Sample records for echocardiography showed severe

  1. [Echocardiography].

    PubMed

    Kawata, Takayuki; Daimon, Masao

    2014-07-01

    Assessment of ischemic mitral regurgitation( IMR) severity is important to stratify patients' management. Because IMR is influenced by loading condition seriously, it is difficult to evaluate severity of IMR in clinically stable condition at rest. Exercise stress echocardiography is useful tool to assess "true" severity of IMR. Recently, mitral valve plasty( undersized annuloplasty) creates a new problem, which is called "functional mitral stenosis". Exercise stress echocardiography also reveals this hemodynamics. Recent 3-dimensional (3D) echocardiography enables an intuitive understanding a valve anatomy by surgeon's view, and a more detailed quantitative evaluation. The 3D echocardiography can contribute to exact valve area calculation and can evaluate the forms of the valve ring which had difficulty in evaluation by 2D echocardiography. The treatment of structural heart disease with catheter has been introduced, and therefore the importance of the 3D echocardiography increases in this field. In this review, we describe the role of stress echocardiography on the assessment of IMR and the current status of 3D echocardiography. PMID:25138926

  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. Echocardiography.

    PubMed Central

    Chambers, J. B.; Monaghan, M. J.; Jackson, G.

    1988-01-01

    Imaging echocardiography is an important extension of the clinical examination and will answer most questions in an emergency-for example, whether an enlarged cardiac shadow on the chest radiograph represents ventricular dilatation or an effusion. Doppler ultrasonography is essential for hospitals with an interest in cardiology because it provides direct haemodynamic data that are complementary to imaging. It requires more skill than imaging and may also be time consuming. Colour flow Doppler mapping is speedy and simple to use and aids the interpretation of continuous wave Doppler. It is therefore a natural companion to conventional Doppler, but there would have to be a high clinical load to justify its purchase. Images FIG 3 FIG 4 FIG 4 FIG 5 FIG 6 PMID:3143434

  4. Echocardiography and pulmonary embolism severity index have independent prognostic roles in pulmonary embolism.

    PubMed

    Sanchez, Olivier; Trinquart, Ludovic; Planquette, Benjamin; Couturaud, Francis; Verschuren, Franck; Caille, Vincent; Meneveau, Nicolas; Pacouret, Gérard; Roy, Pierre-Marie; Righini, Marc; Perrier, Arnaud; Bertoletti, Laurent; Parent, Florence; Lorut, Christine; Meyer, Guy

    2013-09-01

    We analysed a cohort of patients with normotensive pulmonary embolism (PE) in order to assess whether combining echocardiography and biomarkers with the pulmonary embolism severity index (PESI) improves the risk stratification in comparison to the PESI alone. The PESI was calculated in normotensive patients with PE who also underwent echocardiography and assays of cardiac troponin I and brain natriuretic peptide. 30-day adverse outcome was defined as death, recurrent PE or shock. 529 patients were included, 25 (4.7%, 95% CI 3.2-6.9%) had at least one outcome event. The proportion of patients with adverse events increased from 2.1% in PESI class I-II to 8.4% in PESI class III-IV, and to 14.3% in PESI class V (p<0.001). In PESI class I-II, the rate of outcome events was significantly higher in patients with abnormal values of biomarkers or right ventricular dilatation. In multivariate analysis, the PESI (class III-IV versus I-II, OR 3.1, 95% CI 1.2-8.3; class V versus I-II, OR 5.5, 95% CI 1.5-25.5 and echocardiography (right ventricular/left ventricular ratio, OR (for an increase of 0.1) 1.3, 95% CI 1.1-1.5) were independent predictors of an adverse outcome. In patients with normotensive PE, biomarkers and echocardiography provided additional prognostic information to the PESI. PMID:23258789

  5. Mechanisms of regional ischaemic changes during dipyridamole echocardiography in patients with severe aortic valve stenosis and normal coronary arteries.

    PubMed Central

    Baroni, M.; Maffei, S.; Terrazzi, M.; Palmieri, C.; Paoli, F.; Biagini, A.

    1996-01-01

    OBJECTIVE: Vasodilator stress echocardiography can cause myocardial ischaemia in patients with severe aortic valve stenosis and angiographically normal coronary arteries. The aim of the study was to determine the mechanism of ischaemia in this clinical model. METHODS: The study group comprised patients with severe aortic valve stenosis and normal coronary arteries: 25 patients (17 males, eight females; age 63 (SD 11) years) underwent a high dose (up to 0.84 mg/kg over 10 min) dipyridamole echocardiography test both before (2-4 d) and after (10-15 d) aortic valve replacement. Mean aortic pressure gradient was 96 (15) mm Hg, with a left ventricular mass index of 228 (49) g/m2. The dipyridamole echocardiography test was well tolerated and interpretable in all patients. RESULTS: Dipyridamole infusion induced chest pain in seven patients before and in no patient after surgery (28 v 0%, P < 0.01), ST segment depression in 12 patients before and two after surgery (48 v 8%, P < 0.01), and a transient regional dyssynergy in 10 patients before and two after surgery (40 v 8%, P < 0.01). In the preoperative evaluation, patients with an echocardiographically positive dipyridamole echocardiography test were comparable with patients with negative test as far as left ventricular mass index [240 (67) v 230 (64) g/m2, NS] and mean aortic pressure gradient [95 (22) v 92 (21) mm Hg, NS] were concerned. When compared to the preoperative assessment, the resting echo assessment in the postoperative evaluation showed unchanged values of left ventricular mass index [pre 228 (49) g/m2 v post 220 (36) g/m2, NS], but markedly decreased values of mean aortic gradient [pre 95 (15) mm Hg v post 22 (5) mm Hg, P < 0.01] and left ventricular wall stress index [pre 134 (30) g/cm2 v post 89 (19) g/cm2]. CONCLUSIONS: Dipyridamole echocardiography is a suitable clinical technique for assessing the ischaemic vulnerability of the left ventricle in severe aortic valve stenosis with angiographically normal coronary arteries. The frequent disappearance of the ischaemic response early after aortic valve replacement suggests that haemodynamic factors such as compressive diastolic wall stress or afterload reduction are important components of myocardial ischaemic vulnerability under these circumstances. Images PMID:8665343

  6. Incremental value of contrast myocardial perfusion to detect intermediate versus severe coronary artery stenosis during stress-echocardiography

    Microsoft Academic Search

    Nicola Gaibazzi; Fausto Rigo; Angelo Squeri; Fabrizio Ugo; Claudio Reverberi

    2010-01-01

    BACKGROUND: We aimed to compare the incremental value of contrast myocardial perfusion imaging (MPI) for the detection of intermediate versus severe coronary artery stenosis during dipyridamole-atropine echocardiography (DASE). Wall motion (WM) assessment during stress-echocardiography demonstrates suboptimal sensitivity to detect coronary artery disease (CAD), particularly in patients with isolated intermediate (50%-70%) coronary stenosis. METHODS: We performed DASE with MPI in 150

  7. Comparative definitions for moderate-severe ischemia in stress nuclear, echocardiography, and magnetic resonance imaging.

    PubMed

    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

    2014-06-01

    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. 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

  9. The relationship between tricuspid regurgitation severity and right atrial mechanics: a speckle tracking echocardiography study.

    PubMed

    Teixeira, Rogério; Monteiro, Ricardo; Garcia, João; Baptista, Rui; Ribeiro, Miguel; Cardim, Nuno; Gonçalves, Lino

    2015-08-01

    The aim at this study was to assess the influence of the tricuspid regurgitation volume (TRvol) in right atrium (RA) reservoir phase myocardial mechanics. We included 55 heart failure (HF) patients referred for transthoracic echocardiography during a 2-month period. 18 Had HF with a reduced ejection fraction (HFREF) and 37 HF with a preserved ejection fraction (HFPEF). TR was chronic and functional. TRvol was calculated according to the PISA method. This study of RA used 2D-speckle tracking echocardiography to measure strain (r?R) and strain rate (rSRR). The reference frame coincided with the onset of the QRS. RA stiffness was assessed as the ratio: (rE/e')/r?R. The median age of the sample was 78 (64-84) years, with female gender predominance (63.6 %). The median value of r?R was 16 % (range, 12.7-24.0) and of rSRR was 1.57 s(-1) (range, 1.09-2.05). We observed a significant negative correlation between r?R (r = -0.68, p < 0.01) and rSRR (r = -0.58, p < 0.01) and TRvol. RA mechanics decreased significantly with an increase in the TR grade. We created two multivariate linear regression models for r?R and rSRR, separately for the patients with sinus rhythm or atrial fibrillation. The TRvol was independently associated with r?R after adjusting to the RA area, right ventricular longitudinal systolic function and the estimated pulmonary vascular resistance. We demonstrated an increase in RA stiffness with an increase in TR severity, and an association for functional status (NYHA class) and RA compliance. The HFREF group had a significantly lower r?R and rSRR that the HFPEF patients. According to our study, in HF patients, a chronic volume overload state significantly reduced the RA reservoir phase mechanics. PMID:25904401

  10. Comparison of real-time three-dimensional transesophageal echocardiography to two-dimensional transesophageal echocardiography for quantification of mitral valve prolapse in patients with severe mitral regurgitation.

    PubMed

    Izumo, Masaki; Shiota, Maiko; Kar, Saibal; Gurudevan, Swaminatha V; Tolstrup, Kirsten; Siegel, Robert J; Shiota, Takahiro

    2013-02-15

    Real-time 3-dimensional (3D) transesophageal echocardiography (TEE) provides more accurate geometric information on the mitral valve (MV) than 2-dimensional (2D) TEE. The aim of this study was to quantify MV prolapse using real-time 3D TEE in patients with severe mitral regurgitation. In 102 patients with severe mitral regurgitation due to MV prolapse and/or flail, 2D TEE quantified MV prolapse, including prolapse gap and width in the commissural view. Three-dimensional TEE also determined prolapse gap and width with the use of the 3D en face view. On the basis of the locations of MV prolapse, all patients were classified into group 1 (pure middle leaflet prolapse, n = 50) or group 2 (involvement of medial and/or lateral prolapse, n = 52). Prolapse gap and prolapse width determined by 3D TEE were significantly greater than those by 2D TEE (all p values <0.001). The differences in prolapse gap and prolapse width between 2D TEE and 3D TEE were significantly greater in group 2 than group 1 (? gap 1.3 ± 1.4 vs 2.4 ± 1.8 mm, ? width 2.5 ± 3.0 vs 4.4 ± 5.1 mm, all p values <0.01). The differences in prolapse gap and width between 2D TEE and 3D TEE were best correlated with 3D TEE-derived prolapse width (r = 0.41 and r = 0.74, respectively). Two-dimensional TEE underestimated the width of MV prolapse and leaflet gap compared to 3D TEE. Two-dimensional TEE could not detect the largest prolapse gap and width, because of the complicated anatomy of the MV. In conclusion, 3D TEE provided more precise quantification of MV prolapse than 2D TEE. PMID:23206924

  11. Liquid Medical Marijuana Shows Promise Against Severe Epilepsy

    MedlinePLUS

    ... gov/medlineplus/news/fullstory_151982.html Liquid Medical Marijuana Shows Promise Against Severe Epilepsy Child and adult ... 2015 (HealthDay News) -- A liquid form of medical marijuana may help people with severe epilepsy that does ...

  12. CT Scan-Measured Pulmonary Artery to Aorta Ratio and Echocardiography for Detecting Pulmonary Hypertension in Severe COPD

    PubMed Central

    Iyer, Anand S.; Vishin, Sonia; Bhatt, Surya P.; Wille, Keith M.; Dransfield, Mark T.

    2014-01-01

    Background: COPD is associated with significant morbidity primarily driven by acute exacerbations. Relative pulmonary artery (PA) enlargement, defined as a PA to ascending aorta (A) diameter ratio greater than one (PA:A > 1) identifies patients at increased risk for exacerbations. However, little is known about the correlation between PA:A, echocardiography, and invasive hemodynamics in COPD. Methods: A retrospective observational study of patients with severe COPD being evaluated for lung transplantation at a single center between 2007 and 2011 was conducted. Clinical characteristics, CT scans, echocardiograms, and right-sided heart catheterizations were reviewed. The PA diameter at the bifurcation and A diameter from the same CT image were measured. Linear and logistic regression were used to examine the relationships between PA:A ratio by CT scan and PA systolic pressure (PASP) by echocardiogram with invasive hemodynamics. Receiver operating characteristic analysis assessed the usefulness of the PA:A ratio and PASP in predicting resting pulmonary hypertension (PH) (mean pulmonary artery pressure [mPAP] > 25 mm Hg). Results: Sixty patients with a mean predicted FEV1 of 27% ± 12% were evaluated. CT scan-measured PA:A correlated linearly with mPAP after adjustment for multiple covariates (r = 0.30, P = .03), a finding not observed with PASP. In a multivariate logistic model, mPAP was independently associated with PA:A > 1 (OR, 1.44; 95% CI, 1.02-2.04; P = .04). PA:A > 1 was 73% sensitive and 84% specific for identifying patients with resting PH (area under the curve, 0.83; 95% CI, 0.72-0.93; P < .001), whereas PASP was not useful. Conclusions: A PA:A ratio > 1 on CT scan outperforms echocardiography for diagnosing resting PH in patients with severe COPD. PMID:24114440

  13. The Impact of Fetal Echocardiography

    Microsoft Academic Search

    J. P. Kovalchin; N. H. Silverman

    2004-01-01

    Fetal echocardiography has impacted the fetus with congenital heart disease in many important ways. Advances in fetal echocardiography have allowed for more accurate and earlier detection of cardiac abnormalities. In turn, the prenatal diagnosis of cardiac abnormalities has improved the care and outcome of selected fetuses with severe cardiac malformations or arrhythmias. Fetal echocardiography has improved the understanding of the

  14. 11. CONTROL ROOM INTERIOR, SHOWING SEVERAL PERISCOPES. Looking north along ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. CONTROL ROOM INTERIOR, SHOWING SEVERAL PERISCOPES. Looking north along west wall. - Edwards Air Force Base, Air Force Rocket Propulsion Laboratory, Instrumentation & Control Building, Test Area 1-115, northwest end of Saturn Boulevard, Boron, Kern County, CA

  15. Transesophageal Echocardiography

    MedlinePLUS

    ... Congenital Heart Defects Coronary Heart Disease Echocardiography Heart Valve Disease Send a link to NHLBI to someone by E-MAIL | PRINT | SHARE this page from the NHLBI BOOKMARK & SHARE X Share this page from the NHLBI on Blogger. ...

  16. Correlation of ascending aorta elasticity and the severity of coronary artery stenosis in hypertensive patients with coronary heart disease assessed by M-mode and tissue Doppler echocardiography.

    PubMed

    Lu, Qixiu; Liu, Houlin

    2015-03-01

    The main objective of this study is to investigate the relationship between ascending aorta elasticity and the severity of coronary artery stenosis in essential hypertensive patients with coronary heart disease (CHD) using M-mode and tissue Doppler echocardiography. A total of 184 hypertensive patients with CHD were enrolled. Patients were divided into three groups based on the severity of coronary stenosis measured by coronary arteriography (CAG): slight stenosis (group 1), moderate stenosis (group 2) and serious stenosis (group 3). M-mode and tissue Doppler echocardiography were performed, and elasticity indexes of ascending aorta including stiffness index, distensibility index, and S wave speed of anterior wall were calculated and correlated with the severity of coronary stenosis. Ascending aorta stiffness index was increased, whereas distensibility index and S wave speed of anterior wall were decreased in moderate and severe stenosis groups compared with slight stenosis group (P < 0.01). Elasticity indexes change in a stepwise pattern with the narrowness of coronary artery, and there was a significant correlation between aortic elasticity and severity of coronary artery by Pearson correlation analysis (P < 0.01). Elasticity indexes of ascending aorta correlate well with severity of coronary stenosis. Elasticity indexes of ascending aorta can serve as predictors for coronary arterial lesion in hypertensive patients. PMID:25269774

  17. 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.

  18. 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.

  19. Stress echocardiography--2010.

    PubMed

    Upadhyayula, Satyanarayana; Kapur, Kanwal Kishore

    2011-01-01

    Owing to the level of sensitivity, specificity, positive predictive value, negative predictive value and accuracy, stress echocardiography (SE) perhaps has the highest overall utility and is the most preferred and prescribed modality for the assessment of coronary artery disease (CAD). Additionally exercise stress echocardiography (ESE) and pharmacologic stress echocardiography (PSE) turn out to be the most cost-effective & risk-effective modality, without significant environmental/radiation/bio hazard, with the added advantage of repeatability, portability, an acceptable learning curve and high level of safety. Strain (E), Strain Rate Imaging (SRI), tissue Doppler imaging (TDI), myocardial contrast echocardiography (MCE), real time 3-dimensional echocardiography (RT-3DE), Speckle tracking Echocardiography (STE), combined MCE & RT-3DE, combined STE & TDI add newer dimensions and may unleash the full potential of SE. PMID:22734368

  20. 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

  1. Caveolin-2-deficient mice show evidence of severe pulmonary dysfunction without disruption of caveolae.

    PubMed

    Razani, Babak; Wang, Xiao Bo; Engelman, Jeffery A; Battista, Michela; Lagaud, Guy; Zhang, Xiao Lan; Kneitz, Burkhard; Hou, Harry; Christ, George J; Edelmann, Winfried; Lisanti, Michael P

    2002-04-01

    Caveolin-2 is a member of the caveolin gene family with no known function. Although caveolin-2 is coexpressed and heterooligomerizes with caveolin-1 in many cell types (most notably adipocytes and endothelial cells), caveolin-2 has traditionally been considered the dispensable structural partner of the widely studied caveolin-1. We now directly address the functional significance of caveolin-2 by genetically targeting the caveolin-2 locus (Cav-2) in mice. In the absence of caveolin-2 protein expression, caveolae still form and caveolin-1 maintains its localization in plasma membrane caveolae, although in certain tissues caveolin-1 is partially destabilized and shows modestly diminished protein levels. Despite an intact caveolar membrane system, the Cav-2-null lung parenchyma shows hypercellularity, with thickened alveolar septa and an increase in the number of endothelial cells. As a result of these pathological changes, these Cav-2-null mice are markedly exercise intolerant. Interestingly, these Cav-2-null phenotypes are identical to the ones we and others have recently reported for Cav-1-null mice. As caveolin-2 expression is also severely reduced in Cav-1-null mice, we conclude that caveolin-2 deficiency is the clear culprit in this lung disorder. Our analysis of several different phenotypes observed in caveolin-1-deficient mice (i.e., abnormal vascular responses and altered lipid homeostasis) reveals that Cav-2-null mice do not show any of these other phenotypes, indicating a selective role for caveolin-2 in lung function. Taken together, our data show for the first time a specific role for caveolin-2 in mammalian physiology independent of caveolin-1. PMID:11884617

  2. Caveolin-2-Deficient Mice Show Evidence of Severe Pulmonary Dysfunction without Disruption of Caveolae

    PubMed Central

    Razani, Babak; Wang, Xiao Bo; Engelman, Jeffery A.; Battista, Michela; Lagaud, Guy; Zhang, Xiao Lan; Kneitz, Burkhard; Hou, Harry; Christ, George J.; Edelmann, Winfried; Lisanti, Michael P.

    2002-01-01

    Caveolin-2 is a member of the caveolin gene family with no known function. Although caveolin-2 is coexpressed and heterooligomerizes with caveolin-1 in many cell types (most notably adipocytes and endothelial cells), caveolin-2 has traditionally been considered the dispensable structural partner of the widely studied caveolin-1. We now directly address the functional significance of caveolin-2 by genetically targeting the caveolin-2 locus (Cav-2) in mice. In the absence of caveolin-2 protein expression, caveolae still form and caveolin-1 maintains its localization in plasma membrane caveolae, although in certain tissues caveolin-1 is partially destabilized and shows modestly diminished protein levels. Despite an intact caveolar membrane system, the Cav-2-null lung parenchyma shows hypercellularity, with thickened alveolar septa and an increase in the number of endothelial cells. As a result of these pathological changes, these Cav-2-null mice are markedly exercise intolerant. Interestingly, these Cav-2-null phenotypes are identical to the ones we and others have recently reported for Cav-1-null mice. As caveolin-2 expression is also severely reduced in Cav-1-null mice, we conclude that caveolin-2 deficiency is the clear culprit in this lung disorder. Our analysis of several different phenotypes observed in caveolin-1-deficient mice (i.e., abnormal vascular responses and altered lipid homeostasis) reveals that Cav-2-null mice do not show any of these other phenotypes, indicating a selective role for caveolin-2 in lung function. Taken together, our data show for the first time a specific role for caveolin-2 in mammalian physiology independent of caveolin-1. PMID:11884617

  3. 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

  4. Contrast echocardiography for the evaluation of tumors and thrombi.

    PubMed

    Uenishi, Eliza Kaori; Caldas, Márcia A; Saroute, Ally N R; Tsutsui, Jeane Mike; Piotto, Gustavo H M; Falcão, Sandra N R S; Mathias, Wilson

    2008-11-01

    Contrast echocardiography is based on intravenous injection of microbubbles that act as blood flow tracers and increase ultra-sound signal. Contrast agents have shown to improve cardiac cavities opacification and endocardial border delineation in addition to helping perfusion evaluation. Contrast echocardiography has recently been used to evaluate cardiac masses. In this report we will describe three cases evaluated by contrast echocardiography: a left atrial myxoma (benign tumor), a lung adenocarcinoma metastasis (malign tumor), and one thrombus. Contrast echocardiography showed to be valuable in the diagnosis of the different types of cardiac masses. PMID:19142370

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

    SciTech Connect

    Raguenes, O.; Ferec, C.; Mercier, B. [Universite de Bordeaux II, Paris (France)] [and others

    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.

  6. 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

  7. The explosive outbreak and intercontinental spread of Severe Acute Respiratory Syndrome (SARS) shows

    E-print Network

    The explosive outbreak and intercontinental spread of Severe Acute Respiratory Syndrome (SARS (Mills and Childs 1998). Monkeypox, hantavirus pulmonary syndrome (HPS), Lassa fever, Argentine evidence for top-down regulation of zoonotic disease reservoirs Richard S Ostfeld1 and Robert D Holt2

  8. Mitral annular calcium detected by transthoracic echocardiography is a marker for high prevalence and severity of coronary artery disease in patients undergoing coronary angiography

    Microsoft Academic Search

    Yehuda Adler; Itzhak Herz; Mordehay Vaturi; Renato Fusman; Ronit Shohat-Zabarski; Noam Fink; Avital Porter; Yaron Shapira; Abid Assali; Alex Sagie

    1998-01-01

    This study tests the hypothesis that mitral annular calcium (MAC) detected by transthoracic echocardlography (TTE) is a marker for high prevalence and severity of coronary artery disease (CAD) in patients undergoing coronary angiography. Pathological studies have suggested that there is an association between MAC and calcific deposits in coronary arteries; however, there are no clinical data to support this association.

  9. 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

  10. Comparative study of rest technetium-99m sestamibi SPET and low-dose dobutamine stress echocardiography for the early assessment of myocardial viability after acute myocardial infarction: importance of the severity of the infarct-related stenosis.

    PubMed

    Claeys, M J; Rademakers, F E; Vrints, C J; Krug, B; Bosmans, J M; Conraads, V; Bossaert, L L; Snoeck, J P; Blockx, P P

    1996-07-01

    Rest technetium-99m sestamibi single-photon emission tomography (SPET) has been shown to underestimate viability in some patients with chronic ischaemic myocardial dysfunction. The present study was designed to appraise the value of 99mTc-sestamibi as a viability tracer in patients with a recent myocardial infarction and to determine factors that might influence its accuracy in assessing infarct size. Therefore, rest 99mTc-sestamibi SPET, low-dose dobutamines stress echocardiography and quantitative coronary angiography were performed in 51 patients with a recent myocardial infarction. Perfusion activity and regional wall motion were scored semi-quantitatively using the same segmental division of the left ventricle. Assessment of 99mTc-sestamibi uptake as a marker of viability was performed by comparing a binary uptake score (viable=>50% vs necrotic =severe infarct-related stenosis (% diameter stenosis >/=65%-100%) and particularly those with "late" reperfusion therapy (time delay >/=180 min). In patients without a severe infarct-related stenosis, 99mTc-sestamibi was able to accurately distinguish viable from necrotic segments. Thus, rest 99mTc-sestamibi scintigraphy early after acute myocardial infarction may underestimate residual viability within the infarct region, particularly in patients with low flow state coronary anatomy, as a result of a severe infarct-related stenosis and/or late reperfusion therapy. PMID:8662112

  11. [Newly developed technology for intravenous contrast echocardiography].

    PubMed

    Senda, S; Ohmori, K; Ueeda, M

    2000-03-01

    Until now we have not been able to employ a contrast enhancer for ultrasonic echocardiography at the everyday clinical level because the agent itself, composed of microbubbles, was too easily dispersed or even destroyed by several factors. However, contrast echocardiography has made a great leap forward with major developments on two fronts; the application of some new intravenous contrast enhancers, and newly developed machine technology permitting second harmonic imaging, intermittent or triggered imaging, pulse inversion harmonic imaging, and so on. New contrast enhancing agents are proving durability enough to permit greatly enhanced imaging for more than several minutes after injection. Recent new echocontrast specific imaging allows real-time visualizing of myocardial perfusion and assessment of myocardial function. PMID:10834167

  12. Hand-held echocardiography: its use and usefulness.

    PubMed

    Mondillo, Sergio; Giannotti, Giovanna; Innelli, Pasquale; Ballo, Pier Carlo; Galderisi, Maurizio

    2006-07-28

    In recent years, several echocardiographic hand-held devices have been developed and are now available for a growing number of cardiologists. After the first clinical use 25 years ago, hand-held echocardiography (HHE) is now earning important commercial positions. Their transportability permits echo performance out the echo-labs and offers the possibility to make diagnosis in intensive care unit, emergency room, outpatient clinic, at the bedside, and even in ambulance. Experiences in the clinical setting have demonstrated the ability of HHE to detect multiple diseases including abdominal aortic aneurysms, left ventricular hypertrophy, regional wall motion abnormalities, pericardial and pleural effusions. At the present time, four varieties of HHE have to be recognized: the first includes high-cost, miniaturized machines, similar to the most advanced instrumentations, provided by new tools and imaging transfer systems; a second intermediate, middle-cost variety encompasses devices corresponding to standard echocardiography, but not miniaturized; according to the definition of the American Society of Echocardiography, a third and a fourth category comprise machines of weight lower than 2.7 kg, battery supplied and appropriately defined as "portable cardioschopes", which can be utilized as a technical refinement of physical examination. The use of HHE opens main controversy concerning their diagnostic accuracy, the opportunity to establish in which clinical settings they should be used and the identification of both potential users and required competence level. Preliminary experiences show the possibility to improve and anticipate diagnosis of several cardiovascular diseases but also the need to plan specific ultrasound training to avoid incorrect use of HHE. PMID:16087257

  13. Healed perivalvular abscess: Incidental finding on transesophageal echocardiography [corrected].

    PubMed

    Datt, Vishnu; Diwakar, Anitha; Malik, Indra; Geelani, M A; Tomar, A S; Virmani, Sanjula

    2014-01-01

    A 36-year-old male patient presented with the complaints of palpitations and breathlessness. Preoperative transthoracic echocardiography (TTE) revealed a bicuspid aortic valve; severe aortic regurgitation with dilated left ventricle (LV) and mild LV systolic dysfunction (ejection fraction 50%). He was scheduled to undergo aortic valve replacement. History was not suggestive of infective endocarditis (IE). Preoperative TTE did not demonstrate any aortic perivalvular abscess. Intraoperative transesophageal echocardiography (TEE) examination using the mid-esophageal (ME) long-axis view, showed an abscess cavity affecting the aortic valve, which initially was assumed to be a dissection flap, but later confirmed to be an abscess cavity by color Doppler examination. The ME aortic valve short-axis view showed two abscesses; one was at the junction of the non-coronary and left coronary commissure and the other one above the right coronary cusp. Intraoperatively, these findings were confirmed by the surgeons. The case report demonstrates the superiority of TEE over TTE in diagnosing perivalvular abscesses. PMID:24732616

  14. [Clinical significance of mitral valve insufficiency detected by Doppler echocardiography in acute myocardial infarction].

    PubMed

    Kraska, T; Liszewska-Pfejfer, D; Dziduszko-Fedorko, E; Jakubowska-Najnigier, M; Opolski, G; Stanis?awska-Nielepkiewicz, J; Stawicki, S; Zawadzka-By?ko, M

    1990-10-01

    Doppler echocardiography revealed in the third week of the recent myocardial infarction a pattern of mitral insufficiency in 27 (36%) of the 75 patients studied. Mitral insufficiency was usually associated with the more severe clinical course of myocardial infarction, with more frequent supraventricular and ventricular arrhythmias, heart failure, and with more extensive infarction area, as compared with the patients without mitral failure. A decreased contractibility of the left ventricle wall (especially in patients with anterior myocardial infarction accompanied by mitral insufficiency and enlargement ventricular dimension) may suggest its role in the development of mitral insufficiency in myocardial infarction. The results show the need of Doppler echocardiography in recent myocardial infarction to detect patients with an increased risk. PMID:2080111

  15. Assessment of electrocardiography, echocardiography, and heart rate variability in dynamic and static type athletes

    PubMed Central

    Toufan, Mehrnoush; Kazemi, Babak; Akbarzadeh, Fariborz; Ataei, Amin; Khalili, Majid

    2012-01-01

    Background: Over the last two decades, morphological cardiac changes induced by athletic conditioning have been of great interest. Therefore, several studies have been orchestrated to delineate electrocardiography (ECG), echocardiography, and heart rate variability (HRV) findings in athletes. Purpose: To assess the ECG, echocardiography, and HRV in a group of dynamic and static type athletes. Methods: Fifty professional athletes (20 static and 30 dynamic exercise athletes) and 50 healthy nonathletes (control group) were recruited. Standard 12-lead ECG and transthoracic echocardiography was performed on all athletes and the control group. Through echocardiography, variables including left ventricular (LV) end-diastolic/systolic diameter, LV mass, and left atrial volume index were measured. In addition, both the athletes and the control group underwent ECG Holter monitoring for 15 minutes and several parameters related to HRV (time and frequency domain) were recorded. Results: The most common ECG abnormalities among the athletes were sinus bradycardia and incomplete right bundle branch block. LV end-diastolic diameter and left atrial volume index were significantly greater in the dynamic athletes (P < 0.001). LV end-systolic diameter was significantly lower in the static group (P < 0.001). LV mass of the dynamic and static athletes was significantly greater than that of the controls (P < 0.001). Among the ECG Holter monitoring findings, the dynamic athletes had lower systolic blood pressure than the controls (P = 0.01). Heart rate was lowest in the control group (P < 0.001). Conclusion: The most common ECG abnormalities among adolescent Iranian athletes were sinus bradycardia and incomplete right bundle branch block. Static exercise seemed to reduce LV end-systolic diameter, while dynamic exercise resulted in increased LV end-diastolic diameter and left atrial volume index. Additionally, Iranian athletes showed no differences in HRV parameters, excluding heart rate and systolic blood pressure, compared with the nonathletes. PMID:22924010

  16. Nuclear Magnetic Resonance Structure Shows that the Severe Acute Respiratory Syndrome Coronavirus-Unique Domain Contains a Macrodomain Fold?

    PubMed Central

    Chatterjee, Amarnath; Johnson, Margaret A.; Serrano, Pedro; Pedrini, Bill; Joseph, Jeremiah S.; Neuman, Benjamin W.; Saikatendu, Kumar; Buchmeier, Michael J.; Kuhn, Peter; Wüthrich, Kurt

    2009-01-01

    The nuclear magnetic resonance (NMR) structure of a central segment of the previously annotated severe acute respiratory syndrome (SARS)-unique domain (SUD-M, for “middle of the SARS-unique domain”) in SARS coronavirus (SARS-CoV) nonstructural protein 3 (nsp3) has been determined. SUD-M(513-651) exhibits a macrodomain fold containing the nsp3 residues 528 to 648, and there is a flexibly extended N-terminal tail with the residues 513 to 527 and a C-terminal flexible tail of residues 649 to 651. As a follow-up to this initial result, we also solved the structure of a construct representing only the globular domain of residues 527 to 651 [SUD-M(527-651)]. NMR chemical shift perturbation experiments showed that SUD-M(527-651) binds single-stranded poly(A) and identified the contact area with this RNA on the protein surface, and electrophoretic mobility shift assays then confirmed that SUD-M has higher affinity for purine bases than for pyrimidine bases. In a further search for clues to the function, we found that SUD-M(527-651) has the closest three-dimensional structure homology with another domain of nsp3, the ADP-ribose-1"-phosphatase nsp3b, although the two proteins share only 5% sequence identity in the homologous sequence regions. SUD-M(527-651) also shows three-dimensional structure homology with several helicases and nucleoside triphosphate-binding proteins, but it does not contain the motifs of catalytic residues found in these structural homologues. The combined results from NMR screening of potential substrates and the structure-based homology studies now form a basis for more focused investigations on the role of the SARS-unique domain in viral infection. PMID:19052085

  17. Nuclear magnetic resonance structure shows that the severe acute respiratory syndrome coronavirus-unique domain contains a macrodomain fold.

    PubMed

    Chatterjee, Amarnath; Johnson, Margaret A; Serrano, Pedro; Pedrini, Bill; Joseph, Jeremiah S; Neuman, Benjamin W; Saikatendu, Kumar; Buchmeier, Michael J; Kuhn, Peter; Wüthrich, Kurt

    2009-02-01

    The nuclear magnetic resonance (NMR) structure of a central segment of the previously annotated severe acute respiratory syndrome (SARS)-unique domain (SUD-M, for "middle of the SARS-unique domain") in SARS coronavirus (SARS-CoV) nonstructural protein 3 (nsp3) has been determined. SUD-M(513-651) exhibits a macrodomain fold containing the nsp3 residues 528 to 648, and there is a flexibly extended N-terminal tail with the residues 513 to 527 and a C-terminal flexible tail of residues 649 to 651. As a follow-up to this initial result, we also solved the structure of a construct representing only the globular domain of residues 527 to 651 [SUD-M(527-651)]. NMR chemical shift perturbation experiments showed that SUD-M(527-651) binds single-stranded poly(A) and identified the contact area with this RNA on the protein surface, and electrophoretic mobility shift assays then confirmed that SUD-M has higher affinity for purine bases than for pyrimidine bases. In a further search for clues to the function, we found that SUD-M(527-651) has the closest three-dimensional structure homology with another domain of nsp3, the ADP-ribose-1"-phosphatase nsp3b, although the two proteins share only 5% sequence identity in the homologous sequence regions. SUD-M(527-651) also shows three-dimensional structure homology with several helicases and nucleoside triphosphate-binding proteins, but it does not contain the motifs of catalytic residues found in these structural homologues. The combined results from NMR screening of potential substrates and the structure-based homology studies now form a basis for more focused investigations on the role of the SARS-unique domain in viral infection. PMID:19052085

  18. Contrast echocardiography in Canada: Canadian Cardiovascular Society/Canadian Society of Echocardiography position paper

    PubMed Central

    Honos, George; Amyot, Robert; Choy, Jonathan; Leong-Poi, Howard; Schnell, Greg; Yu, Eric

    2007-01-01

    As an adjunct to transthoracic, transesophageal and stress echocardiography, contrast echocardiography (CE) improves the diagnostic accuracy of technically suboptimal studies when used in conjunction with harmonic imaging. Intravenous ultrasound contrast agents are indicated for left ventricular (LV) opacification and improvement of LV endocardial border delineation in patients with suboptimal acoustic windows. Demonstrated benefits of CE include improvement in the accuracy of LV measurements, regional wall motion assessment, evaluation of noncompaction cardiomyopathy, thrombus detection, Doppler signal enhancement and conjunctive use with stress echocardiography. Studies have shown the value of CE in the assessment and quantification of myocardial perfusion, and recent clinical trials have suggested a role for contrast perfusion imaging in the stratification of patients with suspected coronary artery disease. While it adds some time and cost to the echocardiographic study, CE frequently obviates the need for additional specialized, expensive and less accessible cardiac investigations, and allows for prompt and optimal subsequent patient management. Despite its proven advantages, CE is presently underused in Canada, and this situation will, unfortunately, not improve until several barriers to its use are overcome. Resolving these important hurdles is vital to the future of CE and to its eventual implementation into clinical practice of promising contrast-based diagnostic and therapeutic applications, including the assessment of perfusion by myocardial CE. PMID:17440639

  19. Suitability of Doppler echocardiography for the assessment of right heart hemodynamics after De Vega tricuspid annuloplasty.

