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Sample records for echocardiography showed severe

  1. Echocardiography

    MedlinePLUS

    ... page from the NHLBI on Twitter. What Is Echocardiography? Echocardiography (EK-o-kar-de-OG-rah-fee), or ... heart attack . A type of echo called Doppler ultrasound shows how well blood flows through your heart's ...

  2. Transesophageal echocardiography assessment of severe ostial left main coronary stenosis

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Greenberg, N. L.; Lin, S. S.; Garcia, M. J.; Alexander, L. A.; Thomas, J. D.

    2000-01-01

    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.

  3. Stress echocardiography

    MedlinePLUS

    Echocardiography stress test; Stress test - echocardiography; CAD - stress echocardiography; Coronary artery disease - stress Echocardiography; Chest pain - stress echocardiography; Angina - stress echocardiography; ...

  4. New Drug Shows Promise Against Severe Sinusitis

    MedlinePLUS

    ... nlm.nih.gov/medlineplus/news/fullstory_157064.html New Drug Shows Promise Against Severe Sinusitis In early ... more severe patients are the target of the new treatment option," explained study author Dr. Claus Bachert, ...

  5. Transesophageal echocardiography guided patent ductus arteriosus occlusion in adults with severe pulmonary hypertension through a parasternal approach

    PubMed Central

    Dai, Xiao-Fu; Chen, Liang-Wan; Chen, Dong-Zhong; Chen, Qiang; Zhen, Guo-Zhong; Zhang, Gui-Can

    2015-01-01

    Between April 2010 and April 2014, 39 consective adult patients (> 18 years) with PDA associated severe pulmonary hypertension underwent transesophageal echocardiography guided patent ductus arteriosus occlusion through a parasternal minimally invasive approach. Among 39 patients, the procedure was successful in 32 cases (82.1%) and failed in 7 cases (17.9%). In the failed cases, 3 cases had a large residual shunt and 4 cases had persistent pulmonary hypertension. The mean minimum miameter of the successfully closed PDAs was 15.2 ± 2.1 mm (range 9 to 24), and the mean diameter of the mushroom-shaped occluder was 17.5 ± 2.5 mm (range 11 to 26). The pulmonary artery pressure decreased significantly after occlusion (P < 0.05), but there were no significant differences in the aortic pressure and blood oxygen saturation before and after occlusion (P > 0.05). Echocardiography performed on the first postoperative day showed decreased volume within the left atrium, left ventricle, and pulmonary artery in 23 cases, decreased volume within the left atrium and left ventricle in 4 cases, and no change in the volume of the atrium and ventricle in 3 cases. A minor residual shunt was observed in 6 cases. The posteroanterior chest X-ray showed improved pulmonary congestion in all cases and significantly reduced cardiothoracic ratio in 25 cases. Patients were followed-up at least for 1 year. No symptoms including palpitation, dyspnoea, or chest tightness were observed. The heart function ranged from NYHA class I to II. A minor residual shunt was observed only in one case. There were varying degrees of decrease in volume within the atrium and ventricle. In conclusion, transesophageal echocardiography guided patent ductus arteriosus occlusion through a parasternal minimally invasive approach is a feasible and effective method for the treatment of PDA in adults with severe pulmonary hypertension. PMID:26722416

  6. Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia.

    PubMed

    Araujo, Ana Carla Pereira de; Santos, Bruno F de Oliveira; Calasans, Flavia Ricci; Pinto, Ibraim M Francisco; Oliveira, Daniel Pio de; Melo, Luiza Dantas; Andrade, Stephanie Macedo; Tavares, Irlaneide da Silva; Sousa, Antonio Carlos Sobral; Oliveira, Joselina Luzia Menezes

    2014-11-01

    Background: Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective: To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods: This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1) or positive (G2) for myocardial ischemia. The endpoints analyzed were all-cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results: G2 comprised 205 patients (23.7%). During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 - 6.01; p = 0.016). The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 - 6.53; p = 0.022) and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively). Conclusion: Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia.Fundamento: Estudos têm demonstrado a acurácia diagnóstica e o valor prognóstico da ecocardiografia com estresse físico na doença arterial coronária, mas a predição de mortalidade e de eventos cardíacos maiores, em pacientes com teste ergométrico positivo para isquemia miocárdica, é limitada. Objetivo: Avaliar a predição de mortalidade e de eventos cardíacos maiores pela ecocardiografia com estresse físico em pacientes com teste ergométrico positivo para isquemia miocárdica. Métodos: Trata-se de uma coorte retrospectiva em que foram estudados 866 pacientes consecutivos, com teste ergométrico positivo para isquemia miocárdica, submetidos à ecocardiografia com estresse físico. Os pacientes foram divididos em dois grupos: ecocardiografia com estresse físico negativa (G1) ou positiva (G2) para isquemia miocárdica. Os desfechos avaliados foram mortalidade por qualquer causa e eventos cardíacos maiores, definidos como óbito cardíaco e infarto agudo do miocárdio não fatal. Resultados: O G2 constituiu-se de 205 (23,7%) pacientes. Durante o seguimento médio de 85,6 ± 15,0 meses, ocorreram 26 óbitos, sendo seis por causa cardíaca, e 25 casos de infarto agudo do miocárdio não fatais. Os preditores independentes de mortalidade foram idade, diabetes melito e a ecocardiografia com estresse físico + (hazard ratio: 2,69; intervalo de confiança de 95%: 1,20 - 6,01; p = 0,016), com os seguintes eventos cardíacos maiores: idade, doença arterial coronária prévia, ecocardiografia com estresse físico + (hazard ratio: 2,75; intervalo de confiança de 95%: 1,15 - 6,53; p = 0,022) e ausência do incremento de 10% na fração de ejeção. A mortalidade por qualquer causa e os eventos cardíacos maiores foram significativamente superiores no G2 (p < 0, 001 e p = 0,001, respectivamente). Conclusão: A ecocardiografia com estresse físico oferece informações prognósticas adicionais em pacientes com teste ergométrico positivo para isquemia miocárdica. PMID:25352460

  7. Comparative Definitions for Moderate-Severe Ischemia in Stress Nuclear, Echocardiography, and Magnetic Resonance Imaging

    PubMed Central

    Shaw, Leslee J.; Berman, Daniel S.; Picard, Michael H.; Friedrich, Matthias G.; Kwong, Raymond Y.; Stone, Gregg W.; Senior, Roxy; Min, James K.; Hachamovitch, Rory; Scherrer-Crosbie, Marielle; Mieres, Jennifer H.; Marwick, Thomas H.; Phillips, Lawrence M.; Chaudhry, Farooq A.; Pellikka, Patricia A.; Slomka, Piotr; Arai, Andrew E.; Iskandrian, Ami E.; Bateman, Timothy M.; Heller, Gary V.; Miller, Todd D.; Nagel, Eike; Goyal, Abhinav; Borges-Neto, Salvador; Boden, William E.; Reynolds, Harmony R.; Hochman, Judith S.; Maron, David J.; Douglas, Pamela S.

    2014-01-01

    The lack of standardized reporting of the magnitude of ischemia on noninvasive imaging contributes to variability in translating the severity of ischemia across stress imaging modalities. We identified the risk of coronary artery disease (CAD) death or myocardial infarction (MI) associated with ?10% ischemic myocardium on stress nuclear imaging as the risk threshold for stress echocardiography and cardiac magnetic resonance. A narrative review revealed that ?10% ischemic myocardium on stress nuclear imaging was associated with a median rate of CAD death or MI of 4.9%/year (interquartile range: 3.75% to 5.3%). For stress echocardiography, ?3 newly dysfunctional segments portend a median rate of CAD death or MI of 4.5%/year (interquartile range: 3.8% to 5.9%). Although imprecisely delineated, moderate-severe ischemia on cardiac magnetic resonance may be indicated by ?4 of 32 stress perfusion defects or ?3 dobutamine-induced dysfunctional segments. Risk-based thresholds can define equivalent amounts of ischemia across the stress imaging modalities, which will help to translate a common understanding of patient risk on which to guide subsequent management decisions. PMID:24925328

  8. Dobutamine echocardiography and thallium-201 imaging predict functional improvement after revascularisation in severe ischaemic left ventricular dysfunction.

    PubMed Central

    Senior, R.; Glenville, B.; Basu, S.; Sridhara, B. S.; Anagnostou, E.; Stanbridge, R.; Edmondson, S. J.; Handler, C. E.; Raftery, E. B.; Lahiri, A.

    1995-01-01

    OBJECTIVES--To evaluate the concordance between thallium-201 uptake and echocardiographic wall thickening, which are both indicators of potentially reversible myocardial dysfunction, in patients with chronic ischaemic left ventricular failure and to assess their relative contribution to predicting improvement in regional function after revascularisation in a subgroup. PATIENTS AND METHODS--45 patients with chronic ischaemic left ventricular dysfunction (mean (SD) ejection fraction 25 (8)%) underwent echocardiography before and after dobutamine infusion (10 micrograms/kg/min). Of these, 22 patients underwent rest echocardiography at a mean (SD) of 9 (1) weeks after revascularisation. 201Tl imaging was performed during dobutamine echocardiography and at rest, 1, and 4 h after treatment with sublingual glyceryl trinitrate on two separate days. Potentially reversible dysfunction was thought to be present when a myocardial segment contained a Tl score of > or = 3 (ascending score 1-4), or showed improved wall thickening of a dysynergic segment during dobutamine stimulation. RESULTS--Of the 201Tl protocols, the redistribution scan 1 h after treatment with glyceryl trinitrate best demonstrated myocardial viability. Concordance between 201Tl and dobutamine induced wall thickening was 82% (kappa = 0.59) for detecting potentially reversible myocardial dysfunction before revascularisation (n = 45). Regional function improved in 18 of 22 patients after revascularisation. There were 168 dysynergic segments before intervention. The sensitivity of echocardiography and 201Tl imaging for detecting "recoverable" or viable segments after revascularisation was 87% and 92% respectively and specificity was 82% and 78% respectively (P = NS). CONCLUSIONS--Dobutamine echocardiography and 201Tl imaging may be used to predict mechanical improvement in dysynergic segments after revascularisation in patients with chronic ischaemic left ventricular dysfunction. Images PMID:7488446

  9. Fetal echocardiography

    PubMed Central

    Chaubal, Nitin G.; Chaubal, Jyoti

    2009-01-01

    USG performed with a high-end machine, using a good cine-loop facility is extremely helpful in the diagnosis of fetal cardiac anomalies. In fetal echocardiography, the four-chamber view and the outflow-tract view are used to diagnose cardiac anomalies. The most important objective during a targeted anomaly scan is to identify those cases that need a dedicated fetal echocardiogram. Associated truncal and chromosomal anomalies need to be identified. This review shows how fetal echocardiography, apart from identifying structural defects in the fetal heart, can be used to look at rhythm abnormalities and other functional aspects of the fetal heart. PMID:19774143

  10. Fetal echocardiography

    MedlinePLUS

    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 most ...

  11. Comparative Assessment of Mitral Regurgitation Severity by Transthoracic Echocardiography and Cardiac Magnetic Resonance Using an Integrative and Quantitative Approach.

    PubMed

    Lopez-Mattei, Juan C; Ibrahim, Homam; Shaikh, Kamran A; Little, Stephen H; Shah, Dipan J; Maragiannis, Dimitrios; Zoghbi, William A

    2016-01-15

    Although transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) are validated in quantitation of mitral regurgitation (MR), discrepancies may occur. This study assesses the agreement between TTE and CMR in MR and evaluates characteristics and clinical outcome of patients with discrepancy. From our institutional database, 70 subjects with MR underwent both TTE and CMR within 30 days (median 3 days). MR was evaluated semiquantitatively (n = 70) using a 4-grade scale and quantitatively (n = 60) with calculation of regurgitant volume (RVol) and regurgitant fraction (RF). Of the 70 subjects, qualitative assessment by TTE yielded 30 subjects with mild MR, 17 moderate, and 23 moderately severe or severe MR. Exact concordance in MR grade was seen in 50% and increased to 91% when considering concordance within one grade of severity (? = 0.44). A modest correlation was observed for RVol and RF between both methods (r = 0.59 and 0.54, respectively, p <0.0001). Ten patients had a significant discrepancy in quantitative MR (difference in RF >20%); the frequency of secondary MR was higher (100% vs 46%; p = 0.003) in patients with discrepancy. Although interobserver variability in RF was higher with TTE compared with CMR (-5.5 ± 15% vs 0.1 ± 7.3%), patients with discrepancy were equally distributed by severity and clinical outcome without an overestimation by either method. In conclusion, there is a modest agreement between TTE and CMR in assessing MR severity. In patients with discrepancy, there is a higher prevalence of functional MR, without a consistent overestimation of MR severity by either method. PMID:26684513

  12. Comparison of Gated SPECT Myocardial Perfusion Imaging with Echocardiography for the Measurement of Left Ventricular Volumes and Ejection Fraction in Patients With Severe Heart Failure

    PubMed Central

    Shojaeifard, Maryam; Ghaedian, Tahereh; Yaghoobi, Nahid; Malek, Hadi; Firoozabadi, Hasan; Bitarafan-Rajabi, Ahmad; Haghjoo, Majid; Amin, Ahmad; Azizian, Nasrin; Rastgou, Feridoon

    2015-01-01

    Background: Gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is known as a feasible tool for the measurement of left ventricular ejection fraction (EF) and volumes, which are of great importance in the management and follow-up of patients with coronary artery diseases. However, considering the technical shortcomings of SPECT in the presence of perfusion defect, the accuracy of this method in heart failure patients is still controversial. Objectives: The aim of the present study was to compare the results from gated SPECT MPI with those from echocardiography in heart failure patients to compare echocardiographically-derived left ventricular dimension and function data to those from gated SPECT MPI in heart failure patients. Patients and Methods: Forty-one patients with severely reduced left ventricular systolic function (EF ? 35%) who were referred for gated SPECT MPI were prospectively enrolled. Quantification of EF, end-diastolic volume (EDV), and end-systolic volume (ESV) was performed by using quantitative gated spect (QGS) (QGS, version 0.4, May 2009) and emory cardiac toolbox (ECTb) (ECTb, revision 1.0, copyright 2007) software packages. EF, EDV, and ESV were also measured with two-dimensional echocardiography within 3 days after MPI. Results: A good correlation was found between echocardiographically-derived EF, EDV, and ESV and the values derived using QGS (r = 0.67, r = 0.78, and r = 0.80 for EF, EDV, and ESV, respectively; P < 0.001) and ECTb (r = 0.68, 0.79, and r = 0.80 for EF, EDV, and ESV, respectively; P < 0.001). However, Bland-Altman plots indicated significantly different mean values for EF, 11.4 and 20.9 using QGS and ECTb, respectively, as compared with echocardiography. ECTb-derived EDV was also significantly higher than the EDV measured with echocardiography and QGS. The highest correlation between echocardiography and gated SPECT MPI was found for mean values of ESV different. Conclusions: Gated SPECT MPI has a good correlation with echocardiography for the measurement of left ventricular EF, EDV, and ESV in patients with severe heart failure. However, the absolute values of these functional parameters from echocardiography and gated SPECT MPI measured with different software packages should not be used interchangeably. PMID:26889455

  13. Doppler echocardiography

    SciTech Connect

    Labovitz, A.J.; Williams, G.A.

    1988-01-01

    The authors are successful in presenting a basic book on clinical quantitative Doppler echocardiography. It is not intended to be a comprehensive text, but it does cover clinical applications in a succinct fashion. Only the more common diseases in the adult are considered. The subjects are presented logically and are easy to comprehend. The illustrations are good, and the book is paperbound. The basic principles of Doppler echocardiography are presented briefly. The book ends with chapters on left ventricular function (stroke volume and cardiac output), congenital heart disease, and color Doppler echo-cardiography. There are numerous references and a good glossary and index.

  14. Neonatal echocardiography.

    PubMed

    Wyllie, Jonathan

    2015-06-01

    Echocardiography is a technique within neonatal care increasingly used in acute management of patients because of its potential to guide care and hemodynamic management. However, its use continues to provoke controversy, as it was originally within the purview of pediatric cardiologists trained to identify structural as well as functional heart disease. This article examines some of the echocardiographic techniques available to the neonatologist, their applications, and the concerns surrounding their use on neonatal units. PMID:25936835

  15. Doppler echocardiography

    SciTech Connect

    Nanda, N.C.

    1985-01-01

    This text will serve to introduce the use of Doppler in clinical cardiology in a straightforward, practical format. The work features the following categories: a review and discussion of the fundamental principles and characteristics of ultrasound; examination techniques, including continuous and pulse modes; clinical application with acquired disease the focus; congenital disease, particularly defects, stenotic lesions, and complicated lesions; and fetal clinical applications of Doppler echocardiography.

  16. Stress echocardiography beyond coronary artery disease.

    PubMed

    Schwammenthal, E; Vered, Z; Rabinowitz, B; Kaplinsky, E; Feinberg, M S

    1997-06-01

    Doppler echocardiography has become the major diagnostic tool of evaluation of valvular heart disease and the cardiomyopathies because of its ability to provide valuable haemodynamic information accurately and non-invasively. It is therefore ideally suited for haemodynamic stress testing in these patients. In aortic stenosis, dobutamine echocardiography can distinguish severe from non-severe stenosis in patients with depressed left ventricular function, low transvalvular gradients, and a relatively small (flow-related) valve area at baseline. Patients with non-severe aortic stenosis increase cardiac output and valve area with dobutamine infusion while the transvalvular gradient does not change significantly. In severe aortic stenosis, the pressure gradient increases significantly with stroke volume, but valve area does not. In patients who fail to increase stroke volume (absent contractile reserve) and therefore do not show a change in haemodynamics, the severity of the lesion is 'indeterminate'; these patients are characterized by a very poor prognosis. In mitral stenosis, patients can be identified who increase valve area during exercise, which is the fundamental mechanism by which stroke volume can be increased in mitral stenosis. The increase in pulmonary artery pressure during exercise (assessed from tricuspid regurgitant signal) can be dramatically different in patients with comparable resting haemodynamics; therefore exercise echocardiography provides information which cannot be obtained from resting measurements alone and can help to guide medical and surgical therapy. Whether stress echocardiography may be similarly helpful in patients with regurgitant lesions is still a subject of investigation. Exercise Doppler echocardiographic studies following aortic valve replacement (small valves) can identify impairment of systolic and diastolic function indicative of 'valve prosthesis-patient mismatch'. In hypertrophic cardiomyopathy the dynamics of outflow obstruction can be assessed following exercise or pharmacological intervention. In dilative cardiomyopathy, contractile reserve can be assessed by dobutamine echocardiography which may help in evaluating prognosis, guiding heart failure therapy, and monitoring therapy with cardiotoxic chemotherapeutic agents. PMID:9183622

  17. Measurement of mitral regurgitation by Doppler echocardiography.

    PubMed Central

    Zhang, Y; Ihlen, H; Myhre, E; Levorstad, K; Nitter-Hauge, S

    1985-01-01

    In an attempt to develop a new approach to the non-invasive measurement of mitral regurgitation, Doppler echocardiography and left ventriculography were performed in 20 patients without valvar heart disease (group A) and in 30 patients with pure mitral regurgitation (group B). Volumetric flows through the aortic and the mitral orifices were determined by Doppler echocardiography. Aortic flow (AF) was calculated as the product of the aortic orifice area and the systolic velocity integral. The mitral flow (MF) was calculated as the product of the corrected mitral orifice area and the diastolic velocity integral. The mitral regurgitant fraction (RF) was calculated as RF = 1 - AF/MF. In group A aortic and mitral flow were very similar and the difference between the two did not differ significantly from zero. In group B the mitral flow was significantly larger than the aortic flow. There was a good correlation (r = 0.82) between the regurgitant fraction determined by Doppler echocardiography and the regurgitant grades determined by left ventriculography. The regurgitant fraction increased significantly with each grade of severity. These results show that Doppler echocardiography can be used to give a reliable measure of both aortic and mitral flow. This technique is a new and promising approach to the non-invasive measurement of mitral regurgitation. Images PMID:4052279

  18. Stress echocardiography in heart failure.

    PubMed

    Agricola, Eustachio; Oppizzi, Michele; Pisani, Matteo; Margonato, Alberto

    2004-01-01

    Echocardiography has the ability to noninvasively explore hemodynamic variables during pharmacologic or exercise stress test in patients with heart failure. In this review, we detail some important potential applications of stress echocardiography in patients with heart failure. In patients with coronary artery disease and chronic LV dysfunction, dobutamine stress echocardiography is able to distinguish between viable and fibrotic tissue to make adequate clinical decisions. Exercise testing, in combination with echocardiographic monitoring, is a method of obtaining accurate information in the assessment of functional capacity and prognosis. Functional mitral regurgitation is a common finding in patients with dilated and ischaemic cardiomyopathy and stress echocardiography in the form of exercise or pharmacologic protocols can be useful to evaluate the behaviour of mitral regurgitation. It is clinical useful to search the presence of contractile reserve in non ischemic dilated cardiomyopathy such as to screen or monitor the presence of latent myocardial dysfunction in patients who had exposure to cardiotoxic agents. Moreover, in patients with suspected diastolic heart failure and normal systolic function, exercise echocardiography could be able to demonstrate the existence of such dysfunction and determine that it is sufficient to limit exercise tolerance. Finally, in the aortic stenosis dobutamine echocardiography can distinguish severe from non-severe stenosis in patients with low transvalvular gradients and depressed left ventricular function. PMID:15285780

  19. Enoximone very low-dose dobutamine stress echocardiography: a new test for detecting viability in severe myocardial dysfunction after acute myocardial infarction.

    PubMed

    Mangieri, Enrico; Tanzilli, Gaetano; Barillà, Francesco; Pannitteri, Gaetano; Acconcia, Maria Cristina; Mezzanotte, Roberto; Donati, Roberto; Comito, Cosimo; Critelli, Giuseppe

    2003-09-01

    Relying on the synergistic action on contractility of enoximone and dobutamine when concomitantly infused, 25 patients with their first acute Q-wave anterior myocardial infarctions underwent conventional low-dose dobutamine echocardiography (LDE) and enoximone very-LDE to assess myocardial viability in severely dysfunctioning areas. Images were recorded at peak of pharmacodynamic effect of drugs and 4 months after revascularization. At peak-dose stage of LDE and enoximone very-LDE the regional infarct zone wall-motion score significantly decreased from the basal value of 25.6 +/- 2.9 to 16 +/- 6.0 (P <.001) and to 14.5 +/- 5.2 (P <.001), respectively. A high correlation was found by comparing the wall-motion score of each patient calculated at peak effect of combined drug administration with follow-up values (r(s) = 0.9). Enoximone very-LDE has proven to be a new test useful to evaluate viability in asynergic segments especially when the results of conventional tests are questionable. PMID:12931106

  20. Transoesophageal Echocardiography Related Complications

    PubMed Central

    Mathur, S K; Singh, Pooja

    2009-01-01

    Summary The application of transesophageal echocardiography (TEE) has been continuously increasing over past several decades. It is usually considered a very safe diagnostic and monitoring device. Though the complications are rare, but these complications must be known to the operators performing TEE. The goal of this article is to encapsulate the potential complications associated with TEE. The complications are primarily related to gastrointestinal, cardiovascular and respiratory systems along with some miscellaneous problems related to probe insertion, drugs and inexperience of the operator. Strategies for the prevention of these complications are also analyzed in order to avoid the risk. PMID:20640107

  1. The practice of echocardiography

    SciTech Connect

    Kraus, R.

    1985-01-01

    This volume is an anthology by noted authorities on all clinically useful aspects of echocardiography. Its articles cover such subjects as: historical perspectives, physics, instrumentation and techniques, M mode and 2D echocardiography.

  2. Technology update: intracardiac echocardiography – a review of the literature

    PubMed Central

    Vitulano, Nicola; Pazzano, Vincenzo; Pelargonio, Gemma; Narducci, Maria Lucia

    2015-01-01

    The development of new imaging tools helps in better investigation of cardiac structures and function by showing detailed images during interventional procedures. Intracardiac echocardiography plays a pivotal role as an intraoperative real-time imaging tool during invasive cardiac procedures. Initially, this echocardiographic technique was particularly useful when transthoracic image quality was insufficient and to avoid general anesthesia for transesophageal imaging. Nowadays, intracardiac echocardiography is routinely used in several cardiac invasive laboratories to support several types of procedures, such as extraction and implantation of cardiac devices, electrophysiological mapping, ablation, and endomyocardial biopsies. This review gives an overview of the basic principles of intracardiac echocardiography and examines its applications in the different settings of invasive cardiology. PMID:26060415

  3. Left Ventricular Systolic Dysfunction in Asymptomatic Marfan Syndrome Patients Is Related to the Severity of Gene Mutation: Insights from the Novel Three Dimensional Speckle Tracking Echocardiography

    PubMed Central

    Abd El Rahman, Mohamed; Haase, Denise; Rentzsch, Axel; Olchvary, Julia; Schäfers, Hans-Joachim; Henn, Wolfram; Wagenpfeil, Stefan; Abdul-Khaliq, Hashim

    2015-01-01

    Background In asymptomatic Marfan syndrome (MFS) patients we evaluated the relationship between the types of fibrillin-1 (FBN1) gene mutation and possible altered left ventricular (LV) function as assessed by three-dimensional speckle tracking echocardiography (3D-STE). Methods and Results Forty-five MFS patients (mean age 24±15 years) and 40 age-matched healthy controls were studied. Genetic evaluation for the FBN1 gene was carried on 32 MFS patients. Gene mutation (n = 15, 47%) was classified as mild when the mutation resulted in nearly normally functioning protein, while mutations resulting in abnormally function protein were considered to be severe (n = 17, 53%). All patients and controls underwent 3D-STE for evaluation of LV function by an echocardiographer blinded to the results of the genetic testing. Compared to controls, MFS patients had significantly lower 3D-STE derived LV ejection fraction (EF, 57.43±7.51 vs. 62.69±4.76%, p = 0.0001), global LV longitudinal strain (LS, 14.85±2.89 vs. 17.90±2.01%, p = 0.0001), global LV circumferential strain (CS, 13.93±2.81 vs. 16.82±2.17%, p = 0.0001) and global LV area strain (AS, 25.76±4.43 vs. 30.51±2.61%, p = 0.0001). Apart from the global LV LS all these parameters were significantly lower in patients with severe gene mutation than in those with mild mutation (p<0.05). In the multivariate linear regression analysis only the type of mutation had a significant influence on the 3D-STE derived LVEF (p = 0.017), global CS (p = 0.005) and global AS (p = 0.03). Conclusions In asymptomatic MFS patients latent LV dysfunction can be detected using 3D STE. The LV dysfunction is mainly related to the severity of gene mutation, suggesting possible primary cardiomyopathy in MFS patients. PMID:25901601

  4. Assessment of global function of left ventricle with dual-source CT in patients with severe arrhythmia: a comparison with the use of two-dimensional transthoracic echocardiography.

    PubMed

    Kim, Song Soo; Ko, Sung Min; Song, Meong Gun; Kim, Joon Suk

    2010-12-01

    To evaluate the agreement between dual-source computed tomography (DSCT) and two-dimensional transthoracic echocardiography (2D-TTE) with respect to the assessment of global left ventricular (LV) function in patients with severe arrhythmia. With 2D-TTE serving as the reference method, we performed both DSCT and 2D-TTE, at an interval of less than 2 days, in 54 patients with severe arrhythmia (average heart rate difference >30 beats per min) before open heart surgery for evaluation of valvular heart disease (VHD) and coronary artery disease. DSCT was performed using retrospective electrocardiography (ECG) without dose modulation. Ten phases of the cardiac cycle were analyzed for identification of end-diastolic and end-systolic phases with ECG-editing. Pearson's correlation coefficient (r) and Bland-Altman analysis were used to determine agreement for parameters of LV global function. Correlation between DSCT and 2D-TTE measurements was good or excellent in terms of the values of the LV ejection fraction (51.0 ± 11.4% vs. 55.8 ± 11.6%; r = 0.8), LV end-diastolic volume (179.5 ± 98.6 ml vs. 152.1 ± 73.8 ml; r = 0.95), LV end-systolic volume (90.7 ± 60.7 ml vs. 69.1 ± 46.8 ml; r = 0.90), and LV stroke volume (89.0 ± 48.1 ml vs. 82.9 ± 37.3 ml; r = 0.89). Left ventricular ejection fraction measured using DSCT was less than that measured using 2D-TTE by an average of -4.8 ± 7.3%. Dual-source CT with ECG editing can provide results comparable to those of 2D-TTE for assessment of LV global function in patients with severe arrhythmia. PMID:20798989

  5. The basics of echocardiography

    PubMed Central

    Mohamed, Alaa A.; Arifi, Ahmed A.; Omran, Ahmed

    2010-01-01

    Cardiac echocardiography is becoming an essential diagnostic tool for a variety of cardiac pathology. Acquiring the necessary knowledge will help non cardiac and the cardiac specialist to understand the echocardiography images and reports and in return will improve the care of the patients. The aim of these of publication is to address the basic knowledge of cardiac echocardiography and the recent advances of its applications. PMID:23960599

  6. Stress echocardiography: safety and tolerability

    PubMed Central

    2013-01-01

    Background Stress echocardiography is a valuable tool for the noninvasive diagnosis of ischemic heart disease. Despite its widely use in the clinical practice, safety and side effects profile have never been evaluated in Moroccans. The aim To assess the safety and tolerability of the two stress echo modalities in Moroccans. Methods The study was made by 311 patients with known or suspected coronary artery disease, 203 underwent exercise echocardiography and 108 underwent dobutamine echocardiography, major and minor rhythmic complications and side effects were recorded for the two groups. Results We registered 3 (2, 8%) major rhythmic events in the dobutamine group (2 sustained supraventricular tachycardia and 1 sustained ventricular tachycardia), there was no major rhythmic events in the exercise group. Minor rhythmic events were frequent (43, 5% in the dobutamine group and 19, 2% in the exercise group with a p?=?0, 0001). Severe hypotension occurs in 4 (3, 7%) patients during a dobutamine stress, there was no significant drop in the blood pressure during exercise stress procedures. Non cardiac side effects were more common among patients who underwent a dobutamine stress echo (13, 9% vs. 3, 4% with p?=?0,001). Conclusion Exercise is safer than dobutamine stress echocardiography, complications and adverse effects with the use of dobutamine are usually minor and self-limiting. PMID:23961806

  7. Quadricuspid pulmonary valve identified by transthoracic echocardiography.

    PubMed

    Fernández-Armenta, Juan; Villagómez, David; Fernández-Vivancos, Carla; Vázquez, Rafael; Pastor, Luis

    2009-03-01

    The quadricuspid pulmonary valve is a rare congenital anomaly. It tends to be clinically quiescent. Its diagnosis by two-dimensional echocardiography could be very difficult because of the anatomical features. We report on the echocardiographic findings of a 66-year-old female patient with mitral and aortic regurgitation of rheumatic origin and severe pulmonary hypertension. There was an aneurismatic dilation of the pulmonary artery trunk allowing visualization of the short-axis view of the pulmonary valve. It showed four cusps of similar size and an important deficit of central coaptation. Very few cases of the quadricuspid pulmonary valve are documented in live patients. PMID:19017322

  8. Beta adrenergic receptor blockade causing severe left ventricular systolic dysfunction during dobutamine stress echocardiography in a patient with no structural heart disease.

    PubMed

    Okada, David R; Okada, Robert D; Bonow, Robert O

    2012-02-01

    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

  9. The Origin of Echocardiography

    PubMed Central

    Singh, Siddharth; Goyal, Abha

    2007-01-01

    The original description of M-mode echocardiography in 1953, by Inge Edler (1911–2001) and his physicist friend Hellmuth Hertz, marked the beginning of a new diagnostic noninvasive technique. Edler used this technique primarily for the preoperative study of mitral stenosis and diagnosis of mitral regurgitation. His work was carried forward by cardiologists all over the world, who developed Doppler, 2-dimensional, contrast, and transesophageal echocardiography. These are now standard in cardiologic examinations. Edler also influenced neurologists and obstetricians at Lund University (Sweden) to use ultrasound in their fields. For his landmark discovery, Edler is recognized as the “Father of Echocardiography.” PMID:18172524

  10. Impact of Severe Obesity and Weight Loss on Systolic Left Ventricular Function and Morphology: Assessment by 2-Dimensional Speckle-Tracking Echocardiography

    PubMed Central

    Karimian, Sevda; Stein, Jürgen; Bauer, Boris; Teupe, Claudius

    2016-01-01

    Obesity is associated with an increased risk of heart failure. Little is known about the impact of dietary changes on the cardiac sequelae in obese patients. Twenty-one obese subjects underwent a 12-week low calorie fasting phase of a formula diet. Transthoracic two-dimensional speckle-tracking echocardiography was performed to obtain systolic left ventricular strain before and after weight loss. Body mass index decreased significantly from 38.6 ± 6.2 to 31.5 ± 5.3 kg/m2, and the total percentage fat loss was 19%. Weight reduction was associated with a reduction in blood pressure and heart rate. Left ventricular longitudinal global peak systolic strain was in the lower normal range (−18.7 ± 3.2%) before weight loss and was unchanged (−18.8 ± 2.4%) after 12 weeks on diet with substantial weight loss. Also, no significant change in global radial strain after weight loss was noted (41.1 ± 22.0 versus 43.9 ± 23.3, p = 0.09). Left atrial and ventricular dimensions were in normal range before fasting and remained unchanged after weight loss. In our study obesity was associated with normal systolic left ventricular function. A 12-week low calorie diet with successful weight loss can reduce blood pressure and heart rate. Systolic left ventricular function and morphology were not affected by rapid weight reduction. PMID:27006823

  11. Frontotemporal lobar degeneration with motor neuron disease showing severe and circumscribed atrophy of anterior temporal lobes.

    PubMed

    Kuwahara, Hiroya; Tsuchiya, Kuniaki; Saito, Yukinobu; Kobayashi, Zen; Miyazaki, Hiroshi; Izumiyama, Yoko; Akiyama, Haruhiko; Arai, Tetsuaki; Mizusawa, Hidehiro

    2010-10-15

    Frontotemporal lobar degeneration (FTLD) is characterized by a variety of behavioral and psychiatric symptoms based on the dysfunction of frontal and/or temporal lobes. A 63-year-old Japanese man without a family history of neurological diseases developed progressive symptoms of frontotemporal dementia, followed by motor neuron disease (MND). Brain magnetic resonance images demonstrated severe atrophy in the anterior temporal lobes from early clinical stage. The symptoms got rapidly worsened and the patient died of respiratory failure 1year 8months after the disease onset. A postmortem study revealed severe and circumscribed atrophy in the anterior temporal lobes, and histological examination disclosed marked neuronal loss with many neuronal cytoplasmic inclusions which were immunoreactive for ubiquitin antibodies and phosphorylated TAR DNA-binding protein of 43kDa (TDP-43) antibodies in hippocampal dentate granule cells and amygdalae, as well as a few neuronal cytoplasmic inclusions without dystrophic neurites in the temporal neocortex. This case report showed typical features of FTLD-MND in clinical course and TDP-43 pathology with unusual severity and distribution of cerebral atrophy, suggesting a unique manifestation of FTLD-MND. PMID:20674934

  12. Pediatric stress echocardiography.

    PubMed

    Kimball, Thomas R

    2002-01-01

    Traditional health evaluations are performed while the patient is at rest. Stress echocardiography extends these examinations by providing data in a physiologic setting more closely mimicking the typically active state of children. The test represents a fusion of the fields of two-dimensional echocardiography and cardiovascular stress testing and can be used to assess myocardial perfusion in patients with suspected coronary artery pathology or to evaluate cardiac gradients or functional reserve in patients with noncoronary artery pathology. Testing should be performed with a trained sonographer and attending physician and in collaboration with adult cardiology colleagues. Stress can be administered to the patient through either exercise or pharmacologic agents. Echocardiography is used to assess regional wall motion abnormalities when evaluating myocardial perfusion or gradients and/or function when assessing the patient without coronary artery issues. Conditions with potential coronary artery pathology for which stress echocardiography is appropriate include Kawasaki disease, transplant graft vasculopathy, arterial switch operation for transposition of the great arteries, anomalous coronary artery origins or courses, pulmonary atresia with intact ventricular septum, hyperlipidemia, insulin-dependent diabetes mellitus, and supravalvar aortic stenosis. Stress echocardiography can also be helpful in determining the behavior during activity of gradients in conditions such as hypertrophic cardiomyopathy or aortic and pulmonic stenosis, of cardiac pressures in pulmonary hypertension and of ventricular function in conditions such as dilated cardiomyopathy or mitral and aortic regurgitation. PMID:11976781

  13. Echocardiography for hypertrophic cardiomyopathy.

    PubMed

    Patil, Pravin V; Wiegers, Susan E

    2014-01-01

    Hypertrophic cardiomyopathy (HCM) is a genetic cardiomyopathy. The prevalence of phenotypic expression, in the absence of another systemic or cardiac disease causing increased left ventricular (LV) wall thickness, is estimated to be 1:500. The frequency of clinical presentation is far less, highlighting the need for a non-invasive diagnostic imaging tool. Echocardiography is readily available and allows for structural characterization and hemodynamic assessment of the hypertrophic heart and to screen patients at-risk for HCM, such as first degree relatives of affected individuals, and differentiate HCM from the athletic heart. Echocardiography can also be used to assess for anatomic abnormalities of the mitral valve apparatus that may exacerbate LV outflow track obstruction and to further risk stratify patients during exercise. Finally, echocardiography plays an integral role in guiding alcohol septal ablation procedures. PMID:25081404

  14. Ebstein's anomaly assessed by real-time 3-D echocardiography.

    PubMed

    Acar, Philippe; Abadir, Sylvia; Roux, Daniel; Taktak, Assaad; Dulac, Yves; Glock, Yves; Fournial, Gerard

    2006-08-01

    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

  15. The history of echocardiography.

    PubMed

    Edler, Inge; Lindström, Kjell

    2004-12-01

    Following a brief review of the development of medical ultrasonics from the mid-1930s to the mid-1950s, the collaboration between Edler and Hertz that began in Lund in 1953 is described. Using an industrial ultrasonic flaw detector, they obtained time-varying echoes transcutaneously from within the heart. The first clinical applications of M-mode echocardiography were concerned with the assessment of the mitral valve from the shapes of the corresponding waveforms. Subsequently, the various M-mode recordings were related to their anatomical origins. The method then became established as a diagnostic tool and was taken up by investigators outside Lund, initially in China, Germany, Japan and the USA and, subsequently, world-wide. The diffusion of echocardiography into clinical practice depended on the timely commercial availability of suitable equipment. The discovery of contrast echocardiography in the late 1960s further validated the technique and extended the range of applications. Two-dimensional echocardiography was first demonstrated in the late 1950s, with real-time mechanical systems and, in the early 1960s, with intracardiac probes. Transesophageal echocardiography followed, in the late 1960s. Stop-action two-dimensional echocardiography enjoyed a brief vogue in the early 1970s. It was, however, the demonstration by Bom in Rotterdam of real-time two-dimensional echocardiography using a linear transducer array that revolutionized and popularized the subject. Then, the phased array sector scanner, which had been demonstrated in the late 1960s by Somer in Utrecht, was applied to cardiac studies from the mid-1970s onwards. Satomura had demonstrated the use of the ultrasonic Doppler effect to detect tissue motion in Osaka in the mid-1950s and the technique was soon afterwards applied in the heart, often in combination with M-mode recording. The development of the pulsed Doppler method in the late 1960s opened up new opportunities for clinical innovation. The review ends with a mention of color Doppler echocardiography. (E-mail: PMID:15617829

  16. MRI Shows More Severe Hippocampal Atrophy and Shape Deformation in Hippocampal Sclerosis Than in Alzheimer's Disease

    PubMed Central

    Zarow, C.; Wang, L.; Chui, H. C.; Weiner, M. W.; Csernansky, J. G.

    2011-01-01

    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

  17. Echocardiography. Fourth edition

    SciTech Connect

    Feigenbaum, H.

    1986-01-01

    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.

  18. Microsatellites haplotyping of CF chromosomes shows linkage disequilibrium and several founder effects in Brittany (France)

    SciTech Connect

    Raguenes, O.; Ferec, C.; Mercier, B.

    1994-09-01

    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.

  19. The Role of Focused Echocardiography in Pediatric Intensive Care: A Critical Appraisal

    PubMed Central

    Gaspar, Heloisa Amaral; Morhy, Samira Saady

    2015-01-01

    Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU). Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged. PMID:26605333

  20. New Drug for Severe Form of Arthritis Shows Promise in Trial

    MedlinePLUS

    ... Shows Promise in Trial Already approved to treat psoriasis, higher dose of Cosentyx helped 60 percent of ... A drug recently approved for the skin condition psoriasis may also help people with a debilitating form ...

  1. Computing Myocardial Motion in 4D Echocardiography

    PubMed Central

    Mukherjee, Ryan; Sprouse, Chad; Pinheiro, Aurélio; Abraham, Theodore; Burlina, Philippe

    2012-01-01

    4D (3D spatial+time) echocardiography is gaining widespread acceptance at clinical institutions for its high temporal resolution and relatively low cost. We describe a novel method for computing dense 3D myocardial motion with high accuracy. The method is based on a classical variational optical flow technique, but exploits modern developments in optical flow research to utilize the full capabilities of 4D echocardiography. Using a variety of metrics, we present an in-depth performance evaluation of the method on synthetic, phantom, and intraoperative 4D Transesophageal Echocardiographic (TEE) data. When compared with state-of-the-art optical flow and speckle tracking techniques currently found in 4D echocardiography, the method we present shows notable improvements in error. We believe the performance improvements shown can have a positive impact when the method is used as input for various applications, such as strain computation, biomechanical modeling, or automated diagnostics. PMID:22677256

  2. Simplified approach for delivering medicine to patients with severe pain shows promise.

    PubMed

    2015-08-01

    A new study suggests that in a busy emergency environment, a protocol based on simply asking patients if they need more pain medicine at 30-minute intervals can be effective at controlling pain, although some experts urge stricter limits on the automatic authorization of hydromorphone, and a mechanism to keep physicians more involved in care. Experts suggest that soliciting patient input is more effective than relying on numbered pain scales to gauge whether pain has been adequately controlled. For non-elderly patients in severe pain, the protocol includes an automatic authorization for an additional milligram of hydromorphone up to four times at 30-minute intervals. Study results indicate that all but two of 207 study participants achieved satisfactory pain control at one or more points in the study, and that most were satisfied with their treatment. PMID:26258202

  3. Progesterone Treatment Shows Benefit in a Pediatric Model of Moderate to Severe Bilateral Brain Injury

    PubMed Central

    Geddes, Rastafa I.; Sribnick, Eric A.; Sayeed, Iqbal; Stein, Donald G.

    2014-01-01

    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. PMID:24489882

  4. [Valve prostheses and transesophageal echocardiography].

    PubMed

    Espinola Zavaleta, N; de la Rosa, G; Tamayo Rebolledo, E; Romero Cárdenas, A; Rijlaarsdam, M; Vargas Barrón, J

    1995-01-01

    The aim of this paper is to inform about the experience of the Echocardiography Department of the National Institute of Cardiology Ignacio Chávez, in the assessment of prosthetic valves dysfunction by transesophageal echocardiography. Sixty patients with a total of 75 prosthetic valves: 19 bioprostheses and 56 mechanical valves were studied. Forty four were in mitral position, 27 in aortic position and 4 in tricuspid position. All patients were evaluated using 5 MHz monoplane or biplane transesophageal transducers. The 52% (39) of the studied prosthetic valves were found normally functioning. However, 48% (36) of these showed signs of dysfunction. The causes of dysfunction in the mechanical valves were: obstruction, pannus, infectious endocarditis and periprosthetic leak, and in relation with bioprostheses rupture of the leaflets, stenosis and calcification, partial dehiscence, infectious endocarditis and periprosthetic leak were identified. The obtained percentage and type of prosthetic valves dysfunction in our results agree with those reported in the literature and confirm the great utility of transesophageal research in the detection of the valvular prosthetic dysfunction. PMID:7639596

  5. [Echocardiography in elderly patients].

    PubMed

    Tabet, J-Y; Pascal, O; Monin, J-L

    2004-03-27

    IN THE CONTEXT OF AGEING: The Doppler echocardiography is a non-invasive technique that permits assessment of the "physiological" ageing of the cardiac and vascular structures, notably including a concentric remodelling of the left ventricle associated with relaxation abnormalities, dilatation of the left atrium, valvular reorganisation and a modification in the large vessels. IN A PATHOLOGICAL CONTEXT: The Doppler echocardiography also detects the various cardiovascular affections related to ageing: valvulopathies, notably calcified aortic stenosis and mitral failure due to mitral anulus calcification or prolapsus of the valve; primary hypertrophic cardiomyopathy or secondary to arterial hypertension or an amyloidosis, and possibly leading to heart failure with spared systolic function, frequent in elderly patients; ischemic cardiopathies that have benefited, as in younger patient, from new echographical stress testing techniques, which safely study the variability in myocardial ischemia. Transoesophageal echography can also be performed in elderly patients, but the indications of this more invasive and less well-tolerated examination must be assessed case by case. It is very useful when an intra-parietal aortic hematoma is suspected or during aortic dissection or infectious endocarditis. PMID:15105787

  6. The Evolutionary Development of Echocardiography

    PubMed Central

    Maleki, Majid; Esmaeilzadeh, Maryam

    2012-01-01

    Echocardiography is a non-invasive diagnostic technique which provides information on cardiac morphology, function, and hemodynamics. It is the most frequently used cardiovascular diagnostic test only after electrocardiography. In less than five decades, the evolution in this technique has made it the basic part of cardiovascular medicine. Herein, the evolution of various forms of echocardiography is briefly described. PMID:23390327

  7. Contrast echocardiography 1996. A review.

    PubMed Central

    Villarraga, H R; Foley, D A; Mulvagh, S L

    1996-01-01

    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 PMID:8792539

  8. Evolution of echocardiography.

    PubMed

    Feigenbaum, H

    1996-04-01

    The evolution of echocardiography has been interesting and dramatic. The technology has grown and has become an integral part of the practice of cardiology. As with all technology, there are advantages and disadvantages. The principal disadvantage is the fact that education and training are imperative to provide high-quality examinations and proper interpretations. In addition, many of the diagnoses are still qualitative and subjective. The principal advantage is the amazing versatility of this technology. The wealth of information that can be provided both noninvasively with a transthoracic examination and invasively with either transesophageal or intravascular ultrasound is tremendous. The anatomic and physiological data provided frequently give definitive diagnoses. If performed properly and for the right reason, this test should be very cost effective and should be a major asset in the coming era of medical cost containment. There are many technological advances that should enhance this information. With technology such as digital recordings, it is hoped that the clinicians will have better access to these data and will be more comfortable in interacting with this important diagnostic tool. PMID:8641018

  9. Echocardiography in a Patient on Mechanical Ventilation.

    PubMed

    Sachdeva, Ankush

    2015-07-01

    Cardiopulmonary interactions or effects of spontaneous and mechanical ventilation (MV) were first documented in the year 1733. Stephen Hales showed that the blood pressure of healthy individual fell during spontaneous inspiration and he later went on to discover the ventilator. A year later Kussmaul described pulsus paradoxus (inspiratory absence of radial pulse) in patients with tubercular pericarditis. Echocardiography can help to diagnose a wide variety of cardiovascular diseases and can guide therapeutic decisions in patients on mechanical ventilation. PMID:26731826

  10. The Effects of a "Tell-Show-Try-Apply" Professional Development Package on Teachers of Students with Severe Developmental Disabilities

    ERIC Educational Resources Information Center

    Browder, Diane M.; Jimenez, Bree Ann; Mims, Pamela J.; Knight, Victoria F.; Spooner, Fred; Lee, Angel; Flowers, Claudia

    2012-01-01

    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…

  11. [First experience with "live" three-dimensional echocardiography in Russia].

    PubMed

    Saidova, M A; Rogoza, A N; Belenkov, Iu N

    2004-01-01

    Revival of interest to three-dimensional echocardiography during recent years was invoked by introduction of essentially novel ultrasound technology of "live" three-dimensional imaging. We introduce here the first experience of the use of three-dimensional echocardiography in Russia comprising examination of 74 patients with various pathology of the heart. Positions and sections are described allowing best visualization of pathology of cardiac valves and other intracardiac structures. Our experience shows that at present three-dimensional echocardiography should be considered to be an important supplement to standard echocardiography. However in some cases it can be the only non-invasive technique able to provide complete information on the size of ventricular and atrial septal defects, valvular and other cardiac pathology. PMID:15159729

  12. Quantification methods in contrast echocardiography.

    PubMed

    Agati, L; Tonti, G; Galiuto, L; Di Bello, V; Funaro, S; Madonna, M P; Garramone, B; Magri, F

    2005-12-01

    New technologies and the availability of new echo-contrast agents have resulted in advances of diagnostic and prognostic indications of left ventricular opacification (LVO) and myocardial perfusion. The clinical diagnostic value of ultrasound contrast media for LVO and its impact on the clinical decision-making process has been demonstrated in several studies. Recent research aims at developing new quantitative software to improve the delineation of the endocardial border, to assess 3D myocardial perfusion for more accurate regional/global LV function measurements, and to evaluate 4D intra-cardiac flow dynamics. Furthermore, a general consensus has been reached on the incremental value of myocardial contrast echocardiography (MCE) for obtaining additional information in both chronic and acute coronary artery disease (CAD) patients and on the possibility to make quantitative measurements of microvascular damage. Q-contrast is a new software system which provides quantitative measurements to generate parametric images of microcirculatory flow. In a research project including 120 patients, Q-contrast software has been tested to assess the role of contrast in AMI (Acute Myocardial Infarction Contrast Imaging (A.M.I.C.I. Study); good agreement between parametric MCE and SPECT has been found. Preliminary results further confirm that quantitative MCE may provide additional clinical value over qualitative information for the assessment of LV function and of the effects of coronary artery disease on the myocardial microcirculation (viability, ischemia or infarct). PMID:16360628

  13. Dynamic Three-Dimensional Echocardiography

    NASA Astrophysics Data System (ADS)

    Matsusaka, Katsuhiko; Doi, Motonori; Oshiro, Osamu; Chihara, Kunihiro

    2000-08-01

    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.

  14. Transoesophageal echocardiography during liver transplantation

    PubMed Central

    De Pietri, Lesley; Mocchegiani, Federico; Leuzzi, Chiara; Montalti, Roberto; Vivarelli, Marco; Agnoletti, Vanni

    2015-01-01

    Liver transplantation (LT) has become the standard of care for patients with end stage liver disease. The allocation of organs, which prioritizes the sickest patients, has made the management of liver transplant candidates more complex both as regards their comorbidities and their higher risk of perioperative complications. Patients undergoing LT frequently display considerable physiological changes during the procedures as a result of both the disease process and the surgery. Transoesophageal echocardiography (TEE), which visualizes dynamic cardiac function and overall contractility, has become essential for perioperative LT management and can optimize the anaesthetic management of these highly complex patients. Moreover, TEE can provide useful information on volume status and the adequacy of therapeutic interventions and can diagnose early intraoperative complications, such as the embolization of large vessels or development of pulmonary hypertension. In this review, directed at clinicians who manage TEE during LT, we show why the procedure merits a place in challenging anaesthetic environment and how it can provide essential information in the perioperative management of compromised patients undergoing this very complex surgical procedure. PMID:26483865

  15. Echocardiography and cardiac resynchronisation therapy, friends or foes?

    PubMed

    van Everdingen, W M; Schipper, J C; van 't Sant, J; Ramdat Misier, K; Meine, M; Cramer, M J

    2016-01-01

    Echocardiography is used in cardiac resynchronisation therapy (CRT) to assess cardiac function, and in particular left ventricular (LV) volumetric status, and prediction of response. Despite its widespread applicability, LV volumes determined by echocardiography have inherent measurement errors, interobserver and intraobserver variability, and discrepancies with the gold standard magnetic resonance imaging. Echocardiographic predictors of CRT response are based on mechanical dyssynchrony. However, parameters are mainly tested in single-centre studies or lack feasibility. Speckle tracking echocardiography can guide LV lead placement, improving volumetric response and clinical outcome by guiding lead positioning towards the latest contracting segment. Results on optimisation of CRT device settings using echocardiographic indices have so far been rather disappointing, as results suffer from noise. Defining response by echocardiography seems valid, although re-assessment after 6 months is advisable, as patients can show both continuous improvement as well as deterioration after the initial response. Three-dimensional echocardiography is interesting for future implications, as it can determine volume, dyssynchrony and viability in a single recording, although image quality needs to be adequate. Deformation patterns from the septum and the derived parameters are promising, although validation in a multicentre trial is required. We conclude that echocardiography has a pivotal role in CRT, although clinicians should know its shortcomings. PMID:26645707

  16. Ten cases of severe oral lichen planus showing granular C3 deposition in oral mucosal basement membrane zone.

    PubMed

    Hashimoto, Takashi; Fukuda, Aoi; Himejima, Akio; Morita, Shosuke; Tsuruta, Daisuke; Koga, Hiroshi; Krol, Rafal P; Ishii, Norito

    2015-12-01

    Oral lichen planus (OLP) may show depositions of immunoglobulins and complement components in oral mucosal basement membrane zone (BMZ) in direct immunofluorescence, although these finding are not frequently seen. We collected and examined ten cases of severe OLP showing granular C3 deposition in BMZ. In addition to clinical, histopathological and direct immunofluorescence assessments, we performed various immune-serological tests, including indirect immunofluorescence of normal human skin and 1M NaCl-split skin, immunoblotting of normal human epidermal and dermal extracts, recombinant proteins of BP180 NC16a and C-terminal domains, concentrated culture supernatant of HaCaT cells and purified human laminin-332, and enzyme-linked immunosorbent assays for BP230 and BP180. Direct immunofluorescence showed C3 deposition in BMZ exclusively of granular pattern in 7 cases and of both granular and linear patterns in 3 cases. The 10 cases showed no positive reactivity for either IgG or IgA antibodies in any immuno-serological tests. Detailed analyses of clinical, histopathological and immunological findings revealed striking female prevalence, although other parameters were in general characteristic of OLP. Granular C3 deposition in oral BMZ may be one of the characteristic features of severe OLP, although mechanisms for C3 deposition and its pathogenic role in OLP are currently unknown. PMID:26462453

  17. Quadricuspid aortic valve defined by echocardiography and cardiac computed tomography.

    PubMed

    Karlsberg, Daniel W; Elad, Yaron; Kass, Robert M; Karlsberg, Ronald P

    2012-01-01

    A 54 year old female presented with lower extremity edema, fatigue, and shortness of breath with physical findings indicative of advanced aortic insufficiency. Echocardiography showed severe aortic regurgitation and a probable quadricuspid aortic valve. In anticipation of aortic valve replacement, cardiac computed tomography (Cardiac CT) was performed using 100 kV, 420 mA which resulted in 6 mSv of radiation exposure. Advanced computing algorithmic software was performed with a non-linear interpolation to estimate potential physiological movement. Surgical photographs and in-vitro anatomic pathology exam reveal the accuracy and precision that preoperative Cardiac CT provided in this rare case of a quadricuspid aortic valve. While there have been isolated reports of quadricuspid diagnosis with Cardiac CT, we report the correlation between echocardiography, Cardiac CT, and similar appearance at surgery with confirmed pathology and interesting post-processed rendered images. Cardiac CT may be an alternative to invasive coronary angiography for non-coronary cardiothoracic surgery with the advantage of providing detailed morphological dynamic imaging and the ability to define the coronary arteries non-invasively. The reduced noise and striking depiction of the valve motion with advanced algorithms will require validation studies to determine its role. PMID:22442640

  18. Severe Septic Patients with Mitochondrial DNA Haplogroup JT Show Higher Survival Rates: A Prospective, Multicenter, Observational Study

    PubMed Central

    Martín, María M.; López-Gallardo, Esther; Solé-Violán, Jordi; Blanquer, José; Labarta, Lorenzo; Díaz, César; Borreguero-León, Juan María; Jiménez, Alejandro; Montoya, Julio; Ruiz-Pesini, Eduardo

    2013-01-01

    Objective In a previous cohort study (n=96), we found an association between mitochondrial (mt) DNA haplogroup JT and increased survival of severe septic patients, after controlling for age and serum lactic acid levels. The aim of this research was to increase the predictive accuracy and to control for more confounder variables in a larger cohort (n=196) of severe septic patients, to confirm whether mtDNA haplogroup JT influences short and medium-term survival in these patients. Methods We conducted a prospective, multicenter, observational study in six Spanish Intensive Care Units. We determined 30-day and 6-month survival and mtDNA haplogroup in this second cohort of 196 patients and in the global cohort (first and second cohorts combined) with 292 severe septic patients. Multiple logistic regression and Cox regression analyses were used to test for the association of mtDNA haplogroups JT with survival at 30-days and 6-months, controlling for age, sex, serum interleukin-6 levels and SOFA score. Results Logistic and Cox regression analyses showed no differences in 30-day and 6-month survival between patients with mtDNA haplogroup JT and other haplogroups in the first cohort (n=96). In the second cohort (n=196), these analyses showed a trend to higher 30-day and 6-month survival in those with haplogroup JT. In the global cohort (n=292), logistic and Cox regression analyses showed higher 30-day and 6-month survival for haplogroup JT. There were no significant differences between J and T sub-haplogroups in 30-day and 6-month survival. Conclusions The global cohort study (first and second cohorts combined), the largest to date reporting on mtDNA haplogroups in septic patients, confirmed that haplogroup JT patients showed increased 30-day and 6-month survival. This finding may be due to single nucleotide polymorphism defining the whole haplogroup JT and not separately for J or T sub-haplogroups. PMID:24069186

  19. Dual thrombosis of the pulmonary arterial and venous anastomotic sites after single lung transplantation: role of transesophageal echocardiography in diagnosis and management.

    PubMed

    Fadel, Bahaa M; Abdulbaki, Khaled; Nambiar, Vijayaraghavan; Al Amri, Mohammad; Shahid, Maie; Khouqeer, Farid; Canver, Charles

    2007-04-01

    We present the case of a patient who developed severe respiratory and hemodynamic compromise shortly after single right lung transplantation. Transesophageal echocardiography showed a large intraluminal thrombus at the right pulmonary artery anastomosis resulting in severe obstruction to flow together with thrombosis of the right pulmonary veins extending into the left atrium. After thrombectomy and surgical revision of the vascular anastomoses, the patient made an uneventful recovery. This case illustrates the usefulness of transesophageal echocardiography in the diagnosis and treatment of patients who are hemodynamically unstable after lung transplantation. PMID:17400127

  20. Important advances in technology: echocardiography.

    PubMed

    Nagueh, Sherif F; Quiñones, Miguel A

    2014-01-01

    Echocardiography has evolved over the past 45 years from a simple M-mode tracing to an array of technologies that include two-dimensional imaging, pulsed and continuous wave spectral Doppler, color flow and tissue Doppler, and transesophageal echocardiography. Together, these modalities provide a comprehensive anatomic and functional evaluation of cardiac chambers and valves, pericardium, and ascending and descending aorta. The switch from analog to digital signal processing revolutionized the field of ultrasound, resulting in improved image resolution, smaller instrumentation that allows bedside evaluation and diagnosis of patients, and digital image storage for more accurate quantification and comparison with previous studies. It also opened the door for new advances such as harmonic imaging, automated border detection and quantification, 3-dimensional imaging, and speckle tracking. This article offers an overview of some newer developments in echocardiography and their promising applications. PMID:25574341

  1. Non-Coronary Patients with Severe Chest Pain Show More Irrational Beliefs Compared to Patients with Mild Pain

    PubMed Central

    Bahremand, Mostafa; Saeidi, Mozhgan

    2015-01-01

    Background Despite providing insufficient medical evidence of the existence of a real cardiac condition, patients with non-coronary chest pain still interpret their pain incorrectly. The present study, therefore, sought to compare the irrational beliefs in non-coronary patients with mild chest pain against those with severe chest pain. Methods A cross-sectional design was used. The statistical population comprised non-coronary patients who presented to the Heart Emergency Center of Kermanshah city, Iran. Using a matching method, 96 participants were selected and studied in two groups of 48. The instruments used were the Comorbidity Index, Brief Pain Index, and the Jones Irrational Beliefs Test (short-form). The multivariate analysis of variance, chi-square test, and t-test were used for data analysis. Results Controlling for the effects of age and comorbid conditions, the severity of three types of irrational beliefs, including emotional irresponsibility (P<0.001), hopelessness changes (P<0.001), and problem avoiding (P=0.002) was higher among patients with severe chest pain (according to effect level). However, in terms of demand for approval, no difference was seen between the two groups (P=0.180). Conclusion Non-coronary patients with severe chest pain showed a greater number of irrational beliefs in comparison to patients with mild pain. Irrational beliefs are common mental occurrences in patients with non-coronary chest pain, and they should be attended to by health professionals, especially in severe non-coronary chest pain. Further investigation to determine the association between irrational beliefs and non-coronary chest pain is necessary. PMID:26217482

  2. Classification of left ventricular size: diameter or volume with contrast echocardiography?

    PubMed Central

    Gibson, Patrick H; Becher, Harald; Choy, Jonathan B

    2014-01-01

    Background Left ventricular (LV) size is an important clinical variable, commonly assessed at echocardiography by measurement of the internal diameter in diastole (IDD). However, this has recognised limitations and volumetric measurement from apical views is considered superior, particularly with the use of echocardiographic contrast. We sought to determine the agreement in classification of LV size by different measures in a large population of patients undergoing echocardiography. Methods and results Data were analysed retrospectively from consecutive patients (n=2008, 61% male, median 62?years) who received echocardiographic contrast for LV opacification over 3?years in a single institution. Repeat studies were not included. LVIDD was measured, and LV end-diastolic volume (LVEDV) calculated using Simpson's biplane method. Both measures were indexed (i) to body surface area and categorised according to the American Society of Echocardiography (ASE) guidelines as normal, mild, moderate or severely dilated. Of 320 patients with a severely dilated LVEDVi, only 95 (30%) were similarly classified by LVIDD, with 86 patients (27%) measuring in the normal range. LVIDDi agreement was poorer, with only 43 patients (13%) classified as being severely dilated, and 173 (54%) measuring in the normal range. Conclusions Currently recommended echocardiographic measures of LV size show limited agreement when classified according to currently recommended cut-offs. LV diameter should have a limited role in the assessment of LV size, particularly where a finding of LV dilation has important diagnostic or therapeutic implications. PMID:25525505

  3. Bacterial vaginosis and inflammatory response showed association with severity of cervical neoplasia in HPV-positive women.

    PubMed

    de Castro-Sobrinho, Juçara Maria; Rabelo-Santos, Silvia Helena; Fugueiredo-Alves, Rosane Ribeiro; Derchain, Sophie; Sarian, Luis Otávio Z; Pitta, Denise R; Campos, Elisabete A; Zeferino, Luiz Carlos

    2016-02-01

    Vaginal infections may affect susceptibility to and clearance of human papillomavirus (HPV) infection and chronic inflammation has been linked to carcinogenesis. This study aimed to evaluate the association between bacterial vaginosis (BV) and inflammatory response (IR) with the severity of cervical neoplasia in HPV-infected women. HPV DNA was amplified using PGMY09/11 primers and genotyping was performed using a reverse line blot hybridization assay in 211 cervical samples from women submitted to excision of the transformation zone. The bacterial flora was assessed in Papanicolaou stained smears, and positivity for BV was defined as ?20% of clue cells. Present inflammatory response was defined as ?30 neutrophils per field at 1000× magnification. Age higher than 29 years (OR:1.91 95% CI 1.06-3.45), infections by the types 16 and/or 18 (OR:1.92 95% CI 1.06-3.47), single or multiple infections associated with types 16 and/or 18 (OR: 1.92 CI 95% 1.06-3.47), BV (OR: 3.54 95% CI 1.62-7.73) and IR (OR: 6.33 95% CI 3.06-13.07) were associated with severity of cervical neoplasia (CIN 2 or worse diagnoses), while not smoking showed a protective effect (OR: 0.51 95% CI 0.26-0.98). After controlling for confounding factors, BV(OR: 3.90 95% CI 1.64-9.29) and IR (OR: 6.43 95% CI 2.92-14.15) maintained their association with the severity of cervical neoplasia. Bacterial vaginosis and inflammatory response were independently associated with severity of cervical neoplasia in HPV-positive women, which seems to suggest that the microenvironment would relate to the natural history of cervical neoplasia. Diagn. Cytopathol. 2016;44:80-86. © 2015 Wiley Periodicals, Inc. PMID:26644228

  4. [Intracoronary air embolism detected during intraoperative transesophageal echocardiography].

    PubMed

    Cabrera Schulmeyer, M C; Santelices Cuevas, E; Vega Sepúlveda, R; Allamand, F; De la Maza, J C

    2005-01-01

    A 39-year-old hypertensive man with severe aortic stenosis underwent aortic valve replacement monitored by intraoperative transesophageal echocardiography. Upon weaning the patient off extracorporeal circulation, hemodynamics became severely compromised, with hypotension, tachycardia, and elevated precordial electrocardiographic tracings. The echocardiographic images were instrumental during the episode to demonstrate that the anterior wall presented hypokinesis consistent with ischemia in the region but that there were also images of hyperrefringence highly suggestive of intracoronary air embolism. Intraoperative transesophageal echocardiography allowed us to diagnose the real cause of the ischemic event and rule out an atheromatous plaque as the source. Perfusion pressure was increased to treat the air embolism. The echocardiographic image demonstrated success, specifically restoration of left ventricular regional contractility. This experience revealed the usefulness of transesophageal echocardiography in intraoperative monitoring to diagnose ischemia, assess the cause, and guide treatment. PMID:16038178

  5. An autopsied case of corticobasal degeneration showing severe cerebral atrophy over a protracted disease course of 16 years.

    PubMed

    Kondo, Daizo; Hino, Hiroaki; Shibuya, Katsuhiko; Fujisawa, Koshiro; Kosaka, Kenji; Hirayasu, Yoshio; Yamamoto, Ryoko; Kasanuki, Koji; Minegishi, Michiko; Sato, Kiyoshi; Hosokawa, Masato; Arai, Tetsuaki; Arai, Heii; Iseki, Eizo

    2015-06-01

    The patient was a 72-year-old Japanese woman. At the age of 57, she started having difficulty performing daily work and developed agraphia. She also exhibited restlessness and loss of interest, and began to speak less. Thereafter, stereotypical behavior, gait disturbance and dysphagia were noted. CT scan demonstrated left-dominant frontal and temporal lobe atrophy. She died at the age of 72, about 16 years after the onset of symptoms. Neuropathologically, the brain weighed 867?g, and showed remarkable cerebral atrophy with degeneration of the white matter, predominantly in the left dorsal frontal lobe and anterior temporal lobe. Microscopically, severe neuronal loss and gliosis with rarefaction were found in the cerebral cortex, and severe destruction of myelin and axons was observed in the cerebral white matter. Moderate neuronal loss with gliosis was also found in the pallidum and substantia nigra. Gallyas-Braak staining and tau immunostaining revealed pretangle neurons, NFTs, ballooned neurons and astrocytic plaques in the cerebral cortex, subcortical nuclei and brainstem, and argyrophilic threads and coiled bodies in the subcortical white matter. Tau isoform-specific immunostaining revealed that most tau-immunoreactive structures were positive for 4-repeat (4R) tau, but some of the NFTs were positive for 3-repeat (3R) tau in the cerebral neocortex. Immunoblotting demonstrated an accumulation of 4R tau in the cerebral cortex and subcortical white matter. The patient was pathologically diagnosed as having corticobasal degeneration. Her long survival course likely accounts for the severe white matter degeneration and accumulation of 3R tau in NFTs. PMID:25516199

  6. The Blood Transcriptome of Experimental Melioidosis Reflects Disease Severity and Shows Considerable Similarity with the Human Disease.

