text:
... page from the NHLBI on Twitter. What Is Echocardiography? Echocardiography (EK-o-kar-de-OG-rah-fee), or ... problems in infants and children. Rate This Content: Echocardiography Clinical Trials Clinical trials are research studies that ...
Transesophageal echocardiography assessment of severe ostial left main coronary stenosis
NASA Technical Reports Server (NTRS)
Doppler echocardiography is commonly used in the assessment of stenotic valvular orifices. We describe the application of transesophageal echocardiography for the detection of a critical ostial left main coronary stenosis. Because preoperative coronary angiography often is not routinely performed in young patients undergoing valve surgery, application of Doppler echocardiography can potentially prevent catastrophic complications, particularly in atypical cases.
Firstenberg, M. S.; Greenberg, N. L.; Lin, S. S.; Garcia, M. J.; Alexander, L. A.; Thomas, J. D.
Comparison of echocardiography and angiography in determining the cause of severe aortic regurgitation.
To assess the accuracy of echocardiography in determining the cause of aortic regurgitation M mode and cross sectional echocardiography were compared with angiography in 43 patients with predominant aortic regurgitation. Each patient had all three investigations performed during the same admission to hospital. In each instance, the cause of aortic regurgitation was confirmed at surgery or necropsy. Seventeen patients had rheumatic aortic valve disease, 13 bacterial endocarditis with a perforated or partially destroyed cusp, five a bicuspid aortic valve (four with a history of endocarditis), and eight aortic regurgitation secondary to aortic root dilatation or aneurysm. Overall sensitivity of echocardiography and aortography was 84% in determining the cause of aortic regurgitation. Thus, rheumatic valve disease and endocarditis appear to be the most common causes of severe aortic regurgitation in this hospital based population. Furthermore, echocardiography is a sensitive non-invasive technique for determining the cause of aortic regurgitation and allows differentiation of valvular from root causes of aortic regurgitation. Images
DePace, N L; Nestico, P F; Kotler, M N; Mintz, G S; Kimbiris, D; Goel, I P; Glazier-Laskey, E E; Ross, J
Exercise Echocardiography in Asymptomatic Patients with Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction
The management of asymptomatic patients with severe aortic stenosis (AS) remains controversial. Recent series reported that early aortic valve replacement might be associated with improved clinical outcomes. However, the risk-benefit ratio should be carefully evaluated and early surgery only be proposed to a subset of asymptomatic patients considered at higher risk. Exercise echocardiography can help unmask symptomatic patients combined with assessment of the hemodynamic consequences of AS. Recent studies have demonstrated that exercise echocardiography can provide incremental prognostic value to identify patients who may benefit most from early surgery. In "truly" asymptomatic patients, an increase in mean aortic gradient ? 18-20 mmHg, a limited left ventricular contractile reserve or a pulmonary hypertension during exercise are predictive parameters of adverse cardiac events. Exercise echocardiography is low-cost, safe and available in many referral centers, and does not expose patients to radiation. The purpose of this article is to describe the role of exercise testing and echocardiography in the management of asymptomatic patients with severe AS and preserved left ventricular ejection fraction.
Henri, Christine
Myocardial Viability During Dobutamine Echocardiography Predicts Survival in Patients With Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction
Objectives. The purpose of this study was to assess whether the presence or absence of myocardial viability during dobutamine echocardiography (DE) predicts survival in patients with coro- nary artery disease (CAD) and severe left ventricular (LV) dysfunction. Background. In patients with CAD, the presence of myocardial viability during DE identifies viable myocardium and predicts recovery of LV systolic function after
Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction
Objectives. The purpose of this study was to assess whether the presence or absence of myocardial viability during dobutamine echocardiography (DE) predicts survival in patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction.Background. In patients with CAD, the presence of myocardial viability during DE identifies viable myocardium and predicts recovery of LV systolic function after revascularization. However,
Imran Afridi; Paul A Grayburn; Julio A Panza; Jae K Oh; William A Zoghbi; Thomas H Marwick
Utility of transthoracic echocardiography to estimate severity of right ventricular dysfunction: an MRI comparison study.
Prognostic implications of severe right ventricular (RV) dysfunction are difficult to assess because of limitations in functional characterization using standard echocardiography (TTE) and the cost and availability of options such as MRI. We sought to determine how assessments of RV dysfunction via TTE correlate with RV ejection fraction (EF) by MRI. Patients undergoing MRI and TTE within 21�days of one another were included. Left ventricular (LV) and RV EF were recorded from MRI and subjective assessment of RV function (normal, mild, moderate, or severe dysfunction), right ventricular index of myocardial performance (RIMP), and right ventricular systolic pressure (RVSP) were recorded from TTE. Patients were considered to have significant RV dysfunction if EF�?�35% on MRI and normal function if EF�?�45%. A total of 474 patients were included (age 50���12, 57% male). Of these, 363 (76.6%) had normal function, 54 (11.4%) had mild dysfunction, 41 (8.6%) had moderate dysfunction, and 16 (3.4%) had severe dysfunction on TTE. Moderate or severe dysfunction had good sensitivity (80%) and specificity (97%) for RV EF�?�35%. Furthermore, RIMP�>�0.70 and RVSP�>�70�mm Hg were very specific for RV EF�?�35% (sensitivity�=�29%, 22%, respectively; specificity�=�98%, 99%, respectively). Specificity and sensitivity of TTE assessments did not change if LV function or disease indication was considered. A subjective assessment of moderate to severe RV dysfunction on TTE compares favorably with quantitative MRI assessment of the RV EF. Further study is needed to evaluate whether this comparability is true across institutions. PMID:21279688
Kapa, Suraj; Elias, Richard; Connolly, Heidi J; Syed, Imran S; Asirvatham, Samuel J
Fetal echocardiography is a test that uses sound waves ( ultrasound ) to evaluate the baby�s heart for problems before birth. ... Fetal echocardiography is a test that is done while the baby is still in the womb. It is usually ...
The Impact of Fetal Echocardiography
Fetal echocardiography has impacted the fetus with congenital heart disease in many important ways. Advances in fetal echocardiography have allowed for more accurate and earlier detection of cardiac abnormalities. In turn, the prenatal diagnosis of cardiac abnormalities has improved the care and outcome of selected fetuses with severe cardiac malformations or arrhythmias. Fetal echocardiography has improved the understanding of the
J. P. Kovalchin; N. H. Silverman
[Report of a case of lung cancer with metastasis to the myocardium which showed electrocardiographic findings similar to acute myocardial infarction and intramyocardial mass on echocardiography].
A 61-year-old man was admitted to our hospital with complaints of cough and left back and chest pain. He had suffered from left tuberculous pleurisy at the age of 20 years. Chest X-ray film and CT revealed atelectasis of the left lung, a left hilar mass and an irregular left atrial wall. Depressed P-Ta segment in the inferior limb and anterior chest leads and an abnormal P wave were found on ECG. Transbronchial lung biopsy showed squamous cell carcinoma. After radiation therapy, the patient complained of chest oppression. ECG revealed a normalized P-Ta segment deviation, markedly elevated ST segment in the inferior limb and lateral chest leads and a depressed ST segment in the anterior chest leads. These findings persisted until his death. An obscure appearance of the pericardium and an echogenic intramyocardial mass in the posteroinferior and lateral wall were evident by echocardiography. The patient died due to heart failure. Postmortem needle biopsy showed scattered intramyocardial tumor cell nests with keratinization. CPK, GOT and LDH were within normal limits throughout the course, but CPK-MB was slightly increased. Cardiac metastasis with an ECG appearance similar to that of acute myocardial infarction has been rarely reported. Our present case showed peculiar feature including 1) ECG findings similar to atrial and ventricular myocardial infarction, and 2) an echogenic intramyocardial mass and an ill-defined pericardium on echocardiography. These findings suggested direct invasion of squamous cell carcinoma of the lung to the ventricular myocardium.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2740646
Dazai, Y; Katoh, I; Sueda, S; Katoh, T; Yoshida, R; Fujii, M; Kazatani, S
Several engine technology advances show potential in labs; Part 2
Cutting fuel consumption and reducing emissions are dominant goals of stationary gas engine operators. Recent technology advances show promise and could result in money-saving retrofit options. Selected new technologies include sensors, actuators--defined as anything controlling the engine: fuel and ignition--and control techniques. An attractive feature of most of these technologies is that they can be retrofitting onto existing engines, allowing the potential for improved performance at a fraction of engine replacement cost. This paper describes these technologies.
McCoy, J.J. (Tenneco Gas Co., Houston, TX (United States)); Willson, B. (Colorado State Univ., Fort Collins, CO (United States). Engines and Energy Conservation Lab.)
Striatal neurones show sustained recovery from severe hypoglycaemic insult.
Glucose deprivation provides a reliable model to investigate cellular responses to metabolic dysfunction, and is reportedly associated with permanent cell death in many paradigms. Consistent with previous studies, primary cultures of rat striatal neurones exposed to 24-h hypoglycaemia showed dramatically decreased sodium 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) metabolism (used as a marker of cell viability) and increased TUNEL staining, suggesting widespread DNA damage typical of apoptotic cell death. Remarkably, restoration of normal glucose levels initiated a sustained recovery in XTT staining, along with a concomitant decrease in TUNEL staining, even after 24 h of hypoglycaemia, suggesting recovery of damaged neurones and repair of nicked DNA. No alterations in the levels of four DNA repair proteins could be detected during hypoglycaemia or recovery. A reduction in intracellular calcium concentration was seen in recovered cells. These data suggest that striatal cells do not die after extended periods of glucose deprivation, but survive in a form of suspended animation, with sufficient energy to maintain membrane potential. PMID:12871579
McDermott, C J; Bradley, K N; McCarron, J G; Palmer, A M; Morris, B J
Exercise echocardiography has been used for 30 years. It is now considered a consolidated technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). Of the stress echocardiography techniques, it represents the first choice for patients who are able to exercise. Given that the cost-effectiveness and safety of stress echocardiography are higher than those of other imaging techniques, its use is likely to be expanded further. Recent research has also proposed this technique for the evaluation of cardiac pathology beyond CAD. Although the role of new technology is promising, the assessment of cardiac function relies on good quality black and white harmonic images.
Peteiro, Jesus; Bouzas-Mosquera, Alberto
Transesophageal echocardiography
Transesophageal echocardiography (TOE) is a specialised echo application that is frequently utilised by cardiologists and\\u000a also by surgeons, anaesthesiologists and intensivists for quick decision making, monitoring and guiding operative procedures,\\u000a interventions, and managing critically ill patients. It is the term used to describe the study of the heart from the oesophagus\\u000a using two-dimensional, three-dimensional, M-mode or Doppler echocardiography. The clinical
Satish C. Govind; S. S. Ramesh
Dipyridamole stress echocardiography in patients with severe left main coronary artery narrowing. Echo Persantine International Cooperative (EPIC) Study Group--Subproject "Left Main Detection".
From a population of 2,698 patients (579 evaluated early after an uncomplicated acute myocardial infarction) who underwent dipyridamole echocardiography testing (DET) and subsequent coronary angiography, left main (LM) stenosis > or = 50% was present in 73 (61 men and 12 women, mean age 62 +/- 8 years). These 73 patients were compared with a control group comprising 100 consecutive coronary patients without LM disease. Both groups were similar regarding mean age, sex, incidence of previous myocardial infarction, left ventricular function at rest, and severity of coronary artery disease by the number of diseased vessels excluding the LM. The proportion of patients receiving antianginal therapy during DET was higher in the LM than in the non-LM group (32 vs 14%; p < 0.01). No major complication (severe hypotension, sustained arrhythmia, myocardial infarction or death) occurred during DET. Of 73 patients with LM disease, 68 had positive DET (sensitivity 93%), dipyridamole time was 7.1 +/- 3.8 minutes, and the rest-peak stress variation in dipyridamole wall motion score index (1 = normal to 4 = dyskinesia, in an 11-segment model) was 0.37 +/- 0.23; 14 patients (19%) were resistant to aminophylline and needed nitrates to resolve ischemia. In the non-LM group, DET was positive in 72% (p < 0.001 vs LM), with a longer dipyridamole time (9.6 +/- 5.2 minutes; p < 0.001 vs LM), lower rest-peak stress wall motion score index variation (0.29 +/- 0.25; p < 0.05 vs LM), and less frequent antidote resistance (1%; p < 0.001 vs LM).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8141085
Andrade, M J; Picano, E; Pingitore, A; Petix, N; Mazzoni, V; Landi, P; Raciti, M
A case of acute aortic insufficiency due to severe rheumatoid arthritis, showing progression in two weeks
A 74-year-old woman with a history of myocardial infarction and severe rheumatoid arthritis on immunosuppressants was referred to our hospital because of nausea and tooth pain, but no abnormalities were detected on physical or laboratory examination. Two weeks after the first assessment, she was referred to our hospital again because of tooth pain and dyspnea. Her echocardiogram showed severe aortic regurgitation, which was not detected at the assessment 2 weeks previously. After the patient�s congestive heart failure showed improvement, she underwent aortic valve replacement; the aortic valve leaflets were severely shrunken and thickened, without any evidence of endocarditis. Pathological examination of the leaflets showed infiltration of inflammatory cells into the valve leaflets. Therefore, rheumatoid arthritis needs to be considered as an important risk factor for acute valvular disease.
Kobayashi, Yutaka; Suzuki, Haruo
Noninvasive evaluation of membranous subaortic stenosis: complimentary roles of echocardiography and computed tomographic angiography.
A 29-year-old Ethiopian woman that was referred to the Wisconsin Heart Hospital for treatment of subaortic stenosis, diagnosed 4 years earlier, in Ethiopia, using transthoracic echocardiography. Preoperative evaluation included transesophageal echocardiography, which showed severe membranous subaortic stenosis with a mean outflow gradient of 70 mmHg. Cardiac computed tomographic angiography also demonstrated a subaortic membrane, and additionally showed normal epicardial coronary arteries. The patient underwent uneventful surgical resection of the subaortic membrane without undergoing cardiac catheterization. PMID:20486955
Mun, Hee-Sun; Wann, L Samuel
[Hand-held echocardiography in clinical practice].
In the last years the industry has created echocardiographic portable machines of reduced size, available for a growing number of operators. After the first experiences of the '70s, hand-held echocardiography (HHE) is earned interesting commercial positions. The transportability of these machines allows to perform examinations outside the echo-lab and provides diagnostic information in heterogeneous locations such as intensive care unit, emergency room and outpatient structures, at the bedside and even in ambulance. HHE can be useful for detection of several pathologies including aortic aneurysms and left ventricular hypertrophy, regional wall motion abnormalities, pericardial and pleural effusion. To date, four main kinds of HHE can be distinguished: a first, high-cost variety, including miniaturized machines, equipped with instrumentations of standard echocardiography and even new softwares for tissue Doppler and myocardial contrast echocardiography; a second kind of machines of high level but not miniaturized; a third (intermediate level and low cost), and a fourth one (basic level and very low cost), including "cardioscopes" corresponding to the ultrasound stethoscope, able to complete efficaciously the clinical examination. The introduction of HHE opens controversy about its diagnostic accuracy, the opportunity to establish the clinical scenario where it should be utilized and the identification of the potential users and the needed competence level. Preliminary experiences show the possibility of improving and anticipating the diagnosis of several cardiac diseases but also the need to plan specific ultrasound training to avoid inappropriate use of HHE. PMID:15934422
Mondillo, Sergio; Galderisi, Maurizio
Effects of percutaneous aortic valve replacement on coronary blood flow assessed with transesophageal Doppler echocardiography in patients with severe aortic stenosis.
The aim of this study was to assess the change in coronary flow in patients who underwent percutaneous aortic valve replacement (PAVR) for severe aortic stenosis. The left main coronary artery was visualized using transesophageal echocardiography in 17 patients who underwent PAVR. The peak systolic and diastolic velocities of coronary flow and the time-velocity integral were obtained before and after PAVR using pulsed-wave Doppler. The median age was 80.0 years (interquartile range [IQR] 80.0 to 88.0). Median gradients decreased from 40.0 mm Hg (IQR 35.0 to 50.0) before PAVR to 4.0 mm Hg (IQR 2.75 to 4.2) afterward (p <0.001). Aortic valve area increased from 0.6 cm(2) (IQR 0.5 to 0.7) to 1.9 cm(2) (IQR 1.7 to 2.0) (p <0.001). Cardiac output increased from 3.3 L/min (IQR 2.4 to 4.0) to 3.6 L/min (IQR 3.1 to 4.4) (p <0.001). Aortic systolic pressure did not change significantly, from 126.0 mm Hg (IQR 11.7 to 137.7) before to 134 mm Hg (IQR 116.3 to 142.5) after valve implantation (p = 0.8). Left ventricular end-diastolic pressure decreased significantly from 19.0 mm Hg (IQR 18.0 to 22.0) before to 14.0 mm Hg (IQR 12.0 to 17.0) after valve implantation (p = 0.01). The medians of the following coronary flow parameters increased significantly after PAVR: peak systolic velocity, 25.0 cm/s (IQR 17.0 to 30.0) to 37.0 cm/s (IQR 23.0 to 44.0) (p <0.001); peak diastolic velocity, 49.0 cm/s (IQR 39.5 to 61.0) to 57.0 cm/s (IQR 42.9 to 83.9) (p = 0.006); total velocity-time integral, 23.7 cm (IQR 15.0 to 27.1) to 28.1 cm (IQR 21.3 to 34.7) (p = 0.001); and systolic velocity-time integral, 5.4 cm (IQR 3.5 to 6.2) to 9.0 cm (IQR 4.5 to 9.8) (p = 0.001). The diastolic time-velocity integral increased from 17.2 cm (IQR 12.0 to 24.0) to 20.1 cm (IQR 15.0 to 25.9) (p = 0.02). In conclusion, after PAVR, there is a significant increase in coronary flow as measured by peak systolic velocity, diastolic velocity, and velocity-time integral using pulsed-wave Doppler by transesophageal echocardiography. PMID:19733723
Ben-Dor, Itsik; Goldstein, Steven A; Waksman, Ron; Satler, Lowell F; Li, Yanlin; Syed, Asmir I; Maluenda, Gabriel; Collins, Sara D; Suddath, William O; Torguson, Rebecca; Xue, Zhenyi; Kaneshige, Kimberly; Okubagzi, Petros; Wang, Zuyue; Kent, Kenneth M; Pichard, Augusto D
Recent trends in prostate cancer mortality show a continuous decrease in several countries
Int. J. Cancer: 123, 421�429 (2008) ' 2008 Wiley-Liss, Inc. Recent trends in prostate cancer mortality show a continuous decrease in several countries Christine Bouchardy1, Gerald Fioretta1, Elisabetta Rapiti1, Helena Maria Verkooijen1,2, Charles
Beta adrenergic receptor blockade causing severe left ventricular systolic dysfunction during dobutamine stress echocardiography in a patient with no structural heart disease.
A 41-year-old woman with a history of neurocardiogenic syncope treated with beta-blockers was admitted with chest pain. Dobutamine echocardiogram images demonstrated decreased global LV systolic wall motion and thickening. Coronary angiograms were normal. Beta-blockers were stopped and dobutamine stress echocardiogram (DSE) was repeated. Dobutamine images demonstrated increased global LV systolic wall motion and thickening. Beta-blockers were restarted and again dobutamine produced global LV dysfunction. This case suggests that DSE wall motion response may be falsely abnormal in a patient on beta-blockers. Physicians should be aware of this possibility when interpreting dobutamine echocardiography in patients taking beta-blockers. PMID:21988278
Okada, David R; Okada, Robert D; Bonow, Robert O
MRI Shows More Severe Hippocampal Atrophy and Shape Deformation in Hippocampal Sclerosis Than in Alzheimer's Disease
While hippocampal atrophy is a key feature of both hippocampal sclerosis (HS) and Alzheimer's disease (AD), the pathology underlying this finding differs in these two conditions. In AD, atrophy is due primarily to loss of neurons and neuronal volume as a result of neurofibrillary tangle formation. While the etiology of HS is unknown, neuron loss in the hippocampus is severe to complete. We compared hippocampal volume and deformations from premortem MRI in 43 neuropathologically diagnosed cases of HS, AD, and normal controls (NC) selected from a longitudinal study of subcortical ischemic vascular disease (IVD Program Project). HS cases (n = 11) showed loss of neurons throughout the rostral-caudal extent of the hippocampus in one or both hemispheres. AD cases (n = 24) met NIA-Reagan criteria for high likelihood of AD. Normal control cases (n = 8) were cognitively intact and showed no significant AD or hippocampal pathology. The mean hippocampal volumes were significantly lower in HS versus AD groups (P < .001). Mean shape deformations in the CA1 and subiculum differed significantly between HS versus AD, HS versus NC, and AD versus NC (P < .0001). Additional study is needed to determine whether these differences will be meaningful for clinical diagnosis of individual cases.
Zarow, C.; Wang, L.; Chui, H. C.; Weiner, M. W.; Csernansky, J. G.
MRI shows more severe hippocampal atrophy and shape deformation in hippocampal sclerosis than in Alzheimer's disease.
While hippocampal atrophy is a key feature of both hippocampal sclerosis (HS) and Alzheimer's disease (AD), the pathology underlying this finding differs in these two conditions. In AD, atrophy is due primarily to loss of neurons and neuronal volume as a result of neurofibrillary tangle formation. While the etiology of HS is unknown, neuron loss in the hippocampus is severe to complete. We compared hippocampal volume and deformations from premortem MRI in 43 neuropathologically diagnosed cases of HS, AD, and normal controls (NC) selected from a longitudinal study of subcortical ischemic vascular disease (IVD Program Project). HS cases (n = 11) showed loss of neurons throughout the rostral-caudal extent of the hippocampus in one or both hemispheres. AD cases (n = 24) met NIA-Reagan criteria for high likelihood of AD. Normal control cases (n = 8) were cognitively intact and showed no significant AD or hippocampal pathology. The mean hippocampal volumes were significantly lower in HS versus AD groups (P < .001). Mean shape deformations in the CA1 and subiculum differed significantly between HS versus AD, HS versus NC, and AD versus NC (P < .0001). Additional study is needed to determine whether these differences will be meaningful for clinical diagnosis of individual cases. PMID:21547227
Zarow, C; Wang, L; Chui, H C; Weiner, M W; Csernansky, J G
Microsatellites haplotyping of CF chromosomes shows linkage disequilibrium and several founder effects in Brittany (France)
A large study on cystic fibrosis (CF) is underway in Brittany (France). It is based on 902 CF patients distributed in 795 families who were or are still followed at the {open_quotes}Centre Helio-Marin{close_quotes} in Roscoff and/or were subjected to a molecular analysis at the {open_quotes}Centre de Biogenetique{close_quotes} in Brest. At present, the CF mutations have been identified in 309 patients born in Brittany, most of them of Celtic origin. A microsatellite (MS) study using IVS 17b TA, IVS 17b CA and IVS 8 CA was also completed in 63 CF patients and their parents (carriers of the {Delta}F508 mutation or the G551D mutation or the 1078delT mutation or the W846X mutation). All the 21 chromosomes carrying the 1078delT mutation had the same MS haplotype (16-21-13), which was also found on 9 of the 83 non-CF chromosomes analyzed. All the 16 chromosomes with the G551D mutation carried another MS haplotype (16-7-17), which was also found on 13.3% of the non-CF chromosomes. All the 6 chromosomes with the W846X mutation carried the 16-32-13 haplotype, also found on 6.0% of the non-CF chromosomes. Sixteen different MS haplotypes were found among the 74 chromosomes carrying the{Delta}F508 mutation, three of them representing 74.3% (55/74) of the chromosomes. These were the 23-31-13 haplotype (31/74 - 41.9%), the 17-31-13 haplotype (11/74 - 14.9%), and the 17-32-13 haplotype (13/74 - 17.6%). These results show that the CF mutations observed in Brittany are in linkage disequilibrium with the MS haplotypes. They also suggest that their presence in Brittany is the consequence of several founder effects.
Raguenes, O.; Ferec, C.; Mercier, B. [Universite de Bordeaux II, Paris (France)] [and others
Echocardiography in liver transplant candidates.
Involvement of the cardiovascular system in patients with end-stage liver disease (ESLD) is well recognized and may be seen in several scenarios in adult liver transplantation (LT) candidates. The hemodynamic effects of ESLD may result in apparent heart disease, or in some instances may mask cardiac disease. Alternatively, cardiac disease can occasionally be the underlying etiology of ESLD. LT imposes significant hemodynamic stresses, with cardiovascular complications accounting for considerable perioperative mortality and morbidity. Pre-operative assessment of the cardiac status of LT candidates is thus critically important for risk stratification and management. Cardiac imaging plays an integral role in the assessment of LT candidates. In this review, we discuss the role of cardiac imaging, including transthoracic echocardiography with Doppler and contrast enhancement, noninvasive functional assessment for routine pre-operative assessment of coronary artery disease, and transesophageal echocardiography in select cases to aid in intra-operative fluid management and monitoring in LT candidates. PMID:23328568
Garg, Anubhav; Armstrong, William F
Introduction to Echocardiography
The use of ultrasound to provide noninvasive evaluation of cardiac structure and function was a revolutionary advancement\\u000a in cardiac care in the late 20th century (1). Development of the field of echocardiography has allowed detailed serial examinations of the development, structure, and\\u000a function of the human heart in normal physiological states and in pathological conditions. Echocardiography has increased\\u000a the diagnostic
JAMIE L. LOHRf
Progesterone Treatment Shows Benefit in a Pediatric Model of Moderate to Severe Bilateral Brain Injury
Purpose Controlled cortical impact (CCI) models in adult and aged Sprague-Dawley (SD) rats have been used extensively to study medial prefrontal cortex (mPFC) injury and the effects of post-injury progesterone treatment, but the hormone's effects after traumatic brain injury (TBI) in juvenile animals have not been determined. In the present proof-of-concept study we investigated whether progesterone had neuroprotective effects in a pediatric model of moderate to severe bilateral brain injury. Methods Twenty-eight-day old (PND 28) male Sprague Dawley rats received sham (n?=?24) or CCI (n?=?47) injury and were given progesterone (4, 8, or 16 mg/kg per 100 g body weight) or vehicle injections on post-injury days (PID) 1�7, subjected to behavioral testing from PID 9�27, and analyzed for lesion size at PID 28. Results The 8 and 16 mg/kg doses of progesterone were observed to be most beneficial in reducing the effect of CCI on lesion size and behavior in PND 28 male SD rats. Conclusion Our findings suggest that a midline CCI injury to the frontal cortex will reliably produce a moderate TBI comparable to what is seen in the adult male rat and that progesterone can ameliorate the injury-induced deficits.
Geddes, Rastafa I.; Sribnick, Eric A.; Sayeed, Iqbal; Stein, Donald G.
The role of echocardiography in assessing parachute mitral valve.
Treadmill exercise echocardiography with Doppler evaluation during effort has been used for several years in our department. The usefulness of this methodology in the management of patients with coronary heart disease is recognized but it is being increasingly used in patients with valvular heart disease. We report the case of a 44-year-old man with parachute mitral valve, in which transesophageal echocardiography characterized the pathology and exercise stress echocardiography was important for accurate functional assessment and clinical decisions. PMID:19480316
Almeida, Sofia; Cotrim, Carlos; Miranda, Rita; Lopes, Lu�s; Almeida, Ana Rita; Loureiro, Maria J; Sim�es, Ot�lia; Cordeiro, Pedro; Fazendas, Paula; Jo�o, Isabel; Carrageta, Manuel
Diagnosis of Celiac Artery In-Stent Thrombosis by Transesophageal Echocardiography.
We present a case of a 70-year-old woman with severe peripheral arterial disease presenting with celiac artery in-stent thrombosis diagnosed by transesophageal echocardiography (TEE). Routine assessment of the visceral arteries is not performed in most TEE studies. A review of the literature shows that the celiac and superior mesenteric arteries can be successfully visualized during transgastric views of the abdominal aorta. We propose that two-dimensional and color Doppler echocardiography have several intrinsic advantages over computed tomography, magnetic resonance angiography and catheterization when assessing aortic and visceral arterial pathology. PMID:22931198
Biederman, Robert W W; Fakhri, Abid Ali; Young, Joseph C
Ebstein's anomaly assessed by real-time 3-D echocardiography.
The outcome of patients with Ebstein's malformation depends mainly on the severity of the tricuspid valve malformation. Accurate description of the tricuspid anatomy by two-dimensional echocardiography remains difficult. We applied real-time three-dimensional echocardiography to 3 patients with Ebstein's anomaly. Preoperative and postoperative descriptions of the tricuspid valve were obtained from views taken inside the right ventricle. Surface of the leaflets as well as the commissures were obtained by three-dimensional echocardiography. Real time three-dimensional echocardiography is a promising tool, providing new views that will help to evaluate the ability and efficiency of surgical valve repair in patient with Ebstein's malformation. PMID:16863801
Acar, Philippe; Abadir, Sylvia; Roux, Daniel; Taktak, Assaad; Dulac, Yves; Glock, Yves; Fournial, Gerard
Inverted Takotsubo Cardiomyopathy Induced by Dobutamine Stress Echocardiography with Atypical Presentation
A 48-year-old woman was scheduled by our lab to perform a standard dobutamine/atropine stress echocardiogram. During the test, the patient referred to a slight chest discomfort and developed a progressive left ventricle akinesia of all midbasal LV segments, thus mimicking a midbasal ballooning. ECG persisted without significant abnormalities and with no raise of Troponin I. Coronary angiography showed normal coronary arteries and ventriculography a severe EF reduction and apical hypercontractility. Echocardiography showed a progressive improvement with a complete recovery 48 hours later. This is a rare case of inverted takotsubo syndrome induced by dobutamine stress echocardiography that occurred with atypical presentation.
Cadeddu, Christian; Nocco, Silvio; Cadeddu, Fabio; Deidda, Martino; Bassareo, Pierpaolo; Serra, Alessandra; Piga, Mario; Mercuro, Giuseppe
Murine models have been utilized with increasing frequency mainly due to availability of genetically engineered models. With advancement in high spatial and temporal resolution, echocardiography is used extensively for the evaluation of cardiovascular function in murine models of cardiovascular disease. This review summarizes the general applications and methods involved in echocardiography used to study mouse models for cardiovascular research, based on 20 years of experience in our laboratory. The goal of this article is to provide a practical guide to the use of echo techniques in mice to evaluate cardiac systolic and diastolic function.
Gao, Shumin; Ho, David; Vatner, Dorothy E.; Vatner, Stephen F.
Safety of ultrasound contrast agents in stress echocardiography.
Definity and Optison are perflutren-based ultrasound contrast agents used in echocardiography. United States Food and Drug Administration warnings regarding serious cardiopulmonary reactions and death after Definity administration highlighted the limited safety data in patients who undergo contrast stress echocardiography. From 1998 and 2007, 2,022 patients underwent dobutamine stress echocardiography and 2,764 underwent exercise stress echocardiography with contrast at the Cleveland Clinic. The echocardiographic database, patient records, and the Social Security Death Index were reviewed for the timing and cause of death, severe adverse events, arrhythmias, and symptoms. Complication rates for contrast dobutamine stress echocardiography and exercise stress echocardiography were compared with those in a control group of 5,012 patients matched for test year and type who did not receive contrast. Ninety-five percent of studies were performed in outpatients. There were no differences in the rates of severe adverse events (0.19% vs 0.17%, p = 0.7), death within 24 hours (0% vs 0.04%, p = 0.1), cardiac arrest (0.04% vs 0.04%, p = 0.96), and sustained ventricular tachycardia (0.2% vs 0.1%, p = 0.32) between patients receiving and not receiving intravenous contrast, respectively. In conclusion, severe adverse reactions to intravenous contrast agents during stress echocardiography are uncommon. Contrast use does not add to the baseline risk for severe adverse events in patients who undergo stress echocardiography. PMID:18940305
Gabriel, Ruvin S; Smyth, Yvonne M; Menon, Venu; Klein, Allan L; Grimm, Richard A; Thomas, James D; Sabik, Ellen Mayer
Echocardiography. Fourth edition
In this book the author presents an updated survey of echocardiography: equipment, techniques, examinations, evaluation and interpretation of data, and heart diseases. Doppler, M-mode, two-dimensional and contrast examinations are detailed in a way that delineates their similarities and differences.
Feigenbaum, H.
Evaluation of myocardial viability with contrast echocardiography
Identification of viable myocardium after acute myocardial infarction (MI) or in the setting of severe chronic ischemic heart disease has important clinical implications. Myocardial contrast echocardiography (MCE) has been used for the evaluation of myocardial viability by assessing myocardial perfusion and microvascular integrity. In acute MI, MCE can identify the no-reflow phenomenon after revascularization, which has significant implications regarding recovery
William A Zoghbi
Stress echocardiography: technical considerations.
Stress echocardiography has evolved into a widely practiced and accepted method for the noninvasive assessment of the status of the coronary anatomy. Furthermore, this modality incorporates the ability to assess left ventricular function, valvular structure and function, intracardiac masses, the pericardium, and hemodynamics. The extent to which this tool can reliably provide useful clinical information is dependent, in part, on optimal performance. The purpose of this report is to provide an overview of those technical considerations that can contribute to the successful operation of a stress echocardiography laboratory. Consideration is given to personnel qualifications, functional requirements of the digital acquisition/storage/replay system, functional integration of the various hardware components, characteristics of the software, physical layout of the facility, and alternatives to treadmill exercise as the stressor. A thorough understanding of the physiologic basis of stress echocardiography, coupled with optimization of resources used in its performance, enable this tool to be an extraordinarily useful and cost-efficient method for comprehensive cardiovascular assessment. PMID:11235846
Crouse, L J; Kramer, P H
The Effects of a "Tell-Show-Try-Apply" Professional Development Package on Teachers of Students with Severe Developmental Disabilities
ERIC Educational Resources Information Center
The "What Works Clearinghouse" guidelines for high-quality professional development were used to develop a Tell, Show, Try, and Apply (TSTA) method of training. This method was used to train teachers to align instruction to grade-level content for students with severe developmental disabilities. A total of 193 teachers of students who participate�
Browder, Diane M.; Jimenez, Bree Ann; Mims, Pamela J.; Knight, Victoria F.; Spooner, Fred; Lee, Angel; Flowers, Claudia
[Newly developed technology for intravenous contrast echocardiography].
Until now we have not been able to employ a contrast enhancer for ultrasonic echocardiography at the everyday clinical level because the agent itself, composed of microbubbles, was too easily dispersed or even destroyed by several factors. However, contrast echocardiography has made a great leap forward with major developments on two fronts; the application of some new intravenous contrast enhancers, and newly developed machine technology permitting second harmonic imaging, intermittent or triggered imaging, pulse inversion harmonic imaging, and so on. New contrast enhancing agents are proving durability enough to permit greatly enhanced imaging for more than several minutes after injection. Recent new echocontrast specific imaging allows real-time visualizing of myocardial perfusion and assessment of myocardial function. PMID:10834167
Senda, S; Ohmori, K; Ueeda, M
Contrast echocardiography 1996. A review.
Remarkable advances in the field of contrast echocardiography have been made during the last decade. Interest in ultrasound contrast agents that strengthen the backscattered ultrasound signal and improve image display has stimulated further research. Echocardiographic contrast agents providing left ventricular cavity image enhancement after intravenous injection are now available. A role for contrast echocardiography in the assessment of myocardial perfusion has been established within the invasive clinical setting. With the development of newer contrast agents and new ultrasound technology, myocardial perfusion imaging using contrast echocardiography after venous injection is no longer the unattainable "holy grail," but is fast approaching clinical applicability. Images
Villarraga, H R; Foley, D A; Mulvagh, S L
Experimental infection of Calomys callosus with atypical strains of Toxoplasma gondii shows gender differences in severity of infection.
There is a significant genetic diversity of Toxoplasma gondii in Brazil. Two parasite isolates were recently obtained from chickens in Uberl�ndia, Minas Gerais state, Brazil, namely, TgChBrUD1 and TgChBrUD2. In this study, we investigated Calomys callosus susceptibility to these atypical T. gondii strains. Male and female animals were intraperitoneally infected with tachyzoites and monitored to evaluate body weight change, morbidity, and mortality. Immunohistochemical assay and qPCR were performed to determine the parasitism in liver, spleen, and brain. Our data showed that TgChBrUD2-infected males died earlier than TgChBrUD1-infected males and 100% of mortality was observed after 10 and 12 days of infection, respectively. Also, TgChBrUD1-infected females died earlier than TgChBrUD1-infected males and 100% of mortality was observed after 9 and 12 days of infection, respectively. Both strains were able to induce a decrease in body weight of males, but only the TgChBrUD1 strain induced an increase in body weight of females. TgChBrUD2-infected females had significantly higher parasite load in both liver and spleen in comparison to TgChBrUD1-infected females, but no significant difference was found between genders or strains when males were infected. There was higher parasitism in the liver than the brain from both males and females infected with either strain. In conclusion, C. callosus specimens are susceptible to both T. gondii atypical strains with differences between males and females in severity of infection. These findings open new prospects for understanding different aspects of T. gondii infection, including reinfection and vertical transmission with these atypical strains when utilizing this experimental model. PMID:24781027
Franco, Priscila Silva; Ribeiro, Mayara; Lopes-Maria, Janice Buiate; Costa, Louren�o Faria; Silva, Deise Aparecida Oliveira; de Freitas Barbosa, Bellisa; de Oliveira Gomes, Angelica; Mineo, Jos� Roberto; Ferro, Eloisa Am�lia Vieira
Healed perivalvular abscess: Incidental finding on transthoracic echocardiography.
A 36-year-old male patient presented with the complaints of palpitations and breathlessness. Preoperative transthoracic echocardiography (TTE) revealed a bicuspid aortic valve; severe aortic regurgitation with dilated left ventricle (LV) and mild LV systolic dysfunction (ejection fraction 50%). He was scheduled to undergo aortic valve replacement. History was not suggestive of infective endocarditis (IE). Preoperative TTE did not demonstrate any aortic perivalvular abscess. Intraoperative transesophageal echocardiography (TEE) examination using the mid-esophageal (ME) long-axis view, showed an abscess cavity affecting the aortic valve, which initially was assumed to be a dissection flap, but later confirmed to be an abscess cavity by color Doppler examination. The ME aortic valve short-axis view showed two abscesses; one was at the junction of the non-coronary and left coronary commissure and the other one above the right coronary cusp. Intraoperatively, these findings were confirmed by the surgeons. The case report demonstrates the superiority of TEE over TTE in diagnosing perivalvular abscesses. PMID:24732616
Datt, Vishnu; Diwakar, Anitha; Malik, Indra; Geelani, M A; Tomar, A S; Virmani, Sanjula
Echocardiography during treadmill exercise testing in a patient with mitral stenosis.
Treadmill exercise echocardiography with Doppler during effort has been used for several years in our department. This form of echocardiography is used mainly in evaluation of patients with coronary heart disease and it is being increasingly used in valvular heart disease. We report the case of a 49-year-old woman with moderate mitral stenosis, in which stress echocardiography was important in making correct clinical decisions. PMID:19438154
Almeida, Ana Rita; Cotrim, Carlos; Miranda, Rita; Almeida, Sofia; Lopes, Lu�s; Loureiro, Maria J; Sim�es, Ot�lia; Cordeiro, Pedro; Fazendas, Paula; Jo�o, Isabel; Carrageta, Manuel
An african-specific functional polymorphism in KCNMB1 shows sex-specific association with asthma severity
A highly heritable and reproducible measure of asthma severity is baseline pulmonary function. Pulmonary function is largely determined by airway smooth muscle (ASM) tone and contractility. The large conduc- tance, voltage and calcium-activated potassium (BK) channel negatively regulates smooth muscle tone and contraction in ASM. The modulatory subunit of BK channels, the b1-subunit, is critical for proper acti- vation of
Max A. Seibold; Bin Wang; Celeste Eng; Gunjan Kumar; Kenneth B. Beckman; Saunak Sen; Shweta Choudhry; Kelley Meade; Michael Lenoir; H. Geoffrey Watson; Shannon Thyne; L. Keoki Williams; Rajesh Kumar; Kevin B. Weiss; Leslie C. Grammer; Pedro C. Avila; Robert P. Schleimer; Esteban Gonz�lez Burchard; Robert Brenner
Dynamic Three-Dimensional Echocardiography
NASA Astrophysics Data System (ADS)
Conventional three-dimensional (3D) ultrasound imaging equipment for diagnosis requires much time to reconstruct 3D images or fix the view point for observing the 3D image. Thus, it is inconvenient for cardiac diagnosis. In this paper, we propose a new dynamic 3D echocardiography system. The system produces 3D images in real-time and permits changes in view point. This system consists of ultrasound diagnostic equipment, a digitizer and a computer. B-mode images are projected to a virtual 3D space by referring to the position of the probe of the ultrasound diagnosis equipment. The position is obtained by the digitizer to which the ultrasound probe is attached. The 3D cardiac image is constructed from B-mode images obtained simultaneously in the cardiac cycle. To obtain the same moment of heartbeat in the cardiac cycle, this system uses the electrocardiography derived from the diagnosis equipment. The 3D images, which show various scenes of the stage of heartbeat action, are displayed sequentially. The doctor can observe 3D images cut in any plane by pushing a button of the digitizer and zooming with the keyboard. We evaluated our prototype system by observation of a mitral valve in motion.
Matsusaka, Katsuhiko; Doi, Motonori; Oshiro, Osamu; Chihara, Kunihiro
[Fetal echocardiography. The normal heart].
At 20 weeks amenorrhoea, it is currently possible to determine with echocardiography whether a fetal heart, which then weighs approximately 400g with a diameter of 15 mm, is normal or not. The incidence of cardiac malformations has been estimated at 8 per 1000 fetuses. Fetal factors including retarded growth, hydramnios and arrhythmia and maternal factors including rubeola, diabetes, systemic lupus erythematosus, Rhesus incompatibility and drugs increase fetal risk. In certain cardiopathies such as aortic stenosis, coarctation, malformation of the mitral valve or left ventricle hypoplasia, the risk of recurrence in a second fetus is greatly increased. With 2D echocardiography, the apical section of the four heart cavities orients the heart in the thorax, identifies the atria and ventricles and visualizes valve movement. The origin of the aorta and the kinetics of the mitral and aortic valves are studied on the para-sternal section. TM mode reproduces the P-QRS sequence thus allowing a measurement of heart rate, the thicknesses of heart walls and septa and identifies conduction disorders. The transvalvular systolic pressures can be measured with Doppler echocardiography and pulsed Doppler quantifies blood flow through the different heart structures. Precision can be increased with colour coding. A complete echocardiography of the fetal heart should be an integral part of all examinations of fetal morphology. Usually performed between 22 and 32 weeks of amenorrhoea, echocardiography of the fetal heart requires a perfect understanding of two-dimensional Doppler modes and of three-dimensional representation of heart anatomy. PMID:8072977
Kchouk, H; Bernard, J P; Taurelle, R
Screening for Staphylococcal Superantigen Genes Shows No Correlation with the Presence or the Severity of Chronic Rhinosinusitis and Nasal Polyposis
Background Staphylococcus aureus secretes numerous exotoxins which may exhibit superantigenic properties. Whereas the virulence of several of them is well documented, their exact biological effects are not fully understood. Exotoxins may influence the immune and inflammatory state of various organs, including the sinonasal mucosa: their possible involvement in chronic rhinosinusitis has been suggested and is one of the main trends in current research. The aim of this study was to investigate whether the presence of any of the 22 currently known staphylococcal exotoxin genes could be correlated with chronic rhinosinusitis. Methodology/Principal Findings We conducted a prospective, multi-centred European study, analysing 93 Staphylococcus aureus positive swabs taken from the middle meatus of patients suffering from chronic rhinosinusitis, with or without nasal polyposis, and controls. Strains were systematically tested for the presence of the 22 currently known exotoxin genes and genotyped according to their agr groups. No direct correlation was observed between chronic rhinosinusitis, with or without nasal polyposis, and either agr groups or the presence of the most studied exotoxins genes (egc, sea, seb, pvl, exfoliatins or tsst-1). However, genes for enterotoxins P and Q were frequently observed in nasal polyposis for the first time, but absent in the control group. The number of exotoxin genes detected was not statistically different among the 3 patient groups. Conclusions/Significance Unlike many previous studies have been suggesting, we did not find any evident correlation between staphylococcal exotoxin genes and the presence or severity of chronic rhinosinusitis with or without nasal polyposis.
Girard, Myriam; Vourexakis, Zacharias; Courtis, Antoine Des; Renzi, Gesuele; Huggler, Elzbieta; Vlaminck, Stefan; Bonfils, Pierre; Mladina, Ranko; Lund, Valerie; Schrenzel, Jacques; Francois, Patrice; Lacroix, Jean Silvain
Severe SMA mice show organ impairment that cannot be rescued by therapy with the HDACi JNJ-26481585
Spinal muscular atrophy (SMA) is the leading genetic cause of early childhood death worldwide and no therapy is available today. Many drugs, especially histone deacetylase inhibitors (HDACi), increase SMN levels. As all HDACi tested so far only mildly ameliorate the SMA phenotype or are unsuitable for use in humans, there is still need to identify more potent drugs. Here, we assessed the therapeutic power of the pan-HDACi JNJ-26481585 for SMA, which is currently used in various clinical cancer trials. When administered for 64?h at 100?n?, JNJ-26481585 upregulated SMN levels in SMA fibroblast cell lines, including those from non-responders to valproic acid. Oral treatment of Taiwanese SMA mice and control littermates starting at P0 showed no overt extension of lifespan, despite mild improvements in motor abilities and weight progression. Many treated and untreated animals showed a very rapid decline or unexpected sudden death. We performed exploratory autopsy and histological assessment at different disease stages and found consistent abnormalities in the intestine, heart and lung and skeletal muscle vasculature of SMA animals, which were not prevented by JNJ-26481585 treatment. Interestingly, some of these features may be only indirectly caused by ?-motoneuron function loss but may be major life-limiting factors in the course of disease. A better understanding of � primary or secondary � non-neuromuscular organ involvement in SMA patients may improve standard of care and may lead to reassessment of how to investigate SMA patients clinically.
Schreml, Julia; Riessland, Markus; Paterno, Mario; Garbes, Lutz; Rossbach, Kristina; Ackermann, Bastian; Kramer, Jan; Somers, Eilidh; Parson, Simon H; Heller, Raoul; Berkessel, Albrecht; Sterner-Kock, Anja; Wirth, Brunhilde
Assessment of electrocardiography, echocardiography, and heart rate variability in dynamic and static type athletes
Background: Over the last two decades, morphological cardiac changes induced by athletic conditioning have been of great interest. Therefore, several studies have been orchestrated to delineate electrocardiography (ECG), echocardiography, and heart rate variability (HRV) findings in athletes. Purpose: To assess the ECG, echocardiography, and HRV in a group of dynamic and static type athletes. Methods: Fifty professional athletes (20 static and 30 dynamic exercise athletes) and 50 healthy nonathletes (control group) were recruited. Standard 12-lead ECG and transthoracic echocardiography was performed on all athletes and the control group. Through echocardiography, variables including left ventricular (LV) end-diastolic/systolic diameter, LV mass, and left atrial volume index were measured. In addition, both the athletes and the control group underwent ECG Holter monitoring for 15 minutes and several parameters related to HRV (time and frequency domain) were recorded. Results: The most common ECG abnormalities among the athletes were sinus bradycardia and incomplete right bundle branch block. LV end-diastolic diameter and left atrial volume index were significantly greater in the dynamic athletes (P < 0.001). LV end-systolic diameter was significantly lower in the static group (P < 0.001). LV mass of the dynamic and static athletes was significantly greater than that of the controls (P < 0.001). Among the ECG Holter monitoring findings, the dynamic athletes had lower systolic blood pressure than the controls (P = 0.01). Heart rate was lowest in the control group (P < 0.001). Conclusion: The most common ECG abnormalities among adolescent Iranian athletes were sinus bradycardia and incomplete right bundle branch block. Static exercise seemed to reduce LV end-systolic diameter, while dynamic exercise resulted in increased LV end-diastolic diameter and left atrial volume index. Additionally, Iranian athletes showed no differences in HRV parameters, excluding heart rate and systolic blood pressure, compared with the nonathletes.
Toufan, Mehrnoush; Kazemi, Babak; Akbarzadeh, Fariborz; Ataei, Amin; Khalili, Majid
Echocardiography in the flight program
NASA Technical Reports Server (NTRS)
Observations on American and Soviet astronauts have documented the association of changes in cardiovascular function during orthostasis with space flight. A basic understanding of the cardiovascular changes occurring in astronauts requires the determination of cardiac output and total peripheral vascular resistance as a minimum. In 1982, we selected ultrasound echocardiography as our means of acquiring this information. Ultrasound offers a quick, non-invasive and accurate means of determining stroke volume which, when combined with the blood pressure and heart rate measurements of the stand test, allows calculation of changes in peripheral vascular resistance, the body's major response to orthostatic stress. The history of echocardiography in the Space Shuttle Program is discussed and the results are briefly presented.
Charles, John B.; Bungo, Michael W.; Mulvagh, Sharon L.
Sector-scanning echocardiography
NASA Technical Reports Server (NTRS)
The mechanical sector scanner is described in detail, and its clinical application is discussed. Cross sectional images of the heart are obtained in real time using this system. The sector scanner has three major components: (a) hand held scanner, (b) video display, and (c) video recorder. The system provides diagnostic information in a wide spectrum of cardiac diseases, and it quantitates the severity of mitral stenosis by measurement of the mitral valve orifice area in diagnosing infants, children and adults with cyanotic congenital heart disease.
Henry, W. L.; Griffith, J. M.
Role of Echocardiography in Atrial Fibrillation
Atrial fibrillation (AF) is most common arrhythmia and its prevalence appears to be increasing as the population ages. Echocardiography can play a key role in risk stratification and management of patients with AF. Transthoracic echocardiography allows rapid and comprehensive assessment of cardiac anatomical structure and function. Pulmonary vein flow monitoring using echocardiography has the potential to an increasing role in the evaluation of cardiac function and AF ablation procedures. Transesophageal echocardiography also provides accurate information about the presence of a thrombus in the atria and thromboembolic risk. The novel technique of intracardiac echocardiography has emerged as a popular and useful tool in the everyday practice of interventional electrophysiology. Other imaging modalities, such as computed tomography and magnetic resonance imaging have complementary roles in risk stratification and assessment of patients with AF. Echocardiography continues to be the foundation of clinical evaluation and management of AF.
Kim, Tae-Seok
Transesophageal Echocardiography for Quantifying Size of Patent Foramen Ovale in Patients With Cryptogenic Cerebrovascular Events
Background and Purpose�Patent foramen ovale (PFO) is a risk factor for paradoxical embolism, and severe shunting and wide opening of PFO are risk factors for severe and recurrent cerebrovascular events. Neither contrast echocardiography nor 2-dimensional (2D) measurement of PFO size have been validated or compared with invasive balloon sizing. Methods�We performed transesophageal echocardiography (TEE) in 100 patients with cryptogenic stroke
Herwig W. Schuchlenz; Wolfgang Weihs; Albrecht Beitzke; J�rg-Ingolf Stein; Andreas Gamillscheg; Peter Rehak
The Safety of Contrast Echocardiography: Report of the Committee on Contrast Echocardiography for the American Society of Echocardiography
NASA Technical Reports Server (NTRS)
The results of a survey of 363 physicians performing were evaluated to assess the relative safety of contrast echocardiography. Fifteen physicians reported a variety of transient side effects, including neurologic and respiratory symptoms. Although contrast echocardiography appeared to carry some risk for side effects, that risk was low (0.062%) and no residual side effects or complications were observed.
Bommer, W. J.; Shah, P. M.; Allen, H.; Meltzer, R.; Kisslo, J.
Shone's syndrome diagnosed with echocardiography and confirmed at pathology.
The Shone's complex, defined by four cardiovascular defects such as a supravalvular mitral membrane, valvular mitral stenosis by a parachute mitral valve, subaortic stenosis, and aortic coarctation, is a rare entity, which occurs most frequently in its incomplete form. We report the case of a 19-year-old female patient who presented at the emergency room for progressively worsening dyspnoea, orthopnoea, fever, and productive cough, due to bronchopneumonia. Echocardiography revealed the co-existence of aortic coarctation with bicuspid aortic valves, mitral supravalvular ring, and dysplastic mitral valves producing severe mitral stenosis and severe pulmonary hypertension. Although wide spectrum antibiotics were administered from the first day of hospitalization, the patient developed severe sepsis and died. The components of the Shone's complex diagnosed by echocardiography were confirmed at pathology. PMID:18621780
Popescu, Bogdan A; Jurcut, Ruxandra; Serban, Marinela; Parascan, Liliana; Ginghina, Carmen
[Real time 3D echocardiography
NASA Technical Reports Server (NTRS)
Three-dimensional representation of the heart is an old concern. Usually, 3D reconstruction of the cardiac mass is made by successive acquisition of 2D sections, the spatial localisation and orientation of which require complex guiding systems. More recently, the concept of volumetric acquisition has been introduced. A matricial emitter-receiver probe complex with parallel data processing provides instantaneous of a pyramidal 64 degrees x 64 degrees volume. The image is restituted in real time and is composed of 3 planes (planes B and C) which can be displaced in all spatial directions at any time during acquisition. The flexibility of this system of acquisition allows volume and mass measurement with greater accuracy and reproducibility, limiting inter-observer variability. Free navigation of the planes of investigation allows reconstruction for qualitative and quantitative analysis of valvular heart disease and other pathologies. Although real time 3D echocardiography is ready for clinical usage, some improvements are still necessary to improve its conviviality. Then real time 3D echocardiography could be the essential tool for understanding, diagnosis and management of patients.
Bauer, F.; Shiota, T.; Thomas, J. D.
Pentacuspid aortic valve diagnosed by transoesophageal echocardiography
Congenital aortic valve anomalies are quite a rare finding in echocardiographic examinations. A case of a 19�year old man with a pentacuspid aortic valve without aortic stenosis and regurgitation, detected by transoesophageal echocardiography, is presented.???Keywords: pentacuspid aortic valve; echocardiography
Cemri, M; Cengel, A; Timurkaynak, T
Dobutamine echocardiography: usefulness of digital image processing.
