bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of Right Atrial Volume and Function by an Online Echocardiographic Edge Detection System
Authors: VITARELLI ANTONIO , SCIOMER SUSANNA , FERRO LUZZI MARCO , DAGIANTI ARMANDO
Published: December 2007

To define the accuracy of real‐time two‐dimensional echocardiographic imaging with automatic border detection (ABD) for the assessment of right atrial volume and function, we studied with ABD echocardiography 29 healthy subjects and 43 patients with sinus rhythm and various forms of heart disease. Twenty‐three patients had right ventricular (RV) dysfunction (fractional area change < 45%), and 20 had RV hypertrophy from pressure overload. Doppler color flow imaging disclosed moderate‐to‐severe tricuspid regurgitation (TR) in 20 patients and trivial or no TR in 23. The ABD‐derived end‐diastolic (EDV) and end‐systolic (ESV) volumes by the method of discs were used to compute fractional indexes of right atrial (RA) volume changes. Right atrial emptying fraction (RAEF) percent [(ESV ‐ EDV) /ESV X 100] was calculated. The ABD‐derived EDV and ESV correlated well with conventional offline measurements of two‐dimensional echocardiographic images in the 43 patients (r = 0.94 for the end‐diastolic values; r = 0.93 for the end‐systolic values). Intraobserver and interobserver variability showed a high correlation between different measurements (r = 0.97 and 0.90, respectively). RA volumes were significantly higher in the patient population than in the control subjects (148.9 ± 66.7 ml vs 43.1 ± 9.2 ml, P < 0.0001). The right atrial emptying fraction (RAEF) was higher in patients with RV pressure overload than in normal subjects (61%± 11% vs 46%± 9%, P < 0.05) and lower in those with RV dysfunction than in the control subjects (29%± 7% vs 46%± 9%, P < 0.01). In both groups (RV pressure overload and RV dysfunction), RAEF was higher in patients without or with trivial TR compared with those with significant TR (29%± 7% vs 23%± 6%; 61%± 11% vs 42%± 7%; P < 0.05). Thus, changes in right atrial volume and function can be measured noninvasively by the ABD method. This imaging technique may prove to be useful for assessing right atrial size and function under different physiological and pathological conditions and for identifying factors that influence atrial function in right ventricular diseases.
Assessment of Left Ventricular Area at Risk by Myocardial Contrast Two‐Dimensional Echocardiography
Authors: LAFITTE STÉPHANE , LAFFORT PATRICK , ROVAI DANIELE , ALZIEU PHILIPPE , BONORON SIMONE , BESSE PIERRE , ROUDAUT RAYMOND
Published: December 2007

Background: New echocardiographic contrast agents are commonly tested in the dog model. However, this species has a number of drawbacks, including difficulties in experimentation, cost, and ethical considerations. The rabbit has a number of advantages due to its relative simple coronary circulation. The present study was designed to evaluate the rabbit model for determination of areas of risk (ARs) by contrast echocardiography. Methods: Eight rabbits were intubated and mechanically ventilated after occlusion of the left coronary artery with a ligature. The transducer (operating at 7.5 MHz) was positioned on the right ventricle through a right thoracotomy. The images were obtained after intra‐aortic injection of 1 ml of Albunex, followed by 3 ml of dye (Blue Uniperse) for histological analysis postmortem. The ARs were obtained after circumscription of the various echocardiographic and histological images. Results: Excellent echocardiographic images were obtained, largely due to the hemodynamic stability of the rabbit to ischemia. Echocardiographic ventricular areas, absolute AR, and relative AR correlated closely with postmortem data (r = 0.86, 0.94, and 0.94, respectively). The measurements were highly reproducible with low variability. Conclusions: The rabbit model shows promise for study by contrast echocardiography of myocardium subjected to ischemia. This method for determination of ARs was validate against postmortem findings. The method also should be of value in the evaluation of reperfusion.
Case of Biatrial Thrombosis
Authors: GÖRENEK BÜLENT , ÇAVUÇSOŞGLU YÜKSEL , TIMURALP BILGIN , ATA NECMI , ÜNALIR AHMET , DOKUMACI BARBAROS
Published: December 2007

A 52‐year‐old woman was admitted with the complaint of dyspnea that was present at rest and lasted a few hours. On bedside echocardiography, multiple small thrombus formations were detected in the right atrium under the tricuspid valve. Similar thrombus formation was detected in the left atrium. The lung perfusion scintigraphy indicated pulmonary embolism. Recombinant tissue plasminogen activator was started via intravenous infusion; after a dose of 60 mg, speech disturbance was observed, so thrombolytic therapy was terminated. The patient's speech problem subsided spontaneously. The dyspnea improved dramatically. Repeated bedside echocardiographic examination revealed the thrombi in both atria had disappeared.
Diagnosis of Coronary Artery Fistula Confirmed by Intravenous Contrast Echocardiography
Authors: LAFITTE STÉPHANE , ROUDAUT RAYMOND
Published: December 2007

Congenital coronary fistulae are rare, but their accurate diagnosis is important because of several complications. We describe the first case of the echocardiographic diagnosis using an intravenous contrast agent.
Influence of Pulsed‐Doppler Sample Volume Location and Upper Body Tilt on Left Ventricular Filling Indices in Healthy Persons
Authors: VIRTANEN VESA , GROUNDSTROEM KAJ
Published: December 2007