    PubMed

    Conejero, Laura; Potempa, Krzysztof; Graham, Christine M; Spink, Natasha; Blankley, Simon; Salguero, Francisco J; Pankla-Sranujit, Rungnapa; Khaenam, Prasong; Banchereau, Jacques F; Pascual, Virginia; Chaussabel, Damien; Lertmemongkolchai, Ganjana; O'Garra, Anne; Bancroft, Gregory J

    2015-10-01

    Melioidosis, a severe human disease caused by the bacterium Burkholderia pseudomallei, has a wide spectrum of clinical manifestations ranging from acute septicemia to chronic localized illness or latent infection. Murine models have been widely used to study the pathogenesis of infection and to evaluate novel therapies or vaccines, but how faithfully they recapitulate the biology of human melioidosis at a molecular level is not known. In this study, mice were intranasally infected with either high or low doses of B. pseudomallei to generate either acute, chronic, or latent infection and host blood and tissue transcriptional profiles were generated. Acute infection was accompanied by a homogeneous signature associated with induction of multiple innate immune response pathways, such as IL-10, TREM1, and IFN signaling, largely found in both blood and tissue. The transcriptional profile in blood reflected the heterogeneity of chronic infection and quantitatively reflected the severity of disease. Genes associated with fibrosis and tissue remodeling, including matrix metalloproteases and collagen, were upregulated in chronically infected mice with severe disease. Transcriptional signatures of both acute and chronic melioidosis revealed upregulation of iNOS in tissue, consistent with the expression of IFN-γ, but also Arginase-1, a functional antagonist of the iNOS pathway, and was confirmed by immunohistochemistry. Comparison of these mouse blood datasets by pathway and modular analysis with the blood transcriptional signature of patients with melioidosis showed that many genes were similarly perturbed, including Arginase-1, IL-10, TREM1, and IFN signaling, revealing the common immune response occurring in both mice and humans. PMID:26311902

  7. Myotubes from Severely Obese Type 2 Diabetic Subjects Accumulate Less Lipids and Show Higher Lipolytic Rate than Myotubes from Severely Obese Non-Diabetic Subjects

    PubMed Central

    Bakke, Siril S.; Kase, Eili T.; Moro, Cedric; Stensrud, Camilla; Damlien, Lisbeth; Ludahl, Marianne O.; Sandbu, Rune; Solheim, Brita Marie; Rustan, Arild C.; Hjelmesæth, Jøran; Thoresen, G. Hege; Aas, Vigdis

    2015-01-01

    About 80% of patients with type 2 diabetes are classified as overweight. However, only about 1/3 of severely obese subjects have type 2 diabetes. This indicates that several severely obese individuals may possess certain characteristics that protect them against type 2 diabetes. We therefore hypothesized that this apparent paradox could be related to fundamental differences in skeletal muscle lipid handling. Energy metabolism and metabolic flexibility were examined in human myotubes derived from severely obese subjects without (BMI 44±7 kg/m2) and with type 2 diabetes (BMI 43±6 kg/m2). Lower insulin sensitivity was observed in myotubes from severely obese subjects with type 2 diabetes. Lipolysis rate was higher, and oleic acid accumulation, triacylglycerol content, and fatty acid adaptability were lower in myotubes from severely obese subjects with type 2 diabetes compared to severely obese non-diabetic subjects. There were no differences in lipid distribution and mRNA and protein expression of the lipases HSL and ATGL, the lipase cofactor CGI-58, or the lipid droplet proteins PLIN2 and PLIN3. Glucose and oleic acid oxidation were also similar in cells from the two groups. In conclusion, myotubes established from severely obese donors with established type 2 diabetes had lower ability for lipid accumulation and higher lipolysis rate than myotubes from severely obese donors without diabetes. This indicates that a difference in intramyocellular lipid turnover might be fundamental in evolving type 2 diabetes. PMID:25790476

  8. Do we need echocardiography before commencing thrombolytic therapy?

    PubMed

    Hasanin, Adel M; Kinsara, Abdulhalim J

    2011-02-01

    We report a case of a 41-year-old man who had fatal multiple cerebral and bilateral renal infarcts 1 hour after initiation of thrombolytic therapy for acute ST elevation myocardial infarction. Echocardiography study disclosed dilated left ventricle with severe global hypokinesia suggestive of preexisting cardiomyopathy and a disintegrated left ventricular apical thrombus pointing out to the source of the embolic complication. This raises the question whether echocardiography before initiating thrombolytic therapy would affect the decision of commencing thrombolytic therapy and help avoiding such lethal embolic complications. PMID:20825889

  9. Benzocaine Induced Methemoglobinemia: A Potentially Fatal Complication of Transesophageal Echocardiography

    PubMed Central

    Chander, Keshav; Lavie, Carl J.; Ventura, Hector O.; Milani, Richard V.

    2003-01-01

    Transesophageal echocardiography (TEE) is a relatively safe procedure with complications including bleeding, esophageal perforation, and respiratory failure being rare. One of our patients recently developed severe cyanosis despite pulse oximetry of 85% following TEE. This directs our attention to a rare, easily treatable, but potentially fatal complication of this procedure. PMID:22826681

  10. Echocardiography in the flight program

    NASA Technical Reports Server (NTRS)

    Charles, John B.; Bungo, Michael W.; Mulvagh, Sharon L.

    1991-01-01

    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.

  11. Sector-scanning echocardiography

    NASA Technical Reports Server (NTRS)

    Henry, W. L.; Griffith, J. M.

    1975-01-01

    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.

  12. Myocardial perfusion echocardiography and coronary microvascular dysfunction.

    PubMed

    Barletta, Giuseppe; Del Bene, Maria Riccarda

    2015-12-26

    Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation, but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography (MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction, respectively, and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall, MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice, but the approval of regulatory authorities is lacking. PMID:26730291

  13. Myocardial perfusion echocardiography and coronary microvascular dysfunction

    PubMed Central

    Barletta, Giuseppe; Del Bene, Maria Riccarda

    2015-01-01

    Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation, but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography (MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction, respectively, and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall, MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice, but the approval of regulatory authorities is lacking. PMID:26730291

  14. Maternal psychological impact of fetal echocardiography.

    PubMed

    Sklansky, Mark; Tang, Alvin; Levy, Denis; Grossfeld, Paul; Kashani, Iraj; Shaughnessy, Robin; Rothman, Abraham

    2002-02-01

    The maternal psychological impact of fetal echocardiography may be deleterious in the face of newly diagnosed congenital heart disease. This questionnaire-based study prospectively examined the psychological impact of both normal and abnormal fetal echocardiography. Normal fetal echocardiography decreased maternal anxiety, increased happiness, and increased the closeness women felt toward their unborn children. In contrast, when fetal echocardiography detected congenital heart disease, maternal anxiety typically increased, and mothers commonly felt less happy about being pregnant. However, among women who had recently delivered infants with congenital heart disease, those who had had fetal echocardiography during the pregnancy felt less responsible for their infants' defects and tended to have improved their relationships with the infants' fathers after the prenatal diagnosis of congenital heart disease. Further study of the psychological and medical impact of fetal echocardiography will be necessary to define and optimize the clinical value of this powerful diagnostic tool. PMID:11836491

  15. Physical Activity in the Life of a Woman with Severe Cerebral Palsy: Showing Competence and Being Socially Connected

    ERIC Educational Resources Information Center

    Gaskin, Cadeyrn J.; Andersen, Mark B.; Morris, Tony

    2009-01-01

    We used a life-history approach to investigate the meanings and experiences of physical activity in the life of a 25-year-old woman with severe cerebral palsy (Amy). Amy and her mother were interviewed about Amy's life and her involvement in physical activity. The conversation was audio-recorded and transcribed verbatim. We interpreted Amy's story…

  16. Exercise stress echocardiography in patients with valvular heart disease

    PubMed Central

    Newby, David E; Stewart, Ralph A H; Lee, Mildred; Gabriel, Ruvin; Van Pelt, Niels; Kerr, Andrew J

    2015-01-01

    Stress echocardiography is recommended for the assessment of asymptomatic patients with severe valvular heart disease (VHD) when there is discrepancy between symptoms and resting markers of severity. The aim of this study is to determine the prognostic value of exercise stress echocardiography in patients with common valve lesions. One hundred and fifteen patients with VHD (aortic stenosis (n=28); aortic regurgitation (n=35); mitral regurgitation, (n=26); mitral stenosis (n=26)), and age- and sex-matched controls (n=39) with normal ejection fraction underwent exercise stress echocardiography. The primary endpoint was a composite of death or hospitalization for heart failure. Asymptomatic VHD patients had lower exercise capacity than controls and 37% of patients achieved <85% of their predicted metabolic equivalents (METS). There were three deaths and four hospital admissions, and 24 patients underwent surgery during follow-up. An abnormal stress echocardiogram (METS <5, blood pressure rise <20 mmHg, or pulmonary artery pressure post exercise >60 mmHg) was associated with an increased risk of death or hospital admission (14% vs 1%, P<0.0001). The assessment of contractile reserve did not offer additional predictive value. In conclusion, an abnormal stress echocardiogram is associated with death and hospitalization with heart failure at 2 years. Stress echocardiography should be considered as part of the routine follow-up of all asymptomatic patients with VHD. PMID:26795878

  17. Exercise stress echocardiography in patients with valvular heart disease.

    PubMed

    Sharma, Vishal; Newby, David E; Stewart, Ralph A H; Lee, Mildred; Gabriel, Ruvin; Van Pelt, Niels; Kerr, Andrew J

    2015-09-01

    Stress echocardiography is recommended for the assessment of asymptomatic patients with severe valvular heart disease (VHD) when there is discrepancy between symptoms and resting markers of severity. The aim of this study is to determine the prognostic value of exercise stress echocardiography in patients with common valve lesions. One hundred and fifteen patients with VHD (aortic stenosis (n=28); aortic regurgitation (n=35); mitral regurgitation, (n=26); mitral stenosis (n=26)), and age- and sex-matched controls (n=39) with normal ejection fraction underwent exercise stress echocardiography. The primary endpoint was a composite of death or hospitalization for heart failure. Asymptomatic VHD patients had lower exercise capacity than controls and 37% of patients achieved <85% of their predicted metabolic equivalents (METS). There were three deaths and four hospital admissions, and 24 patients underwent surgery during follow-up. An abnormal stress echocardiogram (METS <5, blood pressure rise <20 mmHg, or pulmonary artery pressure post exercise >60 mmHg) was associated with an increased risk of death or hospital admission (14% vs 1%, P<0.0001). The assessment of contractile reserve did not offer additional predictive value. In conclusion, an abnormal stress echocardiogram is associated with death and hospitalization with heart failure at 2 years. Stress echocardiography should be considered as part of the routine follow-up of all asymptomatic patients with VHD. PMID:26795878

  18. Development of subaortic stenosis and regurgitation several years after successful operation on a common atrium.

    PubMed Central

    Misra, M; Thakur, R; Bhandari, K

    1987-01-01

    A patient who had had successful operation for a common atrium subsequently developed subaortic stenosis and regurgitation several years later. The diagnosis of subaortic lesion was confirmed by echocardiography. This case shows that the left ventricular outflow tract gradient should be measured before operation for common atrium and that after operation such cases should be examined by cross sectional echocardiography at follow up visits. Images Fig 1 Fig 2 PMID:3676044

  19. Emerging Concepts in Transesophageal Echocardiography

    PubMed Central

    Maxwell, Cory; Konoske, Ryan; Mark, Jonathan

    2016-01-01

    Introduced in 1977, transesophageal echocardiography (TEE) offered imaging through a new acoustic window sitting directly behind the heart, allowing improved evaluation of many cardiac conditions. Shortly thereafter, TEE was applied to the intraoperative environment, as investigators quickly recognized that continuous cardiac evaluation and monitoring during surgery, particularly cardiac operations, were now possible. Among the many applications for perioperative TEE, this review will focus on four recent advances: three-dimensional TEE imaging, continuous TEE monitoring in the intensive care unit, strain imaging, and assessment of diastolic ventricular function. PMID:26998250

  20. Screening for Staphylococcal Superantigen Genes Shows No Correlation with the Presence or the Severity of Chronic Rhinosinusitis and Nasal Polyposis

    PubMed Central

    Girard, Myriam; Vourexakis, Zacharias; Courtis, Antoine Des; Renzi, Gesuele; Huggler, Elzbieta; Vlaminck, Stefan; Bonfils, Pierre; Mladina, Ranko; Lund, Valerie; Schrenzel, Jacques; François, Patrice; Lacroix, Jean Silvain

    2010-01-01

    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. PMID:20221434

  1. Oesophageal perforation following perioperative transoesophageal echocardiography.

    PubMed

    Massey, S R; Pitsis, A; Mehta, D; Callaway, M

    2000-05-01

    Transoesophageal echocardiography (TOE) is being used more often by cardiothoracic anaesthetists for the perioperative management of cardiac problems. Reports of iatrogenic oesophageal perforation by instrumentation of the oesophagus are increasing. Although TOE is considered safe, it may be more risky during surgery, because the probe is passed and manipulated in an anaesthetized patient. It may be in place for several hours so the risk of mucosal pressure and thermal damage is increased. Patients on cardiopulmonary bypass are also fully anticoagulated. We describe a case of oesophageal perforation following insertion of the TOE probe in a patient with gross cardiomegaly. Oesophageal distortion by cardiac enlargement may increase the risk of oesophageal perforation. Difficulty in passage of the TOE probe should be regarded with suspicion and withdrawal should be contemplated because the symptoms of oesophageal perforation are often delayed and non-specific. Delay in investigation, diagnosis and treatment will increase morbidity and mortality. PMID:10844846

  2. The Safety of Contrast Echocardiography: Report of the Committee on Contrast Echocardiography for the American Society of Echocardiography

    NASA Technical Reports Server (NTRS)

    Bommer, W. J.; Shah, P. M.; Allen, H.; Meltzer, R.; Kisslo, J.

    1984-01-01

    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.

  3. Clinical Application of 3-Dimensional Echocardiography in the USA.

    PubMed

    Shiota, Takahiro

    2015-10-23

    Three-dimensional (3D) echocardiography is one of the most promising methods for the diagnosis of cardiac disease. Left and right ventricular size and function are currently evaluated with 2D echocardiography. However, for unpredictable asymmetry of the chamber geometry, conventional 2D echocardiography cannot be used to accurately determine absolute chamber volumes and ejection fraction. As for valvular heart diseases, the 3D echo approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the valves and their dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical procedures such as edge-to-edge mitral valve repair. Color Doppler 3D echo has also been valuable to identify the location of the regurgitant orifice, and the severity and character of the valvular regurgitation. In addition, 3D echo is invaluable in the diagnosis and management of congenital heart disease and in certain other situations, such as evaluation of the aortic annulus for transcatheter aortic valve implantation or replacement. It is now clear that 3D echocardiography, especially with the continued development of real-time 3D transesophageal echo technology, will enhance the diagnosis and management of patients with heart diseases. (Circ J 2015; 79: 2287-2298). PMID:26459394

  4. [Real time 3D echocardiography

    NASA Technical Reports Server (NTRS)

    Bauer, F.; Shiota, T.; Thomas, J. D.

    2001-01-01

    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.

  5. Transoesophageal echocardiography in the dog.

    PubMed

    Domenech, Oriol; Oliveira, Pedro

    2013-11-01

    Transoesophageal echocardiography (TEE) allows imaging of the heart through the oesophagus using a special transducer mounted on a modified endoscope. The proximity to the heart and minimal intervening structures enables the acquisition of high-resolution images that are consistently superior to routine transthoracic echocardiography and optimal imaging of the heart base anatomy and related structures. TEE provides high-quality real-time imaging free of ionizing radiation, making it an ideal instrument not only for diagnostic purposes, but also for monitoring surgical or minimally invasive cardiac procedures, non-cardiac procedures and critical cases in the intensive care unit. In human medicine, TEE is routinely used in these settings. In veterinary medicine, TEE is increasingly used in referral centres, especially for perioperative assessment and guidance of catheter-based cardiovascular procedures, such as patent ductus arteriosus, balloon valvuloplasty, and atrial and ventricular septal defect occlusion with vascular devices. TEE can also aid in heartworm retrieval procedures. The purpose of this paper is to review the current uses of TEE in veterinary medicine, focusing on technique, indications and complications. PMID:24183715

  6. Severe SMA mice show organ impairment that cannot be rescued by therapy with the HDACi JNJ-26481585.

    PubMed

    Schreml, Julia; Riessland, Markus; Paterno, Mario; Garbes, Lutz; Roßbach, Kristina; Ackermann, Bastian; Krämer, Jan; Somers, Eilidh; Parson, Simon H; Heller, Raoul; Berkessel, Albrecht; Sterner-Kock, Anja; Wirth, Brunhilde

    2013-06-01

    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?nM, 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. PMID:23073311

  7. Clinical value of exercise Doppler echocardiography in patients with cardiac-valvular disease.

    PubMed

    Maréchaux, Sylvestre; Bellouin, Annaïk; Polge, Anne Sophie; Richardson-Lobbedez, Marjorie; Lubret, Rémi; Asseman, Philippe; Berrebi, Alain; Chauvel, Christophe; Vanoverschelde, Jean Louis; Nevière, Rémi; Jude, Brigitte; Deklunder, Ghislaine; Le Jemtel, Thierry H; Ennezat, Pierre Vladimir

    2008-05-01

    Besides its usefulness for the detection of exercise-induced ischemia, conventional exercise testing may help to predict the onset of clinical events and the need for surgery in asymptomatic patients with cardiac-valvular disease. Doppler echocardiography examination during exercise recently emerged as a new stress testing modality that may add useful information regarding dynamism of LV function, valve disease severity and pulmonary circulation. Few studies have demonstrated a correlation between the results of exercise Doppler echocardiography and clinical outcome. Preliminary experience needs to be confirmed to warrant routine use of Doppler echocardiography examination during exercise in the evaluation of patients with cardiac-valve disease. PMID:18656094

  8. The role of speckle tracking echocardiography in assessment of lipopolysaccharide-induced myocardial dysfunction in mice

    PubMed Central

    Chu, Ming; Gao, Yao; Zhang, Yanjuan; Zhou, Bin; Wu, Bingruo

    2015-01-01

    Background Sepsis-induced myocardial dysfunction is a common and severe complication of septic shock. Conventional echocardiography often fails to reveal myocardial depression in severe sepsis due to hemodynamic changes; in contrast, decline of strain measurements by speckle tracking echocardiography (STE) may indicate impaired cardiac function. This study investigates the role of STE in detecting lipopolysaccharide (LPS)-induced cardiac dysfunction with mouse models. Methods We evaluated cardiac function in 20 mice at baseline, 6 h (n=10) and 20 h (n=10) after LPS injection to monitor the development of heart failure induced by severe sepsis using 2-D and M-mode echocardiography. Ejection fraction (EF) and fractional shortening (FS) were measured with standard M-mode tracings, whereas circumferential and radial strain was derived from STE. Serum biochemical and cardiac histopathological examinations were performed to determine sepsis-induced myocardial injury. Results Left ventricular (LV) myocardial function was significantly reduced at 6 h after LPS treatment assessed by circumferential strain (−14.65%±3.00% to −8.48%±1.72%, P=0.006), whereas there were no significant differences between 6 and 20 h group. Conversely, EF and FS were significantly increased at 20 h when comparing to 6 h (P<0.05) accompanied with marked decreases in EF and FS 6 h following LPS administration. Consistent with strain echocardiographic results, we showed that LPS injection leaded to elevated serum level of cardiac Troponin-T (cTnT), CK-MB and rising leucocytes infiltration into myocardium within 20 h. Conclusions Altogether, these results demonstrate that, circumferential strain by STE is a specific and reliable value for evaluating LPS-induced cardiac dysfunction in mice. PMID:26793347

  9. Transesophageal echocardiography and monitoring applications.

    PubMed

    Connor, B G

    1995-11-01

    Transesophageal echocardiography (TEE) is a widely used cardiac imaging technique that provides the clinician with a view of the heart as seen from the esophagus or stomach. Rapid advances in TEE transducer technology, coupled with the low-risk, semi-invasive nature of the procedure, have fueled its use for cardiac monitoring of surgical and critical care patients, in addition to diagnostic imaging. Many recent research studies have demonstrated the utility of TEE for direct, real-time evaluation of global and regional left ventricular function not achievable with current competing technologies at the bedside. As a result of these advantages, TEE has become an emerging tool in cardiac monitoring at many centers around the world. PMID:8576724

  10. A novel platform device for rodent echocardiography.

    PubMed

    Kutschka, Ingo; Sheikh, Ahmad Y; Sista, Ramachandra; Hendry, Stephen L; Chun, Hyung J; Hoyt, Grant; Kutschka, Werner; Pelletier, Marc P; Quertermous, Tom; Wu, Joseph C; Robbins, Robert C

    2008-01-01

    Acquisition of echocardiographic data from rodents is subject to wide variability due to variations in technique. We hypothesize that a dedicated imaging platform can aid in standardization of technique and improve the quality of images obtained. We constructed a device consisting of a boom-mounted steel platform frame (25 x 35 x 3 cm) on which a transparent polyethylene membrane is mounted. The animal is placed onto the membrane and receives continual inhaled anesthesia via an integrated port. The membrane allows for probe positioning from beneath the animal to obtain standard echo-views in left lateral decubitus or prone positions. The frame can be set at any desired angle ranging from 0 to 360 degrees along either the long or short axis. Adult male Sprague-Dawley rats (n = 5) underwent echocardiography (General Electric, Vivid 7, 14 MHz) using the platform. The device allowed for optimal positioning of animals for a variety of standard echocardiographic measurements. Evaluations among all animals showed minimal variability between two different operators and time points. We tested the feasibility of the device for supporting the assessment of cardiac function in a disease model by evaluating a separate cohort of adult male spontaneously hypertensive rats (n = 5) that underwent left anterior descending coronary artery ligation. Serial echocardiography demonstrated statistically significant decreases of fractional shortening and ejection fraction (p < 0.01) 240 days after surgery. Our novel imaging platform allowed for consistent collection of high-quality echocardiographic data from rats. Future studies will focus on improving this technology to allow for standardized high-throughput echocardiographic analysis in small animal models of disease. PMID:18506056

  11. Interventional Imaging: The Role Of Echocardiography

    PubMed Central

    Maragiannis, Dimitrios; Little, Stephen H.

    2014-01-01

    Interventional echocardiography is a rapidly evolving field requiring imaging expertise. An increasing number of structural heart interventions now require real-time imaging guidance for device placement and immediate functional evaluation. Continuous 2- and 3-dimensional transesophageal echocardiography are now required by many heart teams during complex structural interventions, including percutaneous closure of atrial septal defects, left atrial appendage occlusion, transcatheter aortic valve replacement (TAVR), transcatheter repair of paravalvular regurgitation, and percutaneous mitral valve repair. In this review, we describe the role of echocardiography during the initial structural evaluation, throughout the device placement procedure, and for the assessment of acute device function and complications. PMID:25574345

  12. An omnidirectional M-mode echocardiography system and its clinical application.

    PubMed

    Lin, Qiang; Wu, Wenji; Huang, Liqin; Lin, Yonghua

    2006-01-01

    This paper introduces the omnidirectional M-mode echocardiography (OME), which can detect dynamic information from sequential echocardiography images. The method for detecting dynamic information is based on the rebuilding of their "gray (position)-time" function [Qiang L, Wenjing J, Li Z. A method for detecting dynamic information of sequential images--omnidirectional gray-time waveform and its applications in echocardiography images. In: Proceedings of CISST' 2001. 2001. p. 760-3; Qiang L, Wenjing J, Xiuzhi Y. A method for mining data of sequetial images-rebuilding of gray (position)-time function on arbitrary direction lines. In: Proceeding of CISST' 2002, vol. 3-6. 2002; Qiang L, Li Z, Wenjing J. The realization of omnidirectional gray-time waveform system and its application on echocardiography. J Electron Meas Instrum, 2002;16(1):70-5] on direction lines. The system can obtain motion and inherent dynamic information of a certain part of the cardiac structure at a certain moment. The system also shows a group of omnidirectional M-mode echocardiography images with synchronous ECG, which is rebuilt from 2D echocardiography images. The ECG supplies a standard time for the omnidirectional M-mode echocardiography images. The system has been applied in clinical application for 3 years and the results are good. PMID:17092688

  13. Therapeutic implications of transesophageal echocardiography after transthoracic echocardiography on acute stroke patients

    PubMed Central

    de Abreu, Tiago Tribolet; Mateus, Sonia; Carreteiro, Cecilia; Correia, Jose

    2008-01-01

    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. PMID:18629351

  14. Evaluation of aortic valve disorders using stress echocardiography.

    PubMed

    Wu, Wen-Chih; Ireland, Linda A; Sadaniantz, Ara

    2004-07-01

    Stress echocardiography is a safe and valuable test to aid in the diagnosis and management of patients with aortic valve disorders. In patients with suspected severe aortic stenosis (AS) and low aortic gradients secondary to low cardiac output, dobutamine echocardiography distinguishes those patients with contractile reserve (CR) from those without it. By increasing the stroke volume in subjects with CR, true severe AS patients have an increase in transaortic gradients without a significant change in the valve area, whereas patients with pseudostenosis have an increase in the gradients with concomitant increase in the aortic valve area to >1 cm(2). Patients without CR are indeterminate in their AS status and have a poor prognosis. The presence of CR is also important in patients suffering from aortic insufficiency, as it may predict the development of symptoms, myocardial dysfunction, or death in the asymptomatic phase of the disease, and the potential for left ventricular functional recovery after valve replacement. Finally, both exercise and dobutamine echocardiography can help in the assessment of valve malfunction or mismatch in patients with aortic valve prostheses experiencing exercise intolerance by correlating the symptoms with the change in the aortic gradients induced during stress testing. PMID:15209730

  15. Fetal Echocardiography/Your Unborn Baby's Heart

    MedlinePLUS

    ... High Blood Pressure Tools & Resources Stroke More Fetal Echocardiography / Your Unborn Baby's Heart Updated:Oct 26,2015 ... fetal echocardiogram? A fetal echocardiogram is a detailed ultrasound performed of the baby's heart before the baby ...

  16. Intracardiac echocardiography for immediate detection of intracardiac thrombus formation.

    PubMed

    Baran, Jakub; Sikorska, Agnieszka; Piotrowski, Roman; Kry?ski, Tomasz

    2015-12-01

    An 85-year-old man with persistent atrial flutter (AFL) with slow ventricular rate of 44/min, causing fatigue and presyncope, was referred for urgent treatment. In spite of thromboembolic risk scale value 4, he had not been treated with anticoagulants because of high risk of bleeding. The decision was made to perform urgent catheter ablation to interrupt and cure AFL. Intracardiac echocardiography probe was placed in the pulmonary artery and visualized left atrial appendage free from thrombus with its proper function. Heparin was administered and AFL stopped during energy application. Intracardiac echocardiography showed immediate thrombus formation in left atrial appendage owing to complete atrial standstill and no retrograde conduction during hemodynamically effective escape nodal rhythm. This case report shows that in patients with sinus node disease effective ablation of AFL with escape rhythm without retrograde conduction to the atria may result in complete 'electrically induced' atrial standstill and immediate thrombus formation. PMID:26192113

  17. Management of asymptomatic intracardiac missiles using echocardiography.

    PubMed

    Robison, R J; Brown, J W; Caldwell, R; Stone, K S; King, H

    1988-09-01

    A child sustained a low-velocity airgun pellet injury to the left ventricle. No cardiovascular compromise was produced. The foreign body was localized by two-dimensional echocardiography to the left ventricular chamber near the mitral valve, and subsequently removed through a left atriotomy incision. In asymptomatic patients, missiles clearly embedded within a chamber wall may be observed; all others should be removed. Two-dimensional echocardiography is recommended for localization. PMID:3418770

  18. The potential role and limitations of echocardiography in acute respiratory distress syndrome.

    PubMed

    Lazzeri, Chiara; Cianchi, Giovanni; Bonizzoli, Manuela; Batacchi, Stefano; Peris, Adriano; Gensini, Gian Franco

    2016-04-01

    Bedside use of Doppler echocardiography is being featured as a promising, clinically useful tool in assessing the pulmonary circulation in patients with acute respiratory distress syndrome (ARDS). The present review is aimed at summarizing the available evidence obtained with echocardiography on right ventricle (RV) function and pulmonary circulation in ARDS and to highlight the potential of this technique in clinical practice (only articles in English language were considered). According to the available evidence on echocardiographic findings, the following conclusions can be drawn: (a) echocardiography (transthoracic and transesophageal) has a growing role in the management ARDS patients mainly because of the strict interactions between the lung (and ventilation) and the RV and pulmonary circulation; (b) there may be a continuum of alterations in RV size and function and pulmonary circulation which may end in the development of acute cor pulmonale, probably paralleling ARDS disease severity; and (c) the detection of acute cor pulmonale should prompt intensivists to tailor their ventilatory strategy to the individual patient depending on the echocardiography findings. Bearing in mind the clinical role and growing importance of echocardiography in ARDS and the available evidence on this topic, we present a flow chart including the parameters to be measured and the timing of echo exams in ARDS patients. Despite the important progress that echocardiography has gained in the evaluation of patients with ARDS, several open questions remain and echocardiography still appears to be underused in these patients. A more systematic use of echocardiography (mainly through shared protocols) in ARDS could help intensivists to tailor the optimal treatment in individual patients as well as highlighting the limits and potential of this methodology in patients with ALI. PMID:26660667

  19. Estimating pulmonary artery pressures by echocardiography in patients with emphysema.

    PubMed

    Fisher, M R; Criner, G J; Fishman, A P; Hassoun, P M; Minai, O A; Scharf, S M; Fessler, H E

    2007-11-01

    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

  20. Myocardial perfusion assessment with contrast echocardiography

    NASA Astrophysics Data System (ADS)

    Desco, Manuel; Ledesma-Carbayo, Maria J.; Santos, Andres; Garcia-Fernandez, Miguel A.; Marcos-Alberca, Pedro; Malpica, Norberto; Antoranz, Jose C.; Garcia-Barreno, Pedro

    2001-05-01

    Assessment of intramyocardial perfusion by contrast echocardiography is a promising new technique that allows to obtain quantitative parameters for the assessment of ischemic disease. In this work, a new methodology and a software prototype developed for this task are presented. It has been validated with Coherent Contrast Imaging (CCI) images acquired with an Acuson Sequoia scanner. Contrast (Optison microbubbles) is injected continuously during the scan. 150 images are acquired using low mechanical index U/S pulses. A burst of high mechanical index pulses is used to destroy bubbles, thus allowing to detect the contrast wash-in. The stud is performed in two conditions: rest and pharmacologically induced stress. The software developed allows to visualized the study (cine) and to select several ROIs within the heart wall. The position of these ROIs along the cardiac cycle is automatically corrected on the basis of the gradient field, and they can also be manually corrected in case the automatic procedure fails. Time curves are analyzed according to a parametric model that incorporates both contrast inflow rate and cyclic variations. Preliminary clinical results on 80 patients have allowed us to identify normal and pathological patterns and to establish the correlation of quantitative parameters with the real diagnosis.

  1. Transesophageal echocardiography during MitraClip® procedure.

    PubMed

    Guarracino, Fabio; Baldassarri, Rubia; Ferro, Baldassare; Giannini, Cristina; Bertini, Pietro; Petronio, Anna Sonia; Di Bello, Vitantonio; Landoni, Giovanni; Alfieri, Ottavio

    2014-06-01

    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

  2. Automated mutual exclusion rules discovery for structured observational codes in echocardiography reporting

    PubMed Central

    Forsberg, Thomas A.; Sevenster, Merlijn; Bieganski, Szymon; Bhagat, Puran; Kanasseril, Melvin; Jia, Yugang; Spencer, Kirk T.

    2015-01-01

    Structured reporting in medicine has been argued to support and enhance machine-assisted processing and communication of pertinent information. Retrospective studies showed that structured echocardiography reports, constructed through point-and-click selection of finding codes (FCs), contain pair-wise contradictory FCs (e.g., “No tricuspid regurgitation” and “Severe regurgitation”) downgrading report quality and reliability thereof. In a prospective study, contradictions were detected automatically using an extensive rule set that encodes mutual exclusion patterns between FCs. Rules creation is a labor and knowledge-intensive task that could benefit from automation. We propose a machine-learning approach to discover mutual exclusion rules in a corpus of 101,211 structured echocardiography reports through semantic and statistical analysis. Ground truth is derived from the extensive prospectively evaluated rule set. On the unseen test set, F-measure (0.439) and above-chance level AUC (0.885) show that our approach can potentially support the manual rules creation process. Our methods discovered previously unknown rules per expert review.

  3. Fast GPU based adaptive filtering of 4D echocardiography.

    PubMed

    Broxvall, Mathias; Emilsson, Kent; Thunberg, Per

    2012-06-01

    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

  4. Echocardiography in the evaluation of athletes

    PubMed Central

    Montserrat, Silvia; Vidal, Bàrbara; Sitges, Marta

    2015-01-01

    Echocardiography is currently a widely available imaging technique that can provide useful data in the field of sports cardiology particularly in two areas: pre-participation screening and analysis of the cardiac adaptation induced by exercise. The application of pre-participation screening and especially, the type and number of used diagnostic tests remains controversial. Echocardiography has shown though, higher sensitivity and specificity as compared to the ECG, following a protocol adapted to athletes focused on ruling out the causes of sudden death and the most common disorders in this population. It is still a subject of controversy the actual cost of adding it, but depending on the type of sport, echocardiography might be cost-effective if added in the first line of examination. Regarding the evaluation of cardiac adaptation to training in athletes,  echocardiography has proved to be useful in the differential diagnosis of diseases that can cause sudden death, analysing both the left ventricle (hypertrophy cardiomyopathy, dilated cardiomyopathy, left ventricle non compaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy). The aim of this paper is to review the current knowledge and the clinical practical implications of it on the field of echocardiography when applied in sport cardiology areas. PMID:26236468

  5. Echocardiography in the evaluation of athletes.

    PubMed

    Grazioli, Gonzalo; Sanz, Maria; Montserrat, Silvia; Vidal, Bàrbara; Sitges, Marta

    2015-01-01

    Echocardiography is currently a widely available imaging technique that can provide useful data in the field of sports cardiology particularly in two areas: pre-participation screening and analysis of the cardiac adaptation induced by exercise. The application of pre-participation screening and especially, the type and number of used diagnostic tests remains controversial. Echocardiography has shown though, higher sensitivity and specificity as compared to the ECG, following a protocol adapted to athletes focused on ruling out the causes of sudden death and the most common disorders in this population. It is still a subject of controversy the actual cost of adding it, but depending on the type of sport, echocardiography might be cost-effective if added in the first line of examination. Regarding the evaluation of cardiac adaptation to training in athletes,  echocardiography has proved to be useful in the differential diagnosis of diseases that can cause sudden death, analysing both the left ventricle (hypertrophy cardiomyopathy, dilated cardiomyopathy, left ventricle non compaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy). The aim of this paper is to review the current knowledge and the clinical practical implications of it on the field of echocardiography when applied in sport cardiology areas. PMID:26236468

  6. Evaluation of fetal echocardiography as a routine antenatal screening tool for detection of congenital heart disease

    PubMed Central

    Nayak, Krishnananda; Shetty, Ranjan; Narayan, Pratap Kumar

    2016-01-01

    Background Fetal echocardiography plays a pivotal role in identifying the congenital heart defects (CHDs) in utero. Though foetal echocardiography is mostly reserved for high risk pregnant women, its role as a routine prenatal screening tool still needs to be defined. Performing foetal echocardiography based on only these indications can lead to a significant numbers of CHD cases going undetected who will be deprived of further management leading to increased early neonatal mortalities. The aim of this study is to assess the incidence of CHDs by fetal echocardiography in an unselected population of pregnant women in comparison with pregnant women with conventional high risk factors for CHD. Methods This study enrolled consecutive pregnant women who attended antenatal clinic between 2008 and 2012 in a tertiary care hospital. These pregnant women were categorized into two groups: high risk group included pregnant women with traditional risk factors for CHD as laid down by Pediatric Council of the American Society of Echocardiography and low risk group. Detailed fetal 2 D echocardiography was done. Results A total of 1,280 pregnant women were included in study. The 118 women were categorized as the high risk group while remaining 1,162 were included in the low risk group. Twenty six cases of CHDs were detected based on abnormal foetal echocardiography (20.3 per 1,000). Two of the 26 cases of CHD occurred in high risk group whereas the remaining 24 occurred in low risk pregnancy. The difference in the incidence of CHDs between the two groups was not significant statistically (P=0.76). Conclusions Our study shows no difference in incidence of CHDs between pregnancies associated with high risk factors compared to low risk pregnancies. So we advocate foetal echocardiography should be included as a part of routine antenatal screening and all pregnant women irrespective of risk factors for CHDs. PMID:26885491

  7. Digital echocardiography 2002: now is the time

    NASA Technical Reports Server (NTRS)

    Thomas, James D.; Greenberg, Neil L.; Garcia, Mario J.

    2002-01-01

    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.

  8. Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC).

    PubMed

    Sicari, Rosa; Nihoyannopoulos, Petros; Evangelista, Arturo; Kasprzak, Jaroslav; Lancellotti, Patrizio; Poldermans, Don; Voigt, Jen-Uwe; Zamorano, Jose Luis

    2008-07-01

    Stress echocardiography is the combination of 2D echocardiography with a physical, pharmacological or electrical stress. The diagnostic end point for the detection of myocardial ischemia is the induction of a transient worsening in regional function during stress. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. Among different stresses of comparable diagnostic and prognostic accuracy, semisupine exercise is the most used, dobutamine the best test for viability, and dipyridamole the safest and simplest pharmacological stress and the most suitable for combined wall motion coronary flow reserve assessment. The additional clinical benefit of myocardial perfusion contrast echocardiography and myocardial velocity imaging has been inconsistent to date, whereas the potential of adding - coronary flow reserve evaluation of left anterior descending coronary artery by transthoracic Doppler echocardiography adds another potentially important dimension to stress echocardiography. New emerging fields of application taking advantage from the versatility of the technique are Doppler stress echo in valvular heart disease and in dilated cardiomyopathy. In spite of its dependence upon operator's training, stress echocardiography is today the best (most cost-effective and risk-effective) possible imaging choice to achieve the still elusive target of sustainable cardiac imaging in the field of noninvasive diagnosis of coronary artery disease. PMID:18579481

  9. Stress echocardiography in valvular heart disease.

    PubMed

    Decena, B F; Tischler, M D

    1999-08-01

    Stress echocardiography has been widely accepted as an important diagnostic and prognostic tool in the assessment of known or suspected coronary artery disease. Its use in valvular heart disease, to date, has been more limited, but is continuing to grow as the technology and the understanding of valvular disorders progress. In this article, we will review the current literature regarding the use of both exercise and pharmacological stress testing in conjunction with echocardiography in the settings of native and prosthetic mitral and aortic valve disease. We will also discuss the limitations of this modality and touch upon possible future areas of investigation. PMID:10453298

  10. Echocardiography for the Assessment of Congenital Heart Defects in Calves.

    PubMed

    Mitchell, Katharyn Jean; Schwarzwald, Colin Claudio

    2016-03-01

    Congenital heart disease should be considered when evaluating calves with chronic respiratory signs, failure to thrive, poor growth, or if a murmur is heard on physical examination. Echocardiography is currently the gold standard for diagnosing congenital heart defects. A wide variety of defects, either alone or in combination with a ventricular septal defect, are possible. A standardized approach using sequential segmental analysis is required to fully appreciate the nature and severity of more complex malformations. The prognosis for survival varies from guarded to poor and depends on the hemodynamic relevance of the defects and the degree of cardiac compensation. PMID:26922111

  11. Quadricuspid aortic valve by using intraoperative transesophageal echocardiography

    PubMed Central

    2010-01-01

    Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. Its diagnosis is often missed even with the use of transthoracic echocardiogram. Many of these patients progress to aortic incompetence later in life, hence requiring surgical intervention. In the case described in this report, a 61-year-old woman is presented with the features of congestive heart failure. The preoperative transthoracic echocardiogram disclosed a moderate to severe aortic valve insufficiency but failed to reveal the quadricuspid aortic value anomaly. This case underscores the important role of three-dimensional transesophageal echocardiography for the diagnosis of quadricuspid aortic valve. PMID:20813040

  12. Assessment of Myocardial Collateral Blood Flow with Contrast Echocardiography

    PubMed Central

    2015-01-01

    Humans have pre-formed collateral vessels that enlarge with ischemia. In addition, new vessels can be formed within ischemic zones from pre-formed endocardial arcades of vessels providing rich collateral flow. Collateral flow under resting conditions (if >25% of normal) is enough to maintain myocardial viability, but may be insufficient to prevent myocardial ischemia under stress. Coronary angiography is a poor tool for collateral flow assessment. Myocardial contrast echocardiography is arguably the gold standard for experimental and clinical measurement of collateral flow. This review describes several experimental and clinical studies that highlight the importance of the collateral circulation in coronary artery disease. PMID:26413100

  13. Recent advances in echocardiography for valvular heart disease

    PubMed Central

    Hahn, Rebecca

    2015-01-01

    Echocardiography is the imaging modality of choice for the assessment of patients with valvular heart disease. Echocardiographic advancements may have particular impact on the assessment and management of patients with valvular heart disease. This review will summarize the current literature on advancements, such as three-dimensional echocardiography, strain imaging, intracardiac echocardiography, and fusion imaging, in this patient population. PMID:26594349

  14. Strain Echocardiography in Acute Cardiovascular Diseases

    PubMed Central

    Favot, Mark; Courage, Cheryl; Ehrman, Robert; Khait, Lyudmila; Levy, Phillip

    2016-01-01

    Echocardiography has become a critical tool in the evaluation of patients presenting to the emergency department (ED) with acute cardiovascular diseases and undifferentiated cardiopulmonary symptoms. New technological advances allow clinicians to accurately measure left ventricular (LV) strain, a superior marker of LV systolic function compared to traditional measures such as ejection fraction, but most emergency physicians (EPs) are unfamiliar with this method of echocardiographic assessment. This article discusses the application of LV longitudinal strain in the ED and reviews how it has been used in various disease states including acute heart failure, acute coronary syndromes (ACS) and pulmonary embolism. It is important for EPs to understand the utility of technological and software advances in ultrasound and how new methods can build on traditional two-dimensional and Doppler techniques of standard echocardiography. The next step in competency development for EP-performed focused echocardiography is to adopt novel approaches such as strain using speckle-tracking software in the management of patients with acute cardiovascular disease. With the advent of speckle tracking, strain image acquisition and interpretation has become semi-automated making it something that could be routinely added to the sonographic evaluation of patients presenting to the ED with cardiovascular disease. Once strain imaging is adopted by skilled EPs, focused echocardiography can be expanded and more direct, phenotype-driven care may be achievable for ED patients with a variety of conditions including heart failure, ACS and shock. PMID:26823931

  15. Severe pulmonic valve regurgitation due to histoplasma endocarditis

    PubMed Central

    Bremer, Merri; Lin, Peter T; Pislaru, Sorin V

    2015-01-01

    Summary A 67-year-old man with myelodysplastic syndrome, disseminated histoplasmosis, and mitral valve replacement presented with dyspnea and peripheral edema. Transthoracic echocardiography demonstrated abnormal pulmonic valve with possible vegetation. Color flow imaging showed laminar flow from main pulmonary artery into right ventricular outflow tract (RVOT) in diastole. The continuous wave Doppler signal showed dense diastolic envelope with steep deceleration slope. These findings were consistent with severe pulmonic valve regurgitation, possibly due to endocarditis. Transesophageal echocardiography demonstrated an echodense mass attached to the pulmonic valve. The mitral valve bioprosthesis appeared intact. Bacterial and fungal blood cultures were negative; however, serum histoplasma antigen was positive. At surgery, the valve appeared destroyed by vegetations. Gomori methenamine silver-stains showed invasive fungal hyphae and yeast consistent with a dimorphic fungus. Valve cultures grew one colony of filamentous fungus. Itraconazole was continued based on expert infectious diseases diagnosis. After surgery, dyspnea and ankle edema resolved. To the best of our knowledge, histoplasma endocarditis of pulmonic valve has not been previously reported. Isolated pulmonic valve endocarditis is rare, accounting for about 2% of infectious endocarditis (IE) cases. Fungi account for about 3% of cases of native valve endocarditis. Characterization of pulmonary valve requires thorough interrogation with 2D and Doppler echocardiography techniques. Parasternal RVOT view allowed visualization of the pulmonary valve and assessment of regurgitation severity. As an anterior structure, it may be difficult to image with transesophageal echocardiography. Mid-esophageal right ventricular inflow–outflow view clearly showed the pulmonary valve and vegetation. Learning points Identification and characterization of pulmonary valve abnormalities require thorough interrogation with 2D and Doppler echocardiography techniques.Isolated pulmonary valve IE is rare and requires high index of suspicion. Histoplasma capsulatum IE is rare and requires high index of suspicion. PMID:26693325

  16. [A new approach to the tricuspid valve in Ebstein's anomaly by real time 3D echocardiography].

    PubMed

    Taktak, A; Acar, P; Dulac, Y; Abadir, S; Chilon, T; Roux, D; Glock, Y; Fournial, G

    2005-05-01

    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

  17. [Usefulness and limitations of dobutamine stress echocardiography for detection of coronary artery disease].

    PubMed

    Takagi, T; Yoshikawa, J; Yoshida, K; Akasaka, T; Honda, Y; Maenishi, A

    1994-01-01

    The value of dobutamine stress echocardiography for detecting coronary artery disease was evaluated in 67 patients with normal left ventricular wall motion at rest who also underwent quantitative angiography. The overall sensitivity and specificity of dobutamine stress echocardiography for detecting coronary artery disease were 83% and 70%, respectively. The sensitivities for detecting multivessel disease and single vessel disease were 92% and 76%, respectively. The sensitivity of dobutamine stress echocardiography was 91% in patients treated without beta-blocker, and 70% in patients treated with beta-blocker (p < 0.001). The relatively low peak heart rate during dobutamine infusion in patients treated with beta-blocker seems to affect the sensitivity of dobutamine stress echocardiography. There were no severe complications during dobutamine infusion. Dobutamine stress echocardiography is a safe and accurate method for detecting coronary artery disease. However, an additional technique to increase peak heart rate in patients treated with beta-blocker such as injection of atropin should be considered. PMID:7932068

  18. Registration of multi-view apical 3D echocardiography images

    NASA Astrophysics Data System (ADS)

    Mulder, H. W.; van Stralen, M.; van der Zwaan, H. B.; Leung, K. Y. E.; Bosch, J. G.; Pluim, J. P. W.

    2011-03-01

    Real-time three-dimensional echocardiography (RT3DE) is a non-invasive method to visualize the heart. Disadvantageously, it suffers from non-uniform image quality and a limited field of view. Image quality can be improved by fusion of multiple echocardiography images. Successful registration of the images is essential for prosperous fusion. Therefore, this study examines the performance of different methods for intrasubject registration of multi-view apical RT3DE images. A total of 14 data sets was annotated by two observers who indicated the position of the apex and four points on the mitral valve ring. These annotations were used to evaluate registration. Multi-view end-diastolic (ED) as well as end-systolic (ES) images were rigidly registered in a multi-resolution strategy. The performance of single-frame and multi-frame registration was examined. Multi-frame registration optimizes the metric for several time frames simultaneously. Furthermore, the suitability of mutual information (MI) as similarity measure was compared to normalized cross-correlation (NCC). For initialization of the registration, a transformation that describes the probe movement was obtained by manually registering five representative data sets. It was found that multi-frame registration can improve registration results with respect to single-frame registration. Additionally, NCC outperformed MI as similarity measure. If NCC was optimized in a multi-frame registration strategy including ED and ES time frames, the performance of the automatic method was comparable to that of manual registration. In conclusion, automatic registration of RT3DE images performs as good as manual registration. As registration precedes image fusion, this method can contribute to improved quality of echocardiography images.

  19. Utility of intracardiac echocardiography for atrial baffle leak closure in repaired transposition of the great arteries.

    PubMed

    Kuppahally, Suman S; Litwin, Sheldon E; Green, Larry S; Ishihara, Stephen M; Freedman, Roger A; Michaels, Andrew D

    2010-09-01

    A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair in childhood and dual-chamber pacemaker placement for sinus node dysfunction in adulthood. Transthoracic echocardiography showed a lead in the systemic (anatomic right) ventricle. Multidetector computed tomography showed the lead perforating the baffle in the region of the body of the systemic venous atrium into the systemic ventricle. The lead was extracted, and a new lead was placed in the pulmonary (anatomic left) ventricle. A bidirectional baffle shunt persisted. The iatrogenic baffle leak was percutaneously closed with an Amplatzer septal occluder device using both intracardiac echocardiography (ICE) and three-dimensional transesophageal echocardiography (3D-TEE). We report the first use of ICE for baffle leak closure, which provided a good definition of the complex anatomy and guided the procedure. PMID:20849476

  20. The role of three-dimensional echocardiography in interventricular mass evaluation.

    PubMed

    Miglioranza, Marcelo Haertel; Leiria, Tiago Luiz Luz; Haertel, José Carlos; Winkler, Maristela; Fernández-Golfin, Covadonga; Zamorano, José Luis

    2013-05-01

    A young patient underwent a screening electrocardiogram (EKG) that suggested apical hypertrophic cardiomyopathy. Serial investigation with echocardiography showed a well-defined hyperechogenic mass involving the interventricular septal. To better define the lesion extension three-dimensional (3D) echocardiography was done and it demonstrated a mass invading the septal myocardium, involving the major part of the muscular portion. The findings were highly suggestive of a cardiac fibroma. A cardiac magetic resonance image (MRI) was also compatible with this diagnosis. In our case, 3D echo showed a high accuracy, proving to be a useful tool to determine the anatomy of the lesion, complementary to MRI, guiding best management strategy. PMID:23489108

  1. Left atrial ball thrombus with acute mesenteric ischemia: anesthetic management and role of transesophageal echocardiography.

    PubMed

    Makhija, Neeti; Malankar, Dhananjay; Singh, Pooja; Goyal, Sameer; Patel, Kartik; Jagia, Priya

    2014-01-01

    A 62 year old female with severe mitral stenosis, large left atrial ball thrombus and acute mesenteric ischemia emergently underwent mitral valve replacement, left atrial clot removal and emergency laparotomy for mesenteric ischemia. Peri-operative management issues, particularly, the anesthetic challenges and the role of transesophageal echocardiography are discussed. PMID:24732618

  2. The accuracy of echocardiography versus surgical and pathological classification of patients with ruptured mitral chordae tendineae: a large study in a Chinese cardiovascular center

    PubMed Central

    2011-01-01

    Background The accuracy of echocardiography versus surgical and pathological classification of patients with ruptured mitral chordae tendineae (RMCT) has not yet been investigated with a large study. Methods Clinical, hemodynamic, surgical, and pathological findings were reviewed for 242 patients with a preoperative diagnosis of RMCT that required mitral valvular surgery. Subjects were consecutive in-patients at Fuwai Hospital in 2002-2008. Patients were evaluated by thoracic echocardiography (TTE) and transesophageal echocardiography (TEE). RMCT cases were classified by location as anterior or posterior, and classified by degree as partial or complete RMCT, according to surgical findings. RMCT cases were also classified by pathology into four groups: myxomatous degeneration, chronic rheumatic valvulitis (CRV), infective endocarditis and others. Results Echocardiography showed that most patients had a flail mitral valve, moderate to severe mitral regurgitation, a dilated heart chamber, mild to moderate pulmonary artery hypertension and good heart function. The diagnostic accuracy for RMCT was 96.7% for TTE and 100% for TEE compared with surgical findings. Preliminary experiments demonstrated that the sensitivity and specificity of diagnosing anterior, posterior and partial RMCT were high, but the sensitivity of diagnosing complete RMCT was low. Surgical procedures for RMCT depended on the location of ruptured chordae tendineae, with no relationship between surgical procedure and complete or partial RMCT. The echocardiographic characteristics of RMCT included valvular thickening, extended subvalvular chordae, echo enhancement, abnormal echo or vegetation, combined with aortic valve damage in the four groups classified by pathology. The incidence of extended subvalvular chordae in the myxomatous group was higher than that in the other groups, and valve thickening in combination with AV damage in the CRV group was higher than that in the other groups. Infective endocarditis patients were younger than those in the other groups. Furthermore, compared other groups, the CRV group had a larger left atrium, higher aortic velocity, and a higher pulmonary arterial systolic pressure. Conclusions Echocardiography is a reliable method for diagnosing RMCT and is useful for classification. Echocardiography can be used to guide surgical procedures and for preliminary determination of RMCT pathological types. PMID:21801375

  3. Exercise echocardiography for structural heart disease.

    PubMed

    Izumo, Masaki; Akashi, Yoshihiro J

    2016-03-01

    Since the introduction of transcatheter structural heart intervention, the term "structural heart disease" has been widely used in the field of cardiology. Structural heart disease refers to congenital heart disease, valvular heart disease, and cardiomyopathy. In structural heart disease, valvular heart disease is frequently identified in the elderly. Of note, the number of patients who suffer from aortic stenosis (AS) and mitral regurgitation (MR) is increasing in developed countries because of the aging of the populations. Transcatheter aortic valve replacement and percutaneous mitral valve repair has been widely used for AS and MR, individually. Echocardiography is the gold standard modality for initial diagnosis and subsequent evaluation of AS and MR, although the difficulties in assessing patients with these diseases still remain. Here, we review the clinical usefulness and prognostic impact of exercise echocardiography on structural heart disease, particularly on AS and MR. PMID:26758899

  4. Diagnostic value of echocardiography in cardiac tamponade.

    PubMed

    Tsang, T S; Oh, J K; Seward, J B; Tajik, A J

    2000-12-01

    Cardiac tamponade is a life-threatening condition. Accurate diagnosis and prompt intervention are necessary to prevent adverse outcomes. Clinical features of tamponade such as pulsus paradoxus, tachycardia, elevated jugular venous pressure, and hypotension are important clues to the diagnosis, but are non-specific. Echocardiography allows rapid confirmation of the presence or absence of an effusion, and enables assessment of its hemodynamic impact. Decisions regarding treatment must take into account the clinical presentation and echocardiographic findings. Echocardiographically-guided pericardiocentesis with catheter drainage is the primary treatment strategy of choice for most large or hemodynamically significant effusions. In contemporary clinical practice, echocardiography is the gold standard for diagnosis of tamponade and is essential for directing treatment. PMID:11200121

  5. Quantification of systemic right ventricle by echocardiography.

    PubMed

    Iriart, Xavier; Roubertie, François; Jalal, Zakaria; Thambo, Jean-Benoit

    2016-02-01

    Improvements in cardiac imaging have recently focused a great interest on the right ventricle (RV). In patients with congenital heart disease, the right ventricle (RV) may support the systemic circulation (systemic RV). There are 2 different anatomic conditions providing such physiology: the congenitally corrected transposition of the great arteries (ccTGA) and the TGA surgically corrected by atrial switch. During the last decades, evidence is accumulating that progressive systemic RV failure develops leading to considerable morbidity and mortality. Various imaging modalities have been used to evaluate the systemic RV, but echocardiography is still predominantly used in clinical practice, allowing an anatomic and functional approach of the systemic RV function and the potential associated anomalies. The goal of this review is to offer a clinical perspective of the non-invasive evaluation of the systemic RV by echocardiography. PMID:26850171

  6. Echocardiography: profiling of the athlete's heart.

    PubMed

    Paterick, Timothy E; Gordon, Tia; Spiegel, Denise

    2014-09-01

    Cardiovascular physiologic remodeling associated with athleticism may mimic many of the features of genetic and acquired heart disease. The most pervasive dilemma is distinguishing between normal and abnormal physiologic remodeling in an athlete's heart. Imaging examinations, such as magnetic resonance imaging and computed tomography, which focus predominantly on anatomy, and electrocardiography, which monitors electrical components, do not simultaneously evaluate cardiac anatomy and physiology. Despite nonlinear anatomic and electrical remodeling, the athlete's heart retains normal or supernormal myocyte function, whereas a diseased heart has various degrees of pathophysiology. Echocardiography is the only cost-effective, validated imaging modality that is widely available and capable of simultaneously quantifying variable anatomic and physiologic features. Doppler echocardiography substantially redefines the understanding of normal remodeling from preemergent and overt disease. PMID:25042411

  7. [Infective Endocarditis--Blood Culture and Echocardiography].

    PubMed

    Nagano, Yasuko; Nakagawa, Mikiko; Teshima, Yasushi; Takahashi, Naohiko

    2015-08-01

    Infective endocarditis (IE) is a systemic septic disease that is a microbial infection of the endothelial surface of the heart. Despite advances in medical, surgical, and critical care interventions, IE remains a life-threatening illness. Therefore, it is important to promptly diagnose it using the modified Duke criteria. These criteria integrate factors predisposing patients to the development of IE, the blood-culture isolates and persistence of bacteremia, and echocardiographic findings, along with other clinical and laboratory information. Positive blood culture and a positive echocardiogram are the cornerstones of IE diagnosis. Identification of the infecting organisms is of primary importance because this knowledge guides antibiotic therapy. For the detection of vegetation, transesophageal echocardiography has a sensitivity of 76-100%, whereas that of transthoracic echocardiography ranges from 50 to 60%. Transesophageal echocardiography is particularly useful in patients with prosthetic valves and sparse vegetation. Recent studies reported that causative microorganisms of IE are changing. Staphylococcus aureus is now the most common cause of IE in Western countries. This shift is due in part to a higher rate of Staphylococcus aureus infection in patients with cardiac devices (for example, prosthetic valve, pacemaker, and implantable cardioverter defibrillator [ICD]). PMID:26638432

  8. Role of modern 3D echocardiography in valvular heart disease

    PubMed Central

    2014-01-01

    Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases. PMID:25378966

  9. Diagnostic Yield of Echocardiography in Syncope Patients with Normal ECG

    PubMed Central

    Chang, Nai-Lun; Shah, Priyank; Bajaj, Sharad; Virk, Hartaj; Bikkina, Mahesh; Shamoon, Fayez

    2016-01-01

    Aim. This study aimed to assess the role of echocardiography as a diagnostic tool in evaluating syncope patients with normal versus abnormal electrocardiogram. Methods. We conducted a retrospective study of 468 patients who were admitted with syncope in 2011 at St. Joseph's Regional Medical Center, Paterson, NJ. Hospital records and patient charts, including initial emergency room history and physical, were carefully reviewed. Patients were separated into normal versus abnormal electrocardiogram groups and then further divided as normal versus abnormal echocardiogram groups. Causes of syncope were extrapolated after reviewing all test results and records of consultations. Results. Three hundred twelve of the total patients (68.6%) had normal ECG. Two-thirds of those patients had echocardiograms; 11 patients (5.7%) had abnormal echo results. Of the aforementioned patients, three patients had previous documented history of severe aortic stenosis on prior echocardiograms. The remaining eight had abnormal but nondiagnostic echocardiographic findings. Echocardiography was done in 93 of 147 patients with abnormal ECG (63.2%). Echo was abnormal in 27 patients (29%), and the findings were diagnostic in 6.5% patients. Conclusions. This study demonstrates that echocardiogram was not helpful in establishing a diagnosis of syncope in patients with normal ECG and normal physical examination. PMID:26881172

  10. Congenital mitral stenosis. Anatomical and functional assessment by echocardiography.

    PubMed Central

    Smallhorn, J; Tommasini, G; Deanfield, J; Douglas, J; Gibson, D; Macartney, F

    1981-01-01

    Digitised left ventricular echocardiograms were studied in nine children with congenital mitral stenosis to assess the severity of inflow obstruction. In six children the two prime indices of mitral stenosis were abnormal, with a prolonged time from minimum dimension to 20 per cent dimension change and a reduced peak dimension change during diastole. In three, however, these values did not suggest inflow obstruction, depsite significant gradients at cardiac catheterisation. Two-dimensional echocardiography was performed in 10 children with congenital mitral stenosis to determine the mitral annular size and the morphology of the valve and subvalvular apparatus. The annular size and number of papillary muscles could be assessed along with the detection of combined mitral abnormalities. Two-dimensional studies can reliably delineate the type of mitral abnormality, and should be performed in all cases with congenital heart disease having a high incidence of associated left ventricular inflow obstruction. Digitised M-mode left ventricular echocardiography is in general unreliable in assessing congenital obstruction, though it may be of some value in individual cases. Images PMID:7236458

  11. Role of modern 3D echocardiography in valvular heart disease.

    PubMed

    Shiota, Takahiro

    2014-11-01

    Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases. PMID:25378966

  12. Open access echocardiography: a prospective audit of referral patterns from primary care.

    PubMed

    Williams, S G; Currie, P; Silas, J H

    2003-03-01

    Following recently published recommendations and guidelines, a prospective audit of 222 consecutive patients referred for open access echocardiography was conducted over a period of three months in a large district general hospital in the UK. Our study demonstrated the waiting time for an open access echocardiogram to be shorter than the waiting time for the outpatient clinic, which allowed identification of clinically significant cardiac disease sooner, leading to early advice on patient management. Specialist referral was avoided by the inclusion of management comments by a cardiologist in the technical echocardiogram report. We showed that open access echocardiography for detection of left ventricular systolic function, should be performed only if the ECG is abnormal, confirming previous reports. ECG interpretation in primary care is unreliable. In view of limited resources, hospitals should vigorously screen referrals for open access echocardiography. PMID:12661798

  13. Three glycosylated polypeptides secreted by several embryogenic cell cultures of pine show highly specific serological affinity to antibodies directed against the wheat germin apoprotein monomer.

    PubMed Central

    Domon, J M; Dumas, B; Lainé, E; Meyer, Y; David, A; David, H

    1995-01-01

    Embryogenic tissues of Pinus caribaea Morelet var hondurensis produce extracellular proteins; among them germins have been identified. Two-dimensional electrophoresis followed by electroblotting onto a polyvinylidene difluoride membrane allowed isolation and N-terminal amino acid sequencing of extracellular GP111, which is present within the five embryogenic cell lines studied. The amino acid sequence showed strong homologies with the sequences of germins deduced from cDNA sequencing, starting at the same amino acid position but one, compared with other sequences of mature germins deduced from protein sequencing. Immunoblots of embryogenic and nonembryogenic extracellular proteins indicated that the polypeptide GP111 plus two others with similar relative molecular mass values are present in embryogenic cell lines but not in nonembryogenic ones. They were recognized by an antiserum raised against the nonglycosylated monomer of wheat germin. The cross-reaction between pine and wheat apoproteins was highly specific. An antiserum against the glycosylated pentameric germin-like protein (an oxalate oxidase) of barley cross-reacted with all three, as well as with several other glycosylated polypeptides. PMID:7784502

  14. Leaf-specific pathogenesis-related 10 homolog, PgPR-10.3, shows in silico binding affinity with several biologically important molecules

    PubMed Central

    Han, Jin Haeng; Lee, Jin Hee; Lee, Ok Ran

    2015-01-01

    Background Pathogenesis-related 10 (PR-10) proteins are small, cytosolic proteins with a similar three-dimensional structure. Crystal structures for several PR-10 homologs have similar overall folding patterns, with an unusually large internal cavity that is a binding site for biologically important molecules. Although structural information on PR-10 proteins is substantial, understanding of their biological function remains limited. Here, we showed that one of the PgPR-10 homologs, PgPR-10.3, shares binding properties with flavonoids, kinetin, emodin, deoxycholic acid, and ginsenoside Re (1 of the steroid glycosides). Methods Gene expression patterns of PgPR-10.3 were analyzed by quantitative real-time PCR. The three-dimensional structure of PgPR-10 proteins was visualized by homology modeling, and docking to retrieve biologically active molecules was performed using AutoDock4 program. Results Transcript levels of PgPR-10.3 expressed in leaves, stems, and roots of 3-wk-old ginseng plantlets were on average 86-fold lower than those of PgPR-10.2. In mature 2-yr-old ginseng plants, the mRNA of PgPR-10.3 is restricted to leaves. Ginsenoside Re production is especially prominent in leaves of Panax ginseng Meyer, and the binding property of PgPR-10.3 with ginsenoside Re suggests that this protein has an important role in the control of secondary metabolism. Conclusion Although ginseng PR-10.3 gene is expressed in all organs of 3-wk-old plantlets, its expression is restricted to leaves in mature 2-yr-old ginseng plants. The putative binding property of PgPR-10.3 with Re is intriguing. Further verification of binding affinity with other biologically important molecules in the large hydrophobic cavity of PgPR-10.3 may provide an insight into the biological features of PR-10 proteins. PMID:26869835

  15. Utility of transesophageal echocardiography in infective endocarditis. A review.

    PubMed Central

    Jessurun, C; Mesa, A; Wilansky, S

    1996-01-01

    Despite recent diagnostic and therapeutic advances, infective endocarditis continues to be a very serious illness, with high patient morbidity and mortality rates. The diagnosis of infective endocarditis has been based primarily on clinical signs and positive blood cultures. Echocardiography is currently recognized as the technique of choice for the detection of valvular vegetations, which are the hallmark of endocarditis. We briefly review the use of echocardiography in the diagnosis of suspected infective endocarditis, with emphasis on transesophageal echocardiography. High-resolution imaging of the cardiac valves with transesophageal echocardiography has proved to be invaluable in the management of infective endocarditis. Images PMID:8792540

  16. Is cardiac magnetic resonance imaging as accurate as echocardiography in the assessment of aortic valve stenosis?

    PubMed

    Wong, Sophia; Spina, Roberto; Toemoe, Sianne; Dhital, Kumud

    2016-04-01

    A best evidence topic was written according to a structured protocol. The question addressed was: is cardiac magnetic resonance (CMR) imaging as accurate as echocardiography in the assessment of aortic valve stenosis? Altogether 239 papers were found using the reported search. Only 12 demonstrated the best evidence to answer the clinical question. Nine of these 12 papers found CMR to correlate well with transthoracic echocardiography (TTE) or transoesophageal echocardiography (TOE) in the evaluation of aortic valve stenosis. When aortic valve areas were measured with cardiac tomography (CT) or cardiac catheterization (CC), four papers found CMR to be more accurate than TTE. Eight of 12 papers found CMR to have excellent reliability and reproducibility, as demonstrated by the low inter- and intraobserver variability. Four papers did not estimate intra- or interobserver variability. One paper noted a sensitivity and specificity of 96 and 100%, respectively, when using CMR to detect severe aortic stenosis (AS) that had been diagnosed during CC. A second paper noted a lower sensitivity and specificity of 78 and 89%, respectively, but this was still better than the sensitivities and specificities found when using TOE or TTE to detect severe AS, as noted on CC. We conclude that current evidence finds echocardiography and CMR to be equally reliable in assessing aortic stenosis. CMR has better inter- and intraobserver reliability and demonstrates an advantage over echocardiography in the detection of severe AS with greater specificity and sensitivity. The final choice, however, is as likely to be influenced by the availability of magnetic resonance imaging and expertise in interpreting the results as by accuracy and reliability. PMID:26718319

  17. Measurement of Thrombus Flux Using Transesophageal Echocardiography

    NASA Astrophysics Data System (ADS)

    Yamaguchi, Tadashi; Hirai, Kazuki; Aoki, Masami; Miyagi, Jin; Suzuki, Masahiko; Moriya, Hideshige; Hachiya, Hiroyuki

    2006-05-01

    Deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) are serious problem of total knee replacement (TKR). These diseases may be caused by a thrombus formed during the TKR operation. Therefore, understanding the flow volume of thrombus is important for curing and preventing PTE. In this paper, we tried to understanding the situation of the flow of thrombus by using transesophageal echocardiography movies. We applied the signal processing technique the FSET to extract the anomalous information from ultrasonic echo image. As a result of processing, the time change of the flow volume of thrombus was confirmed.

  18. The Role of Echocardiography in the Management of Atrial Fibrillation.

    PubMed

    Cohen, Ira S.

    1998-10-01

    From the time of its introduction as a clinical tool in the early 1970s, efforts have been made to use echocardiography to characterize the atrium and its function as these relate to attempted cardioversion and embolic risk. M-mode and 2-D echo studies suggest left atrial size is not a definitive determinant of the potential for successful cardioversion. Doppler studies show that atrial function can take weeks to recover postcardioversion, accounting in part for the delayed embolic risk. TEE is particularly effective at detecting atrial thrombi and shows that slow velocities in the atrium and appendage are an important risk factor for embolism and clot. All are associated with the finding of spontaneous echo contrast and atrial stunning postcardioversion. The ultimate role of TEE in management is not yet fully defined. The insights these and other studies provide to our understanding of atrial physiology and the appropriate management of atrial fibrillation are reviewed. PMID:11416471

  19. The emerging role of exercise testing and stress echocardiography in valvular heart disease.

    PubMed

    Picano, Eugenio; Pibarot, Philippe; Lancellotti, Patrizio; Monin, Jean Luc; Bonow, Robert O

    2009-12-01

    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

  20. Real-time scan assistant for echocardiography.

    PubMed

    Snare, Sten Roar; Torp, Hans; Orderud, Fredrik; Haugen, Bjørn Olav

    2012-03-01

    A real-time scan assistant (SA) for use with echocardiography is presented. The motivation is to aid nonexpert users in capturing apical 4-chamber views (A4CH) during echocardiography. The algorithm is based on a parametric multi-chamber model of the A4CH view, updated in an extended Kalman filter framework. The regional model goodness-of-fit is used to calculate a score, which is provided to the user during acquisition, together with an icon (emoticon) indicating whether the current view is acceptable or not. The SA was implemented on a commercially available scanner. A feasibility test was performed using two healthy volunteers as models and 10 medical students acting as nonexpert users. The students examined the models on two occasions, separated more than four days in time. Half of the students used the SA during the first exam and no SA at the second exam. The other half used the opposite order. The recordings were later rated by a cardiologist. A Wilcoxon signed pair rank test revealed a statistically significant improvement when using SA. Nine cases were rated as poor without using the SA. In eight (89%) of these cases, view quality improved to acceptable when the SA was used. PMID:22481796

  1. Early Fetal Echocardiography: Ready for Prime Time?

    PubMed Central

    Mirza, Fadi G.; Bauer, Samuel T.; Williams, Ismee A.; Simpson, Lynn L.

    2013-01-01

    The objective of this study was to examine the performance of early fetal echocardiography as a screening tool for major cardiac defects in a high-risk population. Fetal echocardiograms performed at 12 to 16 weeks were reviewed. Cases that did not undergo a follow-up echocardiogram at 18 to 22 weeks were excluded. Results of the early and follow-up echocardiograms were compared. Over a 4-year period, 119 early fetal echocardiograms were recorded. Of those, 81 (68%) had follow-up fetal echocardiograms. Results of the early echocardiogram were normal in 77 of 81 (95.1%) cases. Of these, the follow-up was normal in 75 of these 77 cases; in the remaining 2, the follow-up raised suspicion for a ventricular septal defect (VSD) in one and persistent left superior vena cava in the other. On the other hand, the early echocardiogram was abnormal in 4 (4.9%) cases: (1) atrioventricular canal defect, with the follow-up demonstrating a VSD; (2) hypoplastic right ventricle and transposition of the great arteries, confirmed on follow-up; (3) VSD and coarctation of the aorta, confirmed on follow-up. In the fourth case, the early echocardiogram suspected a VSD and right-left disproportion, yet the follow-up was normal. In conclusion, early fetal echocardiography appears to be a reasonable screening tool for major cardiac defects. PMID:22143968

  2. WHO cares? Safety checklists in echocardiography

    PubMed Central

    Quarterman, Clare; Fletcher, Nick

    2015-01-01

    The number of potentially preventable medical errors that occur has been steadily increasing. These are a significant cause of patient morbidity, can lead to life-threatening complications and may result in a significant financial burden on health care. Effective communication and team working reduce errors and serious incidents. In particular the implementation of the World Health Organisation (WHO) Safe Surgery Checklist has been shown to reduce in-hospital mortality, postoperative complications and the incidence of surgical site infection. However an increasing number of complex medical procedures and interventions are being performed outside of the theatre environment. The lessons learnt from the surgical setting are relevant to other procedures performed in other areas. For the echocardiographer, transoesophageal echocardiography (TOE) is one such procedure in which there is the potential for medical errors that may result in patient harm. This risk is increased if patient sedation is being administered. The British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists have developed a procedure specific checklist to facilitate the use of checklists into routine practice. In this article we discuss the evolution of the WHO safety checklist and explore its relevance to TOE.

