bluuebunny/crossref_metadata_2025 huggingface dataset:
A parasitoid wasp uses landmarks while monitoring potential resources
Authors: van Nouhuys Saskya , Kaartinen Riikka
Published: December 2007

Social insects and insects that provision nests are well known to have complex foraging behaviour involving repeated visits to learned locations. Other insects do not forage from a central location and are generally assumed to respond to resources by simple attraction without spatial memory. This simple response to resource cues is generally taken as giving rise to patterns of resource use that correspond directly to resource distribution. By contrast, the solitary parasitoid wasp
Hyposoter horticola
monitors the locations of multiple potential hosts (butterfly eggs) for up to several weeks, until the hosts become susceptible to parasitism. Essentially all hosts in the landscape are found, and one-third of them are parasitized, independent of host density. Here, we show that the wasps do not relocate hosts using odour markers previously left by themselves or other foragers, nor do they find the eggs anew repeatedly. Instead, the wasps relocate host eggs by learning the position of the eggs relative to visual landmarks. The anticipatory foraging behaviour presented here is a key to the wasp's exceptionally stable population dynamics.
A New Approach to Assessing Regional and Global Myocardial Contractility
Authors: DOMANSKI MICHAEL J. , FOLLMANN DEAN , MIRSKY ISRAEL
Published: December 2007

A number of studies that assessed myocardial contractility by noninvasive means have been conducted in the past. However, many of these studies are limited because they assessed the velocity of fiber shortening‐afterload relationship at only a single location in the ventricle, thus assuming uniform contractility throughout the ventricle. This is often not the case, particularly in patients with coronary disease. The present study provides a new approach to assessing regional and global function that will be applicable to patients with nonuniform contractile function and makes use of entirely noninvasively obtained data. In addition, the method proposed will permit the question of linearity or nonlinearity of shortening rate‐afterload relationship to be addressed in a more detailed, quantitative manner.
Interobserver Variability of Left Ventricular Measurements in a Population of Predominantly Obese Hypertensives Using Simultaneously Acquired and Displayed M‐Mode and 2‐D Cine Echocardiography
Authors: JHANG JEFFREY S. , DIAMOND JOSEPH A. , PHILLIPS ROBERT A.
Published: December 2007

Achieving low interobserver variability is a goal of echocardiographic determined left ventricular (LV) mass measurements. In a group of hypertensives, we evaluated interobserver variation using a method of simultaneously acquired two‐dimensional (2‐D) cine and M‐mode images displayed in a split screen format. Sixty echocardiographic images from ongoing hypertension trials, including serial studies of the same patients, were obtained with an UltraMarkTM 6 Ultrasound System (Advanced Technology Laboratories, Inc., Bothell, WA, USA). Images were digitized online, coded with a random number, and pooled prior to the analysis to minimize observer bias. Studies were read by two independent observers in a blinded fashion and in a random order using a Color Vue II Nova MicroSonicsTM analyzer (Nova Microsonics, Mahwah, NJ, USA). The M‐mode tracing and cine of three consecutive frames of 2‐D parasternal short‐axis views of the LV were simultaneously displayed in a split screen format. The 2‐D cine was used as a reference image during M‐mode measurements of LV dimensions. Measurements were obtained and the LV mass estimated according to the Penn convention. Interobserver variability for left ventricular internal dimension (LVID), inter‐ventricular septal thickness (IVS), posterior wall thickness (PWT), and left ventricular mass (LV mass) is low when either correlated (Pearson correlation coefficients of 0.94, 0.82, 0.75, and 0.93, respectively) or expressed as a percent of the mean (3.0%, 10.0%, 10.2%, and 8.9%, respectively). When read in a blinded fashion, interobserver variability (especially for LV mass) is small using digitized, simultaneously acquired and displayed cines of 2‐D and M‐mode echocardiograms. This is likely due to the ability to discriminate myocardial wall edges (endocardium) from other associated structures such as tricuspid and mitral apparatus. This method may prove useful in studies of LV mass.
Evaluation of Ventricular dP/dt Before and After Open Heart Surgery Using Transesophageal Echocardiography
Authors: RHODES JONATHAN , MARX GERALD R. , TARDIF JEAN‐CLAUDE , ROMERO BARBARA A. , ROBINSON ANDREW , ACAR PHILLIPPE , PANDIAN NATESA G. , FULTON DAVID R.
Published: December 2007

The mean dP/dt during isovolumetric contraction (mean dP/dtic) is a new echocardiographic index of ventricular function that has been shown to approximate and closely correlate with invasively measured peak dP/dt. It is amenable to rapid measurement via transesophageal echocardiography (TEE) and is theoretically independent of variations in ventricular anatomy and wall motion. It is therefore well suited for the assessment of ventricular function during surgery. The purpose of this study was to assess the clinical value of TEE determinations of mean dP/dtic before and after cardiopulmonary bypass (CPB). The mean dP/dtic of 50 patients undergoing open heart surgery for a variety of congenital and acquired heart defects was measured before and 15–30 minutes after CPB. Mean dP/dtic averaged 1147 ± 492 before and 1428 ± 702 mmHg/sec after CPB (P < 0.01). Mean dP/dtic was unchanged or increased in 45 patients and fell in only 5 patients. It increased significantly even among patients who did not receive supplemental inotropic agents. Mean dP/dtic correlated well with the shortening fraction, especially among patients without segmental left ventricular wall‐motion abnormalities. The general patterns observed for mean dP/dtic were also seen when the data was corrected for variations in heart rate. A preoperative mean dP/dtic < 765 mmHg/sec or a heart rate corrected mean dP/dtic < 620 mmHg/sec indicated a high likelihood that inotropic support would be needed to facilitate weaning from CPB. Mean dP/dtic may be a clinically useful, quantitative TEE index of perioperative changes in ventricular contractility.
Effects of Temperature on Albunex and FS069 Echocardiographic Contrast Agents: In Vitro Investigation Using Ultrasonic Irradiation
Authors: MOR‐AVI VICTOR , ROBINSON KIMBERLY A. , SHROFF SANJEEV G. , LANG ROBERTO M.
Published: December 2007