Doppler echocardiographic analysis of mitral flow is a noninvasive tool for analyzing left ventricular diastolic function. Changes in preload alter both normal and abnormal Doppler patterns of left ventricular filling. The velocities of mitral flow measured by transthoracic pulsed‐Doppler echocardiography are different when measured at the mitral leaflet tips and at the mitral annulus. Transesophageal echocardiography provides an excellent image of cardiac anatomy whereby it is possible to place the Doppler sample volume exactly at the mitral annulus or at the tips of mitral leaflets. We studied with the use of transesophageal echocardiography how changes in preload and measurement at the annulus or valve tips affect the velocities of mitral flow. Upper body‐up tilting (60°) decreased maximum E wave velocity by 16% and, hence, E/A ratio by 15%. A wave did not change by tilt. E wave velocity was 13%–15% lower at the annulus than at the tips of the mitral valve in both the supine and tilt position. E/A ratio was significantly higher at the tips than at the annulus of the mitral valve (supine, P = 0.048; tilt, P = 0.001). E/A ratio was 38% lower if the measurements were done at the annulus in the tilt position than at the tips with the patient lying horizontal. It may be important for pulsed‐Doppler mitral flow‐velocity measurements to be standardized for sample volume location and for body position.
Changes in Systolic and Diastolic Function Indexes Throughout Dobutamine Stress Echocardiography in Healthy Volunteers and Patients with Ischemic Heart Disease
Authors: EDNER MAGNUS , BRODIN LARS‐ÅKE , AL‐KHALILI FARIS , SVANE BERTIL , MOOR ELISABETH , STÅHLE AGNETA , NORDLANDER ROLF
Published: December 2007

Background and Hypothesis: Dobutamine stress echocardiography is a well‐established diagnostic method for investigating patients with suspected ischemic coronary disease. A positive test result is based on systolic parameters, but left ventricular filling parameters also are affected by myocardial ischemia. The aim of the present study was to study changes in both systolic and diastolic left ventricular variables throughout the test, including the period following it.Methods and Results:Seven healthy control subjects (group I), 10 patients with chest pain but without significant coronary stenosis (group II), and 17 patients with significant coronary stenosis (group III) were entered in the study. Dobutamine stress echocardiography was performed according to a preset standardized protocol. Two‐dimensional echocardiography and transmitral pulsed‐Doppler images were stored for later analysis at rest, low dose, peak dose, and 5 minutes after termination of the dobutamine infusion. The wall motion score index increased from rest to low dose by 6.7%± 6.4% (P < 0.05) and to the peak dose by 39.1%± 9.9% (P < 0.001) in all three groups. The increase from rest to peak dose was significantly higher in groups I and II than in group III (P < 0.01). There was a significant increase in the atrial velocity‐time integral (A‐VTI) at peak dose in groups I and II (64.8%± 52.1% and 103.8%± 68.7%, respectively; P < 0.05 and < 0.001), but no change in group III was noted. At the peak dose, A‐VTI was significantly greater in groups I and II than in group III (P < 0.05). Among the 17 patients with proved coronary stenosis, 15 (88.2%) had a positive systolic response and 14 (82.3%) had a positive diastolic response, expressed as an A‐VTI increase of ± 2.5 cm. Among patients without significant stenosis, 9 (52.9%) had a negative systolic response, and 12 (70.6%) had a negative diastolic response. Conclusion: Changes in systolic parameters are the most sensitive ones to identify in a patient with significant coronary stenosis, but diastolic changes indicated by changes in A‐VTI from rest to peak dose might contribute to decreasing the number of false‐positive dobutamine stress echocardiography tests.
Pericardiocentesis Guided by Contrast Echocardiography
Authors: WATZINGER NORBERT , BRUSSEE HELMUT , FRUHWALD FRIEDRICH M. , SCHUMACHER MARTIN , ZWEIKER ROBERT , STOSCHITZKY KURT , KLEIN WERNER
Published: December 2007

Although pericardiocentesis is a relatively safe procedure, there are some hazards, particularly when hemorrhagic fluid is aspirated. Having the opportunity to outline the space from which the fluid is withdrawn is of particular interest in this situation. A current technique of echocardiography with contrast enhancement involves injection of a few milliliters of agitated saline solution or reinjection of blood‐stained fluid. Performing this procedure, we repeatedly observed a weak and inhomogeneous echo contrast; therefore, we evaluated the applicability of the ultrasound contrast medium SH U 454 (Echovist Schering, Berlin, Germany) for contrast enhancement in hemorrhagic pericardiocentesis. In all patients, pericardiocentesis was performed in a supine position by a subxiphoid approach. A Teflon catheter / needle unit attached to a syringe containing a few milliliters of contrast medium was introduced in the usual way. On the return of hemorrhagic fluid, 1–2 ml of Echovist was injected to provide contrast from the space from which it had been aspirated. We observed excellent contrast clearly outlining the pericardial space through the injection of 1–2 ml of contrast medium. No adverse or side effects were seen resulting from Echovist injection to the pericardial sac. In conclusion, contrast echocardiography appears to be a useful tool to secure the correct position of the needle during pericardiocentesis of hemorrhagic or loculated effusions. It is suggested that injection of Echovist should be considered whenever the contrast obtained by the conventional technique is poor and inconclusive.
Intracardiac Echocardiographic Imaging in Guiding and Monitoring Radiofrequency Catheter Ablation at the Tricuspid Annulus
Authors: REN JIAN‐FANG , SCHWARTZMAN DAVID , CALLANS DAVID J. , MARCHLINSKI FRANCIS E. , ZHANG LI‐PING , CHAUDHRY FAROOQ A.
Published: December 2007

Intracardiac echocardiography (ICE) with lower frequency is a new imaging modality. We present the case of a patient with dilated cardiomyopathy and recurrent supraventricular tachycardia due to a right posterolateral accessory pathway. ICE imaging was performed using a 9‐MHz (9‐Fr) catheter positioned in the right atrium and guided precise catheter localization at the lateral tri‐cuspid annulus where the bypass tract was located, which facilitated successful radiofrequency ablation. In addition, ICE imaging detected anatomic abnormalities, including localized pericar‐dial effusion and torn tricuspid chordae tendineae, which were all identified at the onset of the procedure. The effusions remained stable during imaging monitoring throughout the procedure, which helped reassure us that these abnormalities were not procedure related. In summary, ICE imaging may significantly improve procedural efficacy in selected catheter ablation procedure and help detect anatomic abnormalities, procedural complications, or both.
The Effect of Snoring on Atrial Septum
Authors: Sadaniantz Ara , Herlihy Carol M.
Published: December 2007