    PubMed

    Di Bello, V; Maffei, S; Piacenti, M; Magagnini, E; Giusti, C; Verunelli, F; Salvatore, L; Biagini, A

    1993-02-01

    Cardiac Doppler Echocardiography is a suitable method for to evaluating right heart hemodynamics. However, the surgical correction of tricuspid valve annuloplasty changes valve geometry and might possibly lead to a technical obstacle to this estimation. The accuracy of Doppler echocardiography in the assessment of tricuspid regurgitation and systolic pulmonary pressure in patients who had undergone De Vega annuloplasty was evaluated in this study. Ten patients (9 females and 1 male), mean age 55.7 +/- 7.8 years, who had a previous De Vega annuloplasty for the treatment of tricuspid regurgitation due to a severe mitral stenosis, underwent a Doppler echocardiography study and, within two hours, right heart catheterization for a direct comparison of parameters calculated by different methods. Right ventricular-atrial maximal pressure gradient was found to be 32.6 +/- 11.07 mmHg by Doppler and 31.4 +/- 11.07 mmHg by catheterization. Pulmonary systolic pressure was 42.6 +/- 9.1 mmHg at Doppler and 39.1 +/- 11.3 mmHg at catheterization, with a highly significant correlation between the 2 techniques (r = 0.98%, p < 0.01). With semiquantitative Doppler evaluation 10 patients showed tricuspid insufficiency, which was mild in 8 and medium in 2. At catheterization all patients were found to have mild tricuspid insufficiency. Cardiac Doppler seems a reliable method in the evaluation of tricuspid regurgitation and of pulmonary systolic pressure even in patients who underwent De Vega annuloplasty. PMID:8482705

  20. Echocardiography in Pediatric Pulmonary Hypertension

    PubMed Central

    Jone, Pei-Ni; Ivy, D. Dunbar

    2014-01-01

    Pulmonary hypertension (PH) can be a rapidly progressive and fatal disease. Although right heart catheterization remains the gold standard in evaluation of PH, echocardiography remains an important tool in screening, diagnosing, evaluating, and following these patients. In this article, we will review the important echocardiographic parameters of the right heart in evaluating its anatomy, hemodynamic assessment, systolic, and diastolic function in children with PH. PMID:25429362

  1. 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…

  2. An african-specific functional polymorphism in KCNMB1 shows sex-specific association with asthma severity

    Microsoft Academic Search

    Max A. Seibold; Bin Wang; Celeste Eng; Gunjan Kumar; Kenneth B. Beckman; Saunak Sen; Shweta Choudhry; Kelley Meade; Michael Lenoir; H. Geoffrey Watson; Shannon Thyne; L. Keoki Williams; Rajesh Kumar; Kevin B. Weiss; Leslie C. Grammer; Pedro C. Avila; Robert P. Schleimer; Esteban González Burchard; Robert Brenner

    2008-01-01

    A highly heritable and reproducible measure of asthma severity is baseline pulmonary function. Pulmonary function is largely determined by airway smooth muscle (ASM) tone and contractility. The large conduc- tance, voltage and calcium-activated potassium (BK) channel negatively regulates smooth muscle tone and contraction in ASM. The modulatory subunit of BK channels, the b1-subunit, is critical for proper acti- vation of

  3. 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

  4. Physical Activity in the Life of a Woman with Severe Cerebral Palsy: Showing competence and being socially connected

    Microsoft Academic Search

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

    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 using psychodynamic theory. Although Amy enjoyed learning to

  5. Carbonic anhydrase activators: gold nanoparticles coated with derivatized histamine, histidine, and carnosine show enhanced activatory effects on several mammalian isoforms.

    PubMed

    Saada, Mohamed-Chiheb; Montero, Jean-Louis; Vullo, Daniela; Scozzafava, Andrea; Winum, Jean-Yves; Supuran, Claudiu T

    2011-03-10

    Lipoic acid moieties were attached to amine or amino acids showing activating properties against the zinc enzyme carbonic anhydrase (CA, EC 4.2.1.1). The obtained lipoic acid conjugates of histamine, L-histidine methyl ester, and L-carnosine methyl ester were attached to gold nanoparticles (NPs) by reaction with Au(III) salts in reducing conditions. The CA activators (CAAs)-coated NPs showed low nanomolar activation (K(A)s of 1-9 nM) of relevant cytosolic, membrane-bound, mitochondrial, and transmembrane CA isoforms, such as CA I, II, IV, VA, VII, and XIV. These NPs also effectively activated CAs ex vivo, in whole blood experiments, with an increase of 200-280% of the CA activity. This is the first example of enzyme activation with nanoparticles and may lead to biomedical applications for conditions in which the CA activity is diminished, such as aging, Alzheimer's disease, or CA deficiency syndrome. PMID:21291238

  6. Echocardiography

    MedlinePLUS

    ... Congenital Heart Defects Heart Attack Heart Failure Heart Valve Disease Holes in the Heart Send a link to NHLBI to someone by E-MAIL | PRINT | SHARE this page from the NHLBI BOOKMARK & SHARE X Share this page from the NHLBI on Blogger. ...

  7. [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.

  8. Impact of endometriosis on women's health: comparative historical data show that the earlier the onset, the more severe the disease.

    PubMed

    Ballweg, Mary Lou

    2004-04-01

    Looking at endometriosis from the bigger picture -- as a systemic endocrine, immunological, and gastrointestinal disease -- opens the door to broader treatments. The bigger-picture understanding of the disease also makes clear a variety of patterns of presenting symptoms, again clarifying the diagnosis. Data from over 7000 confirmed cases clearly show that delay in diagnosis (the average time to diagnosis is >9 years) is a major problem and that current treatments are far from satisfactory. In conclusion, the impact of endometriosis, a disease that already produces intense symptoms, is worsened by a current lack of understanding of the disease beyond its pelvic definition. PMID:15157638

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

    PubMed Central

    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

    2013-01-01

    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?n?, JNJ-26481585 upregulated SMN levels in SMA fibroblast cell lines, including those from non-responders to valproic acid. Oral treatment of Taiwanese SMA mice and control littermates starting at P0 showed no overt extension of lifespan, despite mild improvements in motor abilities and weight progression. Many treated and untreated animals showed a very rapid decline or unexpected sudden death. We performed exploratory autopsy and histological assessment at different disease stages and found consistent abnormalities in the intestine, heart and lung and skeletal muscle vasculature of SMA animals, which were not prevented by JNJ-26481585 treatment. Interestingly, some of these features may be only indirectly caused by ?-motoneuron function loss but may be major life-limiting factors in the course of disease. A better understanding of – primary or secondary – non-neuromuscular organ involvement in SMA patients may improve standard of care and may lead to reassessment of how to investigate SMA patients clinically. PMID:23073311

  10. The role of echocardiography in heart failure.

    PubMed

    Marwick, Thomas H

    2015-06-01

    Data from echocardiography provide a cornerstone in the management of heart failure. All imaging techniques can provide an ejection fraction, but the versatility of echocardiography makes it unique in the provision of volumes, diastolic function, right ventricular function, hemodynamics, and valvular regurgitation. The early detection of heart failure has been facilitated by the assessment of global longitudinal strain, which is also useful in later heart failure for the assessment of left ventricular synchrony. The use of echocardiography has been associated with favorable outcomes, probably on the basis of facilitation of appropriate therapy. This review examines the evidence provided by echocardiography and its application in specific settings. Although the guidelines emphasize that no single test satisfies all imaging requirements in heart failure, and other modalities can provide additional information about specific questions (especially tissue characterization), echocardiography is indispensable in the management of heart failure. PMID:26033901

  11. Hand-held echocardiography: its use and usefulness

    Microsoft Academic Search

    Sergio Mondillo; Giovanna Giannotti; Pasquale Innelli; Pier Carlo Ballo; Maurizio Galderisi

    2006-01-01

    In recent years, several echocardiographic hand-held devices have been developed and are now available for a growing number of cardiologists. After the first clinical use 25 years ago, hand-held echocardiography (HHE) is now earning important commercial positions. Their transportability permits echo performance out the echo-labs and offers the possibility to make diagnosis in intensive care unit, emergency room, outpatient clinic,

  12. The cardiac sodium channel shows a regular substate pattern indicating synchronized activity of several ion pathways instead of one.

    PubMed

    Schreibmayer, W; Tritthart, H A; Schindler, H

    1989-11-17

    Cardiac sodium channel substates were induced by using different gating modifiers, namely S-DPI 201-106 (s), toxin II from Anemonia sulcata (a), veratridine (v) and mixtures of these agents (s + v, a + v). Current ratios (normalized substate currents), slope conductances, reversal potentials and saturation characteristics were evaluated for the individual channel substates. The results can be summarized as follows: (i) Current ratios fell into a pattern of six equidistant values (I to VI) irrespective of the modification applied (0.20, 0.34, 0.51, 0.69, 0.85, 1.00). Slope conductances, determinable for substates II, V and VI (4.8, 11.7 and 14.0, respectively), are also consistent with six conductance substates which are integer multiples of a smallest conductance (state I). (ii) The permeability ratio PNa+/PK+ (i.e., reversal potential of substate currents) of the sodium channel was conserved both for different modifications, i.e., by s, a, s + v and a + v, and for the different substates (at least for II, IV and VI) observed for each modification. (iii) Sodium binding to the channel is substate independent. Analysis of slope conductances of states II and VI for three sodium chloride concentrations (71.5, 140 and 303 mM) revealed different maximal conductances (geVImax = 2.9.geIImax) but similar apparent affinities for sodium (KNa + VI = 286 mM; KNa + II = 303 mM). These findings are shown to seriously challenge the commonly unquestioned conception that 'single-current events' reflect ion passage through only one single pathway. The alternative view, that not one pore, but either six or three pores with synchronized gating ('oligochannel') underlie 'single-channel events', is shown to readily account for the observed substate properties and appears not to contradict known properties of 'the sodium channel'. This fundamentally new view of the sodium channel aims to invoke further efforts to distinguish between conceptually distinct models of structure-function relationships for a variety of channels which show multiple substates and conserved ion selectivity. PMID:2573393

  13. Use of Contrast Agents with Echocardiography in Patients with Suboptimal Echocardiography

    PubMed Central

    2010-01-01

    Executive Summary Objective The objective of this report is to assess the ability of microbubble contrast agents to enhance the visualization of cardiac structures in patients with suboptimal echocardiography results. Contrast Echocardiography The most common use of contrast echocardiography is the enhancement of the endocardial border. Left ventricular (LV) opacification with contrast echocardiography has the potential to improve the definition of the LV border. The aim of contrast echocardiography is to provide better quantification of LV volume and assessment of LV wall motion analysis than echocardiography alone. Some patients, however, are more likely to exhibit poor echocardiograms than others. These patients include critically ill patients on ventilators or with lung problems, patients who’ve had recent chest operations, and obese patients. Echocardiography studies performed in the intensive care unit (ICU) are frequently inadequate or suboptimal because of the difficulties in positioning patients properly, poor lighting, chest tubes and bandages. Contrast agents could potentially be used in 5% to 10% of resting echocardiography exams and in an estimated 30% of stress echocardiography tests due to suboptimal echocardiograms. The American Society of Echocardiography guidelines stated that 75% to 90% of suboptimal echocardiography results can yield interpretable results with the use of contrast agents. Evidence-Based Analysis Methods Research Question Do contrast agents improve the visualization of the cardiac structures in patients exhibiting suboptimal echocardiograms? Literature Search A literature searches was performed on June 22, 2009 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published since 1950. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria; full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. Inclusion Criteria Systematic reviews, meta-analyses, randomized controlled trials, observational studies Minimum sample size of 20 enrolled patients The contrast agent used in the study must be licensed by Health Canada (at least Notice of Compliance) Patient population must include patients with suboptimal echocardiography results Compares echocardiography without contrast to echocardiography with contrast English Human Exclusion Criteria Non-systematic reviews, case reports Grey literature (e.g. conference abstracts) Outcomes of Interest Change in visualization with and without contrast agent Summary of Findings Based on the results of this review: Five studies consistently demonstrated that the addition of contrast to echocardiography improves heart visualization in patients with previously uninterpretable or suboptimal echocardiography results. Suboptimal echocardiography was consistently defined as >2 contiguous segments not seen in non- contrast images. The additional cost of using contrast agents in Ontario would range from approximately $5M to $30M annually. PMID:23074390

  14. Three-dimensional echocardiography for left ventricular quantification: fundamental validation and clinical applications

    Microsoft Academic Search

    J. A. van der Heide; S. A. Kleijn; M. F. A. Aly; J. Slikkerveer; O. Kamp

    2011-01-01

    One of the earliest applications of clinical echocardiography is evaluation of left ventricular (LV) function and size. Accurate,\\u000a reproducible and quantitative evaluation of LV function and size is vital for diagnosis, treatment and prediction of prognosis\\u000a of heart disease. Early three-dimensional (3D) echocardiographic techniques showed better reproducibility than two-dimensional\\u000a (2D) echocardiography and narrower limits of agreement for assessment of LV

  15. Echocardiography in children with Down syndrome

    PubMed Central

    Al-Biltagi, Mohammed A

    2013-01-01

    Congenital heart disease is a common problem in children with Down syndrome (DS). Echocardiography plays an important role in the detection of both structural and functional abnormalities in this group of patients. Fetal echocardiography can help in the early recognition of DS by detecting soft markers of DS, but its main role is to define the exact nature of the suspected cardiac problem in the fetus. Postnatal echocardiography is mandatory in the first month of life for all neonates with DS. It is also indicated before any cardiac surgery and for serial follow-up after cardiac surgery. In this article, we discuss the types and mechanism of cardiac abnormalities in DS children and the role of both fetal and postnatal echocardiography in the detection of these abnormalities. PMID:25254173

  16. Current Clinical Applications of Transthoracic Three-Dimensional Echocardiography

    PubMed Central

    Boccalini, Francesca; Muraru, Denisa; Bianco, Lucia Dal; Peluso, Diletta; Bellu, Roberto; Zoppellaro, Giacomo; Iliceto, Sabino

    2012-01-01

    The advent of three-dimensional echocardiography (3DE) has significantly improved the impact of non-invasive imaging on our understanding and management of cardiac diseases in clinical practice. Transthoracic 3DE enables an easier, more accurate and reproducible interpretation of the complex cardiac anatomy, overcoming the intrinsic limitations of conventional echocardiography. The availability of unprecedented views of cardiac structures from any perspective in the beating heart provides valuable clinical information and new levels of confidence in diagnosing heart disease. One major advantage of the third dimension is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. Another benefit of 3DE is the realistic en face views of heart valves, enabling a better appreciation of the severity and mechanisms of valve diseases in a unique, noninvasive manner. The purpose of this review is to provide readers with an update on the current clinical applications of transthoracic 3DE, emphasizing the incremental benefits of 3DE over conventional two-dimensional echocardiography. PMID:22509433

  17. Current clinical applications of transthoracic three-dimensional echocardiography.

    PubMed

    Badano, Luigi P; Boccalini, Francesca; Muraru, Denisa; Bianco, Lucia Dal; Peluso, Diletta; Bellu, Roberto; Zoppellaro, Giacomo; Iliceto, Sabino

    2012-03-01

    The advent of three-dimensional echocardiography (3DE) has significantly improved the impact of non-invasive imaging on our understanding and management of cardiac diseases in clinical practice. Transthoracic 3DE enables an easier, more accurate and reproducible interpretation of the complex cardiac anatomy, overcoming the intrinsic limitations of conventional echocardiography. The availability of unprecedented views of cardiac structures from any perspective in the beating heart provides valuable clinical information and new levels of confidence in diagnosing heart disease. One major advantage of the third dimension is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. Another benefit of 3DE is the realistic en face views of heart valves, enabling a better appreciation of the severity and mechanisms of valve diseases in a unique, noninvasive manner. The purpose of this review is to provide readers with an update on the current clinical applications of transthoracic 3DE, emphasizing the incremental benefits of 3DE over conventional two-dimensional echocardiography. PMID:22509433

  18. 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

  19. Clinical utility of echocardiography and magnetic resonance imaging for detecting cardiac complications in systemic sclerosis. A case report.

    PubMed

    Cojan Minzat, Bianca Olivia; Cioanca, Carmen; Mihalcea, Isabella; Lupu, Silvia; Agoston-Coldea, Lucia

    2015-06-01

    Systemic sclerosis (SSc) is a chronic autoimmune disease that beside the skin involvement it may affect the peripheral vessels and several organs, such as the lungs, the kidneys or the heart. Cardiac impairment usually becomes symptomatic in the late stages of the disease and is associated with poor prognosis. We report the case of a 80-year-old woman patient presenting symptoms of heart failure, subsequently diagnosed with limited SSc. The cardiac function was evaluated using a combined approach based on echocardiography, cardiac magnetic resonance imaging with late gadolinium enhancement. This case shows the fatal consequences of the late diagnosis of SSc. PMID:26052582

  20. 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

  1. Echocardiography in the Era of Multimodality Cardiovascular Imaging

    PubMed Central

    Shah, Benoy Nalin

    2013-01-01

    Echocardiography remains the most frequently performed cardiac imaging investigation and is an invaluable tool for detailed and accurate evaluation of cardiac structure and function. Echocardiography, nuclear cardiology, cardiac magnetic resonance imaging, and cardiovascular-computed tomography comprise the subspeciality of cardiovascular imaging, and these techniques are often used together for a multimodality, comprehensive assessment of a number of cardiac diseases. This paper provides the general cardiologist and physician with an overview of state-of-the-art modern echocardiography, summarising established indications as well as highlighting advances in stress echocardiography, three-dimensional echocardiography, deformation imaging, and contrast echocardiography. Strengths and limitations of echocardiography are discussed as well as the growing role of real-time three-dimensional echocardiography in the guidance of structural heart interventions in the cardiac catheter laboratory. PMID:23878804

  2. SEDATION FOR PEDIATRIC ECHOCARDIOGRAPHY: A BRIEF REVIEW

    Microsoft Academic Search

    Vikas Kohli

    Sedation is required for echocardiography in the pediatric age group for accurate diagnosis and reliable studies. The drugs used for sedation for echocardiograms include chloral hydrate and midazolam. Though chloral hydrate continues to be used, there may be concerns regarding its safety. Midazolam may have advantages, especially with the oral form of the drug. The status of these drugs and

  3. Assessment of coronary artery intimal thickening in patients with a previous diagnosis of Kawasaki disease by using high resolution transthoracic echocardiography: our experience

    PubMed Central

    2014-01-01

    Background Kawasaki disease (KD) is a generalized systemic vasculitis of unknown etiology involving medium and small size blood vessels, particularly the coronary arteries. In these vessels a progressive stenosis may result from active remodeling with an intimal proliferation and neoangiogenesis. The aim of our study was to assess, by using high-resolution transthoracic 2D Echocardiography, if subjects with a previous diagnosis of Kawasaki disease after several years show a coronary intimal thickening, suggestive of a persistent cardiovascular risk. Methods We assessed measurement of thickening, inner diameter and outer diameter of coronary arteries using 2D Echocardiography (Philips E 33 with multy-frequency S8-3 and S12-4 probes) and examining the proximal portion of left main coronary artery just above the aortic valve with parasternal short axis view. Results We found a significant intimal thickening in patients with previous Kawasaki disease compared to healthy controls. In particular, we noticed that also subjects not suffering from coronary impairment in acute phase have higher values of thickening than healthy controls, and this wall thickening may confer a higher cardiovascular risk. Conclusions Therefore we concluded that the assessment of coronary artery thickening by high-resolution transthoracic 2D Echocardiography may become an essential instrument to evaluate late cardiovascular risk in subjects with a diagnosis of Kawasaki disease in childhood. PMID:25139118

  4. 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

  5. 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

  6. Use of intracardiac echocardiography in interventional electrophysiology.

    PubMed

    Kalman, J M; Olgin, J E; Karch, M R; Lesh, M D

    1997-09-01

    Intracardiac echocardiography is emerging as a potentially useful tool during RF ablation procedures. There are a number of potential benefits of direct endocardial visualization during RF ablation including: (1) precise anatomical localization of the ablation catheter tip in relation to important endocardial structures, which cannot be visualized with fluoroscopy; (2) reduction in fluoroscopy time; (3) evaluation of catheter tip tissue contact; (4) confirmation of lesion formation and identification of lesion size and continuity; (5) immediate identification of complications; and (6) as a research tool to help in understanding the critical role played by specific endocardial structures in arrhythmogenesis. This article will review existing data and speculate as to possible future roles for intracardiac echocardiography in interventional electrophysiology. PMID:9309751

  7. [Hemodynamic monitoring from the data of intracardiac and transesophageal echocardiography].

    PubMed

    Sandrikov, V A; Revunenkov, G V; Doroshenko, D A; Eremenko, A A

    2009-01-01

    The constantly increasing complexity and duration of surgical intervention, comorbidity that leads to severe circulatory and respiratory disorders, multifactoriness of functional and metabolic disorders--this also needs a rapid and accurate assessment of patients and objective monitoring. The value of monitoring is determined by the results of timely diagnosis of disorders and the prevention of severe complications, including circulatory arrest, regional and global systolic function of the ventricles, which undoubtedly assists in choosing the tactic of intensive care. Intracardiac echocardiography makes it possible to record changes in cardiac cavity volume in real time, to calculate ejection fraction as the major pump coefficient, which is of prime importance in the surgical correction of coronary circulation with one-stage correction of mitral insufficiency. Imaging of cardiac cavities, evaluation of valve apparatus function, timely diagnosis of myocardial contractility, by detecting the areas of a pathological condition, are main criteria for undertaking medical measures and choosing a treatment policy. PMID:20099647

  8. Digital echocardiography: its role in modern medical practice.

    PubMed

    Bansal, S; Ehler, D; Vacek, J L

    2001-01-01

    Digital echocardiography has evolved rapidly during the last decade, and the all-digital echocardiographic laboratory has just reached the threshold of reality. This review article explains what this transition means for the modern medical practice and concisely presents what a digital echocardiogram is, the technical aspects of digital image acquisition and processing, and the advantages and limitations of digital echocardiography vs analog echocardiography. This review should serve as a useful source of information for the general cardiologist not working closely with digital echocardiography, as well as a resource for the noncardiologist. PMID:11157614

  9. Pulmonary hypertension: prevalence and mortality in the Armadale echocardiography cohort

    PubMed Central

    Strange, Geoff; Stewart, Simon; Deague, Jenny A; Nelson, Helen; Kent, Aaron; Gabbay, Eli

    2012-01-01

    Background Pulmonary hypertension (PHT) lacks community prevalence and outcome data. Objective To characterise minimum ‘indicative’ prevalences and mortality data for all forms of PHT in a selected population with an elevated estimated pulmonary artery systolic pressure (ePASP) on echocardiography. Design Observational cohort study. Setting Residents of Armadale and the surrounding region in Western Australia (population 165?450) referred to our unit for transthoracic echocardiography between January 2003 and December 2009. Results Overall, 10?314 individuals (6.2% of the surrounding population) had 15?633 echo studies performed. Of these, 3320 patients (32%) had insufficient TR to ePASP and 936 individuals (9.1%, 95% CI 8.6% to 9.7%) had PHT, defined as, ePASP>40?mm?Hg. The minimum ‘indicative’ prevalence for all forms of PHT is 326 cases/100?000 inhabitants of the local population, with left heart disease-associated PHT being the commonest cause (250 cases/100?000). 15 cases of pulmonary arterial hypertension/100?000 inhabitants were identified and an additional 144 individuals (15%) with no identified cause for their PHT. The mean time to death for those with ePASP >40?mm?Hg, calculated from the first recorded ePASP, was 4.1?years (95% CI 3.9 to 4.3). PHT increased mortality whatever the underlying cause, but patients with PHT from left heart disease had the worst prognosis and those with idiopathic pulmonary arterial hypertension receiving disease-specific treatment the best prognosis. Risk of death increased with PHT severity: severe pulmonary hypertension shortened the lifespan by an average of 1.1?years compared with mild pulmonary hypertension. Conclusions In this cohort, PHT was common and deadly. Left heart disease was the most common cause and had the worst prognosis and treated pulmonary arterial hypertension had the best prognosis. PMID:22760869

  10. 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.

  11. Can Hospital Rounds With Pocket Echocardiography By Cardiologists Reduce Standard Transthoracic Echocardiography?

    PubMed Central

    Khan, Hashim A.; Wineinger, Nathan E.; Uddin, Poulina Q.; Mehta, Hirsch S.; Rubenson, David S.; Topol, Eric J.

    2014-01-01

    Background Hospitalized patients are frequently referred for transthoracic echocardiograms (TTE). The availability of a pocket, mobile echocardiography (PME) device that can be incorporated on bedside rounds by cardiologists may be a useful and frugal alternative. Methods This was a cross-sectional study designed to compare the accuracy of PME images with those acquired by TTE in a sample of hospitalized patients. Each patient referred for echocardiography underwent PME acquisition and interpretation by a senior cardiology fellow with level II training in echocardiography. Subsequently, a TTE was performed by skilled ultrasonographers and interpreted by experienced echocardiographers. Both groups were blinded to the results of the alternative imaging modality. Visualizability and accuracy for all key echocardiographic parameters (ejection fraction, wall motion abnormalities, left ventricular end diastolic dimension, inferior vena cava size, aortic and mitral valve pathology, and pericardial effusion) were determined and compared between imaging modalities. Results 240 hospitalized patients underwent echocardiography with PME and TTE. The mean age was 71 ± 17 years. PME imaging time was 6.3 ± 1.5 min. Sensitivity of PME varied by parameter; was highest for aortic stenosis (97%) and lowest for aortic insufficiency (76%). Specificity also varied by parameter; was highest for mitral regurgitation (100%) and lowest for left ventricular ejection fraction (92%). Equivalence testing revealed the PME outcomes to be significantly equivalent to the TTE outcomes with no discernible differences in image quality between the PME and TTE (p=7.22×10-7). All outcomes remain significant after correcting for multiple testing using the false discovery rate (FDR). Conclusion The results from rapid bedside PME examinations performed by experienced cardiology fellows compared favorably with those from formal TTE studies. For hospitalized patients, this finding could shift the burden of performing and interpreting the echocardiogram to the examining physician and reduce the number and cost associated with formal echocardiography studies. PMID:24674919

  12. Reproducibility of two-dimensional exercise echocardiography.

    PubMed

    Oberman, A; Fan, P H; Nanda, N C; Lee, J Y; Huster, W J; Sulentic, J A; Storey, O F

    1989-10-01

    To determine the reproducibility of two-dimensional exercise echocardiography, duplicate studies were performed on the same patients a median of 14 days apart. Because measurements are operator-dependent, interobserver variability was calculated for two experienced readers who interpreted the findings independently in a blinded manner. A high degree of interobserver agreement was found in evaluation of both ejection fraction measurements and wall motion abnormalities. Readings for ejection fraction immediately after exercise taken on different days could be estimated within 4% of the values measured in the first test; similarly measured wall motion score index was within 6% of that in the first test. Ejection fractions and wall motion scores were highly correlated between tests 1 and 2. The correlation coefficients between tests 1 and 2 were 0.92 for both the pre- and postexercise ejection fractions and 0.98 for both the pre- and postexercise wall motion scores. Quantitative two-dimensional echocardiography immediately after exercise is highly reproducible, providing a valuable tool for assessing serial changes in left ventricular function. PMID:2794280

  13. Intraoperative transesophageal echocardiography during surgery for congenital heart defects

    Microsoft Academic Search

    Guy R. Randolph; Donald J. Hagler; Heidi M. Connolly; Joseph A. Dearani; Francisco J. Puga; Gordon K. Danielson; Martin D. Abel; V. Shane Pankratz; Patrick W. O'Leary

    2002-01-01

    Objective: This study was undertaken to further define the impact of intraoperative transesophageal echocardiography during surgery for congenital heart disease and to determine appropriate indications.Methods: The impact of transesophageal echocardiography on patient care was assessed in 1002 patients who underwent this procedure during surgery for congenital heart defects. It had major impact when new information altered the planned procedure or

  14. A New Sentinel Surveillance System for Severe Influenza in England Shows a Shift in Age Distribution of Hospitalised Cases in the Post-Pandemic Period

    PubMed Central

    Bolotin, Shelly; Pebody, Richard; White, Peter J.; McMenamin, James; Perera, Luke; Nguyen-Van-Tam, Jonathan S.; Barlow, Thomas; Watson, John M.

    2012-01-01

    Background The World Health Organization and European Centre for Disease Prevention and Control have highlighted the importance of establishing systems to monitor severe influenza. Following the H1N1 (2009) influenza pandemic, a sentinel network of 23 Trusts, the UK Severe Influenza Surveillance System (USISS), was established to monitor hospitalisations due to confirmed seasonal influenza in England. This article presents the results of the first season of operation of USISS in 2010/11. Methodology/Principal Findings A case was defined as a person hospitalised with confirmed influenza of any type. Weekly aggregate numbers of hospitalised influenza cases, broken down by flu type and level of care, were submitted by participating Trusts. Cases in 2010/11 were compared to cases during the 2009 pandemic in hospitals with available surveillance data for both time periods (n?=?19). An unexpected resurgence in seasonal A/H1N1 (2009) influenza activity in England was observed in December 2010 with reports of severe disease. Reported cases over the period of 4 October 2010 to 13 February 2011 were mostly due to influenza A/H1N1 (2009). One thousand and seventy-one cases of influenza A/H1N1 (2009) occurred over this period compared to 409 at the same Trusts over the 2009/10 pandemic period (1 April 2009 to 6 January 2010). Median age of influenza A/H1N1 (2009) cases in 2010/11 was 35 years, compared with 20 years during the pandemic (p?=?<0.0001). Conclusions/Significance The Health Protection Agency successfully established a sentinel surveillance system for severe influenza in 2010/11, detecting a rise in influenza cases mirroring other surveillance indicators. The data indicate an upward shift in the age-distribution of influenza A/H1N1 (2009) during the 2010/11 influenza season as compared to the 2009/10 pandemic. Systems to enable the ongoing surveillance of severe influenza will be a key component in understanding and responding to the evolving epidemiology of influenza in the post-pandemic era. PMID:22291929

  15. Diagnosis of cardiac tamponade with transesophageal echocardiography following the induction of anesthesia for suspected testicular torsion.

    PubMed

    McHugh, Stephen M; Wang, Xiao; Sullivan, Erin A

    2015-01-01

    Transesophageal echocardiography (TEE) is a valuable tool for evaluating hemodynamic instability in patients under general anesthesia. We present the case of a 28-year-old man who presented with complaints of testicular pain concerning for testicular torsion. After induction of general anesthesia for scrotal exploration and possible orchiopexy, the patient developed severe and persistent hypotension. Using intraoperative TEE, the diagnosis of pericardial tamponade was made, and an emergent pericardial window was performed. PMID:26139762

  16. [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

  17. Electrospray MS and MALDI imaging show that non-specific lipid-transfer proteins (LTPs) in tomato are present as several isoforms and are concentrated in seeds.

    PubMed

    Bencivenni, Mariangela; Faccini, Andrea; Zecchi, Riccardo; Boscaro, Francesca; Moneti, Gloriano; Dossena, Arnaldo; Sforza, Stefano

    2014-12-01

    Non-specific lipid-transfer proteins (nsLTPs) are major human allergens in many plant species, albeit their role in plant biochemistry is still undefined. They are found in many plant species, either as one or several isoforms according to the species, and usually they are found to concentrate in the outer part of the fruits. In this work, the characterization of tomato nsLTP isoforms was performed on the three main fractions of Piccadilly tomato fruit (peel, pulp and seeds) by using ultracentrifuge devices with molecular cut-off able to retain proteins with molecular weight typical of plant LTPs. The isolated proteins were further analysed by LC-MS, in order to investigate the occurrence and the localization of tomato LTP isoforms. The chromatographic retention times, the molecular masses, the presence of eight cysteine residues in their tertiary structures and the sequence information obtained by MS, although not complete yet, allowed us to identify four different LTP isoforms, not yet reported in the literature, which were found to be concentrated in the seed fractions. None of the molecular masses of these potential LTPs was already present in the UniProtKB/SwissProt database. MALDI imaging experiments confirmed their presence and main localization in seeds, although the actual data hinted at their presence around seeds, rather than exactly in them. These data hint to a complicated scenario concerning LTP proteins in tomato. PMID:25476944

  18. Genetic analyses of several Drosophila ananassae-complex species show a low-frequency major gene for parthenogenesis that maps to chromosome 2.

    PubMed

    Matsuda, Muneo; Tobari, Yoshiko N

    2004-04-01

    Parthenogenetic strains of several species have been found in the genus Drosophila. The mode of diploidization in the eggs of females has been found to be post-meiotic nuclear fusion. The genetic basis for this parthenogenesis is not understood but is believed to be under the control of a complex polygenic system. We found parthenogenetic females in an isofemale strain (LAE345) of D. pallidosa-like collected in 1981 at Lae, Papua New Guinea, and established a parthenogenetically reproducing strain. Parthenogenetic strains of D. ananassae and D. pallidosa collected at Taputimu, American Samoa had also been established by Futch (1972). D. ananassae, D. pallidosa and D. pallidosa-like are very closely related species belonging to the ananassae complex of the ananassae species subgroup of the melanogaster species group. Using these three species, we found that more than 80% of females from parthenogenetic strains produced progeny parthenogenetically and that inter-specific hybrid females also produced impaternate progeny. In the present report, we demonstrate that the mode of parthenogenesis of D. ananassae appears to be the post-meiotic nuclear doubling of a single meiotic product, and that a major gene responsible for the parthenogenesis maps to the left arm of the second chromosome of D. ananassae. We also suggest that the genetic basis for parthenogenesis capacity may be identical among the three closely related species. We discuss the function of the gene required for parthenogenesis and its significance for the evolutionary process. PMID:15219153

  19. Severe chest pain during stress dobutamine echocardiogram in patient with patent epicardial coronary arteries.

    PubMed

    Hussein, Hesham; El-Menyar, Ayman; Ahmed, Emad; Gehani, Abdulrazzak

    2011-03-01

    Dobutamine induced ST-segment elevation in the absence of obstructive coronary artery disease is a rare condition. We report a case of a 37-year-old man, a smoker, who developed severe chest pain associated with transient ST-segment elevation in anterolateral leads and significant segmental wall motion abnormalities during dobutamine stress echocardiography that was immediately relieved by sublingual nitrates without evidence of acute myocardial infarction. Coronary angiogram showed patent epicardial coronary arteries. PMID:20685062

  20. Usefulness of intraoperative real-time three-dimensional transesophageal echocardiography for pre-procedural evaluation of mitral valve cleft: a case report.

    PubMed

    Jung, Hyun Ju; Yu, Ga-Yon; Seok, Jung-Ho; Oh, Chungsik; Kim, Seong-Hyop; Yoon, Tae-Gyoon; Kim, Tae-Yop

    2014-01-01

    A precise pre-procedural evaluation of mitral valve (MV) pathology is essential for planning the surgical strategy for severe mitral regurgitation (MR) and preparing for the intraoperative procedure. In the present case, a 38-year-old woman was scheduled to undergo MV replacement due to severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy. A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet. However, the "en face" view of the MV in the left atrial perspective using intraoperative real time three-dimensional transesophageal echocardiography (RT 3D-TEE) provided a different diagnosis: a torn cleft in the P2-scallop of the posterior mitral leaflet (PML) with rupture of the chordae. Thus, surgical planning was changed intraoperatively to MV repair (MVRep) consisting of patch closure of the PML, commissurotomy, and lifting annuloplasty. The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making. PMID:24567819

  1. Monitoring male canoeists' cardiac function by Doppler-echocardiography during heavy load exercise

    NASA Astrophysics Data System (ADS)

    Xu, Guodong; Tan, Huan; Mao, Zongzhen

    2007-05-01

    This study is to evaluate cardiac systolic and diastolic function of Chinese male canoeists during heavy load exercise training by Doppler echocardiography. Eighteen young male volunteer canoeists were tested, and trained five weeks. Then the change of cardiac systolic and diastolic function of the tester was examined by the Doppler echocardiography method.The results showed that there were no significant differences of LVEF and ?%D, but the E/A ratio of elite canoeists reduced (p<0.05) after the heavy load exercise training. Moreover, the ratio of E/A less than 1 was found in two elite canoeists. The further research is required to understand the mechanism of the change. These results showed that monitoring of diastolic function was more meaningful than monitoring of systolic function during the heavy load exercise training, especially not neglected the cardiac function of elite canoeists.

  2. Teaching focused echocardiography for rheumatic heart disease screening.

    PubMed

    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

  3. 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.