  3. Gated cardiac NMR imaging and 2D echocardiography in the detection of intracardial neoplasm

    SciTech Connect

    Go, R.T.; O'Donnell, J.K.; Salcedo, E.E.; Feiglin, D.H.; Underwood, D.A.; MacIntyre, W.J.; Meaney, T.F.

    1985-05-01

    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.

  4. Exercise testing and exercise stress echocardiography in asymptomatic aortic valve stenosis.

    PubMed

    Ennezat, P V; Maréchaux, S; Iung, B; Chauvel, C; LeJemtel, T H; Pibarot, P

    2009-06-01

    Management of asymptomatic patients with severe aortic valve stenosis (AVS) remains a source of debate. Exercise testing is no longer contraindicated and needs now to be considered when evaluating asymptomatic patients with AVS. Several studies have clearly demonstrated that exercise-elicited symptoms during conventional upright exercise portends clinical events. Semi-supine exercise with continuous Doppler echocardiography monitoring elicits cardiovascular abnormalities that are not detected at rest. Abnormal left ventricular response to exercise and/or major increase in mean transvalvular gradient add to the prognostic value of elicited symptoms in asymptomatic patients with severe AVS. However, preliminary experience needs to be confirmed to warrant routine use of exercise Doppler echocardiography in the evaluation of patients with asymptomatic AVS. PMID:18812409

  5. Dobutamine echocardiography and myocardial contrast echocardiography. Two new techniques for the assessment of myocardial viability.

    PubMed Central

    Cheirif, J; Meza, M; Murgo, J P

    1995-01-01

    As investigators have discovered that cardiac regions displaying resting wall motion abnormalities are not the necessary equivalent of myocardial scar (and therefore of irreversible injury) but are potentially viable regions rendered dysfunctional by stunning or hibernation, a new field of medicine has developed to identify viable myocardium that can improve in function after revascularization. Moreover, improvements in myocardial preservation and perfusion during coronary artery bypass grafting and percutaneous transluminal coronary angioplasty have enabled patients with poor resting ejection fractions to undergo safer revascularization. In this review, we describe briefly the diagnostic techniques most commonly used in identifying dysfunctional but viable myocardium. We give specific attention to the assets and limitations of these techniques and special emphasis to 2 promising new techniques: dobutamine echocardiography and myocardial contrast echocardiography. PMID:7787468

  6. [How to do a stress echocardiography?].

    PubMed

    von Roeder, Maximilian; Breithardt, Ole-Alexander

    2015-06-01

    Stress echocardiography (SE) is a powerful functional imaging technique to assess cardiac performance under work conditions. The main indication is the detection of myocardial ischemia due to coronary artery disease (CAD), however it can also be used in patients with structural heart disease (e.?g. valvular disease, hypertrophic obstructive cardiomyopathy). Dynamic or pharmacological (dobutamine?/?adenosine) modalities are available to induce cardiac stress, basically depending on the clinical problem and the patient's ability to exercise. Exercise on a treadmill or a semi-supine bicycle is the most physiological way to induce stress. Dobutamine stimulation is useful in patients who are unable to exercise and for detection of viable myocardium in hypo- or akinetic segments. Adenosin-induced hyperaemia causes steal effects in myocardial segments with significant CAD. Main limitations of SE are the need for an appropriate acoustic window and the user-dependent variability with regard to the interpretation of the results. PMID:26115134

  7. Intracardiac echocardiography in congenital heart disease.

    PubMed

    Barker, Piers C A

    2009-03-01

    The use of intracardiac echocardiography (ICE) in congenital heart disease has become well established over the past 7 years since its introduction into clinical imaging. The greatest experience has been to guide percutaneous device closures of secundum atrial septal defects and patent foramen ovale, with excellent safety and clinical results. However, ICE has also been used for the evaluation and management of many other congenital heart defects given its unique blood/transducer interface and close proximity to relevant cardiac anatomy. Clinical application of ICE is expanding, with the current ICE catheters being used as micro-transesophageal echo probes, and three-dimensional prototypes already developed and tested in animal models. It is expected that ICE will further increase in use with refinements in technology and greater operator experience, aiding the management of complex congenital heart disease. PMID:20559965

  8. Transesophageal Echocardiography for the Noncardiac Surgical Patient

    PubMed Central

    Rebel, Annette; Klimkina, Oksana; Hassan, Zaki-Udin

    2012-01-01

    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. PMID:23102000

  9. 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.

    PubMed

    Shrestha, B

    2012-09-01

    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

  10. Tumour cells of extramammary Paget's disease do not show either p53 mutation or allelic loss at several selected loci implicated in other cancers.

    PubMed Central

    Takata, M.; Hatta, N.; Takehara, K.

    1997-01-01

    Extramammary Paget's disease is a particular form of skin cancer of unknown histogenesis. To look for the genetic defects underlying the pathogenesis of this tumour, we have examined loss of heterozygosity (LOH), p53 and human papillomavirus (HPV) status, and the expression of c-erbB-2 and bcl-2 proteins in 14 cases. Unexpectedly, no LOH was detected at several loci commonly lost in other human cancers (namely 3p, 9p, 9q, 13q, 16q, 17p, and 17q) in 12 tumours examined. Altered p53 protein expression was entirely or mostly negative in all 14 cases. Direct sequencing of exons 5-8 of the p53 gene in eight cases revealed no mutation. Polymerase chain reaction amplification of the L1 gene of human papillomavirus (HPV) did not detect the virus that could inactivate p53 and retinoblastoma tumour-suppressor gene products. As expected, c-erbB-2 proto-oncogene protein was overexpressed in six cases. The expression of bcl-2 was negative in all cases. The results presented in this study suggest that molecular events underlying extramammary Paget's disease differ from those of other common epithelial malignancies and that tumour-suppressor genes located in chromosome regions not examined in this study may be important. Images Figure 1 Figure 2 PMID:9328150

  11. Diagnostic echocardiography in an unstable intensive care patient

    PubMed Central

    Baldwin, F; Bruemmer-Smith, S

    2015-01-01

    Summary A previously fit and well 57-year-old gentleman who had recently undergone a colonoscopy and biopsy of a polyp presented with a 4-day history of progressive breathlessness and abdominal discomfort. The day after admission, he became haemodynamically unstable, developed ischaemic legs and suffered a brief cardiac arrest. Blood tests demonstrated a coagulopathy and hypoglycaemia. Continued haemodynamic instability post-arrest and clinical findings of high right-sided heart pressures were investigated by bedside screening echocardiogram. This demonstrated a massive pericardial effusion causing tamponade of the right ventricle. Heavily blood stained pericardial fluid was drained, with marked improvement in haemodynamic stability. Retrospective review of the admission-electrocardiogram (ECG) and chest X-ray demonstrated electrical alternans and cardiac enlargement. The differential diagnosis included bowel malignancy causing a haemorrhagic metastatic pericardial effusion and a type A aortic dissection. Therefore a computerised tomography (CT) scan of chest, abdomen, pelvis and aorta was performed. This was negative for disseminated malignancy and showed a type B aortic dissection, but was inconclusive for a type A aortic dissection. A subsequent transoesophageal echocardiogram confirmed the diagnosis of type B dissection and ruled out a type A dissection. The histology of the colonic polyp was negative for malignancy, but it was subsequently discovered that the patient had metastatic adenocarcinoma from a primary lung cancer diagnosed from pleural fluid cytology. With hindsight the presenting clinical picture was of type B aortic dissection with concurrent but not directly related pericardial tamponade. Learning points Basic echocardiography skills are increasingly being used acutely by physicians' as part of resuscitative care in intensive care unit (ICU) patients.The availability of expert skills in transoesophageal echocardiography are essential in ICU, as demonstrated in this case, where it was needed for discriminating between sub types of aortic dissection.Cardiac tamponade is a clinical diagnosis, although the presence of electrical alternans on an ECG with associated tachycardia is highly suggestive of cardiac tamponade. PMID:26693323

  12. Prognostic importance of tissue velocity imaging during exercise echocardiography in patients with systolic heart failure

    PubMed Central

    van Zalen, Jet; Patel, Nikhil R; J Podd, Steven; Raju, Prashanth; McIntosh, Rob; Brickley, Gary; Beale, Louisa; Sturridge, Lydia P

    2015-01-01

    Resting echocardiography measurements are poor predictors of exercise capacity and symptoms in patients with heart failure (HF). Stress echocardiography may provide additional information and can be expressed using left ventricular ejection fraction (LVEF), or diastolic parameters (E/E?), but LVEF has some major limitations. Systolic annular velocity (S?) provides a measure of longitudinal systolic function, which is relatively easy to obtain and shows a good relationship with exercise capacity. The objective of this study was to investigate the relationship among S?, E/E? and LVEF obtained during stress echocardiography and both mortality and hospitalisation. A secondary objective was to compare S? measured using a simplified two-wall model. A total of 80 patients with stable HF underwent exercise stress echocardiography and simultaneous cardiopulmonary exercise testing. Volumetric and tissue velocity imaging (TVI) measurements were obtained, as was peak oxygen uptake (VO2 peak). Of the total number of patients, 11 died and 22 required cardiac hospitalisation. S? at peak exertion was a powerful predictor for death and hospitalisation. Cut-off points of 5.3?cm/s for death and 5.7?cm/s for hospitalisation provided optimum sensitivity and specificity. This study suggests that, in patients with systolic HF, S? at peak exertion calculated from the averaged spectral TVI systolic velocity of six myocardial segments, or using a simplified measure of two myocardial segments, is a powerful predictor of future events and stronger than LVEF, diastolic velocities at rest or exercise and VO2 peak. Results indicate that measuring S? during exercise echocardiography might play an important role in understanding the likelihood of adverse clinical outcomes in patients with HF.

  13. Cardiac Magnetic Resonance Imaging Might Complement Two-Dimensional Echocardiography in the Detection of a Reversible Nonischemic Cardiomyopathy

    PubMed Central

    Madanieh, Raef; Mathew, Shawn; Shah, Pratik; Vatti, Satya K.; Madanieh, Abed; Kosmas, Constantine E.; Vittorio, Timothy J.

    2015-01-01

    We report a case of reversible nonischemic dilated cardiomyopathy in a male in his 60s who presented with an acute heart failure syndrome. Both conventional two-dimensional echocardiography and cardiac magnetic resonance imaging (cMRI) demonstrated severe left ventricular systolic dysfunction; however, both modalities were devoid of significant valvular heart disease as well as the presence of fibrosis, infiltration, inflammation, and scar. After six months of aggressive neurohumoral modulation, there was complete reverse remodeling and normalization of left ventricular function, which highlights the role of cMRI as an adjunct to two-dimensional echocardiography in the detection of a potentially reversible nonischemic cardiomyopathy. PMID:26740746

  14. A feasibility study of epicardial coronary angiography from microbubble-contrasted tridimensional echocardiography: segmentation approaches

    NASA Astrophysics Data System (ADS)

    Lage, Danilo Meneses; Tsutsui, Jeane Mike; Furuie, Sérgio Shiguemi

    2010-03-01

    Conventional coronary angiography has been the current gold standard for evaluation of coronary stenosis severity. However, this is an invasive procedure, based on ionizing radiation (X-Ray) and dependent of nephrotoxic contrast agents. In the past three decades, echocardiography has emerged as an important medical image modality in Cardiology. With the advent of microbubble-based contrast agents and array transducers, 3D-echocardiography now presents itself as a relative low-cost, non invasive and non ionizing alternative method to visibilize arteries and their dynamics. This paper investigates some segmentation techniques to emphasize and isolate epicardial coronaries in tridimensional microbubblecontrasted echocardiographic images, since available computational tools do not provide adequate processing.

  15. Teaching focused echocardiography for rheumatic heart disease screening

    PubMed Central

    Engelman, Daniel; Kado, Joseph H; Reményi, Bo; Colquhoun, Samantha M; Watson, Caroline; Rayasidamu, Sera C; Steer, Andrew C

    2015-01-01

    Screening for rheumatic heart disease (RHD) requires workers skilled in echocardiography, which typically involves prolonged, specialized training. Task shifting echocardiographic screening to nonexpert health workers may be a solution in settings with limited human resources. An 8-week training program was designed to train health workers without any prior experience in focused echocardiography for RHD screening. Seven health workers participated. At the completion of training, the health workers performed unsupervised echocardiography on 16 volunteer children with known RHD status. A pediatric cardiologist assessed image quality. Participants provided qualitative feedback. The quality of echocardiograms were high at completion of training (55 of 56 were adequate for diagnosis) and all cases of RHD were identified. Feedback was strongly positive. Training health workers to perform focused echocardiography for RHD screening is feasible. After systematic testing for accuracy, this training program could be adapted in other settings seeking to expand echocardiographic capabilities. PMID:26085762

  16. Routine echocardiography in the management of stroke and transient ischaemic attack: a systematic review and economic evaluation.

    PubMed Central

    Holmes, Michael; Rathbone, John; Littlewood, Chris; Rawdin, Andrew; Stevenson, Matt; Stevens, John; Archer, Rachel; Evans, Pippa; Wang, Jenny

    2014-01-01

    BACKGROUND Identification of the underlying cause of stroke and transient ischaemic attack (TIA) is important so that preventative therapy can be used to reduce the risk of recurrence. Transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE) are diagnostic tools used to identify those cardiac sources of stroke that may respond to treatment. OBJECTIVES (1) Undertake systematic reviews to determine (a) the prevalence of cardiac sources of stroke and TIA and (b) the diagnostic accuracy of echocardiography; (2) undertake a survey to ascertain which guidelines and management strategies are used by UK stroke centres; and (3) evaluate the cost-effectiveness of the addition of TTE to the routine assessment of patients who have had a first-episode diagnosed stroke or TIA in the UK. DATA SOURCES Bibliographic databases including MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the NHS Economic Evaluation Database were searched from inception to December 2010 (prevalence) or September 2011 (diagnostic accuracy). Bibliographies of related papers were screened and experts were contacted to identify additional published and unpublished references. REVIEW METHODS The systematic reviews were undertaken according to the general principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A decision-analytic model was developed to estimate the costs and quality-adjusted life-years accrued by each potential echocardiography strategy in the management of stroke and TIA for patients aged 45, 55 and 65 years. The model took a lifetime horizon and a NHS perspective. Costs and health benefits were discounted at an annual rate of 3.5%. Evidence to enable modelling was found for left atrial thrombus only. The cost-effectiveness of echocardiography is therefore based on all stroke patients being tested but only those with a left atrial thrombus receiving the benefits and harms of treatment. To describe current NHS stroke management practice we provided a questionnaire to the lead clinician of all stroke units in the UK. RESULTS The searches identified 17,278 citations for the systematic review of the prevalence of potential cardiac sources of stroke and TIA, of which 65 studies were included. Patent foramen ovale was the most frequently reported pathology, followed by atrial septal aneurysm and mitral valve prolapse, with prevalence ranging from 0.25% to 73%, from 0.4% to 28% and from 0% to 31.6% respectively. For the systematic review of the diagnostic accuracy of echocardiography, 16,504 citations were identified, of which 51 studies were included. The pooled sensitivity to detect left atrial thrombus in three studies using transthoracic echocardiography in second harmonic imaging mode (TTEh) was 0.79 [95% credible interval (CrI) 0.47 to 0.94], with a pooled specificity of 1.00 (95% CrI 0.99 to 1.00) compared with TOE. Differences in the diagnostic accuracy of tests occurred mostly in their sensitivity to detect cardiac sources of stroke. No adverse events data were reported. Our principal economic finding is that TTEh is a cost-effective use of NHS resources compared with TOE when clinicians deem it the most appropriate test. The survey showed that the decision-making process for the management of stroke and TIA is very complex and varies considerably by site. It is clear that to accurately describe current management practice a very sophisticated questionnaire would be required. LIMITATIONS The prevalence review highlights the difficulties that clinicians face when identifying the cause of cardioembolic stroke (the limitations of the tests, the confounding comorbidities and the inherent mobility of blood clots). The diagnostic accuracy review was limited by the small number of studies reporting data or because studies included too few participants with a cardiac pathology, leaving a large degree of uncertainty about the underlying diagnostic accuracy. The economic model has limitations because of the limited data available for important parameters such as the efficacy of treatment in reducing stroke recurrence. CONCLUSION The economic analysis indicates that, in those cases in which TTEh is deemed the most appropriate test, it is a cost-effective use of NHS resources. However, this analysis has highlighted a lack of evidence in several areas and the results of the economic evaluation should therefore be treated with caution. There is a need for further evaluation of current echocardiography technologies, the causal associations between potential risk factors and stroke and whether or not anticoagulation therapies prevent recurrent stroke. Studies attempting to establish the prevalence of cardiac sources of stroke should identify all potential risk factors, rule out those that are not relevant and grade the findings according to risk. Research is also needed to reduce the uncertainty around the estimates of the sensitivity and specificity of TTEh and TOE, singly and in combination, in detecting treatable cardiac abnormalities compared with the 'gold standard' in each pathology. STUDY REGISTRATION The study is registered as PROSPERO no. CRD42011001353. FUNDING The National Institute for Health Research Health Technology Assessment programme. PMID:24602782

  17. Complete Neurological Recovery After Transesophageal Echocardiography-Guided Diagnosis and Management of Prolonged Cardiopulmonary Resuscitation.

    PubMed

    Ramarapu, Srikiran

    2015-12-01

    A 70-year-old man was scheduled for open reduction and internal fixation of his right knee fracture. When the tourniquet was deflated after 150 minutes, his arterial blood pressure and heart rate decreased precipitously. The patient was deemed to exhibit pulseless electrical activity. Cardiopulmonary resuscitation was initiated. The bispectral index reading improved to 25 to 30, but his end-tidal carbon dioxide was still very low (5 mm Hg). Transesophageal echocardiography showed a pulmonary embolism. Feedback from echo imaging improved the quality of chest compressions and motivated the resuscitation team to maintain the diastolic blood pressure>25 mm Hg. Although capnographic guidance was ineffective by itself, echocardiography monitoring was very helpful for showing the intracardiac events. PMID:26588031

  18. Microlesions induced by microcavitation during contrast echocardiography

    NASA Astrophysics Data System (ADS)

    Miller, Douglas; Li, Peng; Gordon, David; Armstrong, William

    2001-05-01

    The purpose of this study was to search for histologically identifiable lesions associated with myocardial contrast echocardiography (MCE) in rats. Diagnostic ultrasound scans with 1:4 end-systolic triggering provided a short-axis view of the left ventricle in rats at 1.5 MHz with 1.45-?s pulses of 1.7 Mechanical Index. Two relatively high doses (500 ?l/kg) of OptisonTM ultrasound contrast agent were given 5 min apart during 10 min of MCE. One day after scanning, rats were sacrificed and the hearts fixed for histology. Slides were scored blind by a pathologist, and photomicrographs in the anterior half of the heart sections were characterized by digital image analysis. Microlesions identified by inflammatory infiltrates were scattered primarily over the anterior half of the sections. Pathologically, there was inflammatory cell infiltration in areas of 0.6+/-0.5% of the sections for shams and 3.6+/-3.6% for MCE (P<0.01). Analysis of the photographs from the anterior wall found microlesion areas of 0.5+/-0.8% for shams and 7.4+/-5.0% for MCE (P<0.02). Diagnostic MCE at high Mechanical Index has a potential for causing microscale lesions in the myocardium by nucleation of microcavitation. [Work supported by NIH Grant EB0338.

  19. 3D reconstruction and quantitative assessment method of mitral eccentric regurgitation from color Doppler echocardiography

    NASA Astrophysics Data System (ADS)

    Liu, Qi; Ge, Yi Nan; Wang, Tian Fu; Zheng, Chang Qiong; Zheng, Yi

    2005-10-01

    Based on the two-dimensional color Doppler image in this article, multilane transesophageal rotational scanning method is used to acquire original Doppler echocardiography while echocardiogram is recorded synchronously. After filtering and interpolation, the surface rendering and volume rendering methods are performed. Through analyzing the color-bar information and the color Doppler flow image's superposition principle, the grayscale mitral anatomical structure and color-coded regurgitation velocity parameter were separated from color Doppler flow images, three-dimensional reconstruction of mitral structure and regurgitation velocity distribution was implemented separately, fusion visualization of the reconstructed regurgitation velocity distribution parameter with its corresponding 3D mitral anatomical structures was realized, which can be used in observing the position, phase, direction and measuring the jet length, area, volume, space distribution and severity level of the mitral regurgitation. In addition, in patients with eccentric mitral regurgitation, this new modality overcomes the inherent limitations of two-dimensional color Doppler flow image by depicting the full extent of the jet trajectory, the area of eccentric regurgitation on three-dimensional image was much larger than that on two-dimensional image, the area variation tendency and volume variation tendency of regurgitation have been shown in figure at different angle and different systolic phase. The study shows that three-dimensional color Doppler provides quantitative measurements of eccentric mitral regurgitation that are more accurate and reproducible than conventional color Doppler.

  20. The effect of PSF spatial-variance and nonlinear transducer geometry on motion estimation from echocardiography

    NASA Astrophysics Data System (ADS)

    Tavakoli, Vahid; Amini, Amir A.

    2011-03-01

    Two-dimensional echocardiography continues to be the most widely used modality for the assessment of cardiac function due to its effectiveness, ease of use, and low costs. Echocardiographic images are derived from the mechanical interaction between the ultrasound field and the contractile heart tissue. Previously, in [6], based on B-mode echocardiographic simulations, we showed that motion estimation errors are significantly higher in shift-varying simulations when compared to shift-invariant simulations. In order to ascertain the effect of the spatial variance of the Ultrasonic field point spread function (PSF) and the transducer geometry on motion estimation, in the current paper, several simple canonical cardiac motions such as translation in axial and horizontal direction, and out-of-plane motion were simulated and the motion estimation errors were calculated. For axial motions, the greatest angular errors occurred within the lateral regions of the image, irrespective of the motion estimation technique that was adopted. We hypothesize that the transducer geometry and the PSF spatial-variance were the underlying sources of error for the motion estimation methods. No similar conclusions could be made regarding motion estimation errors for azimuthal and out-of-plane ultrasound simulations.

  1. Use of transoesophageal echocardiography to detect left atrial thrombi before percutaneous balloon dilatation of the mitral valve: a prospective study.

    PubMed Central

    Manning, W J; Reis, G J; Douglas, P S

    1992-01-01

    OBJECTIVE--Systemic emboli related to atrial thrombi are a well known complication of percutaneous balloon dilatation of the mitral valve. The presence of left atrial thrombi therefore, is believed to be a contraindication to balloon dilatation. The purpose of this study was to determine the frequency of left atrial thrombi in patients referred for balloon dilatation of the mitral valve, the added benefit of pre-procedural transoesophageal echocardiography, and to identify factors that predicted left atrial thrombi. DESIGN--Prospective study over a 14 month period of 20 consecutive patients by cross sectional transthoracic echocardiography 24-48 hours before balloon dilatation of the mitral valve and by transoesophageal echocardiography immediately before the procedure. RESULTS--One patient had a left atrial thrombus detected by transthoracic study. Two patients (10%) had left atrial thrombi identified by transoesophageal echocardiography. In both valve dilatation was not attempted and the thrombi were confirmed at surgery. The remaining 18 patients all underwent successful balloon dilatation of the mitral valve without clinical evidence of an embolic event. No association was found between patient age, mitral valve area, transmitral gradient, left atrial size, presence of atrial fibrillation, severity of mitral regurgitation, cardiac output, or the presence of left atrial swirling and an increased prevalence of atrial thrombi. CONCLUSION--Left atrial thrombi are often seen despite long term systemic anticoagulation in patients referred for balloon dilatation of the mitral valve. The frequency of unsuspected left atrial thrombi detected by transoesophageal echocardiography was similar to the reported frequency of embolic events after balloon dilatation of the mitral valve. Transoesophageal echocardiography for the identification of left atrial thrombi is strongly recommended in all patients before balloon dilatation of the mitral valve including those treated with systemic anticoagulation and those who have had a normal transthoracic echocardiographic study. Images PMID:1540437

  2. Stress Echocardiography in Aortic Stenosis: Insights into Valve Mechanics and Hemodynamics.

    PubMed

    Bermejo, Javier; García-Fernández, Miguel A.; Antoranz, J. Carlos; Moreno, M. Mar; Delcán, Juan Luis

    1999-10-01

    Stress interventions have been classically combined with cardiac catheterization recordings to understand the hemodynamic principles of valvular stenosis. Indices of aortic stenosis such as pressure gradient and valve area were based on simple hydraulic principles and have proved to be clinically useful for patient management during a number of decades. With the advent of Doppler echocardiography, these hemodynamic indices can be readily obtained noninvasively. Abundant evidence obtained using exercise and pharmacological stress echocardiography has demonstrated that the assumptions of classic hemodynamic models of aortic stenosis were wrong. Consequently, it is recognized that conventional indices may be misleading indicators of aortic stenosis significance in particular clinical situations. To improve diagnostic accuracy, several alternative hemodynamic models have been developed in the past few years, including valve resistance and left ventricular stroke work loss, among others. Nevertheless, these more-accurate indices should be obtainable noninvasively and need to demonstrate greater diagnostic and prognostic power than conventional indices; preliminary data suggest such superiority. Stress echocardiography is well established as the tool of choice for testing hypothesis and physical models of cardiac valve function. Although the final role of alternative indices is not yet well established, the new insights into valvular hemodynamics provided by this technique may change the clinical assessment of aortic stenosis. PMID:11175211

  3. Clinical utility of three-dimensional echocardiography for the evaluation of ventricular function.

    PubMed

    Biswas, Santanu; Ananthasubramaniam, Karthikeyan

    2013-01-01

    The evaluation of ventricular function is a core component of 2-dimensional echocardiography (2DE). Given the known limitations of 2DE, a more accurate assessment of ventricular function has long been desired. Three-dimensional echocardiography (3DE) holds promise to fulfill this role while still maintaining the same benefits of low cost, portability, and efficiency of 2DE. Although 3DE has been investigated for over 30 years, the technology has seen little use in the modern clinical echocardiography lab. Although the benefit provided by the additional dimension of 2DE over M-Mode was immediately apparent, the clinical advantages of 3DE over 2DE have been difficult to appreciate. Several reasons for the lack of adoption include the learning curve, concerns about workflow, skepticism about clinical validity, and perceptions that the technology is too unrefined. Nonetheless, the past 2 decades have seen tremendous technical improvements in the field and a wealth of clinically applicable research. In particular, 3DE now has an established role in evaluating left ventricular systolic function. This review highlights the clinical relevancy of 3DE in evaluating ventricular function in terms of the history, relevant data, advantages, and the limitations of current generation 3DE. PMID:23422017

  4. Standard and advanced echocardiography in takotsubo (stress) cardiomyopathy: clinical and prognostic implications.

    PubMed

    Citro, Rodolfo; Lyon, Alexander R; Meimoun, Patrick; Omerovic, Elmir; Redfors, Björn; Buck, Thomas; Lerakis, Stamatios; Parodi, Guido; Silverio, Angelo; Eitel, Ingo; Schneider, Birke; Prasad, Abhiram; Bossone, Eduardo

    2015-01-01

    Echocardiography is frequently the initial noninvasive imaging modality used to assess patients with takotsubo cardiomyopathy (TTC). Standard transthoracic echocardiography can provide, even in the acute care setting, useful information about left ventricular (LV) morphology as well as regional and global systolic or diastolic function. It allows the differentiation of different LV morphologic patterns according to the localization of wall motion abnormalities. A "circumferential pattern" of LV myocardial dysfunction characterized by symmetric wall motion abnormalities involving the midventricular segments of the anterior, inferior, and lateral walls should be considered suggestive of TTC and included in the differential diagnosis of acute coronary syndromes. Moreover, advanced echocardiographic techniques, including speckle-tracking, myocardial contrast, and coronary flow studies, are providing mechanistic and pathophysiologic insights into this unique syndrome. Early identification of any potential complications (i.e., LV outflow tract obstruction, reversible moderate to severe mitral regurgitation, right ventricular involvement, thrombus formation, and cardiac rupture) are crucial for the management, risk stratification, and follow-up of patients with TTC. Because of the dynamic evolution of the syndrome, comprehensive serial echocardiographic examinations should be systematically performed. This review focuses on these aspects of imaging and the increasing understanding of the clinical and prognostic utility of echocardiography in TTC. PMID:25282664

  5. Diagnosis of recurrent left ventricular pseudoaneurysm by echocardiography with color flow imaging.

    PubMed

    Lasorda, D M; Dianzumba, S B; Casaday, F M; Joyner, C R

    1991-05-01

    Left ventricular pseudoaneurysms are a rare complication of myocardial rupture. The diagnosis is paramount because of the propensity of pseudoaneurysms to rupture. Color flow imaging has been reported to be an aid in the diagnosis of pseudoaneurysms. We recently studied a patient with a myocardial infarction who developed a left ventricular pseudoaneurysm. Diagnosis was made by two-dimensional imaging with color flow imaging. He subsequently had a repair procedure with a gortex graft. One week after repair, repeat echocardiography with color flow imaging showed flow into the aneurysmal sac at multiple sites, consistent with recurrence of the pseudoaneurysm. Echocardiography with color flow imaging provides a safe noninvasive diagnostic tool for evaluating pseudoaneurysms preoperatively and in assessing the competency of the repair postoperatively. PMID:2049894

  6. Quantitative M-mode and two-dimensional echocardiography in calves.

    PubMed

    Amory, H; Jakovljevic, S; Lekeux, P

    1991-01-12

    A standardised echocardiographic protocol was applied to 18 healthy calves for the estimation of 51 anatomical and functional cardiac variables. These variables were measured in a long axis and a short axis view of the heart, and both two-dimensional and cursor-directed time-motion (M-) modes were used. The repeatability of each of the measurements was estimated by comparing values obtained twice within 24 hours, and most of the 51 variables showed a high degree of repeatability. Statistical analysis revealed a close correlation between cardiac measurements taken post mortem and by in vivo echocardiography, and between the echocardiographic values obtained in different scanning planes of the heart or ultrasonic modes, indicating that quantitative echocardiography is a reliable technique in calves. PMID:2017840

  7. Speckle reduction in echocardiography by temporal compounding and anisotropic diffusion filtering

    NASA Astrophysics Data System (ADS)

    Giraldo-Guzmán, Jader; Porto-Solano, Oscar; Cadena-Bonfanti, Alberto; Contreras-Ortiz, Sonia H.

    2015-01-01

    Echocardiography is a medical imaging technique based on ultrasound signals that is used to evaluate heart anatomy and physiology. Echocardiographic images are affected by speckle, a type of multiplicative noise that obscures details of the structures, and reduces the overall image quality. This paper shows an approach to enhance echocardiography using two processing techniques: temporal compounding and anisotropic diffusion filtering. We used twenty echocardiographic videos that include one or three cardiac cycles to test the algorithms. Two images from each cycle were aligned in space and averaged to obtain the compound images. These images were then processed using anisotropic diffusion filters to further improve their quality. Resultant images were evaluated using quality metrics and visual assessment by two medical doctors. The average total improvement on signal-to-noise ratio was up to 100.29% for videos with three cycles, and up to 32.57% for videos with one cycle.

  8. Automatic computation of 2D cardiac measurements from B-mode echocardiography

    NASA Astrophysics Data System (ADS)

    Park, JinHyeong; Feng, Shaolei; Zhou, S. Kevin

    2012-03-01

    We propose a robust and fully automatic algorithm which computes the 2D echocardiography measurements recommended by America Society of Echocardiography. The algorithm employs knowledge-based imaging technologies which can learn the expert's knowledge from the training images and expert's annotation. Based on the models constructed from the learning stage, the algorithm searches initial location of the landmark points for the measurements by utilizing heart structure of left ventricle including mitral valve aortic valve. It employs the pseudo anatomic M-mode image generated by accumulating the line images in 2D parasternal long axis view along the time to refine the measurement landmark points. The experiment results with large volume of data show that the algorithm runs fast and is robust comparable to expert.

  9. The role of echocardiography in diagnosis and management of isolated meningococcal pericarditis.

    PubMed

    Falcão, Sandra N R S; Tsutsui, Jeane Mike; Ramires, Felix J; de Oliveira, Tathiana Delgado; Mady, Charles; Ramires, José A F; Mathias, Wilson

    2007-03-01

    Although pericarditis may complicate the course of meningococcemia, it is distinctly unusual as a presenting sign. Herein we report a case of a previously healthy 16-year-old male with isolated meningococcal pericarditis, in which transthoracic echocardiography was of great importance for the initial diagnosis and for guiding the therapeutic approach during the hospitalization period. The patient presented with symptoms of chest pain and fever that deteriorated into cardiac tamponade. Pericardiocentesis was successful and Neisseria meningitidis was identified as the causative agent in the pericardial fluid. Because of failure of clinical resolution, echocardiogram was repeated and showed evidence of maintenance of large echo dense content in pericardial space. The presence of purulent content was confirmed during open-chest surgery. The role of echocardiography for the correct management of this rare form of pericarditis is discussed. PMID:17313638

  10. Speckle tracking echocardiography assessment of global and regional contraction dysfunction in the mice model of pressure overload.

    PubMed

    Wang, Guan; Zhang, Le; Ruan, Lei; Quan, Xiao-qing; Yang, Jun; Lv, Cai-xia; Zhang, Cun-tai

    2015-04-01

    Speckle tracking echocardiography (STE) has been applied to the evaluation of cardiac contraction dysfunction. However, there were few studies on alteration of global and regional STE parameters in the process of myocardial hypertrophy and heart failure. In this study, STE was applied to evaluate the global and regional cardiac function under heart failure and hypertrophy in the mice model of pressure overload. Adult mice were subjected to mild or severe aortic banding with a 25 Gauge (G) or 27 G needle. After surgery, STE and conventional echocardiography were used in the sham group (n=10), mild trans-aortic banding (TAB) group (n=14) and severe TAB group (n=10) for 8 weeks. The results showed that the mice subjected to severe TAB showed a significant change in fractional shortening (FS), left ventricular (LV) mass, and left ventricular end diastolic diameter (LVEDD) (P<0.05 for each). Meanwhile, there were no significant differences in FS and LVEDD between the sham group and mild TAB group during the experimental procedures (P>0.05 for both). STE analysis revealed that longitudinal strain (LS) was significantly decreased in the severe TAB group as compared with the sham and mild TAB groups (P<0.05 for both) from the postoperative week 1. LS in the mild TAB group was reduced as compared to the sham group (P<0.05). Radial strain (RS) and circumferential strain (CS) were significantly decreased in the severe TAB group as compared to the sham group and the mild TAB group (P<0.05 for both) from the postoperative week 1 (P<0.05 for both). Compared to the sham group, CS in the mild TAB group maintained unchanged during the test period, and RS was reduced only on the postoperative week 6 (P<0.05). Finally, regional contraction dysfunction was analyzed in both hypertrophic and failing myocardium in longitudinal and radial directions. It was found that LS was largest in the apex region and RS was smallest in the apex region in the healthy and hypertrophic myocardium. It was also found that compared to the sham group, only base longitudinal strain in the mild TAB group was decreased. Each of regional strain in the severe TAB group was uniformly depressed in radial and longitudinal directions. It is concluded that STE has provided a non-invasive and highly feasible way to explore the global and regional contraction dysfunction in hypertrophic and heart failure myocardium in the murine model of pressure overload. PMID:25877364

  11. Back-propagation beamformer design for motion estimation in echocardiography.

    PubMed

    Guo, Xinxin; Liebgott, Hervé; Friboulet, Denis

    2015-07-01

    Transverse oscillation (TO) techniques have shown their potential for improving the accuracy of local motion estimation in the transverse direction (i.e., the direction perpendicular to the beam axis). The conventional design of TOs in linear geometry, which is based on the Fraunhofer approximation, relates point spread function (PSF) and apodization function through a Fourier transform. Motivated by the adaptation of TOs in echocardiography, we propose a specific beamforming approach based on back-propagation (BP) to build TOs in sector-shaped geometry. Numerical simulations and experimental data give a comparison between proposed and conventional beamforming for TOs. The accuracy is first quantified by comparing the generated and theoretical PSF using the root mean square error (RMSE) and shows that BP-based beamforming approximates the desired TOs more closely than the conventional approach. Motion estimation is then evaluated. The axial and lateral displacements are within the range [0-0.6] mm and [0°-6.4°], respectively, which correspond to 0.8 times the axial (0.73 mm) and lateral (8°) wavelengths. The result shows that the proposed method yields a clear improvement for lateral displacements, by reducing the error by 28.6% compared with Fourier transform-based beamforming, while maintaining the same error for axial motion estimation. Experimental measurements are discussed to complete this study and confirm that BP-based beamforming leads to better controlled TO images than conventional Fourier-based beamforming. PMID:25252774

  12. Utility of transesophageal echocardiography in the examination of adult patients with patent ductus arteriosus.

    PubMed

    Andrade, A; Vargas-Barron, J; Rijlaarsdam, M; Romero-Cardenas, A; Keirns, C; Espinola, N

    1995-09-01

    Thirteen patients with clinical suspicion of patent ductus arteriosus were evaluated by transthoracic and transesophageal echocardiographic studies. Findings were corroborated during corrective surgery in 8 patients and by cardiac catheterization in 5. Transthoracic echocardiography confirmed the diagnosis in 7 patients; in 2 of the patients endarteritis of the pulmonary artery was demonstrated, and in one infective vegetations in aortic and mitral valves. With transesophageal echocardiography, patent ductus arteriosus was established in all 8 patients and endarteritis of the pulmonary artery was shown in 3, including 1 not discovered by transthoracic technique. In 1 of these patients, vegetations were also found on the pulmonic valve. Both techniques demonstrated significant pulmonary hypertension in 5 cases; contrast studies showed the venoarterial shunt between the pulmonary artery and the aorta with particular clarity in transesophageal images. On the basis of these findings it may be concluded that transesophageal echocardiography complements the information provided by transthoracic recordings in adult patients with patent ductus arteriosus, especially when it is associated with pulmonary hypertension or pulmonary endarteritis. PMID:7661073

  13. Assessment of right ventricular systolic function by echocardiography after surgical repair of congenital heart defects.

    PubMed

    Khraiche, Diala; Ben Moussa, Nidhal

    2016-02-01

    Postoperative impairment of right ventricular (RV) systolic function can appear after surgical repair of complex congenital heart defects, such as tetralogy of Fallot; it is caused by chronic volume and/or pressure overload due to pulmonary regurgitation and/or stenosis. RV dysfunction is strongly associated with prognosis in these patients. Cardiac magnetic resonance imaging is the gold standard for quantification of RV volumes and ejection fraction in patients with congenital heart diseases; however, it is costly and is not widely available. Echocardiography is the imaging modality that is most available and most frequently used to assess RV systolic function. However, RV ejection fraction cannot be measured accurately by standard two-dimensional echocardiography because of its pyramidal shape. Surrogate parameters of RV systolic function are mostly used in routine practice. New techniques of two-dimensional strain and three-dimensional quantification of RV volumes and ejection fraction have been developed in recent years. The aim of this article is to show the pertinence of each variable of RV systolic function measured by echocardiography in patients with repaired congenital heart disease and residual chronic RV overload. PMID:26774976

  14. [Electrocardiography and echocardiography aspects of hypertrophic myocardiopathy in pediatrics].

    PubMed

    Maldonado Tapia, B; Calderón Colmenero, J; de Micheli, A; Rijlaarsdam, M; Casanova Garcés, J M; Attie, F; Buendia, A

    2000-01-01

    Hypertrophic cardiomyopathy (HCM) is a heterogeneous disease, characterized by asymmetric hypertrophy of the left and/or right ventricle with disarray of myocardial fibers. In order to know its clinical and electrocardiographic manifestation in the pediatric age group, we made a retrospective study of 24 cases from 1986 to 1995. There were: 15 girls and 9 boys, with a mean age of 6 years (age range: 1 month to 17 years). Clinical manifestations were dyspnea (71%), syncope (42%) and palpitations (42%). Physical examination disclosed an aortic systolic murmur in all patients, a mitral regurgitation in 42% and physical signs of congestive heart failure in 54% of patients. Chest X rays showed cardiac enlargement in 71% and pulmonary capillary hypertension in 42%. The most frequent ECG abnormalities were: a prolonged time in the intrinsecoid deflection onset on leads corresponding to the affected region, more or less deep and clean Q waves on leads aVF, aVL, V5 and V6, as well as supraventricular and ventricular rhythm disturbances in 11 patients (46%) with and without congestive heart failure. Bidimensional echocardiography confirmed antero-septal hypertrophy in all patients. The mortality rate was 17%. HCM is rare disease in the pediatric age group. Mortality increases when congestive heart failure and arrhythmias are present. Treatment must be individualized in all cases. PMID:10959455

  15. Standard transthoracic echocardiography and transesophageal echocardiography views of mitral pathology that every surgeon should know

    PubMed Central

    Tan, Timothy C.

    2015-01-01

    The mitral valve is the most commonly diseased heart valve and the prevalence of mitral valve disease increases proportionally with age. Echocardiography is the primary diagnostic imaging modality used in the assessment of patients with mitral valve disease. It is a noninvasive method which provides accurate anatomic and functional information regarding the mitral valve and can identify the mechanism of mitral valve pathology. This is especially useful as it may guide surgical repair. This is increasingly relevant given the growing trend of patients undergoing mitral valve repair. Collaboration between cardiac surgeons and echocardiographers is critical in the evaluation of mitral valve disease and for identification of complex valvular lesions that require advanced surgical skill to repair. This article will provide an overview of transthoracic and transesophageal assessment of common mitral valve pathology that aims to aid surgical decision making. PMID:26539350

  16. Stress echocardiography: a useful tool for children with aortic stenosis.

    PubMed

    Naik, Ronak; Kunselman, Allen; Wackerle, Elizabeth; Johnson, Gerald; Cyran, Stephen E; Chowdhury, Devyani

    2013-06-01

    The development of echocardiographic ventricular wall motion abnormalities and ST segment changes with exercise may enhance the detection of myocardial ischemia in children with aortic valve stenosis (AS). This study aimed to assess the relationship between the exercise wall motion index (WMIe), ST segment depression (STd), and overall functionality in asymptomatic children with isolated AS. A prospective interpretation of collected stress echocardiographic images was performed. The 98 children who met the inclusion criteria had a mean age of 12.8 years and a male/female ratio of 4/1. Group 1 (mild AS) was composed of 70 children, and group 2 (moderate or severe AS) was composed of 28 children. Abnormal WMIe was seen in 8 patients (5 in group 1 and 3 in group 2), and significant STd was observed in 13 children (3 in group 1 and 10 in group 2). Four (50 %) of the eight patients with abnormal WMIe also had significant STd. Severity of stenosis was associated with STd (odds ratio [OR], 12.0; 95 % CI 3.0-49.0), logistic regression). A significant association also existed between abnormal WMIe and STd (OR, 9.0; 95 % CI 1.9-42.0, logistic regression). Exercise duration was significantly shorter in group 2 (12 ± 4.52 min) than in group 1 (13 ± 5.28 min) (p = 0.02, analysis of covariance). The appearance of wall motion abnormalities and STd during exercise may be helpful in detecting inducible, functionally important myocardial ischemia in asymptomatic children with AS. Stress echocardiography may be a useful adjunct to more traditional exercise testing in risk stratifying asymptomatic children with AS. PMID:23377382

  17. Transient global amnesia after dobutamine--atropine stress echocardiography.

    PubMed

    Saura, Daniel; Peñafiel, Pablo; Morales, Ana; Albert, Laura; Martínez, Francisco; de la Morena, Gonzalo; Valdés-Chávarri, Mariano

    2008-07-01

    Dobutamine-atropine stress echocardiography is a useful and relatively safe test for coronary artery disease assessment. However, possible complications should be recognized. We describe a case of transient global amnesia in a woman who underwent a standard-protocol dobutamine-atropine stress echocardiogram for coronary ischaemia detection, after having complained about chest pain. The test was not positive for coronary ischaemia, but a typical picture of transient global amnesia ensued. Symptoms shortly resolved spontaneously. Neurological work up was negative for organic disease. Transient global amnesia is a neurological syndrome of unknown origin and good prognosis. Dobutamine-atropine stress echocardiography can be added to the described precipitants of transient global amnesia. This neurological syndrome should be taken into account as a possible complication of dobutamine-atropine stress echocardiography. PMID:17698416

  18. Role of Echocardiography Before Transcatheter Aortic Valve Implantation (TAVI).

    PubMed

    Badiani, Sveeta; Bhattacharyya, Sanjeev; Lloyd, Guy

    2016-04-01

    Aortic stenosis (AS) is the most common primary valve disorder in the elderly with an increasing prevalence; transcatheter aortic valve implantation (TAVI) has become an accepted alternative to surgical aortic valve replacement (AVR) in the high risk or inoperable patient. Appropriate selection of patients for TAVI is crucial and requires a multidisciplinary approach including cardiothoracic surgeons, interventional cardiologists, anaesthetists, imaging experts and specialist nurses. Multimodality imaging including echocardiography, CT and MRI plays a pivotal role in the selection and planning process; however, echocardiography remains the primary imaging modality used for patient selection, intra-procedural guidance, post-procedural assessment and long-term follow-up. The contribution that contemporary transthoracic and transoesophageal echocardiography make to the selection and planning of TAVI is described in this article. PMID:26960423

  19. "The Show"

    ERIC Educational Resources Information Center

    Gehring, John

    2004-01-01

    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…

  20. Detection of intra-atrial conduit leakage by transesophageal echocardiography.

    PubMed

    Wang, T L; Lai, L P; Kuan, P

    1993-09-01

    A 19-year-old male patient who had undergone total cavo-pulmonary connection for complex congenital cyanotic heart disease with partial anomalous pulmonary venous return, was found to have persistent postoperative cyanosis. Transesophageal echocardiography disclosed leakage of the intra-atrial Gortex conduit with a right-to-left shunt. Prompt re-do operation confirmed the site of the leakage which was successfully repaired. Intraoperative transesophageal echocardiography may be indicated so as to avoid a secondary open-chest procedure for this complication. PMID:8282444

  1. Need for a standardized protocol for stress echocardiography in provoking subaortic and valvular gradient in various cardiac conditions

    PubMed Central

    2014-01-01

    (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). PMID:25017422

  2. Need for a standardized protocol for stress echocardiography in provoking subaortic and valvular gradient in various cardiac conditions.

    PubMed

    Petkow Dimitrow, Pawel; Cotrim, Carlos; Cheng, Tsung O

    2014-01-01

    (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). PMID:25017422

  3. A systematic approach to echocardiography in hypertrophic cardiomyopathy: a guideline protocol from the British Society of Echocardiography

    PubMed Central

    Smith, Nicola; Steeds, Richard; Masani, Navroz; Sandoval, Julie; Wharton, Gill; Allen, Jane; Chambers, John; Jones, Richard; Lloyd, Guy; Rana, Bushra; O'Gallagher, Kevin; Wheeler, Richard

    2015-01-01

    Hypertrophic cardiomyopathy (HCM) is a relatively common inherited cardiac condition with a prevalence of approximately one in 500. It results in otherwise unexplained hypertrophy of the myocardium and predisposes the patient to a variety of disease-related complications including sudden cardiac death. Echocardiography is of vital importance in the diagnosis, assessment and follow-up of patients with known or suspected HCM. The British Society of Echocardiography (BSE) has previously published a minimum dataset for transthoracic echocardiography, providing the core parameters necessary when performing a standard echocardiographic study. However, for patients with known or suspected HCM, additional views and measurements are necessary. These additional views allow more subtle abnormalities to be detected or may provide important information in order to identify patients with an adverse prognosis. The aim of this Guideline is to outline the additional images and measurements that should be obtained when performing a study on a patient with known or suspected HCM.

  4. Accuracy of cardiac auscultation in the era of Doppler-echocardiography: a comparison between cardiologists and internists.

    PubMed

    Sztajzel, Juan M; Picard-Kossovsky, Michel; Lerch, René; Vuille, Cédric; Sarasin, François P

    2010-02-01

    To investigate the present accuracy of cardiac auscultation, we asked a group of senior cardiologists and internists to auscultate respectively 72 and 70 selected patients and to give a diagnosis of the type of lesions heard and their degree of severity, using transthoracic Doppler-echocardiography as the standard reference. The percentage of correctly identified auscultations by cardiologists and by internists, particularly for common valvular lesions, such as aortic stenosis and mitral regurgitation, was respectively 76.1 vs 64.9% (P=0.0787) for all types of lesions taken together, 57.1 vs 48%.0 (P=0.5057) for mild, 82.4 vs 76.0% (P= 0.3335) for moderate-severe and 81.8 vs 27.3% (P=0.0300) for lesions without degree of severity, which included cases of atrial septal defect (ASD) and of hypertrophic cardiomyopathiy (HCM). Our findings show that in the Doppler-echocardiographic era overall cardiac auscultatory proficiency for common valvular lesions is similar in cardiologists and internists. Cardiologists perform better than internists only when auscultating more rare cadiac lesions, such as cases of ASD or HCM. PMID:18762344

  5. Three-Dimensional Echocardiography-based Prediction of Posterior Leaflet Resection

    PubMed Central

    Rim, Yonghoon; Choi, Ahnryul; Laing, Susan T.; McPherson, David D.; Kim, Hyunggun

    2014-01-01

    Clinical long-term outcomes have shown that partial leaflet resection followed by ring annuloplasty is a reliable and reproducible surgical repair technique for treatment of mitral valve (MV) leaflet prolapse. We report a 61-year-old male for three-dimensional transesophageal echocardiography (3D TEE)-based virtual posterior leaflet resection and ring annuloplasty. Severe mitral regurgitation was found and computational evaluation demonstrated substantial leaflet malcoaptation and high stress concentration. Following virtual resection and ring annuloplasty, posterior leaflet prolapse markedly decreased, sufficient leaflet coaptation was restored, and high stress concentration disappeared. Virtual MV repair strategies using 3D TEE have the potential to help optimize MV repair. PMID:25109487

  6. Quantitative evaluation of local myocardial blood volume in contrast echocardiography.

    PubMed

    Zwirn, Gil; Beeri, Ronen; Gilon, Dan; Friedman, Zvi; Akselrod, Solange

    2009-02-01

    Myocardial perfusion is usually assessed by Single Photon Emission Computed Tomography (SPECT) imaging. Information about myocardial perfusion is sometimes deduced from angiography or Computed Tomography (CT) angiography, which detect coronary artery stenosis. Contrast echocardiography can be used for that purpose as well. However, the currently available data acquisition and analysis methods are difficult to manage in the clinical environment. This paper presents a novel contrast echo data acquisition protocol and parameter extraction procedure, providing an automatic quantitative evaluation of the local myocardial blood volume for the entire left ventricular myocardium. This information is indicative of local perfusion. Our method evaluates the myocardial blood volume according to the local gray level intensity, as measured during a single heartbeat, when there is a distinct myocardial opacification (based on visual estimation). The echocardiographic image analysis is based on a new attenuation correction technique, which compensates for the ultrasonic signal attenuation in both the tissue and the contrast agent. In comparison, the existing contrast echo based methods utilize the long-term temporal variability of the gray level to extract information regarding the local myocardial blood flow velocity. Our technique has been tested on 17 cine-loops of 15 different patients. We have found a high correlation between abnormal segments, detected automatically by our technique, and segments that have been clinically diagnosed as ischemic (at rest) or infarcted. For that purpose, we have defined ischemic segments as segments fed by coronary arteries with severe stenosis, as determined by angiography, and infarcted segments as segments after Acute Myocardial Infarction, as detected by electrocardiography. Furthermore, we have found a high correlation between the automatically calculated myocardial blood volume levels and the clinical evaluation of segmental contractility, based on echocardiographic imaging. PMID:18653376

  7. Low dose dobutamine echocardiography for predicting functional recovery after coronary revascularisation

    PubMed Central

    Piscione, F; Perrone-Filardi, P; De Luca, G; Prastaro, M; Indolfi, C; Golino, P; Dellegrottaglie, S; Chiariello, M

    2001-01-01

    OBJECTIVE—To evaluate the effects of chronic coronary occlusion on the accuracy of low dose dobutamine echocardiography in predicting recovery of dysfunctional myocardium after revascularisation.
DESIGN—Retrospective study.
SETTING—Tertiary referral centre.
PATIENTS—53 consecutive patients with ⩾ 70% stenosis of the left anterior descending coronary artery (LAD) and regional ventricular dysfunction (group 1, non-occluded LAD; group 2, occluded LAD) who underwent dobutamine echocardiography.
INTERVENTIONS—26 patients underwent coronary artery bypass grafting and 27 had percutaneous transluminal coronary angioplasty.
MAIN OUTCOME MEASURES—Baseline studies before revascularisation included cross sectional echocardiography at rest and during dobutamine infusion (5-10 µg/kg/min), and coronary angiography. The dobutamine study was performed mean (SD) 35 (28) days before revascularisation. Echocardiography at rest was repeated 90 (48) days after revascularisation.
RESULTS—Of 296 dysfunctional segments, 63 in group 1 (43%; 63/146) and 69 in group 2 (46%; 69/150) (NS) improved at follow up. Mean (SD) regional wall motion score index decreased from 1.97 (0.48) (95% confidence interval (CI) 1.01 to 2.93) before revascularisation to 1.74 (0.52) (95% CI 0.70 to 2.78) at follow up in group 1 (p = 0.001), and from 2.12 (0.41) (95% CI 1.30 to 2.98) to 1.88 (0.36) (95% CI 1.16 to 2.60) in group 2 (p = 0.0006). In group 1, sensitivity (87% v 52%; p < 0.0001), negative predictive value (88% v 65%; p = 0.001), and accuracy (77% v 64%; p = 0.01) were all significantly higher than in group 2, despite the angiographic evidence of collaterals in patients with occluded vessels.
CONCLUSIONS—Dobutamine echocardiography shows reduced sensitivity in predicting recovery of dysfunctional myocardium supplied by totally occluded vessels. Thus caution should be used in selecting such patients for revascularisation on the basis of a viability assessment made in this way.


Keywords: dobutamine; coronary artery disease; viability; chronic occlusion PMID:11711467

  8. Transesophageal echocardiography: first-line imaging for aortic diseases

    NASA Technical Reports Server (NTRS)

    Yalcin, F.; Thomas, J. D.; Homa, D.; Flachskampf, F. A.

    2000-01-01

    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.

  9. AN ANALOGUE ECHOGRAM RANGE GATE TRACKER FOR CLINICAL ECHOCARDIOGRAPHY

    EPA Science Inventory

    The fundamental purpose of this paper is to present the results of a feasibility study for an on-line, real-time automatic range gate tracker (ARGT) for clinical echocardiography specifically for the purpose of determining cardiac output noninvasively and in real time. The basic ...

  10. Echocardiography in cardiovascular public health: the Feigenbaum Lecture 2008.

    PubMed

    Tsang, Teresa S M

    2009-06-01

    The magnitude of age-related public health problems, such as atrial fibrillation (AF) and heart failure (HF) is enormous and escalating, despite conventional strategies of clinical risk factor assessment and management. New paradigms for risk stratification need to be considered. Of all technologies, echocardiography is the only imaging modality that has a wide margin of patient safety and is mature enough for preventive applications. Along with its unique characteristics of portability, ready availability at the population level, and relatively low cost, echocardiography is well-positioned for integration into preventive strategies. The ability to detect subclinical abnormalities early in the natural history of a disease may potentially allow treatment within the window of opportunity, interrupting the cascade of events that lead to adverse outcomes. The 2008 Feigenbaum Lecture describes the body of literature confirming the important contribution of echocardiography in prognostication and its role in risk stratification, and documents the evolution of echocardiography from being solely a tool for confirming diagnosis to one that will also guide prevention of public health problems. PMID:19501324

  11. Low-dose adenosine stress echocardiography: Detection of myocardial viability

    PubMed Central

    Djordjevic-Dikic, Ana; Ostojic, Miodrag; Beleslin, Branko; Nedeljkovic, Ivana; Stepanovic, Jelena; Stojkovic, Sinisa; Petrasinovic, Zorica; Nedeljkovic, Milan; Saponjski, Jovica; Giga, Vojislav

    2003-01-01

    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, 110 mcg/kg/min in 3 minutes intervals) echocardiography test. Gold standard for myocardial viability was improvement in systolic thickening of dyssinergic segments of ? 1 grade at follow-up. Coronary angiography was done in 41 pts. Twenty-seven patients were revascularized and 16 were medically treated. Echocardiographic follow up data (12 ± 2 months) were available in 24 revascularized patients. Results Wall motion score index improved from rest 1.55 ± 0.30 to 1.33 ± 0.26 at low-dose adenosine (p < 0.001). Of the 257 segments with baseline dyssynergy, adenosine echocardiography identified 122 segments as positive for viability, and 135 as necrotic since no improvement of systolic thickening was observed. Follow-up wall motion score index was 1.31 ± 0.30 (p < 0.001 vs. rest). The sensitivity of adenosine echo test for identification of viable segments was 87%, while specificity was 95%, and diagnostic accuracy 90%. Positive and negative predictive values were 97% and 80%, respectively. Conclusion Low-dose adenosine stress echocardiography test has high diagnostic potential for detection of myocardial viability in the group of patients with left ventricle dysfunction due to previous myocardial infarction. Low dose adenosine stress echocardiography may be adequate alternative to low-dose dobutamine test for evaluation of myocardial viability. PMID:12812523

  12. Current diagnostic and treatment strategies for Lutembacher syndrome: the pivotal role of echocardiography

    PubMed Central

    Dzudie, Anastase; Takah, Noah Fongwen; Ngu, Kathleen Blackett; Sliwa, Karen; Kengne, Andre Pascal

    2015-01-01

    Lutembacher syndrome (LS) is a rare cardiac abnormality characterized by any combination of a congenital or iatrogenic atrial septal defect (ASD) and a congenital or acquired mitral stenosis (MS). Clinical features and hemodynamic effects of LS depend on the balance of effects of the MS and the ASD. Prognosis is influenced by several factors [pulmonary vascular resistance, right ventricle (RV) compliance, size of ASD and MS severity] but the occurrence of secondary pulmonary hypertension and congestive heart failure is commonly associated with poor outcome. Echocardiography remains the gold standard for diagnosis and evaluation of LS. Timely diagnosis is critical for modifying the natural course, by allowing patients to benefit from currently available percutaneous trans-catheter therapies with favorable effects on the outcomes. This article is a review of published literature on the current diagnostic and therapeutic modalities for LS, focusing on the pivotal role of echocardiography as the key diagnostic tool. Clinical suspicion of LS should prompt extensive investigation with non-invasive and where possible, invasive technics. Multicenter registers have a potential to assist the evaluation of long term outcomes of percutaneous trans-catheter therapies in patients with LS. PMID:25984452

  13. Current diagnostic and treatment strategies for Lutembacher syndrome: the pivotal role of echocardiography.

    PubMed

    Aminde, Leopold Ndemnge; Dzudie, Anastase; Takah, Noah Fongwen; Ngu, Kathleen Blackett; Sliwa, Karen; Kengne, Andre Pascal

    2015-04-01

    Lutembacher syndrome (LS) is a rare cardiac abnormality characterized by any combination of a congenital or iatrogenic atrial septal defect (ASD) and a congenital or acquired mitral stenosis (MS). Clinical features and hemodynamic effects of LS depend on the balance of effects of the MS and the ASD. Prognosis is influenced by several factors [pulmonary vascular resistance, right ventricle (RV) compliance, size of ASD and MS severity] but the occurrence of secondary pulmonary hypertension and congestive heart failure is commonly associated with poor outcome. Echocardiography remains the gold standard for diagnosis and evaluation of LS. Timely diagnosis is critical for modifying the natural course, by allowing patients to benefit from currently available percutaneous trans-catheter therapies with favorable effects on the outcomes. This article is a review of published literature on the current diagnostic and therapeutic modalities for LS, focusing on the pivotal role of echocardiography as the key diagnostic tool. Clinical suspicion of LS should prompt extensive investigation with non-invasive and where possible, invasive technics. Multicenter registers have a potential to assist the evaluation of long term outcomes of percutaneous trans-catheter therapies in patients with LS. PMID:25984452

  14. Will transoesophageal echocardiography become a standard tool for anesthetists to assess haemodynamic status during non-cardiac surgeries? Case report and literature review.

    PubMed

    Starczewska, Ma?gorzata H; Stach, Orest; Ka?ski, Andrzej

    2014-12-01

    A 53-year-old male, with no history of cardiovascular diseases, underwent elective extended right hemihepatectomy for large metastatic tumor. Approximately 2 hours after the start of procedure sudden onset of severe hypotension associated with profound desaturation and significant fall in end-tidal carbon dioxide pressure was noted. Transoesophageal echocardiography was performed and massive air embolism was confirmed. Patient was turned into Trendelenburg position, inspired oxygen was increased to 100% and positive end-expiratiory pressure turned up to 10 cm H20. Patient was further resuscitated with iv fluids, blood products and vasopressors under surveillance of transoesophageal echocardiography. In this report we present a case in which intraoperative use of transoesophageal echocardiography by trained anaesthetist helped to immediately identify the cause of sudden hypotension and hypoxaemia. Transoesophageal echocardiographywas also a valuable tool for direct monitoring of efficacy of instituted treatment. PMID:26674775

  15. Semi-supine exercise stress echocardiography in children and adolescents: feasibility and safety.

    PubMed

    Ciliberti, P; McLeod, I; Cairello, F; Kaski, J P; Fenton, M; Giardini, A; Marek, J

    2015-03-01

    Although exercise stress echocardiography (ESE) is a well-validated technique in adult population, its use in children is quite limited. We aimed to assess the feasibility, the safety and the reproducibility of ESE, using on-line scanning in semi-supine cyclo-ergometer protocol in a large pediatric population. Between July 2008 and January 2013, 42 patients (mean age 14 ± 3) were evaluated with a bicycle ESE performing 50 studies. ESE was successfully performed and well tolerated by all patients. None of the patients presented with adverse effects of stress-induced ischemia. HR was 82 ± 13 at rest, and 153 ± 19.1 during peak exercise. Among 544 views analyzed for grading of image quality, the visualization was optimal in 473 (87 %), suboptimal in 39, and inadequate in 32 (6 %). 37 tests were performed in patients with congenital or acquired coronary abnormality. Regional wall motion abnormalities (RWMA) were revealed in nine cases (24 %). The agreement between the two different observers showed a K index of 0.7276 (95 % CI 0.6497-0.8055) for the image quality and a K index of 0.5125 (95 % CI 0.4782-0.5468) for the RWMA analysis. Among ten patients with hypertrophic cardiomyopathy, we were able to demonstrate the new comparison of significant left ventricular outflow tract gradient (?30 mmHg) during exercise in three patients (30 %). Bicycle stress echocardiography performed by on-line scanning during exercise is a feasible, safe, and reproducible modality in children. Further data to assess its diagnostic accuracy are, however, needed. Stress echocardiography provides a dynamic assessment of the myocardial structure and function under conditions of physiologic or pharmacologic stress. PMID:25410823

  16. Feature extraction and wall motion classification of 2D stress echocardiography with support vector machines

    NASA Astrophysics Data System (ADS)

    Chykeyuk, Kiryl; Clifton, David A.; Noble, J. Alison

    2011-03-01

    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).

  17. Spatial compounding of large sets of 3D echocardiography images

    NASA Astrophysics Data System (ADS)

    Yao, Cheng; Simpson, John M.; Jansen, Christian H. P.; King, Andrew P.; Penney, Graeme P.

    2009-02-01

    We present novel methodologies for compounding large numbers of 3D echocardiography volumes. Our aim is to investigate the effect of using an increased number of images, and to compare the performance of different compounding methods on image quality. Three sets of 3D echocardiography images were acquired from three volunteers. Each set of data (containing 10+ images) were registered using external tracking followed by state-of-the-art image registration. Four compounding methods were investigated, mean, maximum, and two methods derived from phase-based compounding. The compounded images were compared by calculating signal-to-noise ratios and contrast at manually identified anatomical positions within the images, and by visual inspection by experienced echocardiographers. Our results indicate that signal-to-noise ratio and contrast can be improved using increased number of images, and that a coherent compounded image can be produced using large (10+) numbers of 3D volumes.

  18. Use of adenosine echocardiography for diagnosis of coronary artery disease

    SciTech Connect

    Zoghbi, W.A. )

    1991-07-01

    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.

  19. On-Orbit Prospective Echocardiography on International Space Station

    NASA Technical Reports Server (NTRS)

    Hamilton, Douglas R.; Sargsyan, Ashot E.; Martin, David; Garcia, Kathleen M.; Melton, Shannon; Feiverson, Alan; Dulchavsky, Scott A.

    2010-01-01

    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.

  20. Influence of psoriasis on circulatory system function assessed in echocardiography.

    PubMed

    Milaniuk, Sylwia; Pietrzak, Aldona; Mosiewicz, Barbara; Mosiewicz, Jerzy; Reich, Kristian

    2015-12-01

    Psoriasis vulgaris is a chronic disease with a multifactorial pathogenesis. It affects about 2-4 % of the population all over the world. In course of psoriatic arthritis, joints' damages are observed. In patients with psoriasis vulgaris and psoriatic arthritis, there is increased morbidity and mortality caused by cardiovascular diseases observed. The aim of the study is to analyze the echocardiography of patients with psoriasis vulgaris and psoriatic arthritis on the basis of the literature available in PubMed database. Abnormalities found in echocardiography of patients with psoriasis include valvular defects (40.7 % of the patients), left ventricle diastolic dysfunction (27.8 %), and left ventricle hypertrophy (11.1 %). Left ventricle's systolic disorders, increased aorta stiffness index and increased pulmonary artery blood pressure were also observed in this group of patients. PMID:26121943

  1. Current Clinical Application of Intracardiac Flow Analysis Using Echocardiography

    PubMed Central

    Kim, Minji; Pedrizzetti, Gianni; Vannan, Mani A

    2013-01-01

    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. PMID:24459561

  2. Transoesophageal echocardiography reduces invasiveness of cavoatrial tumour thrombectomy

    PubMed Central

    Sobczy?ski, Robert; Mazur, Piotr; Ch?osta, Piotr

    2014-01-01

    The traditional approach to cavoatrial thrombus excision requires median sternotomy, cardiopulmonary bypass with or without hypothermia and circulatory arrest and is associated with significant morbidity and mortality. We describe a transoesophageal echocardiography guided balloon catheter assisted technique for cavoatrial thrombectomy that avoids thoracotomy, extracorporeal circulation and circulatory arrest as an alternative to traditional methods. A 74-year-old man presented with a right solid renal mass confined to the kidney with thrombus extension through the right renal vein and the inferior vena cava into the right atrium. A right radical nephrectomy with cavoatrial thrombectomy under transoesophageal echocardiography guidance was successfully achieved using a balloon catheter-assisted technique with minimal intra-and postoperative morbidity. Cavoatrial tumour thrombectomy can be successfully performed without cardiopulmonary bypass, hypothermia and circulatory arrest. PMID:25337178

  3. How best to assess right ventricular function by echocardiography*

    PubMed Central

    DiLorenzo, Michael P.; Bhatt, Shivani M.; Mercer-Rosa, Laura

    2016-01-01

    Right ventricular function is a crucial determinant of long-term outcomes of children with heart disease. Quantification of right ventricular systolic and diastolic performance by echocardiography is of paramount importance, given the prevalence of children with heart disease, particularly those with involvement of the right heart, such as single or systemic right ventricles, tetralogy of Fallot, and pulmonary arterial hypertension. Identification of poor right ventricular performance can provide an opportunity to intervene. In this review, we will go through the different systolic and diastolic indices, as well as their application in practice. Quantification of right ventricular function is possible and should be routinely performed using a combination of different measures, taking into account each disease state. Quantification is extremely useful for individual patient follow-up. Laboratories should continue to strive to optimise reproducibility through quality improvement and quality assurance efforts in addition to investing in technology and training for new, promising techniques, such as three-dimensional echocardiography. PMID:26675593

  4. Transesophageal echocardiography probe shutdown in a patient with hyperthermia

    PubMed Central

    Saluja, Vandana; Singh, Gaganpal; Pandey, Chandrakant

    2016-01-01

    The use of transesophageal echocardiography (TEE) has been increasing over the past few years. It is considered a semi-invasive monitor and a safe diagnostic device. Though complications are rare, they must be known to operators who frequently perform TEE. TEE probes are known to cause tissue heating and damage on prolonged use. In this case report, we describe shutdown of the transesophageal probe in our patient with high-grade fever.

  5. Open access echocardiography is feasible in the Netherlands

    PubMed Central

    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.

    2006-01-01

    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. PMID:25696570

  6. 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)

    PubMed Central

    Komori, Hiroyuki; Beppu, Toru; Sakamoto, Yasuo; Miyamoto, Yuji; Hayashi, Hiromitsu; Imai, Katsunori; Nitta, Hidetoshi; Watanabe, Masayuki; Baba, Hideo

    2014-01-01

    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). PMID:25031875

  7. 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).