While performing transesophageal echocardiograms, on two occasions we observed extreme atrial septal bulging into the lefi atrium during stertor. (ECHOCARDIOGRAPm, Volume 15, October 1998)
Post‐Traumatic Pseudoaneurysm of the Left Sinus of Valsalva Revealed by an Acute Coronary Compression
Authors: HABIB GILBERT , CAUS THIERRY , AVIERINOS JEAN‐FRANÇOIS , RICHARD DOMINIQUE , GARCIA MARC , BIOU FRÉDÉRIC , MAXIMOVITCH‐RODAMINOFF ALEXANDRE , AMBROSI PIERRE , LUCCIONI ROGER
Published: December 2007

A 69‐year‐old woman presented with chest pain and electrocardiographic evidence ofsubacute anterior ischaemia. Transthoracic and transesophageal echocardiography allowed correct diagnosis of a post‐traumatic pseudoaneurysm of the left sinus of Valsalva. The large pseudoaneurysm caused compression of the left main coronary artery and was successfully treated by aortic root replacement, left main coronary artery ligation, and arterial bypass.
Stress Echocardiography
Authors: SEBASTIAN CHERIAN , PATEL JANMEJAY J. , SADANIANTZ ARA , JOACHIM NESSER H. , J CURRIE PHILIP , NANDA NAVIN C. , CHANDRASEKARAN KRISHNASWAMY
Published: December 2007

Stress echocardiography, both pharmacologic and physiological, is an established noninvasive diagnostic method of detecting coronary artery disease. It also has a role in the assessment of patients with chest pain, the assessment of cardiovascular risk before noncardiac surgery, the assessment of patients after a myocardial infarction, the detection of viability in dysfunctional myocardium, and the prediction of functional recovery. The prognostic value of stress echocardiography is emerging. In this article, we discuss the methodology, diagnostic accuracy, and various clinical applications of stress echocardiography. We also review its limitations and compared it with other noninvasive methods of assessing patients with coronary artery disease.
Usefulness of Transesophageal Echocardiography in Diagnosing Valve Leakage of Left Ventricular Assist Device
Authors: Moursi Mohamed , Nanda Navin C. , Holman William , McGiffin David , Samal Aditya , de Sousa Joao B.
Published: December 2007

In this case report, we present the utility of transesophageal echocardiography in the detection of two uncommon complications of left ventricular assist devices: regurgitation of the bioprosthetic valve in the inflow conduit and a tear of a Dacron conduit with hematoma formation and compression of the right ventricular free wall.
Estimation of Left Ventricular Ejection Fraction by Semiautomated Edge Detection
Authors: VANDENBERG BYRON F. , CARDONA HIRAM , MILLER JAMES G. , BURNS TRUDY L. , SKORTON DAVID J. , PÉREZ JULIO E.
Published: December 2007

Left ventricular (LV) volume and ejection fraction estimation from two‐dimensional echocardiograms requires off‐line analysis and time‐consuming manual tracing. LV volumes may be estimated on‐line with a semiautomated edge detection echocardiographic system [also known as acoustic quantification (AQ)], but there are few data that compare volumes obtained from the AQ method with volumes derived from off‐line manual tracing of conventional two‐dimensional echocardiograms. Echocardiograms were performed in 48 patients at two medical centers. LV volumes were measured from the apical view with the method of discs and area‐length formulae and from the parasternal short‐axis view with the modified ellipsoid model. Based on the criterion of ± 75% endocardial visualization, 25 (52%) of the short‐axis views and 14 (29%) of the apical views were analyzed by a single investigator. End‐diastolic and end‐systolic LV volumes derived on line with the AQ system showed a very strong linear association with off‐line, manually traced volumes (r = 0.96–0.99). Correlations for ejection fraction also were strong (r = 0.90–0.96). End‐diastolic and end‐systolic LV volumes, measured from the apical views, were underestimated by the AQ method. However, because the error was in the same direction, ejection fractions measured with the AQ system and by manual tracing of conventional echocardiograms were similar. Estimation of ejection fraction using a semiautomated edge detection echocardiographic system is a promising method for noninvasive evaluation of systolic function in carefully selected patients.
“Peak Summation” Left Ventricular Filling Pattern in Patients with Chronic Heart Failure
Authors: CAPOMOLLA SOCCORSO , FEBO ORESTE , RICCARDI GIORGIO , PARZIALE PAOLO , PINNA GIANDOMENICO , OPASICH CRISTINA , COBELLI FRANCO , TAVAZZI LUIGI
Published: December 2007

