associated AR, and the PHT method produced a significant overestimation (24%) of MVA obtained by planimetry in these patients. We conclude that the PISA method allows accurate estimation of MVA and is not influenced by AR.
Eccentric Mitral Regurgitation Jets Among Patients Having Sustained Inferior Wall Myocardial Infarction
Authors: Levi Gabriel S. , Bolling Steven F. , Bach David S.
Published: July 2003

A strong association has been recognized between partial or complete mitral leaflet flail and highly eccentric mitral regurgitation jets. In light of anecdotal observation of eccentric mitral regurgitation apparently due to geometric and functional changes accompanying inferior wall myocardial infarction, the present study was performed to systematically study the eccentricity of mitral regurgitation jets complicating nonacute inferior wall myocardial infarction. Forty‐eight consecutive patients with evidence of prior isolated inferior wall myocardial infarction and at least moderate mitral regurgitation but without other valvular, annular, chordal, or ventricular pathology potentially contributory to mitral regurgitation were studied. Mitral regurgitation jets were characterized with respect to eccentricity and anterior versus posterior direction. Regurgitant jet and mitral leaflet position were quantified relative to the mitral annulus. Five of 48 patients (10.4%) had eccentric jets, of which four were directed posterior and one anterior. Although not reaching statistical significance, patients with eccentric jets tended to have somewhat smaller left atrial size (41.2 ± 7.8 vs 47.2 ± 9.3 mm, P= 0.17) and left ventricular size (51.5 ± 3.4 vs 55.1 ± 7.8 mm, P= 0.13), and higher left ventricular ejection fraction (0.52 ± 0.11 vs 0.46 ± 0.09, P= 0.25) compared with patients with noneccentric jets. Leaflet position relative to the mitral annulus was significantly different among patients with eccentric compared with noneccentric posterior jets (54 ± 10° vs 33 ± 11°, P= 0.02), implying greater leaflet restriction toward the left ventricular apex. In conclusion, approximately one in 10 patients with isolated inferior wall myocardial infarction and at least moderate mitral regurgitation was found to have marked eccentricity of the regurgitant jet. Leaflet position was more apically displaced among patients with eccentric jets, suggesting greater leaflet restriction in systole. The finding of a highly eccentric posterior mitral regurgitation jet can be due to inferior wall myocardial infarction with posterior leaflet restriction as well as partial or complete anterior mitral leaflet flail.
Prognostic Implications of Right Atrial Ischemic Dysfunction in Patients with Biventricular Inferior Infarction: Transesophageal Echocardiographic Analysis
Authors: Vargas‐Barron Jesus , Roldan Javier , Espinola‐Zavaleta Nilda , Romero‐Cárdenas Angel , Keirns Candace , López‐Meneses Mauricio , Martínez‐Ríos Marco Antonio
Published: July 2003

In order to determine the effect of right atrial dysfunction on clinical outcome, six patients with inferior myocardial infarction with extension to right ventricle and right atrium involving only obstructions of the right coronary artery were examined with transesophageal echocardiography (TEE) at the time of the event. Five of the patients were reexamined 15 to 55 months later. Two patients underwent thrombolysis and maintained ratios of right‐to‐left ventricular diameters of less than 1, as well as normal convexity of the interatrial septum. One patient had spontaneous reperfusion of the right coronary artery, reduction in right ventricular diameter, and normalization of interatrial septum. Another patient underwent delayed angioplasty and manifested a diminished wall movement score (WMS) in the follow‐up echocardiogram. One patient died during his first hospitalization with significant right ventricular dilatation, inverted convexity of the interatrial septum, and right atrial thrombosis. The last patient died during follow‐up with right ventricular dilatation, increased WMS, right atrial akinesis, and inverted interatrial convexity. Serial TEE examination of patients with infarction of the left ventricular inferior wall is a safe technique for determining the degree of the extension of the ischemic process to the right chambers.
Lack of Agreement Between Left Ventricular Volumes and Ejection Fraction Determined by Two‐Dimensional Echocardiography and Contrast Cineangiography in Postinfarction Patients
Authors: Bernard Yvette , Meneveau Nicolas , Boucher Sophie , Magnin Dominique , Anguenot Thierry , Schiele François , Vuillemenot Alain , Bassand Jean‐Pierre
Published: July 2003

