bluuebunny/crossref_metadata_2025 huggingface dataset:
Two‐ and Three‐Dimensional Transesophageal Echocardiographic Localization of a Right Atrial Lipoma: Importance of Orienting Echocardiographic Images to the Surgeon's View
Authors: Mukhtar Osman M. , Miller Andrew P. , Nanda Navin C. , Pacifico Albert D. , Kirklin James K. , Nekkanti Rajasekhar
Published: July 2003

We present a patient in whom the exact location of a right atrial lipoma identified with two‐ and three‐dimensional transesophageal echocardiography (2‐D and 3‐D TEE) was correlated with the surgical findings. By orienting the 3‐D TEE images to conform to the view of the surgeon from the right side of the patient and referencing the site of attachment of the tumor to the surrounding structures, this lipoma was correctly localized to a 7 o'clock position in the right atrium.
Transthoracic and Transesophageal Echocardiographic Indices Predictive of Sinus Rhythm Maintenance After Cardioversion of Atrial Fibrillation: An Echocardiographic Study During Direct Current Shock
Authors: De Piccoli Bruno , Rigo Fausto , Ragazzo Monica , Zuin Guerrino , Martino Anna , Raviele Antonio
Published: July 2003

Background: Up to 57% of atrial fibrillation (AF) recurrences after cardioversion take place during the first 30 days following direct current shock (DCS) delivery. Previous echocardiographic studies on sinus rhythm (SR) maintenance after cardioversion have focused mainly on parameters recorded before DCS, while other studies have reported on the indices recorded soon after delivery of the shock. Methods: Therefore, we investigated 18 patients with nonrheumatic AF, selected to undergo DCS, by both transthoracic (TTE) and transesophageal (TEE) echocardiography performed within 10 minutes before and after the electrical shock delivery. TTE was utilized for the evaluation of left atrium and left ventricle shape as well as for mitral Doppler flow sampling, while TEE was used to evaluate left atrial appendage (LAA) morphology and function, to score the LAA spontaneous echo contrast, and to evaluate the flow of left superior pulmonary vein; the transesophageal probe was left in situ during the electrical procedure. Thirty days after cardioversion, 10 (55%) patients maintained SR (Group 1) while 8 (45%) reverted to AF (Group 2). We compared the mean values of the parameters recorded in the two groups both before and after DCS. Results: Although many parameters of preand postcardioversion analysis proved to be significantly different between the two groups, the most marked differences were exhibited by the following postcardioversion indices: Peak Doppler flow velocity of the end‐diastolic mitral flow (30.10 ± 5.24 vs 20.50 ± 6.32 cm/sec, P 0.003); sum of peak velocities of the end‐diastolic contraction (A) and relaxation (A1) of LAA (A + A1= 58.20 ± 17.02 vs 31.25 ± 9.27 cm/sec, P 0.001); duration of A + A1 (162.70 ± 27.01 vs 133.75 ± 5.31 msec, P = 0.002); and sum of durations of the early diastolic forward (E) and reverse (E1) flow of LAA (101.90 35.15 vs 53.33 ± 16.33 msec, P 0.006). Conclusions: Using a single echocardiographic examination during DCS and after induction of anesthesia, without further discomfort to patients, we were able to identify useful parameters for the prediction of future electrical activity of the heart before as well as soon after DCS. Postcardioversion indices, derived by both TTE and TEE, were even more predictive of SR maintenance after 1 month than precardioversion parameters.
Validation of Transesophageal Echocardiography to Determine Physiologic Coronary Flow
Authors: Chaudhry Farooq A. , Ren Jian‐Fang , Ramani Kishin , Yaacoub Adel S. , Kane Bonnie J. , Greene Rodney , McPherson David D.
Published: July 2003

Human studies have suggested that Doppler transesophageal echocardiography (TEE) can determine normal physiologic coronary blood flow (CBF) and alterations in CBF due to proximal flow‐limiting stenoses. However, assessment of CBF by Doppler TEE has not been validated. To determine if true estimation of CBF could be obtained with Doppler TEE, seven mongrel dogs (weight range 28 kg–36 kg) were evaluated. Simultaneous CBF determinations by Doppler TEE and epicardial electromagnetic flow (EMF) and/or epicardial Doppler flow (EDF) probes were compared. Measurements were obtained at baseline and following varying degrees of proximal coronary occlusion, which produced reactive hyperemia. Results: Consistent Doppler flow waveforms were obtainable by Doppler TEE in 34 different measurements during perturbations:

TEE Flow (ml/min)
EMF or EDF Flow (ml/min)

Mean
85
53

Standard Deviation
45
38

Minimum
42
11

Maximum
174
130

TEE Flow (ml/min) = 1.1 EMF/EDF flow + 26.3. There was a general trend towards overestimation of CBF by Doppler TEE. This study demonstrates that Doppler TEE is a promising method for obtaining measurements of CBF over the physiologic range.
Noninvasive Detection of Endothelial Dysfunction in Elderly with NIDDM by Ultrasonography
Authors: Kimura Yasuhiro , Matsumoto Masayuki , Miyauchi Eiji , Deng You‐Bin , Iwai Kunimitsu , Hattori Hideyuki
Published: July 2003

We compared endothelial function noninvasively in 15 elderly patients with noninsulin‐dependent diabetes mellitus (NIDDM) with 12 nondiabetic elderly patients. Using high resolution ultrasound, we measured flow‐mediated dilatation (FMD) of the brachial artery and sublingual nitroglycerin (NTG)‐mediated dilatation. FMD was significantly impaired in subjects with NIDDM compared with control subjects. In NIDDM subjects, FMD with complications was lower than in subjects with noncomplications. However, there was no significant difference in NTG between NIDDM subjects and the control group. Hyperemic blood flow change was lower in NIDDM subjects, but not significant. These results suggest that elderly patients with NIDDM have impaired L‐arginine/nitric oxide (NO) pathways and the possibility of capillary rarefaction.
Real‐Time Strain Rate Imaging: Validation of Peak Compression and Expansion Rates by a Tissue‐Mimicking Phantom
Authors: Belohlavek Marek , Bartleson Virginia B. , Zobitz Mark E.
Published: July 2003