    PubMed

    Komori, Hiroyuki; Beppu, Toru; Sakamoto, Yasuo; Miyamoto, Yuji; Hayashi, Hiromitsu; Imai, Katsunori; Nitta, Hidetoshi; Watanabe, Masayuki; Baba, Hideo

    2014-01-01

    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). PMID:25031875

  8. Assessment of myocardial perfusion using contrast echocardiography – Case report

    PubMed Central

    Rotaru, L; Nanea, T

    2015-01-01

    Contrast echocardiography is a technique that improves endocardial demarcation and provides real-time data on blood circulation (blood flow, velocity). Left ventricle imaging study using contrast agents that cross the pulmonary circulation allows an improved visualization of endocardial tissue. This creates a more accurate ultrasound evaluation of left ventricular dimensions and its kinetics. Contrast echocardiography can improve Doppler mode evaluation and can provide information on myocardial perfusion precisely through this mechanism. Microbubble contrast agents are second-generation ultrasound contrast agents and are especially useful in endocardial demarcation. Second generation ultrasound contrast agents available now, include “Definity”, “Optison” - available in almost all countries with an average medical system except for Europe and “SonoVue” - available in most European countries. Contrast agents are represented by microbubbles between 1-10?m in diameter, containing a gas surrounded by a phospholipid membrane (SonoVue) or protein (Optison). Because the microbubble ultrasound characteristics used are different from the characteristics of the surrounding tissue or blood elements and cardiac structures, their diffusion produce very strong acoustic signals, which are directly proportional to blood volume. Quantitative assessment of myocardial microcirculation is now possible due to the advancing techniques in contrast echocardiography, provided that the left ventricular cavity has an increased echogenicity compared with the surrounding myocardium (which has a lower blood volume). PMID:26664473

  9. Visualization techniques for improved orientation in three-dimensional echocardiography

    NASA Astrophysics Data System (ADS)

    Wolf, Ivo; de Simone, Raffaele; Hastenteufel, Mark; Mottl-Link, Sibylle; Meinzer, Hans-Peter

    2002-05-01

    Repair of a defect heart valve is of great advantage for the patient in comparison to replacement with a prosthesis. The applicability and the success of heart valve repair can be improved by an exact diagnosis of the valve's pathological modification. The best way for imaging heart valve insufficiencies is echocardiography, since it is fast, relatively cheap, can be used intraoperatively and provides information about morphology as well as blood flow. Three-dimensional echocardiography has been proven to be superior to conventional echocardiographic techniques. Although the overall structures are much better displayed by three-dimensional visualization methods, it is sometimes difficult to comprehend the orientation of the scene, since anatomical landmarks like the aortic outflow tract may be hidden by other structures. Also, such anatomical landmarks often are only partly contained in the acquired data set so that they are clearly visible in a few slices only, making them difficult to find in a three-dimensional visualization. The knowledge of the absolute orientation is of essential value for the surgeon to mentally transfer the preoperatively acquired data to the intraoperative situs. Therefore, it is desirable to have additional hints for orientation in the three-dimensional scene. We present methods that enable better and easier orientation and therefore improve the usability of three-dimensional echocardiography.

  10. Assessment of myocardial perfusion using contrast echocardiography - Case report.

    PubMed

    Rotaru, L; Nanea, T

    2015-01-01

    Contrast echocardiography is a technique that improves endocardial demarcation and provides real-time data on blood circulation (blood flow, velocity). Left ventricle imaging study using contrast agents that cross the pulmonary circulation allows an improved visualization of endocardial tissue. This creates a more accurate ultrasound evaluation of left ventricular dimensions and its kinetics. Contrast echocardiography can improve Doppler mode evaluation and can provide information on myocardial perfusion precisely through this mechanism. Microbubble contrast agents are second-generation ultrasound contrast agents and are especially useful in endocardial demarcation. Second generation ultrasound contrast agents available now, include "Definity", "Optison" - available in almost all countries with an average medical system except for Europe and "SonoVue" - available in most European countries. Contrast agents are represented by microbubbles between 1-10?m in diameter, containing a gas surrounded by a phospholipid membrane (SonoVue) or protein (Optison). Because the microbubble ultrasound characteristics used are different from the characteristics of the surrounding tissue or blood elements and cardiac structures, their diffusion produce very strong acoustic signals, which are directly proportional to blood volume. Quantitative assessment of myocardial microcirculation is now possible due to the advancing techniques in contrast echocardiography, provided that the left ventricular cavity has an increased echogenicity compared with the surrounding myocardium (which has a lower blood volume). PMID:26664473

  11. [Diagnosis of thoracic aorta dissection using transesophageal echocardiography].

    PubMed

    Hernández Herrera, C; Morón-Malek, A; Romero-Cárdenas, A; Rijlaarsdam, M; Vargas-Barrón, J

    1994-01-01

    During a 36 month period there were 20 patients in our hospital with aortic dissection suspected clinically. All of them were examined with transesophageal echocardiography (TEE); 17 were examined with transthoracic echocardiography (TTE); six with computed tomography (CT) and seven with aortography. Twelve patients required surgery: eight with proximal aortic dissection (Type-A), two with distal dissection (Type-B) and two with aortic aneurysm without dissection. With the goal of investigating the utility of TEE for the diagnosis of aortic dissection in our hospital, we compared this and other available methods to the surgery findings. The sensitivity to TEE was 100% and the specificity 92%, with test accuracy at 92%. The sensitivity of the other tests was low: 66% with TTE; 50% with TAC; 57%, with aortography. The specificity was 90% with TTE, and higher with CT and aortography (100%). The ultrasound tests reveal additional information about complications like aortic regurgitation. Transesophageal echocardiography is the best test to examine patients with aortic dissection in our hospital. Computed tomography, aortography and magnetic resonance imaging have indication only to answer specific doubts. PMID:8074589

  12. Live 3D echocardiography with the pediatric matrix probe.

    PubMed

    Acar, Philippe; Abadir, Sylvia; Paranon, Soizic; Latcu, Gabriel; Grosjean, Juliette; Dulac, Yves

    2007-08-01

    Three-dimensional echocardiography (3DE) enables new views of heart valves and the septa to be imaged. While the previous 3DE system was cumbersome, the recent introduction of live 3DE allowed for routine use of the technique in adult patients. Here, we report our initial experiences in adapting live 3DE and the adult matrix probe to the pediatric population. Thirty-four 3DE examinations were performed on children, aged 1 day to 12 years (n = 23; median 4 years) and fetuses 20-33 weeks in gestation (n = 11; median 25 weeks), many of whom had various congenital heart diseases. The pediatric matrix probe (2-7 MHz) was used for 2D, Doppler, and 3DE. New modalities of the Vision 2007 (Philips) were applied: live, full volume, thick slice, 3D color Doppler, the QLAB system for navigation, and cropping. The pediatric matrix probe allows for complete 2D and 3D echocardiography, and new acoustic windows are now available to perform live 3DE. The higher frequency of the probe increases the 3D image resolution obtained in neonates and fetuses. This advancement allows new views of the aorta, pulmonary valve, septa and intra cardiac anatomy to be captured. Real time 3DE is a feasible method in addition to conventional 2D echocardiography for evaluating congenital heart disease. PMID:17651105

  13. Exercise treadmill saline contrast echocardiography for the detection of patent foramen ovale in hypoxia.

    PubMed

    Fenster, Brett E; Freeman, Andrew M; Silveira, Lori; Buckner, J Kern; Curran-Everett, Douglas; Carroll, John D

    2015-12-01

    Percutaneous patent foramen ovale (PFO) occluder placement improves dyspnea and oxygen requirement in hypoxic patients with PFO-mediated right-to-left shunt (RTLS). Although saline contrast echocardiography (SCE) in the resting state can identify PFO RTLS, SCE performed with exercise stress testing may provide incremental diagnostic yield compared to rest SCE. We evaluated the ability of exercise SCE to predict PFO presence and size using intracardiac echocardiography (ICE) as a gold standard in a hypoxic cohort. Thirty-three hypoxic patients with suspected PFO RTLS who underwent rest, Valsalva, and exercise stress SCE prior to ICE were evaluated retrospectively. PFO RTLS was defined by ICE findings including PFO anatomy, RTLS by saline contrast and color Doppler, and probe patency. SCE shunt severity was compared to the presence of ICE-defined PFO RTLS and PFO size. Exercise SCE for the detection of PFO RTLS performed with an area under the curve of 0.77, sensitivity of 73 %, and specificity of 86 %. Among 26 patients with PFO RTLS, exercise SCE identified four additional patients with PFO that had negative rest SCE and two patients with negative Valsalva SCE. Exercise SCE had a stronger correlation with PFO size than resting or Valsalva SCE. Exercise SCE detects PFO RTLS and predicts PFO size in a hypoxic cohort. In addition, exercise SCE can identify PFO RTLS that is otherwise undetected with rest or Valsalva SCE. Exercise SCE may be appropriate when a clinical suspicion for PFO RTLS persists despite negative rest and Valsalva SCE. PMID:26231342

  14. Incremental value of live/real time three-dimensional transthoracic echocardiography over two-dimensional echocardiography in hypertrophic cardiomyopathy with mid-ventricular obstruction and apical aneurysm.

    PubMed

    Thind, Munveer; Joson, Marisa; Gaba, Saurabh; Elsayed, Mahmoud; Bulur, Serkan; Guvenc, Tolga; Elguindy, Mostafa; Nanda, Navin C

    2015-03-01

    We describe a case of hypertrophic cardiomyopathy with mid-left ventricular obstruction and apical aneurysm containing thrombi where live/real time three-dimensional transthoracic echocardiography provided incremental value over two-dimensional echocardiography in assessing the findings. PMID:25418547

  15. Assessment of anomalous systemic and pulmonary venous connections by transoesophageal echocardiography in infants and children.

    PubMed Central

    Stümper, O; Vargas-Barron, J; Rijlaarsdam, M; Romero, A; Roelandt, J R; Hess, J; Sutherland, G R

    1991-01-01

    OBJECTIVE--To assess the value of transoesophageal echocardiography in the preoperative definition of systemic and pulmonary venous connections. DESIGN--Transoesophageal echocardiographic studies were performed prospectively under general anaesthesia in 76 consecutive unoperated children. Results were compared with those obtained by earlier transthoracic ultrasound studies (n = 76), cardiac catheterisation (n = 62), and subsequent surgical inspection (n = 58). SETTING--Two tertiary referral centres. PATIENTS--76 unoperated infants and children (age 0.2-14.8 years, mean age 4.1 years) with congenital heart disease. MAIN OUTCOME MEASURE--Identification of anomalous systemic and pulmonary venous connections. RESULTS--Transoesophageal studies showed anomalous venous connections in 14 patients. Two had both anomalous systemic and pulmonary venous connections. Transoesophageal studies showed 12 anomalous systemic venous connections in nine patients. In eight patients these were confirmed at operation or catheterisation: one patient is awaiting operation. Six anomalous systemic venous connections were missed during earlier transthoracic studies. Anomalous pulmonary venous connections (one mixed total, six partial) were shown in seven patients. These were confirmed at operation in six and by cardiac catheterisation in one. Four of these patients were missed during earlier transthoracic ultrasound studies. No patient defined as having normal venous connections by the transoesophageal study was subsequently shown to have anomalous venous connections at operation or angiography. CONCLUSIONS--Transoesophageal echocardiography is a highly sensitive tool for the preoperative definition of systemic and pulmonary venous connections. In this series it was better than transthoracic ultrasound and complemented cardiac catheterisation and angiocardiography. Images PMID:1772706

  16. Myocardial perfusion imaging using contrast echocardiography.

    PubMed

    Pathan, Faraz; Marwick, Thomas H

    2015-01-01

    Microbubbles are an excellent intravascular tracer, and both the rate of myocardial opacification (analogous to coronary microvascular perfusion) and contrast intensity (analogous to myocardial blood volume) provide unique insights into myocardial perfusion. A strong evidence base has been accumulated to show comparability with nuclear perfusion imaging and incremental diagnostic and prognostic value relative to wall motion analysis. This technique also provides the possibility to measure myocardial perfusion at the bedside. Despite all of these advantages, the technique is complicated, technically challenging, and has failed to scale legislative and financial hurdles. The development of targeted imaging and therapeutic interventions will hopefully rekindle interest in this interesting modality. PMID:25817740

  17. Advanced Echocardiography in Adult Zebrafish Reveals Delayed Recovery of Heart Function after Myocardial Cryoinjury

    PubMed Central

    Kossack, Mandy; Juergensen, Lonny; Fuchs, Dieter; Katus, Hugo A.; Hassel, David

    2015-01-01

    Translucent zebrafish larvae represent an established model to analyze genetics of cardiac development and human cardiac disease. More recently adult zebrafish are utilized to evaluate mechanisms of cardiac regeneration and by benefiting from recent genome editing technologies, including TALEN and CRISPR, adult zebrafish are emerging as a valuable in vivo model to evaluate novel disease genes and specifically validate disease causing mutations and their underlying pathomechanisms. However, methods to sensitively and non-invasively assess cardiac morphology and performance in adult zebrafish are still limited. We here present a standardized examination protocol to broadly assess cardiac performance in adult zebrafish by advancing conventional echocardiography with modern speckle-tracking analyses. This allows accurate detection of changes in cardiac performance and further enables highly sensitive assessment of regional myocardial motion and deformation in high spatio-temporal resolution. Combining conventional echocardiography measurements with radial and longitudinal velocity, displacement, strain, strain rate and myocardial wall delay rates after myocardial cryoinjury permitted to non-invasively determine injury dimensions and to longitudinally follow functional recovery during cardiac regeneration. We show that functional recovery of cryoinjured hearts occurs in three distinct phases. Importantly, the regeneration process after cryoinjury extends far beyond the proposed 45 days described for ventricular resection with reconstitution of myocardial performance up to 180 days post-injury (dpi). The imaging modalities evaluated here allow sensitive cardiac phenotyping and contribute to further establish adult zebrafish as valuable cardiac disease model beyond the larval developmental stage. PMID:25853735

  18. Left ventricular diastolic function in children measured by Doppler echocardiography: normal values and relation with growth.

    PubMed Central

    Bu'Lock, F. A.; Mott, M. G.; Martin, R. P.

    1995-01-01

    OBJECTIVES--To determine normal values for variables of left ventricular diastolic function in children measured by Doppler echocardiography and their relations to body surface area (BSA). BACKGROUND--There is increasing interest in echocardiographic assessment of left ventricular diastolic function in children but normal data for children are limited. METHODS--Assessment of left ventricular diastolic function was performed in 130 normal participants (aged from 2.4 months to 19.6 years) from their transmitral flow patterns obtained by pulsed wave Doppler echocardiography. RESULTS--Centile charts for commonly used left ventricular diastolic functional variables plotted against BSA are presented. Peak early diastolic filling velocity and atrial phase filling velocity integral were independent of BSA. Although most other filling indices showed strong relations with BSA, some had more curvilinear relations with BSA due to additional interactions with heart rate. The increase in left ventricular filling with growth is largely achieved by an increase in the early "passive" contribution to filling. The slower heart rates of older children are associated with lower atrial phase filling velocities but increased filling time, so the atrial contribution to filling remains relatively constant. CONCLUSIONS--Normal values of many left ventricular diastolic function variables change with growth in children and cannot be extrapolated from adult data. The data presented are suitable for use in size matched matched comparative studies of left ventricular function in children. Careful standardisation of echocardiographic protocols is necessary to ensure the validity of any comparisons. Images PMID:7756066

  19. Comparison Between Echocardiography and Cardiac Magnetic Resonance Imaging in Predicting Transplant-Free Survival After the Fontan Operation.

    PubMed

    Ghelani, Sunil J; Harrild, David M; Gauvreau, Kimberlee; Geva, Tal; Rathod, Rahul H

    2015-10-01

    Adverse outcomes increase in frequency as patients after Fontan operation approach adulthood. Cardiac magnetic resonance (CMR) imaging-derived parameters have been shown to predict death/transplant; however, limited data are available on the usefulness of echocardiography in risk stratification. We conducted a retrospective, single-center review of records of patients after Fontan operation with an echocardiogram and CMR within 1 year of each other. The primary end point was time to all-cause mortality or listing for transplant. Of the 127 eligible patients, there were 12 end points (9%; 10 deaths and 2 listing for transplant). Median age was 16.8 years (interquartile range 12 to 23.1) with a median follow-up of 3.8 years (interquartile range 2.6 to 5.7). Among clinical parameters, protein-losing enteropathy had the strongest association with the outcome. Among echocardiographic variables, global circumferential strain showed the strongest association (hazard ratio 1.3 per unit change, 95% confidence interval 1.1 to 1.5, p value 0.001, C-index 0.81), whereas among CMR variables indexed ventricular end-diastolic volume showed the strongest association with the outcome (hazard ratio 1.04 per 10 ml/BSA(1.3) increase in volume, 95% confidence interval 1.02 to 1.06, p value 0.001, C-index 0.82). Cox proportional hazards analysis revealed echocardiography and CMR models to each individually have a higher predictive ability than the clinical model; however, in direct comparison, neither technique was superior. In conclusion, both echocardiography-derived circumferential strain and CMR-derived ventricular end-diastolic volume index are associated with transplant-free survival in patients after Fontan operation. Echocardiography and CMR parameters have higher discriminative ability than clinical variables. Although neither imaging technique is superior in this cohort, both introduce important factors for risk stratification. PMID:26251003

  20. A Holographic Road Show.

    ERIC Educational Resources Information Center

    Kirkpatrick, Larry D.; Rugheimer, Mac

    1979-01-01

    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)

  1. Assessment of right ventricular volumes and ejection fraction by echocardiography: from geometric approximations to realistic shapes

    PubMed Central

    A Flachskampf, Frank

    2015-01-01

    Right ventricular volumes and ejection fraction are challenging to assess by echocardiography, but are well established as functional and prognostic parameters. Three-dimensional (3D) echocardiography has become widespread and relatively easy to use, making calculation of these parameters feasible in the large majority of patients. We review past attempts to estimate right ventricular volumes, current strengths and weaknesses of 3D echocardiography for this task, and compare with corresponding data from magnetic resonance imaging.

  2. Comparison of two-dimensional echocardiography with gated radionuclide ventriculography in the evaluation of global and regional left ventricular function in acute myocardial infarction

    SciTech Connect

    Van Reet, R.E.; Quinones, M.A.; Poliner, L.R.; Nelson, J.G.; Waggoner, A.D.; Kanon, D.; Lubetkin, S.J.; Pratt, C.M.; Winters, W.L. Jr.

    1984-02-01

    Two-dimensional echocardiography and gated radionuclide ventriculography were performed in 93 patients (66 men, 27 women; mean age 61 years) with 95 episodes of acute myocardial infarction within 48 hours and at 10 days after infarction. Abnormal motion of an inferior or posterior wall segment was seen in 91% of inferoposterior infarctions by echocardiography versus 61% seen by radionuclide ventriculography. Ejection fractions determined by echocardiography and radionuclide ventriculography correlated well (r . 0.82) and did not change from the first 48 hours to 10 days after infarction (0.48 +/- 0.14). Similarly, wall motion score showed minimal change from the first 48 hours to 10 days. In-hospital mortality was 37 and 42% in patients with an ejection fraction of 0.35 or less by echocardiography and radionuclide ventriculography, respectively. No mortality was seen in patients with an ejection fraction above 0.40 by either test. The echocardiographic wall motion score was also predictive of mortality (40 versus 2%; score less than or equal to 0.50 versus greater than 0.50). The 1 year mortality rate in the 81 short-term survivors was 17%. Mortality was lowest in patients with an ejection fraction above 0.49 or wall motion score above (0.79 (2 to 5%) and worse in those with an ejection fraction below 0.36 or wall motion score below 0.51 (36 to 63%) by either technique. Thus in acute myocardial infarction, echocardiography and radionuclide ventriculography provide a comparable assessment of left ventricular function and wall motion in anterior infarction. Echocardiography appears more sensitive in detecting inferoposterior wall motion abnormalities. Both techniques are capable of identifying subgroups of patients with a high risk of death during the acute event and with an equally high mortality rate over a 1 year follow-up period.

  3. A maximum likelihood approach to diffeomorphic speckle tracking for 3D strain estimation in echocardiography.

    PubMed

    Curiale, Ariel H; Vegas-Sánchez-Ferrero, Gonzalo; Bosch, Johan G; Aja-Fernández, Santiago

    2015-08-01

    The strain and strain-rate measures are commonly used for the analysis and assessment of regional myocardial function. In echocardiography (EC), the strain analysis became possible using Tissue Doppler Imaging (TDI). Unfortunately, this modality shows an important limitation: the angle between the myocardial movement and the ultrasound beam should be small to provide reliable measures. This constraint makes it difficult to provide strain measures of the entire myocardium. Alternative non-Doppler techniques such as Speckle Tracking (ST) can provide strain measures without angle constraints. However, the spatial resolution and the noisy appearance of speckle still make the strain estimation a challenging task in EC. Several maximum likelihood approaches have been proposed to statistically characterize the behavior of speckle, which results in a better performance of speckle tracking. However, those models do not consider common transformations to achieve the final B-mode image (e.g. interpolation). This paper proposes a new maximum likelihood approach for speckle tracking which effectively characterizes speckle of the final B-mode image. Its formulation provides a diffeomorphic scheme than can be efficiently optimized with a second-order method. The novelty of the method is threefold: First, the statistical characterization of speckle generalizes conventional speckle models (Rayleigh, Nakagami and Gamma) to a more versatile model for real data. Second, the formulation includes local correlation to increase the efficiency of frame-to-frame speckle tracking. Third, a probabilistic myocardial tissue characterization is used to automatically identify more reliable myocardial motions. The accuracy and agreement assessment was evaluated on a set of 16 synthetic image sequences for three different scenarios: normal, acute ischemia and acute dyssynchrony. The proposed method was compared to six speckle tracking methods. Results revealed that the proposed method is the most accurate method to measure the motion and strain with an average median motion error of 0.42 mm and a median strain error of 2.0 ± 0.9%, 2.1 ± 1.3% and 7.1 ± 4.9% for circumferential, longitudinal and radial strain respectively. It also showed its capability to identify abnormal segments with reduced cardiac function and timing differences for the dyssynchrony cases. These results indicate that the proposed diffeomorphic speckle tracking method provides robust and accurate motion and strain estimation. PMID:26084033

  4. Quantitation of mitral regurgitation after percutaneous MitraClip repair: comparison of Doppler echocardiography and cardiac magnetic resonance imaging

    PubMed Central

    Strugnell, Wendy; Gaikwad, Niranjan; Ischenko, Matthew; Speranza, Vicki; Chan, Jonathan; Neill, Johanne; Platts, David; Scalia, Gregory M.; Burstow, Darryl J.; Walters, Darren L.

    2015-01-01

    Objective Percutaneous valve intervention for severe mitral regurgitation (MR) using the MitraClip is a novel technology. Quantitative assessment of residual MR by transthoracic echocardiography (TTE) is challenging, with multiple eccentric jets and artifact from the clips. Cardiovascular magnetic resonance (CMR) is the reference standard for left and right ventricular volumetric assessment. CMR phase-contrast flow imaging has superior reproducibility for quantitation of MR compared to echocardiography. The objective of this study was to establish the feasibility and reproducibility of CMR in quantitating residual MR after MitraClip insertion in a prospective study. Methods Twenty-five patients underwent successful MitraClip insertion. Nine were excluded due to non-magnetic resonance imaging (MRI) compatible implants or arrhythmia, leaving 16 who underwent a comprehensive CMR examination at 1.5 T (Siemens Aera) with multiplanar steady state free precession (SSFP) cine imaging (cine CMR), and phase-contrast flow acquisitions (flow CMR) at the mitral annulus atrial to the MitraClip, and the proximal aorta. Same-day echocardiography was performed with two-dimensional (2D) visualization and Doppler. CMR and echocardiographic data were independently and blindly analyzed by expert readers. Inter-rater comparison was made by concordance correlation coefficient (CCC) with 95% confidence intervals (CIs), and Bland-Altman (BA) methods. Results Mean age was 79 years, and mean LVEF was 44%±11% by CMR and 54%±16% by echocardiography. Inter-observer reproducibility of echocardiographic visual categorical grading by expert readers was poor, with a CCC of 0.475 (?0.7, 0.74). Echocardiographic Doppler regurgitant fraction reproducibility was modest (CCC 0.59, 0.15-0.84; BA mean difference ?3.7%, ?38% to 31%). CMR regurgitant fraction reproducibility was excellent (CCC 0.95, 0.86-0.98; BA mean difference ?2.4%, ?11.9 to 7.0), with a lower mean difference and narrower limits of agreement compared to echocardiography. Categorical severity grading by CMR using published ranges had good inter-observer agreement (CCC 0.86, 0.62-0.95). Conclusions CMR performs very well in the quantitation of MR after MitraClip insertion, with excellent reproducibility compared to echocardiographic methods. CMR is a useful technique for the comprehensive evaluation of residual regurgitation in patients after MitraClip. Technical limitations exist for both techniques, and quantitation remains a challenge in some patients. PMID:26309843

  5. Novel techniques in stress echocardiography: a focus on the advantages and disadvantages.

    PubMed

    Vamvakidou, Anastasia; Gurunathan, Sothinathan; Senior, Roxy

    2016-04-01

    Stress echocardiography (SE) is an established tool not only for the assessment of coronary artery disease (CAD), but also for the evaluation of valvular disease and cardiomyopathy. New techniques, namely contrast echocardiography for function and perfusion including assessment of coronary flow reserve, strain imaging, 3-dimensional echocardiography, Doppler-derived coronary flow reserve and multimodality echocardiography, have been incorporated into stress protocols for improving assessment of cardiac disease. In this review, the advantages and disadvantages of these novel SE techniques are examined in terms of feasibility, accuracy, reproducibility and applications. PMID:26686698

  6. Dobutamine stress echocardiography in clinical practice with a review of the recent literature.

    PubMed Central

    Barasch, E; Wilansky, S

    1994-01-01

    Stress echocardiography has been developed in recent years as an effective noninvasive test for the detection and assessment of coronary artery disease. This method combines exercise with 2-dimensional echocardiography, which can assess regional and global left ventricular function during stress. Dobutamine infusion, a pharmacologic means of producing cardiovascular stress, appears to be an excellent alternative to exercise in echocardiographic studies. Currently, it is reserved for patients who cannot exercise at a meaningful level because of advanced age, physical deconditioning, or other factors. This review evaluates the current clinical application of dobutamine stress echocardiography and compares its efficacy with that of exercise echocardiography and nuclear perfusion imaging. PMID:8000267

  7. [Measurement of left atrial and ventricular volumes in real-time 3D echocardiography. Validation by nuclear magnetic resonance

    NASA Technical Reports Server (NTRS)

    Bauer, F.; Shiota, T.; Qin, J. X.; White, R. D.; Thomas, J. D.

    2001-01-01

    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.

  8. Echocardiography Comparison Between Two and Three Dimensional Echocardiograms

    NASA Technical Reports Server (NTRS)

    2003-01-01

    Echocardiography uses sound waves to image the heart and other organs. Developing a compact version of the latest technology improved the ease of monitoring crew member health, a critical task during long space flights. NASA researchers plan to adapt the three-dimensional (3-D) echocardiogram for space flight. The two-dimensional (2-D) echocardiogram utilized in orbit on the International Space Station (ISS) was effective, but difficult to use with precision. A heart image from a 2-D echocardiogram (left) is of a better quality than that from a 3-D device (right), but the 3-D imaging procedure is more user-friendly.

  9. [Transient apical ballooning syndrome during dobutamine stress echocardiography].

    PubMed

    Martínez-Quintana, Efrén; Miranda-García, Cristian; Gopar-Gopar, Silvia; Sáiz-Udaeta, Beatriz; Rodríguez-González, Fayna

    2014-01-01

    The transient left ventricular apical ballooning syndrome, also known as Tako-Tusbo syndrome, has an acute onset, is more common in postmenopausal women, and is characterized by transient left ventricular apical ballooning, chest pain, electrocardiographic abnormalities, and slight elevation of markers for myocardial injury, mimicking a myocardial infarction in patients with no significant coronary lesions. However, before making the diagnosis, other causes of reversible left ventricular dysfunction must be ruled out, such as subarachnoid hemorrhage, pheochromocytoma crisis, acute myocarditis, or the presence of tachycardiomyopathy. The case is presented of a patient who developed ST elevation electrocardiographic changes with apical transient dyskinesia during dobutamine stress echocardiography. PMID:24725681

  10. Non-ischaemic cardiac conditions: role of stress echocardiography

    PubMed Central

    2014-01-01

    Stress echocardiography (SE) has a unique ability for simultaneous assessment of both functional class and exercise-related haemodynamic changes and as such is increasingly recognised for the evaluation of non-coronary artery disease pathologies. Some indications such as valvular heart disease or hypertrophic cardiomyopathy have been well established already, while others such as diastolic exercise testing are emerging of late. This paper addresses the main and best established indications for SE in non-ischaemic conditions, providing a practical perspective correlated with updated guidelines. PMID:26693299

  11. Intraparenchymal haemorrhage and uncal herniation resulting from dobutamine stress echocardiography

    PubMed Central

    Bennin, Charles-Lwanga Kobina; Ramoutar, Virin; Velarde, Gladys

    2014-01-01

    Intracranial haemorrhage (ICH) resulting from dobutamine stress echocardiography (DSE) is a rare complication in an otherwise relatively safe procedure. There has been one previously reported case of ICH associated with DSE in a patient who was fully anticoagulated. The authors report a second case of ICH associated with DSE leading to a poor outcome. Unlike the previous report, this patient was not fully anticoagulated and bleeding resulted from uncontrolled hypertension. Clinicians should be attentive to the risk of ICH associated with DSE in the setting of uncontrolled hypertension. PMID:24642173

  12. Diagnostic Performance of Echocardiography for the Detection of Acute Cardiac Allograft Rejection: A Systematic Review and Meta-Analysis

    PubMed Central

    Pan, Xudong; Sun, Lizhong

    2015-01-01

    Objective Many studies have addressed the diagnostic performance of echocardiography to evaluate acute cardiac allograft rejection compared with endomyocardial biopsy. But the existence of heterogeneity limited its clinical application. Thus, we conducted a comprehensive, systematic literature review and meta-analysis for the purpose. Methods Studies prior to September 1, 2014 identified by Medline/PubMed, EMBASE and Cochrance were examined by two independent reviews. We conducted meta-analysis by using Meta-DiSc 1.4 software. An assessment tool of QUADAS-2 was applied to evaluate the risk of bias and applicability of the studies. Results Thirty studies met the inclusion criteria of meta-analysis. The four parameters of pressure half time, isovolumic relaxation time, index of myocardial performance and late diastolic mitral annular motion velocity were included in the meta-analysis, with a pooled diagnostic odds ratio of 10.43, 6.89, 15.95 and 5.68 respectively, and the area under the summary receiver operating characteristic curves value of 0.829, 0.599, 0.871 and 0.685 respectively. Conclusion The meta-analysis and systematic review demonstrate that no single parameter of echocardiography showed a reliable diagnostic performance for acute cardiac allograft rejection. A result of echocardiography for ACAR should be comprehensively considered by physicians in the context of clinical presentations and imaging feature. PMID:25822627

  13. Use of transoesophageal echocardiography during the peri-operative period for trauma patients.

    PubMed

    Smyth, K; Hebballi, R; Peterson, M K

    2010-12-01

    The medical facility at Camp Bastion continues to evolve as a consequence of the increased throughput of battlefield trauma patients. There is a requirement for rapid and accurate diagnosis of haemodynamic instability and continued haemodynamic monitoring throughout the peri-operative period. Transoesophageal echocardiography (TOE) has been used for this purpose in the arena of cardiac anaesthesia since the mid 1980s. It is being introduced to other peri-operative settings where severe haemodynamic instability is expected. The old proverb: 'There are none so blind as those who cannot see' (Jeremiah 5:21) is applicable to this topic, in that TOE is proven to be a rapid, portable, safe and effective tool in the assessment of the haemodynamically unstable patient. This paper explores the application of TOE for the assessment of the major causes of haemodynamic instability in the trauma population. PMID:21302659

  14. Left Atrium by Echocardiography in Clinical Practice: From Conventional Methods to New Echocardiographic Techniques

    PubMed Central

    Caso, Pio; D'Andrea, Antonello; Di Salvo, Giovanni; Arenga, Fortunato; Coppola, Maria Gabriella; Sellitto, Vincenzo; Macrino, Maria; Calabrò, Raffaele

    2014-01-01

    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. PMID:25009828

  15. Right ventricular strain analysis from three-dimensional echocardiography by using temporally diffeomorphic motion estimation

    PubMed Central

    Zhu, Meihua; Ashraf, Muhammad; Broberg, Craig S.; Sahn, David J.; Song, Xubo

    2014-01-01

    Purpose: Quantitative analysis of right ventricle (RV) motion is important for study of the mechanism of congenital and acquired diseases. Unlike left ventricle (LV), motion estimation of RV is more difficult because of its complex shape and thin myocardium. Although attempts of finite element models on MR images and speckle tracking on echocardiography have shown promising results on RV strain analysis, these methods can be improved since the temporal smoothness of the motion is not considered. Methods: The authors have proposed a temporally diffeomorphic motion estimation method in which a spatiotemporal transformation is estimated by optimization of a registration energy functional of the velocity field in their earlier work. The proposed motion estimation method is a fully automatic process for general image sequences. The authors apply the method by combining with a semiautomatic myocardium segmentation method to the RV strain analysis of three-dimensional (3D) echocardiographic sequences of five open-chest pigs under different steady states. Results: The authors compare the peak two-point strains derived by their method with those estimated from the sonomicrometry, the results show that they have high correlation. The motion of the right ventricular free wall is studied by using segmental strains. The baseline sequence results show that the segmental strains in their methods are consistent with results obtained by other image modalities such as MRI. The image sequences of pacing steady states show that segments with the largest strain variation coincide with the pacing sites. Conclusions: The high correlation of the peak two-point strains of their method and sonomicrometry under different steady states demonstrates that their RV motion estimation has high accuracy. The closeness of the segmental strain of their method to those from MRI shows the feasibility of their method in the study of RV function by using 3D echocardiography. The strain analysis of the pacing steady states shows the potential utility of their method in study on RV diseases. PMID:25471981

  16. Evaluation of short-axis and long-axis myocardial function with two-dimensional strain echocardiography in patients with different degrees of coronary artery stenosis.

    PubMed

    Deng, You-Bin; Liu, Rong; Wu, Yu-Han; Xiong, Li; Liu, Ya-Ni

    2010-02-01

    This study was designed to characterize the changes in the peak systolic longitudinal, circumferential and radial strains by using 2-D strain echocardiography in patients with coronary artery stenosis without segmental wall motion abnormalities on conventional 2-D echocardiography. 2D strain echocardiography was performed in 44 patients with different degrees of coronary artery stenosis. Myocardial longitudinal, circumferential and radial strain profiles were obtained and peak systolic strain values were measured. The peak systolic longitudinal strain was significantly reduced in myocardial segments subtended by coronary arteries with greater than 75% stenosis when compared with those subtended by coronary artery with less than 75% stenosis and those in control. Sensitivity and specificity were 74% and 72%, respectively, for peak systolic longitudinal strain to predict segments subtended by coronary arteries with greater than 75% stenosis (cutoff value--17.7%; area under the receiver operating characteristic curve, 0.825). There were no significant differences in circumferential and radial strains among myocardial segments subtended by coronary arteries with greater than 75% stenosis and those with less than 75% stenosis and in control. In conclusion, our study suggests that analysis of long-axis cardiac function by using the 2-D strain echocardiography may help to identify the myocardial segments subtended by coronary arteries with severe stenosis. PMID:20045591

  17. Reversion of Severe Mitral Insufficiency in Peripartum Cardiomyopathy Using Levosimendan

    PubMed Central

    Nieto Estrada, Victor H.; Molano Franco, Daniel L.; Valencia Moreno, Albert Alexander; Rojas Gambasica, Jose A.; Jaller Bornacelli, Yamil E.; Martinez Del Valle, Anacaona

    2015-01-01

    Idiopathic peripartum cardiomyopathy presenting with heart failure is a true diagnostic and treatment challenge. Goal oriented clinical management aims at the relapse of left ventricular systolic dysfunction. A 35-year-old patient on her 12th day post-delivery presents progressive signs of heart failure. Transthoracic echocardiography showed severe mitral insufficiency, mild left ventricular dysfunction, mild tricuspid insufficiency, severe pulmonary hypertension, and right atrial enlargement. With wet and cold heart failure signs, the patient was a candidate for inodilator cardiovascular support and volume depletion therapy. As the patient presented a persistent tachycardia at rest, levosimendan was chosen over dobutamine. Levosimendan was administered at a dose of 0.2 µg/kg/min during a period of 24 hours. After inodilator therapy, the patient’s signs and symptoms of heart failure began to decrease, showing improvement of dyspnea, mitral murmur grade went from IV/IV to II/IV, filling pressures and systemic and pulmonary resistance indexes decreased, arterial blood gases improved, and an echocardiography performed 72 h later showed non-dilated cardiomyopathy, mild cardiac contractile dysfunction, mild mitral insufficiency, type I diastolic dysfunction and improvement of pulmonary hypertension. Cardiovascular function in peripartum cardiomyopathy tends to go back to normality in 23-41% of the cases, but in a large group of patients, severe ventricle dysfunction remains months after initial symptoms. This article describes the diagnostic process of a patient with peripartum cardiomyopathy and a successful reversion of a severe case of mitral insufficiency using levosimendan as a new therapeutic strategy in this clinical context. PMID:26566415

  18. The transesophageal echocardiography simulator based on computed tomography images.

    PubMed

    Piórkowski, Adam; Kempny, Aleksander

    2013-02-01

    Simulators are a new tool in education in many fields, including medicine, where they greatly improve familiarity with medical procedures, reduce costs, and, importantly, cause no harm to patients. This is so in the case of transesophageal echocardiography (TEE), in which the use of a simulator facilitates spatial orientation and helps in case studies. The aim of the project described in this paper is to simulate an examination by TEE. This research makes use of available computed tomography data to simulate the corresponding echocardiographic view. This paper describes the essential characteristics that distinguish these two modalities and the key principles of the wave phenomena that should be considered in the simulation process, taking into account the conditions specific to the echocardiography. The construction of the CT2TEE (Web-based TEE simulator) is also presented. The considerations include ray-tracing and ray-casting techniques in the context of ultrasound beam and artifact simulation. An important aspect of the interaction with the user is raised. PMID:23144029

  19. Prognostic Value of Normal Stress Echocardiography in Obese Patients

    PubMed Central

    Murphy, Michele; Krothapalli, Siva; Cuellar, Jose; Kanjanauthai, Somsupha; Heeke, Brian; Gomadam, Pallavi S.; Guha, Avirup; Barnes, Vernon A.; Litwin, Sheldon E.; Sharma, Gyanendra K.

    2014-01-01

    Background. Chest pain is a common problem in obese patients. Because of the body habitus, the results of noninvasive evaluation for CAD may be limited in this group. Methods. We reviewed the records of 1446 consecutive patients who had undergone clinically indicated stress echocardiography (SE). We compared major adverse cardiac events (MACE; myocardial infarction, cardiac intervention, cardiac death, subsequent hospitalization for cardiac events, and emergency department visits) at 1 year in normal weight, overweight, and obese subjects with normal SE. Results. Excluding patients with an abnormal and indeterminate SE and those who were lost to follow-up, a retrospective analysis of 704 patients was performed. There were 366 obese patients (BMI ? 30), 196 overweight patients (BMI 25–29.9), and 142 patients with normal BMI (18.5–24.9). There was no MACE in the groups at 1-year follow-up after a normal SE. Conclusions. In obese patients including those with multiple risk factors and symptoms concerning for cardiac ischemia, stress echocardiography is an effective and reliable noninvasive tool for identifying those with a low 1-year risk of cardiac events. PMID:25258682

  20. [Predictive value of aortic atherosclerosis detected by transoesophageal echocardiography for the presumption of coronary artery disease].

    PubMed

    Ben Khalfallah, A; Najjar, K; Hadrich, M

    2004-09-01

    The aim of this study was to determine the relationship between plaques of aortic atheroma detected by transoesophageal echocardiography and the condition of the coronary arteries at coronary angiography. Two hundred and seventeen consecutive patients were included for systematic transoesophageal echocardiography blinded to the results of coronary angiography. Significant coronary disease was defined as stenosis of at least 70% of the artery lumen. Aortic atherosclerosis was classified in four grades. The average age of the patients was 54.5 +/- 10.5 years. The sex ratio was 2.55 in favour of men. The average coronary score was 5 +/- 4.5 and the lesion index was 1.1 +/- 0.96. One hundred and fifty-nine patients had aortic atheroma, 73% of which (80 cases) were complex lesions. The descending aorta was the commonest site (91%) followed by the transverse (40% and ascending aorta (14%). When the ascending aorta was affected there was a very significant association with coronary artery disease (100% of cases). Sixty-one per cent of patients had lesions of one aortic segment, 28% had lesions of two aortic segments and in 10%, all three aortic segments were involved. The presence of aortic atheroma was correlated with coronary artery disease with a sensitivity and specificity of 86% and 76% respectively. The positive and negative predictive values were 81% and 31% respectively. Seventy-five per cent of patients with a coronary score of at least 7 had aortic atheroma with complex lesions in 47% of cases. The lesion index was significantly higher in this group when the coronary score was less than 7 (1.98 +/- 0.8 vs 0.65 +/- 0.7, p<0.00001). Patients with coronary artery disease have more complex lesions of the descending than of the ascending aorta (94 vs 25%). Significant coronary artery disease was correlated with the presence of aortic atheroma, especially of the ascending aorta. The specificity and positive predictive values were 100% but the negative predictive value was poor, irrespective of the aortic segment involved (32% for the ascending aorta, 36% for the transverse and 35% for the descending aorta). The authors conclude that transoesophageal echocardiography of the thoracic aorta is a good method of predicting severe coronary atherosclerotic disease. PMID:15521479

  1. UK Cardiology Training in Core Echocardiography Symposium Report: the good the bad and the ugly

    PubMed Central

    Kydd, Anna; Sohaib, Afzal; Sarwar, Rizwan; Holdsworth, David

    2014-01-01

    Training in core echocardiography skills within the UK has been the focus of considerable discussion following recent national surveys. This article reports the proceedings of a joint meeting held by the British Society of Echocardiography and British Junior Cardiologists' Association. It considers the current issues impacting on high-quality training and presents potential solutions for the future.

  2. Multi-view 3D echocardiography compounding based on feature consistency

    NASA Astrophysics Data System (ADS)

    Yao, Cheng; Simpson, John M.; Schaeffter, Tobias; Penney, Graeme P.

    2011-09-01

    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.

  3. A safety checklist for transoesophageal echocardiography from the British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists

    PubMed Central

    Alderton, Susan; Steeds, Richard; Bradlow, Will; Chenzbraun, Adrian; Oxborough, David; Mathew, Thomas; Jones, Richard; Wheeler, Richard; Sandoval, Julie; Lloyd, Guy; O'Gallagher, Kevin; Knight, Daniel; Ring, Liam; Collins, Katherine; O'Keeffe, Niall; Fletcher, Nick; Harkness, Allan; Rana, Bushra

    2015-01-01

    The World Health Organisation (WHO) launched the Surgical Safety Checklist in 2008. The introduction of this checklist resulted in a significant reduction in the incidence of complications and death in patients undergoing surgery. Consequently, the WHO Surgical Safety checklist is recommended for use by the National Patient Safety Agency for all patients undergoing surgery. However, many invasive or interventional procedures occur outside the theatre setting and there are increasing requirements for a safety checklist to be used prior to such procedures. Transoesophageal echocardiography (TOE) is an invasive procedure and although generally considered to be safe, it carries the risk of serious and potentially life-threatening complications. Strict adherence to a safety checklist may reduce the rate of significant complications during TOE. However, the standard WHO Surgical Safety Checklist is not designed for procedures outside the theatre environment and therefore this document is designed to be a procedure-specific safety checklist for TOE. It has been endorsed for use by the British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists.

  4. A safety checklist for transoesophageal echocardiography from the British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists.

    PubMed

    Sharma, Vishal; Alderton, Susan; McNamara, Helen; Steeds, Richard; Bradlow, Will; Chenzbraun, Adrian; Oxborough, David; Mathew, Thomas; Jones, Richard; Wheeler, Richard; Sandoval, Julie; Lloyd, Guy; O'Gallagher, Kevin; Knight, Daniel; Ring, Liam; Collins, Katherine; O'Keeffe, Niall; Fletcher, Nick; Harkness, Allan; Rana, Bushra

    2015-12-01

    The World Health Organisation (WHO) launched the Surgical Safety Checklist in 2008. The introduction of this checklist resulted in a significant reduction in the incidence of complications and death in patients undergoing surgery. Consequently, the WHO Surgical Safety checklist is recommended for use by the National Patient Safety Agency for all patients undergoing surgery. However, many invasive or interventional procedures occur outside the theatre setting and there are increasing requirements for a safety checklist to be used prior to such procedures. Transoesophageal echocardiography (TOE) is an invasive procedure and although generally considered to be safe, it carries the risk of serious and potentially life-threatening complications. Strict adherence to a safety checklist may reduce the rate of significant complications during TOE. However, the standard WHO Surgical Safety Checklist is not designed for procedures outside the theatre environment and therefore this document is designed to be a procedure-specific safety checklist for TOE. It has been endorsed for use by the British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists. PMID:26798486

  5. Intra-cardiac echocardiography in alcohol septal ablation: a prospective comparative study against trans-thoracic echocardiography

    PubMed Central

    Shahzad, Adeel; Newton, James; Vejlstrup, Niels; Axelsson, Anna; Sharma, Vishal; Ormerod, OIiver; Stables, Rodney H

    2015-01-01

    Alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy reduces left ventricular outflow tract gradients. A third of patients do not respond; inaccurate localisation of the iatrogenic infarct can be responsible. Transthoracic echocardiography (TTE) using myocardial contrast can be difficult in the laboratory environment. Intra-cardiac echocardiography (ICE) provides high-quality images. We aimed to assess ICE against TTE in ASA. The ability of ICE and TTE to assess three key domains (mitral valve (MV) anatomy and systolic anterior motion, visualisation of target septum, adjacent structures) was evaluated in 20 consecutive patients undergoing ASA. Two independent experts scored paired TTE and ICE images off line for each domain in both groups. The ability to see myocardial contrast following septal arterial injection was also assessed by the cardiologist performing ASA. In patients undergoing ASA, ICE was superior in viewing MV anatomy (P=0.02). TTE was superior in assessing adjacent structures (P=0.002). There was no difference in assessing target septum. Myocardial contrast: ICE did not clearly identify the area of contrast in 17/19 patients due to dense acoustic shadowing (8/19) and inadequate opacification of the myocardium (6/19). ICE only clearly localised contrast in 2/19 cases. ICE does not visualise myocardial contrast well and therefore cannot be used to guide ASA. TTE was substantially better at viewing myocardial contrast. There was no significant difference between ICE and TTE in the overall ability to comment on cardiac anatomy relevant to ASA. PMID:26693311

  6. The diagnostic ability of echocardiography for infective endocarditis and its associated complications.

    PubMed

    Vilacosta, Isidre; Olmos, Carmen; de Agustín, Alberto; López, Javier; Islas, Fabián; Sarriá, Cristina; Ferrera, Carlos; Ortiz-Bautista, Carlos; Sánchez-Enrique, Cristina; Vivas, David; San Román, Alberto

    2015-11-01

    Echocardiography, transthoracic and transoesophageal, plays a key role in the diagnosis and prognosis assessment of patients with infective endocarditis. It constitutes a major Duke criterion and is pivotal in treatment guiding. Seven echocardiographic findings are major criteria in the diagnosis of infective endocarditis (IE) (vegetation, abscess, pseudoaneurysm, fistulae, new dehiscence of a prosthetic valve, perforation and valve aneurysm). Echocardiography must be performed as soon as endocarditis is suspected. Transoesophageal echocardiography should be done in most cases of left-sided endocarditis to better define the anatomic lesions and to rule out local complications. Transoesophageal echocardiography is not necessary in isolated right-sided native valve IE with good quality transthoracic examination and unequivocal echocardiographic findings. Echocardiography is a very useful tool to assess the prognosis of patients with IE at any time during the course of the disease. Echocardiographic predictors of poor outcome include presence of periannular complications, prosthetic dysfunction, low left ventricular ejection fraction, pulmonary hypertension and very large vegetations. PMID:26471429

  7. Imaging the heart: cardiac scintigraphy and echocardiography in US hospitals (1983)

    SciTech Connect

    McPhee, S.J.; Garnick, D.W.

    1986-10-01

    The rapid growth of cardiac catheterization has raised questions about the availability of less costly, noninvasive tests such as cardiac scintigraphy and echocardiography. To assess their availability and rates of use, we surveyed 3778 non-federal short-term US hospitals in June, 1983. Overall, 2605 hospitals (69%) offered /sup 201/Tl myocardial perfusion scans, 2580 (68%) 99mTc equilibrium gated blood pool scans, and 2483 (67%) cardiac shunt scans; 1679 hospitals (44%) offered M-mode and/or 2-dimensional echocardiography, and 768 (20%) pulsed Doppler echocardiography. Volumes of procedures varied enormously among hospitals capable of performing them. High volumes of both scintigraphy and echocardiography were performed in a small number of hospitals. Larger, voluntary, and teaching hospitals performed higher volumes of both procedures. Despite widespread availability of these noninvasive technologies, high volumes of both cardiac scintigraphy and echocardiography procedures are concentrated in a small number of US hospitals.

  8. Effect of color coding and subtraction on the accuracy of contrast echocardiography

    NASA Technical Reports Server (NTRS)

    Pasquet, A.; Greenberg, N.; Brunken, R.; Thomas, J. D.; Marwick, T. H.

    1999-01-01

    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.

  9. Patient-Specific Mitral Valve Closure Prediction using 3D Echocardiography

    PubMed Central

    Burlina, Philippe; Sprouse, Chad; Mukherjee, Ryan; DeMenthon, Daniel; Abraham, Theodore

    2013-01-01

    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. PMID:23497987

  10. Improvement of Automated Identification of the Heart Wall in Echocardiography by Suppressing Clutter Component

    NASA Astrophysics Data System (ADS)

    Takahashi, Hiroki; Hasegawa, Hideyuki; Kanai, Hiroshi

    2013-07-01

    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.

  11. Operator guidance in 2D echocardiography via 3D model to image registration

    NASA Astrophysics Data System (ADS)

    Bergmeir, Christoph; Subramanian, Navneeth

    2009-02-01

    Ubiquitous use of 2D ultrasound (US) is limited by the difficulty in interpretation of images for an untrained operator. We present a solution for operator guidance through visual cues via registration of US to a 3D model. The method is demonstrated on 2D echocardiography data, where we are able to localize the scan plane in relation to the standard planes on the 3D model. Our algorithm operates by pre-processing both the US and CT images to the most basic information- muscle, blood pool - using classification. Subsequently, these labels are registered using the match cardinality metric for binary labeled images. We evaluated our method on four parasternal long-axis and three parasternal short-axis images from different patients. Results show that our system is able to correctly distinguish between the different US standard views and is able to localize the scan on the 3D model, correctly on five out of seven cases.

  12. Patient-specific mitral valve closure prediction using 3D echocardiography.

    PubMed

    Burlina, Philippe; Sprouse, Chad; Mukherjee, Ryan; DeMenthon, Daniel; Abraham, Theodore

    2013-05-01

    This article presents an approach to modeling the closure of the mitral valve using patient-specific anatomical information derived from 3D transesophageal echocardiography (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 uses a tensile shape-finding approach based on energy minimization. This method is employed to predict the aptitude of the mitral valve leaflets to coapt. We tested the method using 10 intraoperative 3D TEE sequences by comparing the closed valve configuration predicted from the segmented open valve with 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. PMID:23497987

  13. Electrocardiographic detection of left atrial enlargement. Correlation of P wave with left atrial dimension by echocardiography.

    PubMed Central

    Chirife, R; Feitosa, G S; Frankl, W S

    1975-01-01

    The validity of various electrocardiographic P wave measurements was tested in 48 patients by comparing them to left atrial dimensions determined by echocardiography (echo), a proved method of left atrial size estimation. Of all the measurements considered, only the width of the P wave (PW), the P terminal force in lead V1 (PV1), and the PW/PR segment ratio (PW/PR) showed statistically significant correlations with left atrial size measurements by echo, with r values of 0-746, 0-491, and 0-479, respectively. The results indicated that P widths in excess of 105 ms were present in all the patients who had left atria equal to or greater than 3-8 cm by echo and in 11 per cent of patients without atrial enlargement (false positives), and that when measurements were less than 105 ms left atrial enlargement was unlikely. Images PMID:131563

  14. Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

    PubMed Central

    Okabe, Toshimasa; Julien, Howard M.; Kaliyadan, Antony G.; Siu, Henry

    2015-01-01

    In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment. PMID:26504446

  15. Quantitative approach using multiple single parameters versus visual assessment in dobutamine stress echocardiography

    PubMed Central

    2012-01-01

    Background A number of myocardial Doppler-derived velocity, strain myocardial imaging parameters (DMI) and speckle tracking imaging (STI) have been proposed for the quantification of myocardial ischemia during stress echocardiography. The purpose of the study was to identify the best single ultrasound quantitative parameter for prediction of significant coronary stenosis and compare it with visual assessment during dobutamine stress echocardiography (DSE). Methods Prospective analysis included data of 151 patients (age 61.8?±?9.2) who underwent dobutamine stress echocardiography for known (n?=?35) or suspected coronary artery disease (CAD) (n?=?36) or symptomatic chest pain (n?=?80), excluding patients with previous myocardial infarction. Systolic, post-systolic and diastolic velocities, strain and strain rate parameters were obtained at rest and at peak dobutamine challenge. Derivative markers as E'/A' ratio, post-systolic index and changes from rest to stress were calculated (98 parameters overall, predominantly longitudinal). Coronary angiography was chosen as reference method considering at least one stenosis ?70% per patient as significant CAD. The predictive value of quantitative parameters and wall motion score index (WMSI) was obtained using logistic regression and ROC analysis. Results The value of single parameters discriminated as independent predictors of CAD appeared to be modest (area under the curve [AUC] ranged from 0.63 to 0.72 for 16 PW-DMI, 12 CC-DMI and 12 STI markers), comparing to AUC of WMSI 0.88. Sensitivity, specificity and accuracy of visual DSE evaluation was 82.4% (95%CI 77.4%; 85.2%), 92.6% (95%CI 83.4%; 97.5%) and 86.0% (95%CI 79.5%; 89.6%), respectively, Youden index 0.75. Sensitivity, specificity and accuracy of single predictors ranged from 40.0% to 93.3% (95% CI 22.7%; 99.2%), from 34.2% to 88.7% (95% CI 25.6%; 94.1%) and from 45.8% to 80.0% (95% CI 37.5%; 87.2%) respectively, Youden index ranged from 0.20 to 0.52. Conclusions Multiple single quantitative parameters showed limited predictive ability to identify significant coronary artery stenosis. Visual assessment of DSE appears to be more accurate than single velocity and strain/strain rate markers in the diagnosis of CAD. PMID:22846395

  16. Value of adenosine infusion for infarct size determination using real-time myocardial contrast echocardiography

    PubMed Central

    Dourado, Paulo Magno Martins; Tsutsui, Jeane Mike; Chagas, Antonio Carlos Palandri; Sbano, João César Nunes; Aiello, Vera demarchi; da Luz, Protásio Lemos; Mathias Jr, Wilson; Ramires, Jose AF

    2006-01-01

    Background Myocardial contrast echocardiography has been used for determination of infarct size (IS) in experimental models. However, with intermittent harmonic imaging, IS seems to be underestimated immediately after reperfusion due to areas with preserved, yet dysfunctional, microvasculature. The use of exogenous vasodilators showed to be useful to unmask these infarcted areas with depressed coronary flow reserve. This study was undertaken to assess the value of adenosine for IS determination in an open-chest canine model of coronary occlusion and reperfusion, using real-time myocardial contrast echocardiography (RTMCE). Methods Nine dogs underwent 180 minutes of coronary occlusion followed by reperfusion. PESDA (Perfluorocarbon-Exposed Sonicated Dextrose Albumin) was used as contrast agent. IS was determined by RTMCE before and during adenosine infusion at a rate of 140 mcg·Kg-1·min-1. Post-mortem necrotic area was determined by triphenyl-tetrazolium chloride (TTC) staining. Results IS determined by RTMCE was 1.98 ± 1.30 cm2 and increased to 2.58 ± 1.53 cm2 during adenosine infusion (p = 0.004), with good correlation between measurements (r = 0.91; p < 0.01). The necrotic area determined by TTC was 2.29 ± 1.36 cm2 and showed no significant difference with IS determined by RTMCE before or during hyperemia. A slight better correlation between RTMCE and TTC measurements was observed during adenosine (r = 0.99; p < 0.001) then before it (r = 0.92; p = 0.0013). Conclusion RTMCE can accurately determine IS in immediate period after acute myocardial infarction. Adenosine infusion results in a slight better detection of actual size of myocardial damage. PMID:16466579

  17. Altered mitral inflow orifice in severe aortic regurgitation: real time three-dimensional echocardiographic findings.

    PubMed

    Bertrand, Philippe B; Verhaert, David; Vandervoort, Pieter

    2014-01-01

    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

  18. Optical Flow Active Contours with Primitive Shape Priors for Echocardiography

    NASA Astrophysics Data System (ADS)

    Hamou, Ali K.; El-Sakka, Mahmoud R.

    2009-12-01

    Accurate delineation of object borders is highly desirable in echocardiography, especially at the left ventricle. Among other model-based techniques, active contours (or snakes) provide a unique and powerful approach to image analysis. In this work, we propose the use of a new external energy for a gradient vector flow (GVF) snake, being the optical flow of a moving sequence (modeling the mechanical movement of the heart). This external energy can provide additional information to the active contour model garnering adequate results for moving sequences. An automatic iterative primitive shape prior was also applied in order to further improve the results of a GVF snake, when dealing with especially noisy echocardiographic images. Results were compared with expert-defined segmentations yielding acceptable sensitivity, precision rate and overlap ratio performance.

  19. The role of intracardiac echocardiography in interventional electrophysiology.

    PubMed

    Knackstedt, C; Mischke, K; Frechen, D; Gramley, F; Schimpf, T; Becker, M; Franke, A; Kelm, M; Schauerte, P

    2007-12-01

    Visualization of the cardiac anatomy becomes more and more important as the complexity of interventions increases. Intracardiac echocardiography (ICE) provides good depiction of cardiac soft tissue structures and has become an important tool in today's cardiology. It has been shown to be valuable during many ablation procedures for supraventricular and ventricular arrhythmias. ICE has been used for monitoring catheter placement, observing catheter-tissue contact and lesion formation as well as titrating ablation energy. The rate of complications could be reduced, outcome of procedures improved and radiation exposure decreased. Even more, new therapy strategies have been evaluated based on ICE and it has also been used in the setting of three- dimensional imaging and image integration. PMID:18091644

  20. On-Orbit Prospective Echocardiography on International Space Station Crew

    NASA Technical Reports Server (NTRS)

    Hamilton, Douglas R.; Sargsyan, Ashot E.; Martin, David S.; Garcia, Kathleen M.; Melton, Shannon L.; Feiveson, Alan; Dulchavsky, Scott A.

    2010-01-01

    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.

  1. Extreme Tele-Echocardiography: Methodology for Remote Guidance of In-flight Echocardiography Aboard the International Space Station

    NASA Technical Reports Server (NTRS)

    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.

    2011-01-01

    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.

  2. LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice.

    PubMed

    Armstrong, Anderson C; Gidding, Samuel; Gjesdal, Ola; Wu, Colin; Bluemke, David A; Lima, João A C

    2012-08-01

    The authors investigated 3 important areas related to the clinical use of left ventricular mass (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 (LV) as a prolate ellipsoid of revolution. CMR permits a modeling of the LV 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 body surface area 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 the allometric power of 1.7 or 2.7 is the most promising normalization method in terms of practicality and usefulness from a clinical and scientific standpoint for scaling myocardial mass to body size. The measurement of LVM, calculation of LVM index, and classification for LV hypertrophy should be standardized by scientific societies across measurement techniques and adopted by clinicians in risk stratification and therapeutic decision making. PMID:22897998

  3. Interrogating Congenital Heart Defects with Noninvasive Fetal Echocardiography in a Mouse Forward Genetic Screen

    PubMed Central

    Liu, Xiaoqin; Francis, Richard; Kim, Andrew J.; Ramirez, Ricardo; Chen, Guozhen; Subramanian, Ramiah; Anderton, Shane; Kim, Youngsil; Wong, Liyin; Morgan, Judy; Pratt, C. Herbert; Reinholdt, Laura; Devine, William; Leatherbury, Linda; Tobita, Kimimasa; Lo, Cecilia W.

    2014-01-01

    Background Congenital heart disease (CHD) has a multifactorial etiology, but a genetic contribution is indicated by heritability studies. To investigate the spectrum of CHD with a genetic etiology, we conducted a forward genetic screen in inbred mice using fetal echocardiography to recover mutants with CHD. Mice are ideally suited for these studies, given they have the same four-chamber cardiac anatomy that is the substrate for CHD. Methods and Results Ethylnitrosourea mutagenized mice were ultrasound interrogated by fetal echocardiography using a clinical ultrasound system, and fetuses suspected to have cardiac abnormalities were further interrogated with an ultra-high frequency ultrasound biomicroscopy (UBM). Scanning of 46,270 fetuses revealed 1,722 with cardiac anomalies, with 27.9% dying prenatally. Most of the structural heart defects can be diagnosed using the UBM, but not with the clinical ultrasound system. Confirmation with analysis by necropsy and histopathology showed excellent diagnostic capability of UBM for most CHD. Ventricular septal defect was the most common CHD observed, while outflow tract and atrioventricular septal defects were the most prevalent complex CHD. Cardiac/visceral organ situs defects were observed at surprisingly high incidence. The rarest CHD found was hypoplastic left heart syndrome (HLHS), a phenotype never seen in mice previously. Conclusions We developed a high throughput two-tier ultrasound phenotyping strategy for efficient recovery of even rare CHD phenotypes, including the first mouse models of HLHS. Our findings support a genetic etiology for a wide spectrum of CHD and suggest the disruption of left-right patterning may play an important role in CHD. PMID:24319090

  4. Endurance and Strength Athlete's Heart: Analysis of Myocardial Deformation by Speckle Tracking Echocardiography

    PubMed Central

    Santoro, Amato; Antonelli, Giovanni; Caputo, Maria; Padeletti, Margherita; Lisi, Matteo; Mondillo, Sergio

    2014-01-01

    Background Intensive training induces two morphological myocardial typologies of athlete's heart. Endurance training (ET) induces eccentric remodeling, bradycardia and better diastolic filling. Strength training (ST) determines concentric chamber remodelling maintaining a normal heart rate (HR). Aim of the study was to compare ET and ST athletes' heart using speckle tracking echocardiography (STE). Methods 33 professional ET, 36 ST athletes, and 17 healthy controls (CT) were enrolled. All subjects underwent standard transthoracic echocardiography at rest and STE. Results In ET group, HR was lower than ST group and CT group (p < 0.001; p < 0.01). ET group had higher E/A ratio than ST group and CT group (p < 0.01; p < 0.001). The left ventricular apical circumferential strain in ET group was lower than ST group and CT group (-21.6 ± 4.1% vs. -26.8 ± 7.7%, p < 0.05; vs. -27.8 ± 5.6%, p < 0.01). ET group had lower left ventricular twist (LVT) and untwisting (UTW) than ST group (6.2 ± 0.1° vs. 12.0 ± 0.1°, p < 0.01; -67.3 ± 22.9°/s vs. -122.5 ± 52.8°/s, p < 0.01) and CT group (10.0 ± 0.1°, p < 0.01; -103.3 ± 29.3°/s, p < 0.01). The univariate analysis showed significant correlation between E/A ratio and HR (r = -0.54; p < 0.001), LVT (r = -0.45; p < 0.01), UTW (r = 0.24; p < 0.05). At the multivariate analysis only HR was confirmed as independent predictor of diastolic function in all groups (Beta -0.52; p < 0.001). Conclusion In ET there was a better global systolic and diastolic functional reserve at rest observed with strain analysis and it maybe depended on autonomic modulation. PMID:25580194

  5. Indium-111 platelet scintigraphy and two-dimensional echocardiography for detection of left ventricular thrombus: influence of clot size and age

    SciTech Connect

    Seabold, J.E.; Schroeder, E.C.; Conrad, G.R.; Ponto, J.; Bruch, P.; Petersen, D.; Johnson, J.; Kieso, R.; Hunt, M.; Olson, J.D.

    1987-05-01

    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.

  6. History of echocardiography in the Netherlands: 30 years of education and clinical applications

    PubMed Central

    Kamp, O.

    2008-01-01

    The development of ultrasound has created great opportunities for diagnostic cardiac imaging. For more than 30 years, echocardiography has been the most important and cost-effective diagnostic imaging modality in clinical cardiology. Many developments originated in the Netherlands, including the very first practical real-time crosssectional imaging of the moving heart with a linear array. Milestones include the first portable echo apparatus, early versions of echo catheters and transoesophageal echocardiography probes as well as many clinical ‘firsts’ with reference to the more than 100 Dutch dissertations related to echocardiography. The future of echocardiography promises to be as productive and exciting as it has been in the previous three decades, including threedimensional echocardiography, myocardial perfusion echocardiography, tissue Doppler imaging and speckle tracking. New potential therapeutic applications are upcoming. In this article, the advances of echocardiography in the Netherlands are described, in the past and during 30 years of education, as was recently presented by three Dutch pioneers during the ‘Echomiddagen 2006-2007’ organised by the CVOI. (Neth Heart J 2008;16:16-20.18317539) PMID:18317539

  7. Usefulness of adenosine triphosphate-atropine stress echocardiography for detecting coronary artery stenosis.

    PubMed

    Miyazono, Y; Kisanuki, A; Toyonaga, K; Matsushita, R; Otsuji, Y; Arima, S; Nakao, S; Tanaka, H

    1998-08-01

    There have been few studies on adenosine triphosphate (AT) stress echocardiography. The AT stress test may have fewer adverse effects than the adenosine stress test. The addition of atropine to AT echocardiography may enhance the sensitivity for detection of coronary artery disease (CAD). The purpose of this study was to determine the utility of AT-atropine echocardiography for detection of CAD. The group studied consisted of 112 patients with suspected CAD. Sixty-one patients did not have a history of prior myocardial infarction (group I) and 51 patients did (group II). AT was infused intravenously at 180 microg/kg/min for 14 minutes. Atropine (0.25 mg intravenously, repeated up to maximum total dose of 1 mg) was administered starting after 8 minutes of AT infusion. Ischemic response was defined as new or worsening wall motion abnormality occurring during the infusion. The sensitivity and specificity for detection of CAD were assessed using the representative echocardiograms during single AT infusion and AT-atropine infusion. Sixty-two patients had CAD. Fifty-eight patients (52%) developed minor side effects that resolved promptly. The rate-pressure product (10(3)/mm Hg beats/min) was significantly increased at 12 minutes of infusion (12.4+/-3.2) compared with that at baseline (9.1+/-2.3) and that at 6 minutes of infusion (9.4+/-2.1). The sensitivity for detection of CAD was 45% for AT echocardiography and 74% for AT-atropine echocardiography. The specificity was 94% for AT echocardiography and 90% for AT-atropine echocardiography. The sensitivity and specificity of AT-atropine echocardiography was 78% and 93%, respectively, in group I, and 70% and 86%, respectively, in group II. In conclusion, AT-atropine stress echocardiography seems to be well tolerated, safe, and useful for detection of CAD. PMID:9708655

  8. Three-Dimensional Transesophageal Echocardiography in the Anatomical Assessment of Isolated Parachute Mitral Valve in an Adult Patient.

    PubMed

    López-Pardo, Francisco; Urbano-Moral, Jose Angel; González-Calle, Antonio; Laviana-Martinez, Fernando; Esteve-Ruiz, Iris; Lagos-Degrande, Oscar; López-Haldon, Jose E

    2015-11-01

    Parachute mitral valve (PMV) is a rare congenital anomaly of the mitral valve apparatus usually evidenced in infants and young children. Adult presentation is extremely rare and is generally mild in terms of mitral stenosis. A 73-year-old woman was admitted to the emergency department due to progressive dyspnea, with NYHA functional class IV symptoms on presentation. The echocardiographic examination identified a PMV with moderate mitral stenosis and a secondary smaller subvalvular mitral orifice. The report shows the usefulness of three-dimensional transesophageal echocardiography in the detection and quantification of this rare anomaly. PMID:26096823

  9. Comparison of Transesophageal and Transthoracic Contrast Echocardiography for Detection of a Patent Foramen Ovale

    NASA Technical Reports Server (NTRS)

    Siostrzonek, Peter; Zangeneh, Massoud; Gossinger, Heinz; Lang, Wilfried; Rosenmayr, Georg; Heinz, Gottfried; Stumpflen, Andreas; Zeiler, Karl; Schwarz, Martin; Mosslacher, Herbert

    1991-01-01

    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.

  10. Cardiac output monitoring by echocardiography: should we pass on Swan-Ganz catheters?

    PubMed Central

    Perrino, A. C.