Objective: To assess the agreement between left ventricular (LV) volumes and ejection fraction (EF) determined by two‐dimensional echocardiography (2‐D echo) and by cineangiography in postinfarction patients. Design: LV end‐diastolic and end‐systolic volumes indexed (EDVI and ESVI) to body surface area as well as EF were determined by both methods in all patients. Setting: Multicenter trial conducted in five university hospitals. Patients: 63 patients, 61 male, two female, mean age 55.5 ± 10.4 years, suffering from a recent myocardial infarction. Eighty‐one pairs of measurements were available. Methods: The results of biplane 2‐D echo measures, using apical four‐chamber (4C) and two‐chamber (2C) views were compared to those of a 30° right anterior oblique cineangiography projection, using either the apical method of discs or the area‐length 2‐D echo method. Moreover, eyeball EF was estimated at 2‐D echo and cineangiography, and was compared to the conventional methods. The agreement between results was assessed by the Bland and Altman method. Results: The agreement between 2‐D echo and cineangiography results was poor. Mean differences (MD) were −21.8 (EDVI, ml/m2), −9.5 (ESVI, ml/m2), and −0.9 (EF, %), respectively for 2‐D echo method of discs versus cineangiography, and −23.2, −9.3, and −5.7 for area‐length 2‐D echo versus cineangiography. For EF (%), MD was −3.6 for eyeball cineangiography versus cineangiography, −1.3 for eyeball 2‐D echo versus method of discs, and + 0.30 for eyeball 2‐D echo versus area‐length 2‐D echo, respectively. Two‐dimensional echo is likely to underestimate LV volumes compared to cineangiography, especially for largest volumes. Even for EF, discrepancies are large, with a lack of agreement of 21%–25% between conventional methods, but agreement is better between eyeball EF and usual methods. Conclusions: Even with modern echocardiographic devices, agreement between 2‐D echo and cineangiography‐derived LV volumes and EF remains moderate, and both methods must not be considered interchangeable in clinical practice.
Effects of Verapamil in Normal Elderly Individuals with Left Ventricular Diastolic Dysfunction
Authors: Hung Ming‐Jui , Cherng Wen‐Jin , Wang Chao‐Hung , Kuo Li‐Tang
Published: July 2003

Treatment with oral verapamil for 3 to 4 days has been found to enhance left ventricular (LV) diastolic filling in elderly subjects as assessed by radionuclide angiography. However, there are no Doppler echocardiographic studies to assess the long‐term effect of verapamil in normal elderly subjects. Thirteen healthy elderly subjects (mean age, 64 ± 7 years; 8 men and 5 women) with LV diastolic dysfunction underwent this placebo‐controlled cross‐over trial. The effect of verapamil on LV diastolic function was assessed by treadmill exercise test and Doppler echocardiography at baseline, and after each 3‐month treatment period (placebo or verapamil 120 mg once daily), separated by a 1‐week washout period before cross‐over. Blood pressure, heart rate, LV ejection fraction, LV mass, and cardiac output were unaltered by placebo or verapamil. The exercise time was similar at baseline (11.4 ± 2.4 min) and after placebo treatment (11.4 ± 2.3 min) but significantly increased (P < 0.05) after verapamil treatment (12.3 ± 2.0 min). The ratio of mitral A wave duration/pulmonary venous atrial systolic reversal duration increased after verapamil treatment (1.12 ± 0.08) compared to placebo (0.93 ± 0.06, P < 0.05) and baseline (0.89 ± 0.09), which had similar durations. The isovolumic relaxation time (IVRT) was significantly decreased (P < 0.05) from 85 ± 13 msec at baseline and 87 ± 13 msec with placebo to 73 ± 9 msec with verapamil. The results of this study suggest that in normal elderly patients with Doppler evidence of diastolic dysfunction, 3 months treatment with verapamil can increase exercise tolerance and improve LV diastolic function.
Doppler Tissue Imaging to Evaluate Early Myocardium Damage in Patients with Undetermined Form of Chagas' Disease and Normal Echocardiogram
Authors: Barros Márcio Vinicius Lins , Rocha Manoel Otávio Costa , Ribeiro Antonio Luiz Pinho , Machado Fernando Santana
Published: July 2003