The present study was undertaken in order specifically to evaluate the usefulness of digital image processing so as to enhance the diagnostic power of dobutamine stress echocardiography. For this purpose 44 dobutamine echocardiographic tests, routinely performed in our echo laboratory, were analysed blindly by two observers using traditional videotape recording and digitized image acquisition. The results obtained from both observers show a trend which suggests that the traditional videotape approach provides more true-positive tests than the digitized approach (27/38 vs 23/38 and 24/38 vs 22/38 for the first and second observer, respectively). True-negative test detection was 6/6 with the videotape and 5/6 with the digitized method for both observers. As a consequence of the discrepancies observed between the two modalities, the videotape indicates that it can provide higher diagnostic accuracy than the digitized approach (72 +/- 9% vs 63 +/- 10%). The tests results concordance (positive or negative) between the two modalities of analysis was 66% for both the observers. The inter-observer agreement on the test results was 84% and 80% for the videotape analysis and the digitized analysis, respectively. On the basis of the results, we consider that digitized analysis applied to dobutamine stress echocardiography does not afford significant diagnostic advantages and should not be considered as an alternative option to traditional videotape analysis. However, it may be considered an extremely useful integrative tool since it produces the on-line image evaluation more easily and faster and allows a more practical form of stress test storage. PMID:8746911
Castini, D; Gentile, F; Ornaghi, M; Montani, E; Lippolis, A; Mangiarotti, E; Esposti, D; Cirino, D; Maggi, G C
Relationship between incidentally detected calcification of the mitral valve on 64-row multidetector computed tomography and mitral valve disease on echocardiography
Background Mitral valve calcification is often incidentally detected on chest computed tomography (CT) scans obtained for a variety of noncardiac indications. In this study, we evaluated the association between mitral valve calcification incidentally detected on chest CT and the presence and severity of mitral valve disease on echocardiography. Methods Of 760 patients undergoing 64-row multidetector CT of the chest, 50 with mitral valve calcification and 100 controls were referred on for echocardiography. Calcifications of the mitral valve leaflet and annulus were assessed for length, Agatston score, and site, and were compared with echocardiographic findings. Results Mitral valve calcification was noted in 59 (7.7%) patients on multidetector CT. Fifty of these patients were assessed by echocardiography, and 32 (64%) were found to have mitral annular calcification. Nine patients (18%) had posterior mitral valve leaflet calcification, and both mitral valve leaflet and annular calcification were detected in nine (18%) cases. Nine (18%) patients had mild, three (6%) had moderate, and one (2%) had severe mitral stenosis. None of the patients with isolated mitral annular calcification had mitral stenosis; however, all the patients with mitral stenosis showed mitral valve leaflet calcification with or without mitral annular calcification (P < 0.001). Moreover, patients with mitral stenosis had a larger mitral calcification length and greater Agatston scores in comparison with those without mitral stenosis (P = 0.001). While 31 patients (62%) with mitral calcification had mitral regurgitation on echocardiography, 21 (21%) in the control group showed mitral regurgitation (P = 0.001). Conclusion Mitral valve leaflet calcification, with or without annular calcification, may be an indicator of mitral stenosis. Mitral calcification can also be considered as an indicator for mitral regurgitation in general. Therefore, patients with mitral valve calcification detected incidentally on chest CT scan may benefit from functional assessment of the valve using echocardiography.
Toufan, Mehrnoush; Javadrashid, Reza; Paak, Neda; Gojazadeh, Morteza; Khalili, Majid
Therapeutic implications of transesophageal echocardiography after transthoracic echocardiography on acute stroke patients
Background The role of transesophageal echocardiography (TEE) in the evaluation of acute stroke patients is still ill-defined. We conducted a prospective observational study to find the prevalence of TEE findings that indicate anticoagulation as beneficial, in acute ischemic stroke patients without indication for anticoagulation based on clinical, electrocardiographic and transthoracic echocardiography (TTE) findings. Methods We prospectively studied all patients referred to our laboratory for TTE and TEE. Patients were excluded if the diagnosis was not acute ischemic stroke or if they had an indication for anticoagulation based on clinical, electrocardiographic, or TTE data. Patients with TEE findings that might indicate anticoagulation as beneficial were identified. Results A total of 84 patients with acute ischemic stroke and without indication for anticoagulation based on clinical and electrocardiographic or TTE data were included in the study. Findings indicating anticoagulation as beneficial were found in 32.1%: spontaneous echo contrast (1.2%), complex aortic atheroma (27.4%), thrombus (8.3%), and simultaneous patent foramen ovale and atrial septal aneurysm (2.4%). Conclusions The results of our study show that TEE can have therapy implications in 32.1% of ischemic stroke patients in sinus rhythm and with TTE with no indication for anticoagulation.
de Abreu, Tiago Tribolet; Mateus, Sonia; Carreteiro, Cecilia; Correia, Jose
Successful repair of intraoperative aortic dissection detected by transesophageal echocardiography.
Aortic dissection is a rare but devastating complication of cardiac surgery. Early intraoperative diagnosis and management are essential for a favorable outcome. We describe the case of a 69-year-old man with worsening dyspnea who was admitted for mitral valve replacement having previously had a mitral valve repair. Precardiopulmonary bypass transesophageal echocardiography confirmed mitral regurgitation and showed mild atherosclerotic changes in the descending aorta. Following successful replacement of the mitral valve, an attempt to wean from cardiopulmonary bypass failed. This was characterized by acute onset hypovolemia. The transesophageal echocardiography showed the presence of features of acute aortic dissection involving only the descending aorta without identifying the entry point. The tear was successfully repaired by direct suture within the lumen. PMID:11899959
Varghese, David; Riedel, Bernhard J C J; Fletcher, S Nicholas; Al-Momatten, Mohammed I; Khaghani, Asghar
Congenital left ventricular diverticulum diagnosed by echocardiography.
Congenital left ventricular diverticulum is a rare cardiac malformation. The incidence of left ventricular diverticulum is reported to be 0.05% of all congenital heart malformations. This case series comprised three infants with the diagnosis of congenital left ventricular diverticulum determined by echocardiography. In addition, two of the three babies also were detected to have other cardiac disease. Echocardiography is a useful tool for diagnosing congenital left ventricular diverticulum. PMID:22290590
Yang, Hui; Zhu, Qi; Chen, Jiao; Guo, Nan
Dipyridamole Echocardiography in Essential Hypertensive Patients with Chest Pain
SUMMARY The exerdse-electrocardiography test shows limited feasibility and diagnostic accuracy for the ooninvaslve detection of coronary artery disease hi hypertensive patients. Recently, the dipyridamole- echocardiography test (two-dimensional echocardtographic monitoring with dipyridamole infusion, up to 0.84 mg\\/kg over 10 minutes) has been proposed as an exercise-independent method for the diagnosis of coronary artery disease. The diagnostic usefulness of the exerdse-electrocardiography test
Correlation Between Epicardial Fat Thickness by Echocardiography and Other Parameters in Obese Adolescents
Background and Objectives Obesity has reached epidemic proportions globally and affects people of all ages. Recent studies have shown that visceral adipose tissue measured by magnetic resonance imaging and/or computed tomography correlates positively with epicardial adipose tissue. Epicardial fat, which is correlated to several metabolic parameters, can be assessed by echocardiography. The aim of this study was to evaluate epicardial fat thickness and other metabolic parameters in obese adolescents and investigate the correlation between epicardial fat thickness and other metabolic parameters in obese adolescents. Subjects and Methods We selected 99 subjects, between ages 15-17 years of age, to be enrolled in this study. Sixty five obese adolescents with a body mass index (BMI) >95 percentile and 34 control subjects were included in this study. Echocardiographic measurements including epicardial fat thickness as well as anthropometric and blood pressure (BP) measurements were performed. The following parameters were estimated: blood glucose, total cholesterol, triglyceride, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, aspartate aminotransferase, alanine aminotransferase, free fatty acid, interleukin-6, tumor necrosis factor-?, leptin, adiponectin and high sensitive C reactive protein. Results The obese group showed a statistically significant correlation with echocardiographic epicardial fat thickness and, BMI, waist circumference, obesity index, fat percentage, systolic BP, insulin level, leptin and adiponectin. Multivariate linear regression analysis showed epicardial fat thickness as the most significant independent parameter to correlate with obese adolescents. Conclusion These data suggest that epicardial fat thickness measured by echocardiography is a practical and accurate parameter for predicting visceral obesity.
Kim, Sung Jin; Kim, Hae Soon; Jung, Jo Won; Kim, Nam Su; Noh, Chung Il
Evaluation of the interpretative skills of participants of a limited transthoracic echocardiography training course (H.A.R.T.scan course).
Limited transthoracic echocardiography performed by treating physicians may facilitate assessment of haemodynamic abnormalities in perioperative and critical care patients. The interpretative skills of one hundred participants who completed an education program in limited transthoracic echocardiography were assessed by reporting five pre-recorded case studies. A high level of agreement was observed in ventricular volume assessment (left 95%, right 96%), systolic function (left 99%, right 96%), left atrial pressure (96%) and haemodynamic state (97%). The highest failure to report answers (that is, no answer given) was for right ventricular volume and function. For moderate or severe valve lesions, agreement ranged from 90 to 98%, with failure to report <5% in all cases except for mitral stenosis (18%). For mild valve lesions, the range of agreement was lower (53 to 100%) due to overestimation of severity. Medical practitioners who completed the structured educational program showed good agreement with experts in interpretation of valve and ventricular function. PMID:22577916
Royse, C F; Haji, D L; Faris, J G; Veltman, M G; Kumar, A; Royse, A G
A review of echocardiography in anaesthetic and peri-operative practice. Part 1: impact and utility.
Echocardiography is migrating rapidly across speciality boundaries and clinical demand is expanding. Echocardiography shows promise for evolving applications in the peri-operative assessment and therapeutic management of patients undergoing non-cardiac surgery, whether it be elective or emergency. Although evidence is limited with regard to significant impact on outcomes from anaesthesia and surgery, there is little doubt about the validity and power of two-dimensional real-time viewing of cardiac anatomy and function. Echocardiography can be used to assist in decision-making along the entire peri-operative pathway, and is increasingly delivered by the previously referring physicians. The discussion around more widespread incorporation of cardiac ultrasound into anaesthetic practice must take into account competency, training and governance. Failure to do so adequately may mean that the use of echocardiography is poorly applied and costly. PMID:24773366
Barber, R L; Fletcher, S N
Estimating pulmonary artery pressures by echocardiography in patients with emphysema.
In patients with emphysema being evaluated for lung volume reduction surgery, Doppler echocardiography has been used to screen for pulmonary hypertension as an indicator of increased peri-operative risk. To determine the accuracy of this test, the present authors compared the results of right heart catheterisations and Doppler echocardiograms in 163 patients participating in the cardiovascular substudy of the National Emphysema Treatment Trial. Substudy patients had both catheterisation and Doppler echocardiography performed before and after randomisation. In 74 paired catheterisations and echocardiograms carried out on 63 patients, the mean values of invasively measured pulmonary artery systolic pressures and the estimated right ventricular systolic pressures were similar. However, using the World Health Organization's definitions of pulmonary hypertension, echocardiography had a sensitivity of 60%, specificity of 74%, positive predictive value of 68% and a negative predictive value of 67% compared with the invasive measurement. Bland-Altman analysis revealed a bias of 0.37 kPa with 95% limits of agreement from -2.5-3.2 kPa. In patients with severe emphysema, echocardiographic estimates of pulmonary artery pressures correlate very weakly with right heart catheterisations, and the test characteristics (e.g. sensitivity, specificity, etc.) of echocardiographic assessments are poor. PMID:17652313
Fisher, M R; Criner, G J; Fishman, A P; Hassoun, P M; Minai, O A; Scharf, S M; Fessler, H E
Transesophageal Echocardiography During MitraClip� Procedure.
The percutaneous mitral valve (MV) repair procedure performed with the MitraClip delivery system is increasingly used to treat severe mitral regurgitation in high-risk patients. The treatment involves percutaneous insertion and positioning of a clip between the MV leaflets. Transesophageal echocardiography (TEE) plays a key role in the procedure by providing information regarding clip navigation, clip alignment to the MV coaptation line, transmitral advancement of the system, leaflet grasping, confirmation of valve tissue catching, and assessment of the final result. Real-time 3-dimensional TEE has increasing value in percutaneous MV repair providing high-quality visualization of both the heart and the intravascular devices. Optimal visualization by 3-dimensional TEE is obtained through both the atrial and ventricular aspects. In contrast to MV surgery, where TEE is involved in the prebypass assessment phase and in evaluation of the final repair, TEE is mandatory to guide management during MitraClip repair. Cardiac anesthesiologists may provide assistance to interventional cardiologists during the procedure itself in addition to their anesthetic-related tasks. PMID:24842173
Guarracino, Fabio; Baldassarri, Rubia; Ferro, Baldassare; Giannini, Cristina; Bertini, Pietro; Petronio, Anna Sonia; Di Bello, Vitantonio; Landoni, Giovanni; Alfieri, Ottavio
Limitations of transoesophageal echocardiography in patients with focal cerebral ischaemic events.
OBJECTIVE--To investigate the detection rate of cardiac sources of embolism by transoesophageal echocardiography in patients with focal cerebral ischaemic events and to relate the echocardiographic findings to other clinical findings. DESIGN--Prospective study with blinded analysis of the echocardiographic data and subsequent comparison with the other clinical findings. SETTING--Regional cardiothoracic unit based in a teaching hospital. PATIENTS--131 consecutive patients with focal ischaemic cerebral events (49 with a transient ischaemic attack, 77 with a cerebrovascular accident, and five with a retinal arterial embolus) referred for echocardiography. INTERVENTIONS--Full M mode, cross sectional, Doppler, and contrast echocardiography by both the precordial and transoesophageal techniques. RESULTS--Precordial echocardiography detected a cardiac abnormality in 72 patients. Transoesophageal echocardiography confirmed all the precordial findings (except left ventricular hypertrophy, which at present cannot be defined with this technique) and detected other abnormalities in a further 20 patients (18 with potential right-to-left shunts and two with valve vegetations). It also showed spontaneous contrast echoes in 27 of 28 patients with a large left atrium and showed atrial thrombus in three. Cardiac abnormalities were clinically detected in 53 patients, all of which were confirmed or documented by echocardiography. In the 78 patients with no clinically detectable cardiac abnormality six had mitral valve prolapse and one had a regional wall motion defect (identified by precordial echocardiography) and 17 had potential right-to-left shunts (11 of which were identified only by transoesophageal echocardiography). CONCLUSIONS--Transoesophageal echocardiography is more sensitive than precordial echocardiography in detecting potential sources of embolism in these patients. However, except for the detection of a potential right-to-left shunt, the yield in patients with no cardiac abnormality is low. Moreover, the abnormalities detected in those with previously detected cardiac disease merely confirm the clinical diagnosis. Patients with left atrial spontaneous contrast echoes may benefit from anticoagulation but this requires further study. Until more data are available on this feature and on the role of potential right-to-left shunts in this population, the contribution of echocardiography, precordial or transoesophageal, remains limited. Images
de Belder, M A; Lovat, L B; Tourikis, L; Leech, G; Camm, A J
Hyperglycemic Ins2AkitaLdlr?/? mice show severely elevated lipid levels and increased atherosclerosis: a model of type 1 diabetic macrovascular disease[S
Accelerated atherosclerosis is the leading cause of death in type 1 diabetes, but the mechanism of type 1 diabetes-accelerated atherosclerosis is not well understood, in part due to the lack of a good animal model for the long-term studies required. In an attempt to create a model for studying diabetic macrovascular disease, we have generated type 1 diabetic Akita mice lacking the low density lipoprotein receptor (Ins2AkitaLdlr?/?). Ins2AkitaLdlr?/? mice were severely hyperglycemic with impaired glucose tolerance. Compared with Ldlr?/? mice, 20-week-old Ins2AkitaLdlr?/? mice fed a 0.02% cholesterol AIN76a diet showed increased plasma triglyceride and cholesterol levels, and increased aortic root cross-sectional atherosclerotic lesion area [224% (P < 0.001) in males and 30% (P < 0.05) in females]. Microarray and quantitative PCR analyses of livers from Ins2AkitaLdlr?/? mice revealed altered expression of lipid homeostatic genes, including sterol-regulatory element binding protein (Srebp)1, liver X receptor (Lxr)?, Abca1, Cyp7b1, Cyp27a1, and Lpl, along with increased expression of pro-inflammatory cytokine genes, including interleukin (Il)1?, Il1?, Il2, tumor necrosis factor (Tnf)?, and Mcp1. Immunofluorescence staining showed that the expression levels of Mcp1, Tnf?, and Il1? were also increased in the atherosclerotic lesions and artery walls of Ins2AkitaLdlr?/? mice. Thus, the Ins2AkitaLdlr?/? mouse appears to be a promising model for mechanistic studies of type 1 diabetes-accelerated atherosclerosis.
Zhou, Changcheng; Pridgen, Brian; King, Nakesha; Xu, Jinxian; Breslow, Jan L.
Efficacy of Transthoracic Echocardiography for Diagnosing Heart Failure in Septic Shock
Background Cardiac dysfunction occurs in up to 80% of patients with septic shock. Transthoracic echocardiography (TTE) is an ideal tool for the detailed characterization of cardiac function. Its feasibility is perceived to be poor in critically ill patients, but this has never been studied. To address this question, the authors evaluated the efficacy of TTE to diagnose heart failure in septic shock. Methods This was a retrospective study. Patients admitted to the intensive care unit with septic shock and who had a TTE within 72 hours of intensive care unit admission were identified by a computer algorithm and validated by chart review. Echocardiography images were reviewed by a single cardiologist blinded to clinical outcomes. Clinical information was collected from patients� medical record. Results Seventy-six patients met the studies� inclusion criteria. The feasibility of TTE to calculate left ventricular ejection fraction was 90% and to assess diastolic function was 74%. Significant mitral regurgitation or aortic stenosis was the most frequent impediments for the assessment of diastolic function. Seventy-four percent of all patients showed some type of cardiac dysfunction (left or right ventricular systolic dysfunction and/or left ventricular diastolic dysfunction). In regression analyses, TTE feasibility was not impacted by factors previously associated with poor image acquisition: high body mass index, mechanical ventilation, tachycardia, advanced age or high severity of illness. Conclusions This study demonstrated that TTE is a useful tool to assess myocardial function in critically ill patients and suggested its potential to assist in the management of patients with septic shock.
Beraud, Anne-Sophie; Guillamet, Cristina Vazquez; Hammes, Jessie L.; Meng, Lina; Nicolls, Mark R.; Hsu, Joe L.
[A case of Charcot-Marie-Tooth disease 1 B with Val 146Phe mutation of myelin protein zero showing a severe clinical phenotype].
A 15-year-old boy had complaints of progressive gait disturbance and foot deformity. He started to walk at the age of 18 months. Since two years of age, he had noticed unstable gait. He showed evident scoliosis and enlarged great auricular nerves. Moderate to slight degrees of muscular atrophy and weakness of distal upper, and proximal and distal lower limbs were observed. Pes equinovarus deformity of both feet was obvious. Muscle stretch reflexes were absent in both limbs except decreased triceps brachii reflex. Vibratory sensation was decreased severely in the toes and mildly in the fingers. In cerebrospinal fluid, protein was mildly elevated. Median nerve motor conduction velocity was 5.0 m/sec. On sural nerve biopsy, both demyelinated and remyelinated axons and onion-bulbs without hypomyelination were observed. Therefore, the diagnosis of Charcot-Marie-Tooth disease 1 was made. The direct sequencing of the genomic DNA encoding the Po gene revealed a mutant allele, a guanine to thymine substitution of nucleotide position 436, which caused a substitution of phenylalanine for valine at amino acid position 146. This type of Po mutation is different from any type of Po mutation reported in the literature. PMID:10885340
Ohnishi, A; Aoki, A; Yamamoto, T; Tsuji, S
Mice deficient for the secreted glycoprotein SPARC/osteonectin/BM40 develop normally but show severe age-onset cataract formation and disruption of the lens.
SPARC (secreted protein acidic and rich in cysteine, also known as osteonectin/BM40) is a secreted Ca2+-binding glycoprotein that interacts with a range of extracellular matrix molecules, including collagen IV. It is widely expressed during embryogenesis, and in vitro studies have suggested roles in the regulation of cell adhesion and proliferation, and in the modulation of cytokine activity. In order to analyse the function of this protein in vivo, the endogenous Sparc locus was disrupted by homologous recombination in murine embryonic stem cells. SPARC-deficient mice (Sparctm1Cam) appear normal and fertile until around 6 months of age, when they develop severe eye pathology characterized by cataract formation and rupture of the lens capsule. The first sign of lens pathology occurs in the equatorial bow region where vacuoles gradually form within differentiating epithelial cells and fibre cells. The lens capsule, however, shows no qualitative changes in the major basal lamina proteins laminin, collagen IV, perlecan or entactin. These mice are an excellent resource for further studies on how SPARC affects cell behaviour in vivo.
Gilmour, D T; Lyon, G J; Carlton, M B; Sanes, J R; Cunningham, J M; Anderson, J R; Hogan, B L; Evans, M J; Colledge, W H
Fast GPU based adaptive filtering of 4D echocardiography.
Time resolved three-dimensional (3D) echocardiography generates four-dimensional (3D+time) data sets that bring new possibilities in clinical practice. Image quality of four-dimensional (4D) echocardiography is however regarded as poorer compared to conventional echocardiography where time-resolved 2D imaging is used. Advanced image processing filtering methods can be used to achieve image improvements but to the cost of heavy data processing. The recent development of graphics processing unit (GPUs) enables highly parallel general purpose computations, that considerably reduces the computational time of advanced image filtering methods. In this study multidimensional adaptive filtering of 4D echocardiography was performed using GPUs. Filtering was done using multiple kernels implemented in OpenCL (open computing language) working on multiple subsets of the data. Our results show a substantial speed increase of up to 74 times, resulting in a total filtering time less than 30 s on a common desktop. This implies that advanced adaptive image processing can be accomplished in conjunction with a clinical examination. Since the presented GPU processor method scales linearly with the number of processing elements, we expect it to continue scaling with the expected future increases in number of processing elements. This should be contrasted with the increases in data set sizes in the near future following the further improvements in ultrasound probes and measuring devices. It is concluded that GPUs facilitate the use of demanding adaptive image filtering techniques that in turn enhance 4D echocardiographic data sets. The presented general methodology of implementing parallelism using GPUs is also applicable for other medical modalities that generate multidimensional data. PMID:22167599
Broxvall, Mathias; Emilsson, Kent; Thunberg, Per
Right atrial angiosarcoma with severe biventricular dysfunction and massive pericardial effusion.
This paper presents the case of a 35 year-old woman with symptoms of heart failure from the last month. A physical examination at admission showed paleness, dyspnea, peripheral edema and fatigue. In a two-dimensional echocardiography and transesophageal echocardiography, normal thickness but severe left and right ventricular dysfunction with severe pericardial effusion and thickened pericardium were found. In the enlarged right atrium, an oval-shaped structure was found with features of continuity with lateral right atrial wall and also a bulging of the structure through the orifice of the tricuspid valve to the right ventricle. In the echocardiography, we did not saw any blocking of the tricuspid valve or the inflow from inferior vena cava (IVC) or superior vena cava (SVC) or coronary sinus. On the basis of the echocardiography examination and clinical presentation, tentative diagnosis of the right atrium myxoma was made. A coronary angiography revealed normal coronary arteries and no feeding of tumor by branch of right coronary artery (RCA). Surgical removal of the tumor was performed without complication. The histopathological examination confirmed the diagnosis of angiosarcoma. In the follow-up echocardiography carried out after three months, severe left ventricular (LV) and right ventricular (RV) dysfunction continued and was demonstrated. Magnetic resonance imaging revealed no lymphadenopathy or re-growth of the tumor in the mediastinum or pericardium. PMID:23585321
Sabzi, Feridoun; Dadkhah, Heidar; Shojaei, Sharam; Mahdavi, Masoume; Poormotaabed, Alireza; Javid, Nasrin; Dabiri, Samsam
Reproducibility of quantitative two-dimensional echocardiography.
In order to assess reproducibility of quantitative planimetry, three physicians trained in two-dimensional echocardiography performed five successive studies on one another over 2 weeks (30 total studies). Then each physician traced each study (90 total tracings) for left ventricular and atrial volumes and ejection fraction by means of a modification of Simpson's rule, and left ventricular mass and average wall thickness by means of a truncated ellipsoid formula. Calculation of intertechnician variability, intertracer variability, and 95% confidence limits showed that measurements of volumes were less reproducible than measurements of ejection fraction, average wall thickness, and mass. Mean intertracer variability of 15% exceeded mean intertechnician variability of 11%; this disparity was magnified in the subject who was technically difficult to image. Ninety-five percent confidence limits were: ejection fraction +/- 7%, average wall thickness +/- 9%, left ventricular mass +/- 12%, left ventricular end-diastolic volume +/- 11%, stroke volume +/- 14%, left ventricular end-systolic volume +/- 15%, and left atrial volume +/- 19%. Reproducible planimetry data can be obtained in normal hearts with the use of a protocol for quantitative imaging and planimetry. PMID:3341178
Himelman, R B; Cassidy, M M; Landzberg, J S; Schiller, N B
Dynamic 3D echocardiography in virtual reality
Background This pilot study was performed to evaluate whether virtual reality is applicable for three-dimensional echocardiography and if three-dimensional echocardiographic 'holograms' have the potential to become a clinically useful tool. Methods Three-dimensional echocardiographic data sets from 2 normal subjects and from 4 patients with a mitral valve pathological condition were included in the study. The three-dimensional data sets were acquired with the Philips Sonos 7500 echo-system and transferred to the BARCO (Barco N.V., Kortrijk, Belgium) I-space. Ten independent observers assessed the 6 three-dimensional data sets with and without mitral valve pathology. After 10 minutes' instruction in the I-Space, all of the observers could use the virtual pointer that is necessary to create cut planes in the hologram. Results The 10 independent observers correctly assessed the normal and pathological mitral valve in the holograms (analysis time approximately 10 minutes). Conclusion this report shows that dynamic holographic imaging of three-dimensional echocardiographic data is feasible. However, the applicability and use-fullness of this technology in clinical practice is still limited.
van den Bosch, Annemien E; Koning, Anton HJ; Meijboom, Folkert J; McGhie, Jackie S; Simoons, Maarten L; van der Spek, Peter J; Bogers, Ad JJC
Audit of cardiac pathology detection using a criteria-based perioperative echocardiography service.
Transthoracic echocardiography is often used to screen patients prior to non-cardiac surgery to detect conditions associated with perioperative haemodynamic compromise and to stratify risk. However, anaesthetists' use of echocardiography is quite variable. A consortium led by the American College of Cardiology Foundation has developed appropriate use criteria for echocardiography. At Joondalup Hospital in Western Australia, we have used these criteria to order echocardiographic studies in patients attending our anaesthetic pre-admission clinic. We undertook this audit to determine the incidence of significant echocardiographic findings using this approach. In a 22-month period, 606 transthoracic echocardiographic studies were performed. This represented 8.7% of clinic attendees and 1.7% of all surgical patients. In about two-thirds of the patients, the indication for echocardiography was identified on the basis of a telephone screening questionnaire. The most common indications were poor exercise tolerance (27.4%), ischaemic heart disease (20.9%) and cardiac murmurs (16.3%). Over 26% of patients studied had significant cardiac pathology (i.e. moderate or severe echocardiographic findings), most importantly moderate or severe aortic stenosis (8.6%), poor left ventricular function (7.1%), a regional wall motion abnormality (4.3%) or moderate or severe mitral regurgitation (4.1%). Using appropriate use criteria to guide ordering transthoracic echocardiography studies led to a high detection rate of clinically important cardiac pathology in our perioperative service. PMID:22813500
Faris, J G; Hartley, K; Fuller, C M; Langston, R B; Royse, C F; Veltman, M G
Digital echocardiography 2002: now is the time
NASA Technical Reports Server (NTRS)
The ability to acquire echocardiographic images digitally, store and transfer these data using the DICOM standard, and routinely analyze examinations exists today and allows the implementation of a digital echocardiography laboratory. The purpose of this review article is to outline the critical components of a digital echocardiography laboratory, discuss general strategies for implementation, and put forth some of the pitfalls that we have encountered in our own implementation. The major components of the digital laboratory include (1) digital echocardiography machines with network output, (2) a switched high-speed network, (3) a high throughput server with abundant local storage, (4) a reliable low-cost archive, (5) software to manage information, and (6) support mechanisms for software and hardware. Implementation strategies can vary from a complete vendor solution providing all components (hardware, software, support), to a strategy similar to our own where standard computer and networking hardware are used with specialized software for management of image and measurement information.
Thomas, James D.; Greenberg, Neil L.; Garcia, Mario J.
Echocardiography and genetic counselling in tuberous sclerosis.
OBJECTIVE--To assess echocardiography as an investigation for the detection of occult gene carriers in tuberous sclerosis. PATIENTS--Sixty parents of children with tuberous sclerosis who had been extensively investigated for signs of the disease and 60 age and sex matched controls. PROCEDURE--Blind study by two experienced echocardiographers and blind interpretation of video recordings by an adult cardiologist. SETTING--Cardiology department of a district general hospital. RESULTS--Two parents and three controls had bright echodense areas interpreted as possible rhabdomyomas. CONCLUSIONS--In our hands echocardiography of adults is not an investigation with a high specificity for gene detection in tuberous sclerosis. Images
Webb, D W; Thomas, R D; Osborne, J P
Three-dimensional contrast echocardiography in assessing left ventricular diverticulum.
Congenital left ventricular (LV) diverticulum is a rare malformation that can be alone or in association with other congenital abnormalities. Since the several complications have been reported in association with LV diverticulum, as cardiac rupture, heart failure, and endocarditis, patients with LV diverticulum who are managed with conservative treatment would require regular checkups to ascertain the absence of such complications. We report a case of LV diverticulum in a 47-year-old man. He took the serial three-dimensional contrast echocardiography, which was reliable and readily available tool for defining LV diverticulum and monitoring the presence of complications. PMID:22672537
Park, Sang-Don; Shin, Sung-Hee; Kim, Dae-Hyeok; Kwan, Jun; Woo, Sung-Il
Assessment of right ventricular systolic function by tissue Doppler echocardiography.
This thesis summarizes a series of studies performed in order to assess the clinical usefulness of a novel echocardiographic technology that allows non-invasive assessment of regional right ventricular myocardial velocities and deformation: tissue Doppler echocardiography. While the technology is a promising tool for improving our understanding of right ventricular hemodynamics, several aspects of the technology must be evaluated. The accuracy and reproducibility of the technology is evaluated in vitro, and normal values, impact of changes in loading of the right ventricle, response to exercise and pharmacological pulmonary vasodilatation is established in normal subjects. The diagnostic and prognostic importance of adding tissue Doppler echocardiography to conventional echocardiographic and clinical parameters was evaluated in studies on patients with diseases associated with different modes of impact on right ventricular hemodynamics: pulmonary embolism, Arrhythmogenic right ventricular cardiomyopathy and pulmonary regurgitation, the latter in an animal model. The conclusions of the thesis are: Color tissue Doppler echocardiography accurately measures velocities, SR and strain in vitro. No systematic bias between ultrasound systems can be found, and accuracy of the measurements is good. However, the reproducibility of measurements in a test-retest design can limit the usefulness of the technology in daily clinical use, as 25% to 80% of change would be needed for the technology to identify a change in individual patients [I]. Normal values of tissue Doppler based measurements of RV regional velocities, SR and strain exist, and apply to both sexes and in all age groups with the exception of slightly decreasing values in strain with increasing age. Increasing preload and afterload changes regional myocardial velocities, but no changes in SR, strain or isovolumic acceleration could be observed [II and III]. Tissue Doppler echocardiography of the RV free wall in non-massive pulmonary embolism quantifies degree of RV dysfunction, and supports the existence of the McConnell sign of mid-ventricular RV dysfunction. Echocardiographic signs of RV dysfunction are present if > 25% of the pulmonary vascular bed is obstructed. However, Tissue Doppler echocardiography and deformation analysis has no independent value over other clinical and quantitative echocardiographic measures of RV size, pressure and function in these patients [IV and V]. Regional deformation of the RV free wall has significant prognostic importance in a population suspected of first non-massive pulmonary embolism, and is significantly associated with adverse events in patients with proven pulmonary embolism, however, it does not add to the information gained from other quantitative echocardiographic measures of LV and RV function and pressure [VI]. Changes in tissue Doppler based measures of RV systolic function can be used to monitor the effect of selective vasodilation by phosphodiestares-5 inhibition in hypoxic pulmonary hypertension and exercise in normal individuals. Phosphodiestares-5 inhibition by sildenafil may predominantly be effective during hypoxia in resting conditions, and may improve the blunted response in RV contractility seen with exercise in hypoxia [VII]. Reduced RV free wall deformation can be quantified by tissue Doppler echocardiography in patients with confirmed Arrhythmogenic Right Ventricular Cardiomyopathy, but the clinical application of the technique may be limited by considerable overlap with normal values [VIII]. Acute RV volume loading in free pulmonary regurgitation is associated with abrupt geometric changes in the RV structure including significant dilatation, but is well tolerated with only mild reduction in measures of global RV systolic function as estimated by 2D echocardiography in an experimental animal model. Regional RV myocardial function is also only mildly reduced. Also no differences in global or regional RV function can be observed after 1-3 months of pulmonary regurgitation [IX and X]. Relief of free pulmonary r
Kj�rgaard, Jesper
Tissue Doppler echocardiography � A case of right tool, wrong use
BACKGROUND: The developments in echocardiography or ultrasound cardiography (UCG) have improved our clinical capabilities. However, advanced hardware and software capabilities have resulted in UCG facilities of dubious clinical benefits. Is tissue Doppler echocardiography (TDE) is one such example? PRESENTATION OF THE HYPOTHESIS: TDE has been touted as advancement in the field of echocardiography. The striking play of colors, impressive waveforms
George Thomas
Myocardial perfusion imaging using contrast echocardiography
A program for objective automatic mapping of myocardial perfusion was developed. The program acquires a sequence of end-diastolic ultrasound images, using automatic echocardiography gating. Each image is divided into multiple regions of interest. The division is done either manually tracing the endocardial and epicardial borders, or automatically, using a running square window which covers the entire image. The analysis is
Menachem Halmann; Shimon Reisner; Rafael Beyar
[A new approach to the tricuspid valve in Ebstein's anomaly by real time 3D echocardiography].
Ebstein's anomaly affects the tricuspid valve with a large range of anatomical forms. Successful tricuspid valvuloplasty depends mainly on the ability to mobilise the leaflets. Evaluation of the leaflet surface is difficult with 2D echocardiography whereas 3D echocardiography provides intracardiac views of the valve. The authors used this method in 10 patients with 3 modes of imaging: biplane, real time and total volume. The study population (age: 1 day to 30 years) included: 1 prenatal diagnosis, 1 neonate with refractory cyanosis, 5 patients with mild tricuspid regurgitation, 3 patients with severe tricuspid regurgitation, 2 of whom underwent valvuloplasty. 3D echocardiography was disappointing in the foetus and neonate because of poor spatial resolution. The ventricular view of the tricuspid valve in older children and adults allowed analysis of tricuspid leaflet coaptation and of the mechanism of regurgitation. The commissures and leaflet surfaces were assessed. The results of surgical valvuloplasty could be evaluated by 3D echocardiography. 3D echocardiography is now transthoracic and a real time investigation. Technical advances are required before it comes into routine usage: a more manoeuvrable matricial probe (integrating pulsed and continuous wave Doppler) and larger volume real time 3D imaging with better resolution. Its role in the assessment of Ebstein's anomaly should be evaluated in a larger series of patients. PMID:15966604
Taktak, A; Acar, P; Dulac, Y; Abadir, S; Chilon, T; Roux, D; Glock, Y; Fournial, G
Genetic analyses of several Drosophila ananassae-complex species show a low-frequency major gene for parthenogenesis that maps to chromosome 2.
Parthenogenetic strains of several species have been found in the genus Drosophila. The mode of diploidization in the eggs of females has been found to be post-meiotic nuclear fusion. The genetic basis for this parthenogenesis is not understood but is believed to be under the control of a complex polygenic system. We found parthenogenetic females in an isofemale strain (LAE345) of D. pallidosa-like collected in 1981 at Lae, Papua New Guinea, and established a parthenogenetically reproducing strain. Parthenogenetic strains of D. ananassae and D. pallidosa collected at Taputimu, American Samoa had also been established by Futch (1972). D. ananassae, D. pallidosa and D. pallidosa-like are very closely related species belonging to the ananassae complex of the ananassae species subgroup of the melanogaster species group. Using these three species, we found that more than 80% of females from parthenogenetic strains produced progeny parthenogenetically and that inter-specific hybrid females also produced impaternate progeny. In the present report, we demonstrate that the mode of parthenogenesis of D. ananassae appears to be the post-meiotic nuclear doubling of a single meiotic product, and that a major gene responsible for the parthenogenesis maps to the left arm of the second chromosome of D. ananassae. We also suggest that the genetic basis for parthenogenesis capacity may be identical among the three closely related species. We discuss the function of the gene required for parthenogenesis and its significance for the evolutionary process. PMID:15219153
Matsuda, Muneo; Tobari, Yoshiko N
LRP1b shows restricted expression in human tissues and binds to several extracellular ligands, including fibrinogen and apoE - carrying lipoproteins
Objective To investigate low-density lipoprotein receptor-related protein 1b (LRP1b) expression in human tissues and to identify circulating ligands of LRP1b. Methods and results Using two independent RT-PCR assays, LRP1b mRNA was detected in human brain, thyroid gland, skeletal muscle, and to a lesser amount in testis but absent in other tissues, including heart, kidney, liver, lung, and placenta. Circulating ligands were purified from human plasma by affinity chromatography using FLAG-tagged recombinant LRP1b ectodomains and identified by mass spectrometry. Using this technique, several potential ligands (fibrinogen, clusterin, vitronectin, histidine rich glycoprotein, serum amyloid P-component, and immunoglobulins) were identified. Direct binding of LRP1b ectodomains to fibrinogen was verified by co-immunoprecipitation. ApoE � carrying lipoproteins were shown to bind to LRP1b ectodomains in a lipoprotein binding assay. Furthermore, binding as well as internalization of very low density lipoproteins by cells expressing an LRP1b minireceptor was demonstrated. Discussion LRP1b expression in humans appears to be confined to few tissues, which could point out to specialized functions of LRP1b in certain organs. Most of the newly identified LRP1b ligands are well-known factors in blood coagulation and lipoprotein metabolism, suggesting a possible role of LRP1b in atherosclerosis.
Haas, J.; Beer, A.G.; Widschwendter, P.; Oberdanner, J.; Salzmann, K.; Sarg, B.; Lindner, H.; Herz, J.; Patsch, J.R.; Marschang, P.
Methylation Analysis of Several Tumour Suppressor Genes Shows a Low Frequency of Methylation of CDKN2A and RARB in Uveal Melanomas
We have investigated the frequency of methylation of several tumour suppressor genes in uveal melanoma. As the loss of one copy of chromosome 3 (monosomy 3), which is found in about half of these tumours, is tightly associated with metastatic disease, a special emphasis was laid on genes located on this chromosome, including the fragile histidine triad (FHIT), von Hippel�Lindau (VHL), ?-catenin (CTNNB1), activated leukocyte cell adhesion molecule (ALCAM) and retinoic acid receptor-?2 (RARB) genes. In addition, the methylation patterns of the CpG-rich regions 5? of the E-cadherin (CDH1), p16/cyclin-dependent kinase inhibitor 2 A (CDKN2A) and retinoblastoma (RB1) genes were analysed by bisulphite genomic sequencing or methylation-specific PCR (MSP). Furthermore, the SNRPN and D15S63 loci, which are located in the imprinted region of chromosome 15, were included in the study. Aberrant methylation was detected in nine of 40 tumours analysed: The imprinted SNRPN and D15S63 loci were hypermethylated in three tumours, all of which retained both copies of chromosome 3. Methylated RARB alleles were detected in three tumours, whereas in three other tumours CDKN2A was found to be methylated. As we did not find RARB and CDKN2A preferentially methylated in tumours with monosomy 3, which is a significant predictor of metastatic disease, we suggest that these genes may play a causative role in the formation of uveal melanoma but not in the development of metastases.
Tschentscher, Frank; Lich, Christina; Brandt, Birgit; Horsthemke, Bernhard; Lohmann, Dietmar R.
Clinical usefulness of biplane transesophageal echocardiography.
The clinical usefulness of biplane color Doppler transesophageal echocardiography is illustrated by the results obtained in 300 successive examinations. The additional contribution of the newer longitudinal plane was judged significant or major in 64% of the cases. The method was useful mainly for intraoperative examinations, assessment of native valvular disease, prosthetic valve evaluation, search for tumors, and assessment of endocarditis, congenital heart disease, and aortic disease. In contrast, the longitudinal plane option was not contributory in 68% of the cases of thromboembolism. Typically, the technique aided in the evaluation of mitral valve insufficiency and the detection of paraprosthetic leaks. Lesions located at the level of the ascending aorta, the left and right ventricular outflow tracts, and the interatrial septum were also visualized best. The limitations of the method were negligible and the duration of the examination was not significantly increased in comparison to the monoplane method. When available, biplane transesophageal echocardiography seems to be preferred in most clinical settings. PMID:10171191
Decoodt, P; Kacenelenbogen, R; Bar, J P; Salmon, K; Peperstraete, B; Verbeet, T; Telerman, M
Three dimensional echocardiography in congenital heart defects
Three dimensional echocardiography (3DE) is a new, rapidly evolving modality for cardiac imaging. Important technological advances have heralded an era where practical 3DE scanning is becoming a mainstream modality. We review the modes of 3DE that can be used. The literature has been reviewed for articles that examine the applicability of 3DE to congenital heart defects to visualize anatomy in a spectrum of defects ranging from atrioventricular septal defects to mitral valve abnormalities and Ebstein's anomaly. The use of 3DE color flow to obtain echocardiographic angiograms is illustrated. The state of the science in quantitating right and left ventricular volumetrics is reviewed. Examples of novel applications including 3DE transesophageal echocardiography and image-guided interventions are provided. We also list the limitations of the technique, and discuss potential future developments in the field.
Shirali, Girish S.
Echocardiography Guided Therapy for Myocarditis after Scorpion Sting Envenomation
Objective: This study was to evaluate echocardiographic findings and its usefulness in clinical management of patients with scorpion sting envenomation. Material and Methods: A total of 84 consecutive patients were prospectively studied. The data included demographics, at the time of presentation to the hospital, the clinical features, echocardiographic findings, admission to intensive care unit, use of inotropic medication, time to discharge, and mortality. Results: Out of 84 patients studied 60 patients (71.4%) had echocardiographic evidence of myocarditis (LVEF <50%). Majority of patients had LVEF <40% (50 patients, 83.3%). Severe LV dysfunction (LVEF <30%) was noted in 20 patients (33.3%). No patient had significant valvular regurgitation. RV dysfunction was noted in half of the patients who had LV dysfunction. RV dysfunction was not seen in isolation. Twenty four patients without evidence of myocarditis on echocardiography were observed in general wards and were discharged in 24 to 48 hours of admission. Ten patients with mild LV dysfunction (LVEF 50-40%) and 20 patients with moderate LV dysfunction were observed in high dependency units with regular monitoring for 24 to 48 hours. Only 3 patients were put on inotropics support and others could be discharged in 72 to 96 hours. All the patients with severe LV dysfunction and moderate LV dysfunction with significant RV dysfunction were admitted in intensive care unit irrespective of symptoms (Total 30 patients). These patients were put on inotropics support. Among severe LV dysfunction group, 4 patients required ventilator support and 2 (2.3%) patients died with refractory shock and multi-organ failure. Tachycardia, muffled and or gallop heart sounds and hypertension didn�t predict presence of LV dysfunction. Persistent hypotension requiring inotropics support was a marker of severe LV dysfunction. Conclusion: Echocardiography is a useful tool in emergency to assess LV function in patients with scorpion sting envenomation. It can guide therapy by identifying patients with severe LV dysfunction.
Sagarad, Suresh V; Kerure, Sudha Biradar; Thakur, Balaramsingh; Reddy, S S; K, Balasubramanya; Joshi, R M
Cardiac Disease in Pregnancy: Value of Echocardiography
Cardiovascular disease in women during pregnancy poses particular challenges. It continues to be a leading cause of maternal\\u000a mortality and contributes to significant morbidity. Echocardiography is essential in characterizing the extent and effects\\u000a of heart disease prior to, during, and after pregnancy. By understanding the physiologic adaptation in pregnancy with increases\\u000a in heart rate, blood volume, and cardiac output, and
Sarah Tsiaras; Athena Poppas
The surgeon's use of transesophageal echocardiography.
Transesophageal echocardiography has become an instrumental diagnostic modality for the accurate evaluation of cardiac and aortic anatomy and function. Multiplanar technology has facilitated improved visualization of structures and enhanced TEE over TTE in many situations. Care of the trauma patient and critically ill patient is improved with the appropriate and timely performance of TEE. Education, certification, credentialing, and determination of competency are areas that need to be addressed continually in the future. PMID:9602849
Johnson, S B; Sisley, A C
Left Ventricular Myocardial Function in Hemodialysis and Nondialysis Uremia Patients: A Three-Dimensional Speckle-Tracking Echocardiography Study
Background Several studies have demonstrated that uremic patients who have preserved left ventricular ejection fraction (LVEF) could still have the potential for systolic dysfunction. The aim of this study was to assess the differences between the left ventricular (LV) myocardial function in hemodialysis and nondialysis uremic patients based on three-dimensional speckle-tracking echocardiography. Methods The study population consisted of 35 maintenance hemodialysis patients (the hemodialysis group), 30 uremic patients who were hospitalized for the creation of a primary arteriovenous fistula (the nondialysis group), and 32 healthy volunteers. All of the patients had normal left ventricular ejection fractions (i.e., 55% or greater). Three-dimensional speckle tracking echocardiography was performed to assess the left ventricle's global three-dimensional strain, regional longitudinal strain, circumferential strain, and radial strain. Results The left ventricular regional longitudinal strain, radial strain, circumferential strain, and global three-dimensional strain were significantly decreased in the nondialysis patients compared with the other two groups (all, P<0.001). However, the three-dimensional strain and the regional longitudinal strain were lower in the hemodialysis patients than in the controls (P<0.01). In the hemodialysis patients and the control group, the longitudinal strain, circumferential strain, and radial strain were higher at the apical level than they were at the basal level and midlevels. A multivariate linear regression analysis showed that the blood urea nitrogen and creatinine levels were independently associated with the values of the global three-dimensional strain (??=??0.217, P?=?0.000; ??=??0.243, P?=?0.011, respectively) and the longitudinal strain (??=??0.154, P?=?0.032; ??=??0.188, P?=?0.029, respectively). Conclusions Three-dimensional speckle-tracking echocardiography may detect myocardial dysfunction in patients with uremia who have preserved LVEF. The global three-dimensional strain and the regional longitudinal strain appear to be superior in hemodialysis patients compared with nondialysis patients.
Chen, Ran; Wu, Xia; Shen, Li-Jun; Wang, Bei; Ma, Ming-Ming; Yang, Yuan; Zhao, Bo-Wen
Intraoperative echocardiography and Doppler color flow mapping in freehand allograft aortic valve and root replacement.
Intraoperative epicardial echocardiography and color flow Doppler were performed before and after cardiopulmonary bypass in 17 consecutive patients undergoing 20 freehand allograft aortic valve replacements. Native aortic valves were replaced in 12, and prostheses in 8 patients. Precardiopulmonary bypass echocardiography estimates of annular diameter guided allograft selection and predicted length of allograft aortic root required, defined coronary situs, and revealed other cardiac abnormalities. These included unanticipated severe mitral regurgitation (which precluded allograft aortic valve replacements in one patient), left-to-right shunts in the membranous septum, ascending aortic dissection, and aortic root pathology requiring coronary reimplantation or bypass. Postcardiopulmonary bypass echocardiography demonstrated acceptable competency of 18/19 allograft valves (mild or no aortic insufficiency), and successful repair of 3/4 shunts. Mild mitral regurgitation was detected more often at postcardiopulmonary bypass than precardiopulmonary bypass (15 vs 11 cases) and postcardiopulmonary bypass estimates of mitral regurgitation severity corollated well with subsequent postoperative follow-up. IOE allows selection and thawing of the allograft valves prior to aortic cross clamping, minimizing cross-clamp time. It detects important concomitant cardiac abnormalities, and predicts postoperative allograft valve and mitral competency. Intraoperative echocardiography Doppler, is therefore, a useful adjunct for allograft aortic valve replacements or aortic root replacement. PMID:10149225
Bolger, A F; Bartzokis, T; Miller, D C
Severe tricuspid regurgitation mimicking constrictive pericarditis
Patient: Female, 62 Final Diagnosis: Tricuspid regurgitation Symptoms: Dyspnea exertional � fatigue � leg edema Medication: � Clinical Procedure: � Specialty: Cardiology Objective: Challenging differential diagnosis Background: Tricuspid regurgitation (TR) can mimic some hemodynamic findings of constrictive pericarditis (CP), due to the restraining effect of the enlarged right heart on intact pericardium and on the left ventricle. In this article, we report a case of severe tricuspid regurgitation in which hemodynamic findings were consistent with CP. Case Report: A 62-year-old Caucasian woman presented with right heart failure symptoms. Echocardiography showed enlarged right heart chambers and severe tricuspid regurgitation. Right heart catheterization surprisingly demonstrated a constrictive physiology. Diastolic pressures of both ventricles were elevated and equalized, with a prominent deep and plateau pattern. The patient was re-evaluated with a further focus on constrictive pericarditis. However, echocardiography, thorax CT, and cardiac MRI did not demonstrate any pathological finding related to pericardium. The remaining explanation was that the severe TR itself and secondary right heart enlargement caused the restraining effect on the intact pericardium and on the left ventricle. The pericardium was normal and tricuspid annulus was severely dilated on surgical inspection. The tricuspid valve was replaced with a bioprosthetic valve. The patient did well just after the surgery, with a rapid decrease in cardiac pressures; however, she died due to respiratory failure on the 15th postoperative day. Conclusions: This was a case with right heart failure symptoms in which invasive hemodynamic findings were consistent with constrictive pericarditis and the noninvasive imaging modalities were not. This case illustrates that severe TR can mimic some hemodynamic findings of constrictive pericarditis, due to restraining effect of the enlarged right heart on intact pericardium and on the left ventricle. Lack of significant respiratory changes in hemodynamic parameters that can safely be demonstrated by echocardiography and cardiac MRI suggest a normal pericardium.
Ozpelit, Ebru; Akdeniz, Bahri; Ozpelit, Mehmet Emre; Goldeli, Ozhan
ERIC Educational Resources Information Center
For the past 16 years, the blue-collar city of Huntington, West Virginia, has rolled out the red carpet to welcome young wrestlers and their families as old friends. They have come to town chasing the same dream for a spot in what many of them call "The Show". For three days, under the lights of an arena packed with 5,000 fans, the state's best�
Gehring, John
Two-dimensional speckle tracking echocardiography for the assessment of atrial function
Echocardiography is the most common diagnostic method for assessing atrial function but the technique has some limitations. Traditionally, assessment of left atrial function has been performed by measuring volumes with 2D echocardiography. Additionally, it can be assessed with transmitral Doppler and pulmonary vein Doppler. Recently, an alternative method has been incorporated, namely, measurement of myocardial deformation with color tissue Doppler-derived strain. However, this method has several limitations, such as suboptimal reproducibility, angle-dependence, signal artifacts and the fact that it only measures regional strain and does not obtain information about the curved portion of the atrial roof. To overcome these limitations in the quantification of atrial function, the use of speckle tracking echocardiography (STE) strain has been proposed. This technique is not derived from Doppler but rather from 2D echocardiography; it is angle-independent and allows one to measure global as well as regional atrial strain. In this editorial, we describe the physical and pathophysiological concepts of STE and underline the clinical usefulness of this new technique.
Cianciulli, Tomas Francisco; Saccheri, Maria Cristina; Lax, Jorge Alberto; Bermann, Alejandra Marina; Ferreiro, Daniel Ernesto
The emerging role of exercise testing and stress echocardiography in valvular heart disease.
Exercise testing has an established role in the evaluation of patients with valvular heart disease and can aid clinical decision making. Because symptoms may develop slowly and indolently in chronic valve diseases and are often not recognized by patients and their physicians, the symptomatic, blood pressure, and electrocardiographic responses to exercise can help identify patients who would benefit from early valve repair or replacement. In addition, stress echocardiography has emerged as an important component of stress testing in patients with valvular heart disease, with relevant established and potential applications. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. The versatile applications of stress echocardiography can be tailored to the individual patient with aortic or mitral valve disease, both before and after valve replacement or repair. Hence, exercise-induced changes in valve hemodynamics, ventricular function, and pulmonary artery pressure, together with exercise capacity and symptomatic responses to exercise, provide the clinician with diagnostic and prognostic information that can contribute to subsequent clinical decisions. Nevertheless, there is a lack of convincing evidence that the results of stress echocardiography lead to clinical decisions that result in better outcomes, and therefore large-scale prospective randomized studies focusing on patient outcomes are needed in the future. PMID:19958961
Picano, Eugenio; Pibarot, Philippe; Lancellotti, Patrizio; Monin, Jean Luc; Bonow, Robert O
Two-dimensional speckle tracking echocardiography for the assessment of atrial function.
Echocardiography is the most common diagnostic method for assessing atrial function but the technique has some limitations. Traditionally, assessment of left atrial function has been performed by measuring volumes with 2D echocardiography. Additionally, it can be assessed with transmitral Doppler and pulmonary vein Doppler. Recently, an alternative method has been incorporated, namely, measurement of myocardial deformation with color tissue Doppler-derived strain. However, this method has several limitations, such as suboptimal reproducibility, angle-dependence, signal artifacts and the fact that it only measures regional strain and does not obtain information about the curved portion of the atrial roof. To overcome these limitations in the quantification of atrial function, the use of speckle tracking echocardiography (STE) strain has been proposed. This technique is not derived from Doppler but rather from 2D echocardiography; it is angle-independent and allows one to measure global as well as regional atrial strain. In this editorial, we describe the physical and pathophysiological concepts of STE and underline the clinical usefulness of this new technique. PMID:21160748
Cianciulli, Tom�s Francisco; Saccheri, Mar�a Cristina; Lax, Jorge Alberto; Bermann, Alejandra Marina; Ferreiro, Daniel Ernesto
Gated cardiac NMR imaging and 2D echocardiography in the detection of intracardial neoplasm
Noninvasive 2D echocardiography has replaced contrast angiography as the procedure of choice in the diagnosis of intracardiac neoplasm. The purpose of this study was to determine whether intracardiac neoplasm can be detected as well by gated cardiac NMR. Four patients with known intracardiac neoplasm previously diagnosed by 2D echocardiography had gated cardiac NMR imaging using a superconductive 0.6 Tesla magnet. All patients were performed using a Tl weighted spin echo pulse sequence with a TE of 30 msec and TR of one R-R interval. Two-dimensional planar single or multiple slice techniques were used. In one patient, imaging at different times along the R-R interval were performed for cine display. The results of the present study show detection of the intracardiac neoplasm in all four cases by gated cardiac NMR imaging and the results were comparable to 2D echocardiography. The former imaging technique showed superior spatial resolution. Despite its early stage of development, gated cardiac NMR imaging appears at least equal to 2D echocardiography in the detection of intracardiac neoplasm. The availability of multislice coupled with multiframe acquisition techniques now being developed will provide a cinematic display that will be more effective in the display of the tumor in motion within the cardiac chamber involved and facilitate visualization of the relationship of the tumor to adjacent cardiac structures.
Go, R.T.; O'Donnell, J.K.; Salcedo, E.E.; Feiglin, D.H.; Underwood, D.A.; MacIntyre, W.J.; Meaney, T.F.
Color Doppler and transesophageal echocardiography of vascular sling
Summary Three patients with vascular sling were studied by two-dimensional and color Doppler echocardiography and angiocardiography. One case was associated with atrial septal defect and another with tetralogy of Fallot and patent ductus arteriosus. The third case had no associated intracardiac anomalies. Color Doppler flow mapping was performed in all three patients, and transesophageal echocardiography was studied in two patients.