The effects of temperature on the stability of two contrast agents, Albunex and perfluoropropane filled albumin microspheres (FS069), were investigated by studying the variations in their reflective properties, induced by high dose ultrasound irradiation at different temperatures. Diluted contrast agents were introduced into a 3.5‐mL latex balloon, placed in a plastic water tank, and continuously irradiated over a period of 6 minutes using different power levels: 0, 20, 25, and 30 dB. The irradiation was interrupted for imaging every 30 seconds for 2 seconds. The protocol was carried out at three different temperatures: 8°C, 22°C, and 37°C. For each temperature, the concentration of contrast solution was matched to produce approximately the same initial video intensity. Time variations in mean video intensity in the balloon cross section were studied. Contrast enhancement was found to be directly related to temperature. Under continuous ultrasonic irradiation, video intensity gradually decreased over time. This decrease was dependent on both transmitted power and temperature, and was more pronounced with Albunex when compared to FS069 (P < 0.05). Abruptly dropping temperature consistently resulted in rapid, irreversible disappearance of contrast induced by Albunex. Temperature affects the reflectivity and stability of diluted Albunex and FS069. To enhance the reproducibility of contrast enhancement achieved by these agents, their temperature should be carefully controlled.
Three Different Coexisting Mechanical Complications of Myocardial Infarction Detected by Transthoracic and Transesophageal Echocardiography
Authors: ESPINOLA‐ZAVALETA NILDA , VARGAS‐BARRÓN JESUS , ROMERO‐CARDENAS ANGEL , GONZALEZ‐SANCHEZ SADIA , LOPEZ‐SORIANO FERNANDO , RIJLAARSDAM MARIA , KEIRNS CANDACE
Published: December 2007

An aneurysm, pseudoaneurysm, and interventricular septal rupture were detected by transthoracic and transesophageal echocardiography (TEE) in a 61‐year‐old man with anterior myocardial infarction. This case illustrates the value of these techniques in the assessment of mechanical complications associated with myocardial infarction.
Flail Tricuspid Valve in an Adult Patient with Congenitally Corrected Transposition of the Great Arteries
Authors: MELONI LUIGI , ABBRUZZESE PIERO A. , PIRISI RAIMONDO , CHERCHI ANGELO
Published: December 2007

We describe a case of a 50‐year‐old woman with congenitally corrected transposition of the great vessels, in whom severe left‐sided tricuspid (systemic atrioventricular) valve insufficiency was the only associated anomaly. The tricuspid valve was dysplastic and abnormally oriented toward the interventricular septum, without the downward displacement of Ebstein's anomaly. The mechanism of atrioventricular regurgitation was unusual in that it consisted of the rupture of chordae tendineae of both the anterior and septal leaflets. The left‐sided tricuspid valve was replaced with a St. Jude prosthesis and the postoperative course was uneventful.
Technical Issues Related to Digital Stress Echocardiography Analysis and Acquisition Stations
Authors: LINKER DAVID T.
Published: December 2007

Digital acquisition and display of echocardiographic images has facilitated the development of stress echocardiography. This review will outline technical issues involved with digital capture and manipulation of echocardiographic data, referring to currently available commercial equipment. Among the acquisition items to be discussed are the source of the digitized data (direct digital transfer from the echo machine vs video capture); image resolution (spatial and temporal spacing of the digitized data); and EKG triggering options (direct triggering of the QRS complex vs detecting the QRS on the video transfer). During playback, rest and stress images may be displayed at different frame rates, so that systole will occupy approximately the same time interval. Currently available commercial systems are compared with regard to these features, as well as hardware architecture and operating system.
Tricuspid Regurgitation and Right Heart Dimensions at Early and Late Follow‐Up After Orthotopic Cardiac Transplantation
Authors: WILLIAMS MICHAEL J.A. , LEE MYUNG‐YONG , DISALVO THOMAS G. , DEC G. WILLIAM , SEMIGRAN MARC J. , LEVINE ROBERT A. , PICARD MICHAEL H.
Published: December 2007