Chagas' disease can lead to severe and potentially lethal damage of cardiac function. Thus, the identification of contractile abnormalities in asymptomatic patients can be important for risk stratification in those patients. Doppler tissue imaging (DTI) is a new diagnostic modality for the study of regional and longitudinal contractility of the left ventricle. However, DTI has not been used for the assessment of Chagas' cardiopathy. The purpose of this study was to identify abnormalities related to longitudinal contractility by means of DTI in patients with an undetermined form of Chagas' disease and with normal echocardiogram and Doppler studies. Forty patients were studied, including 21 chagasic ones with normal electrocardiographic, radiologic, and echocardiographic studies, and 19 normal control individuals. All of the patients were submitted to DTI to evaluate longitudinal contractility in the various myocardial segments, including assessment of systolic and diastolic velocities and isovolumic contraction time (IVCT). Similar values were observed among the various systolic function rates in both groups, except for the IVCT along the septal wall, which was significantly higher in the chagasic group. DTI enabled the early detection of contractile abnormalities in patients with an undetermined form of Chagas' disease and with normal echocardiogram. Such abnormalities were particularly striking in the interventricular septum. The present study could be useful in risk stratification for those patients.
Proximal Isovelocity Surface Area (PISA) as a Noninvasive Method for the Estimation of the Shunt Quantification in Perimembranous Ventricular Septal Defects
Authors: Eren Mehmet , Dagdeviren Bahadir , Bolca Osman , Polat Mustafa , Gürlertop Yekta , Norgaz Tugrul , Tezel Tuna
Published: July 2003

This study was designed to assess the reliability of the proximal isovelocity surface area (PISA) method for the estimation of shunt quantification in perimembranous ventricular septal defects (PVSD). The study group was composed of 30 patients (age 11 ± 7 years, 13 female) with PVSD. The shunt flow (Qp‐Qs) and the ratio of the pulmonary flow to the systemic flow (Qp/Qs) were calculated by spectral Doppler and catheterization. The Qp‐Qs, the defect area (DA), and the shunt volume (SV) were obtained by the PISA method. The PISA method estimated the DA (cm2/m2), the SV (cm3/m2), and the Qp‐Qs (L/min/m2) to be equal to (2 ×π× R2× NL)/(Vmax× Body surface area), DA × TVIshunt, and to SV × Heart rate, respectively (R is the distance of the maximal PISA from the first aliasing line to the left ventricular side of the defect, NL is the nyquist limit, and Vmax and TVIshunt are the peak velocity and time‐velocity integral of transdefect Doppler tracing obtained by continuous‐wave Doppler). The PISA method (3.4 ± 1.5 L/min/m2) underestimated the Qp‐Qs according to spectral Doppler (r = 0.96, P < 0.001; mean difference −0.74 ± 0.61 L/min/m2; SEE = 0.11 L/min/m2, P < 0.001) and catheterization (r = 0.92, P < 0.001; mean difference − 0.45 ± 0.7 L/min/m2; SEE = 0.13 L/min/m2, P < 0.001). The correlations between the PISA findings (Qp‐Qs, DA, SV) and the catheterization Qp/Qs (r − 0.86, 0.84, and 0.86; P < 0.001, respectively), or between these and the spectral Doppler Qp/Qs (r = 0.80, 0.80, and 0.79; P < 0.001, respectively) were significant. The accuracies of the PISA findings in identifying large defects were high (0.90, 0.93, and 0.90 for cut‐off values of Qp‐Qs = 3.67 L/min/m2, DA = 0.44 cm2/m2, and SV = 43 cm3/m2, respectively). As a result, the PISA method can be a simple and reliable alternative to the spectral Doppler method in the identification of large shunts in PVSD.
In Vitro Measurement Accuracy of Three‐Dimensional Ultrasound
Authors: Zotz Rainer J. , Trabold Tobias , Bock Alexander , Kollmann Christian
Published: July 2003

