bluuebunny/crossref_metadata_2025_split huggingface dataset:
AORTIC VALVE AREA CAN DETERMINE MYOCARDIAL CONTRACTILE DETERIORATION IN SEVERE AORTIC STENOSIS: STUDY WITH TISSUE DOPPLER
Authors: Obregón R. , Garcia E. , Riera J.S. , Cayre. R. 
Published: February 2004

Introduction: After‐load increase in aortic stenosis does not alter the left ventricular ejection fraction (LVEF), even in advanced stages of the illness. We analyzed the ventricular long‐axis velocities and amplitude using tissue Doppler (TD) imaging of the mitral annulus, as this perhaps provides a more sensitive index of systolic function than LVEF. Objectives: (1) To evaluate the left ventricular function in patients with chronically high afterload and (2) determine the effective aortic valve area able to produce changes in left ventricular contractility. Methods: We studied 111 subjects, mean age 68.7 years (range 29–90 years). Of these, 106 (88%) had a valvular area smaller that 1 cm2, and there were 18 age‐matched normal controls (mean age 63.9 years, range 71–81 years) representing the control group (C). The Doppler sample volume was placed at the lateral and septal margins of the mitral annulus. We measured the peak of the systolic apically directed (S‐wave), early diastolic (E), and late diastolic (A) myocardial velocities, the isovolumetric relaxation time (IVRT), and isovolumetric contraction time (IVCT). Patients were classified in groups representing valvular areas 1.1–1.5 cm2 (Group 1, n = 13), 0.71–1 cm2 (Group 2, n = 42),: and <0.7 cm2 (Group 3, n = 64). Statistics: Data are expressed as mean (SD). Group data were compared using the unpaired Student's t test or analysis of variance (ANOVA) with Fisher's PLSD test where appropriate. Linear regression analysis was used (stepwise) to compare continuous variables. A probability value of p < 0.05 was considered significant. Results: The only significant difference observed among groups C and 1 was an increase in the time of ventricular relaxation (103 ± 22 vs.137 ± 35, p < 0.003). Group 2 had a significantly smaller S‐wave than group 1 (5.71 ± 1.15 vs. 6.9 ± 0.91, p < 0.001). Group 3 had significantly smaller A‐wave (6.45 ± 2.5 vs. 8 ± 2.1, p < 0.002), and S‐wave (5.06 ± 1.02 vs. 5.71 ± 1.15, p < 0.005) velocities than group 2, as well as a significant increase in the E/A ratio compared to group 2 (1.00 ± 0.62 vs. 0.74 ± 0.35, p < 0.018). In the regression analysis, we observed a moderate direct relationship between the aortic area and the S‐wave of the TD (r = 0.49, p < 0.0001). LVEF diminished significantly more in group 3 than in group 2 (56 ± 16 vs. 63 ± 15, p < 0.015) but were within normal values. Conclusions: (1) AS first deteriorates the left ventricular diastolic function, prolonging the IVRT. (2) Left ventricular contraction (S‐wave) deteriorates when the aortic valve area decreases below 1 cm2, and this deterioration has a direct relationship with aortic valve area. LVEF decreases when the valvular area is smaller than 1 cm2, but remains inside what is considered normal values.
COMPLEMENTARY VALUE OF TRANSTHORACIC ECHOCARDIOGRAPHY AND CINEFLUOROSCOPIC EVALUATION OF MECHANICAL HEART PROSTHETIC VALVES
Authors: Cianciulli T.F. , Lax J.A. , Cerruti F.E. , Gigena G.E. , Redruello H.J. , Orsi M.A. , Gagliardi J.A. , Dorelle A.N. , Riccitelli M.A. , Prezioso. H.A. 