Strain rate imaging is a new modality in echocardiography intended for analysis of left ventricular function. This modality extends ultrasonographic techniques for analysis of tissue velocities by providing information about rates of local myocardial compression and expansion. Cyclic cardiac deformation is a complex process. Precision and accuracy of real‐time strain rate (rtSR) measurements have not been studied under controlled laboratory conditions. Using a cyclically compressed tissue‐mimicking gelatin phantom, we compared rtSR values to corresponding strain rate values calculated off line from local tissue velocities measured by Doppler echocardiography. We tested a clinically relevant range of strain rates (0.5 − 3.5 sec−1) and different angles of insonation. Initial tests showed high precision (r ≥ 0.973, P < 0.001), but the assessment of accuracy (bias ≤ 0.559 sec−1) suggested a trend toward systematic underestimation of the reference values. We suspected a confounding influence of a clutter filter and repeated the tests with the filter inactive. The resulting accuracy improved tenfold (bias ≤ 0.045 sec−1), and the systematic underestimation was no longer present. We conclude that the rtSR is precise and accurate for a range of the tested values.
Relationship Between Dobutamine Echocardiography and the Elevation of Cardiac Troponin I in Patients with Acute Coronary Syndromes
Authors: Wang Chao‐Hung , Cherng Wen‐Jin , Meng Hsiang‐Chi , Hong Ming‐Jui , Kuo Li‐Tang
Published: July 2003

An elevated cardiac troponin I (cTnI) and a positive dobutamine echocardiography are powerful predictors for future cardiac events in patients with coronary artery disease. Investigating their correlation also should be helpful in understanding their clinical usefulness in evaluating patients with acute coronary syndromes (ACS). Dobutamine echocardiography and a blood sampling for cTnI were performed on 117 patients with ACS 70 ± 2 hours after arriving at the hospital. CTnI was considered elevated when its value was greater than 2.0 ng/ml. Dobutamine echocardiography was positive in 86 (73.5%) patients, and cTnI was elevated in 37 (31.6%). The occurrence of positive dobutamine echocardiography in patients with elevated cTnI was significantly higher than in those with normal cTnI (86.5% vs 67.5%, P = 0.042). More patients in the elevated cTnI group developed myocardial ischemia before or at the stage of dobutamine 20 μ g/kg/min (43.2% vs 15%, P = 0.002). When compared with patients with normal cTnI, patients with elevated cTnI had a lower ischemic threshold during dobutamine echocardiography, and more frequently had baseline echocardiographic wall‐motion abnormalities, a history of myocardial infarction, and a positive dobutamine echocardiography. Using multivariate analysis, we found that only a lower dobutamine echocardiography ischemic threshold (P = 0.0008) and baseline wall‐motion abnormalities (P = 0.0004) were associated independently with the elevation of cTnI. Our results suggest that in patients with ACS, dobutamine echocardiography can offer information regarding wall‐motion abnormalities and ischemic threshold, which are suggested to have a clinical value similar to elevated cTnI.
Bulls‐Eye Display and Quantitation of Myocardial Perfusion Defects Using Three‐Dimensional Contrast Echocardiography
Authors: Yao Jiefen , De Castro Stefano , Delabays Alain , Masani Navroz , Udelson James E. , Pandian Natesa G.
Published: July 2003

Three‐dimensional (3‐D) myocardial contrast echocardiography (MCE) is able to derive parallel cutting planes of the left ventricle (LV). However, assessment of the site and extent of myocardial perfusion abnormalities has to rely on the reader's 3‐D mental reconstruction from the tomograms, and a manual approach has to be employed for quantitative analysis. The objective of this study was to explore the display and quantitative capability of a bulls‐eye format from contrast 3‐D MCE in the assessment of perfusion abnormalities derived from a canine model of acute myocardial infarction (MI). Three‐dimensional MCE data were acquired sequentially in a rotational scanning format during triggered harmonic imaging with an intravenous contrast agent. Reconstructed short‐axis views of the LV were aligned in a bulls‐eye format with the apex as the inner most ring. The total LV was divided into 120 sectors. The number of sectors with lack of contrast enhancement was used to derive the percent of the LV (%LV) with perfusion defect and was compared with the extent of MI calculated from postmortem triphenyl tetrazolium chloride (TTC) staining. The perfusion defect regions shown on bulls‐eye images corresponded correctly with the territories of the occluded coronary arteries. Three‐dimensional MCE perfusion defect mass (19.2 ± 6.0 %LV) correlated well with anatomic MI mass (19.3 ± 5.6 %LV; r = 0.92, SEE = 2.3%, mean differential = 0.1 ± 2.4%). We conclude that bulls‐eye display of contrast 3‐D MCE demonstrates the site and extent of perfusion abnormalities in an easily appreciable manner. It also allows fast and accurate assessment of endangered myocardium.
Complete Follow‐Up Echocardiograms are Needed to Detect Stenosis of Normally Connecting Pulmonary Veins
Authors: Minich L. Luann , Tani Lloyd Y. , Breinholt John P. , Tuohy Anne Marie , Shaddy Robert E.
Published: July 2003