Hiromichi Nakajima; Gengi Satomi; Makoto Nakazawa; Kazuo Momma
Intraoperative transesophageal echocardiography during surgery for congenital heart defects
Objective: This study was undertaken to further define the impact of intraoperative transesophageal echocardiography during surgery for congenital heart disease and to determine appropriate indications.Methods: The impact of transesophageal echocardiography on patient care was assessed in 1002 patients who underwent this procedure during surgery for congenital heart defects. It had major impact when new information altered the planned procedure or
Guy R. Randolph; Donald J. Hagler; Heidi M. Connolly; Joseph A. Dearani; Francisco J. Puga; Gordon K. Danielson; Martin D. Abel; V. Shane Pankratz; Patrick W. O'Leary
Echocardiography in the diagnosis of right ventricular endomyocardial fibrosis
Twenty-one patients with endomyocardial fibrosis (EMF) and right ventricular involvement were studied by M-mode echocardiography. All 21 patients showed echocardiographic findings consisting of (i) increased right ventricular dimension, (ii) paradoxical septal motion, (iii) increased right ventricular outflow dimension (iv) thickening of the right ventricular anterior wall with increased right ventricular anterior wall motion, and (v) easily recordable tricuspid valve. In addition, some of the patients had posterior pericardial effusion, and fine fluttering of the tricuspid valve. EMF was diagnosed clinically in all the patients, haemodynamically and angiographically in 15 and confirmed at autopsy in one. None of these echo findings was present in two patients with constrictive pericarditis, and two patients with massive ascites due to portal hypertension. ImagesFig. 1Fig. 2Fig. 3Fig. 4
George, B. O.; Gaba, F. E.; Talabi, A. I.; Adeniyi, D. S.
The role of echocardiography in percutaneous left atrial appendage occlusion.
Percutaneous device closure of the left atrial appendage (LAA) has been introduced in the last decade as a minimally invasive alternative treatment to long-term anticoagulation to reduce the risk of thrombo-embolism in patients with atrial fibrillation. Echocardiography is an essential tool at all stages of the procedure. Pre-procedural echocardiography is used to screen suitable candidates and to define LAA morphology and dimension; peri-procedural transoesophageal or intracardiac echocardiography has a major role in guiding, delivery, and deployment of the device, for screening of procedural complications and for assessing procedural success; and post-procedural echocardiography is important in the surveillance and monitoring of long-term outcome. This article aims to outline the role of echocardiography at each stage of LAA occlusion. PMID:21998466
Chue, Colin D; de Giovanni, Joseph; Steeds, Richard P
Intracranial hemorrhage as a complication of dobutamine stress echocardiography: case report and review of the literature.
Dobutamine stress echocardiography is a generally well-tolerated study to evaluate patients with suspected coronary artery disease. Rare but life-threatening complications of this study have been well described. Severe hypertensive responses are a known but uncommon adverse reaction to dobutamine infusion. The authors report a case of intracranial hemorrhage in the setting of severe hypertension as a complication of dobutamine stress echocardiography. The patient was on systemic anticoagulation with warfarin for a prosthetic mitral valve and had an international normalized ratio (INR) of 3.8 that was slightly over the therapeutic goal INR of 2.5-3.5. He had no predisposing intracranial lesions such as tumor, vascular malformation, or aneurysm. He suffered an intraparenchymal hemorrhage in three distinct areas of his brain. Intracranial hemorrhage related to dobutamine infusion has not been reported previously, but given the known risk of hypertension, life-threatening sequelae including intracranial hemorrhage are possible. PMID:22537238
Shah, Sachin P; Chaudhry, G Muqtada
Nepal's noble echocardiography-database with video clips and color still images: a single individual's 6 years' experience at the Echocardiography Lab of Nepal Medical College, Teaching Hospital.
Echocardiographic reporting system is very poor in Nepal. No long-term feasibility and efficacy data about the echocardiography database with video clips has been studied. Snazzi Movie Studio S4 was used to convert analog video signals into MPEG2 and color photographs were converted into JPEG format for storage and use for the database. All together 2272 patients' echocardiography were performed by one individual prospectively at the Nepal Medical College Teaching Hospital from 10th January 2007 to 9th January 2012. Echocardiographic findings of these patients were evaluated. Mean age +/- SD were 44.4 +/- 28.7 years. Male female ratio was 0.8:1. Brahman/Chhetri were the usual ethnic group to undergo echocardiography (943, 41.5%), followed byjanajati (631, 27.8%) and newar (496, 21.8%). Age group of 60-69 years was the most common echo users (519, 22.8%). Total time for echocardiography/report writing with database compared to non database was 13.9 +/- 2.4 minutes vs. 12.3 +/- 0.8 minutes, p = 0.51. Out of all lesions, valvular lesions were the most common lesions detected (4885, 215%). Mild tricuspid regurgitation (1213, 53.4%) was the most common valvular lesion followed by mild mitral regurgitation (742, 32.7%). Patent foramen ovale was the most common congenital heart disease (32, 45.7%) followed by atrial septal defect (12, 17.1%). About one seventh of the total patients (318, 13.9%) had systolic dysfunction. Out of total chronic cor pulmonale (383, 16.9%), severe Pulmonary arterial dysfulction (PAH) was noted in more than one third of the patients (169, 44.1%). PMID:24047011
Shrestha, B
3-T magnetic resonance for determination of aortic valve area: A comparison to echocardiography.
Abstract Objectives. For evaluation of aortic valve area (AVA), transthoracic echocardiography (TTE) is the method of choice. Cardiac magnetic resonance (CMR) at 1.5-Tesla is an alternative. The aim of the study was to check whether quantification of whole range of AVA without severe aortic stenosis is possible and reliable in higher magnetic field strength, and also including a comparison to TTE. Methods. In 3-T CMR phase contrast sequences were assessed above aortic valve and left ventricular output tract. AVA was calculated using the continuity equation. Planimetric analysis of AVA was performed in magnitude images. TTE was used as reference method for graduation of AVA. Results. Totally 48 patients (64 � 18 years) without severe aortic valve stenosis were prospectively enrolled. In CMR planimetric AVA was 2.5 � 1.3 cm(2) and calculated AVA 2.4 � 1.3 cm(2), whereas AVA in TTE was 1.9 � 1.1 cm(2). Planimetric and calculated AVA in CMR and also AVA in CMR and TTE showed good correlation (r = 0.97, 0.92, respectively). Bland-Altman analysis demonstrated no signs of over- or underestimation. Inter- and intraobserver variabilities were low. Discussion. Determination of AVA using 3-T CMR is possible using direct planimetry and continuity equation. CMR is the alternative first choice method in cases with discrepant or insufficient echocardiographic results. PMID:24650089
Speiser, Uwe; Quick, Silvio; Haas, David; Youssef, Akram; Waessnig, Nadine K; Ibrahim, Karim; Strasser, Ruth H; Schoen, Steffen
Myocardial contrast echocardiography after myocardial infarction.
Myocardial contrast echocardiography (MCE) enables direct assessment of the degree and adequacy of microvascular perfusion as well as the presence of wall motion abnormalities. MCE has the following benefits in patients with acute myocardial infarction (MI): 1) rapid and definite diagnosis of acute MI; 2) identification of patients who may benefit from prompt reperfusion therapy; 3) assessment of the efficacy of mechanical or pharmacologic intervention for an open infarct-related artery; 4) estimation of MI size early after reperfusion and residual myocardial viability; 5) identification of being at high risk for post-MI complications and left ventricular remodeling; and 6) assessment of myocardial viability and ischemia prior to hospital discharge. Therefore, MCE is an ideal tool for correct triaging of patients to revascularization and has both prognostic and therapeutic implications in patients with acute MI. PMID:22437372
Ito, Hiroshi
Transesophageal Echocardiography for the Noncardiac Surgical Patient
Transesophageal echocardiography (TEE) has been established as a very valuable asset for patient monitoring during cardiac surgery. The value of perioperative TEE for patients undergoing noncardiac surgery is less clear. This article reviews the technical aspects of TEE and comments on the potential benefit of using TEE as a monitoring modality apart from cardiac surgery. Based on patient's comorbidities and/or injury pattern, TEE is a fast and minimally invasive approach to obtain important hemodynamic information, especially useful in a hemodynamically unstable patient. However, certain requirements for the use of the technique are necessary, most important the development of sufficient echocardiographic skills by the anesthesiologists. Indications, skill requirements, and possible complications of the technique are reviewed.
Rebel, Annette; Klimkina, Oksana; Hassan, Zaki-Udin
European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease).
Mitral and tricuspid are increasingly prevalent. Doppler echocardiography not only detects the presence of regurgitation but also permits to understand mechanisms of regurgitation, quantification of its severity and repercussions. The present document aims to provide standards for the assessment of mitral and tricuspid regurgitation. PMID:20435783
Lancellotti, Patrizio; Moura, Luis; Pierard, Luc A; Agricola, Eustachio; Popescu, Bogdan A; Tribouilloy, Christophe; Hagendorff, Andreas; Monin, Jean-Luc; Badano, Luigi; Zamorano, Jose L
Three-dimensional speckle-tracking echocardiography: methodological aspects and clinical potential.
Speckle-tracking echocardiography (STE) is an advanced echocardiographic technique that allows a novel approach to the assessment of cardiac physiology through the study of myocardial mechanics. In its three-dimensional (3D) modality, it overcomes the drawbacks inherent to other echocardiographic techniques, namely two-dimensional echocardiography and tissue Doppler imaging. Several research studies and software improvements have led 3D-STE to become a promising tool for accurate evaluation of global and regional cardiac function. This article addresses the image acquisition, analytical methods, and parameters of myocardial mechanics that could be derived from 3D-STE. This systematic guidance may help to establish its usefulness in the global and regional evaluation of cardiac function, and to facilitate its clinical application. PMID:22783969
Urbano-Moral, Jose A; Patel, Ayan R; Maron, Martin S; Arias-Godinez, Jose A; Pandian, Natesa G
Monitoring male canoeists' cardiac function by Doppler-echocardiography during heavy load exercise
NASA Astrophysics Data System (ADS)
This study is to evaluate cardiac systolic and diastolic function of Chinese male canoeists during heavy load exercise training by Doppler echocardiography. Eighteen young male volunteer canoeists were tested, and trained five weeks. Then the change of cardiac systolic and diastolic function of the tester was examined by the Doppler echocardiography method.The results showed that there were no significant differences of LVEF and ?%D, but the E/A ratio of elite canoeists reduced (p<0.05) after the heavy load exercise training. Moreover, the ratio of E/A less than 1 was found in two elite canoeists. The further research is required to understand the mechanism of the change. These results showed that monitoring of diastolic function was more meaningful than monitoring of systolic function during the heavy load exercise training, especially not neglected the cardiac function of elite canoeists.
Xu, Guodong; Tan, Huan; Mao, Zongzhen
[Systolic time intervals and echocardiography in monitoring adriamycin-treated tumor patients].
By means of systolic time intervals (PEP/LVET) and echocardiography (Vfr) 218 tumour patients were controlled concerning a cardiomyopathy induced by cytostatic agents. 13% of the patients (28/218) transgressed an absolute cumulative dose of 1,000 mg of doxorubicin or daunorubicin, of which, however, 12% (26/218) showed normal values for PEP/LVET. 11% of the patients (24/218) showed pathologic PEP/LVET values in 6% (49/787) of the investigations, in which case in 15 patients the clinical diagnosis of a cardiomyopathy could be assumed with simultaneously decreased shortening fraction. The sex and age distribution of this group corresponded to that one of the total cohort. The investigation presented confirm the value of systolic time intervals and of echocardiography as screening methods for a cardiomyopathy and speak against a general establishment of a borderline diagnosis. PMID:1897287
Schott, G
Usefulness of intraoperative real-time three-dimensional transesophageal echocardiography for pre-procedural evaluation of mitral valve cleft: a case report.
A precise pre-procedural evaluation of mitral valve (MV) pathology is essential for planning the surgical strategy for severe mitral regurgitation (MR) and preparing for the intraoperative procedure. In the present case, a 38-year-old woman was scheduled to undergo MV replacement due to severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy. A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet. However, the "en face" view of the MV in the left atrial perspective using intraoperative real time three-dimensional transesophageal echocardiography (RT 3D-TEE) provided a different diagnosis: a torn cleft in the P2-scallop of the posterior mitral leaflet (PML) with rupture of the chordae. Thus, surgical planning was changed intraoperatively to MV repair (MVRep) consisting of patch closure of the PML, commissurotomy, and lifting annuloplasty. The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making. PMID:24567819
Jung, Hyun Ju; Yu, Ga-Yon; Seok, Jung-Ho; Oh, Chungsik; Kim, Seong-Hyop; Yoon, Tae-Gyoon; Kim, Tae-Yop
Myocardial ischaemia and viability: the pivotal role of echocardiography.
Echocardiography has a central role for the diagnosis and management of patients with known or suspected coronary artery disease. Besides the fact that it provides an essential role in the differential diagnosis of patients presenting with chest pain in the emergency department, echocardiography provides a comprehensive non-invasive haemodynamic and functional assessment of those patients. Stress echocardiography in many institutions is now the preferred stress modality associated with imaging as it is cost-effective and does not use ionizing radiation. It is used for assessing patients with known or suspected coronary artery disease, risk stratification and for assessing myocardial viability. The recent introductions of ultrasound contrast agents as well as deformation imaging techniques have eliminated the last limitations of stress echocardiography such as image quality and quantification, respectively. PMID:21297129
Nihoyannopoulos, Petros; Vanoverschelde, Jean Louis
A Novel Method for Quantification of Left Ventricular Noncompaction Using Two-Dimensional Echocardiography in Children
Objective Although there are several echocardiographic criteria, there is not yet a general consensus about the diagnosis of left ventricular noncompaction. The current criteria are mostly based on the areas with maximal noncompaction in the heart. The echocardiographer may miss this maximal point leading to a misdiagnosis. Accordingly, we suggested a new method to measure the percentage of myocardial noncompaction using two-dimensional echocardiography. Methods In this study, the new method was examined on 4 noncompaction and 26 dilated cardiomyopathies, and 25 normal subjects. The percentage of noncompaction was measured at 3 levels (apical, papillary muscle and mitral valve) and averaged. Findings The mean percentages of myocardial noncompaction were 3.59�2.27, 8.86�5.52 and 34.7�26.1 in the control, dilated cardiomyopathy and noncompaction groups, respectively. A value of 17% or greater could distinguish left ventricular noncompaction from dilated cardiomyopathy with 92% specificity and 100% sensitivity and from normal subjects with 100% specificity and sensitivity. This percentage had a statistically significant association with noncompacted to compacted myocardial thickness ratio (P<0.001). Conclusion This method showed good correlations with the existing echocardiographic and magnetic resonance criteria. However, it is not dependent on finding the area of maximal involvement. Being comparable to magnetic resonance imaging in accuracy, it is easier to perform and more available.
Khosroshahi, Ahmad Ghamei; Zanjani, Keyhan Sayadpour; Kocharian, Armen; Zeinaloo, Aliakbar; Kiani, Abdolrazagh; Rad, Elaheh Malakan
An Appraisal of Echocardiography as an Epidemiological Tool
PURPOSE: Despite the prognostic importance of left ventricular (LV) mass (LVM) by M-mode echocardiography, concern exists about bias introduced by missing data. The American Society of Echocardiography has made recommendations for linear measurements of LV wall thickness and internal dimension used to calculate LVM, but it is unknown whether their substitution for suboptimal M-modes improves measurement yield and reduces bias.METHODS:
Richard B Devereux; Mary J Roman; Jennifer E Liu; Elisa T Lee; Wenyu Wang; Richard R Fabsitz; Thomas K Welty; Barbara V Howard
Three-Dimensional Echocardiography and Mitral Valve Disease
Three-dimensional echocardiography is a growing imaging modality, particularly for the evaluation of mitral valve pathology.\\u000a Functional anatomy in disease states such as mitral regurgitation and stenosis as well as prosthetic valves can be effectively\\u000a studied, offering superior knowledge to treating physicians. Additionally, three-dimensional echocardiography has the ability\\u000a to help guide operative and percutaneous interventions, allowing for improved patient outcomes and
Carrie B. Chapman; Peter S. Rahko
Analysis of microvascular integrity, contractile reserve, and myocardial viability after acute myocardial infarction by dobutamine echocardiography and myocardial contrast echocardiography
The purpose of this study was to evaluate, in postinfarction dysfunctioning myocardium, the relative potential of myocardial contrast and low-dose dobutamine echocardiography in detecting myocardial viability, and the relation between microvascular integrity, contractile reserve, and functional recovery at follow-up. Twenty-four patients with recent myocardial infarction were studied before hospital discharge with low-dose dobutamine and myocardial contrast echocardiography. In the dysfunctioning
Sabino Iliceto; Leonarda Galiuto; Alfredo Marchese; Daniela Cavallari; Paolo Colonna; Giuseppina Biasco; Paolo Rizzon
Evaluation of 17-mm St. Jude Medical Regent prosthetic aortic heart valves by rest and dobutamine stress echocardiography
BACKGROUND: The prosthesis used for aortic valve replacement in patients with small aortic root can be too small in relation to body size, thus showing high transvalvular gradients at rest and\\/or under stress conditions. This study was carried out to evaluate rest and Dobutamine stress echocardiography (DSE) hemodynamic response of 17-mm St. Jude Medical Regent (SJMR-17 mm) in relatively aged
Giovanni Minardi; Carla Manzara; Vittorio Creazzo; Daniele Maselli; Giovanni Casali; Giovanni Pulignano; Francesco Musumeci
ERIC Educational Resources Information Center
Describes the viewing sessions and the holograms of a holographic road show. The traveling exhibits, believed to stimulate interest in physics, include a wide variety of holograms and demonstrate several physical principles. (GA)
Kirkpatrick, Larry D.; Rugheimer, Mac
Irinotecan Plus S-1 Followed by Hepatectomy for a Patient with Initially Unresectable Colorectal Liver Metastases, Who Showed Severe Drug Rash with Oxaliplatin Plus 5-FU and Leucovorin (FOLFOX)
For unresectable colorectal liver metastases (CRLM), hepatic resection with or without chemotherapy is the only curative treatment that sufficiently achieves long-term survival. However, occasional severe allergic responses to anticancer drugs necessitate treatment discontinuation. A 45-year-old woman presented with metachronous unresectable colorectal liver metastases. Chemotherapy with oxaliplatin plus 5-FU and leucovorin (FOLFOX) was initiated, but severe allergic dermatitis developed after the second cycle. Although she reported no prior history of adverse reactions to tegafur-uracil, a drug lymphocyte stimulation test showed an allergic response to 5-FU. We subsequently replaced with Irinotecan plus S-1 (IRIS) chemotherapy which was well tolerated and resulted in a partial response after 3 cycles. As a result, right trisectionectomy was successfully performed and no recurrence was detected in the following 3 years. A severe allergic reaction to intravenous 5-FU-containing drug regimens can be successfully alleviated by switching to S-1-containing regimens such as IRIS or S-1 plus oxaliplatin (SOX).
Komori, Hiroyuki; Beppu, Toru; Sakamoto, Yasuo; Miyamoto, Yuji; Hayashi, Hiromitsu; Imai, Katsunori; Nitta, Hidetoshi; Watanabe, Masayuki; Baba, Hideo
Doppler echocardiography in the study of patients with mitral disc valve prostheses.
A combination of M mode and Doppler echocardiography was used to study patients with mitral disc valve prostheses. The probe used in these investigations consisted of a circular Doppler crystal mounted around the M mode crystal in the same plane. Because of the strong echoes produced by the prosthesis the transducer (probe) could be angled for optimum Doppler signals without losing the M mode echocardiographic recording of the prosthesis. With this equipment mean and maximum blood velocities and Doppler amplitude signals could be measured simultaneously with M mode echocardiography. A depth indication line in the M mode recording ensured that the Doppler signal was recorded in the region of interest. The Doppler ultrasound technique was also used separately in both the pulsed wave and the continuous wave mode. The data show the usefulness of this technique in patients with normally functioning valve prostheses and in three patients with valve malfunction due to thrombus formation. The data in the latter three cases seem to indicate that the Doppler technique provides valuable information in addition to that obtained by M mode echocardiography in recognising mitral valve prosthetic malfunction. Images
Nitter-Hauge, S
Echocardiography and vascular ultrasound: new developments and future directions.
There have been major technological advances in echocardiography over the past decade. New and robust measures of myocardial function, both systolic and diastolic, have been identified and extensively evaluated. Some of the new measures such as annular velocities by tissue Doppler imaging have become an integral part of the echocardiographic examination, and other measures such as strain and strain rate have yet to be widely adopted. Three-dimensional (3D) echocardiography has evolved greatly since its introduction in the 1980s. Currently, its main clinical application is the perioperative assessment of the mitral valve. Though 3D echocardiography provides superior quantification of cardiac chamber size, its adoption has been limited by the lack of robust automated data analysis software with smooth integration of analysis packages into clinical workstations and suboptimal temporal and spatial resolution. With advancement in electronics and miniaturization, these limitations can be overcome. The history of contrast echocardiography is long and arduous. Use of a microbubble contrast for left ventricular opacification has become commonplace in most echocardiographic laboratories, but the routine use of microbubble contrast for myocardial perfusion will require standardization of the procedure and/or development of new contrast agents. The applications of 3D and microbubble contrast are also under active evaluation in vascular ultrasound. This review summarizes the current and future applications of these exciting developments in echocardiography and vascular ultrasound. PMID:23333166
Ducas, Robin; Tsang, Wendy; Chong, Adrian A; Jassal, Davinder S; Lang, Roberto M; Leong-Poi, Howard; Chan, Kwan Leung
Freehand allograft aortic valve replacement and aortic root replacement. Utility of intraoperative echocardiography and Doppler color flow mapping.
Seventeen consecutive patients undergoing 20 planned aortic valve replacements with allograft valves at Stanford University Medical Center were studied with intraoperative epicardial echocardiography and Doppler color flow mapping before and after cardiopulmonary bypass. Native aortic valves were replaced in 12 of the 20 patients, and eight patients underwent second aortic valve procedures. In 17 of 20 patients allograft selection was guided by prebypass echocardiographic estimates of annular diameter and/or length of allograft aortic root required. Other prebypass findings included unanticipated severe mitral regurgitation in one patient (which precluded allograft aortic valve replacement), left-to-right shunts in five patients, ascending aortic dissection in one, and aortic root disease necessitating coronary reimplantation or bypass in two. Postbypass echocardiography demonstrated acceptable competency of 18 of 19 allograft valves (mild or no aortic insufficiency). Postbypass echocardiography also documented successful repair of four of five shunts and mild mitral regurgitation in 15 of 19 patients (versus 11 of 19 before bypass). Conclusions: Intraoperative echocardiography-Doppler mapping is a useful adjunct for allograft aortic valve or aortic root replacement; it allows confident selection of appropriate tissue size before aortic cross clamping, which minimizes delay from allograft thawing procedures. It also provides helpful information about the extent of aortic root disease and coronary ostial anatomy before bypass, confirms allograft competency after bypass, and detects accompanying valvular and other hemodynamic lesions before and after allograft valve replacement. PMID:1999949
Bartzokis, T; St Goar, F; DiBiase, A; Miller, D C; Bolger, A F
Need for a standardized protocol for stress echocardiography in provoking subaortic and valvular gradient in various cardiac conditions
(Semi) supine exercise testing has an established role in the evaluation of patients with valvular heart disease and can help clinical decision making. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. However, exercise-induced changes in valve hemodynamics, left ventricular outflow obstruction and pulmonary artery pressure depended on load variation. Changing position from supine to upright rapidly decreases load conditions for the ventricles. Therefore several cardiac centers have proposed exercise stress echocardiography in the upright position with gradient monitoring sometimes also in post-exercise recovery. Doppler measurement of subaortic gradient has been a very helpful and informative examination in several heart diseases (especially in hypertrophic cardiomyopathy, valve heart diseases, prosthesis dysfunction).
Role of M-mode technique in today's echocardiography.
M-mode echocardiography is considered to be obsolete by many. The technique rarely is included in American Society of Echocardiography standards documents, except for M-mode measurements, which have limited value. The superior temporal resolution of M-mode echocardiography is frequently overlooked. Doppler recordings reflect blood velocity, whereas M-mode motion of cardiac structures reflect volumetric blood flow. The 2 examinations are hemodynamically complementary. In the current digital era, recording multiple cardiac cycles of two-dimensional echocardiographic images is no longer necessary. However, there are times when intermittent or respiratory changes occur. The M-mode technique is an effective and efficient way to record the necessary multiple cardiac cycles. In certain situations, M-mode recordings of the valves and interventricular septum can be particularly helpful in making a more accurate and complete echocardiographic cardiac assessment, thus helping to make the examination more cost-effective. PMID:20206828
Feigenbaum, Harvey
Efficacy of chordal cutting in alleviating ischemic mitral regurgitation: insights from 3-dimensional echocardiography
Background Ischemic mitral regurgitation often complicates severe ischemic heart disease and adversely affects the prognosis in these patients. There is wide variation in the clinical spectrum of ischemic mitral regurgitation due to varying location and chronicity of ischemia and anomalies in annular and ventricular remodeling. As a result, there is lack of consensus in treating these patients. Treatment has to be individualized for each patient. Most of the available surgical options do not consistently correct this condition in all the patients. Chordal cutting is one of the newer surgical approaches in which cutting a limited number of critically positioned basal chordae have found success by relieving the leaflet tethering and thereby improving the coaptation of leaflets. Three-dimensional echocardiography is a potentially valuable tool in identifying the specific pattern of tethering and thus the suitability of this procedure in a given clinical scenario. Case Presentation A 66-year-old man with cardiomyopathy and ischemic mitral regurgitation presented to us with the features of congestive heart failure. The three-dimensional echocardiography revealed severe mitral regurgitation associated with the tethering of the lateral (P1) and medial (P3) scallops of the posterior leaflet of the mitral valve due to secondary chordal attachments. The ejection fraction was only 15% with severe global systolic and diastolic dysfunction. Mitral regurgitation was successfully corrected with mitral annuloplasty and resection of the secondary chordae tethering the medial and lateral scallops of the posterior leaflet of the mitral valve. Conclusion Cutting the second order chordae along with mitral annuloplasty could be a novel method to remedy Ischemic mitral regurgitation by relieving the tethering of the valve leaflets. The preoperative three-dimensional echocardiography should be considered in all patients with Ischemic mitral regurgitation to assess the complex three-dimensional interactions between the mitral valve apparatus and the left ventricle. This aids in timely surgical planning.
Sai-Sudhakar, Chittoor B; Vandse, Rashmi; Armen, Todd A; Bickle, Katherine M; Nathan, Nadia S
Three-dimensional echocardiography of the mitral valve: lessons learned.
Three-dimensional echocardiography has markedly improved our understanding of normal and pathologic mitral valve (MV) mechanics. Qualitative and quantitative analysis of three-dimensional (3D) data on the mitral valve could have a clinical impact on diagnosis, patient referral, surgical strategies, annuloplasty ring design and evaluation of the immediate and long-term surgical outcome. This review covers the contribution of 3D echocardiography in the diagnosis of MV disease, its role in selecting and monitoring surgical procedures, and in the assessment of surgical outcomes. Moreover, advantages of this technique versus the standard 2D modality, as well as future applications of advanced analysis techniques, will be reviewed. PMID:23686753
Maffessanti, Francesco; Mirea, Oana; Tamborini, Gloria; Pepi, Mauro
Type F Congenital Quadricuspid Aortic Valve: A Very Rare Case Diagnosed by 3-dimenional Transoesophageal Echocardiography.
Congenital quadricuspid aortic valve (QAV) is a rare cardiac anomaly. Several different anatomical variations of a quadricuspid aortic valve have been described. Aortic regurgitation is the predominant valvular dysfunction associated with QAV and patients tend to present in their 5(th) or 6(th) decade of life. This anomaly is rarely picked up by transthoracic echocardiogram (TTE). A comprehensive transoesophageal echocardiography (TOE) study is more likely to diagnose it. We describe a very rare type of QAV - Type F in a 52-year-old lady who presented with symptoms of shortness of breath and pre-syncope. We include TOE images and intra-operative valve images. PMID:24707324
Garg, Pankaj; Kamaruddin, Hazlyna; Orme, Rachel; Watt, Victoria
Type F Congenital Quadricuspid Aortic Valve: A Very Rare Case Diagnosed by 3-dimenional Transoesophageal Echocardiography
Congenital quadricuspid aortic valve (QAV) is a rare cardiac anomaly. Several different anatomical variations of a quadricuspid aortic valve have been described. Aortic regurgitation is the predominant valvular dysfunction associated with QAV and patients tend to present in their 5th or 6th decade of life. This anomaly is rarely picked up by transthoracic echocardiogram (TTE). A comprehensive transoesophageal echocardiography (TOE) study is more likely to diagnose it. We describe a very rare type of QAV � Type F in a 52-year-old lady who presented with symptoms of shortness of breath and pre-syncope. We include TOE images and intra-operative valve images.
Garg, Pankaj; Kamaruddin, Hazlyna; Orme, Rachel; Watt, Victoria
Biventricular Tako-Tsubo cardiomyopathy: usefulness of 2D speckle tracking strain echocardiography.
Tako-Tsubo cardiomyopathy is a transient left ventricular apical ballooning syndrome also known as stress-induced cardiomyopathy. This reversible cardiomyopathy without epicardial coronary artery disease mimics acute myocardial infarction. Right ventricular involvement, which has been infrequently reported, is present in about a quarter of cases of Tako-Tsubo cardiomyopathy and is associated with a more severe clinical outcome. We report the case of a 55-year-old postmenopausal woman with transient biventricular apical ballooning. She recently had acute exacerbation of multiple sclerosis. Regional and global function of both ventricles was estimated using two-dimensional speckle tracking strain echocardiography. PMID:23765730
Vizzardi, Enrico; Bonadei, Ivano; Piovanelli, Barbara; Bugatti, Silvia; D'Aloia, Antonio
Left internal mammary artery graft dysfunction diagnosed by transthoracic Doppler echocardiography. A report of two cases.
Transthoracic Doppler echocardiography (TDE) is a non-invasive and easy reproducible method to assess the left internal mammary artery (LIMA) graft patency after coronary artery bypass graft surgery (CABG). LIMA graft dysfunction is rare, its rate being 10% at 10 to 15 years after revascularization. The most common cause of graft dysfunction is the competitive flow with the native coronary artery, when the stenosis of the bypassed vessels is not severe. We present two cases of LIMA graft dysfunction diagnosed by TDE and confirmed by angiography, with two particular pulsed-wave color Doppler flow signals. PMID:23243649
Parv, Annamaria; Anchidin, Ovidiu; Ober, Camelia; Bindea, Dan; Radulescu, Dan; Duncea, Caius; Capalneanu, Radu
Quantitative Texture Analysis and Transesophageal Echocardiography to Characterize the Acute Myocardial Contusion
Myocardial contusion (MC) is a common injury following blunt chest trauma without any specific symptoms. Several techniques such as electrocardiogram, estimation of myocardial band fraction of creatine phosphokinase, chest radiography and the scintiscanning missed efficiency to characterize the MC. Another technique based on transesophageal echocardiography [TEE] allows to visualize the structures of the heart with a good spatial resolution. We postulated that the quantitative texture analysis of regional image texture in two- dimensional [2D] TEE echocardiograms would be an accurate method to differentiate normal from abnormal myocardial wall. This preliminary experimental study demonstrated the feasibility of the proposed technique.
Amichi, Abdelaziz; Laugier, Pascal
Esophageal perforation: a rare complication of transesophageal echocardiography in a patient with asymptomatic esophagitis.
Transesophageal echocardiography (TEE) is a commonly used procedure in patients with suspected endocarditis. A rare but dreadful complication of this procedure is perforation of the esophagus. We report the case of an elderly female with multiple comorbidities, who presented with polyarticular septic arthritis. TEE was performed to rule out endocarditis. Though the standard procedure protocol was followed, she developed esophageal perforation. It was managed with esophageal stenting but she developed multiorgan failure and did not survive. This case highlights the potential of severe morbidity and mortality associated with TEE. Appropriate screening must be done and high-risk individuals must be identified before such procedures are attempted. PMID:23341798
Ahmed, Kabir; Lal, Yasir; Condron, Steven
Real time computerization of two-dimensional echocardiography.
A computerized system was developed for real time acquisition, enhanced processing, analysis, and display of cross-sectional images of the left ventricle derived by two-dimensional echocardiography (2DE). The new methodology couples a standard medical imaging computer system to the video output of any current 2DE unit, uses a 128 x 128 or 64 x 64 matrix window and stores the real time 30 frames/sec digitized images on a magnetic disk. Computerized beat-to-beat and frame-by-frame processing employs space-time smoothing the automatic detection of endocardial interfaces by standard threshold and second derivative techniques. Multiple views are displayed in real time with 256 levels of gray and color. The methodology was used to analyze and graphically display frame-by-frame changes throughout the cardiac cycle. In addition, regional wall motion and thickness were analyzed in 12 sectors of individual cross-sections using a standardized angular subdivision originating at the center of area and indexed by an external reference point. An algorithm was developed to correct cross-sectional interference definition from the commonly used trailing-to-leading edge to the more valid leading-to-leading outline technique. Computerized analysis of spatial and temporal variations of cardiac contraction were demonstrated in several clinical and experimental applications, including bicycle exercise testing, investigation of acute myocardial infarction, and assessment of interventions. Initial evaluation indicates that the new real time computerized digital acquisition and data analysis represents a major advances toward quantitation of left ventricular function using 2DE. PMID:7234656
Garcia, E; Gueret, P; Bennett, M; Corday, E; Zwehl, W; Meerbaum, S; Corday, S; Swan, H J; Berman, D
Stress-echocardiography in idiopathic dilated cardiomyopathy: instructions for use
A number of studies have suggested that stress-echocardiography may be used for prognostic stratification in patients with idiopathic dilated cardiomyopathy. There is no consensus on which protocol or which measurements of left ventricular contractile reserve to use. The most frequently used protocol is low-dose dobutamine stress-echocardiography, and most commonly used measures of left ventricular systolic performance are ejection fraction, wall motion score index and cardiac power output. Stress-echocardiography has been shown to predict improvement in cardiac function in patients with recently diagnosed dilated cardiomyopathy, as well as to predict which patients will benefit from the treatment with beta-blockers. Most importantly, stress-echocardiography can identify patients with worse prognosis in terms of cardiac death and need for transplantation. Additionally, contractile reserve is closely correlated with maximal oxygen consumption and can even be used for further stratification in patients with maximal oxygen consumption between 10 and 14 ml/kg/min. Future studies are needed for head-to-head comparison of various protocols in an attempt to make standardization in the assessment of patients with dilated cardiomyopathy.
Neskovic, Aleksandar N; Otasevic, Petar
Quadricuspid Aortic Valve Visualized by Three-Dimensional Transthoracic Echocardiography
Quadricuspid aortic valve is a rare congenital anomaly that may cause aortic regurgitation. A 77-year-old male patient was referred to our clinic with complaints of stable angina pectoris. We report a case of a quadricuspid aortic valve diagnosed by 3-dimentional transthoracic echocardiography.
Acar, Eser; Sahin, Tayfun; Y?lmaz, Irem; Celikyurt, Umut
Preventing complicated transseptal puncture with intracardiac echocardiography: case report
BACKGROUND: Recently, intracardiac echocardiography emerged as a useful tool in the electrophysiology laboratories for guiding transseptal left heart catheterizations, for avoiding thromboembolic and mechanical complications and assessing the ablation lesions characteristics. Although the value of ICE is well known, it is not a universal tool for achieving uncomplicated access to the left atrium. We present a case in which ICE
Tchavdar Nikolov Shalganov; Dora Paprika; Sarolta Borb�s; Andr�s Temesv�ri; Tam�s Szili-T�r�k
Transesophageal echocardiography: first-line imaging for aortic diseases
NASA Technical Reports Server (NTRS)
Transesophageal echocardiography (TEE) is now commonly used to evaluate the thoracic aorta, because it is widely available and provides high-resolution images and flow information by Doppler. This article reviews the essential features on TEE of acute and chronic aortic diseases, such as aortic dissection, aneurysm, and atherosclerosis, and discusses its strengths, weaknesses, and indications.
Yalcin, F.; Thomas, J. D.; Homa, D.; Flachskampf, F. A.
Stress echocardiography for risk assessment of diabetic patients
Coronary artery disease in patients suffering from diabetes mellitus will become an increasing problem in the future. Because diabetic patients benefit from treatment of symptomatic but also asymptomatic coronary artery disease, early diagnosis is warranted. The diagnostic techniques used to detect ischaemia, with a focus on stress echocardiography, are described. ImagesFigure 1
Baur, L.H.B.; Graal, M.
Prognostic value of exercise echocardiography in diabetic patients
BACKGROUND: Coronary artery disease (CAD) is the leading cause of death in diabetic patients. Although exercise echocardiography (EE) is established as a useful method for diagnosis and stratification of risk for CAD in the general population, there are few studies on its value as a prognostic tool in diabetic patients. The purpose of this investigation was to evaluate the value
Joselina LM Oliveira; Jos� AS Barreto-Filho; Carla RP Oliveira; Thaiana A Santana; Fernando D Anjos-Andrade; �rica O Alves; Ad�o C Nascimento-Junior; Thiago JS G�es; Nathalie O Santana; Francis L Vasconcelos; Martha A Barreto; Argemiro D'Oliveira Junior; Roberto Salvatori; Manuel H Aguiar-Oliveira; Ant�nio CS Sousa
The intraoperative assessment of ascending aortic atheroma: Epiaortic imaging is superior to both transesophageal echocardiography and direct palpation
Objectives: To determine the optimal method for detecting ascending aortic atheroma intraoperatively by comparing manual palpation by the operating surgeon, intraoperative transesophageal echocardiography, and epiaortic ultrasound (linear and phased-array imaging); and to assess risk factors for severe aortic atheroma.Design: A longitudinal prospective study. Assessment of the atheroma by manual palpation was blinded to the results of the ultrasound images.Setting: The
Stephen Sylivris; Paul Calafiore; George Matalanis; Alexander Rosalion; Hok Pan Yuen; Brian F. Buxton; Andrew M. Tonkin
A case of cardiac hydatidosis: role for transesophageal echocardiography in evaluating bilateral pulmonary nodules.
Echinococcusis is a zoonotic disease, which is endemic in sheep-raising areas such as Iran. Cardiac involvement of the hydatidosis is rare and mostly asymptomatic, but it could lead to lethal complications. Thus, early diagnosis with accurate treatment would be life-saving. Here we report a 17-year-old female with nonspecific pulmonary presentations and a positive history of pulmonary hydatid cysts. Transesophageal echocardiography showed multiple cardiac hydatid cysts in the right ventricle. Patient underwent the bypass surgery to remove cardiac cysts. Postoperatively patient was on Albendazole and Praziquantel for two years. In a two-year-follow up, the patient had no complications. PMID:23894793
Mohosen, Seyed; Mirhosseini; Parsaiyan, Zahra; Fakhri, Mohammad
[Diagnosis and evaluation of a patient with cor triatriatum using perioperative transesophageal echocardiography].
Cor triatriatum is a rare congenital cardiac anomaly accounting for only 0.1-0.4% of all congenital heart diseases usually diagnosed in infancy or childhood and rarely found in adults. It is characterized by fibromuscular membrane dividing the left atrium into two chambers. This congenital heart disease is reported to be frequently associated with variety of cardiac anomalies such as an atrial septal defect, anomalous pulmonary venous drainage, and persistent left superior vena cava. A woman with no cardiac history was admitted to the hospital due to acute heart failure and diagnosed as severe mitral regurgitation and cor triatriatum by pre-orerative transthoracic echocardiography. Emergency mitral valve plasty was undertaken because of the severity of mitral regurgitation without determining the detailed type of cor triatriatum. Thus, diagnosis of the type of cor triatriatum with perioperative transesophageal echocardiography (TEE) was required to establish correct cardiopulmonary bypass and determine the operative procedure. Perioperative TEE revealed that the type was Lucas-Schmidt- I A, and cardiopulmonary bypass was established safely. Operation was performed without any problems. The TEE skill of our anesthesiologists could contribute to the safe management of the cardiac surgery. PMID:24724446
Kurazumi, Takuya; Suzuki, Takeshi; Morita, Yoshihisa; Masuda, Junich
Preoperative morphological analysis by transesophageal echocardiography and predictive value of plasma landiolol concentration during systolic anterior motion mitral valve repair : a report of three cases.
We report three cases with systolic anterior motion (SAM) after mitral valve plasty. Preoperative mitral valve morphology is a risk factor for SAM. The morphological characteristics of SAM have been revealed in several studies. We found a small distance between coaptation and the interventricular septum in all cases, and cases 2, and 3 had a low AL/PL ratio, whereas case 3 had a large PML, which was revealed by transesophageal echocardiography. With the use of 3D transesophageal echocardiography, when mitral valve prolapse was investigated, in all three cases, it was easy to specify lesions. The issue for the future is 3D analysis when SAM is occurring. PMID:24162450
Yoshimura, Manabu; Kunisawa, Takayuki; Iida, Takafumi; Matsumoto, Megumi; Takakai, Hayato; Kanda, Hirotsugu; Kurosawa, Atsushi; Takahata, Osamu; Iwasaki, Hiroshi
Takotsubo-Like Severe Left Ventricular Dysfunction After Cesarean Delivery in a 28-Year Old Woman
Takotsubo cardiomyopathy typically affects post-menopausal women who experience severe psychological or physical stress. It can also develop after medical procedures or surgery. Although the underlying mechanism has not been clearly elucidated, catecholamine overload is one of the most plausible etiologies. Herein we report a case of takotsubo-like left ventricular (LV) dysfunction in a 28-year old woman who underwent Cesarean delivery. She presented with acute heart failure and pulmonary edema immediately after the delivery. Her echocardiography showed severe LV dysfunction and apical ballooning. This case is clinically and pathophysiologically similar to peripartum cardiomyopathy.
Kim, Soo-Young; Yoon, Ji Hyun
A review of echocardiography in anaesthetic and peri-operative practice. Part 2: training and accreditation.
Echocardiography has been widely adopted as a diagnostic and monitoring tool in cardiac anaesthesia and critical care. There is considerable interest in how echocardiography could be used to benefit patients in other areas of anaesthesia and peri-operative practice. The first part of review examines the impact and utility of echocardiography, while this second part is concerned with the matter of training and accreditation. There are a number of existing clinical protocols for the use of transthoracic echocardiography with a focused approach. Some of these, such as Focused Intensive Care Echocardiography in the UK, have been developed into structured accreditation processes with embedded supervision. Learning opportunities are now emerging for anaesthetists who wish to acquire echocardiography skills - these encompass clinical, simulation and online resources. Whilst the roll-out of echocardiography for more widespread use in peri-operative management is a long-term project, it is now an appropriate time to consider how this may be achieved. PMID:24801304
Sharma, V; Fletcher, S N
Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS)
Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements
Susanna Price; Gabriele Via; Erik Sloth; Fabio Guarracino; Raoul Breitkreutz; Emanuele Catena; Daniel Talmor
Feature extraction and wall motion classification of 2D stress echocardiography with support vector machines
NASA Astrophysics Data System (ADS)
Stress echocardiography is a common clinical procedure for diagnosing heart disease. Clinically, diagnosis of the heart wall motion depends mostly on visual assessment, which is highly subjective and operator-dependent. Introduction of automated methods for heart function assessment have the potential to minimise the variance in operator assessment. Automated wall motion analysis consists of two main steps: (i) segmentation of heart wall borders, and (ii) classification of heart function as either "normal" or "abnormal" based on the segmentation. This paper considers automated classification of rest and stress echocardiography. Most previous approaches to the classification of heart function have considered rest or stress data separately, and have only considered using features extracted from the two main frames (corresponding to the end-of-diastole and end-of-systole). One previous attempt [1] has been made to combine information from rest and stress sequences utilising a Hidden Markov Model (HMM), which has proven to be the best performing approach to date. Here, we propose a novel alternative feature selection approach using combined information from rest and stress sequences for motion classification of stress echocardiography, utilising a Support Vector Machines (SVM) classifier. We describe how the proposed SVM-based method overcomes difficulties that occur with HMM classification. Overall accuracy with the new method for global wall motion classification using datasets from 173 patients is 92.47%, and the accuracy of local wall motion classification is 87.20%, showing that the proposed method outperforms the current state-of-the-art HMM-based approach (for which global and local classification accuracy is 82.15% and 78.33%, respectively).
Chykeyuk, Kiryl; Clifton, David A.; Noble, J. Alison
"Echocardiography in Nigeria: use, problems, reproducibility and potentials"
Background Although echocardiography is a useful and cost-effective technique for the detection of morphological and functional cardiac abnormalities, it has a main limitation in its subjectivity. Therefore the aim of the present study was to assess the intra-observer reproducibility and validity of 2-dimensional guided M-mode echo measurements at a Nigerian metropolitan Hospital Methods Standard echocardiographic examination was performed on twenty randomly selected patients (11 men and 9 women) aged 59.8 � 12.6 years in two different sessions seven days apart. Results A good degree of intraobserver agreement was observed between test 1 and test 2. The correlation coefficient between the first and second studies ranged between 0.60 and 0.96; measurement errors between 0.050 and 0.205. Conclusion We would conclude that 2-dimensional guided M-mode measurements at echocardiography performed at our centre are reproducible with low intra-observer variability.
Ogah, Okechukwu S; Adebanjo, Ademola T; Otukoya, Adedeji S; Jagusa, Tarwanger J
On-Orbit Prospective Echocardiography on International Space Station
NASA Technical Reports Server (NTRS)
A number of echocardiographic research projects and experiments have been flown on almost every space vehicle since 1970, but validation of standard methods and the determination of Space Normal cardiac function has not been reported to date. Advanced Diagnostics in Microgravity (ADUM) -remote guided echocardiographic technique provides a novel and effective approach to on-board assessment of cardiac physiology and structure using a just-in-time training algorithm and real-time remote guidance aboard the International Space Station (ISS). The validation of remotely guided echocardiographic techniques provides the procedures and protocols to perform scientific and clinical echocardiography on the ISS and the Moon. The objectives of this study were: 1.To confirm the ability of non-physician astronaut/cosmonaut crewmembers to perform clinically relevant remotely guided echocardiography using the Human Research Facility on board the ISS. 2.To compare the preflight, postflight and in-flight echocardiographic parameters commonly used in clinical medicine.
Hamilton, Douglas R.; Sargsyan, Ashot E.; Martin, David; Garcia, Kathleen M.; Melton, Shannon; Feiverson, Alan; Dulchavsky, Scott A.
Can simulation help to answer the demand for echocardiography education?
There has been a recent explosion of education and training in echocardiography in the specialties of anesthesiology and critical care. These devices, by their impact on clinical management, are changing the way surgery is performed and critical care is delivered. A number of international bodies have made recommendations for training and developed examinations and accreditations.The challenge to medical educators in this area is to deliver the training needed to achieve competence into already over-stretched curricula.The authors found an apparent increase in the use of simulators, with proven efficacy in improving technical skills and knowledge. There is still an absence of evidence on how it should be included in training programs and in the accreditation of certain levels.There is a conviction that this form of simulation can enhance and accelerate the understanding and practice of echocardiography by the anesthesiologist and intensivists, particularly at the beginning of the learning curve. PMID:24212199
Clau-Terr�, Fernando; Sharma, Vivek; Cholley, Bernard; Gonzalez-Alujas, Teresa; Gali�anes, Manuel; Evangelista, Artur; Fletcher, Nick
Speckle tracking echocardiography: A new approach to myocardial function
Echocardiography is the most common diagnostic method for assessing cardiac function but some limitations affect this technique. Until now, visual assessment of wall motion and thickening has allowed only a subjective evaluation of myocardial function and requires long-term training. Recently, new echocardiographic techniques have been introduced to evaluate myocardial mechanics. Tissue Doppler imaging (TDI) technique is limited by angle-dependency such that only deformation along the ultrasound beam can be derived from velocities, while myocardium deforms simultaneously in three dimensions. Speckle tracking echocardiography (STE) is a more recent technique that provides a global approach to left ventricular myocardial mechanics, giving information about the three spatial dimensions of cardiac deformation. In this editorial, we describe the physical and pathophysiological concepts of STE, discussing the differences compared to TDI and underlining the pitfalls of this new technique.
Sitia, Simona; Tomasoni, Livio; Turiel, Maurizio
Current Clinical Application of Intracardiac Flow Analysis Using Echocardiography
In evaluating the cardiac function, it is important to have a comprehensive assessment of structural factors, such as the myocardial or valvular function and intracardiac flow dynamics that pass the heart. Vortex flow that form during left ventricular filling have specific geometry and anatomical location that are critical determinants of directed blood flow during ejection. The formation of abnormal vortices relates to the abnormal cardiac function. Therefore, vortex flow may offer a novel index of cardiac dysfunction. Intracardiac flow visualization using ultrasound technique has definite advantages with a higher temporal resolution and availability in real time clinical setting. Vector flow mapping based on color-Doppler and contrast echocardiography using particle image velocimetry is currently being used for visualizing the intracardiac flow. The purpose of this review is to provide readers with an update on the current method for analyzing intracardiac flow using echocardiography and its clinical applications.
Kim, Minji; Pedrizzetti, Gianni; Vannan, Mani A
Assessing the Cardiac Toxicity of Chemotherapeutic Agents: Role of Echocardiography
Advancements in cancer treatment have resulted in sufficient survival length for patients to experience treatment-related cardiac complications. In particular, chemotherapy-induced cardiac dysfunction significantly impacts morbidity and mortality rates in cancer patients. The presence of cardiotoxicity from chemotherapy has been traditionally assessed using clinical symptoms and decreases in left ventricular ejection fraction (LVEF). However, in this indication, LVEF lacks accuracy as a measure of subclinical cardiotoxicity and its prognostic value is controversial. There is an emphasis to identify subclinical and left ventricular dysfunction early, in order to allow cancer patients and their physicians to make informed decisions about therapeutic options. Echocardiography is a readily available noninvasive tool to measure cardiac function and plays a major role in the diagnosis of cardiotoxicity. This review focuses on the role of echocardiography in detecting cardiotoxicity, and will discuss conventional and more recent echocardiographic approaches for assessing subclinical cardiotoxicity.
Tan, Timothy C.
Use of adenosine echocardiography for diagnosis of coronary artery disease
Two-dimensional echocardiography combined with exercise is sensitive and specific in the detection of coronary artery disease (CAD) by demonstrating transient abnormalities in wall motion. Frequently, however, patients cannot achieve maximal exercise because of various factors. Pharmacologic stress testing with intravenous adenosine was evaluated as a means of detecting CAD in a noninvasive manner. Patients with suspected CAD underwent echocardiographic imaging and simultaneous thallium 201 single-photon emission computed tomography during the intravenous administration of 140 micrograms/kg/min of adenosine. An increase in heart rate, decrease in blood pressure, and increase in double product were observed during adenosine administration. Initial observations revealed that wall motion abnormalities were induced by adenosine in areas of perfusion defects. The adenosine infusion was well tolerated, and symptoms disappeared within 1 to 2 minutes after termination of the infusion. Therefore preliminary observations suggest that adenosine echocardiography appears to be useful in the assessment of CAD.
Zoghbi, W.A. (Section of Cardiology Baylor College of Medicine, Methodist Hospital, Houston, TX (USA))
Left atrium function assessment by echocardiography - physiological and clinical implications.
Left atrium enlargement is a pathophysiological response to volume and pressure overload associated with a wide range of cardiovascular disorders leading to left ventricle systolic and diastolic dysfunction. Physiological factors contribute to significant differences in left atrium size in normal individuals. Moreover, left atrium enlargement was shown to have a significant prognostic value for cardiovascular events such as heart failure, atrial fibrillation or stroke, and increased cardiovascular and all-cause mortality rates. Current imaging techniques such as two- and three dimensional echocardiography, cardiac magnetic resonance imaging and multi-detector computed tomography allow a detailed assessment of the left atrium. The current paper aims to offer an overview of two-dimensional echocardiography parameters which provide data concerning left atrium dimensions and phasic functions and may lead to a better understanding of left atrium physiology and pathology. PMID:24791847
Lupu, Silvia; Mitre, Adriana; Dobreanu, Dan
Echocardiography may help detect pulmonary vasculopathy in the early stages of pulmonary artery hypertension associated with systemic sclerosis
Background Pulmonary arterial hypertension (PAH) in patients with systemic sclerosis is associated with a poor prognosis, but this can be improved by early disease detection. Abnormal pulmonary and cardiac function can be detected early by means of echocardiography, whereas right heart catheterization is usually performed later. Objectives The purpose of this prospective study was to detect early the presence of pulmonary artery vasculopathy in patients with verified systemic sclerosis without significant pulmonary fibrosis, normal lung volumes and a mildly reduced lung diffusion capacity of carbon monoxide (DLCO). Methods Nineteen consecutive female NYHA class I-II patients with scleroderma and a PAPs of < 35 mm/Hg measured by echocardiography, were enrolled between September 2007 and September 2009. They had a mean age of 51 � 13 years, body mass index of 25 � 5 kg/m2). They all underwent complete Doppler echocardiography, CPET, a pulmonary ventilation test (carbon monoxide lung diffusion, DLCO), HRCT. To investigate PAH by means of complete resting Doppler echocardiography estimates of systolic pulmonary artery pressure (PAPs) derived from tr icuspid regurgitation, mean PAP derived from pulmonary regurgitation, pulmonary vessel resistance (PVR) derived from the acceleration time of the pulmonary outflow tract (ACTpo), and right ventricular function derived from tricuspid annular plane systolic excursion (TAPSE). Right heart catheterisation was conducted only, if pulmonary hypertension was suggested by echocardiography and an abnormal ventilator test. The data are given as mean values � SD, unless otherwise stated. The correlations between the variables were analysed using Pearson's r coefficient, and the predictive value of the variables was calculated using linear regression analysis. A p value of > 0.05 was considered significant. Results Right heart catheterization detected PAH in 15/19 patients; mean PAP was 30.5 mm/Hg and RVP 3.6 UW. Coronary angiography of the patients aged more than 55 years showed some evidence of significant coronary artery disease. Echocardiography showed high systolic PAP values (46 � 8 mmHg), whereas right ventricular function was normal (TAPSE 23 � 3 mm), and in line with the NYHA class. ACTpo was reduced in the patients with a systolic PAP of < 46 mm/Hg (p > 0.001) and positively correlated with DLCO (p > 0.001) and the hemodynamic data. There was a good correlation between ACTpo and PVR (hemodynamic data) (r = -0615; p > 0.01). Conclusions Although they need to be confirmed by studies of larger series of patients, our findings suggest that, in comparison with hemodynamic data, non-invasive echocardiographic measurements are an excellent means of identifying early-stage PAH.
Incidence of complications in pediatric transesophageal echocardiography: experience in 1650 cases.