In patients with chronic heart failure (CHF) and a “peak summation” left ventricular pattern, no hemodynamic and prognostic information can be drawn from Doppler examination of mitral flow. In 263 consecutive patients with CHF who were undergoing simultaneous right heart catheterization and echo‐Doppler examination, we prospectively determined (1) the frequency of the peak summation left ventricular filling pattern and (2) the incremental information contributed by pulmonary venous flow velocity patterns in providing noninvasive hemodynamic profile estimation. Isovolumic relaxation time of mitral flow, peak systolic (X), diastolic forward (Y), reverse (Z) flow velocity, and systolic fraction (X/X + Y) of pulmonary venous flow were measured. Forty‐six of 263 (17%) patients had a peak summation left ventricular filling pattern. This subgroup showed more clinical deterioration (New York Heart Association functional class III‐IV, 57% vs 49%; P < 0.01) and left atrial dysfunction (left atrial ejection fraction, 31% vs 39%; P < 0.001). However, 40% of these patients had a pulmonary wedge pressure of> 18 mmHg and a cardiac index of < 2.2 L/min/m2. The systolic fraction of peak velocities of pulmonary venous flow showed a good correlation with pulmonary wedge pressure (r = ‐0.70, P < 0.05). The correlation was stronger in patients without mitral regurgitation (r = ‐0.81, P < 0.05). A systolic fraction of < 40% was accurate (sensitivity, 100%; specificity, 95%) in identifying patients with a pulmonary wedge pressure of < 18 mmHg. In patients without mitral regurgitation, this variable was also correlated with cardiac index (r = ‐0.65, P < 0.05) and predicted a cardiac index of < 2.2 L/min/m2 (sensitivity, 91% specificity, 71%). In conclusion, a peak summation left ventricular filling pattern is common in patients with CHF. Pulmonary venous flow provides useful information about the hemodynamic profile of these patients.
Myocardial Perfusion Abnormalities by Intravenous Administration of the Contrast Agent NC100100 in an Experimental Model of Coronary Artery Thrombosis and Reperfusion
Authors: ROVAI DANIELE , JANEROT‐SJÖBERG BIRGITTA , NAGY ANDRÁS , MARINI CECILIA , BURCHIELLI SILVIA , CASTELLARI MICHELE , MORALES MARIA‐AURORA , GIOVANNA TRIVELLA M. , OSTENSEN JONNY , DISTANTE ALESSANDRO , L'ABBATE ANTONIO
Published: December 2007

The aim of this study was to evaluate a second‐generation echo contrast agent (NC100100) for the study of myocardial perfusion. In eight anesthetized open‐chest dogs, this agent was injected intravenously under baseline conditions, during acute coronary thrombosis, and after reperfusion, using both fundamental (FI) and harmonic (HI) imaging, both continuous and intermittent imaging, and both ultrasound (US) and integrated backscatter (IBS) imaging. Contrast injections did not modify the hemodynamic parameters. With all imaging modalities, myocardial contrast enhancement (MCE) was higher with intermittent than with continuous imaging (134 vs 82 gray level/pixel using FI, P = 0.02; 62 vs 32 acoustic units using US HI, P = 0.02; and 52 vs 12 dB using IBS, P = 0.05). MCE equally increased using either US or IBS imaging. The accuracy of MCE in detecting perfusion defects during coronary occlusion and myocardial reperfusion after thrombolysis was very good (sensitivity and specificity = 93% and 95% and 89% and 93%, respectively). The extent of myocardial perfusion defects by echo contrast showed a closer correlation with microspheres using HI (r = 0.82) than FI (r = 0.53). Thus, the intravenous administration of NC100100 during intermittent HI allows myocardial perfusion abnormalities to be accurately detected during acute myocardial infarction.
Three‐Dimensional Echocardiographic Assessment of Aortic Dissection
Authors: NANDA NAVIN C. , KHATRI GAJENDRA K. , SAMAL ADITYA K. , MOHAMMED ABD EL‐RAHMAN SAYED , THAKUR ABHASH C. , JAMIL FARRUKH , MOURSI MOHAMED , JOHN ABRAHAM S. , AALURI SRINIVASA R. , de SOUSA JOAO B. , AGGARWAL RAMESH , SHOEB GAMAL , ESPINAL MIGUEL A. , KUMAR NARAYAN VIRENJAN
Published: December 2007

In the present study, we report our experience of using three‐dimensional reconstruction of transesophageal two‐dimensional echocardiographic images in the assessment of aortic dissection (22 patients), aortic rupture (1 patient), aortic aneurysm without dissection (2 patients), and aortic tumor (1 patient).
Examination of Left External and Internal Carotid Arteries During Transesophageal Echocardiography
Authors: NANDA NAVIN C. , BIEDERMAN ROBERT W. , THAKUR ABHASH C. , BECHER HARALD , TIEMANN KLAUS , SAMAL ADITYA K. , JOHN ABRAHAM S. , NANDA ANIL , NANDA ANITA , KUMAR NARAYAN VIRENJAN
Published: December 2007

The present study demonstrates the feasibility of delineating the carotid bulb and the proximal portions of the left external and left internal carotid arteries during transesophageal examination. This was accomplished by slowly and carefully withdrawing the probe from the esophagus into the pharynx.
Echocardiographic Features of Right Heart Failure in Infancy and Childhood
Authors: DI SESSA THOMAS G. , SALIM MUBADDA A. , ALPERT BRUCE S.
Published: December 2007

In infants and children, right heart failure is most frequently a consequence of increased afterload (pulmonary hypertension). However, it is also observed as a sequela of congenital cardiovascular surgery. The purpose of this report is to present the causes of right heart dysfunction in children and to define the echo‐Doppler methods used in the evaluation of right heart failure.
Should Transesophageal Echocardiography Become a Routine Test in Patients with Suspected Pulmonary Thromboembolism?
Authors: LENGYEL MARIA
Published: December 2007

Pulmonary thromboembolism presents in two clinical subsets: acute pulmonary embolism (PE) with or without right heart thrombi or paradoxical embolism and chronic thromboembolic pulmonary hypertension (CTEPH). Both PE and CTEPH have been underdiagnosed and carry high mortality rates. Acute massive PE is a hemodynamic entity leading to right ventricular overload readily identified with the use of transthoracic echocardiography. Transesophageal echocardiography (TEE) is a noninvasive bedside technique that has high diagnostic accuracy for the detection of central pulmonary thromboembolism. Due to the high prevalence of central pulmonary thromboembolism in acute PE, TEE is a useful method to provide the necessary proof for the institution of thrombolytic therapy. In the subset of patients with acute PE combined with right heart thrombi or paradoxical embolism, TEE is the technique of choice to guide surgery. CTEPH presents as primary pulmonary hypertension, but it has become a surgically curable disease. TEE is a fast, fairly sensitive, and highly specific diagnostic bedside modality to select surgical candidates with CTEPH. TEE should become a routine test in patients with suspected massive acute PE, suspected right heart thrombi, or paradoxical embolism associated with acute pulmonary embolism and in patients with primary pulmonary hypertension to select those having CTEPH who are suitable for surgery.
Three‐Dimensional Echocardiography of Right Heart Pathology
Authors: SADANIANTZ ARA , BURTT DOUGLAS , NANDA NAVIN C. , LI ZHIAN
Published: December 2007