  4. Clinical application and laboratory protocols for performing contrast echocardiography

    PubMed Central

    Chong, Adrian; Haluska, Brian; Wahi, Sudhir

    2013-01-01

    Technically difficult echocardiographic studies with suboptimal images remain a significant challenge in clinical practice despite advances in imaging technologies over the past decades. Use of microbubble ultrasound contrast for left ventricular opacification and enhancement of endocardial border detection during rest or stress echocardiography has become an essential component of the operation of the modern echocardiography laboratory. Contrast echocardiography has been demonstrated to improve diagnostic accuracy and confidence across a range of indications including quantitative assessment of left ventricular systolic function, wall motion analysis, and left ventricular structural abnormalities. Enhancement of Doppler signals and myocardial contrast echocardiography for perfusion remain off-label uses. Implementation of a contrast protocol is feasible for most laboratories and both physicians and sonographers will require training in contrast specific imaging techniques for optimal use. Previous concerns regarding the safety of contrast agents have since been addressed by more recent data supporting its excellent safety profile and overall cost-effectiveness. PMID:23809394

  5. Effects of Prolonging Peak Dobutamine Dose During Stress Echocardiography

    Microsoft Academic Search

    Neil J Weissman; Geoffrey A Rose; Gary P Foster; Michael H Picard

    1997-01-01

    Objectives. This study sought to test whether the physiologic advantage of a prolonged dobutamine stage during stress echocardiography can be effectively combined with a clinically practical infusion protocol.Background. Dobutamine has a half-life of 2 min and requires up to 10 min to achieve steady state. Despite these known pharmacodynamics, dobutamine stress echocardiography is routinely performed by advancing doses at 3-min

  6. Diagnostic value of echocardiography in infective endocarditis: a probabilistic approach.

    PubMed

    Cecchi, E; Chinaglia, A; Parrini, I; Pomari, F; Brusca, A; Trinchero, R

    1997-12-01

    The high sensitivity and specificity of echocardiography in the diagnosis of infective endocarditis have been well established for a number of years. However, little is known yet about the incremental value of this technique over the clinical and serological findings already available in subsets of patients presenting different initial probabilities in infective endocarditis. In this report, sensitivity and specificity of echocardiography were calculated in 173 consecutive patients with suspected infective endocarditis who underwent echocardiography within 5 days following admission. The echocardiogram was considered positive when Duke major criteria were fulfilled. Infective endocarditis was diagnosed in 88 patients, while other illnesses in the remaining 85. The diagnoses were confirmed retrospectively with a follow-up done after at least 3 months, at surgery or during autopsy. Sensitivity and specificity of the echocardiography in this population were 85 and 97% respectively. The initial probabilities of infective endocarditis in patients with different clinical presentations were taken from a thorough review of the literature available in English and from personal research. The positive predictive value of echocardiography is already high or very high even at low or very low levels of initial probability, and this has a strong impact on clinical decisions. In these situations and with intermediate probabilities, a negative echocardiogram would theoretically rule out the disease. However, this result, if considered alone, calls for a careful reassessment of the entire clinical context. As with any other test, when the initial probabilities of infective endocarditis are highest, the incremental value of echocardiography is poor. PMID:9470057

  7. 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

  8. Cancer therapy and cardiotoxicity: the need of serial Doppler echocardiography.

    PubMed

    Galderisi, Maurizio; Marra, Francesco; Esposito, Roberta; Lomoriello, Vincenzo Schiano; Pardo, Moira; de Divitiis, Oreste

    2007-01-01

    Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the quality of life and the prognosis. For several years the most common noninvasive method of monitoring cardiotoxicity has been represented by radionuclide ventriculography while other tests as effort EKG and stress myocardial perfusion imaging may detect ischemic complications, and 24-hour Holter monitoring unmask suspected arrhythmias. Also biomarkers such as troponine I and T and B-type natriuretic peptide may be useful for early detection of cardiotoxicity. Today, the widely used non-invasive method of monitoring cardiotoxicity of cancer therapy is, however, represented by Doppler-echocardiography which allows to identify the main forms of cardiac complications of cancer therapy: left ventricular (systolic and diastolic) dysfunction, valve heart disease, pericarditis and pericardial effusion, carotid artery lesions. Advanced ultrasound tools, as Integrated Backscatter and Tissue Doppler, but also simple ultrasound detection of "lung comet" on the anterior and lateral chest can be helpful for early, subclinical diagnosis of cardiac involvement. Serial Doppler echocardiographic evaluation has to be encouraged in the oncologic patients, before, during and even late after therapy completion. This is crucial when using anthracyclines, which have early but, most importantly, late, cumulative cardiac toxicity. The echocardiographic monitoring appears even indispensable after radiation therapy, whose detrimental effects may appear several years after the end of irradiation. PMID:17254324

  9. Cancer therapy and cardiotoxicity: The need of serial Doppler echocardiography

    PubMed Central

    Galderisi, Maurizio; Marra, Francesco; Esposito, Roberta; Lomoriello, Vincenzo Schiano; Pardo, Moira; de Divitiis, Oreste

    2007-01-01

    Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the quality of life and the prognosis. For several years the most common noninvasive method of monitoring cardiotoxicity has been represented by radionuclide ventriculography while other tests as effort EKG and stress myocardial perfusion imaging may detect ischemic complications, and 24-hour Holter monitoring unmask suspected arrhythmias. Also biomarkers such as troponine I and T and B-type natriuretic peptide may be useful for early detection of cardiotoxicity. Today, the widely used non-invasive method of monitoring cardiotoxicity of cancer therapy is, however, represented by Doppler-echocardiography which allows to identify the main forms of cardiac complications of cancer therapy: left ventricular (systolic and diastolic) dysfunction, valve heart disease, pericarditis and pericardial effusion, carotid artery lesions. Advanced ultrasound tools, as Integrated Backscatter and Tissue Doppler, but also simple ultrasound detection of "lung comet" on the anterior and lateral chest can be helpful for early, subclinical diagnosis of cardiac involvement. Serial Doppler echocardiographic evaluation has to be encouraged in the oncologic patients, before, during and even late after therapy completion. This is crucial when using anthracyclines, which have early but, most importantly, late, cumulative cardiac toxicity. The echocardiographic monitoring appears even indispensable after radiation therapy, whose detrimental effects may appear several years after the end of irradiation. PMID:17254324

  10. Impact of Implantable Transvenous Device Lead Location on Severity of Tricuspid Regurgitation

    PubMed Central

    Addetia, Karima; Maffessanti, Francesco; Mediratta, Anuj; Yamat, Megan; Weinert, Lynn; Moss, Joshua D.; Nayak, Hemal M.; Burke, Martin C.; Patel, Amit R.; Kruse, Eric; Jeevanandam, Valluvan; Mor-Avi, Victor; Lang, Roberto M.

    2015-01-01

    Background Implantable device leads can cause tricuspid regurgitation (TR) when they interfere with leaflet motion. The aim of this study was to determine whether lead-leaflet interference is associated with TR severity, independent of other causative factors of functional TR. Methods A total of 100 patients who underwent transthoracic two-dimensional and three-dimensional (3D) echocardiography of the tricuspid valve before and after lead placement were studied. Lead position was classified on 3D echocardiography as leaflet-interfering or noninterfering. TR severity was estimated by vena contracta (VC) width. Logistic regression analysis was used to identify factors associated with postdevice TR, including predevice VC width, right ventricular end-diastolic and end-systolic areas, fractional area change, right atrial size, tricuspid annular diameter, TR gradient, device lead age, and presence or absence of lead interference. Odds ratios were used to describe the association with moderate (VC width ? 0.5 cm) or severe (VC width ? 0.7 cm) TR, separately, using bivariate and stepwise multivariate logistic regression analysis. Results Forty-five of 100 patients showed device lead tricuspid valve leaflet interference. The septal leaflet was the most commonly affected (23 patients). On bivariate analysis, preimplantation VC width, right atrial size, tricuspid annular diameter, and lead-leaflet interference were significantly associated with postdevice TR. On multivariate analysis, preimplantation VC width and the presence of an interfering lead were independently associated with postdevice TR. Furthermore, the presence of an interfering lead was the only factor associated with TR worsening, increasing the likelihood of developing moderate or severe TR by 15- and 11-fold, respectively. Conclusion Lead-leaflet interference as seen on 3D echocardiography is associated with TR after device lead placement, suggesting that 3D echocardiography should be used to assess for lead interference in patients with significant TR. PMID:25129393

  11. Judicious use of transthoracic echocardiography in infective endocarditis screening

    PubMed Central

    Liu, Yen-Wen; Tsai, Wei-Chuan; Hsu, Chih-Hsin; Lin, Li-Jen; Li, Wei-Ting; Chen, Chun-Hsiu; Chen, Jyh-Hong

    2009-01-01

    BACKGROUND: Patients with a very low probability of infective endocarditis (IE) do not benefit from transthoracic echocardiography (TTE). Because the term ‘very low probability’ has not yet been defined, the present prospective study sought to identify the population with a ‘very low probability’. METHODS: TTE was performed between July 2005 and October 2006 in consecutive patients clinically suspected of having IE. Clinical parameters suggestive of IE and presence of infectious focus were recorded. RESULTS: Twenty-four (15.5%) of 155 patients studied had positive findings on TTE. Significant positive predictors were embolic events, intravenous drug use, the presence of a prosthetic valve, positive blood cultures and immunological phenomena. The significant negative predictor was confirmed infection sites other than endocardium. Sixty-three (40.6%) of 155 patients without positive predictors were found to have no vegetation. Thus, the collective absence of these predictors indicated a zero probability of TTE showing evidence of IE. A significant negative predictor was a definite etiology of infection other than IE. Only one in 76 patients was diagnosed with both IE and infection at another site. CONCLUSIONS: The absence of positive predictors or the presence of a negative predictor indicate a near-zero probability of IE being detected by TTE. Use of clinical parameters may avoid up to 41% of unnecessary TTE examinations, increasing the likelihood that such a diagnosis will be correct. PMID:19960131

  12. 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

  13. Reliability of subcostal TD echocardiography to detect atrial septal defect.

    PubMed

    Gullace, G; Savoia, M T; Knippel, M; Ravizza, P; Ranzi, C

    1982-01-01

    Echocardiography was used in 40 patients with atrial septal defect (ASD), diagnosed by cardiac catheterization. A dilated right ventricle and abnormal interventricular septal motion were observed at M-mode echocardiography in patients with large L-R shunt. The two-dimensional apical four chamber view was reliable to detect the ostium primum type but not the secundum type of ASD. Moreover the presence of false positives reduced the specificity and predictivity of this approach. The two-dimensional subcostal view provided a direct visualization of the interatrial communication (sensitivity, specificity and predictivity = 100%) and whether the defect was in the uppermost, lowermost or midportion of the septum. Subcostal two-dimensional echocardiography is considered valuable and reliable technique to detect atrial septal defect and the type of the defect itself. PMID:7128991

  14. Visualization of elusive structures using intracardiac echocardiography: Insights from electrophysiology

    PubMed Central

    Szili-Torok, T; McFadden, EP; Jordaens, LJ; Roelandt, JRTC

    2004-01-01

    Electrophysiological mapping and ablation techniques are increasingly used to diagnose and treat many types of supraventricular and ventricular tachycardias. These procedures require an intimate knowledge of intracardiac anatomy and their use has led to a renewed interest in visualization of specific structures. This has required collaborative efforts from imaging as well as electrophysiology experts. Classical imaging techniques may be unable to visualize structures involved in arrhythmia mechanisms and therapy. Novel methods, such as intracardiac echocardiography and three-dimensional echocardiography, have been refined and these technological improvements have opened new perspectives for more effective and accurate imaging during electrophysiology procedures. Concurrently, visualization of these structures noticeably improved our ability to identify intracardiac structures. The aim of this review is to provide electrophysiologists with an overview of recent insights into the structure of the heart obtained with intracardiac echocardiography and to indicate to the echo-specialist which structures are potentially important for the electrophysiologist. PMID:15253772

  15. Quantitative Texture Analysis and Transesophageal Echocardiography to Characterize the Acute Myocardial Contusion

    PubMed Central

    Amichi, Abdelaziz; Laugier, Pascal

    2009-01-01

    Myocardial contusion (MC) is a common injury following blunt chest trauma without any specific symptoms. Several techniques such as electrocardiogram, estimation of myocardial band fraction of creatine phosphokinase, chest radiography and the scintiscanning missed efficiency to characterize the MC. Another technique based on transesophageal echocardiography [TEE] allows to visualize the structures of the heart with a good spatial resolution. We postulated that the quantitative texture analysis of regional image texture in two- dimensional [2D] TEE echocardiograms would be an accurate method to differentiate normal from abnormal myocardial wall. This preliminary experimental study demonstrated the feasibility of the proposed technique. PMID:19587806

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

    Microsoft Academic Search

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

    2007-01-01

    ABSTRACT: 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

  17. "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…

  18. Association of atheroma as assessed by intraoperative transoesophageal echocardiography with long-term mortality in patients undergoing cardiac surgery

    Microsoft Academic Search

    Senthil K. Thambidorai; Sukaina J. Jaffer; Tushar K. Shah; William J. Stewart; Allan L. Klein; Michael S. Lauer

    2007-01-01

    Aims To determine whether the presence and severity of aortic atheroma predict long-term all-cause mortality among patients undergoing cardiac surgery. Methods and results We followed 8581 patients who underwent cardiac surgery and had routine intra- operative transoesophageal echocardiography for 2.8 years (range 0.06-6.0 years). Data regarding mul- tiple potential confounders were prospectively collected and electronically recorded. There were 2878 (34%)

  19. Evaluation of cardiac function using transthoracic echocardiography in patients with myocardial injury secondary to methomyl poisoning.

    PubMed

    Lee, Dong Keon; Cho, Nam Hyub; Kim, Oh Hyun; Go, Jin; Kim, Tae Hoon; Cha, Kyoung Chul; Kim, Hyun; Lee, Kang Hyun; Hwang, Sung Oh; Cha, Yong Sung

    2015-07-01

    Generally, the mortality rate for cases of carbamate poisoning is low, but fatalities secondary to methomyl poisoning have been reported including a case report of cardiac toxicity following short-term exposure to methomyl. There have been no reports, however, regarding patterns of cardiac toxicity after exposure to methomyl. Therefore, we investigated the prevalence and patterns of myocardial injury using a biochemical marker, troponin I (TnI), and evaluated cardiac function using transthoracic echocardiography (TTE). We conducted a retrospective review of 14 consecutive methomyl poisoning cases that were diagnosed and treated at the emergency department of the Wonju Severance Christian Hospital between January 2009 and December 2013. On ECG analysis, ST depression and T-wave inversion were seen in five patients (35.7 %) and one patient (7.1 %), respectively. On cardiac biochemical marker analysis, initial TnI was elevated in 11 patients (78.6 %). TTE was performed in nine patients among the 11 patients in whom TnI was found to be elevated. Of the nine patients that underwent TTE, three patients (33.3 %) showed a reduced ejection fraction (EF), and RWMA was noted in two patients. There were two patients (22.2 %) that had both reduced systolic function and RWMA. One patient did not regain normal systolic function on admission. None of the three patients with reduced EF received any specific treatment to support cardiac function. One patient expired due to pneumonia, and one patient was transferred as moribund. We followed up on 12 patients who survived to discharge for 6-44 months. One patient (8.3 %) was died to follow-up, and 11 patients survived without any further complications. Methomyl exposure can cause direct myocardial injury and reversible cardiac dysfunction. Monitoring of TnI levels and TTE for evaluation of cardiac function may be useful in the workup of patients suffering from methomyl poisoning. PMID:25410938

  20. Sci Show

    NSDL National Science Digital Library

    The Sci Show, an entertaining series of quirky YouTube videos, tackles topics ranging from â??How Do Polarized Sunglasses Workâ? to â??Strong Interaction: The Four Fundamental Forces of Physics.â? Most episodes are less than five minutes long, but they pack a wallop of handy science info. Anyone short on time but long on big questions will benefit from the series. Episodes will be helpful to teachers and parents looking to spark enthusiasm in young minds. Viewers may want to start with recent episodes like â??Todayâ??s Mass Extinction,â? and the â??Worldâ??s First See-Through Animalâ? and â??How Do Animals Change Color?â? before digging into the archives for gems like â??The Truth About Gingersâ? and â??The Science of Lying.â?

  1. Effect of dobutamine stress echocardiography on mitral regurgitation

    Microsoft Academic Search

    Sheila K Heinle; Frank D Tice; Joseph Kisslo

    1995-01-01

    Objectives. This study was performed to examine the effect of dobutamine stress echocardiography on mitral regurgitation and to test the hypothesis that mitral regurgitation will increase in patients with an ischemic response.Background. New or worsening mitral regurgitation during stress testing has been proposed as a marker of ischemia. However, it is unclear whether ischemia induced by dobutamine is associated with

  2. Prediction of Ductus Arteriosus Closure by Neonatal Screening Echocardiography

    Microsoft Academic Search

    Sheng-Ling Jan; Betau Hwang; Yun-Ching Fu; Ching-Shiang Chi

    2004-01-01

    Aims: We reported the incidence, clinical manifestations and outcome of patent ductus arteriosus (PDA) in full-term infants by screening echocardiography. Methods and results: Total 1230 infants received echocardiographic screening and periodic follow-up. On the third day of life, there were 109 infants with isolated ductus arteriosus aneurysm (DAA), those with persistent patency of the ductus arteriosus (DA) in 26. The

  3. Transthoracic echocardiography in obstetric anaesthesia and obstetric critical illness

    Microsoft Academic Search

    A. T. Dennis

    2011-01-01

    Transthoracic echocardiography (TTE) is a powerful non-invasive diagnostic, monitoring and measurement device in medicine. In addition to cardiologists, many other specialised groups, including emergency and critical care physicians and cardiac anaesthetists, have recognised its ability to provide high quality information and utilise TTE in the care of their patients. In obstetric anaesthesia and management of obstetric critical illness, the favourable

  4. Estimating pulmonary artery pressures by echocardiography in patients with

    Microsoft Academic Search

    M. R. Fisher; G. J. Criner; A. P. Fishman; P. M. Hassoun; O. A. Minai; S. M. Scharfe

    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

  5. Feasibility Study for Real Time Three Dimensional Doppler Intracardiac Echocardiography

    E-print Network

    Smith, Stephen

    obtained real-time three-dimensional Color Flow and Spectral Doppler ultrasound images in phantoms. We have1 Feasibility Study for Real Time Three Dimensional Doppler Intracardiac Echocardiography Edward D Doppler signals in two phantoms, a string phantom and a pulsatile flow phantom. Using an open chest sheep

  6. 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 ...

  7. Contrast-echocardiography and videodensitometry for assessing right ventricular hemodynamics

    Microsoft Academic Search

    M. Suurkula; T. Gustavsson

    1997-01-01

    Available techniques for diagnosis and evaluation of right ventricular (RV) function are limited. In patients with arrhythmogenic right ventricular dysplasia (ARVD) it is of great importance to assess RV wall motion and function for diagnosis, prognosis and treatment. Contrast echocardiography and videodensitometry can be used to illustrate regional and global RV hemodynamics. The authors investigated patients with ARVD and healthy

  8. Accurate adjustment of de Vega tricuspid annuloplasty using transesophageal echocardiography.

    PubMed

    Cook, J W

    1994-08-01

    Intraoperative transesophageal echocardiography is used to adjust the tension of a de Vega tricuspid annuloplasty suture. Leading the suture outside the right atrium allows the annulus to be adjusted after cardiopulmonary bypass is discontinued when cardiac function has returned. PMID:8067873

  9. Transcranial Doppler Sonography: Atypical Dicrotic Pulse Waveforms in a Man with HIV Infection and Severe Cardiomyopathy.

    PubMed

    Suwatcharangkoon, Sureerat; Meads, Dana B; Tegeler, Charles H; Reynolds, Patrick S

    2015-07-01

    A 27-year-old human immunodeficiency virus-positive man presented with abdominal pain. Computed tomography of the abdomen revealed large right pleural effusion, pericardial effusion and marked ascites with diffuse intra- and extraperitoneal lymphadenopathy. Echocardiography showed severely reduced left ventricular systolic function. After drainage of pleural and pericardial fluid, the patient developed severe hypotension and hypoxic respiratory failure. Extra- and intracranial neurovascular sonography demonstrated low carotid artery flow volume and dicrotic pulse waveforms in all vessels insonated bilaterally. This case report demonstrates an atypical dicrotic waveform pattern of transcranial Doppler in advanced ventricular dysfunction with shock. PMID:25289479

  10. Multiplane transesophageal echocardiography performed according to the guidelines of the American Society of Echocardiography in patients with mitral valve prolapse, flail, and endocarditis: Diagnostic accuracy in the identification of mitral regurgitant defects by correlation with surgical findings

    Microsoft Academic Search

    Eustachio Agricola; Michele Oppizzi; Michele De Bonis; Francesco Maisano; Lucia Toracca; Tiziana Bove; Ottavio Alfieri

    2003-01-01

    Multiplane transesophageal echocardiography is a useful tool to study mitral regurgitation. We evaluated the diagnostic accuracy of multiplane transesophageal echocardiography performed according to the guidelines of the American Society of Echocardiography. We used 4 midesophageal and 2 transgastric views in 313 patients with degenerative lesions, endocarditic lesions, or both to identify regurgitant defects, comparing transesophageal echocardiography results with surgical findings.

  11. Detection of coronary artery disease in diabetic hypertensive patients using conventional transthoratic echocardiography at rest.

    PubMed

    Zhang, Jie; Fan, Ji-Xu; Sun, Cheng-Bo; Liu, Yan; Wang, Yan; Guo, Yang; Li, Hong-E

    2015-06-01

    To investigate the usefulness of conventional transthoratic echocardiography in identifying coronary artery disease (CAD) in diabetic hypertensive patients, transthoratic echocardiography and coronary angiography were performed in 122 diabetic hypertensive patients with suspected CAD. Correlation analysis, multivariate analysis and receiver operating characteristic curve (ROC) analysis were done. Diabetic hypertensive patients with CAD had significantly smaller coronary sinus diameter (Dcs), less velocity time integral (VTI), less coronary sinus flow (Flow) and less Flow divided by left ventricular mass (Flow/LVM) at rest versus normal participants (P < 0.01) and diabetic hypertensive patients without CAD (P < 0.05). The VTI, Dcs, Flow, LVM and Flow/LVM all showed significant correlations with the maximal percent stenosis of the coronary artery lesions (P < 0.05). However, only Flow showed statistically significant correlations with the maximal percent stenosis of the coronary artery lesions (P < 0.01) when multiple stepwise regression analysis was performed. For predicting CAD (angiographically proven, >50 %) in diabetic hypertensive patients, the area under the ROC (AUC) was 0.92 for Flow, and a cut-off of <220 ml/min had a 93.2 % sensitivity, 87.9 % specificity and 91.3 % accuracy. For predicting a >70 % coronary artery stenosis, the AUC was 0.88 for Flow, and a cut-off of <147 ml/min had an 89.5 % sensitivity, 87.4 % specificity and 88.5 % accuracy. Conventional transthoratic echocardiography can effectively and sensitively detect the CAD in diabetic hypertensive patients at rest. The reduced coronary sinus flow is a sensitive and specific predictor of CAD in diabetic hypertensive patients. PMID:25827068

  12. Comparison of direct planimetry of mitral valve regurgitation orifice area by three-dimensional transesophageal echocardiography to effective regurgitant orifice area obtained by proximal flow convergence method and vena contracta area determined by color Doppler echocardiography.

    PubMed

    Altiok, Ertunc; Hamada, Sandra; van Hall, Silke; Hanenberg, Mehtap; Dohmen, Guido; Almalla, Mohammed; Grabskaya, Eva; Becker, Michael; Marx, Nikolaus; Hoffmann, Rainer

    2011-02-01

    Direct measurement of anatomic regurgitant orifice area (AROA) by 3-dimensional transesophageal echocardiography was evaluated for analysis of mitral regurgitation (MR) severity. In 72 patients (age 70.6 ± 13.3 years, 37 men) with mild to severe MR, 3-dimensional transesophageal echocardiography and transthoracic color Doppler echocardiography were performed to determine AROA by direct planimetry, effective regurgitant orifice area (EROA) by proximal convergence method, and vena contracta area (VCA) by 2-dimensional color Doppler echocardiography. AROA was measured with commercially available software (QLAB, Philips Medical Systems, Andover, Massachusetts) after adjusting the first and second planes to reveal the smallest orifice in the third plane where planimetry could take place. AROA was classified as circular or noncircular by calculating the ratio of the medial-lateral distance above the anterior-posterior distance (?1.5 compared to >1.5). AROA determined by direct planimetry was 0.30 ± 0.20 cm², EROA determined by proximal convergence method was 0.30 ± 0.20 cm², and VCA was 0.33 ± 0.23 cm². Correlation between AROA and EROA (r = 0.96, SEE 0.058 cm²) and between AROA and VCA (r = 0.89, SEE 0.105 cm²) was high considering all patients. In patients with a circular regurgitation orifice area (n = 14) the correlation between AROA and EROA was better (r = 0.99, SEE 0.036 cm²) compared to patients with noncircular regurgitation orifice area (n = 58, r = 0.94, SEE 0.061 cm²). Correlation between AROA and EROA was higher in an EROA ?0.2 cm² (r = 0.95) than in an EROA <0.2 cm² (r = 0.60). In conclusion, direct measurement of MR AROA correlates well with EROA by proximal convergence method and VCA. Agreement between methods is better for patients with a circular regurgitation orifice area than in patients with a noncircular regurgitation orifice area. PMID:21257014

  13. A review of echocardiography in anaesthetic and peri-operative practice. Part 2: training and accreditation.

    PubMed

    Sharma, V; Fletcher, S N

    2014-08-01

    Echocardiography has been widely adopted as a diagnostic and monitoring tool in cardiac anaesthesia and critical care. There is considerable interest in how echocardiography could be used to benefit patients in other areas of anaesthesia and peri-operative practice. The first part of review examines the impact and utility of echocardiography, while this second part is concerned with the matter of training and accreditation. There are a number of existing clinical protocols for the use of transthoracic echocardiography with a focused approach. Some of these, such as Focused Intensive Care Echocardiography in the UK, have been developed into structured accreditation processes with embedded supervision. Learning opportunities are now emerging for anaesthetists who wish to acquire echocardiography skills--these encompass clinical, simulation and online resources. Whilst the roll-out of echocardiography for more widespread use in peri-operative management is a long-term project, it is now an appropriate time to consider how this may be achieved. PMID:24801304

  14. Methodologic comparison of left ventricular stroke volumes in the early neonatal period by echocardiography.

    PubMed

    Nagasawa, Hiroyuki; Kohno, Yoshinori; Yamamoto, Yutaka; Kondo, Masashi; Sugawara, Masami; Koyama, Toshinari; Terazawa, Daisuke; Miura, Ryosuke

    2014-12-01

    Several methods for evaluating left ventricular stroke volume (SV) in neonates using echocardiography have been reported. However, no studies on methodologic comparison of SV with three-dimensional (3D) echocardiography are available. This is the first detailed report on a methodologic comparison of SV in the early neonatal period. The study group included 70 normal neonates (35 boys and 35 girls). An iE33 echocardiograph and Q-LAB supplied by Philips Electronics were used to examine and calculate volumes. Comparisons of SV were performed using Teichholz (T), the velocity time integral (VTI), Pombo (P), modified Simpson (MS), and 3D methods with normal neonates who had no persistent ductus arteriosus less than 7 days after birth. The mean SVs were 33.7 mL/m(2) (T), 30.6 mL/m(2) (VTI), 22.0 mL/m(2) (P), 17.5 mL/m(2) (3D), and 14.9 mL/m(2) (MS) using Haycock's formula of body surface area. The stroke volumes differed significantly depending on the different methods. The correlation coefficient was highest between the MS and 3D methods. The SVs of the T and VTI methods were significantly greater than those previously reported, and it seemed inappropriate to evaluate volumes in neonates. The 3D and MS methods were appropriate for measuring SV in neonates during the early neonatal period. PMID:24916967

  15. 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

  16. 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.

  17. Left atrium function assessment by echocardiography - physiological and clinical implications.

    PubMed

    Lupu, Silvia; Mitre, Adriana; Dobreanu, Dan

    2014-06-01

    Left atrium enlargement is a pathophysiological response to volume and pressure overload associated with a wide range of cardiovascular disorders leading to left ventricle systolic and diastolic dysfunction. Physiological factors contribute to significant differences in left atrium size in normal individuals. Moreover, left atrium enlargement was shown to have a significant prognostic value for cardiovascular events such as heart failure, atrial fibrillation or stroke, and increased cardiovascular and all-cause mortality rates. Current imaging techniques such as two- and three dimensional echocardiography, cardiac magnetic resonance imaging and multi-detector computed tomography allow a detailed assessment of the left atrium. The current paper aims to offer an overview of two-dimensional echocardiography parameters which provide data concerning left atrium dimensions and phasic functions and may lead to a better understanding of left atrium physiology and pathology. PMID:24791847

  18. 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

  19. Transoesophageal echocardiography reduces invasiveness of cavoatrial tumour thrombectomy.

    PubMed

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

    2014-09-01

    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

  20. Preoperative Evaluation for Bariatric Surgery using Transesophageal Dobutamine Stress Echocardiography

    Microsoft Academic Search

    Geetha Bhat; Kathy Daley; Margaret Dugan; Gerald Larson

    2004-01-01

    Background: Bariatric surgery is an effective option for weight control in morbid obesity. The goal of this study was to assess\\u000a cardiac risk prior to bariatric surgery using transesophageal-dobutamine stress echocardiography (TE-DSE). Methods: 7 morbidly\\u000a obese patients (mean BMI 67.7 ? 15.6) were prospectively evaluated by TE-DSE prior to bariatric surgery. Results: All patients\\u000a underwent TE-DSE without complications. 6 of

  1. Hemodynamic evaluation of the prone position by transesophageal echocardiography

    Microsoft Academic Search

    Shigeyoshi Toyota; Yoshikiyo Amaki

    1998-01-01

    Study Objective: To evaluate the hemodynamic response in the prone position in surgical patients by measuring the effects of prone positioning on cardiac function using transesophageal echocardiography (TEE).Design: Prospective study.Setting: Elective surgery at a university hospital.Patients: 15 adult ASA physical status I and II patients free of significant coexisting disease undergoing lumbar laminectomy.Interventions and Measurements: Approximately 15 minutes after the

  2. Integrated surface model optimization for freehand three-dimensional echocardiography

    Microsoft Academic Search

    Mingzhou Song; Robert M. Haralick; Florence H. Sheehan; Richard K. Johnson

    2002-01-01

    The major obstacle of three-dimensional (3-D) echocardiography is that the ultrasound image quality is too low to reliably detect features locally. Almost all available surface-finding algorithms depend on decent quality boundaries to get satisfactory surface models. We formulate the surface model optimization problem in a Bayesian framework, such that the inference made about a surface model is based on the

  3. How standard transesophageal echocardiography views change with dextrocardia.

    PubMed

    Raut, Monish S; Maheshwari, Arun; Shad, Sujay; Rachna, G

    2013-01-01

    Dextrocardia with situs inversus is a rare condition. Situs inversus with dextrocardia is also called as "situs inversus totalis". Transesophageal echocardiography (TEE) views in dextrocardia patient are not discussed in the literature. The cardiac position and the cardiac chambers are mirror image of the normal anatomy. Because of this positional change, certain TEE probe and multiplane angle manipulations are required to obtain the recommended views. PMID:23816679

  4. Echocardiography-Guided Ethanol Septal Reduction for Hypertrophic Obstructive Cardiomyopathy

    Microsoft Academic Search

    Nasser M. Lakkis; Sherif F. Nagueh; Neal S. Kleiman; Donna Killip; Zuo-Xiang He; Mario S. Verani; Robert Roberts; William H. Spencer III

    2010-01-01

    Background—Left ventricular outflow tract (LVOT) obstruction is frequently responsible for symptoms in hypertrophic obstructive cardiomyopathy (HOCM). Medical therapy is often not sufficient to control these symptoms, and surgical myotomy-myomectomy is required. Methods and Results—We enrolled 33 symptomatic patients with HOCM and obstruction ( $40 mm Hg gradient at rest or $60 mm Hg dobutamine-provoked). By contrast echocardiography, the bulging septum

  5. Quantifying Pulmonary Regurgitation and Right Ventricular Function in Surgically Repaired Tetralogy of Fallot: A Comparative Analysis of Echocardiography and Magnetic Resonance Imaging

    PubMed Central

    Mercer-Rosa, Laura; Yang, Wei; Kutty, Shelby; Rychik, Jack; Fogel, Mark; Goldmuntz, Elizabeth

    2012-01-01

    Background Patients with repaired tetralogy of Fallot (TOF) are monitored for pulmonary regurgitation (PR), and right ventricular (RV) function. We sought to compare measures of PR and RV function on echocardiogram to those on cardiac magnetic resonance (CMR), and to develop a new tool for assessing PR by echocardiogram. Methods and Results Patients with repaired TOF (N=143, 12.5± 3.2 years) had an echocardiogram and CMR within three months of each other. On echocardiogram, RV function was assessed by (1) Doppler tissue imaging of the RV free wall, and (2) myocardial performance index (MPI). The ratio of diastolic and systolic time-velocity integrals (DSTVI) measured by Doppler of the main pulmonary artery was calculated. CMR variables included RV ejection fraction (EF), RV volumes, and pulmonary regurgitant fraction (RF). Pulmonary regurgitation was graded as mild (RF <20%), moderate (RF=20–40%), and severe (RF>40%). On CMR, RF was 34±17% and RV EF was 61±8%. Echocardiography had good sensitivity identifying cases with RF>20% (sensitivity 97%, 95% CI: 92–99%) but overestimated the amount of PR when RF<20% (false positive rate 36%, 95% CI: 18–57%). The DSTVI on echocardiogram showed moderate correlation with RF on CMR (R=0.60, P<0.0001). On CMR, RF of 20% and 40% corresponded with a DSTVI of 0.49 (95% CI: 0.44–0.56), and 0.72 (95% CI: 0.68–0.76), respectively. RV MPI correlated modestly with RV EF (r=?0.33, P<0.001). Conclusions This study suggests that the DSTVI ratio may make a modest contribution to the overall assessment of PR in patients with repaired TOF and warrants further investigation. However, echocardiography continues to have a limited ability to quantify PR and RV function as compared to CMR. PMID:22869820

  6. Regional wall motion analysis by dobutamine stess echocardiography to distinguish between ischemic and nonischemic dilated cardiomyopathy.

    PubMed

    Vigna, C; Russo, A; De Rito, V; Perna, G P; Testa, M; Lombardo, A; Lanna, P; Langialonga, T; Salvatori, M P; Fanelli, R; Loperfido, F

    1996-03-01

    To distinguish between ischemic and nonischemic dilated cardiomyopathy (DCM), we studied 43 patients with left ventricular dysfunction (15 ischemic and 28 nonischemic detected by coronary angiography) by dobutamine stress echocardiography. At rest, there were more normal segments (p<0.001) and a trend toward more akinetic segments (p, not significant) per ischemic than per nonischemic DCM patient. However, either at rest or with low-dose dobutamine, individual data largely overlapped. At peak dose, in ischemic DCM, regional contraction worsened in many normal or dys-synergic regions at rest (in the latter case after improvement with low-dose dobutamine); in contrast, in nonischemic DCM, further mild improvement was observed in a variable number of left ventricular areas. Thus with peak-dose dobutamine, more akinetic and less normal segments were present per ischemic than per nonischemic DCM patient (both, p<0.001). A value of six or more akinetic segments was 80% sensitive and 96% specific for ischemic DCM. Our data show that analysis of regional contraction by dobutamine stress echocardiography can distinguish between ischemic and nonischemic DCM. PMID:8604635

  7. Additive value of dobutamine stress echocardiography in patients with an anomalous origin of a coronary artery.

    PubMed

    Lameijer, Heleen; Ter Maaten, Jozine M; Steggerda, Robbert C

    2015-02-01

    An anomalous origin of a coronary artery (AOCA) is the second most common cause of non-traumatic sudden cardiac death in young athletes. Patients with a malignant course of an AOCA of the right coronary artery only need surgical correction when myocardial ischaemia is detected. An AOCA and its malignant or benign course can be detected by coronary angiography, coronary computed tomography or cardiac magnetic resonance imaging. Detection of ischaemia can be more difficult since even a negative maximal-effort stress ECG does not exclude a potential lethal coronary anomaly. Also, there are no case series or trials showing sensitivity or specificity for any form of ischaemia detection for AOCA in the literature. Although not described previously in adults, dobutamine stress echocardiography was previously described in a paediatric population with AOCA. We are the first to describe ischaemia detection by dobutamine stress echocardiography in three adult patients with an AOCA of the right coronary artery who were subsequently referred for surgery. PMID:25620696

  8. 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

  9. 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

  10. [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.