Reimbursement for limited echocardiograms focusing on known pathology rather than complete studies has recently received widespread attention. Few data are available to determine if these limited examinations provide enough information to adequately evaluate many forms of congenital heart disease. Stenosis of normally connecting pulmonary veins is a congenital or acquired cardiac anomaly that is difficult to diagnose clinically and may be detectable only by echocardiography. To evaluate the yield of complete versus limited echocardiograms for detecting the presence and development of stenosis in pulmonary veins with anatomically normal connections, the cardiology database was searched for all patients with this diagnosis presenting between June 1990 and January 2000. Charts were reviewed for demographic data, associated defects, surgeries, and outcomes. Angiograms and echocardiograms were reviewed for location and severity of pulmonary vein stenosis. A pulsed‐wave Doppler signal of > 1.6 mm/sec with loss of phasic flow was used to define stenosis. Eighteen patients were identified and ranged in age at first evaluation from 1 day to 17 years (median 15 days). All 18 patients had associated cardiac anomalies, and 4 (22%) of 18 had Trisomy 21. Pulmonary vein stenosis was detected on the initial evaluation in 5 patients, detected 8 ± 5 months after the initial echocardiogram in 11 patients, and missed by echocardiography in 2 patients who were diagnosed by cardiac catheterization. The initial echocardiograms were complete, with pulsed‐Doppler sampling of all four pulmonary veins in 17 of 18 patients. Of the 12 patients who had echocardiographic evidence of late stenosis, 10 had 17 limited interim studies prior to eventually having a complete diagnostic follow‐up study. Of the two patients in whom the diagnosis was missed by echocardiography, one initial study was technically inadequate (17‐year‐old) and one had only limited interim studies after the initial echocardiogram. Of the 9 patients in whom repair of the pulmonary vein stenosis was attempted, 3 had no residual obstruction and 6 had progressive stenosis (three deaths). Of the remaining nine patients who had no intervention for their pulmonary venous stenosis, four have died from progressive pulmonary hypertension. Stenosis of normally connecting pulmonary veins is an uncommon lesion that has a significant impact on clinical outcome. The stenoses might be undetectable on limited echocardiograms that focus on evaluating only specified pathology. Complete follow‐up examinations might be warranted to diagnose this lesion. This may be an important consideration when formulating reimbursement policies.
Ultrasonic Tissue Characterization: Review of an Approach to Assess Hypertrophic Myocardium
Authors: Tamirisa Praveen K. , Holland Mark R. , Miller James G. , Pérez Julio E.
Published: July 2003

It is well known that left ventricular hypertrophy is associated with increased cardiovascular morbidity and mortality. Recently, there has been considerable interest in the application and refinement of noninvasive diagnostic techniques for identification of myocardial tissue composition to permit differentiation between left ventricular hypertrophy that may be associated with irreversible, and therefore, possibly adverse, collagen accumulation (“pathological hypertrophy”) as opposed to the type of possibly “benign” hypertrophy devoid of such characteristics (i.e., “physiological hypertrophy”). We review the current state of knowledge in the application of ultrasonic tissue characterization that addresses this question with respect to left ventricular myocardium.
Echocardiographic Features in a Patient with Primary Oxalosis
Authors: Yoshioka Jun , Park Yung‐Dae , Tanaka Yoshimu , Kobayashi Yasushi , Miyajima Makoto , Tani Akihiro , Hori Masatsugu , Shirai Dairoku
Published: July 2003

Primary oxalosis is a rare congenital disorder of oxalate metabolism characterized by deposits of calcium oxalate in several organs, including the heart. We present the case of a 38‐year‐old man with primary oxalosis who had unique echocardiographic findings. Two‐dimensional echocardiography revealed the sparkling high intensity echocardiographic pattern and concentric thickening of myocardial walls. Microscopic examinations showed the extensive deposits of calcium oxalate crystals in the myocardium. Therefore, we suggest that primary oxalosis should be given important consideration in the differential diagnosis of a hypertrophied myocardium with high intensity echocardiograms.
Unusual Presentation of a Left Ventricular Aneurysm
Authors: Ciaroni Stefano , Rudhart Anne‐Madeleine , Fournet Pierre‐Claude
Published: July 2003

We report on a case of left ventricular aneurysm in a 42‐year‐old woman presenting with atypical chest pains. The resting electrocardiogram showed abnormal Q and T negative waves in leads II, III, and aVF. Transthoracic echocardiography revealed an aneurysm on the posterior wall of the left ventricle. Thallium myocardial tomoscintigraphy confirmed the presence of a persistent defect with uneven uptake in the posterior wall, and coronary arteriography showed perfectly normal coronary arteries. A left ventricular aneurysm associated with normal coronary arteries and transient ischemia was diagnosed following a comparison with one of the patient's old electrocardiograms.
Primary Cardiac Angiosarcoma
Authors: Yaymaci Bengi , Kirali Kaan , Akdemir Ramazan , Kotiloǧlu Esin , Başaran Yelda
Published: July 2003

Primary malignant cardiac tumors are extremely rare neoplasms. About three‐quarters of all cardiac tumors are histologically benign. A 24‐year‐old man presented to the hospital with dyspnea and chest pain. A solid, dense, nonhomogeneous and rough‐surfaced mass (89 × 90 × 36 mm) with protrusion into the right heart cavities was observed on transthoracic echocardiography. The findings were confirmed by transesophageal echocardiography and magnetic resonance imaging. The histopathology of the mass confirmed a diagnosis of angiosarcoma. No evidence of an extracardiac origin of the tumor was found by radiological body imaging. The patient died 2 months after presentation to the hospital.
Cardiac Echinococcus Complicated by Ventricular Tachycardia
Authors: Marcì Marcello , Ajello Abele , Finazzo Francesca , Violante Francesco , Pizzuto Andrea , Battaglia Antonino , Quarti Andrea , Alfieri Ottavio
Published: July 2003

Echinococcosis is a parasitic disease that usually involves lungs and liver. Occasionally, it localizes in the heart (less than 2% of cases). We present a case of an adult patient with cardiac echinococcosis complicated by ventricular tachycardia. The diagnosis, based on transthoracic two‐dimensional echocardiography, magnetic resonance imaging (MRI), and computerized tomography (CT), was confirmed by surgery.
Thrombosed Chamber of Cor‐Triatriatum Mimicking Left Atrial Tumor (Case Report)
Authors: Ridha Mustafa , Sequeira Rafael F. , Bilsker Martin , Andrade Sharon , Chakko Simon
Published: July 2003