Three‐dimensional (3‐D) echocardiography uses sequentially acquired tomography echocardiographic data, which is gated to the cardiac cycle, to reconstruct 3‐D views of the heart. So far, this technique has been used primarily to evaluate left‐sided heart structures. This report focuses on congenital and acquired right‐sided heart pathologies that have been visualized by 3‐D echocardiography. In addition to reviewing the literature, several representative figures are included illustrating the unique ability of 3‐D echo to elucidate complex right heart anatomy. After a brief introduction to the technical aspects of 3‐D echocardiography, the discussion centers on evaluation of congenital heart disease and right‐sided masses, determination of right ventricular mass and volume, and evaluation of right‐sided valvular heart disease. Congenital heart diseases that are reviewed include atrial septal defect (location, size, efficacy of repair), ventricular septal defect, and congenital heart disease in the fetus being evaluated in utero. Evaluation of right‐sided masses, including tumors, vegetations, and thrombi, is reviewed. Methods of determining right ventricular volume and mass using 3‐D echo are discussed. Evaluation of valvular heart disease, including Doppler analysis of regurgitant flow, is examined. Finally, special attention is given to the perioperative and intraoperative use of 3‐D echocardiography for patients with these conditions. The conclusion summarizes the current and potential future uses of 3‐D echocardiography.
Echocardiography Detects and Demonstrates Disappearance of Right Atrial and Pulmonary Artery Thrombus
Authors: TSOUKAS ATHANASIOS , MARANTIDOU PETIA , KOLIANDRIS IOANNIS , MARKAKIS NIKOLAOS , CHRISTAKOS STAMATIOS
Published: December 2007

We present the case of a patient with acute pulmonary embolism and a large right atrial and a smaller pulmonary artery thrombus. Thrombi were successfully treated with intravenous heparin. Echocardiography was used to document the morphological evolution of thrombi and to evaluate the medical treatment.
Tissue Poppler Echocardiography
Authors: SUTHERLAND GEORGE R. , BIJNENS BART , McDICKEN W. NORMAN
Published: December 2007

Tissue Doppler echocardiography is a new ultrasonographic approach to the quantification of myocardial function. It is based on the interrogation of the high amplitude, low velocity reflected ultrasound signals from the myocardium. Velocity data can be obtained during pulsed‐ or color Doppler methodologies. Color Doppler data can be processed to determine regional acceleration, strain, strain rate, delay, and amplitude of motion. Color myocardial Doppler frame rates of up to 200 s−1 can be implemented by parallel processing of the data, thus overcoming the early temporal resolution limitations of the technique.
Quantitative Analysis of Tissue Doppler Data
Authors: PELLERIN DENIS , VEYRAT COLETTE
Published: December 2007

A visual qualitative analysis of color Doppler myocardial images cannot show the low velocity changes in myocardial walls, and a quantitative analysis of tissue Doppler data is mandatory for an analysis of color Doppler myocardial recordings, including an assessment of myocardial velocity gradient across the thickness of the wall. Measurement of myocardial velocity in each pixel should provide access to a broader pathophysiological insight into regional contraction across wall thickness and into all myocardial segments throughout the cardiac cycle.
Evaluation of Hemodynamic Determinants of Quantitative Tissue Doppler Echocardiography in the Assessment of Left Ventricular Function
Authors: BARTEL THOMAS , MÜLLER SILVANA , REICH DOROTHEE , GASSMANN BERNHARD , BRUCH CHRISTIAN , ERBEL RAIMUND
Published: December 2007

The aim of the present study was to determine whether quantitative tissue Doppler echocardiography has a role in the assessment of left ventricular hemodynamics. Thirty patients with suspected or known heart disease, but no wall motion abnormalities, took part in the study. Quantitative tissue Doppler echocardiography was performed using new software for digital analysis of the tissue Doppler signal. Average systolic subendocardial (S1), subepicardial (S2), and transmural (S3) wall velocity data were obtained from the inferoposterior wall and compared with the hemodynamics, including high fidelity pressure readings. S1 and S3 rates were found to be most reliable, being directly related to the peak rate of left ventricular pressure rise (dP/dtpeak) and inversely to systemic vascular resistance (SVR) and resistance index (SVRI). The best correlation was between S1, dP/dtpeak, and SVRI (multiple regression analysis: r = 0.76, P < 0.0001; simple regression analysis relating S1 to dP/dtpeak/SVRI: r = 0.77, SEE = 0.25, P < 0.0001). Thus, wall velocity indices as defined in this study have promise to become helpful in guiding the therapeutic modulation of inotropy and afterload in patients with heart failure.
Two‐Dimensional Echocardiographic Quantitation of Left Ventricular Global and Regional Shape
Authors: ARSENAULT MARIE , AVELAR ERICK , SMITH STEPHEN , BRITTAIN PAUL , FAIRHURST MICHAEL , VANNAN MANI
Published: December 2007