    1993-01-01

    Transesophageal echocardiography offers a noninvasive technique for the continuous monitoring of cardiac performance. The combination of 2-dimensional echocardiography and Doppler velocitometry provide assessment of cardiac anatomy, valve function and, ventricular loading conditions. Although transesophageal echocardiography has become accepted for perioperative monitoring, it is typically used in conjunction with Swan-Ganz catheterization. To supplant Swan-Ganz catheters, an echocardiographic technique to monitor cardiac output is necessary. Despite considerable effort to achieve this goal, a satisfactory technique has been difficult to realize. This paper discusses the role of cardiac output monitoring in perioperative care and critically examines echocardiographic techniques for cardiac output monitoring. Images Figure 4 Figure 7 Figure 10 PMID:7825341

  11. Obesity in show cats.

    PubMed

    Corbee, R J

    2014-12-01

    Obesity is an important disease with a high prevalence in cats. Because obesity is related to several other diseases, it is important to identify the population at risk. Several risk factors for obesity have been described in the literature. A higher incidence of obesity in certain cat breeds has been suggested. The aim of this study was to determine whether obesity occurs more often in certain breeds. The second aim was to relate the increased prevalence of obesity in certain breeds to the official standards of that breed. To this end, 268 cats of 22 different breeds investigated by determining their body condition score (BCS) on a nine-point scale by inspection and palpation, at two different cat shows. Overall, 45.5% of the show cats had a BCS > 5, and 4.5% of the show cats had a BCS > 7. There were significant differences between breeds, which could be related to the breed standards. Most overweight and obese cats were in the neutered group. It warrants firm discussions with breeders and cat show judges to come to different interpretations of the standards in order to prevent overweight conditions in certain breeds from being the standard of beauty. Neutering predisposes for obesity and requires early nutritional intervention to prevent obese conditions. PMID:24612018

  12. The use of intracardiac echocardiography during percutaneous pulmonary valve replacement.

    PubMed

    Awad, Sawsan M; Masood, Syed Asif; Gonzalez, Ismael; Cao, Qi-Ling; Abdulla, Ra-id; Heitschmidt, Mary G; Hijazi, Ziyad M

    2015-01-01

    High-quality live imaging assessment of cardiac valves and cardiac anatomy is crucial for the success of catheter-based procedures. We present our experience using Intracardiac echocardiography (ICE) during transcatheter Percutaneous Pulmonary Valve replacement (tPVR).This is a retrospective study that included 35 patients who underwent tPVR between April 2008 and June 2012. Thirty-one of these patients had the procedure performed under continuous ICE guidance. Pre-procedure transthoracic echocardiography (TTE) was obtained in all patients. ICE was performed at baseline, during the procedure, and at the conclusion of the procedure. Comparisons between the pre-procedure TTE and baseline ICE data and between post-procedure ICE data and the following day TTE were performed. Total of 35 patients had tPVR during the above-mentioned time period. Twenty-one patients received the Edwards Sapien valve and 14 patients had the Melody valve. Thirty-one patients had the procedure performed under continuous ICE guidance. The mean Pre-TTE peak gradient (PG) and Pre-ICE-PG were 45.5 ± 20 vs 33 ± 13 mmHg (p < 0.001) and the mean Pre-TTE mean gradient (MG) and Pre-ICE-MG were 27.7 ± 13 vs 21 ± 18 mmHg (p < 0.001). The mean Post-TTE- PG and Post-ICE-PG were 24.3 ± 11 vs 15.3 ± 7 mmHg (p < 0.001) and the mean of the Post-TTE-MG and Post-ICE-MG were 14.2 ± 7 vs 8.4 ± 4 mmHg (p < 0.001). There was a good correlation between peak ICE and TTE gradient at baseline and after valve placement. For the degree of pulmonary regurgitation, there was no significant difference between TTE and ICE. ICE is an important modality to guide tPVR in patients with dysfunctional homograft valve between the right ventricle and pulmonary artery and should be used to assess valve function before, during and immediately after the procedure. PMID:25070389

  13. Diagnostic Value of Fetal Echocardiography for Congenital Heart Disease

    PubMed Central

    Zhang, Ya-Fei; Zeng, Xian-Ling; Zhao, En-Fa; Lu, Hong-Wei

    2015-01-01

    Abstract Prenatal diagnosis of fetal congenital heart disease (CHD) has been shown to have a significant effect on prenatal and postnatal management and outcomes. However, the factors influencing the diagnostic accuracy and which pregnant trimester is the most adaptive for fetal heart disease remain uncertain despite of extensive researches. The aim of the present study was to evaluate the accuracy of echocardiography for detecting CHD and potential influence factors. We searched Chinese Biomedical Database (CBM), Medline, ISI Web of Knowledge, the Cochrane Library, and China National Knowledge Infrastructure (CNKI) to identify relevant studies from January 1, 1990 to August 13, 2015. Overall, the pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were 68.5% (95% confidence interval [CI], 66.8%–70.2%), 99.8% (95% CI, 99.7%–99.8%), 3026.9 (95% CI, 1417.9–6461.8), 659.41 (95% CI, 346.38–1255.3), and 0.246 (95% CI, 0.187–0.324) respectively (AUC?=?0.9924). The pooled sensitivity of basic cardiac echocardiographic examination (BCEE), extended cardiac echocardiographic examination (ECEE), BCEE plus outflow tract view (BCEE?+?OTV), BCEE?+?OTV?+?3VTV (BCEE plus outflow tract view plus three vessel and trachea view) for the prenatal diagnosis of CHD were 49.0%, 75.5%, 66.1%, and 83.7% respectively. The pooled sensitivity of the prenatal echocardiographic diagnosis of CHD during the first trimester, second trimester, the second to third trimester were 60.3%, 60.9%, and 77.4%, respectively. The pooled sensitivity of BCEE and ECEE for the prenatal diagnosis of CHD during the second to third trimester was significantly higher than that during the second trimester. The pooled sensitivity of the prenatal echocardiographic diagnosis of CHD for pregnancies with low risk, high risk, low and high risk, and unselected risk were 45.4%, 85.1%, 89.1%, and 66.2%, respectively. The sensitivity analysis was robust and risk level was significant source of heterogeneity. Deek test indicated no potential significant publication bias. Prenatal ultrasound is a powerful tool for the diagnosis of CHD; however, echocardiography has individual sensitivity for different gestation period, different levels of risk, and different echo-views. PMID:26496297

  14. The Role of Echocardiography in Diagnosing Space-Occupying Lesions of the Heart

    PubMed Central

    Ragland, Moluk Mirrasouli; Tak, Tahir

    2006-01-01

    In contrast to primary cardiac tumors, which are less frequent and mostly benign in nature, the majority of intracardiac tumors are metastatic lesions. Cardiac ultrasound has evolved enormously since its emergence in the 1950s and is presently the modality of choice for imaging space-occupying lesions of the heart; it provides high quality, real-time images that are extremely valuable in the evaluation of cardiac masses. Although transthoracic echocardiography is an excellent initial diagnostic technique to evaluate and diagnose cardiac masses, transesophageal echocardiography provides superior image resolution and better visualization of cardiac masses in patients with suboptimal transthoracic echocardiography studies. Computed tomography and magnetic resonance imaging are additional tools used for cardiac imaging and may provide useful information in addition to that obtained by echocardiography, especially when the images obtained by the latter are suboptimal. PMID:16595790

  15. Retrieval of a Dislodged Catheter Using Combined Fluoroscopy and Intracardiac Echocardiography

    PubMed Central

    Mitsopoulos, Gus; Hanna, Robert F.; Brejt, Sidney Z.; Goldstein, Greg E.; Sheynzon, Vladimir; Weintraub, Joshua L.; Gray, William A.

    2015-01-01

    This report details a method of percutaneous, transluminal retrieval of an intracardiac foreign body using fluoroscopy in combination with intracardiac echocardiography. During retrieval, intracardiac echocardiography (ICE) provided real-time anatomic localization of a constantly moving, almost radiolucent micropuncture coaxial dilator fragment with respect to the tricuspid and pulmonary valves. This method may serve as a crucial aid in retrieval of intracardiac foreign bodies that are difficult to see with fluoroscopy and which may be adjacent to cardiac valves. PMID:26075131

  16. Use of contrast echocardiography to detect displacement of the needle during pericardiocentesis.

    PubMed

    Salazar, Miguel; Mohar, Dilbahar; Bhardwaj, Rahul; Schuetz, Joseph; Chandraratna, Premindra A N

    2012-03-01

    Bedside pericardiocentesis is a safe and routinely practiced procedure. We report a case in which echocardiography-guided pericardiocentesis was performed urgently for cardiac tamponade. In this case, there was displacement of the periocardiocentesis needle that was only detected by change in the color of aspirated fluid and confirmed by the use of contrast echocardiography. We prescribe the use of routine echocardiographic monitoring during pericardiocentesis to avoid this type of complication. PMID:22098371

  17. Anesthetic Management Guided by Transthoracic Echocardiography During Cesarean Delivery Complicated by Hypertrophic Cardiomyopathy.

    PubMed

    DesRoches, Jaclyn M; McKeen, Dolores Madeline; Warren, Andrew; Allen, Victoria M; George, Ronald B; Kells, Catherine; Shukla, Romesh

    2016-03-15

    We describe the management of a parturient woman with hypertrophic cardiomyopathy who developed a symptomatic accelerated idioventricular rhythm who required an urgent cesarean delivery at 32 weeks. Transthoracic echocardiography helped guide anesthetic management, including epidural dosing, fluid management, and phenylephrine infusion rates. This case demonstrates the application of transthoracic echocardiography to guide anesthetic management in a parturient woman at risk for cardiovascular compromise. PMID:26720049

  18. Results of a Prospective Echocardiography Trial in International Space Station Crew

    NASA Technical Reports Server (NTRS)

    Hamilton, Douglas R.; Sargsyan, Ashot E.; Martin, David; Garcia, Kathleen M.; Melton, Shannon; Feiverson, Alan; Dulchavsky, Scott A.

    2009-01-01

    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.

  19. Prevalence of coronary artery spasm during dobutamine stress echocardiography.

    PubMed

    Mansencal, Nicolas; El Hajjaji, Imane; El Mahmoud, Rami; Digne, Franck; Dubourg, Olivier

    2012-03-15

    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

  20. Intracardiac echocardiography for guidance of transcatheter aortic valve implantation under monitored sedation: a solution to a dilemma?

    PubMed

    Bartel, Thomas; Edris, Ahmad; Velik-Salchner, Corinna; Müller, Silvana

    2016-01-01

    Transcatheter aortic valve implantation (TAVI) has been established as a valuable alternative to surgical aortic valve replacement in patients deemed to have high or prohibitive perioperative risk. However, there are several technical constraints and procedural risks inherent to TAVI. These risks include annulus rupture, ventricular perforation, aortic dissection, coronary occlusion, and dislodgement or migration of the valve prosthesis to the aorta or the left ventricle (LV). Other complications may be related to inappropriate valve deployment and subsequent paravalvular leak. Most complications cannot be detected at an early stage without echocardiographic guidance. Although not addressed by current guidelines, some European centres have advocated a 'minimalist' approach with exclusively fluoroscopic and angiographic guidance. Transoesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging, has been established as a standard approach for peri-interventional guidance of TAVI. However, TEE monitoring almost always necessitates general anaesthesia and endotracheal intubation. A potential alternative to TEE is intracardiac echocardiography (ICE) that may provide a solution to a common dilemma: the most important advantage of ICE being the compatibility with monitored anaesthesia care without endotracheal intubation. Other advantages of ICE include uninterrupted monitoring, no fluoroscopic interference, and precise Doppler-based assessment of pulmonary artery pressures. Limitations of ICE include the need for additional venous access, the learning curve associated with a new device, and potentially increased cost. PMID:26497737

  1. A Primer on the Methods and Applications for Contrast Echocardiography in Clinical Imaging

    PubMed Central

    Seol, Sang-Hoon

    2014-01-01

    Contrast echocardiography is broadly described as a variety of techniques whereby the blood pool on cardiac ultrasound is enhanced with encapsulated gas-filled microbubbles or other acoustically active nano- or microparticles. The development of this technology has occurred primarily in response to the need improve current diagnostic applications of echocardiography such as the need to better define left ventricular cavity volumes, regional wall motion, or the presence or absence of masses and thrombi. A secondary reason for the development of contrast echocardiography has been to expand the capabilities of echocardiography. These new applications include myocardial perfusion imaging for detection of ischemia and viability, perfusion imaging of masses/tumors, and molecular imaging. The ability to fill all of these current and future clinical roles has been predicated on the ability to produce robust contrast signal which, in turn, has relied on technical innovation with regards to the microbubble contrast agents and the ultrasound imaging paradigms. In this review, we will discuss the basics of contrast echocardiography including the composition of microbubble contrast agents, the unique imaging methods used to optimize contrast signal-to-noise ratio, and the clinical applications of contrast echocardiography that have made a clinical impact. PMID:25309685

  2. An assessment of the clinical utility of echocardiography criteria in a Tertiary Health Center

    PubMed Central

    Ogbemudia, Ehimwenma J.; Sadoh, Wilson E.

    2015-01-01

    Background: The rising prevalence of cardiovascular diseases in the population has increased the demand for cardiovascular imaging procedures (specifically echocardiography) in our center. Aim: To determine the percentage of appropriate indications for echocardiography. Materials and Methods: This was a prospective study conducted over a period of 1 year in the Department of Medicine of a Tertiary Health Care Center. The clinical diagnoses by the referring clinician and the indications (specific reasons for the study) for the echocardiography were consecutively recorded. The age and gender of the patients were also recorded. The indications were given a score of one to nine according to the revised appropriate use criteria of the American College of Cardiology Foundation and the American Society of Echocardiography (ASE). These indications were then classified into appropriate, inappropriate or uncertain based on the score. (1-3)-inappropriate use, (4-6) were derived. Results: There were 25 indications, 16 (64%) were appropriate, 6 (24%) were inappropriate and three (12%) were rated as uncertain. Conclusion: Sixty-four percent of the indications for echocardiography are appropriate for the procedure. This implies that the criteria for echocardiography are yet to be fully implemented resulting in overutilization of the procedure. PMID:26759512

  3. Obesity in show dogs.

    PubMed

    Corbee, R J

    2012-08-11

    Obesity is an important disease with a growing incidence. Because obesity is related to several other diseases, and decreases life span, it is important to identify the population at risk. Several risk factors for obesity have been described in the literature. A higher incidence of obesity in certain breeds is often suggested. The aim of this study was to determine whether obesity occurs more often in certain breeds. The second aim was to relate the increased prevalence of obesity in certain breeds to the official standards of that breed. To this end, we investigated 1379 dogs of 128 different breeds by determining their body condition score (BCS). Overall, 18.6% of the show dogs had a BCS >5, and 1.1% of the show dogs had a BCS>7. There were significant differences between breeds, which could be correlated to the breed standards. It warrants firm discussions with breeders and judges in order to come to different interpretations of the standards to prevent overweight conditions from being the standard of beauty. PMID:22882163

  4. Quantitative Evaluation of Mitral Regurgitation Secondary to Mitral Valve Prolapse by Magnetic Resonance Imaging and Echocardiography.

    PubMed

    Le Goffic, Caroline; Toledano, Manuel; Ennezat, Pierre-Vladimir; Binda, Camille; Castel, Anne-Laure; Delelis, François; Graux, Pierre; Tribouilloy, Christophe; Maréchaux, Sylvestre

    2015-11-01

    The present prospective study was designed to evaluate the accuracy of quantitative assessment of mitral regurgitant fraction (MRF) by echocardiography and cardiac magnetic resonance imaging (cMRI) in the modern era using as reference method the blinded multiparametric integrative assessment of mitral regurgitation (MR) severity. 2-Dimensional (2D) and 3-dimensional (3D) MRF by echocardiography (2D echo MRF and 3D echo MRF) were obtained by measuring the difference in left ventricular (LV) total stroke volume (obtained from either 2D or 3D acquisition) and aortic forward stroke volume normalized to LV total stroke volume. MRF was calculated by cMRI using either (1) (LV stroke volume - systolic aortic outflow volume by phase contrast)/LV stroke volume (cMRI MRF [volumetric]) or (2) (mitral inflow volume - systolic aortic outflow volume)/mitral inflow volume (cMRI MRF [phase contrast]). Six patients had 1 + MR, 6 patients had 2 + MR, 12 patients had 3 + MR, and 10 had 4 + MR. A significant correlation was observed between MR grading and 2D echo MRF (r = 0.60, p <0.0001) and 3D echo MRF (r = 0.79, p <0.0001), cMRI MRF (volumetric) (r = 0.87, p <0.0001), and cMRI MRF (phase contrast r = 0.72, p <0.001). The accuracy of MRF for the diagnosis of MR ?3+ or 4+ was the highest with cMRI MRF (volumetric) (area under the receiver-operating characteristic curve [AUC] = 0.98), followed by 3D echo MRF (AUC = 0.96), 2D echo MRF (AUC = 0.90), and cMRI MRF (phase contrast; AUC = 0.83). In conclusion, MRF by cMRI (volumetric method) and 3D echo MRF had the highest diagnostic value to detect significant MR, whereas the diagnostic value of 2D echo MRF and cMRI MRF (phase contrast) was lower. Hence, the present study suggests that both cMRI (volumetric method) and 3D echo represent best approaches for calculating MRF. PMID:26372213

  5. Cardiopulmonary function and scoliosis severity in idiopathic scoliosis children

    PubMed Central

    Huh, Seokwon; Kim, Nam Kyun; Jung, Jo Won; Choi, Jae Young; Kim, Hak Sun

    2015-01-01

    Purpose Idiopathic scoliosis is a structural lateral curvature of the spine of unknown etiology. The relationship between degree of spine curvature and cardiopulmonary function has not yet been investigated. The purpose of this study was to determine the association between scoliosis and cardiopulmonary characteristics. Methods Ninety children who underwent preoperative pulmonary or cardiac evaluation at a single spine institution over 41 months were included. They were divided into the thoracic-dominant scoliosis (group A, n=78) and lumbar-dominant scoliosis (group B, n=12) groups. Scoliosis severity was evaluated using the Cobb method. In each group, relationships between Cobb angles and cardiopulmonary markers such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, left ventricular ejection fraction, pulmonary artery flow velocity, and tissue Doppler velocities (E/E', E'/A') were analyzed by correlation analysis linear regression. Results In group A, 72 patients (92.3%) underwent pulmonary function tests (PFTs), and 41 (52.6%) underwent echocardiography. In group B, 9 patients (75.0%) underwent PFT and 8 (66.7%) underwent echocardiography. Cobb angles showed a significant negative correlation with FVC and FEV1 in group A (both P<0.05), but no such correlation in group B, and a significant negative correlation with mitral E/A ratio (P<0.05) and tissue Doppler E'/A' (P<0.05) in group A, with a positive correlation with mitral E/A ratio (P<0.05) in group B. Conclusion Pulmonary and cardiac function was significantly correlated with the degree of scoliosis in patients with thoracic-dominant scoliosis. Myocardial diastolic function might be impaired in patients with the most severe scoliosis. PMID:26213550

  6. Severe pulmonary arterial hypertensive rats are tolerant to mild exercise.

    PubMed

    Hargett, Leslie A; Hartman, Lauren J; Scruggs, April K; McLendon, Jared M; Haven, April K; Bauer, Natalie N

    2015-06-01

    A frequently used end point of clinical outcomes in patients with pulmonary arterial hypertension (PAH) is the 6-minute walk distance. Furthermore, some data suggest that mild to moderate exercise as an intervention in stable PAH is beneficial. Some of these questions have been recapitulated in the monocrotaline and hypoxia animal models of pulmonary hypertension. However, mild exercise and walk distance as end points have not been rigorously examined in the severe progressive Sugen 5416/hypoxia/normoxia (Su/Hx/Nx) animal model of PAH at each stage of worsening disease. Our hypothesis was that animals that were preselected as runners would have increased walk times and improved right ventricle/left ventricle plus septum (RV/LV+S) ratios, echocardiography, and histology compared with nonexercised Su/Hx/Nx animals. We examined four groups of rats: Su/Hx/Nx sedentary, Su/Hx/Nx exercised, control sedentary, and control exercised. Echocardiography was performed at 5, 8, and 13 weeks to assess right ventricular inner diameter in diastole and left ventricular eccentricity index. We found no difference between exercised and sedentary Su/Hx/Nx rats, and both were worsened compared with controls. Rats were euthanized at 13 weeks, and we found that neither RV/LV+S nor the occurrence of occlusive lesions were influenced by exercise. Most interesting, however, was that despite progressive PAH development, exercised Su/Hx/Nx rats showed no decrease in time or distance for treadmill exercise. In all, our data suggest that, despite severe PAH development, Su/Hx/Nx rats retain the same treadmill exercise capacity as control animals. PMID:26064461

  7. Automatic quantification of aortic regurgitation using 3D full volume color doppler echocardiography: a validation study with cardiac magnetic resonance imaging.

    PubMed

    Choi, Jaehuk; Hong, Geu-Ru; Kim, Minji; Cho, In Jeong; Shim, Chi Young; Chang, Hyuk-Jae; Mancina, Joel; Ha, Jong-Won; Chung, Namsik

    2015-10-01

    Recent advances in real-time three-dimensional (3D) echocardiography provide the automated measurement of mitral inflow and aortic stroke volume without the need to assume the geometry of the heart. The aim of this study is to explore the ability of 3D full volume color Doppler echocardiography (FVCDE) to quantify aortic regurgitation (AR). Thirty-two patients with more than a moderate degree of AR were enrolled. AR volume was measured by (1) two-dimensional-CDE, using the proximal isovelocity surface area (PISA) and (2) real-time 3D-FVCDE with (3) phase-contrast cardiac magnetic resonance imaging (PC-CMR) as the reference method. Automated AR quantification using 3D-FVCDE was feasible in 30 of the 32 patients. 2D-PISA underestimated the AR volume compared to 3D-FVCDE and PC-CMR (38.6 ± 9.9 mL by 2D-PISA; 49.5 ± 10.2 mL by 3D-FVCDE; 52.3 ± 12.6 mL by PC-CMR). The AR volume assessed by 3D-FVCDE showed better correlation and agreement with PC-CMR (r = 0.93, p < 0.001, 2SD: 9.5 mL) than did 2D-PISA (r = 0.76, p < 0.001, 2SD: 15.7 mL). When used to classify AR severity, 3D-FVCDE agreed better with PC-CMR (k = 0.94) than did 2D-PISA (k = 0.53). In patients with eccentric jets, only 30% were correctly graded by 2D-PISA. Conversely, almost all patients with eccentric jets (86.7%) were correctly graded by 3D-FVCDE. In patients with multiple jets, only 3 out of 10 were correctly graded by 2D-PISA, while 3D-FVCDE correctly graded 9 out of 10 of these patients. Automated quantification of AR using the 3D-FVCDE method is clinically feasible and more accurate than the current 2D-based method. AR quantification by 2D-PISA significantly misclassified AR grade in patients with eccentric or multiple jets. This study demonstrates that 3D-FVCDE is a valuable tool to accurately measure AR volume regardless of AR characteristics. PMID:26164059

  8. Intraoperative transoesophageal echocardiography in a low birth weight neonate with atrioventricular septal defect.

    PubMed

    Kawahito, Shinji; Kitahata, Hiroshi; Tanaka, Katsuya; Nozaki, Junpei; Oshita, Shuzo

    2003-10-01

    An 18-day-old male neonate (45 cm, 1.8 kg) with a history of cyanosis and congestive heart failure from an atrioventricular septal defect (AVSD) with a large left-to-right shunt was scheduled for surgical repair of the AVSD. After routine induction of anaesthesia with fentanyl and vecuronium, a 4.5-mm diameter transoesophageal echocardiography (TOE) probe was inserted into the oesophagus, and systematic echocardiographic evaluation was performed during surgery. After cardiopulmonary bypass was stopped, intraoperative TOE revealed mild residual mitral valve regurgitation. Because good left ventricular wall motion was confirmed and haemodynamic parameters were stable, cardiopulmonary bypass was not reinitiated. The patient's cardiac output was low in the postoperative intensive care unit. TOE was performed the next day to detect the source of this problem, revealed severe regurgitation compared with that observed intraoperatively. TOE was useful for evaluation of the residual mitral valve regurgitation, and we reconfirmed the importance of continuous monitoring even in a low birthweight neonate undergoing repair of a complete AVSD. PMID:14535917

  9. Design of a Matrix Transducer for Three-Dimensional Second Harmonic Transesophageal Echocardiography

    NASA Astrophysics Data System (ADS)

    Blaak, Sandra; van Neer, Paul L. M. J.; Prins, Christian; Bosch, Johan G.; Lancée, Charles T.; van der Steen, Antonius F. W.; de Jong, Nico

    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.

  10. Estimation of diastolic intraventricular pressure gradients by Doppler M-mode echocardiography

    NASA Technical Reports Server (NTRS)

    Greenberg, N. L.; Vandervoort, P. M.; Firstenberg, M. S.; Garcia, M. J.; Thomas, J. D.

    2001-01-01

    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.

  11. Intracardiac Echocardiography Evaluation in Secundum Atrial Septal Defect Transcatheter Closure

    SciTech Connect

    Zanchetta, Mario; Pedon, Luigi; Rigatelli, Gianluca; Carrozza, Antonio; Zennaro, Marco; Di Martino, Roberta; Onorato, Eustaquio; Maiolino, Pietro

    2003-02-15

    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.

  12. Effectiveness of screening for abdominal aortic aneurysm during echocardiography.

    PubMed

    Aboyans, Victor; Bataille, Vincent; Bliscaux, Pascale; Ederhy, Stéphane; Filliol, Didier; Honton, Benjamin; Kurtz, Baptiste; Messas, Emmanuel; Mohty, Dania; Brochet, Eric; Kownator, Serge

    2014-10-01

    Screening patients with abdominal aortic aneurysm (AAA) is associated with reduced AAA-related mortality, but population screening is poorly implemented. Opportunistic screening during imaging for other indications might be efficient. Single-center series reported AAA rates of 0.8% to 6.5% in patients undergoing transthoracic echocardiography (TTE), with disparities due to selection bias. In this first multicenter study, we aimed to assess the feasibility and criteria for screening AAA during TTE in real-life practice. During a week of May 2011, 79 centers participated in a nationwide survey. All patients aged ?65 years requiring TTE for any indication were eligible, except for those with operated abdominal aorta. We defined AAA by an anteroposterior diameter of the infrarenal aorta?30 mm. Of 1,382 consecutive patients, abdominal aorta imaging was feasible in 96.7%, with a median delay of 1.7 minutes (>3 minutes in 3.6% of cases). We found AAA in 50 patients (3.7%). Unknown AAA (2.7%) was more frequent in men than women (3.7% vs 1.3%, respectively, p=0.007) and increased by age at 2.2%, 2.5%, and 5.8% in age bands of 65 to 74, 75 to 84, and 85+ years, respectively. None of the female participants aged <75 years had AAA. Smoking status and family history of AAA were significantly more frequent among patients with AAA. The ascending aorta was larger in those with AAA (36.2±4.7 vs 34.0±5.2 mm, p=0.006), and bicuspid aortic valve and/or major aortic regurgitation were also more frequent (8% vs 2.6%, p=0.017). In conclusion, rapid AAA screening during TTE is feasible and should be limited to men ?65 years and women?75 years. PMID:25127549

  13. Assessment of left ventricular longitudinal function in cats with subclinical hypertrophic cardiomyopathy using tissue Doppler imaging and speckle tracking echocardiography

    PubMed Central

    SUGIMOTO, Keisuke; FUJII, Yoko; SUNAHARA, Hiroshi; AOKI, Takuma

    2015-01-01

    Hypertrophic cardiomyopathy (HCM) in cats is characterized by concentric left ventricular (LV) hypertrophy and both diastolic and systolic dysfunction. Although impaired cardiac function detected by tissue Doppler imaging (TDI) in cats with HCM was previously reported, reference ranges of TDI in normal cats and cats with HCM have been reported as widely variable. Two-dimensional speckle tracking echocardiography (STE) was useful for assessment of cardiac function in human patients with HCM, but clinical utility was not known in cats. The aim of this study was to assess global and segmental LV myocardial function using STE in cats with HCM whose TDI variables were within the reference range. A total of 35 cats of different breeds were enrolled in this study. The HCM group (n=22) was cats diagnosed as HCM without left atrial enlargement and with normal TDI measurements. HCM cats were further divided into a segmental hypertrophy (S-HCM) group and a diffuse hypertrophy (D-HCM) group. The control group consisted of 13 clinically healthy cats. No cats in any group showed any clinical symptoms. Conventional echocardiography, TDI, and global and segmental STE indices were evaluated and compared between groups. Only the longitudinal strain rate during early diastole was significantly decreased in both HCM groups, even in all segments including those without hypertrophy in S-HCM group. This study suggests that STE parameters are the more sensitive variables compared with conventional TDI parameters to detect early myocardial diastolic dysfunction in cats with HCM. PMID:25877405

  14. The relationship between immediate relevant basic science knowledge and clinical knowledge: physiology knowledge and transthoracic echocardiography image interpretation.

    PubMed

    Nielsen, Dorte Guldbrand; Gotzsche, Ole; Sonne, Ole; Eika, Berit

    2012-10-01

    Two major views on the relationship between basic science knowledge and clinical knowledge stand out; the Two-world view seeing basic science and clinical science as two separate knowledge bases and the encapsulated knowledge view stating that basic science knowledge plays an overt role being encapsulated in the clinical knowledge. However, resent research has implied that a more complex relationship between the two knowledge bases exists. In this study, we explore the relationship between immediate relevant basic science (physiology) and clinical knowledge within a specific domain of medicine (echocardiography). Twenty eight medical students in their 3rd year and 45 physicians (15 interns, 15 cardiology residents and 15 cardiology consultants) took a multiple-choice test of physiology knowledge. The physicians also viewed images of a transthoracic echocardiography (TTE) examination and completed a checklist of possible pathologies found. A total score for each participant was calculated for the physiology test, and for all physicians also for the TTE checklist. Consultants scored significantly higher on the physiology test than did medical students and interns. A significant correlation between physiology test scores and TTE checklist scores was found for the cardiology residents only. Basic science knowledge of immediate relevance for daily clinical work expands with increased work experience within a specific domain. Consultants showed no relationship between physiology knowledge and TTE interpretation indicating that experts do not use basic science knowledge in routine daily practice, but knowledge of immediate relevance remains ready for use. PMID:21952688

  15. Validation of Echo-Dynamography by virtual color doppler echocardiography generated from phase contrast magnetic resonance angiography datasets.

    PubMed

    Kojima, Takanori; Omori, Aiko; Nakajima, Hiroyuki; Kurokawa, Takafumi; Kameyama, Takeyoshi; Saijo, Yoshifumi

    2013-01-01

    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

  16. Comparison of exercise echocardiography with an exercise score to diagnose coronary artery disease in women.

    PubMed

    Williams, M J; Marwick, T H; O'Gorman, D; Foale, R A

    1994-09-01

    This study compares the accuracy of the routine exercise electrocardiogram, exercise score, and exercise echocardiography for the diagnosis of coronary artery disease (CAD) in women. Seventy women with a pretest probability of 53 +/- 30% for CAD were stressed using a maximal symptom-limited bicycle exercise protocol. Significant ST-segment change was defined by a depression of > 0.1 mV 0.06 second after the J point. The exercise score was calculated from ST response, heart rate, and workload using an equation derived from a multivariate model. A positive stress echocardiogram was defined by development of a new or worsening wall motion abnormality. The results were compared with the presence or absence of significant (> 50% diameter) stenoses at angiography. Exercise echocardiography identified 29 of the 33 patients (88%) with CAD, compared with 22 (67%) using ST analysis alone, and 20 (61%) using the exercise score (both p < 0.05 vs exercise echocardiography). The specificity of exercise echocardiography (84%) and the multivariate score (73%) were comparable, and exceeded that of the ST analysis (51%) in 37 patients without CAD (p < 0.01). The accuracy of exercise echocardiography (86%) exceeded that of the exercise score (67%, p = 0.01) and ST analysis (59%, p < 0.01). Among all 70 patients, an intermediate (20% to 80%) probability of coronary disease was identified in 21 patients on the basis of exercise echocardiography, in 38 based on the multivariate score, and in 38 based on the ST analysis alone. Exercise echocardiography is more sensitive than the exercise score, and more sensitive and specific than ST-segment analysis for the diagnosis of CAD in women.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8059721

  17. Focused Cardiac Ultrasound in Place of Repeat Echocardiography: Reliability and Cost Implications

    PubMed Central

    Kini, Vinay; Mehta, Nidhi; Mazurek, Jeremy A.; Ferrari, Victor A.; Epstein, Andrew J.; Groeneveld, Peter W.; Kirkpatrick, James N.

    2016-01-01

    Background Health care systems are increasingly moving toward models that emphasize the delivery of high-quality health care at lower costs. Rates of repeat echocardiography (two or more transthoracic echocardiographic studies performed within a short interval) are high and can contribute substantially to the cost of providing cardiovascular care. Certain findings from handheld ultrasound scans performed by echocardiographers have been shown to correlate well with findings on transthoracic echocardiography (TTE). It therefore may be feasible and cost effective to use expert focused cardiac ultrasound (eFCU) in place of repeat TTE for highly selected indications in certain settings. The aim of this study was to determine the reliability and cost implications of using eFCU in place of repeat TTE in selected inpatients. Methods Inpatients who underwent repeat TTE (prior TTE within 30 days) ordered for the assessment of ventricular function, pericardial effusion, or inferior vena cava collapse were prospectively enrolled. Subjects underwent eFCU in addition to TTE, and results were compared for correlation using the weighted ? statistic. The potential cost savings of using eFCU in place of TTE were modeled from the provider perspective (i.e., physicians and hospitals). Results Over 45 days, 105 patients were enrolled. The majority of scans were performed for assessment of left ventricular function and pericardial effusions. eFCU showed excellent correlation with TTE for most parameters, including left ventricular systolic function (? = 0.80) and the presence and size of pericardial effusions (? = 0.81) (P < .001 for both). Adoption of this eFCU protocol could save between $41 and $64 per study, or between $34,512 and $53,871 annually at the authors’ institution. Conclusions Findings from eFCU correlate well with those from TTE when used in the setting of repeat testing for assessment of ventricular function, pericardial effusion, and inferior vena cava collapse. The judicious use of eFCU in place of repeat inpatient TTE has the potential to deliver quality cardiac imaging at reduced cost. PMID:26165448

  18. Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS)

    PubMed Central

    Price, Susanna; Via, Gabriele; Sloth, Erik; Guarracino, Fabio; Breitkreutz, Raoul; Catena, Emanuele; Talmor, Daniel

    2008-01-01

    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 of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described. Obtaining competence in ICU echocardiography may be achieved in different ways – either through completion of an appropriate fellowship/training scheme, or, where not available, via a staged approach designed to train the practitioner to a level at which they can achieve accreditation. Here, peri-resuscitation focused echocardiography represents the entry level – obtainable through established courses followed by mentored practice. Next, a competence-based modular training programme is proposed: theoretical elements delivered through blended-learning and practical elements acquired in parallel through proctored practice. These all linked with existing national/international echocardiography courses. When completed, it is anticipated that the practitioner will have performed the prerequisite number of studies, and achieved the competency to undertake accreditation (leading to Level 2 competence) via a recognized National or European examination and provide the appropriate required evidence of competency (logbook). Thus, even where appropriate fellowships are not available, with support from the relevant echocardiography bodies, training and subsequently accreditation in ICU echocardiography becomes achievable within the existing framework of current critical care and cardiological practice, and is adaptable to each countrie's needs. PMID:18837986

  19. Extreme Tele-Echocardiography: Methodology for Remote Guidance of In-Flight Echocardiography Aboard the International Space Station

    NASA Technical Reports Server (NTRS)

    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.

    2012-01-01

    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.

  20. Assessment of Atrial Fibrillation and Vulnerability in Patients with Wolff-Parkinson-White Syndrome Using Two-Dimensional Speckle Tracking Echocardiography

    PubMed Central

    Li, Jing-Jie; Wei, Fang; Chen, Ju-Gang; Yu, Yan-Wei; Gu, Hong-Yue; Jiang, Rui; Wu, Xiu-Li; Sun, Qian

    2014-01-01

    Purpose The aim was to assess atrial fibrillation (AF) and vulnerability in Wolff-Parkinson-White (WPW) syndrome patients using two-dimensional speckle tracking echocardiography (2D-STE). Methods All patients were examined via transthoracic echocardiography and 2D-STE in order to assess atrial function 7 days before and 10 days after RF catheter ablation. A postoperative 3-month follow-up was performed via outpatient visit or telephone calls. Results Results showed significant differences in both body mass index (BMI) and supraventricular tachycardia (SVT) duration between WPW patients and DAVNP patients (both P<0.05). Echocardiography revealed that the maximum left atrial volume (LAVmax) and the left ventricular mass index (LVMI) in diastole increased noticeably in patients with WPW compared to patients with DAVNP both before and after ablation (all P<0.05). Before ablation, there were obvious differences in the levels of SRs, SRe, and SRa from the 4-chamber view (LA) in the WPW patients group compared with patients in the DAVNP group (all P<0.05). In the AF group, there were significant differences in the levels of systolic strain rate (SRs), early diastolic strain rate (SRe), and late diastolic strain rate (SRa) from the 4-chamber view (LA) both before and after ablation (all P<0.05). In the non-AF group, there were decreased SRe levels from the 4-chamber view (LA/RA) pre-ablation compared to post-ablation (all P<0.05). Conclusion Our findings provide convincing evidence that WPW syndrome may result in increased atrial vulnerability and contribute to the development of AF. Further, RF catheter ablation of AAV pathway can potentially improve atrial function in WPW syndrome patients. Two-dimensional speckle tracking echocardiography imaging in WPW patients would be necessary in the evaluation and improvement of the overall function of RF catheter ablation in a long-term follow-up period. PMID:25397668

  1. /sup 111/In-labeled platelet scintigraphy and two-dimensional echocardiography for detection of left atrial appendage thrombi. Studies in a new canine model

    SciTech Connect

    Vandenberg, B.F.; Seabold, J.E.; Conrad, G.R.; Kieso, R.; Johnson, J.; Fox-Eastham, K.; Ponto, J.; Bruch, P.; Kerber, R.E.

    1988-10-01

    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.

  2. Exercise testing in asymptomatic severe aortic stenosis.

    PubMed

    Magne, Julien; Lancellotti, Patrizio; Piérard, Luc A

    2014-02-01

    The management and the clinical decision making in asymptomatic patients with aortic stenosis are challenging. An "aggressive" management, including early aortic valve replacement, is debated in these patients. However, the optimal timing for surgery remains controversial due to the lack of prospective data on the determinants of aortic stenosis progression, multicenter studies on risk stratification, and randomized studies on patient management. Exercise stress testing with or without imaging is strictly contraindicated in symptomatic patients with severe aortic stenosis. Exercise stress test is now recommended by current guidelines in asymptomatic patients and may provide incremental prognostic value. Indeed, the development of symptoms during exercise or an abnormal blood pressure response are associated with poor outcome and should be considered as an indication for surgery, as suggested by the most recently updated European Society of Cardiology 2012 guidelines. Exercise stress echocardiography may also improve the risk stratification and identify asymptomatic patients at higher risk of a cardiac event. When the test is combined with imaging, echocardiography during exercise should be recommended rather than post-exercise echocardiography. During exercise, an increase >18 to 20 mm Hg in mean pressure gradient, absence of improvement in left ventricular ejection fraction (i.e., absence of contractile reserve), and/or a systolic pulmonary arterial pressure >60 mm Hg (i.e., exercise pulmonary hypertension) are suggestive signs of advanced stages of the disease and impaired prognosis. Hence, exercise stress test may identify resting asymptomatic patients who develop exercise abnormalities and in whom surgery is recommended according to current guidelines. Exercise stress echocardiography may further unmask a subset of asymptomatic patients (i.e., without exercise stress test abnormalities) who are at high risk of reduced cardiac event free survival. In these patients, early surgery could be beneficial, whereas regular follow-up seems more appropriate in patients without echocardiographic abnormalities during exercise. PMID:24524744

  3. Comparison of dipyridamole-echocardiography with dipyridamole-thallium scintigraphy for the diagnosis of myocardial ischemia

    SciTech Connect

    Perin, E.C.; Moore, W.; Blume, M.; Hernandez, G.; Dhekne, R.; DeCastro, C.M. )

    1991-06-01

    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.

  4. Comparison of echocardiography-guided and fluoroscopy-guided endomyocardial biopsy techniques.

    PubMed

    Nelson, O Lynne; Robbins, Charles T

    2005-01-01

    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

  5. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism.

    PubMed

    Saric, Muhamed; Armour, Alicia C; Arnaout, M Samir; Chaudhry, Farooq A; Grimm, Richard A; Kronzon, Itzhak; Landeck, Bruce F; Maganti, Kameswari; Michelena, Hector I; Tolstrup, Kirsten

    2016-01-01

    Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations. PMID:26765302

  6. Front-end receiver electronics for a matrix transducer for 3-D transesophageal echocardiography.

    PubMed

    Yu, Zili; Blaak, Sandra; Chang, Zu-yao; Yao, Jiajian; Bosch, Johan G; Prins, Christian; Lancée, Charles T; de Jong, Nico; Pertijs, Michiel A P; Meijer, Gerard C M

    2012-07-01

    There is a clear clinical need for creating 3-D images of the heart. One promising technique is the use of transesophageal echocardiography (TEE). To enable 3-D TEE, we are developing a miniature ultrasound probe containing a matrix piezoelectric transducer with more than 2000 elements. Because a gastroscopic tube cannot accommodate the cables needed to connect all transducer elements directly to an imaging system, a major challenge is to locally reduce the number of channels, while maintaining a sufficient signal-to-noise ratio. This can be achieved by using front-end receiver electronics bonded to the transducers to provide appropriate signal conditioning in the tip of the probe. This paper presents the design of such electronics, realizing time-gain compensation (TGC) and micro-beamforming using simple, low-power circuits. Prototypes of TGC amplifiers and micro-beamforming cells have been fabricated in 0.35-μm CMOS technology. These prototype chips have been combined on a printed circuit board (PCB) to form an ultrasound-receiver system capable of reading and combining the signals of three transducer elements. Experimental results show that this design is a suitable candidate for 3-D TEE. PMID:22828845

  7. Echocardiography to magnetic resonance image registration for use in image-guide electrophysiology procedures

    NASA Astrophysics Data System (ADS)

    Ma, YingLiang; Rhode, Kawal S.; King, Andrew P.; Cauldfield, Dennis; Cooklin, Michael; Razavi, Reza; Penney, Graeme P.

    2009-02-01

    We present a novel method to register three-dimensional echocardiography (echo) images with magnetic resonance images (MRI) based on anatomical features, which could be used in the registration pipeline for overlaying MRI-derived roadmaps onto two-dimensional live X-ray images in electrophysiology (EP) procedures. The features used in image registration are the surface of the left ventricle and a manually defined centerline of the descending aorta. The MR-derived surface is generated using a fully automated algorithm, and the echo-derived surface is produced using a semi-automatic process. We test our method on six volunteers and three patients. We validated registration accuracy using two methods. The first calculated a root mean square distance error using anatomical landmarks. The second method used catheters as landmarks in one clinical EP procedure. Results show a mean error of 4.24 mm, which is acceptable for our clinical application, and no failed registrations were observed. In addition, our algorithm works on clinical data, is fast and only requires a small amount of manual input, and so it is applicable to use during EP procedures.

  8. Cardiac output by Doppler echocardiography in the premature baboon: Comparison with radiolabeled microspheres

    SciTech Connect

    Kinsella, J.P.; Morrow, W.R.; Gerstmann, D.R.; Taylor, A.F.; deLemos, R.A. )

    1991-04-01

    Pulsed-Doppler echocardiography (PDE) is a useful noninvasive method for determining left ventricular output (LVO). However, despite increasingly widespread use in neonatal intensive care units, validation studies in prematures with cardiopulmonary disease are lacking. The purpose of this study was to compare radiolabeled microsphere (RLM) and PDE measurements of LVO, using the critically ill premature baboon as a model of the human neonate. Twenty-two paired RLM and PDE measurements of LVO were obtained in 14 animals between 3 and 24 h of age. Average PDE LVO was 152 ml/min/kg (range, 40-258 ml/min/kg) compared to 158 ml/min/kg (range, 67-278 ml/min/kg) measured by RLM. Linear regression analysis of the paired measurements showed good correlation with a slope near unity (gamma = 0.94x + 4.20, r = 0.91, SEE = 25.7 ml). The authors conclude that PDE determinations of LVO compare well with those measured by RLM in the premature baboon. PDE appears to provide a valid estimate of LVO and should be useful in human prematures with cardiopulmonary distress.

  9. Echocardiography to magnetic resonance image registration for use in image-guided cardiac catheterization procedures

    NASA Astrophysics Data System (ADS)

    Ma, Ying Liang; Penney, Graeme P.; Aldo Rinaldi, C.; Cooklin, Mike; Razavi, Reza; Rhode, Kawal S.

    2009-08-01

    We present a robust method to register three-dimensional echocardiography (echo) images to magnetic resonance images (MRI) based on anatomical features, which is designed to be used in the registration pipeline for overlaying MRI-derived roadmaps onto two-dimensional live x-ray images during cardiac catheterization procedures. The features used in image registration are the endocardial surface of the left ventricle and the centre line of the descending aorta. The MR-derived left ventricle surface is generated using a fully automated algorithm, and the echo-derived left ventricle surface is produced using a semi-automatic segmentation method provided by the QLab software (Philips Healthcare) that it is routinely used in clinical practice. We test our method on data from six volunteers and four patients. We validated registration accuracy using two methods: the first calculated a root mean square distance error using expert identified anatomical landmarks, and the second method used catheters as landmarks in two clinical electrophysiology procedures. Results show a mean error of 4.1 mm, which is acceptable for our clinical application, and no failed registrations were observed. In addition, our algorithm works on clinical data, is fast and only requires a small amount of manual input, and so it is applicable for use during cardiac catheterization procedures.

  10. Role of three-dimensional echocardiography in structural complications after acute myocardial infarction.

    PubMed

    Ermacora, Davide; Muraru, Denisa; Pontarollo, Sara; Casablanca, Simona; Livi, Ugolino; Iliceto, Sabino; Badano, Luigi P

    2014-07-01

    Three-dimensional echocardiography (3DE) is a unique cardiovascular imaging modality in terms of: ability to provide realistic anatomical views of cardiac structures in the beating heart and possibility to visualize cardiac structures from any desired perspective. Therefore, 3DE is emerging as an accurate imaging modality for a prompt diagnosis and detailed anatomical description of structural complications (SC) of acute myocardial infarction (AMI). We report 3 emblematic cases which show how both the transthoracic (TTE) and transesophageal (TEE) 3D imaging can provide precise anatomic information useful to address management of SC in AMI patients: (1) detailed assessment of size, location, and morphology of an apical ventricular septal defect (VSD) obtained with 3DTTE was pivotal in referring the patient to percutaneous closure of it; (2) size and location of a complex inferior VSD with irregular margins advised against percutaneous closure; and (3) 3DTEE assisted surgeons to choose between reparative or replacement surgery for an acute mitral regurgitation due to complete papillary muscle rupture. PMID:24661074

  11. Stochastic analysis of heart rate variability and its relation to echocardiography parameters in hypertrophic cardiomyopathy patients.

    PubMed

    Petelczyc, M; Zebrowski, J J; Baranowski, R; Chojnowska, L

    2010-12-01

    The heart rate variability of 10 healthy males (age 26 - 4/+ 3 y) and 49 patients with hypertrophic cardiomyopathy (HCM) (25 males, 24 females, age 29.5 - 11.5/+ 10.5 y) was studied. We applied Kramers-Moyal expansion to extract the drift and diffusion terms of the Langevin equation for the RR interval time series. These terms may be used for a stochastic reconstruction of the time series and for description of the properties of heart rate variability. New parameters characterizing the diffusion term are proposed: the coefficients of the linear fit to the left (LCF) and right (RCF) branch of the dependence of the diffusion term on the rescaled heart rate. Relations of the new parameters to classical echocardiography parameters were studied. Using the relation between the difference LCF-RCF and the left ventricular systolic diameter, the HCM patients studied were divided into three groups. In addition, comparison of the properties of the heart rate variability in the HCM group with that obtained for the healthy young men showed that the parameter LCF-RCF may be treated as a measure of the effect of HCM on heart rate variability and may have diagnostic value. PMID:21071828

  12. Pulse wave velocity correlates with aortic atherosclerosis assessed with transesophageal echocardiography.

    PubMed

    Szmigielski, C; Styczy?ski, G; Sobczy?ska, M; Milewska, A; Placha, G; Kuch-Wocial, A

    2016-02-01

    Aortic pulse wave velocity (PWV) is a noninvasive vascular parameter that is related to cardiovascular risk. We studied the relationship between aortic PWV and aortic atherosclerosis assessed with transesophageal echocardiography (TEE). The patients referred for TEE before electrical cardioversion of atrial fibrillation were included in the study. Maximal intima-media thickness (IMT) including maximal atherosclerotic plaque thickness of the descending thoracic aorta was measured on TEE images. PWV was measured in those patients who had the sinus rhythm restored. Univariable linear regression was used to test associations between the parameters studied. Variables identified by linear regression, as significantly related to PWV, were further analyzed by multivariable linear regression models. We studied 99 patients (57 men, 42 women, mean age 70.4±11.5 years). With univariable regression, we found that PWV was significantly related to IMT (P<0.0001), age (P<0.0001) and pulse pressure (PP, P=0.005). There was no significant relationship between PWV and systolic, diastolic and mean blood pressures, as well as heart rate. The multivariable regression analysis, with all the variables significant in the univariable analysis in the model, showed that only IMT remained significantly related to PWV (P<0.0001, ?=0.31), whereas age (P=0.18) and PP (P=0.16) were not. In conclusion, PWV is related to aortic atherosclerosis assessed with TEE independent of age and blood pressure. PMID:25903165

  13. The role of optical coherence tomography in clarifying the mechanisms for dobutamine stress echocardiography-induced takotsubo cardiomyopathy.

    PubMed

    Fineschi, Massimo; D'Ascenzi, Flavio; Sirbu, Vasile; Mondillo, Sergio; Pierli, Carlo

    2013-05-01

    Takotsubo cardiomyopathy is a clinical disorder characterized by a transient dilatation and akynesis or dyskinesis of the left ventricular (LV) apex, mimicking an anterior wall acute myocardial infarction in the absence of significant coronary artery disease (CAD). It typically occurs during an episode of severe emotional or physical stress. Recent reports suggested the potential of dobutamine stress echocardiography (DSE) in inducing the aforementioned syndrome. The transient dysfunction of the LV does not fit any known coronary distribution. Furthermore, there is no obstructive CAD demonstrated at angiography to account for the observed dysfunction. Consequently, the pathophysiology of this syndrome is still undetermined. Here, we report a case of DSE-induced Takotsubo cardiomyopathy in which high-resolution intracoronary imaging was utilized to exclude possible vessel alterations to help provide potential mechanistic explanations for the development of this condition. PMID:23305309

  14. Valve Stress Echocardiography: A Practical Guide for Referral, Procedure, Reporting, and Clinical Implementation of Results From the HAVEC Group.

    PubMed

    Garbi, Madalina; Chambers, John; Vannan, Mani A; Lancellotti, Patrizio

    2015-06-01

    Valve stress echocardiography (VSE) is increasingly used both within specialist valve clinics and within dedicated VSE services, mandating practical guidance for referral, procedure, reporting, and clinical implementation of results. Therefore, a didactic VSE guide was compiled based on current European Society of Cardiology and American College of Cardiology/American Heart Association valve disease management guidelines, review of existing evidence, and the authors' extensive experience with VSE. The VSE indications were grouped into 3 categories: symptoms despite nonsevere valve disease, asymptomatic severe valve disease, and valve disease with reduced left ventricular systolic function. The aim of the test, the type of stress to be used, the sequence of image acquisition, the information to be included in the report, and the implication of the VSE results for clinical management were described for every indication and summarized in user-friendly tables. PMID:26068289

  15. Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography

    PubMed Central

    de Abreu, José Sebastião; Lima, José Wellington Oliveira; Diógenes, Tereza Cristina Pinheiro; Siqueira, Jordana Magalhães; Pimentel, Nayara Lima; Gomes, Pedro Sabino; de Abreu, Marília Esther Benevides; Paes, José Nogueira

    2014-01-01

    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. PMID:24676368

  16. Red cell Distribution Width as a Predictor of Left Atrial Spontaneous Echo Contrast in Echocardiography

    PubMed Central

    Gerede, Demet M.; Kaya, Cans?n T.; Vurgun, Veysel K.; Ac?buca, Aynur; Tak, Bahar T.; Ongun, Aydan; K?l?ckap, Mustafa; Erol, Cetin

    2015-01-01

    Abstract Red cell distribution width (RDW) represents the heterogeneity of red blood cells (anisocytosis). Spontaneous echo contrast (SEC) is thought to be a manifestation of red cell aggregation and it has been linked to the development of thromboemboli. The aim of this study was to evaluate the association between RDW levels and the presence of left atrial SEC (LASEC). One-hundred and 72 patients who underwent transesophageal echocardiography for various indications were enrolled in the study. All patients were categorized into 2 groups according to the presence of LASEC and into 4 groups according to the severity of LASEC. The baseline clinical characteristics, echocardiographic measurements, and laboratory findings, including RDW, were compared between the groups. The RDW (%) level was higher in the LASEC group (14.95?±?1.32) compared with the non-LASEC group (12.20?±?1.45; P?=?0.0001). When the relationship between RDW and SEC was evaluated according to the increasing grade of SEC, a significant positive correlation was found (r?=?0.645, P?13.8% had 70% sensitivity and 89.2% specificity in predicting LASEC (area under the curve?=?0.834, P?13.8% and the presence of atrial fibrillation were independently associated with LASEC (odds ratio [OR] 1.697; 95% confidence interval [CI] 1.198–2.085; P?=?0.001 and OR 1.586; 95% CI 1.195–2.098; P?=?0.003, respectively]. Elevated RDW value is associated with the presence and the severity of SEC. RDW may be a useful marker and independent predictor for the presence of SEC. PMID:25860216

  17. The Early Variation of Left Ventricular Strain after Aortic Valve Replacement by Three-Dimensional Echocardiography

    PubMed Central

    Cheng, Leilei; Fan, Li; Wang, Chunsheng; Shu, Xianhong

    2015-01-01

    Aortic stenosis (AS) and aortic incompetence (AI) are common aortic valve diseases. Both may deteriorate into irreversible myocardial dysfunction and will increase the risk of sudden death. In this study, we aimed to investigate the early variation trend of left ventricular function by three-dimensional speckle tracking echocardiography (3D-STE) in the patients who underwent cardiac surgeries for aortic valve disease. Twenty patients with severe aortic AS and 16 patients with severe AI were enrolled. All of them underwent the aortic valve replacement (AVR) procedures. The patients’ global longitudinal strain (GLS) and global circumferential strain (GCS) were evaluated by 3D-STE before surgery and at 1 week after surgery. In addition, GLS and GCS were followed at 1 month as well as 3 months after AVR. In AS patients, the GCS after AVR altered little both at 1 week (p = 0.562) and at 1 month (p = 0.953) compared with the data before the surgery. And it increased significantly at 3 months of follow-up observation compared to that before AVR (p<0.05). Meanwhile, GLS increased progressively after AVR and improved significantly at 3 months after surgery (p<0.05). For the AI patients, GLS as well as GCS decreased at 1 week after AVR compared to those data at baseline (p<0.05). However, these two parameters recovered at 1 month after AVR. Furthermore, GLS and GCS improved significantly at 3 months after the surgery (p<0.05). Therefore, both GLS and GCS were influenced by AVR and would be improved at 3 months after surgery both in AS patients or AI patients. GLS and GCS can be finely evaluated by 3D-STE, and they are helpful to determine the variation tendency of left ventricular function in patients with AVR. PMID:26473730

  18. Echocardiography Practice: Insights into Appropriate Clinical Use, Technical Competence and Quality Improvement Program

    PubMed Central

    Kossaify, Antoine; Grollier, Gilles

    2014-01-01

    Echocardiography accounts for nearly half of all cardiac imaging techniques. It is a widely available and adaptable tool, as well as being a cost-effective and mainly a non-invasive test. In addition, echocardiography provides extensive clinical data, which is related to the presence or advent of different modalities (tissue Doppler imaging, speckle tracking imaging, three-dimensional mode, contrast echo, etc.), different approaches (transesophageal, intravascular, etc.), and different applications (ie, heart failure/resynchronization studies, ischemia/stress echo, etc.). In view of this, it is essential to conform to criteria of appropriate use and to keep standards of competence. In this study, we sought to review and discuss clinical practice of echocardiography in light of the criteria of appropriate clinical use, also we present an insight into echocardiographic technical competence and quality improvement project. PMID:24516342

  19. [Echocardiography in emergency admissions. Recognition of cardiac low-output failure].

    PubMed

    Schmidt, J; Maier, A; Christ, M

    2012-10-01

    Detection of acute cardiac dysfunction and differential diagnosis of low cardiac output syndrome is challenging for emergency physicians. For the critical ill patient it is essential to rapidly identify the underlying disease to initiate the correct therapy and optimize patient outcome. Echocardiography is the diagnostic tool of choice for the evaluation of low cardiac output states. In the setting of the emergency department the use of focused echocardiography instead of detailed echocardiographic studies of cardiologists is appropriate and should be provided for emergency care. The differentiation in preserved versus reduced left ventricular ejection fraction as a first assessment is helpful, particularly for physicians not well trained in echocardiography. The structured and focused approach to evaluate or exclude differential diagnoses of cardiac dysfunction is the key for optimal management of acute and critically ill patients with low cardiac output. PMID:23052991

  20. Critical appraisal on the utility of echocardiography in the management of acute pulmonary embolism.

    PubMed

    Mookadam, Farouk; Jiamsripong, Panupong; Goel, Ramil; Warsame, Tahlil A; Emani, Usha R; Khandheria, Bijoy K

    2010-01-01

    Echocardiography can be used for rapid and accurate risk stratification of patients with pulmonary embolism to appropriately direct the therapeutic strategies for those at high risk. Echocardiography is an ideal risk stratification tool in this regard because of its easy portability to the emergency room or to the bed side. It can be performed at a relatively low cost and at no risk to the patient. Furthermore, echocardiography allows repetitive noninvasive assessment of the cardiovascular and hemodynamic status of the patient and the response to the therapeutic interventions. Right ventricular hypokinesis, persistent pulmonary hypertension, a patent foramen ovale, and a free floating right heart thrombus are echocardiographic markers that identify patients at a higher risk for morbidity and mortality. Such patients warrant special consideration for thrombolysis or embolectomy. PMID:20010336

  1. Left ventricular thrombi: in vivo detection by indium-111 platelet imaging and two dimensional echocardiography

    SciTech Connect

    Stratton, J.R.; Ritchie, J.L.; Hamilton, G.W.; Hammermeister, K.E.; Harker, L.A.

    1981-04-01

    Indium-111 platelet imaging, which can identify sites of active intravascular platelet deposition, and two dimensional echocardiography, which can identify intracardiac masses, can both be used to detect left ventricular thrombi noninvasively. We compared these techniques in 44 men at risk for thrombi from remote transmural myocardial infarction (31 patients) or cardiomyopathy (13 patients). All 44 patients underwent platelet imaging; 35 underwent echocardiography. On platelet imaging nine patients had thrombi and onehad a possible thrombus. Of these 10 studies, none were positive at 2 hours, 5 were positive at 24 hours and all were positive 48 or 72 hours after platelet labeling. Nine of these patients underwent echocardiography, and all had an intraventricular mass. The findings on platelet scanning were negative in six patients who had positive (four patients) or equivocally positive (two patients) findings on echocardiography. All patients with thrombi detected by either noninvasive method had transmural anterior myocardial infarction with ventricular aneurysm. Of the seven patients who underwent cardiac surgery or autopsy, three had thrombi. Platelet imaging failed to identify one thrombus in a patient in whom imaging was performed only at 24 hours after labeling. There were no false positive platelet images in this group. Five of these seven patients (two with throbi, three without) underwent echocardiography; in all cases the echocardiographic findings agreed with the pathologic findings. Both platelet imaging and echocardiography detect ventricular thrombi. Platelet imaging may detect only the most hematologically active thrombi. Both techniques may help define patients at risk of embolization and may be useful for in vivo assessment of antithrombotic drugs.

  2. Diagnostic accuracy of peak exercise echocardiography in coronary artery disease: comparison with thallium-201 myocardial scintigraphy.

    PubMed

    Galanti, G; Sciagrà, R; Comeglio, M; Taddei, T; Bonechi, F; Giusti, F; Malfanti, P; Bisi, G

    1991-12-01

    To evaluate the accuracy of exercise two-dimensional echocardiography for the recognition of coronary artery disease, 53 patients (46 men and 7 women, age range 35 to 69 years) without either previous myocardial infarction or resting wall motion abnormalities, were studied. According to coronary angiography 26 had normal coronary arteries, 14 had one-vessel, seven had two-vessel, and six had three-vessel disease. After withdrawal of any therapy, all patients underwent a single exercise stress test with a stress table during which cine-loop digitized echocardiography was acquired and 74 MBq of thallium-201 (TI-201) were injected. Echocardiographic images were evaluated at rest and at peak exercise. Three-view planar scintigraphic images were collected immediately after exercise and 4 hours later. For the overall recognition of coronary artery disease, exercise electrocardiography had 77.8% sensitivity and 65.4% specificity; myocardial scintigraphy had 100% sensitivity and 92.3% specificity; and exercise echocardiography had 92.6% sensitivity and 96.2% specificity (both NS versus myocardial scintigraphy). Global accuracy was 71.7% for exercise electrocardiography, 94.3% for stress echocardiography, and 96.2% for myocardial scintigraphy. For the classification of the individual involved coronary arteries, the sensitivity of myocardial scintigraphy was 84.8% and that of exercise echocardiography was 63% (p less than 0.01); the related specificities were 98% and 98.2% respectively (NS). It may be concluded that exercise echocardiography is highly accurate for the recognition of coronary artery disease, whereas it appears less sensitive in the identification of the involved vessels, particularly in patients with multivessel disease. PMID:1957756

  3. Floating thrombus in the right heart associated with pulmonary embolism: The role of echocardiography

    PubMed Central

    Naeem, Kashif

    2015-01-01

    Free-floating right heart thrombi are rare and usually represent travelling clots from venous system to the lung. Almost exclusively, they are associated with pulmonary embolism. Despite associated high mortality, they are frequently under-diagnosed. We report a case of bilateral pulmonary embolism which was found to have a free-floating right atrial thrombus on echocardiography. The case, therefore, highlights the importance of echocardiography as a key examination in this setting. It can be performed at bedside to directly visualize the thrombi, assess and monitor right ventricular (RV) function, and help in making treatment decisions. PMID:25878652

  4. Temporally diffeomorphic cardiac motion estimation from three-dimensional echocardiography by minimization of intensity consistency error

    PubMed Central

    Zhang, Zhijun; Ashraf, Muhammad; Sahn, David J.; Song, Xubo

    2014-01-01

    Purpose: Quantitative analysis of cardiac motion is important for evaluation of heart function. Three dimensional (3D) echocardiography is among the most frequently used imaging modalities for motion estimation because it is convenient, real-time, low-cost, and nonionizing. However, motion estimation from 3D echocardiographic sequences is still a challenging problem due to low image quality and image corruption by noise and artifacts. Methods: The authors have developed a temporally diffeomorphic motion estimation approach in which the velocity field instead of the displacement field was optimized. The optimal velocity field optimizes a novel similarity function, which we call the intensity consistency error, defined as multiple consecutive frames evolving to each time point. The optimization problem is solved by using the steepest descent method. Results: Experiments with simulated datasets, images of an ex vivo rabbit phantom, images of in vivo open-chest pig hearts, and healthy human images were used to validate the authors’ method. Simulated and real cardiac sequences tests showed that results in the authors’ method are more accurate than other competing temporal diffeomorphic methods. Tests with sonomicrometry showed that the tracked crystal positions have good agreement with ground truth and the authors’ method has higher accuracy than the temporal diffeomorphic free-form deformation (TDFFD) method. Validation with an open-access human cardiac dataset showed that the authors’ method has smaller feature tracking errors than both TDFFD and frame-to-frame methods. Conclusions: The authors proposed a diffeomorphic motion estimation method with temporal smoothness by constraining the velocity field to have maximum local intensity consistency within multiple consecutive frames. The estimated motion using the authors’ method has good temporal consistency and is more accurate than other temporally diffeomorphic motion estimation methods. PMID:24784402

  5. [Doppler echocardiography in assessing mechanical and biological heart valve prostheses].

    PubMed

    Minardi, G; Di Segni, M; Boccardi, L; Ferrari, O; Giovannini, E

    1988-02-01

    The study was performed to assess Doppler echocardiographic features of mitral and aortic prosthetic valves of different types with both normal and abnormal function. Two hundred and twenty-three patients with 250 prostheses were studied. Two hundred eight valves (111 mitral, 95 aortic and 2 tricuspid) were considered to be functioning normally after clinical examination, phonocardiography and M-mode and 2D echocardiography. This group enabled us to define normal Doppler echocardiographic findings for different types of prosthesis. In mitral position, peak (p) and mean (m) gradients were lower for disc prostheses and higher for ball and biological prosthetic valves; values of effective orifice area (A), calculated by pressure half-time method, were lower for biological and ball prostheses and higher in disc valves. Results were as follows: St. Jude (p 10.6 mmHg, m 3.9 mmHg, A 2.7 cm2), Duromedics (p 10.6, m 4.3, A 2.8), Björk-Shiley (p 10.4, m 4, A 2.3), Omniscience (p 14.2, m 6.2, A 2.1), Starr-Edwards (p 15.9, m 5.4, A 2.1), Hancock (p 14.7, m 6, A 2), Carpentier (p 13.2, m 5.4, A 1.9). Mild regurgitation, considered "physiological", was found in 2/8 Carpentier valves and in 3/34 St. Jude prostheses. In aortic valves lower peak gradients were found in Lillehei (18.3 mmHg), St. Jude (23.8 mmHg), Björk-Shiley (26 mmHg), Duromedics (27 mmHg) and higher values in Starr-Edwards (30.2 mmHg), Hancock (30 mmHg) and Omniscience (35.5 mmHg) prostheses. Mild regurgitation, considered "physiological", was found in 17% of Omniscience valves, 21% of Hancock, 33% of Duromedics, 45% of St. Jude, 60% of Björk-Shiley prostheses. Hancock mitral valves implanted for over 7 years had a mean gradient higher than valves with a shorter period of implantation (7.6 vs 4.85 mmHg, p less than 0.1), whereas the effective orifice area was similar. Hancock aortic valves implanted for over 7 years had a peak gradient slightly higher than the other group (implantation less than 7 years previously), but the difference was not statistically significant. Forty-two valves (19 aortic and 23 mitral) were considered to be malfunctioning. Regurgitation Doppler signals of malfunctioning valves appeared different from those of "physiological" reverse flow; in the former cases forward gradient was higher than normal prostheses. In stenotic aortic prostheses, peak systolic gradient was greatly increased; in stenotic mitral prostheses, a very significant increase in mean gradient and a great decrease in effective orifice area were found. In 14 patients who underwent surgical re-operation and in the patient who died before operation, Doppler echocardiographic findings were confirmed.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3410201

  6. Characteristics of sepsis-induced cardiac dysfunction using speckle-tracking echocardiography: a feasibility study.

    PubMed

    Zaky, A; Gill, E A; Paul, C P; Bendjelid, K; Treggiari, M M

    2016-01-01

    Septic cardiomyopathy is commonly encountered in patients with severe sepsis and septic shock. This study explores whether novel global and segmental echocardiographic markers of myocardial deformation, using two-dimensional speckle tracking, are associated with adverse sepsis outcomes. We conducted a retrospective observational feasibility study, at a tertiary care centre, of patients admitted to the ICU with a diagnosis of sepsis who underwent an echocardiogram within the first week of sepsis diagnosis. Data were collected on chamber dimensions, systolic and diastolic function, demographics, haemodynamics, and laboratory parameters. Global and segmental left ventricular longitudinal strain (LVLS) and tissue mitral annular displacement (TMAD) were assessed on 12 left ventricular segments and six mitral annulus segments in apical views, respectively. We explored associations of abnormal LVLS and TMAD with duration of mechanical ventilation, hospital length of stay, and mortality. Fifty-four patients were included. Global LVLS was not associated with any of the primary study endpoints. However, reduced systolic LVLS of the basal anterior segment was associated with in-hospital mortality. There was a suggestion that patients with a reduced global TMAD were associated with an increased risk of mortality and a short length of hospital stay but these associations were not statistically significant. Reduced global LVLS was associated with lower ejection fraction. Reduced global TMAD was associated with reduced global and segmental LVLS, reduced left ventricular ejection fraction, and increased left ventricular end-systolic and end-diastolic volumes. Speckle-tracking echocardiography can be performed feasibly in patients in sepsis. Global and segmental left ventricular deformation indices are associated with ejection fraction. Further studies need to evaluate the ability of these new indices to predict sepsis outcomes. PMID:26673591

  7. Initial experience of using intracardiac echocardiography (ICE) for guiding balloon mitral valvuloplasty (BMV)

    PubMed Central

    Ahmari, Saeed AL; Amro, Ahmed; Otabi, Mohammed AL; Abdullah, Moheeb AL; Kasab, Saad AL; Amri, Husien AL

    2011-01-01

    Background and aims BMV is an established treatment for rheumatic mitral valve stenosis. The procedure is historically guided by fluoroscopy, and the role of intracardiac echocardiogram (ICE) guidance is not well defined. We report our initial experience of using ICE to guide BMV procedures. Methods During BMV procedure, ICE catheter was inserted into the right atrium from the right femoral vein, and the septal puncture was monitored by ICE, as well as positioning of the balloon in the mitral valve. Comparisons were made between ICE, transthoracic echocardiography (TTE), and catheterization derived hemodynamic measurements (cath). Results Seventeen patients with mitral stenosis underwent the procedure. The mean age was 44.4 ± 21 years. The mean MV area increased from 0.9 ± 0.1 cm2 to 1.7 ± 0.2 cm2, P < 0.0001 and the mean gradient decreased from 12.6 ± 5.8 mmHg to 4.9 ± 1.8 mmHg, P < 0.001. Atrial septum puncture and guidance of the balloon into the MV apparatus were obtained in all patients under ICE guidance. Severe MR developed in one patient and was readily detected by ICE. ICE derived gradient measurements were comparable to those obtained by TTE, and cath. Conclusion ICE guidance of BMV is feasible, and useful in monitoring safe septal puncture, optimizing balloon positioning, and in detecting complications. The hemodynamic measurements obtained were comparable to those obtained by TTE, and cath. PMID:23960664

  8. Screening for Abdominal Aortic Aneurysm during Transthoracic Echocardiography in Patients with Significant Coronary Artery Disease

    PubMed Central

    Lee, Sung Ho; Chang, Sung-A; Jang, Shin Yi; Lee, Sang-Chol; Song, Young Bin; Park, Seung Woo; Choi, Seung-Hyuk; Gwon, Hyeon-Cheol; Oh, Jae K.