  11. Two and three dimensional echocardiography for pre-operative assessment of mitral valve regurgitation.

    PubMed

    Quader, Nishath; Rigolin, Vera H

    2014-01-01

    Mitral regurgitation may develop when the leaflets or any other portion of the apparatus becomes abnormal. As the repair techniques for mitral valve disease evolved, so has the need for detailed and accurate imaging of the mitral valve prior to surgery in order to better define the mechanism of valve dysfunction and the severity of regurgitation. In patients with significant mitral valve disease who require surgical intervention, multiplane transesophageal echocardiogram (TEE) is invaluable for surgical planning. However, a comprehensive TEE in a patient with complex mitral valve disease requires great experience and skill. There is evidence to suggest that 3D echocardiography can overcome some of the limitations of 2D multiplane TEE and thus is crucial in evaluation of patients undergoing mitral valve surgery. In the following sections, we review some of the crucial 2D and 3D echo images necessary for evaluation of MR based on the Carpentier classification. PMID:25344779

  12. Evaluation of the regional ventricular systolic function by two-dimensional strain echocardiography in gestational diabetes mellitus (GDM) fetuses with good glycemic control.

    PubMed

    Wang, Hongying; Xu, Yi; Fu, Jing; Huang, Lan

    2014-11-28

    Abstract Objective: The aim is to quantitatively assess regional ventricular systolic function by two-dimensional strain (2DS) echocardiography in gestational diabetes mellitus (GDM) fetuses with good glycemic control. Methods: We studied 60 consecutive normal fetuses and 35 fetuses of GDM mothers with good glycemic control by echocardiography. M-mode and two-dimensional echocardiography were used to measure ejection fraction and wall dimensions of left ventricle and right ventricle. Both left and right ventricle peak systolic myocardial strain values were obtained by 2DS echocardiography. Results: Compared with normal fetuses, the thickness of the interventricular septum (IVS) and the thickness of right ventricular wall were significantly increased in GDM fetuses (p?showing a significant linear correlation(r?=?-0.625, p?

  13. Rapid progression of bacterial aortitis to an ascending aortic mycotic aneurysm documented by transesophageal echocardiography

    Microsoft Academic Search

    Matthias Wein; Thomas Bartel; Martin Kabatnik; Volker Sadony; Olaf Dirsch; Raimund Erbel

    2001-01-01

    A case of bacterial aortitis of the ascending aorta caused by Staphylococcus aureus progressed to an aortic mycotic aneurysm. Transesophageal echocardiography was the diagnostic approach of choice. The different stages of the disease from the initial aortic wall infection to formation of an abscess that communicated with the aortic lumen were documented by transesophageal echocardiography. (J Am Soc Echocardiogr 2001;14:646-9.)

  14. Diagnostic ability of hand-held echocardiography in ventilated critically ill patients

    Microsoft Academic Search

    Philippe Vignon; Catherine Chastagner; Bruno François; Jean-François Martaillé; Sandrine Normand; Michel Bonnivard; Hervé Gastinne

    2003-01-01

    STUDY OBJECTIVES: To compare the diagnostic capability of recently available hand-held echocardiography (HHE) and of conventional transthoracic echocardiography (TTE) used as a gold standard in critically ill patients under mechanical ventilation. DESIGN: A prospective and descriptive study. SETTING: The general intensive care unit of a teaching hospital. PATIENTS: All mechanically ventilated patients requiring a TTE study with a full-feature echocardiographic

  15. Prognostic significance of mild mitral regurgitation by color Doppler echocardiography in acute myocardial infarction

    Microsoft Academic Search

    Micha S Feinberg; Ehud Schwammenthal; Lev Shlizerman; Avital Porter; Hanoch Hod; Dov Freimark; Shlomi Matezky; Valentina Boyko; Lori Mandelzweig; Zvi Vered; Solomon Behar; Alex Sagie

    2000-01-01

    Mitral regurgitation (MR) complicating acute myocardial infarction (AMI) is associated with increased mortality. The prognostic significance of only mild MR detected by echocardiography in patients with AMI is unknown. This study assessed the long-term risk associated with mild MR detected by color Doppler echocardiography within the first 48 hours of admission in 417 consecutive patients with AMI. No MR was

  16. Three-dimensional echocardiography in the evaluation of global and regional function in patients with recent myocardial infarction: a comparison with magnetic resonance imaging.

    PubMed

    Thorstensen, Anders; Dalen, Håvard; Hala, Pavel; Kiss, Gabriel; D'hooge, Jan; Torp, Hans; Støylen, Asbjørn; Amundsen, Brage

    2013-07-01

    We aimed to compare three-dimensional (3D) and two-dimensional (2D) echocardiography in the evaluation of patients with recent myocardial infarction (MI), using late-enhancement magnetic resonance imaging (LE-MRI) as a reference method. Echocardiography and LE-MRI were performed approximately 1 month after first-time MI in 58 patients. Echocardiography was also performed on 35 healthy controls. Left ventricular (LV) ejection fraction by 3D echocardiography (3D-LVEF), 3D wall-motion score (WMS), 2D-WMS, 3D speckle tracking-based longitudinal, circumferential, transmural and area strain, and 2D speckle tracking-based longitudinal strain (LS) were measured. The global correlations to infarct size by LE-MRI were significantly higher (P < 0.03) for 3D-WMS and 2D-WMS compared with 3D-LVEF and the 4 different measurements of 3D strain, and 2D global longitudinal strain (GLS) was more closely correlated to LE-MRI than 3D GLS (P < 0.03). The segmental correlations to infarct size by LE-MRI were also significantly higher (P < 0.04) for 3D-WMS, 2D-WMS, and 2D LS compared with the other indices. Three-dimensional WMS showed a sensitivity of 76% and a specificity of 72% for identification of LV infarct size >12%, and a sensitivity of 73% and a specificity of 95% for identification of segments with transmural infarct extension. Three-dimensional WMS and 2D gray-scale echocardiography showed the strongest correlations to LE-MRI. The tested 3D strain method suffers from low temporal and spatial resolution in 3D acquisitions and added diagnostic value could not be proven. PMID:23347171

  17. Intracardiac Echocardiography (ICE) Measurement of Dynamic Myocardial Stiffness with Shear Wave Velocimetry

    PubMed Central

    Hollender, Peter J.; Wolf, Patrick D.; Goswami, Robi; Trahey, Gregg E.

    2012-01-01

    Acoustic Radiation Force (ARF)-based methods have been demonstrated to be a viable tool for noninvasively estimating tissue elastic properties, and shear wave velocimetry has been used to quantitatively measure the stiffening and relaxation of myocardial tissue in open-chest experiments. Dynamic stiffness metrics may prove to be indicators for certain cardiac diseases, but a clinically-viable means of remotely generating and tracking transverse wave propagation in myocardium is needed. Intracardiac echocardiography (ICE) catheter-tip transducers are demonstrated here as a viable tool for making this measurement. ICE probes achieve favorable proximity to the myocardium, enabling the use of shear wave velocimetry from within the right ventricle throughout the cardiac cycle. This work describes the techniques used to overcome the challenges of using a small probe to perform ARF-driven shear wave velocimetry, and presents in vivo porcine data showing the effectiveness of this method in the interventricular septum. Acoustic Radiation Force (ARF)-based methods have been demonstrated to be a viable tool for noninvasively estimating tissue elastic properties, and shear wave velocimetry has been used to quantitatively measure the stiffening and relaxation of myocardial tissue in open-chest experiments. Dynamic stiffness metrics may prove to be indicators for certain cardiac diseases, but a clinically-viable means of remotely generating and tracking transverse wave propagation in myocardium is needed. Intracardiac echocardiography (ICE) catheter-tip transducers are demonstrated here as a viable tool for making this measurement. ICE probes achieve favorable proximity to the myocardium, enabling the use of shear wave velocimetry from within the right ventricle throughout the cardiac cycle. This work describes the techniques used to overcome the challenges of using a small probe to perform ARF-driven shear wave velocimetry, and presents in vivo porcine data showing the effectiveness of this method in the interventricular septum. PMID:22579544

  18. 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

  19. Evaluation of cardiac functions of infants of diabetic mothers using tissue Doppler echocardiography

    PubMed Central

    Çimen, Derya; Karaaslan, Sevim

    2014-01-01

    Aim: Transient cardiac hypertrophy occurs in infants of diabetic mothers. The effect of this state on cardiac functions was investigated with a case-control study using tissue Doppler technique. Material and Methods: In this study, right and left ventricle systolic and diastolic functions of 45 term babies of diabetic mothers and 50 healthy term newborns were examined using tissue Doppler echocardiography. Results: The septum was found to be thick in 16 (36%) of the babies of diabetic mothers. Both the left and right ventricle myocardial velocities were found to be lower in the babies of diabetic mothers compared to the control group. In our study, the Em/Am ratio was found to be below one only in the babies of diabetic mothers in the left ventricle in contrast to the control group. In addition, the Em/Am ratio in the septum and right ventricle was found to be below one both in the babies of diabetic mothers (group 1, 2) and control group. The calculated Tei index was found to be higher in the babies of diabetic mothers who had a thicker interventricular septum compared to the control group. Conclusion: Interventricular septal thickening in babies of diabetic mothers disrupt the diastolic function of both ventricles. This can be demonstrated by tissue Doppler echocardiography. These results show that diastolic function is disrupted in both ventricles in babies of diabetic mothers and only in the right ventricle in healthy babies. It was thought that this could be explained by right ventricular dysfunction arising from physiological pulmonary hypertension in the neonatal period. Subclinical right and left ventricular diastolic dysfunctions which we found by tissue Doppler indicate that babies of diabetic mothers especially with a thick septum should be closely monitored.

  20. Atrioventricular conduction time in fetuses assessed by Doppler echocardiography.

    PubMed

    Tomek, V; Janoušek, J; Reich, O; Gilík, J; Gebauer, R A; Skovránek, J

    2011-01-01

    We performed measurement of mechanical atrioventricular conduction time intervals in human fetuses assessed by Doppler echocardiography and provided reference values. We found that atrioventricular conduction time interval was prolonged with gestational age and decreased with increasing fetal heart rate. No correlation between gestational age and heart rate was found. Using normal limits established by this study, mechanical atrioventricular interval >135 ms in the 20(th) week and/or >145 ms in the 26(th) week of gestation could be suspected of having the first-degree AV block. We compared reference values with fetuses of mothers with anti-SSA Ro/SSB La autoantibodies, being in risk of isolated congenital heart block development. One of 21 fetuses of mothers with positive autoantibodies was affected by prolonged atrioventricular interval according to the established limits, with sinus rhythm after the birth. PMID:21574757

  1. A practical guide to pediatric coronary artery imaging with echocardiography.

    PubMed

    Brown, Lynne M; Duffy, C Elise; Mitchell, Carol; Young, Luciana

    2015-04-01

    Few resources exist to educate cardiac sonographers regarding proper techniques and specific issues to consider when performing pediatric coronary artery imaging. The main objective of this report is to review the echocardiographic techniques used to image the coronary arteries of children when screening for anomalous origin of the coronary arteries, as well as coronary involvement in the setting of Kawasaki disease. The authors discuss the physics and instrumentation for developing optimal coronary artery imaging system settings and present the commonly used anatomic and echocardiographic views. Use of the correct settings and a thorough understanding of the associated ultrasound physics are crucial for obtaining quality images. With this report, the authors provide guidance to sonographers and a resource for pediatric echocardiography laboratories to help ensure high-quality echocardiographic imaging of the coronary arteries. PMID:25691000

  2. Feasibility and Reproducibility of Left Ventricular Rotation by Speckle Tracking Echocardiography in Elderly Individuals and the Impact of Different Software

    PubMed Central

    Park, Chloe M.; March, Katherine; Williams, Suzanne; Kukadia, Suraj; Ghosh, Arjun K.; Jones, Siana; Tillin, Therese; Chaturvedi, Nish; Hughes, Alun D.

    2013-01-01

    Background Changes in ventricular rotation measured by two-dimensional speckle tracking echocardiography (2DSTE) are early indicators of cardiac disease. Data on the clinical feasibility of this important measure are scarce and there is no information on the comparability of different software versions. We assessed the feasibility, reproducibility and within patient temporal variability of 2DSTE in a large community based sample of older adults. We additionally compared 2DSTE results to those generated by 3DSTE. Methods and results 1408 participants underwent transthoracic echocardiography. Using Philips Qlab 8.1 peak LV rotation at either the base or the apex was analysable in 432 (31%) participants. Peak twist measurements were achieved in 274 (20%) participants. 66 participants were randomly selected for the reproducibility study. 20 additional participants had scans 4–6 weeks apart for temporal variability and 3D echocardiography to assess the agreement between 2DSTE and 3DSTE. Reproducibility was evaluated using the intraclass coefficient of correlation (ICC). Better reproducibility for rotation and twist were obtained when measured at the endocardium, and when using more recent software versions, Peak twist and rotation were significantly different using two versions of the same software. Agreement with 3DSTE was better using newer software. Conclusion Feasibility of 2DSTE is low in this cohort of elderly individuals severely limiting its utility in clinical settings. However if high quality images can be acquired assessment of ventricular rotation by 2DSTE is reproducible. Caution should be taken when comparing measurements of ventricular rotation by software from different vendors or different versions of software from the same vendor. PMID:24058652

  3. 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.

  4. 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

  5. Use of Contrast Echocardiography in Intensive Care and at the Emergency Room

    PubMed Central

    Cosyns, Bernard; Roossens, Bram; Hernot, Sophie; Haddad, Philippe El; Lignian, Hervé; Pierard, Luc; Lancellotti, Patrizio

    2011-01-01

    Bedside echocardiography in emergency room (ER) or in intensive care unit (ICU) is an important tool for managing critically ill patients, to obtain a timely accurate diagnosis and to immediately stratify the risk to the patient’s life. It may also render invasive monitoring unnecessary. In these patients, contrast echocardiography may improve quality of imaging and also may provide additional information, especially regarding myocardial perfusion in those with suspected coronary artery disease. This article focuses on the principle of contrast echocardiography and the clinical information that can be obtained according to the most frequent presentations in ER and ICU. PMID:22758614

  6. 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

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

    PubMed Central

    Hartman, Lauren J.; Scruggs, April K.; McLendon, Jared M.; Haven, April K.; Bauer, Natalie N.

    2015-01-01

    Abstract 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.

  8. A Study of the Adult Zebrafish Ventricular Function by Retrospective Doppler-Gated Ultrahigh-Frame-Rate Echocardiography

    PubMed Central

    Liu, Ting-Yu; Lee, Po-Yang; Huang, Chih-Chung; Sun, Lei; Shung, K. Kirk

    2014-01-01

    The zebrafish (Danio rerio) has become a preferred animal model for studying various human diseases, particularly those related to cardiovascular regeneration; therefore, a noninvasive imaging modality is needed for observing the cardiac function of zebrafish. Because of its high resolution, high-frequency ultrasound B-mode imaging has recently been used successfully to observe the heart of adult zebrafish. However, ultrahigh-frame-rate echocardiography combining B-mode imaging and color flow imaging is still needed to observe the detailed transient motions of the zebrafish ventricle. This study develops an 80-MHz ultrahigh-frame-rate echocardiography system for this purpose, based on retrospective Doppler- gated technology. B-mode and color flow images of the cardiovascular system of the zebrafish were reconstructed by two-dimensional autocorrelation at maximum frame rates of up to 40 000 and 400 fps, respectively. The timings of end diastole (ED) and end systole (ES) of ventricle can be determined by using this high-resolution image system. Two ventricular function parameters—fractional shortening (FS) and fractional area change (FAC)—were measured for evaluating the ventricular function by using ED and ES with their corresponding ventricular dimensions. The experimental results indicated that the measured FS values were 42 ± 4% (mean ± standard deviation) and 60 ± 13% for the long axis and short axis of the ventricle, respectively, and that FAC was 77 ± 9%. This is the first report of these ventricular function parameters for a normal adult zebrafish. The results showed that retrospective high-frequency echocardiography is a useful tool for studying the cardiac function of normal adult zebrafish. PMID:24658716

  9. New onset right ventricular enlargement in recent dyspnea: Is echocardiography enough for a diagnosis of pulmonary thrombo-embolism?

    PubMed

    De Gennaro, Luisa; Giannoccaro, Viviana; Lopriore, Vincenzo; Caldarola, Pasquale; Lentini, Salvatore; Di Biase, Matteo; Brunetti, Natale Daniele

    2014-01-01

    Pulmonary embolism may be often promptly diagnosed just by bedside echocardiography, in the case of new onset severe right ventricular enlargement, increased pulmonary pressure and dyspnea. However, CT confirmation could be required in the presence of contrasting findings during diagnostic work up. We report the case of a 79-year old woman who presented with acute dyspnea, right ventricular enlargement and leftward septal shift. Despite first diagnosis of pulmonary embolism, an irregular mass was detected at CT scan in mid left lung, apparently infiltrating left pulmonary artery branches, without signs of evident pulmonary thrombo-embolism. Visceral pleural and lymphonodular infiltration suspected for malignancy was also present. We hypothesize that acutely increased pulmonary pressures and enlarged right ventricle were caused by the infiltrating pulmonary mass, presumably a lung tumor, partly involving left pulmonary artery branches and by tumor pulmonary embolism. A diagnosis of pulmonary thrombo-embolism exclusively based on echocardiography may be occasionally misleading without a careful diagnostic work-up. PMID:24751339

  10. Non-invasive measurement of the regurgitant fraction by pulsed Doppler echocardiography in isolated pure mitral regurgitation.

    PubMed Central

    Tribouilloy, C; Shen, W F; Slama, M A; Dufossé, H; Choquet, D; Marek, A; Lesbre, J P

    1991-01-01

    OBJECTIVE--To assess the usefulness of pulsed Doppler echocardiography as a method of measuring the regurgitant fraction in patients with mitral regurgitation. PATIENTS AND METHODS--Twenty controls and 27 patients with isolated mitral regurgitation underwent Doppler studies. In the patients the study was performed within 48 hours of cardiac catheterisation. Aortic outflow was measured in the centre of the aortic annulus, and mitral inflow was derived from the flow velocity at the tip of the leaflets and the area of the elliptical mitral opening. The regurgitant fraction was calculated as the difference between the two flows divided by the mtiral inflow. RESULTS--In the 20 controls the two flows were almost identical (mitral inflow, 4.44 (SD 0.88) l/min; aortic outflow, 4.58 (SD 0.84) l/min), with a mean regurgitant fraction of 4.2 (SD 8.4)%. In patients with mitral regurgitation, the mitral inflow was significantly higher than the aortic outflow (8.8 (3.6) v 4.3 (1.1) l/min). In most patients the Doppler-derived regurgitant fraction (45.8 (19.2)%) accorded closely with the regurgitant fraction (41.3 (SD 17.8)%) determined by the haemodynamic technique. CONCLUSION--Pulsed Doppler echocardiography, with an instantaneous velocity-valve area method for calculating mitral inflow, reliably measured the severity of regurgitation in patients with mitral regurgitation. Images PMID:1747280

  11. The relation between transaortic pressure difference and flow during dobutamine stress echocardiography in patients with aortic stenosis

    PubMed Central

    Takeda, S; Rimington, H; Chambers, J

    1999-01-01

    OBJECTIVE—To investigate the relation between transaortic pressure difference and flow in patients with aortic stenosis.?METHODS—50 asymptomatic patients with all grades of aortic stenosis were studied using dobutamine stress echocardiography. Individual plots of mean pressure drop against flow were drawn. Comparisons were made between grades of aortic stenosis as defined by the continuity equation.?RESULTS—A significant linear relation between pressure difference and flow was found in 34 patients (68%). There was a significant curvilinear relation in four (8%), while no significant regression line could be fitted in 12 (24%). In the 34 patients with linear fits, the slopes (mean (SD)) were 0.08 (0.07) in mild, 0.10 (0.04) in moderate, and 0.22 (0.16) in severe aortic stenosis (p = 0.0055).?CONCLUSIONS—Transaortic pressure difference can be related directly to flow in many patients with all grades of aortic stenosis. However, there are individual differences in slope and intercept suggesting that resistance calculated at rest may not always be representative. Raw pressure drop/flow plots may be an alternative method of describing valve function.???Keywords: aortic stenosis; continuity equation; resistance; Doppler echocardiography PMID:10377300

  12. Doppler echocardiography during the follow-up of hematological patients undergoing chemotherapy.

    PubMed

    Marra, Francesco; Galderisi, Maurizio; Camera, Andrea; Rinaldi, Ciro R; Innelli, Pasquale; Rotoli, Bruno; de Divitiis, Oreste

    2007-01-18

    Our retrospective experience underscores the ability of Doppler echocardiography to detect the cardiotoxicity of chemotherapy (functional and pericardial abnormalities, heart involvement) and points out the need for an accurate echocardiographic follow-up of hematologic patients. PMID:16626820

  13. Radiofrequency catheter ablation of atrioventricular nodal reciprocating tachycardia using intracardiac echocardiography in pregnancy.

    PubMed

    Bongiorni, Maria Grazia; Di Cori, Andrea; Soldati, Ezio; Zucchelli, Giulio; Segreti, Luca; Solarino, Gianluca; De Lucia, Raffaele; Marzilli, Mario

    2008-08-01

    We describe a case report of a 32-year-old woman during the 10th week of pregnancy with symptomatic and recurrent atrioventricular nodal reciprocating tachycardia successfully treated by conventional radiofrequency ablation, under intracardiac echocardiography surveillance. PMID:18460548

  14. [Standardized findings in echocardiography using WWW: EchoBefundSystem].

    PubMed

    Schweikart, O; Metzger, F

    2001-01-01

    As a non-invasive imaging system, ultrasound echocardiography has a very high impact on modern diagnosis and is widely used in clinical routine but without any structured and standardized documentation of the results. Thus, quality management (QM), statistics and comparison of the results are difficult. Therefore, a working group of the German Cardiac Society issued a consensus proposal. For evaluation and wide public distribution, we have developed the first internet-based application covering the full proposal: EchoBefundSystem. The EchoBefundSystem is a web based client-server application for standardized documentation of echocardiography results right at the workplace. The software leads the examiner by means of a user interface design and stored medical knowledge. The level of detail is scaled automatically to the ongoing examination. Every day clinical routine is performed on only two pages, one for general patient data and a second one covering the complete minimal data set called "minimum finding" in the standard. As the examiner discovers more and more special findings or might even enter a complete medical study, the interface offers more and more fields and checkboxes. One data set can contain up to 600 values and findings. The structured user interface reflects the organ structure as well as examination methods familiar to the examiner. Automatically calculated fields speed up the examination. Judgements, diagnoses, values and ranges are interrelated. If there is a difference between the entered data and the medical knowledge base, a warning will be issued but the doctor's decision is authoritative. Some values may be gathered by different methods and even different units are converted automatically. The final doctor's letter is generated automatically in clear text but still editable and can be given out to the patient right after the examination without any further delay. Beside the minimal data set, all abnormal findings will appear and findings will be summarized wherever possible. The report is intended for the referring general practitioner, your own documentation, expert witness as well as clinical studies. Interested examiners may test the full version online at http://echo.ma.uni-heidelberg.de PMID:11220082

  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.

  16. Oesophageal perforation in a neonate during transoesophageal echocardiography for cardiac surgery.

    PubMed

    Miller, Jeffrey W; Hart, Catherine K; Statile, Christopher J

    2015-06-01

    Oesophageal perforation is a rarely reported complication of transoesophageal echocardiography in infants. This case involves a 3.1-kg neonate with Trisomy 21, atrioventricular septal defect, and hypoplastic aortic arch undergoing aortic arch advancement and pulmonary artery banding. A paediatric transoesophageal echocardiography probe was placed intraoperatively causing a contained false passage from the oesophagus below the cricopharyngeus muscle with extension into the left posterior mediastinum. The perforation healed within 2 weeks without permanent sequelae after conservative medical management. PMID:25200845

  17. Clinical significance of echocardiography in patients supported by venous-venous extracorporeal membrane oxygenation.

    PubMed

    Peris, Adriano; Lazzeri, Chiara; Cianchi, Giovanni; Bonizzoli, Manuela; Batacchi, Stefano; Bernardo, Pasquale; Valente, Serafina; Gensini, Gian Franco

    2015-06-01

    Although there are extensive published data regarding venous-arterial (VA) ECMO, particularly in the pediatric population, there is a paucity of data (mainly including case reports and observational studies) delineating the role of echocardiography in the management of adult patients supported by venous-venous (VV) ECMO. The present review is aimed at specifically addressing the rationale for echocardiography use in patients supported by VV-ECMO and at summarizing the available evidence on this topic. Based on the available evidence and on the experience of our group, practical considerations on the use of echocardiography in adult patients on VV-ECMO support are reported. To date, echocardiography is mainly used for selecting the type of ECMO (VA vs VV), monitoring cannulation and the early detection of complications, but it is underused in patients supported by VV-ECMO. Nevertheless, in these patients, this methodology can provide useful information in monitoring cardiac function, cannula positioning, pericardial fluid (for early detection of tamponade) during ECMO support, and therefore it can contribute to the integrated assessment and management of these complex patients. There is a clinical need to elaborate shared protocols for echocardiography use during VV ECMO support, particularly at this time when advanced echocardiography is gaining interest among intensivists. PMID:25708044

  18. Mitral valve anatomy and function: new insights from three-dimensional echocardiography.

    PubMed

    Muraru, Denisa; Cattarina, Maria; Boccalini, Francesca; Dal Lin, Carlo; Peluso, Diletta; Zoppellaro, Giacomo; Bellu, Roberto; Sarais, Cristiano; Xhyheri, Borejda; Iliceto, Sabino; Badano, Luigi P

    2013-02-01

    Integrating volumetric rendering with motion in real-time, three-dimensional (3D) echocardiography is the most suitable imaging technique for assessing heart valves. Today, the rapidly advancing 3D technology allows us to perform a virtual 'dissection' of the heart intra vitam and to discover unprecedented, realistic views of cardiac valves in just a few minutes. The mitral valve is the cardiac structure easiest to visualize by transthoracic or transoesophageal approach. Three-dimensional echocardiography is able to display the non-planar valve leaflets and annulus, the complex subvalvular apparatus and their spatial relationships with the surrounding structures. The complementary use of 3D colour flow adds data about valve integrity and allows the quantitation of valvular diseases. Accumulating evidence suggests that 3D echocardiography is emerging as the reference technique to assess mitral valve morphology and function and guide valvular procedures of mounting complexity. The purpose of this review is to provide an update on the current clinical applications of 3D echocardiography for assessing mitral valves and to stress the incremental benefits of 3D echocardiography over conventional two-dimensional echocardiography. PMID:23275024

  19. Exercise two-dimensional echocardiography for diagnosis of coronary artery disease.

    PubMed

    Heng, M K; Simard, M; Lake, R; Udhoji, V H

    1984-09-01

    To improve ultrasound images during exercise 2-dimensional echocardiography (2-D echo), a device was developed to hold the transducer and maintain its orientation relative to the heart. The value of this technique in detecting wall motion abnormalities and changes in ejection fraction was evaluated in 54 men undergoing stress test for angina. Thallium-201 scanning, electrocardiography and exercise 2-D echo were recorded concurrently. Technically satisfactory echo studies were obtained in 47 patients (87%). The sensitivity and specificity of exercise echo in the detection of myocardial ischemia as judged by wall motion abnormalities were 100% and 93%, respectively. Sixteen patients with normal thallium scans increased their ejection fraction (EF) estimated by echo (from 52 +/- 1% at rest to 67 +/- 1% at maximal exercise, p less than 0.001); all showed an increase of 5% or more. In contrast, 11 patients who had reversible thallium scan defects showed a consistent decrease in EF (from 53 +/- 2% at rest to 43 +/- 2% during exercise, p less than 0.001); 20 patients with irreversible thallium scan defects showed no specific trend in the EF (48 +/- 2% at rest and 50 +/- 2% during exercise, difference not significant). Changes in heart rate and blood pressure did not distinguish the 3 groups of patients. Our technique of exercise 2-D echo may be useful for detecting wall motion abnormalities and EF changes during exercise and possibly enhance the sensitivity of thallium scanning in the noninvasive diagnosis of coronary artery disease. PMID:6475767

  20. Focused emergency echocardiography: lifesaving tool for a 14-year-old girl suffering out-of-hospital pulseless electrical activity arrest because of cardiac tamponade.

    PubMed

    Steiger, Holger V; Rimbach, Klaus; Müller, Edgar; Breitkreutz, Raoul

    2009-04-01

    Cardiac arrest presenting as pulseless electrical activity (PEA) is associated with poor outcome. Its major underlying causes (e.g. cardiac tamponade, pulmonary embolism, tension pneumothorax or hypovolaemia) are difficult to detect reliably in an out-of-hospital setting. We here present a case of a 14-year-old girl suffering from PEA because of cardiac tamponade 4 weeks after surgical closure of a ventricular septal defect. Immediate focused echocardiography on scene by an emergency physician showed a large pericardial effusion that had led to cardiac tamponade and finally to a PEA cardiac arrest. Immediate pericardiocentesis was carried out. The girl progressed to complete neurological recovery. This case report demonstrates that focused emergency echocardiography may be useful for the diagnosis of pericardial tamponade leading to cardiac arrest and this diagnosis can be made out-of-hospital by an appropriately trained physician. PMID:19218856

  1. Prospective study of blood culture during transesophageal echocardiography.

    PubMed

    Shyu, K G; Hwang, J J; Lin, S C; Tzou, S S; Cheng, J J; Kuan, P; Lien, W P

    1992-12-01

    To ascertain the incidence and significance of bacteremia associated with transesophageal echocardiography (TEE), 132 consecutive patients (aged 17 to 73 years) free of apparent infection who were undergoing 135 transesophageal echocardiographic procedures from October 1990 to August 1991, were prospectively studied. For each procedure, two sets of blood cultures were obtained for culture 30 to 60 minutes before TEE, immediately after, and 180 to 240 minutes after the procedure. For each blood culture, 10 ml of venous blood was evenly inoculated into aerobic and anaerobic culture bottles and inoculated for 7 days using a radiometric system. A throat swab was obtained immediately before each procedure. Three of 270 preprocedure blood cultures were positive for Bacillus cereus, Staphylococcus simulans, and Peptostreptococcus species, respectively. No blood culture was positive in the immediate postprocedure period. Two of 270 late blood samples grew Staphylococcus epidermidis in the same patient. Nevertheless, the microorganisms isolated from blood cultures were different from those isolated from the throat swab. No patients had fever or evidence of infective endocarditis after TEE during the follow-up period. It is concluded that the incidence of TEE-related bacteremia is extremely low, and a general recommendation for antibiotic prophylaxis during TEE is not warranted. PMID:1462911

  2. Transthoracic echocardiography reference values in juvenile and adult 129/Sv mice

    PubMed Central

    2013-01-01

    Background In the recent years, the use of Doppler-echocardiography has become a standard non-invasive technique in the analysis of cardiac malformations in genetically modified mice. Therefore, normal values have to be established for the most commonly used inbred strains in whose genetic background those mutations are generated. Here we provide reference values for transthoracic echocardiography measurements in juvenile (3 weeks) and adult (8 weeks) 129/Sv mice. Methods Echocardiographic measurements were performed using B-mode, M-mode and Doppler-mode in 15 juvenile (3 weeks) and 15 adult (8 weeks) mice, during isoflurane anesthesia. M-mode measurements variability of left ventricle (LV) was determined. Results Several echocardiographic measurements significantly differ between juvenile and adult mice. Most of these measurements are related with cardiac dimensions. All B-mode measurements were different between juveniles and adults (higher in the adults), except for fractional area change (FAC). Ejection fraction (EF) and fractional shortening (FS), calculated from M-mode parameters, do not differ between juvenile and adult mice. Stroke volume (SV) and cardiac output (CO) were significantly different between juvenile and adult mice. SV was 31.93?±?8.67 ?l in juveniles vs 70.61?±?24.66 ?l in adults, ??

  3. Use of Echocardiography Reveals Reestablishment of Ventricular Pumping Efficiency and Partial Ventricular Wall Motion Recovery upon Ventricular Cryoinjury in the Zebrafish

    PubMed Central

    Marques, Inês João; Sánchez-Iranzo, Héctor; Jiménez-Borreguero, Luis Jesús; Mercader, Nadia

    2014-01-01

    Aims While zebrafish embryos are amenable to in vivo imaging, allowing the study of morphogenetic processes during development, intravital imaging of adults is hampered by their small size and loss of transparency. The use of adult zebrafish as a vertebrate model of cardiac disease and regeneration is increasing at high speed. It is therefore of great importance to establish appropriate and robust methods to measure cardiac function parameters. Methods and Results Here we describe the use of 2D-echocardiography to study the fractional volume shortening and segmental wall motion of the ventricle. Our data show that 2D-echocardiography can be used to evaluate cardiac injury and also to study recovery of cardiac function. Interestingly, our results show that while global systolic function recovered following cardiac cryoinjury, ventricular wall motion was only partially restored. Conclusion Cryoinjury leads to long-lasting impairment of cardiac contraction, partially mimicking the consequences of myocardial infarction in humans. Functional assessment of heart regeneration by echocardiography allows a deeper understanding of the mechanisms of cardiac regeneration and has the advantage of being easily transferable to other cardiovascular zebrafish disease models. PMID:25532015

  4. 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.

  5. Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions.