Left ventricular geometry is an important parameter of its function; however, left ventricular function has been conventionally quantified through measurements of volume, ejection fraction, and mass. Left ventricular global shape has been quantified previously using methods that are based on assumptions of idealized cavity shape. Although these indices have been applied to various disease states of the left ventricle, the underlying assumption of an ideal left ventricular geometry is inherently flawed. Regional left ventricular shape using echocardiography has not been previously evaluated, principally because of the difficulty in quantitative regional geometry. Alterations in left ventricular geometry have a direct impact on wall stress and thus the diastolic performance of the left ventricle. We developed an algorithm based on Fourier transformation of traced endocardial borders from two‐dimensional echocardiograms that allowed global shape of the left ventricular to be quantified without assumptions of any ideal left ventricular shape. This method is an adaptation of an algorithm defined for cineventriculograms by Marino and colleagues (Am J Physiol 1988;254:H547–H557). We further described a method to quantify regional endocardial curvature as an index of regional shape. In this preliminary validation study, we primarily tested the reproducibility of these two parameters.
Overall and Segmental Agreement of Stress Echocardiography
Authors: LOIMAALA ANTTI , GROUNDSTROEM KAJ , PASANEN MATTI , VUORI ILKKA
Published: December 2007

Several stress echocardiography (SE) modalities have been introduced for diagnosing coronary artery disease (CAD). Exercise and dobutamine SE are commonly considered to have a better diagnostic accuracy than vasodilator SE. The purpose of this study was to assess the agreement between the test results and the segmental concordance between three SE tests in patients with chest pain. A total of 60 patients (mean age, 55.1 years; SD, 2.1) were tested by symptom‐limited bicycle (BSE), dipyridamole‐atropine (DiASE), and dobutamine (DSE) tests. CAD (50% stenosis) was present in 44 patients, and 26 patients had one‐vessel disease. In BSE and DSE, the double product at peak stress (26.5 and 16.1 vs 13.3 × 103, respectively, P < 0.005 vs DiASE) and the peak wall motion score index were higher than in DiASE (1.40 and 1.35 vs 1.26, respectively, P < 0.05 vs DiASE). BSE, DiASE, and DSE did not differ in sensitivity in diagnosing CAD (90%, 93%, and 95%, respectively). Similarly, there were no statistically significant differences in the diagnostic accuracy of BSE, DiASE, and DSE (78%, 88%, and 87%, respectively). The intermethod agreement was moderate between BSE and DiASE (k = 0.51), good between BSE and DSE (k = 0.62), and moderate between DiASE and DSE (k = 0.57). The segmental agreement between BSE, DiASE, and DSE was mostly moderate. Agreement was best between the pharmacologic tests due to test protocols, especially the anterior wall (k > 0.60). Also, the basal segments showed good agreement. In conclusion, BSE, DiASE, and DSE have a similar diagnostic accuracy in detecting CAD. The overall agreement between the tests was good, and the assessment of wall motion was variable. Nevertheless, concordant diagnosis of a patient can be obtained by BSE, DiASE, and DSE without loss of diagnostic power.
Noninvasive Measurement of Left Coronary Blood Flow Reserve by Transthoracic Doppler Echocardiography
Authors: KURIKI SATOSHI , NASU MASATAKA , FUKAMI KEN‐ICHI , HIRAMORI KATSUHIKO
Published: December 2007

The development of new ultrasound instrumentation has made epicardial coronary artery blood flow imaging easier with the use of transthoracic coronary Doppler echocardiography (TCDE). This study was performed to investigate the accuracy of coronary blood flow reserve (CFR) measurement by TCDE. In 15 patients with ischemic heart disease in the absence of valvular disease or atrial fibrillation, coronary flow at rest and flow with hyperemia induced by intravenous dipyridamole infusion were recorded by TCDE and Doppler guidewire ultrasonography. The CFR was determined as the ratio of the maximum hyperemic diastolic time‐averaged peak velocity to the velocity at rest in the proximal or distal left anterior descending coronary artery. It was found that the CFR of the left anterior descending coronary artery measured by TCDE was comparable in accuracy with CFR measured by invasive methods (r = 0.87, P < 0.0001, n = 15).
Isolated Rheumatic Tricuspid Stenosis with Reverse Lutembacher's Physiology
Authors: FADEL BAHAA M. , HIATT BONNIE L. , KERINS DAVID M.
Published: December 2007

Tricuspid valve dysfunction occurs frequently in patients with rheumatic heart disease and is usually manifested as functional or organic tricuspid regurgitation. Rheumatic tricuspid stenosis is less common and occurs characteristically in the presence of concomitant mitral valve disease. In this report, we describe the clinical and echocardiographic findings in a patient with isolated rheumatic tricuspid stenosis and a right‐to‐left shunt across the interatrial septum, likely as a result of a patent foramen ovale, resulting in central cyanosis. This case illustrates an interesting association of tricuspid stenosis and an interatrial right‐to‐left shunt suggestive of a reverse Lutembacher's physiology.
Diagnosis of Myocardial Abscess After Acute Myocardial Infarction by Transesophageal Echocardiography
Authors: VINEREANU DRAGOS , MUSUMECI FRANCESCO , FRASER ALAN G.
Published: December 2007

A 56‐year‐old man received thrombolysis for an anterior myocardial infarction after chest pain for 18 hours. Ten days later he was readmitted with fever and hemodynamic deterioration. Transesophageal echocardiography demonstrated a thin‐walled cavity at the apex of the left ventricle. At operation he was found to have a myocardial abscess, and after excision and antibiotics his subsequent clinical course was uneventful. We review the echocardiographic diagnosis and clinical features of myocardial abscess complicating acute infarction. Presumed etiologic factors in our patient included late thrombolysis, mural thrombus, and poor dental hygiene leading to septicaemia.
Nonsurgical Treatment of Hypertrophic Cardiomyopathy
Authors: HENEIN MICHAEL Y. , GIBSON DEREK G. , SIGWART ULRICH
Published: December 2007