    2015-01-01

    Purpose Coronary artery disease (CAD) shares several risk factors with abdominal aortic aneurysm (AAA). We evaluated the prevalence during transthoracic echocardiography (TTE) and risk factors of AAA in patients with CAD. Materials and Methods A total of 1300 CAD patients were screened from August 2009 to May 2010, and measurement of abdominal aorta size was feasible in 920 patients (71%) at the end of routine TTE. An AAA was defined as having a maximal diameter of ?30 mm. Results Of the 920 patients, 22 (2.4% of the study population) were diagnosed with AAA; of these AAA patients, 86% were male, and 82% were over 65 years-old. Abdominal aortic size was weakly correlated with aortic root diameter (r=0.22, p<0.01). Although the proportions of male gender, hypertension, and dyslipidemia were higher in AAA patients, such differences were not statistically significant. Advanced age [odds ratio (OR)=1.07; 95% confidence interval (CI): 1.01-1.12; p<0.01], smoking (OR=3.44; 95% CI: 1.18-10.04; p=0.02), and peripheral arterial disease (OR=5.88; 95% CI: 1.38-25.05; p=0.01) were found to be associated with AAA. Conclusion Although prevalence of AAA is very low in the Asian population, the prevalence of AAA in Asian CAD patients is higher than the general population. Therefore, opportunistic examination of the abdominal aorta during routine TTE could be effective, especially for male CAD patients over 65 years with a history of smoking or peripheral arterial disease. PMID:25510745

  9. Assessment of Right Ventricular Structure and Function in Mouse Model of Pulmonary Artery Constriction by Transthoracic Echocardiography

    PubMed Central

    Cheng, Susan; Bauer, Michael; Ngoy, Soeun; Qiu, Yiling; Guan, Jian; Mishra, Shikha; Mbah, Christopher; Liao, Ronglih

    2014-01-01

    Emerging clinical data support the notion that RV dysfunction is critical to the pathogenesis of cardiovascular disease and heart failure1-3. Moreover, the RV is significantly affected in pulmonary diseases such as pulmonary artery hypertension (PAH). In addition, the RV is remarkably sensitive to cardiac pathologies, including left ventricular (LV) dysfunction, valvular disease or RV infarction4. To understand the role of RV in the pathogenesis of cardiac diseases, a reliable and noninvasive method to access the RV structurally and functionally is essential. A noninvasive trans-thoracic echocardiography (TTE) based methodology was established and validated for monitoring dynamic changes in RV structure and function in adult mice. To impose RV stress, we employed a surgical model of pulmonary artery constriction (PAC) and measured the RV response over a 7-day period using a high-frequency ultrasound microimaging system. Sham operated mice were used as controls. Images were acquired in lightly anesthetized mice at baseline (before surgery), day 0 (immediately post-surgery), day 3, and day 7 (post-surgery). Data was analyzed offline using software. Several acoustic windows (B, M, and Color Doppler modes), which can be consistently obtained in mice, allowed for reliable and reproducible measurement of RV structure (including RV wall thickness, end-diastolic and end-systolic dimensions), and function (fractional area change, fractional shortening, PA peak velocity, and peak pressure gradient) in normal mice and following PAC. Using this method, the pressure-gradient resulting from PAC was accurately measured in real-time using Color Doppler mode and was comparable to direct pressure measurements performed with a Millar high-fidelity microtip catheter. Taken together, these data demonstrate that RV measurements obtained from various complimentary views using echocardiography are reliable, reproducible and can provide insights regarding RV structure and function. This method will enable a better understanding of the role of RV cardiac dysfunction. PMID:24513696

  10. The advantages of live/real time three-dimensional transesophageal echocardiography during assessments of pulmonary stenosis.

    PubMed

    Kemaloğlu Öz, Tuğba; Özpamuk Karadeniz, Fatma; Akyüz, Şükrü; Ünal Dayı, Şennur; Esen Zencirci, Aycan; Atasoy, Işıl; Ösken, Altuğ; Eren, Mehmet

    2016-04-01

    This report sought to compare live/real-time three-dimensional transesophageal echocardiography (3D-TEE) with two-dimensional transesophageal echocardiography (2D-TEE) and to determine whether there are advantages to using 3D-TEE on patients with pulmonary stenosis (PS). Sixteen consecutive adult patients (50 % male and 50 % female; mean age 33 ± 13.4 years) with PS and indications of TEE were prospectively enrolled in this study. Following this, initial 2D-TEE and 3D-TEE examinations were performed, and 3D-TEE images were analyzed using an off-line Q-lab software system. Finally, the 2D-TEE and 3D-TEE findings were compared. In the present study, 3D-TEE allowed us to obtain the en face views of pulmonary valves (PVs) in all but one patient. While this patient was without a PV due to a previous tetralogy of Fallot operation, we could detect the type of PV in the other 15 (93.7 %) patients by using 3D-TEE. Due to poor image quality, the most stenotic area was not measurable in only one (6.2 %) of the patients. In eight (50 %) of the patients, severity and localization of stenosis were more precisely determined with 3DTEE than with 2D-TEE. The PVs' maximal annulus dimensions were found to be significantly larger when they were measured using 3D modalities. This study provides evidence of the incremental value of using 3D-TEE rather than 2D-TEE during assessments of PS, specifically in cases where special conditions (pregnancy, pulmonary regurgitation, and concomitant atrial septal defects) cause recordings of the transvalvular peak gradient to be inaccurate. Therefore, 3D-TEE should be used as a complementary imaging tool to 2D-TEE during routine echocardiographic examinations. PMID:26613764

  11. Automated Classification of Disease Patterns from Echo-cardiography Images Based on Shape Features of the Left Ventricle

    NASA Astrophysics Data System (ADS)

    Das, Shaoli; Parekh, Ranjan

    2010-10-01

    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%.

  12. Intraoperative three-dimensional transesophageal echocardiography for evaluating an unusual structure in the left ventricular outflow tract: a case report

    PubMed Central

    Sung, Tae-Yun; Kwon, Won-Kyoung; Park, Dong-Ho; Park, Cheol-Hwan

    2015-01-01

    Intraoperative three-dimensional (3D) transesophageal echocardiography (TEE) facilitates an understanding of the complex cardiac pathology that is not fully delineated in a two-dimensional (2D) echocardiographic evaluation, and it suggests earlier and more precise surgical planning and intraoperative decision making. In the present case, the intraoperative 2D-TEE midesophageal long-axis view indicated a significant narrowing of the left ventricular outflow tract (LVOT) area by a band-like structure that vertically traversed the middle of the LVOT and connected to the anterior mitral leaflet base and the interventricular septum. However, additional 3D-TEE images of the LVOT and their cropped and rendered 2D images showed that web-like tissue, which presumably had grown around the patch closure from a previous atrioventricular septal defect, was obstructing the LVOT partially. PMID:26495063

  13. Automated Classification of Disease Patterns from Echo-cardiography Images Based on Shape Features of the Left Ventricle

    SciTech Connect

    Das, Shaoli; Parekh, Ranjan

    2010-10-26

    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%.

  14. Gunshot-Induced Aorto-Left Atrial Fistula Diagnosed by Intraoperative Transesophageal Echocardiography.

    PubMed

    Nandate, Koichiro; Krishnamoorthy, Vijay; McIntyre, Lisa K; Verrier, Edward D; Mackensen, G Burkhard

    2016-02-01

    Aorto-left atrial fistula (AAF) is rarely encountered in clinical practice, and the early diagnosis can be very challenging. This report describes a unique case of AAF caused by a gunshot injury and the pivotal role of transesophageal echocardiography for diagnosis and assessment. PMID:26777940

  15. Three Different Coexisting Mechanical Complications of Myocardial Infarction Detected by Transthoracic and Transesophageal Echocardiography.

    PubMed

    Espinola-Zavaleta, Nilda; Vargas-Barrón, Jesus; Romero-Cardenas, Angel; Gonzalez-Sanchez, Sadia; Lopez-Soriano, Fernando; Rijlaarsdam, Maria; Keirns, Candace

    1997-01-01

    An aneurysm, pseudoaneurysm, and interventricular septal rupture were detected by transthoracic and transesophageal echocardiography (TEE) in a 61-year-old man with anterior myocardial infarction. This case illustrates the value of these techniques in the assessment of mechanical complications associated with myocardial infarction. PMID:11174922

  16. Television Quiz Show Simulation

    ERIC Educational Resources Information Center

    Hill, Jonnie Lynn

    2007-01-01

    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.

  17. Contrast and harmonic imaging improves accuracy and efficiency of novice readers for dobutamine stress echocardiography

    NASA Technical Reports Server (NTRS)

    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.

    2002-01-01

    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.

  18. Echocardiography detects elevated left ventricular filling pressures in heart transplant recipients.

    PubMed

    Bech-Hanssen, Odd; Al-Habeeb, Waleed; Ahmed, Waqas; Di Salvo, Giovanni; Pergola, Valeria; Al-Admawi, Mohammed; Al-Amri, Mohammed; Al-Shahid, Maie; Al-Buraiki, Jehad; Fadel, Bahaa M

    2015-03-01

    Diastolic dysfunction is a recognized complication in heart transplant (HTx) recipients that limits exercise capacity and is a risk factor for mortality. We investigated the ability of echocardiography to detect elevated pulmonary capillary wedge pressure (mean PCWP>15 mmHg) in HTx recipients. This retrospective study comprised HTx recipients with echocardiography and right heart catheterization within 24 hours (n = 100, 113 investigations). Echocardiographic assessment was performed using mitral inflow (E/A ratio, deceleration time [DT], isovolumic relaxation time [IVRT]), tissue Doppler (E/E' lateral) parameters, and the Doppler-estimated pulmonary artery systolic pressure (Doppler PASP). The right atrial pressure (RAP) was estimated based on size and the effect of respiration or sniffing on the inferior vena cava diameter. Cutoff values were determined from a derivation group (n = 57, receiver operator characteristic curve analysis) and evaluated in a test group (n = 56). Elevated PCWP were found in 38%. The RAP and PCWP were both normal in 58 investigations and elevated in 39 investigations (concordance rate of 86.6%). The presence of signs of increased RAP by echocardiography or with three of five parameters (E/A, DT, IVRT, E/E' lateral, and Doppler PASP) reaching the cutoff values ruled in elevated PCWP with positive likelihood ratios ranging from 15.3 to 9. With normal RAP by echocardiography or none of the other parameters reaching cutoff values elevated PCWP can be ruled out with negative likelihood ratios ranging from 0.07 to 0.19. In conclusion, elevated PCWP in HTx recipients can be assessed using echocardiography. PMID:24995376

  19. A Novel Stress Echocardiography Pattern for Myocardial Bridge With Invasive Structural and Hemodynamic Correlation

    PubMed Central

    Lin, Shin; Tremmel, Jennifer A.; Yamada, Ryotaro; Rogers, Ian S.; Yong, Celina Mei; Turcott, Robert; McConnell, Michael V.; Dash, Rajesh; Schnittger, Ingela

    2013-01-01

    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. PMID:23591827

  20. Responsiveness of raised pulmonary vascular resistance to oxygen assessed by pulsed Doppler echocardiography.

    PubMed Central

    Vogel, M; Weil, J; Stern, H; Bühlmeyer, K

    1991-01-01

    OBJECTIVE--To assess whether changes in Doppler echocardiographic indices in the pulmonary artery correlated with changes in pulmonary vascular resistance. DESIGN--Acceleration time, ejection time, maximal flow velocity, and velocity time integrals were measured at the same time as pressure and oxygen saturation measurements in room air and during 10 minutes of oxygen breathing in the catheterisation laboratory. Pulmonary vascular resistance and pulmonary blood flow (Qp) were calculated from catheterisation data by use of the Fick principle. PATIENTS--14 consecutive patients with a congenital heart defect and a left to right shunt associated with raised pulmonary artery pressure who underwent routine diagnostic cardiac catheterisation to assess their pulmonary vascular resistance. RESULTS--Though pulmonary vascular resistance and systolic pulmonary artery pressure fell significantly during oxygen administration, there was no significant change in the acceleration time or ejection time. Peak velocity increased significantly during oxygen administration. During oxygen breathing Doppler derived measurements of pulmonary flow showed a significant increase in Qp similar to the increase in Qp measured by the Fick principle. There was no significant correlation between the fall in pulmonary vascular resistance and the increase in acceleration time or ejection time, increase in peak velocity, increase in pulmonary artery diameter, or increase in Doppler derived pulmonary blood flow. CONCLUSIONS--Measurements of acceleration and ejection time by Doppler echocardiography did not predict the response of pulmonary artery pressure and resistance to oxygen. Though changes in maximal flow velocity across the pulmonary artery and in Doppler derived pulmonary blood flow measurements became significant during oxygen breathing, the correlation of these changes with fall in pulmonary vascular resistance was poor. PMID:1747277

  1. Evaluation of transesophageal echocardiography in detecting cardiac sources of emboli in ischemic stroke patients

    PubMed Central

    Toodeji, Mohammad Amin; Izadi, Sadegh; Shariat, Abdolhamid; Nikoo, Mohamad Hosin

    2015-01-01

    Background: Embolus is one of the causes of ischemic stroke that can be due to cardiac sources such as valvular heart diseases and atrial fibrillation and atheroma of the aorta. Transesophageal echocardiography (TEE) is superior in identifying potential cardiac sources of emboli. Due to insufficient data on TEE findings in ischemic stroke in Iran, the present study was done to evaluate TEE in detecting cardiac sources of emboli. The main aim of this study was to describe the cardiogenic sources of emboli using TEE in the ischemic stroke patients. Methods: This is a cross-sectional study conducted during a 13-month period from January 2012 to February 2013 in Shiraz Nemazee teaching hospital. Patients admitted with stroke diagnosis were included; but hemorrhagic stroke cases were excluded. 229 patients with ischemic stroke diagnosis were included and underwent TEE. Results: Causes of cardiac emboli were detected in 65 cases (40.7%) and categorized to high-risk (29.7%) and potential risk (11%). High risk cardiac sources included atrial fibrillation (8.7%), mitral valve disease (MS or MI) 11 cases (4.75%), aortic valve disease (AS or AI) 8 (3.5%), prosthetic valve 3 (1.35%), dilated cardiomyopathy 45 (19.65%) and congestive heart failure with ejection fraction < 30% in 8 cases (3.5%). Potential cardiac sources of emboli comprised 7 cases (3.05%) of septal aneurysm, 4 (1.75%) left ventricular hypokinesia, 13 (5.7%) mitral annular calcification and 9 cases (3.95%) complex atheroma in the ascending aorta or proximal arch. Conclusion: Our study showed that high risk cardiac sources of emboli can be detected using TEE in a considerable percentage of ischemic stroke patients. The most common high risk cardiac etiologies were dilated cardiomyopathy and valvular heart diseases. PMID:26793628

  2. Quantitative analysis of myocardial perfusion in rabbits by transthoracic real-time myocardial contrast echocardiography.

    PubMed

    Deng, Heping; Xie, Mingxing; Wang, Xinfang; Lv, Qing; Li, Songnan; Bao, Yuting; Wang, Jing; Lu, Xiaofang; Yang, Yali; Lu, Bo

    2009-12-01

    To evaluate the feasibility of real-time myocardial contrast echocardiography (RTMCE) by quantitative analysis of myocardial perfusion in rabbits, transthoracic RTMCE was performed in 10 healthy rabbits by using continuous infusion of SonoVue into the auricular vein. The short axis view at the papillary muscle level was obtained. The duration of the time that the contrast took to appear in right heart, left heart and myocardium was recorded. The regional myocardial signal intensity (SI) versus refilling time plots were fitted to an exponential function: y(t) =A(1-e(-beta(t-t0))) + C, where y is SI at any given time, A is the SI plateau that reflects myocardial blood volume, and beta is the slope of the refilling curve that reflects myocardial microbubble velocity. The A, beta and Axbeta values at different infusion rate of SonoVue were analyzed and the A, beta and Axbeta values in each segment in the short axis view at the papillary muscle level were compared. All the animal experiments were successful and high-quality images were obtained. The best intravenous infusion rate for SonoVue was 30 mL/h. The contrast appeared in right heart, left heart and myocardium at 7.5+/-2.2 s, 9.1+/-2.4 s and 12.2+/-1.6 s respectively. After 16.6+/-2.3s, myocardial opacification reached a steady state. The mean A, beta and Axbeta value in the short axis view at the papillary muscle level were 9.8+/-3.0 dB, 1.4+/-0.5 s(-1) and 13.5+/-3.6 dBxs(-1) respectively. A, beta and Axbeta values showed no significant differences among 6 segments. It was suggested that RTMCE was feasible for quantitative analysis of myocardial perfusion in rabbits. It provides a non-invasive method to evaluate the myocardial perfusion in rabbit disease models. PMID:20037830

  3. Intraoperative echocardiography in valvular heart disease: an evidence-based appraisal.

    PubMed

    Michelena, Hector I; Abel, Martin D; Suri, Rakesh M; Freeman, William K; Click, Roger L; Sundt, Thoralf M; Schaff, Hartzell V; Enriquez-Sarano, Maurice

    2010-07-01

    Intraoperative (IO) transesophageal echocardiography (TEE) is widely used for assessing the results of valvular heart disease (VHD) surgery. Epiaortic ultrasonography (EAU) has been recommended for prevention of perioperative strokes. To what extent does high-quality evidence justify the widespread use of these imaging modalities? In March 2009, we searched MEDLINE (PubMed and OVID interfaces) and EMBASE for studies published in English using database-specific controlled vocabulary describing the concepts of IOTEE, cardiac surgery, VHD, and EAU. We found no randomized trials or studies with control groups assessing the impact of IOTEE in VHD surgery. Pooled analysis of 8 observational studies including 15,540 patients showed an average incidence of 11% for prebypass surgical changes and 4% for second pump runs, suggesting that patients undergoing VHD surgery may benefit significantly from IOTEE, particularly from postcardiopulmonary bypass IOTEE in aortic repair and mitral repair and replacement, but less so in isolated aortic replacement. Further available indirect evidence was satisfactory in the test accuracy and surgical quality control aspects, with low complication rates for IOTEE. The data supporting EAU included 12,687 patients in 2 prospective randomized studies and 4 nonrandomized, controlled studies, producing inconsistent outcome-related results. Despite low-quality scientific evidence supporting IOTEE in VHD surgery, we conclude that indirect evidence supporting its use is satisfactory and suggests that IOTEE may offer considerable benefit in valvular repairs and mitral replacements. The value of IOTEE in isolated aortic valve replacement remains less clear. Evidence supporting EAU is scientifically more robust but conflicting. These findings have important clinical policy and research implications. PMID:20592170

  4. Intraoperative Echocardiography in Valvular Heart Disease: An Evidence-Based Appraisal

    PubMed Central

    Michelena, Hector I.; Abel, Martin D.; Suri, Rakesh M.; Freeman, William K.; Click, Roger L.; Sundt, Thoralf M.; Schaff, Hartzell V.; Enriquez-Sarano, Maurice

    2010-01-01

    Intraoperative (IO) transesophageal echocardiography (TEE) is widely used for assessing the results of valvular heart disease (VHD) surgery. Epiaortic ultrasonography (EAU) has been recommended for prevention of perioperative strokes. To what extent does high-quality evidence justify the widespread use of these imaging modalities? In March 2009, we searched MEDLINE (PubMed and OVID interfaces) and EMBASE for studies published in English using database-specific controlled vocabulary describing the concepts of IOTEE, cardiac surgery, VHD, and EAU. We found no randomized trials or studies with control groups assessing the impact of IOTEE in VHD surgery. Pooled analysis of 8 observational studies including 15,540 patients showed an average incidence of 11% for prebypass surgical changes and 4% for second pump runs, suggesting that patients undergoing VHD surgery may benefit significantly from IOTEE, particularly from postcardiopulmonary bypass IOTEE in aortic repair and mitral repair and replacement, but less so in isolated aortic replacement. Further available indirect evidence was satisfactory in the test accuracy and surgical quality control aspects, with low complication rates for IOTEE. The data supporting EAU included 12,687 patients in 2 prospective randomized studies and 4 nonrandomized, controlled studies, producing inconsistent outcome-related results. Despite low-quality scientific evidence supporting IOTEE in VHD surgery, we conclude that indirect evidence supporting its use is satisfactory and suggests that IOTEE may offer considerable benefit in valvular repairs and mitral replacements. The value of IOTEE in isolated aortic valve replacement remains less clear. Evidence supporting EAU is scientifically more robust but conflicting. These findings have important clinical policy and research implications. PMID:20592170

  5. Early and late improvement of global and regional left ventricular function after transcatheter aortic valve implantation in patients with severe aortic stenosis: an echocardiographic study

    PubMed Central

    Giannini, Cristina; Petronio, Anna Sonia; Talini, Enrica; De Carlo, Marco; Guarracino, Fabio; Grazia, Maria; Donne, Delle; Nardi, Carmela; Conte, Lorenzo; Barletta, Valentina; Marzilli, Mario; Di Bello, Vitantonio

    2011-01-01

    The recent development of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) treatment offers a viable option for high-risk patient categories. Our aim is to evaluate whether 2D strain and strain rate can detect subtle improvement in global and regional LV systolic function immediately after TAVI. 2D conventional and 2D strain (speckle analysis) echocardiography was performed before, at discharge and after three months in thirty three patients with severe AS. After TAVI, we assessed by conventional echocardiography an immediate reduction of transaortic peak pressure gradient (p<0.0001), of mean pressure gradient (p<0.0001) and a concomitant increase in aortic valve area (AVA: 1.08±0.31 cm2/m2; p<0.0001). 2D longitudinal systolic strain showed a significant improvement in all patients, both at septal and lateral level, as early as 72 h after procedure (septal: -14.2±5.1 vs -16.7±3.7%, p<0.001; lateral: -9.4±3.9 vs -13.1±4.5%, p<0.001; respectively) and continued at 3 months follow-up (septal: -18.1±4.6%, p<0.0001; lateral: -14.8±4.4%, p<0.0001; respectively). Conventional echocardiography after TAVI proved a significant reduction of LV end-systolic volume and of LV mass with a mild improvement of LV ejection fraction (EF) (51.2±11.8 vs 52.9±6.4%; p<0.02) only after three months. 2D strain seems to be able to detect subtle changes in LV systolic function occurring early and late after TAVI in severe AS, while all conventional echo parameters seem to be less effective for this purpose. Further investigations are needed to prove the real prognostic impact of these echocardiographic findings. PMID:22254204

  6. The Great Cometary Show

    NASA Astrophysics Data System (ADS)

    2007-01-01

    The ESO Very Large Telescope Interferometer, which allows astronomers to scrutinise objects with a precision equivalent to that of a 130-m telescope, is proving itself an unequalled success every day. One of the latest instruments installed, AMBER, has led to a flurry of scientific results, an anthology of which is being published this week as special features in the research journal Astronomy & Astrophysics. ESO PR Photo 06a/07 ESO PR Photo 06a/07 The AMBER Instrument "With its unique capabilities, the VLT Interferometer (VLTI) has created itself a niche in which it provide answers to many astronomical questions, from the shape of stars, to discs around stars, to the surroundings of the supermassive black holes in active galaxies," says Jorge Melnick (ESO), the VLT Project Scientist. The VLTI has led to 55 scientific papers already and is in fact producing more than half of the interferometric results worldwide. "With the capability of AMBER to combine up to three of the 8.2-m VLT Unit Telescopes, we can really achieve what nobody else can do," added Fabien Malbet, from the LAOG (France) and the AMBER Project Scientist. Eleven articles will appear this week in Astronomy & Astrophysics' special AMBER section. Three of them describe the unique instrument, while the other eight reveal completely new results about the early and late stages in the life of stars. ESO PR Photo 06b/07 ESO PR Photo 06b/07 The Inner Winds of Eta Carinae The first results presented in this issue cover various fields of stellar and circumstellar physics. Two papers deal with very young solar-like stars, offering new information about the geometry of the surrounding discs and associated outflowing winds. Other articles are devoted to the study of hot active stars of particular interest: Alpha Arae, Kappa Canis Majoris, and CPD -57o2874. They provide new, precise information about their rotating gas envelopes. An important new result concerns the enigmatic object Eta Carinae. Using AMBER with its high spatial and spectral resolution, it was possible to zoom into the very heart of this very massive star. In this innermost region, the observations are dominated by the extremely dense stellar wind that totally obscures the underlying central star. The AMBER observations show that this dense stellar wind is not spherically symmetric, but exhibits a clearly elongated structure. Overall, the AMBER observations confirm that the extremely high mass loss of Eta Carinae's massive central star is non-spherical and much stronger along the poles than in the equatorial plane. This is in agreement with theoretical models that predict such an enhanced polar mass-loss in the case of rapidly rotating stars. ESO PR Photo 06c/07 ESO PR Photo 06c/07 RS Ophiuchi in Outburst Several papers from this special feature focus on the later stages in a star's life. One looks at the binary system Gamma 2 Velorum, which contains the closest example of a star known as a Wolf-Rayet. A single AMBER observation allowed the astronomers to separate the spectra of the two components, offering new insights in the modeling of Wolf-Rayet stars, but made it also possible to measure the separation between the two stars. This led to a new determination of the distance of the system, showing that previous estimates were incorrect. The observations also revealed information on the region where the winds from the two stars collide. The famous binary system RS Ophiuchi, an example of a recurrent nova, was observed just 5 days after it was discovered to be in outburst on 12 February 2006, an event that has been expected for 21 years. AMBER was able to detect the extension of the expanding nova emission. These observations show a complex geometry and kinematics, far from the simple interpretation of a spherical fireball in extension. AMBER has detected a high velocity jet probably perpendicular to the orbital plane of the binary system, and allowed a precise and careful study of the wind and the shockwave coming from the nova. The stream of results from the VLTI and AMBER

  7. Echocardiography and invasive hemodynamics during stress testing for diagnosis of heart failure with preserved ejection fraction: an experimental study.

    PubMed

    Leite, Sara; Oliveira-Pinto, José; Tavares-Silva, Marta; Abdellatif, Mahmoud; Fontoura, Dulce; Falcão-Pires, Inês; Leite-Moreira, Adelino F; Lourenço, André P

    2015-06-15

    Inclusion of exercise testing in diagnostic guidelines for heart failure with preserved ejection fraction (HFpEF) has been advocated, but the target population, technical challenges, and underlying pathophysiological complexity raise difficulties to implementation. Hemodynamic stress tests may be feasible alternatives. Our aim was to test Trendelenburg positioning, phenylephrine, and dobutamine in the ZSF1 obese rat model to find echocardiographic surrogates for end-diastolic pressure (EDP) elevation and HFpEF. Seventeen-week-old Wistar-Kyoto, ZSF1 lean, and obese rats (n = 7 each) randomly and sequentially underwent (crossover) Trendelenburg (30°), 5 ?g·Kg(-1)·min(-1) dobutamine, and 7.5 ?g·Kg(-1)·min(-1) phenylephrine with simultaneous left ventricular (LV) pressure-volume loop and echocardiography evaluation under halogenate anesthesia. Effort testing with maximum O2 consumption (V?o 2 max) determination was performed 1 wk later. Obese ZSF1 showed lower effort tolerance and V?o 2 max along with higher resting EDP. Both Trendelenburg and phenylephrine increased EDP, whereas dobutamine decreased it. Significant correlations were found between EDP and 1) peak early filling Doppler velocity of transmitral flow (E) to corresponding myocardial tissue Doppler velocity (E') ratio, 2) E to E-wave deceleration time (E/DT) ratio, and 3) left atrial area (LAA). Diagnostic efficiency of E/DT*LAA by receiver-operating characteristic curve analysis for elevation of EDP above a cut-off of 13 mmHg during hemodynamic stress was high (area under curve, AUC = 0.95) but not higher than that of E/E' (AUC = 0.77, P = 0.15). Results in ZSF1 obese rats suggest that noninvasive echocardiography after hemodynamic stress induced by phenylephrine or Trendelenburg can enhance diagnosis of stable HFpEF and constitute an alternative to effort testing. PMID:25862827

  8. Apex to Base Left Ventricular Twist Mechanics Computed From High Frame Rate Two-Dimensional and Three-Dimensional Echocardiography: A Comparison Study

    PubMed Central

    Ashraf, Muhammad; Zhou, Zhiwen; Nguyen, Thuan; Ashraf, Shiza; Sahn, David J.

    2012-01-01

    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. PMID:21995883

  9. The Art Show

    ERIC Educational Resources Information Center

    Scolarici, Alicia

    2004-01-01

    This article describes what once was thought to be impossible--a formal art show extravaganza at an elementary school with 1,000 students, a Department of Defense Dependent School (DODDS) located overseas, on RAF Lakenheath, England. The dream of this this event involved the transformation of the school cafeteria into an elegant art show…

  10. Severe Weather

    ERIC Educational Resources Information Center

    Forde, Evan B.

    2004-01-01

    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,…

  11. Severe Weather

    ERIC Educational Resources Information Center

    Forde, Evan B.

    2004-01-01

    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…

  12. Microtubule severing.

    PubMed

    Quarmby, L M; Lohret, T A

    1999-01-01

    The regulation of microtubule stability by severing of the polymer along its length is a newly appreciated and potentially important mechanism for controlling microtubule function. Microtubule severing occurs in living cells, but direct observation of this event is infrequent. The paucity of direct observations leave open to question the significance of regulated microtubule severing in the control of microtubule organization. Nevertheless, several lines of evidence suggest that microtubule severing is an important cellular activity. First, the ATP-dependent microtubule-severing activity of katanin is well documented. Katanin is found in most cell types and is enriched at MTOCs. Although it is possible that katanin does not sever microtubules in vivo, this seems unlikely. Second, a physiological event, deflagellation, has been shown to depend on microtubule severing. The deflagellation system of Chlamydomonas has provided a genetic approach to the problem of microtubule severing. The FA genes are essential for the regulated severing of axonemal microtubules during deflagellation, but whether these genes define new severing proteins or whether they are important for katanin activity remains to be determined. Microtubule severing is a relatively new area of investigation and there are still many more questions than answers. It is anticipated that the recent cloning of katanin and the introduction of a genetic model system will soon lead to significant breakthroughs in this problem. PMID:10340698

  13. Severe Weather

    ERIC Educational Resources Information Center

    Forde, Evan B.

    2004-01-01

    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…

  14. Severe Weather

    ERIC Educational Resources Information Center

    Forde, Evan B.

    2004-01-01

    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,…

  15. Intraprocedural myocardial contrast echocardiography as a routine procedure in percutaneous transluminal septal myocardial ablation: detection of threatening myocardial necrosis distant from the septal target area.

    PubMed

    Faber, L; Seggewiss, H; Ziemssen, P; Gleichmann, U

    1999-08-01

    Percutaneous transluminal septal myocardial ablation (PTSMA) has been introduced as an alternative to surgery for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). Visualization of the ablation area prior to induction of the chemical necrosis is possible by intraprocedural myocardial contrast echocardiography (MCE). We report on two patients in whom MCE showed opacification of the medial papillary muscle or the left ventricular posterolateral free wall. In both patients the correct ablation area could be identified by MCE after a change of the target vessel, thus avoiding potentially fatal complications due to induction of a necrosis of myocardium distant from the septal target area. PMID:10470478

  16. Assessment of Myocardial Ischemia in Obese Individuals Undergoing Physical Stress Echocardiography (PSE)

    PubMed Central

    Silveira, Mara Graziele Maciel; Sousa, Antônio Carlos Sobral; Santos, Marcos Antônio Almeida; Tavares, Irlaneide da Silva; Andrade, Stephanie Macedo; Melo, Luiza Dantas; de Andrade, Loren Suyane Oliveira; Santos, Emmanuel Lima Almeida; Oliveira, Joselina Luzia Menezes

    2015-01-01

    Background Physical stress echocardiography is an established methodology for diagnosis and risk stratification of coronary artery disease in patients with physical capacity. In obese (body mass index ? 30 kg/m2) the usefulness of pharmacological stress echocardiography has been demonstrated; however, has not been reported the use of physical stress echocardiography in this growing population group. Objective To assess the frequency of myocardial ischemia in obese and non-obese patients undergoing physical stress echocardiography and compare their clinical and echocardiographic differences. Methods 4,050 patients who underwent treadmill physical stress echocardiography were studied according to the Bruce protocol, divided into two groups: obese (n = 945; 23.3%) and non-obese (n = 3,105; 76.6%). Results There was no difference regarding gender. Obese patients were younger (55.4 ± 10.9 vs. 57.56 ± 11.67) and had a higher frequency of hypertension (75.2% vs. 57, 2%; p < 0.0001), diabetis mellitus (15.2% vs. 10.9%; p < 0.0001), dyslipidemia (59.5% vs 51.9%; p < 0.0001), family history of coronary artery disease (59.3% vs. 55.1%; p = 0.023) and physical inactivity (71.4% vs. 52.9%, p < 0.0001). The obese had greater aortic dimensions (3.27 vs. 3.14 cm; p < 0.0001), left atrium (3.97 vs. 3.72 cm; p < 0.0001) and the relative thickness of the ventricule (33.7 vs. 32.8 cm; p < 0.0001). Regarding the presence of myocardial ischemia, there was no difference between groups (19% vs. 17.9%; p = 0.41). In adjusted logistic regression, the presence of myocardial ischemia remained independently associated with age, female gender, diabetes and hypertension. Conclusion Obesity did not behave as a predictor of the presence of ischemia and the physical stress echocardiography. The application of this assessment tool in large scale sample demonstrates the feasibility of the methodology, also in obese. PMID:25714197

  17. Talk Show Science.

    ERIC Educational Resources Information Center

    Moore, Mitzi Ruth

    1992-01-01

    Proposes having students perform skits in which they play the roles of the science concepts they are trying to understand. Provides the dialog for a skit in which hot and cold gas molecules are interviewed on a talk show to study how these properties affect wind, rain, and other weather phenomena. (MDH)

  18. Showing What They Know

    ERIC Educational Resources Information Center

    Cech, Scott J.

    2008-01-01

    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…

  19. The Ozone Show.

    ERIC Educational Resources Information Center

    Mathieu, Aaron

    2000-01-01

    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)

  20. Stage a Water Show

    ERIC Educational Resources Information Center

    Frasier, Debra

    2008-01-01

    In the author's book titled "The Incredible Water Show," the characters from "Miss Alaineus: A Vocabulary Disaster" used an ocean of information to stage an inventive performance about the water cycle. In this article, the author relates how she turned the story into hands-on science teaching for real-life fifth-grade students. The author also…

  1. Show Them the Money.

    ERIC Educational Resources Information Center

    Levine, Elliott

    2002-01-01

    Strategies to help garner community support in school technology growth or maintenance include the following: (1) consider a "current state of technology" report; (2) forget five-year plans; (3) develop annual technology reports; (4) look to your website; (5) seek constructive opportunities to share technology, and (6) show off best examples at…

  2. Comparison of indium-111 platelet scintigraphy and two-dimensional echocardiography in the diagnosis of left ventricular thrombi

    SciTech Connect

    Ezekowitz, M.D.; Wilson, D.A.; Smith, E.O.; Burow, R.D.; Harrison, L.H. Jr.; Parker, D.E.; Elkins, R.C.; Peyton, M.; Taylor, F.B.

    1982-06-24

    In a study comparing indium-111 platelet scintigraphy and two-dimensional echocardiography as methods of identifying left ventricular thrombi, the results obtained with both techniques were verified at surgery or autopsy in 53 patients-34 with left ventricular aneurysms, and 19 with mitral-valve disease. Left ventricular thrombi were found at surgery or autopsy in 14 of the patients with aneurysms and in none of those with mitral-valve disease. Thirteen of 53 echocardiograms (25%) were technically inadequate and excluded from the analysis. In the group with aneurysms, the sensitivity of scintigraphy in detecting thrombi was 71%, and that of echocardiography was 77%. The specificity of scintigraphy was 100%, and that of echocardiography was 93%. We conclude that indium-111 platelet scintigraphy and two-dimensional echocardiography have useful and complementary roles in the detection of left ventricular thrombi. Both these noninvasive techniques can be used to monitor therapy.

  3. Early Left Ventricular Dysfunction in Children after Hematopoietic Stem Cell Transplantation for Acute Leukemia: A Case Control Study Using Speckle Tracking Echocardiography

    PubMed Central

    Yoon, Ji-Hong; Kim, Hye Jin; Lee, Eun-Jung; Moon, Sena; Lee, Jae Wook; Chung, Nack Gyun; Cho, Bin; Kim, Hack Ki

    2015-01-01

    Background and Objectives Cardiovascular complications are the leading cause of morbidity and mortality in childhood cancer survivors. Hematopoietic stem cell transplantation (HSCT) is a curable therapy for pediatric cancer. However, changes in cardiac function in children after HSCT are not well known. We assessed left ventricular (LV) function in children after HSCT using speckle tracking echocardiography (STE). Subjects and Methods Forty consecutive patients with median age of 11.9 years (range, 1.5-16 years) who received HSCT for acute leukemia and had comprehensive echocardiography before and after (median 9.2 month) HSCT were included in this study. The LV function parameters including conventional tissue Doppler imaging (TDI) and STE data were collected from pre- and post-HSCT echocardiography. These data were compared to those of 39 age-matched normal controls. Results Compared to normal controls, post HSCT patients had similar (p=0.06) LV ejection fraction. However, the following three LV function parameters were significantly decreased in post HSCT patients: rate-corrected velocity of circumferential fiber shortening (p=0.04), mitral inflow E velocity (p<0.001), and mitral septal annular E' velocity (p=0.03). The following four STE parameters were also significantly decreased in post HSCT patients: LV global circumferential systolic strain (p<0.01), strain rate (SR, p=0.01), circumferential diastolic SR (p<0.01), and longitudinal diastolic SR (p<0.001). There was no significant change in TDI or STE parameters after HSCT compared to pre-HSCT. Patients with anthracycline cumulative dose >400 mg/m2 showed significantly (p<0.05) lower circumferential systolic strain and circumferential diastolic SR. Conclusion Subclinical cardiac dysfunction is evident in children after HSCT. It might be associated with pre-HSCT anthracycline exposure with little effect of conditioning regimens. Serial monitoring of cardiac function is mandatory for all children following HSCT. PMID:25653704

  4. Intraoperative epicardial echocardiography with a miniature high-frequency transducer: imaging techniques and scanning planes.

    PubMed

    Kenny, A; Cary, N R; Murphy, D; Shapiro, L M

    1994-01-01

    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

  5. Real-time 3-dimensional echocardiography for follow-up of Waterston shunt.

    PubMed

    Lilje, Christian; Lê, Trong-Phi; Weil, Jochen; Rázek, Vit

    2008-04-01

    A 37-year-old man presented with Eisenmenger's reaction. He had progressive cyanosis and signs of right-sided heart failure. In early childhood he was palliated with a Waterston shunt for cyanotic congenital heart disease. Two-dimensional echocardiography provided only a rudimentary view of his heart's anatomy and hemodynamics. Real-time three-dimensional echocardiography (RT3DE) was superior in visualizing both the size and the shape of the large shunt. RT3DE easily identifies and quantifies a key pathogenic factor for pulmonary hypertension with irreversible vascular damage in such patients. If applied early, RT3DE may prove to be a valuable follow-up tool. PMID:17919886

  6. Imaging Tuberous Sclerosis: The Incremental Benefit of Three-Dimensional and Speckle Tracking Echocardiography.

    PubMed

    Garg, Pankaj; Musa, Tarique A; Ripley, David P

    2015-09-01

    Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome and multisystem disorder with autosomal dominant inheritance and variable penetrance. Cardiac rhabdomyomas have been reported in 50-64% of patients with TSC and transthoracic echocardiography is established as the primary imaging modality for their detection. The precise functional assessment of the left ventricle in these patients requires clarification. We report a case of a 19-year-old male with known TSC who was referred for outpatient transthoracic echocardiography (TTE) to investigate for the presence of cardiac rhabdomyomas. TTE demonstrated multiple rhabdomyomas with a normal ejection fraction but altered global and regional deformation on speckle tracking. The regional longitudinal strain was notably reduced in the anterior septum (-11%) and inferior septum (-15%). The global circumferential strain (GCS) was significantly reduced at -15.6%. The distribution of regional circumferential strain reduction for the mid-ventricular segment correlated with the location of cardiac rhabdomyomas. PMID:25736174

  7. Methodological Gaps in Left Atrial Function Assessment by 2D Speckle Tracking Echocardiography

    PubMed Central

    Rimba?, Roxana Cristina; Dulgheru, Raluca Elena; Vinereanu, Drago?

    2015-01-01

    The assessment of left atrial (LA) function is used in various cardiovascular diseases. LA plays a complementary role in cardiac performance by modulating left ventricular (LV) function. Transthoracic two-dimensional (2D) phasic volumes and Doppler echocardiography can measure LA function non-invasively. However, evaluation of LA deformation derived from 2D speckle tracking echocardiography (STE) is a new feasible and promising approach for assessment of LA mechanics. These parameters are able to detect subclinical LA dysfunction in different pathological condition. Normal ranges for LA deformation and cut-off values to diagnose LA dysfunction with different diseases have been reported, but data are still conflicting, probably because of some methodological and technical issues. This review highlights the importance of an unique standardized technique to assess the LA phasic functions by STE, and discusses recent studies on the most important clinical applications of this technique. PMID:26761370

  8. [Intraoperative transesophageal echocardiography to guide removal of a hypernephroma with vena cava and right atrial extension].

    PubMed

    Cabrera, M C; Murillo, C; Díaz de Valdés, V; Farías, J; Bernier, P; Luly de La Fuente, E U

    2005-01-01

    We describe the case of a 70-year-old man who underwent resection of a right hypernephroma with vena caval and right atrial extension with continuous monitoring by transesophageal echocardiography. The monitoring technique brought important advantages, providing images that facilitated anatomical and functional evaluation of cardiac structures without obstructing the surgical field. Images of the heart and great vessels obtained in real time allowed the surgeon to make operative decisions based on accurate assessment of the cephalad extension of the tumor to the right chambers. Transesophageal echocardiography also allowed the anesthesiologist to monitor hemodynamic status throughout surgery and watch for tumoral emboli. The imaging technique proved to be highly useful for both anesthetic and surgical management of the patient. PMID:15747705

  9. Non-invasive determination of cardiac output by Doppler echocardiography and electrical bioimpedance.

    PubMed Central

    Northridge, D B; Findlay, I N; Wilson, J; Henderson, E; Dargie, H J

    1990-01-01

    Cardiac output measured by thermodilution in 25 patients within 24 hours of acute myocardial infarction was compared with cardiac output measured by Doppler echocardiography (24 patients) and electrical bioimpedance (25 patients). The mean (range) cardiac outputs measured by Doppler (4.03 (2.2-6.0) 1/min) and electrical bioimpedance (3.79 (1.1-6.2) 1/min) were similar to the mean thermodilution value (3.95 (2.1-6.2) 1/min). Both non-invasive techniques agreed closely with thermodilution in most patients. None the less, three results with each method disagreed with thermodilution by more than 1 1/min. Both non-invasive techniques were reproducible and accurate in most patients with acute myocardial infarction. Doppler echocardiography was time consuming and technically demanding. Electrical bioimpedance was simple to use and had the additional advantage of allowing continuous monitoring of the cardiac output. PMID:2317415

  10. Clinical Use of Doppler Echocardiography in Organic Mitral Regurgitation: From Diagnosis to Patients' Management

    PubMed Central

    Russo, Antonio; Pasquale, Ferdinando; Biagini, Elena; Barberini, Francesco; Ferlito, Marinella; Leone, Ornella; Rapezzi, Claudio

    2015-01-01

    Knowledge of mitral regurgitation (MR) is essential for any care provider, and not only for those directly involved in the management of cardiovascular diseases. This happens because MR is the most frequent valvular lesion in North America and the second most common form of valve disease requiring surgery in Europe. Furthermore, due to the ageing of the general population and the reduced mortality from acute cardiovascular events, the prevalence of MR is expected to increase further. Doppler echocardiography is essential both for the diagnosis and the clinical management of MR. In the present article, we sought to provide a practical step-by-step approach to help either performing a Doppler echocardiography or interpreting its findings in light of contemporary knowledge on organic (but not only) MR. PMID:26448820

  11. Combination of contrast with stress echocardiography: A practical guide to methods and interpretation

    PubMed Central

    Moir, Stuart; Marwick, Thomas H

    2004-01-01

    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. PMID:15331015

  12. Clinical applications of exercise stress echocardiography in the treadmill with upright evaluation during and after exercise

    PubMed Central

    2013-01-01

    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

  13. Safe and efectivef guidance by intracardiac echocardiography for transcatheter closure in atrial septal defects

    PubMed Central

    Wang, Yu; Guo, Tao; Liang, Guizheng; Zhao, Ling; Pan, Jiahua; Li, Shumin; Hua, Baotong; Pu, Lijin

    2015-01-01

    Background: The aim of this study was to investigate the clinical outcome of intracardiac echocardiography (ICE) for transcatheter closure of atrial septal defect (ASD) compared with the trans-esophageal echocardiography (TEE) guided method. Methods: From May 2010 to April 2011, 46 patients who underwent ICE guided (n=23) or TEE guided (n=23) transcatheter closure of ASD were analyzed retrospectively. We compared the demographic characteristic, procedure parameters and outcomes between ICE- and TEE-guided groups. Results: No significant difference was found between 2 groups on demographic characteristics. Fluoroscopy time and procedure time was significantly decreased in ICE guided group than that in TEE-guided group. In addition, no significant difference was found on treatment outcomes, complications between these 2 groups. Conclusion: ICE-guided ASD occlusion is safe and effective method, which provides more accurate anatomical information, shorter fluoroscopy time and procedure time. PMID:26221364

  14. Safe and effective guidance by intracardiac echocardiography for transcatheter closure in atrial septal defects

    PubMed Central

    Zhao, Jing; Li, Li; Peng, Ling

    2015-01-01

    The aim of this study was to investigate the clinical outcome of intracardiac echocardiography (ICE) for transcatheter closure of atrial septal defect (ASD) compared with the trans-esophageal echocardiography (TEE) guided method. From May 2010 to April 2011, 46 patients who underwent ICE guided (n = 23) or TEE guided (n = 23) transcatheter closure of ASD were analyzed retrospectively. We compared the demographic characteristic, procedure parameters and outcomes between ICE- and TEE-guided groups. No significant difference was found between 2 groups on demographic characteristics. Fluoroscopy time and procedure time was significantly decreased in ICE guided group than that in TEE-guided group. In addition, no significant difference was found on treatment outcomes, complications between these 2 groups. ICE-guided ASD occlusion is safe and effective method, which provides more accurate anatomical information, shorter fluoroscopy time and procedure time. PMID:26309662

  15. Influence of continuous positive airways pressure treatment on ductus arteriosus shung assessed by echocardiography.

    PubMed Central

    Björkhem, G E; Lundström, N R; Svenningsen, N W

    1977-01-01

    In a preterm infant with the respiratory distress syndrome complicated by patent ductus arteriosus, continuous positive airways pressure (CPAP) treatment relieved the signs of cardiac decompensation associated with left-to-right shunt. Echocardiography enabled the change in left atrial size, an indirect measure of the shunt, to be followed. In this way the rapid effect of CPAP in reducing left-to-right shunting could be monitored. This noninvasive technique could have many applications in neonatology. Images Fig. 1 PMID:335982

  16. Incidence of bacteremia in transesophageal echocardiography: a prospective study of 140 consecutive patients.

    PubMed

    Melendez, L J; Chan, K L; Cheung, P K; Sochowski, R A; Wong, S; Austin, T W

    1991-12-01

    The incidence of bacteremia related to transesophageal echocardiography was studied in 140 consecutive patients (71 women and 69 men with a mean age of 53.7 +/- 15 years). Thirty-four patients had one or more prosthetic heart valves. Blood cultures were obtained from each patient through separate venipuncture sites immediately before and after transesophageal echocardiography. An additional late blood culture was obtained in 114 patients 1 h later. The skin was cleaned with povidone-iodine and venipunctures were performed with separate butterfly needles with use of sterile gloves and drapes. Blood samples were drawn into separate syringes, transferred to aerobic and anaerobic culture bottles and processed with use of a semiautomated system. The overall incidence of blood cultures positive for bacteremia was 2% (8 of 394 bottles) and all positive cultures grew in a single blood culture bottle. Positive cultures occurred in 4 (1.4%) of 280 bottles before the procedure, in 2 (0.7%) of 280 bottles immediately after the procedure and in 2 (0.9%) of 228 late (1-h) blood culture bottles. Bacterial isolates were coagulase-negative staphylococci (n = 5), Propionibacterium (n = 2) and Moraxella (n = 1). All were considered contaminants. Mean endoscopic time in these patients was not significantly different from that in the other patients. Follow-up of patients with a blood culture positive for bacteremia revealed no clinical evidence of systemic infection. It is concluded that 1) the incidence of bacteremia related to transesophageal echocardiography is very low, and 2) the incidence of blood cultures positive for bacteremia after transesophageal echocardiography is indistinguishable from the anticipated contamination rate. PMID:1960310

  17. The Clinical Impact of Bedside Contrast Echocardiography in Intensive Care Settings: A Korean Multicenter Study

    PubMed Central

    Hwang, Hui-Jeong; Kim, Woo-Shik; Hong, Geu-Ru; Choi, Eui-Young; Rim, Se-Joong; Lee, Sang-Chol; Chung, Wook-Jin; Choi, Jung-Hyun; Seo, Hye-Sun; Yoon, Se Jung; Cho, Kyoung Im; Kim, Hyung Seop; Yoon, Hyun Ju

    2015-01-01

    Background and Objectives We assessed the ability of portable echocardiography (with contrasts) to clearly delineate the cardiac structure, and evaluated the impact of its use on the diagnosis and management of critically ill patients in Korea. Subjects and Methods We prospectively enrolled 123 patients (mean age 66±16 years), who underwent portable transthoracic echocardiography (with contrast) for image enhancement at 12 medical centers. The quality of the global left ventricular (LV) images, the number of the regional LV segments visualized, the ability to visualize the LV apex and the right ventricle (RV), and any changes in the diagnostic procedure and treatment strategy were compared before and after the contrast. Results Of the 123 patients, 52 (42%) were using mechanical ventilators. The amount of poor or uninterpretable images decreased from 48% to 5% (p<0.001), after the contrast. Before the contrast, 15.6±1.1 of 16 LV segments were seen, which improved to 15.9±0.6 segments (p=0.001) after the contrast. The ability to visualize the LV apex increased from 47% to 94% (p<0.001), while the inability to clearly visualize the RV decreased from 46% to 19% (p<0.001). Changes in the diagnostic procedure (for example, not requiring other types of imaging studies) were observed in 18% of the patients, and the treatment plan (medication) was altered in 26% of patients after the contrast echocardiography. Conclusion The use of a contrast agent during the portable echocardiography, in intensive care settings, can improve the image quality and impact the diagnostic procedures and treatment for Korean patients. PMID:26617651

  18. Surgeon-Performed Hemodynamic Transesophageal Echocardiography in the Burn Intensive Care Unit.

    PubMed

    Held, Jenny M; Litt, Jeffrey; Kennedy, Jason D; McGrane, Stuart; Gunter, Oliver L; Rae, Lisa; Kahn, Steven A

    2016-01-01

    The use of transesophageal echocardiography (TEE) for resuscitation after burn injury has been reported in small case studies. Conventional TEE is invasive and often requires a subspecialist with a high level of training. The authors report a series of surgeon-performed hemodynamic TEE with an indwelling, less bulky, user-friendly probe. Records of patients treated in a regional burn center who underwent hemodynamic TEE between October 1, 2012 and May 30, 2014 were reviewed. The clinical course of each patient was recorded. All bedside interpretations were retrospectively reviewed for accuracy by a cardiac anesthesiologist. Eleven patients were included in the study. Median age was 68.5 years (interquartile range, 49.5-79.5). Median burn size was 37% TBSA (interquartile range: 16.3-53%). Seven patients were male, and four suffered inhalation injury. The operator's interpretation matched that of the echocardiography technician and cardiac anesthesiologist in all instances. No complications occurred from probe placement. Four patients underwent hemodynamic TEE to determine volume status during resuscitation. Changes in volume status on echocardiography preceded the eventual changes in urine output and vital signs for one patient. Hemodynamic TEE diagnosed cardiogenic shock and was used to titrate inotropes and vasopressors in seven elderly patients. Hemodynamic TEE is a useful adjunct to manage the burn patient who deviates off the expected course, especially if there is a question of cardiac function or volume status. It is less invasive and can be accurately performed by surgical intensivists when transthoracic echo windows are limited. The role of echocardiography in optimizing routine burn resuscitations needs to be further studied. PMID:26594864

  19. Transpulmonary echocardiography to guide stent implantation into coarctation of the aorta.

    PubMed

    Teramachi, Yozo; Suda, Kenji; Yoshimoto, Hironaga; Kishimoto, Shintaro; Kudo, Yoshiyuki; Iemura, Motofumi

    2015-05-01

    Although stent implantation into aortic coarctation has been performed solely under fluoroscopy, we successfully applied intracardiac echocardiography (ICE) to guide this procedure in a 13-year-old patient. Placing an intracardiac echocardiographic catheter in the left pulmonary artery facing upward, we readily visualized the precise anatomy of coarctation, measured the pressure gradient, and monitored the stent inflation process. This report suggests a new application of ICE for intervention with structural and vascular diseases other than interatrial septum. PMID:25903698

  20. Interventricular septal hydatid cyst: Transesophageal echocardiography as a therapeutic tool during bypass.

    PubMed

    Jain, Pawan Kumar; Malik, Vishwas; Divya, Abha; Narula, Jitin; Hote, Milind

    2015-01-01

    Cystic echinococcosis (hydatid disease) arising from infestation with a larval or adult form of the Echinococcus granulosus tapeworm is endemic in certain states of India, but affecting interventricular septum (IVS) solitarily is a scarce phenomenon. We present a rare case of transesophageal echocardiography guided management of IVS hydatid cyst even during cardiopulmonary bypass, which presented with a rather unusual complaint of repeated syncope. PMID:26139754

  1. Unusual "Polycystic" Appearance of a Right Atrial Angiosarcoma Described by Transesophageal Echocardiography.

    PubMed

    Bustamante-Labarta, Miguel H.; Torino, Augusto F.; Favaloro, Mariano

    1997-03-01

    Angiosarcoma is the most common primary sarcoma of the heart and the most frequent location of the tumor is the right atrium. In the few published cases of right atrial angiosarcoma studied by transesophageal echocardiography, the features described greatly differ from one to another. We describe the transesophageal images of a prolapsing mass type angiosarcoma with polycystic appearance previously misinterpreted as a right atrial myxoma in two consecutives transthoracic echocardiograms. PMID:11174937

  2. Severe Sarcoidosis.

    PubMed

    Kouranos, Vasileios; Jacob, Joe; Wells, Athol U

    2015-12-01

    In sarcoidosis, reduction in mortality and the prevention of disability due to major organ involvement are treatment goals. Thus, it is important to recognize severe disease and identify patients at higher risk of progression to severe disease. In this article, fibrotic lung disease and cardiac sarcoidosis are reviewed as the major contributors to sarcoidosis mortality and morbidity. In the absence of a standardized definition of severe pulmonary disease, a multidisciplinary approach to clinical staging is suggested, based on symptoms, pulmonary function tests, and imaging findings at presentation, integrated with the duration of disease and longitudinal disease behavior during early follow-up. PMID:26593144

  3. Ablation lesions in Koch's triangle assessed by three-dimensional myocardial contrast echocardiography

    PubMed Central

    Szili-Torok, Tamas; Kimman, Geert-Jan; Scholten, Marcoen; Thornton, Andrew; Cate, Folkert Ten; Roelandt, Jos; Jordaens, Luc

    2004-01-01

    Background Myocardial contrast echocardiography (MCE) allows visualization of radiofrequency (RF) ablation lesions in the left ventricle in an animal model. Aim: To test whether MCE allows visualization of RF and cryo ablation lesions in the human right atrium using three-dimensional echocardiography. Methods 18 patients underwent catheter ablation of a supraventricular tachycardia and were included in this prospective single-blind study. Twelve patients were ablated inside Koch's triangle and 6, who served as controls, outside this area. Three-dimensional echocardiography of Koch's triangle was performed before and after the ablation procedure in all patients, using respiration and ECG gated pullback of a 9 MHz ICE transducer, with and without continuous intravenous echocontrast infusion (SonoVue, Bracco). Two independent observers analyzed the data off-line. Results MCE identified ablation lesions as a low contrast area within the normal atrial myocardial tissue. Craters on the endocardial surface were seen in 10 (83%) patients after ablation. Lesions were identified in 11 out of 12 patients (92%). None of the control patients were recognized as having been ablated. The confidence score of the independent echo reviewer tended to be higher when the number of applications increased. Conclusions 1. MCE allows direct visualization of ablation lesions in the human atrial myocardium. 2. Both RF and cryo energy lesions can be identified using MCE. PMID:15588305

  4. Reproducibility of cardiac output measurements by Doppler echocardiography in prepubertal children and adults.

    PubMed

    Vinet, A; Nottin, S; Lecoq, A M; Guenon, P; Obert, P

    2001-08-01

    The aim of this study was to examine reproducibility of stroke volume and cardiac output measurements by Doppler echocardiography during submaximal and maximal exercise in adults and children. Fourteen healthy children (8 girls and 6 boys aged 10.9 +/- 0.9yr) and eleven healthy young adults (1 female and 10 males aged 22.3 +/- 3.8 yr) underwent a progressive maximal upright cycle test until exhaustion with estimation of stroke volume and cardiac output by Doppler echocardiography on two separate occasions (one week apart). Maximal oxygen uptake and maximal heart rate were not significantly different between both tests in the children and adults indicating that similar exhaustive efforts were achieved at each test. No significant differences for mean values of stroke volume and cardiac output were observed at rest in the children and whatever the exercise intensity in the children and adults. No significant differences were observed between values of root mean square (precision and precision of error) in both groups. Thus we demonstrated that stroke volume and cardiac output values obtained by Doppler echocardiography at rest and during submaximal and maximal exercise were reproducible on test-retest measurements in children and adults. PMID:11531037

  5. Assessment of myocardial viability in patients with postischemic left ventricular dysfunction: role of myocardial contrast echocardiography.

    PubMed

    Agati, Luciano; De Majo, Francesca; Madonna, Maria Pina; Celani, Flavia; Funaro, Stefania; Tonti, Gianni

    2003-08-01

    The distinction between viable and nonviable dysfunctional left ventricular (LV) segments after acute myocardial infarction is very important, because revascularization increases survival only in patients with viable myocardial tissue. Recent studies have highlighted a mismatch between two highly specific investigations for viability assessment: dobutamine echocardiography, which measures inotropic reserve, and myocardial contrast echocardiography (MCE), which measures microvascular perfusion. Viability and functional reserve are not synonymous. Maintenance of microvascular perfusion, independently of functional reserve, attenuates left ventricular remodelling, reduces the risk of major cardiac events, and increases survival. MCE provides similar perfusion information as myocardial blush, but image quality is much higher. Quantitative analysis of digital data provides more accurate diagnostic MCE information than qualitative analysis of video signal intensity. In a recent study relating MCE findings to histologic data, MCE-derived quantitative data were closely correlated with microvascular density and capillary area, and inversely correlated with collagen content. One of the contrast agents routinely used for MCE is SonoVue, a second generation microbubble contrast agent, which is characterized by high response to ultrasound energy, ease of destruction at high energy, and strong harmonic signal at low energy. Recommendations for the assessment of postischemic LV dysfunction: routine use of MCE, followed by dobutamine echocardiography if perfusion is documented. If MCE is negative, revascularization is not indicated; if both tests are positive, revascularization is strongly recommended; if they are discordant, useful information can be obtained by assessing the extent of 201T1 viability. PMID:23573622

  6. Implementation of Ultraportable Echocardiography in an Adolescent Sudden Cardiac Arrest Screening Program

    PubMed Central

    Vanhecke, Thomas E; Weber, James E; Ebinger, Matthew; Bonzheim, Kimberly; Tilli, Frank; Rao, Sunilkumar; Osman, Abdulfatah; Silver, Marc; Fliegner, Karsten; Almany, Steve; Haines, David

    2014-01-01

    BACKGROUND Over a 12-month period, adolescent heart-screening programs were performed for identifying at-risk adolescents for sudden cardiac death (SCD) in our community. Novel to our study, all adolescents received an abbreviated, ultraportable echocardiography (UPE). In this report, we describe the use of UPE in this screening program. METHODS AND RESULTS Four hundred thirty-two adolescents underwent cardiac screening with medical history questionnaire, physical examination, 12-lead electrocardiogram (ECG), and an abbreviated transthoracic echocardiographic examination. There were 11 abnormalities identified with uncertain/varying clinical risk significance. In this population, 75 adolescents had a murmur or high ECG voltage, of which only three had subsequent structural abnormalities on echocardiography that may pose risk. Conversely, UPE discovered four adolescents who had a cardiovascular structural abnormality that was not signaled by the 12-lead ECG, medical history questionnaire, and/or physical examination. CONCLUSIONS The utilization of ultraportable, handheld echocardiography is feasible in large-scale adolescent cardiovascular screening programs. UPE appears to be useful for finding additional structural abnormalities and for risk-stratifying abnormalities of uncertain potential of adolescents’ sudden death. PMID:25249762

  7. Heart wall motion analysis by dynamic 3D strain rate imaging from tissue Doppler echocardiography

    NASA Astrophysics Data System (ADS)

    Hastenteufel, Mark; Wolf, Ivo; de Simone, Raffaele; Mottl-Link, Sibylle; Meinzer, Hans-Peter

    2002-04-01

    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.

  8. [The usefulness of transesophageal echocardiography in the diagnosis of intracardiac and extracardiac tumors].

    PubMed

    López, L; Arroyo, A; Romero-Cárdenas, A; Espinola-Zavaleta, N; Aranda, A; Rijlaarsdam, M; Vargas-Barrón, J

    1994-01-01

    We studied 18 patients with suspected intrathoracic mass from january 1990 to august 1993. In all patients electrocardiogram, X-ray, transthoracic and transesophageal echocardiography were performed. Accordingly, the patients were divided into two groups: I) 8 patients with intracardiac myxoma, and II) 10 patients with no myxomatous tumor. The histopathologic identification of the intracardiac or extracardiac tumor was corroborated in all patients of group I and in only 8 patients of group II. In group I the mean age was 39 years and the female sex was more frequently (75%); with transthoracic and transesophageal approaches the myxoma was found in right atrium in four patients, in left atrium in three, and in the last patient the four chambers were occupied. In group II the mean age was 36 years, and the male sex was predominant (60%). In three patients cardiac tumors were detected by echocardiography, two of them were found in the right cavities (leiomyoma and leiomyosarcoma), in the rest the histologic lineage of the left atrial tumors was not possible to recognize. In the other seven patients with mediastinal tumor the heart was not infiltrated. On the basis of the obtained results we conclude that transthoracic echocardiography permits the identification of the intracardiac tumor; in these patients transesophageal studies give us an additional valuable information about the valves, the site of tumoral implantation and the wall infiltration. Transesophageal approach provides more information about its potential cardiac compression. PMID:8179436

  9. Is tissue Doppler echocardiography the Holy Grail for the intensivist?

    PubMed Central

    Poelaert, Jan; Roosens, Carl

    2007-01-01

    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. PMID:17567926

  10. Management of asymptomatic severe aortic stenosis.

    PubMed

    Dal-Bianco, Jacob P; Khandheria, Bjoy K; Mookadam, Farouk; Gentile, Federico; Sengupta, Partho P

    2008-10-14

    Patients with symptomatic severe aortic stenosis (AS) benefit from aortic valve replacement (AVR). Management of severe AS in the absence of symptoms is, however, controversial and often challenging. Unselected premature AVR carries the risks of cardiac surgery; delayed AVR due to unrecognized symptoms can result in a dismal outcome. Echocardiography is the standard tool to evaluate and follow patients with AS. Nevertheless, most of the current echocardiographic parameters have limitations in predicting symptom onset and clinical outcome. The same applies to clinical parameters, exercise stress testing, and other imaging modalities used in AS evaluation and serial follow-up. Predictors of outcome could, however, help to identify asymptomatic patients who would benefit from expedited AVR with the goal to reduce mortality. This review will discuss the most relevant clinical studies and guidelines on management of asymptomatic severe AS, with an emphasis on providing concise information for identifying patients at high risk. PMID:18929238

  11. Public medical shows.

    PubMed

    Walusinski, Olivier

    2014-01-01

    In the second half of the 19th century, Jean-Martin Charcot (1825-1893) became famous for the quality of his teaching and his innovative neurological discoveries, bringing many French and foreign students to Paris. A hunger for recognition, together with progressive and anticlerical ideals, led Charcot to invite writers, journalists, and politicians to his lessons, during which he presented the results of his work on hysteria. These events became public performances, for which physicians and patients were transformed into actors. Major newspapers ran accounts of these consultations, more like theatrical shows in some respects. The resultant enthusiasm prompted other physicians in Paris and throughout France to try and imitate them. We will compare the form and substance of Charcot's lessons with those given by Jules-Bernard Luys (1828-1897), Victor Dumontpallier (1826-1899), Ambroise-Auguste Liébault (1823-1904), Hippolyte Bernheim (1840-1919), Joseph Grasset (1849-1918), and Albert Pitres (1848-1928). We will also note their impact on contemporary cinema and theatre. PMID:25273491

  12. Assessment of atrial electromechanical delay by tissue Doppler echocardiography in obese subjects.

    PubMed

    Yagmur, Julide; Cansel, Mehmet; Acikgoz, Nusret; Ermis, Necip; Yagmur, Murat; Atas, Halil; Tasolar, Hakan; Karakus, Yasin; Pekdemir, Hasan; Ozdemir, Ramazan

    2011-04-01

    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

  13. Endocardial left ventricle feature tracking and reconstruction from tri-plane trans-esophageal echocardiography data

    NASA Astrophysics Data System (ADS)

    Dangi, Shusil; Ben-Zikri, Yehuda K.; Cahill, Nathan; Schwarz, Karl Q.; Linte, Cristian A.

    2015-03-01

    Two-dimensional (2D) ultrasound (US) has been the clinical standard for over two decades for monitoring and assessing cardiac function and providing support via intra-operative visualization and guidance for minimally invasive cardiac interventions. Developments in three-dimensional (3D) image acquisition and transducer design and technology have revolutionized echocardiography imaging enabling both real-time 3D trans-esophageal and intra-cardiac image acquisition. However, in most cases the clinicians do not access the entire 3D image volume when analyzing the data, rather they focus on several key views that render the cardiac anatomy of interest during the US imaging exam. This approach enables image acquisition at a much higher spatial and temporal resolution. Two such common approaches are the bi-plane and tri-plane data acquisition protocols; as their name states, the former comprises two orthogonal image views, while the latter depicts the cardiac anatomy based on three co-axially intersecting views spaced at 600 to one another. Since cardiac anatomy is continuously changing, the intra-operative anatomy depicted using real-time US imaging also needs to be updated by tracking the key features of interest and endocardial left ventricle (LV) boundaries. Therefore, rapid automatic feature tracking in US images is critical for three reasons: 1) to perform cardiac function assessment; 2) to identify location of surgical targets for accurate tool to target navigation and on-target instrument positioning; and 3) to enable pre- to intra-op image registration as a means to fuse pre-op CT or MR images used during planning with intra-operative images for enhanced guidance. In this paper we utilize monogenic filtering, graph-cut based segmentation and robust spline smoothing in a combined work flow to process the acquired tri-plane TEE time series US images and demonstrate robust and accurate tracking of the LV endocardial features. We reconstruct the endocardial LV geometry using the tri-plane contours and spline interpolation, and assess the accuracy of the proposed work flow against gold-standard results from the GE Echopac PC clinical software according to quantitative clinical LV characterization parameters, such as the length, circumference, area and volume. Our proposed combined work flow leads to consistent, rapid and automated identification of the LV endocardium, suitable for intra-operative applications and "on-the-fly" computer-assisted assessment of ejection fraction for cardiac function monitoring.Two-dimensional (2D) ultrasound (US) has been the clinical standard for over two decades for monitoring and assessing cardiac function and providing support via intra-operative visualization and guidance for minimally invasive cardiac interventions. Developments in three-dimensional (3D) image acquisition and transducer design and technology have revolutionized echocardiography imaging enabling both real-time 3D trans-esophageal and intra-cardiac image acquisition. However, in most cases the clinicians do not access the entire 3D image volume when analyzing the data, rather they focus on several key views that render the cardiac anatomy of interest during the US imaging exam. This approach enables image acquisition at a much higher spatial and temporal resolution. Two such common approaches are the bi-plane and tri-plane data acquisition protocols; as their name states, the former comprises two orthogonal image views, while the latter depicts the cardiac anatomy based on three co-axially intersecting views spaced at 600 to one another. Since cardiac anatomy is continuously changing, the intra-operative anatomy depicted using real-time US imaging also needs to be updated by tracking the key features of interest and endocardial left ventricle (LV) boundaries. Therefore, rapid automatic feature tracking in US images is critical for three reasons: 1) to perform cardiac function assessment; 2) to identify location of surgical targets for accurate tool to target navigation and on-target instrument positioning; and 3) to enable pre- to intra-op image registration as a means to fuse pre-op CT or MR images used during planning with intra-operative images for enhanced guidance. In this paper we utilize monogenic filtering, graph-cut based segmentation and robust spline smoothing in a combined work flow to process the acquired tri-plane TEE time series US images and demonstrate robust and accurate tracking of the LV endocardial features. We reconstruct the endocardial LV geometry using the tri-plane contours and spline interpolation, and assess the accuracy of the proposed work flow against gold-standard results from the GE Echopac PC clinical software according to quantitative clinical LV characterization parameters, such as the length, circumference, area and volume. Our proposed combined work flow leads to consistent, rapid and automated identification of the LV endocardium, suitable for intra-operative applications and on-the- y" computer-assisted assessment of ejection fraction for cardiac function monitoring.

  14. Analysis of blood flow in pulmonary hypertension with the pulsed Doppler flowmeter combined with cross sectional echocardiography.