Cor‐triatriatum is an uncommon congenital cardiac anomaly. In this case report, transesophageal echocardiographic and operative findings in a 57‐year‐old female with cor‐triatriatum are presented.
Transesophageal Three‐Dimensional Color Doppler Echocardiographic Reconstruction of the Left Vertebral Artery
Authors: Ansingkar Kamlesh G. , Nanda Navin C. , Nekkanti Rajasekhar , Aaluri Srinivasa R. , Mukhtar Osman P.
Published: July 2003

We present a patient in whom we successfully reconstructed a long segment of the proximal left vertebral artery in three dimensions using color Doppler transesophageal echocardiography (TEE). Three‐dimensional (3‐D) color Doppler TEE may complement two‐dimensional (2‐D) TEE by its ability to view cross sections of the left vertebral artery at any desired level from the 3‐D data stored in the computer.
Comparison of Echocardiography with Technetium 99m‐Gated Single Photon Emission Computed Tomography as Diagnostic Tools for Left Ventricular Ejection Fraction
Authors: Choragudi Nagaraju L. , Prakash Anita M. , Sun Ying , Prasad Paturu , Chiaramida Salvatore A. , Lucariello Richard J.
Published: July 2003

Left ventricular ejection fractions (LVEF) are routinely measured and result in critical decisionmaking algorithms in cardiology. This study was conducted to compare the accepted standard two‐dimensional (2‐D) echocardiogram ejection fraction (EFECHO) with single photon emission computed tomography rest ejection fraction (EFSPECT). Data were acquired and analyzed from 51 inpatients. EFECHO was obtained using modified Simpson's rule in the four‐chamber apical view, and gated EFSPECT was computed by an automated method (Siemens ICON software). Comparison between EFECHO and EFSPECT was done by linear regression, Bland‐Altman, and receiver operator characteristic (ROC) analyses. Linear regression analysis revealed EFSPECT= 1.12 × EFECHO− 3.6%, r = 0.93, n = 51, P < 0.0001. Bland‐Altman analysis showed that the limits of 95% confidence for the difference between EFSPECT and EFECHO were − 12% to 18%. Ninety‐eight percent of the datapoints were within the limits of confidence. The ROC analysis showed that the sensitivity and specificity for detecting abnormal EF (≤ 50%) were 85% and 86% with EFSPECT, and 91% and 90% with EFECHO. This study showed good correlation as well as agreement between SPECT and two‐dimensional echocardiograms in measuring EF.
Papillary Muscle Contribution to Ventricular Ejection in Normal and Hypertrophic Ventricles: A Transesophageal Echocardiographic Study
Authors: Madu Ernest C. , Baugh Dainia S. , Johns Cameila , D'Cruz Ivan A.
Published: July 2003

Background: The interrelationship between left ventricular (LV) volume, stroke volume, and papillary muscle (PM) volume have not been studied. These volumes are relevant in understanding LV ejection mechanics in normal chambers and ascertaining whether differences exist between normal and hypertrophied LV chambers. Methods and Results: PM basal areas were measured in short‐axis transesophageal echocardiographic views and lengths were measured in long‐axis views. PM volume was estimated by the formula for volume of a cone: ⅓× PM base area × PM length. The formula for LV volume was as follows: LV volume ⅔× LV area × LV length. Of the initial 82 subjects with normal LV function studied by TEE, data on 71 are presented in this report. Thirty‐two patients had normal LV size and wall thickness, and 39 had LV hypertrophy (LVH). PM volume/LV volume % in end‐diastole (ED) and end‐systole (ES) in normal muscles was 3.1 ± 1.0 and 9.6 ± 4.9, respectively. In LVH, the respective values were 5.1 ± 2.0(P < 0.05) and 13.5 ± 4.9 (P < 0.05). For those with severe LVH, the values were 7.1 ± 2.5 (P < 0.001) and 15.9 ± 4.1 (P < 0.001), respectively, for ED and ES. Similar trends were seen in the PM volume/stroke volume relationships in normal and hypertrophic ventricles. Conclusions: PMs are larger and form a larger fraction of LV volume in LVH than in normal muscles. In patients with severe LVH, the contribution of PMs to ventricular ejection is more pronounced. PMs may, therefore, play a larger role in LV ejection in LVH than in normal ventricles (i.e., hypertrophied PM enhance the pump efficiency of LV ejection).
Contrast‐Enhanced Harmonic Color Doppler for Left Ventricular Opacification: Improved Endocardial Border Definition Compared to Tissue Harmonic Imaging and Optimization of Methodology in Patients with Suboptimal Echocardiograms
Authors: Chen Lijun , Colonna Paolo , Corda Marco , Cadeddu Christian , Montisci Roberta , Caiati Carlo , Meloni Luigi , Iliceto Sabino
Published: July 2003