    PubMed

    Biswas, Monodeep; Sudhakar, Selvin; Nanda, Navin C; Buckberg, Gerald; Pradhan, Manish; Roomi, Asad Ullah; Gorissen, Willem; Houle, Helene

    2013-01-01

    Two-dimensional speckle tracking echocardiography (2D STE) is a novel technique of cardiac imaging for quantifying complex cardiac motion based on frame-to-frame tracking of ultrasonic speckles in gray scale 2D images. Two-dimensional STE is a relatively angle independent technology that can measure global and regional strain, strain rate, displacement, and velocity in longitudinal, radial, and circumferential directions. It can also quantify rotational movements such as rotation, twist, and torsion of the myocardium. Two-dimensional STE has been validated against hemodynamics, tissue Doppler, tagged magnetic resonance imaging, and sonomicrometry studies. Two-dimensional STE has been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies, and identifying early subclinical changes in various pathologies. A large number of studies have evaluated the role of 2D STE in predicting response to cardiac resynchronization therapy in patients with severe heart failure. However, the clinical utility of 2D STE in the above mentioned conditions remains controversial because of conflicting reports from different studies. Emerging areas of application include prediction of rejection in heart transplant patients, early detection of cardiotoxicity in patients receiving chemotherapy for cancer, and effect of intracoronary injection of bone marrow stem cells on left ventricular function in patients with acute myocardial infarction. The emerging technique of three-dimensional STE may further extend its clinical usefulness. PMID:23297852

  6. Bicuspid aortic valve and severe aortic stenosis in a newborn exposed to carbamazapine during pregnancy

    PubMed Central

    Karata?, Zehra; Karata?, Ahmet; Özlü, Tülay; Goksugur, Sevil B.; Varan, Birgül

    2014-01-01

    The use of antiepileptic drugs increases the risk of major congenital malformations during pregnancy. Here, we report an infant who had a history of in-utero carbamazepine exposure and who was born with a cardiac malformation. The infant was born at 39 weeks of gestation vaginally to an epileptic mother who had been treated with carbamazepine throughout her pregnancy. He was referred due to cardiac murmur in the second week of his life. The mother had not received folic acid supplementation. Transthoracic echocardiography revealed bicuspid aortic valve, mild aortic stenosis, patent ductus arteriosus, patent foramen ovale and the renal ultrasound revealed mild left hydronephrosis. Follow-up echocardiography performed 14 weeks later showed increased severity of aortic stenosis and percutaneous balloon aortic valvuloplasty was performed. To our knowledge, there is only one case report in the literature mentioning the association of a bicuspid aortic valve and aortic stenosis with oxcarbazepine exposure, which is a structural derivative of carbamazepine. However, there are no reports for association with carbamazepine itself. Bicuspid aorta and aortic stenosis may be among the cardiac malformations that result from the teratogenic effect of carbamazepine. PMID:25584038

  7. Role of transesophageal echocardiography in dissection of the aorta and evaluation of degenerative aortic disease.

    PubMed

    Erbel, R

    1993-08-01

    The combination of different ultrasound techniques such as transthoracic, suprasternal, subcostal, and TEE has a high sensitivity and specificity in the diagnosis of aortic dissection. Limitations of this combined ultrasound technique are related to the visualization of the ascending part of the aortic arch, which, because of the interposition of the trachea, cannot be visualized completely. The beginning or end of a dissection in this part of the aorta may be misinterpreted. However, false-negative results are rare. False-positive results due to artifacts resulting from reverberations in an ectatic ascending aorta must be taken into account. The most important diagnostic goals in acute or chronic aortic dissection are (1) confirmation of the diagnosis by visualization of the intimal membrane; (2) the differentiation of true and false lumen, depending on visualization of spontaneous echocardiographic contrast, thrombus formation, slow or reduced reversed flow, systolic diameter reduction, and signs of entry jet into the false lumen; (3) detection of intimal tear, demonstrating communication by 2-D or color Doppler echocardiography; (4) determination of the extent of dissection with classification according to DeBakey types I, II, and III, or Stanford types A and B, with differentiation between communicating or noncommunicating dissection and antegrade or retrograde dissection limited to the descending aorta or expanding into the ascending aorta; (5) detection of wall motion abnormalities as a sign of preexisting coronary artery disease or myocardial ischemia due to ostium occlusion by an intimal flap, coronary artery rupture, or collapse of the true lumen during diastole; (6) detection and grading of aortic insufficiency; (7) detection of side branch involvement by suprasternal, subcostal, and abdominal sonography (which will provide information about the choice of the site for cannulation or catheterization of the femoral artery); and (8) detection of pericardial or pleural effusion and mediastinal hematoma as signs of an emergency situation (i.e., suspending rupture). Based on ultrasound diagnostic information, operation can be performed in all acute situations in patients with type A dissection without further investigation. The ability to act decisively in this setting is particularly important in patients with signs suggesting a dire prognosis (i.e., pericardial or pleural effusion or mediastinal hematoma). For follow-up studies, the combination of echocardiography with MR tomography is recommended. With TEE, entry tears can be detected with a higher sensitivity than with MR tomography. This capability may be important for the patient's prognosis. MR tomography, on the other hand, has a better spatial resolution showing the entire aorta, particularly the ascending aortic arch. PMID:8402774

  8. Evaluation of diastolic function with Doppler echocardiography: the PDF formalism.

    PubMed

    Kovács, S J; Barzilai, B; Pérez, J E

    1987-01-01

    A new parametrized diastolic filling (PDF) formalism for evaluation of holodiastolic (left and right) ventricular function via Doppler echocardiography is presented. It is motivated by the empiric observation that during diastole the heart behaves as a suction pump whose dynamics, in certain respects, are those of a damped harmonic oscillator. An expression for elastic recoil (suction) initiated ventricular diastolic fluid inflow velocity v(t) is obtained by differentiation from the solution x(t) of the linear differential equation that describes the motion of a forced, damped harmonic oscillator. It is solved for "over-damped" motion, for zero initial velocity and initial displacement = xo cm. An explicit forcing term F(t) = Fosin(omega t) is included to account for late diastolic (atrial) filling. The quantitative parameters of the model include inertia (mass; m), viscosity (damping constant; c), source of stored energy for suction (spring constant; k), and its initial displacement xo, the amplitude and frequency of the (atrial) forcing term Fo, omega. The mathematical behavior of the solution v(t) and its dependence on the parameters xo, c, and k, which characterize the contour of the Doppler velocity profile (DVP), is discussed. When clinical examples of normal and abnormal transmitral DVPs are compared with v(t) calculated using the harmonic oscillator model, excellent agreement [DVP-v(t)]/v(t) approximately 0.05 is obtained throughout diastole. Thus the model allows accurate qualitative and quantitative characterization of global ventricular diastolic behavior by noninvasive means in a variety of normal and abnormal stiffness-compliance states. In addition, it may serve as a prototype for a class of mathematical models that can encompass the essential dynamic elements of ventricular diastolic function that couple to flow and further enhance the role of the heart as a suction pump. PMID:3812709

  9. Experience with a DICOM-compatible digital pediatric echocardiography laboratory.

    PubMed

    Frommelt, P C; Whitstone, E N; Frommelt, M A

    2002-01-01

    A digital pediatric echocardiography laboratory, without videotape redundancy was established at Children's Hospital of Wisconsin in December 1998. To characterize the experience, 1198 consecutive patient studies were reviewed-50% from the first 2 months after establishing the digital protocol and 50% from the last 2 months available. Each study was stored using a protocol that was based on capture of single beat clips of relevant two-dimensional/color Doppler imaging and static frame spectral Doppler tracings. Studies were digitally compressed using a DICOM-compatible JPEG algorithm at 20:1 and edited with deletions of redundant clips to minimize archival storage needs. Study quality was uniformly excellent, and no errors were attributable to the digital protocol or compression-related loss of information. The average study required 21.5 +/- 11.4 MB of storage space with 35.4 +/- 12.3 total clips/study captured. Studies reviewed from the earlier experience were not significantly larger (23.6 +/- 14 vs 19.7 +/- 8.1 MB, 35.6 +/- 12.5 vs 35.2 +/- 12 clips) than those done recently. Studies in patients with isolated ventricular septal defect used comparable storage (23.7 +/- 8.9 MB, 42.8 +/- 11.5 clips) to that of the group as a whole. More complex congenital heart disease studies were slightly larger-tetralogy of Fallot (28.2 +/- 19.5 MB, 43.4 +/- 13.9 clips), transposition of the great arteries (30.6 +/- 17.4 MB, 40.3 +/- 16.7 clips), and single ventricle (29.7 +/- 19.6 MB, 39.9 +/- 12 clips)--although this trend was not significant. This study suggests that digital pediatric echo is feasible using a DICOM-compatible protocol with maintenance of diagnostic integrity despite compression of study size to allow rapid archival storage and retrieval. PMID:11922509

  10. 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 [Department of Cardiovascular Disease, Cittadella General Hospital, Cittadella, Padua (Italy); Onorato, Eustaquio [Operative Unit ofCardiology, Clinica S. Rocco, Ome, Brescia (Italy); Maiolino, Pietro [Department of Cardiovascular Disease, Cittadella General Hospital, Cittadella, Padua (Italy)

    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.

  11. INTRODUCTION Several literature reviews show convincingly that pre-

    E-print Network

    are a major group of invertebrate predators in litter and on the foliage of trop- ical rain forests, both in a lowland forest in Papua New Guinea tests whether Australian Journal of Ecology (1999) 24, 477 in such refugia. Predation risk from invertebrate predators was measured as the disappearance rate of live

  12. 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

  13. Effect of Obesity on Left Ventricular Longitudinal Myocardial Strain by Speckle Tracking Echocardiography in Children and Adolescents

    PubMed Central

    Kibar, Ay?e Esin; Pac, Feyza Ay?enur; Ece, ?brahim; Oflaz, Mehmet Burhan; Ball?, ?evket; Bas, Veysel Nejat; Aycan, Zehra

    2015-01-01

    Background: Impaired subclinical ventricular function may contribute to the risk of cardiovascular disease in obesity. Aims: The aim of this study was to determine the influence of obesity on left ventricular (LV) longitudinal myocardial function in normotensive obese children using two-dimensional (2D) speckle tracking echocardiography (STE). Study Design: Case-control study. Methods: Sixty normotensive obese children aged 10–16 years (mean age, 13.9±2.3 years) were compared with 50 normal-weight controls. Obese participants had a body mass index (BMI)?95th percentile. Regional strain/strain rate (SR) values were compared with left ventricular (LV) parameters. The correlation was studied by linear regression analysis. Results: Obese subjects exhibited a significantly higher LV end-diastolic diameter, left atrium/aortic diameter ratio, and LV mass/index when compared to controls (p<0.001). Left ventricular ejection fraction and regional systolic myocardial velocities were similar in the obese and control groups. By 2D STE, regional strain of both the septal wall (average strain: ?16.0±3.9% vs ?21.9±2.4%, p<0.001) and lateral wall (average strain: ?15.6±2.3% vs ?22.9±3.5%, p<0.001); regional SR of both the septal wall (average SRsys: ?0.7±0.22 s?1 vs ?1.3±0.32 s?1, p<0.001) and lateral wall (average SRsys: ?0.67±0.19 s?1 vs ?1.33±0.31 s?1, p<0.001); regional SRE/A of both the septal wall (average SRE/A: 1.8±0.83 vs. 2.2±0.91, p: 0.004) and lateral wall (average SRE/A: 1.4±0.43 vs. 2.4±1.21, p<0.001); and global strain (?14.6±7.34% vs ?20.9±3.24%, p<0.001) were lower in the obese group compared with the controls. These strain imaging parameters appear to be related to the severity of obesity and can contribute to increased BMI. Left ventricular mass was found to be correlated with a decrease in global LV strain. Conclusion: Our study showed that childhood obesity is associated with an alteration in the longitudinal LV function. Segmental analysis of the LV can provide subtle markers for the emergence of future obesity-related cardiac disease. PMID:25759773

  14. Impact of Overweight and Obesity on Left Ventricular Diastolic Function and Value of Tissue Doppler Echocardiography

    PubMed Central

    Kossaify, Antoine; Nicolas, Nayla

    2013-01-01

    Background Diastolic dysfunction is a common cause of heart failure with preserved systolic function in obese patients. Objective To assess diastolic function in a series of overweight and obese patients using conventional and tissue Doppler echocardiography. Setting and method University hospital; left ventricular diastolic function was evaluated in 99 patients (mean age 61.59 ± 13.9 years); body mass index and waist circumference were assessed, and patients were subdivided into three groups according to their body mass index (kg/m2): [normal, (18.5–24.9); overweight, (25–29.9); obese, (>29.9)]. Peak early (E) and late (A) transmitral flow and peak early (E?) diastolic mitral annulus velocities were measured. Results Diastolic dysfunction was significantly higher in the overweight/obese groups compared to the normal body mass index group. The analysis was made with regard to waist circumference and other clinical characteristics, and multivariate regression analysis showed a direct and independent effect of body mass index on diastolic function [OR: 2.75; CI: 1.34–5.67; P = 0.006]. Discussion was made in view of the latest clinical data. Also, an insight into normal weight obesity is presented and discussed. Conclusion Overweight and obesity are found to have an independent negative impact on diastolic function as assessed by tissue Doppler imaging. PMID:23471126

  15. Histopathological validation of high frequency epicardial echocardiography of the coronary arteries in vitro.

    PubMed Central

    Kenny, A; Fuller, C A; Cary, N R; Shapiro, L M

    1991-01-01

    The accuracy and reliability of measurement of coronary artery dimensions and detection of atherosclerotic lesions by high frequency epicardial echocardiography were compared with histopathological results. Ten pressure perfused human hearts were examined in vitro with a 10 MHz (Diasonics) transducer and a 7.5 MHz (Vingmed/Sonotron) transducer. There was close agreement between ultrasound and pathological measurements of coronary artery luminal diameter. Qualitative changes in wall structure such as diffuse wall thickening and calcification were readily identified; however, the resolution of the transducers was not high enough accurately to measure wall dimensions in normal coronary arteries. Coefficient of variation measurements for intra and inter observer variability (5.2% and 6.9% respectively) showed excellent reproducibility. The technique was accurate in identifying atherosclerotic lesions, imaging arteries distal to an occlusion, locating deeply sited arteries, and identifying complete obliteration of an artery. Intraoperative video playback and transducer miniaturisation may minimise problems caused by cardiac movement and restricted access. With these developments intraoperative assessment of coronary artery disease may become a real possibility. Images PMID:2054242

  16. 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.

  17. 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

    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 cm(2)/m(2); 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

  18. 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

  19. Segmenting echocardiography images using B-Spline snake and active ellipse model.

    PubMed

    Marsousi, Mahdi; Alirezaie, Javad; Ahmadian, Alireza; Kocharian, Armen

    2010-01-01

    In this paper, a fully automated method for segmenting Left Ventricle (LV) in echocardiography images is proposed. A new method named active ellipse model is developed to automatically find the best ellipse inside the LV chamber without intervention of any specialist. A modified B-Spline Snake algorithm is used to segment the LV chamber in which the initial contour is formed by the predefined ellipse. As a result of using active ellipse model, the segmentation is extricated from dealing with gaps within myocardium boundary which are highly problematic in echocardiography image segmentation. Based on the results obtained from different studies, the proposed method is faster and more accurate than previous approaches. Our method is evaluated on 20 sets of echocardiography images of patients; and acquired results (92.30 ± 4.45% dice's coefficient) indicate the proposed method has remarkable performance. PMID:21095747

  20. Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Vena Contracta Area in Mitral Regurgitation

    PubMed Central

    Little, Stephen H.; Pirat, Bahar; Kumar, Rahul; Igo, Stephen R.; McCulloch, Marti; Hartley, Craig J.; Xu, Jiaqiong; Zoghbi, William A.

    2012-01-01

    OBJECTIVES Our goal was to prospectively compare the accuracy of real-time three-dimensional (3D) color Doppler vena contracta (VC) area and two-dimensional (2D) VC diameter in an in vitro model and in the clinical assessment of mitral regurgitation (MR) severity. BACKGROUND Real-time 3D color Doppler allows direct measurement of VC area and may be more accurate for assessment of MR than the conventional VC diameter measurement by 2D color Doppler. METHODS Using a circulatory loop with an incorporated imaging chamber, various pulsatile flow rates of MR were driven through 4 differently sized orifices. In a clinical study of patients with at least mild MR, regurgitation severity was assessed quantitatively using Doppler-derived effective regurgitant orifice area (EROA), and semiquantitatively as recommended by the American Society of Echocardiography. We describe a step-by-step process to accurately identify the 3D-VC area and compare that measure against known orifice areas (in vitro study) and EROA (clinical study). RESULTS In vitro, 3D-VC area demonstrated the strongest correlation with known orifice area (r = 0.92, p < 0.001), whereas 2D-VC diameter had a weak correlation with orifice area (r = 0.56, p = 0.01). In a clinical study of 61 patients, 3D-VC area correlated with Doppler-derived EROA (r = 0.85, p < 0.001); the relation was stronger than for 2D-VC diameter (r = 0.67, p < 0.001). The advantage of 3D-VC area over 2D-VC diameter was more pronounced in eccentric jets (r = 0.87, p < 0.001 vs. r = 0.6, p < 0.001, respectively) and in moderate-to-severe or severe MR (r = 0.80, p < 0.001 vs. r = 0.18, p = 0.4, respectively). CONCLUSIONS Measurement of VC area is feasible with real-time 3D color Doppler and provides a simple parameter that accurately reflects MR severity, particularly in eccentric and clinically significant MR where geometric assumptions may be challenging. PMID:19356505

  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. Three-dimensional echocardiography in the assessment of congenital mitral valve disease.

    PubMed

    Kutty, Shelby; Colen, Timothy M; Smallhorn, Jeffrey F

    2014-02-01

    Congenital mitral valve abnormalities are rare and cause mitral stenosis, regurgitation, or a combination of the two. Three-dimensional echocardiography has provided new insight into the structure and function of both normal and abnormal mitral valves. Three-dimensional imaging permits accurate anatomic diagnosis and enhances two-dimensional echocardiographic data. Moreover, it enables echocardiographers to communicate effectively with cardiothoracic surgeons when displaying, analyzing, and describing pathology. The purpose of this report is to review congenital mitral valve disease, focusing on the benefits of three-dimensional echocardiography in its evaluation. PMID:24360740

  3. Intraoperative transesophageal two-dimensional echocardiography: a basic vertical plane patient examination sequence.

    PubMed

    Rafferty, T D; Tousignant, G

    1995-01-01

    We have previously reported a standardized stepwise transesophageal echocardiography transverse plane (monoplane) patient examination sequence suitable for intraoperative use. Biplane transesophageal echocardiography furnishes images of the heart and great vessels in both transverse and vertical planes. This report describes a seven-step vertical plane examination, the completion component of a comprehensive intraoperative biplane evaluation. Each step is illustrated by presentation of a two-dimensional echocardiographic image, a matching diagram and a schematic representation of the corresponding axis of interrogation. Examples of clinical presentations complete the report. PMID:8792603

  4. Emergent echocardiography and extracorporeal membrane oxygenation: Lifesaving in massive pulmonary embolism.

    PubMed

    Chowdhury, Mohammed Andaleeb; Moza, Ankush; Siddiqui, Nauman Saleem; Bonnell, Mark; Cooper, Christopher J

    2015-01-01

    Massive pulmonary embolism is a life-threatening emergency that results in circulatory failure. The main challenges in management are early diagnosis and maintenance of hemodynamic stability. We present a case of a 63-year-old male who was in cardiac arrest. After resuscitation, massive pulmonary embolism was diagnosed with the help of bedside echocardiography and extracorporeal membrane oxygenation (ECMO). We were able to maintain hemodynamic stability and improve hypoxia until the patient underwent embolectomy. This case demonstrates a common presentation of massive pulmonary embolism highlighting the main challenges in its management and the role of echocardiography and ECMO in improving outcomes in such scenarios. PMID:26025763

  5. Value of transthoracic echocardiography in the diagnosis of pulmonary embolism: results of a prospective study in unselected patients

    Microsoft Academic Search

    Massimo Miniati; Simonetta Monti; Lorenza Pratali; Giorgio Di Ricco; Carlo Marini; Bruno Formichi; Renato Prediletto; Claudio Michelassi; Maria Di Lorenzo; Lucia Tonelli; Massimo Pistolesi

    2001-01-01

    PURPOSE: Echocardiography is advocated by some as a useful diagnostic test for patients with suspected pulmonary embolism (PE), but its diagnostic accuracy is unknown. The present study was undertaken to determine prospectively the sensitivity and specificity of transthoracic echocardiography in the diagnosis of PE.SUBJECTS AND METHODS: We examined 110 consecutive patients with suspected PE. The study protocol included assessment of

  6. Automatic Systole-Diastole Classification of Mitral Valve Complex from RT-3D Echocardiography based on Multiresolution Processing

    E-print Network

    Wong, Kenneth K.Y.

    Automatic Systole-Diastole Classification of Mitral Valve Complex from RT-3D Echocardiography based, The Chinese University of Hong Kong, Hong Kong ABSTRACT Mitral valve repair is one of the most prevalent operations for various mitral valve conditions. Echocardiography, being famous for its low-cost, non

  7. Obstructed bi-leaflet prosthetic mitral valve imaging with real-time three-dimensional transesophageal echocardiography.

    PubMed

    Shimbo, Mai; Watanabe, Hiroyuki; Kimura, Shunsuke; Terada, Mai; Iino, Takako; Iino, Kenji; Ito, Hiroshi

    2015-01-01

    Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) can provide unique visualization and better understanding of the relationship among cardiac structures. Here, we report the case of an 85-year-old woman with an obstructed mitral prosthetic valve diagnosed promptly by RT3D-TEE, which clearly showed a leaflet stuck in the closed position. The opening and closing angles of the valve leaflets measured by RT3D-TEE were compatible with those measured by fluoroscopy. Moreover, RT3D-TEE revealed, in the ring of the prosthetic valve, thrombi that were not visible on fluoroscopy. RT3D-TEE might be a valuable diagnostic technique for prosthetic mitral valve thrombosis. PMID:24796869

  8. 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%.

  9. Magnetic resonance imaging of microvascular leakage induced by myocardial contrast echocardiography in rats.

    PubMed

    Swanson, Scott D; Dou, Chunyan; Miller, Douglas L

    2006-06-01

    The extent and magnitude of microvascular leakage induced by myocardial contrast echocardiography (MCE) were characterized with contrast-aided magnetic resonance imaging (MRI). Evans blue dye, Definity ultrasound contrast agent and Omniscan magnetic resonance contrast agent were injected intravenously in anesthetized rats suspended in a water bath. Diagnostic ultrasound B mode scans with 1:4 end-systolic triggering were performed at 1.5 MHz using a cardiac phased array scanhead to provide a short axis view of the left ventricle. The in situ peak rarefactional pressure amplitude (PRPA) was 2.0 MPa. Microvascular leakage was characterized by extraction of the dye from tissue samples and by imaging the distribution and concentration of Omniscan within the myocardium. The extracted Evans blue was 2.3 times greater than in shams (P<.05) for heart samples perfused with heparin saline, and 1.6 times greater than shams (not significant) for unperfused samples. The MRI showed the penetration of the ultrasound-induced capillary leakage throughout much of the scan plane. The overall gadolinium content measured by MR showed the same trends as the extracted Evans blue, but was more variable. For pooled data (perfused and unperfused), the exposed samples were significantly increased (P<.05) relative to the sham samples for both Evans blue and gadolinium content. Omniscan leakage was also discernable in two of four MRIs from intact rats (after sacrifice). These results demonstrate a potential for MR mapping of capillary leakage induced by contrast-aided ultrasound, with a possible application to spatial characterization of local drug delivery. PMID:16735182

  10. Incremental value of three-dimensional transoesophageal echocardiography for guiding double percutaneous MitraClip ® implantation in a 'no option' patient.

    PubMed

    Ciobanu, A; Bennett, S; Azam, M; Clark, A; Vinereanu, D

    2011-02-01

    Mitral valve repair for significant mitral regurgitation (MR) is preferred to valve replacement, whenever feasible. Freedom from re-operation is high, reaching 92% at 15 years. However, high-risk patients develop more complications and may be refused surgery. The results from the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) II showed they might benefit from the percutaneous edge-to-edge mitral valve repair using MitraClip(®) system (Evalve, Inc., Menlo Park, CA, USA). We present a case of a ventilator-dependent 57-year-old man with ischaemic A2, A3 prolapse and severe MR causing persistent haemodynamic instability and pulmonary oedema. Attempts to wean the ventilator failed during the 7 month period. High predicted surgical mortality ruled out surgical mitral repair. The percutaneous mitral valve repair became the only option. The use of real-time three-dimensional transoesophageal echocardiography (RT 3D-TOE) to navigate through the cardiac chambers has been previously described. Here, the precise positioning and placement of a second clip, after failure of the first one, was facilitated by 3D-TOE. These images provided 'en-face' views of the mitral valve from both the atrial and ventricular perspective, allowing safe advancement and positioning of the second clip delivery system. Failure of the second clip would have resulted in emergency open heart surgery. This case demonstrates the incremental value of RT 3D-TOE images for a percutaneous double clip mitral repair with the MitraClip(®) system in a patient with no other treatment options. PMID:20876188

  11. Intraoperative transesophageal echocardiography for the evaluation of mitral, aortic and tricuspid valve repair

    Microsoft Academic Search

    R. De Simone; R. Lange; W. Saggau; E. Gams; A. Tanzeem; S. Hag; Universitgt Heidelberg

    The present study reviews the clinical applicability and usefulness of intraoperative transesophageal echocardio- graphy (TEE) during valve repair. Intraoperative TEE was performed in 48 consecutive patients, who were divided into three groups: 1. mitral valve repair (MVR), 2. aortic valve repair (AVR), 3. tricuspid valve repair (TVR). Residual valve regurgitation was assessed by color Doppler echocardiography on a scale from

  12. Using a Robotic Arm for Echocardiography to X-ray Image Registration during Cardiac Catheterization

    E-print Network

    Boyer, Edmond

    Using a Robotic Arm for Echocardiography to X-ray Image Registration during Cardiac Catheterization C-arm, we are able to register the 3D echo images with live 2D X-ray images. In addition, we can fluoroscopic guidance. Pure X-ray guidance has a number of disadvantages. Firstly, X-ray images are two

  13. Regional wall motion analysis by dobutamine stress echocardiography to distinguish between ischemic and nonischemic dilated cardiomyopathy

    Microsoft Academic Search

    Carlo Vigna; Aldo Russo; Vicenzo De Rito; Gian Piero Perna; Marco Testa; Antonella Lombardo; Pompeo Lanna; Tommaso Langialonga; Mauro Pellegrino Salvatori; Raffaele Fanelli; Francesco Loperfido

    1996-01-01

    To distinguish between ischemic and nonischemic dilated cardiomyopathy (DCM), we studied 43 patients with left ventricular dysfunction (15 ischemic and 28 nonischemic detected by coronary angiography) by dobutamine stress echocardiography. At rest, there were more normal segments (p < 0.001) and a trend toward more akinetic segments (p, not significant) per ischemic than per nonischemic DCM patient. However, either at

  14. Non-invasive assessment of cardiac physiology by tissue Doppler echocardiography A comparison with invasive haemodynamics

    Microsoft Academic Search

    J. Zamorano; D. R. Wallbridge; J. Ge; J. Drozd; J. Nesser; R. Erbel

    Aim The purpose of this study was to determine the relationship of myocardial velocity patterns, as assessed by tissue Doppler echocardiography, to the contraction and relaxation phases of the cardiac cycle, as determined during cardiac catheterization. Methods Recordings of left ventricular\\/aortic and left ventricular\\/pulmonary wedge pressures were obtained sim- ultaneously with apical tissue Doppler echocardiographic images of the left ventricle.

  15. Utility of transesophageal echocardiography during port-access minimally invasive cardiac surgery

    Microsoft Academic Search

    Robert M Applebaum; Wayne M Cutler; Nisha Bhardwaj; Stephen B Colvin; Aubrey C Galloway; Greg H Ribakove; Eugene A Grossi; Daniel S Schwartz; Richard V Anderson; Paul A Tunick; Itzhak Kronzon

    1998-01-01

    In this study, we sought to determine the use of transesophageal echocardiography (TEE) as the primary imaging technique to assist in the placement of endovascular catheters during minimally invasive, port-access cardiac surgery. The recent development of endovascular catheters that are placed via the femoral artery and vein has enabled patients to be placed on cardiopulmonary bypass without the need for

  16. Coronary Segmentation from Echocardiography using Fuzzy Connectedness A.F.L. Souza1

    E-print Network

    Lewiner, Thomas (Thomas Lewiner)

    Coronary Segmentation from Echocardiography using Fuzzy Connectedness A.F.L. Souza1 ­ D.M. Lage ­ S images (phantoms) using Fuzzy Connectedness concepts implemented using Image Foresting Transform (IFT be applied to process the image segmentation. In echocardiographic scenario, it is necessary a preprocessing

  17. The Role of Transesophageal Echocardiography in Rapid Diagnosis and Treatment of Migratory Tumor Embolus

    Microsoft Academic Search

    Hsiupei Chen; Victor Ng; Christopher J. Kane; Isobel A. Russell

    2004-01-01

    Transesophageal echocardiography (TEE) is sometimes used in renal cell carcinoma excision for evaluating the extension of tumor in the inferior vena cava (IVC), charac- terizing the tumor anatomy, monitoring the tumor during surgical mobilization, and assessing cardiac function. Al- though the risk for embolization is small, when emboliza- tion does occur, its consequences can be catastrophic. In this case report,

  18. Relation between myocardial oxygen consumption and myocardial blood volume: A study using myocardial contrast echocardiography

    Microsoft Academic Search

    D. Elizabeth Le; Jian-Ping Bin; Matthew P. Coggins; Kevin Wei; Jonathan R. Lindner; Sanjiv Kaul

    2002-01-01

    Myocardial blood volume (MBV) is the volume of blood residing in myocardial vessels, 90% of which is in capillaries. MBV can be measured in vivo using myocardial contrast echocardiography (MCE). It has been shown that when increases in coronary blood flow (CBF) are not associated with increase in myocardial oxygen consumption (MVO2), MBV does not increase. We hypothesized that MBV

  19. Transnasal Transesophageal Echocardiography: A Modified Application Mode for Cardiac Examination in Ventilated Patients

    Microsoft Academic Search

    Clemens-A. Greim; Iris Kraus; Christian Apfel; Holger Thiel; Norbert Roewer

    In 42 endotracheally intubated patients, we exam- ined the utility of a miniaturized monoplane probe for transnasal transesophageal echocardiography (TEE). Transnasal TEE was prospectively evaluated in 26 deeply and 16 mildly sedated patients receiving topical anesthesia with lidocaine jelly 2%. The pa- tients with deep sedation were additionally exam- ined with transoral monoplane and multiplane TEE. Transnasal esophageal insertion of

  20. A mathematical model for the assessment of hemodynamic parameters using quantitative contrast echocardiography

    Microsoft Academic Search

    Xucai Chen; Karl Q. Schwarz; Daniel Phillips; Sherry D. Steinmetz; Reinhard Schlief

    1998-01-01

    A mathematical model for the assessment of hemodynamic parameters using quantitative echocardiography is presented. The method involves the intravenous injection of an ultrasonic echo contrast agent. The relative enhancement of the backscattered ultrasound intensity is measured as a function of time (the time-intensity curve). From this measurement, the volume flow rate (cardiac output) and the mixing volume are calculated. Relevant

  1. 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

  2. Optimal method for early detection of cardiac disorders in thalassemia major patients: magnetic resonance imaging or echocardiography?

    PubMed Central

    Moussavi, Farideh; Roodpeyma, Shahla; Alavi, Samin; Shakiba, Majid; Gheiratmand, Riaz; Omidghaemi, Maryam

    2014-01-01

    Background Heart failure resulting from myocardial iron deposition is the most important cause of death in ?-thalassemia major (TM) patients. Cardiac T2*magnetic resonance imaging (MRI), echocardiography, and serum ferritin level serve as diagnostic methods for detecting myocardial iron overload. In this study, we aimed to evaluate the relationship between the above-mentioned methods. Methods T2*MRI and echocardiographic measurement of left ventricular (LV) systolic and diastolic function were performed in 63 patients. Serum ferritin level was measured. The relationships between all assessments were evaluated. Results There were 40 women and 23 men with a mean age of 23.7±5.1 years (range, 15-35 years). There was no statistically significant correlation between serum ferritin level and LV systolic and diastolic function (P=0.994 and P=0.475, respectively). T2*MRI results had a significant correlation with ferritin level; 63.6% of patients with serum ferritin level >2,000 ng/mL had abnormal cardiac MRI, while none of the patients with ferritin level <1,000 ng/mL had abnormal cardiac MRI (P=0.001). There was no significant correlation between MRI findings and LV systolic function (P=1.00). However, we detected a significant difference between LV diastolic function and cardiac siderosis (P=0.03) Conclusion MRI findings are a good predictor of future cardiac dysfunction, even in asymptomatic TM patients; however, diastolic dysfunction may happen prior to cardiac siderosis in some patients, and echocardiography is able to diagnose this diastolic dysfunction while T2*MRI shows normal findings. PMID:25325038

  3. Real-Time Three-Dimensional Echocardiography to Assess Right Ventricle Function in Patients with Pulmonary Hypertension

    PubMed Central

    Li, Yidan; Wang, Yidan; Zhai, Zhenguo; Guo, Xiaojuan; Yang, Yuanhua; Lu, Xiuzhang

    2015-01-01

    Background The convenience and availability of real-time three-dimensional echocardiography (RT3DE) makes it an attractive candidate for assessing right ventricle function. However, the viability of RT3DE is not conclusive. Aim of Study This study aims to evaluate RT3DE relative to cardiac magnetic resonance and 2-dimensional echocardiography (2DE) for measuring right ventricular systolic function in patients with pulmonary hypertension. Methods Patients with pulmonary hypertension (n = 23) underwent cardiac magnetic resonance, 2DE, and RT3DE. Specifically, 2DE was used to measure the right ventricular index of myocardial performance (RIMP), fractional area change, tricuspid annular plane systolic excursion (TAPSE), and tissue Doppler-derived tricuspid annular systolic velocity (S?). Cardiac magnetic resonance and RT3DE were used to measure right ventricular end-diastolic volume (RVEDV) and end-systolic volume (RVESV). The right ventricular ejection fraction (RVEF) was calculated. Results Regarding the measurements taken by 2DE, RVEF positively correlated with fractional area change (r = 0.595, P = 0.003) and S?(r = 0.489, P = 0.018), and negatively correlated with RIMP (r = ?0.745, P = 0.000). There was no association between RVEF and TAPSE (r = ?0.029, P = 0.896). There existed a close correlation between the values of RVEDV, RVESV, and RVEF as measured by RT3DE and CMR respectively (P<0.001); Bland-Altmanan analyses showed good agreement between them. Conclusion RT3DE was a viable method for noninvasive, accurate assessment of right ventricular systolic function in patients with pulmonary hypertension. PMID:26075788

  4. The diagnostic accuracy of pharmacological stress echocardiography for the assessment of coronary artery disease: a meta-analysis

    PubMed Central

    Picano, Eugenio; Molinaro, Sabrina; Pasanisi, Emilio

    2008-01-01

    Background Recent American Heart Association/American College of Cardiology guidelines state that "dobutamine stress echo has substantially higher sensitivity than vasodilator stress echo for detection of coronary artery stenosis" while the European Society of Cardiology guidelines and the European Association of Echocardiography recommendations conclude that "the two tests have very similar applications". Who is right? Aim To evaluate the diagnostic accuracy of dobutamine versus dipyridamole stress echocardiography through an evidence-based approach. Methods From PubMed search, we identified all papers with coronary angiographic verification and head-to-head comparison of dobutamine stress echo (40 mcg/kg/min ± atropine) versus dipyridamole stress echo performed with state-of-the art protocols (either 0.84 mg/kg in 10' plus atropine, or 0.84 mg/kg in 6' without atropine). A total of 5 papers have been found. Pooled weight meta-analysis was performed. Results the 5 analyzed papers recruited 435 patients, 299 with and 136 without angiographically assessed coronary artery disease (quantitatively assessed stenosis > 50%). Dipyridamole and dobutamine showed similar accuracy (87%, 95% confidence intervals, CI, 83–90, vs. 84%, CI, 80–88, p = 0.48), sensitivity (85%, CI 80–89, vs. 86%, CI 78–91, p = 0.81) and specificity (89%, CI 82–94 vs. 86%, CI 75–89, p = 0.15). Conclusion When state-of-the art protocols are considered, dipyridamole and dobutamine stress echo have similar accuracy, specificity and – most importantly – sensitivity for detection of CAD. European recommendations concluding that "dobutamine and vasodilators (at appropriately high doses) are equally potent ischemic stressors for inducing wall motion abnormalities in presence of a critical coronary artery stenosis" are evidence-based. PMID:18565214

  5. Echocardiography of the normal camel (Camelus dromedaries) heart: technique and cardiac dimensions

    PubMed Central

    2012-01-01

    Background Echocardiography and intra-cardiac dimensions have not previously been reported in adult camels despite its potential application for medical purpose. The aim of this study was to describe the results of a prospective study, aiming to report normal cardiac appearance and normal chamber dimensions in adult camels (Camelus dromedarius). Results On the right side, when the probe was placed in the 5th or 4th intercostal space (ICS), the caudal long-axis four-chamber view of the ventricles, atria, and the interventricular septum was obtained. Placing the probe slightly more cranially in the 4th ICS, the caudal long-axis four-chamber view and the caudal long-axis view of the left ventricular outflow tract (LVOT) were imaged. In 7 camels, a hybrid view between a “four-chamber” and “LVOT view” was imaged from the same position. The short-axis view of the ventricles was obtained in the 4th ICS where the transducer was rotated between 0° and 25°. Placement of the transducer in the 3rd ICS allowed visualisation of the right ventricular outflow tract (RVOT). On the left side, when the probe was placed in the 5th or 4th ICS, a four-chamber view was obtained. The LVOT is imaged in the 4th ICS and the RVOT was seen from the 3rd ICS. Conclusions This study showed that it is possible to obtain good-quality echocardiograms in adult camels and provide normal cardiac dimensions. This study could be used as a reference for further studies concerning camels with cardiac diseases. PMID:22862855

  6. Two-dimensional intraventricular flow mapping by digital processing conventional color-Doppler echocardiography images.

    PubMed

    Garcia, Damien; Del Alamo, Juan C; Tanne, David; Yotti, Raquel; Cortina, Cristina; Bertrand, Eric; Antoranz, José Carlos; Perez-David, Esther; Rieu, Régis; Fernandez-Aviles, Francisco; Bermejo, Javier

    2010-10-01

    Doppler echocardiography remains the most extended clinical modality for the evaluation of left ventricular (LV) function. Current Doppler ultrasound methods, however, are limited to the representation of a single flow velocity component. We thus developed a novel technique to construct 2D time-resolved (2D+t) LV velocity fields from conventional transthoracic clinical acquisitions. Combining color-Doppler velocities with LV wall positions, the cross-beam blood velocities were calculated using the continuity equation under a planar flow assumption. To validate the algorithm, 2D Doppler flow mapping and laser particle image velocimetry (PIV) measurements were carried out in an atrio-ventricular duplicator. Phase-contrast magnetic resonance (MR) acquisitions were used to measure in vivo the error due to the 2D flow assumption and to potential scan-plane misalignment. Finally, the applicability of the Doppler technique was tested in the clinical setting. In vitro experiments demonstrated that the new method yields an accurate quantitative description of the main vortex that forms during the cardiac cycle (mean error for vortex radius, position and circulation). MR image analysis evidenced that the error due to the planar flow assumption is close to 15% and does not preclude the characterization of major vortex properties neither in the normal nor in the dilated LV. These results are yet to be confirmed by a head-to-head clinical validation study. Clinical Doppler studies showed that the method is readily applicable and that a single large anterograde vortex develops in the healthy ventricle while supplementary retrograde swirling structures may appear in the diseased heart. The proposed echocardiographic method based on the continuity equation is fast, clinically-compliant and does not require complex training. This technique will potentially enable investigators to study of additional quantitative aspects of intraventricular flow dynamics in the clinical setting by high-throughput processing conventional color-Doppler images. PMID:20562044

  7. Cancer therapy and cardiotoxicity: The need of serial Doppler echocardiography

    Microsoft Academic Search

    Maurizio Galderisi; Francesco Marra; Roberta Esposito; Vincenzo Schiano Lomoriello; Moira Pardo; Oreste de Divitiis

    2007-01-01

    Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the quality of life and the prognosis. For several years the most common noninvasive

  8. 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.