The purpose of this study was to tabulate the complications encountered in 1650 patients who underwent pediatric transesophageal echocardiography. The occurrence of complications and their type and severity were prospectively recorded. The patients had a mean age of 3.6 years (range 1 day to 21 years) and a mean weight of 17.2 kg (range 1.6 to 118 kg). Of the 1650 cases, 1534 were intraoperative. Most patients studied (97%) had congenital heart disease. Complications occurred in 52 (3.2%) of the 1650 patients. Failure to insert the probe occurred in 13 (0.8%) patients; if those cases are not counted as complications, the incidence of overall complications falls to 2.4%. Airway obstruction occurred in 14 (1%) patients, right mainstem advancement of the endotracheal tube in 3 (0.2%), inadvertent tracheal extubation in 8 (0.5%), vascular compression in 10 (0.6%), and single additional complications in 4 (0.2%). No significant bleeding, arrhythmias, esophageal injuries, or deaths occurred. Failure to insert the probe and airway complications occurred predominantly and significantly in smaller subjects. It is concluded that the incidence of complications during pediatric transesophageal echocardiography is low. PMID:10359925
Stevenson, J G
A review and critique of the statistical methods used to generate reference values in pediatric echocardiography.
Several articles have proposed echocardiographic reference values in normal pediatric subjects, but adequate validation is often lacking and has not been reviewed. The aim of this study was to review published reference values in pediatric two-dimensional and M-mode echocardiography with a specific focus on the adequacy of the statistical and mathematical methods used to normalize echocardiographic measurements. All articles proposing reference values for transthoracic pediatric echocardiography were reviewed. The types of measurements, the methods of normalization, the regression models used, and the methods used to detect potential bias in proposed reference values were abstracted. The detection of residual associations, residual heteroscedasticity, and departures from the normal distribution theory predictions were specifically analyzed. Fifty-two studies met the inclusion criteria. Most authors (87%) used parametric normalization to account for body size, but their approaches were very heterogeneous. Linear regression and indexing were the most common models. Heteroscedasticity was often present but was mentioned in only 27% of studies. The absence of residual heteroscedasticity and residual associations between the normalized measurements and the independent variables were mentioned in only 9% and 22% of the studies, respectively. Only 14% of studies documented that the distribution of the residual values was appropriate for Z score calculation or that the proportion of subjects falling outside the reference range was appropriate. Statistical suitability of the proposed reference ranges was often incompletely documented. This review underlines the great need for better standardization in echocardiographic measurement normalization. PMID:23140845
Mawad, Wadi; Drolet, Christian; Dahdah, Nagib; Dallaire, Frederic
A Randomized Controlled Trial of Enteral versus Parenteral Feeding in Patients with Predicted Severe Acute Pancreatitis Shows a Significant Reduction in Mortality and in Infected Pancreatic Complications with Total Enteral Nutrition
Background: Infectious complications are the main cause of late death in patients with acute pancreatitis. Routine prophylactic antibiotic use following a severe attack has been proposed but remains controversial. On the other hand, nutritional support has recently yielded promising clinical results. The aim of study was to compare enteral vs. parenteral feeding for prevention of infectious complications in patients with
Maxim S. Petrov; Mikhail V. Kukosh; Nikolay V. Emelyanov
An Algerian child homozygous for the M470V polymorphism and for a deletion of two nucleotides in exon 10 of the CFTR gene, shows severe cystic fibrosis symptoms.
When screening for the presence of major cystic fibrosis mutations in Algerian cystic fibrosis families by heteroduplex formation, aberrant heteroduplexes were observed for exon 10 in one family. Here we describe the clinical and molecular findings in a severely affected child of this family, homozygous for the 1609delCA and for the M470V polymorphism. PMID:1282016
Loumi, O; Cuppens, H; Bakour, R; Benabadji, M; Baghriche, M; Marynen, P; Cassiman, J J
Low-dose adenosine stress echocardiography: Detection of myocardial viability
OBJECTIVE: The aim of this study was to evaluate the diagnostic potential of low-dose adenosine stress echocardiography in detection of myocardial viability. BACKGROUND: Vasodilation through low dose dipyridamole infusion may recruit contractile reserve by increasing coronary flow or by increasing levels of endogenous adenosine. METHODS: Forty-three patients with resting dyssynergy, due to previous myocardial infarction, underwent low-dose adenosine (80, 100,
Ana Djordjevic-Dikic; Miodrag Ostojic; Branko Beleslin; Ivana Nedeljkovic; Jelena Stepanovic; Sinisa Stojkovic; Zorica Petrasinovic; Milan Nedeljkovic; Jovica Saponjski; Vojislav Giga
Oesophageal perforation complicating intraoperative transoesophageal echocardiography: suspicion can save lives.
Oesophageal injury is an extremely rare complication of intra-operative transoesophageal echocardiography (TOE) associated with cardiac surgery. We report a case of delayed presentation (19 days after surgery) of oesophageal injury that was likely due to TOE following an aortic valve replacement. Lack of suspicion led to a delay in diagnosis but the patient fortunately survived. We advocate that in the event of postoperative hydropneumothorax, the differential diagnosis must include iatrogenic oesophageal injury from transoesophageal echo. PMID:20494972
Elsayed, Hany; Page, Richard; Agarwal, Seema; Chalmers, John
Echocardiography-Guided Ethanol Septal Reduction for Hypertrophic Obstructive Cardiomyopathy
Background�Left ventricular outflow tract (LVOT) obstruction is frequently responsible for symptoms in hypertrophic obstructive cardiomyopathy (HOCM). Medical therapy is often not sufficient to control these symptoms, and surgical myotomy-myomectomy is required. Methods and Results�We enrolled 33 symptomatic patients with HOCM and obstruction ( $40 mm Hg gradient at rest or $60 mm Hg dobutamine-provoked). By contrast echocardiography, the bulging septum
Nasser M. Lakkis; Sherif F. Nagueh; Neal S. Kleiman; Donna Killip; Zuo-Xiang He; Mario S. Verani; Robert Roberts; William H. Spencer III
Intracardiac echocardiography for the guidance of percutaneous procedures
Interventional cardiology has seen great advances in the past decade. A wide range of interventional procedures has been established\\u000a as standard therapeutic modalities and more are yet to come. Multiple imaging modalities have been used to guide these procedures.\\u000a Intracardiac echocardiography (ICE) provides an accurate imaging tool to guide the appropriate performance of many of these\\u000a procedures. Early studies compared
Sawsan M. Awad; Qi-Ling Cao; Ziyad M. Hijazi
Open access echocardiography is feasible in the Netherlands
Objectives In an urban region in the Netherlands, general practitioners (GPs) were offered an open access echocardiographic service. We report the outcomes of the first two years of this project. Methods GPs were given a course on the indications and restrictions for diagnostic referral as well as the interpretation of echocardiographic results. Indications were restricted to `dyspnoea', `cardiac murmur' and `peripheral oedema'. A uniform request form was developed, using ticking boxes for quick completion. The echocardiogram was performed within one week after the request. Results were interpreted by the cardiologist according to the criteria of the Dutch, European and American Societies of Echocardiography. Results Sixty GPs from 43 general practices participated, covering a practice population of 130,000 persons. During a period of 24 months, 198 patients were referred. Only 1.5% of the workload of the echocardiography department was due to requests from GPs. The GPs kept well to the agreements on indications for echocardiography (91% approved reasons). An abnormal echocardiographic outcome was found in 53% of all patients. For `cardiac murmur' this was 52%, for `dyspnoea' 63%, and for `peripheral oedema' 58%. Left ventricular dysfunction was present in 49 patients (25%); diastolic dysfunction was present in most of them (39 patients, 19%). Systolic dysfunction (LVEF < 40%) was found in 19 patients (10%). Twenty patients (10%) appeared to have relevant aortic or mitral valve disease. Conclusion GPs did not overuse the open access echocardiographic service; they possibly used it conservatively. To prevent underdiagnosis of left ventricular dysfunction, diagnostic strategies in which electrocardiogram, NT-pro-BNP and echocardiography are combined, should be developed.
Baur, L.H.B.; Veenstra, L.; Lenderink, T.; der Bolt, C.L.B. Lodewijks-van; Winkens, R.A.G.; Soomers, F.L.M.; Stoffers, H.E.J.H.
Early Assessment of Left Ventricular Viability of Dyskinesia and Akinesia Myocardium in Patients with Acute Myocardial Infarction: Real-time Contrast Echocardiography Versus Low-dose Dobutamine Echocardiography
Purpose: Low-dose dobutamine echocardiography (LDDE) has been demonstrated as an accurate imaging modality to identify viability after acute myocardial infarction (AMI), but LDDE has its limitations. Myocardial contrast echocardiography (MCE) is a good tool to assess microvascular perfusion. This study was undertaken to compare the effect of real-time MCE and LDDE in early assessment of left ventricular (LV) viability of
Wei-Chun Huang; Kuan-Rau Chiou; Chun-Peng Liu; Doyal Lee; Guang-Yuan Mar; Shih-Hung Hsiao; Chuen-Wang Chiou; Ming-Ho Kung; Shoa-Lin Lin
Quantification of mitral valve regurgitation: new solutions provided by 3D echocardiography.
The accurate quantification of mitral regurgitation (MR) using 2D imaging tools is difficult due to its structural complexity; however, it is crucially important in clinical medicine as MR severity has prognostic consequences. Novel 3-dimensional (3D) echocardiography and 3-dimensional (3D) color Doppler methods can provide quantitative and qualitative classification of MR including measurement of the vena contracta area, regurgitant volume, regurgitant fraction, and effective regurgitant orifice area (EROA). Nevertheless, with so many conventional and developing techniques it can be difficult to decide which technique to use for selected patients. We suggest using an approach that is focused not only on the techniques and measurements but also combines imaging portability, availability, clinical efficiency, and accurate and reproducible assessments. In this review we discuss the established and emerging applications of 3D color Doppler for the quantification of MR severity. PMID:23812836
Maragiannis, Dimitrios; Little, Stephen H
Education Statistics Slide Show
NSDL National Science Digital Library
Created by Grace York, coordinator of the University of Michigan's Documents Center, the Education Statistics Slide Show is an online presentation demonstrating how to locate, obtain, and manipulate educational data on the Web. The presentation consists of 72 slides and offers instruction on the use of several Websites including the US Census Bureau's American Factfinder site (see the April 2, 1999 Scout Report), the Center for International Earth Science Information Network (CIESIN) Census Mapping site, the National Center for Education Statistics (NCES) site, the FEDSTATS site (see the May 30, 1997 Scout Report), and many more. The tutorial presentation also provides ten practice questions and a detailed Webliography.
LVM Assessed by Echocardiography and Cardiac Magnetic Resonance, Cardiovascular Outcomes, and Medical Practice
We investigate three important areas related to the clinical use of LVM (LVM): accuracy of assessments by echocardiography and cardiac magnetic resonance (CMR), the ability to predict cardiovascular outcomes, and the comparative value of different indexing methods. The recommended formula for echocardiographic estimation of LVM uses linear measurements and is based on the assumption of the left ventricle as a prolate ellipsoid of revolution. CMR permits a modeling of the left ventricle free of cardiac geometric assumptions or acoustic window dependency, showing better accuracy and reproducibility. However, echocardiography has lower cost, easier availability, and better tolerability. From the Medline database, 26 longitudinal echocardiographic studies and 5 CMR studies, investigating LVM or LV hypertrophy as predictors of death or major cardiovascular outcomes, were identified. LVM and LV hypertrophy were reliable cardiovascular risk predictors using both modalities. However, no study directly compared the methods for the ability to predict events, agreement in hypertrophy classification, or performance in cardiovascular risk reclassification. Indexing LVM to BSA was the earliest normalization process used, but it seems to underestimate the prevalence of hypertrophy in obese and overweight subjects. Dividing LVM by height to 1.7 or 2.7 as allometric powers are the most promising normalization methods in terms of practicality and usefulness from a clinical ans scientific standpoints for scaling myocardial mass to body size. The measurement of LVM, calculation of LVMi, and classification for LVH should be standardized by scientific societies across measurement techniques and adopted by clinicians in risk stratification and therapeutic decision.
Armstrong, Anderson C.; Gidding, Samuel; Gjesdal, Ola; Wu, Colin; Bluemke, David A; Lima, Joao A.
Mechanisms of functional mitral regurgitation in ischemic cardiomyopathy determined by transesophageal echocardiography (from the Surgical Treatment for Ischemic Heart Failure Trial).
The mechanisms underlying functional mitral regurgitation (MR) and the relation between mechanism and severity of MR have not been evaluated in a large, multicenter, randomized controlled trial. Transesophageal echocardiography (TEE) was performed in 215 patients at 17 centers in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Both 2-dimensional (n = 215) and 3-dimensional (n = 81) TEEs were used to assess multiple quantitative measurements of the mechanism and severity of MR. By 2-dimensional TEE, leaflet tenting area, anterior and posterior leaflet angles, mitral annulus diameter, left ventricular (LV) end-systolic volume index, LV ejection fraction (LVEF), and sphericity index (p <0.05 for all) were significantly different across MR grades. By 3-dimensional TEE, mitral annulus area, leaflet tenting area, LV end-systolic volume index, LVEF, and sphericity index (p <0.05 for all) were significantly different across MR grades. A multivariate analysis showed a trend for annulus area (p = 0.069) and LV end-systolic volume index (p = 0.071) to predict effective regurgitant orifice area and for annulus area (p = 0.018) and LV end-systolic volume index (p = 0.073) to predict vena contracta area. In the STICH trial, multiple quantitative parameters of the mechanism of functional MR are related to MR severity. The mechanism of functional MR in ischemic cardiomyopathy is heterogeneous, but no single variable stands out as a strong predictor of quantitative severity of MR. PMID:24035166
Golba, Krzysztof; Mokrzycki, Krzysztof; Drozdz, Jaroslaw; Cherniavsky, Alexander; Wrobel, Krzysztof; Roberts, Bradley J; Haddad, Haissam; Maurer, Gerald; Yii, Michael; Asch, Federico M; Handschumacher, Mark D; Holly, Thomas A; Przybylski, Roman; Kron, Irving; Schaff, Hartzell; Aston, Susan; Horton, John; Lee, Kerry L; Velazquez, Eric J; Grayburn, Paul A
Evaluation of myocardial viability after myocardial infarction with intravenous real-time myocardial contrast echocardiography
Summary��The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography. Intravenous\\u000a real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization.\\u000a Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using\\u000a 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Viable myocardium was defined by
Weihui Shentu; Youbin Deng; Runqing Huang; Peng Li; Xiang Wei; Haoyi Yang; Yun Zhang; Li Xiong; Fen Yu; Yuhan Wu
Simulation of congenital heart defects: a novel way of training in echocardiography
Background:Echocardiography is one of the most important diagnostic imaging modalities in paediatric cardiology. Owing to the large number of lesions, achieving expertise often requires years of training. Echocardiography is still taught using the apprenticeship model, which is time- and personnel consuming.Objectives:To extend the echocardiography simulator EchoCom to enable simulation of congenital heart lesions and validate it for training in paediatric
M Weidenbach; V R�zek; F Wild; S Khambadkone; T Berlage; J Janou�ek; J Marek
The development of echocardiography in China: the pioneering role of Xin-fang Wang.
I cannot discuss the history of the development of echocardiography in China without describing the pioneering role of Xin-fang Wang (???) from Wuhan, China, who is the "father of modern echocardiography."(1) Although Inge Edler from Sweden(2-5) and Harvey Feigenbaum from the United States(6) were also oftentimes referred to as the fathers of echocardiography, both Edler(7) and Feigenbaum(8) recognized that the Chinese used cardiac ultrasonography in the very early years (Figure 1). PMID:23227296
Cheng, Tsung O
[Measurement of left atrial and ventricular volumes in real-time 3D echocardiography. Validation by nuclear magnetic resonance
NASA Technical Reports Server (NTRS)
The measurement of the left ventricular ejection fraction is important for the evaluation of cardiomyopathy and depends on the measurement of left ventricular volumes. There are no existing conventional echocardiographic means of measuring the true left atrial and ventricular volumes without mathematical approximations. The aim of this study was to test anew real time 3-dimensional echocardiographic system of calculating left atrial and ventricular volumes in 40 patients after in vitro validation. The volumes of the left atrium and ventricle acquired from real time 3-D echocardiography in the apical view, were calculated in 7 sections parallel to the surface of the probe and compared with atrial (10 patients) and ventricular (30 patients) volumes calculated by nuclear magnetic resonance with the simpson method and with volumes of water in balloons placed in a cistern. Linear regression analysis showed an excellent correlation between the real volume of water in the balloons and volumes given in real time 3-dimensional echocardiography (y = 0.94x + 5.5, r = 0.99, p < 0.001, D = -10 +/- 4.5 ml). A good correlation was observed between real time 3-dimensional echocardiography and nuclear magnetic resonance for the measurement of left atrial and ventricular volumes (y = 0.95x - 10, r = 0.91, p < 0.001, D = -14.8 +/- 19.5 ml and y = 0.87x + 10, r = 0.98, P < 0.001, D = -8.3 +/- 18.7 ml, respectively. The authors conclude that real time three-dimensional echocardiography allows accurate measurement of left heart volumes underlying the clinical potential of this new 3-D method.
Bauer, F.; Shiota, T.; Qin, J. X.; White, R. D.; Thomas, J. D.
Right ventricular function impaired in children and adolescents with severe idiopathic scoliosis
Background Although it is speculated that scoliosis may induce cardiac dysfunction, there is no report about evaluation of cardiac function, especially right cardiac function in patients with scoliosis. Therefore, we evaluated right ventricular function in idiopathic scoliotic patients with mild to severe curves and compared them with healthy children and adolescents matched in age, then explored relationship between scoliosis and right ventricular function. Methods Thirty-seven patients diagnosed with idiopathic scoliosis with a mean age of 16y/o (range, 8-25y/o) and an average spine curve of 77.5�Cobb (range, 30-157�) were studied by echocardiography. TAD was obtained using M-mode echocardiography. Similar examination was performed in a control group of 17 healthy individuals in matched-age. According to the different curve degree, all patients were divided into 3 groups (mild, moderate and severe). Comparison was done among the groups and the relationship between TAD and spine curve of Cobb was analyzed. Results Patients with severe scoliosis showed depressed TAD. There was good correlation between TAD and spine curve of Cobb. Conclusions Patients with severe scoliosis showed a significant lower right ventricular systolic function.
Repair of recurrent pseudoaneurysm of the mitral-aortic intervalvular fibrosa: Role of transesophageal echocardiography.
Pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare cardiac surgical condition. P-MAIVF commonly occurs as a complication of aortic and mitral valve replacement surgeries. The surgical trauma during replacement of the valves weakens the avascular mitral and aortic intervalvular area. We present a case of P-MAIVF recurrence 5 years after a primary repair. Congestive cardiac failure was the presenting feature with mitral and aortic regurgitation. In view of the recurrence, the surgical team planned for a double valve replacement. The sewing rings of the two prosthetic-valves were interposed to close the mouth of the pseudoaneurysm and to provide mechanical reinforcement of the MAIVF. Intra-operative transesophageal echocardiography (TEE) helped in delineating the anatomy, extent of the lesion, rupture of one of the pseudoaneurysm into left atrium and severity of the valvular regurgitation. Post-procedure TEE confirmed complete obliteration of the pseudoaneurysm and prosthetic valve function. PMID:24732619
Joshi, Shreedhar S; Thimmarayappa, Ashwini; Nagaraja, P S; Jagadeesh, A M; Furtado, Arul; Bhat, Seetharam
Left Atrium by Echocardiography in Clinical Practice: From Conventional Methods to New Echocardiographic Techniques
Although often referred to as �the forgotten chamber�, compared with left ventricle (LV), especially in the past years, the left atrium (LA) plays a critical role in the clinical expression and prognosis of patients with heart and cerebrovascular disease, as demonstrated by several studies. Echocardiographers initially focused on early detection of atrial geometrical abnormalities through monodimensional atrial diameter quantification and then bidimensional (2D) areas and volume estimation. Now, together with conventional echocardiographic parameters, new echocardiographic techniques, such as strain Doppler, 2D speckle tracking and three-dimensional (3D) echocardiography, allow assessing early LA dysfunction and they all play a fundamental role to detect early functional remodelling before anatomical alterations occur. LA dysfunction and its important prognostic implications may be detected sooner by LA strain than by volumetric measurements.
Caso, Pio; D'Andrea, Antonello; Di Salvo, Giovanni; Arenga, Fortunato; Coppola, Maria Gabriella; Sellitto, Vincenzo; Macrino, Maria; Calabro, Raffaele
Reliability of quantitative echocardiography in adult sheep and goats
Background Echocardiography is a non-invasive method for assessment of the ovine and caprine heart. Complete reference ranges for cardiac dimensions and time indices for both species are not currently available and reliability of these measurements has not been evaluated. The objectives for this study are to report reliability, normal cardiac dimensions and time indices in a large group of adult sheep and goats. Fifty-one adult sheep and forty adult goats were recruited. Full echocardiographic examinations were performed in the standing unsedated animal. All animals underwent echocardiography four times in a 72-hour period. Echocardiography was performed three times by one author and once by another. Images were stored and measured offline. Technique and measurement repeatability and reproducibility and any differences due to animal or day were evaluated. Reference ranges (mean?�?2 standard deviations) were calculated for both species. Results Majority of the images obtained were of good to excellent quality. Image acquisition was straightforward with 5.4% of animals demonstrating a small scanning window. Reliability was excellent for majority of dimensions and time indices. There was less variation in repeatability when compared with reproducibility and differences were greater for technique than for measurements. Dimensions that were less reliable included those for right ventricular diameter and left ventricular free wall. There were many differences in cardiac dimensions between sheep and goats. Conclusions This study has demonstrated that specific reference ranges are required for these two species. Repeatability and reproducibility were excellent for the majority of cardiac dimensions and time indices suggesting that this technique is reliable and valuable for examination of clinical cases over time and for longitudinal research studies.
Speckle tracking echocardiography in pediatric and congenital heart disease.
Assessment of myocardial strain using speckle tracking echocardiography is an emerging echocardiographic technique that is increasingly used in the diagnosis and management of acquired heart disease in adults. In pediatric heart disease, this is still mainly considered as a research tool as the application of this technology has been slowed by the lack of vendor-independent technology and of normative data across the different age ranges. We believe that the technology has potential applications for the early detection of myocardial dysfunction, the quantification of ventricular function in congenital heart disease, and the detection of dyssynchrony. PMID:23551605
Forsey, Jonathan; Friedberg, Mark K; Mertens, Luc
Aortic intramural haematoma and chronic anticoagulation: role of transoesophageal echocardiography.
The case of a 66-year-old patient with acute intramural haematoma in descending aorta, receiving anticoagulant treatment with warfarin for chronic atrial fibrillation, is presented. Transoesophageal echocardiography was fundamental in the diagnosis of the intramural haematoma, assessment of the cardioembolic risk of atrial fibrillation and in follow-up the evolution of the intramural haematoma, which facilitated therapeutic management. Although no established recommendation exists on anticoagulation in aortic intramural haematoma, individual risk-benefit assessment of anticoagulation and follow-up with imaging techniques are essential to elect the most appropriate therapeutic management. PMID:17046331
Ruggiero, Alberto; Gonz�lez-Alujas, Teresa; Rodr�guez, Jos�; Bossone, Eduardo; Evangelista, Arturo
Intraoperative transoesophageal echocardiography (ITEE) in mitral valve surgery
Background��Patients undergoing mitral valve surgery were assessed for morphology and function by Transoesophageal Echocardiography (TEE)\\u000a at surgery over a 5 year period.\\u000a \\u000a \\u000a \\u000a \\u000a Methods��From January 1994 through May 1998, 591 patients underwent mitral valve surgery. Four hundred and eleven patients (mean age\\u000a 22+3.6 yrs, range 8 years to 55 years, 186 male) underwent mitral valve reconstruction, 143 patients (mean age 24.5+4.2
Arkalgud Sampath Kumar; Anita Saxena
Transoesophageal echocardiography during scoliosis repair: comparison with CVP monitoring
Purpose��Accurate haemodynamic assessment during surgical repair of scoliosis is crucial to the care of the patient. The purpose of\\u000a this study was to compare transoesophageal echocardiography (TEE) with central venous pressure monitoring in patients with\\u000a spinal deformities requiring surgery in the prone position.\\u000a \\u000a \\u000a \\u000a Methods��Twelve paediatric patients undergoing corrective spinal surgery for scoliosis\\/kyphosis in the prone position were studied.\\u000a Monitoring included
D. E. Soliman; A. D. Maslow; P. M. Bokesch; M. Strafford; L. Karlin; J. Rhodes; G. R. Marx
[Demonstration of an acute myocardial infarction by nuclear magnetic resonance: comparison with 2-dimensional echocardiography in localization of the necrotic area].
In order to evaluate the ability of magnetic resonance imaging (MRI) to detect acute myocardial infarction (AMI) in man, we studied 15 normal volunteers and 22 patients with a recent AMI (13.5 +/- 7.7 days, range 4-28). To establish the ability of MRI in localizing the site of infarction we also performed a comparison between the segments of the left ventricle showing evidence of AMI by MRI and those presenting wall motion abnormalities by 2-dimensional echocardiography. By using strict criteria and 2 imaging planes MRI proved to be a reliable technique for the detection of AMI. MRI correctly identified AMI in 20 out of 22 subjects (90.9%). The site of AMI appeared as an area of increased signal intensity on spin echo images, particularly evident on late echoes: 15 patients had MRI findings compatible with transmural AMI and 5 patients with non-transmural AMI. The site of AMI as detected by MRI closely correlated with that indicated by 2-dimensional echocardiography, thus showing that MRI is a reliable tool for AMI localization. We also observed that the number of left ventricular segments judged as infarcted by MRI was significantly higher than that showing wall motion abnormalities. As MRI correctly identified the presence of 2 subendocardial lesions, not detected by echocardiography, it is suggested that MRI may be superior to echocardiography in detecting non-transmural lesions and the lateral extension of a transmural infarct. Our data show that MRI is a reliable tool for the detection and location of recent AMI in man. In particular MRI can locate AMI with a precision similar to that offered by 2-dimensional echocardiography. PMID:2743364
Casolo, G C; Buonafede, N; Bertini, G; Gensini, G F; Petacchi, D; Bartolozzi, C
Diabetic Cardiomyopathy in OVE26 Mice Shows Mitochondrial ROS Production and Divergence Between In Vivo and In Vitro Contractility
Many diabetic patients suffer from a cardiomyopathy that cannot be explained solely by poor coronary perfusion. This cardiomyopathy may be due to either organ-based damage like fibrosis, or to direct damage to cardiomyocytes. Mitochondrial-derived reactive oxygen species (ROS) have been proposed to contribute to this cardiomyopathy. To address these questions, we used the OVE26 mouse model of severe type 1 diabetes to measure contractility in isolated cardiomyocytes by edge detection and in vivo with echocardiography. We also assessed the source of ROS generation using both a general and a mitochondrial specific indicator. When contractility was assayed in freshly isolated myocytes, contraction was much stronger in control myocytes. However, contractility of normal myocytes became weaker during 24 hours of in vitro culture. In contrast, contractility of diabetic OVE26 myocytes remains stable during culture. Echocardiography revealed normal or hyperdynamic function in OVE26 hearts under basal conditions but with a sharply reduced response to isoproterenol, a ?-adrenergic agonist. For ROS generation, we found that ROS production in diabetic myocytes was elevated after exposure to either high glucose or angiotensin II (AngII). Superoxide detection with the mitochondrial sensor MitoSOX Red confirmed that mitochondria are a major source of ROS generation in diabetic myocytes. These results show that contractile deficits in OVE26 diabetic hearts are due primarily to cardiomyocyte impairment and that ROS from mitochondria are a cause of that impairment.
Song, Ye; Du, Yibo; Prabhu, Sumanth D.; Epstein, Paul N.
Bronchial compression in an infant with isolated secundum atrial septal defect associated with severe pulmonary arterial hypertension
Symptomatic pulmonary arterial hypertension (PAH) in patients with isolated atrial septal defect (ASD) is rare during infancy. We report a case of isolated ASD with severe PAH in an infant who developed airway obstruction as cardiomegaly progressed. The patient presented with recurrent severe respiratory insufficiency and failure to thrive before the repair of the ASD. Echocardiography confirmed volume overload on the right side of heart and severe PAH (tricuspid regurgitation [TR] with a peak pressure gradient of 55 to 60 mmHg). The chest radiographs demonstrated severe collapse of both lung fields, and a computed tomography scan showed narrowing of the main bronchus because of an intrinsic cause, as well as a dilated pulmonary artery compressing the main bronchus on the left and the intermediate bronchus on the right. ASD patch closure was performed when the infant was 8 months old. After the repair of the ASD, echocardiography showed improvement of PAH (TR with a peak pressure gradient of 22 to 26 mmHg), and the patient has not developed recurrent respiratory infections while showing successful catch-up growth. In infants with symptomatic isolated ASD, especially in those with respiratory insufficiency associated with severe PAH, extrinsic airway compression should be considered. Correcting any congenital heart diseases in these patients may improve their symptoms.
Park, Sung-Hee; Park, So Young; Kim, Nam Kyun; Park, Su-Jin; Park, Han Ki; Park, Young Hwan
Discrete subpulmonic membrane in association with isolated severe pulmonary valvar stenosis
Background Subpulmonic membrane as a cause of right ventricular outflow tract obstruction in patients with concordant ventriculoarterial connection and intact ventricular septum is considered to be rare. Case presentation A 7 � year � old boy was referred to a tertiary care hospital with complaints of dyspnea on moderate exertion and palpitations of about 2 years duration. Physical examination revealed parasternal lift, systolic thrill and a 4/6 ejection systolic murmur, best heard over the left 2nd intercostal space. His oxygen saturation was 88% on room air. Two-dimensional echocardiography showed a thickened pulmonary valve with fused leaflets that show severe systolic doming. There was a discrete subpulmonic membrane about 1.3 cm below the pulmonary valve annulus. Continuous wave Doppler interrogation showed peak systolic pressure gradient of 185 mmHg across the pulmonary valve. Balloon dilation of the pulmonary valve was performed and the pressure gradient came down to 50 mmHg. Follow-up transthoracic echocardiography showed residual pressure gradient of about 50 � 60 mmHg across the pulmonary valve. The residual pressure gradient appeared to be mainly subvalvar, as seen on the continuous wave Doppler tracing. The patient reported marked improvement in terms of exercise tolerance and subjective symptoms. Conclusions Association of subpulmonic membrane with severe pulmonary valvar stenosis, concordant ventriculoarterial connection and intact ventricular septum is rare. When it occurs, the result of percutaneous valve dilation may be suboptimal.
Morphometric investigations in mitral stenosis using two dimensional echocardiography.
A method is proposed for comparing the orifice size and the morphology of stenotic mitral valves, removed intact at the time of replacement, with the preoperative two dimensional echocardiographic cross-sections. The excised mitral valve apparatus is suspended on a specially constructed mounting. To avoid shrinkage the orifice is stabilised with an airfilled balloon. A radiography is taken directing the x-ray beam perpendicular to the valve orifice. In 40 of 51 patients this method provided the means of relating the echocardiographic cross-sections to the morphology of the valve. Planimetry of the valve area compared favourably with the postoperatively determined orifice size. Agreement was found in 34 of 40 patients in orifice shape between preoperative echocardiograms and x-rays of th excised valve. The relation between intraoperative estimation of size of the valve, using dilators with known diameters, and the postoperative results was less favourable. Areas of calcification were identified on echocardiography as dense conglomerate echoes. In 30 patients (75%) the localisation of calcium deposits and in 67% the degree of calcification was in agreement with the x-rays of the valve taken after operation. In addition to determination of the area, two dimensional echocardiography allows detailed studies of the stenotic valves, and is of particular importance for planning operative treatment. Images
Schweizer, P; Bardos, P; Krebs, W; Erbel, R; Minale, C; Imm, S; Messmer, B J; Effert, S
Exercise stress echocardiography for the study of the pulmonary circulation.
Exercise stress tests have been used for the diagnosis of pulmonary hypertension, but with variable protocols and uncertain limits of normal. The pulmonary haemodynamic response to progressively increased workload and recovery was investigated by Doppler echocardiography in 25 healthy volunteers aged 19-62 yrs (mean 36 yrs). Mean pulmonary artery pressure ((Ppa)) was estimated from the maximum velocity of tricuspid regurgitation. Cardiac output (Q) was calculated from the aortic velocity-time integral. Slopes and extrapolated pressure intercepts of (Ppa)-Q plots were calculated after using the adjustment of Poon for individual variability. A pulmonary vascular distensibility alpha was calculated from each (Ppa)-Q plot to estimate compliance. (Ppa) increased from 14+/-3 mmHg to 30+/-7 mmHg, and decreased to 19+/-4 mmHg after 5 min recovery. The slope of (Ppa)-Q was 1.37+/-0.65 mmHg x min(-1) x L(-1) with an extrapolated pressure intercept of 8.2+/-3.6 mmHg and an alpha of 0.017+/-0.018 mmHg(-1). These results agree with those of previous invasive studies. Multipoint (pa)-Q plots were well described by a linear approximation, from which resistance can be calulated. We conclude that exercise echocardiography of the pulmonary circulation is feasible and provides realistic resistance and compliance estimations. Measurements during recovery are unreliable because of rapid return to baseline. PMID:19926746
Argiento, P; Chesler, N; Mul�, M; D'Alto, M; Bossone, E; Unger, P; Naeije, R
Altered mitral inflow orifice in severe aortic regurgitation: real time three-dimensional echocardiographic findings.
We present the case of a young man with severe eccentric aortic regurgitation, obstructing mitral inflow and provoking an audible Austin Flint murmur at clinical examination. Two-dimensional color Doppler echocardiography depicts the remarkable mechanical interaction between aortic regurgitant jet and anterior mitral leaflet opening. Three-dimensional transesophageal echocardiography aids in understanding the geometric and hemodynamic consequences of the regurgitant jet and in the genesis of the Austin Flint murmur. This case accentuates the incremental value of three-dimensional echocardiography when evaluating valvular pathology, and offers more insight in the interaction between aortic regurgitant flow and mitral leaflet dynamics. PMID:23742271
Bertrand, Philippe B; Verhaert, David; Vandervoort, Pieter
Objective structured assessment of technical competence in transthoracic echocardiography: a validity study in a standardised setting
Background Competence in transthoracic echocardiography (TTE) is unrelated to traditional measures of TTE competence, such as duration of training and number of examinations performed. This study aims to explore aspects of validity of an instrument for structured assessment of echocardiographic technical skills. Methods The study included 45 physicians with three different clinical levels of echocardiography competence who all scanned the same healthy male following national guidelines. An expert in echocardiography (OG) evaluated all the recorded, de-identified TTE images blindly using the developed instrument for assessment of TTE technical skills. The instrument consisted of both a global rating scale and a procedure specific checklist. Two scores were calculated for each examination: A global rating score and a total checklist score. OG rated ten examinations twice for intra-rater reliability, and another expert rated the same ten examinations for inter-rater reliability. A small pilot study was then performed with focus on content validity. This pilot study included nine physicians who scanned three patients with different pathologies as well as different technical difficulties. Results Validity of the TTE technical skills assessment instrument was supported by a significant correlation found between level of expertise and both the global score (Spearman 0.76, p<0.0001) and the checklist score (Spearman 0.74, p<0.001). Both scores were able to distinguish between the three levels of competence that were represented in the physician group. Reliability was supported by acceptable inter- and intra-rater values. The pilot study showed a tendency to improved scores with increasing expertise levels, suggesting that the instrument could also be used when pathologies were present. Conclusions We designed and developed a structured assessment instrument of echocardiographic technical skills that showed evidence of validity in terms of high correlations between test scores on a normal person and the level of physician competence, as well as acceptable inter- and intra-rater reliability scores. Further studies should, however, be performed to determine the adequate number of assessments needed to ensure high content validity and reliability in a clinical setting.
Echocardiographie, Ventrikulographie und Coronarangiographie bei Patienten mit Zustand nach akutem Myocardinfarkt. (Echocardiography, ventriculography and coronary angiography in patients just recovering from acute myocardial infarction).
National Technical Information Service (NTIS)
Comparative evaluations were carried out on the basis of ventriculography, echocardiography and corornary angiography that would permit to throw some light on the following issues: Can the changes in overall ventricular function occurring in response to t...
S. Goetz
Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: a critical appraisal. Supported by the British Society of Echocardiography
Stress echocardiography today has matured into a robust and reliable technique not only for the diagnosis of suspected coronary artery disease (CAD) but also for the accurate risk stratification of patients with suspected and established CAD. This is mainly because of rapid advances in image acquisition, digital display, and the development of harmonic and contrast imaging. Stress echocardiography today is also utilised in patients with heart failure both for assessing the cause of heart failure and determining the extent of hibernating myocardium. With advances in myocardial perfusion imaging, stress echocardiography now allows simultaneous assessment of myocardial function and perfusion. Tissue Doppler imaging allows quantitation of wall motion. Ready availability and reliability makes stress echocardiography a cost effective technique for the assessment of CAD.
Senior, R; Monaghan, M; Becher, H; Mayet, J; Nihoyannopoulos, P
Multi-view 3D echocardiography compounding based on feature consistency.
Echocardiography (echo) is a widely available method to obtain images of the heart; however, echo can suffer due to the presence of artefacts, high noise and a restricted field of view. One method to overcome these limitations is to use multiple images, using the 'best' parts from each image to produce a higher quality 'compounded' image. This paper describes our compounding algorithm which specifically aims to reduce the effect of echo artefacts as well as improving the signal-to-noise ratio, contrast and extending the field of view. Our method weights image information based on a local feature coherence/consistency between all the overlapping images. Validation has been carried out using phantom, volunteer and patient datasets consisting of up to ten multi-view 3D images. Multiple sets of phantom images were acquired, some directly from the phantom surface, and others by imaging through hard and soft tissue mimicking material to degrade the image quality. Our compounding method is compared to the original, uncompounded echocardiography images, and to two basic statistical compounding methods (mean and maximum). Results show that our method is able to take a set of ten images, degraded by soft and hard tissue artefacts, and produce a compounded image of equivalent quality to images acquired directly from the phantom. Our method on phantom, volunteer and patient data achieves almost the same signal-to-noise improvement as the mean method, while simultaneously almost achieving the same contrast improvement as the maximum method. We show a statistically significant improvement in image quality by using an increased number of images (ten compared to five), and visual inspection studies by three clinicians showed very strong preference for our compounded volumes in terms of overall high image quality, large field of view, high endocardial border definition and low cavity noise. PMID:21873770
Yao, Cheng; Simpson, John M; Schaeffter, Tobias; Penney, Graeme P
Multi-view 3D echocardiography compounding based on feature consistency
NASA Astrophysics Data System (ADS)
Echocardiography (echo) is a widely available method to obtain images of the heart; however, echo can suffer due to the presence of artefacts, high noise and a restricted field of view. One method to overcome these limitations is to use multiple images, using the 'best' parts from each image to produce a higher quality 'compounded' image. This paper describes our compounding algorithm which specifically aims to reduce the effect of echo artefacts as well as improving the signal-to-noise ratio, contrast and extending the field of view. Our method weights image information based on a local feature coherence/consistency between all the overlapping images. Validation has been carried out using phantom, volunteer and patient datasets consisting of up to ten multi-view 3D images. Multiple sets of phantom images were acquired, some directly from the phantom surface, and others by imaging through hard and soft tissue mimicking material to degrade the image quality. Our compounding method is compared to the original, uncompounded echocardiography images, and to two basic statistical compounding methods (mean and maximum). Results show that our method is able to take a set of ten images, degraded by soft and hard tissue artefacts, and produce a compounded image of equivalent quality to images acquired directly from the phantom. Our method on phantom, volunteer and patient data achieves almost the same signal-to-noise improvement as the mean method, while simultaneously almost achieving the same contrast improvement as the maximum method. We show a statistically significant improvement in image quality by using an increased number of images (ten compared to five), and visual inspection studies by three clinicians showed very strong preference for our compounded volumes in terms of overall high image quality, large field of view, high endocardial border definition and low cavity noise.
Yao, Cheng; Simpson, John M.; Schaeffter, Tobias; Penney, Graeme P.
Limitations in assessing the severity of aortic stenosis by Doppler gradients.
Continuous wave Doppler echocardiography was performed before cardiac catheterisation in 69 consecutive patients with suspected aortic stenosis. Agreement between the maximum and the mean Doppler gradients and catheterisation gradients was good. Doppler echocardiography, however, systematically underestimated the maximum and mean gradients, particularly in the high range. Stepwise regression analysis of the small pressure difference between the two methods showed that it could not be explained by age, sex, stroke volume, differences in heart rate, ejection fraction, the presence of coronary artery disease, or severity of aortic regurgitation. There was a negative curvilinear correlation between the maximum and mean Doppler gradients and the aortic valve areas that were measured at catheterisation in patients with pure aortic stenosis. The degree of correlation decreased when patients with concomitant aortic regurgitation were included. The scatter of gradients above and below the correlation line was large and this was caused by low and high transvalvar flow. These results show that the usefulness of Doppler gradients for judging the severity of aortic stenosis, both in relation to immediate diagnosis and follow up, is severely limited if transvalvar flow is not taken into account.
Danielsen, R; Nordrehaug, J E; Stangeland, L; Vik-Mo, H
Use of echocardiography for predicting myocardial viability in patients with reperfused anterior wall myocardial infarction
Dobutamine stress echocardiography (DSE), myocardial contrast echocardiography (MCE), and ultrasonic tissue characterization with integrated backscatter are useful methods for assessing myocardial viability in acute myocardial infarction. In this study, we compared the potential of 3 methods for predicting myocardial viability in 38 patients with reperfused anterior wall acute myocardial infarction. We performed MCE shortly after coronary reperfusion with an intracoronary
Katsuomi Iwakura; Hiroshi Ito; Nagahiro Nishikawa; Ken Sugimoto; Yasunori Shintani; Koichi Yamamoto; Yorihiko Higashino; Tohru Masuyama; Masatsugu Hori; Kenshi Fujii
Sensitivity and specificity of transesophageal echocardiography for determination of aortic valve morphology
Background Preoperative recognition of the presence of bicuspid aortic valve can be important in the planning of procedures. Multiplane transesophageal echocardiography may allow more accurate detection of valvular morphology than does biplane transesophageal echocardiography.Methods and Results The studies of 710 patients who subsequently underwent valvular or aortic surgery were reviewed in a blinded fashion. The inclusion criteria were adequate short-axis
Miguel Espinal; Anthon R. Fuisz; Navin C. Nanda; Srinivasa Reddy Aaluri; Osman Mukhtar; Padmini C. Sekar
Myocardial viability assessed by Dobutamine echocardiography in acute myocardial infarction after successful primary coronary angioplasty
Dobutamine echocardiography (5 and 10 ?g\\/kg\\/ min) was performed in 40 patients 4 � 1 days after acute myocardial infarction reperfused by primary coronary angioplasty. The left ventricle was divided into 11 segments. Reversible myocardial dysfunction was indicated by a decrease in at least 2 grades in the total segmental score. Follow-up echocardiography was performed 2 months later. Contractile reserve
Florence Leclercq; Patrick Messner-Pellenc; Christophe Moragues; Fran�ois Rivalland; Denis Carabasse; Jean-Marc Davy; Robert Grolleau-Raoux
Accuracy of echocardiography for detection of aortic arch obstruction after stage I Norwood procedure
Background Echocardiography has been widely used in postoperative assessment after stage I Norwood procedure, but its accuracy in detecting aortic arch obstruction (AAO) has not been determined. This study was designed to determine the accuracy of echocardiography in the diagnosis of AAO after stage I Norwood procedure, identify echocardiographic predictors of arch obstruction, and examine the time course of its
Alain Fraisse; Steven D. Colan; Richard A. Jonas; Kimberlee Gauvreau; Tal Geva
Effect of color coding and subtraction on the accuracy of contrast echocardiography
NASA Technical Reports Server (NTRS)
BACKGROUND: Contrast echocardiography may be used to assess myocardial perfusion. However, gray scale assessment of myocardial contrast echocardiography (MCE) is difficult because of variations in regional backscatter intensity, difficulties in distinguishing varying shades of gray, and artifacts or attenuation. We sought to determine whether the assessment of rest myocardial perfusion by MCE could be improved with subtraction and color coding. METHODS AND RESULTS: MCE was performed in 31 patients with previous myocardial infarction with a 2nd generation agent (NC100100, Nycomed AS), using harmonic triggered or continuous imaging and gain settings were kept constant throughout the study. Digitized images were post processed by subtraction of baseline from contrast data and colorized to reflect the intensity of myocardial contrast. Gray scale MCE alone, MCE images combined with baseline and subtracted colorized images were scored independently using a 16 segment model. The presence and severity of myocardial contrast abnormalities were compared with perfusion defined by rest MIBI-SPECT. Segments that were not visualized by continuous (17%) or triggered imaging (14%) after color processing were excluded from further analysis. The specificity of gray scale MCE alone (56%) or MCE combined with baseline 2D (47%) was significantly enhanced by subtraction and color coding (76%, p<0.001) of triggered images. The accuracy of the gray scale approaches (respectively 52% and 47%) was increased to 70% (p<0.001). Similarly, for continuous images, the specificity of gray scale MCE with and without baseline comparison was 23% and 42% respectively, compared with 60% after post processing (p<0.001). The accuracy of colorized images (59%) was also significantly greater than gray scale MCE (43% and 29%, p<0.001). The sensitivity of MCE for both acquisitions was not altered by subtraction. CONCLUSION: Post-processing with subtraction and color coding significantly improves the accuracy and specificity of MCE for detection of perfusion defects.
Pasquet, A.; Greenberg, N.; Brunken, R.; Thomas, J. D.; Marwick, T. H.
Patient-Specific Mitral Valve Closure Prediction using 3D Echocardiography
This paper presents an approach to modeling the closure of the mitral valve using patient-specific anatomical information derived from 3D transesophageal echocardiography (3D TEE). Our approach uses physics-based modeling to solve for the stationary configuration of the closed valve structure from the patient-specific open valve structure, which is recovered using a user-in-the-loop, thin-tissue detector segmentation. The method utilizes a tensile shape finding approach based on energy minimization. This method is used to predict the aptitude of the mitral valve leaflets to coapt. We tested the method using ten intraoperative 3D TEE sequences by comparing (a) the closed valve configuration predicted from the segmented open valve, with (b) the segmented closed valve, taken as ground truth. Experiments show promising results, with prediction errors on par with 3D TEE resolution and with good potential for applications in pre-operative planning.
Burlina, Philippe; Sprouse, Chad; Mukherjee, Ryan; DeMenthon, Daniel; Abraham, Theodore
Intracardiac echocardiography measurement of dynamic myocardial stiffness with shear wave velocimetry.
Acoustic radiation force (ARF)-based methods have been demonstrated to be a viable tool for noninvasively estimating tissue elastic properties, and shear wave velocimetry has been used to measure quantitatively the stiffening and relaxation of myocardial tissue in open-chest experiments. Dynamic stiffness metrics may prove to be indicators for certain cardiac diseases, but a clinically viable means of remotely generating and tracking transverse wave propagation in myocardium is needed. Intracardiac echocardiography (ICE) catheter-tip transducers are demonstrated here as a viable tool for making this measurement. ICE probes achieve favorable proximity to the myocardium, enabling the use of shear wave velocimetry from within the right ventricle throughout the cardiac cycle. This article describes the techniques used to overcome the challenges of using a small probe to perform ARF-driven shear-wave velocimetry and presents in vivo porcine data showing the effectiveness of this method in the interventricular septum. PMID:22579544
Hollender, Peter J; Wolf, Patrick D; Goswami, Robi; Trahey, Gregg E
Radial Basis Functions for Combining Shape and Speckle Tracking in 4D Echocardiography.
Quantitative analysis of left ventricular deformation can provide valuable information about the extent of disease as well as the efficacy of treatment. In this work, we develop an adaptive multi-level compactly supported radial basis approach for deformation analysis in 3D+time echocardiography. Our method combines displacement information from shape tracking of myocardial boundaries (derived from B-mode data) with mid-wall displacements from radio-frequency-based ultrasound speckle tracking. We evaluate our methods on open-chest canines (N=8) and show that our combined approach is better correlated to magnetic resonance tagging-derived strains than either individual method. We also are able to identify regions of myocardial infarction (confirmed by postmortem analysis) using radial strain values obtained with our approach. PMID:24893257
Compas, Colin B; Wong, Emily Y; Huang, Xiaojie; Sampath, Smita; Lin, Ben A; Pal, Prasanta; Papademetris, Xenophon; Thiele, Karl; Dione, Donald P; Stacy, Mitchel; Staib, Lawrence H; Sinusas, Albert J; O'Donnell, Matthew; Duncan, James S
Improvement of Automated Identification of the Heart Wall in Echocardiography by Suppressing Clutter Component
NASA Astrophysics Data System (ADS)
For the facilitation of analysis and elimination of the operator dependence in estimating the myocardial function in echocardiography, we have previously developed a method for automated identification of the heart wall. However, there are misclassified regions because the magnitude-squared coherence (MSC) function of echo signals, which is one of the features in the previous method, is sensitively affected by the clutter components such as multiple reflection and off-axis echo from external tissue or the nearby myocardium. The objective of the present study is to improve the performance of automated identification of the heart wall. For this purpose, we proposed a method to suppress the effect of the clutter components on the MSC of echo signals by applying an adaptive moving target indicator (MTI) filter to echo signals. In vivo experimental results showed that the misclassified regions were significantly reduced using our proposed method in the longitudinal axis view of the heart.
Takahashi, Hiroki; Hasegawa, Hideyuki; Kanai, Hiroshi
Enoximon-echocardiography. A new diagnostic approach for the detection of viable myocardium comparison to dobutamin-echocardiography.
Hypo- or akinetic myocardial regions can be identified as viable myocardium through recruitment of inotropic reserve. Both, dobutamine (D) as well as enoximone (E) mediate their inotropic action via an increase in intracellular c-AMP concentration based on a different action. In 10 patients with documented myocardial infarction either D (5 to 40 micrograms/kg/min, increments of 5 micrograms/kg/min every 3 min) or E (1 to 9 micrograms/kg/min, increments of 1 microgram/kg/min every 2 min) was administered intravenously on two consecutive days. Heart rate (HR), systolic and diastolic blood pressure (BP), as well as a wall motion score in 16 segment (WMS) and ejection fraction (EF) with 2D-echocardiography were determined at rest and during each increment. Viability of myocardial regions was assessed with 201thallium-SPECT (Table 1). Results: *p < 0.05 vs. rest, data: mean +/- SD. While E did not cause any side effects, patients complained about rash (n = 10), headache (n = 8), angina pectoris (n = 5), and anxiety (n = 2) during the administration of D. D and E are both able to recruit a potential inotropic reserve in infarcted myocardium, and thus, identify viable myocardium. In contrast to E, D caused an increase in HR and systolic BP. Enoximone-echocardiography seems to be a new, promising tool for the identification of viable myocardium. PMID:7959537
Baumgart, D; Buck, T; Leischik, R; Oelert, H; Farahati, J; Reiners, C; Erbel, R
Cardiac Impairment Evaluated by Transesophageal Echocardiography and Invasive Measurements in Rats Undergoing Sinoaortic Denervation
Background Sympathetic hyperactivity may be related to left ventricular (LV) dysfunction and baro- and chemoreflex impairment in hypertension. However, cardiac function, regarding the association of hypertension and baroreflex dysfunction, has not been previously evaluated by transesophageal echocardiography (TEE) using intracardiac echocardiographic catheter. Methods and Results We evaluated exercise tests, baroreflex sensitivity and cardiovascular autonomic control, cardiac function, and biventricular invasive pressures in rats 10 weeks after sinoaortic denervation (SAD). The rats (n?=?32) were divided into 4 groups: 16 Wistar (W) with (n?=?8) or without SAD (n?=?8) and 16 spontaneously hypertensive rats (SHR) with (n?=?8) or without SAD (SHRSAD) (n?=?8). Blood pressure (BP) and heart rate (HR) did not change between the groups with or without SAD; however, compared to W, SHR groups had higher BP levels and BP variability was increased. Exercise testing showed that SHR had better functional capacity compared to SAD and SHRSAD. Echocardiography showed left ventricular (LV) concentric hypertrophy; segmental systolic and diastolic biventricular dysfunction; indirect signals of pulmonary arterial hypertension, mostly evident in SHRSAD. The end-diastolic right ventricular (RV) pressure increased in all groups compared to W, and the end-diastolic LV pressure increased in SHR and SHRSAD groups compared to W, and in SHRSAD compared to SAD. Conclusions Our results suggest that baroreflex dysfunction impairs cardiac function, and increases pulmonary artery pressure, supporting a role for baroreflex dysfunction in the pathogenesis of hypertensive cardiac disease. Moreover, TEE is a useful and feasible noninvasive technique that allows the assessment of cardiac function, particularly RV indices in this model of cardiac disease.
Sirvente, Raquel A.; Irigoyen, Maria C.; Souza, Leandro E.; Mostarda, Cristiano; La Fuente, Raquel N.; Candido, Georgia O.; Souza, Pamella R. M.; Medeiros, Alessandra; Mady, Charles; Salemi, Vera M. C.
Intracardiac Echocardiography (ICE) Measurement of Dynamic Myocardial Stiffness with Shear Wave Velocimetry
Acoustic Radiation Force (ARF)-based methods have been demonstrated to be a viable tool for noninvasively estimating tissue elastic properties, and shear wave velocimetry has been used to quantitatively measure the stiffening and relaxation of myocardial tissue in open-chest experiments. Dynamic stiffness metrics may prove to be indicators for certain cardiac diseases, but a clinically-viable means of remotely generating and tracking transverse wave propagation in myocardium is needed. Intracardiac echocardiography (ICE) catheter-tip transducers are demonstrated here as a viable tool for making this measurement. ICE probes achieve favorable proximity to the myocardium, enabling the use of shear wave velocimetry from within the right ventricle throughout the cardiac cycle. This work describes the techniques used to overcome the challenges of using a small probe to perform ARF-driven shear wave velocimetry, and presents in vivo porcine data showing the effectiveness of this method in the interventricular septum. Acoustic Radiation Force (ARF)-based methods have been demonstrated to be a viable tool for noninvasively estimating tissue elastic properties, and shear wave velocimetry has been used to quantitatively measure the stiffening and relaxation of myocardial tissue in open-chest experiments. Dynamic stiffness metrics may prove to be indicators for certain cardiac diseases, but a clinically-viable means of remotely generating and tracking transverse wave propagation in myocardium is needed. Intracardiac echocardiography (ICE) catheter-tip transducers are demonstrated here as a viable tool for making this measurement. ICE probes achieve favorable proximity to the myocardium, enabling the use of shear wave velocimetry from within the right ventricle throughout the cardiac cycle. This work describes the techniques used to overcome the challenges of using a small probe to perform ARF-driven shear wave velocimetry, and presents in vivo porcine data showing the effectiveness of this method in the interventricular septum.
Hollender, Peter J.; Wolf, Patrick D.; Goswami, Robi; Trahey, Gregg E.
Three-dimensional echocardiography in the evaluation of global and regional function in patients with recent myocardial infarction: a comparison with magnetic resonance imaging.