Tricuspid regurgitation is common immediately after cardiac transplantation, but its course over long‐term follow‐up is not known. This study was performed to determine the prevalence of valvular regurgitation and to evaluate if pulmonary hypertension or right ventricular enlargement were associated with the severity of tricuspid regurgitation at early and late follow‐up after cardiac transplantation. Fifty‐five patients had hemodynamic and echocardiographic studies performed at 1 week and 2.4 ± 1.3 years after cardiac transplantation. Right ventricular dimensions were measured and related to the severity of tricuspid regurgitation as assessed by Doppler color flow. There was a fall in right heart filling pressures with decreases in the systolic pulmonary artery pressure (31 mmHg ± 7 mmHg vs 27 mmHg ± 7 mmHg, P = 0.0001) and right atrial pressure (8 ± 5 mmHg vs 6 ± 4 mmHg, P < 0.01). Sixty‐three percent of patients had mild or higher grade tricuspid regurgitation initially and 71% at follow‐up (P = NS). The major determinant of tricuspid regurgitation severity at late follow‐up was the presence of flail tricuspid leaflets (P < 0.0001). There was an association between the change in grade of tricuspid regurgitation and the change in right ventricular diastolic area (P = 0.002) and the change in tricuspid annulus diameter (P < 0.0001). The prevalence of tricuspid regurgitation remains high at late follow‐up after cardiac transplantation and neither pulmonary hypertension nor right ventricular dilatation are prerequisites for tricuspid regurgitation, which can persist in their absence. Flail tricuspid leaflets are the most important predictors of the severity of tricuspid regurgitation following cardiac transplantation.
Multiplane Transesophageal and Intracardiac Echocardiography in Large Swine: Imaging Technique, Normal Values, and Research Applications
Authors: REN JIAN‐FANG , SCHWARTZMAN DAVID , Jr GEORGE W. LIGHTY , MENZ VOLKER , MICHELE JOHN J. , LI KUN S. , DILLON STEPHEN M. , MARCHLINSKI FRANCIS E. , SEGAL BERNARD L.
Published: December 2007

Transthoracic echocardiographic imaging has been difficult to attain in the swine model. This study: (1) compares multiplane transesophageal echocardiography (TEE) with single plane TEE and intracardiac catheter echocardiography (ICE) for imaging of the swine cardiovascular system; and (2) defines normal values using these techniques in a closed chest large swine model (n = 24, body weight 50–114 kg). Multiplane TEE increased success rate over the single plane (the variable plane array only at 0°) TEE (P < 0.01) for imaging the left ventricular (LV) long‐axis view (100% vs 50%), LV outflow tract (100% vs 33%), right atrium and its appendage (79% vs 33%), ascending aorta (100% vs 58%), and aortic arch (100% vs 17%). TEE‐derived normal values at end‐diastole (ED) and end‐ systole (ES) were: LV internal diameter (ID) = 49 ± 3 mm (ED) and 33 ± 4 mm (ES); LV wall thickness = 7 ± 1 mm (ED); right ventricular (RV) ID = 24 ± 4 mm (ED); RV wall thickness = 4 ± 2 mm (ED); left atrial ID = 48 ± 6 mm (ES); aortic root ID = 26 ± 3 mm (ES); LV volume = 157 ± 49 ml (ED) and 57 ± 22 ml (ES). Baseline LV ejection fraction (64%± 6%), Doppler‐derived stroke volume (86 ± 14 ml), and cardiac index (107 ml/min per kg) were determined. Basal normal values, except for an elevated cardiac index in swine, are comparable to those reported for human adults. Multiplane TEE provided better overall cardiac imaging than did single plane TEE. ICE provided higher resolution imaging of individual cardiac chambers and structures when the ultrasound catheter was introduced into the right or left heart, but whole heart imaging was limited by ultrasound penetration at 12.5 MHz. Normal indices of chamber size and function provide a reference for the physiological significance of induced pathological states in this relevant animal model.
A Case of Uterine Leiomyomatosis Extending into the Right Heart with an Unusual Echocardiographic Appearance
Authors: MIRANDA‐GUARDIOLA FAUSTINO , JOSA MIGUEL , VALLS VALENTÍ , AZQUETA MANEL , ANGUERA IGNASI , PARÉ CARLOS
Published: December 2007

Intravenous extension of uterine leiomyomatosis is a rare condition characterized by tumor invasion of the venous system and propagation toward the large abdominal veins. A few cases with extension to the right atrium have been reported, and the echocardiographic appearance of this entity is well described. The case we herein report is of interest because of its unusual echocardiographic findings.
Utility of Transesophageal Echocardiography in Diagnosis of a Left Atrial Myxoma with Regional Pulmonary Venous Obstruction
Authors: VARGAS‐BARRÓN JESÚS , ESPÍNOLA‐ZAVALETA NILDA , RODRÍGUEZ‐CUERVO JORGE , SANDOVAL‐ZÁRATE JULIO , BIALOSTOZKY DAVID , MARTÍNEZ‐SÁNCHEZ CARLOS , KEIRNS CANDACE , CARDENAS ANGEL ROMERO
Published: December 2007

A case of a 57‐year‐old patient with regional pulmonary edema secondary to obstruction of the right lower pulmonary vein by a left atrial myxoma is described. Diagnosis was established by transesophageal echocardiography.
Unusual “Polycystic” Appearance of a Right Atrial Angiosarcoma Described by Transesophageal Echocardiography
Authors: BUSTAMANTE‐LABARTA MIGUEL H. , TORINO AUGUSTO F. , FAVALORO MARIANO
Published: December 2007

Angiosarcoma is the most common primary sarcoma of the heart and the most frequent location of the tumor is the right atrium. In the few published cases of right atrial angiosarcoma studied by transesophageal echocardiogaphy, the features described greatly differ from one to another. We describe the transesophageal images of a prolapsing mass type angiosarcoma with polycystic appearance previously misinterpreted as a right atrial myxoma in two consecutives transthoracic echocar‐diograms.
Echocardiographic Assessment of Right Ventricular Volume and Function
Authors: JIANG LENG , LEVINE ROBERT A. , WEYMAN ARTHUR E.
Published: December 2007