  9. Severe Tricuspid Regurgitation Diagnosed 13 Years after a Car Accident: A Case Report

    PubMed Central

    Acar, Burak; Suleymanoglu, Muhammed; Burak, Cengiz; Demirkan, Burcu Mecit; Guray, Yesim; Tufekcioglu, Omac; Aydogdu, Sinan

    2015-01-01

    Abstract Blunt chest traumas mostly occur due to car accidents and can cause many cardiac complications such as septal rupture, free-wall rupture, coronary artery dissection or thrombosis, heart failure, arrhythmias, and chordae and papillary muscle rupture. One of the most serious complication is tricuspid regurgitation (TR), which can be simply diagnosed by physical examination and confirmed by echocardiography. We describe a 48-year-old female patient, diagnosed with severe TR 13 years after a blunt chest trauma due to a car accident. TR was diagnosed with transthoracic echocardiography and three dimensional transthoracic echocardiography had defined the exact pathology of the tricuspid valve. The patient underwent successful surgery with bioprosthetic valve implantation and was discharged at 6th postoperative day without any complication. The patient had no problem according to the follow-up one month and six months after operation.

  10. Optimizing utilization of pediatric echocardiography and implications for telemedicine 1 1 The content of this article does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names commercial products, or organizations imply endorsement by the U.S. government

    Microsoft Academic Search

    Thomas D Scholz; Michael G Kienzle

    1999-01-01

    Telemedicine can deliver tertiary level services to remote communities where subspecialty care is limited. Locally performed echocardiography has been initiated at several locations around Iowa. The goal of this study was to examine utilization and diagnostic yield of community-based echocardiographic services. Community physicians selected patients for remote echocardiograms (echoes), and studies were performed locally by sonographers trained in recording pediatric

  11. Is the addition of ECG gating to technetium-99m sestamibi SPET of value in the assessment of myocardial viability? An evaluation based on two-dimensional echocardiography following revascularization.

    PubMed

    González, P; Massardo, T; Muñoz, A; Jofré, J; Rivera, A; Yovanovich, J; Maiers, E; Ayala, F; Humeres, P; Ramírez, A; Arriagada, M; Zavala, A

    1996-10-01

    The main goal of this study was to evaluate whether the addition of ECG gating to technetium-99m sestamibi single-photon emission tomographic (SPET) perfusion imaging assists the prediction of recovery of regional wall motion abnormalities after revascularization. Thirty-six patients with coronary artery disease were included in the study. All had wall motion abnormalities, and 31 (86%) had a clinical history of myocardial infarction. Coronary artery bypass surgery was performed in 18 patients and angioplasty in the remainder. All underwent ECG-gated and non-gated SPET at rest and after intravenous dipyridamole. Two-dimensional echocardiography was performed at a mean of 27 days before revascularization and at a mean of 69 days following revascularization to assess segmental wall motion changes. Perfusion prior to revascularization was analysed qualitatively and quantitatively on gated and non-gated SPET, and the results compared with those of echocardiography. Bullseye parameters were obtained from a normal database, generated from data in 40 normal volunteers, using dipyridamole ECG-gated and non-gated sestamibi SPET. There was good concordance between gated and non-gated qualitative analysis (79% with kappa=0.65) for normal, viable or necrotic segments. Gated SPET predicted functional recovery in 27 of 35 (77%) segments showing echocardiographic improvement while non-gated SPET did so in 30 of 39 (77%) such segments. Gated SPET predicted no functional recovery in 20 of 45 (44%) segments that did not show improved wall motion after revascularization, while with non-gated SPET the figure was 18 of 51 (35%). The positive predictive values of gated and non-gated SPET with regard to the recovery of wall motion following revascularization were 52% and 48%, while the negative predictive values were 71% and 67%, respectively. 99mTc-sestamibi had a low predictive value for recovery of function if visual assessment was used in the analysis of SPET data. Quantitative bullseye sestamibi parameters (defect extension and severity, reversibility and percentage change in extension), from gated or non-gated studies, appear best to distinguish which segments will display improved motility on the echocardiogram after revascularization. The addition of ECG gating does not significantly increase the predictive value of SPET imaging with regard to recovery of function. PMID:8781135

  12. Beyond Show and Tell.

    ERIC Educational Resources Information Center

    Krovetz, Martin; And Others

    1993-01-01

    Developing their own criteria for authentic learning prompted several teachers of a three-hour interdisciplinary block combining biology, U.S. history, and American literature to critique old, favorite assignments and develop new, more powerful ones for their tenth graders. Book reports and Civil War battle research yielded to more authentic and…

  13. 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

  14. Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department.

    PubMed

    Lee, Mirae; Chang, Sung-A; Cho, Eun Jeong; Park, Sung-Ji; Choi, Jin-Oh; Lee, Sang-Chol; Oh, Jae K; Park, Seung Woo

    2015-03-01

    Left ventricular strain echocardiography is reported to be more sensitive in detecting myocardial ischemia than conventional transthoracic echocardiography (TTE). We evaluated the usefulness of 2D strain analysis for the assessment of acute chest pain in emergency department (ED). Patients presenting to ED with acute chest pain were recruited. Patients with ST-elevation myocardial infarction, known coronary artery disease (CAD), non-ischemic cardiomyopathy, or non-cardiac chest pain were excluded. The pretest probability of CAD and TTEs were evaluated in all patients. TTEs included visual assessments of regional wall motion abnormality (RWMA) and analysis of global and regional longitudinal strain (GLS and RLS). The diagnosis of CAD and the occurrence of cardiac events during 1 month after ED visit were reviewed. Cardiac events were observed in 25% of total 104 patients, and CAD was detected in 36% of 69 patients with coronary imaging tests. Compared to RWMA, RLS showed higher sensitivity (sensitivity/specificity = 64/89 vs. 92/77%) with similar diagnostic accuracy (79.7 vs. 82.6%, p = 0.791) for CAD. RLS also demonstrated better diagnostic performance than either GLS (sensitivity/specificity = 92/57%) or pretest probability (sensitivity/specificity = 72/64 %). Similarly, RLS had the higher predictive value for 1-month cardiac events. In multivariable analyses including pretest probability, LVEF, RWMA, cardiac enzyme, GLS, and RLS; only pretest probability (OR 1.91, 95% CI 1.22-2.99, p = 0.005) and RLS (OR 25.42, 95 % CI 1.84-342.04, p = 0.016) independently predicted CAD. Strain echocardiography appears to be effective in diagnosing CAD and predicting future events with high sensitivity and negative predictive value in acute chest pain patients visiting ED. PMID:25583630

  15. Acute assessment of microvascular perfusion patterns by myocardial contrast echocardiography during myocardial infarction: relation to timing and extent of functional recovery

    PubMed Central

    Czitrom, D; Karila-Cohen, D; Brochet, E; Juliard, J; Faraggi, M; Aumont, M; Assayag, P; Steg, P

    1999-01-01

    Objective—To examine the relation between the initial microvascular perfusion pattern, as assessed by intracoronary myocardial contrast echocardiography (MCE), immediately after restoration of TIMI (thrombolysis in myocardial infarction) (TIMI) grade 3 flow during acute myocardial infarction, and the extent and timing of functional recovery in the area at risk.?Setting—Referral centre for interventional cardiology.?Methods—Intracoronary MCE was performed 15 minutes after TIMI grade 3 recanalisation of the infarct artery in 25 patients. Segmental myocardial contrast patterns were graded semiquantitatively (0, none; 0.5, heterogeneous; 1, homogeneous). Functional recovery was assessed by echocardiography on days 9 and 42.?Results—Among 174 myocardial segments in the area at risk, wall motion recovery on day 9 was observed in 40% of MCE grade 1 segments but there was no significant recovery in grade 0 or 0.5 segments. On day 42, recovery had occurred in 56% of MCE grade 1 segments (p < 0.0001 v MCE grade 0 and 0.5; p = 0.0001 v MCE grade 1 on day 9), and 22% of MCE grade 0.5 segments (p = 0.02 v MCE grade 0; p = 0.0005 v MCE grade 0.5 on day 9); MCE grade 0 segments did not recover. Negative predictive value in predicting recovery by contrast enhancement was 95% and 89% by days 9 and 42, respectively.?Conclusions—Contractile recovery occurs earliest in well reperfused segments. Up to one quarter of segments with heterogeneous contrast enhancement show wall motion recovery within the first six weeks. Myocardial perfusion after recanalisation in acute myocardial infarction, even if heterogeneous, is a prerequisite for postischaemic functional recovery. Thus preservation of acute myocardial perfusion is associated with more complete and early functional recovery.?? Keywords: acute myocardial infarction;  myocardial contrast echocardiography;  microcirculation;  functional recovery PMID:10220538

  16. Severe Weather

    NSDL National Science Digital Library

    National Science Teachers Association (NSTA)

    2005-04-01

    Meteorologists disagree as to what constitutes severe weather. However, most concur that thunderstorms, tornadoes, and hurricanes, all considered to be "convective" weather, fit the definition of severe weather, which is a weather condition likely to cause hardship. This science guide will explore each of the three weather phenomena. By virtue of their locations, most students are familiar with at least one of the three severe weather events. Students who tour the web sites will have an opportunity to make connections between the familiar and the perhaps less understood weather events.

  17. Severe Storms

    NSDL National Science Digital Library

    2010-01-01

    Part of the University of Illinois Weather World 2010 project, this guide uses multimedia technology and the dynamic capabilities of the web to incorporate text, colorful diagrams, animations, computer simulations, audio, and video to introduce topics and concepts in the atmospheric sciences. This module is a combination of two elements. The first is the National Oceanic and Atmospheric Administration (NOAA) Severe Storms Spotters Guide. The second is a section discussing the efforts and results of modeling severe storms. The Spotters Guide contains supplemental instructional resources and a program designed to familiarize meteorologists and advanced severe storm spotters with the building blocks of convective storm structure. The focus of the training series is the development of a thunderstorm spectrum and a discussion of the physical characteristics and severe weather potential of the various storm types in the spectrum.

  18. Sever's Disease

    MedlinePLUS

    ... pretty frightening, Sever's disease is really a common heel injury that occurs in kids. It can be ... inflammation (swelling) of the growth plate in the heel. A growth plate, also called an epiphyseal plate, ...

  19. Autumn shows roundup

    Microsoft Academic Search

    Richard Bloss

    2002-01-01

    A report on three major American automation shows where innovative products and automated assembly technologies formed a focus. Products reviewed include grippers, actuators, assembly modules, dispensing controller and pneumatic components from a number of suppliers.

  20. Peri-operative assessment of right heart function: role of echocardiography.

    PubMed

    Tan, Timothy C; Dudzinski, David M; Hung, Judy; Mehta, Vipin

    2015-07-01

    The right heart contributes significantly to overall cardiac function. Right ventricular (RV) haemodynamics and function have been defined to be physiologically different from the left ventricle, and yet independently associated with outcomes in a spectrum of conditions. In particular, RV function has been shown to influence prognosis of patients undergoing surgery. The assessment of right heart function during the intra-operative and immediate postoperative periods plays an important role in the clinical management of patients having surgery. While a number of techniques are available for the assessment of the right heart intra-operatively, echocardiography remains the prime choice being least invasive, relatively safe, readily accessible and cost-effective. Advancements in the field of echocardiographic have improved ability to assess right heart function. This review examines the role echocardiography and advances in this imaging modality in the assessment of right heart function within the peri-operative setting. PMID:25989109

  1. Real-time three-dimensional intracardiac echocardiography: an early single-center experience.

    PubMed

    Maini, Brijeshwar

    2015-01-01

    As interventional procedures in structural heart diseases are coming of age, there is a significant lag in the periinterventional imaging development for these procedures to become safe, expedient, accurate, and well tolerated by this patient population. Currently, transesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D), has been used for monitoring and guidance for these procedures. Accurate identification of the pathology, its anatomy, and its relationship with the adjoining structures along with spatial resolution is of paramount importance for wire and catheter placement, device deployment, evaluation of the results, and any potential complications. Two-dimensional intracardiac echocardiography (ICE) has been used extensively for a variety of interventional procedures that undergo conscious sedation of monitored anesthesia. RT-3D ICE has recently become available; we describe our initial experience with this new imaging technology. PMID:25589706

  2. Comparison of conventional and transesophageal echocardiography with magnetic resonance imaging for anatomical mapping of thoracic aortic dissection

    Microsoft Academic Search

    Christoph A. Nienaber; Yskert von Kodolitsch; Carsten J. Brockhoff; Dietmar H. Koschyk; Rolf P. Spielmann

    1994-01-01

    Thirty-five consecutive patients with clinically suspected aortic dissection were subjected to a dual noninvasive imaging protocol using comprehensive echocardiography and ECG-triggered MRI with multi-slice spin echo and cine sequences in random order. The purpose of this dual imaging study was to compare the diagnostic accuracy of two-dimensional and color-coded Doppler echocardiography using the conventional transthoracic (TTE) and the transesophageal approach

  3. 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

  4. Open access echocardiography in management of the heart failure in the community

    Microsoft Academic Search

    C. M. Francis; L. Caruana; P. Kearney; M. Love; G. R. Sutherland; I. R. Starkey; T. R. D. Shaw; J. J. V. McMurray; J. R. Hampton; A. R. Barlow

    1995-01-01

    AbstractObjective: To assess the value of an open access echocardiography service.Design: Study of new open access service for general practitioners, who were invited to refer patients taking diuretics for suspected heart failure, untreated patients with symptoms of possible heart failure, and asymptomatic patients with risk factors for left ventricular systolic dysfunction.Setting: Regional cardiology centre.Subjects: 259 consecutive patients.Main outcome measures: Presence

  5. Feasibility, Accuracy, and Incremental Value of Intraoperative Three-Dimensional Transesophageal Echocardiography in Valve Surgery

    Microsoft Academic Search

    Theodore P Abraham; James G Warner; Neal D Kon; Patrick E Lantz; Karen M Fowle; Robert F Brooker; Shuping Ge; Abdel M Nomeir; Dalane W Kitzman

    1997-01-01

    In this prospective trial, intraoperative 2-dimensional (2-D) and 3-dimensional (3-D) transesophageal echocardiography (TEE) examinations were performed on 60 consecutive patients undergoing cardiac valve surgery. Both 2-D (including color flow and Doppler data) and 3-D images were reviewed by blinded observers, and major valvular morphologic findings recorded. In vivo morphologic findings were noted by the surgeon and all explanted valves underwent

  6. The Role of Transesophageal Echocardiography in Endovascular Repair of Traumatic Aortic Transection

    PubMed Central

    Al-Shamsi, Sulaiman Saif; Sabek, Said Abdelrahman; Al-Hajri, Mahmood

    2014-01-01

    Traumatic rupture of the thoracic aorta is a leading cause of death, following major blunt trauma, and endovascular repair has evolved as a viable alternative to open repair. This report highlights the role of transesophageal echocardiography as a valuable imaging tool for locating the exact position of the lesion, guiding placement of the endograft, detecting leaks around it and supplementing information derived from angiography during endograft deployment. PMID:25337315

  7. Real-time intraoperative transesophageal echocardiography-how useful? experience of 5,016 cases

    Microsoft Academic Search

    Manisha Mishra; Rajesh Chauhan; Krishan K. Sharma; Ajay Dhar; Milind Bhise; Sunil Dhole; Ashok Omar; Ravi R. Kasliwal; Naresh Trehan

    1998-01-01

    Objective: To evaluate transesophageal echocardiography (TEE) as an intraoperative monitoring modality and to assess its safety, reliability, and overall utility in real-time use during cardiac surgery.Design: Prospective, observational cohort study performed from January 1993 to June 1997.Setting: Operating room of a tertiary care hospital for cardiology and cardiovascular surgery.Participants: Five thousand and sixteen adult patients with acquired heart disease, who

  8. Right-to-Left-Shunts Detected by Transesophageal Echocardiography and Transcranial Doppler Sonography

    Microsoft Academic Search

    Dirk W. Droste; Carsten Schmidt-Rimpler; Thomas Wichter; Ralf Dittrich; Martin Ritter; Jörg Stypmann; E. Bernd Ringelstein

    2004-01-01

    Background: Transesophageal echocardiography (TEE) and transcranial Doppler sonography (TCD) can identify right-to-left-shunts that predispose to paradoxical embolism. In a large cohort we compared the results of both techniques. Methods: 222 patients were investigated by both techniques using the contrast agent Echovist®-300 and performing each test once without and once with the Valsalva maneuver (VM). Results: TEE-proven right-to-left-shunts were detected by

  9. Harmonic 3-d echocardiography with a fast-rotating ultrasound transducer

    Microsoft Academic Search

    Marco M. Voormolen; Boudewijn J. Krenning; C. T. Lancee; Folkert Ten Cate; Jos T. C. Roelandt; Antonius W. Van Der Steen; Nico Jong

    2006-01-01

    Although the advantages of three-dimensional (3-D) echocardiography have been acknowledged, its application for routine diagnosis is still very limited. This is mainly due to the relatively long acquisition time. Only recently has this problem been addressed with the introduction of new real-time 3-D echo systems. This paper describes the design, characteristics, and capabilities of an alternative concept for rapid 3-D

  10. 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

  11. Clinical utility of troponin T levels and echocardiography in the emergency department

    Microsoft Academic Search

    Emile R. Mohler III; Thomas Ryan; Douglas S. Segar; Stephen G. Sawada; Ali F. Sonel; Laura Perkins; Naomi Fineberg; Harvey Feigenbaum; Robert L. Wilensky

    1998-01-01

    We investigated the clinical utility of cardiac troponin T (TnT) and echocardiography in the emergency department to predict subsequent in-hospital diagnosis and adverse cardiac events. TnT is a cardiac-specific protein released during cell injury such as that following acute myocardial infarction (MI). Unlike creatine kinase-MB isoenzymes, TnT is increased in a subset of patients with unstable angina, and these may

  12. Diagnostic ability of hand-held echocardiography in ventilated critically ill patients

    PubMed Central

    Vignon, Philippe; Chastagner, Catherine; François, Bruno; Martaillé, Jean-François; Normand, Sandrine; Bonnivard, Michel; Gastinne, Hervé

    2003-01-01

    Study objectives To compare the diagnostic capability of recently available hand-held echocardiography (HHE) and of conventional transthoracic echocardiography (TTE) used as a gold standard in critically ill patients under mechanical ventilation. Design A prospective and descriptive study. Setting The general intensive care unit of a teaching hospital. Patients All mechanically ventilated patients requiring a TTE study with a full-feature echocardiographic platform (Sonos 5500®; Philips Medical Systems, Andover, MA, USA) also underwent an echocardiographic examination using a small battery-operated device (33 × 23 cm2, 3.5 kg) (Optigo®; Philips Medical Systems). Interventions Each examination was performed independently by two intensivists experienced in echocardiography and was interpreted online. For each patient, the TTE videotape was reviewed by a cardiologist experienced in echocardiography and the final interpretation was used as a reference diagnosis. Results During the study period, 106 TTE procedures were performed in 103 consecutive patients (age, 59 ± 18 years; Simplified Acute Physiology Score, 46 ± 14; body mass index, 26 ± 9 kg/m2; positive end-expiratory pressure, 8 ± 4 cmH2O). The number of acoustic windows was comparable using HHE and TTE (233/318 versus 238/318, P = 0.72). HHE had a lower overall diagnostic capacity than TTE (199/251 versus 223/251 clinical questions solved, P = 0.005), mainly due to its lack of spectral Doppler capability. In contrast, diagnostic capacity based on two-dimensional imaging was comparable for both approaches (129/155 versus 135/155 clinical questions solved, P = 0.4). In addition, HHE and TTE had a similar therapeutic impact in 45 and 47 patients, respectively (44% versus 46%, P = 0.9). Conclusions HHE appears to have a narrower diagnostic field when compared with conventional TTE, but promises to accurately identify diagnoses based on two-dimensional imaging in ventilated critically ill patients. PMID:12974974

  13. Evaluation of Congenital Heart Diseases with Real-time Three-dimensional Echocardiography

    Microsoft Academic Search

    Kai-Sheng Hsieh; Ta-Cheng Huang; Ken-Peng Wong; Wen-Hsien Lu; Kaung-Jen Chien

    2008-01-01

    Background. As a beating organ in the human body, the structure and motion of the heart can be depicted best with real-time 3-dimensional (RT-3D) image modality. Traditional M-mode and real-time two-dimensional (2D) echocardiography can be used for diagnosis of complex congenital heart defects, but with these modalities, the type of lesion and its complexity can only be appreciated indirectly, after

  14. Mapping Myocardial Fiber Orientation Using Echocardiography-Based Shear Wave Imaging

    Microsoft Academic Search

    Wei-Ning Lee; Mathieu Pernot; Mathieu Couade; Emmanuel Messas; Patrick Bruneval; Alain Bel; Albert A. Hagege; Mathias Fink; Mickaël Tanter

    2012-01-01

    The assessment of disrupted myocardial fiber arrangement may help to understand and diagnose hypertrophic or ischemic cardiomyopathy. We hereby proposed and developed shear wave imaging (SWI), which is an echocardiography-based, noninvasive, real-time, and easy-to-use technique, to map myofiber orientation. Five in vitro porcine and three in vivo open-chest ovine hearts were studied. Known in physics, shear wave propagates faster along

  15. 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

  16. Microbubbles detection during cardiopulmonary bypass with transoesophageal echocardiography: a case report

    PubMed Central

    Zanatta, Paolo; Bosco, Enrico; Salandin, Valeria; Salvador, Loris; Valfrè, Carlo; Sorbara, Carlo

    2008-01-01

    Introduction Microembolic signals are usually detected with transcranial doppler during cardiac surgery. This report focuses on suggesting the transesophageal echocardiography as a different diagnostic approach to detect microemboli during cardiopulmonary bypass. Case presentation A 58 year old male patient, caucasian race, was operated on video assisted minimally invasive mitral valve repair using right minithoracotomy approach. His past medical history included an uncontrolled hypertension, dyslipidemia, insulin dependent diabetes mellitus, carotid arteries stenosis. The extracorporeal circulation was performed with femoral-femoral artery and venous approach. Negative pressure for vacuum assist venous drainage was applied in order to facilitate venous blood return. The patient had a brain monitoring with bilateral transcranial doppler of middle cerebral arteries and a double channels electroencephalogram. A three dimensional transesophageal echocardiography to evaluate the mitral valve repair was performed. During the cardiopulmonary bypass a significant microembolic activity was detected in the middle cerebral arteries spectrum velocities due to gas embolism from venous return. Simultaneous recording of microbubbles was also observed on the descending thoracic aorta transesophageal echo views. Conclusion During the aortic cross-clamping time the transesophageal echocardiography can be useful as an alternative method to assess the amount of gas embolism coming from cardiopulmonary bypass. These informations can promote immediate interaction between perfusionist, surgeon and anesthesiologist to perform adequate manoeuvres in order to reduce the microembolism during extracorporeal circulation. PMID:18775067

  17. Myocardial layer-specific analysis of ischemic memory using speckle tracking echocardiography.

    PubMed

    Sakurai, Daisuke; Asanuma, Toshihiko; Masuda, Kasumi; Hioki, Ayana; Nakatani, Satoshi

    2014-04-01

    The assessment of post-systolic shortening (PSS) by speckle tracking echocardiography allows myocardial ischemic memory imaging. Because the endocardial layer is more vulnerable to ischemia, the assessment of this layer might be useful for detecting ischemic memory. Serial echocardiographic data were acquired from nine dogs with 2 min of coronary occlusion followed by reperfusion. Regional deformation parameters were measured in the risk and normal areas. Using speckle tracking echocardiography, circumferential strain was analyzed in the endocardial, mid-wall, and epicardial layers; and radial strain was analyzed in the inner half, outer half and entire (transmural) layers. In the risk area, peak systolic and end-systolic strain in the circumferential and radial directions significantly decreased during occlusion, but recovered to the baseline levels immediately after reperfusion in all layers. However, circumferential post-systolic strain index (PSI), a parameter of PSS, significantly increased during occlusion, and the significant increases persisted until 20 min after reperfusion in the endocardial and mid-wall layers. Radial PSI tended to increase after reperfusion in the inner half and entire layers but these increases were not significant compared with baseline. In the normal area, systolic strains and PSI in the radial and circumferential directions hardly changed before and after occlusion/reperfusion in all layers. In layer-specific analysis with speckle tracking echocardiography, circumferential PSS in the endocardial and mid-wall layers may be useful for detecting ischemic memory. PMID:24532055

  18. The feasibility of dobutamine stress echocardiography in the emergency department with telemedicine interpretation.

    PubMed

    Trippi, J A; Kopp, G; Lee, K S; Morrison, H; Risk, G; Jones, J H; Cordell, W H; Chrapla, M; Nelson, D

    1996-01-01

    Dobutamine stress echocardiography (DSE) was performed on 26 patients admitted for chest pain deemed at low risk for myocardial infarction. Pharmacologic stress in the emergency department on a 24-hour basis was administered by nurses and echocardiographic ultrasonographers with electrocardiograms and echocardiograms being interpreted through telemedicine relay by an off-site cardiologist. Target heart rate was achieved in 84% of patients with an average peak dobutamine dose of 48 microg/kg/min. Echocardiographic transmission to the cardiologist over standard telephone lines took 9 minutes per quad-screen cine-loop display. The entire protocol added 2.2 hours to the emergency room evaluation. The one patient out of 26 who had incipient myocardial infarction was diagnosed by resting echocardiography. The remaining 25 patients were found clinically to have no infarction or ischemia. Of these, 22 out of 25 had normal DSE in the emergency department; three had wall motion abnormalities on peak stress images. Another three patients had other cardiac diseases documented by echocardiography. Evaluation of chest pain on a 24-hour basis with DSE with telemedicine interpretation appears to be a rapid and safe means of screening patients at low risk in the emergency department. Further experience with this modality is needed before all patients should be enrolled or early discharge of patients on the basis of DSE can be advised. PMID:8849606

  19. Do Elephants Show Empathy?

    Microsoft Academic Search

    Lucy A. Bates; Phyllis C. Lee; Norah Njiraini; Joyce H. Poole; Katito Sayialel; Soila Sayialel; Cynthia J. Moss; Richard W. Byrne

    2008-01-01

    Elephants show a rich social organization and display a number of unusual traits. In this paper, we analyse reports collected over a thirty-five year period, describing behaviour that has the potential to reveal signs of empathic understanding. These include coalition formation, the offering of protection and comfort to others, retrieving and 'babysitting' calves, aiding individuals that would otherwise have difficulty

  20. Show Me the Way

    ERIC Educational Resources Information Center

    Dicks, Matthew J.

    2005-01-01

    Because today's students have grown up steeped in video games and the Internet, most of them expect feedback, and usually gratification, very soon after they expend effort on a task. Teachers can get quick feedback to students by showing them videotapes of their learning performances. The author, a 3rd grade teacher describes how the seemingly…

  1. Demonstration Road Show

    NSDL National Science Digital Library

    2009-04-06

    The Idaho State University Department of Physics conducts science demonstration shows at S. E. Idaho schools. Four different presentations are currently available; "Forces and Motion", "States of Matter", "Electricity and Magnetism", and "Sound and Waves". Information provided includes descriptions of the material and links to other resources.

  2. Earthquake Damage Slide Show

    NSDL National Science Digital Library

    This slide show presents examples of various types of damage caused by earthquakes. Photos include structural failures in bridges and buildings, landshifts, landslides, liquefaction, fires, tsunamis, and human impacts. Supplemental notes are provided to aid instructors about the photos presented on each slide.

  3. Honored Teacher Shows Commitment.

    ERIC Educational Resources Information Center

    Ratte, Kathy

    1987-01-01

    Part of the acceptance speech of the 1985 National Council for the Social Studies Teacher of the Year, this article describes the censorship experience of this honored social studies teacher. The incident involved the showing of a videotape version of the feature film entitled "The Seduction of Joe Tynan." (JDH)

  4. What Do Maps Show?

    ERIC Educational Resources Information Center

    Geological Survey (Dept. of Interior), Reston, VA.

    This curriculum packet, appropriate for grades 4-8, features a teaching poster which shows different types of maps (different views of Salt Lake City, Utah), as well as three reproducible maps and reproducible activity sheets which complement the maps. The poster provides teacher background, including step-by-step lesson plans for four geography…

  5. Show-Me Center

    NSDL National Science Digital Library

    The Show-Me Center is a partnership of four NSF-sponsored middle grades mathematics curriculum development Satellite Centers (University of Wisconsin, Michigan State University, University of Montana, and the Educational Development Center). The group's website provides "information and resources needed to support selection and implementation of standards-based middle grades mathematics curricula." The Video Showcase includes segments on Number, Algebra, Geometry, Measure, and Data Analysis, with information on ways to obtain the complete video set. The Curricula Showcase provides general information, unit goals, sample lessons and teacher pages spanning four projects: the Connected Mathematics Project (CMP), Mathematics in Context (MiC), MathScape: Seeing and Thinking Mathematically, and Middle Grades Math Thematics. The website also posts Show-Me Center newsletters, information on upcoming conferences and workshops, and links to resources including published articles and unpublished commentary on mathematics school reform.

  6. The Truman Show

    Microsoft Academic Search

    Rolf F. Nohr

    The Truman Show is hardly a film you would automatically speak about as a game. At first glance, it is tempting to interpret the story of\\u000a Truman Burbank — his perpetual subjection to the artificial (televisual) world of Seahaven and its gargantuan reality TV project,\\u000a his eventual escape from the “OmniCam Ecosphere” building and the paternalistic surveillance of director Christof

  7. 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

  8. American History Picture Show

    NSDL National Science Digital Library

    Ms. Bennion

    2009-11-23

    In class we read Katie's Picture Show, a book about a girl who discovers art first-hand one day at an art museum in London. She realizes she can climb into the paintings, explore her surroundings, and even solve problems for the subjects of the paintings. As part of our unit on American history, we are going to use art to further learn about some of the important events we have been discussing. Each of these works of art depicts an important event in American History. When you click on a picture, you will be able to see the name of the event as well as the artist who created it. You will be using all three pictures for this assignment.Use the websites ...

  9. 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

  10. Relationship between myocardial perfusion and dysfunction in diabetic cardiomyopathy: a study of quantitative contrast echocardiography and strain rate imaging

    PubMed Central

    Moir, S; Hanekom, L; Fang, Z?Y; Haluska, B; Wong, C; Burgess, M; Marwick, T H

    2006-01-01

    Objective To use quantitative myocardial contrast echocardiography (MCE) and strain rate imaging (SRI) to assess the role of microvascular disease in subclinical diabetic cardiomyopathy. Methods Stress MCE and SRI were performed in 48 patients (22 with type II diabetes mellitus (DM) and 26 controls), all with normal left ventricular systolic function and no obstructive coronary disease by quantitative coronary angiography. Real?time MCE was acquired in three apical views at rest and after combined dipyridamole–exercise stress. Myocardial blood flow (MBF) was quantified in the 10 mid? and apical cardiac segments at rest and after stress. Resting peak systolic strain rate (SR) and peak systolic strain (?) were calculated in the same 10 myocardial segments. Results The DM and control groups were matched for age, sex and other risk factors, including hypertension. The DM group had higher body mass index and left ventricular mass index. Quantitative SRI analysis was possible in all patients and quantitative MCE in 46 (96%). The mean ?, SR and MBF reserve were all significantly lower in the DM group than in controls, with diabetes the only independent predictor of each parameter. No correlation was seen between MBF and SR (r??=???0.01, p??=??0.54) or between MBF and ? (r??=???0.20, p??=??0.20). Conclusions Quantitative MCE shows that patients with diabetes but no evidence of obstructive coronary artery disease have impaired MBF reserve, but abnormal transmural flow and subclinical longitudinal myocardial dysfunction are not related. PMID:16606865

  11. A case of anastomosis malposition of the Blalock-Taussig shunt diagnosed using perioperative transesophageal echocardiography monitoring.

    PubMed

    Yamamoto, Tomohiro; Schindler, Ehrenfried

    2014-04-01

    The perioperative transesophageal echocardiography (TEE) is a very useful and minimal invasive monitoring not only for the cardiac anesthesia management, but also for the anesthesia management of the non-cardiac operations of the heart high risk patients. In this case report, we report a case of the urgent Blalock-Taussig shunt (BT shunt) operation for a small patient of Fallot's tetralogy with anoxic spell, which showed an atypical change of hemodynamics and SpO2 with the shunt opening. After the BT shunt anastomosis, the diastolic blood pressure decreased with the shunt opening, however, the expected rise of SpO2 was not provided. By the perioperative TEE monitoring with the single plane TEE transducer for neonate; UST-52110S (Hitachi Aloka Medical, Tokyo, Japan) with 4.5 mm in diameter, the cause of this atypical change of hemodynamics and SpO2 was diagnosed to be an accidental anastomosis malposition of the BT shunt to the right pulmonary vein and reported to the operator during the operation, and the operation was performed correctly. PMID:24046098

  12. Stress Echocardiography with Contrast for the Diagnosis of Coronary Artery Disease

    PubMed Central

    2010-01-01

    Executive Summary In July 2009, the Medical Advisory Secretariat (MAS) began work on Non-Invasive Cardiac Imaging Technologies for the Diagnosis of Coronary Artery Disease (CAD), an evidence-based review of the literature surrounding different cardiac imaging modalities to ensure that appropriate technologies are accessed by patients suspected of having CAD. This project came about when the Health Services Branch at the Ministry of Health and Long-Term Care asked MAS to provide an evidentiary platform on effectiveness and cost-effectiveness of non-invasive cardiac imaging modalities. After an initial review of the strategy and consultation with experts, MAS identified five key non-invasive cardiac imaging technologies for the diagnosis of CAD. Evidence-based analyses have been prepared for each of these five imaging modalities: cardiac magnetic resonance imaging, single photon emission computed tomography, 64-slice computed tomographic angiography, stress echocardiography, and stress echocardiography with contrast. For each technology, an economic analysis was also completed (where appropriate). A summary decision analytic model was then developed to encapsulate the data from each of these reports (available on the OHTAC and MAS website). The Non-Invasive Cardiac Imaging Technologies for the Diagnosis of Coronary Artery Disease series is made up of the following reports, which can be publicly accessed at the MAS website at: www.health.gov.on.ca/mas or at www.health.gov.on.ca/english/providers/program/mas/mas_about.html Single Photon Emission Computed Tomography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis Stress Echocardiography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis Stress Echocardiography with Contrast for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis 64-Slice Computed Tomographic Angiography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis Cardiac Magnetic Resonance Imaging for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis Pease note that two related evidence-based analyses of non-invasive cardiac imaging technologies for the assessment of myocardial viability are also available on the MAS website: Positron Emission Tomography for the Assessment of Myocardial Viability: An Evidence-Based Analysis Magnetic Resonance Imaging for the Assessment of Myocardial Viability: an Evidence-Based Analysis The Toronto Health Economics and Technology Assessment Collaborative has also produced an associated economic report entitled: The Relative Cost-effectiveness of Five Non-invasive Cardiac Imaging Technologies for Diagnosing Coronary Artery Disease in Ontario [Internet]. Available from: http://theta.utoronto.ca/reports/?id=7 Objective The objective of this report is to compare echocardiography (ECHO) performed with microsphere contrast agents (contrast echocardiography) to ECHO performed without contrast and to single photon emission computed tomography (SPECT). Contrast ECHO Contrast agents for ECHO have been available since the technology was first introduced in the 1990s. Composed of tiny ‘microbubbles’ of an inert gas encapsulated within a lipid, protein, or polymer coat, these agents act to scatter incident ultrasound waves at the gas/liquid interface to increase the strength of a returning ECHO signal. When injected into a patient’s arm, they are transported throughout even the smallest capillaries to greatly enhance the blood pool signal, which would otherwise appear black on conventional two dimensional ECHO. The enhanced signal then helps cardiologists to determine what parts of the patient’s heart muscle are poorly perfused. The first commercially available microsphere contrast agent was Albunex, which received approval by the Food and Drug Administration in the United States in 1994. This original microsphere agent was limited by its rapid gas volume loss which caused a decline in the ultrasound signal. It worked well in the right chambers of the heart, but disso

  13. 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

  14. A Trimodal System for the Acquisition of Synchronous Echocardiography, Electrocardiography, and Seismocardiography Data

    PubMed Central

    Wick, Carson A.; Su, Jin-Jyh; Brand, Oliver; McClellan, James H.; Bhatti, Pamela T.; Tridandapani, Srini

    2013-01-01

    A novel system was developed to acquire synchronous echocardiography, electrocardiography (EKG), and seismocardiography (SCG) data. The system was developed to facilitate the study of the relationship between the mechanical and electrical characteristics of the heart. The system has both a hardware and software component. The hardware component consists of an application-specific device designed and built to acquire both SCG and EKG signals simultaneously. The software component consists of a package developed to record and synchronize data from both the device and a clinical ultrasound machine. A feasibility test was performed by simultaneous acquisition of a synchronous dataset from a human subject. PMID:22255927

  15. Role of perioperative transesophageal echocardiography in the management of adolescent truncus arteriosus: rare case report.