We aimed to compare three-dimensional (3D) and two-dimensional (2D) echocardiography in the evaluation of patients with recent myocardial infarction (MI), using late-enhancement magnetic resonance imaging (LE-MRI) as a reference method. Echocardiography and LE-MRI were performed approximately 1�month after first-time MI in 58 patients. Echocardiography was also performed on 35 healthy controls. Left ventricular (LV) ejection fraction by 3D echocardiography (3D-LVEF), 3D wall-motion score (WMS), 2D-WMS, 3D speckle tracking-based longitudinal, circumferential, transmural and area strain, and 2D speckle tracking-based longitudinal strain (LS) were measured. The global correlations to infarct size by LE-MRI were significantly higher (P�<�0.03) for 3D-WMS and 2D-WMS compared with 3D-LVEF and the 4 different measurements of 3D strain, and 2D global longitudinal strain (GLS) was more closely correlated to LE-MRI than 3D GLS (P�<�0.03). The segmental correlations to infarct size by LE-MRI were also significantly higher (P�<�0.04) for 3D-WMS, 2D-WMS, and 2D LS compared with the other indices. Three-dimensional WMS showed a sensitivity of 76% and a specificity of 72% for identification of LV infarct size >12%, and a sensitivity of 73% and a specificity of 95% for identification of segments with transmural infarct extension. Three-dimensional WMS and 2D gray-scale echocardiography showed the strongest correlations to LE-MRI. The tested 3D strain method suffers from low temporal and spatial resolution in 3D acquisitions and added diagnostic value could not be proven. PMID:23347171
Thorstensen, Anders; Dalen, H�vard; Hala, Pavel; Kiss, Gabriel; D'hooge, Jan; Torp, Hans; St�ylen, Asbj�rn; Amundsen, Brage
Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease
OBJECTIVES: The prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease according to disease severity has not yet been established. The aim of this study was to assess the prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease patients according to disease severity. METHODS: The study included 25 mild/moderate chronic obstructive pulmonary disease patients and 25 severe/very severe chronic obstructive pulmonary disease patients. All participants underwent clinical evaluation, spirometry and electrocardiography/echocardiography. RESULTS: Electrocardiography and echocardiography showed Q-wave alterations and segmental contractility in five (10%) patients. The most frequent echocardiographic finding was mild left diastolic dysfunction (88%), independent of chronic obstructive pulmonary disease stage. The proportion of right ventricular overload (p<0.05) and blockage of the anterosuperior division of the left bundle branch were higher in patients with greater obstruction. In an echocardiographic analysis, mild/moderate chronic obstructive pulmonary disease patients showed more abnormalities in segmental contractility (p<0.05), whereas severe/very severe chronic obstructive pulmonary disease patients showed a higher prevalence of right ventricular overload (p<0.05), increased right cardiac chamber (p<0.05) and higher values of E-wave deceleration time (p<0.05). Age, sex, systemic arterial hypertension, C-reactive protein and disease were included as independent variables in a multiple linear regression; only disease severity was predictive of the E-wave deceleration time [r2?=?0.26, p?=?0.01]. CONCLUSION: Chronic obstructive pulmonary disease patients have a high prevalence of left ventricular diastolic dysfunction, which is associated with disease severity. Because of this association, it is important to exclude decompensated heart failure during chronic obstructive pulmonary disease exacerbation.
de Oliveira Caram, Laura Miranda; Ferrari, Renata; Naves, Cristiane Roberta; Tanni, Suzana Erico; Coelho, Liana Sousa; Zanati, Silmeia Garcia; Minicucci, Marcos Ferreira; Godoy, Irma
Non-Invasive Determination of Left Ventricular Workload in Patients with Aortic Stenosis Using Magnetic Resonance Imaging and Doppler Echocardiography
Early detection and accurate estimation of aortic stenosis (AS) severity are the most important predictors of successful long-term outcomes in patients. Current clinical parameters used for evaluation of the AS severity have several limitations including flow dependency. Estimation of AS severity is specifically challenging in patients with low-flow and low transvalvular pressure gradient conditions. A proper diagnosis in these patients needs a comprehensive evaluation of the left ventricle (LV) hemodynamic loads. This study has two objectives: (1) developing a lumped-parameter model to describe the ventricular-valvular-arterial interaction and to estimate the LV stroke work (SW); (2) introducing and validating a new index, the normalized stroke work (N-SW), to assess the global hemodynamic load imposed on the LV. N-SW represents the global hemodynamic load that the LV faces for each unit volume of blood ejected. The model uses a limited number of parameters which all can be measured non-invasively using current clinical imaging modalities. The model was first validated by comparing its calculated flow waveforms with the ones measured using Cardiovascular Magnetic Resonance (CMR) in 49 patients and 8 controls. A very good correlation and concordance were found throughout the cycle (median root mean square: 12.21 mL/s) and between the peak values (r?=?0.98; SEE?=?0.001, p<0.001). The model was then used to determine SW using the parameters measured with transthoracic Doppler-echocardiography (TTE) and CMR. N-SW showed very good correlations with a previously-validated index of global hemodynamic load, the valvular arterial impedance (), using data from both imaging modalities (TTE: r?=?0.82, SEE?=?0.01, p<0.001; CMR: r?=?0.74, SEE?=?0.01, p<0.001). Furthermore, unlike , N-SW was almost independent from variations in the flow rate. This study suggests that considering N-SW may provide incremental diagnostic and prognostic information, beyond what standard indices of stenosis severity and provide, particularly in patients with low LV outflow.
Keshavarz-Motamed, Zahra; Garcia, Julio; Gaillard, Emmanuel; Capoulade, Romain; Le Ven, Florent; Cloutier, Guy; Kadem, Lyes; Pibarot, Philippe
Ventricular performance after surgery for a congenital heart defect as assessed using advanced echocardiography: from doppler flow to 3D echocardiography and speckle-tracking strain imaging.
A varying degree of impairment of ventricular performance is observed over the long-term after surgery for a congenital heart defect (CHD). Impaired ventricular performance has been shown to be of prognostic value for increased risk of cardiovascular events in adult CHD patients. This emphasizes the importance of delineating the timing and cause of this postoperative impairment. Impairment of ventricular performance could develop over time as a consequence of residua, sequelae and complications of the CHD or surgical procedure. Yet, impaired ventricular performance has also been observed immediately after surgery and can persist and/or worsen over time. This postoperative impairment of ventricular performance is the focus of this review. This article provides an overview of echocardiographic techniques currently used to assess ventricular performance. Furthermore, we review current literature describing ventricular performance, as assessed using echocardiography, after correction of a CHD. In general, a decrease in ventricular performance is observed directly after surgery for CHD�s. Subsequent follow-up of ventricular performance is characterized by a varying degree of postoperative recovery. A consistent observation is the persistent impairment of right-ventricular performance after repair in several different subgroups of CHD patients ranging from ventricular septal defect repair to surgery for Tetralogy of Fallot. PMID:24121730
Klitsie, Liselotte M; Roest, Arno A W; Blom, Nico A; ten Harkel, Arend D J
Angiographically borderline left main coronary artery lesions: correlation of transthoracic doppler echocardiography and intravascular ultrasound: a pilot study
Background the clinical decision making could be difficult in patients with borderline lesions (visually assessed stenosis severity of 30 to 50%) of the left main coronary artery (LM). The aim of the study was to evaluate the relationship between transthoracic Doppler (TTDE) peak diastolic flow velocity (PDV) and intravascular ultrasound (IVUS) measurements in the assessment of angiographically borderline LM lesions. Methods 27 patients (mean age 64 � 8 years, 21 males) with borderline LM stenosis referred for IVUS examination were included in the study. We performed standard IVUS with minimal lumen area (MLA) and plaque burden (PB) measurement and routine quantitative coronary angiography (QCA) with diameter stenosis (%DS) and area stenosis (%AS) assessment in all. During TTDE, resting PDV was measured in the LM. Results interpretable Doppler signal could be obtained in 24 patients (88% feasibility); therefore these patients entered the final analysis. MLA was 7.1 � 2.7 mm2. TTDE measured PDV correlated significantly with IVUS-derived MLA (r = -0.46, p < 0.05) and plaque burden (r = 0.51, p < 0.05). Using a velocity cut-off of 112 cm/sec TTDE showed a 92% sensitivity and 62% specificity to identify IVUS-significant (MLA < 6 mm2) LM stenosis. Conclusion In angiographically borderline LM disease, resting PDV from transthoracic echocardiography is increased in presence of increased plaque burden by IVUS. TTDE evaluation might be a useful adjunct to other invasive and non-invasive methods in the assessment of borderline LM lesions. Further, large scale studies are needed to establish the exact cut-off value of PDV for routine clinical application.
Relationship between mitral leaflets angles, left ventricular geometry and mitral deformation indices in patients with ischemic mitral regurgitation: imaging by echocardiography and cardiac magnetic resonance
Chronic ischemic mitral regurgitation (IMR) is associated with a markedly worse prognosis after myocardial infarction (MI).The\\u000a study aimed to evaluate the relationship between anterior and posterior mitral leaflet angle (MLA) values, left ventricle\\u000a remodeling and severity of ischaemic mitral regurgitation (IMR). Methods: Forty-two patients (age 63.5���9.7�years, 36 men) with chronic IMR (regurgitant volume, RV�>�20�ml; >6�months after MI)\\u000a underwent transthoracic echocardiography
Agata Lesniak-SobelgaEwa; Ewa Wicher-Muniak; Magdalena Kostkiewicz; Maria Olszowska; Piotr Musia?ek; Piotr Klimeczek; Pawe? Bany?; Mieczys?aw Pasowicz; Wies?awa Tracz; Piotr Podolec
Exercise echocardiography in the detection of anthracycline cardiotoxicity.
Twenty long-term survivors of childhood cancer underwent exercise echocardiography to evaluate possible late anthracycline-induced cardiac toxicity. Ten patients ages 10 to 20 years had received anthracyclines, and ten patients ages 8 to 27 years had not received anthracyclines as part of their medical regimen. Both groups had normal cardiac function at rest. Patients who had not received anthracyclines had a greater increase in M-mode shortening fraction (P less than 0.005), velocity of circumferential fiber shortening (P = 0.05), and Doppler aortic peak flow velocity (P = 0.01) than patients receiving anthracyclines. There were no significant differences in work performed, or increase in heart rate or blood pressure with exercise between the groups. These results suggest that subtle abnormalities in myocardial function exist which become apparent only after exercise in survivors of childhood cancer who have received anthracyclines and have normal resting cardiac function. PMID:2070339
Weesner, K M; Bledsoe, M; Chauvenet, A; Wofford, M
On-Orbit Prospective Echocardiography on International Space Station Crew
NASA Technical Reports Server (NTRS)
Introduction A prospective trial of echocardiography was conducted on of six crewmembers onboard the International Space Station. The main objective was to determine the efficacy of remotely guided tele-echocardiography, including just-in-time e-training methods and determine what "space normal" echocardiographic data is. Methods Each crewmember operator (n=6) had 2-hour preflight training. Baseline echocardiographic data were collected 55 to 167days preflight. Similar equipment was used in each 60-minute in-flight session (mean microgravity exposure - 114 days (34 -- 190)). On Orbit ultrasound operators used an e-learning system within 24h of these sessions. Expert assistance was provided using ultrasound video downlink and two-way voice. Testing was repeated 5 to 16 days after landing. Separate ANOVA was used on each echocardiographic variable (n=33). Within each ANOVA, three tests were made: a) effect of mission phase (preflight, in-flight, post flight); b) effect of echo technician (two technicians independently analyzed the data); c) interaction between mission phase and technician. Results Nine rejections of the null hypothesis (mission phase or technician or both had no effect) were discovered and considered for follow up. Of these, six rejections were for significant technician effects, not as a result of space flight. Three rejections of the null hypothesis (Aortic Valve time velocity integral, Mitral E wave Velocity and heart rate) were attributable to space flight, however determined not to be clinically significant. No rejections were due to the interaction between technician and space flight. Conclusion No consistent clinically significant effects of long-duration space flight were seen in echocardiographic variables of the given group of subjects.
Hamilton, Douglas R.; Sargsyan, Ashot E.; Martin, David S.; Garcia, Kathleen M.; Melton, Shannon L.; Feiveson, Alan; Dulchavsky, Scott A.
Transesophageal echocardiography in patients with cryptogenic cerebral ischemia
Background In about one third of all patients with cerebral ischemia, no definite cause can be identified (cryptogenic stroke). In many patients with initially suspected cryptogenic stroke, however, a cardiogenic etiology can eventually be determined. Hence, the aim of this study was to describe the prevalence of abnormal echocardiographic findings in a large number of these patients. Method Patients with cryptogenic cerebral ischemia (ischemic stroke, IS, and transient ischemic attack, TIA) were included. The initial work-up included a neurological examination, EEG, cCT, cMRT, 12-lead ECG, Holter-ECG, Doppler ultrasound of the extracranial arteries, and transthoracic echocardiography. A multiplane transeophageal echocardiography (TEE, including i.v. contrast medium application [Echovist], Valsalva maneuver) was performed in all patients Results 702 consecutive patients (380 male, 383 IS, 319 TIA, age 18�90 years) were included. In 52.6% of all patients, TEE examination revealed relevant findings. Overall, the most common findings in all patients were: patent foramen ovale (21.7%), previously undiagnosed valvular disease (15.8%), aortic plaques, aortic valve sclerosis, atrial septal aneurysms, regional myocardial dyskinesia, dilated left atrium and atrial septal defects. Older patients (> 55 years, n = 291) and patients with IS had more relevant echocardiographic findings than younger patients or patients with TIA, respectively (p = 0.002, p = 0.003). The prevalence rates of PFO or ASD were higher in younger patients (PFO: 26.8% vs. 18.0%, p = 0.005, ASD: 9.6% vs. 4.9%, p = 0.014). Conclusion A TEE examination in cryptogenic stroke reveals contributing cardiogenic factors in about half of all patients. Younger patients had a higher prevalence of PFO, whereas older patients had more frequently atherosclerotic findings. Therefore, TEE examinations seem indicated in all patients with cryptogenic stroke � irrespective of age � because of specific therapeutic consequences.
Knebel, Fabian; Masuhr, Florian; von Hausen, Wolfram; Walde, Torsten; Dreger, Henryk; Raab, Vanessa; Yuerek, Mahsun; Baumann, Gert; Borges, Adrian C
Extreme Tele-Echocardiography: Methodology for Remote Guidance of In-flight Echocardiography Aboard the International Space Station
NASA Technical Reports Server (NTRS)
Echocardiography is ideally suited for cardiovascular imaging in remote environments, but the expertise to perform it is often lacking. In 2001, an ATL HDI5000 was delivered to the International Space Station (ISS). The instrument is currently being used in a study to investigate the impact of long-term microgravity on cardiovascular function. The purpose of this report is to describe the methodology for remote guidance of echocardiography in space. Methods: In the year before launch of an ISS mission, potential astronaut echocardiographic operators participate in 5 sessions to train for echo acquisitions that occur roughly monthly during the mission, including one exercise echocardiogram. The focus of training is familiarity with the study protocol and remote guidance procedures. On-orbit, real-time guidance of in-flight acquisitions is provided by a sonographer in the Telescience Center of Mission Control. Physician investigators with remote access are able to relay comments on image optimization to the sonographer. Live video feed is relayed from the ISS to the ground via the Tracking and Data Relay Satellite System with a 2 second transmission delay. The expert sonographer uses these images along with two-way audio to provide instructions and feedback. Images are stored in non-compressed DICOM format for asynchronous relay to the ground for subsequent off-line analysis. Results: Since June, 2009, a total of 19 resting echocardiograms and 4 exercise studies have been performed in-flight. Average acquisition time has been 45 minutes, reflecting 26,000 km of ISS travel per study. Image quality has been adequate in all studies, but remote guidance has proven imperative for fine-tuning imaging and prioritizing views when communication outages limit the study duration. Typical resting studies have included 12 video loops and 21 still-frame images requiring 750 MB of storage. Conclusions: Despite limited crew training, remote guidance allows research-quality echocardiography to be performed by non-experts aboard the ISS. Analysis is underway and additional subjects are being recruited to define the impact of microgravity on cardiac structure and systolic and diastolic function.
Martin, David; Borowski, Allan; Bungo, Michael W.; Dulchavsky, Scott; Gladding, Patrick; Greenberg, Neil; Hamilton, Doug; Levine, Benjamin D.; Norwoord, Kelly; Platts, Steven H.; Poston, Sue; Roper, Matthew; Sandoz, Gwenn; Thomas, James D.
Indium-111 platelet scintigraphy and two-dimensional echocardiography for detection of left ventricular thrombus: influence of clot size and age
Two-dimensional echocardiography and indium-111 platelet scintigraphy were performed on 50 dogs to determine the influence of clot age and size on the detection of experimentally induced left ventricular mural thrombus. Thrombus was induced by apical infarction and injection of a sclerosing agent and thrombin. The animals were classified into four groups according to the time of indium-111 platelet injection after thrombus induction: Group I (17 dogs, 1/2 hour after induction; 3 dogs, before induction), Group II (12 dogs, 24 hours after induction) and Group III (12 dogs, 1 week after induction). In Group IV (six control dogs) apical infarction was produced, but thrombin was not injected; indium-111 platelets were injected 1/2 to 1 hour after infarction. The dogs were studied by indium-111 platelet scintigraphy and by two-dimensional echocardiography 1/2 to 5 hours (Group I) and 1 to 5 and up to 72 hours (Groups II to IV) after platelet administration and before death was induced. Two-dimensional echocardiography showed the best overall sensitivity for detection of acute thrombus (97%; 29 of 30). The sensitivity of indium-111 platelet scintigraphy was 86% (18 of 21) for clots greater than or equal to 0.08 ml in size, and 67% (20 of 30) for detection of all clots. Thrombus did not form in 14 dogs of Groups I to III and in 6 of 6 control dogs. The specificity of scintigraphy was 100% (20 of 20) compared with 80% (16 of 20) for echocardiography. Echocardiography was more sensitive than scintigraphy for detecting very small clots in this experimental model.
Seabold, J.E.; Schroeder, E.C.; Conrad, G.R.; Ponto, J.; Bruch, P.; Petersen, D.; Johnson, J.; Kieso, R.; Hunt, M.; Olson, J.D.
Television Quiz Show Simulation
ERIC Educational Resources Information Center
This article explores the simulation of four television quiz shows for students in China studying English as a foreign language (EFL). It discusses the adaptation and implementation of television quiz shows and how the students reacted to them.
Hill, Jonnie Lynn
Screening Adult Survivors of Childhood Cancer for Cardiomyopathy: Comparison of Echocardiography and Cardiac Magnetic Resonance Imaging
Purpose To compare two-dimensional (2D) echocardiography, the current method of screening for treatment-related cardiomyopathy recommended by the Children's Oncology Group Guidelines, to cardiac magnetic resonance (CMR) imaging, the reference standard for left ventricular (LV) function. Patients and Methods Cross-sectional, contemporaneous evaluation of LV structure and function by 2D and three-dimensional (3D) echocardiography and CMR imaging in 114 adult survivors of childhood cancer currently median age 39 years (range, 22 to 53 years) exposed to anthracycline chemotherapy and/or chest-directed radiation therapy. Results In this survivor population, 14% (n = 16) had an ejection fraction (EF) less than 50% by CMR. Survivors previously undiagnosed with cardiotoxicity (n = 108) had a high prevalence of EF (32%) and cardiac mass (48%) that were more than two standard deviations below the mean of normative CMR data. 2D echocardiography overestimated the mean EF of this population by 5%. Compared with CMR, 2D echocardiography (biplane method) had a sensitivity of 25% and a false-negative rate of 75% for detection of EF less than 50%, although 3D echocardiography had 53% and 47%, respectively. Twelve survivors (11%) had an EF less than 50% by CMR but were misclassified as ? 50% (range, 50% to 68%) by 2D echocardiography (biplane method). Detection of cardiomyopathy was improved (sensitivity, 75%) by using a higher 2D echocardiography cutoff (EF < 60%) to detect an EF less than 50% by the reference standard CMR. Conclusion CMR identified a high prevalence of cardiomyopathy among adult survivors previously undiagnosed with cardiac disease. 2D echocardiography demonstrated limited screening performance. In this high-risk population, survivors with an EF 50% to 59% by 2D echocardiography should be considered for comprehensive cardiac assessment, which may include CMR.
Armstrong, Gregory T.; Plana, Juan Carlos; Zhang, Nan; Srivastava, Deokumar; Green, Daniel M.; Ness, Kirsten K.; Daniel Donovan, F.; Metzger, Monika L.; Arevalo, Alejandro; Durand, Jean-Bernard; Joshi, Vijaya; Hudson, Melissa M.; Robison, Leslie L.; Flamm, Scott D.
Applicability, limitations and downstream impact of echocardiography utilization based on the Appropriateness Use Criteria for transthoracic and transesophageal echocardiography.
To evaluate impact of echocardiography on patient management based on published transthoracic echocardiography (TTE) Appropriate Use Criteria (AUC). A prospective analysis of 170 consecutive outpatients who underwent TTE over a period of 2 months. Echo studies were classified into appropriate (A), inappropriate (I), or uncertain (U) based on the 2007/2011 AUC. A fourth group of studies which were not addressed by the 2007 AUC and therefore have unclassifiable category (UC) were also included in the analysis. The impact of AUC categorized echo results on patient management were evaluated by review of patient records in the ensuing 2 months. Based on 2007 AUC, 77% (131/170) were A, 9% were I, and 14% were UC category. Echo studies classified as A were more likely to be associated with new and major findings, (P = 0.034) and (P = 0.028) respectively when compared to all other studies. Furthermore, patient care intervention as defined in the study protocol was significantly associated with A studies as opposed to I and UC studies (P = 0.004). A studies were also more likely to have an impact on patient management when compared to other studies (P = 0.022). When studies were re-evaluated based on the 2011 AUC, all prior UC studies were now included in the U group in the new AUC of 2011, and there was no change in A or I study classification. This study demonstrates that the 2007/2011 AUC are helpful in evaluating practice patterns in a majority of outpatients undergoing TTE. Implementing AUC have a direct clinical impact as A studies are significantly more likely to reveal new and major findings, and more likely to result in a patient care intervention based on the echo findings. PMID:22231468
Alqarqaz, Mohammad; Koneru, Jayanth; Mahan, Meredith; Ananthasubramaniam, Karthik
Mitral annular disjunction in myxomatous mitral valve disease: a relevant abnormality recognizable by transthoracic echocardiography
Background Mitral annular disjunction (MAD) consists of an altered spatial relation between the left atrial wall, the attachment of the mitral leaflets, and the top of the left ventricular (LV) free wall, manifested as a wide separation between the atrial wall-mitral valve junction and the top of the LV free wall. Originally described in association with myxomatous mitral valve disease, this abnormality was recently revisited by a surgical group that pointed its relevance for mitral valve reparability. The aims of this study were to investigate the echocardiographic prevalence of mitral annular disjunction in patients with myxomatous mitral valve disease, and to characterize the clinical profile and echocardiographic features of these patients. Methods We evaluated 38 patients with myxomatous mitral valve disease (mean age 57 � 15 years; 18 females) and used standard transthoracic echocardiography for measuring the MAD. Mitral annular function, assessed by end-diastolic and end-systolic annular diameters, was compared between patients with and without MAD. We compared the incidence of arrhythmias in a subset of 21 patients studied with 24-hour Holter monitoring. Results MAD was present in 21 (55%) patients (mean length: 7.4 � 8.7 mm), and was more common in women (61% vs 38% in men; p = 0.047). MAD patients more frequently presented chest pain (43% vs 12% in the absence of MAD; p = 0.07). Mitral annular function was significantly impaired in patients with MAD in whom the mitral annular diameter was paradoxically larger in systole than in diastole: the diastolic-to-systolic mitral annular diameter difference was -4,6 � 4,7 mm in these patients vs 3,4 � 1,1 mm in those without MAD (p < 0.001). The severity of MAD significantly correlated with the occurrence of non-sustained ventricular tachycardia (NSVT) on Holter monitoring: MAD�8.5 mm was a strong predictor for (NSVT), (area under ROC curve = 0.74 (95% CI, 0.5-0.9); sensitivity 67%, specificity 83%). There were no differences between groups regarding functional class, severity of mitral regurgitation, LV volumes, and LV systolic function. Conclusions MAD is a common finding in myxomatous mitral valve disease patients, easily recognizable by transthoracic echocardiography. It is more prevalent in women and often associated with chest pain. MAD significantly disturbs mitral annular function and when severe predicts the occurrence of NSVT.
Usefulness of the multiplanar reformatting mode of three-dimensional echocardiography in evaluating valvular and structural heart disease: An experience from Saudi Arabia
Objective The aim of this study is to compare the feasibility and capacity of multiplanar reformatting (MPR) mode of three-dimensional echocardiography (3DE-MPR technique) with two-dimensional echocardiography (2DE) for visualizing morphological details during evaluation of congenital heart disease (CHD). The study also seeks to validate the accuracy of 3DE MPR in determining cardiac valvular lesions and the application of the 3DE-MPR technique in daily clinical practice. Methods A cross-sectional study was carried out at Madinah Cardiac Centre, Saudi Arabia from May to December 2012. Various forms of CHD were diagnosed in 43 patients by conventional 2DE, and the patients were then examined with the 3DE-MPR technique using dedicated software and a standard protocol. Results Of the 43 patients, 23 (53.5%) were males and 20 (46.5%) females. Their age varied from 30�days to 146�months (mean age, 70.2�months and SD�=�42.5�months) and their weight from 4 to 42�kg (mean weight, 20.2�kg and SD�=�9.7�kg). The 2DE showed left heart lesions in nine patients (20.9%), right heart lesions in 23 (53.5%), atrial septal defects in five (11.6%) and complex CHD in six patients (14%). The 3DE MPR technique application and analysis was possible in all patients. The study demonstrated the fields where 3DE MPR was of additive value to conventional 2DE for the vena contracta area in valvular regurgitation severity and the planimetry for the valvular stenosis precise estimation, enface views of atrial septal defects with direct visualisation of shape and size of the defect, and segmental analysis of complex CHD using one window. The clinician and surgeon were then able to determine the mechanism and severity of the lesions and thus decide on appropriate treatment and management. Conclusion The study demonstrated the usefulness of 3DE-MPR as a complement to conventional 2DE. The technique is a significant technological breakthrough that allows instant visualization of morphological details and precise determination of cardiac valvular lesions, which were less clearly delineated by 2DE alone.
Khoshhal, Saad Q.
Left Ventricular Mass in 169 Healthy Children and Young Adults Assessed by Three-Dimensional Echocardiography
The aims of this study were to establish normal values of left ventricular (LV) mass in children and young adults using three-dimensional\\u000a echocardiography (3-DE) and to compare 3-DE LV mass estimates with those obtained by conventional echocardiographic methods.\\u000a We studied 169 healthy subjects aged 2�27 years by digitized 3-D, two-dimensional (2-D), and M-mode echocardiography. 3-D\\u000a echocardiography was performed by using
T. Poutanen; E. Jokinen
Use of Contrast Echocardiography in Intensive Care and at the Emergency Room
Bedside echocardiography in emergency room (ER) or in intensive care unit (ICU) is an important tool for managing critically ill patients, to obtain a timely accurate diagnosis and to immediately stratify the risk to the patient�s life. It may also render invasive monitoring unnecessary. In these patients, contrast echocardiography may improve quality of imaging and also may provide additional information, especially regarding myocardial perfusion in those with suspected coronary artery disease. This article focuses on the principle of contrast echocardiography and the clinical information that can be obtained according to the most frequent presentations in ER and ICU.
Cosyns, Bernard; Roossens, Bram; Hernot, Sophie; Haddad, Philippe El; Lignian, Herve; Pierard, Luc; Lancellotti, Patrizio
Comparison of Transesophageal and Transthoracic Contrast Echocardiography for Detection of a Patent Foramen Ovale
NASA Technical Reports Server (NTRS)
Presence of a patent foramen ovale may indicate paradoxic embolism in patients with otherwise unexplained embolic disease. Transthoracic contrast echocardiography has been used as a simple technique for detecting patent foramen ovale. However, particularly in patients with poor transthoracic image quality, presence of a patent foramen ovale might be missed. Transesophageal contrast echocardiography provides superior visualization of the atrial septum and therefore is believed to improve diagnostic accuracy. The present study investigates the influence of image quality on the detection of a patent foramen ovale by both transthoracic and transesophageal contrast echocardiography.
Siostrzonek, Peter; Zangeneh, Massoud; Gossinger, Heinz; Lang, Wilfried; Rosenmayr, Georg; Heinz, Gottfried; Stumpflen, Andreas; Zeiler, Karl; Schwarz, Martin; Mosslacher, Herbert
NSDL National Science Digital Library
With a laser pointer and some household items, learners can create their own laser light show. They can explore diffuse reflection, refraction and diffraction. The webpage includes a video which shows how to set up the activity and also includes scientific explanation. Because this activity involves lasers, it requires adult supervision.
Houston, Children'S M.
Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dipyridamole echocardiography.
Dipyridamole echocardiography test (DET) has gained acceptance due to its safety, feasibility, diagnostic accuracy and prognostic power. The main limitation of the test is a less than ideal sensitivity in some patient subsets, such as those with limited coronary artery disease. Atropine with dipyridamole might theoretically combine to become a synergistic ischaemic stress test, by increasing myocardial oxygen demand through chronotropic stress and by reducing flow supply through a shortening of the diastolic interval under maximal coronary vasodilation. The aim of this study was to assess the effects of the addition of atropine to DET. Three hundred and twenty-one patients (age = 58 +/- 9 years), referred for testing in the echo lab, were initially studied by DET. Of these, 151 were stopped during or within the 2 min following dipyridamole infusion because of achievement of a predetermined end-point: obvious echocardiographic positivity (n = 137), severe chest pain (n = 3), diagnostic ST segment changes (n = 7) or limited side effects (n = 4). In another three cases, atropine was not given due to a history of glaucoma or severe prostatic hypertrophy. In the remaining 167 patients with a negative DET test, atropine (0.25 mg intravenously, repeated every min up to a maximum of 1 mg, if necessary) was added, starting 3 min after the end of the dipyridamole infusion. The dipyridamole-atropine echo test (DETA) was positive in 32 and negative in 135 patients, and no major side effects occurred in any patient.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8223736
Picano, E; Pingitore, A; Conti, U; Koz�kov�, M; Boem, A; Cabani, E; Ciuti, M; Distante, A; L'Abbate, A
Severe left ventricular dysfunction in left atrial myxoma--report of 2 cases.
We report 2 patients with left atrial (LA) myxoma with associated severe left ventricular (LV) dysfunction. Both presented with progressive effort intolerance without a history suggestive of acute coronary event. LA myxoma was diagnosed by transthoracic echocardiography, which also detected severe systolic dysfunction and LV dilatation. Regional wall motion abnormality and thinning were absent. Coronary angiograms also showed no occlusive disease, but distal ectasia was seen in 1 patient. Metabolic and endocrine causes of reversible LV dysfunction were excluded. Cardiac function improved following surgery for myxoma in 1 patient. LV dysfunction, thus far, has not been directly attributed to myxoma. Coronary embolization leading to myocardial infarction and coexisting coronary atherosclerosis are the recognized methods by which LV dysfunction manifests in myxoma. Our report suggests the possibility of reversible severe global LV dysfunction due to cardiodepressant effect of myxoma through as yet unclear mechanisms. PMID:16444467
Chockalingam, Anand; Jaganathan, V; Gnanavelu, G; Dorairajan, Smrita; Chockalingam, V
[Standardized findings in echocardiography using WWW: EchoBefundSystem].
As a non-invasive imaging system, ultrasound echocardiography has a very high impact on modern diagnosis and is widely used in clinical routine but without any structured and standardized documentation of the results. Thus, quality management (QM), statistics and comparison of the results are difficult. Therefore, a working group of the German Cardiac Society issued a consensus proposal. For evaluation and wide public distribution, we have developed the first internet-based application covering the full proposal: EchoBefundSystem. The EchoBefundSystem is a web based client-server application for standardized documentation of echocardiography results right at the workplace. The software leads the examiner by means of a user interface design and stored medical knowledge. The level of detail is scaled automatically to the ongoing examination. Every day clinical routine is performed on only two pages, one for general patient data and a second one covering the complete minimal data set called "minimum finding" in the standard. As the examiner discovers more and more special findings or might even enter a complete medical study, the interface offers more and more fields and checkboxes. One data set can contain up to 600 values and findings. The structured user interface reflects the organ structure as well as examination methods familiar to the examiner. Automatically calculated fields speed up the examination. Judgements, diagnoses, values and ranges are interrelated. If there is a difference between the entered data and the medical knowledge base, a warning will be issued but the doctor's decision is authoritative. Some values may be gathered by different methods and even different units are converted automatically. The final doctor's letter is generated automatically in clear text but still editable and can be given out to the patient right after the examination without any further delay. Beside the minimal data set, all abnormal findings will appear and findings will be summarized wherever possible. The report is intended for the referring general practitioner, your own documentation, expert witness as well as clinical studies. Interested examiners may test the full version online at http://echo.ma.uni-heidelberg.de PMID:11220082
Schweikart, O; Metzger, F
Trade show management is a multi-faceted field, requiring a breadth of skills on the part of those engaged in the craft. Whether they go by the title of Show Manager, Director of Marketing, Vice President of Meetings\\/Conventions, or Director of Meetings\\/Conventions, these professionals work with exhibitors, attendees, and service providers to produce their events. The managers of the 200 largest
Susan Gregory; Deborah Breiter
Left atrial thrombus associated with ablation for atrial fibrillation: identification with intracardiac echocardiography
ObjectivesThis study reports the incidence of, risk factors for, and management of left atrial (LA) thrombus documented by intracardiac echocardiography (ICE) during LA ablation for atrial fibrillation (AF).
Jian-Fang Ren; Francis E Marchlinski; David J Callans
Value of live 3D transoesophageal echocardiography in the diagnosis of mitral valve lesions.
We experienced a case in which live 3D transoesophageal echocardiography (TEE) was found much more valuable than 2D TEE in assessing mitral lesions in circumferential direction and making surgical plans for mitral valve prolapse. PMID:18786947
Uno, Kansei; Takenaka, Katsu; Ebihara, Aya; Nawata, Kan; Hayashi, Naoto; Nagasaki, Mika; Sonoda, Makoto; Takayuki, Ohno; Ono, Minoru; Kyo, Shunei; Nagai, Ryozo; Takamoto, Shinichi
Mitral valve rheumatic multiple fenestrations: usefulness of 3D real-time echocardiography.
We describe a case that demonstrates and confirms the usefulness of 3D transesophageal echocardiography in the morphological analysis of the mitral valve in a rare occurrence of postrheumatic mitral leaflet perforation. PMID:23442809
D'Aloia, Antonio; Vizzardi, Enrico; Rovetta, Riccardo; Bugatti, Silvia; Bonadei, Ivano; Curnis, Antonio
Remote Echocardiography: Proof of Concept for Support of National Disasters, Combat and Humanitarian Mission.
National Technical Information Service (NTIS)
Echocardiography is an essential tool in the evaluation of patients with cardiac emergencies and chest trauma. The objective of our study was to establish the feasibility and diagnostic accuracy of a portable satellite transmission system in the assessmen...
S. Y. Boyd L. L. Huffer T. D. Bauch J. L. Furgerson
[Chronic chagasic cardiopathy in the Rio Negro, Amazon State. Report of three new autochthonous cases confirmed by serology, clinical examination, chest X-rays, electro and echocardiography].
We report three new autochthonous cases of chronic chagasic cardiomyopathy from Rio Negro, Amazon State, confirmed by serology (indirect immunofluorescence, ELISA and Western-blot for Trypanosoma cruzi infection), clinical examination, chest X-rays, electro- and echocardiography. The three patients were born and lived all their lives in the Rio Negro region working as pia�aba gatherers, where they were bitten several times by sylvatic triatomine bugs. The clinical feature was congestive heart failure and intraventricular conduction impairment in the three cases (right bundle branch block with left anterior hemiblock in two cases, left bundle branch block of 3rd degree in one), polymorphic ventricular extrasystoles in two cases and primary T wave inversion in another one. The echocardiographic evaluation showed a significant increasing of the left ventricular diameters with ejection fraction lesser than 36%, and myocardial segmental impairment pattern, including apical aneurysm and postero-inferior akinesia in the three patients. These are the first autochthonous cases of chronic Chagasic cardiomyopathy from the Brazilian Amazon state with echocardiographic pattern suggestive of Chagas' disease. PMID:16699652
Xavier, S�rgio Salles; Sousa, Andr�a Silvestre; Vi�as, Pedro Albajar; Junqueira, Angela C V; B�ia, M�rcio Neves; Coura, Jos� Rodrigues
The Echocardiography in the Cardiovascular Laboratory: A Guide to Research with Animals
The feasibility and potential for the morphological and hemodynamic investigation of the heart has been increasing the use of the echocardiography in the research setting. Additionally, the development of new technologies, like the real time 3D echocardiography and speckle tracking, demands validation throughout experimental studies before being instituted in the clinical setting. This paper aims to provide information concerning the particularities of the echocardiographic examination in quadruped mammals, targeting the experimental research.
Abduch, Maria Cristina Donadio; Assad, Renato Samy; Mathias Jr, Wilson; Aiello, Vera Demarchi
Combined low dose dipyridamole-dobutamine stress echocardiography to identify myocardial viability
Objectives. We sought to evaluate the effects of combined administration of infra-low dose dipyridamole and low dose dobutamine on assessment of myocardial viability.Background. Low dose pharmacologic stress echocardiography with either dobutamine or dipyridamolc infusion has been proposed for the recognition of myocardial viability.Methods. Thirty-four patients with rest wall motion dyssynergy by two-dimensional echocardiography and with angiographically proved coronary artery disease
Eugenio Picano; Miodrag Ostojic; Albert Varga; Rosa Sicari; Ana Djordjevic-Dikic; Ivana Nedeljkovic; Marco Torres
Comparison of Dobutamine Transesophageal Echocardiography and Dobutamine Magnetic Resonance Imaging for Detection of Residual Myocardial Viability
A dobutamine-induced contraction reserve in akinetic but viable myocardium, observed by echocardiography or magnetic resonance imaging (MRI), is a reliable indicator of myocardial viability. However, the comparative diagnostic accuracy of these 2 techniques is unknown. Therefore, 43 patients with myocardial infarction (infarct age ?4 months) and regional akinesia underwent dobutamine transesophageal echocardiography (TEE) and dobutamine MRI (10 ?g dobutamine\\/min\\/kg). Both
Frank Michael Baer; Eberhard Voth; Karl LaRos�e; Christian Alfons Schneider; Peter Theissen; Hans Joseph Deutsch; Harald Schicha; Erland Erdmann; Udo Sechtem
Mycotic aneurysm of the descending thoracic aorta: the role of transesophageal echocardiography.
Mycotic aneurysms of the aorta are prone to rupture. Thus rapid and accurate diagnosis is essential so that surgical repair can be undertaken. We report a case of mycotic aortic aneurysm caused by mitral valve endocarditis. The aneurysm situated at the junction of the thoracoabdominal aorta was readily detected by transesophageal echocardiography. Computed tomography and aortography were complementary to transesophageal echocardiography in establishing the diagnosis. The patient underwent successful repair and acute inflammation of the aneurysm was present at histologic examination. PMID:8887869
Joffe, I I; Emmi, R P; Oline, J; Jacobs, L E; Owen, A N; Ioli, A; Najjar, D; Kotler, M N
Myocardial contrast echocardiography for predicting functional recovery after acute myocardial infarction
Myocardial contrast echocardiography (MCE) is a promising diagnostic tool for detecting microvascular integrity. The aim of the study was to investigate the comparative specificity and sensitivity of intravenous MCE, technetium-99m Sestamibi single-photon emission computed tomography (SPECT) and dipyridamole�dobutamine (DIDO) stress echocardiography for predicting functional recovery after coronary revascularization in patients with acute myocardial infarction (AMI). Methods: In a prospective, observational
Adrian C. Borges; Wolf S. Richter; Christian Witzel; Matthias Witzel; Andrea Grohmann; Rona K. Reibis; Wolfgang Rutsch; Ingeborg K�chler; Dieter L. Munz; Gert Baumann
Diagnosis of patent foramen ovale with multiplane transesophageal echocardiography in adult cardiac surgical patients
Objective: To evaluate multiplane transesophageal echocardiography (TEE) for detection of patent foramen ovale (PFO) and to compare multiplane TEE with visual inspection (VI) for PFO detection.Design: A prospective observational study.Setting: University hospital (single institution).Participants: Patients presenting for cardiac surgery requiring TEE.Interventions: Multiplane TEE including 2 atrial views with color-flow Doppler (CFD) and contrast echocardiography (CE) with a provocative respiratory maneuver
John G. Augoustides; Stuart J. Weiss; Justin Weiner; Joshua Mancini; Joseph S. Savino; Albert T. Cheung
Results of a Prospective Echocardiography Trial in International Space Station Crew
NASA Technical Reports Server (NTRS)
In the framework of an operationally oriented investigation, we conducted a prospective trial of a standard clinical echocardiography protocol in a cohort of long-duration crewmembers. The resulting primary and processed data appear to have no precedents. Our tele-echocardiography paradigm, including just-in-time e-training methods, was also assessed. A critical review of the imaging technique, equipment and setting limitations, and quality assurance is provided, as well as the analysis of "space normal" data.
Hamilton, Douglas R.; Sargsyan, Ashot E.; Martin, David; Garcia, Kathleen M.; Melton, Shannon; Feiverson, Alan; Dulchavsky, Scott A.
A double-blind trial of glycopyrrolate for transesophageal echocardiography.
Glycopyrrolate is an anticholinergic agent used to dry oral secretions and has been advocated for routine use with transesophageal echocardiography (TEE). To evaluate the safety and efficacy of glycopyrrolate for this unique application, a prospective double-blind placebo-controlled study of glycopyrrolate was performed in 61 patients who were awake while undergoing TEE. Thirty patients were randomized to the standard dose of glycopyrrolate (0.2 mg intravenously), and 31 patients received 1 ml of saline solution as placebo. Intravenous midazolam was used for sedation in all but one patient. Heart rate, electrocardiogram, blood pressure, and oxygen saturation were continuously monitored before, during, and after TEE. The patients scored their comfort immediately after TEE and were interviewed at 24 hours for side effects. The operator scored the ease of performing the TEE. No complications occurred in either group. Changes in vital signs and oxygen saturation were similar in both groups. The operator ease and patient comfort was similar in both groups. A significantly higher incidence of the following side effects was observed at 24 hours in patients who received glycopyrrolate versus those who received placebo: sore throat, 63% versus 19%; dry mouth, 43% versus 6%; and urinary retention, 16% versus 0% (p < 0.05 for all). No benefit from glycopyrrolate was noted in operator ease or patient comfort. In conclusion, glycopyrrolate is not recommended for routine use when performing TEE on patients who are awake. PMID:8481249
Gorcsan, J; Thornton, J K; DiLucente, L; Ziady, G M; Katz, W E
Quantification of mitral valve morphology with three-dimensional echocardiography.
The mitral valve (MV) has complex 3-dimensional (3D) morphology and motion. Advance in real-time 3D echocardiography (RT3DE) has revolutionized clinical imaging of the MV by providing clinicians with realistic visualization of the valve. Thus far, RT3DE of the MV structure and dynamics has adopted an approach that depends largely on subjective and qualitative interpretation of the 3D images of the valve, rather than objective and reproducible measurement. RT3DE combined with image-processing computer techniques provides precise segmentation and reliable quantification of the complex 3D morphology and rapid motion of the MV. This new approach to imaging may provide additional quantitative descriptions that are useful in diagnostic and therapeutic decision-making. Quantitative analysis of the MV using RT3DE has increased our understanding of the pathologic mechanism of degenerative, ischemic, functional, and rheumatic MV disease. Most recently, 3D morphologic quantification has entered into clinical use to provide more accurate diagnosis of MV disease and for planning surgery and transcatheter interventions. Current limitations of this quantitative approach to MV imaging include labor-intensiveness during image segmentation and lack of a clear definition of the clinical significance of many of the morphologic parameters. This review summarizes the current development and applications of quantitative analysis of the MV morphology using RT3DE.??(Circ J?2014; 78: 1029-1037). PMID:24717235
Lee, Alex Pui-Wai; Fang, Fang; Jin, Chun-Na; Kam, Kevin Ka-Ho; Tsui, Gary K W; Wong, Kenneth K Y; Looi, Jen-Li; Wong, Randolph H L; Wan, Song; Sun, Jing Ping; Underwood, Malcolm J; Yu, Cheuk-Man
Transesophageal echocardiography in the management of burn patients.
A systematic review was conducted to assess the level of evidence for the use of transesophageal echocardiography (TEE) in the management of burn patients. We searched any article published before and including June 30, 2013. Our search yielded 118 total publications, 11 met the inclusion criteria of burn injury and TEE. Available studies published in any language were rated and included. At the present time, there are no available systematic reviews/meta-analyses published that met our search criteria. Only a small number of clinical trials, all with a limited number of patients were available. Therefore, a meta-analysis on outcome parameters was not performed. However, the major pathologic findings in burn patients were reduced left ventricular (LV) systolic and diastolic function, mitral valve vegetation, pulmonary hypertension, pericardial effusion, fluid overload, and right heart failure. The advantages of TEE include offering direct assessment of cardiac valve competency, myocardial contractility, and most importantly real time assessment of adequacy of hemodynamic resuscitation and preload in the acute phase of resuscitation, with minimal additional risk. TEE serves multiple diagnostic purposes and is being used to better understand the fluid status and cardiac physiology of the critically ill burn patient. Randomized controlled trials especially on fluid resuscitation and cardiac performance in acute burns are warranted to potentially further improve outcome. PMID:24035579
Maybauer, Marc O; Asmussen, Sven; Platts, David G; Fraser, John F; Sanfilippo, Filippo; Maybauer, Dirk M
Prevalence of coronary artery spasm during dobutamine stress echocardiography.
The aim of this study was to assess the prevalence of coronary artery spasm during dobutamine stress echocardiography (DSE). Over a 9-year period (from November 2001 to October 2010) we reviewed all patients (n = 2,224) referred for DSE. Criteria for selection included patients > 18 years old who underwent DSE. We systematically analyzed all electrocardiograms obtained during DSE to detect ST-segment elevation during the examination. All patients with ST-segment elevation underwent coronary angiography. DSE was performed in 2,179 patients. ST-segment elevation was observed in 21 patients, all of whom underwent emergency coronary angiography. In 13 of these 21 patients (62%) significant coronary stenosis was observed: 6 patients with critical coronary stenosis and 7 patients with chronic coronary occlusion. The remaining 8 patients (38% of patients presenting with ST-segment elevation during DSE, 7 men, mean age 67 � 11 years) had no significant coronary stenosis. Prevalence of coronary artery spasm during DSE was 0.4%. In conclusion, physicians should be aware that, although rare, coronary artery spasm may occur during DSE. PMID:22189013
Mansencal, Nicolas; El Hajjaji, Imane; El Mahmoud, Rami; Digne, Franck; Dubourg, Olivier
[Transesophageal echocardiography in adults with congenital heart defects].
The authors give an account of their experience with transesophageal echocardiography (TEE) in 61 adult patients with congenital heart disease. The main indications for examination in this group of patients were: confirmation of an atrial septal defect, unsatisfactory visualization, in particular in complex defects, evaluation of the results of surgical correction, detailed valvular morphology, in particular of the mitral and aortic valve, search for the source of embolization, suspected aneurysm of the aorta. A high diagnostic yield of TEE was obtained in: defects of the atrial septum, or other pathological conditions affecting the atrium, defects of the atrioventricular septum (AV), pathology of the AV valves, in particular the mitral one, pathology of the aortic valve and the efflux tract of the left ventricle, aortic arch and its descendent part, transposition of the large arteries or other complex defects, incl. conditions following surgical correction. A small diagnostic contribution of TEE was obtained when visualizing defects of the ventricular septum, pulmonary valves and the efflux tract of the right ventricle and the distal portions of the ascendant aorta. PMID:8358762
Kamen�k, L; Van?cek, T; Popelov�, J
NSDL National Science Digital Library
The Idaho State University Department of Physics conducts science demonstration shows at S. E. Idaho schools. Four different presentations are currently available; "Forces and Motion", "States of Matter", "Electricity and Magnetism", and "Sound and Waves". Information provided includes descriptions of the material and links to other resources.
Shropshire, Steven
ERIC Educational Resources Information Center
Having students show their skills in three dimensions, known as performance-based assessment, dates back at least to Socrates. Individual schools such as Barrington High School--located just outside of Providence--have been requiring students to actively demonstrate their knowledge for years. The Rhode Island's high school graduating class became�
Cech, Scott J.
ERIC Educational Resources Information Center
Uses a talk show activity for a final assessment tool for students to debate about the ozone hole. Students are assessed on five areas: (1) cooperative learning; (2) the written component; (3) content; (4) self-evaluation; and (5) peer evaluation. (SAH)
Mathieu, Aaron
ERIC Educational Resources Information Center
Describes the process of selecting judges for a Blue Ribbon Art Show (Springfield, Missouri). Used adults (teachers, custodians, professional artists, parents, and principals) chosen by the Willard South Elementary School art teacher to judge student artwork. States that nominated students received blue ribbons. (CMK)
Bowen, Judy Domeny
NSDL National Science Digital Library
The Show-Me Center is a partnership of four NSF-sponsored middle grades mathematics curriculum development Satellite Centers (University of Wisconsin, Michigan State University, University of Montana, and the Educational Development Center). The group's website provides "information and resources needed to support selection and implementation of standards-based middle grades mathematics curricula." The Video Showcase includes segments on Number, Algebra, Geometry, Measure, and Data Analysis, with information on ways to obtain the complete video set. The Curricula Showcase provides general information, unit goals, sample lessons and teacher pages spanning four projects: the Connected Mathematics Project (CMP), Mathematics in Context (MiC), MathScape: Seeing and Thinking Mathematically, and Middle Grades Math Thematics. The website also posts Show-Me Center newsletters, information on upcoming conferences and workshops, and links to resources including published articles and unpublished commentary on mathematics school reform.
NSDL National Science Digital Library
This lesson plan assesses student interpretation of graphs utilizing cooperative learning to further students understanding. Types of graphs used are horizontal and vertical bar graphs, picture graphs, and pictographs. In the lesson students play a game called the Graphing Game Show, in which they must work as a team to answer questions about specific graphs. The lesson includes four student resource worksheets and suggestions for extension and differentiation.
Erroneous diagnosis of significant obstruction by Doppler in a patient with discrete subaortic membrane: correct diagnosis by 3D-transthoracic echocardiography.
We report an adult with a discrete subaortic membrane in whom two-dimensional transthoracic Doppler echocardiography demonstrated peak and mean gradients of 64 and 33 mmHg, respectively in the left ventricular outflow tract (LVOT) and a calculated orifice area by continuity equation of 1.14 cm(2) consistent with significant obstruction. However, by direct en face visualization of the LVOT at the level of the membrane by live/real time three-dimensional transthoracic echocardiography (3D TTE), a larger orifice measuring 2.29 cm(2) was seen and was indicative of no significant obstruction. This finding was confirmed at cardiac catheterization, which showed insignificant obstruction. PMID:18771551
Bandarupalli, Naveen; Faulkner, Michael; Nanda, Navin C; Pothineni, Koteswara R
Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions.
Two-dimensional speckle tracking echocardiography (2D STE) is a novel technique of cardiac imaging for quantifying complex cardiac motion based on frame-to-frame tracking of ultrasonic speckles in gray scale 2D images. Two-dimensional STE is a relatively angle independent technology that can measure global and regional strain, strain rate, displacement, and velocity in longitudinal, radial, and circumferential directions. It can also quantify rotational movements such as rotation, twist, and torsion of the myocardium. Two-dimensional STE has been validated against hemodynamics, tissue Doppler, tagged magnetic resonance imaging, and sonomicrometry studies. Two-dimensional STE has been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies, and identifying early subclinical changes in various pathologies. A large number of studies have evaluated the role of 2D STE in predicting response to cardiac resynchronization therapy in patients with severe heart failure. However, the clinical utility of 2D STE in the above mentioned conditions remains controversial because of conflicting reports from different studies. Emerging areas of application include prediction of rejection in heart transplant patients, early detection of cardiotoxicity in patients receiving chemotherapy for cancer, and effect of intracoronary injection of bone marrow stem cells on left ventricular function in patients with acute myocardial infarction. The emerging technique of three-dimensional STE may further extend its clinical usefulness. PMID:23297852
Biswas, Monodeep; Sudhakar, Selvin; Nanda, Navin C; Buckberg, Gerald; Pradhan, Manish; Roomi, Asad Ullah; Gorissen, Willem; Houle, Helene
Design of a Matrix Transducer for Three-Dimensional Second Harmonic Transesophageal Echocardiography
NASA Astrophysics Data System (ADS)
Three-dimensional (3D) echocardiography visualizes the 3D anatomy and function of the heart. For 3D imaging an ultrasound matrix of several thousands of elements is required. To connect the matrix to an external imaging system, smart signal processing with integrated circuitry in the tip of the TEE probe is required for channel reduction. To separate the low voltage integrated receive circuitry from the high voltages required for transmission, our design features a separate transmit and receive subarray. In this study we focus on the transmit subarray. A 3D model of an individual element was developed using the finite element method (FEM). The model was validated by laser interferometer and acoustic measurements. Measurement and simulations matched well. The maximum transmit transfer was 3 nm/V at 2.4 MHz for both the FEM simulation of an element in air and the laser interferometer measurement. The FEM simulation of an element in water resulted in a maximum transfer of 43 kPa/V at 2.3 MHz and the acoustic measurement in 55 kPa/V at 2.5 MHz. The maximum pressure is ~1 MPa/120Vpp, which is sufficient pressure for second harmonic imaging. The proposed design of the transmit subarray is suitable for its role in a 3D 2H TEE probe.
Blaak, Sandra; van Neer, Paul L. M. J.; Prins, Christian; Bosch, Johan G.; Lanc�e, Charles T.; van der Steen, Antonius F. W.; de Jong, Nico
Estimation of diastolic intraventricular pressure gradients by Doppler M-mode echocardiography
NASA Technical Reports Server (NTRS)
Previous studies have shown that small intraventricular pressure gradients (IVPG) are important for efficient filling of the left ventricle (LV) and as a sensitive marker for ischemia. Unfortunately, there has previously been no way of measuring these noninvasively, severely limiting their research and clinical utility. Color Doppler M-mode (CMM) echocardiography provides a spatiotemporal velocity distribution along the inflow tract throughout diastole, which we hypothesized would allow direct estimation of IVPG by using the Euler equation. Digital CMM images, obtained simultaneously with intracardiac pressure waveforms in six dogs, were processed by numerical differentiation for the Euler equation, then integrated to estimate IVPG and the total (left atrial to left ventricular apex) pressure drop. CMM-derived estimates agreed well with invasive measurements (IVPG: y = 0.87x + 0.22, r = 0.96, P < 0.001, standard error of the estimate = 0.35 mmHg). Quantitative processing of CMM data allows accurate estimation of IVPG and tracking of changes induced by beta-adrenergic stimulation. This novel approach provides unique information on LV filling dynamics in an entirely noninvasive way that has previously not been available for assessment of diastolic filling and function.
Greenberg, N. L.; Vandervoort, P. M.; Firstenberg, M. S.; Garcia, M. J.; Thomas, J. D.
NSDL National Science Digital Library
The Show-Me Center, located at the University of Missouri, is a math education project of the National Science Foundation. The center's Web site "provides information and resources needed to support selection and implementation of standards-based middle grades mathematic curricula." There are some sample lesson plans offered, but most of the material is solely for use by teachers. Five different middle grade math curriculums were started in 1992, and now, the implementation and results of each curriculum are presented on this site. Teachers can examine each one, view video clips, and read case studies and other reports to choose which parts of the curriculums would fit best into their own classes.