Objectives: This study compared the efficacy of contrast‐enhanced harmonic color Doppler (C‐HCD) and tissue harmonic imaging (THI) for left ventricular endocardial border delineation and explored the optimal methodology of C‐HCD in patients with suboptimal echocardiograms. Background: The value of C‐HCD in improving endocardium remains unknown. Effects of harmonic velocity‐encoded color Doppler (HVD) and harmonic power Doppler (HPD) as well as contrast administration and image acquisition modalities on left ventricular opacification (LVO) have not been established. Methods: One hundred (50 HVD, 50 HPD) patients with suboptimal echocardiograms during conventional fundamental echocardiography were studied with THI and C‐HCD using Levovist. Each patient underwent different random contrast administration and image acquisition modalities. Endocardial border definition score index (EBDI), blooming artifacts, contrast destruction, and salvage of suboptimal echocardiograms were calculated in each patient after contrast enhancement. Results: EBDI improved from 2.05 ± 0.61 in THI to 2.73 ± 0.48 in HVD, and 1.98 ± 0.73 in THI to 2.69 ± 0.51 in HPD (both P < 0.001). The conversion of a nondiagnostic image from fundamental echocardiography to an optimal diagnostic image was 33 (33%) patients in THI compared to 77 (77%) patients in C‐HCD (P < 0.001). Blooming artifacts were seen more commonly in HVD than HPD, intermittent than continuous image acquisition, and bolus than infusion administration (all P < 0.001). There was less contrast destruction in intermittent compared with continuous image acquisition (P < 0.001). Contrast destruction was similar in HVD and HPD, bolus and infusion injection of contrast. The highest salvage rate of a nondiagnostic image from THI to an optimal diagnostic image was 45.5% and 42.4% in HPD mode, with intermittent image acquisition during bolus and infusion contrast administrations. Conclusions: C‐HCD seems more effective in demonstrating improved endocardial border definition compared to THI. HPD has less blooming artifacts compared with HCD. The optimal method for LVO was to use HPD with intermittent image acquisition during bolus or infusion administration of Levovist.
Feasibility of Continuous Transthoracic Cardiac Imaging Using a Novel Ultrasound Transducer
Authors: Chandraratna P. Anthony N. , Vijayasekaran Sridhar , Brar Ramandeep , Azer Maged , Brar Banumati , Gandhi Swathi , Niguse Gebeyehu T. , Chen Qiuxiong
Published: July 2003

Background: The feasibility of hands‐free transthoracic continuous ultrasonic cardiac imaging has not been demonstrated previously. We developed a 2.5‐MHZ spherical transducer mounted in an external housing to permit steering in 360° (CONTISON). The external housing was attached to the chest wall using an adhesive patch. Methods and Results: The transducer was placed in the third or fourth interspace at the left sternal border to permit imaging of the left ventricle (LV) in its short axis and attached to the chest wall. The transducer then was attached to an ultrasound machine. Ten normal subjects and 20 patients with previous myocardial infarction were studied. The following maneuvers were performed at the beginning of the study: (1) The patient was rotated from the supine position (0°) in 20° increments to the left lateral decubitus position (90°). The echocardiogram was displayed continuously and was recorded on videotape (parasternal short‐axis view) at 0°, 20°, 40°, 60°, 80°, and 90°. (2) The patient was returned to the supine position and an echocardiogram was obtained. The patient was then seated up 20°, 40°, 60°, 80°, and 90° by using the controls on the bed. (3) The patient then was returned to the supine position and the echocardiogram was displayed continuously on the monitor. The echocardiogram was recorded every 15 minutes for a period of 4 hours. All segments of the LV were visualized in the supine position and during lateral rotation (0°–90°). Thus, body position did not affect the image. All segments of the LV were visualized during sitting up (0°–90°), and all segments were visualized during the 4 hours of imaging. The patients were able to move around without distortion of the image. Conclusion: The CONTISON transducer permitted continuous imaging of LV wall motion. Body position did not affect interpretation of wall motion. This device has potential applicability in monitoring LV function in the intensive care setting.
Pulsed Tissue Doppler Imaging to Assess Myocardial Viability by Quantification of Regional Myocardial Functional Reserve
Authors: Yuan Dinghua , Kühl Harald , Nowak Bernd , Kleinhans Eduard , Kaiser Hans‐Jürgen , Franke Andreas , Büll Udalrich , Hanrath Peter , Hoffmann Rainer
Published: July 2003

Dobutamine stress echocardiography (DSE) is used widely to evaluate myocardial viability, but is limited by the subjective nature of test interpretation. Assessment of systolic function by pulsed tissue Doppler imaging (TDI) during dobutamine stimulation may allow a more objective evaluation of myocardial functional reserve and, thus, myocardial viability. In 30 patients (58 ± 9 years) with prior myocardial infarction, pulsed TDI with low dose dobutamine stress (10 μg/kg/min) was performed to assess myocardial viability. Qualitative assessment of two‐dimensional (2‐D) DSE and positron emission tomography (PET) were used for comparison. Peak systolic myocardial velocity was measured for each left ventricular segment (16 segments) at baseline and low dose dobutamine stress using pulsed TDI. The absolute and relative increases of peak systolic velocity from rest to low dose dobutamine stress were calculated. Three hundred sixty‐four segments with adequate pulsed TDI tracing were divided according to either 2‐D DSE or PET findings into normal, viable (mismatch), and nonviable (match) segments. The increase of peak systolic myocardial velocity from baseline to low dose dobutamine was significantly different between segments defined as normal, viable, and nonviable by 2‐D DSE (2.71 ± 1.91 cm/sec, 1.86 ± 2.15 cm/sec, and 0.99 ± 1.16 cm/sec, respectively; P < 0.001). The increase of peak systolic myocardial velocity from rest to low dose dobutamine for normal, mismatch, and match segments defined by PET was 2.72 ±1.96, 1.01 ± 0.96 and 0.80 ± 1.07 cm/sec, respectively (P < 0.001). In conclusion, the increase of peak systolic myocardial velocity during low dose dobutamine stimulation determined by pulsed TDI distinguishes between different myocardial viability states. It complements the standard interpretation of stress echocardiograms.
Myocardial Contrast Echocardiography: Texture Analysis for Identification of Nonperfused versus Perfused Myocardium
Authors: Bae Richard Y. , Belohlavek Marek , Greenleaf James F. , Seward James B.
Published: July 2003