    PubMed

    Nagaraja, P S; Singh, Naveen G; Simha, Parimala Prasanna; Davan, K R; Manjunath, V; Jagadeesh, A M

    2015-01-01

    Truncus arteriosus (TA) is a rare congenital heart disease defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. The truncal valve in majority of the cases is tricuspid though quadricuspid and bicuspid valves have been reported. Patients with TA typically have a large nonrestrictive sub truncal ventricular septal defect. Survival of these infants beyond 1-year is uncommon. Here, we report a unique case of 12-year-old female patient with persistent TA who underwent surgical repair by using transesophageal echocardiography as a monitoring device during the perioperative management. PMID:25849699

  16. A trimodal system for the acquisition of synchronous echocardiography, electrocardiography, and seismocardiography data.

    PubMed

    Wick, Carson A; Su, Jin-Jyh; Brand, Oliver; McClellan, James H; Bhatti, Pamela T; Tridandapani, Srini

    2011-01-01

    A novel system was developed to acquire synchronous echocardiography, electrocardiography (EKG), and seismocardiography (SCG) data. The system was developed to facilitate the study of the relationship between the mechanical and electrical characteristics of the heart. The system has both a hardware and software component. The hardware component consists of an application-specific device designed and built to acquire both SCG and EKG signals simultaneously. The software component consists of a package developed to record and synchronize data from both the device and a clinical ultrasound machine. A feasibility test was performed by simultaneous acquisition of a synchronous dataset from a human subject. PMID:22255927

  17. Intracardiac echocardiography in electrophysiology: a review of current applications in practice.

    PubMed

    Dravid, Sanjay G; Hope, Brian; McKinnie, James J

    2008-11-01

    Intracardiac echocardiography (ICE) has emerged as a widespread useful tool in the everyday practice of interventional electrophysiology. Advances in catheter-based ultrasound transducers and imaging technology have made this modality integral to guiding evaluation of anatomy and ablation therapy. Evolution of ablative procedures of the left heart for tachyarrhythmia has highlighted the importance of direct visualization of anatomic landmarks to guide transseptal catheterization and immediately identify complications. The ability to position mapping and ablation catheters according to anatomic landmarks (Fig. 1) has greatly enhanced the safety and efficacy of catheter ablation procedures. ICE has supplanted fluoroscopy as the gold standard for precise imaging of endocardial structures during complex procedures. PMID:18986404

  18. 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

  19. Diagnosis of coronary artery disease by stress echocardiography and perfusion scintigraphy.

    PubMed

    Imran, Muhammad Babar; Khan, Muhammad Aleem; Aslam, Muhammad Naseem; Irfanullah, Javaid

    2003-08-01

    This meta-analysis was performed to compare the diagnostic efficacy of stress echocardiography (SE) and Stress perfusion studies (SPS) in detecting coronary artery disease (CAD). A meta-analysis of peer reviewed articles, published in English language, reporting head-to-head comparison of vasodilator stress echocardiography (VSE) and SPS for the diagnosis of CAD, was performed. Data of 13 studies comprising of 860 patients from 13 different institutions were analyzed. Algorithms were developed to generate raw data from published papers to calculate statistical parameters with confidence intervals and then compare them at specified significance levels. The overall diagnostic accuracy of the two tests was almost similar, 0.77 for VSE vs 0.8 for SPS (p=ns). SPS gave higher sensitivity, 0.88 vs 0.70 in cumulative data (p<0.0001) while VSE gave higher specificity, 0.90 vs 0.67 (p<0.0001). Accuracy of VSE with state-of-the-art protocols became even better than SPS (p<0.05). In hypertensive patients specificity of SPS was markedly deteriorated. Contrary to this, VSE gave higher specificity (0.90 vs 0.40) in this subgroup of patients as well. VSE might become an effective alternative of SPS where scintigraphy techniques are not available or affordable. PMID:12921688

  20. Porous PLGA microparticles: AI-700, an intravenously administered ultrasound contrast agent for use in echocardiography.

    PubMed

    Straub, Julie A; Chickering, Donald E; Church, Charles C; Shah, Bhavdeep; Hanlon, Thomas; Bernstein, Howard

    2005-11-01

    The production and characterization of AI-700, an intravenously administered ultrasound contrast agent under investigation for myocardial perfusion echocardiography, are described. The product consists of small, porous microparticles filled with decafluorobutane gas, and formulated as a dry powder. Small scale spray drying studies demonstrated that porous PLGA microparticles could be produced with varying porosity using ammonium bicarbonate as a volatile pore-forming agent. The porous microparticles of AI-700 were created aseptically by spray drying a water-in-oil emulsion containing poly-d,l-lactide-co-glycolide, 1,2-diarachidoyl-sn-glycero-3-phosphocholine, and ammonium bicarbonate using a two-chamber spray dryer. The porous microparticles were further formulated into a dry powder drug product (AI-700) containing decafluorobutane gas and excipients. The dry powder was reconstituted with sterile water prior to evaluation. Microscopy demonstrated that the microparticles were sphere-shaped and internally porous. The microparticles were appropriately sized for intravenous administration, having an average diameter of 2.3 mum. Zeta-potential analysis demonstrated that the microparticles would be expected to be stable post-reconstitution. The microparticles retained encapsulated gas post-reconstitution, had high acoustic potency that was stable over time and were physically stable upon exposure to high-power ultrasound, as used clinically. AI-700 has the characteristics desirable for an intravenously administered ultrasound contrast agent for myocardial perfusion echocardiography. PMID:16126299

  1. Feasibility of real-time three-dimensional stress echocardiography: pharmacological and semi-supine exercise

    PubMed Central

    2010-01-01

    Background Real time three dimensional (RT3D) echocardiography is an accurate and reproducible method for assessing left ventricular shape and function. Aim assess the feasibility and reproducibility of RT3D stress echocardiography (SE) (exercise and pharmacological) in the evaluation of left ventricular function compared to 2D. Methods and results One hundred eleven patients with known or suspected coronary artery disease underwent 2D and RT3DSE. The agreement in WMSI, EDV, ESV measurements was made off-line. The feasibility of RT-3DSE was 67%. The inter-observer variability for WMSI by RT3D echo was higher during exercise and with suboptimal quality images (good: k = 0.88; bad: k = 0.69); and with high heart rate both for pharmacological (HR < 100 bpm, k = 0.83; HR ? 100 bpm, k = 0.49) and exercise SE (HR < 120 bpm, k = 0.88; HR ? 120 bpm, k = 0.78). The RT3D reproducibility was high for ESV volumes (0.3 ± 14 ml; CI 95%: -27 to 27 ml; p = n.s.). Conclusions RT3DSE is more vulnerable than 2D due to tachycardia, signal quality, patient decubitus and suboptimal resting image quality, making exercise RT3DSE less attractive than pharmacological stress. PMID:20334676

  2. Speckle Tracking in Intracardiac Echocardiography for the Assessment of Myocardial Deformation

    PubMed Central

    Yue, Yong; Clark, John W.; Khoury, Dirar S.

    2009-01-01

    Intracardiac echocardiography has proven to be useful for online anatomical imaging during catheterization. Our objective was to develop a speckle tracking method for myocardial motion estimation from intracardiac echocardiographic image sequences in order to provide a mean for regional functional imaging. Our approach was to solve two problems in motion estimation from two-dimensional intracardiac echocardiographic image sequences: non-rigid myocardial deformation and speckle decorrelation. To achieve robust noise resistance, we employed maximum likelihood estimation while fully exploiting ultrasound speckle statistics, and treated the maximization of motion probability as the minimization of an energy function. Non-rigid myocardial deformation was estimated by optimizing this energy function within a framework of parametric elastic registration. Evaluation of the method was carried out using a computer model that synthesized echocardiographic image sequences, and subsequently an animal model that provided continuous intracardiac echocardiographic images as well as reference measurements using sonomicrometry crystals. In conclusion, accurate estimation of regional myocardial deformation from intracardiac echocardiography by novel speckle tracking is feasible. This approach may have important clinical implications for multimodal imaging during catheterization. PMID:19272903

  3. Assessment of myocardial perfusion in patients with coronary artery disease. Comparison of myocardial contrast echocardiography and 99mTc MIBI single photon emission computed tomography

    Microsoft Academic Search

    Maria Olszowska; Magdalena Kostkiewicz; Wies?awa Tracz; Tadeusz Przew?ocki

    2003-01-01

    Background: Myocardial perfusion (MP) can be assessed in real time when using a low mechanical index (MI) and harmonic imaging following an intravenous injection of contrast agent. The aim of the study was to determine the feasibility and accuracy of the real-time imaging of contrast echocardiography (MCE) for detecting myocardial perfusion defects at rest and during dobutamine stress echocardiography (DE)

  4. The role of cross sectional echocardiography and pulsed Doppler ultrasound in the management of neonates in whom congenital heart disease is suspected. A prospective study

    Microsoft Academic Search

    M P Leung; C K Mok; K C Lau; R Lo; C Y Yeung

    1986-01-01

    The application of cross sectional echocardiography and pulsed Doppler ultrasound to the management of symptomatic neonates with suspected congenital heart disease was studied in 96 consecutive cases. The ability of echocardiography to establish a complete and accurate diagnosis and a correct management plan was evaluated. Sequential segmental analysis of data from cardiac catheterisation and necropsy identified 536 cardiovascular anomalies. Of

  5. Quantification of resting myocardial blood flow velocity in normal humans using real-time contrast echocardiography. A feasibility study

    PubMed Central

    Malm, Siri; Frigstad, Sigmund; Helland, Frode; Oye, Kjetil; Slordahl, Stig; Skjarpe, Terje

    2005-01-01

    Background Real-time myocardial contrast echocardiography (MCE) is a novel method for assessing myocardial perfusion. The aim of this study was to evaluate the feasibility of a very low-power real-time MCE for quantification of regional resting myocardial blood flow (MBF) velocity in normal human myocardium. Methods Twenty study subjects with normal left ventricular (LV) wall motion and normal coronary arteries, underwent low-power real-time MCE based on color-coded pulse inversion Doppler. Standard apical LV views were acquired during constant IV. infusion of SonoVue®. Following transient microbubble destruction, the contrast replenishment rate (?), reflecting MBF velocity, was derived by plotting signal intensity vs. time and fitting data to the exponential function; y (t) =A (1-e-?(t-t0)) + C. Results Quantification was feasible in 82%, 49% and 63% of four-chamber, two-chamber and apical long-axis view segments, respectively. The LAD (left anterior descending artery) and RCA (right coronary artery) territories could potentially be evaluated in most, but contrast detection in the LCx (left circumflex artery) bed was poor. Depending on localisation and which frames to be analysed, mean values of were 0.21–0.69 s-1, with higher values in medial than lateral, and in basal compared to apical regions of scan plane (p = 0.03 and p < 0.01). Higher ?-values were obtained from end-diastole than end-systole (p < 0.001), values from all-frames analysis lying between. Conclusion Low-power real-time MCE did have the potential to give contrast enhancement for quantification of resting regional MBF velocity. However, the technique is difficult and subjected to several limitations. Significant variability in ? suggests that this parameter is best suited for with-in patient changes, comparing values of stress studies to baseline. PMID:15958173

  6. Oral Sildenafil for Treatment of Severe Pulmonary Hypertension in an Infant

    Microsoft Academic Search

    Kam-lun Ellis Hon; Kam-lau Cheung; Kiu-lok Siu; Ting-fan Leung; Man-ching Yam; Tai-fai Fok; Pak-cheung Ng

    2005-01-01

    We report the use of oral sildenafil in a 5-month-old preterm infant with severe bronchopulmonary dysplasia and pulmonary arterial hypertension refractory to inhaled nitric oxide treatment, maximal ventilatory support and conventional vasodilator therapy. Sildenafil was prepared as a liquid suspension by the method of trituration and administered via an orogastric tube to the patient. Forty-eight hours after sildenafil treatment, echocardiography

  7. Comparison of exercise and dobutamine echocardiography in the haemodynamic assessment of small size mechanical aortic valve prostheses

    Microsoft Academic Search

    Isaac Kadir; Catherine Walsh; Peter Wilde; Alan J. Bryan; Gianni D. Angelini

    2002-01-01

    Objective: Doppler echocardiographic evaluation of prosthetic heart valve function is usually performed at rest although this situation is not representative of patients' daily activities. Following aortic valve replacement, patients most likely to remain symptomatic are those with a small aortic root and dobutamine or exercise echocardiography has been proposed to elicit the presence of abnormal haemodynamics or persistently elevated transvalvular

  8. [Aneurysm of the interatrial septum and right-to-left shunt during biventricular infarction. Diagnosis by transesophageal echocardiography].

    PubMed

    Abassade, P; Lhosmot, J P; Voyer, C; Lebard, C; Gobet, L; Baudouy, P Y

    2000-01-01

    A right-to-left shunt during infarction with right ventricular extension is a rare and recently described complication. It results from opening of a foramen ovale due to increased right heart pressures. The authors describe another case occurring in a patient with an interatrial septal aneurysm, the diagnosis of which was made by transoesophageal echocardiography. PMID:11227724

  9. 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

  10. Pivotal Role of Bedside Doppler Echocardiography in the Assessment of Patients with Acute Heart Failure and Mitral Regurgitation

    Microsoft Academic Search

    Pierre Vladimir Ennezat; Annaïk Bellouin; Sylvestre Maréchaux; Francis Juthier; Georges Fayad; André Vincentelli; Alain Berrébi; Jean Luc Auffray; Jean Jacques Bauchart; Frédéric Mouquet; David Montaigne; Philippe Asseman; Thierry H. Le Jemtel; Philippe Pibarot

    2009-01-01

    Patients presenting with mitral regurgitation and acute heart failure remain a challenge for the clinicians. Bedside echocardiography ascertains the functional or primary nature of mitral regurgitation, thereby allowing to focus therapy on the left ventricle and mitral valve apparatus in patients with functional mitral regurgitation and to hasten mitral valve repair or replacement when acute heart failure results from primary

  11. Biophysical characteristics of radiofrequency lesion formation in vivo: Dynamics of catheter tip–tissue contact evaluated by intracardiac echocardiography

    Microsoft Academic Search

    Jonathan M. Kalman; Adam P. Fitzpatrick; Jeffrey E. Olgin; Michael C. Chin; Randall J. Lee; Melvin M. Scheinman; Michael D. Lesh

    1997-01-01

    During clinical radiofrequency catheter ablation a wide range of delivered power may be necessary to achieve success despite an apparently stable catheter position on fluoroscopy. The purpose of this study was to use intracardiac echocardiography to characterize the relation between catheter tip–tissue contact and the efficiency of heating during applications of radiofrequency energy in vivo and to determine whether intracardiac

  12. Measurement of left ventricular volume after anterior myocardial infarction: comparison of magnetic resonance imaging, echocardiography, and radionuclide ventriculography

    Microsoft Academic Search

    K. H. Darasz; S. R. Underwood; J. Bayliss; S. M. Forbat; J. Keegan; P. A. Poole-Wilson; G. C. Sutton

    2002-01-01

    We have compared echocardiography (echo) and radionuclide ventriculography (RNV) with magnetic resonance imaging (MRI) for the measurement of left ventricular (LV) volume and ejection fraction. Seventy asymptomatic patients were studied up to 12 days after first Q wave anterior myocardial infarction and again after 6 months. Each patient had LV volume measured by all three techniques within 24 hours of

  13. Comparison of wall thickening and ejection fraction by cardiovascular magnetic resonance and echocardiography in acute myocardial infarction

    Microsoft Academic Search

    Martha Nowosielski; Michael Schocke; Agnes Mayr; Kathrin Pedarnig; Gert Klug; Almut Köhler; Thomas Bartel; Silvana Müller; Thomas Trieb; Otmar Pachinger; Bernhard Metzler

    2009-01-01

    OBJECTIVES: The purpose of this study was to compare cardiovascular magnetic resonance (CMR) and echocardiography (echo) in patients treated with primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) with emphasis on the analysis of left ventricular function and left ventricular wall motion characteristics. METHODS: We performed CMR and echo in 52 patients with first AMI shortly after primary

  14. Evaluation of Diastolic Filling of Left Ventricle in Health and Disease: Doppler Echocardiography Is the Clinician’s Rosetta Stone

    Microsoft Academic Search

    Rick A Nishimura; A. Jamil Tajik

    1997-01-01

    Abnormalities of diastolic function have a major role in producing the signs and symptoms of heart failure. However, diastolic function of the heart is a complex sequence of multiple interrelated events, and it has been difficult to understand, diagnose and treat the various abnormalities of diastolic filling that occur in patients with heart disease. Recently, Doppler echocardiography has been used

  15. Early myocardial deformation changes in hypercholesterolemic and obese children and adolescents: a 2D and 3D speckle tracking echocardiography study.

    PubMed

    Vitarelli, Antonio; Martino, Francesco; Capotosto, Lidia; Martino, Eliana; Colantoni, Chiara; Ashurov, Rasul; Ricci, Serafino; Conde, Ysabel; Maramao, Fabio; Vitarelli, Massimo; De Chiara, Stefania; Zanoni, Cristina

    2014-09-01

    Dyslipidemia and obesity are considered strong risk factors for premature atherosclerotic cardiovascular disease and increased morbidity and mortality and may have a negative impact on myocardial function.Our purpose was to assess the presence of early myocardial deformation abnormalities in dyslipidemic children free from other cardiovascular risk factors, using 2-dimensional speckle tracking echocardiography (2DSTE) and 3-dimensional speckle tracking echocardiography (3DSTE).We studied 80 consecutive nonselected patients (6-18 years of age) with hypercholesterolemia (low-density lipoprotein [LDL] cholesterol levels >95th percentile for age and sex). Forty of them had normal weight and 40 were obese (body mass index >95th percentile for age and sex). Forty healthy age-matched children were selected as controls. Left ventricular (LV) global longitudinal, circumferential, and radial strains were calculated by 2DSTE and 3DSTE. Global area strain (GAS) was calculated by 3DSTE as percentage of variation in surface area defined by the longitudinal and circumferential strain vectors. Right ventricular (RV) global and free-wall longitudinal strain and LV and RV diastolic strain rate parameters were obtained. Data analysis was performed offline.LV global longitudinal strain and GAS were lower in normal-weight and obese dyslipidemic children compared with normal controls and reduced in obese patients compared with normal-weight dyslipidemic children. LV early diastolic strain rate was lower compared with normals. RV global and free-wall longitudinal strain was significantly reduced in obese patients when compared with the control group. A significant inverse correlation was found between LV strain, LDL cholesterol levels, and body mass index.2DSTE and 3DSTE show LV longitudinal strain and GAS changes in dyslipidemic children and adolescents free from other cardiovascular risk factors or structural cardiac abnormalities. Obesity causes an additive adverse effect on LV strain parameters and RV strain impairment. PMID:25211047

  16. Pulse Wave Transit Time Measurements of Cardiac Output in Septic Shock Patients: A Comparison of the Estimated Continuous Cardiac Output System with Transthoracic Echocardiography

    PubMed Central

    Feissel, Marc; Aho, Ludwig Serge; Georgiev, Stefan; Tapponnier, Romain; Badie, Julio; Bruyère, Rémi; Quenot, Jean-Pierre

    2015-01-01

    Background We determined reliability of cardiac output (CO) measured by pulse wave transit time cardiac output system (esCCO system; COesCCO) vs transthoracic echocardiography (COTTE) in mechanically ventilated patients in the early phase of septic shock. A secondary objective was to assess ability of esCCO to detect change in CO after fluid infusion. Methods Mechanically ventilated patients admitted to the ICU, aged >18 years, in sinus rhythm, in the early phase of septic shock were prospectively included. We performed fluid infusion of 500ml of crystalloid solution over 20 minutes and recorded CO by EsCCO and TTE immediately before (T0) and 5 minutes after (T1) fluid administration. Patients were divided into 2 groups (responders and non-responders) according to a threshold of 15% increase in COTTE in response to volume expansion. Results In total, 25 patients were included, average 64±15 years, 15 (60%) were men. Average SAPSII and SOFA scores were 55±21.3 and 13±2, respectively. ICU mortality was 36%. Mean cardiac output at T0 was 5.8±1.35 L/min by esCCO and 5.27±1.17 L/min by COTTE. At T1, respective values were 6.63 ± 1.57 L/min for esCCO and 6.10±1.29 L/min for COTTE. Overall, 12 patients were classified as responders, 13 as non-responders by the reference method. A threshold of 11% increase in COesCCO was found to discriminate responders from non-responders with a sensitivity of 83% (95% CI, 0.52-0.98) and a specificity of 77% (95% CI, 0.46-0.95). Conclusion We show strong correlation esCCO and echocardiography for measuring CO, and change in CO after fluid infusion in ICU patients. PMID:26126112

  17. Usefulness of right ventricular basal free wall strain by two-dimensional speckle tracking echocardiography in patients with chronic thromboembolic pulmonary hypertension.

    PubMed

    Shiino, Kenji; Sugimoto, Kunihiko; Yamada, Akira; Takada, Kayoko; Kawai, Hideki; Sugimoto, Keiko; Takahashi, Hiroshi; Takagi, Yasushi; Iwase, Masatsugu; Ozaki, Yukio

    2015-01-01

    Recently two-dimensional (2D) speckle tracking echocardiography (STE) derived from right ventricular (RV) free wall has been shown to be a very useful tool for the estimation of RV performance. The purpose of this study was to examine whether RV basal free wall strain can detect increased mean pulmonary arterial pressure (mPAP) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We investigated a total of 126 patients with CTEPH (mean age, 56 ± 12 years). They underwent echocardiography and right heart catheter examination. 2D STE-derived longitudinal strain was measured by placing 2 regions of interests (ROIs) on the RV basal free wall in RV-focused apical 4-chamber view. Peak strain (RV-PS) was acquired between the 2 ROIs. Conventional echocardiographic RV parameters (RV fractional area change, RV myocardial performance index, tricuspid annular plane systolic excursion, tricuspid annular peak systolic velocity, and tricuspid regurgitant pressure gradient) were evaluated as well. Right heart catheterization was performed on the day following of echocardiographic evaluation. Among RV echo parameters, RV-PS showed the best correlation with mPAP (r = 0.75, P < 0.0001). Receiver operating characteristic analysis revealed that a cut-off value of RV-PS -20.8% could detect mPAP ? 25 mmHg (sensitivity 78%, specificity 93%, area under the curve 0.90, P < 0.001). RV basal free wall strain was a useful tool for the non-invasive detection of increased mPAP in patients with CTEPH. PMID:25742946

  18. 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.

  19. Two-Dimensional Echocardiography in the Assessment of Long-Term Prognosis in Patients with Pulmonary Arterial Hypertension

    PubMed Central

    Sun, Ling-yue; Zhao, Hang; Kang, Yu; Shen, Xue-dong; Cai, Zong-ye; Shen, Jie-yan; He, Ben; Yang, Cheng-de

    2014-01-01

    Objective To investigate the relationship between cardiac diastolic dysfunction and outcomes in patients with pulmonary arterial hypertension (PAH) and to clarify the potential effect of two-dimensional echocardiography (2D-echo) on prognostic value in patients with PAH. Methods Patients diagnosed with PAH (as WSPH (World Symposia on Pulmonary Hypertension) classification I) confirmed by right heart catheterization (RHC), received targeted monotherapy or combination therapy. 2D-echo parameters, World Health Organization (WHO) functional classification and 6-minute walking distance (6MWD) were recorded. The clinical prognosis of patients was assessed by the correlation between echo parameters and clinical 6MWD using receiver operating characteristic (ROC) curve analysis. Results Fifty-eight patients were included. Left and right ventricular diastolic dysfunction (LVDD and RVDD) scores measured by 2D-echo had good correlation with 6MWD at baseline (rLVDD ?=??0.699; rRVDD ?=??0.818, both P<0.001) and at last follow-up (rLVDD ?=??0.701; rRVDD ?=??0.666, both P<0.001). Furthermore, bi-ventricular (LVDD+RVDD) scores measured by 2D-echo had a better correlation with 6MWD at baseline and last follow-up (r?=??0.831; r?=??0.771, both P<0.001). ROC curve analysis showed that the area under curves (AUCs) for LVDD score, RVDD score and (LVDD+RVDD) scores were 0.823 (P<0.0001), 0.737 (P?=?0.0002), and 0.825 (P<0.0001), respectively. Compared with ROC analysis of other single parameters, cardiac diastolic function score was more accurate in predicting survival in patients with PAH. Conclusion LVDD score, RVDD score and (LVDD+RVDD) scores yielded a comprehensive quantitative assessment of LV and RV diastolic function that correlated moderately with clinical functional parameters and might be useful in the assessment of PAH. PMID:25485890

  20. 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.

  1. What is really a nonobstructive hypertrophic cardiomyopathy? The importance of orthostatic factor in exercise echocardiography.

    PubMed

    Cotrim, Carlos; Almeida, Ana Rita; Lopes, Luís; Fazendas, Paula; João, Isabel; Pereira, Hélder

    2011-01-01

    The authors report the case of a 23-year-old girl with nonobstructive hypertrophic cardiomyopathy evaluated by resting echocardiography. The patient complained of syncope after playing basketball. The patient was submitted to treadmill exercise echocardiogram, and she exercised for 9 minutes in standard Bruce protocol. The left ventricular outflow gradient did not occur at peak workload; however she developed intraventricular gradient greater than 100?mmHg after exercise in orthostatic position. There was fall in arterial pressure, and the patient was then put in supine position. The authors suggest the possible role of exercise stress echo in symptomatic patients with no significant gradient at baseline, as well as maintenance in orthostatic position after exercise, as an important stress factor. This can disclose the occurrence of left ventricular outflow tract obstruction that should not be detected in other way and has potential relevance in the patient's symptoms understanding. PMID:22347638

  2. Real-time three dimensional transesophageal echocardiography: technical aspects and clinical applications

    PubMed Central

    Agricola, Eustachio; Badano, Luigi; Mele, Donato; Galderisi, Maurizio; Slavich, Massimo; Sciomer, Susanna; Nistri, Stefano; Ballo, Piercarlo; D'Andrea, Antonello; Mondillo, Sergio

    2010-01-01

    Real-time three-dimensional transesophageal echocardiography (RT3DTEE) is now commonly used in daily clinical practice. The transesophageal, compared to the transthoracic approach, allows the visualization of the whole spectrum of the mitral valve apparatus and the posterior cardiac structures. Moreover, images obtained by RT 3D TEE provide a unique and complete visualization of the mitral valve prosthetic elements. Indeed, the possibility to visualize guidewires and catheters in cardiac chambers and their relationship with cardiac structures during percutaneous transcatheter procedures reduces the time of radiation exposure and simplifies the approach becoming the reference method for monitoring. This review aims to underline the potential clinical applications and the advantages of RT3DTEE compared to other methods. PMID:21977291

  3. Racial Differences in the Prevalence of Severe Aortic Stenosis

    PubMed Central

    Patel, Devin K.; Green, Kelly D.; Fudim, Marat; Harrell, Frank E.; Wang, Thomas J.; Robbins, Mark A.

    2014-01-01

    Background In an era of expanded treatment options for severe aortic stenosis, it is important to understand risk factors for the condition. It has been suggested that severe aortic stenosis is less common in African Americans, but there are limited data from large studies. Methods and Results The Synthetic Derivative at Vanderbilt University Medical Center, a database of over 2.1 million de?identified patient records, was used to identify individuals who had undergone echocardiography. The association of race with severe aortic stenosis was examined using multivariable logistic regression analyses adjusting for conventional risk factors. Of the 272 429 eligible patients (mean age 45 years, 44% male) with echocardiography, 14% were African American and 82% were Caucasian. Severe aortic stenosis was identified in 106 (0.29%) African?American patients and 2030 (0.91%) Caucasian patients (crude OR 0.32, 95% CI [0.26, 0.38]). This difference persisted in multivariable?adjusted analyses (OR 0.41 [0.33, 0.50], P<0.0001). African?American individuals were also less likely to have severe aortic stenosis due to degenerative calcific disease (adjusted OR 0.47 [0.36, 0.61]) or congenitally bicuspid valve (crude OR 0.13 [0.02, 0.80], adjusted OR dependent on age). Referral bias against those with severe valvular disease was assessed by comparing the prevalence of severe mitral regurgitation in Caucasians and African Americans and no difference was found. Conclusions These findings suggest that African Americans are at significantly lower risk of developing severe aortic stenosis than Caucasians. PMID:24870936

  4. Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction

    PubMed Central

    Hodges, Ryan; Endo, Masayuki; La Gerche, Andre; Eixarch, Elisenda; DeKoninck, Philip; Ferferieva, Vessilina; D'hooge, Jan; Wallace, Euan M.; Deprest, Jan

    2013-01-01

    Fetal intrauterine growth restriction (IUGR) results in abnormal cardiac function that is apparent antenatally due to advances in fetoplacental Doppler ultrasound and fetal echocardiography. Increasingly, these imaging modalities are being employed clinically to examine cardiac function and assess wellbeing in utero, thereby guiding timing of birth decisions. Here, we used a rabbit model of IUGR that allows analysis of cardiac function in a clinically relevant way. Using isoflurane induced anesthesia, IUGR is surgically created at gestational age day 25 by performing a laparotomy, exposing the bicornuate uterus and then ligating 40-50% of uteroplacental vessels supplying each gestational sac in a single uterine horn. The other horn in the rabbit bicornuate uterus serves as internal control fetuses. Then, after recovery at gestational age day 30 (full term), the same rabbit undergoes examination of fetal cardiac function. Anesthesia is induced with ketamine and xylazine intramuscularly, then maintained by a continuous intravenous infusion of ketamine and xylazine to minimize iatrogenic effects on fetal cardiac function. A repeat laparotomy is performed to expose each gestational sac and a microultrasound examination (VisualSonics VEVO 2100) of fetal cardiac function is performed. Placental insufficiency is evident by a raised pulsatility index or an absent or reversed end diastolic flow of the umbilical artery Doppler waveform. The ductus venosus and middle cerebral artery Doppler is then examined. Fetal echocardiography is performed by recording B mode, M mode and flow velocity waveforms in lateral and apical views. Offline calculations determine standard M-mode cardiac variables, tricuspid and mitral annular plane systolic excursion, speckle tracking and strain analysis, modified myocardial performance index and vascular flow velocity waveforms of interest. This small animal model of IUGR therefore affords examination of in utero cardiac function that is consistent with current clinical practice and is therefore useful in a translational research setting. PMID:23852345

  5. Transoesophageal echocardiography in selecting patients for anticoagulation after ischaemic stroke or transient ischaemic attack

    PubMed Central

    Strandberg, M; Marttila, R; Helenius, H; Hartiala, J

    2002-01-01

    Objectives: To investigate prospectively the role of transoesophageal echocardiography (TEE) in selecting patients for anticoagulation in an unselected stroke population. Methods: Transthoracic echocardiography (TTE) and TEE were done in all clinically suitable hospitalised patients (n = 457) with transient ischaemic attack or ischaemic stroke in the acute phase during a two year period in Turku University Hospital. 441 patients were successfully evaluated for cardiac sources of embolism using TEE within 31 days of the event. Results: A major risk factor for a cardiac source of embolism excluding atrial fibrillation, acute myocardial infarction, and prosthetic valve was detected in 10% of patients and a minor risk factor for a cardiac source of embolism in 46%. When a major risk factor of a cardiac source of embolism was detected using TTE or TEE and no contraindications were present, the patient was given anticoagulation drugs. If a minor risk factor for a cardiac source of embolism was detected, anticoagulation treatment was started after clinical assessment, if no contraindications were present. In 62 (14%) cases, the patient was given oral anticoagulation drugs or the necessity of ongoing anticoagulation treatment was confirmed on the basis of TEE. When these anticoagulation treated patients were evaluated using logistic regression analysis, they were found to have significantly more atrial fibrillation and histories of myocardial infarctions. Moreover, the patients were mainly men. When patients in sinus rhythm and without any history of cardiac disease were analysed, 8% of patients were found to have been given anticoagulation drugs on the basis of TEE data. Conclusion: This study suggests that TEE should be used in patients with stroke even without any clinical evidence of cardiac disease when the patients are candidates for anticoagulation. PMID:12082041

  6. [Noninvasive measurement of cardiac output by pulsed Doppler echocardiography. Correlation with thermodilution].

    PubMed

    Dericbourg, C; Tribouilloy, C; Kugener, H; Avinee, P; Rey, J L; Lesbre, J P

    1990-02-01

    Cardiac output was measured simultaneously by pulsed Doppler echocardiography and thermodilution in 22 patients, 18 of whom also underwent atrial pacing at different rates to give a total of 42 different measurements. The aortic diameter was measured firstly at the aortic ring at the level of insertion of the aortic cusps and then at the point of maximum separation of the valve cups in the left parasternal long-axis view. The aortic velocities were recorded in the apical 5-chamber view immediately below the level of the aortic valve. The correlations obtained at the aortic ring (R1) and at the point of maximum separation of the valve cusps (R2) were 0.77 (y = 0.67x + 1.17: standard error = 0.81 l/m) and 0.64 (y = 0.56x + 0.87; standard error = 1.01 l/mn) respectively. The correlations were much better when 7 technically unsatisfactory measurements were excluded (R2 = 0.76: y = 0.59x + 0.74: standard error = 0.79 l/mn) (R1 = 0.87: y = 0.72x + 1.04: standard error = 0.65 l/mn). THe correlations of stroke volume measured at aortic ring level also improved from r = 0.82 (y = 0.75x + 7.29: standard error = 8.9 ml) to r = 0.89 (y = 0.78x + 7.38: standard error = 7.3 ml). The measurement of cardiac output by pulsed Doppler echocardiography in the aortic root seems to be reliable. The correlations of the values of stroke volume and cardiac output with the thermodilution method are good, allowing detection of beat-to-beat variations of cardiac output, in suitable patients in the hands of experienced operators. PMID:2106860

  7. Casimir experiments showing saturation effects

    E-print Network

    Bo E. Sernelius

    2009-10-27

    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 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.

  8. Casimir experiments showing saturation effects

    SciTech Connect

    Sernelius, Bo E. [Division of Theory and Modeling, Department of Physics, Chemistry and Biology, Linkoeping University, SE-581 83 Linkoeping (Sweden)

    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.

  9. Comparison of exercise electrocardiography, technetium-99m sestamibi single photon emission computed tomography, and dobutamine and dipyridamole echocardiography for detection of coronary artery disease in hypertensive women.