Echocardiographic evaluation of right ventricular volume and function has become a subject of growing interest with the increasing awareness of the important role of the right ventricle in the entire circulation. However, the anatomically complex and load‐dependent shaped right ventricle shape is difficult to describe by a simple geometric figure and its volume and function are, therefore, difficult to assess in a simple manner. A number of echocardiographic methods for evaluating right ventricular volume and function have emerged; to date, however, their quantification remains a clinical challenge. The major goal is to develop a reproducible method that will allow for quantitative comparisons between patients or serially within a given patient. This discussion examines the available methods with specific attention to their reliability and limitations. Visual inspection or measurement of single plane indices is limited by their lack of standardization and failure to describe the entire right ventricle. Simpson's rule requires computer calculations and assumes an elliptic symmetry present in the left, but not the right ventricle. Application of the area‐length method to the subcostal outflow tract and apical four‐chamber views is a particularly practical current approach. Three‐dimensional echo reconstruction, which eliminates the need for geometric assumptions and individual standardized views, although only in its infancy, promises to be the most accurate method for right ventricular volume calculation and in the future should emerge as the standard for research and many clinical applications.
Quantitative Echocardiographic Assessment in Pericardial Disease
Authors: D'CRUZ IVAN , UR REHMAN AFZAL , HANCOCK HOLLY L.
Published: December 2007

Although echocardiography has been used for diagnosing pericardial effusions since 1965, the grading of such effusions for size, and also the diagnosis of tamponade have depended almost entirely on qualitative observations or “signs.” The categorization of pericardial effusions into small, moderate, or large according to the width of pericardial space is very roughly semiquantitative. Diagnostic criteria for tamponade are based on altered ventricular or atrial wall contour, and on phasic respiratory fluctuations of ventricular size and flow velocities. We review a new approach to pericardial effusion volume estimation, based on assessing the pericardial sac volume as well a s cardiac volume by the ellipsoid formula. A new quantitative criteria for tamponade (i.e., biatrial width to cardiac width) (annular level) ratio may be useful, a ratio < 0.85 indicating tamponade, reflecting late diastolic biatrial collapse. The echo diagnosis of pericardial constriction depends on pericardial thickening combined with various abnormalities of septal and ventricular wall motion, some of them subtle. We review a new two‐dimensional echo “sign” present in some cases of pericardial constriction: abnormal posterior displacement of the left atrial posterior wall, and reduced angle (< 150°) between it and left ventricular wall in long‐axis view. Measurements reflecting the fluctuation of certain Doppler parameters can also be useful in diagnosis of this entity.
Comparison Between the Mean dP/dt During Isovolumetric Contraction and Other Echocardiographic Indexes of Ventricular Systolic Function
Authors: RHODES JONATHAN , FULTON DAVID R. , LEVINE JAMI C. , MARX GERALD R.
Published: December 2007

Echocardiographic assessments of ventricular function derived from estimates of the mean dP/dt during isovolumetric contraction (mean dP/dtic) were compared with those obtained from measurements of the shortening fraction and the stress‐velocity index (SVI). Mean dP/dtic correlated well with the shortening fraction, r = 0.74, P < 0.0001. Furthermore, 10 out of 11 patients with mean dP/dtic below 800 had a shortening fraction < 0.28, whereas all patients with a mean dP/dtic > 1000 mmHg/sec had a shortening fraction > 0.28. A good correlation also existed between mean dP/dtic and the SVI, r = 0.73, P < 0.0001. Nine out of 11 patients with a mean dP/dtic < 800 mmHg/sec had an SVI > 2 standard deviations below normal, whereas all patients with mean dP/dtic > 1000 mmHg/sec had normal or increased SVI. The correlation between mean dP/dtic and the SVI was strengthened when mean dP/dtic was adjusted for heart rate and preload. Hence, assessments of ventricular function derived from measurements of mean dP/dtic appear to agree well with those provided by the shortening fraction and SVI. Because the determination of mean dP/dtic is not hampered by unusual anatomy or wall motion (conditions which compromise the validity of the shortening fraction and SVI), mean dP/dtic may be a good index of ventricular function in cases where measurements of the shortening fraction and SVI would be unreliable.
Echocardiographic Changes in Cases of Intermittent Acute Porphyria
Authors: PANWAR RAJA BABU , SETIA VIJAY , GUPTA BAL KISHAN , SAKSENA HEM CHAND
Published: December 2007

Intermittent acute porphyria (IAP) is an inborn metabolic disorder of biosynthesis of haeme, characterized by increased excretion of porphyrin or porphyrin precursor in urine and clinically by gastrointestinal, neuro‐psychiatric and cardiovascular manifestations.

Significant observations were made on echocardiographic examination of 25 IAP patients in our study. Significant decrease in ejection fraction (48.4 ± 7.9, control group 63.0 ± 7.5, P < 0.001) and percentage of fractional shortening (23.5%± 6.87%, control group = 36.4 ± 4.26, P ± .001) was observed in IAP, this shows derangement in left ventricular systolic functions in IAP.

The study also shows significant thickening of IVS (1.22 ± 0.20, control group 0.88 ± 0.12 cm, P ± 0.001). The most interesting finding was the significantly increased incidence of mitral valve and/or tricuspid valve prolapse in 15 (60%) patients of IAP. Thickening of AML, PML, and calcification of AML were also observed.
Proximal Aortic Dissection Complicated by Cardiac Tamponade
Authors: BOOK WENDY , MOLLOD MICHAEL , FELNER JOEL M.
Published: December 2007

Cardiac tamponade is a well recognized complication of acute proximal aortic dissection and is almost uniformly fatal if not immediately diagnosed and surgically treated. Pericardiocentesis has an ill‐defined and perhaps deleterious role in the management of this condition. Severe concentric left ventricular hypertrophy and intravascular volume depletion may further impede ventricular filling in a patient with cardiac tamponade. We describe the management of a patient who presented in a confused state with an acute proximal aortic dissection complicated by cardiac tamponade and associated with evidence of left ventricular outflow tract obstruction. In such a patient, aggressive fluid administration and emergency surgery should be the treatment of choice.
Aspergillus Mural Vegetation Identified by Transesophageal Echocardiography
Authors: LIM MARCY L. , OLIVER DWIGHT H. , BARASCH EDDY
Published: December 2007