Objectives: We sought to validate distance and volume measurements in three‐dimensional (3‐D) ultrasound images. Background: Even with the latest equipment, it is not known how accurate 3‐D echocardiographic measurements are. Methods: Six models were imaged in ethanol solution and two within a tissue phantom using a mechanical rotation device rotating in 1° intervals and a real‐time 3‐D scanner. Distance and volume measurements (n = 60) were performed in two‐dimensional (2‐D) and 3‐D images using TomTec and InViVo software. Results: Distance measurements had a mean total error between 1.12% and 2.31% for Acuson (2.5 MHZ, 3 MHZ, and 4 MHZ) and Hewlett Parkard (HP) fusion frequencies h and m, HP fusion harmonic B in the axial, and between 3.5% and 4.9% in the lateral dimension. HP Harmonic A and B, Volumetrics (2.5 MHZ), and HP fusion Harmonic A exhibited significantly higher differences to reality with a mean difference between 5.1% and 8.9% in the axial and between 6.2% and 7.9% in the lateral direction. Axial 2‐D measurements were not different from real dimensions except Volumetrics model 1. In the lateral axis, all imaging modalities were different from reality except the fusion harmonic modus B. Using the HP fusion frequency h and HP fusion Harmonic B‐mode, volume measurements in 3‐D images significantly underestimated reality, while Acuson's fundamental frequency 3.5 MHZ was not different from real volumes. Conclusion: Three‐dimensional visualization using different ultrasound settings results in different accuracy.
Rapid Formation of Left Atrial Appendage Thrombus After Unsuccessful Cardioversion of Atrial Fibrillation
Authors: Kamalesh Masoor , Subbiah Sathya , Sharan Leena , Tawam Mouaz , Sawada Stephen
Published: July 2003

The acute effect of failed attempts of cardioversion on left atrial (LA) and left atrial appendage (LAA) functions are generally considered benign and no adverse effects have been reported. We report on a subject who had rapid formation of a fresh, mobile thrombus in the LAA despite unsuccessful cardioversion and therapeutic anticoagulation.
Left Atrial and Ventricular Ball Thrombi Complicating Rheumatic Heart Disease with Combined Mitral and Aortic Stenosis
Authors: Lee Andrew Ying‐Siu , Chang Michael Chich‐Kuang , Chen Tien‐Jen , Chang Wen‐Fung
Published: July 2003

A 42‐year‐old woman with chronic mitral stenosis was admitted for progressive dyspnea, palpitation, and weakness of lower extremities. Echocardiography revealed rheumatic, thickened, and stenotic mitral and aortic valves, and two free‐floating ball thrombi were detected in the left atrium and ventricle, respectively. She died suddenly the next day, probably due to mitral or aortic outflow obstruction by the ball thrombi. We believe that the occurrence of free‐floating ball thrombi in both the left atrium and left ventricle concomitantly has never been reported.
Three‐Dimensional Echocardiography of Left Atrial Appendage Thrombus
Authors: Khan Gazala N. , Dairywala Ismail T. , Liu Zheng , Li Peng , Carroll Jim , Vannan Mani A.
Published: July 2003

Transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) in evaluating the left atrial appendage (LAA) as a potential cardiac source of embolus in patients with stroke. We describe two such patients in whom a TEE and subsequently a three‐dimensional (3‐D) reconstruction of the LAA were performed. These case reports show that 3‐D echocardiography provides better visualization of LAA anatomy, and that a 3‐D description of LAA morphology may be the basis of describing normal and abnormal LAA.
Myocardial Contusion Presented as Acute Myocardial Infarction after Chest Trauma
Authors: Tsoukas Atrhanasios , Andreades Androcles , Zacharogiannis Charilaos , Kifnidis Konstantinos , Karlis Philip , Anastasakis Alexandros , Christakos Stamatios
Published: July 2003

A 46‐year‐old male patient developed an acute myocardial infarction and congestive heart failure following blunt chest trauma. Electrocardiogram (ECG) revealed acute anterior myocardial infarction. Echocardiography showed akinesis of interventricular septum, dyskinesis in apical anterior wall, and severe impairment of left ventricular overall systolic function. Coronary angiography revealed normal coronary arteries. The patient followed a low‐intensity physical medicine rehabilitation program. Follow‐up was without new complications or deterioration of congestive heart failure. Five months later the patient presented with fulminant acute pulmonary edema and cardiogenic shock. Cardiopulmonary resuscitation was unsuccessful.
Fibroma of the Left Ventricle in a Patient with Sotos Syndrome
Authors: Marcì Marcello , Ziino Ottavio , D'Angelo Paolo , Miranda Giuseppe , Pappone Carlo , Battaglia Antonino
Published: July 2003

Primary tumors of the heart are rare, with an incidence between 0.001% and 0.33% in autopsy findings, and with fibromas representing about 4% of benign cardiac tumors. We report the case of a cardiac fibroma in a 5‐year‐old child affected by Sotos syndrome. The mean sign was a ventricular tachycardia.
Squamous Cell Carcinoma Masquerading as a Thoracic Intramural Hematoma
Authors: Draznin Julia , Spencer Kirk T.
Published: July 2003