Comparative measurement of aortic root by transthoracic echocardiography in normal Korean population based on two different guidelines
Background Aortic root size is an important parameter in vascular diseases and can be easily assessed by transthoracic echocardiography. However, measurements values may vary according to cardiac cycle and the definition used for edge. This study aimed to define normal values according to the measurement method specified by two different guidelines to determine the influence of the different methods on echocardiographic measurements. Methods Healthy Korean adults were enrolled. The aortic root diameters were measured twice at four levels (aortic annulus, sinuses of Valsalva, sinotubular junction, and ascending aorta) by the 2005 American Society of Echocardiography (ASE) guidelines (measured from leading edge to leading edge during diastole) and the 2010 ASE pediatric guidelines (measured from inner edge to inner edge during systole). Results One hundred twelve subjects aged 20�69 years were enrolled. The aortic diameters (cm) determine by the aforementioned two guidelines showed significant difference. Measurements were larger in 2005 ASE guideline at aortic annuls, sinuses of Valsalva, and sinotubular junction level, but smaller at ascending aortic level with 2-3mm of differences. Intraobserver variability was similarly good, but interobserver variability was slightly higher than intraobserver variability in both measurement methods. BSA and age was most important determinant for aortic root size. Conclusions The measurement method of aortic root can affect the echocardiographic result. The measurement method should be noted when assessing clinical significance of aortic root measurement.
Early Left Atrial Mechanics and Volume Abnormalities in Subjects with Prehypertension: A Real Time Three-Dimensional Echocardiography Study.
The aim of this study was to evaluate left atrial (LA) volume and mechanical functions by real time three-dimensional echocardiography (RT3DE) in prehypertensive subjects. The study included 54 (34 male and 20 female) prehypertensive subjects and 36 (14 male and 22 female) healthy control subjects. Transthoracic echocardiography and RT3DE were performed in all patients. Interventricular septum thickness and isovolumetric relaxation time were significantly higher in prehypertensives than in controls (10.7���0.7 vs. 10.1���0.8 P�=�0.001 and 89.9���10 vs. 82.4���11 P�=�0.002, respectively). LA maximum volume, volume before atrial contraction, total and active stroke volume, total and active emptying fractions, expansion index, and LA max volume index were significantly higher in prehypertensives when compared with controls (P�<�0.0001 for all). However, the passive emptying fraction was significantly lower in prehypertensives than controls (45.7���5.6 vs. 48.6���4.1, P�=�0.006), and the minimum LA volume between the two groups was similar. The main finding of this study was that although LA volume and LA active systolic functions were significantly increased in prehypertensive people, there was a reduction in passive LA systolic functions. These parameters may be important in showing hemodynamic and structural changes in cardiac tissue caused by prehypertension. PMID:22931064
Akt�rk, Erdal; Ermis, Necip; Ya?mur, J�lide; Acikgoz, Nusret; Kurto?lu, Ertu?rul; Cansel, Mehmet; Ey�pkoca, Ferhat; Pekdemir, Hasan; Ozdemir, Ramazan
Validation of Echo-Dynamography by virtual color doppler echocardiography generated from phase contrast magnetic resonance angiography datasets.
Echo-Dynamography (EDG) is a smart visualization technique in echocardiography in which two-dimensional distribution of blood flow vectors in cardiovascular system is deduced by applying fluid dynamics theories into Doppler velocity datasets. Previous validation studies such as numerical simulation of free jet model or model circulation were too simple to reproduce unstable and asymmetrical flow in left ventricle. In the present study, virtual color Doppler echocardiography is generated from PC-MRA (phase contrast magnetic resonance angiography) datasets. EDG is applied on virtual Doppler data and the blood flow vectors are compared with those of the original PC-MRA data. EDG-derived blood flow vectors showed similar pattern as the original PC-MRA data when blood flow velocity had high value. The errors were caused from underestimating the magnitude of vortex flow component in the flow field near the boundary of the left ventricular wall. The results also indicated that apical long axis view had small error compared with parasternal long axis view. Despite EDG method causes small errors, it provides important information on blood flow dynamics in most parts. PMID:24109635
Kojima, Takanori; Omori, Aiko; Nakajima, Hiroyuki; Kurokawa, Takafumi; Kameyama, Takeyoshi; Saijo, Yoshifumi
Analysis of the quantitative improvements in resting echocardiographic image sharpness through the use of contrast enhanced echocardiography.
Contrast enhanced echocardiography (CEE) is a technique for the improvement of suboptimal echocardiographic studies. While commonly performed at selected institutions, its value has only been shown qualitatively, and to this point no study has been directed at establishing a quantitative improvement in image quality compared with non-contrast enhanced echocardiography (non-CEE). The purpose of this study was to quantitatively measure the effect of contrast on the quality of images obtained during non-CEE versus CEE. Thirty consecutive patients underwent CEE. In all subjects a non-CEE was obtained prior to administering any contrast, allowing for a direct comparison and an internal control group. Sharpness of the septal, apical and lateral myocardial walls in the apical 4-chamber view was calculated with and without contrast. Three signal intensity levels were obtained for each wall then averaged to compare the images with and without contrast for a statistically significant difference in sharpness. Quantitative analysis showed a significant difference in sharpness between CEE and non-CEE in the left ventricular septal myocardial wall, p�<�0.01. A more drastic significant increase in image sharpness was observed between non-CEE and CEE in the apical and lateral left ventricular myocardial walls, both p�<�0.000001. CEE significantly increases the sharpness at all left ventricular myocardial walls thus allowing higher quality images with presumably more accurate diagnosis of regional wall motion abnormalities, left ventricular endocardial border detection, left ventricular dimensions, ejection fraction and apical pathology. PMID:24647916
Glassy, Matthew S; Groves, Elliott M
Severe aortic valve stenosis and nosebleed.
Aortic valve stenosis is known to be associated with loss of high molecular von Willebrand multimers. This can lead to gastrointestinal bleeding in patients with gastrointestinal angiodysplasia, the Heyde syndrome. Here we present a case of anaemia and severe epistaxis associated with acquired von Willebrand syndrome. Gastrointestinal endoscopy revealed no bleeding source. Calcifying aortic stenosis was confirmed by echocardiography. Loss of high molecular weight multimers of von Willebrand factor in our patient was shown by immunoblot analysis. If severe epistaxis occurs in the context of symptomatic aortic valve stenosis, it might be an additional reason to recommend valve replacement surgery to the patient. PMID:17150267
Sch�del, Johannes; Obergfell, Achim; Maass, Alexander H
Clinical evaluation of ATS prosthetic valve by doppler echocardiography: comparison with St. Jude Medical (SJM) valve.
ATS valve is a bileaflet valve developed to have a superior function to traditional prosthetic valves on anti-thrombogenesis and hemolysis. The orifice area was enlarged in consequence of making its orifice with pyrolytic carbon materials, and the pivot was open pivot and the strut was eliminated. The efficiency of this valve has been reported in the Europe. In Japan, its clinical trial was performed in September 1993 and its clinical use was permitted in August 1996. In this study, we compared the functions of ATS and St. Jude Medical (SJM) valves with echocardiography. The pressure gradients at the mitral valve position were not significantly different between ATS and SJM valves, but that of ATS was lower than that of SJM. The pressure gradient at the aortic valve position of ATS was also lower than that of SJM, and especially those of the patients who performed aortic valve replacement with 23-mm ATS and SJM valves were 8.9+/-1.6 and 23.3+/-6.6 mmHg, showing a significant difference. Though further observation and review of this valve are needed at the chronic phase, ATS valve is an excellent bileaflet valve on the valvular function, showing a low pressure gradient. PMID:11042481
Hasegawa, M
Repeated bedside echocardiography in children with respiratory failure
Background The aim of this study was to verify the benefits and limitations of repeated bedside echocardiographic examinations in children during mechanical ventilation. For the purposes of this study, we selected the data of over a time period from 2006 to 2010. Methods A total of 235 children, average age 3.21 (SD 1.32) years were included into the study and divided into etiopathogenic groups. High-risk groups comprised: Acute lung injury and acute respiratory distress syndrome (ALI/ARDS), return of spontaneous circulation after cardiopulmonary resuscitation (ROSC), bronchopulmonary dysplasia (BPD), cardiomyopathy (CMP) and cardiopulmonary disease (CPD). Transthoracic echocardiography was carried out during mechanical ventilation. The following data were collated for statistical evaluation: right and left ventricle myocardial performance indices (RV MPI; LV MPI), left ventricle shortening fraction (SF), cardiac output (CO), and the mitral valve ratio of peak velocity of early wave (E) to the peak velocity of active wave (A) as E/A ratio. The data was processed after a period of recovery, i.e. one hour after the introduction of invasive lines (time-1) and after 72 hours of comprehensive treatment (time-2). The overall development of parameters over time was compared within groups and between groups using the distribution-free Wilcoxons and two-way ANOVA tests. Results A total of 870 echocardiographic examinations were performed. At time-1 higher average values of RV MPI (0.34, SD 0.01 vs. 0.21, SD 0.01; p < 0.001) were found in all groups compared with reference values. Left ventricular load in the high-risk groups was expressed by a higher LV MPI (0.39, SD 0.13 vs. 0.29, SD 0.02; p < 0.01) and lower E/A ratio (0.95, SD 0.36 vs. 1.36, SD 0.64; p < 0.001), SF (0.37, SD 0.11 vs. 0.47, SD 0.02; p < 0.01) and CO (1.95, SD 0.37 vs. 2.94, SD 1.03; p < 0.01). At time-2 RV MPI were lower (0.25, SD 0.02 vs. 0.34, SD 0.01; p < 0.001), but remained higher compared with reference values (0.25, SD 0.02 vs. 0.21, SD 0.01; p < 0.05). Other parameters in high-risk groups were improved, but remained insignificantly different compared with reference values. Conclusion Echocardiography complements standard monitoring of valuable information regarding cardiac load in real time. Chest excursion during mechanical ventilation does not reduce the quality of the acquired data.
Assessing Epicardial Substrate Using Intracardiac Echocardiography During VT Ablation
Background Intracardiac echocardiography (ICE) has played a limited role in defining the substrate for ventricular tachycardia (VT). The purpose of this study was to assess whether ICE could identify abnormal epicardial substrate in patients (pts) with nonischemic cardiomyopathy (NICM) and VT. Methods and Results We studied 18 pts with NICM and recurrent VT who had abnormal echogenicity identified on ICE imaging. Detailed LV endocardial (ENDO) and epicardial (EPI) electroanatomic mapping was performed in all pts. Low voltage areas (< 1.0mV) in the epicardium were analyzed. ICE imaging in the NICM group was compared to a control group of 30 pts with structurally normal hearts who underwent ICE imaging for other ablation procedures. In 18 pts (53 � 13 years, 17 men) with NICM (EF: 37 � 13%) increased echogenicity was identified in the lateral LV by ICE imaging. LV ENDO electroanatomic mapping identified normal voltage in 9 pts and at least one, confluent low voltage area [6.6 cm2 (minimum 2.1 to maximum 31.7 cm2)] in 9 pts (5 posterolateral LV and 4 perivalvular LV). Detailed EPI mapping revealed areas of low voltage [39 cm2 (minimum 18.5 to maximum 96.3 cm2)] and abnormal, fractionated electrograms (EGMs) in all 18 pts (15 posterolateral LV and 3 lateral LV). In all pts, the EPI scar identified by electroanatomic mapping correlated with the echogenic area identified on ICE imaging. ICE imaging identified no areas of increased echogenicity in the control group. Conclusions ICE imaging identified increased echogenicity in the lateral wall of the LV that correlated to abnormal EPI substrate. These findings suggest that ICE imaging may be useful to identify EPI substrate in NICM.
Bala, Rupa; Ren, Jian-Fang; Hutchinson, Mathew D.; Desjardins, Benoit; Tschabrunn, Cory; Gerstenfeld, Edward P.; Deo, Rajat; Dixit, Sanjay; Garcia, Fermin C.; Cooper, Joshua; Lin, David; Riley, Michael P.; Tzou, Wendy S.; Verdino, Ralph; Epstein, Andrew E.; Callans, David J.; Marchlinski, Francis E.
Evaluation of reperfusion hyperemia with myocardial contrast echocardiography.
In this study we used myocardial contrast echocardiography to evaluate reperfusion hyperemia in an open-chest canine model of temporary coronary artery occlusion. Eight dogs had coronary occluders and electromagnetic flow probes on the left circumflex coronary artery. Aortic root injections of agitated sodium diatrizoate and saline solution were used for myocardial contrast. Data were collected at baseline (n = 16), during coronary occlusion (n = 18), immediately after coronary release (n = 18), and 5 minutes after coronary artery release (n = 12). Baseline coronary flow was 23.8 +/- 5.9 ml/min, decreasing to 0 ml/min during coronary occlusion. Immediately after coronary release flow was 96.6 +/- 41 ml/min (p less than 0.001 compared with baseline), and 5 minutes after coronary release flow was 68.2 +/- 27.9 ml/min (p less than 0.001 compared with baseline). The myocardial image intensity change after injection of contrast material was 74.25 +/- 30.6 ml/min at baseline and declined to 10.4 +/- 10.9 ml/min during coronary occlusion (p less than 0.001 compared with baseline). During reperfusion hyperemia image intensity change was 102.3 +/- 33.3 ml/min (p less than 0.001 compared with occlusion, p less than 0.02 compared with baseline, p less than 0.001 compared with remote regions). Considering all observations, myocardial image intensity change after contrast injection correlated positively with coronary flow (r = 0.67, p less than 0.001). Correlations within individual dogs ranged from r = 0.70 to 0.98. We conclude that image intensity change after aortic root injection of echocardiographic contrast correlates with coronary blood flow. Objective measurements of contrast intensity reflect increases in coronary flow associated with reactive hyperemia after coronary occlusion and release. PMID:2978809
Armstrong, W F; Gage, S W
Intracardiac Echocardiography Evaluation in Secundum Atrial Septal Defect Transcatheter Closure
Purpose: This study was designed to assess the balloon sizing maneuvers and deployment of an Amplatzer Septal Occluder (ASO). In addition, intraprocedural balloon sizing was compared with off-line intracardiac echocardiographic measurements. Methods: The intracardiac echocardiography (ICE) measurements were: maximum transverse and longitudinal atrial septal defect (ASD) diameters in the aortic valve and four-chamber planes;area of the ASD and its equivalent circle diameter. Thirteen consecutive patients underwent transcatheter implantation of an ASO device using ICE guidance under local anesthesia. The device matching the balloon sizing diameter of the defect was implanted. Qualitative ICE assessment of the ASO devices implanted was performed off line. Results: The mean equivalent circle diameter predicted by ICE was 24.40 {+-} 5.61 mm and was significantly higher(p 0.027) than the ASD measured by balloonsizing (21.38 {+-} 5.28 mm). Unlike previous studies we did not find any correlation between the two measurements (correlation coefficient = 0.47). Only four of the 13 patients had optimal device positioning as shown by the qualitative ICE evaluation, whereas the remaining nine patients had inadequate device placement. This resulted in a waist diameter that was an average 26.1% undersized in seven patients and 12.7% oversized in two patients. Five of the seven patients with an undersized device had ASO-atrial septum misalignment with leftward device deviation. Conclusion: The ICE images allowed careful measurement of the dimensions of the ASD and accurately displayed the spatial relations of the ASO astride the ASD.Moreover, use of the ICE measurement led to selection of a different size of device in comparison with those of balloon sizing. The clinical benefit of this new approach needs to be rigorously tested.
Zanchetta, Mario; Pedon, Luigi; Rigatelli, Gianluca; Carrozza, Antonio; Zennaro, Marco; Di Martino, Roberta [Department of Cardiovascular Disease, Cittadella General Hospital, Cittadella, Padua (Italy); Onorato, Eustaquio [Operative Unit ofCardiology, Clinica S. Rocco, Ome, Brescia (Italy); Maiolino, Pietro [Department of Cardiovascular Disease, Cittadella General Hospital, Cittadella, Padua (Italy)
Optimal role of rest and stress echocardiography in cardiac resynchronization therapy.
Cardiac resynchronization therapy (CRT) is an effective treatment for patients with advanced heart failure (HF), depressed left ventricular (LV) function and wide QRS complex. CRT improves symptoms, exercise capacity, LV function and reduces HF hospitalization and mortality rates. However, in parallel with the impressive results for CRT in several large trials, a consistent percentage of patients do not respond to CRT when the traditional patient selection criteria are applied. The prevalence of non-responders is about 30% when clinical end-points are considered but it is much higher (? 45%) if echocardiographic end-points are used. Reduction of the number of non-responders is currently one of the main challenges in the field of CRT. Response to CRT has been related to the presence of cardiac dyssynchrony prior to implantation. LV dyssynchrony can be evaluated using different echocardiographic methods. When LV dyssynchrony is added to traditional patient selection criteria, the prevalence of non-responders decreases considerably. However, the value of LV dyssynchrony to predict response to CRT has shown some limitations and is possibly not sufficient. CRT response is clearly modulated by several factors. Regional and global myocardial viability are key pieces of the puzzle as well as the presence and severity of mitral regurgitation (MR). Echocardiography thus plays an important role in the care of HF patients treated with cardiac resynchronization therapy and is useful to assess acute and long-term beneficial effects of CRT. Numerous recent published reports have used echocardiographic techniques to potentially help patient selection for CRT prior to implantation and to optimize device settings afterwards. These topics are discussed in this review. PMID:21705999
Pons, J; Voisine, P; S�n�chal, M
/sup 111/In-labeled platelet scintigraphy and two-dimensional echocardiography for detection of left atrial appendage thrombi. Studies in a new canine model
111In-labeled platelet scintigraphy and two-dimensional echocardiography were performed in 40 dogs to determine the ability of the two techniques to detect left atrial appendage thrombi. Thrombi were induced in 33 dogs that were classified into two groups, acute or chronic, according to the time of labeled-platelet injection after thrombus induction. In the acute group (17 dogs), platelets were injected 24 hours after thrombus induction. In the chronic group (16 dogs), platelets were injected 4-8 days after thrombus induction. Sham thoracotomies were performed on seven additional control dogs who did not receive thrombin injections. Analog and blood pool-corrected 111In-labeled platelet scintigraphy images were obtained 4-72 hours later. Closed-chest two-dimensional echocardiography was performed before thoracotomy and repeated at the time of scintigraphy. The location and size of each thrombus were verified at autopsy. Two-dimensional echocardiography detected three of 17 acute (mean volume, 1.2 +/- 1.0 cc) and three of 10 chronic (mean volume, 0.4 +/- 0.3 cc; p less than 0.025) left atrial appendage thrombi. 111In-labeled platelet scintigraphy detected all 17 acute thrombi but only two of 10 chronic thrombi. The measured radioactivity levels of the excised thrombi were 1,949 +/- 1,665 cpm/clot/dose in group 1 and 228 +/- 213 cpm/clot/dose in group 2 (p less than 0.005). In this model, 111In-labeled platelet scintigraphy was able to detect acute left atrial appendage thrombi that could not be identified by two-dimensional echocardiography. Both techniques showed poor sensitivity for detection of chronic thrombi. The decline in sensitivity of 111In-labeled platelet scintigraphy for detection of older thrombi is probably due to diminished labeled-platelet incorporation.
Vandenberg, B.F.; Seabold, J.E.; Conrad, G.R.; Kieso, R.; Johnson, J.; Fox-Eastham, K.; Ponto, J.; Bruch, P.; Kerber, R.E.
Extreme Tele-Echocardiography: Methodology for Remote Guidance of In-Flight Echocardiography Aboard the International Space Station
NASA Technical Reports Server (NTRS)
Methods: In the year before launch of an ISS mission, potential astronaut echocardiographic operators participate in 5 sessions to train for echo acquisitions that occur roughly monthly during the mission, including one exercise echocardiogram. The focus of training is familiarity with the study protocol and remote guidance procedures. On-orbit, real-time guidance of in-flight acquisitions is provided by a sonographer in the Telescience Center of Mission Control. Physician investigators with remote access are able to relay comments on image quality to the sonographer. Live video feed is relayed from the ISS to the ground via the Tracking and Data Relay Satellite System with a 2- second transmission delay. The expert sonographer uses these images, along with twoway audio, to provide instructions and feedback. Images are stored in non-compressed DICOM format for asynchronous relay to the ground for subsequent off-line analysis. Results: Since June, 2009, a total of 27 resting echocardiograms and 5 exercise studies have been performed during flight. Average acquisition time has been 45 minutes, reflecting 26,000 km of ISS travel per study. Image quality has been adequate in all studies, and remote guidance has proven imperative for fine-tuning imaging and prioritizing views when communication outages limit the study duration. Typical resting studies have included 27 video loops and 30 still-frame images requiring 750 MB of storage. Conclusions: Despite limited crew training, remote guidance allows research-quality echocardiography to be performed by non-experts aboard the ISS. Analysis is underway and additional subjects are being recruited to define the impact of microgravity on cardiac structure and systolic and diastolic function.
Martin, David S.; Borowski, Allan; Bungo, Michael W.; Gladding, Patrick; Greenberg, Neil; Hamilton, Doug; Levine, Benjamin D.; Lee, Stuart M.; Norwood, Kelly; Platts, Steven H.; Matz, Timothy; Roper, Matthew; Sandoz, Gwenn; Thomas, James D.
Recurrence of Congenital Heart Disease in Cases with Familial Risk Screened Prenatally by Echocardiography
Objectives. To evaluate the recurrence of congenital heart disease (CHD) in pregnant women with familial risk who had been referred for fetal echocardiography. Material and Methods. 1634 pregnancies from 1483 women with familial history of CHD in one or more relatives were studied. Fetal cardiologic diagnosis was compared with postnatal findings at 6 months or at autopsy. Results. Total recurrence rate of CHD was 3.98%, 4.06% in single familial risk, 2.9% in double, and 5% in multiple risk. It was 3.5% in case of one previously affected child; 4.5% with 2 children; 5.2% with the mother alone affected and 7,5% with father alone affected and 3.5% with a single distant relative. Exact concordance of CHD was found in 21.5% and a partial concordance in 20% of cases. Conclusions. Our data show a higher recurrence rate of CHD than previously published data and high relative risk ratios compared to normal population.
Fesslova, Vlasta; Brankovic, Jelena; Lalatta, Faustina; Villa, Laura; Meli, Valerio; Piazza, Luciane; Ricci, Cristian
Perivalvular abscess complicating infective endocarditis: complementary role of echocardiography and indium-111-labeled leukocytes.
A 49-year-old black man with hypertension-induced chronic renal failure requiring hemodialysis and a history of arteriovenous access graft infection was admitted with Staphylococcus aureus sepsis, dyspnea, and peri-incisional erythema over his arteriovenous graft fistula. Results of a transthoracic echo demonstrated aortic sclerosis and concentric left ventricular hypertrophy. Results of a whole-body In-111 white cell (WBC) scan were negative over the arteriovenous graft site; however, an intense abnormal focus of labeled WBCs was evident to the left of the sternum. A subsequent transesophageal echocardiogram showed a mixed cystic-solid calcified mass adjacent the left aortic cusp. Surgery confirmed a perivalvular abscess. As a whole-body imaging modality, the In-111 WBC scintigram indicated the true location of the infectious process responsible for the patient's sepsis. The combination of echocardiography and radiolabeled WBC imaging increases sensitivity for detection of endocarditis/perivalvular abscess. Radiolabeled WBC imaging is more efficacious for monitoring therapy because the echocardiogram often does not change with treatment of endocarditis/perivalvular abscess. PMID:9735977
Campeau, R J; Ingram, C
Comparison of echocardiography-guided and fluoroscopy-guided endomyocardial biopsy techniques.
The accuracy of bioptome placement for endomyocardial biopsy was evaluated using standard fluoroscopic guidance and compared simultaneously with two-dimensional echocardiography in six healthy subadult grizzly bears (Ursus arctos horribilis). Despite perceived adequate positioning of the bioptome toward the septum when judged using fluoroscopy, only one out of the six placements were actually positioned in the right ventricular apex toward the septum when evaluated using two-dimensional echocardiography. The bioptome was readily relocated to the right ventricular apex/septal location by echocardiography. The forceps were easily visualized at all times and the open cups were readily directed into the desired location for biopsy. Based on a subjective score for tissue quantity from 1 to 4 (poor to excellent), biopsies collected by echocardiographic-guided technique had a mean score of 3.4, while biopsies collected by fluoroscopic-guided technique had a mean score of 1.8. In summary, this study suggests that endomyocardial biopsy locations can be accurately positioned using two-dimensional echocardiography with the advantages of less radiation, lower procedural costs, and direct visualization of the sampling site. Clear definition of endocardial surface as afforded by echocardiography may enhance tissue sample quality and lower potential complications from this procedure. PMID:15869156
Nelson, O Lynne; Robbins, Charles T
Comparison of dipyridamole-echocardiography with dipyridamole-thallium scintigraphy for the diagnosis of myocardial ischemia
After an intravenous infusion of dipyridamole (0.56 mg/kg), the authors performed both echocardiography and thallium scintigraphy in 63 patients who were referred for known or suspected coronary artery disease. Of those patients, 25 returned for coronary arteriography within 1 month after the tests, thus forming the study group for this report. Sensitivity for detection of coronary artery disease, when analyzed region-by-region, was 80% for thallium scintigraphy and 57% for echocardiography, whereas specificity was 85% and 98%, respectively. When evaluating individual patients for the presence or absence of ischemia, they found a sensitivity of 95% for scintigraphy and 58% for echocardiography; corresponding specificities were 50% and 100%. By using arteriography as the gold standard for comparison, it appears that thallium scintigraphy has a significantly higher sensitivity but lower specificity for the detection of coronary artery disease than does echocardiography. Echocardiography may, however, be a useful adjunct to thallium scintigraphy in the evaluation of patients with coronary artery disease.
Perin, E.C.; Moore, W.; Blume, M.; Hernandez, G.; Dhekne, R.; DeCastro, C.M. (St. Luke's Episcopal Hospital/Texas Heart Institute, Houston (USA))
Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography
Background A coronary flow velocity reserve (CFVR) ? 2 is adequate to infer a favorable prognosis or the absence of significant coronary artery disease. Objective To identify parameters which are relevant to obtain CFVR (adequate or inadequate) in the left anterior descending coronary artery (LAD) during dobutamine stress echocardiography (DSE). Methods 100 patients referred for detection of myocardial ischemia by DSE were evaluated; they were instructed to discontinue the use of ?-blockers 72 hours prior to the test. CFVR was calculated as a ratio of the diastolic peak velocity (cm/s) (DPV) on DSE (DPV-DSE) to baseline DPV at rest (DPV-Rest). In group I, CFVR was < 2 and, in group II, CFVR was ? 2. The Fisher's exact test and Student's t test were used for the statistical analyses. P values < 0.05 were considered statistically significant. Results At rest, the time (in seconds) to obtain Doppler in LAD in groups I and II was not different (53�31 vs. 45�32; p=0.23). During DSE, LAD was recorded in 92 patients. Group I patients were older (65.9�9.3 vs. 61.2�10.8 years; p=0.04), had lower ejection fraction (61�10 vs. 66�6%; p=0.005), higher DPV-Rest (36.81�08 vs. 25.63 � 06cm/s; p<0.0001) and lower CFVR (1.67 � 0.24 vs. 2.53 � 0.57; p<0.0001), but no difference was observed regarding DPVDSE (61.40�16 vs. 64.23�16cm/s; p=0.42). ?-blocker discontinuation was associated with a 4-fold higher chance of a CFVR < 2 (OR= 4; 95% CI [1.171-13.63], p=0.027). Conclusion DPV-Rest was the main parameter to determine an adequate CFVR. ?-blocker discontinuation was significantly associated with inadequate CFVR. The high feasibility and the time to record the LAD corroborate the use of this methodology.
de Abreu, Jose Sebastiao; Lima, Jose Wellington Oliveira; Diogenes, Tereza Cristina Pinheiro; Siqueira, Jordana Magalhaes; Pimentel, Nayara Lima; Gomes, Pedro Sabino; de Abreu, Marilia Esther Benevides; Paes, Jose Nogueira
Reliability and clinical relevance of detection of vegetations by echocardiography in bacterial endocarditis.
The efficacy of M-mode echocardiography in identifying vegetations and the clinical relevance of such a finding were evaluated in 36 patients with bacterial endocarditis, 18 of whom had pre-existing valvar lesions. Of 22 patients with vegetations demonstrated by echocardiography, 21 had major complications of bacterial endocarditis and eight died, whereas only eight of the 14 patients without detectable vegetations had similar complications and only two died. Nine of the 11 patients with pre-existing valvar lesions and echocardiographic evidence of vegetations came to operation or necropsy, and in eight of these the presence of vegetations was confirmed. In the other, none was found at surgery performed after an interval of six months. M-mode echocardiography can reliably detect vegetations in patients with bacterial endocarditis even in the presence of pre-existing valvar lesions, and may permit the identification of a subset of high risk patients who may need early surgery. Images
Hickey, A J; Wolfers, J; Wilcken, D E
Open-access echocardiography to general practitioners for suspected heart failure.
Echocardiography is now considered to be the key investigation when heart failure is suspected, and should improve clinical management. An open-access echocardiography service was piloted to 24 general practitioners and the service was audited after 250 cases. The impact on clinical management was assessed by reviewing general practice notes 2 months after the echocardiogram. Significant impairment of left ventricular function was found in 49 patients (20%). Out of these subjects, 38 had been started on an ACE inhibitor. Twenty patients were considered to have a significant valve lesion by echocritiera, of whom 14 had been referred for a cardiological opinion. The provision of an open-access echocardiography service was popular with general practitioners and the information resulted in appropriate management decisions being made. PMID:8949328
Murphy, J J; Frain, J P; Ramesh, P; Siddiqui, R N; Bossingham, C M
Rupture of a submitral ventricular aneurysm into the left atrium diagnosed by transesophageal echocardiography.
Submitral ventricular aneurysm is a thoroughly studied pathology but is not well known due to its rarity. Clinically, it is manifested by symptoms and signs of heart failure, mitral regurgitation and/or ventricular arrhythmias, and may be associated with thromboembolic phenomena and myocardial ischemia due to compression of the coronary arteries by the aneurysm. A rare complication of this type of aneurysm is rupture into the left atrium. Transthoracic echocardiography plays an important role in the definitive diagnosis of this pathology, although the role of transesophageal echocardiography in the evaluation of these patients is less known. We report a case of a submitral ventricular aneurysm complicated by rupture into the left atrium, which was diagnosed by transesophageal echocardiography. PMID:17695731
Morais, Humberto; Branco, Lu�sa Moura; Cunha, Rosa; Martins, Telmo
Effects of Bariatric Surgery on Early Myocardial Alterations in Adult Severely Obese Subjects
Objective:Aim of this study was to investigate the effect of weight loss on structural and functional myocardial alterations in severely obese subjects treated with bariatric surgery. Patients and Methods: Thirteen severely obese patients (2 males and 11 females) were enrolled in the study. All subjects underwent conventional 2D color Doppler echocardiography. The new ultrasonic techniques used were: (a) integrated backscatter
Vitantonio Di Bello; Ferruccio Santini; Andrea Di Cori; Andrea Pucci; Enrica Talini; Caterina Palagi; Maria Grazia Delle Donne; Alessandro Marsili; Paola Fierabracci; Rocco Valeriano; Giovanna Scartabelli; Monica Giannetti; Marco Anselmino; Aldo Pinchera; Mario Mariani
Relationship of Cigarette Smoking to the Severity of Coronary and Thoracic Aortic Atherosclerosis
We studied the relationship of cigarette smoking to the severity of coronary and thoracic aortic atherosclerosis in 116 men who received coronary angiography and transesophageal echocardiography. Severity of coronary atherosclerosis was assessed in terms of Gensini�s score (GS), and that of thoracic aortic atherosclerosis was assessed by the average sclerotic length (ASL) and average sclerotic area (ASA). The plasma fibrinogen
Toji Inoue; Keiko Oku; Kazuyuki Kimoto; Makiko Takao; Junko Nomoto; Koichi Handa; Suminori Kono; Kikuo Arakawa
Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Vena Contracta Area in Mitral Regurgitation
OBJECTIVES Our goal was to prospectively compare the accuracy of real-time three-dimensional (3D) color Doppler vena contracta (VC) area and two-dimensional (2D) VC diameter in an in vitro model and in the clinical assessment of mitral regurgitation (MR) severity. BACKGROUND Real-time 3D color Doppler allows direct measurement of VC area and may be more accurate for assessment of MR than the conventional VC diameter measurement by 2D color Doppler. METHODS Using a circulatory loop with an incorporated imaging chamber, various pulsatile flow rates of MR were driven through 4 differently sized orifices. In a clinical study of patients with at least mild MR, regurgitation severity was assessed quantitatively using Doppler-derived effective regurgitant orifice area (EROA), and semiquantitatively as recommended by the American Society of Echocardiography. We describe a step-by-step process to accurately identify the 3D-VC area and compare that measure against known orifice areas (in vitro study) and EROA (clinical study). RESULTS In vitro, 3D-VC area demonstrated the strongest correlation with known orifice area (r = 0.92, p < 0.001), whereas 2D-VC diameter had a weak correlation with orifice area (r = 0.56, p = 0.01). In a clinical study of 61 patients, 3D-VC area correlated with Doppler-derived EROA (r = 0.85, p < 0.001); the relation was stronger than for 2D-VC diameter (r = 0.67, p < 0.001). The advantage of 3D-VC area over 2D-VC diameter was more pronounced in eccentric jets (r = 0.87, p < 0.001 vs. r = 0.6, p < 0.001, respectively) and in moderate-to-severe or severe MR (r = 0.80, p < 0.001 vs. r = 0.18, p = 0.4, respectively). CONCLUSIONS Measurement of VC area is feasible with real-time 3D color Doppler and provides a simple parameter that accurately reflects MR severity, particularly in eccentric and clinically significant MR where geometric assumptions may be challenging.
Little, Stephen H.; Pirat, Bahar; Kumar, Rahul; Igo, Stephen R.; McCulloch, Marti; Hartley, Craig J.; Xu, Jiaqiong; Zoghbi, William A.
Comparison of two surgical techniques for complete atrioventricular septal defect repair using two- and three-dimensional echocardiography.
Different surgical techniques for complete atrioventricular septal defect (CAVSD) repair have been described, with the double-patch technique being most frequently employed. More recently a newer technique using a modified single-patch repair has been advocated. We hypothesized that the modified single-patch technique would result in an increased incidence of the two major post-repair comorbidities, namely, distortion of the left AV valve (LAVV) leaflets and narrowing of the left-ventricular outflow tract (LVOT). We studied 14 patients with CAVSD who underwent either traditional double-patch technique [group 1 (n = 7)] or modified single-patch technique [group 2 (n = 7)]. Preoperative and immediate postoperative two-dimensional (2D) echocardiograms, as well as follow-up 2D and three-dimensional (3D) studies, were reviewed. For group 1, the median age at repair was 4.1 months with a median duration from surgical repair and last echocardiogram of 44 months. For group 2, the median age at repair was 3 months with a median duration from surgical repair and last echocardiogram of 28 months. The two groups had similar demographics and ventricular septal defect size before surgery. For the LAVV, no significant difference was observed with respect to LAVV annulus size, tenting height, and the size of the vena contracta. Furthermore, there was no significant difference in the 2D echocardiographic areas and volumes of the LVOT between pre-repair and immediate post-repair studies for both groups. At the last evaluation, although there had been growth of the LVOT in both groups, no significant difference between areas and volumes were observed. Areas of the LVOT measured by 3D echocardiography on the final study showed no significant statistical difference between both groups. There was good correlation of the areas measured by 2D and 3D echocardiography within each group. In this small group, modified single-patch technique does not appear to tether the LAVV or promote an increase in regurgitation. In the short term, LVOT growth is unaffected, and the repair does not promote LVOT obstruction. 3D echocardiography is useful for area measurements of the LVOT and showed good correlation with areas measured by assumption of the LVOT shape as determined using 2D techniques. PMID:24022512
Al Senaidi, Khalfan S; Ross, David B; Rebeyka, Ivan M; Harder, Joyce; Kakadekar, Ashok P; Garros, Daniel; Mackie, Andrew S; Smallhorn, Jeffrey
Outcome After Normal Exercise Echocardiography and Predictors of Subsequent Cardiac Events: Follow-Up of 1,325 Patients
Objectives. This study sought to examine the outcome of a large group of patients after normal exercise echocardiography and to identify potential predictors of subsequent cardiac events. Background. Earlier studies suggested that prognosis after normal exercise echocardiography is favorable, with a low subse- quent cardiac event rate. These studies involved a small number of patients and did not have sufficient
The role of transesophageal echocardiography in transcatheter closure of secundum atrial septal defects by the Amplatzer septal occluder
Background Our purpose was to determine the role of transesophageal echocardiography (TEE) in the closure of atrial septal defects by the Amplatzer septal occluder (ASO) (AGA Medical, Golden Valley, Minn). Methods A total of 240 patients with atrial septal defect (ASD) secundum were examined by transthoracic 2-dimensional echocardiography (TTE) and TEE to determine the ASD morphologic features, diameter, and rims.
Uros Mazic; Pavol Gavora; Jozef Masura
NSDL National Science Digital Library
Educating the public about safety issues related to severe weather is part of the National Oceanic and Atmospheric Administration's (NOAA) mission. This month's insert, Severe Weather, has been created by NOAA to help educate the public about hazardous weather conditions. The four types of severe weather highlighted in this poster are hurricanes, flash floods, lightning, and tornadoes.
Forde, Evan B.
ERIC Educational Resources Information Center
Educating the public about safety issues related to severe weather is part of the National Oceanic and Atmospheric Administration's (NOAA) mission. This article deals with a poster entitled, "Severe Weather," that has been created by NOAA to help educate the public about hazardous weather conditions. The four types of severe weather highlighted in�
Forde, Evan B.
ERIC Educational Resources Information Center
Educating the public about safety issues related to severe weather is part of the National Oceanic and Atmospheric Administration's (NOAA) mission. This month's insert, Severe Weather, has been created by NOAA to help educate the public about hazardous weather conditions. The four types of severe weather highlighted in this poster are hurricanes,�
Forde, Evan B.
Relationships between left heart chamber dilatation on echocardiography and left-to-right ventricle shunting quantified by cardiac catheterization in children with ventricular septal defects.
Left atrium and/or left ventricle dilatation on echocardiography is considered to be an indication for closure of ventricular septal defects (VSD). No study has addressed the accuracy of using dilated left heart chambers when defining significant left-to-right shunting quantified by cardiac catheterization in isolated small or moderate VSDs. In this study, the relation between dilated left heart chambers, measured by echocardiography, and left-to-right ventricle shunting, quantified by cardiac catheterization, was evaluated in patients with isolated VSD. The medical records of all patients with isolated VSD who had undergone catheterization from 1996 to 2010 were examined retrospectively. Normative data for left heart chambers adjusted for body weight (BW) and body surface area (BSA) were used. The pulmonary-to-systemic flow ratio (Qp:Qs) was calculated by an oximetry technique. A total of 115 patients (mean age 7.3 � 5 years) fulfilled the inclusion criteria. There was a statistically significant difference in terms of Qp:Qs between the patient groups with normal and dilated left heart chambers, when adjusted for BW and BSA (p = 0.001 and p = 0.002, respectively). But the relationships between Qp:Qs and left heart chamber sizes on echocardiography were not strong enough to be useful for making surgical decisions, as left heart chamber dilatation was not significantly associated with Qp:Qs ? 2 (p = 0.349 when adjusted for BW, p = 0.107 when adjusted for BSA). Left heart chamber dilatation was significantly associated with Qp:Qs ? 1.5 only when it was adjusted for BSA (for BW p = 0.022, for BSA p = 0.006). As a result, left heart chamber dilatation measured by echocardiography does not show significant left-to-right ventricle shunting, as quantified by catheterization. We still advocate that catheter angiography should be undertaken when left heart chambers are dilated in echocardiography in order to make decisions about closing small- to moderate-sized VSD. PMID:24259011
Gokalp, Selman; Guler Eroglu, Ayse; Saltik, Levent; Koca, Bulent
Aortic valve area assessed with 320-detector computed tomography: comparison with transthoracic echocardiography.
To evaluate the diagnostic accuracy of aortic valve area (AVA) assessment with 320-detector Computed Tomography (MDCT) compared to transthoracic echocardiography (TTE) in a population with mild to severe aortic valve stenosis. AVA was estimated in 169 patients by planimetry on MDCT images (AVA(MDCT)) and by the continuity equation with TTE (AVA(TTE)). To generate a reference AVA (AVA(REF)) we used the stroke volume from MDCT divided by the velocity time integral from CW Doppler by TTE (according to the continuity equation: stroke volume in LVOT = stroke volume passing the aortic valve). AVA(REF) was used as the reference to compare both measures against, since it bypasses the assumption of LVOT being circular in the continuity equation and the potential placement error of PW Doppler in the LVOT. The mean (�SD) age of the patients was 71 (�9) years, 113 (67%) were males. Mean AVA(TTE) was 0.93 (�0.33) cm(2), mean AVA(MDCT) was 0.99 (�0.36) cm(2) and mean AVA(REF) was 1.00 (�0.39) cm(2). The mean difference between AVA(TTE) and AVA(MDCT) was -0.06 cm(2), p = 0.001, mean difference between AVA(TTE) and AVA(REF) was -0.06 cm(2), p < 0.001, and mean difference between AVA(MDCT) and AVA(REF) was -0.01 cm(2), p = 0.60. Calcification of the aortic valve quantified by Agatston score, significantly decreased the correlation between AVA(MDCT) and AVA(REF), (r low Agatston = 0.90, r high Agatston = 0.57). MDCT measured AVA is slightly larger than AVA measured by TTE (0.06 cm(2)). The accuracy and precision errors on AVA measurements are comparable for MDCT and TTE. Valvular calcification may primarily affect the accuracy of AVA(MDCT). PMID:24126620
Larsen, Linnea Hornbech; Kofoed, Klaus Fuglsang; Carstensen, Helle Gervig; Mejdahl, Mads Rams; Andersen, Mads J�nsson; Kjaergaard, Jesper; Nielsen, Olav Wendelboe; K�ber, Lars; M�gelvang, Rasmus; Hassager, Christian
Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography
Objective: To assess the prevalence, mechanisms, and significance of paraprosthetic regurgitation detected incidentally by transoesophageal echocardiography (TOE) in patients after heart valve replacement. Design: Prospective observational study. Setting: Tertiary referral centre. Patients: 360 consecutive patients (mean (SD) age 65.8(9.5) years, 193 women) undergoing elective first ever valve replacement. Methods: Postoperative and follow up TOE, and tests for haemolysis and anaemia. Results: There were 243 aortic, 90 mitral, and 27 double valve replacements, using 316 mechanical and 44 tissue valves, giving 270 aortic and 117 mitral valves. One patient with severe paraprosthetic mitral regurgitation underwent immediate reoperation and was excluded from subsequent analyses. Paraprosthetic jets were detected around 16 (6%) of the aortic and 38 (32%) of the mitral valves (p < 0.05) at the postoperative study. Follow up TOE was available for 151 aortic and 67 mitral valves, 0.9 (0.5) years after operation. Paraprosthetic jets were present in 15 (10%) of the aortic and 10 (15%) of the mitral valves (NS). Two thirds of the aortic and a fifth of the mitral jets were new. Paraprosthetic jets were more common in aortic valves in a supra-annular (12 of 88, 14%) than in an intra-annular position (4 or 182, 2%; p < 0.005) and in mitral valves inserted with continuous (36 of 88, 41%) rather than interrupted sutures (2 of 28, 7%; p < 0.001). Lactate dehydrogenase concentration was higher in patients with paraprosthetic jets than in those without (752 (236) v 654 (208) IU/l, p < 0.001). Haemoglobin and haptoglobin concentrations were not different. Conclusions: Small paraprosthetic leaks are common, are related to surgical factors, are not associated with increased subclinical haemolysis, and are benign during the first year after heart valve replacement.
Ionescu, A; Fraser, A G; Butchart, E G
Left atrial longitudinal strain parameters predict postoperative persistent atrial fibrillation following mitral valve surgery: a speckle tracking echocardiography study.
Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with increased morbidity, mortality, and prolonged hospital stay. Speckle tracking echocardiography (STE) has been applied recently for evaluation of LA function. The purpose of this study was to examine whether left atrial longitudinal strain measured by STE is a predictor for the development of POAF following mitral valve surgery for severe mitral regurgitation. We studied 53 patients undergoing mitral valve surgery in sinus rhythm at the time of surgery. Echocardiography with evaluation of LA strain by STE was performed. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Patients who did not develop POAF were taken as group 1 and those who had POAF constituted group 2. The echocardiographic and clinical predictors of POAF were investigated. POAF occurred in 28.3% of subjects. Mean age, LAVi and BNP were found higher in group 2 while peak atrial longitudinal strain (PALS) (13.9 � 3.8% vs. 24.8 � 7.3%; P < 0.001), peak atrial contraction strain (PACS) (7.6 � 1.95% vs. 11.3 � 3.5%; P < 0.001) were significantly lower. By multivariate logistic regression analysis, PALS and LAVi were independent predictor of POAF development. LA longitudinal strain was found to predict POAF in patients undergoing mitral valve surgery. It could be used to better identify patients at greater risk of developing POAF, and thus to guide in risk stratification and to take appropriate intensive prophylactic therapy. PMID:23600893
Candan, Ozkan; Ozdemir, Nihal; Aung, Soe Moe; Dogan, Cem; Karabay, Can Yucel; Gecmen, Cetin; Omaygen�, Onur; G�ler, Ahmet
Automated Classification of Disease Patterns from Echo-cardiography Images Based on Shape Features of the Left Ventricle
Computer assisted diagnosis using analysis of medical images is an area of active research in health informatics. This paper proposes a technique for indication of heart diseases by using information related to shapes of the left ventricle (LV). LV boundaries are tracked from echo-cardiography images taken from LV short axis view, corresponding to two disease conditions viz. dilated cardiomyopathy and hypertrophic cardiomyopathy, and discriminated from the normal condition. The LV shapes are modeled using shape histograms generated by plotting the frequency of normalized radii lengths drawn from the centroid to the periphery, against a specific number of bins. A 3-layer neural network activated by a log-sigmoid function is used to classify the shape histograms into one of the three classes. Experimentations on a dataset of 240 images show recognition accuracies of the order of 80%.
Das, Shaoli; Parekh, Ranjan [School of Education Technology, Jadavpur University, Kolkata 700032 (India)
Novel spatiotemporal voxel interpolation with multibeat fusion for 3D echocardiography with irregular data distribution
NASA Astrophysics Data System (ADS)
We developed a novel multi-beat image fusion technique using a special spatiotemporal interpolation for sparse, irregularly sampled data (ISI). It is applied to irregularly distributed 3D cardiac ultrasound data acquired with a fast rotating ultrasound (FRU) transducer. ISI is based on Normalized Convolution with Gaussian kernels tuned to irregular beam data spacing over cardiac phase (?), and beam rotation (?) and elevation angles (?). Methods: images are acquired with the FRU transducer developed in our laboratory, a linear phased array rotating mechanically continuously at very high speed (240-480rpm). High-quality 2D images are acquired at ~100 frames/s over 5-10 seconds. ECG is recorded simultaneously. Images are irregularly distributed over ? and ?, because rotation is not synchronized to heartrate. ISI was compared quantitatively to spatiotemporal nearest neighbor interpolation (STNI) on synthetic (distance function) data of a pulsating ellipsoid for 32 angles (?) and 37 phases (?). ISI was also tested qualitatively on 20 in-vivo cardiac image sets and compared to classical temporal binning with trilinear voxel interpolation, at resolutions of 256*256*400 for 16 phases. Results: From the synthetic data simulations, ISI showed absolute distance errors (mean+/-SD) of 1.23 +/- 1.52mm; considerably lower than for STNI (3.45 +/- 3.03mm). For in-vivo images, ISI voxel sets showed reduced motion artifacts, suppression of noise and interpolation artifacts and better delineation of endocardium. Conclusions: ISI improves the quality of 3D+T images acquired with a fast rotating transducer in simulated and in-vivo data. It may also be useful for similar spatiotemporal irregularly distributed data, e.g. freehand 3D echocardiography.
Bosch, Johan G.; van Stralen, Marijn; Voormolen, Marco M.; Krenning, Boudewijn J.; Lanc�e, Charles T.; Reiber, Johan H. C.; van der Steen, Anton F. W.; de Jong, Nico
Echocardiography and right ventricular function in NKF stage III cronic kidney disease: Ultrasound nephrologists' role?
TAPSE measurement during echocardiography is a well known measure of right heart systo-diastolic function. Low TAPSE means reduced cranio-caudal excursion of tricuspidal annulus, sign of both reduced ejection fraction and reduced distensibility of right ventricle. It is a good prognostic index for cardiac mortality risk in CHF patients, adding significant prognostic information to NYHA stadiation. Nephrologists do not always fully aware of right ventricular function in their patients affected by chronic renal failure (CRF), even if this datum is probably crucial in vascular access policy. Our study was designed to study right ventricle function and TAPSE on 202 patients affected by moderate chronic renal failure, free from overt pulmonary hypertension. TAPSE, PAPs, right chambers diameters, classical Framingham factors, estimated glomerular filtration rate were recorded. TAPSE was reduced (<23�mm) in 43% of patients enrolled, while dilated right chambers were present in 24%. PAPs exceeded 30�mmHg in 29% of patients. Echocardiographic signs of left ventricular hypertrophy were found in 36% of patients. The ejection fraction was normal in all patients. Statistical analysis showed a significant indirect correlation between TAPSE and PAPs and between TAPSE and tele-diastolic diameters and volumes of the right ventricle, while a direct correlation was observed between TAPSE and Framingham score. TAPSE showed a bimodal distribution, with a subpopulation �low TAPSE � high PAPs�, next to a population characterized by normal values ??for both parameters. A reduction in compliance and systolic function of the right heart chambers is quite early and frequent in course of CKD, a fact that the nephrologist should take in due consideration, managing blood volume or planning vascular access for hemodialysis.
Floccari, F.; Granata, A.; Rivera, R.; Marrocco, F.; Santoboni, A.; Malaguti, M.; Andrulli, S.; Di Lullo, L.
Intracardiac Echocardiography Guided Transeptal Catheter Injection of Microspheres for Assessment of Cerebral Microcirculation in Experimental Models
The use of microspheres for the determination of regional microvascular blood flow (RMBF) has previously used different approaches. This study presents for the first time the intracardiac injection of microspheres using transeptal puncture under intracardiac echocardiography guidance. Five Merino sheep were instrumented and cardiovascularly supported according to local guidelines. Two catheter sheaths into the internal jugular vein facilitated the introduction of an intracardiac probe and transeptal catheter, respectively. Five million colour coded microspheres were injected into the left atrium via this catheter. After euthanasia the brain was used as proof of principle and the endpoint for determination of microcirculation at different time points. Homogeneous allocation of microspheres to different regions of the brain was found over time. Alternate slices from both hemispheres showed the following flow ranges: for slice 02; 0.57�1.02?mL/min/g, slice 04; 0.45�1.42?mL/min/g, slice 06; 0.35�1.87?mL/min/g, slice 08; 0.46�1.77?mL/min/g, slice 10; 0.34�1.28?mL/min/g. A mixed effect regression model demonstrated that the confidence interval did include zero suggesting that the apparent variability intra- and intersubject was not statistically significant, supporting the stability and reproducibility of the injection technique. This study demonstrates the feasibility of the transeptal injection of microspheres, showing a homogeneous distribution of blood flow through the brain unchanged over time and has established a new interventional model for the measurement of RMBF in ovine models.
Bellapart, Judith; Dunster, Kimble R.; Diab, Sara; Platts, David G.; Raffel, Christopher; Maybauer, Marc O.; Barnett, Adrian; Boots, Robert James; Fraser, John F.
Intracardiac echocardiography (9 MHz) in humans: methods, imaging views and clinical utility
A new low-frequency (9 MHz, 9 Fr) catheter-based ultrasound (US) transducer has been designed that allows greater depth of cardiac imaging. To demonstrate the imaging capability and clinical utility, intracardiac echocardiography (ICE) using this lower frequency catheter was performed in 56 patients undergoing invasive electrophysiological procedures. Cardiac imaging and monitoring were performed with the catheter transducer placed in the superior
Jian-Fang Ren; David Schwartzman; David J Callans; Susan E Brode; Charles D Gottlieb; Francis E Marchlinski
Influence of arterial compliance on presence and extent of ischaemia during stress echocardiography
Objective To seek an association between total arterial compliance (TAC) and the extent of ischaemia at stress echocardiography. Design Cohort study. Setting Regional cardiac centre. Methods 255 consecutive patients (147 men; mean (SD) age 58 (8)) presenting for stress echocardiography for clinical indications were studied. Wall motion score index (WMSI) was calculated and ischaemia was defined by an inducible or worsening wall motion abnormality. Peak WMSI was used to reflect the extent of dysfunction (ischaemia or scar), and ?WMSI was indicative of extent of ischaemia. TAC was assessed at rest by simultaneous radial applanation tonometry and pulsed wave Doppler in all patients. Results Ischaemia was identified by stress echocardiography in 65 patients (25%). TAC was similar in the groups with negative and positive echocardiograms (1.08 (0.41) v 1.17 (0.51)?ml/mm?Hg, not significant). However, the extent of dysfunction was associated with TAC independently of age, blood pressure, risk factors, and use of a ? blocker. Moreover, the extent of ischaemia was determined by TAC, risk factors, and use of a ? blocker. Conclusion While traditional cardiovascular risk factors are strong predictors of ischaemia on stress echocardiography, TAC is an independent predictor of the extent of ischaemia.
Haluska, B A; Matthys, K; Fathi, R; Rozis, E; Carlier, S G; Marwick, T H
Effect of tissue Doppler on the accuracy of novice and expert interpreters of dobutamine echocardiography
The subjective interpretation of dobutamine echocardiography (DBE) makes the accuracy of this technique dependent on the experience of the observer, and also poses problems of concordance between observers. Myocardial tissue Doppler velocity (MDV) may offer a quantitative technique for identification of coronary artery disease, but it is unclear whether this parameter could improve the results of less expert readers and
Robert Fathi; Peter Cain; Satoshi Nakatani; Henry C. M Yu; Thomas H Marwick
Evaluation of membranous subaortic stenosis using biplane transesophageal echocardiography. Report of two cases.
A biplane transesophageal echocardiography was performed in two young adult patients with discrete subvalvular aortic stenosis. The combined information obtained in the transverse and in the longitudinal plane allows in these instances an accurate diagnosis and the choice of an optimal approach. PMID:1957551
Decoodt, P; Kacenelenbogen, R; Viart, P; De Paepe, J; Deuvaert, F; Telerman, M
Evaluation of echocardiography in the management of elderly patients with heart failure
Objective: to determine the validity of a clinical diagnosis of systolic dysfunction in elderly patients with heart failure and assess the contribution of echocardiography to their management. Subjects: 61 elderly patients with a diagnosis of heart failure in a geriatric assessment unit setting. Methods: prospective study determining sensitivity, specificity and predictive values of a clinical and radiological diagnosis compared with
Pediatric cardiac surgery after exclusively echocardiography-based diagnostic work-up.