We report a case of Aspergillus sp. mural or nonvalvular endocarditis, which was diagnosed by transesophageal echocardiography (TEE) as a vegetation attached to the anterolateral papillary muscle of the left ventricle. Mural endocarditis is often missed by transthoracic echocardiography (TTE) as was the case with this patient. TEE easily identified the vegetation.
Three‐Dimensional Myocardial Perfusion Maps by Contrast Echocardiography
Authors: AIAZIAN ARIC A. , ATAOULLAKHANOVA DILA , VLETTER WIM , VARCHENKO NATALIA , GANKIN KONSTANTIN , TEN CATE FOLKERT J. , SERRUYS PATRICK W. , ROELANDT JOS R.T.C.
Published: December 2007

We evaluated the clinical applicability of a system for three‐dimensional (3‐D) display of a perfusion map following myocardial contrast echocardiography (MCE). The system was used in 12 patients (9 males and 3 females, mean age 52 ± 10 years) undergoing interventional treatment of chronic total coronary occlusion. In each patient three standard apical views were acquired at baseline with sonicated IopamidolR injections into the left coronary artery (LCA) and into the right coronary artery (RCA). Following successful recanalization of the occluded artery MCE was repeated. The patients tolerated the procedure well. Acquisition of three standard apical views provided sufficient information for the reconstruction of 3‐D perfusion maps containing the 16 standard left ventricular (LV) segments. Side‐by‐side display of the perfusion maps obtained following LCA and RCA echocontrast injections allowed us to classify the myocardial segments (192) into three groups: (1) those supplied by one major artery (124); (2) those supplied by collaterals from contralateral or both major arteries (58); and (3) segments supplied by none of the major arteries (10). Decreased opacification was observed in 50 segments of group 2. Following successful intervention we were able to visualize the redistribution of blood flow delivered to the LV myocardium by each major coronary artery in 3‐D format. We conclude that this 3‐D approach, which can easily be performed with currently available ultrasound equipment, allows an estimate of the contribution of each major coronary artery to LV perfusion before and after coronary angioplasty.
Dynamic Three‐Dimensional Reconstruction of Abnormal Intracardiac Blood Flow
Authors: LI ZHIAN , WANG XINFANG , XIE MINGXING , NANDA NAVIN C. , HSIUNG MING C.
Published: December 2007

Dynamic three‐dimensional (3‐D) echocardiography has so far focused on reconstruction of cardiac structures. In this preliminary study, abnormal intracardiac blood flow has been reconstructed in 3‐D from multiplane transesophageal and transthoracic two‐dimensional (2‐D) echocardiograms using modified omniplane probes with 3.7‐ or 5.0‐MHz transducers. The study group included patients with native (40) and prosthetic (11) mitral regurgitant jets, aortic regurgitant jets (8), and shunt flow in atrial septal defect (20), ventricular septal defect (19), tetralogy of Fallot (14), and ruptured sinus of Valsalva aneurysm (6). For dynamic 3‐D intracardiac flow imaging the gain of 2‐D images of cardiac structures was lowered slightly and color Doppler flow signals were transformed into gray scale flow signals, which were then collected in the TomTec 3‐D Echo Scan System. Dynamic 3‐D cardiac flow images were displayed with volume rendering. The results indicated that dynamic 3‐D cardiac flow imaging facilitates display of the stereo shape, spatial orientation, profiles and volume of regurgitant jets, and the intracardiac shunting blood flow. It allows differentiation of prosthetic transvalvular from paravalvular regurgitant jets. Limitations include nonvelocity and nonECG synchronized display.
Two‐Dimensional and Doppler Echocardiographic Features of a Left Atrial Ball Thrombus
Authors: MANGA PRAVIN , POCOCK WENDY A.
Published: December 2007

Left atrial thrombi are not infrequent in patients with mitral stenosis. Occasionally, free‐floating thrombi have been reported in these patients. We report on the echocardiographic and Doppler findings in a patient with mitral stenosis.
Survival in Infarct Related Intramyocardial Dissection: Importance of Early Echocardiography and Prompt Surgery
Authors: TIGHE DENNIS A. , PAUL JAMES J. , MANIET A.R. , FLACK JOSEPH E. , MANNION JOHN D. , RIFKIN ROBERT D. , RAICHLEN JOEL S.
Published: December 2007

Infarct related intramyocardial dissection, an unusual mechanical complication associated with recent inferior/inferoposterior myocardial infarction, is characterized by a septal defect and a dissection tract that originates on the left side of the interventricular septum, extends beyond the septum into the right ventricular free wall, and subsequently re‐enters the right ventricle. The utility of echo‐cardiography for diagnosis has been described. Despite aggressive therapy, the prognosis of intramyocardial dissection is reported to be dismal. We describe the use of prompt echocardiography in two patients, which established the diagnosis of infarct related intramyocardial dissection allowing early definitive surgery and long‐term survival.
Transesophageal Echocardiographic Imaging of the Left Atrium Behind the Ascending Aorta Mimicking Aortic Dissection: Validation by Contrast Echocardiography
Authors: AGRAWAL GOPAL G. , PAREKH HEMAL H. , TIRTAMAN CONNY , NANDA NAVIN C.
Published: December 2007