This study examined texture analysis for objective identification of nonperfused myocardial segments in myocardial contrast echocardiographic (MCE) images. Short‐axis MCE images from six open chest pigs after coronary artery ligation were examined. Six of 26 features (low gray level run emphasis, high gray level run emphasis, sum mean, sum variance, coefficient of variance and diagonal variance) demonstrated a significant texture value difference (P < 0.01) between the nonperfused and perfused segments with minimal statistical distribution overlap between the two groups. This study demonstrates that texture features other than mean gray level can objectively distinguish nonperfused from perfused myocardium in MCE images and may thus augment the diagnostic accuracy of current analysis techniques.
Additional Value of Pulmonary Vein Parameters in Defining Pseudonormalization of Mitral Inflow Pattern
Authors: Rossi Andrea , Loredana Latina , Cicoira Mariantonietta , Bonapace Stefano , Zanolla Luisa , Zardini Piero , Golia Giorgio
Published: July 2003

Background: An echocardiographic assessment of left ventricular (LV) diastolic dysfunction is still challenging when identifying a pseudonormal mitral pattern (PSE) in an unselected population. The present study analyzed and compared the accuracy of various parameters in correctly identifying a PSE pattern in patients with a broad range of ejection fraction (EF) and degree of mitral regurgitation. Methods: Eighty‐two patients with E/A ≥ 1 and an invasive determination of left ventricular end‐diastolic pressure (LVEDP) were enrolled in the study. Mitral E wave (Emax) and A (Amax) velocities, E (DTe) and A (DTa) deceleration times, pulmonary vein systolic and diastolic velocities, and time velocity integrals were measured. The different duration between mitral and pulmonary vein A wave (A′‐A) also was calculated. Emax and E/A during Valsalva maneuver were measured and expressed as percentage compared with baseline. LV end‐diastolic (LVD), end‐systolic (LVS), and EF were measured from the apical four‐chambers view (area‐length method). Left atrial end‐systolic (LAmax) and end‐diastolic (LAmin) were measured from the apical four‐ and two‐chambers views (area‐length method). Left atrial filling volume (LAfill) was the difference between LAmax and LAmin. Mitral regurgitant volume was estimated by the following equation: MRvol= 6.18 + (1.01 * LAfill− (0.783 * PVs %). Results: Thirty‐two patients (age: 55 ± 21 years; 75% male) had LVEDP ≤ 18 mmHg and were classified as normal mitral pattern (Group 1). Fifty patients (age: 57 ± 22 years; 76% male) had LVEDP > 18 mmHg, and were classified accordingly as having PSE (Group 2). At logistic univariate analysis, DTa (0.005), LV EF (0.01), A′‐A (<0.0001) and % E/A (0.03) were the more powerful predictors of PSE. A′‐A had the highest global accuracy in identifying PSE in patients with reduced (90%) and normal (88%) LV EF. Conclusion: A′‐A has the highest accuracy in identifying PSE in an unselected population. This parameters should be implemented in routine echocardiography since it allows additional information about LV diastolic function assessment.
Cerebral Embolism Resulting from a Transvenous Pacemaker Catheter Inadvertently Placed in the Left Ventricle: A Report of Two Cases Confirmed by Echocardiography
Authors: Arnar David O. , Kerber Richard E.
Published: July 2003

Background: Transvenous pacemaker catheters may be placed unintentionally into the left ventricle. This can lead to thromboembolic complications. Methods and Results: We report two cases where pacemaker catheters placed unintentionally in the left ventricle via a patent foramen ovale resulted in cerebrovascular accidents. The malpositioned pacemaker catheters were demonstrated by transthoracic and transesophageal echocardiography. In both patients, no further embolic events have occurred after treatment, which in one case consisted of pacemaker catheter removal and in the other case, anticoagulation. Conclusion: Echocardiography can be useful to confirm inadvertent left ventricular pacemaker placement in patients with pacemakers who have cerebrovascular accidents.
Obstructive Sleep Apnea Is a False‐Negative Cause of Flow Velocity Paradoxus in Pericardial Effusion: Case Report
Authors: Paydak Hakan , Nair Ravi , Hoit Brian D.
Published: July 2003

We report on a patient with obstructive sleep apnea in whom percutaneous transmyocardial revascularization was complicated by hemopericardium. Absence of phasic variation in the transmitral and transtricuspid Doppler inflow velocities during apneic episodes and marked variation during spontaneous respiration were identified with a respirometer, and helped us identify a novel false‐negative cause of flow velocity paradoxus.
Subendocardial Steal Effect Seen with Real‐Time Perfusion Imaging at Low Emission Power during Adenosine Stress: Replenishment M‐Mode Processing Allows Visualization of Vertical Steal
Authors: Tiemann Klaus , Ghanem Alexander , Schlosser Thomas , Ehlgen Alexander , Kuntz‐Hehner Stefanie , Haushofer Markus , Bimmel Dieter , Borovac Mirela , Nanda Navin C. , Omran Heyder , Becher Harald
Published: July 2003

We present a patient in whom power pulse inversion imaging clearly demonstrated a subendocardial myocardial perfusion defect during contrast vasodilator stress using adenosine. The defect was best appreciated with M‐mode postprocessing of power pulse inversion imaging data.
Left Ventricular Outflow Tract Obstruction in the Transposition of Great Arteries Defined by Transthoracic Three‐Dimensional Echocardiography
Authors: Pisacane Carlo , Pacileo Giuseppe , Palladino Maria Teresa , Iacono Carola , Santoro Giuseppe , Sarubbi Berardo , Vosa Carlo , Calabrò Raffaele
Published: July 2003