Published: February 2004

Many different mechanical heart valve prostheses (MVP) are used but in most of the cases transthoracic echocardiography (TTE) cannot recognize the type and the information obtained from the patients about the implanted prostheses is incomplete or lacking. Objective: (1) To compare TTE transprosthetic gradients with cinefluoroscopic (F) prosthetic disc opening angles, and (2) To determine F utility in MVP dysfunction diagnosis. Methods: 100 MVP implanted in 84 patients (47 men and 37 female; mean age 59 ± 17 y/o, 63 in sinus rhythm) were prospectively evaluated with F; 68 had aortic and 32 mitral. Results: TTE was not useful in identifing the type of prosthesis, but F was successful in all cases. F could not obtain the “in profile projection” (with the radiographic beam parallel to both the valve ring plane and the tilting axis of leaflets) in 15% aortic and 30% mitral valve prostheses. F identified Tri‐Technologies and HP‐Biplus prostheses, but no functional data were obtained due to disc radiopacity absence. In aortic valve prostheses, the opening angle was 53 ± 17°, the maximal and mean pressure gradients were 27 ± 14 mmHg, and the correlation gradient‐opening angles was r =−0.73 (95% CI, −0.85 to −0.53) p < 0.0001. In mitral valve prostheses the opening angle was 56 ± 24°, the effective orifice area was 1.43 ± 0.52 cm2 and the correlations effective orifice area‐opening angles was: r =−0.74 (95% CI 0.21 to 0.93) p < 0.001). Conclusions: (1) Fluoroscopy is a low‐cost, quick, and simple noninvasive procedure that permits distinguishing between normal and dysfunctioning MVP. (2) With adequate orientation of the X‐ray film, fluorosocpy measured the complete opening of the prosthetic valve, indicating free motion of the tilting disc and allowed distinguishing between normal and dysfunctioning MVP. (3) When TTE detected high gradients with fluoroscopic normal motion of the disc, prosthetic–patient mismatch is diagnosed. (4) Fluorosocpy is superior to TTE for identifing the motion of the disc; nonetheless, both techniques should be considered complementary and not exclusive.
ECHOCARDIOGRAPHIC QUANTIFICATION OF RIGHT VENTRICULAR FUNCTION IN THE LATE FOLLOW‐UP OF SENNING PROCEDURE
Authors: Morhy S. , Soares A. , Ribeiro Z. , Wilberg T. , Bustamante L. , Parga J. , Atik E. , Lopes A. , Mathias, Jr. W. , Andrade. J. 
Published: February 2004

Background: Deteriorating ventricular function is a major concern after Senning operation. Echocardiographic assessment of right ventricular (RV) function is limited because of the complex geometry of this ventricle. A myocardial performance index (MPI) that is a Doppler‐derived nongeometric measurement has been reported in adults and children. Because this index is independent of geometry it may be particularly useful in the evaluation of the RV function. The aims of this study were: (1)‐ to prospectively determine normal values for RVMPI in patients in the late follow‐up of Senning procedure; (2)‐ to correlate the ejection fraction (EF) and dP/dt measured by echocardiography (ECHO) with the EF measured by magnetic resonance imaging (MRI). Methods: From August 1999 to March 2003, 44 patients submitted to Senning procedure were prospectively studied by echo and MRI. Mean age was 16.7 years (12–26 years). Mean postoperative period was 15.3 years (10–23.5 years). Forty‐one patients were in NYHA Class I, and 3. The RVMPI was calculated using PW Doppler from tricuspid inflow and aortic outflow, the EF by the modified Simpson's rule, and the dP/dt by CW Doppler tricuspid regurgitation signal. All patients underwent MRI and Echo within one month. The Echo results were compared to RV EF calculated by MRI. Results: RVMPI ranged from 0.16 to 1.42 (mean = 0.50). The EF calculated by echo ranged from 6% to 63% (mean = 39%). Th dP/dt was calculated in 29 raging from 457 to 3213 mmHg/s (mean = 1398 mmHg/s). By MRI the EF ranged from 16% to 85% (mean = 60%). A cut‐off value of 0.47 for the RVMPI was determined (ROC curve), with a sensitivity of 75% and a specificity of 62.5%. There was no correlation between the EF and dP/dt calculated by ECHO and the EF calculated by MRI (R2= 0.29 and 0.04 respectively). The NYHA functional classes of the patients did not correlate with RVMPI or MRI values (Kappa). Conclusion: (1)‐Patients with normal RV function had RVMPI values <0.47, and this index could be useful in the evaluation of Senning procedure; (2)‐ no correlation between the EF and dP/dt calculated by ECHO and the EF calculated by MRI was found.
EVALUATION OF PULMONARY FLOW BY DOPPLER ECHOCARDIOGRAPHY AND SCINTIGRAPHY AFTER PERCUTANEOUS CLOSURE OF PATENT DUCTUS ARTERIOSUS
Authors: Soares A. , Andrade J. , Morhy S. , Soares, Jr. J. , Kajita L. , Mathias, Jr. W. , Lopes A. , Aiello. V. 