We describe the presence of a localized echo‐free space behind the ascending aorta, which could mimic an aortic dissection. This space was confirmed to be the left atrium by intraoperative contrast echocardiography.
Prediction of the Third and Fourth Heart Sounds by Doppler Echocardiography
Authors: MARCON CARLO , MORO EUGENIO , PILLON LUANA , PICCOLI ANTONIO
Published: December 2007

Doppler echocardiographic variables were sought for predicting the third and fourth heart sounds, as documented by phonocardiography. Phonocardiographic recordings of gallop sounds and Doppler echocardiographic investigations of mitral inflow and pulmonary venous flow were evaluated in 85 subjects by discriminant and multiple regression analysis. Of 85 subjects 47% had a third sound and 72% a fourth sound, evaluated by phonocardiography. A correct identification of 85% subjects with, and 82% without, the third sound was possible by discriminant analysis using the ratio of peak early diastolic to peak atrial mitral flow velocity (FV), the interval from peak ECG R wave to peak early diastolic mitral FV, and the early diastolic mitral FV deceleration time. At the observed prevalence of the third heart sound (47%), the predictive positive value was 81% and the predictive negative value was 86%. A correct identification of 72% of the subjects with, and 83% without, a fourth sound was possible by discriminant analysis using the ratio of peak early diastolic to peak atrial mitral FV, the interval between the end of atrial mitral FV and the peak ECG R wave, and the duration of pulmonary venous reverse FV at atrial systole. At the observed prevalence of the fourth heart sound (72%) the predictive positive value was 92% and the predictive negative value was 54%. By multiple regression analysis, up to 50% of the amplitude of both gallop sounds was predictable by a combination of Doppler echocardiographic variables.
Assessment of Renal Perfusion in a Canine Model Using FS069, A New Transpulmonary Echocontrast Agent
Authors: MOBAREK SAMEH K. , KATES MARC A. , MURGO JOSEPH P. , MORENO CARLOS A. , REVALL SUSAN , CHEIRIF JORGE
Published: December 2007

We have previously demonstrated the safety and efficacy of FS069, a new transpulmonary echocontrast agent, for myocardial opacification. To our knowledge, no information exists regarding the use of this agent for transcutaneous assessment of renal perfusion. We studied 14 mongrel dogs using intravenously administered FS069. Renal ultrasound imaging was performed with a Hewlett‐Packard Sonos 1500 using a 3.5‐MHz transducer. Renal blood flow (ReBF) was altered using renal artery occlusion in four dogs and dipyridamole (0.56 rag / kg IV) in ten dogs. Renal perfusion was quantitatively assessed before and after each intervention using background subtracted peak intensity. ReBF was assessed with radiolabeled microspheres in ten dogs. Renal opacification was observed in all 14 dogs at baseline. The intravenous contrast dose required to produce optimal renal opacification ranged from 0.3–0.7 cc. After renal artery occlusion, peak intensity was reduced from 5.4 ± 5.8 to 0.93 ± 1.1 units (r = 0.99, P < 0.008). As expected, blood pressure and ReBF dropped in all ten dogs after dipyridamole administration. Interestingly, peak intensity increased in all but one dog. An inverse correlation (r = ‐0.75, P = 0.02) was observed between ReBF and peak intensity (percent change from baseline). The inverse relation between ReBF and peak intensity observed suggests vasocon‐striction of the afferent arterioles in response to dipyridamole and a reduced clearance of the contrast. These findings are in agreement with previous data demonstrating decreased renal thallium clearance postdipyridamole administration. Our data document the feasibility to assess renal perfusion under various flow states after intravenous injection of FS069.
Transseptal Catheterization with Transesophageal Guidance in High Risk Patients
Authors: HAHN KENNETH , BAJWA TANVIR , SARNOSKI JOSEPH , SCHMIDT DONALD H. , GAL RAMI
Published: December 2007

Atrial transseptal catheterization is usually performed with fluoroscopic guidance of the needle. We report our experience with both fluoroscopic and transesophageal guidance in patients who would otherwise have been at risk by using only fluoroscopy. A total of eleven procedures were performed during a 4 year period. The relative contraindications (some patients had several contraindications) included prior valve replacement (5 patients), prior myocardial revascularization (4 patients), severe dilatation of the left atrium (4 patients), severe dilatation of the ascending aorta (4 patients), and kyphoscoliosis (3 patients). All eleven patients had the transesophageal guided transseptal catheterization performed without complications and without significantly prolonging the procedure. The results of this preliminary, small, and retrospective study suggest that transesophageal echocardiography may enhance the safety of transseptal catheterization in high risk patients. Further prospective studies are needed.
Transesophageal Echocardiography During Interventional Catheterization in Congenital Heart Disease
Authors: VAN DER VELDE MARY E. , PERRY STANTON B.
Published: December 2007

The rapidly expanding role of transesophageal echocardiography (TEE) in the management and treatment of congenital heart disease includes guidance of interventional cardiac catheterization procedures and monitoring of results. TEE is particularly helpful for assessing device position during device closure of atrial septal defects (ASD), ventricular septal defects, and perivalvar defects, especially when multiple or complex defects are present. It is also useful during balloon dilation of certain congenital and postoperative obstructions. Stent placement for treatment of intracardiac obstructions is facilitated by TEE guidance. The risks associated with Brockenbrough transseptal puncture and ASD enlargement, particularly in the setting of unusual atrial anatomy, may be reduced by TEE guidance of the procedure. TEE monitoring of video assisted thoracoscopic closure of patent ductus arteriousus has contributed to the high success rate of this innovative procedure. TEE imaging assists in positioning of devices and catheters, reduces radiation exposure and contrast load, and provides immediate and continous assessment not only of results, but of potential complications of interventional procedures. As the applications of interventional catheterization in the field of pediatric cardiology increase so will the role of TEE.
Values for Mitral Valve Annulus Dimensions in Normals and Patients with Mitral Regurgitation
Authors: HERREGODS MARIE‐CHRISTINE , TAU ANCA , VANDEPLAS ANNE , BIJNENS BART , VAN DE WERF FRANS
Published: December 2007