This study was performed to evaluate the accuracy of exclusively non-invasive preoperative diagnostic work-up based on echocardiography and to assess the safety of cardiac surgery using this diagnostic approach in children with heart disease. During a 3. 5-year period, accuracy of preoperative (invasive and non-invasive) diagnostic work-up was prospectively tested by comparison with the intraoperative findings obtained by surgical inspection and transoesophageal echocardiography. Included were all consecutive 358 children undergoing cardiac surgery (except pulmonary artery bandings and ductus ligations) during the study period at our institution. Of the patients, 44% were operated on in infancy, 84% of procedures were on cardiopulmonary bypass. Echocardiography as the only preoperative imaging modality was used in 231 patients (65%), in the other children, a diagnostic catheter was done. Diagnostic errors occurred in 3.9% (n=5) of patients after diagnostic catheter and in 6.9% (n=16) of patients with echocardiography only. Major diagnostic errors (resulting in prolongation of cardiac bypass time) were observed at equal frequency in both groups (1.7% or four children in the echo-only group and 1.6% or two patients in the catheter group). In no case was the outcome affected by the previously unrecognized findings. It was shown that diagnostic cardiac catheterization could be avoided in a majority of pediatric patients prior to surgical palliation or correction of cardiac defects, without increasing the risk of complications or the overall outcome. PMID:10962120
Pfammatter, J P; Berdat, P; H�mmerli, M; Carrel, T
Dobutamine Stress Echocardiography Early After Heart Transplantation Predicts Development of Allograft Coronary Artery Disease and Outcome
Objectives. This study sought to determine the prognostic significance of serial dobutamine stress echocardiography (DSE) in new heart transplant recipients and to examine the relation between persistent wall motion abnormalities and the eventual development of coronary artery disease (CAD) as assessed by angiography.Background. Allograft CAD is a major cause of graft failure. However, clinical diagnosis of the early disease remains
Kwame O Akosah; Susan McDaniel; Josephine S Hanrahan; Pramod K Mohanty
Magnetic resonance imaging compared to echocardiography to assess left ventricular mass in the hypertensive patient
Echocardiography (ECHO) is useful to document changes in left ventricular mass (LVM) in groups of patients, but may be too variable for use in the individual patient. Magnetic resonance imaging (MRI) may be a more precise and reliable method to quantify the mass of the left ventricle. This study reports the accuracy, precision, and reliability of LVM estimates by MRI
Peter B. Bottini; Albert A. Carr; L. Michael Prisant; Fred W. Flickinger; Jerry D. Allison; John S. Gottdiener
Potential utility of left heart contrast agents in diagnosis of myocardial rupture by 2-dimensional echocardiography.
This case illustrates the use of intravenous injections of a contrast agent during 2-dimensional echocardiography in a patient with myocardial rupture after myocardial infarction. Intravenous injections of echocardiographic contrast agents may have potential use in the identification of intrapericardial hemorrhage after myocardial infarction caused by myocardial rupture or development of ventricular pseudoaneurysm. PMID:10196505
Waggoner, A D; Williams, G A; Gaffron, D; Schwarze, M
Diagnosis of patent foramen ovale by transesophageal echocardiography and correlation with autopsy findings
Transesophageal echocardiography (TEE) is accepted as the method of choice for the diagnosis of a patent foramen ovale (PFO). However, direct anatomic confirmation regarding the presence or absence of a PFO on transesophageal imaging has been obtained in only a limited number of patients. Consequently, this study was performed to assess the diagnostic accuracy of contrast and color Doppler TEE
Birke Schneider; Tomasz Zienkiewicz; Viola Jansen; Thomas Hofmann; Harald Noltenius; Thomas Meinertz
Contrast dobutamine stress echocardiography: Clinical practice assessment in 300 consecutive patients
In this study we compared non-contrast imaging with contrast imaging of the left ventricle during dobutamine stress echocardiography (DSE). Wall segment visualization, image quality, and confidence of interpretation were determined with and without the use of intravenous Optison, a second-generation echocardiographic contrast agent, in 300 consecutive patients undergoing rest and peak DSE. At rest and at peak stress, the percentage
Andrew J. Rainbird; Sharon L. Mulvagh; Jae K. Oh; Robert B. McCully; Kyle W. Klarich; Clarence Shub; Douglas W. Mahoney; Patricia A. Pellikka
Prognostic significance of renal function in patients undergoing dobutamine stress echocardiography
Background. Dobutamine stress echocardiography (DSE) is used for risk stratification of patients with suspected coronary artery disease (CAD). However, the prognostic value of DSE among the entire strata of renal function has yet to be determined. We assessed the prognostic value of renal function relative to DSE findings. Methods. We studied 2292 patients, divided into 729 (32%) patients with normal
Stefanos E. Karagiannis; Harm H. H. Feringa; Abdou Elhendy; Domburg van R. T; Michel Chonchol; Radosav Vidakovic; Jeroen J. Bax; George Karatasakis; George Athanasopoulos; Dennis V. Cokkinos; Don Poldermans
Quantitative Texture Analysis in Two-Dimensional Echocardiography: Application to the Diagnosis of Myocardial Hemochromatosis.
BACKGROUND: Myocardial reflectivity is abnormally increased in patients with thalassemia major under transfusion treatment, probably due to myocardial iron deposits and/or secondary structural changes. Such increased reflectivity has been detected by both qualitative and subjective analysis of two-dimensional echocardiographic (2-D echo) images and quantitative assessment of integrated backscatter amplitude with noncommercially available ultrasound prototypes. The purpose of this study was to assess the acoustic properties of myocardium in patients with beta-thalassemia major and iron overload by means of quantitative computerized offline textural analysis of conventionally recorded 2-D echo images, and to compare textural data with other qualitative (visual assessment) and quantitative (ultrasound backscatter analysis) approaches for myocardial ultrasound tissue characterization simultaneously applied to these patients. METHODS AND RESULTS: Thirty-five young patients with thalassemia major, without clinical signs of cardiac failure, and 20 age and sex matched normal controls were studied by echocardiography. Each patient was receiving blood transfusion every 2-3 weeks. Two-dimensional echo images, obtained with a commercially available echocardiograph using the parasternal long-axis view, were digitized off line and analyzed by first and second order texture algorithms applied to regions of interest in the myocardium (septal and posterior wall). The mean gray level value was higher in thalassemic patients than in controls on both the septum (110 +/- 25 vs 57 +/- 13, arbitrary units on a 0-255 scale; P < 0.01) and posterior wall (91 +/- 25 vs 67 +/- 18; P < 0.01). Among second order statistical parameters, contrast and angular second moment significantly (P < 0.01) differentiated septal and posterior walls of patients and controls. In thalassemic patients, no consistent correlation was found between wall texture parameters and hematologic (years of transfusions and chelation, number of transfusions), 2-D echo (posterior wall thickness, left ventricular end-diastolic diameter), and Doppler (transmitral E/A waves ratio) parameters. Myocardial walls with visually assessed increased echo reflectivity showed a trend toward higher values of mean gray level when compared with myocardial segments with qualitatively assessed normal reflectivity (septum: 121 +/- 26 vs 106 +/- 24; posterior wall: 105 +/- 23 vs 87 +/- 23). Although radiofrequency integrated backscatter has been demonstrated to be capable of identifying thalassemic patients, no significant correlation was found between mean gray level (by texture analysis) and radiofrequency data (septum: r = 0.03; posterior wall: r = 0.09; P = NS for both). CONCLUSIONS: Myocardial walls affected by hemochromatosis show ultrasound image texture alterations that may be quantified with digital image analysis techniques and appear mostly unrelated to hematologic and conventional, as well as radiofrequency-based, echocardiographic parameters. These changes in quantitatively evaluated echo reflectivity are present even before the development of clinical and echocardiographic signs of cardiac dysfunction. (ECHOCARDIOGRAPHY, Volume 13, January 1996) PMID:11442899
Lattanzi, Fabio; Bellotti, Paolo; Picano, Eugenio; Chiarella, Francesco; Paterni, Marco; Forni, Gianluca; Landini, Luigi; Distante, Alessandro; Vecchio, Carlo
Echocardiography of the normal camel (Camelus dromedaries) heart: technique and cardiac dimensions
Background Echocardiography and intra-cardiac dimensions have not previously been reported in adult camels despite its potential application for medical purpose. The aim of this study was to describe the results of a prospective study, aiming to report normal cardiac appearance and normal chamber dimensions in adult camels (Camelus dromedarius). Results On the right side, when the probe was placed in the 5th or 4th intercostal space (ICS), the caudal long-axis four-chamber view of the ventricles, atria, and the interventricular septum was obtained. Placing the probe slightly more cranially in the 4th ICS, the caudal long-axis four-chamber view and the caudal long-axis view of the left ventricular outflow tract (LVOT) were imaged. In 7 camels, a hybrid view between a �four-chamber� and �LVOT view� was imaged from the same position. The short-axis view of the ventricles was obtained in the 4th ICS where the transducer was rotated between 0� and 25�. Placement of the transducer in the 3rd ICS allowed visualisation of the right ventricular outflow tract (RVOT). On the left side, when the probe was placed in the 5th or 4th ICS, a four-chamber view was obtained. The LVOT is imaged in the 4th ICS and the RVOT was seen from the 3rd ICS. Conclusions This study showed that it is possible to obtain good-quality echocardiograms in adult camels and provide normal cardiac dimensions. This study could be used as a reference for further studies concerning camels with cardiac diseases.
Real-time three-dimensional transthoracic echocardiography in daily practice: initial experience
Aim of the work To evaluate the feasibility and possible additional value of transthoracic real-time three-dimensional echocardiography (RT3D-TTE) for the assessment of cardiac structures as compared to 2D-TTE. Methods 320 patients (mean age 45 � 8.4 years, 75% males) underwent 2D-TTE and RT3D-TTE using 3DQ-Q lab software for offline analysis. Volume quantification and functional assessment was performed in 90 patients for left ventricle and in 20 patients for right ventricle. Assessment of native (112 patients) and prosthetic (30 patients) valves morphology and functions was performed. RT3D-TTE was performed for evaluation of septal defects in 30 patients and intracardiac masses in 52 patients. Results RT3D-TTE assessment of left ventricle was feasible and reproducible in 86% of patients while for right ventricle, it was (55%). RT3D-TTE could define the surface anatomy of mitral valve optimally (100%), while for aortic and tricuspid was (88% and 81% respectively). Valve area could be planimetered in 100% for the mitral and in 80% for the aortic. RT3D-TTE provided a comprehensive anatomical and functional evaluation of prosthetic valves. RT3D-TTE enface visualization of septal defects allowed optimal assessment of shape, size, area and number of defects and evaluated the outcome post device closure. RT3D-TTE allowed looking inside the intracardiac masses through multiple sectioning, valuable anatomical delineation and volume calculation. Conclusion Our initial experience showed that the use of RT3D-TTE in the assessment of cardiac patients is feasible and allowed detailed anatomical and functional assessment of many cardiac disorders.
A Novel Stress Echocardiography Pattern for Myocardial Bridge With Invasive Structural and Hemodynamic Correlation
Background Patients with a myocardial bridge (MB) and no significant obstructive coronary artery disease (CAD) may experience angina presumably from ischemia, but noninvasive assessment has been limited and the underlying mechanism poorly understood. This study seeks to correlate a novel exercise echocardiography (EE) finding for MBs with invasive structural and hemodynamic measurements. Methods and Results Eighteen patients with angina and an EE pattern of focal end?systolic to early?diastolic buckling in the septum with apical sparing were prospectively enrolled for invasive assessment. This included coronary angiography, left anterior descending artery (LAD) intravascular ultrasound (IVUS), and intracoronary pressure and Doppler measurements at rest and during dobutamine stress. All patients were found to have an LAD MB on IVUS. The ratios of diastolic intracoronary pressure divided by aortic pressure at rest (Pd/Pa) and during dobutamine stress (diastolic fractional flow reserve [dFFR]) and peak Doppler flow velocity recordings at rest and with stress were successfully performed in 14 patients. All had abnormal dFFR (?0.75) at stress within the bridge, distally or in both positions, and on average showed a more than doubling in peak Doppler flow velocity inside the MB at stress. Seventy?five percent of patients had normalization of dFFR distal to the MB, with partial pressure recovery and a decrease in peak Doppler flow velocity. Conclusions A distinctive septal wall motion abnormality with apical sparing on EE is associated with a documented MB by IVUS and a decreased dFFR. We posit that the septal wall motion abnormality on EE is due to dynamic ischemia local to the compressed segment of the LAD from the increase in velocity and decrease in perfusion pressure, consistent with the Venturi effect.
Lin, Shin; Tremmel, Jennifer A.; Yamada, Ryotaro; Rogers, Ian S.; Yong, Celina Mei; Turcott, Robert; McConnell, Michael V.; Dash, Rajesh; Schnittger, Ingela
Left ventricular twist during dobutamine stress echocardiography after acute myocardial infarction: association with reverse remodeling.
Left ventricular (LV) twist is emerging as a marker of global LV contractility after acute myocardial infarction (AMI). This study aimed to describe stress-induced changes in LV twist during dobutamine stress echocardiography (DSE) after AMI and investigate their association with LV reverse remodeling at 6 months follow-up. In 82 consecutive first AMI patients (61 � 12 years, 85 % male) treated with primary percutaneous coronary intervention, DSE was performed at 3 months follow-up. Two-dimensional speckle-tracking-derived apical and basal rotation and LV twist were calculated at rest, low- and peak-dose stages. LV reverse remodeling was defined as ?10 % decrease in LV end-systolic volume between baseline and 6 months follow-up. Patterns of LV twist response on DSE consisted of either a progressive increase throughout each stage (n = 18), an increase at either low- or peak-dose (n = 53) or no significant increase (n = 11). LV reverse remodeling occurred in 28 (34 %) patients, who showed significantly higher peak-dose LV twist (8.51� vs. 6.69�, p = 0.03) and more frequently progressive LV twist increase from rest to peak-dose (39 vs. 13 %, p < 0.01) compared to patients without reverse remodeling. Furthermore, increase in LV twist from rest to peak-dose was the only independent predictor of LV reverse remodeling at 6 months follow-up (OR 1.3, 95 % CI 1.1-1.5, p = 0.005). Both the pattern of progressive increase in LV twist and the stress-induced increment in LV twist on DSE are significantly associated with LV reverse remodeling at 6 month follow-up after AMI, suggesting its potential use as a novel marker of contractile reserve. PMID:24352595
Joyce, Emer; Leong, Darryl P; Hoogslag, Georgette E; van Herck, Paul L; Debonnaire, Philippe; Abate, Elena; Holman, Eduard R; Schalij, Martin J; Bax, Jeroen J; Delgado, Victoria; Marsan, Nina Ajmone
Contrast and harmonic imaging improves accuracy and efficiency of novice readers for dobutamine stress echocardiography
NASA Technical Reports Server (NTRS)
BACKGROUND: Newer contrast agents as well as tissue harmonic imaging enhance left ventricular (LV) endocardial border delineation, and therefore, improve LV wall-motion analysis. Interpretation of dobutamine stress echocardiography is observer-dependent and requires experience. This study was performed to evaluate whether these new imaging modalities would improve endocardial visualization and enhance accuracy and efficiency of the inexperienced reader interpreting dobutamine stress echocardiography. METHODS AND RESULTS: Twenty-nine consecutive patients with known or suspected coronary artery disease underwent dobutamine stress echocardiography. Both fundamental (2.5 MHZ) and harmonic (1.7 and 3.5 MHZ) mode images were obtained in four standard views at rest and at peak stress during a standard dobutamine infusion stress protocol. Following the noncontrast images, Optison was administered intravenously in bolus (0.5-3.0 ml), and fundamental and harmonic images were obtained. The dobutamine echocardiography studies were reviewed by one experienced and one inexperienced echocardiographer. LV segments were graded for image quality and function. Time for interpretation also was recorded. Contrast with harmonic imaging improved the diagnostic concordance of the novice reader to the expert reader by 7.1%, 7.5%, and 12.6% (P < 0.001) as compared with harmonic imaging, fundamental imaging, and fundamental imaging with contrast, respectively. For the novice reader, reading time was reduced by 47%, 55%, and 58% (P < 0.005) as compared with the time needed for fundamental, fundamental contrast, and harmonic modes, respectively. With harmonic imaging, the image quality score was 4.6% higher (P < 0.001) than for fundamental imaging. Image quality scores were not significantly different for noncontrast and contrast images. CONCLUSION: Harmonic imaging with contrast significantly improves the accuracy and efficiency of the novice dobutamine stress echocardiography reader. The use of harmonic imaging reduces the frequency of nondiagnostic wall segments.
Vlassak, Irmien; Rubin, David N.; Odabashian, Jill A.; Garcia, Mario J.; King, Lisa M.; Lin, Steve S.; Drinko, Jeanne K.; Morehead, Annitta J.; Prior, David L.; Asher, Craig R.; Klein, Allan L.; Thomas, James D.
Apex to Base Left Ventricular Twist Mechanics Computed From High Frame Rate Two-Dimensional and Three-Dimensional Echocardiography: A Comparison Study
Background The aim of this study was to compare two-dimensional (2D) and three-dimensional (3D) methods for computing left ventricular (LV) rotation. Methods A two-axis linear/rotary system was designed using rotary motors controlled through a digital interface, and 10 freshly harvested pig hearts were studied. Each heart was mounted on the rotary actuator with the base being rotated at different known degrees of rotation (10�, 15�, 20�, and 25�) and was passively driven by a pump with calibrated stoke volume (50 mL) at a constant rate (60 beats/min) simultaneously. Cardiac motion was scanned to acquire 2D short-axis views using a GE Vivid 7 system for assessing rotation, and 3D apical full-volume loops were acquired using a Toshiba Applio Artida ultrasound system. Full-volume 3D image loops were analyzed online with Toshiba Wall Motion Tracking software, and short-axis 2D images were analyzed offline for LV rotation in GE EchoPAC PC at corresponding LV levels. Results At each state, both 2D and 3D echocardiography detected the changes in LV rotation but overestimated the rotation degrees. The biases for overestimation from 3D imaging were smaller compared with 2D imaging at each LV level. Both methods, when compared with each other, showed a linear correlation (r = 0.84, P < .0001). Bland-Altman comparison showed 99% of data points within range, with a constant bias between both methods (adjusted values of 3D = 1.892 + 0.964 � 3D). Conclusions Although 3D echocardiography showed smaller bias, the results between 2D and 3D echocardiography were comparable.
Ashraf, Muhammad; Zhou, Zhiwen; Nguyen, Thuan; Ashraf, Shiza; Sahn, David J.
NSDL National Science Digital Library
Meteorologists disagree as to what constitutes severe weather. However, most concur that thunderstorms, tornadoes, and hurricanes, all considered to be "convective" weather, fit the definition of severe weather, which is a weather condition likely to cause hardship. This science guide will explore each of the three weather phenomena. By virtue of their locations, most students are familiar with at least one of the three severe weather events. Students who tour the web sites will have an opportunity to make connections between the familiar and the perhaps less understood weather events.
National Science Teachers Association (NSTA)
The impact of internet and simulation-based training on transoesophageal echocardiography learning in anaesthetic trainees: a prospective randomised study.
With the increasing role of transoesophageal echocardiography in clinical fields other than cardiac surgery, we decided to assess the efficacy of multi-modular echocardiography learning in echo-na�ve anaesthetic trainees. Twenty-eight trainees undertook a pre-test to ascertain basic echocardiography knowledge, following which the study subjects were randomly assigned to two groups: learning via traditional methods such as review of guidelines and other literature (non-internet group); and learning via an internet-based echocardiography resource (internet group). After this, subjects in both groups underwent simulation-based echocardiography training. More tests were then conducted after a review of the respective educational resources and simulation sessions. Mean (SD) scores of subjects in the non-internet group were 28 (10)%, 44 (10)% and 63 (5)% in the pre-test, post-intervention test and post-simulation test, respectively, whereas those in the internet group scored 29 (8)%, 59 (10)%, (p�=�0.001) and 72 (8)%, p�=�0.005, respectively. The use of internet- and simulation-based learning methods led to a significant improvement in knowledge of transoesophageal echocardiography by anaesthetic trainees. The impact of simulation-based training was greater in the group who did not use the internet-based resource. We conclude that internet- and simulation-based learning methods both improve transoesophageal echocardiography knowledge in echo-na�ve anaesthetic trainees. PMID:23594265
Sharma, V; Chamos, C; Valencia, O; Meineri, M; Fletcher, S N
Serial measurements of left ventricular dimensions by echocardiography. Assessment of week-to-week, inter- and intraobserver variability in normal subjects and patients with valvular heart disease.
The week-to-week, inter- and intraobserver variation in left ventricular echocardiographic measurements has been studied in 10 normal male volunteers and in five patients with stable valvular disease. A two-way analysis of variance showed no statistically significant variation either from week to week or between observers. Furthermore the within observer variation was minimal. Calculation of the coefficient of variation allowed confidence limits to be applied to each of the six ventricular measurements, thus providing ranges of variation in follow-up studies using M-mode echocardiography. Images
Ladipo, G O; Dunn, F G; Pringle, T H; Bastian, B; Lawrie, T D
Combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after acute reperfused myocardial infarction
OBJECTIVE�To evaluate the combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after myocardial infarction.?DESIGN�Myocardial contrast echocardiography was performed in patients with acute myocardial infarction shortly after successful coronary reperfusion (TIMI 3�patency) by direct angioplasty. Collateral flow was assessed before coronary angioplasty, and contrast reflow was evaluated 15�minutes after reperfusion. The presence of contractile reserve was assessed by low dose dobutamine echocardiography (5�to 15��g/kg/min) at (mean (SD)) 3�(2) days after myocardial infarction. Recovery of segmental function (myocardial viability) was evaluated by resting echocardiography at a two month follow up. The study was prospective.?PATIENTS�35 consecutive patients referred for acute transmural myocardial infarction.?RESULTS�Contrast reflow was observed in 20�patients (57%) and collateral flow in 14�(40%). Contrast reflow and collateral contrast flow were both correlated with reversible dysfunction on initial dobutamine echocardiography and at follow up (p�<�0.05). The presence of reflow or collateral flow on myocardial contrast echocardiography was a highly sensitive (100%) but weakly specific (60%) indicator of segmental dysfunction recovery. Simultaneous presence of contrast reflow and collateral flow was more specific of reversible dysfunction than reflow alone (90% v 60%).?CONCLUSIONS�Combined assessment of reflow and collateral blood flow enhanced the sensitivity of myocardial contrast echocardiography in predicting myocardial viability after acute, reperfused myocardial infarction. The simultaneous presence of reflow and collateral blood flow was highly specific of recovery of segmental dysfunction.???Keywords: contrast echocardiography; coronary reflow; collateral blood flow; dobutamine echocardiography; myocardial dysfunction
Leclercq, F; Messner-Pellenc, P; Descours, Q; Daures, J; Pasquie, J; Hager, F; Davy, J; Grolleau-Raoux, R
Tissue motion annular displacement of the mitral valve using two-dimensional speckle tracking echocardiography predicts the left ventricular ejection fraction in normal children.
Background: The gold standard for determining the left ventricular ejection fraction is cardiac magnetic resonance imaging. Other parameters for determining the ejection fraction such as M-mode echocardiography are operator-dependant and often inaccurate. Assessment of the displacement of the mitral valve annulus using two-dimensional speckle tracking echocardiography may provide an accurate and simple method of determining the left ventricular ejection fraction in children. Method: We retrospectively studied 70 healthy 9-year-old children with no history of cardiovascular disease who had been assessed using cardiac magnetic resonance imaging and two-dimensional transthoracic echocardiography. Mitral displacement was determined using the tissue motion annular displacement (TMAD) feature of Philips QLAB version 9. The midpoint displacement of the mitral valve was calculated, and the predicted left ventricular ejection fraction was compared with magnetic resonance imaging-derived and M-mode-derived ejection fractions. Results: The mean ejection fraction derived from magnetic resonance imaging (64.5 (4.6)) was similar to that derived from the TMAD midpoint (60.9 (2.7), p = 0.001) and the M-mode (61.9 (7), p = 0.012). The TMAD midpoint correlated strongly with the magnetic resonance imaging-derived ejection fraction (r = 0.69, p < 0.001), as did the predicted fraction (r = 0.67, p < 0.001). The M-mode ejection fraction showed a poor linear correlation with both magnetic resonance imaging-derived and TMAD-derived fractions (r = 0.33 and 0.04, respectively). Conclusion: TMAD of the mitral valve is a simple, effective, and highly reproducible method of assessing the ejection fraction in normal children. It shows a strong linear correlation with magnetic resonance imaging-derived ejection fraction and is superior to M-mode-derived ejection fractions. PMID:23803408
Black, David E; Bryant, Jen; Peebles, Charles; Godfrey, Keith M; Hanson, Mark; Vettukattil, Joseph J
Ventricular septal rupture imaged with real-time three-dimensional transesophageal echocardiography: diagnosis at a glance.
Ventricular septal rupture is a rare complication of acute myocardial infarction and its diagnosis can be really challenging especially in the case of complex lesions. Echocardiography is the technique of choice for the detection of mechanical complications following myocardial infarction. The introduction of three-dimensional echocardiography offers new imaging possibilities with precise localization and easiest definition of the defect anatomy. This information is of paramount importance in the setting of a percutaneous closure procedure. We describe a case where real-time three-dimensional transesophageal echocardiography correctly defined the complex anatomy of a postmyocardial infarction septal defect with an associated pseudoaneurysm. PMID:23079609
Squeri, Angelo; Conti, Rita; Bosi, Stefano
Assessment of myocardial viability in patients with acute myocardial infarction by two-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography.
It is clinically important to determine the myocardial viability of regional wall motion abnormality segments in patients with acute myocardial infarction (AMI). The purpose of this study was to ascertain the ability and value of a combination of speckle tracking echocardiography (STE) and low dose dobutamine stress echocardiography (LDDSE) for the evaluation of viable myocardium in patients with AMI. Forty-two hospitalized patients with AMI and left ventricular systolic dysfunction (left ventricular ejection fraction <50%) were underwent STE in conjunction with LDDSE and dual isotope simultaneous acquisition single photon emission computed tomography (DISA-SPECT). Percutaneous coronary intervention (PCI) was performed subsequently in all patients. STE was used to measure radial, circumferential, and longitudinal end-systolic strain and peak systolic strain rate. The movement of each segment was observed by routine echocardiography 1, 3, and 6 months after PCI, and its improvement over time was the criterion of viable myocardium. The sensitivity, specificity and accuracy of DISA-SPECT for the assessment of viable myocardium were 83.6, 74.4, and 80.7%, respectively. Among the radial, circumferential, and longitudinal strain and strain rate parameters, only longitudinal strain (LS) and longitudinal strain rate (LSr) at rest and LDDSE emerged as independent predictors of viable myocardium, When combining LS and LSr at LDDSE, the sensitivity, specificity and accuracy for the assessment of viable myocardium rose to 89.8, 90.2 and 89.9%, respectively. The sensitivity of STE in conjunction with LDDSE was similar to DISA-SPECT for detecting viable myocardium in patients with AMI, but the specificity and accuracy of STE performed with LDDSE were higher than DISA-SPECT. PMID:23358919
Gong, Lei; Li, Dongye; Chen, Junhong; Wang, Xiaoping; Xu, Tongda; Li, Wenhua; Ren, Shaoyang; Wang, Cheng
Casimir experiments showing saturation effects
NASA Astrophysics Data System (ADS)
We address several different Casimir experiments where theory and experiment disagree. First out is the classical Casimir force measurement between two metal half spaces; here both in the form of the torsion pendulum experiment by Lamoreaux and in the form of the Casimir pressure measurement between a gold sphere and a gold plate as performed by Decca ; theory predicts a large negative thermal correction, absent in the high precision experiments. The third experiment is the measurement of the Casimir force between a metal plate and a laser irradiated semiconductor membrane as performed by Chen ; the change in force with laser intensity is larger than predicted by theory. The fourth experiment is the measurement of the Casimir force between an atom and a wall in the form of the measurement by Obrecht of the change in oscillation frequency of a R87b Bose-Einstein condensate trapped to a fused silica wall; the change is smaller than predicted by theory. We show that saturation effects can explain the discrepancies between theory and experiment observed in all these cases.
Sernelius, Bo E.
Casimir experiments showing saturation effects
We address several different Casimir experiments where theory and experiment disagree. First out is the classical Casimir force measurement between two metal half spaces; here both in the form of the torsion pendulum experiment by Lamoreaux and in the form of the Casimir pressure measurement between a gold sphere and a gold plate as performed by Decca et al.; theory predicts a large negative thermal correction, absent in the high precision experiments. The third experiment is the measurement of the Casimir force between a metal plate and a laser irradiated semiconductor membrane as performed by Chen et al.; the change in force with laser intensity is larger than predicted by theory. The fourth experiment is the measurement of the Casimir force between an atom and a wall in the form of the measurement by Obrecht et al. of the change in oscillation frequency of a {sup 87}Rb Bose-Einstein condensate trapped to a fused silica wall; the change is smaller than predicted by theory. We show that saturation effects can explain the discrepancies between theory and experiment observed in all these cases.
Sernelius, Bo E. [Division of Theory and Modeling, Department of Physics, Chemistry and Biology, Linkoeping University, SE-581 83 Linkoeping (Sweden)
Assessment of right ventricular function by three-dimensional echocardiography and myocardial strain imaging in adult atrial septal defect before and after percutaneous closure.
Real-time three-dimensional (3D) echocardiography allows us to measure right ventricular (RV) end-diastolic volume irrespective of its shape. Tissue Doppler imaging (TDI) and speckle tracking imaging (STI) are new tools to assess myocardial function. We sought to evaluate RV function by 3D echocardiography and myocardial strain imaging in adult patients with atrial septal defect (ASD) before and 6 months after transcatheter closure in order to assess the utility of these new indexes in comparison with standard two-dimensional (2D) and Doppler parameters. Thirty-nine ASD patients and 39 healthy age- and sex-matched controls were studied using a commercially available cardiovascular ultrasound system. 2D-Doppler parameters of RV function (fractional area change, tricuspid annular plane systolic excursion, myocardial performance index) were calculated. 3D RV volumes were also obtained. RV peak-systolic velocities, peak-systolic strain, and peak systolic and diastolic strain-rate were measured in the basal, mid and apical segments of lateral and septal walls in apical 4-chamber view by TDI and STI. In open ASD, RV ejection fraction (3D-RVEF) and global and regional RV longitudinal strain were significantly higher than control group and decreased significantly after closure. By multivariate analysis 3D-RVEF, apical strain and strain rate were independent predictors of functional class. ROC analysis showed 3D-RVEF and apical strain to be more sensitive predictors of unfavorable outcome after defect closure compared to 2D-Doppler indexes. 3D echocardiography and myocardial strain imaging give useful insights in the quantitative assessment of RV function in ASD patients before and after closure. PMID:22310981
Vitarelli, Antonio; Sardella, Gennaro; Roma, Angelo Di; Capotosto, Lidia; De Curtis, Guglielmo; D'Orazio, Simona; Cicconetti, Paolo; Battaglia, Daniela; Caranci, Fiorella; De Maio, Melissa; Bruno, Pasqualina; Vitarelli, Massimo; De Chiara, Stefania; D'Ascanio, Michela
A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness
Introduction The accurate assessment of intravascular volume status for the therapy of severe hypovolemia and shock is difficult and critical to critically ill patients. Non-invasive evaluation of fluid responsiveness by the rapid infusion of a very limited amount of volume is an important clinical goal. This study aimed to test whether echocardiographic parameters could predict fluid responsiveness in critically ill patients following a low-volume (50-ml crystalloid solution) infusion over 10?seconds. Methods We prospectively studied 55 mechanically ventilated patients. Echocardiography was performed during a 50-ml infusion of crystalloid solution over 10?seconds and a further 450?ml over 15?minutes. Cardiac output (CO), stroke volume (SV), aortic velocity time index (VTI), and left ventricular ejection fraction (LVEF) were recorded. Patients were classified as responders (Rs) if CO increased by at least 15% following the 500-ml volume expansion or were classified as non-responders (NRs) if CO increased by less than 15%. Area under the receiver operating characteristic curves (AUC) compared CO variations after 50?ml over 10?seconds (?CO50) and 500?ml over 15?minutes (?CO500) and the variation of VTI after infusion of 50?ml of fluid over 10?seconds (?VTI50). Results In total, 50 patients were enrolled, and 27 (54%) of them were Rs. General characteristics, LVEF, heart rate, and central venous pressure were similar between Rs and NRs. In the Rs group, the AUC for ?CO50 was 0.95?�?0.03 (P <0.01; best cutoff value, 6%; sensitivity, 93%; specificity, 91%). Moreover, ?CO50 and ?CO500 were strongly correlated (r?=?0.87; P <0.01). The AUC for ?VTI50 was 0.91?�?0.04 (P <0.01; best cutoff value, 9%; sensitivity, 74%; specificity, 95%). ?VTI50 and ?CO500 were positively correlated (r?=?0.72; P <0.01). Conclusion In critically ill patients, the variation of CO and VTI after the administration of 50-ml crystalloid solution over 10?seconds (?CO50 and ?VTI50) can accurately predict fluid responsiveness. Trial registration Current Controlled Trials ISRCTN10524328. Registered 12 December 2013.
Detection of myocardial viability by contrast echocardiography in acute infarction predicts recovery of resting function and contractile reserve
ObjectivesWe sought to determine whether myocardial contrast echocardiography (MCE) performed before and early after primary coronary stenting (PCS) in patients with acute myocardial infarction (AMI) could predict recovery of resting left ventricular systolic function and contractile reserve.
Eduardo Balcells; Eric R Powers; Wolfgang Lepper; Todd Belcik; Kevin Wei; Michael Ragosta; Habib Samady; Jonathan R Lindner
Combination of contrast with stress echocardiography: A practical guide to methods and interpretation
Contrast echocardiography has an established role for enhancement of the right heart Doppler signals, the detection of intra-cardiac shunts, and most recently for left ventricular cavity opacification (LVO). The use of intravenously administered micro-bubbles to traverse the myocardial microcirculation in order to outline myocardial viability and perfusion has been the source of research studies for a number of years. Despite the enthusiasm of investigators, myocardial contrast echocardiography (MCE) has not attained routine clinical use and LV opacification during stress has been less widely adopted than the data would support. The purpose of this review is to facilitate an understanding of the involved imaging technologies that have made this technique more feasible for clinical practice, and to guide its introduction into the practice of the non-expert user.
Moir, Stuart; Marwick, Thomas H
The Clinical Benefits of Adding a Third Dimension to Assess the Left Ventricle with Echocardiography
Three-dimensional echocardiography is a novel imaging technique based on acquisition and display of volumetric data sets in the beating heart. This permits a comprehensive evaluation of left ventricular (LV) anatomy and function from a single acquisition and expands the diagnostic possibilities of noninvasive cardiology. It provides the possibility of quantitating geometry and function of LV without preestablished assumptions regarding cardiac chamber shape and allows an echocardiographic assessment of the LV that is less operator-dependent and therefore more reproducible. Further developments and improvements for widespread routine applications include higher spatial and temporal resolution to improve image quality, faster acquisition, processing and reconstruction, and fully automated quantitative analysis. At present, three-dimensional echocardiography complements routine 2DE in clinical practice, overcoming some of its limitations and offering additional valuable information that has led to recommending its use for routine assessment of the LV of patients in whom information about LV size and function is critical for their clinical management.
Badano, Luigi P.
Detection of quiescent phases in echocardiography data using non-linear filtering and boundary detection.
In order to detect the quasi-stationary states of the heart within a cardiac cycle from echocardiography data, we present an algorithm that uses non-linear filtering and boundary detection. The non-linear filtering algorithm involves anisotropic diffusion to remove the speckle noise from the data and to smoothen the homogeneous regions while preserving the edges. Following this, we perform binary thresholding and boundary detection, and observe the positional changes in the region of interest. From a series of echocardiography images, we derived the regions of cardiac quiescence, which we then plotted on the electrocardiograph (ECG) R-R interval. It is observed that the quiescence occurs in the diastolic region of the ECG signal, but the position and length of quiescence varies across multiple cardiac cycles for the same individual. PMID:23366202
Ravichandran, Lakshminarayan; Wick, Carson A; Tridandapani, Srini
Vegetations in infective endocarditis. Clinical relevance and diagnosis by cross sectional echocardiography.
Cross sectional echocardiography identified vegetations in 45 of 62 (73%) patients who had clinical evidence of active infective endocarditis. The sensitivity of this technique in diagnosing vegetations in infective endocarditis was 93% and the specificity 89%. The predictive value of a positive test was 96% and that of a negative test 80%. Vegetations were detected with a similar frequency on the aortic and mitral valves. The incidence of valvar incompetence, congestive heart failure, and the need for surgical intervention was similar in the patients with and without vegetations. Embolism occurred in 47% of those patients with vegetations and in 12% of those without. The mortality rate was 27% in those with vegetations, and no patient without vegetations died. Thus cross sectional echocardiography is accurate in diagnosing vegetations in patients with infective endocarditis, and this finding identifies patients at high risk of embolic complications and death. Images
Stafford, W J; Petch, J; Radford, D J
[Diagnosis with helical CT and echocardiography of patients with suspected chronic thromboembolic pulmonary hypertension].
Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a serious disease with a very high mortality after variable periods of time. Early diagnosis of CTEPH is critical because thromboendarterectomy can improve survival, hemodimamics and functional capacity. Based on our experience we have performed a review of diagnostic techniques. Echocardiography, pulmonary angiography, fiberoptic angioscopy, helical CT an MRI. For each diagnostic procedure we have analysed its accuracy, invasiveness and easiness of use. We conclude that currently the most useful techniques are echocardiography (to asses pulmonary hypertension), and helical CT which is a good alternative to pulmonary angiography and can detect very specific findings such as dilatation of central pulmonary arteries, eccentric localized thrombi and mosaic attenuation of the pulmonary parenchyma. Even more accurate findings can be expected by the use of multislice CT, which could allow to asses the degree of narrowing of the pulmonary vessels and bronchial circulation. PMID:12892554
V�zquez Mu�oz, E; R�os Blanco, J J; G�mez Cerezo, J; Barbado Hern�ndez, F J
Clinical applications of exercise stress echocardiography in the treadmill with upright evaluation during and after exercise.
Exercise stress echocardiography is the most frequently used stress test in our laboratory. Exercise echocardiography is used mainly in the study of patients with coronary artery disease. However, the technique is increasingly being used to study other diseases. In our centre, we use an original methodology, published by us in 2000, in which we evaluate heart function during exercise in the treadmill. After the exercise, patients are maintained in orthostatic position when appropriate or lying down in left lateral decubitus for further evaluation. Since this method seems to increase the quality and the quantity of information obtained in so many clinical arenas, we now present a detailed review of this methodology and its applications. PMID:23875614
Cotrim, Carlos; Jo�o, Isabel; Fazendas, Paula; Almeida, Ana R; Lopes, Lu�s; Stuart, Bruno; Cruz, In�s; Caldeira, Daniel; Loureiro, Maria Jos�; Morgado, Gon�alo; Pereira, H�lder
Intraoperative epicardial echocardiography with a miniature high-frequency transducer: imaging techniques and scanning planes.
Intraoperative Doppler echocardiography has the potential to provide anatomic and functional information but is hindered by the large size of standard transducers. We describe new scanning planes accessible through the application of a new 5 MHz miniature transducer with imaging, Doppler, and color-flow capability. Epicardial echocardiography was performed in 15 adults undergoing elective coronary artery bypass grafting. Standard parasternal equivalent, subcostal equivalent, aortopulmonary sulcus and aortosuperior vena caval views were obtained. Previously unobtainable apical four-chamber, five-chamber, and long-axis views were possible by positioning the transducer at the apex. The transducer has a broad bandwidth, allowing high-quality imaging at different depths and could be maneuvered laterally, posteriorly, and over the aorta and pulmonary arteries to provide off-axis views. The proximal-mid coronary arteries were imaged on the beating heart with a standoff medium. Transducer miniaturization should expand the role of epicardial ultrasonography in the surgical management of heart disorders. PMID:8185958
Kenny, A; Cary, N R; Murphy, D; Shapiro, L M
Topology of blood transport in the human left ventricle by novel processing of Doppler echocardiography.
Novel processing of Doppler-echocardiography data was used to study blood transport in the left ventricle (LV) of six patients with dilated cardiomyopathy and six healthy volunteers. Bi-directional velocity field maps in the apical long axis of the LV were reconstructed from color-Doppler echocardiography. Resulting velocity field data were used to perform trajectory-based computation of Lagrangian coherent structures (LCS). LCS were shown to reveal the boundaries of blood injected and ejected from the heart over multiple beats. This enabled qualitative and quantitative assessments of blood transport patterns and residence times in the LV. Quantitative assessments of stasis in the LV are reported, as well as characterization of LV vortex formations from E-wave and A-wave filling. PMID:23817765
Hendabadi, Sahar; Bermejo, Javier; Benito, Yolanda; Yotti, Raquel; Fern�ndez-Avil�s, Francisco; del �lamo, Juan C; Shadden, Shawn C
Clinical applications of exercise stress echocardiography in the treadmill with upright evaluation during and after exercise
Exercise stress echocardiography is the most frequently used stress test in our laboratory. Exercise echocardiography is used mainly in the study of patients with coronary artery disease. However, the technique is increasingly being used to study other diseases. In our centre, we use an original methodology, published by us in 2000, in which we evaluate heart function during exercise in the treadmill. After the exercise, patients are maintained in orthostatic position when appropriate or lying down in left lateral decubitus for further evaluation. Since this method seems to increase the quality and the quantity of information obtained in so many clinical arenas, we now present a detailed review of this methodology and its applications.
Incremental value of three-dimensional transesophageal echocardiography over two-dimensional transesophageal echocardiography in the assessment of Lambl's excrescences and nodules of Arantius on the aortic valve.
In this retrospective study, we identified 7 cases where Lambl's excrescences were identified by two-dimensional transesophageal echocardiography (2DTEE) and also had live/real time three-dimensional transesophageal echocardiography (3DTEE) studies available for comparison. We subsequently assessed them for the presence of Lambl's excrescences (LE) and nodules of Arantius (NA) on the aortic valve. After their identification, we qualitatively and quantitatively organized our findings by number, cusp location, measurements, and orientation if applicable. A greater number of LE was found by 3DTEE than 2DTEE (19 vs. 11, respectively). In all 3DTEE studies, their cusp attachment site, their x-, y-, and z-axis measurements, and orientation were clearly visualized and described. Only 3DTEE studies provided confident visualization of the cusp attachment sites. Similarly, a greater number of NA was found by 3DTEE than 2DTEE (21 vs. 5, respectively). The triad of NA was visualized in all 3DTEE studies and each was described using its x-, y-, and z- axis measurements. Only three 2DTEE studies provided reliable identification of the NA. In conclusion, we present further evidence of the incremental value of 3DTEE over 2DTEE in the qualitative and quantitative assessment of cardiac structures including LE and NA on the aortic valve. PMID:23889489
Dumaswala, Bhavin; Dumaswala, Komal; Hsiung, Ming Chon; Quiroz, Luis David Meggo; Sungur, Aylin; Escanuela, Maximilliano German Amado; Mehta, Kruti; Oz, Tugba Kemaloglu; Bhagatwala, Kunal; Karia, Nidhi M; Nanda, Navin C
Assessment of myocardial viability by dobutamine echocardiography, positron emission tomography and thallium-201 SPECT
Objectives. We examined the relationship among viability assessment by dobutamine echocardiography (DE), positron emission tomography (PET) and thallium-201 single-photon emission computed tomography (Tl-SPECT) to the degree of fibrosis.Background. DE, PET and Tl-SPECT have been shown to be sensitive in identifying viability of asynergic myocardium. However, PET and Tl-SPECT indicated viability in a significant percentage of segments without dobutamine response or
Helmut Baumgartner; Gerold Porenta; Yuk-Kong Lau; Michael Wutte; Ursula Klaar; Mohammad Mehrabi; Robert J Siegel; Johannes Czernin; G�nther Laufer; Heinz Sochor; Heinrich Schelbert; Michael C Fishbein; Gerald Maurer
The heart of the endurance athlete assessed by echocardiography and its modalities: "embracing the delicate balance".
"To go too far is as bad as to fall short."Confucius (BC 551-BC 479) Chinese philosopher Echocardiography has contributed most to our current understanding and indeed our current dilemma regarding the heart of the endurance athlete. Echocardiography assesses and characterizes nicely the effects of Endurance exercise training. It allows us to assess both systolic and diastolic cardiac variables as they change with structure and function associated with intense sporting activity. Much research work using echocardiography has characterized the left and right ventricle of the endurance athlete over the last year. Indeed evidence suggests that intense prolonged exercise may result in myocardial dysfunction which predominantly affects the RV, and that chronic RV remodelling may represent a substrate for ventricular arrhythmias in athletes. This has been the source of many debates and articles over the last 12�months. The reasons underlying the predilection towards RV dysfunction with intense prolonged exercise and the variation between individuals in its occurrence are still under dispute. This article seeks to describe the recent literature over the last year which outlines the different areas research has focused on when we assess the heart of the endurance athletes using echocardiography. Ultimately the goal of all research on the heart of the endurance athletes is to search for the holy grail of when enough is enough and therefore recognize and embrace the delicate balance of endurance intensity, in other words the border line when endurance exercise is no longer beneficial but slumps and slides into the realms of induced cardiac pathology. PMID:23839067
King, Gerard; Wood, Malissa J
Dynamic Evaluation of the 21-mm Medtronic Intact Aortic Bioprosthesis by Dobutamine Echocardiography
Background. High residual transvalvular gradients have been reported with the use of small Medtronic Intact aortic valve prostheses. The aim of this study was to evaluate the hemodynamic performance of 21-mm prostheses using dobutamine Doppler echocardiography.Methods. Ten patients (7 women; mean age, 79 years) who had undergone aortic valve replacement with 21-mm Medtronic Intact prostheses 19.1 � 9.9 (standard deviation)
Prognostic value of detection of myocardial viability using low-dose dobutamine echocardiography in infarcted patients
Revascularization can improve ventricular function in patients with viable myocardium, but whether and how the presence of viable myocardium affects prognosis of infarcted patients is still far from clear. Thus, 202 patients (173 men, 59 � 9 years old) with a previous or recent myocardial infarction (MI) and regional asynergies underwent low-dose dobutamine echocardiography (5�15 ?g\\/kg per min) to assess
Maurizio Anselmi; Giorgio Golia; Mariantonietta Cicoira; Monica Tinto; Maria Teresa Nitti; Roberto Trappolin; Andrea Rossi; Luisa Zanolla; Paolo Marino; Piero Zardini
Early Diastolic Intraventricular Filling Pattern in Acute Myocardial Infarction by Color M-mode Doppler Echocardiography
The aim of the present study was to investigate whether slowing of mitral-to-apical filling is present in patients with acute myocardial infarction (AMI). Twenty-eight patients with their first AMI were examined by color M-mode Doppler echocardiography. Twenty-eight age- and sex-matched healthy individuals served as control subjects. From the color M-mode Doppler images, we measured the time difference (TD) between occurrence
Kjetil Steine; Trond Fl�gstad; Marie Stugaard; Otto A. Smiseth
Heart wall motion analysis by dynamic 3D strain rate imaging from tissue Doppler echocardiography
The knowledge about the complex three-dimensional (3D) heart wall motion pattern, particular in the left ventricle, provides valuable information about potential malfunctions, e.g., myocardial ischemia. Nowadays, echocardiography (cardiac ultrasound) is the predominant technique for evaluation of cardiac function. Beside morphology, tissue velocities can be obtained by Doppler techniques (tissue Doppler imaging, TDI). Strain rate imaging (SRI) is a new technique
Mark Hastenteufel; Ivo Wolf; Raffaele de Simone; Sibylle Mottl-Link; Hans-Peter Meinzer
Open access echocardiography in management of the heart failure in the community
AbstractObjective: To assess the value of an open access echocardiography service.Design: Study of new open access service for general practitioners, who were invited to refer patients taking diuretics for suspected heart failure, untreated patients with symptoms of possible heart failure, and asymptomatic patients with risk factors for left ventricular systolic dysfunction.Setting: Regional cardiology centre.Subjects: 259 consecutive patients.Main outcome measures: Presence
C. M. Francis; L. Caruana; P. Kearney; M. Love; G. R. Sutherland; I. R. Starkey; T. R. D. Shaw; J. J. V. McMurray; J. R. Hampton; A. R. Barlow
Normal serial variability for M-mode and digitized echocardiography in a pediatric population
Summary��The normal serial variability of M-mode and digitized echocardiography was assessed in 18 healthy children aged 3�16 years.\\u000a M-mode echocardiograms were done one month apart in each child and two sets of three beats were analyzed twice for each month's\\u000a tracing. Ejection fraction and shortening fraction were obtained in the standard manner and the tracing digitized and analyzed\\u000a for peak
George G. S. Sandor; Peter Schumacher; Martin L. Puterman; Ruby Popov
Fragment reconstruction of coronary arteries by transesophageal echocardiography: a method for visualizing coronary arteries with ultrasound
Background�If transesophageal echocardiography (TEE) is to play a role in coronary diagnostics, satisfactory image documentation of the coronary status is indispensable so that the requirements for validity and quality assurance of a medical examination can be met. Our goal was to develop a suitable and valid procedure for imaging coronary arteries with 2D TEE. Methods and Results�After pilot trials and
Philipp S. Wild; Rainer J. Zotz
Prognostic Value of Dobutamine�Atropine Stress Echocardiography Early After Acute Myocardial Infarction
Objectives. The aim of this multicenter, multinational, prospective, observational study was to assess the relative value of myocardial viability and induced ischemia early after uncomplicated myocardial infarction.Background. Dobutamine�atropine stress echocardiography allows evaluation of rest function (at baseline), myocardial viability (at low dose) and residual ischemia (peak dose, up to 40 ?g with atropine up to 1 mg) in one test.Methods.
Rosa Sicari; Eugenio Picano; Patrizia Landi; Alessandro Pingitore; Riccardo Bigi; Claudio Coletta; Joanna Heyman; Franco Casazza; Mario Previtali; Wilson Mathias; Claudio Dodi; Giovanni Minardi; Jorge Lowenstein; Xenya Garyfallidis; Lauro Cortigiani; Maria Aurora Morales; Mauro Raciti
Intraoperative cardiac assessment with transesophageal echocardiography for decision-making in cardiac anesthesia.
Transesophageal echocardiography is an invaluable hemodynamic monitoring modality. Extended and anatomically based evaluation of cardiac function with transesophageal echocardiography is essential to prompt and accurate decision-making in anesthetic management during cardiac surgery. Fractional shortening and fractional area changes are indices widely used to assess the global systolic performance of the left ventricle. Monitoring regional function using semi-quantitative scoring has been demonstrated to be a more sensitive indicator of myocardial ischemia. Assessment of left ventricular diastolic function should be performed in a systematic way, measuring transmitral flow, pulmonary venous flow, transmitral color M-mode flow propagation velocity, and mitral annulus tissue Doppler imaging. The unique anatomical features of the right ventricle make echocardiographic evaluation complicated and therefore less frequently employed. Right ventricular fractional area change, tricuspid annular plane systolic excursion, maximal systolic tricuspid annular velocity with tissue Doppler imaging, and myocardial performance index are indices successfully incorporated into intraoperative right ventricular assessment. Left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve may develop after cardiac procedures. Transesophageal echocardiography plays a central role in prevention as well as diagnosis of systolic anterior motion. Transesophageal echocardiography is extremely useful not only for detecting and locating intracardiac air, but also for guiding and evaluating the procedures to remove air. Air is likely to persist in the right and left superior pulmonary vein, left ventricular apex, left atrium, right coronary sinus of Valsalva, and ascending aorta. Accurate evaluation of cardiac function depends on performing TEE examination properly and obtaining optimal images. PMID:23404310
Akiyama, Koichi; Arisawa, Shoji; Ide, Masahiro; Iwaya, Masaaki; Naito, Yoshiyuki
Thromboembolus crossing patent foramen ovale: appearance in multislice computed tomography and echocardiography.
A 31-year-old woman was referred to our hospital due to progressive dyspnea and a family history of pulmonary embolism. Multislice computed tomography depicted massive bilateral pulmonary embolism, and transesophageal echocardiography demonstrated a serpentine structure in both atria with the appearance of a thrombus. Furthermore, a highly mobile mass trapped in her patent foramen ovale was identified. She underwent emergency cardiac embolectomy and was discharged from our hospital with conventional anticoagulant therapy. PMID:22791001
Weymann, Alexander; Schmack, Bastian; Rosendal, Christian; Karck, Matthias; Szabo, Gabor
Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke
Background and Purpose�Transesophageal echocardiography (TEE) is the gold standard in detecting high-risk (ie, aortic thrombi) and potential sources (ie, patent foramen ovale (PFO)) of cerebral embolism. We sought to evaluate the additional information and therapeutic impact provided by TEE in stroke patients and to characterize patients in whom TEE is indispensable. Methods�We included 503 consecutive patients (mean age 62.2 years)
Andreas Harloff; Michael Handke; Matthias Reinhard; Annette Geibel; Andreas Hetzel
Two-Dimensional Intraventricular Flow Mapping by Digital Processing Conventional Color-Doppler Echocardiography Images
Doppler echocardiography remains the most extended clinical modality for the evaluation of left ventricular (LV) function. Current Doppler ultrasound methods, however, are limited to the representation of a single flow velocity component. We thus developed a novel technique to construct 2D time-resolved (2D+t) LV velocity fields from conventional transthoracic clinical acquisitions. Combining color-Doppler velocities with LV wall positions, the cross-beam
Damien Garcia; Juan C. del �lamo; David Tann�; Raquel Yotti; Cristina Cortina; Eric Bertrand; Jos� Carlos Antoranz; Esther P�rez-David; R�gis Rieu; Francisco Fernandez-Aviles; Javier Bermejo
Physician-performed point-of-care echocardiography using a laptop platform compared with physical examination in the cardiovascular patient
OBJECTIVESThe purpose of this study was to compare the results of physical examinations (PEs) performed by board-certified cardiologists with the results of point-of-care (POC) echocardiography in a group of patients with cardiovascular disease.BACKGROUNDAlthough cardiovascular PE is crucial in the evaluation of patients with suspected heart disease, the skills required to diagnose abnormal cardiovascular findings have been declining. Echocardiography is a
Kirk T Spencer; Allen S Anderson; Ajay Bhargava; Amy C Bales; Matthew Sorrentino; Kathy Furlong; Roberto M Lang
Volume Measurement of the Left Ventricle in Children with Congenital Heart Defects: 3Dimensional Echocardiography versus Angiocardiography
Background: Volume measurement of the left ventricle is currently done by 2-dimensional echocardiography or angiocardiography. However, for the calculation of volumes by these methods, geometrical assumptions must be made. For a precise ventricular volumetry, independent of mathematical assumptions, imaging techniques as the 3-dimensional echocardiography (3D-echo) are required, which permit the imaging of the real ventricular shape. The aim of the
A. Heusch; J. R�bo; O. N. Krogmann; H. B�nig; M. Bourgeois
Does contrast echocardiography induce increases in markers of myocardial necrosis, inflammation and oxidative stress suggesting myocardial injury?