Published: February 2004

Background: Most patients who submitted to percutaneous closure of a patent ductus arteriosus (PCPDA), show some degree of protrusion of the occlusive device into the left pulmonary artery (LPA). The purpose of this study is to assess the prevalence of coil protrusion, and whether it causes significant obstruction. Methods: A study group (SG) of 70 patients was submitted to PCPDA with Gianturco coils (mean age: 8.6 years). Doppler Echocardiographic studies were performed, with a mean time follow‐up of 55 months. Coil and LPA were assessed by suprasternal, short‐axis, and high left parasternal views. LPA diameter was indexed to body surface area. A Doppler Index was calculated by the differences of the velocities from each pulmonary artery in relation to the pulmonary trunk, expressed in percentage (VD index). Pulmonary scintigraphy was performed using intravenous injection of 99 Tcm labeled macroaggregated albumin to evaluate lung perfusion. The diameters and disturbances in flow velocities by Doppler echocardiography of the pulmonary arteries were compared with lung perfusion by pulmonary scintigraphy. The same measurements were performed in a control group (CG) of 22 patients (normal or with minimal heart defects). VD Index values of the SG were compared with pulmonary scintigraphy values of the CG to establish normal and abnormal values. Mean time interval between the two studies was 81 days. Results: In 66 patients (95%), the coil protruded into the LPA. Mean LPA diameter was 13mm (SG and CG). Mean VD Index was 22% in the SG and 1.7% in the CG. A cut‐off value of 50% for the VD Index was determined (ROC curve), with 100% sensibility and 98% of specificity. In 8 patients (11%) the VD Index was > 50%, with abnormal left pulmonary perfusion (LPP) in 7 patients. A significant correlation between the VD Index and LPP was demonstrated (R2= 65.19). To estimate the LPP by Doppler a regression equation was obtained: LPP = 47.8 − 0.09 × VD Index. The LPA diameter was compared between patients with VD Index > 50%, < 50%, and CG, with no statistically significant difference (p = 0.6). Conclusion: Protrusion of the coil to LPA was frequently found. LPA diameters did not correlate with flow disturbances and reduced LPP. Patients showing blood flow acceleration >50% at the left pulmonary artery by Doppler have significantly lower values of lung perfusion.
DIAGNOSIS AND FOLLOW‐UP OF FETAL CARDIAC TUMORS
Authors: Marantz P. , Guerchicoff M. , Villa A. , Gutierrez A. , Elias D. , Fustiñana C. , Otaño. L. 
Published: February 2004

Background: Cardiac tumors in childhood are rare, although they would probably appear with greater frequency in fetal life upon closer examination during obstetric ultrasound studies. Prevalence is approximately 0.13%, as reported by fetal echocardiographic studies. We sought to determine the prevalence and natural history of cardiac tumors in patients referred to our laboratory for fetal echocardiography (FE). Methods: Between May 1998 and May 2003, five fetuses with cardiac tumors have been sent to FE out of 8,589 obstetric echographic studies. Gestational age varied from 20 to 34 weeks and maternal age from 19 to 38 years. Results: Prevalence of fetal cardiac tumors was 5 out of 8,589 fetuses: 0.05% in the general population, and 5 of 66: 7.5% of congenital heart disease. Two patients presented with multiple rhabdomyomas in the left venticle (LV), interventricular septum (IVS), and left ventricular outlet; they also had tuberous sclerosis (TS) with intracerebral tumors detected by magnetic resonance imaging (MRI) and cardiac tumors regressed during the first year of life and were asymptomatic. Another fetus with a single tumor with a rhabdomyoma echocardiographic appearance with attachment at the IVS and with a 50‐mmHg LV outlet gradient did well in postpartum, and at 5 months of life the mass became smaller and the gradient decreased to 35 mmHg. One patient with a large LV mass, which in the echo appeared as fibroma, required early surgery at 10 days; the tumor was almost completely resected, and 4 years later the small residual mass has not grown. Histopathological exams revealed cardiac fibrosarcoma. The last fetus, with a single intraseptal tumor, which also appeared as a large fibroma in the echo and that had increased in size after birth, died at 7 months with low cardiac output. MRI did not identify brain tumors. Autopsy was not authorized by the parents. All the prenatal diagnoses were confirmed after birth. Conclusions: (1) Prevalence of fetal cardiac tumors in our hospital was 0.05% and represented 7.5% of congenital heart disease in a 5‐year period; (2) the majority were rhabdomyomas with spontaneous regression after birth; (3) multiple rhabdomyomas were associated with TS; (4) no deaths occurred during fetal life in this series, one died at 7 months due to progresive invasion of the LV cavity and another patient required surgery to relieve the obstruction; (5) fetal echocardiography permits an accurate diagnosis, which allows for pregnancy follow‐up and parental counselling.