    PubMed Central

    Okamoto, M; Miyatake, K; Kinoshita, N; Sakakibara, H; Nimura, Y

    1984-01-01

    Blood flow patterns were analysed at nine points in the pulmonary area using the pulsed Doppler technique combined with cross-sectional echocardiography in 53 patients with heart disease and 10 healthy subjects. In subjects with a normal pulmonary artery pressure the blood flow pattern in systole showed a gradual acceleration and deceleration with a rounded summit in mid systole, designated the round type. In patients with pulmonary hypertension it showed a rapid acceleration and early deceleration with a sharp peak in early systole, designated the triangular type. The acceleration time index, defined as the ratio of the time interval from the beginning to the peak of ejection to the ejection time, showed a significant inverse correlation with mean pulmonary artery pressure. In pulmonary hypertension a prominent reverse flow occurred in the right posterior part of the pulmonary trunk during mid-systole and early diastole, indicating the presence of a vortex. Similar flow patterns were also seen in patients with idiopathic pulmonary artery dilatation. The factors responsible for the triangular type were principally the reduced capacitance and increased impedance of the pulmonary vascular tree. Those responsible for the reverse flow were the curved path of the blood flow and dilatation of the pulmonary artery. Images PMID:6231042

  15. Auto-biometric for M-mode echocardiography

    NASA Astrophysics Data System (ADS)

    Zhang, Wei; Park, Jinhyong; Zhou, S. Kevin

    2010-03-01

    In this paper we present a system for fast and accurate detection of anatomical structures (calipers) in M-mode images. The task is challenging because of dramatic variations in their appearances. We propose to solve the problem in a progressive manner, which ensures both robustness and efficiency. It first obtains rough caliper localization using the intensity profile image. Then run a constrained search for accurate caliper positions. Markov Random Field (MRF) and warping image detectors are used for jointly considering appearance information and the geometric relationship between calipers. Extensive experiments show that our system achieves more accurate results and uses less time in comparison with previously reported work.

  16. Sever's Disease

    MedlinePLUS

    ... causing the swelling, tenderness, and pain of Sever's disease. Such stress commonly results from physical activities and sports that ... and Joints Common Childhood Orthopedic Conditions Osgood-Schlatter Disease Problems With Legs and ... Injuries Contact Us Print Resources Send to a ...

  17. Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)†.

    PubMed

    Marwick, Thomas H; Gillebert, Thierry C; Aurigemma, Gerard; Chirinos, Julio; Derumeaux, Genevieve; Galderisi, Maurizio; Gottdiener, John; Haluska, Brian; Ofili, Elizabeth; Segers, Patrick; Senior, Roxy; Tapp, Robyn J; Zamorano, Jose L

    2015-06-01

    Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment. PMID:25995329

  18. Subclinical Alterations of Cardiac Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus: A Prospective Blinded Speckle Tracking Stress Echocardiography Study.

    PubMed

    Hensel, Kai O; Grimmer, Franziska; Roskopf, Markus; Jenke, Andreas C; Wirth, Stefan; Heusch, Andreas

    2016-01-01

    Diabetic cardiomyopathy substantially accounts for mortality in diabetes mellitus. The pathophysiological mechanism underlying diabetes-associated nonischemic heart failure is poorly understood and clinical data on myocardial mechanics in early stages of diabetes are lacking. In this study we utilize speckle tracking echocardiography combined with physical stress testing in order to evaluate whether left ventricular (LV) myocardial performance is altered early in the course of uncomplicated type 1 diabetes mellitus (T1DM). 40 consecutive asymptomatic normotensive children and adolescents with T1DM (mean age 11.5 ± 3.1 years and mean disease duration 4.3 ± 3.5 years) and 44 age- and gender-matched healthy controls were assessed using conventional and quantitative echocardiography (strain and strain rate) during bicycle ergometer stress testing. Strikingly, T1DM patients had increased LV longitudinal (p = 0.019) and circumferential (p = 0.016) strain rate both at rest and during exercise (p = 0.021). This was more pronounced in T1DM patients with a longer disease duration (p = 0.038). T1DM patients with serum HbA1c > 9% showed impaired longitudinal (p = 0.008) and circumferential strain (p = 0.005) and a reduced E/A-ratio (p = 0.018). In conclusion, asymptomatic T1DM patients have signs of hyperdynamic LV contractility early in the course of the disease. Moreover, poor glycemic control is associated with early subclinical LV systolic and diastolic impairment. PMID:26839891

  19. Subclinical Alterations of Cardiac Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus: A Prospective Blinded Speckle Tracking Stress Echocardiography Study

    PubMed Central

    Hensel, Kai O.; Grimmer, Franziska; Roskopf, Markus; Jenke, Andreas C.; Wirth, Stefan; Heusch, Andreas

    2016-01-01

    Diabetic cardiomyopathy substantially accounts for mortality in diabetes mellitus. The pathophysiological mechanism underlying diabetes-associated nonischemic heart failure is poorly understood and clinical data on myocardial mechanics in early stages of diabetes are lacking. In this study we utilize speckle tracking echocardiography combined with physical stress testing in order to evaluate whether left ventricular (LV) myocardial performance is altered early in the course of uncomplicated type 1 diabetes mellitus (T1DM). 40 consecutive asymptomatic normotensive children and adolescents with T1DM (mean age 11.5 ± 3.1 years and mean disease duration 4.3 ± 3.5 years) and 44 age- and gender-matched healthy controls were assessed using conventional and quantitative echocardiography (strain and strain rate) during bicycle ergometer stress testing. Strikingly, T1DM patients had increased LV longitudinal (p = 0.019) and circumferential (p = 0.016) strain rate both at rest and during exercise (p = 0.021). This was more pronounced in T1DM patients with a longer disease duration (p = 0.038). T1DM patients with serum HbA1c > 9% showed impaired longitudinal (p = 0.008) and circumferential strain (p = 0.005) and a reduced E/A-ratio (p = 0.018). In conclusion, asymptomatic T1DM patients have signs of hyperdynamic LV contractility early in the course of the disease. Moreover, poor glycemic control is associated with early subclinical LV systolic and diastolic impairment. PMID:26839891

  20. Spatio-temporal (2D+T) non-rigid registration of real-time 3D echocardiography and cardiovascular MR image sequences

    NASA Astrophysics Data System (ADS)

    Zhang, Weiwei; Brady, J. Michael; Becher, Harald; Noble, J. Alison

    2011-03-01

    In this paper we describe a method to non-rigidly co-register a 2D slice sequence from real-time 3D echocardiography with a 2D cardiovascular MR image sequence. This is challenging because the imaging modalities have different spatial and temporal resolution. Non-rigid registration is required for accurate alignment due to imprecision of cardiac gating and natural motion variations between cardiac cycles. In our approach the deformation field between the imaging modalities is decoupled into temporal and spatial components. First, temporal alignment is performed to establish temporal correspondence between a real-time 3D echocardiography frame and a cardiovascular MR frame. Spatial alignment is then performed using an adaptive non-rigid registration algorithm based on local phase mutual information on each temporally aligned image pair. Experiments on seven volunteer datasets are reported. Evaluation of registration errors based on expert-identified landmarks shows that the spatio-temporal registration algorithm gives a mean registration error of 3.56 ± 0.49 and 3.54 ± 0.27 mm for the short and long axis sequences, respectively.

  1. The need for annual echocardiography to detect cabergoline-associated valvulopathy in patients with prolactinoma: a systematic review and additional clinical data.

    PubMed

    Caputo, Carmela; Prior, David; Inder, Warrick J

    2015-11-01

    Present recommendations by the US Food and Drug Administration advise that patients with prolactinoma treated with cabergoline should have an annual echocardiogram to screen for valvular heart disease. Here, we present new clinical data and a systematic review of the scientific literature showing that the prevalence of cabergoline-associated valvulopathy is very low. We prospectively assessed 40 patients with prolactinoma taking cabergoline. Cardiovascular examination before echocardiography detected an audible systolic murmur in 10% of cases (all were functional murmurs), and no clinically significant valvular lesion was shown on echocardiogram in the 90% of patients without a murmur. Our systematic review identified 21 studies that assessed the presence of valvular abnormalities in patients with prolactinoma treated with cabergoline. Including our new clinical data, only two (0·11%) of 1811 patients were confirmed to have cabergoline-associated valvulopathy (three [0·17%] if possible cases were included). The probability of clinically significant valvular heart disease is low in the absence of a murmur. On the basis of these findings, we challenge the present recommendations to do routine echocardiography in all patients taking cabergoline for prolactinoma every 12 months. We propose that such patients should be screened by a clinical cardiovascular examination and that echocardiogram should be reserved for those patients with an audible murmur, those treated for more than 5 years at a dose of more than 3 mg per week, or those who maintain cabergoline treatment after the age of 50 years. PMID:25466526

  2. Witnessed migration of a giant, free-floating thrombus into the right atrium during echocardiography, leading to fatal pulmonary embolism.

    PubMed

    Sökmen, Gülizar; Sökmen, Abdullah; Yasim, Alptekin; Oksüz, Hafize

    2009-01-01

    Free-floating right heart thrombus can be seen in 4% to 18% of patients presenting with acute pulmonary embolism. A 76-year-old man was admitted to the intensive coronary care unit due to resting dyspnea and pleuritic pain of sudden onset, raising a high suspicion of acute pulmonary embolism. A recent coronary angiogram showed a 50% stenosis in the proximal left anterior descending coronary artery. He had diabetes and hypertension for more than 10 years, but no history of venous thromboembolism. Bed-side transthoracic echocardiography revealed dilated right heart chambers, and a huge (78x12 mm) mobile mass in the inferior vena cava. We witnessed the migration of the thrombus from the inferior vena cava to the right atrium. The thrombus then totally lodged in the right atrial cavity and protruded into the right ventricle. Surgical removal of the thrombus was decided. However, during induction of anesthesia, cardiac arrest developed. All resuscitation efforts including open heart massage were unsuccessful. The thrombotic material removed from the right atrium was 150 mm in length. Pathological examination showed the mass to be a thrombus. PMID:19225252

  3. Influence of Positive End-Expiratory Pressure on Myocardial Strain Assessed by Speckle Tracking Echocardiography in Mechanically Ventilated Patients

    PubMed Central

    Faltoni, Agnese; Cameli, Matteo; Muzzi, Luigi; Lisi, Matteo; Cubattoli, Lucia; Cecchini, Sofia; Mondillo, Sergio; Biagioli, Bonizella

    2013-01-01

    Purpose. The effects of mechanical ventilation (MV) on speckle tracking echocardiography- (STE-)derived variables are not elucidated. The aim of the study was to evaluate the effects of positive end-expiratory pressure (PEEP) ventilation on 4-chamber longitudinal strain (LS) analysis by STE. Methods. We studied 20 patients admitted to a mixed intensive care unit who required intubation for MV and PEEP titration due to hypoxia. STE was performed at three times: (T1) PEEP = 5?cmH2O; (T2) PEEP = 10?cmH2O; and (T3) PEEP = 15?cmH2O. STE analysis was performed offline using a dedicated software (XStrain MyLab 70 Xvision, Esaote). Results. Left peak atrial-longitudinal strain (LS) was significantly reduced from T1 to T2 and from T2 to T3 (P < 0.05). Right peak atrial-LS and right ventricular-LS showed a significant reduction only at T3 (P < 0.05). Left ventricular-LS did not change significantly during titration of PEEP. Cardiac chambers' volumes showed a significant reduction at higher levels of PEEP (P < 0.05). Conclusions. We demonstrated for the first time that incremental PEEP affects myocardial strain values obtained with STE in intubated critically ill patients. Whenever performing STE in mechanically ventilated patients, care must be taken when PEEP is higher than 10?cmH2O to avoid misinterpreting data and making erroneous decisions. PMID:24066303

  4. Role of dipyridamole-echocardiography test in the evaluation of coronary reserve after coronary artery bypass grafting.

    PubMed

    Biagini, A; Maffei, S; Baroni, M; Levantino, M; Zanobini, M; Piacenti, M; Borzoni, G; Pugliese, S; Comite, C; Salvatore, L

    1991-01-01

    The object of this study was to assess the usefulness of the dipyridamole-echocardiography test in the early evaluation of coronary artery bypass grafting, when the use of an exercise stress test is precluded. We studied 39 consecutive patients (37 men and two women, mean age 57.3 years) referred to our institute for elective coronary artery bypass. Five patients had single, 12 patients double, 20 patients triple vessel disease, and two had left main stem disease. Nineteen left internal mammary artery grafts, 20 sequential grafts, and 39 single vein grafts were performed. All the patients were subjected to the test before (time range 1 to 3 days) and after (time range 6 to 10 days) the operation in the absence of therapy. Dipyridamole was administered intravenously 0.56 mg/kg over 4 minutes (low dose); if no effect was apparent, an additional 0.28 mg/kg over 2 minutes (high dose) was given. During the test, blood pressure and a twelve-lead electrocardiogram were monitored. An arbitrary wall motion score was derived by dividing the left ventricle into six regions and grading from 0 to 3-normokinetic, hypokinetic, akinetic, and dyskinetic zones. Preoperatively the test was positive in 38 patients as evidenced by wall motion abnormalities (36 patients had electrocardiographic changes) and in one patient by electrocardiographic changes and chest pain; 22 tests were positive after the low dose and 17 after the high dose. Angina was present in 33 patients. Mean wall motion score was 1.64 per patient in the basal condition and 4.03 per patient after the test (p less than 0.001). After coronary bypass in three patients the test was positive at the same dosage that was used preoperatively, as shown by wall motion abnormalities (in two patients by electrocardiographic changes, as well). Four patients had symptoms. Furthermore, at 6 months' follow-up, a treadmill stress test performed in these three patients was positive for ischemia and angina. The wall motion score was 1.25 per patient in the basal condition and 1.53 per patient after the test (no significant difference). When the preoperative wall motion score obtained after dipyridamole echocardiography was compared with the postoperative score, a statistically significant difference was seen: 4.03 per patient versus 1.53 per patient (p less than 001). In eight patients we observed an improvement of basal myocardial contractility after the operation, which indicates the reversibility of wall motion abnormalities observed before coronary bypass. In conclusion our data show that the dipyridamole-echocardiography test is a suitable method for the early assessment of bypass grafting when other methods, exercise dependent, are not indicated.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1986152

  5. Clutter Mitigation in Echocardiography Using Sparse Signal Separation

    PubMed Central

    Turek, Javier S.; Elad, Michael; Yavneh, Irad

    2015-01-01

    In ultrasound imaging, clutter artifacts degrade images and may cause inaccurate diagnosis. In this paper, we apply a method called Morphological Component Analysis (MCA) for sparse signal separation with the objective of reducing such clutter artifacts. The MCA approach assumes that the two signals in the additive mix have each a sparse representation under some dictionary of atoms (a matrix), and separation is achieved by finding these sparse representations. In our work, an adaptive approach is used for learning the dictionary from the echo data. MCA is compared to Singular Value Filtering (SVF), a Principal Component Analysis- (PCA-) based filtering technique, and to a high-pass Finite Impulse Response (FIR) filter. Each filter is applied to a simulated hypoechoic lesion sequence, as well as experimental cardiac ultrasound data. MCA is demonstrated in both cases to outperform the FIR filter and obtain results comparable to the SVF method in terms of contrast-to-noise ratio (CNR). Furthermore, MCA shows a lower impact on tissue sections while removing the clutter artifacts. In experimental heart data, MCA obtains in our experiments clutter mitigation with an average CNR improvement of 1.33 dB. PMID:26199622

  6. Severe anasarca due to beriberi heart disease and diabetic nephropathy.

    PubMed

    Toyonaga, Jiro; Masutani, Kohsuke; Tsuruya, Kazuhiko; Haruyama, Naoki; Sugiwaka, Shoichi; Suehiro, Takaichi; Maeda, Hiroto; Taniguchi, Masatomo; Katafuchi, Ritsuko; Iida, Mitsuo

    2009-10-01

    A 40-year-old man was transferred to our hospital because of severe anasarca. He was a heavy drinker for more than 20 years, and diagnosed with diabetes mellitus 8 years earlier and treated with retinal photocoagulation 8 months earlier. He reported loss of appetite after divorce 10 months prior to admission. On admission, he presented with systemic edema and dyspnea. Chest radiography showed massive pleural effusion and cardiomegaly. Serum total protein was 5.6 g/dl, albumin 2.6 g/dl, and urinary protein excretion was 5.3 g/day. Glucose tolerance test showed normal pattern. Ultrafiltration and continuous hemofiltration resulted in loss of 40 kg body weight in 5 days. Echocardiography revealed high-output heart failure and blood tests showed low serum thiamine level of 12 ng/ml (normal, >28 ng/ml). Accordingly, the diagnosis was established as beriberi heart disease complicated with nephrotic syndrome. Treatment with 50 mg/day thiamine intravenously and 80 mg/day furosemide resulted in increase in urine output, decrease in cardiac output, resolution of pulmonary effusion, and about 70 kg body weight loss. Percutaneous renal biopsy showed nodular glomerulosclerosis, mesangial matrix expansion, and thickening of glomerular basement membrane (GBM). Immunofluorescence study showed no glomerular deposition of immunoglobulin or complement. Electron microscopy showed GBM thickening and mesangial matrix deposition without electron-dense deposits or fibrils. These findings were compatible with diabetic glomerulosclerosis. In this patient, extreme malnutrition altered glucose tolerance but, on the other hand, nephrotic syndrome associated with diabetic nephropathy made the diagnosis of beriberi heart disease difficult. PMID:19459028

  7. [Severe Asthma].

    PubMed

    Hagmeyer, Lars; Randerath, Winfried J

    2015-10-01

    The European Respiratory Society and the American Thoracic Society recently published the international ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. It is aim of the guideline to establish standardized diagnostic criteria and to develop evidence based diagnostic and therapeutic strategies. In the diagnostic approach verifying the diagnosis of asthma and identifying comorbidities and contributing factors are very important. In the therapeutic guidance of asthma patients steroid insensitivity and overdosage of betamimetic inhaler therapy are typical challenges. Novel therapeutic strategies open the perspective to personalized therapy in asthma. PMID:26445257

  8. Cross sectional Doppler echocardiography as the initial technique for the diagnosis of acute pulmonary embolism.

    PubMed Central

    Cheriex, E C; Sreeram, N; Eussen, Y F; Pieters, F A; Wellens, H J

    1994-01-01

    OBJECTIVE--To determine the value of cross sectional Doppler echocardiography and derived indices of right ventricular pressure and function in the initial diagnosis of pulmonary embolism. BACKGROUND--Most deaths from acute pulmonary embolism occur because of a delay in diagnosis. Ventilation-perfusion scans are not sufficiently sensitive, whereas angiography is invasive and associated with complications. The use of cross sectional Doppler echocardiography to assess acute changes in right ventricular filling pressure and function, and in pulmonary arterial systolic pressure and its relation to embolism has not been studied in a large population. METHODS--60 consecutive patients with acute symptoms or haemodynamic instability suggestive of pulmonary embolism were studied. Confirmatory investigations included a ventilation-perfusion scan (36 patients), angiography (18 patients), surgery (5 patients), or necropsy (5 patients). RESULTS--There was evidence of right ventricular pressure or volume overload in all. This took the form of increased right ventricular end diastolic diameter and leftward bulging of the interventricular septum in diastole (56 patients); tricuspid valve regurgitation (56 patients) with the peak velocity of the regurgitant jet > 2.6 m/s; and a low collapse index for the inferior vena cava of < 40%, indicating raised mean right atrial pressure (in 49 patients). Intracardiac or pulmonary thrombi were visualised in 10 patients. In 14 patients treatment was undertaken on the basis of the echocardiographic signs alone. Four of them (with visible thrombi) recovered: the other 10 died. Lung emboli were demonstrated in 4 of 5 patients in whom necropsy was performed. CONCLUSIONS--Cross sectional Doppler echocardiography is a sensitive technique for the rapid identification of right ventricular overload in acute pulmonary embolism. It enables further investigations on treatment to be appropriately directed without delay. Resolution of emboli can also be assessed by serial measurement of the described indices. PMID:8068470

  9. Echocardiography for the detection of portopulmonary hypertension in liver transplant candidates: an analysis of cutoff values.

    PubMed

    Raevens, Sarah; Colle, Isabelle; Reyntjens, Koen; Geerts, Anja; Berrevoet, Frederik; Rogiers, Xavier; Troisi, Roberto I; Van Vlierberghe, Hans; De Pauw, Michel

    2013-06-01

    Portopulmonary hypertension (POPH), a complication of chronic liver disease, may be a contraindication to liver transplantation (LT) because of the elevated risk of peritransplant and posttransplant morbidity and mortality. Because POPH is frequently asymptomatic, screening with echocardiography is recommended. The only reliable technique, however, for diagnosing POPH is right heart catheterization (RHC). The aims of this study were to evaluate the current estimated systolic pulmonary artery pressure (sPAP) cutoff value of 30 mm Hg and to determine a better cutoff value. One hundred fifty-two patients underwent pretransplant echocardiography between January 2005 and December 2010. These echocardiographic results were compared with pulmonary artery pressures measured during the pretransplant workup or at the beginning of the transplantation procedure (both by catheterization). With a cutoff value of 30 mm Hg, 74 of the 152 patients met the criteria for POPH on echocardiography, although the diagnosis was confirmed in only 7 patients during catheterization; this resulted in a specificity of 54%. It would have been more accurate to use a cutoff value of 38 mm Hg, which had a maximal specificity of 82% and, at the same time, guaranteed a sensitivity and negative predictive value of 100%. With the incorporation of the presence or absence of right ventricular dilatation, the specificity even increased to 93% for this new cutoff value. In conclusion, the prevalence of POPH was 4.6% among LT candidates in this study. We can recommend that LT candidates with an sPAP?>?38 mm Hg should be referred for RHC. With the cutoff value increased from 30 to 38 mm Hg, the number of patients undergoing invasive RHC during their evaluation could be safely reduced. PMID:23584902

  10. Performance of 3-Dimensional Echocardiography in Measuring Left Ventricular Volumes and Ejection Fraction

    PubMed Central

    Dorosz, Jennifer L.; Lezotte, Dennis C.; Weitzenkamp, David A.; Allen, Larry A.; Salcedo, Ernesto E.

    2013-01-01

    Objectives The primary aim of this systematic review is to objectively evaluate the test performance characteristics of three-dimensional echocardiography (3DE) in measuring left ventricular (LV) volumes and ejection fraction (EF). Background Despite its growing use in clinical laboratories, the accuracy of 3DE has not been studied on a large scale. It is unclear if this technology offers an advantage over traditional two-dimensional (2D) methods. Methods We searched for studies that compared LV volumes and EF measured by 3DE and cardiac magnetic resonance (CMR) imaging. A subset of those also compared standard 2D methods with CMR. We used meta-analyses to determine the overall bias and limits of agreement of LV end-diastolic volume (EDV), end-systolic volume (ESV), and EF measured by 3DE and 2D echocardiography (2DE). Results Twenty-three studies (1,638 echocardiograms) were included. The pooled biases ± 2 SDs for 3DE were ?19.1 ± 34.2 ml, ?10.1 ± 29.7 ml, and ? 0.6 ± 11.8% for EDV, ESV, and EF, respectively. Nine studies also included data from 2DE, where the pooled biases were ?48.2 ± 55.9 ml, ?27.7 ± 45.7 ml, and 0.1 ± 13.9% for EDV, ESV, and EF, respectively. In this subset, the difference in bias between 3DE and 2D volumes was statistically significant (p = 0.01 for both EDV and ESV). The difference in variance was statistically significant (p < 0.001) for all 3 measurements. Conclusions Three-dimensional echocardiography underestimates volumes and has wide limits of agreement, but compared with traditional 2D methods in these carefully performed studies, 3DE is more accurate for volumes and more precise in all 3 measurements. PMID:22575319

  11. Left Atrial Appendage Closure Guided by Integrated Echocardiography and Fluoroscopy Imaging Reduces Radiation Exposure

    PubMed Central

    Balzer, Jan; Eickholt, Christian; Petersen, Margot; Kehmeier, Eva; Veulemans, Verena; Kelm, Malte; Willems, Stephan; Meyer, Christian

    2015-01-01

    Aims To investigate whether percutaneous left atrial appendage (LAA) closure guided by automated real-time integration of 2D-/3D-transesophageal echocardiography (TEE) and fluoroscopy imaging results in decreased radiation exposure. Methods and Results In this open-label single-center study LAA closure (AmplatzerTM Cardiac Plug) was performed in 34 consecutive patients (8 women; 73.1±8.5 years) with (n = 17, EN+) or without (n = 17, EN-) integrated echocardiography/fluoroscopy imaging guidance (EchoNavigator® [EN]; Philips Healthcare). There were no significant differences in baseline characteristics between both groups. Successful LAA closure was documented in all patients. Radiation dose was reduced in the EN+ group about 52% (EN+: 48.5±30.7 vs. EN-: 93.9±64.4 Gy/cm2; p = 0.01). Corresponding to the radiation dose fluoroscopy time was reduced (EN+: 16.7±7 vs. EN-: 24.0±11.4 min; p = 0.035). These advantages were not at the cost of increased procedure time (89.6±28.8 vs. 90.1±30.2 min; p = 0.96) or periprocedural complications. Contrast media amount was comparable between both groups (172.3±92.7 vs. 197.5±127.8 ml; p = 0.53). During short-term follow-up of at least 3 months (mean: 8.1±5.9 months) no device-related events occurred. Conclusions Automated real-time integration of echocardiography and fluoroscopy can be incorporated into procedural work-flow of percutaneous left atrial appendage closure without prolonging procedure time. This approach results in a relevant reduction of radiation exposure. Trial Registration ClinicalTrials.gov NCT01262508 PMID:26465747

  12. Variation in use of echocardiography among veterans who use the Veterans Health Administration vs Medicare

    PubMed Central

    Kini, Vinay; McCarthy, Fenton H.; Rajaei, Sheeva; Epstein, Andrew J.; Heidenreich, Paul A.; Groeneveld, Peter W.

    2016-01-01

    Background Rapid growth in the provision of cardiac imaging tests has led to concerns about overuse. Little is known about the degree to which health care delivery system characteristics influence use and variation in echocardiography. Methods We analyzed administrative claims of veterans with heart failure older than 65 years from 2007 to 2010 across 34 metropolitan service areas (MSAs). We compared overall rates and geographic variation in use of transthoracic echocardiography (TTE) between veterans who used the Veterans Health Administration (VA) and propensity-matched veterans who used Medicare. “Dual users” were excluded. Results There were no significant differences in clinical characteristics or mortality between the propensity-matched cohorts (overall n = 30,404 veterans, mean age 76 years, mortality rate 52%). The Medicare cohort had a significantly higher overall rate of TTE use compared with the VA cohort (1.25 vs 0.38 TTEs per person-year, incidence rate ratio 2.89 [95% CI 2.80-3.00], both P< .001), but a similar coefficient of variation across MSAs (0.36 [95% CI 0.27-045] vs 0.48 [95% CI 0.37-0.59]). There was a moderate to strong correlation in variation at the MSA level between cohorts (Spearman r = 0.58, P < .001). Conclusion Overall rates of TTE use were significantly higher in a Medicare cohort compared with a propensity score-matched VA cohort of veterans with heart failure living in urban areas, with similar relative degrees of geographic variation and moderate to strong regional correlation. Rates of TTE use may be strongly influenced by health care system characteristics, but local practice styles influence echocardiography rates irrespective of health system. PMID:26386805

  13. Does echocardiography accurately reflect CMR-determined changes in left ventricular parameters following exercise training? A prospective longitudinal study.

    PubMed

    Spence, Angela L; Naylor, Louise H; Carter, Howard H; Dembo, Lawrence; Murray, Connor P; O'Driscoll, Gerry; George, Keith P; Green, Daniel J

    2013-04-01

    Cardiac adaptation in response to exercise has historically been described using echocardiography. Cardiac magnetic resonance (CMR), however, has evolved as a preferred imaging methodology for cardiac morphological assessment. While direct imaging modality comparisons in athletes suggest that large absolute differences in cardiac dimensions exist, it is currently unknown whether changes in cardiac morphology in response to exercise training are comparable when using echocardiography and CMR. Twenty-two young men were randomly assigned to undertake a supervised and intensive endurance or resistance exercise-training program for 24 wk. Echocardiography and CMR assessment of left ventricular (LV) mass, LV end-diastolic volume, internal cavity dimensions, and wall thicknesses were completed before and after training. At baseline, pooled data for all cardiac parameters were significantly different between imaging methods, while LV mass (r = 0.756, P < 0.001) and volumes (LV end-diastolic volume, r = 0.792, P < 0.001) were highly correlated across modalities. Changes in cardiac morphology data with exercise training were not significantly related when echocardiographic and CMR measures were compared. For example, posterior wall thickness increased by 8.3% (P < 0.05) when assessed using echocardiography, but decreased by 2% when using CMR. In summary, echocardiography and CMR imaging modalities produce findings that differ with respect to changes in cardiac size and volume following exercise training. PMID:23393067

  14. The utility of intra-operative three-dimensional transoesophageal echocardiography for dynamic measurement of stroke volume.

    PubMed

    Suehiro, K; Tanaka, K; Yamada, T; Matsuura, T; Funao, T; Mori, T; Nishikawa, K

    2015-02-01

    Measurement of left ventricular stroke volume and cardiac output is very important for managing haemodynamically unstable or critically ill patients. The aims of this study were to compare stroke volume measured by three-dimensional transoesophageal echocardiography with stroke volume measured using a pulmonary artery catheter, and to examine the ability of three-dimensional transoesophageal echocardiography to track stroke volume changes induced by haemodynamic interventions. This study included 40 cardiac surgery patients. Haemodynamic variables were measured before and 2 min after haemodynamic interventions, which consisted of phenylephrine 100 ?g or ephedrine 5 mg. We used Bland-Altman analysis to assess the agreement between the stroke volume measured by three-dimensional transoesophageal echocardiography and by the pulmonary artery catheter. Polar-plot and 4-quadrant plot analyses were used to assess the trending ability of three-dimensional transoesophageal echocardiography compared with the pulmonary artery catheter. Bias and percentage error were -1.2 ml and 20%, respectively. The concordance rate in the 4-quadrant analysis after phenylephrine and ephedrine administration was 75% and 84%, respectively. In the polar-plot analysis, the angular concordance rate was 66% and 73% after phenylephrine and ephedrine administration, respectively. Three-dimensional transoesophageal echocardiography was clinically acceptable for measuring stroke volume; however, it was not sufficiently reliable for tracking stroke volume changes after haemodynamic interventions. PMID:25265890

  15. [Severe asthma].

    PubMed

    González, Claudio D

    2016-01-01

    The objectives of this work were to investigate the frequency of severe asthma (SA) according to WHO definition and to compare SA patients' characteristics with those of non-severe asthma (NSA); secondly, to investigate the level of control reached throughout a period of regular treatment. Between 1-1-2005 and 12-31-2014, 471 medical records from patients with bronchial asthma assisted in Buenos Aires City were analyzed. SA frequency was 40.1% (189/471), being significantly higher among patients from the public health system (47.7%, 108/226 vs. 33%, 81/245, p = 0.001). SA patients were older than NSA ones (51.3 ± 17.4 vs. 42.6 ± 17.1 years, p = 0.000), presented longer time since onset of the disease (median 30 vs. 20 years, p = 0.000), lower educational levels (secondary level or higher 41.7% vs. 58.1%, p = 0.000), lower frequency of rhinitis (47% vs. 60.6%, p = 0.004), more severe levels of airway obstruction (FEV% 50.2 ± 13.7 vs. 77.7 ± 12.4, p = 0.000), more frequent antecedents of Near Fatal Asthma (11.1% vs. 2.8%, p = 0.000), higher levels of serum IgE (median of 410 vs. 279 UI/l, p = 0.01) and higher demand of systemic steroids requirements and hospitalizations (68.7% vs. 50.7%, p = 0.000 and 37.5% vs. 15.9%, p = 0.000, respectively). A 30.6% of SA patients (58/189) reached a follow-up period of 12 months, 13 (22.5%) of whom reached the controlled asthma level. The frequency of SA found seems to be considerable. Multicenter studies to investigate the levels of control reached by SA patients with access to proper treatment are recommended. PMID:26826988

  16. THE VALUE OF ECHOCARDIOGRAPHY IN THE MANAGEMENT OF ACUTE AORTIC INSUFFICIENCY

    PubMed Central

    Bekheit, Soad; Ali, A.; Fletcher, E.

    1978-01-01

    Three cases of acute rupture of the aortic cusp complicating bacterial endocarditis are described. Special emphasis is placed on the value of serial echocardiography as a means of identifying progressive changes in aortic valve anatomy during the destructive process of the disease. Prior to the results of blood cultures, an echocardiogram confirmed a diagnosis of vegetations on the valve cusps. It also demonstrated flailing of the aortic cusp, which was confirmed at operation. Echocardiographic findings of flailing aortic valves in these patients coincided with the onset of acute aortic insufficiency and contributed to the timing of surgical intervention for replacement of the affected valves. PMID:15216081

  17. Coumadin ridge: An incidental finding of a left atrial pseudotumor on transthoracic echocardiography

    PubMed Central

    Lodhi, Aadil Mubeen; Nguyen, Tin; Bianco, Christopher; Movahed, Assad

    2015-01-01

    Coumadin ridge is a normal anatomic variant that is occasionally found in the left atrium. It can present as a linear or nodular mass which can undulate with cardiac motion and if particularly prominent, can easily be mistaken for a tumor or thrombus. Careful evaluation and consideration of the common variants discussed in this review can help limit misdiagnosis, as well as unnecessary workup and treatment. We present a case of coumadin ridge that was found on a patient using two-dimensional transthoracic echocardiography. PMID:26380830

  18. Clinical experience in the detection of coronary artery disease with myocardial contrast echocardiography.

    PubMed

    Porter, Thomas R; Xie, Feng

    2002-07-01

    Myocardial contrast enhancement following intravenous infusions or injections of perfluorocarbon-containing microbubbles has now been observed consistently in humans. Currently, the major challenge facing us is interpreting accurately what we see. The myocardial contrast patterns we observe have, thus far, been shown to detect myocardial perfusion abnormalities during dipyridamole, adenosine, and dobutamine stress echocardiography. They also have been shown to detect zones of no reflow following coronary revascularization in patients with acute myocardial infarction. These preliminary data will require validation in larger multicenter clinical studies. PMID:12174204

  19. Paradoxical gas embolism after SCUBA diving: hemodynamic changes studied by echocardiography.

    PubMed

    Boussuges, A; Pontier, J M; Schmid, B; Dussault, C

    2014-02-01

    Hemodynamic changes induced by self-contained underwater breathing apparatus diving were investigated using Doppler echocardiography. We detected circulating bubbles in both right and left cavities of the heart and in the cerebral circulation in two divers with a large patent foramen ovale. A reduction in the left ventricular preload was suggested by echocardiographic measurements. The decreased cardiac preload was paralleled to a lower stroke volume and cardiac output. These findings were also observed in divers with no evidence of circulating bubbles. In these subjects, pulmonary vascular resistances remained unchanged while an increase was observed in the two divers with arterial bubbles. This increase could promote right-to-left shunting. PMID:22612401

  20. Doppler echocardiography in normally functioning replacement aortic valves: a review of 129 studies.

    PubMed

    Rajani, Ronak; Mukherjee, Dayal; Chambers, John B

    2007-09-01

    Echocardiography is the technique of choice for the assessment of replacement aortic valves. Hemodynamic function depends on the design and size of the valve. This review summarizes the published information available to the end of 2005. The most obstructive valve was the caged-ball, followed by the stented porcine and single tilting-disc valves. The stented bovine pericardial valves were slightly less obstructive than these, and similar to the intra-annular bileaflet mechanical valves. Stentless valves appeared slightly less obstructive still, and similar to reduced-cuff mechanical bileaflet valves. Homografts were the least obstructive. Approximate guide thresholds suggesting obstruction were derived. PMID:17944125

  1. Evaluation of left atrial function by speckle tracking echocardiography in patients with systemic lupus erythematosus.

    PubMed

    Dai, M; Li, K L; Qian, D J; Lu, J; Zou, Y H; Cao, Y X; Yang, Z Y; Wang, R X

    2016-04-01

    Left atrial (LA) function plays a key role in maintaining optimal cardiac output. Left ventricular diastolic dysfunction (LVDD) has been reported in systemic lupus erythematosus (SLE), but whether LA functional abnormalities also occur in patients with SLE is unknown. Toward this aim we evaluated left atrial function and volume by strain and strain rate derived from speckle tracking echocardiography (STE) and their associations with LVDD. Sixty SLE patients were compared with age- and gender-matched normal controls. The LA strain (S) and strain rate (SR) during systole, early diastole and late diastole (SRs, SRe and SRa, respectively) were measured by STE. The LA volume index (LAVI), traditional parameters of LA and left ventricular diastolic function also were analysed. Global strain and positive SRe were significantly reduced in the SLE group compared with the control group (26.2% ± 9.5% vs 32.5% ± 9.8% and -2.4 ± 1.0 s(-1) vs -3.1 ± 1.2 s(-1), both p < 0.05). The SRs in the SLE and control groups were not significantly different (2.1 ± 0.7 s(-1) vs 2.4 ± 0.8 s(-1), p = 0.2). The positive SRa was increased in the SLE group compared with the control group (-2.1 ± 0.8 s(-1) vs -1.6 ± 0.5 s(-1), p < 0.05) and the LAVI was larger in the SLE group than in the control group (32.4 ± 8.0 vs 25.8 ± 7.1 ml/m(2), p < 0.001). Patients with SLE exhibiting varying grades of LVDD displayed significant differences in LA parameters, including LAVI, SRs, SRe and SRa (all p < 0.05). Multivariate linear analysis additionally revealed that SLICC/ACR damage index (SDI) was independently and inversely associated with global strain, SRs and positive SRe. LA functions were changed in SLE patients, demonstrating impairment in conduit function, decrease in storage function and increase in pump function. Meanwhile, the magnitude of this impairment was predictively associated with the severity of LVDD. The results from this study demonstrate that STE is capable of detecting various aspects of LA functional impairment during SLE progression, and should be further explored as a diagnostic tool for improving the outcomes of SLE patients. PMID:26657736

  2. A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the British Society of Echocardiography

    PubMed Central

    Wharton, Gill; Steeds, Richard; Allen, Jane; Phillips, Hollie; Jones, Richard; Kanagala, Prathap; Lloyd, Guy; Masani, Navroz; Mathew, Thomas; Oxborough, David; Rana, Bushra; Sandoval, Julie; Wheeler, Richard; O'Gallagher, Kevin

    2015-01-01

    There have been significant advances in the field of echocardiography with the introduction of a number of new techniques into standard clinical practice. Consequently, a ‘standard’ echocardiographic examination has evolved to become a more detailed and time-consuming examination that requires a high level of expertise. This Guideline produced by the British Society of Echocardiography (BSE) Education Committee aims to provide a minimum dataset that should be obtained in a comprehensive standard echocardiogram. In addition, the layout proposes a recommended sequence in which to acquire the images. If abnormal pathology is detected, additional views and measurements should be obtained with reference to other BSE protocols when appropriate. Adherence to these recommendations will promote an increased quality of echocardiography and facilitate accurate comparison of studies performed either by different operators or at different departments.

  3. Use of transthoracic echocardiography in the evaluation of chest pain: illustrative cases and review of recent guidelines.

    PubMed

    Aldwaik, Mohammed; Williams, Aled P; Le Feuvre, Simon; Cowell, Richard

    2014-01-01

    Chest pain (CP) is a very common presentation with a wide range of differential diagnoses, including life-threatening conditions, which need to be considered, diagnosed and treated urgently. Cardiac CP accounts for less than one-third of causes. Echocardiography is a valuable non-invasive tool that can help in diagnosing and treating patients presenting with CP. National Institute for Health and Care Excellence (NICE), European Society of Cardiology (ESC) and American Heart Association (AHA) guidelines state that echocardiography can help in the diagnosis of acute coronary syndromes and also in ruling out other serious conditions. We present three cases where transthoracic echocardiography (TTE) was essential in assessing patients, making the correct diagnosis and offering the right treatment. This article emphasises the importance of using TTE in assessing patients with CP and hopes to promote its consideration in day-to-day practice. PMID:25488885

  4. Second harmonic echocardiography and spontaneous contrast during implantation of a left ventricular assist device.

    PubMed

    Hubbert, Laila; Peterzén, Bengt; Ahn, Henrik; Janerot-Sjoberg, Birgitta

    2010-01-01

    Implantable mechanical left ventricular assist devices (LVADs) are used as a bridge or alternative to heart transplantation. Peroperative transesophageal echocardiography is commonly applied during implantation. Significant air embolism may occur as a result of air leakage at connections and anastomoses when LV filling becomes inadequate, and this must be prevented. Early suspicion and detection of air is mandatory to avoid negative circulatory effects. We hypothesized that monitoring of heart chamber size and occurrence of single air bubbles using second harmonic imaging (SHI) echocardiography may prevent risk for significant air embolism. After implantation of the LVAD in 10 calves, invasive hemodynamic monitoring and epicardial SHI were performed while increasing pump speed. Air bubbles in the ascending aorta were monitored and the left heart visualized for off-line dimensional analysis. Detection of air bubbles in the ascending aorta preceded their appearance in the left ventricle. They occurred exclusively but not always after a decrease in left atrial (LA) size. Decrease in LA pressure did not predict bubble detection or reduction in LA size. We conclude that SHI detects spontaneous ultrasound contrast during implantation of a LVAD and that a decrease in LA size is a warning that air embolism is imminent. PMID:20613488

  5. [Link between diabetes and diastolic dysfunction and the diagnostic role of echocardiography].

    PubMed

    Nagy, András; Cserép, Zsuzsanna

    2009-11-01

    Diabetes mellitus, a disease that has been reaching epidemic proportions, is an important risk factor to the development of cardiovascular complication. The left ventricular diastolic dysfunction represents the earliest pre-clinical manifestation of diabetic cardiomyopathy, preceding systolic dysfunction and being able to evolve to symptomatic heart failure. In early stages, these changes appear reversible with tight metabolic control, but as pathologic processes become organized, the changes are irreversible and contribute to an excess risk of heart failure among diabetic patients. Doppler echocardiography provides reliable data in the stages of diastolic function, as well as for systolic function. Combination of pulsed tissue Doppler study of mitral annulus with transmitral inflow may be clinically valuable for obtaining information about left ventricular filling pressure and unmasking Doppler inflow pseudonormal pattern, a hinge point for the progression toward advanced heart failure. Subsequently we give an overview about diabetes and its complications, their clinical relevance and the role of echocardiography in detection of diastolic heart failure in diabetes. PMID:19861293

  6. Mode vibrations of a matrix transducer for three-dimensional second harmonic transesophageal echocardiography.

    PubMed

    van Neer, Paul L M J; Blaak, Sandra; Bosch, Johan G; Lancée, Charles T; Prins, Christian; van der Steen, Anton F W; de Jong, Nico

    2012-10-01

    Transesophageal echocardiography (TEE) uses the esophagus as an imaging window to the heart. This enables cardiac imaging without interference from the ribs or lungs and allows for higher frequency ultrasound to be used compared with transthoracic echocardiography (TTE). TEE facilitates the successful imaging of obese or elderly patients, where TTE may be unable to produce images of satisfactory quality. Recently, three-dimensional (3-D) TEE has been introduced, which greatly improves the image quality and diagnostic value of TEE by adding an extra dimension. Further improvement could be achieved by optimizing 3-D TEE for harmonic imaging. This article describes the optimal geometry and element configuration for a matrix probe for 3-D second harmonic TEE. The array concept features separated transmit and receive subarrays. The element geometry was studied using finite element modeling and a transmit subarray prototype was examined both acoustically and with laser interferometry. The transmit subarray is suitable for its role, with a 3 MHz resonance frequency, a 40%-50% -3 dB bandwidth and crosstalk levels <-27 dB. The proposed concept for the receive subarray has a 5.6 MHz center frequency and a 50% -3 dB bandwidth. PMID:22958515

  7. Real-Time, Interactive Echocardiography Over High-Speed Networks: Feasibility and Functional Requirements

    NASA Technical Reports Server (NTRS)

    Bobinsky, Eric A.

    1998-01-01

    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.

  8. [Intraoperative transesophageal echocardiography and systolic anterior motion of the mitral valve: findings during noncardiac surgery].

    PubMed

    Cabrera Schulmeyer, M C; Labbé, M; Schmied, S; De la Maza, J

    2007-01-01

    Systolic anterior motion is an under-recognized cause of acute systemic hypotension during noncardiac surgery. This dynamic event has come to light with the introduction of intraoperative transesophageal echocardiography, which provides anatomic and functional images in real time. The cause of this abnormal motion is still uncertain, although it is thought that changes in the shape and function of the left ventricle allow displacement of the mitral valve annulus so that 1 or more leaflets can be pulled toward the outflow tract and obstruct it during the systole. It is important to recognize and diagnose this phenomenon as a cause of hypotension during noncardiac surgery because it can be treated with volume replacement and beta-blockers. The results of such measures can be monitored on intraoperative echocardiographic images. Volume replacement should increase the size of the ventricle and the beta-blockers should decrease the hyperdynamic state. We report a case of abnormal systolic motion during noncardiac surgery that was managed with the help of echocardiography. PMID:17953339

  9. Atrial Myxoma Presenting as Myocardial Infarction Diagnosed by Echocardiography, Managed Endoscopically with Robot-Assisted Surgery

    PubMed Central

    Simmons, Charles, Jr.; Ellison, Douglas; Hemp, James; Chung, Kiyon

    2016-01-01

    Atrial myxomatous embolization into the coronary arteries is a rare event. Management of large myxomas is usually via surgical resection involving a median sternotomy. Echocardiography is not a routine part of non-ST-elevation myocardial infarction (NSTEMI) management. Here, we present the case of a 70-year-old Caucasian man with a history of hypertension and hyperlipidemia who presented to the emergency department with an NSTEMI. Transthoracic echocardiogram and transesophageal echocardiogram revealed a large and highly mobile atrial mass, traversing through the mitral valve orifice during diastole. Coronary angiography revealed a focal 60% lesion in the right coronary artery and no other significant obstructive coronary artery disease, suggesting that the cause of his presentation was tumor embolization into the coronary circulation. The patient underwent robot-assisted endoscopic resection of his atrial mass and was discharged in stable condition on postoperative day 2. Pathology revealed atrial myxoma. To our knowledge, this is the first reported case of an atrial myxoma presenting with an NSTEMI and managed with a robot-assisted endoscopic approach. This case also highlights the importance of routine early echocardiography in patients presenting with NSTEMI. PMID:27014518

  10. The Clinical Benefits of Adding a Third Dimension to Assess the Left Ventricle with Echocardiography

    PubMed Central

    Badano, Luigi P.

    2014-01-01

    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. PMID:24959374

  11. [Effectiveness of transesophageal echocardiography in diagnosing complete rupture of the papillary muscle after acute myocardial infarction].

    PubMed

    Yamazaki, Takenori; Moriwaki, Hiroo

    2011-02-01

    We reviewed a case undergoing emergency surgery for acute post-infarction papillary muscle rupture. The patient was a 79-year-old woman transferred to our hospital with cardiogenic shock who required endotracheal intubation. The acute myocardial infarction diagnosis was based on the electrocardiographic findings. She had developed progressively worsening pulmonary edema. No heart murmur was detected. Transthoracic echocardiography demonstrated hyperdynamic cardiac motion and an intracardiac massive turbulent color Doppler signal, but neither mitral regurgitation nor the ruptured papillary muscle head was demonstrated. Her deteriorating condition precluded cardiac catheterization. We performed transesophageal echocardiography (TEE), which demonstrated massive mitral regurgitation and the ruptured anterior papillary muscle connected to normal chordae tendineae and anterior and commissural leaflets. During systole, the head of the ruptured papillary muscle moved like a whip in the left atrium. Emergency surgery was performed. Complete rupture of the anterior papillary muscle head was found, and the mitral valve was replaced with a porcine bioprosthesis (Mosaic #25). Postoperatively, she was weaned from intra-aortic balloon pumping after 2 days and recovered uneventfully. Postoperative coronary angiography demonstrated no significant coronary arterial stenosis. To make the diagnosis of post-infarction papillary muscle rupture, we recommend immediate TEE. PMID:21387617

  12. The Role of Echocardiography in the Evaluation of Pulmonary Arterial Hypertension.

    PubMed

    Pristera, Nicole; Musarra, Ray; Schilz, Robert; Hoit, Brian D

    2016-01-01

    The evaluation of pulmonary arterial hypertension (PAH) requires a multimodality approach that combines invasive and noninvasive imaging studies to ensure accurate diagnosis and classification. Given the complexity of the hemodynamic relationships between the left heart, pulmonary circulation, and right heart, the diagnosis of PAH is often a challenging task. Right heart catheterization is the gold standard for diagnosis, providing the hemodynamic information that defines the disease. Nonetheless, echocardiography continues to be a valuable tool in the approach to the patient with suspected PAH. Echocardiographic assessment generates a wealth of information about the response of the right heart to elevated pulmonary pressures and provides essential diagnostic and prognostic data to the clinician. Numerous measurements can be used to identify alterations in right heart morphology, pressure, and function; although each variable in isolation may have little utility, meaningful information is revealed when multiple parameters are considered together. In this article, we will review the echocardiographic measurements employed in assessment of the right heart and seek to clarify the role of echocardiography in the diagnostic workup of PAH. PMID:26522749

  13. Assessment of diastolic function by tissue Doppler echocardiography: comparison with standard transmitral and pulmonary venous flow

    NASA Technical Reports Server (NTRS)

    Farias, C. A.; Rodriguez, L.; Garcia, M. J.; Sun, J. P.; Klein, A. L.; Thomas, J. D.

    1999-01-01

    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.

  14. 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)

    Cabanes, L.; Mas, J. L.; Cohen, A.; Amarenco, P.; Cabanes, P. A.; Oubary, P.; Chedru, F.; Guerin, F.; Bousser, M. G.; deRecondo, J.

    1993-01-01

    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

  15. "Show me" bioethics and politics.

    PubMed

    Christopher, Myra J

    2007-10-01

    Missouri, the "Show Me State," has become the epicenter of several important national public policy debates, including abortion rights, the right to choose and refuse medical treatment, and, most recently, early stem cell research. In this environment, the Center for Practical Bioethics (formerly, Midwest Bioethics Center) emerged and grew. The Center's role in these "cultural wars" is not to advocate for a particular position but to provide well researched and objective information, perspective, and advocacy for the ethical justification of policy positions; and to serve as a neutral convener and provider of a public forum for discussion. In this article, the Center's work on early stem cell research is a case study through which to argue that not only the Center, but also the field of bioethics has a critical role in the politics of public health policy. PMID:17926217

  16. Severe right heart failure in a patient with chronic obstructive lung disease: a diagnostic challenge.

    PubMed

    Meysman, M; Pipeleers-Marichal, M; Geers, C; Ilsen, B; Vincken, W

    2013-01-01

    A 55-year-old male was admitted for evaluation of severe dyspnoea and hypoxaemia. Physical examination upon admission showed elevated jugular venous pressure and an accentuated second heart sound. Chest radiograph showed cardiomegaly with increased bibasilar markings. Arterial blood gas analysis while breathing room air showed marked hypoxaemia. High resolution computed tomography angiography of the chest showed modestly enlarged mediastinal lymph nodes with discrete diffuse ground-glass attenuation especially at the lower lung zones. Positron emission tomography using 18F labelled 2-deoxy-D-glucose (FDG) demonstrated the mediastinal lymph nodes were FDG-avid. Transthoracic echocardiography showed dilated hypokinetic right heart chambers with bulging of the interventricular septum to the left, compatible with acute cor-pulmonale. From the tricuspid regurgitation jet measurement a systolic pulmonary artery pressure (PAP) of 48 mmHg was estimated. Patent foramen ovale was suspected on bubble test. Right heart catheterisation confirmed pulmonary arterial hypertension: mPAP 47 mmHg, pulmonary artery occlusion pressure 5 mmHg, cardiac index 1.1 L/min/m2, pulmonary vascular resistance (PVR) 959 dyne.sec.cm(-5). Pulmonary function tests showed a marked diffusing capacity for carbon monoxide (DLCO) decrease of 32% predicted but no obstructive lung deficit. Before an open lung biopsy could be scheduled the patient developed acute cardiogenic shock. At autopsy pulmonary veno-occlusive disease with marked pulmonary hypertension was diagnosed. PMID:24380224

  17. The Effects of Dexmedetomidine on Myocardial Function Assessed by Tissue Doppler Echocardiography During General Anesthesia in Patients With Diastolic Dysfunction

    PubMed Central

    Lee, Su Hyun; Na, Sungwon; Kim, Namo; Ban, Min Gi; Shin, Sung Eui; Oh, Young Jun

    2016-01-01

    Abstract Dexmedetomidine is a commonly used sedative and adjuvant agent to general anesthesia. The present was designed to evaluate the effects of dexmedetomidine on myocardial function by using tissue Doppler echocardiography during general anesthesia in patients with diastolic dysfunction. Forty patients undergoing orthostatic surgery with ejection fraction preserved diastolic dysfunction grade 2 or 3 were randomly allocated to the Control and Dex group (n = 20, each). In the Dex group, dexmedetomidine was given as an initial loading dose of 1.0 μg/kg over 10 minutes followed by a maintenance dose of 0.5 μg/kg/h. The ratio of peak early diastolic transmitral or transtricuspid inflow velocity to early diastolic mitral or tricuspid annular velocity (LV or RV E/e′) and left or right ventricular myocardial performance index (LV or RV MPI) were measured at before and after the administration dexmedetomidine or saline. The Dex group showed significant decrease of heart rate (P = 0.038), and increase of mean blood pressure (P < 0.001), LV E/e′ (P = 0.025), and LV MPI (P < 0.001) compared to those of the Control group on a linear mixed model analysis. Also, the Dex group showed significant increase of RV E/e′ (P < 0.001) and RV MPI (P = 0.028) compared to those of the Control group. Intraoperative dexmedetomidine administration during general anesthesia was appeared to deteriorate biventricular function in patients with diastolic dysfunction. We suggest careful consideration and a need for reducing dosage when administrating dexmedetomidine in patients with diastolic dysfunction. PMID:26871847

  18. Four-dimensional echocardiography with spatiotemporal image correlation and inversion mode for detection of congenital heart disease.

    PubMed

    Qin, Yue; Zhang, Ying; Zhou, Xiaohang; Wang, Yu; Sun, Wei; Chen, Lizhu; Zhao, Dan; Zhan, Ying; Cai, Ailu

    2014-07-01

    The aim of this study was to evaluate the use of 4-D echocardiography with inversion mode and spatiotemporal image correlation (IM-STIC) in the detection of normal and abnormal fetal hearts. We retrospectively studied 112 normal fetuses and 16 fetuses with a confirmed diagnosis of congenital heart disease. Two volumes were acquired from each of the fetuses using transverse and sagittal sweeps. Volumes were reconstructed with IM-STIC. In normal fetuses, IM-STIC facilitated visualization of the interior structures of the fetal heart and great vessels. The visualization rates of intended planes obtained from IM-STIC 4D data ranged from 55% to 100%. In 16 fetuses with congenital heart disease, IM-STIC was able to display the cardiac malformations using digital casting. Some of the malformations were suspected during pre-natal 2-D echocardiography, and their pre-natal IM-STIC diagnoses were confirmed by post-natal echocardiography, surgery and/or autopsy. Hence, 4-D IM-STIC allows better visualization of complex congenital heart disease and should be considered a very useful addition to 2-D echocardiography. PMID:24785438

  19. A hand?carried cardiac ultrasound device in the outpatient cardiology clinic reduces the need for standard echocardiography

    PubMed Central

    Trambaiolo, P; Papetti, F; Posteraro, A; Amici, E; Piccoli, M; Cerquetani, E; Pastena, G; Gambelli, G; Salustri, A

    2007-01-01

    Objective To assess the potential value and cost?effectiveness of a hand?carried ultrasound (HCU) device in an outpatient cardiology clinic. Methods 222 consecutive patients were prospectively enrolled in the study. When standard echocardiography (SE) was specifically indicated on the basis of clinical history, electrocardiogram and physical examination, the same cardiologist (level?2 or level?3 trained) immediately performed an HCU examination. The cardiologist then reassessed the clinical situation to confirm or cancel the SE request according to the information provided by HCU. The SE examination was performed by a sonographer and examined in a blinded fashion by a cardiologist expert in echocardiography. Findings from the two examinations were compared. Results HCU was performed in 108/222 patients, and a definite diagnosis was established in 34 of them (31%), making SE examination potentially avoidable. In the 74 patients with inconclusive HCU results and for whom SE was still indicated, the decision was mainly dictated by the lack of spectral Doppler modality in the HCU system. The overall agreement between HCU and SE for diagnosis of normal/abnormal echocardiograms was 73% (??=?0.4). On the basis of the potentially avoided SE examinations and the obviated need for a second cardiac consultation, a total cost saving of €2142 per 100 patients referred for echocardiography was estimated. Conclusions The use of a simple HCU device in the outpatient cardiology clinic allowed reliable diagnosis in one third of the patients referred for echocardiography, which translates into cost and time saving benefits. PMID:16940393

  20. Aortic dissection after angioplasty and stenting of an aortic coarctation: detection by intravascular ultrasonography but not transesophageal echocardiography.

    PubMed

    Panten, R R; Harrison, J K; Warner, J; Grocott, H P

    2001-01-01

    In this case report, an iatrogenic dissection of the descending aorta occurred during balloon angioplasty and stenting of a recurrent coarctation. The dissection was not seen by transesophageal echocardiography, but intravascular ultrasonography, performed routinely during such procedures at this institution, identified the dissection and guided further therapeutic stent placement. PMID:11174440

  1. Comparison of /sup 111/In platelet scintigraphy and two-dimensional echocardiography in the diagnosis of left ventricular thrombi

    SciTech Connect

    Ezekowitz, M.D.; Wilson, D.A.; Smith, E.O.; Burow, R.D.; Harrison, L.H. Jr.; Parker, D.E.; Elkins, R.C.; Peyton, M.; Taylor, F.B.

    1982-06-24

    In a study comparing /sup 111/In platelet scintigraphy and two-dimensional echocardiography as methods of identifying left ventricular thrombi, the results obtained with both techniques were verified at surgery or autopsy in 53 patients--34 with left ventricular aneurysms, and 19 with mitral-valve disease. Left ventricular thrombi were found at surgery or autopsy in 14 of the patients with aneurysms and in none of those with mitral-valve disease. Thirteen of 53 echocardiograms (25 per cent) were technically inadequate and excluded from the analysis. In the group with aneurysms, the sensitivity of scintigraphy in detecting thrombi was 71 per cent, and that of echocardiography was 77 per cent. The specificity of scintigraphy was 100 per cent, and that of echocardiography was 93 per cent. We conclude that /sup 111/In platelet scintigraphy and two-dimensional echocardiography have useful and complementary roles in the detection of left ventricular thrombi. Both these noninvasive techniques can be used to monitor therapy.

  2. Initial clinical experience of real-time three-dimensional echocardiography in patients with ischemic and idiopathic dilated cardiomyopathy

    NASA Technical Reports Server (NTRS)

    Shiota, T.; McCarthy, P. M.; White, R. D.; Qin, J. X.; Greenberg, N. L.; Flamm, S. D.; Wong, J.; Thomas, J. D.

    1999-01-01

    The geometry of the left ventricle in patients with cardiomyopathy is often sub-optimal for 2-dimensional ultrasound when assessing left ventricular (LV) function and localized abnormalities such as a ventricular aneurysm. The aim of this study was to report the initial experience of real-time 3-D echocardiography for evaluating patients with cardiomyopathy. A total of 34 patients were evaluated with the real-time 3D method in the operating room (n = 15) and in the echocardiographic laboratory (n = 19). Thirteen of 28 patients with cardiomyopathy and 6 other subjects with normal LV function were evaluated by both real-time 3-D echocardiography and magnetic resonance imaging (MRI) for obtaining LV volumes and ejection fractions for comparison. There were close relations and agreements for LV volumes (r = 0.98, p <0.0001, mean difference = -15 +/- 81 ml) and ejection fractions (r = 0.97, p <0.0001, mean difference = 0.001 +/- 0.04) between the real-time 3D method and MRI when 3 cardiomyopathy cases with marked LV dilatation (LV end-diastolic volume >450 ml by MRI) were excluded. In these 3 patients, 3D echocardiography significantly underestimated the LV volumes due to difficulties with imaging the entire LV in a 60 degrees x 60 degrees pyramidal volume. The new real-time 3D echocardiography is feasible in patients with cardiomyopathy and may provide a faster and lower cost alternative to MRI for evaluating cardiac function in patients.

  3. Paradoxical carbon dioxide embolism during endoscopic thyroidectomy confirmed by transesophageal echocardiography.

    PubMed

    Kim, Seong-Hyop; Park, Kyoung-Sik; Shin, Hwa-Yong; Yi, Jun-Hee; Kim, Duk-Kyung

    2010-10-01

    Carbon dioxide (CO?) embolism is a rare but potentially life-threatening complication of laparoscopic procedures. Although endoscopic thyroidectomy using CO? gas insufflation appears to be superior to conventional open thyroidectomy in terms of cosmetic results, it may cause venous or fatal paradoxical CO? embolism. We report a case of paradoxical CO? embolism during CO? gas insufflation in an endoscopic thyroidectomy that was confirmed by transesophageal echocardiography (TEE). Paradoxical embolization via transpulmonary right-to-left shunting of venous CO? gas emboli was revealed by TEE examination. The patient recovered without complications. In conclusion, although endoscopic thyroidectomy is a promising approach that is gaining popularity and offers excellent cosmetic results compared with conventional open thyroidectomy, this case report emphasizes the importance of anticipating and being vigilant for potential CO? embolism. PMID:20683735

  4. Use of intracardiac echocardiography for early detection of phrenic nerve injury during cryoballoon pulmonary vein isolation.

    PubMed

    Lakhani, Mayur; Saiful, Faisal; Bekheit, Soad; Kowalski, Marcin

    2012-08-01

    Cryoballoon catheter ablation has recently emerged as an effective tool to achieve pulmonary vein isolation (PVI). Right-sided PVI with cryoballoon ablation has been associated with a significant incidence of phrenic nerve palsy. Multiple modalities are currently utilized to monitor phrenic nerve function during ablation. We describe a novel approach toward monitoring and diagnosing phrenic nerve palsy using intracardiac echocardiography (ICE) during cryoballoon ablation of the right pulmonary veins. This technique of monitoring has the advantage of continuous direct diaphragmatic visualization without the use of fluoroscopy, hence significantly minimizing radiation to both the patient and the operator. In addition, this technique does not require extra personnel to monitor the diaphragm using manual palpation. Further prospective studies of our and other methods for prevention of phrenic nerve palsy are required. PMID:22494116

  5. [Prenatal diagnosis of congenital heart disease by echocardiography in Matanzas Province, Cuba, from 1990 to 1995].

    PubMed

    González Font, Antonio E; Carrete Ramírez, Francisco A; González Fernández, Diana R

    2005-01-01

    We analyze the intra-uterine diagnoses of congenital cardiopathies performed by means of fetal echocardiographies from 1990 to 1995 in Matanzas, Cuba. All patients were examined in search of risk factors and indicators; 39 complex cardiopathies were detected, the most frequent ones were univentricular heart, hypoplasia of the left ventricle, and pulmonary atresia. Significant references were an abnormal image of the four cavities and the associated fetal anomalies; 66% of the malformations were diagnosed before week 24 of gestation. It was observed that the group of patients not diagnosed prenatally had a significant perinatal mortality. Although 32% of the newborns' complex cardiopathies in that period were diagnosed prenatally, it is necessary to improve this result aimed at reducing the morbidity and mortality due to these anomalies, offering the best survival conditions at the time of birth. PMID:16138699

  6. Transesophageal Echocardiography Assisting in the Diagnosis of Intraabdominal Hemorrhage During Cardiac Arrest.

    PubMed

    Jelly, Christina Anne; Jiang, Yandong; Hoeft, Mark; Liang, Yafen

    2016-04-01

    Transesophageal echocardiography (TEE) has been frequently used to identify potential etiologies of intraoperative cardiac arrest for noncardiac surgical patients. However, rescue TEE to assist in the diagnosis of intraabdominal hemorrhage has never been reported. We present a patient who developed cardiac arrest on emergence after an elective abdominal surgery. Intraoperative TEE revealed hypovolemia with hyperdynamic left and right ventricles. It also demonstrated a 3.3- by 13.2-cm circular perihepatic fluid collection on transgastric views raising concern for major intraabdominal hemorrhage as the cause for the cardiac arrest. This prompted surgical reexploration, which confirmed the diagnosis. We suggest that transgastric views to identify intraabdominal fluid collections should be considered during a rescue TEE if intraabdominal hemorrhage is suspected. PMID:26795911

  7. Cross sectional subcostal echocardiography: atrioventricular septal defects and the short axis cut.

    PubMed Central

    Mortera, C; Rissech, M; Payola, M; Miro, C; Perich, R

    1987-01-01

    A short axis echocardiographic cut of the heart from the subcostal approach was used to study the atrioventricular junction in 47 infants and children with congenital heart disease and 20 with normal hearts. Examination of the diastolic openings of both atrioventricular valves was able to establish normal developments of the valves and annuli even when this was found in cases of complex congenital heart disease. In 30 patients with atrioventricular septal defects the technique distinguished between a partial defect (when the two atrioventricular valves were linked transseptally) and a complete defect (when there was only one atrioventricular valve). A range of atrioventricular attachments was seen in these patients. Short axis echocardiography from the subcostal approach reliably identifies different forms of atrioventricular septal defects by defining the anatomy of the atrioventricular valves during maximal diastolic expansion. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 6 Fig 7 Fig 8 PMID:3663428

  8. Anatomical definition of aortic root abscesses by transesophageal echocardiography: planning a surgical strategy using homograft valves.

    PubMed

    Brecker, S J; Jin, X Y; Yacoub, M H

    1995-06-01

    Infective endocarditis of the native or a prosthetic aortic valve may be complicated by abscess cavity development in the aortic root, and successful treatment depends upon early diagnosis, clear anatomical definition preoperatively, and maintaining sterility of the second implant. Homograft valves offer many advantages in this setting. Timing of surgery and the choice of the particular technique depends on accurate characterization of the anatomical details of the abscess. Five cases of paravalvular aortic root abscess in the setting of prosthetic valve endocarditis are described. In each case the diagnosis was made with transesophageal echocardiography, and the information was used in planning the operative procedure of homograft valve replacement. This strategy is proposed as optimal management of this potentially lethal condition. PMID:7664511

  9. Color atlas of real-time two-dimensional Doppler echocardiography

    SciTech Connect

    Omoto, R.

    1984-01-01

    This atlas represents efforts to provide two-dimensional echocardiography coordinated with simultaneous color-coded Doppler studies. During the past 10 years, real-time two-dimensional echocardiographic images have contributed to the study and understanding of cardiac disease. The recent application of the Doppler technique has also contributed to the understanding and demonstration of cardiac disease and functions in various pathologic conditions. It has also permitted the calculation of various cardiac functions, which previously were only available by invasive studies. This book presents an extension of the Doppler capabilities in the development of an instantaneous color-coded display of normal and abnormal cardiac function in contrast with those that require timely and extensive calculations.

  10. Atrial anatomy and function postcardioversion: insights from transthoracic and transesophageal echocardiography.

    PubMed

    Manning, W J; Silverman, D I

    1996-01-01

    Echocardiography provides a valuable tool for the evaluation and assessment of atrial function in patients with atrial fibrilation (AF). Atrial morphology after restoration of sinus rhythm is dynamic, with a decrease in atrial size if sinus rhythm is maintained and atrial growth among those with sustained AF. Restoration of electrocardiographic sinus rhythm is frequently accompanied by relatively depressed atrial mechanical function, with recovery that appears to be related to multiple factors, including the duration of AF before cardioversion and the mode of cardioversion. Such delay appears to confer ongoing risk for thrombus formation and thromboembolism in the days after cardioversion and argues strongly for the need to maintain therapeutic anticoagulation during the pericardioversion and postcardioversion period. PMID:8693094

  11. Two-dimensional echocardiography for catheter location and placement in infants and children.

    PubMed

    Perry, L W; Galioto, F M; Blair, T; Shapiro, S R; Ruckman, R N; Scott, L P

    1981-04-01

    This paper presents our experience with two-dimensional echocardiography in the detection of 61 intravascular catheters or wires in a series of 39 infants and children. It was possible to identify intravascular wires as small as 0.5 mm in diameter and intravascular catheters as small as 0.9 mm in diameter. In no instance, was an intravascular catheter not detected. The two-dimensional echocardiogram is demonstrated to be a tool to assist the physician in placement of intravascular catheters. In the catheterization laboratory, the two-dimensional echocardiogram is useful in determining catheter location, particularly in the presence of complex congenital defects. Two-dimensional echocardiographic guidance of catheters minimizes exposure to ionizing radiation. PMID:6789295

  12. Automated Assessment of Right Ventricular Volumes and Function Using Three-Dimensional Transesophageal Echocardiography.