We assessed the feasibility of transthoracic three‐dimensional reconstruction of the pulmonary valve and subpulmonary left ventricular outflow tract in two patients with transposition of great arteries, ventricular septal defect, and obstruction to the left ventricular outflow tract. Three dimensional reconstruction of the pulmonary valve could be displayed as ‘en face” through a three‐dimensional generated “pulmotomy view,” allowing an overview of the pulmonary aspect of the valve from a surgeon's perspective. In similar fashion, reconstruction of the subpulmonary outflow tract could be displayed along its longitudinal axis as seen through a left ventriculotomy. Unique views could be obtained equivalent to surgical or autopsy dissections, allowing more complete understanding of the morphology and severity of left‐sided obstructive lesions.
Right Ventricular Infarction: The Role of Echocardiography
Authors: Kozàkovà Michaela , Palombo Carlo , Distante Alessandro
Published: July 2003

Echocardiographic evaluation of patients with right ventricular (RV) ischemia and infarction has a clear clinical relevance, because the presence of RV infarction is associated with a highly increased early in‐hospital mortality, which can be dramatically reduced by successful early reperfusion. However, infarcted RV did recover its function regardless of the infarcted artery patency. This observation suggests that RV myocardium almost always remains viable. This article illustrates the clinical value of echocardiography, including the transthoracic and transesophageal approaches, Doppler, and three‐dimensional ultrasound, for the assessment of RV dimensions, shape, and global and regional function, and the estimation of right atrial involvement that in cases of ischemia may further modulate RV performance. In addition, the use of stress echocardiography to detect RV ischemia and evaluate the viability of infarcted RV myocardium is discussed.
Transpharyngeal Echocardiographic Imaging of the Right and Left Carotid Arteries
Authors: Nanda Navin C. , Miller Andrew P. , Nekkanti Rajasekhar , Aaluri Srinivasa
Published: July 2003

We present a technique for transpharyngeal imaging of the bilateral carotid arteries completed towards the end of a transesophageal echocardiogram. To our knowledge, this is the first report that demonstrates the bifurcation of the right common carotid artery into the right internal and external carotid arteries with a transesophageal echocardiographic probe.
Quantitative Assessment of Fetal Ventricular Function: Establishing Normal Values of the Myocardial Performance Index in the Fetus
Authors: Eidem Benjamin W. , Edwards Jeanette M. , Cetta Frank
Published: July 2003

Objective: Assessment of ventricular function in the fetus has been limited for many reasons, including relative cardiac size and atypical orientation of fetal cardiac structures. A myocardial performance index (MPI) has been described in adult and pediatric populations as an echocardiographic measure of global (systolic and diastolic) ventricular performance. Because the MPI is a Doppler index, it is independent of ventricular geometry and can be applied to both left and right ventricular function. This study attempts to define the MPI in a group of normal fetuses and compare these data to other published studies of this index. Study Design: The right ventricular (RV) and left ventricular (LV) MPI were measured in 125 normal fetuses (20–40 weeks gestation, mean age 28 weeks). These fetuses were divided into five gestational age groups for comparison. These data were compared to 152 normal children (age 3–18 years, mean age 9.3 years). Results: In normal fetuses, the LV MPI was 0.36 ± 0.06 and the RV MPI was 0.35 ± 0.05. This was not statistically different from the group of normal children in whom the LV MPI was 0.35 ± 0.03 and the RV MPI was 0.32 ± 0.03. In addition, no significant change in the fetal MPI was seen with advancing gestational age. Conclusion: This study demonstrates that fetal ventricular function can be quantitatively measured with the MPI. The MPI provides an easily obtainable and reproducible measure of fetal ventricular performance that can be readily incorporated into all fetal echocardiographic examinations.
Differences and Similarities between Patients with and without End‐Stage Renal Disease, with Regard to Location of Intracardiac Calcification
Authors: Bittrick Jon , D'Cruz Ivan A. , Wall Barry M. , Mansour Nawar , Mangold Therese
Published: July 2003

It has been known for some time that mitral annulus calcification is common in end‐stage renal disease (ESRD) patients on long‐term dialysis, as well as in elderly patients without renal failure. However, a systematic comparison of cardiac calcification in these two types of patients has not yet been made. We examined two‐dimensional echocardiograms in 33 patients with ESRD (mean age 66 ± 10 years) and in 34 other patients with intracardiac calcification but no ESRD (mean age 69 ± 9 years), with particular attention to precise anatomic location of calcification. Age was not significantly different in the two groups. The incidences of posterior mitral annulus calcification and aortic valve calcification were not significantly different in the ESRD and non‐ESRD groups, though mitral annulus calcification tended to be larger in ESRD patients. Basal mitral leaflet calcification and papillary muscle calcification was much more common in the ESRD group. Calcification of intervalvar fibrosa and of tricuspid annulus were noted only in ESRD patients.
Multicenter Evaluation of SonoVue for Improved Endocardial Border Delineation
Authors: Nanda Navin C. , Wistran Daniel C. , Karlsberg Ronald P. , Hack Terrence C. , Smith William B. , Foley David A. , Picard Michael H. , Cotter Bruno
Published: July 2003

Objectives: Two multicenter studies were conducted to evaluate the safety and efficacy of SonoVue as a contrast agent for enhanced left ventricular endocardial border delineation (LVEBD), and to compare the efficacy of SonoVue and Albunex in adult patients with a suboptimal, nonenhanced echocardiogram. Background: The use of contrast to enhance echocardiographic assessment of LVEBD is well‐established. SonoVue is a new microbubble contrast agent that contains sulfur hexafluoride. Methods: Patients were randomized to receive four injections of SonoVue (0.5, 1, 2, and 4 ml), or two injections of Albunex and two injections of hand‐agitated saline (0.08 and 0.22 ml/kg). Echocardiographic images were evaluated at the study centers and by four blinded, offsite reviewers for degree of left ventricle opacification (LVO), duration of contrast enhancement, and LVEBD. Results: LVO scores were significantly higher for all doses of SonoVue. Patients with complete LVO ranged from 34%–87% for SonoVue and from 0%–16% for Albunex. The mean duration of useful contrast effect ranged from 0.8–4.1 minutes for SonoVue and < 15 seconds for Albunex. Mean increases in LVEBD scores ranged from 3.8–18.2 for SonoVue and 0.1–4.3 for Albunex. SonoVue (cumulative 7.5 ml dose) was well‐tolerated, with a safety profile similar to that observed in the control group. Conclusions: SonoVue is superior to Albunex for improving visualization of endocardial borders in patients with suboptimal noncontrast echocardiograms. Optimal increases in LVEBD, LVO, and duration of useful contrast effect were observed at the 2.0 ml dose of SonoVue.
Left Atrial Appendage Function and Pulmonary Venous Flow in Patients with Nonrheumatic Atrial Fibrillation and Their Relation to Spontaneous Echo Contrast
Authors: Bollmann Andreas , Binias Karl‐Heinz , Grothues Frank , Schwerdtfeger Andrea , Klein Helmut U.
Published: July 2003