Transesophageal echocardiography (TEE) is an excellent tool for the diagnosis of thoracic aortic pathology. However, not all lesions of the aortic wall represent primary pathology of the aorta. This case presents an elderly, hypertensive patient with back pain and crescentic thickening of the aortic wall that proved to represent external aortic infiltration by lung cancer. Invasion of the aortic wall mimicking intramural hematoma should be considered the differential diagnosis of patients with dissection‐like symptoms and crescentic aortic lesions.
Discovery of a Parachute Mitral Valve Complex (Shone's Anomaly) in an Adult
Authors: Prunier Fabrice , Furber Alain P. , Laporte Jacques , Geslin Philippe
Published: July 2003

Parachute mitral valve complex is an unusual congenital anomaly described by Shone et al. It is characterized by a parachute deformity of the mitral valve associated with additional forms of left heart anomalies, such as aortic valvular stenosis and coarctation of the aorta. Fewer than 50 cases of Shone's complex have been reported in the literature, and it has only been observed in children. We report the case of a 33‐year‐old man who was referred to our department because of atrial fibrillation. Echocardiographic evaluation and aortogram evidenced a Shone's complex, including a parachute mitral valve anomaly, an aortic bicuspid valvular anomaly, and a coarctation of the aorta.
Transesophageal Echocardiographic Diagnosis of Traumatic Rupture of the Noncoronary Cusp of the Aortic Valve
Authors: Nekkanti Rajasekhar , Aaluri Srinivasa R. , Nanda Navin C. , Mukhtar Osman
Published: July 2003

We report a patient with traumatic aortic valve injury in whom a large defect in the noncoronary cusp of the aortic valve was clearly visualized by multiplane TEE and confirmed at surgery.
Power Doppler Myocardial Contrast Echocardiography Using an Improved Multiple Frame Triggered Harmonic Angio Technique
Authors: Murthy Thippeswamy H. , Locricchio Elizabeth , Kuersten Bettina , Li Peng , Baisch Cheryl , Vannan Mani A.
Published: July 2003

Although B‐mode harmonic, intermittent‐triggered myocardial contrast echocardiography (MCE) is a well‐established technique, a variety of MCE techniques have been introduced recently to improve myocardial opacification. One such technique uses a power Doppler method in conjunction with multiple frame triggering (MFT), but has been limited by nonuniform microbubble destruction and blooming as well as motion artifacts. Utilizing two different contrast agents, Definity and Optison, we tested the feasibility of an improved version of Harmonic Angio MFT that utilizes a lower transmit frequency, reduced packet size, and more stringent wall filter in normal volunteers and in patients with known perfusion defects. The results showed that Harmonic Angio MFT produced fill frames with readily visible opacification and destruction frames with little visible opacification. The patterns of opacification also correlated with the expected perfusion patterns in both groups of subjects. Thus, Harmonic Angio MFT appears to be a promising new MCE technique.
The Use of Transesophageal Echocardiography Monitoring of Transcatheter Closure of a Persistent Ductus Arteriosus
Authors: Lam Jan , Tanke Ronald B. , Van Oort Anton , Helbing Wim R. , Ottenkamp Jaap
Published: July 2003

We performed transesophageal echocardiography (TEE) with pediatric biplane probes throughout the procedure of transcatheter closure of the ductus arteriosus in 42 out of 46 patients who were scheduled for this intervention. Patient ages ranged from 15 months to 14 years and body weight from 9–53 kg. Both Rashkind double umbrella devices and coils were used. The described approach resulted in fewer contrast injections and was helpful in monitoring the procedure and in deciding when to release the device. To the best of our knowledge this is the first report describing a large series where continuous monitoring of transcatheter ductus closure was combined with x‐ray fluoroscopy and TEE.
Two‐ and Three‐Dimensional TEE Differentiation of Lymphoma Involving the Atrial Septum from Lipomatous Hypertrophy
Authors: Miller Andrew , Mukhtar Osman , Aaluri Srinivasa R. , Ansingkar Kamlesh G. , Nanda Navin C. , Ryan Kevin , Mitchell John
Published: July 2003

In this case report we present two‐dimensional (2‐D) and three‐dimensional (3‐D) transesophageal echocardiographic (TEE) findings of a patient with lipomatous atrial septal hypertrophy and a patient with Hodgkin's lymphoma with atrial septal involvement. The echocardiographic characteristics that differentiate these two lesions are discussed.
Ultrasound as Treatment for Coronary Artery Disease
Authors: Gunn Julian , Cumberland David C. , Siegel Robert J.
Published: July 2003