IS IT POSSIBLE TO PREDICT THE SEVERITY OF AORTIC REGURGITATION IN A POST‐VALVULOPLASTY PROCEDURE THROUGH KNOWLEDGE OF AORTIC ANATOMY BY ECHO?
Authors: De Dios Ana Maria S. , Flores E. , Fischman E. , Zarlenga B. , Granja M. , Trentacoste L. , Orence V. , Barboza J. , Kreutzer. E. 
Published: February 2004

Objectives: To determinate if it is possible to predict the severity of aortic regurgitation before balloon aortic valvuloplasty through knowledge of aortic anatomy by echo. Background: Twenty patients with severe aortic stenosis were evaluated by echocardiography (echo), before and after the balloon aortic valvuloplasty (BAV) procedure. Two clearly distinct types of bicuspid aorta were found: with vertical and horizontal closing. Those with the vertical closing had a significantly greater severity of aortic regurgitation than those with horizontal closings. Methodology: Before and after the BAV procedure there were recordings in 20 patients with severe aortic stenosis. At the time of the valvuloplasty procedure (BAV), the patients ranged in age from 3 days to 19 years (mean 3.3 years ± 5). Transthoracic parasternal long‐ and short‐axis views at the level of the aortic valve were used to determine cusp fusion site, and aortic regurgitation was graded using pulsed or colored Doppler or both. Criteria of regurgitation were: light (detectable jet adjacent to the valve or narrow jet of low amplitude detected near the aortic valve), moderate (easily detected, moderate amplitude jet associated with left ventricular dilatation), and severe (wide and easily detected high amplitude jet with marked left ventricular enlargement). We found two clearly distinct types of bicuspid aorta: those that had fusion of the right and noncoronary cusp (showed vertical closings in previous echo), and those with fusion of left and right coronary cusps (showed horizontal closings). Statistical Analysis: Statistical significance p < 0.05. Results: Of twenty patients with severe aortic stenosis, with an average age of 4.5 ± 5 (range: 3–19 years) at the time of BAV was effective in 18, with a mean gradient of 87 ± 12 pre‐BAV / 30 ± 11 post‐BAV. Of the 20 patients with aortic BAV, 15 had horizontal closings in the previous echo, and 5 had vertical closings. Of the 15 with horizontal closings, 14 had light regurgitation. Only one patient had early moderate regurgitation and two more had moderate regurgitation later on, at 4.5 and 16 years. No patient, except the patient with early moderate regurgitation, had severe regurgitation; only in one patient BAV was not effective. While there were 5 patients with vertical closing, 4 with effective BAV had early moderate‐to‐severe regurgitation in immediate post‐procedure, 1/5 was no effective. Conclusion: A light post‐procedure insufficiency may be expected in a bicuspid aorta with horizontal closing post aortic valvuloplasty (14/15). We also expected an efficient procedure in the reduction of the aortic stenosis (14/15). A significative aortic regurgitation may be expected in a bicuspid aorta with vertical closing post BAV (4/4).
FOLLOW‐UP IN CLOSING OF ATRIAL SEPTAL DEFECT BY CATHETERISM WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) GUIDANCE
Authors: De Dios Ana Maria S. , Granja M. , Damsky Barbosa J. , Trentacoste L. , Zarlenga B. , Kreutzer E. , Ackerman J. , Fischman E. , Flores E. , Orence. V. 