Objectives. The present study was designed to investigate the dimensions of mitral valve annulus in the presence of mitral regurgitation. Method. Fifty‐four patients were examined. On transthoracic echocardiographic images, we performed linear measurements in the parasternal plane in order to define the size of the left ventricle, left atrium, and mitral valve annulus. We compared these findings with those obtained in 16 control subjects. Results. Twenty‐one patients with mild or moderate mitral regurgitation demonstrated no significant change of the mitral valve annulus compared with the control group (P > 0.05). Seventeen patients with severe mitral regurgitation (grade of 4) had a significant increase of the dimensions of the mitral valve annulus, left ventricle, and left atrium (P < 0.05). The etiology of mitral regurgitation was degenerative in 32 patients, rheumatic in 2 patients, and mitral valve prolapse in 4 patients. All patients had normal left ventricular systolic function. Thirty‐one patients were in normal sinus rhythm, and seven were in atrial fibrillation. Conclusions. The measurement of the diameter of the mitral valve annulus is feasible with transthoracic echo‐cardiography. In addition to the evaluation of mitral valve leaflets and subvalvular apparatus, the measurement of the mitral valve annulus is important in the evaluation of mitral regurgitation, as its enlargement is indicative for severe mitral regurgitation.
Quantitative Tissue Doppler Echocardiography: Physiological Nonuniformity of Left Ventricular Transmural Myocardial Wall‐Motion Velocities and Gradients
Authors: NIXDORFF UWE , MOHR‐KAHALY SUSANNE , KREMER MICHAEL , RIPPIN GERD , MEYER JÜRGEN
Published: December 2007

Tissue Doppler echocardiography (TDE) is a new method by which transmural myocardial function can be studied noninvasively. In order to investigate physiology and reproducibility, 24 young, healthy volunteers were examined by M‐mode TDE. Nonuniformity of transmural tissue layer velocities became apparent: Subendocardial and subepicardial velocities of the anteroseptal myocardial wall (AW) were 3.5 ± 0.7 and 1.3 ± 0.5 cm/sec (P < 0.0001, t‐test), whereas in the posterolateral wall (PW) values of 3.6 ± 0.6 and 1.2 ± 0.4 cm/sec (P < 0.0001, t‐test), respectively, were revealed. The ratios, termed “myocardial velocity gradients” as a new indicator of left ventricular performance, were 3.1 ± 1.0 and 3.4 ± 1.1, respectively. AW and PW did not differ (N.S.). Tolerance borders did not overlap, and intraobserver variability did not reach intersubject variability (P < 0.0001, F‐ratio test). TDE provides new and more sophisticated insights into left ventricular performance. It seems to be accurate and reliable and therefore worth introducing into the clinical arena.
Albunex Does Not Increase the Sensitivity of the Lung to Pulsed Ultrasound
Authors: RAEMAN C.H. , DALECKI D. , CHILD S.Z. , MELTZER R.S. , CARSTENSEN E.L.
Published: December 2007

If cavitation in the vasculature of the lung is the physical mechanism responsible for lung hemorrhage, then addition of cavitation nuclei to the blood should enhance the bioeffect. To test the cavitation hypothesis, the extent of lung hemorrhage in mice injected with the echocontrast agent, Albunex®, was compared to lung hemorrhage in animals injected with saline. Animals were exposed for 5 minutes to 1.1‐MHz pulsed ultrasound (10 μs pulse length, 100‐Hz pulse repetition frequency) at a peak positive pressure at the surface of the animal of 2 MPa. This exposure is approximately twice the threshold pressure amplitude for lung hemorrhage. Lesion areas did not differ significantly in the two groups of animals and were approximately equal to the lesion area in uninjected mice from an earlier study where acoustic exposures were the same. Neither this study nor a related study of hemolysis in vivo suggests that use of Albunex in echocardiographic procedures increases the risk of bioeffects.
Multiplane Transthoracic Echocardiography: Image Orientation, Anatomic Correlation, and Clinical Experience with a Prototype Phased Array Multiplane Surface Probe
Authors: YAO JIEFEN , CAO QI‐LING , PANDIAN NATESA G. , SUGENG LISSA , MARX GERALD , MASANI NAVROZ , YEUNG HUBERT
Published: December 2007

Multiplane transthoracic echocardiography provides numerous sequential images by rotation of the transducer imaging array through 180° with the surface probe at a fixed site. We explored the potential of this new technique with a 3.7/5‐MHz prototype multiplane transthoracic probe. Echoanatomic correlations were first examined in ten explanted hearts. The transducer was then applied in 30 normal humans at transthoracic acoustic windows to determine the imaging planes available. Use of this probe in 76 patients with various cardiac disorders indicated that this probe eases the procedure of transthoracic echocardiographic examination, provides incremental information for improved delineation and understanding of cardiac pathology, and yields many novel insights to echocardiographic interpretation. Multiplane transthoracic echocardiography appears to expand the versatility of transthoracic two‐dimensional echocardiography.
Transesophageal Doppler Analysis of Coronary Sinus Flow A New Method to Assess the Severity of Tricuspid Regurgitation
Authors: ZAMORANO JOSÉ , ALMERÍA CARLOS , ALFONSO FERNANDO , PEREZ MARÍA ANGELES , GRAUPER CATHERINE , MORALES RICARDO , SÁNCHEZ‐HARGUINDEY LUIS
Published: December 2007