    PubMed

    Nillesen, Maartje M; van Dijk, Arie P J; Duijnhouwer, Anthonie L; Thijssen, Johan M; de Korte, Chris L

    2016-02-01

    Assessment of right ventricular (RV) function is known to be of diagnostic value in patients with RV dysfunction. Because of its complex anatomic shape, automated determination of the RV volume is difficult and strong reliance on geometric assumptions is not desired. A method for automated RV assessment was developed using three-dimensional (3-D) echocardiography without relying on a priori knowledge of the cardiac anatomy. A 3-D adaptive filtering technique that optimizes the discrimination between blood and myocardium was applied to facilitate endocardial border detection. Filtered image data were incorporated in a segmentation model to automatically detect the endocardial RV border. End-systolic and end-diastolic RV volumes, as well as ejection fraction, were computed from the automatically segmented endocardial surfaces and compared against reference volumes manually delineated by two expert cardiologists. The results reported good performance in terms of correlation and agreement with the results from the reference volumes. PMID:26633596

  13. A 10-Fr ultrasound catheter with integrated micromotor for 4-D intracardiac echocardiography.

    PubMed

    Lee, Warren; Griffin, Weston; Wildes, Douglas; Buckley, Donald; Topka, Terry; Chodakauskas, Thaddeus; Langer, Mark; Calisti, Serge; Bergstøl, Svein; Malacrida, Jean-Pierre; Lanteri, Frédéric; Maffre, Jennifer; McDaniel, Ben; Shivkumar, Kalyanam; Cummings, Jennifer; Callans, David; Silvestry, Frank; Packer, Douglas

    2011-07-01

    We developed prototype real-time 3-D intracardiac echocardiography catheters with integrated micromotors, allowing internal oscillation of a low-profile 64-element, 6.2-MHz phased-array transducer in the elevation direction. Components were designed to facilitate rotation of the array, including a low-torque flexible transducer interconnect and miniature fixtures for the transducer and micromotor. The catheter tip prototypes were integrated with two-way deflectable 10-Fr catheters and used in in vivo animal testing at multiple facilities. The 4-D ICE catheters were capable of imaging a 90° azimuth by up to 180° elevation field of view. Volume rates ranged from 1 vol/sec (180° elevation) to approximately 10 vol/sec (60° elevation). We successfully imaged electrophysiology catheters, atrial septal puncture procedures, and detailed cardiac anatomy. The elevation oscillation enabled 3-D visualization of devices and anatomy, providing new clinical information and perspective not possible with current 2-D imaging catheters. PMID:21768032

  14. Prognostic value of real time dobutamine stress myocardial contrast echocardiography in patients with chest pain syndrome

    PubMed Central

    Hong, Geu-Ru; Park, Jong-Seon; Lee, Sang-Hee; Shin, Dong-Gu; Kim, Ung; Choi, Jung Hyun; Abdelmalik, Robin; Vera, Jesús A.; Kim, Jin-Kyung; Narula, Jagat

    2015-01-01

    The aims of this study were (1) to evaluate the prognostic value of negative wall motion (WM) and myocardial perfusion during contrast-dobutamine stress echocardiography (DSE), (2) to determine whether WM-myocardial contrast echocardiography (MCE) had incremental prognostic value over just WM during DSE in patients with chest pain in the emergency room(ER), and (3) to compare the prognostic value of negative DSE-WM, and DSE-WM-MCE to nuclear-myocardial perfusion imaging (N-MPI) in a similar patient population over the same time period. We retrospectively studied 569 patients with real time contrast DSE, and 147 patients underwent N-MPI for evaluation of chest pain. Follow-up for cardiac events was obtained between 12 and 25 months. The cumulative cardiac event-free survival was 94.5% in negative DSE-WM, 97.1% in negative DSE-WM-MCE and 96.7% in negative N-MPI group. Cardiac event-free survival of the negative DSE-WM-MCE group was significantly higher than the DSE-WM group (log rank P < 0.01), and similar in the DSE-WM-MCE group compared to the N-MPI group. Combined WM and perfusion during DSE was the strongest independent predictor for cardiac events. The negative predictive power of DSE-WM-MCE is superior to that of just negative DSE-WM and is comparable to that of N-MPI. Myocardial perfusion and WM analysis during DSE provide independent information for predicting cardiac events in patients with chest pain syndrome in the ER. PMID:22143170

  15. Assessment of aortic and mitral annuli dynamics during the cardiac cycle using speckle tracking echocardiography

    PubMed Central

    Bai, Wenjuan; Li, Hui; Tang, Hong; Zhang, Qing; Zhu, Ye

    2014-01-01

    The aims of this study were i) to evaluate mitral and aortic annuli excursion, and aortomitral angle (AMA) during the cardiac cycle in healthy adults using two-dimensional speckle tracking echocardiography, ii) to assess two annuli dynamics and coupling behaviors as an integral, and iii) to detect the relation between two annuli and left ventricular ejection fraction (LVEF). A total of 74 healthy adults underwent transthoracic echocardiography. In the parasternal long-axis view, a number of points were extracted, including right coronary aortic annular, aortomitral fibrous junction, and posterior mitral annular points. The annuli excursion and AMA were measured using a speckle tracking-derived software during the cardiac cycle. During the isovolumic contraction and the isovolumic relaxation phase, annuli excursion and AMA remain stable for a short time. During the systole, annuli excursion increased sharply to the maximum, while AMA narrowed quickly to the minimum value. During the diastole, there are three patterns of decrease in annuli excursion and AMA expansion in different phases. The annuli excursion of three points correlates well with the LVEF (right coronary aortic annulus excursion, r=0.71, P<0.05; non-coronary aortic annulus excursion, r=0.70, P<0.05; posterior mitral annulus excursion, r=0.82, P<0.05). Moreover, there are positive correlations between annuli excursion and the variation of AMA (r=0.60, P<0.05). The annuli excursion and AMA have various regular patterns in healthy adults. The interactions of mitral and aortic annuli correlate with the left ventricular function. Our findings may have relevance to the evaluation of left ventricular function and presurgical planning of patients with valvular diseases. PMID:26693287

  16. Is There a Role for Limited Echocardiography During the Preparticipation Physical Examination?

    PubMed

    Kerkhof, Deanna L; Gleason, Courtney N; Basilico, Frederick C; Corrado, Gianmichel D

    2016-03-01

    Sudden cardiac death (SCD) is the leading cause of death during exercise for athletes younger than 35 years. Structural cardiac abnormalities are responsible for the majority of SCDs among competitive athletes. The screening protocol that is best for detecting athletes at risk for SCD has been the subject of considerable and long-standing debate. The American Heart Association recommends the use of a 14-element history and physical examination (H&P), whereas European standards call for a focused H&P and 12-lead electrocardiogram (ECG). The use of ECG screening has been repeatedly rejected in the United States because of the high rate of false-positive results and an abundance of evidence suggesting that it is a cost-ineffective tool for screening. Attempts have also been made to prescreen athletes for cardiac disease with echocardiography (ECHO) performed by a cardiologist; however, this technique also proved to be cost-ineffective. The use of ECHO performed by a frontline physician reflects recent advancements in ultrasound technology utilization, including the advent of portable ultrasound, and introduces a new, promising screening method to the debate. Portable ECHO by a frontline physician (PEFP) has the ability to directly visualize structural components of the heart that are part of the gold standard ECHO evaluation performed by a cardiologist. The Early Screening for Cardiac Abnormalities with Preparticipation Echocardiography (ESCAPE) protocol developed at Northeastern University is the first attempt to implement the PEFP. Initial inquiries into the reliability and feasibility of the PEFP are promising. Measurements obtained by frontline physicians were not statistically different from those obtained by a cardiologist, focused ECHO was found to reduce the referral rate to cardiology by 33%, and PEFP was completed significantly faster than H&P and an ECG. Early results are encouraging, but continued research to support the widespread use of PEFP for preparticipation examination in all competitive athletes is needed prior to recommending implementation. PMID:26972266

  17. Ejection fraction determination without planimetry by two-dimensional echocardiography: a new method

    SciTech Connect

    Baran, A.O.; Rogal, G.J.; Nanda, N.C.

    1983-06-01

    A new method for determining ejection fraction by two-dimensional echocardiography was assessed in 60 patients undergoing angiography. In method A, the left ventricular minor axis was measured at the midventricular cavity level in end-systole and end-diastole using the apical four chamber view in the 60 patients. The left ventricular major axis was also measured from the left ventricular apex to the base of the mitral valve at end-systole and end-diastole. The ejection fraction was determined using a modified cylinder-ellipse algorithm. In method B, measurements of the left ventricular minor axis were made in 40 consecutive patients, at the upper, middle and lower thirds of the left ventricular cavity at end-systole and end-diastole of the same cardiac cycle and left ventricular major axis was measured as in method A. With use of the same algorithm, three regional ejection fractions were determined and averaged to yield the total ejection fraction. The two echocardiographic methods were compared with single plane cineangiography in all patients and with gated nuclear scanning in 14 patients. Reproducibility was assessed by interobserver comparison. Correlation was determined in all patients and then separately for those with echocardiographic wall motion abnormalities. This method directly measures fractional shortening of left ventricular major axis and ejection fraction values are not arbitrarily modified by type of wall motion abnormality. With this method, accurate measurement of ejection fraction can be made by two-dimensional echocardiography without planimetry. In the absence of echocardiographic wall motion abnormalities, a very simple method A suffices. If wall motion abnormalities are present, the regional ejection fraction method B provides excellent results.

  18. Evaluation of right ventricular function performed by 3D-echocardiography in scleroderma patients.

    PubMed

    Pigatto, E; Peluso, D; Zanatta, E; Polito, P; Miatton, P; Bourji, K; Badano, L P; Punzi, L; Cozzi, F

    2015-01-01

    The impairment of the right ventricle (RV) in systemic sclerosis (SSc) is usually related to pulmonary arterial hypertension (PAH). New echocardiographic techniques, such as 3-dimensional echocardiography (3DE) and 2-dimensional speckle tracking (2DSTE), allow an accurate evaluation of the RV function. The aim of this study was to evaluate the RV function using 3DE and 2DSTE in SSc patients with no history of heart disease and no PAH. Forty-five SSc patients, 42 females and 3 males, 28 with limited cutaneous SSc (lcSSc) and 17 with diffuse cutaneous SSc (dcSSc), were studied. Forty-three age- and gender-matched healthy subjects were enrolled as controls. All of them underwent a 3DE and 2DSTE ecocardiographic evaluation of the RV function. Systolic pulmonary arterial pressure (sPAP) and total pulmonary vascular resistance (tPVR) were also estimated by power doppler. RV echocardiographic parameters were compared in the different subsets of SSc patients. A statistical analysis was performed by t-test, ANOVA and multiple logistic regression. RV areas in 2DSTE and volumes in 3DE were higher and RV function parameters were reduced in SSc patients compared with controls. Also sPAP and tVPR were higher, but they did not reach pathological values. Echocardiographic alterations were more pronounced in patients with lcSSc. 3DE and 2DSTE echocardiography allowed us to detect morphological and functional alterations of the RV in a group of SSc patients with no clinical signs of heart disease and no PAH. These patients had significantly higher sPAP and tPVR than healthy controls without reporting values compatible with PAH. These data suggest that RV alterations are related to a pressure overload rather than to an intrinsic myocardial involvement in SSc. PMID:25829185

  19. Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction

    PubMed Central

    Schnell, Gregory B; Kryski, Albert J; Mann, Luana; Anderson, Todd J; Belenkie, Israel

    2007-01-01

    OBJECTIVES: To determine whether myocardial contrast echocardiography (MCE) can quickly and accurately assess myocardial perfusion and infarct-related artery (IRA) patency before emergency angiography during acute myocardial infarction (AMI). BACKGROUND: Despite encouraging experimental and clinical studies, the reliability and practicality of MCE in predicting IRA patency during AMI before angiography has not been proven. METHODS: Two-dimensional echocardiography and MCE were performed in 51 patients with AMI just before emergency angiography. With knowledge of the electrocardiogram findings and regional wall motion, myocardial perfusion was assessed to predict IRA patency. RESULTS: Myocardial perfusion studies were adequate for interpretation in 40 patients. An occluded IRA was predicted in 28 patients; the artery was occluded in 22 patients, and six patients had Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow or less. A patent IRA was predicted in 12 patients; eight patients had TIMI grade 3 flow, one patient had TIMI grade 2 flow and the IRA was occluded in three patients. In one of the three patients, the appropriate view was not obtained. In another patient, collateral flow was adequate for near-normal regional wall motion, and in the last, the findings suggested reperfusion of the proximal artery with distal embolic occlusion. Taken together, MCE accurately predicted either TIMI grade 2 flow or less, or TIMI grade 3 flow in 36 of 40 patients. Sensitivity was 87.5%, specificity and positive predictive value were 100% and negative predictive power was 66.7% (P<0.001). CONCLUSIONS: MCE, together with the electrocardiogram and regional wall motion, can be used to quickly and reliably predict IRA patency early during AMI and may be useful to facilitate a management strategy. PMID:17985005

  20. Casimir experiments showing saturation effects

    SciTech Connect

    Sernelius, Bo E.

    2009-10-15

    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.

  1. Comparison of echocardiography and device based algorithm for atrio-ventricular delay optimization in heart block patients

    PubMed Central

    Vijayvergiya, Rajesh; Gupta, Ankur

    2015-01-01

    AIM: To compare the atrio-ventricular (AV/PV) delay optimization by echocardiography and intra-cardiac electrocardiogram (IEGM) based QuickOpt algorithm in complete heart block (CHB) patients, implanted with a dual chamber pacemaker. METHODS: We prospectively enrolled 20 patients (age 59.45 ± 18.1 years; male: 65%) with CHB, who were implanted with a dual chamber pacemaker. The left ventricular outflow tract velocity time-integral was measured after AV/PV delay optimization by both echocardiography and QuickOpt algorithm method. Bland-Altman analysis was used for agreement between the two techniques. RESULTS: The optimal AV and PV delay determined by echocardiography was 155.5 ± 14.68 ms and 122.5 ± 17.73 ms (P < 0.0001), respectively and by QuickOpt method was 167.5 ± 16.73 and 117.5 ms ± 9.10 ms (P < 0.0001), respectively. A good agreement was observed between optimal AV and PV delay as measured by two methods. However, the correlation of the optimal AV (r = 0.0689, P = 0.77) and PV (r = 0.2689, P = 0.25) intervals measured by the two techniques was poor. The time required for AV/PV optimization was 45.26 ± 1.73 min by echocardiography and 0.44 ± 0.08 min by QuickOpt method (P < 0.0001). CONCLUSION: The programmer based IEGM method is an automated, quick, easier and reliable alternative to echocardiography for the optimization of AV/PV delay in CHB patients, implanted with a dual chamber pacemaker. PMID:26635928

  2. Registration of 3D trans-esophageal echocardiography to X-ray fluoroscopy using image-based probe tracking.

    PubMed

    Gao, Gang; Penney, Graeme; Ma, Yingliang; Gogin, Nicolas; Cathier, Pascal; Arujuna, Aruna; Morton, Geraint; Caulfield, Dennis; Gill, Jaswinder; Aldo Rinaldi, C; Hancock, Jane; Redwood, Simon; Thomas, Martyn; Razavi, Reza; Gijsbers, Geert; Rhode, Kawal

    2012-01-01

    Two-dimensional (2D) X-ray imaging is the dominant imaging modality for cardiac interventions. However, the use of X-ray fluoroscopy alone is inadequate for the guidance of procedures that require soft-tissue information, for example, the treatment of structural heart disease. The recent availability of three-dimensional (3D) trans-esophageal echocardiography (TEE) provides cardiologists with real-time 3D imaging of cardiac anatomy. Increasingly X-ray imaging is now supported by using intra-procedure 3D TEE imaging. We hypothesize that the real-time co-registration and visualization of 3D TEE and X-ray fluoroscopy data will provide a powerful guidance tool for cardiologists. In this paper, we propose a novel, robust and efficient method for performing this registration. The major advantage of our method is that it does not rely on any additional tracking hardware and therefore can be deployed straightforwardly into any interventional laboratory. Our method consists of an image-based TEE probe localization algorithm and a calibration procedure. While the calibration needs to be done only once, the GPU-accelerated registration takes approximately from 2 to 15s to complete depending on the number of X-ray images used in the registration and the image resolution. The accuracy of our method was assessed using a realistic heart phantom. The target registration error (TRE) for the heart phantom was less than 2mm. In addition, we assess the accuracy and the clinical feasibility of our method using five patient datasets, two of which were acquired from cardiac electrophysiology procedures and three from trans-catheter aortic valve implantation procedures. The registration results showed our technique had mean registration errors of 1.5-4.2mm and 95% capture range of 8.7-11.4mm in terms of TRE. PMID:21624845

  3. Regional left atrial function differentiation in patients with constrictive pericarditis and restrictive cardiomyopathy: a study using speckle tracking echocardiography.

    PubMed

    Liu, Shuang; Ma, Chunyan; Ren, Weidong; Zhang, Jing; Li, Nan; Yang, Jun; Zhang, Yan; Qiao, Wei

    2015-12-01

    Left atrial (LA) function plays an important role in the maintenance of cardiac output. However, whether assessment of regional LA myocardial dysfunction is useful for differentiating between CP and restrictive cardiomyopathy (RCM) remains unclear. Thirty-five patients with CP, 30 patients with RCM, and 30 healthy volunteers (controls) were enrolled in this study. The LA maximum volume (Vmax), LA minimal volume (Vmin), and LA volume before atrial contraction (Vpre-a) were measured using the biplane modified Simpson's rule. All patients underwent two-dimensional speckle tracking echocardiography (STE). The peak systolic strain rate (SrS), early diastolic strain rate (SrE), and late diastolic strain rate (SrA) of the LA septum, LA lateral wall and superior walls were measured. The LA diastolic and systolic function was found to be reduced in patients with CP and RCM. The SrE in the LA superior wall and lateral wall were significantly decreased in patients with CP and RCM compared with controls (P < 0.001). The SrE of the LA septum in patients with CP was preserved compared to normal controls. Althouth the LA septal SrE in patients with CP was significantly reduced (P < 0.001). For the diagnosis of RCM, a cutoff value 1.40 for SrE of the LA septum showed a sensitivity of 94.7 % and a specificity of 89.7 %. The SrE in the LA superior wall and lateral wall were decreased while the LA septal SrE was preserved in patients with CP, indicating that the rigid pericardium might restrict myocardial motion and deformation in the lateral wall. The measurement of STE to determine the LA septal SrE can be helpful for differentiating between CP and RCM. PMID:26245471

  4. Increasing Pyruvate Dehydrogenase Flux as a Treatment for Diabetic Cardiomyopathy: A Combined 13C Hyperpolarized Magnetic Resonance and Echocardiography Study

    PubMed Central

    Le Page, Lydia M.; Rider, Oliver J.; Lewis, Andrew J.; Ball, Vicky; Clarke, Kieran; Johansson, Edvin; Carr, Carolyn A.; Heather, Lisa C.; Tyler, Damian J.

    2015-01-01

    Although diabetic cardiomyopathy is widely recognised, there are no specific treatments available. Altered myocardial substrate selection has emerged as a candidate mechanism behind the development of cardiac dysfunction in diabetes. As pyruvate dehydrogenase (PDH) activity appears central to the balance of substrate utilisation, we aimed to investigate the relationship between PDH flux and myocardial function in a rodent model of type-II diabetes and to explore whether or not increasing PDH flux, with dichloroacetate, would restore the balance of substrate utilisation and improve cardiac function. All animals underwent in vivo hyperpolarized [1-13C]pyruvate magnetic resonance spectroscopy and echocardiography to assess cardiac PDH flux and function respectively. Diabetic animals showed significantly higher blood glucose (10.8±0.7mM vs 8.4±0.5mM), lower PDH flux (0.005±0.001s?1 vs 0.017±0.002s?1) and significantly impaired diastolic function (E/E’ 12.2±0.8 vs 20±2) in keeping with early diabetic cardiomyopathy. Twenty-eight days treatment with dichloroacetate restored PDH flux to normal levels (0.018±0.002s?1), reversed diastolic dysfunction (E/E’ 14±1) and normalized blood glucose (7.5±0.7mM). Treatment of diabetes with dichloroacetate therefore restored the balance of myocardial substrate selection, reversed diastolic dysfunction and normalised blood glucose levels. This suggests that PDH modulation could be a novel therapy for the treatment and/or prevention of diabetic cardiomyopathy. PMID:25795215

  5. Left ventricular ejection fraction: Single-plane and multiplanar transesophageal echocardiography versus equilibrium gated-pool scintigraphy

    SciTech Connect

    Nessly, M.L.; Bashein, G.; Detmer, P.R.; Graham, M.M.; Kao, R.; Martin, R.W. )

    1991-02-01

    The relative accuracy and precision of estimating left ventricular ejection fraction (EF) in dogs were assessed by two-dimensional transesophageal echocardiography (2D-TEE) and by three-dimensional transesophageal echocardiographic (3D-TEE) imaging and reconstruction. This assessment was accomplished by comparing each echocardiographic method to a gated equilibrium blood pool radionuclide (RN) standard. By using both correlation and regression analysis, 2D-TEE performed reasonably well in estimating RNEF (correlation coefficient (r) = 0.80, slope = 1.01, intercept = 6.37, standard error of the estimate (SEE), 8.98), but not as well as 3D-TEE (r = 0.86, slope = 0.83, intercept = 3.38, SEE, 5.74). Using Altman and Bland's methods of comparison analysis, it was found that 2D-TEE overestimated RNEF by 7% (standard deviation (SD), 8.8). This degree of overestimation was not consistent across the range of measurement. In contrast, 3D-TEE slightly underestimated RNEF by less than 3% and showed less variability (SD, 6.0). The accuracy of the 3D-TEE determinations was not dependent on the magnitude of EF. Additionally, a significantly higher proportion of the 2D-TEE measurements (0.30) compared with the 3D-TEE measurements (0.10) differed from RN values by more than 10% (P = 0.009, McNemar's test). At the clinically important low end of the EF range (RNEF less than or equal to 35%), 2D-TEE may be expected (with 95% confidence) to be within -15% to +28% EF of reference values, whereas 3D-TEE can be expected to be within -8% to +5% EF relative to RN.

  6. Effect of scanline orientation on ventricular flow propagation: assessment using high frame-rate color Doppler echocardiography

    NASA Technical Reports Server (NTRS)

    Greenberg, N. L.; Castro, P. L.; Drinko, J.; Garcia, M. J.; Thomas, J. D.

    2000-01-01

    Color M-mode echocardiography has recently been utilized to describe diastolic flow propagation velocity (Vp) in the left ventricle. While increasing temporal resolution from 15 to 200 Hz, this M-mode technique requires the user to select a single scanline, potentially limiting quantification of Vp due to the complex three-dimensional inflow pattern. We previously performed computational fluid dynamics simulations to demonstrate the insignificance of the scanline orientation, however geometric complexity was limited. The purpose of this study was to utilize high frame-rate 2D color Doppler images to investigate the importance of scanline selection in patients for the quantification of Vp. 2D color Doppler images were digitally acquired at 50 frames/s in 6 subjects from the apical 4-chamber window (System 5, GE/Vingmed, Milwaukee, WI). Vp was determined for a set of scanlines positioned through 5 locations across the mitral annulus (from the anterior to posterior mitral annulus). An analysis of variance was performed to examine the differences in Vp as a function of scanline position. Vp was not effected by scanline position in sampled locations from the center of the mitral valve towards the posterior annulus. Although not statistically significant, there was a trend to slower propagation velocities on the anterior side of the valve (60.8 +/- 16.7 vs. 54.4 +/- 13.6 cm/s). This study clinically validates our previous numerical experiment showing that Vp is insensitive to small perturbations of the scanline through the mitral valve. However, further investigation is necessary to examine the impact of ventricular geometry in pathologies including dilated cardiomyopathy.

  7. Cardiovascular effects of 3 months of football training in overweight children examined by comprehensive echocardiography: a pilot study.

    PubMed

    Hansen, Peter Riis; Andersen, Lars Juel; Rebelo, António Natal; Brito, Joao; Hornstrup, Therese; Schmidt, Jakob Friis; Jackman, Sarah R; Mota, Jorge; Rêgo, Carla; Oliveira, Jose; Seabra, André; Krustrup, Peter

    2013-01-01

    We examined effects of a 3-month football training programme in overweight children using comprehensive echocardiography and peripheral arterial tonometry. Twenty preadolescent overweight children (17 boys, 3 girls aged 8-12 yrs; body mass index [BMI] ? 85(th) percentile) participated in a structured 3-month football training programme, consisting of 4 weekly 60-90 min sessions with mean heart rate (HR) > 80% of HRmax (football group, FG). A parallel control group (CG) included 11 children (7 boys, 4 girls) of equivalent age from an obesity clinic. After 3 months, systolic blood pressure was unchanged in FG, but had increased in CG (112 [s 6] vs. 122 [10] mmHg, P = 0.02). FG demonstrated increased left ventricular (LV) posterior wall diameter (0.60 [0.07] vs. 0.68 [0.10] cm, P < 0.001) and an improved right ventricular systolic function determined by tricuspid annular plane systolic excursion (TAPSE, 2.01 [0.29] vs. 2.27 [0.28] cm, P = 0.003). Measures of LV systolic function showed only discrete alterations and two-dimensional (2D) global strain was not changed. After 3 months, global isovolumetric relaxation time (IVRTglobal) had increased in FG (64.0 [7.5] vs. 73.9 [9.4] ms, P < 0.001) while other examined LV diastolic function variables were not altered. No echocardiographic changes were observed in CG. Between-group differences in pre-post delta values were observed for systolic blood pressure, TAPSE, and IVRTglobal (P = 0.02-0.03). We conclude that short-term football training may have positive structural and functional effects on the cardiovascular system in overweight preadolescent children. PMID:23829576

  8. Effect of scanline orientation on ventricular flow propagation: assessment using high frame-rate color Doppler echocardiography.

    PubMed

    Greenberg, N L; Castro, P L; Drinko, J; Garcia, M J; Thomas, J D

    2000-01-01

    Color M-mode echocardiography has recently been utilized to describe diastolic flow propagation velocity (Vp) in the left ventricle. While increasing temporal resolution from 15 to 200 Hz, this M-mode technique requires the user to select a single scanline, potentially limiting quantification of Vp due to the complex three-dimensional inflow pattern. We previously performed computational fluid dynamics simulations to demonstrate the insignificance of the scanline orientation, however geometric complexity was limited. The purpose of this study was to utilize high frame-rate 2D color Doppler images to investigate the importance of scanline selection in patients for the quantification of Vp. 2D color Doppler images were digitally acquired at 50 frames/s in 6 subjects from the apical 4-chamber window (System 5, GE/Vingmed, Milwaukee, WI). Vp was determined for a set of scanlines positioned through 5 locations across the mitral annulus (from the anterior to posterior mitral annulus). An analysis of variance was performed to examine the differences in Vp as a function of scanline position. Vp was not effected by scanline position in sampled locations from the center of the mitral valve towards the posterior annulus. Although not statistically significant, there was a trend to slower propagation velocities on the anterior side of the valve (60.8 +/- 16.7 vs. 54.4 +/- 13.6 cm/s). This study clinically validates our previous numerical experiment showing that Vp is insensitive to small perturbations of the scanline through the mitral valve. However, further investigation is necessary to examine the impact of ventricular geometry in pathologies including dilated cardiomyopathy. PMID:10834233

  9. Validation of real-time three-dimensional echocardiography for quantifying left ventricular volumes in the presence of a left ventricular aneurysm: in vitro and in vivo studies

    NASA Technical Reports Server (NTRS)

    Qin, J. X.; Jones, M.; Shiota, T.; Greenberg, N. L.; Tsujino, H.; Firstenberg, M. S.; Gupta, P. C.; Zetts, A. D.; Xu, Y.; Ping Sun, J.; Cardon, L. A.; Odabashian, J. A.; Flamm, S. D.; White, R. D.; Panza, J. A.; Thomas, J. D.

    2000-01-01

    OBJECTIVES: To validate the accuracy of real-time three-dimensional echocardiography (RT3DE) for quantifying aneurysmal left ventricular (LV) volumes. BACKGROUND: Conventional two-dimensional echocardiography (2DE) has limitations when applied for quantification of LV volumes in patients with LV aneurysms. METHODS: Seven aneurysmal balloons, 15 sheep (5 with chronic LV aneurysms and 10 without LV aneurysms) during 60 different hemodynamic conditions and 29 patients (13 with chronic LV aneurysms and 16 with normal LV) underwent RT3DE and 2DE. Electromagnetic flow meters and magnetic resonance imaging (MRI) served as reference standards in the animals and in the patients, respectively. Rotated apical six-plane method with multiplanar Simpson's rule and apical biplane Simpson's rule were used to determine LV volumes by RT3DE and 2DE, respectively. RESULTS: Both RT3DE and 2DE correlated well with actual volumes for aneurysmal balloons. However, a significantly smaller mean difference (MD) was found between RT3DE and actual volumes (-7 ml for RT3DE vs. 22 ml for 2DE, p = 0.0002). Excellent correlation and agreement between RT3DE and electromagnetic flow meters for LV stroke volumes for animals with aneurysms were observed, while 2DE showed lesser correlation and agreement (r = 0.97, MD = -1.0 ml vs. r = 0.76, MD = 4.4 ml). In patients with LV aneurysms, better correlation and agreement between RT3DE and MRI for LV volumes were obtained (r = 0.99, MD = -28 ml) than between 2DE and MRI (r = 0.91, MD = -49 ml). CONCLUSIONS: For geometrically asymmetric LVs associated with ventricular aneurysms, RT3DE can accurately quantify LV volumes.

  10. Feasibility of 3D4D echocardiography for the detection of colour-coded flow in the left anterior descending artery

    PubMed Central

    Pfeiffer, Dietrich; Hagendorff, Andreas

    2014-01-01

    The aim of this study was to test the feasibility of the visualisation of 3D4D coronary flow in detectable segments of coronary arteries. Regarding the feasibility of this new approach, the hypothesis was proposed that the flow signals of the course of detectable coronary arteries can be better visualised by 3D4D echocardiography than by the conventional 2D approach. A total of 30 consecutive patients with sinus rhythm, in whom the distal left anterior descending artery (LAD) was visualised by 2D colour-coded Doppler echocardiography, were selected for 3D4D scanning procedures. All measurements were performed using a Vivid 7 or E9. All segments visualised by 2D colour-coded Doppler echocardiography were also examined by 3D4D echocardiography. Using defined settings, the width of the colour-coded flow signal differs significantly between 2D- and 3D4D echocardiography. The length of larger segments of the visualised colour-coded flow signal of the coronary flow could be better detected with 2D imaging. Small segments of coronary artery flow (<11?mm), however, could be significantly better visualised by 3D4D echocardiography. The main advantage of 3D4D echocardiography of the coronary artery flow is the visualisation of the proportions of vessels with complex morphology. 3D4D echocardiography of LAD flow by colour-coded Doppler echocardiography raises new possibilities for the direct flow visualisation of the detectable segments of coronaries. With its sufficiently high spatial and temporal resolution, this new method has the potential to be implemented in clinical scenarios. The possible application to the quantification of stenoses by the flow visualisation has to be evaluated in further studies.

  11. Pulmonary Haemodynamics in Sickle Cell Disease Are Driven Predominantly by a High-Output State Rather Than Elevated Pulmonary Vascular Resistance: A Prospective 3-Dimensional Echocardiography/Doppler Study

    PubMed Central

    Mushemi-Blake, Sitali; Melikian, Narbeh; Drasar, Emma; Bhan, Amit; Lunt, Alan; Desai, Sujal R.; Greenough, Anne; Monaghan, Mark J.; Thein, Swee Lay; Shah, Ajay M.

    2015-01-01

    Aims Patients with sickle cell disease have significant morbidity and mortality. Pulmonary hypertension is suggested to be an important contributor but its nature and severity in these patients and how best to non-invasively assess it are controversial. We hypothesised that a high-output state rather than primary pulmonary vascular pathology may be the major abnormality in sickle cell disease. This study aimed to evaluate the characteristics and severity of pulmonary hypertension in patients with sickle cell disease using detailed echocardiography. Methods and Results We undertook a prospective study in 122 consecutive stable outpatients with sickle cell disease and 30 age, gender and ethnicity-matched healthy controls. Echocardiographic evaluation included 3D ventricular volumes, sphericity, tissue Doppler, and non-invasive estimation of pulmonary vascular resistance. 36% of patients had a tricuspid regurgitant velocity ≥2.5 m.s-1 but only 2% had elevated pulmonary vascular resistance and the prevalence of right ventricular dysfunction was very low. Patients with raised tricuspid regurgitant velocity had significantly elevated biventricular volumes and globular left ventricular remodelling, related primarily to anaemia. In a subgroup of patients who underwent cardiac catheterization, invasive pulmonary haemodynamics confirmed the echocardiographic findings. Conclusions Elevated cardiac output and left ventricular volume overload secondary to chronic anaemia may be the dominant factor responsible for abnormal cardiopulmonary haemodynamics in patients with sickle cell disease. 3D echocardiography with non-invasive estimation of pulmonary vascular resistance represents a valuable approach for initial evaluation of cardiopulmonary haemodynamics in sickle cell disease. PMID:26270484

  12. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging.

    PubMed

    Voigt, Jens-Uwe; Pedrizzetti, Gianni; Lysyansky, Peter; Marwick, Tom H; Houle, Hélène; Baumann, Rolf; Pedri, Stefano; Ito, Yasuhiro; Abe, Yasuhiko; Metz, Stephen; Song, Joo Hyun; Hamilton, Jamie; Sengupta, Partho P; Kolias, Theodore J; d'Hooge, Jan; Aurigemma, Gerard P; Thomas, James D; Badano, Luigi Paolo

    2015-02-01

    Recognizing the critical need for standardization in strain imaging, in 2010, the European Association of Echocardiography (now the European Association of Cardiovascular Imaging, EACVI) and the American Society of Echocardiography (ASE) invited technical representatives from all interested vendors to participate in a concerted effort to reduce intervendor variability of strain measurement. As an initial product of the work of the EACVI/ASE/Industry initiative to standardize deformation imaging, we prepared this technical document which is intended to provide definitions, names, abbreviations, formulas, and procedures for calculation of physical quantities derived from speckle tracking echocardiography and thus create a common standard. PMID:25623220

  13. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging.

    PubMed

    Voigt, Jens-Uwe; Pedrizzetti, Gianni; Lysyansky, Peter; Marwick, Tom H; Houle, Helen; Baumann, Rolf; Pedri, Stefano; Ito, Yasuhiro; Abe, Yasuhiko; Metz, Stephen; Song, Joo Hyun; Hamilton, Jamie; Sengupta, Partho P; Kolias, Theodore J; d'Hooge, Jan; Aurigemma, Gerard P; Thomas, James D; Badano, Luigi Paolo

    2015-01-01

    Recognizing the critical need for standardization in strain imaging, in 2010, the European Association of Echocardiography (now the European Association of Cardiovascular Imaging, EACVI) and the American Society of Echocardiography (ASE) invited technical representatives from all interested vendors to participate in a concerted effort to reduce intervendor variability of strain measurement. As an initial product of the work of the EACVI/ASE/Industry initiative to standardize deformation imaging, we prepared this technical document which is intended to provide definitions, names, abbreviations, formulas, and procedures for calculation of physical quantities derived from speckle tracking echocardiography and thus create a common standard. PMID:25525063

  14. 10. INTERIOR VIEW SHOWING MOUNTINGS FROM TUNING DEVICE. VIEW SHOWS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. INTERIOR VIEW SHOWING MOUNTINGS FROM TUNING DEVICE. VIEW SHOWS COPPER SHEETING ON WALLS. - Chollas Heights Naval Radio Transmitting Facility, Helix House, 6410 Zero Road, San Diego, San Diego County, CA

  15. 15. Detail showing lower chord pinconnected to vertical member, showing ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. Detail showing lower chord pin-connected to vertical member, showing floor beam riveted to extension of vertical member below pin-connection, and showing brackets supporting cantilevered sidewalk. View to southwest. - Selby Avenue Bridge, Spanning Short Line Railways track at Selby Avenue between Hamline & Snelling Avenues, Saint Paul, Ramsey County, MN

  16. Diagnostic Value of Fetal Echocardiography for Congenital Heart Disease: A Systematic Review and Meta-Analysis.

    PubMed

    Zhang, Ya-Fei; Zeng, Xian-Ling; Zhao, En-Fa; Lu, Hong-Wei

    2015-10-01

    Prenatal diagnosis of fetal congenital heart disease (CHD) has been shown to have a significant effect on prenatal and postnatal management and outcomes. However, the factors influencing the diagnostic accuracy and which pregnant trimester is the most adaptive for fetal heart disease remain uncertain despite of extensive researches. The aim of the present study was to evaluate the accuracy of echocardiography for detecting CHD and potential influence factors.We searched Chinese Biomedical Database (CBM), Medline, ISI Web of Knowledge, the Cochrane Library, and China National Knowledge Infrastructure (CNKI) to identify relevant studies from January 1, 1990 to August 13, 2015.Overall, the pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were 68.5% (95% confidence interval [CI], 66.8%-70.2%), 99.8% (95% CI, 99.7%-99.8%), 3026.9 (95% CI, 1417.9-6461.8), 659.41 (95% CI, 346.38-1255.3), and 0.246 (95% CI, 0.187-0.324) respectively (AUC = 0.9924). The pooled sensitivity of basic cardiac echocardiographic examination (BCEE), extended cardiac echocardiographic examination (ECEE), BCEE plus outflow tract view (BCEE + OTV), BCEE + OTV + 3VTV (BCEE plus outflow tract view plus three vessel and trachea view) for the prenatal diagnosis of CHD were 49.0%, 75.5%, 66.1%, and 83.7% respectively. The pooled sensitivity of the prenatal echocardiographic diagnosis of CHD during the first trimester, second trimester, the second to third trimester were 60.3%, 60.9%, and 77.4%, respectively. The pooled sensitivity of BCEE and ECEE for the prenatal diagnosis of CHD during the second to third trimester was significantly higher than that during the second trimester. The pooled sensitivity of the prenatal echocardiographic diagnosis of CHD for pregnancies with low risk, high risk, low and high risk, and unselected risk were 45.4%, 85.1%, 89.1%, and 66.2%, respectively. The sensitivity analysis was robust and risk level was significant source of heterogeneity. Deek test indicated no potential significant publication bias.Prenatal ultrasound is a powerful tool for the diagnosis of CHD; however, echocardiography has individual sensitivity for different gestation period, different levels of risk, and different echo-views. PMID:26496297

  17. Determination of left ventricular volume, ejection fraction, and myocardial mass by real-time three-dimensional echocardiography

    NASA Technical Reports Server (NTRS)

    Qin, J. X.; Shiota, T.; Thomas, J. D.

    2000-01-01

    Reconstructed three-dimensional (3-D) echocardiography is an accurate and reproducible method of assessing left ventricular (LV) functions. However, it has limitations for clinical study due to the requirement of complex computer and echocardiographic analysis systems, electrocardiographic/respiratory gating, and prolonged imaging times. Real-time 3-D echocardiography has a major advantage of conveniently visualizing the entire cardiac anatomy in three dimensions and of potentially accurately quantifying LV volumes, ejection fractions, and myocardial mass in patients even in the presence of an LV aneurysm. Although the image quality of the current real-time 3-D echocardiographic methods is not optimal, its widespread clinical application is possible because of the convenient and fast image acquisition. We review real-time 3-D echocardiographic image acquisition and quantitative analysis for the evaluation of LV function and LV mass.

  18. A minimum dataset for a standard transoesphageal echocardiogram: a guideline protocol from the British Society of Echocardiography.

    PubMed

    Wheeler, Richard; Steeds, Richard; Rana, Bushra; Wharton, Gill; Smith, Nicola; Allen, Jane; Chambers, John; Jones, Richard; Lloyd, Guy; O'Gallagher, Kevin; Sharma, Vishal

    2015-12-01

    A systematic approach to transoesophageal echocardiography (TOE) is essential to ensure that no pathology is missed during a study. In addition, a standardised approach facilitates the education and training of operators and is helpful when reviewing studies performed in other departments or by different operators. This document produced by the British Society of Echocardiography aims to provide a framework for a standard TOE study. In addition to a minimum dataset, the layout proposes a recommended sequence in which to perform a comprehensive study. It is recommended that this standardised approach is followed when performing TOE in all clinical settings, including intraoperative TOE to ensure important pathology is not missed. Consequently, this document has been prepared with the direct involvement of the Association of Cardiothoracic Anaesthetists (ACTA). PMID:26798487

  19. A minimum dataset for a standard transoesphageal echocardiogram: a guideline protocol from the British Society of Echocardiography

    PubMed Central

    Wheeler, Richard; Steeds, Richard; Rana, Bushra; Wharton, Gill; Smith, Nicola; Allen, Jane; Chambers, John; Jones, Richard; Lloyd, Guy; O'Gallagher, Kevin

    2015-01-01

    A systematic approach to transoesophageal echocardiography (TOE) is essential to ensure that no pathology is missed during a study. In addition, a standardised approach facilitates the education and training of operators and is helpful when reviewing studies performed in other departments or by different operators. This document produced by the British Society of Echocardiography aims to provide a framework for a standard TOE study. In addition to a minimum dataset, the layout proposes a recommended sequence in which to perform a comprehensive study. It is recommended that this standardised approach is followed when performing TOE in all clinical settings, including intraoperative TOE to ensure important pathology is not missed. Consequently, this document has been prepared with the direct involvement of the Association of Cardiothoracic Anaesthetists (ACTA). PMID:26798487

  20. 28. MAP SHOWING LOCATION OF ARVFS FACILITY AS BUILT. SHOWS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    28. MAP SHOWING LOCATION OF ARVFS FACILITY AS BUILT. SHOWS LINCOLN BOULEVARD, BIG LOST RIVER, AND NAVAL REACTORS FACILITY. F.C. TORKELSON DRAWING NUMBER 842-ARVFS-101-2. DATED OCTOBER 12, 1965. INEL INDEX CODE NUMBER: 075 0101 851 151969. - Idaho National Engineering Laboratory, Advanced Reentry Vehicle Fusing System, Scoville, Butte County, ID

  1. [The use of transesophageal echocardiography to guide the trans-septal puncture. Practical guide, tips and tricks].

    PubMed

    Latcu, D G; Rinaldi, J-P; Yaici, K; Saoudi, N

    2015-02-01

    Transesophageal echocardiography is very useful to guide transseptal puncture for left atrial ablation procedures. This paper is a practical guide for the ultrasonographer who seeks to meet the expectations of the electrophysiologist, but also for young EP's in order to improve their understanding of the echocardiographical views and to ameliorate the communication between the two specialists. The tips and tricks of all the steps of the exam are presented. PMID:24934858

  2. Usefulness of exercise-stress echocardiography for risk stratification of true asymptomatic patients with aortic valve stenosis.

    PubMed

    Maréchaux, Sylvestre; Hachicha, Zeineb; Bellouin, Annaïk; Dumesnil, Jean G; Meimoun, Patrick; Pasquet, Agnès; Bergeron, Sébastien; Arsenault, Marie; Le Tourneau, Thierry; Ennezat, Pierre Vladimir; Pibarot, Philippe

    2010-06-01

    Aims Abnormal exercise test defined as the occurrence of exercise limiting symptoms, fall in blood pressure below baseline, or complex ventricular arrhythmias is useful to predict clinical events in asymptomatic patients with aortic stenosis (AS). The purpose of this study was to determine whether exercise-stress echocardiography (ESE) adds any incremental prognostic value to resting echocardiography in patients with AS having a normal exercise response. Methods and results One hundred and eighty-six asymptomatic patients with at least moderate AS and preserved LV ejection fraction (>/=50%) were assessed by Doppler-echocardiography at rest and during a maximum ramp semi-supine bicycle exercise test. Fifty-one (27%) patients had an abnormal exercise test and were excluded from the present analysis. Among the 135 patients with normal exercise test, 67 had an event (aortic valve replacement motivated by symptoms or cardiovascular death) at a mean follow-up of 20 +/- 14 months. The variables independently associated with events were: age >/=65 years [hazard ratio (HR) = 1.96; 95% confidence interval (CI): 1.15-3.47; P = 0.01], diabetes, (HR = 3.20; 95% CI: 1.33-6.87; P = 0.01), LV hypertrophy (HR = 1.96; 95% CI: 1.17-3.27; P = 0.01), resting mean gradient >35 mmHg (HR = 3.60; 95% CI: 2.11-6.37; P < 0.0001), and exercise-induced increase in mean gradient >20 mmHg (HR = 3.83; 95% CI: 2.16-6.67; P < 0.0001). Conclusion The exercise-induced increase in transvalvular gradient may be helpful to improve risk stratification in asymptomatic AS patients with normal exercise response. These results thus suggest that ESE may provide additional prognostic information over that obtained from standard exercise testing and resting echocardiography. PMID:20308041

  3. Assessment of left atrial ejection force in hypertrophic cardiomyopathy using real-time three-dimensional echocardiography.

    PubMed

    Anwar, Ashraf M; Soliman, Osama I I; Geleijnse, Marcel L; Michels, Michelle; Vletter, Wim B; Nemes, Attila; ten Cate, Folkert J

    2007-06-01

    The study included 30 patients with hypertrophic cardiomyopathy (HCM) (obstructive and nonobstructive) and 15 control subjects. End-diastolic mitral annulus area (MAA(3D)) and mitral valve area (MVA(3D)) were measured by real-time 3-dimensional (3D) echocardiography. MVA(2D) and peak mitral inflow A wave velocity (V) were measured by 2-dimensional (2D) echocardiography. Left atrial ejection force (LA-EF) was calculated by 2D echocardiography and real-time 3D echocardiography using the formula: 0.5 x 1.06 x (MAA or MVA) x V2, where (1.06) is blood viscosity. LA-EF(2D-MVA), LA-EF(3D-MVA), LA-EF(3D-MAA), and V were significantly higher in patients with HCM than control subjects (P < .001). LA-EF(2D-MVA) and LA-EF(3D-MVA) were lower than LA-EF(3D-MAA) in HCM only (P < .001). In obstructive HCM, LA-EF(2D-MVA), LA-EF(3D-MVA), LA-EF(3D-MAA), and V were significantly higher than in nonobstructive HCM (P < .05). Left ventricular outflow tract gradient contributed independently to high LA-EF in obstructive HCM. We concluded that HCM is associated with higher LA-EF than normal, and higher in obstructive HCM than nonobstructive indicating a higher atrial workload that is reflected by LA-EF(3D-MAA). PMID:17543746

  4. Automatic computation of left ventricular volume changes over a cardiac cycle from echocardiography images by nonlinear dimensionality reduction.

    PubMed

    Alizadeh Sani, Zahra; Shalbaf, Ahmad; Behnam, Hamid; Shalbaf, Reza

    2015-02-01

    Curve of left ventricular (LV) volume changes throughout the cardiac cycle is a fundamental parameter for clinical evaluation of various cardiovascular diseases. Currently, this evaluation is often performed manually which is tedious and time consuming and suffers from significant interobserver and intraobserver variability. This paper introduces a new automatic method, based on nonlinear dimensionality reduction (NLDR) for extracting the curve of the LV volume changes over a cardiac cycle from two-dimensional (2-D) echocardiography images. Isometric feature mapping (Isomap) is one of the most popular NLDR algorithms. In this study, a modified version of Isomap algorithm, where image to image distance metric is computed using nonrigid registration, is applied on 2-D echocardiography images of one cycle of heart. Using this approach, the nonlinear information of these images is embedded in a 2-D manifold and each image is characterized by a symbol on the constructed manifold. This new representation visualizes the relationship between these images based on LV volume changes and allows extracting the curve of the LV volume changes automatically. Our method in comparison to the traditional segmentation algorithms does not need any LV myocardial segmentation and tracking, particularly difficult in the echocardiography images. Moreover, a large data set under various diseases for training is not required. The results obtained by our method are quantitatively evaluated to those obtained manually by the highly experienced echocardiographer on ten healthy volunteers and six patients which depict the usefulness of the presented method. PMID:25059548

  5. A low-cost digital filing system for echocardiography data with MPEG4 compression and its application to remote diagnosis.

    PubMed

    Umeda, Akira; Iwata, Yasushi; Okada, Yasumasa; Shimada, Megumi; Baba, Akiyasu; Minatogawa, Yasuyuki; Yamada, Takayasu; Chino, Masao; Watanabe, Takafumi; Akaishi, Makoto

    2004-12-01

    The high cost of digital echocardiographs and the large size of data files hinder the adoption of remote diagnosis of digitized echocardiography data. We have developed a low-cost digital filing system for echocardiography data. In this system, data from a conventional analog echocardiograph are captured using a personal computer (PC) equipped with an analog-to-digital converter board. Motion picture data are promptly compressed using a moving pictures expert group (MPEG) 4 codec. The digitized data with preliminary reports obtained in a rural hospital are then sent to cardiologists at distant urban general hospitals via the internet. The cardiologists can evaluate the data using widely available movie-viewing software (Windows Media Player). The diagnostic accuracy of this double-check system was confirmed by comparison with ordinary super-VHS videotapes. We have demonstrated that digitization of echocardiography data from a conventional analog echocardiograph and MPEG 4 compression can be performed using an ordinary PC-based system, and that this system enables highly efficient digital storage and remote diagnosis at low cost. PMID:15562270

  6. [Evaluation of the size of the left-right shunt using pulse Doppler echocardiography in children--personal experience].

    PubMed

    Kokos, Z; Fabeci?-Sabadi, V; Lukanovi?, T; Marki?evi?-Ruzici?, K

    1993-01-01

    The purpose of the present study was to verify the value of a two-dimensional pulsed Doppler echocardiographic method for measurement of pulmonary (QP) and systemic blood flow (QS) in comparison with the radiocardiography in patients with ventricular and atrial septal defects. We reviewed 42 children with ventricular septal defect and 23 children with atrial septal defect. Two-dimensional echocardiography was employed to measure the diameter of the aorta and pulmonary artery and pulsed Doppler for measurement of pulmonary and systemic blood flow velocity in the pulmonary artery and left ventricular outflow tract. By comparing pulmonary and systemic blood flow ratios by pulsed Doppler echocardiography and radiocardiography, the correlation coefficient for children with atrial septal defect and those with ventricular septal defect respectively amounted to r = 0.71 and r = 0.81. The authors conclude that two-dimensional pulsed Doppler echocardiography, although a semiquantitative technique, appears to be a reliable non-invasive method for measuring pulmonary and systemic blood flow in patients with left-to-right sgunt. PMID:8170279

  7. Detection of Cardiac Quiescence from B-Mode Echocardiography Using a Correlation-Based Frame-to-Frame Deviation Measure

    PubMed Central

    WICK, CARSON A.; MCCLELLAN, JAMES H.; RAVICHANDRAN, LAKSHMINARAYAN; TRIDANDAPANI, SRINI

    2015-01-01

    Two novel methods for detecting cardiac quiescent phases from B-mode echocardiography using a correlation-based frame-to-frame deviation measure were developed. Accurate knowledge of cardiac quiescence is crucial to the performance of many imaging modalities, including computed tomography coronary angiography (CTCA). Synchronous electrocardiography (ECG) and echocardiography data were obtained from 10 healthy human subjects (four male, six female, 23–45 years) and the interventricular septum (IVS) was observed using the apical four-chamber echocardiographic view. The velocity of the IVS was derived from active contour tracking and verified using tissue Doppler imaging echocardiography methods. In turn, the frame-to-frame deviation methods for identifying quiescence of the IVS were verified using active contour tracking. The timing of the diastolic quiescent phase was found to exhibit both inter- and intra-subject variability, suggesting that the current method of CTCA gating based on the ECG is suboptimal and that gating based on signals derived from cardiac motion are likely more accurate in predicting quiescence for cardiac imaging. Two robust and efficient methods for identifying cardiac quiescent phases from B-mode echocardiographic data were developed and verified. The methods presented in this paper will be used to develop new CTCA gating techniques and quantify the resulting potential improvement in CTCA image quality. PMID:26609501

  8. Appropriate Use Criteria in Echocardiography: An Observational Institutional Study with the Perspective of a Quality Improvement Project

    PubMed Central

    Rameh, Vanessa; Kossaify, Antoine

    2016-01-01

    BACKGROUND Appropriate use criteria (AUC) in echocardiography are essential tools for aligning the indications of echocardiography with the best clinical standards, improving clinical outcome, restraining abuse, and preserving health-care resources. OBJECTIVES The aim of this study was to ascertain the AUC for transthoracic echocardiography in a university hospital and create a quality improvement project (QIP). METHODS The assessment of 501 inpatients who received transthoracic cardiac echo was conducted according to the 2011 AUC report. Indications were classified as appropriate, uncertain, or inappropriate, and patients not matching any of the abovementioned divisions were grouped in the nonfitting category. RESULTS Of the 501 eligible patients, 374 patients (74.66%) were in the appropriate group, 85 patients (16.96%) in the inappropriate group, 20 patients (3.99%) in the uncertain group, and 22 patients (4.39%) in the nonfitting category. DISCUSSION Interpretation and analysis of the obtained results are presented, along with the results of many comparable studies; moreover, a QIP was set up accordingly. CONCLUSION AUC are useful to assess local practice, preserve health-care resources, and improve clinical outcome. PMID:26917982

  9. Automated Three-Dimensional Reconstruction of the Left Ventricle From Multiple-Axis Echocardiography.

    PubMed

    Rajan, Navaneetha Krishnan; Song, Zeying; Hoffmann, Kenneth R; Belohlavek, Marek; McMahon, Eileen M; Borazjani, Iman

    2016-01-01

    Two-dimensional echocardiography (echo) is the method of choice for noninvasive evaluation of the left ventricle (LV) function owing to its low cost, fast acquisition time, and high temporal resolution. However, it only provides the LV boundaries in discrete 2D planes, and the 3D LV geometry needs to be reconstructed from those planes to quantify LV wall motion, acceleration, and strain, or to carry out flow simulations. An automated method is developed for the reconstruction of the 3D LV endocardial surface using echo from a few standard cross sections, in contrast with the previous work that has used a series of 2D scans in a linear or rotational manner for 3D reconstruction. The concept is based on a generalized approach so that the number or type (long-axis (LA) or short-axis (SA)) of sectional data is not constrained. The location of the cross sections is optimized to minimize the difference between the reconstructed and measured cross sections, and the reconstructed LV surface is meshed in a standard format. Temporal smoothing is implemented to smooth the motion of the LV and the flow rate. This software tool can be used with existing clinical 2D echo systems to reconstruct the 3D LV geometry and motion to quantify the regional akinesis/dyskinesis, 3D strain, acceleration, and velocities, or to be used in ventricular flow simulations. PMID:26548948

  10. Semiautomatic, Quantitative Measurement of Aortic Valve Area Using CTA: Validation and Comparison with Transthoracic Echocardiography

    PubMed Central

    Tuncay, V.; Prakken, N.; van Ooijen, P. M. A.; Budde, R. P. J.; Leiner, T.; Oudkerk, M.

    2015-01-01

    Objective. The aim of this work was to develop a fast and robust (semi)automatic segmentation technique of the aortic valve area (AVA) MDCT datasets. Methods. The algorithm starts with detection and cropping of Sinus of Valsalva on MPR image. The cropped image is then binarized and seed points are manually selected to create an initial contour. The contour moves automatically towards the edge of aortic AVA to obtain a segmentation of the AVA. AVA was segmented semiautomatically and manually by two observers in multiphase cardiac CT scans of 25 patients. Validation of the algorithm was obtained by comparing to Transthoracic Echocardiography (TTE). Intra- and interobserver variability were calculated by relative differences. Differences between TTE and MDCT manual and semiautomatic measurements were assessed by Bland-Altman analysis. Time required for manual and semiautomatic segmentations was recorded. Results. Mean differences from TTE were −0.19 (95% CI: −0.74 to 0.34) cm2 for manual and −0.10 (95% CI: −0.45 to 0.25) cm2 for semiautomatic measurements. Intra- and interobserver variability were 8.4 ± 7.1% and 27.6 ± 16.0% for manual, and 5.8 ± 4.5% and 16.8 ± 12.7% for semiautomatic measurements, respectively. Conclusion. Newly developed semiautomatic segmentation provides an accurate, more reproducible, and faster AVA segmentation result. PMID:26221603

  11. Prognostic Value of Real Time Myocardial Contrast Echocardiography after Percutaneous Coronary Intervention.

    PubMed

    Yang, Lixia; Xia, Chunmei; Mu, Yuming; Guan, Lina; Wang, Chunmei; Tang, Qi; Verocai, Flavia Gomes; Fonseca, Lea Mirian Barbosa da; Shih, Ming Chi

    2016-03-01

    Real time myocardial contrast echocardiography (RTMCE) is a cost-effective and simple method to quantify coronary flow reserve (CFR). We aimed to determine the value of RTMCE to predict cardiac events after percutaneous coronary intervention (PCI). We have studied myocardial blood volume (A), velocity (?), flow indexes (MBF, A × ?), and vasodilator reserve (stress-to-rest ratios) in 36 patients with acute coronary syndrome (ACS) who underwent PCI. CFR (MBF at stress/MBF at rest) was calculated for each patient. Perfusion scores were used for visual interpretation by MCE and correlation with TIMI flow grade. In qualitative RTMCE assessment, post-PCI visual perfusion scores were higher than pre-PCI (Z = -7.26, P < 0.01). Among 271 arteries with TIMI flow grade 3 post-PCI, 72 (36%) did not reach visual perfusion score 1. The ?- and A × ?-reserve of the abnormal segments supplied by obstructed arteries increased after PCI comparing to pre-PCI values (P < 0.01). Patients with adverse cardiac events had significantly lower ?- and lower A × ?-reserve than patients without adverse cardiac events. In the former group, the CFR was ? 1.5 both pre- and post-PCI. CFR estimation by RTMCE can quantify myocardial perfusion in patients with ACS who underwent PCI. The parameters ?-reserve and CFR combined might predict cardiac events on the follow-up. PMID:26411872

  12. Automated speckle tracking algorithm to aid on-axis imaging in echocardiography

    PubMed Central

    Dhutia, Niti M.; Cole, Graham D.; Zolgharni, Massoud; Manisty, Charlotte H.; Willson, Keith; Parker, Kim H.; Hughes, Alun D.; Francis, Darrel P.

    2014-01-01

    Abstract. Obtaining a “correct” view in echocardiography is a subjective process in which an operator attempts to obtain images conforming to consensus standard views. Real-time objective quantification of image alignment may assist less experienced operators, but no reliable index yet exists. We present a fully automated algorithm for detecting incorrect medial/lateral translation of an ultrasound probe by image analysis. The ability of the algorithm to distinguish optimal from sub-optimal four-chamber images was compared to that of specialists—the current “gold-standard.” The orientation assessments produced by the automated algorithm correlated well with consensus visual assessments of the specialists (r=0.87) and compared favourably with the correlation between individual specialists and the consensus, 0.82±0.09. Each individual specialist’s assessments were within the consensus of other specialists, 75±14% of the time, and the algorithm’s assessments were within the consensus of specialists 85% of the time. The mean discrepancy in probe translation values between individual specialists and their consensus was 0.97±0.87  cm, and between the automated algorithm and specialists’ consensus was 0.92±0.70  cm. This technology could be incorporated into hardware to provide real-time guidance for image optimisation—a potentially valuable tool both for training and quality control. PMID:26158075

  13. Multiplane Transesophageal Echocardiography with Dobutamine in Patients with Biventricular Inferior Myocardial Infarction.

    PubMed

    Espinola-Zavaleta, Nilda; Vargas-Barrón, Jesús; Romero-Cárdenas, Angel; Bialostozky, David; Alexanderson, Erick; Martinez-Sanchez, Carlos; Peña-Duque, Marco; Keirns, Candace; Rijlaarsdam, María; Lupi-Herrera, Eulo

    1998-02-01

    The purpose of this study was to evaluate the alterations of ventricular wall movement in patients with acute posteroinferior myocardial infarction with extension to right cavities with multiplane transesophageal echocardiography (TEE), as well as the utility of dobutamine with this technique to analyze myocardial viability. Nine men with a mean age of 51 years fulfilled the inclusion criteria. Myocardial TEE was performed in all the men 72 hours after the acute event with long- and short-axis transgastric images of both ventricles under basal conditions and with dobutamine infusions of 5 and 10 µg/kg per minute. Results were compared with myocardial perfusion findings obtained with Tc-99m Sestamibi SPECT. Left ventricular myocardial viability was demonstrated in 28 of 45 altered segments with dobutamine stress myocardial TEE and Tc-99m Sestamibi SPECT. Right ventricular myocardial viability was identified in 27 of 30 altered segments with dobutamine stress myocardial TEE in transgastric short and long axes, and with Tc-99m Sestamibi SPECT in 23 of 25 segments only in short-axis images. Multiplane TEE provided excellent image resolution and better definition of endocardial and epicardial borders, which facilitated detailed evaluation of ventricular segmental wall movement. Infusion of low doses of dobutamine made it possible to identify viable tissue in both ventricles, and results were comparable to those of nuclear medicine. PMID:11175029

  14. Noninvasive quantification of jeopardized myocardial mass in dogs using 2-dimensional echocardiography and thallium-201 tomography

    SciTech Connect

    Weiss, R.J.; Buda, A.J.; Pasyk, S.; O'Neill, W.W.; Keyes, J.W. Jr.; Pitt, B.

    1983-12-01

    The evaluation of jeopardized myocardial mass is important in defining the effect of interventions during myocardial infarction. To quantitate the in vivo mass at risk, 2-dimensional echocardiography (2-D echo) and thallium-201 single-photon emission computed tomography (SPECT) was performed in 10 closed-chest dogs after circumflex coronary artery occlusion. The 2-D images were manually digitized to compute left ventricular (LV) mass using a modified Simpson's rule algorithm. This measure of LV mass correlated well with the actual LV mass (r . 0.97). Perfused myocardial mass was estimated from thallium SPECT images 4 hours after occlusion using a region-growing algorithm. After the dogs were killed, the jeopardized mass was outlined using a dual perfusion staining technique using triphenyltetrazolium chloride and Evans blue dye. The actual perfused mass was well estimated by the thallium images (r . 0.96). The noninvasively determined mass at risk was calculated as: 2-D mass--thallium SPECT mass, and correlated well with the pathologically determined mass at risk (r . 0.91). Thus, the jeopardized mass may be determined noninvasively by using 2-D echo and thallium-201 tomography. This approach may provide further information regarding the effect of intervention therapy on jeopardized myocardium.

  15. Integration of trans-esophageal echocardiography with magnetic tracking technology for cardiac interventions

    NASA Astrophysics Data System (ADS)

    Moore, John T.; Wiles, Andrew D.; Wedlake, Chris; Bainbridge, Daniel; Kiaii, Bob; Trejos, Ana Luisa; Patel, Rajni; Peters, Terry M.

    2010-02-01

    Trans-esophageal echocardiography (TEE) is a standard component of patient monitoring during most cardiac surgeries. In recent years magnetic tracking systems (MTS) have become sufficiently robust to function effectively in appropriately structured operating room environments. The ability to track a conventional multiplanar 2D TEE transducer in 3D space offers incredible potential by greatly expanding the cumulative field of view of cardiac anatomy beyond the limited field of view provided by 2D and 3D TEE technology. However, there is currently no TEE probe manufactured with MTS technology embedded in the transducer, which means sensors must be attached to the outer surface of the TEE. This leads to potential safety issues for patients, as well as potential damage to the sensor during procedures. This paper presents a standard 2D TEE probe fully integrated with MTS technology. The system is evaluated in an environment free of magnetic and electromagnetic disturbances, as well as a clinical operating room in the presence of a da Vinci robotic system. Our first integrated TEE device is currently being used in animal studies for virtual reality-enhanced ultrasound guidance of intracardiac surgeries, while the "second generation" TEE is in use in a clinical operating room as part of a project to measure perioperative heart shift and optimal port placement for robotic cardiac surgery. We demonstrate excellent system accuracy for both applications.

  16. Dobutamine stress echocardiography after cardiac transplantation: implications of donor–recipient age difference

    PubMed Central

    Riesgo, Fernando; Choy, Jonathan B; Kim, Daniel H; Becher, Harald

    2015-01-01

    Dobutamine stress echocardiography (DSE) is widely used during follow-up after cardiac transplant for the diagnosis of allograft vasculopathy. We investigated the effect of donor–recipient age difference on the ability to reach target heart rate (HR) during DSE. All cardiac transplant patients who were undergoing DSE over a 3-year period in a single institution were reviewed. Target HR was specified as 85%×(220 – patient age). Further patient and donor demographics were obtained from the local transplant database. 61 patients (45 male, 55±12 years) were stressed with a median dose of 40?mcg/kg per min dobutamine. Only 37 patients (61%) achieved target HR. Donor hearts were mostly younger (mean 41±14 years, P<0.001), with only 11 patients (18%) having donors who were older than they were. Patients with older donors required higher doses of dobutamine (median 50 vs 30?mcg/kg per min, P<0.001) but achieved a lower percentage target HR (mean 93% vs 101%, P=0.003) than those with younger donors did. Patients with older donors were less likely to achieve target HR (18% vs 67%, P=0.003). In conclusion, donor–recipient age difference affects the likelihood of achieving target HR and should be considered when a patient is consistently unable to achieve ‘adequate’ stress according to the patient's age.

  17. Abdominal aortic aneurysm screening during transthoracic echocardiography: Cardiologist and vascular medicine specialist interpretation

    PubMed Central

    Navas, E Viviana; McCalla-Lewis, Andrea; Fernandez Jr, Bernardo B; Pinski, Sergio L; Novaro, Gian M; Asher, Craig R

    2012-01-01

    AIM: To study the interobserver variability between a cardiologist and vascular medicine specialist in the screening of the abdominal aorta during transthoracic echocardiography (TTE). METHODS: Consecutive patients, > 55 years of age, underwent abdominal aortic imaging following standard TTE. Two cardiologists and one vascular medicine specialist performed a blinded review of the images. Interobserver agreement of abdominal aortic size was determined by the correlation coefficient and paired t test. Interobserver reliability for each cardiologist was assessed using Bland-Altman plots. RESULTS: Ninety patients were studied. The mean age of patients was 72 ± 10 years and 48% were male. The mean aortic diameter was 2.31 ± 0.50 cm and 5 patients (5.5%) had an abdominal aortic aneurysm (AAA). The additional time required for the abdominal aortic images was 4.4 ± 0.9 min per patient. Interobserver agreement between the 2 cardiologist interpreters and the vascular medicine specialist was excellent (P > 0.05 for all comparisons). On Bland-Altman analysis of interobserver reliability, the 95% lower and upper limits for measurement by the cardiologists were 84% and 124% of that of the vascular specialist. CONCLUSION: The assessment of the abdominal aorta during a routine TTE performed by a cardiologist is accurate in comparison to that of a vascular medicine specialist. In selected patients undergoing TTE, the detection rate of AAA is significant. Additional time and effort required to perform imaging of the abdominal aorta after TTE is less than 5 min. PMID:22379535

  18. Clinician referrals for stress echocardiography: are we compliant with the NICE guidelines?

    PubMed Central

    Ravi, K A; Ripley, D P; Kane, J; Wass, E; Carr, A; Wilson, D; Watchorn, N; Hobman, R K; Gill, D; Brooksby, W P; Kilcullen, N; Artis, N

    2014-01-01

    Accurate diagnosis of stable angina is of paramount importance, and where possible, this should be based on clinical history. In cases of uncertainty, the National Institute for Health and Care Excellence (NICE) provides a framework for assisting diagnosis based on pre-test likelihood (PTL) of coronary artery disease. Functional testing such as stress echocardiography (SE) is recommended as a first-line investigation in patients with PTL of 30–60%. This study evaluated hospital clinicians' adherence to this recommendation. A prospective analysis of patients referred for SE at a district general hospital between March and May 2013 was performed. Data were extracted from an electronic database of SE reports and medical notes. A total of 193 patients were assessed. The most common PTL was 61–90%, accounting for 40% of the cohort. Of them, 14% had a PTL of 30–60%. Of these, 15% had positive SE; 57% described non-anginal pain, as defined by NICE, of whom only nine cases had SE positivity. None of these patients required revascularisation. Findings suggest that SE is being used in a much broader selection group than advocated by NICE. This may often be for its exclusion value rather than to stratify risk. Although utility may be justified in high-risk patients to avoid proceeding directly to invasive angiography, SE appears to add little in those with non-anginal pain and with low PTL. Greater focus should be directed towards characterisation of symptoms, which may negate the need for subsequent investigation.

  19. Essential training steps to achieving competency in the basic intraoperative transesophageal echocardiography examination for Chinese anesthesiologists.

    PubMed

    Peng, Yong G; Song, Haibo; Wang, E; Wang, Weipeng; Liu, Jin

    2015-03-01

    Guidelines for the intraoperative transesophageal echocardiography (TEE) examination have defined a detailed standard for medical professionals, particularly anesthesiologists, on how a TEE exam should proceed. Over the years, TEE has gained substantial popularity and emerged as a preferred monitoring modality to aid in perioperative management and decision making during hemodynamic instability situations or critical care settings. TEE training pathways and practice guidelines have been well established in western countries and many regions of the world. However, TEE training and practice information for anesthesiologists are lacking in China. As innovative technologies develop, other educational models have emerged to aid in obtaining competency in basic TEE exam. Hence, establishing a consensus on the ideal TEE training approach for anesthesiologists in China is urgently needed. Developing an effective curriculum that can be incorporated into an anesthesiology resident's overall training is also necessary to provide knowledge and skills toward competency in basic TEE exam. With evolving medical system reforms and increasing demands for intraoperative hemodynamic monitoring to accommodate surgical innovations, anesthesiology professionals are increasingly obliged to perform intraoperative TEE exams in their current and future practices. To overcome obstacles and achieve significant progress in using the TEE modality to help in intraoperative management and surgical decision making, publishing basic TEE training guidelines for China's anesthesiologists is an important endeavor. PMID:25337689

  20. Automated Segmentation of the Right Ventricle in 3D Echocardiography: A Kalman Filter State Estimation Approach.

    PubMed

    Bersvendsen, Jorn; Orderud, Fredrik; Massey, Richard John; Fossa, Kristian; Gerard, Olivier; Urheim, Stig; Samset, Eigil

    2016-01-01

    As the right ventricle's (RV) role in cardiovascular diseases is being more widely recognized, interest in RV imaging, function and quantification is growing. However, there are currently few RV quantification methods for 3D echocardiography presented in the literature or commercially available. In this paper we propose an automated RV segmentation method for 3D echocardiographic images. We represent the RV geometry by a Doo-Sabin subdivision surface with deformation modes derived from a training set of manual segmentations. The segmentation is then represented as a state estimation problem and solved with an extended Kalman filter by combining the RV geometry with a motion model and edge detection. Validation was performed by comparing surface-surface distances, volumes and ejection fractions in 17 patients with aortic insufficiency between the proposed method, magnetic resonance imaging (MRI), and a manual echocardiographic reference. The algorithm was efficient with a mean computation time of 2.0 s. The mean absolute distances between the proposed and manual segmentations were 3.6 ± 0.7 mm. Good agreements of end diastolic volume, end systolic volume and ejection fraction with respect to MRI ( -26±24 mL , -16±26 mL and 0 ± 10%, respectively) and a manual echocardiographic reference (7 ± 30 mL, 13 ± 17 mL and -5±7% , respectively) were observed. PMID:26168434