Published: February 2004

Background: Follow‐up in closing atrial septal defects (ASD) by transcatheter device, with TEE guidance. Methodology: In 137 patients with ASD ostium secundum (os) the mean (X) age of the patients was 8.78 years (range from 2 to 50 years). 120 patients with isolated defects, 12 with other small ASDs, 2 with fenestrated ASDs (fASD),1 patients had patent ductus arteriosus, 2 had ventricular Septal Defects (VSD). Following a routine hemodynamic evaluation in the catheter laboratory a TEE was conducted to measure in millimeters the location and size of the defect, as well as the distance from the defect to the upper pulmonary vein (upv), the tricuspid (TV) and mitral (MV) valves, and the superior (SVC) and inferior (IVC) cava veins. The residual shunt as well as complications were evaluated. Statistical Analysis: Statistical significance p < 0.05. Results: The ASD measured by TEE in short axis: X: 14.4 ± 4.53 mm (range: 7.4 ± 32), in 4‐chamber view: X: 14.77 ± 5 mm (range: 6.5–33), in sagittal, at level of cava veins: X: 17.49 ± 10,29 mm (range: 6.5–38); balloon sizing: 18.3 ± 5.39 mm (range: 10–38); mean size of the device: 18.11 ± 5.57 mm (range 10–38). The distance from the upper edge to the upper pulmonary vein (upv): X: 9.11 ± 2.44 mm (range: 5.3–15); to tricuspid valve (T.V): X: 13.35 ± 3.17 mm (range: 6.5–19), mitral valve (M.V): X: 11.26 ± 2.36 (range: 7–14.4), left superior vena cava (SVC): X: 11.21 ± 2.83 mm (range: 6.2–16.9) and inferior vena cava (IVC): X: 10.21 ± 3.12 mm (range: 7–17.7). The Qp/Qs: 1.97 ± 0.45 (range: 1.25–3.5), pressure in RA: 5.79 ± 3 mmhg (range: 2–12), in LA: 7.42 ± 3.19 mmhg (range: 2–12); in RV: 33.82 ± 6.73 mmhg (24–50) and in pulmonary artery: 29.5 ± 5.92 mmhg (range 20–60), the wedge pressure X: 13.76 ± 3.92 mmhg (range: 9–25). The closure was effective in 137 of 134 cases (97.8 %); there were three embolizations: two defects with size in upper limit, and 1 accidental. These three were operated and the device was recovered, 1 died at 48 hours post‐surgery. Residual shunts were found in 16 patients: 12 trivial, 4 light. Four remained permeable to another small ASD (3mm); 1patient had progressive mitral regurgitation and required mitral replacement. Ten patients had arrhythmia (2 with complete branch block, 2 with second degree block, 3 with supraventricular arrythmia, and 1 with sinusal tachycardia). Conclusion: Closure with the Amplatzer device was an effective procedure in 97.8% of the cases (137/134). During the procedure dangerous complications could take place (3 embolizations). The arrhythmias were not frequently in later evolution (10/137). Mortality was 0.72%. We still require further experience to be able to determine which procedure is best in each case.
ABSENCE OF CORRELATION BETWEEN QRS DURATION AND ECHOGRAPHIC PARAMETERS OF VENTRICULAR DESYNCHRONIZATION. CAN WE STILL TRUST THE ELECTROCARDIOGRAPHIC CRITERIA?
Authors: Cozma D. , Kalifa J. , Pescariu S. , Lighezan D. , Ionac A. , Deharo J.C. , Djiane P. , Dragulescu. S.I. 
Published: February 2004

Background: Identification of the responder candidates for multisite pacing is still difficult and severe heart failure, dilated left ventricle with reduced ejection fraction, prolonged QRS with left bundle branch block (LBBB) are still considered the principal indicators of ventricular desynchronization. The aim of the study was to assess if echographic ventricular desynchronization parameters measured in patients with dilated cardiomyopathy and severe heart failure are correlated with the duration of the QRS on surface electrocardiogram. Methods: This study included 51 patients aged 58.8 ± 7.4 years with idiopathic DCM. The following parameters were measured: QRS duration; effective contraction time (ECT) measured as the interval between QRS onset and closure of aortic valve, interventricular delay (IVD) measured as the time between onset of aortic and pulmonary flow, left ventricular mechanical delay (LVD) as the time from maximal interventricular septum contraction and posterior wall contraction, posterior (P), lateral (L), and posterolateral (PL) wall delays, as the time from QRS onset to maximal wall contraction. Regional post‐systolic contraction was defined in a given wall as the difference (contraction delay − ECT)> 50 ms. Results: 29 patients presented complete LBBB, 22 patients had QRS duration < 120 ms. 39 patients had a post‐systolic contraction of the PL wall (32 patients of the L wall and 26 patients of the P wall). 16 patients with QRS duration <120 had a post‐systolic contraction of the PL wall (as for the LBBB the rest of 39 patients). In 40 patients the sequence of regional ventricular contraction was: P‐L‐PL wall (16 patients with QRS < 120). LVD was > 100 ms in 36 patients (26 patients with LBBB and 10 with QRS < 120). 27 patients with LBBB and 6 with QRS < 120 ms presented IVD > 30 ms. There was no correlation between the QRS duration and the parameters listed above. Conclusions: In a population of patients with severe heart failure and dilated cardiomyopathy there is no correlation between the duration of the QRS and echocardiographic parameters of ventricular desynchronization. These results show that mechanical ventricular desynchronization can be observed in patients with a QRS duration < 120 ms. Further studies are needed to evaluate if this population could beneficiate of multisite pacing therapy.