Background Contrast echocardiography is a precise tool for the non-invasive assessment of myocardial function and perfusion. Side effects of contrast echocardiography resulting from contrast-agent induced myocardial micro-lesions have been found in animals. The goal of this study is to measure markers of myocardial necrosis, inflammation and oxidative stress in humans to evaluate potential side-effects of contrast echocardiography. Methods 20 patients who underwent contrast echocardiography with Optison as the contrast medium were investigated. To evaluate myocardial micro-necrosis, inflammation and oxidative stress, cardiac troponin I (cTnI), tumor necrosis factor-? (TNF-?), interleukin (IL)-6, -8 and thiobarbituric acid reactive substances (TBARS) were measured at baseline and at 2, 4, 8 and 24 hours after contrast echocardiography. Results At baseline, 50% of the patients had cTnI and TBARS values outside the reference range. TNF-?, IL-6, IL-8 levels were within the reference range. Patients with cTnI above the RR clustered to significantly higher levels of TNF-? and IL-6. After contrast echocardiography, no statistically significant increase of cTnI, cytokines and TBARS was found. However, for nearly 50% of the patients, the intra-individual cTnI kinetics crossed the critical difference (threefold of methodical variation) which indicates a marker increase. This was neither predicted by the baseline levels of the cytokines nor the markers of oxidative stress. Conclusion There are no clinically relevant increases in serum markers for micro-necrosis, inflammation and oxidative stress in humans after contrast echocardiography. Future studies have to address whether cTnI increase in some patients represent a subset with increased risk for side effects after contrast echocardiography.
Knebel, Fabian; Schimke, Ingolf; Eddicks, Stephan; Walde, Torsten; Ziebig, Reinhard; Schattke, Sebastian; Baumann, Gert; Borges, Adrian Constantin
Is tissue Doppler echocardiography the Holy Grail for the intensivist?
Assessment of left ventricular diastolic function in the critically ill patient remains a difficult issue in clinical practice. Combined use of routine transmitral and pulmonary venous Doppler patterns in conjunction with tissue Doppler imaging have been claimed to allow bedside diagnosis of diastolic dysfunction. Although in the previous issue of Critical Care it was clearly demonstrated there might be a difference in load dependency of the early myocardial tissue Doppler velocity between lateral and septal placed sample volume, there remain still several unanswered questions, particularly with respect to the preload dependency of these indices.
Poelaert, Jan; Roosens, Carl
Current Status of 3-Dimensional Speckle Tracking Echocardiography: A Review from Our Experiences
Cardiac function analysis is the main focus of echocardiography. Left ventricular ejection fraction (LVEF) has been the clinical standard, however, LVEF is not enough to investigate myocardial function. For the last decade, speckle tracking echocardiography (STE) has been the novel clinical tool for regional and global myocardial function analysis. However, 2-dimensional imaging methods have limitations in assessing 3-dimensional (3D) cardiac motion. In contrast, 3D echocardiography also has been widely used, in particular, to measure LV volume measurements and assess valvular diseases. Joining the technology bandwagon, 3D-STE was introduced in 2008. Experimental studies and clinical investigations revealed the reliability and feasibility of 3D-STE-derived data. In addition, 3D-STE provides a novel deformation parameter, area change ratio, which have the potential for more accurate assessment of overall and regional myocardial function. In this review, we introduced the features of the methodology, validation, and clinical application of 3D-STE based on our experiences for 7 years.
Ishizu, Tomko; Aonuma, Kazutaka
Quantitative assessment of left ventricular systolic function using 3-dimensional echocardiography
Assessment of left ventricular systolic function is the commonest and one of the most important indications for performance of echocardiography. It is important for prognostication, determination of treatment plan, for decisions related to expensive device therapies and for assessing response to treatment. The current methods based on two-dimensional echocardiography are not reliable, have high degree of inter-observer and intra-observer variability and are based on presumptions about the geometry of left ventricle (LV). Real-time three-dimensional echocardiography (RT3DE) on the other hand is fast, easy, accurate, relatively operator independent and is not based on any assumptions related to the shape of LV. Owing to these advantages, it is the Echocardiographic modality of choice for assessment of systolic function of the LV. We describe here a step by step approach to evaluation of LV volumes, ejection fraction, regional systolic function and Dyssynchrony analysis based on RT3DE. It has been well validated in clinical studies and is rapidly being incorporated in routine clinical practice.
Mehrotra, Rahul; Alagesan, R.; Srivastava, Sameer
Heart wall motion analysis by dynamic 3D strain rate imaging from tissue Doppler echocardiography
NASA Astrophysics Data System (ADS)
The knowledge about the complex three-dimensional (3D) heart wall motion pattern, particular in the left ventricle, provides valuable information about potential malfunctions, e.g., myocardial ischemia. Nowadays, echocardiography (cardiac ultrasound) is the predominant technique for evaluation of cardiac function. Beside morphology, tissue velocities can be obtained by Doppler techniques (tissue Doppler imaging, TDI). Strain rate imaging (SRI) is a new technique to diagnose heart vitality. It provides information about the contraction ability of the myocardium. Two-dimensional color Doppler echocardiography is still the most important clinical method for estimation of morphology and function. Two-dimensional methods leads to a lack of information due to the three-dimensional overall nature of the heart movement. Due to this complex three-dimensional motion pattern of the heart, the knowledge about velocity and strain rate distribution over the whole ventricle can provide more valuable diagnostic information about motion disorders. For the assessment of intracardiac blood flow three-dimensional color Doppler has already shown its clinical utility. We have developed methods to produce strain rate images by means of 3D tissue Doppler echocardiography. The tissue Doppler and strain rate images can be visualized and quantified by different methods. The methods are integrated into an interactively usable software environment, making them available in clinical everyday life. Our software provides the physician with a valuable tool for diagnosis of heart wall motion.
Hastenteufel, Mark; Wolf, Ivo; de Simone, Raffaele; Mottl-Link, Sibylle; Meinzer, Hans-Peter
Early Doppler-echocardiography evaluation of Carpentier-Edwards Standard and Carpentier-Edwards Magna aortic prosthetic valve: comparison of hemodynamic performance
Objectives This study was designed to describe Doppler-echocardiography values of Carpentier-Edwards Perimount Standard (CEPS) and Carpentier-Edwards Perimount Magna (CEPM) aortic prosthetic valves, evaluated by a single, experienced echo-laboratory, early in the postoperative phase. Methods Three-hundred-seventy-seven consecutive patients, who had had a CEPS or a CEPM implanted in our Hospital due to aortic stenosis and/or insufficiency, underwent baseline Doppler echocardiography evaluation within 7 days after surgery. Hemodynamic performances of CEPS and CEPM were accurately described, evaluating flow-dependent (transprosthetic velocities and gradients) and flow-independent (effective orifice area, indexed effective orifice area and Doppler velocity index) Doppler-echocardiography parameters. Results Out of the 377 patients 48.8% were men (n = 184), mean age was 74.63 � 6.77 years, mean BSA was 1.78 � 0.18 m2, mean ejection fraction was 57.78 � 8%. Two-hundred and sixty two CEPS and 115 CEPM were implanted. Comparing size-by-size CEPS with CEPM, both prostheses showed a good hemodynamic profile, with fairly similar values of pressure gradients (PGmax and mean, in mmHg, = 37,18 � 11.57 and 20.81 � 7.44 in CEPS n�19 compared to 32,47 � 7,76 and 17,67 � 4.63 in CEPM n�19 and progressively lower in higher sized prostheses, having PGmax and mean 15 � 3,16 and 9.15 � 1,29 in CEPS n�29 compared to 15,67 � 1,53 and 9 � 1 in CEPM n�29) and EOAi (being 0,65 � 0,33 cm�/m� in CEPS n�19 compared to 0,77 � 0,29 cm�/m� in CEPM n�19 and progressively higher in higher sized prostheses, being 1,28 � 0,59 cm�/m� in CEPS n�29 compared to 1,07 � 0,18 cm�/m� in CEPM n�29), the latter resulting, however, basically less flow obstructive. Conclusions Our data confirm the good hemodynamic performance of both aortic bioprostheses and the more favourable hemodynamic profile of CEPM compared to CEPS, pointing out the need to perform routinely an accurate baseline Doppler-echocardiography evaluation early after surgery to allow an adequate interpretation of data at follow-up.
Regurgitation quantification using 3D PISA in volume echocardiography.
We present the first system for measurement of proximal isovelocity surface area (PISA) on a 3D ultrasound acquisition using modified ultrasound hardware, volumetric image segmentation and a simple efficient workflow. Accurate measurement of the PISA in 3D flow through a valve is an emerging method for quantitatively assessing cardiac valve regurgitation and function. Current state of the art protocols for assessing regurgitant flow require laborious and time consuming user interaction with the data, where a precise execution is crucial for an accurate diagnosis. We propose a new improved 3D PISA workflow that is initialized interactively with two points, followed by fully automatic segmentation of the valve annulus and isovelocity surface area computation. Our system is first validated against several in vitro phantoms to verify the calculations of surface area, orifice area and regurgitant flow. Finally, we use our system to compare orifice area calculations obtained from in vivo patient imaging measurements to an independent measurement and then use our system to successfully classify patients into mild-moderate regurgitation and moderate-severe regurgitation categories. PMID:22003738
Grady, Leo; Datta, Saurabh; Kutter, Oliver; Duong, Christophe; Wein, Wolfgang; Little, Stephen H; Igo, Stephen R; Liu, Shizhen; Vannan, Mani
Temporal Enhancement of Three Dimensional Echocardiography by Frame Reordering
In this work we describe a method to increase the frame rate for three dimensional ultrasound sequences of periodically moving cardiac structures by reordering the acquired volume series. Frame rate is especially important in studying intracardiac structures such as valve leaflet motion where valve closure times are on the order of milliseconds. Current commercially available systems for volumetric ultrasound imaging are limited to approximately 10�20 volumes per second. While this frame rate is sufficient for real time observation of basic cardiac morphology, to understanding cardiac dynamics requires faster frame rates. The presented work achieves higher frame rates by sampling over several beats and using a simultaneous ECG signal to accurately place the frame within the cardiac cycle. The proposed method relies on periodicity of the heart motion, and that within the temporal regions of highest velocity, structural motions of interest have the least beat to beat variability.
Perrin, Douglas P.; Vasilyev, Nikolay V.; Marx, Gerald R.; del Nido, Pedro J.
Assessment of atrial electromechanical delay by tissue Doppler echocardiography in obese subjects.
Our aim was to evaluate whether atrial electromechanical delay measured by tissue Doppler imaging (TDI), which is an early predictor of atrial fibrillation (AF) development, is prolonged in obese subjects. A total of 40 obese and 40 normal-weight subjects with normal coronary angiograms were included in this study. P-wave dispersion (PWD) was calculated on the 12-lead electrocardiogram (ECG). Systolic and diastolic left ventricular (LV) functions, inter- and intra-atrial electromechanical delay were measured by TDI and conventional echocardiography. Inter- and intra-atrial electromechanical delay were significantly longer in the obese subjects compared with the controls (44.08 � 10.06 vs. 19.35 � 5.94�ms and 23.63 � 6.41 vs. 5.13 � 2.67�ms, P < 0.0001 for both, respectively). PWD was higher in obese subjects (53.40 � 5.49 vs. 35.95 � 5.93�ms, P < 0.0001). Left atrial (LA) diameter, LA volume index and LV diastolic parameters were significantly different between the groups. Interatrial electromechanical delay was correlated with PWD (r = 0.409, P = 0.009), high-sensitivity C-reactive protein (hsCRP) levels (r = 0.588, P < 0.0001). Interatrial electromechanical delay was positively correlated with LA diameter, LA volume index, and LV diastolic function parameters consisting of mitral early wave (E) deceleration time (DT) and isovolumetric relaxation time (IVRT; r = 0.323, P = 0.042; r = 0.387, P = 0.014; r = 0.339, P = 0.033; r = 0.325, P = 0.041; respectively) and, negatively correlated with mitral early (E) to late (A) wave ratio (E/A) (r = -0.380, P = 0.016) and myocardial early-to-late diastolic wave ratio (E(m)/A(m)) (r = -0.326, P = 0.040). This study showed that atrial electromechanical delay is prolonged in obese subjects. Prolonged atrial electromechanical delay is due to provoked low-grade inflammation as well as LA enlargement and early LV diastolic dysfunction in obese subjects. PMID:20829801
Yagmur, Julide; Cansel, Mehmet; Acikgoz, Nusret; Ermis, Necip; Yagmur, Murat; Atas, Halil; Tasolar, Hakan; Karakus, Yasin; Pekdemir, Hasan; Ozdemir, Ramazan
Diagnosis of patent foramen ovale by transesophageal echocardiography and correlation with autopsy findings.
Transesophageal echocardiography (TEE) is accepted as the method of choice for the diagnosis of the patent foramen ovale (PFO). However, direct anatomic confirmation regarding the presence or absence of a PFO on transesophageal imaging has been obtained in only a limited number of patients. Consequently, this study was performed to assess the diagnostic accuracy of contrast and color Doppler TEE for detection of a PFO by comparing the results of TEE with autopsy. The study population comprised 35 consecutive patients (mean age 64 +/- 14 years) who underwent autopsy and prior TEE with examination of the atrial septum. For diagnosis of a PFO, the following criteria were used: (1) no defect in the continuity of the atrial septum on 2-dimensional imaging; (2) > or = 1 bright microbubble appearing in left the atrium within 3 heart cycles after opacification of the right atrium during contrast TEE; and (3) turbulent color jet within the atrial septum by color Doppler TEE. For estimating the PFO size, positive contrast studies were graded semiquantitatively (from 1 to 3), and the maximal color Doppler jet width was measured within the atrium septum at the area of maximal turbulence. At autopsy, a PFO was present in 9 of 35 patients (26%). All were correctly diagnosed by color Doppler TEE. The color Doppler jet width correlated well with the PFO diameter determined at autopsy (r=0.99, SEE=0.51 mm, p<0.0001). By contrast TEE, 8 of the 9 patients with autopsy-proven PFO were correctly identified. In 1 case with left heart disease and a long interatrial channel, a PFO was missed by contrast TEE but clearly demonstrated by color Doppler TEE. All patients with a PFO diameter >10 mm showed intense left atrial opacification of grade 3. With both methods, there were no false-positive results. Sensitivity and specificity for diagnosis of a PFO were 89% and 100% respectively, for contrast TEE, and both 100% for color Doppler TEE. Thus, contrast and color Doppler TEE are complementary and represent a highly sensitive and specific method for diagnosis of a PFO and for estimation of the PFO size. PMID:8651096
Schneider, B; Zienkiewicz, T; Jansen, V; Hofmann, T; Noltenius, H; Meinertz, T
Evaluation of 17-mm St. Jude Medical Regent prosthetic aortic heart valves by rest and dobutamine stress echocardiography
Background The prosthesis used for aortic valve replacement in patients with small aortic root can be too small in relation to body size, thus showing high transvalvular gradients at rest and/or under stress conditions. This study was carried out to evaluate rest and Dobutamine stress echocardiography (DSE) hemodynamic response of 17-mm St. Jude Medical Regent (SJMR-17 mm) in relatively aged patients at mean 24 months follow-up. Methods and results The study population consisted of 19 patients (2 men, 17 women, mean age 69.2 � 7.3 years). All patients underwent rest Doppler echocardiography before and after surgery and basal and DSE at follow up (infused at rate of 5 micrg/Kg/min and increased by 5 microg/Kg/min at 5 min intervals up to 40 microg/Kg/min). The following parameters were evaluated at rest and/or under DSE: heart rate (HR), ejection fraction (EF), cardiac output (CO), peak and mean velocity and pressure gradients (MxV, MnV, MxPG, MnPG), effective orifice area (EOA), indexed EOA (EOAi), left ventricular mass (LVM), indexed LVM (LVMi), Velocity Time Integral at left ventricular outflow tract (VTI LVOT) and transvalvular (Aortic VTI), Doppler velocity index (DVI). At rest MxPG and MnPG were 29.2 � 7.1 and 16.6 � 5.8mmHg, respectively; EOA and EOAi resulted 1.14 � 0.3 cm2 and 0.76 � 0.2 cm2/m2; DVI was normal (0.50 � 0.1). At follow-up LVM and LVMi decreased significantly from pre-operative value of 258 � 43g and 157.4 � 27.7g/m2 to 191 � 23.8g and 114.5 � 10.6g/m2, respectively. DSE increased significantly HR, CO, EF, MxGP (up to 83.4 � 2 1.9mmHg), MnPG (up to 43.2 � 12.7mmHg). EOA, EOAi, DVI increased insignificantly (from baseline up to 1.2 � 0.4 cm2, 0.75 � 0.3cm2/m2 and 0.48 � 0.1 respectively). Two patients developed significant intraventricular gradients. Conclusion These data show that SJMR 17-mm prostheses can be safely implanted in aortic position in relatively aged patients, offering a satisfactory hemodynamic performance at rest and under DSE, with full utilization of its available orifice, suggesting that a possible mild prosthesis-patient mismatch is not an issue of clinical relevance when this small prosthesis is used. Rest and Dobutamine stress echocardiography is a useful and effective means for evaluating prosthesis hemodynamics and for monitoring the expected LVH regression.
Minardi, Giovanni; Manzara, Carla; Creazzo, Vittorio; Maselli, Daniele; Casali, Giovanni; Pulignano, Giovanni; Musumeci, Francesco
Asia: Showing the Changing Seasons
NSDL National Science Digital Library
SeaWiFS false color data showing seasonal change in the oceans and on land for Asia. The data is seasonally averaged, and shows the sequence: fall, winter, spring, summer, fall, winter, spring (for the Northern Hemisphere).
Allen, Jesse; Newcombe, Marte; Feldman, Gene
... page from the NHLBI on Twitter. What Do Blood Tests Show? Blood tests show whether the levels ... changes may work best. Result Ranges for Common Blood Tests This section presents the result ranges for ...
Evaluation of tissue doppler echocardiography and T2* magnetic resonance imaging in iron load of patients with thalassemia major.
Background: Iron-mediated cardiomyopathy is the main complication of thalassemia major (TM) patients. Therefore, there is an important clinical need in the early diagnosis and risk stratification of patients. The aim of this study was to evaluate the efficacy of tissue doppler imaging (TDI) to study cardiac iron overload in patients with TM using T2* magnetic resonance (MR) as the gold-standard non-invasive diagnostic test. Methods: A total of 100 TM patients with the mean age of 19�7 years and 100 healthy controls 18.8�7 years were evaluated. Conventional echocardiography, TDI, and cardiac MRI T2* were performed in all subjects. TDI measures included myocardial systolic (Sm), early (Em) and late (Am) diastolic velocities at basal and middle segments of septal and lateral LV wall. The TM patients were also subgrouped according to those with iron load (T2*�?�20�ms) and those without (T2*�>�20�ms), and also severe (T2*�?�10�ms) versus the non-severe (T2*�?�10�ms). Results: Using T2* cardiovascular MR, abnormal myocardial iron load (T2*�?�20�ms) was detected in 84% of the patients and among these, 50% (42/84) had severe (T2*�?�10�ms) iron load. The mean T2* was 11.6�8.6�ms (5-36.7). A negative linear correlation existed between transfusion period of patients and T2* levels (r�=�-0.53, p=0.02). The following TDI measures were lower in patients than in controls: basal septal Am (p<0.05), mid-septal Em and Am (p<0.05), basal lateral Am (p<0.05), mid-lateral LV wall Sm (p<0.05) and Am (p<0.05). Conclusion: Tissue doppler imaging is helpful in predicting the presence of myocardial iron load in Thalassemia patients. Therefore, it can be used for screening of thalassemia major patients. PMID:24009962
Saravi, Mehrdad; Tamadoni, Ahmad; Jalalian, Rozita; Mahmoodi-Nesheli, Hassan; Hojati, Mosatafa; Ramezani, Saeed
Development of takotsubo cardiomyopathy with severe pulmonary edema before a cesarean section.
Takotsubo cardiomyopathy is an acute syndrome involving apical ballooning and consequent dysfunction of the left ventricle. Most cases of left ventricular dysfunction resolve within 1 month. We present the case of a 40-year-old woman who developed severe heart failure caused by takotsubo cardiomyopathy with severe left ventricular dysfunction during the perinatal period. Because of the presence of multiple myomas, she was scheduled to undergo a cesarean section under general anesthesia. However, after induction of general anesthesia, she had to be awakened because of the presence of a difficult airway. Because she exhibited insufficient oxygenation, she was transferred to the emergency center. Upon hospital admission, she expectorated large amounts of pink sputum, indicating severe pulmonary edema. Cesarean section was performed immediately. Echocardiography revealed severe left ventricular dysfunction. Full recovery of cardiac function required almost 1 month, after which she was discharged from the hospital without further complications. This is the first reported case of takotsubo cardiomyopathy induced by a failed intubation during a scheduled cesarean section. Takotsubo cardiomyopathy usually shows a good prognosis, but if this myopathy develops during the perinatal period, it can worsen because of excessive preload following the termination of fetoplacental circulation. PMID:23877950
Suzuki, Tsuyoshi; Nemoto, Chiaki; Ikegami, Yukihiro; Yokokawa, Tetsuro; Tsukada, Yasuhiko; Abe, Yoshinobu; Shimada, Jiro; Takeishi, Yasuchika; Tase, Choichiro
ERIC Educational Resources Information Center
Describes a science presentation which promotes various ways to improve laboratory safety. Recommendations for storing chemicals include: minimize the type and amount of stocked materials, purchase certain chemicals in small quantities, and use plastic embedments. Cites several books for reference. (RT)
Rayner-Canham, Geoffrey; Layden, William
Early detection of anthracycline cardiotoxicity in children with acute leukemia using exercise-based echocardiography and Doppler echocardiography.
We performed both supine bicycle ergometer (BEx) and hand-grip (HGx) exercise tests to evaluate cardiac function in 13 asymptomatic children with leukemia who had completed a general treatment protocol. We calculated fractional shortening (FS), end-systolic stress-volume index (ESS/ESVI), left ventricular diastolic filing velocity ratio (A/E) and normalized peak rate of diastolic increase in left ventricular internal dimension (dLVDt/dt/LVDt). Before the exercise, we found that dLVDt/dt/LVDt was decreased in the high-dose anthracycline group (anthracycline cumulative dose of 480-570 mg/m2), even though other cardiac function parameters were not different from those in the control. In BEx, the percent change in ESS/ESVI decreased in an anthracycline cumulative dose-dependent fashion. In HGx, ESS/ESVI showed a decreased response only in the high-dose anthracycline group. Therefore, we conclude that: 1) the diastolic function parameter dLVDt/dt/LVDt might show abnormalities prior to other systolic function parameters, 2) the percent change in ESS/ESVI in BEx is the most sensitive parameter studied, and could detect cardiac function abnormalities even in the small-dose anthracycline group (anthracycline cumulative dose of 175 mg/m2), and 3) BEx is more suitable for the early detection of anthracycline cardiotoxicity than HGx. PMID:7967004
Fukazawa, R; Ogawa, S; Hirayama, T
Planning a Successful Tech Show
ERIC Educational Resources Information Center
Tech shows are a great way to introduce prospective students, parents, and local business and industry to a technology and engineering or career and technical education program. In addition to showcasing instructional programs, a tech show allows students to demonstrate their professionalism and skills, practice public presentations, and interact�
Nikirk, Martin
NSDL National Science Digital Library
The British Broadcasting Corporation offers this great collection of fun, educational games that help children learn basic concepts of mathematics. Twelve interactive games are available in all, illustrating principles of data handling, numbers, algebra, and measurement. Children can practice interpreting Cartesian coordinates by guiding a space ship across a grid, or compete with an animated character in a test of fractions and percentages. In addition to the online games, several other activities are presented in one-page documents for easy printing.
Tissue Doppler echocardiography and biventricular pacing in heart failure: Patient selection, procedural guidance, follow-up, quantification of success
Asynchronous myocardial contraction in heart failure is associated with poor prognosis. Resynchronization can be achieved by biventricular pacing (BVP), which leads to clinical improvement and reverse remodeling. However, there is a substantial subset of patients with wide QRS complexes in the electrocardiogram that does not improve despite BVP. QRS width does not predict benefit of BVP and only correlates weakly with echocardiographically determined myocardial asynchrony. Determination of asynchrony by Tissue Doppler echocardiography seems to be the best predictor for improvement after BVP, although no consensus on the optimal method to assess asynchrony has been achieved yet. Our own preliminary results show the usefulness of Tissue Doppler Imaging and Tissue Synchronization Imaging to document acute and sustained improvement after BVP. To date, all studies evaluating Tissue Doppler in BVP were performed retrospectively and no prospective studies with patient selection for BVP according to echocardiographic criteria of asynchrony were published yet. We believe that these new echocardiographic tools will help to prospectively select patients for BVP, help to guide implantation and to optimize device programming.
Knebel, Fabian; Reibis, Rona Katharina; Bondke, Hans-Jurgen; Witte, Joachim; Walde, Torsten; Eddicks, Stephan; Baumann, Gert; Borges, Adrian Constantin
Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography
Aims Staphylococcus aureus infective endocarditis (IE) is a critical medical condition associated with a high morbidity and mortality. In the present study, we prospectively evaluated the importance of screening with echocardiography in an unselected S. aureus bacteraemia (SAB) population. Methods and results From 1 January 2009 to 31 August 2010, a total of 244 patients with SAB at six Danish hospitals underwent screening echocardiography. The inclusion rate was 73% of all eligible patients (n= 336), and 53 of the 244 included patients (22%; 95% CI: 17�27%) were diagnosed with definite IE. In patients with native heart valves the prevalence was 19% (95% CI: 14�25%) compared with 38% (95% CI: 20�55%) in patients with prosthetic heart valves and/or cardiac rhythm management devices (P= 0.02). No difference was found between Main Regional Hospitals and Tertiary Cardiac Hospitals, 20 vs. 23%, respectively (NS). The prevalence of IE in high-risk patients with one or more predisposing condition or clinical evidence of IE were significantly higher compared with low-risk patients with no additional risk factors (38 vs. 5%; P < 0.001). IE was associated with a higher 6 months mortality, 14(26%) vs. 28(15%) in SAB patients without IE, respectively (P < 0.05). Conclusion SAB patients carry a high risk for development of IE, which is associated with a worse prognosis compared with uncomplicated SAB. The presenting symptoms and clinical findings associated with IE are often non-specific and echocardiography should always be considered as part of the initial evaluation of SAB patients.
Rasmussen, Rasmus V.; H?st, Ulla; Arpi, Magnus; Hassager, Christian; Johansen, Helle K.; Korup, Eva; Sch?nheyder, Henrik C.; Berning, Jens; Gill, Sabine; Rosenvinge, Flemming S.; Fowler, Vance G.; M?ller, Jacob E.; Skov, Robert L.; Larsen, Carsten T.; Hansen, Thomas F.; Mard, Shan; Smit, Jesper; Andersen, Paal S.; Bruun, Niels E.
Usefulness of intravenously administered fluid replenishment for detection of patent foramen ovale by transesophageal echocardiography.
Patent foramen ovale (PFO) is associated with cryptogenic stroke, migraine headache, decompression sickness, and platypnea-orthodeoxia syndrome. Patients undergoing transesophageal echocardiography are often hypovolemic from preprocedural fasting and might not demonstrate right to left shunting owing to insufficient right atrial pressure generation, despite provocative maneuvers. We hypothesized that volume replenishment with saline loading could potentially unmask a PFO by favorably modulating the interatrial pressure gradient. Our study sought to examine the role of pre- or intraprocedural intravenous fluid replenishment on PFO detection during transesophageal echocardiography. A total of 103 patients were enrolled. An initial series of bubble injections was performed unprovoked and then with provocative maneuvers such as the Valsalva maneuver and coughing. The patients were then given a rapid 500 ml saline bolus, and the same sequence of bubble injections was repeated. The presence, type, and magnitude of the right to left shunts were noted before and after the saline bolus. The detection rate of PFO increased from 10.6% to 26.2% after saline loading without any provocative maneuvers. When combined with provocative maneuvers (Valsalva or cough), saline loading improved the detection rate from 17.4% to 32.0%. Overall, from amongst the 103 enrolled patients, saline bolusing resulted in a de novo diagnosis of PFO in 15 patients, atrial septal aneurysm in 15, PFO coexisting with an atrial septal aneurysm in 10, and pulmonary arteriovenous fistula in 5 patients. In conclusion, saline infusion in appropriately selected patients during transesophageal echocardiography significantly enhances the detection of PFOs and pulmonary arteriovenous fistulas. PMID:20854974
Afonso, Luis; Kottam, Anupama; Niraj, Ashutosh; Ganguly, Joya; Hari, Pawan; Simegn, Mengistu; Sudhakar, Rajeev; Jacob, Sony; Chaturvedi, Seemant; Ensing, Greg J; Abraham, Theodore P
Comparisons show construction management's benefits.
Analysis of competitive bid, design-build, and construction management approaches shows that construction management offers owners substantial advantages regarding project cost and quality and substantial involvement and control throughout the process. PMID:110667
Payette, T M
Using Graphs to Show Connections
NSDL National Science Digital Library
The purpose of this resource is to show how graphs of GLOBE data over time show the interconnectedness of Earth's system components at the local level. Students visit a study site, where they observe and recall their existing knowledge of air, water, soil, and living things to make a list of interconnections among the four Earth system components. They make predictions about the effects of a change in a system, inferring ways these changes affect the characteristics of other related components.
The GLOBE Program, University Corporation for Atmospheric Research (UCAR)
Persistent fifth aortic arch diagnosed by echocardiography and confirmed by angiography: Case report and literature review
Persistent fifth aortic arch is a rare congenital anomaly that can be discovered incidentally or at postmortem exam. It can be associated with major congenital heart malformations involving the systemic or the pulmonary circuits. It usually has no clinical significance but can be either, beneficial as in systemic outflow tract obstructions or cause hemodynamic compromise when associated with a significant left to right shunt. We report an infant with persistent fifth aortic arch associated with Shone�s complex diagnosed accurately by transthoracic echocardiography and confirmed by cardiac catheterization and computed tomography.
Al Akhfash, Ali A.; Al Mutairi, Mansour B.; Al Habshan, Fahad M.
Value of transesophageal echocardiography (TEE) guidance in minimally invasive mitral valve surgery
The role of intraoperative transesophageal echocardiography (TEE) has increased tremendously since its first use in 1979. Today intraoperative TEE is a class I indication for surgical mitral valve reconstruction for evaluation of mitral valve pathology, graduation of mitral regurgitation and detection of potential risk factors as well as post-repair assessment. Real-time three-dimensional TEE offers anatomical visualization of the mitral valve apparatus, fundamental for virtual surgical planning of proper annuloplasty ring size. As minimally invasive and even off-pump techniques for mitral valve repair become more popular, image guidance by intraoperative TEE will play an essential role.
Sgouropoulou, Sophia
Identification of a retained intravascular wire by three-dimensional transesophageal echocardiography.
A 78-year-old man with an implantable cardioverter-defibrillator (ICD) for ischemic cardiomyopathy and prior ventricular tachycardia (VT) ablation presented with abdominal pain and was found to have a small bowel obstruction requiring immediate surgery. His postoperative course was complicated by incessant VT leading to multiple ICD shocks. He was referred to our hospital for repeat VT ablation. TEE revealed a wire coiled in the right pulmonary artery. This is the first reported identification of an embolized wire by transesophageal three-dimensional echocardiography. PMID:19054022
Tokarz, Stephen R; Aktas, Mehmet K; Kroening, Daniel; Sawyer, Thomas J; Daubert, James P; Huang, David T; Schwarz, Karl Q
Anatomy of the Mitral Valve Apparatus - Role of 2D and 3D Echocardiography
The mitral valve apparatus is a complex three�dimensional functional unit that is critical to unidirectional heart pump function. This review details the normal anatomy, histology and function of the main mitral valve apparatus components 1) mitral annulus, 2) mitral valve leaflets, 3) chordae tendineae and 4) papillary muscles. 2 and 3 dimensional Echocardiography is ideally suited to examine the mitral valve apparatus and has provided insights into the mechanism of mitral valve disease. An overview of standardized image acquisition and interpretation is provided. Understanding normal mitral valve apparatus function is essential to comprehend alterations in mitral valve disease and the rationale for repair strategies.
Dal-Bianco, Jacob P.; Levine, Robert A.
A prominent Eustachian valve dividing the right atrium imaged by three-dimensional transesophageal echocardiography.
A 63-year-old man underwent transesophageal echocardiography (TEE) to rule out left atrial thrombi prior to cardioversion. Initial two-dimensional TEE with color flow Doppler imaging was suggestive of an atrial septal defect. However, three-dimensional TEE imaging revealed that the unusually large elongated Eustachian valve extended toward the superior vena cava and mimicked the interatrial septum, while the true septum was located more posteriorly than the Eustachian valve. Three-dimensional TEE imaging was crucial to understanding the anatomical relationship between the Eustachian valve and the interatrial septum and hence proved helpful in characterizing this unusual anatomical variant. PMID:22467556
Iida, Ryoji; Vonder Muhll, Isabelle
Statistical agreement of left ventricle measurements using cardiac magnetic resonance and 2D echocardiography in ischemic heart failure
Summary Background The aim of this study was to compare cardiac magnetic resonance imaging (CMR) with 2-dimensional echocardiography (2D echo) in the assessment of left ventricle (LV) function parameters and mass in patients with ischemic heart disease and severely depressed LV function. Although 2D echo is commonly used to assess LV indices, CMR is the state-of-the-art technique. Agreement between these 2 methods in these patients has not been well established. Material/Methods LV indexed end systolic and diastolic volumes (EDVi and ESVi), indexed mass (LVMi) and ejection fraction (EF) were assessed in 67 patients (12 women), using 2D echo and CMR. Results According to statistical analysis (Bland-Altman), 2D echo underestimated LV EDV and ESV and overestimated EF and LVMi compared to CMR. The highest correlation between 2D echo and CMR was found for EDVi (R2=0.73, p<0.0001) and ESVi (R2=0.69, p<0.0001) and the lowest for EF (R2=0.21, p=0.001) and LVMi (R2=0.20, p=0.002). The maximal differences between 2D echo and CMR were found for highest mesurements of LV volumes and mass, and for lowest EF values. Conclusions There is moderate to strong correlation between CMR and 2D echo in the assessment of LV function parameters and mass in patients with ischemic heart failure. Between-method agreement depends on the degree of LV dysfunction. The results of assessment of the severely damaged LV obtained by the use of 2D echo should be interpreted with caution.
Gruszczynska, Katarzyna; Krzych, Lukasz J.; Golba, Krzysztof S.; Biernat, Jolanta; Roleder, Tomasz; Deja, Marek A.; Ulbrych, Piotr; Malinowski, Marcin; Janusiewicz, Piotr; Wos, Stanislaw; Baron, Jan
Comparison of accuracy of mitral valve regurgitation volume determined by three-dimensional transesophageal echocardiography versus cardiac magnetic resonance imaging.
Direct planimetry of anatomic regurgitation orifice area (AROA) using 3-dimensional transesophageal echocardiography (TEE) has been described. This study sought to (1) compare mitral valve regurgitant volume (RV) derived by AROA using 3-dimensional TEE with RV obtained by cardiac magnetic resonance (CMR) imaging and (2) determine the impact of AROA and flow velocity changes throughout systole on the dynamic variation in mitral regurgitation. In 43 patients (71 � 11 years old) with mild to severe mitral regurgitation, 3-dimensional TEE and CMR were performed. Mitral valve RV was determined based on (1) AROA at 5 subintervals of systole and analysis of the regurgitant continuous-wave Doppler signal at equal durations of systole, (2) effective regurgitation orifice area (EROA) using the proximal isovelocity surface area method, (3) CMR with subtraction of aortic outflow volume from left ventricular stroke volume. RV calculated by AROA tended to overestimate RV less than RV calculated by EROA compared to RV by CMR (average bias +20 ml, 95% confidence interval [CI] -41 to +81, vs +13 ml, 95% CI -22 to 47). In patients with RV >30 ml by CMR, overestimation of RV using the AROA method was less than using the EROA method (difference in means +18 ml, 95% CI 4 to 32, p <0.001). AROA determined by 3-dimensional TEE varied by only 18% among the 5 subintervals of systole, and the velocity time integral of the subinterval with the highest flow was 120% of the subinterval with the lowest flow. In conclusion, 3-dimensional TEE allows accurate analysis of mitral valve RV. In the clinically relevant group of patients with RV >30 ml as defined by CMR, the AROA method results in less overestimation of RV than the EROA method. Changes in AROA during systole contribute much less to dynamic variation in mitral regurgitation severity than changes in regurgitant flow velocity. PMID:22727180
Hamada, Sandra; Altiok, Ertunc; Frick, Michael; Almalla, Mohammed; Becker, Michael; Marx, Nikolaus; Hoffmann, Rainer
Transesophageal Echocardiography
... called ultrasound) to the heart. As the ultrasound waves bounce off the structures of the heart, a computer in the echo machine converts them into pictures on a screen. TEE involves a flexible tube (probe) with a transducer at its tip. Your doctor will guide the probe down your throat and into your ...
The OOPSLA trivia show (TOOTS)
OOPSLA has a longstanding tradition of being a forum for discussing the cutting edge of technology in a fun and participatory environment. The type of events sponsored by OOPSLA sometimes border on the unconventional. This event represents an atypical panel that conforms to the concept of a game show that is focused on questions and answers related to OOPSLA themes.
Jeff Gray; Douglas C. Schmidt
Real-Time, Interactive Echocardiography Over High-Speed Networks: Feasibility and Functional Requirements
NASA Technical Reports Server (NTRS)
Real-time, Interactive Echocardiography Over High Speed Networks: Feasibility and Functional Requirements is an experiment in advanced telemedicine being conducted jointly by the NASA Lewis Research Center, the NASA Ames Research Center, and the Cleveland Clinic Foundation. In this project, a patient undergoes an echocardiographic examination in Cleveland while being diagnosed remotely by a cardiologist in California viewing a real-time display of echocardiographic video images transmitted over the broadband NASA Research and Education Network (NREN). The remote cardiologist interactively guides the sonographer administering the procedure through a two-way voice link between the two sites. Echocardiography is a noninvasive medical technique that applies ultrasound imaging to the heart, providing a "motion picture" of the heart in action. Normally, echocardiographic examinations are performed by a sonographer and cardiologist who are located in the same medical facility as the patient. The goal of telemedicine is to allow medical specialists to examine patients located elsewhere, typically in remote or medically underserved geographic areas. For example, a small, rural clinic might have access to an echocardiograph machine but not a cardiologist. By connecting this clinic to a major metropolitan medical facility through a communications network, a minimally trained technician would be able to carry out the procedure under the supervision and guidance of a qualified cardiologist.
Bobinsky, Eric A.
Prospective Echocardiography Assessment of Pulmonary Hypertension And Its Potential Etiologies In Children With Sickle Cell Disease
Pulmonary hypertension (PH) is associated with adverse outcomes in adults with sickle cell disease (SCD) but its importance in children is less clear. We define the incidence and etiologies of PH in pediatric patients with SCD. Children with SCD (n = 310) and matched controls (n = 54) were prospectively enrolled under basal conditions. Participants underwent echocardiography, pulse oximetry, 6-minute walk, and hematologic testing. Echocardiographic measures were compared between SCD and control subjects before and after adjusting for hemoglobin. Correlation of echocardiographic and clinical parameters was performed. Tricuspid regurgitation velocity (TRV) was elevated compared to controls (2.28 vs. 2.10 m/s, p <0.0001). Increased TRV was associated with left ventricular diastolic diameter, hemoglobin, and estimated left atrial pressure. TRV remained elevated when controlled for left ventricular diameter and left atrial pressure. An echocardiography-derived pulmonary resistance was not significantly different between SCD and control patients, although it was elevated in the SCD subgroup with elevated TRV. When controlled for hemoglobin, TRV was no longer statistically different, but pulmonary insufficiency velocity, septal wall thickness and estimated pulmonary resistance were statistically higher. TRV, pulmonary insufficiency end diastolic velocity, and markers of increased cardiac output correlated with indicators of adverse functional status including history of acute chest syndrome, stroke, transfusions, and 6-minute walk. In conclusion, children with SCD have mildly increased TRV that correlated with increased cardiac output and left ventricular filling pressures. Hemoglobin adjusted analysis also suggests contribution of primary vascular changes.
Dham, Niti; Ensing, Gregory; Minniti, Caterina; Campbell, Andrew; Arteta, Manuel; Rana, Sohail; Darbari, Deepika; Nouraie, Mehdi; Onyekwere, Onyinye; Lasota, Malgorzata; Kato, Gregory J.; Gladwin, Mark T.; Castro, Oswaldo; Gordeuk, Victor; Sable, Craig
Complications of 2-D Echocardiography Guided Transfemoral Right Ventricular Endomyocardial Biopsy
Endomyocardial biopsy (EMBx) is a useful tool for diagnosing various cardiac pathologies. However, the routine use of EMBx has not gained widespread acceptance due to the possible complications related to the EMBx. Thus, not much information is available on the complications related to the EMBx. We prospectively evaluated 90 consecutive patients who underwent 2-D echocardiography guided transfemoral right ventricular EMBx at Kyungpook National University Hospital between March 2002 and November 2005 to determine the incidence, nature and subsequent management of complications related to EMBx. The clinical diagnoses before the EMBx were arrhythmogenic right ventricular dysplasia in 54, dilated cardiomyopathy in 19, Brugada syndrome in 9, myocarditis in 6 and miscellaneous in 2 patients. The overall major complication rate was 5.6% and no procedure-related mortality occurred. Myocardial perforation (n=3), which was the most frequent complication, did not progress to cardiac tamponade requiring pericardiocentesis in any patient. Hemodynamically unstable ventricular tachycardia occurred in 1 patient. New and persistent right bundle branch block occurred in another. Our findings suggest that 2-D echocardiography guided transfemoral right ventricular EMBx is a relatively safe procedure.
Han, Juyup; Park, Yongwhi; Lee, Hyunsang; Kang, Hyunjae; Kim, Hyungseop; Yang, Dong Heon; Park, Hun Sik; Chae, Shung-Chull; Jun, Jae-Eun; Park, Wee-Hyun
Assessment of diastolic function by tissue Doppler echocardiography: comparison with standard transmitral and pulmonary venous flow
NASA Technical Reports Server (NTRS)
The objective of this study was to determine the utility of Doppler tissue echocardiography in the evaluation of diastolic filling and in discriminating between normal subjects and those with various stages of diastolic dysfunction. We measured myocardial velocities in 51 patients with various stages of diastolic dysfunction and in 27 normal volunteers. The discriminating power of each of the standard Doppler indexes of left ventricular filling, pulmonary venous flow, and myocardial velocities was determined with the use of Spearman rank correlation and analysis of variance F statistics. Early diastolic myocardial velocity (E(m)) was higher in normal subjects (16.0 +/- 3.8 cm/s) than in patients with either delayed relaxation (n = 15, 7.5 +/- 2.2 cm/s), pseudonormal filling (n = 26, 7.6 +/- 2.3 cm/s), or restrictive filling (n = 10, 7.4 +/- 2.4 cm/s, P <.0001). E(m ) was the best single discriminator between control subjects and patients with diastolic dysfunction (P =.7, F = 64.5). Myocardial velocities assessed by Doppler tissue echocardiography are useful in differentiating patients with normal from those with abnormal diastolic function. Myocardial velocity remains reduced even in those stages of diastolic dysfunction characterized by increased preload compensation.
Farias, C. A.; Rodriguez, L.; Garcia, M. J.; Sun, J. P.; Klein, A. L.; Thomas, J. D.
Speckle Tracking in Intracardiac Echocardiography for the Assessment of Myocardial Deformation
Intracardiac echocardiography has proven to be useful for online anatomical imaging during catheterization. Our objective was to develop a speckle tracking method for myocardial motion estimation from intracardiac echocardiographic image sequences in order to provide a mean for regional functional imaging. Our approach was to solve two problems in motion estimation from two-dimensional intracardiac echocardiographic image sequences: non-rigid myocardial deformation and speckle decorrelation. To achieve robust noise resistance, we employed maximum likelihood estimation while fully exploiting ultrasound speckle statistics, and treated the maximization of motion probability as the minimization of an energy function. Non-rigid myocardial deformation was estimated by optimizing this energy function within a framework of parametric elastic registration. Evaluation of the method was carried out using a computer model that synthesized echocardiographic image sequences, and subsequently an animal model that provided continuous intracardiac echocardiographic images as well as reference measurements using sonomicrometry crystals. In conclusion, accurate estimation of regional myocardial deformation from intracardiac echocardiography by novel speckle tracking is feasible. This approach may have important clinical implications for multimodal imaging during catheterization.
Yue, Yong; Clark, John W.; Khoury, Dirar S.
Why is intracardiac echocardiography helpful? Benefits, costs, and how to learn
Current interventional procedures in structural heart disease and cardiac arrhythmias require peri-interventional echocardiographic monitoring and guidance to become as safe, expedient, and well-tolerated for patients as possible. Intracardiac echocardiography (ICE) complements and has in part replaced transoesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging. The latter is still widely accepted as a method to prepare for and to guide interventional treatments. In contrast to TEE, ICE represents a purely intraprocedural guiding and imaging tool unsuitable for diagnostic purposes. Patients tolerate ICE much better, and the method does not require general anaesthesia. Accurate imaging of the particular pathology, its anatomic features, and spatial relation to the surrounding structures is critical for catheter and wire positioning, device deployment, evaluation of the result, and for ruling out complications. This review describes the peri-interventional role of ICE, outlines current limitations, and points out future implications. Two-dimensional ICE has become a suitable guiding tool for a variety of percutaneous treatments in patients who are conscious or under monitored anaesthesia care, whereas RT-3DICE is still undergoing clinical testing. Continuous TEE monitoring under general anaesthesia remains a widely accepted alternative.
Bartel, Thomas; Muller, Silvana; Biviano, Angelo; Hahn, Rebecca T.
A practical approach to using strain echocardiography to evaluate the left ventricle.
Left ventricular (LV) evaluation is the most important use of echocardiography. Speckle tracking strain echocardiography (SE) provides a quantitative regional and global LV assessment, is an independent supplement to wall motion analysis and has been validated over the past 10 years. Despite these facts, SE is not being used routinely, especially in the United States. SE can generate longitudinal, radial, and circumferential strain measurements and LV twist. Although intriguing and potentially useful, these measurements also are confusing, complicated, time consuming, and frequently displayed as difficult-to-interpret wave forms. A pragmatic approach to SE simplifies the suggested method for strain calculation to reduce the time required and enhance reproducibility. With this modification the strain calculations take only 2-4 min. The yield is >80% in all patients. Reproducibility is at least as good as ejection fraction. Longitudinal strain is the most sensitive and reproducible of the various strain measurements, so it is the only strain we record. For simplicity, systolic strain is displayed as a positive number. Lastly, we primarily use a bullseye presentation for peak systolic strain. Many clinical examples are illustrated. However, as with all tests, SE is not perfect; there are limitations and potential false positives, but a practical approach to SE eventually should help make it a part of all echocardiographic examinations. PMID:22789972
Feigenbaum, Harvey; Mastouri, Ronald; Sawada, Stephen
Feasibility and effectiveness of three-dimensional echocardiography in diagnosing congenital heart diseases.
Three-dimensional echocardiography (3DE), a novel approach employed in detecting congenital heart disease (CHD), has gained popularity since it was made commercially available in 2002. This modality is now accepted as an important diagnostic tool for diagnosing CHD. Advancement in transducer technologies and digital data processing allows the use of 3DE in daily clinical practice. In this review, modes of 3DE data acquisition and storage methods in the echocardiogram's machine's hard disk (data processing) are examined. Analysis of the acquired data (cropping or slicing the data set) and methods of illustrating the cropped data set for cardiologists and pediatric cardiovascular surgeons are also discussed. Published literature was searched in PubMed using the keywords "three-dimensional echocardiography", "congenital heart disease", "cropping", and "echoangiogram". This search produced 100 articles, which were further short-listed to 30 articles. Based on this algorithm, the final selected 30 articles were extensively examined in the current review. The clinical applications of real-time transthoracic 3DE, as well as novel transesophageal 3DE and color flow 3DE data set analyses (echoangiogram) in the routine practice of CHD assessment, are also reviewed. Finally, the limitations 3DE, together with the potential future developments required to improve various techniques of 3DE to make it more readily applicable, are examined. PMID:23677391
Khoshhal, Saad
Atrial Septal Aneurysm and Patent Foramen Ovale as Risk Factors for Cryptogenic Stroke in Patients Less Than 55 Years of Age: A Study using Transesophageal Echocardiography
NASA Technical Reports Server (NTRS)
Background and Purpose: An association between atrial septal aneurysm and embolic events has been suggested. Atrial septal aneurysm has been shown to be associated with patent foramen ovale and,.in some reports, with mitral valve prolapse. These two latter cardiac disorder; have been identified as potential risk factors for ischemic stroke. The aim of this prospective study was to assess the role of atrial septal aneurysm as an independent risk factor for stroke, especially for cryptogenic stroke. Methods: We studied the prevalence of atrial septal aneurysm, patent foramen ovale, and mitral valve prolapse in 100 consecutive patients <55 years of age with ischemic stroke who underwent extensive etiological investigations. We compared these results with those in a control group of 50 consecutive patients. The diagnosis of atrial septal aneurysm and patent foramen ovale relied on transesophageal echocardiography with a contrast study and that of mitral valve prolapse, on two-dimensional transthoracic echocardiography. Results: Stepwise logistic regression analysis showed that atrial septal aneurysm (odds ratio, 4.3; 95% confidence interval, 1.3 to 14.6; P=.01) and patent foramen ovale (odds ratio, 3.9; 95% confidence interval, 1.5 to 10; P=.003) but not mitral valve prolapse were significantly associated with the diagnosis of cryptogenic stroke. The stroke odds of a patient with both atrial septal aneurysm and patent foramen ovale were 33.3 times (95% confidence interval, 4.1 to 270) the stroke odds of a patient with neither of these cardiac disorders. For a patient with atrial septal aneurysm of >lo-mm excursion, the stroke odds were approximately 8 times the stroke odds of a patient with atrial septal aneurysm of <10 mm. Conclusions: This study shows that atrial septal aneurysm and patent foramen ovale are both significantly associated with cryptogenic stroke and that their association has a marked synergistic effect. Atrial septal aneurysms of >lo-mm excursion are associated with a higher risk of stroke. (Stroke. 1993;24:1865-1873.) KEY WORDS aneurysm echocardiography foramen ovale, patent mitral valve prolapse o young adults
Cabanes, L.; Mas, J. L.; Cohen, A.; Amarenco, P.; Cabanes, P. A.; Oubary, P.; Chedru, F.; Guerin, F.; Bousser, M. G.; deRecondo, J.
Echocardiography and imaging investigation in congenital cardiovascular anomalies - competition or complementarity? Part II: cyanogenic cardiovascular malformations. Pictorial essay.
The diagnosis of cardiovascular malformations (CVM) is based on the echocardiographic evaluation. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are performant, necessary techniques for the pre- and postoperative assessment of complex malformations, especially of cyanogenic malformations, in which anomalies of the right side of the heart and of the pulmonary circulation are involved and where echocardiography has a limited role. The complementarity of echocardiography with MDCT and MRI for the acquisition of the details necessary for an accurate therapeutic decision and for avoiding invasive exploration, as well as the close relationship between the radiologist and the clinician are crucial and all the more necessary in complex malformations. PMID:23486625
Manole, Simona; Opri?a, Simona; Encica, Svetlana; Cotul, Mircea; Chira, Manuel; Manole, Viorel; Iacob, Daniela; Dudea, Sorin M
European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease).
Valvular regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular regurgitation. The echocardiographic assessment of valvular regurgitation should integrate quantification of the regurgitation, assessment of the valve anatomy, and function as well as the consequences of valvular disease on cardiac chambers. In clinical practice, the management of patients with valvular regurgitation thus largely integrates the results of echocardiography. It is crucial to provide standards that aim at establishing a baseline list of measurements to be performed when assessing regurgitation. PMID:20375260
Lancellotti, Patrizio; Tribouilloy, Christophe; Hagendorff, Andreas; Moura, Luis; Popescu, Bogdan A; Agricola, Eustachio; Monin, Jean-Luc; Pierard, Luc A; Badano, Luigi; Zamorano, Jose L
Two- and three-dimensional transthoracic echocardiography in the assessment of acquired ascending aortic aneurysm to pulmonary artery fistula.
Aorta to pulmonary artery fistula is an uncommon and potentially fatal condition. This case is of a 48-year-old Caucasian male with congestive heart failure and multiple aortic valve replacement surgeries who presented with an acquired ascending aortic aneurysm to pulmonary artery fistula diagnosed using two-dimensional transthoracic echocardiography via nonstandard imaging windows. Three-dimensional transthoracic echocardiography using live/real time three-dimensional color Doppler was used to assess the size of the opening of the fistula, providing additional value. This patient was surgically managed and is doing well 8 months postoperation. PMID:23895668
Roomi, Asad Ullah; Kemaloglu Oz, Tugba; Williams, Shammah O; Nanda, Navin C; Mehta, Kruti J; Sungur, Aylin; McGiffin, David C
[Pseudo-normalization of diastolic filling in severe aortic stenosis].
We report the case of a 79-year-old woman with severe aortic stenosis and alteration of left ventricular diastolic filling demonstrated by Doppler echocardiography, with inverted early/end diastolic flow profile. A sixteen month prospective follow-up study demonstrated progression of the illness, with further augmentation in transvalvular gradient and increased wall hypertrophy, but with apparent concomitant normalization of transmitral flow velocity profile. We conclude that a "normal" velocity pattern does not exclude an altered diastolic filling pattern, and must be interpreted with caution, in the light of all clinical and technical data. PMID:8174856
Desideri, A; Scattolin, G; Gabellini, A; Gallana, S; Formichi, M; Corbara, F
Non-invasive measurement of cardiac output by whole-body bio-impedance during dobutamine stress echocardiography: Clinical implications in patients with left ventricular dysfunction and ischaemia
Objectives: To compare non-invasive determination of cardiac index (CI) by whole body electrical bioimpedance using the NICaS apparatus and Doppler echocardiography, and the role of cardiac power index (Cpi) and total peripheral resistance index (TPRi) calculation during dobutamine stress echocardiography (DSE). Subjects and methods: We enrolled 60 consecutive patients undergoing DSE. Patients were prospectively divided into 3 groups: Group 1
Marina Leitman; Edgar Sucher; Edo Kaluski; Ruth Wolf; Eli Peleg; Yaron Moshkovitz; Olga Milo-Cotter; Zvi Vered; Gad Cotter
Abrupt formation of a right atrium thrombus detected by transesophageal echocardiography during laparoscopic assisted vaginal hysterectomy and spontaneous resolution during thromboembolectomy -A case report-
Intraoperative formation and management of a thrombus in right atrium has been reported occasionally. Nevertheless, it is rare that a right atrial thrombus with unstable hemodynamic changes detected by transesophageal echocardiography is resolved spontaneously. We report upon the 44-year-old woman, who had a right atrial thrombus detected by transesophageal echocardiography during laparoscopic assisted vaginal hysterectomy and resolved during thromboembolectomy.
Chu, Byung-Kwan; Han, Ilyong; Shin, Chee-Mahn; Kim, Young-Jae; Cheong, Soon Ho; Lee, Kun Moo; Lim, Se Hun; Lee, Jeong Han; Kim, Myoung-Hun; Kim, Hyo-Joong