Nonsurgical septal reduction has been proposed as a means of treating patients with hypertrophic cardiomyopathy whose symptoms of exercise limitation by chest pain or breathlessness are inadequately controlled with standard medical therapy (i.e., beta blockers, calcium antagonists, or even DDD pacing).
Left Ventricular Regional Diastolic Dysfunction in Patients with First Myocardial Infarction Determined by Diastolic Motion of the Atrioventricular Plane
Authors: ALAM MAHBUBUL , WARDELL JOHAN , ANDERSSON EVA , SAMAD BASSEM A. , NORDLANDER ROLF
Published: December 2007

Motion of the left ventricular [left ventricle (LV)] atrioventricular (AV) plane has been used to assess systolic LV function. The method has not been used properly to assess diastolic function, especially after a first myocardial infarction (MI). The diastolic function was assessed in 47 previously healthy patients with a first MI assessed by echocardiographic diastolic motion of the LV AV plane. The motion of the AV plane was recorded at four different LV sites, that is, at the septal, anterior, lateral, and inferior walls. Two distinct phases of motion were noticed during diastole at all the sites: one at the early diastole caused by rapid filling of the LV and the other at late diastole during the atrial contraction. The contribution of left atrial contraction to LV filling at different LV sites was calculated by relating the magnitude of the motion caused by atrial contraction to the total diastolic AV plane motion at the respective sites. These left atrial contributions were regarded as the regional diastolic function of the respective LV sites. The global LV diastolic function was determined from the left atrial contribution to total AV plane motion from the above four sites. Patients with anterior MI had a significantly lower ejection fraction than those with inferior MI (41% and 49%, respectively; P < 0.01). Compared with age‐matched healthy subjects, the regional atrial contribution to diastolic filling was significantly higher at the anterior wall in anterior MI (38% and 52%, respectively; P < 0.001) and at the inferior wall in inferior MI (43% and 53%, respectively; P < 0.01). The atrial contribution to global LV filling was increased in anterior MI (48% compared with 42% in healthy subjects; P < 0.05) but not in inferior MI. These findings suggest that the diastolic AV plane displacement (AVPD) may be used to assess both the regional and the global diastolic function in patients following an MI.
In Vitro Feasibility and Accuracy of Three‐Dimensional Echocardiography for Ventricular Volume Assessment in Very Small Hearts
Authors: CAVALLÉ‐GARRIDO TÍSCAR , SMALLHORN JEFFREY F. , MAENO YASUKI , MCCRINDLE BRIAN W. , BOUTIN CHRISTINE
Published: December 2007

To evaluate the in vitro accuracy of three‐dimensional echocardiography (3‐DE) for estimation of ventricular volume in very small hearts, left ventricular (LV) volume was determined by 3‐DE in the excised hearts of 10 guinea pigs and 10 rabbits, and right ventricular (RV) volume was determined in 20 rabbits. The effect of edge enhancement, Sigma filter, and slice distance (1 mm versus 0.5 mm) was assessed in each heart. True volumes were obtained from ventricular casts. Mean cast volume was 1.38 ± 0.83 mL for LVs and 1.63 ± 1.01 mL for RVs. Correlations between 3‐DE and true volumes were r > 0.99 (P < 0.0001) for both ventricles. Accuracy was not affected by ventricular type, slice distance, or Sigma filter. Mean percent difference from true volume was significantly less (P = 0.03) with edge enhancement. Ventricular volume can be assessed reliably by 3‐DE in very small hearts. The edge enhancement feature improved the accuracy of the measurements.
Usefulness of Parameters of Left Ventricular Wall Stress and Systolic Function in the Evaluation of Patients with Aortic Stenosis
Authors: LEGGET MALCOLM E.
Published: December 2007

Left ventricular function and myocardial contractility in aortic stenosis have been intensely studied over the past 40 years. The underlying impetus for a good deal of this work has been to define the interaction between the ventricle and the valve, to predict in an individual patient the clinical course and outcome after aortic valve replacement. Furthermore, the relationship between afterload (wall stress) and contractility has been closely examined. Although wall stress has been shown to be inversely correlated to ejection fraction or fiber shortening, there is wide individual variability for a similar degree of valvular stenosis, which renders interpretation of data regarding left ventricular function and myocardial contractility difficult. A number of other factors affect the response of the left ventricle to chronic pressure overload. The use of stress‐shortening relationships in patients with aortic stenosis requires further study before these measures can be advocated for clinical use. This review examines the usefulness of left ventricular wall stress and parameters of left ventricular function in aortic stenosis, dealing with basic concepts, echocardiographic approach, and clinical usefulness.
Assessment of the Systolic Left Ventricular Myocardial Velocity Profile and Gradient Using Tissue Doppler Imaging in Patients with Hypertrophic Cardiomyopathy
Authors: YAMADA HIROTSUGU , OKI TAKASHI , TABATA TOMOTSUGU , MISHIRO YUICHIRO , ABE MIHO , ONOSE YUKIKO , WAKATSUKI TETSUZO , IUCHI ARATA , ITO SUSUMU
Published: December 2007