Background: Severe mitral regurgitation induces reversal of flow in the pulmonary veins. We hypothesized that severe tricuspid regurgitation may disrupt normal coronary sinus flow. The purpose of this study was to analyze the Doppler flow pattern of the coronary sinus and to determine its value in the assessment of the severity of tricuspid regurgitation. Methods: The coronary sinus flow was analyzed in 70 consecutive patients with some degree of tricuspid regurgitation (27 mild, 14 moderate, and 29 severe) and in 35 patients without tricuspid regurgitation. The coronary sinus flow was obtained by pulsed‐Doppler transesophageal echocardiography in a transverse plane, which showed its drainage into the right atrium. Results: The number of patients with adequate studies of the coronary sinus tended to increase with the severity of the tricuspid regurgitation. In patients without or with only mild tricuspid regurgitation the coronary sinus Doppler flow pattern was formed by two negative waves, a late systolic wave and another diastolic one with higher velocity and longer duration. The systolic wave became reversed in 21 (96%) of the patients with severe tricuspid regurgitation. The sensitivity, specificity, and diagnostic accuracy of the presence of a reversed systolic wave in the coronary sinus for the diagnosis of severe tricuspid regurgitation was 95%, 82%, and 80%, respectively. Conclusions: Significant tricuspid regurgitation modifies the coronary sinus flow pattern as assessed by transesophageal echocardiography. The presence of a reversed systolic flow in the coronary sinus appears to be a reliable new sign with good sensitivity, specificity, and diagnostic accuracy for the diagnosis of severe tricuspid regurgitation.
Age‐Dependent Prevalence of Cardioembolic Sources Detected by TEE: Diagnostic and Therapeutic Implications
Authors: BUSER PETER T. , ZUBER MICHEL , RICKENBACHER PETER , ERNE PAUL , JENZER HANS‐RUDOLF , BURCKHARDT DIETER
Published: December 2007

To define the prevalence of cardioembolic sources found by transesophageal echocardiography (TEE) in different age groups of patients with and without cryptogenic systemic embolism, TEE risk factors for cardiogenic embolism were identified from 341 consecutive patients referred for TEE. One hundred and thirty‐five had cryptogenic cerebral or systemic peripheral embolic events (CEE) and 206 other indications for TEE (CTR). Cardioembolic sources were found in 40% of CEE and in 29% of CTR (P < 0.02). Specifically, left atrial (LA) thrombi (P < 0.0001), atrial septal aneurysm with right‐to‐left shunt (P < 0.002), and atherosclerotic aortic plaques (P < 0.02) were more frequent. The prevalence of potential cardioembolic sources was significantly higher in patients ≥ 70‐years old than in younger patients (P < 0.03), specifically LA thrombi (P < 0.004) and atherosclerotic aortic plaques (P < 0.0001). In patients ≥ 70‐years old, potential cardioembolic sources were found in 63% and in 40% in CEE and CTR (P = 0.073), respectively. However, LA thrombi were more frequent in CEE (P < 0.003). Thus, potential cardioembolic sources observed by TEE are found more frequently in patients ≥ 70‐years old than in younger patients. LA thrombi were more frequent in CEE than in CTR patients ≥ 70‐years old. In patients ≥ 70‐years old with CEE who are eligible for an anticoagulant regimen, a search for potential cardioembolic sources by TEE should be considered.
Harmonic Power Doppler Contrast Echocardiography: Preliminary Clinical Results
Authors: BECHER HARALD , TIEMANN KLAUS , SCHLIEF REINHARD , LÜDERITZ BERNDT , NANDA NAVIN C.
Published: December 2007

Background: In fundamental and second harmonic echocardiography new contrast media opacify the cavities and reduce the difference in the gray level between the cavity and the myocardium thus obscuring the borders of the myocardium. Objectives: The aim of the study was to examine the potential usefulness of second harmonic power Doppler imaging (HPD) in providing adequate delineation of the myocardium from the left ventricular (LV) and right ventricular (RV) cavities during intravenous contrast echocardiography. Using HPD, microbubbles in a cavity or a tissue are imaged as colored pixels superimposed on a conventional B‐scan image. Methods: In a pilot study, three healthy volunteers and two patients with ischemic heart disease were investigated using an ATL‐HDI 3000 echo system. Four chamber views were obtained using fundamental B‐scan, harmonic B‐scan two‐dimensional echocardiography (H2D) and HPD following intravenous injections of 3 g Levovist*. Results: Using intermittent scanning/recording, H2D and HPD provided intensive and homogenous contrast effects in the RV and LV cavities. Good delineation of the myocardium was found in all subjects using HPD, whereas in two of three volunteers and in one of two patients ventricular septal and apical endocardial borders were obscured during H2D. No obvious change in myocardial backscatter was visually found with H2D. However, in all three healthy volunteers and in one of two patients, HPD recordings demonstrated patchy and reticular patterns in the myocardium, which were different from the homogenous signals in the LV cavity. These are consistent with imaging of intramyo‐cardial coronary vessels. Conclusions: HPD with intravenous Levovist is feasible. This technique demonstrated good delineation of ventricular cavities from the myocardium as well as presence of visible contrast in the myocardium. This pilot study justifies further clinical trials to evaluate the clinical benefit of this approach.