This study analyzed the relation between frequency of left atrial appendage (LAA) contractions, pulmonary venous flow (PVF) parameters, and spontaneous echo contrast (SEC). Thirty‐six patients (22 male, 14 female, mean age 61 ± 11 years) with nonrheumatic atrial fibrillation undergoing transesophageal echocardiography were studied. Doppler flow was obtained from both the LAA and the left upper pulmonary vein. Fourier analysis was applied to the LAA signal that exhibited the frequency of LAA contractions. LAA emptying velocity and PVF parameters were determined. There was no relation between velocity and frequency of LAA flow (r = 0.256, P = ns). Among LAA and PVF parameters, patients with left atrial SEC (n = 17) had a lower LAA velocity (16.8 ± 10.8 cm/sec vs 35.6 ± 13.2 cm/sec, P < 0.001), a larger LAA area (4.8 ± 2.2 cm2 vs 3.0 ± 1.3 cm2, P = 0.008), and a reduced systolic velocity time integral of PVF (3.4 ± 2.2 cm vs 5.4 ± 2.2 cm, P = 0.017) when compared with patients without SEC. Frequency of LAA contractions was similar between both groups (6.8 ± 0.4 Hz vs 6.8 ± 1.0 Hz, P = ns). In conclusion, the rate of LAA contraction does not correlate with LAA flow velocity and SEC. A low left atrial flow expressed by low LAA flow velocity and a reduction in systolic PVF is a major hemodynamic determinant for the occurrence of SEC.
Echocardiographic Indices of Doppler Flow Patterns Compared with MRI or Angiographic Measurements to Detect Significant Coarctation of the Aorta
Authors: Lim D. Scott , Ralston Michael A.
Published: July 2003

Evaluation for the presence and severity of coarctation of the aorta (CoA) by two‐dimensional echocardiography alone can be difficult. The purpose of this study was to use Doppler velocity and pressure gradient half‐time in systole and diastole to estimate CoA severity. Doppler echocardiograms of children with suspected CoA and either an aortic angiogram or thoracic magnetic resonance imaging (MRI) performed within 1 month of the echocardiogram were evaluated. Patients with patent ductus arteriosus, significant aortic insufficiency, long tubular CoA, or CoA outside the thorax were excluded. Measured Doppler variables, indexed for heart rate, included systolic velocity half‐time (sVHTi), diastolic velocity half‐time (dVHTi), systolic pressure half‐time (sPHTi), and diastolic pressure half‐time (dPHTi). For each of these variables, sensitivity and specificity to detect a significant CoA were determined. A significant CoA was defined as a ratio of the CoA diameter to the diaphragmatic aortic diameter of < 0.5 as imaged by MRI or angiography. Indexed systolic velocity and pressure half‐times were found not to be significant predictors for CoA. For the Doppler parameter dVHTi, using a critical value of > 200 msec indexed, we found a positive predictive value of 87% and a negative predictive value of 80%. The parameter dPHTi, using a critical value of > 75 msec indexed, demonstrated positive and negative predictive values of 92% and 79%, respectively. Measurement of dVHTi is a useful predictor for significant CoA, but the parameter dPHTi has an improved positive predictive value for detection of significant CoA. Systolic measurements of velocity or pressure half‐times are not adequate to assess severity of CoA.
Malignant Thymoma Invading the Right Atrium: A Rare Echocardiographic Finding
Authors: Özer Necla , Can İlknur , Aytemir Kudret , Atalar Enver , Erman Mustafa , Övünç Kenan , Aksöyek Serdar , Demirkazik Figen , Kes Sirri
Published: July 2003

Malignant thymoma is a rare tumor. We report a case of malignant thymoma with intracaval extension and direct invasion of the right atrium presenting as superior vena cava syndrome.
Local Thrombus as an Isolated Sign of Traumatic Aortic Injury
Authors: Roisinblit Jorge M. , Allende Norberto G. , Neira Jorge A. , Torino Augusto F. , Karmazyn Carlos , Pardo Pablo , Scattini Gabriel
Published: July 2003

We report an unusual case of blunt traumatic aortic injury in which a mobile thrombus located at the isthmus was the only abnormality detected by transesophageal echocardiography. The case illustrates the high sensitivity of this diagnostic tool in aortic trauma and underscores the possibility of finding infrequent evidence of injury in subtle aortic lesions.
Acquired Left Ventricular‐Right Atrial Communication Gerbode‐Type Defect
Authors: Wasserman Scott M. , Fann James I. , Atwood J. Edwin , Burdon Thomas A. , Fadel Bahaa M.
Published: July 2003

Left ventricular‐right atrial (LV‐RA) communications are rare intracardiac defects, often congenital in nature and clinically apparent during childhood. Acquired LV‐RA shunts are encountered occasionally in the adult population as a result of a defect in the upper portion of the membranous ventricular septum. We describe the clinical and echocardiographic features of an elderly patient with an acquired LV‐RA communication in the setting of an aortic composite valve graft and endocarditis. We also review the anatomical features and hemodynamic consequences of such defects.