To determine the systolic characteristics of the hypertrophied myocardium in patients with hypertrophic cardiomyopathy (HCM), we evaluated the left ventricular [left ventricle (LV)] myocardial velocity profile (MVP) and gradient obtained from tissue Doppler imaging (TDI). Transmural wall‐motion velocities in the ventricular septum and LV posterior wall were recorded in 12 patients with asymmetric septal hypertrophy and 12 healthy volunteers, and their profiles and gradients were determined. The maximum systolic myocardial velocity gradient in the ventricular septum was significantly lower in the HCM group than in the control group (0.88 ± 0.35 versus 2.24 ± 0.41; P < 0.001), whereas the gradient in the LV posterior wall was only slightly lower in the HCM group than in the control group (2.69 ± 0.82 versus 3.45 ± 0.96). In the control group, the MVPs in the ventricular septum and LV posterior wall were closely linear, suggesting that the transmural velocity is uniform during systole. MVPs in the ventricular septum and LV posterior wall in the HCM group also were closely linear, whereas the distribution of velocities in the ventricular septum was fairly dispersed compared with the control group. The myocardial velocity gradient on the right ventricular side of the ventricular septum decreased or disappeared in the patients with HCM, suggesting a nonuniform distribution of velocities. In conclusion, the MVP and gradient obtained from TDI may represent new indices for evaluating regional LV contractile abnormality in patients with HCM.
Effect of a Residual Stenosis by Quantitative Angiography on the Myocardial Contrast Defect Observed Following Coronary Reperfusion Using Intermittent Harmonic Ultrasound Imaging and Intravenous Perfluorocarbon Ultrasound Contrast
Authors: PORTER THOMAS R. , LI SHOUPING , KILZER KAREN , DELIGONUL UBEYDULLAH
Published: December 2007

Intermittent harmonic imaging following intravenously injected perfluorocarbon‐containing microbubbles can detect myocardial perfusion abnormalities caused by ischemia. It is unknown whether this technique can differentiate viable, ischemic myocardium from infarcted myocardium immediately following coronary reperfusion. The objective of this paper was to determine whether intermittent harmonic imaging with intravenous microbubbles could define myocardial perfusion abnormalities following reperfusion. In 26 dogs, a prolonged total coronary occlusion (mean occlusion time 2.1 ± 0.4 hours) was followed by coronary reperfusion. Wall thickening (WT) and peak myocardial video intensity (PMVI) within and outside the risk area (PMVI ratio) were measured following intravenous perfluorocarbon microbubbles under resting conditions and during a 5 μ/kg per minute dobutamine [low dose dobutamine (LDD)] infusion in the presence and absence of a ≥ 50% diameter stenosis in the reperfused vessel. Infarct size was determined postmortem. The resting contrast defect in all dogs correlated closely (r = 0.93) with infarct size when no residual stenosis was present but correlated more closely with risk area (r = 0.88) when a ± 50% diameter residual stenosis was present. In dogs with infarction involving > 50% of the risk area, the PMVI ratio was lower under resting conditions (0.51 ± 0.27) than in dogs with no or partial infarction when no residual stenosis was present. However, in dogs with no or partial infarction, the PMVI ratio fell significantly when a ≥ 50% diameter stenosis was present, both under resting conditions and during LDD. We conclude that the myocardial contrast defect observed with intermittent harmonic imaging and intravenous ultrasound contrast is affected by both the infarct size and the presence of a significant residual stenosis.
Real‐Time Contrast Echo Assessment of Myocardial Perfusion at Low Emission Power
Authors: TIEMANN KLAUS , LOHMEIER STEFAN , KUNTZ STEFANIE , KÖSTER JÖRG , POHL CHRISTOPH , BURNS PETER , R PORTER THOMAS , NANDA NAVIN C. , LÜDERITZ BERNDT , BECHER HARALD
Published: December 2007

Power pulse inversion (PPI) has been developed for echocontrast specific imaging in order to reduce destruction of microbubbles. The purpose of this study was to evaluate PPI for real‐time contrast echocardiography. Therefore, in vitro studies in a physiological flow‐phantom and clinical examinations in patients with coronary artery disease were performed. The in vitro rersults of this study indicate that PPI allows real‐time imaging at low emission power and is almost nondestructive to contrast microbubbles of Definity. At this low emission power a strong linear relationship between the dosage of the contrast agent and the resulting PPI signal intensity was found (R = 0.998, p < 0.001). In the clinical examinations real‐time imaging using low mechanical index PPI resulted in strong myocardial signals and a complete filling of the cavities indicating absence of bubble destruction. Most striking was the ability of PPI to display myocardial thickening and wall motion simultaneously with the assessment of myocardial contrast replenishment following ultrasound induced bubble destruction by high power frames. We conclude that PPI allows nondestructive contrast imaging both in experimental and clinical settings. Therefore, real‐time imaging of myocardial perfusion and real‐time assessment of contrast replenishment following ultrasound induced destruction of microbubbles is feasible. Moreover, PPI allows simultaneous assessment of perfusion and myocardial function.
Multicenter Experience Using a New Prototype Transnasal Transesophageal Echocardiography Probe
Authors: SPENCER KIRK T. , GOLDMAN MARTIN , CHOLLEY BERNARD , HULTMAN JAN , BENJAMIN ERNEST , OROPELLO JOHN , HARRIS KEVIN M. , BEDNARZ JAMES , MANASIA ANTHONY , LEIBOWITZ ANDREW , CONNOR BRIAN , LANG ROBERTO M.
Published: December 2007

Transesophageal echocardiography (TEE) is an invaluable diagnostic tool, particularly in patients with inadequate transthoracic echocardiographic examinations. In addition, continuous TEE has been used to monitor ventricular and valvular performance in the intensive care unit and the operating room. However, current generation transesophageal probes have limitations in the critical care setting due to their size. Recently, a prototype miniaturized transesophageal probe was developed to overcome these limitations. This probe was used by five medical centers for 194 examinations. A large proportion of these patients were in the intensive care unit (43%), as well as mechanically ventilated (39%). Seventy percent (70%) of the subjects in this study were intubated nasally with the prototype probe, with a success rate of 88.5%. Oral intubation was successful in every case. Subject tolerance was good, and 25% of the patients were intubated for > 1 h. Nasal intubation with the probe was more likely in intensive care patients, ventilated subjects, and patients who were intubated for > 1 hour. TEE with this miniaturized probe is feasible and safe even in multi‐instrumented critical care patients. This probe provides adequate diagnostic imaging capabilities and may allow imaging over prolonged periods of time, making it suitable for the serial monitoring of ventricular performance.