Therapeutic ultrasound is already established in the treatment of diverse surgical conditions, such as cataract, liver cancer, and stones, without danger to healthy tissue. Clinical trials of catheterdelivered, high energy, low frequency (kHz) ultrasound undertaken over the last decade have demonstrated the safety of ultrasound in the treatment of peripheral and coronary artery disease, and have identified a number of indications in which it may be particularly advantageous. The dispersal of thrombus, the recanalization of chronic total occlusions, and the favorable modification of the distensibility of small, atherosclerotic vessels are three promising areas. The authors review developments in these fields.
Therapeutic Ultrasound for Chronic Total Coronary Artery Occlusions
Authors: Cannon Louis A. , John Jerry , Lalonde Jennifer
Published: July 2003

This article focuses on the use of catheter‐delivered ultrasound as a device for treatment of coronary arterial total occlusion (CTO). The standard treatment of CTO is reviewed and serves as the basis for the need for new treatment options, such as catheter‐delivered ultrasound (SONICROSS). The results of FDA‐approved Phase I and Phase II clinical trials using SONICROSS for refractory CTO are described. The Phase II trials indicate that the SONICROSS‐facilitated guidewire passage in 71% of CTOs are otherwise refractory to guidewire passage. However, at present, the SONICROSS catheter system is limited in its ability to be delivered reliably to the CTO because of catheter size and trackability.
Catheter‐Delivered Ultrasound Therapy for Native Coronary Arterial Thrombosis and Occluded Saphenous Vein Grafts
Authors: Halkin Amir , Rosenschein Uri
Published: July 2003

Acute coronary thrombosis, overlying ruptured atherosclerotic plaque, is the hallmark of myocardial infarction and unstable angina. Despite use of modern therapeutic modalities, including glycoprotein IIb/IIIa antagonists and stenting, intracoronary thrombus heralds an increased risk of serious complications following percutaneous coronary interventions (PCI). Abundant in vitro and in vivo experimental data have proven that ultrasound energy is capable of lysing intravascular thrombus without injuring the vessel wall. Expanding experience and technological advancements now allow us to use this tool in clinical practice. In this article we review the emergence of percutaneous ultrasonic thrombolysis as a safe and effective tool for treatment of patients in various clinical settings associated with coronary thrombosis.
The Use of Transducer‐Tipped Ultrasound Catheter for Recanalization of Thrombotic Arterial Occlusions
Authors: Atar Shaul , Luo Huai , Birnbaum Yochai , Hansmann Douglas , Siegel Robert J.
Published: July 2003

Ultrasound energy is currently being used and intensively investigated for recanalization of thrombotically occluded arteries. The ultrasonic energy is mainly applied either by a transcutaneous approach or by a percutaneous approach through a catheter with an external ultrasound transducer. Catheter‐delivered transducer‐tipped ultrasound thrombolysis is a new and innovative method. In this article we summarize the current available data on the use of this new type of catheter and discuss future directions and clinical applications.
Ultrasound‐Enhanced Thrombolysis
Authors: Francis Charles W.
Published: July 2003

Problems with current thrombolytic therapy include slow and incomplete thrombolysis and frequent bleeding complications. Increasing evidence from in vitro, animal, and initial patient studies indicates that application of ultrasound as an adjunct to thrombolytic therapy offers unique potential to improve effectiveness and decrease bleeding complications. Numerous studies in vitro demonstrate that low intensity ultrasound increases enzymatic fibrinolysis through mechanisms that include improving drug transport, reversibly altering fibrin structure, and increasing tPA binding to fibrin. These observations have been confirmed in animal models that demonstrated that ultrasound delivered transcutaneously or with an endovascular catheter accelerates thrombolysis in models of venous, arterial, and small vessel thrombosis. Ultrasound delivered at higher intensities using either an endovascular vibrating wire or transcutaneously in conjunction with stabilized microbubbles can cause mechanical fragmentation of thrombus without administration of plasminogen activator. Recent studies indicate that ultrasound at lower frequencies in the range of 20–40 kHz has a greater effect on thrombolysis with improved tissue penetration and less heating. These studies form the basis for clinical trials investigating the potential of ultrasound as an adjunct to improve thrombolytic therapy.