    PubMed

    Lu, Chunzeng; Lu, Fei; Fragasso, Gabriele; Dabrowski, Pawel; Di Bello, Vitantonio; Chierchia, Sergio L; Gianolli, Luigi; Marzilli, Mario; Balbarini, Alberto

    2010-05-01

    To assess the performance of currently used stress tests for the detection of coronary artery disease (CAD) in a series of female hypertensive patients. We performed exercise electrocardiography (ECG), technetium-99m sestamibi (MIBI) single photon emission computed tomography, dobutamine and dipyridamole echocardiography, and coronary angiography in 76 hypertensive women. Of the 76 study patients, 31 (41%) had significant CAD. The sensitivity of exercise ECG (81%), MIBI scanning (90%), and dobutamine echocardiography (87%) was greater than that of dipyridamole echocardiography (61%). This finding resulted from the lower sensitivity of dipyridamole echocardiography in the detection of single-vessel CAD (47% vs 76%, 88%, and 82% for the other 3 methods). In contrast, the sensitivity of the 4 tests was similar in the detection of multivessel CAD. The specificity of exercise ECG (56%) and MIBI scanning (53%) was less than that of dobutamine (82%, both p <0.01) and dipyridamole (91%, both p <0.001) echocardiography. This finding related to the lower specificity of exercise ECG in patients with either left ventricular hypertrophy or ST-T abnormalities at rest compared to the specificity in patients without these disorders (33% vs 89%, p <0.01). A lower MIBI scan specificity was found only in patients with left ventricular hypertrophy (31% vs 66%, p <0.05). The overall accuracy of dobutamine echocardiography reached 84% compared to exercise ECG (66%, p <0.01), MIBI scan (68%, p <0.05), and dipyridamole echocardiography (79%, p <0.05). In conclusion, dobutamine echocardiography yielded satisfactory diagnostic accuracy for identifying CAD in hypertensive women. Although dipyridamole echocardiography had the greatest specificity, it might be limited in detecting mild CAD. Both exercise ECG and MIBI scanning had fare sensitivity; however, our findings limit the usefulness of these 2 tests in unselected patients. PMID:20403475

  10. Plan Showing Cross Bracing Under Upper Stringers, Typical Section Showing ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Plan Showing Cross Bracing Under Upper Stringers, Typical Section Showing End Framing, Plan Showing Cross Bracing Under Lower Stringers, End Elevation - Covered Bridge, Spanning Contoocook River, Hopkinton, Merrimack County, NH

  11. 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

  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, 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

  13. BVA at the London Vet Show.

    PubMed

    2015-07-01

    The London Vet Show will take place at Olympia in London on November 19 and 20. A significant event in the veterinary calendar, the show hosts BVA Congress and several BVA programmed streams. Tim Keen, BVA marketing manager, takes a look at what's on offer. PMID:26139680

  14. Comparison of Radiological Findings of Chest X-Ray With Echocardiography in Determination of the Heart Size

    PubMed Central

    Biharas Monfared, Ali; Agha Farajollah, Shahnaz; Sabour, Fahimeh; Farzanegan, Roya; Taghdisi, Shahram

    2015-01-01

    Background: Heart size is an important and effective parameter in chest X-ray (CXR) interpretation. Studies indicate that, especially in middle-aged men, increased cardiothoracic ratio (CTR) is associated with ischemic heart disease (IHD) and increased rate of morbidity and mortality. The CXR is the most common imaging examination of the heart. Objectives: A good quality posterior-anterior (PA) chest radiograph is an important indicator of the cardiac size. Nowadays, CXR has given its place to more advanced approaches such as two-dimensional echocardiography. However, CXR is still more accessible and feasible for most of the physicians. This study was designed to compare the findings of CXR and echocardiography in determination of the heart size. Patients and Methods: This cross-sectional study was carried out from 2006 to 2007. A total of 197 patients entered the study. The cases had been undergone PA CXR and 2-D echocardiography maximum within two days. Results: Of participants, 24.9% had cardiomegaly according to the findings of CXR and 50.8% based on echocardiography. There was a statistically significant difference between the mean size of Right Ventricular End Diastolic Diameter in the patients with cardiothoracic ratio < 50% and ? 50% (P = 0.002) as well as Left Ventricular End Diastolic Diameter (P = 0.023). Also, a statistically significant difference was seen between echocardiography and CXR findings with regard to determination of the heart size (P = 0.003). Nonetheless, it is noteworthy that sensitivity and specificity of CXR findings in the diagnosis of cardiomegaly were 34%, and 84.5%, respectively. Conclusions: CTR is the most common method of describing the heart size. Increased CTR in CXR is associated with poor prognosis, which is suggestive of importance and necessity of early diagnosis. Although CXR may not have the same diagnostic accuracy as echocardiography, its easy accessibility and high specificity in diagnosis of cardiomegaly is very helpful, which can play an important and a cost-benefit role, particularly in screening the enlarged heart size. Moreover, according to the statistics released by Medical Council of Iran, most of Iranian physicians are general practitioners and a few of them are cardiologist. PMID:25763274

  15. Roanoke Area Junior Livestock Show

    E-print Network

    Liskiewicz, Maciej

    & Computations Tom Stanley, Chairman Tyler Painter Beth Hawse Katherine Carter Ribbons & Record Keeping Carolyn Supper at Arena 6:00 PM Hog Show: Showmanship, Market Hog Show and Breeding Gilt Show 7:00 pm Check

  16. Correlation of echocardiographic epicardial fat thickness with severity of coronary artery disease in patients with acute myocardial infarction.

    PubMed

    Wang, Tao; Liu, Qiang; Liu, Cuixia; Sun, Ling; Li, Daixu; Liu, Aihua; Jia, Ruyi

    2014-11-01

    The aim of this study was to test the hypotheses that epicardial adipose tissue (EAT) can be a marker of severe coronary artery disease in patients with acute myocardial infarction. Overall, 373 cases who underwent coronary angiography were classified into 2 groups by SYNTAX score: low-score and high-score group. EAT was measured by transthoracic echocardiography. Obtained data were compared using Pearson correlation analyses and univariate and multiple logistic regression analysis. The results showed that EAT in the high-score group was significantly greater than in the normal group (5.6 ± 1.1 vs. 4.1 ± 1.0 mm, P < 0.01). EAT had a positive correlation with SYNTAX score (r = 0.61, P < 0.01). Receiver operating characteristic (ROC) curve analyses showed that EAT could reliably discriminate patients with high SYNTAX score (? 33) [AUC: 0.86, 95% confidence interval (CI): 0.822-0.898, P < 0.01]. Multivariate regression analyses showed that EAT was an independent predictor for major in-hospital events. These data showed an association between EAT and SYNTAX score. PMID:24645963

  17. 6. VIEW SHOWING DOWNSTREAM FACE OF DAM, SHOWING SEEPAGE CONTROL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. VIEW SHOWING DOWNSTREAM FACE OF DAM, SHOWING SEEPAGE CONTROL REINFORCEMENT, LOOKING SOUTHWEST - High Mountain Dams in Upalco Unit, East Timothy Lake Dam, Ashley National Forest, 8.4 miles North of Swift Creek Campground, Mountain Home, Duchesne County, UT

  18. 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

  19. Hybrid Melody pulmonary valve replacement in an adult with severe pulmonary hypertension and pulmonary artery aneurysm.

    PubMed

    Derk, Gwendolyn; Laks, Hillel; Aboulhosn, Jamil

    2013-11-01

    A 48-year-old female with D-TGA, ventricular septal defect (VSD), pulmonary stenosis, pulmonary hypertension (PAH), and total anomalous pulmonary venous connection underwent hybrid intervention for a pulmonary artery (PA) aneurysm and replacement of a dysfunctional pulmonary valve (PV). She underwent a hemi-Mustard procedure at 9 years of age but remained cyanotic. She developed atrial fibrillation, heart failure, and functional decline at 43 years of age. A chest CT demonstrated a 6 cm PA aneurysm that upon re-imaging at 48 years had increased to 11 cm. A catheterization procedure revealed severe PS, PR, residual VSD, severe PAH with a pulmonary vascular resistance of 30 Wood units. She was evaluated and turned down for heart-lung transplantation at another institution. She was subsequently referred to our institution for heart-lung transplantation but was felt to be at unacceptably high risk given the complexity of her anatomy, imaging suggesting liver cirrhosis and liver biopsy with extensive fibrosis. After extensive discussion of risk and benefits, the patient agreed to proceed with a hybrid intervention, consisting of surgical aneurysm resection/PA repair, tricuspid valve repair; PV replacement with a Melody valve, and VSD closure. There were no complications and she was discharged home within 2 weeks. Six months post procedure, she is not on oxygen, her resting room air saturation is 94%, and echocardiography shows stable Melody valve function. This case highlights the utility of a hybrid approach in the treatment of an adult with complex congenital heart disease, heart failure and severe PAH, considered at the highest risk for adverse surgical outcomes. The short-term efficacy of the Melody valve in severe PAH is reassuring. PMID:23404953

  20. Incidence and severity of atherosclerotic cardiovascular artery disease in patients undergoing TAVI.

    PubMed

    Fusini, Laura; Mirea, Oana; Tamborini, Gloria; Muratori, Manuela; Gripari, Paola; Cefalù, Claudia; Ghulam Ali, Sarah; Maffessanti, Francesco; Andreini, Daniele; Pontone, Gianluca; Bartorelli, Antonio L; Alamanni, Francesco; Agrifoglio, Marco; Pepi, Mauro

    2015-06-01

    Transcatheter aortic valve implantation (TAVI) has extended the treatment options for severe, symptomatic aortic valve stenosis (AS). Risk factors for AS have been shown to be similar to atherosclerosis. Consequently, coronary artery disease (CAD), peripheral vascular and carotid artery diseases are often found concurrently with diagnostic, procedural and prognostic implications. This study sought to describe comprehensive vascular assessment in terms of prevalence, severity and correlations in TAVI candidates. A total of 323 patients (81 ± 6 years) undergoing TAVI were enrolled. Vascular pathologies were evaluated by invasive coronary angiography, computer-tomography (abdominal aorta, renal, iliac and femoral arteries), echo-color Doppler ultrasound (carotid artery), and transoesophageal echocardiography (thoracic aorta). CAD was found in 173 (54 %) patients, of which 65 (38 %) had 1-vessel, 45 (26 %) 2-vessel and 59 (34 %) 3-vessel disease. Carotid artery disease was present in 33.6 % patients, of which 23.6 % unilateral and 10.0 % bilateral. Iliac, femoral and renal stenosis were found in 29.2 %, 22.0 %, and 4.7 %, respectively. Cardiovascular risk factor and gender correlated with CAD. CAD patients presented more frequently with significant stenosis (luminal narrowing ?50 %) of at least one other district. Multi-districts significant stenosis stratified patients on long-term survival and the coexistence of 3-districts involvement with CAD negatively impacts on mortality. Multimodality imaging assessment shows that coronary, carotid, and peripheral artery disease are often found concurrently in patients undergoing TAVI. Several risk factors and gender correlate with the presence and severity of CAD and peripheral pathologies. Long-term mortality is increased in patients with a more compromised vascular situation. PMID:25805046

  1. Automated mitral annular tracking: a novel method for evaluating mitral annular motion using two-dimensional echocardiography.

    PubMed

    Eto, Yoko; Yamada, Hirotsugu; Shin, Joon-Han; Agler, Deborah A; Tsujino, Hiroyuki; Qin, Jian-Xin; Saracino, Giuseppe; Greenberg, Neil L; Thomas, James D; Shiota, Takahiro

    2005-04-01

    We developed an automated mitral annular tracking method based on a digital processing of high frame rate cineloop images of 2-dimensional echocardiography. In this study, its feasibility and accuracy was validated in 11 healthy volunteers and 16 patients with left ventricular (LV) dysfunction. The mitral annular excursion measured by automated mitral annular tracking agreed well with that measured by 3-dimensional echocardiography and correlated with LV ejection fraction. The longitudinal mitral annular excursion was reduced whereas the radial one was preserved for patients with LV dysfunction compared with control subjects. The novel automated mitral annular tracking method is clinically feasible and has potential capability to quantify the comprehensive mitral annular motion for evaluating LV function in a clinical setting. PMID:15846156

  2. Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit

    Microsoft Academic Search

    Philippe Vignon; Anthony Dugard; Julie Abraham; Dominique Belcour; Guillaume Gondran; Frédéric Pepino; Benoît Marin; Bruno François; Hervé Gastinne

    2007-01-01

    Objective  We sought to evaluate the efficacy of a limited training dedicated to residents without knowledge in ultrasound for performing\\u000a goal-oriented echocardiography in ICU patients.\\u000a \\u000a \\u000a \\u000a Design  Prospective pilot observational study.\\u000a \\u000a \\u000a \\u000a Setting  Medical-surgical ICU of a teaching hospital.\\u000a \\u000a \\u000a \\u000a Patients  61 consecutive adult ICU patients (SAPS?II score: 38???17; 46 ventilated patients) requiring a transthoracic echocardiography\\u000a were studied.\\u000a \\u000a \\u000a \\u000a Interventions  After a curriculum including a 3-h training course and 5?h of hands-on training, one

  3. Assessment of atrial regional and global electromechanical function by tissue velocity echocardiography: a feasibility study on healthy individuals

    Microsoft Academic Search

    Miguel Quintana; Peter Lindell; Samir K Saha; Francesca del Furia; Britta Lind; Satish Govind; Lars-Åke Brodin

    2005-01-01

    BACKGROUND: The appropriate evaluation of atrial electrical function is only possible by means of invasive electrophysiology techniques, which are expensive and therefore not suitable for widespread use. Mechanical atrial function is mainly determined from atrial volumes and volume-derived indices that are load-dependent, time-consuming and difficult to reproduce because they are observer-dependent. AIMS: To assess the feasibility of tissue velocity echocardiography

  4. [Value of two-dimensional and Doppler echocardiography in the diagnosis of rupture of the interventricular septum in myocardial infarction].

    PubMed

    Szwed, H; Sadowski, Z; Sitkowski, W; Kraska, A; Biernacka, A

    1989-01-01

    Usefulness of two-dimensional and Doppler echocardiography in diagnosis of the ruptured interventricular septum in a course of myocardial infarction was evaluated basing on own material consisted of 6 cases. Ventricular septal defect was visualized in 5 patients. The blood flow through the ventricular septum was detected in all of 6 patients. Obtained results were concordant with intraoperative and anatomicopathologic findings as for as the localization of the rupture is concerned. PMID:2635239

  5. Percutaneous Transluminal Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy Results With Respect to Intraprocedural Myocardial Contrast Echocardiography

    Microsoft Academic Search

    Lothar Faber; Hubert Seggewiss; Ulrich Gleichmann

    Background—Percutaneous transluminal septal myocardial ablation (PTSMA) has been introduced as an alternative procedure for reducing the left ventricular outflow tract gradient (LVOTG) in hypertrophic obstructive cardiomyopathy. We report on the acute and mid-term results in 91 symptomatic patients with respect to intraprocedural myocardial contrast echocardiography (MCE). Methods and Results—PTSMA was intended for 46 women and 45 men (54.1615.5 years). In

  6. Hand-held echocardiography with doppler capability for the assessment of critically-ill patients: is it reliable?

    Microsoft Academic Search

    Philippe Vignon; Mickaël B. J. Frank; Jérôme Lesage; Frédérique Mücke; Bruno François; Sandrine Normand; Michel Bonnivard; Marc Clavel; Hervé Gastinne

    2004-01-01

    Objective To evaluate the diagnostic capability of a hand-carried ultrasound device (HCU) in critically ill patients when using conventional transthoracic echocardiography (TTE) as a reference. Design Prospective, descriptive study. Setting Medical-surgical intensive care unit of a teaching hospital. Patients All patients requiring a TTE study were eligible. Interventions Each patient underwent an echocardiographic examination using a full-feature echocardiographic platform (Sonos

  7. What Do Blood Tests Show?

    MedlinePLUS

    ... page from the NHLBI on Twitter. What Do Blood Tests Show? Blood tests show whether the levels ... changes may work best. Result Ranges for Common Blood Tests This section presents the result ranges for ...

  8. Asia: Showing the Changing Seasons

    NSDL National Science Digital Library

    Jesse Allen

    1998-09-09

    SeaWiFS false color data showing seasonal change in the oceans and on land for Asia. The data is seasonally averaged, and shows the sequence: fall, winter, spring, summer, fall, winter, spring (for the Northern Hemisphere).

  9. Pheochromocytoma with Markedly Abnormal Liver Function Tests and Severe Leukocytosis

    PubMed Central

    Eun, Chai Ryoung; Ahn, Jae Hee; Seo, Ji A

    2014-01-01

    Pheochromocytoma is a rare neuroendocrine tumor arising from the medulla of the adrenal glands, which causes an overproduction of catecholamines. The common symptoms are headache, palpitations, and sweating; however, various other clinical manifestations might also be present. Accurate diagnosis of pheochromocytoma is important because surgical treatment is usually successful, and associated clinical problems are reversible if treated early. A 49-year-old man with a history of uncontrolled hypertension and diabetes mellitus presented with chest pain, fever, and sweating. His liver function tests and white blood cell counts were markedly increased and his echocardiography results suggested stress-induced cardiomyopathy. His abdominal computed tomography showed a 5×5-cm-sized tumor in the left adrenal gland, and laboratory tests confirmed catecholamine overproduction. After surgical resection of the left adrenal gland, his liver function tests and white blood cell counts normalized, and echocardiography showed normal cardiac function. Moreover, his previous antihypertensive regimen was deescalated, and his previously uncontrolled blood glucose levels normalized without medication. PMID:24741459

  10. Prediction of thrombus-related mechanical prosthetic valve dysfunction using transesophageal echocardiography

    NASA Technical Reports Server (NTRS)

    Lin, S. S.; Tiong, I. Y.; Asher, C. R.; Murphy, M. T.; Thomas, J. D.; Griffin, B. P.

    2000-01-01

    Identification of thrombus-related mechanical prosthetic valve dysfunction (MPVD) has important therapeutic implications. We sought to develop an algorithm, combining clinical and echocardiographic parameters, for prediction of thrombus-related MPVD in a series of 53 patients (24 men, age 52 +/- 16 years) who had intraoperative diagnosis of thrombus or pannus from 1992 to 1997. Clinical and echocardiographic parameters were analyzed to identify predictors of thrombus and pannus. Prevalence of thrombus and diagnostic yields relative to the number of predictors were determined. There were 22 patients with thrombus, 19 patients with pannus, and 12 patients with both. Forty-two of 53 masses were visualized using transesophageal echocardiography (TEE), including 29 of 34 thrombi or both thrombi and panni and 13 of 19 isolated panni. Predictors of thrombus or mixed presentation include mobile mass (p = 0.009), attachment to occluder (p = 0.02), elevated gradients (p = 0.04), and an international normalized ratio of < or = 2.5 (p = 0.03). All 34 patients with thrombus or mixed presentation had > or = 1 predictor. The prevalence of thrombus in the presence of < or = 1, 2, and > or = 3 predictors is 14%, 69%, and 91%, respectively. Thus, TEE is sensitive in the identification of abnormal mass in the setting of MPVD. An algorithm based on clinical and transesophageal echocardiographic predictors may be useful to estimate the likelihood of thrombus in the setting of MPVD. In the presence of > or = 3 predictors, the probability of thrombus is high.

  11. 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.

  12. Feasibility of radial and circumferential strain analysis using 2D speckle tracking echocardiography in cats

    PubMed Central

    TAKANO, Hiroshi; ISOGAI, Tomomi; AOKI, Takuma; WAKAO, Yoshito; FUJII, Yoko

    2014-01-01

    The purpose of the present study is to investigate the feasibility of strain analysis using speckle tracking echocardiography (STE) in cats and to evaluate STE variables in cats with hypertrophic cardiomyopathy (HCM). Sixteen clinically healthy cats and 17 cats with HCM were used. Radial and circumferential strain and strain rate variables in healthy cats were measured using STE to assess the feasibility. Comparisons of global strain and strain variables between healthy cats and cats with HCM were performed. Segmental assessments of left ventricle (LV) wall for strain and strain rate variables in cats with HCM were also performed. As a result, technically adequate images were obtained in 97.6% of the segments for STE analysis. Sedation using buprenorphine and acepromazine did not affect any global strain nor strain rate variable. In LV segments of cats with HCM, reduced segmental radial strain and strain rate variables had significantly related with segmental LV hypertrophy. It is concluded that STE analysis using short axis images of LV appeared to be clinically feasible in cats, having the possibility to be useful for detecting myocardial dysfunctions in cats with diseased heart. PMID:25373881

  13. Use of intracardiac echocardiography during electrophysiologic evaluation and therapy of atrial arrhythmias.

    PubMed

    Lesh, M D; Kalman, J M; Karch, M R

    1998-08-01

    The relationship between endocardial anatomy and the substrate for a variety of atrial arrhythmia mechanisms is being increasingly appreciated. By using intravascular ultrasound imaging systems in the cardiac chambers, direct endocardial visualization can be provided. The advantages include: precise anatomic localization of the ablation catheter tip in relation to important endocardial structures that cannot be visualized with fluoroscopy; the ability to guide ablative procedures partly, or in some instances entirely, by anatomic landmarks; potential reduction in fluoroscopy time; evaluation of stability of catheter tip-tissue contact; confirmation of lesion formation and identification of lesion size and continuity; immediate identification of complications such as clot and pericardial effusion; assistance in the guidance of transseptal puncture; and as a research tool to help in understanding the critical role played by specific endocardial structures in atrial arrhythmogenesis. Presently, intracardiac echocardiography (ICE) is useful as an adjunct in guiding mapping and ablation of focal atrial tachycardia. In our laboratory, it has significant advantage in modification or ablation of sinus node function in patients with inappropriate sinus tachycardia syndrome. Its use in helping to guide ablation of atrial fibrillation remains an exciting, but largely unproved, hypothesis. Better technology will be required if widespread clinical use of ICE is to occur. PMID:9727675

  14. Doppler myocardial imaging: a new method of data acquisition for three-dimensional echocardiography.

    PubMed

    Lange, A; Wright, R A; Al-Nafusi, A; Sang, C; Palka, P; Sutherland, G R

    1996-01-01

    The precise morphologic characteristics of any intracardiac tumor have important implications regarding surgical planning and operative repair. Three-dimensional echocardiography has proved to be a valuable clinical technique in this field. Current methods of three-dimensional reconstruction of two-dimensional images are based on the standard gray-scale imaging technique. However, precordial gray-scale data-set information is frequently of suboptimal quality because of data degradation caused by ultrasound attenuation by chest wall structures. This has limited the use of the transthoracic three-dimensional technique to "echogenic" patients. Doppler myocardial imaging (DMI), a new ultrasound technique based on the Doppler principle, is influenced less by chest wall attenuation and in addition offers a better boundary detection algorithm for the cardiac structures. To determine if there may be a potential benefit of DMI to acquire data for three-dimensional reconstruction, a 33-year-old woman with a large intracardiac mass was studied. In this case three-dimensional gray-scale and DMI data sets were compared and contrasted with pathologic information. DMI allowed both the qualification of mass volume and the correct definition of the morphology of the mass. It was also possible to identify the precise site of attachment of the mass to the mitral valve leaflets. The information thus obtained was correlated with both operative and pathologic findings. PMID:8943461

  15. Prevalence of mitral valve prolapse and associated valvular regurgitations in healthy teenagers undergoing screening echocardiography

    PubMed Central

    Sattur, Sudhakar; Bates, Sharon; Reza Movahed, Mohammad

    2010-01-01

    BACKGROUND: The true prevalence of mitral valve prolapse (MVP) in the population has been controversial. OBJECTIVE: To evaluate the prevalence of MVP and associated valvular abnormalities in healthy teenage students. METHODS: The Anthony Bates Foundation performed screening echocardiography in high schools across the United States. A total of 2072 students between 13 and 19 years of age were identified for the present study. RESULTS: Total prevalence of MVP was 0.7%. The prevalence of MVP was significantly higher among female teenagers (nine of 690 female teenagers [1.3%] versus five of 1382 male teenagers [0.4%], P=0.01, OR 3.6, CI 1.21 to 10.70). The prevalence of mitral regurgitation (MR) and tricuspid regurgitation (TR) was higher in teenagers with MVP. MR occurred in five of 14 teenagers (35.7%) with MVP versus 15 of 2058 controls (0.7%) (P<0.001, OR 75.6, CI 22.6 to 252.5). TR occurred in one of 14 teenagers (7.1%) with MVP versus nine of 2058 controls (0.4%) (P<0.001, OR 17.5, CI 2.0 to 148.3). CONCLUSION: The prevalence of MVP in this cohort of healthy teenage students was less than 1%. Furthermore, the prevalence of MVP was higher in female teenagers and was associated with a higher prevalence of MR and TR. PMID:20664768

  16. Multiframe registration of real-time three-dimensional echocardiography time series

    PubMed Central

    Mulder, Harriët W.; van Stralen, Marijn; van der Zwaan, Heleen B.; Leung, K. Y. Esther; Bosch, Johan G.; Pluim, Josien P. W.

    2014-01-01

    Abstract. Mosaicing of real-time three-dimensional echocardiography (RT3-DE) images aims at extending the field-of-view of overlapping images. Currently available methods discard most of the temporal information available in the time series. We investigate the added value of simultaneous registration of multiple temporal frames using common similarity metrics. We combine RT3-DE images of the left and right ventricles by registration and fusion. The standard approach of registering single frames, either end-diastolic (ED) or end-systolic (ES), is compared with simultaneous registration of multiple time frames, to evaluate the effect of using the information from all images in the metric. A transformation estimating the protocol-specific misalignment is used to initialize the registration. It is shown that multiframe registration can be as accurate as alignment of the images based on manual annotations. Multiframe registration using normalized cross-correlation outperforms any of the single-frame methods. As opposed to expectations, extending the multiframe registration beyond simultaneous use of ED and ES frames does not further improve registration results.

  17. Comparison of one- and 12-month outcomes of transcatheter aortic valve replacement in patients with severely stenotic bicuspid versus tricuspid aortic valves (results from a multicenter registry).

    PubMed

    Kochman, Janusz; Huczek, Zenon; Scis?o, Piotr; Dabrowski, Maciej; Chmielak, Zbigniew; Szyma?ski, Piotr; Witkowski, Adam; Parma, Rados?aw; Ochala, Andrzej; Chodór, Piotr; Wilczek, Krzysztof; Reczuch, Krzysztof W; Kubler, Piotr; Rymuza, Bartosz; Ko?towski, Lukasz; Scibisz, Anna; Wilimski, Rados?aw; Grube, Eberhard; Opolski, Grzegorz

    2014-09-01

    The aim of the study was to evaluate the transcatheter aortic valve replacement (TAVR) in high-risk patients with severe bicuspid aortic valve (BAV) stenosis and to compare the outcomes with a matched group of patients with tricuspid aortic valve. TAVR became an alternative treatment method in high-risk patients with symptomatic aortic stenosis; however, BAV stenosis is regarded as a relative contraindication to TAVR. The study population comprised 28 patients with BAV who underwent TAVR. BAV was diagnosed based on a transesophageal echocardiography. CoreValve and Edwards SAPIEN prostheses were implanted. The control group consisted of 84 patients (3:1 matching) with significant tricuspid aortic valve stenosis treated with TAVR. There were no significant differences between patients with and without BAV in device success (93% vs 93%, p = 1.0), risk of annulus rupture (0% in both groups), or conversion to cardiosurgery (4% vs 0%, respectively, p = 0.25). The postprocedural mean pressure gradient (11.5 ± 6.4 vs 10.4 ± 4.5 mm Hg, p = 0.33), aortic regurgitation grade ?2 of 4 (32% vs 23%, p = 0.45), 30-day mortality (4% vs 7%, p = 0.68), and 1-year all-cause mortality (19% vs 18%, p = 1.00) did not differ between the groups. Echocardiography showed well-functioning valve prosthesis with a mean prosthetic valve area of 1.6 ± 0.4 cm(2) versus 1.7 ± 0.3 cm(2) (p = 0.73), a mean pressure gradient of 10.3 ± 5.4 versus 9.8 ± 2.8 mm Hg (p = 0.64), and aortic regurgitation grade ?2 of 4 (22% vs 22%, p = 1.00) for the 2 groups. In conclusion, selected high-risk patients with BAV can be successfully treated with TAVR, and their outcomes are similar to those reported in patients without BAV. PMID:25037674

  18. 1. Show the synthesis of prontosil. Show the starting

    E-print Network

    Gates, Kent. S.

    how the three analogs shown below can be prepared. Draw an arrow-pushing mechanism for each step is not active in an in vitro assay, but shows good activity in animal models and human patients. Explain: what

  19. Planning a Successful Tech Show

    ERIC Educational Resources Information Center

    Nikirk, Martin

    2011-01-01

    Tech shows are a great way to introduce prospective students, parents, and local business and industry to a technology and engineering or career and technical education program. In addition to showcasing instructional programs, a tech show allows students to demonstrate their professionalism and skills, practice public presentations, and interact…

  20. Acute effects of an energy drink on myocardial function assessed by conventional echo-Doppler analysis and by speckle tracking echocardiography on young healthy subjects.

    PubMed

    Menci, Daniele; Righini, Francesca Maria; Cameli, Matteo; Lisi, Matteo; Benincasa, Susanna; Focardi, Marta; Mondillo, Sergio

    2013-01-01

    Purpose. Previous studies have underlined the effects of the energy drinks containing caffeine end taurine on the cardiovascular system. The aim of this study was to determine acute changes on echocardiographic parameters assessed by conventional echo-Doppler analysis and by speckle tracking echocardiography after the consumption of an energy drink in a young healthy population. Methods. measurement of blood pressure, electrocardiographic, and echocardiographic examination were performed on 35 healthy subjects (mean age 25 ± 2 years, 16 men), at baseline and one hour after the consumption of a body surface area indexed amount of an energy drink (168?mL/m(2)) containing caffeine (0.03%) and taurine (0.4%). Results. The analysis of left ventricular function showed a significant increase of mean relative values of MAPSE (+11%; P < 0.001), global longitudinal strain (+10%, P = 0.004), and left ventricular twisting (+22%, P < 0.0001) in respect to baseline. Also, right ventricular function parameters appeared significantly increased after energy drink consumption, as TAPSE (+15%, P < 0.0001), global, and free wall right ventricular longitudinal strain (+8%, P = 0.001; +5%, P = 0.1, resp.). Conclusion. In conclusion, the consumption of the ED in our population showed a significant increase of right and left ventricular myocardial function, suggesting a possible positive inotropic effect related to the substances contained therein. PMID:24319592

  1. The Maths File Game Show

    NSDL National Science Digital Library

    2007-12-12

    The British Broadcasting Corporation offers this great collection of fun, educational games that help children learn basic concepts of mathematics. Twelve interactive games are available in all, illustrating principles of data handling, numbers, algebra, and measurement. Children can practice interpreting Cartesian coordinates by guiding a space ship across a grid, or compete with an animated character in a test of fractions and percentages. In addition to the online games, several other activities are presented in one-page documents for easy printing.

  2. Hand-held echocardiography in the setting of pre-operative cardiac evaluation of patients undergoing non-cardiac surgery: results from a randomized pilot study.

    PubMed

    Cavallari, Ilaria; Mega, Simona; Goffredo, Costanza; Patti, Giuseppe; Chello, Massimo; Di Sciascio, Germano

    2015-06-01

    Transthoracic echocardiography is not a routine test in the pre-operative cardiac evaluation of patients undergoing non-cardiac surgery but may be considered in those with known heart failure and valvular heart disease or complaining cardiac symptoms. In this setting, hand-held echocardiography (HHE) could find a potential application as an alternative to standard echocardiography in selected patients; however, its utility in this context has not been investigated. The aim of this pilot study was to evaluate the conclusiveness of HHE compared to standard echocardiography in this subset of patients. 100 patients scheduled for non-cardiac surgery were randomized to receive a standard exam with a Philips Ie33 or a bedside evaluation with a pocket-size imaging device (Opti-Go, Philips Medical System). The primary endpoint was the percentage of satisfactory diagnosis at the end of the examination referred as conclusiveness. Secondary endpoints were the mean duration time and the mean waiting time to perform the exams. No significant difference in terms of conclusiveness between HHE and standard echo was found (86 vs 96 %; P = 0.08). Mean duration time of the examinations was 6.1 ± 1.2 min with HHE and 13.1 ± 2.6 min with standard echocardiography (P < 0.001). HHE resulted in a consistent save of waiting time because it was performed the same day of clinical evaluation whereas patients waited 10.1 ± 6.1 days for a standard echocardiography (P < 0.001). This study suggests the potential role of HHE for pre-operative evaluation of selected patients undergoing non-cardiac surgery, since it provided similar information but it was faster and earlier performed compared to standard echocardiography. PMID:25985940

  3. Diarrheal Disease in Show Swine

    E-print Network

    Lawhorn, D. Bruce

    2007-02-27

    Diarrhea, an important problem in show pigs, can be caused by poor nutrition, infectious diseases, internal parasites or a combination of factors. This publication explains how the cause is diagnosed and the illness treated....

  4. Development of Left Ventricular Longitudinal Speckle Tracking Echocardiography in Very Low Birth Weight Infants with and without Bronchopulmonary Dysplasia during the Neonatal Period

    PubMed Central

    Czernik, Christoph; Rhode, Stefanie; Helfer, Sven; Schmalisch, Gerd; Bührer, Christoph; Schmitz, Lothar

    2014-01-01

    Objectives In preterm infants, postnatal myocardial adaptation may be complicated by bronchopulmonary dysplasia (BPD). We aimed to describe the development of left ventricular function by serial 2D, Doppler, and speckle tracking echocardiography (2D-STE) in infants with and without BPD during the neonatal period and compare these to anthropometric and conventional hemodynamic parameters. Study Design Prospective echocardiography on day of life (DOL) 1, 7, 14, and 28 in 119 preterm infants <1500 g birth weight of whom 36 developed BPD (need for oxygen supplementation at 36 weeks gestational age). Non-BPD and BPD infants differed significantly in median (IQR) gestational age (25.5(24–26.5) weeks vs. 29(27–30) weeks, p<0.001) and birth weight (661(552–871) g vs. 1100(890–1290) g, p<0.001). Results The intra- and inter-observer variability of the 2D-STE parameters measured did not depend on time of measurement, although there were significant differences in the reproducibility of the parameters. Low intra- and inter-observer variability was seen for longitudinal systolic strain and strain rate mid septum with a median CV (coefficient of variation) of <4.6%. Much higher CVs (>10%) were seen for the apical segment. While anthropometric parameters show rapid development during the first 4 weeks of life, the speckle tracking parameters did not differ statistically significantly during the neonatal period. Infants with and without BPD differed significantly (p<0.001) in the development of anthropometric parameters, conventional hemodynamic parameters except for heart rate, and 2D-STE parameters: global longitudinal systolic strain rate (GLSSR) and longitudinal systolic strain for the mid left wall (LSSR). The largest differences were seen at DOL 1 and 7 in GLSSR (p<0.001) and in LSSR (p<0.01). Conclusions Reproducible 2D-STE measurements are possible in preterm infants <1500 g. Cardiac deformation reveals early (DOL 1 and 7) ventricular changes (GLSSR and LSSR) in very low birth weight infants who develop BPD. PMID:25184634

  5. Fully automatic segmentation of left ventricular myocardium in real-time three-dimensional echocardiography

    NASA Astrophysics Data System (ADS)

    Walimbe, Vivek; Zagrodsky, Vladimir; Shekhar, Raj

    2006-03-01

    Purpose: We report a deformable model (DM)-based fully automatic segmentation of the left ventricular (LV) myocardium (endocardium + epicardium) in real-time three-dimensional (3D) echocardiography. Methods: Initialization of the DM is performed through automated mutual information-based registration of the image to be segmented with a 3D template (image + corresponding endo-epicardial wiremesh). The initialized endocardial and epicardial wiremesh templates are then simultaneously refined iteratively under the joint influence of mesh-derived internal forces, image-derived external (gradient vector flow-based) forces, and endo-epicardium mesh-interaction forces. Incorporation of adaptive mesh-interaction forces into the DM refinement, a novelty of the current work, ensures appropriate relative endo-epicardial orientation during simultaneous refinement. Repeating for the entire cardiac sequence provides the segmented myocardium for all phases. Preliminary comparison is presented between automatic and expert-defined myocardial segmentation for five subjects imaged in clinical settings using a Philips SONOS 7500 scanner. Results: Root mean square (rms) radial distance error between the algorithm-determined and expert-traced endocardial and epicardial contours in six predetermined planar views was 3.86 +/- 0.72 mm and 4.0 +/- 0.63 mm in end-diastole, 3.9 +/- 0.51 mm and 4.04 +/- 0.65 mm in systole, respectively. Mean absolute error between average myocardial thickness calculated using automatic and expert-defined contours was 1.64 +/- 0.56 mm (apical), 1.3 +/- 0.58 mm (mid) and 1.46 +/- 0.45 mm (basal). The absolute difference in ejection fraction calculated using our algorithm and by the expert using the TomTec software was 7.2 +/- 0.84 %. Conclusion: We demonstrate successful segmentation of LV myocardium, which allows clinically important LV structure and function (e.g. wall thickness, LV volume and ejection fraction) to be tracked over the entire cardiac cycle.

  6. Modified Optical Flow Technique for Cardiac Motions Analysis in Echocardiography Images

    PubMed Central

    Torkashvand, Paria; Behnam, Hamid; Sani, Zahra Alizadeh

    2012-01-01

    The quantitative analysis of cardiac motions in echocardiography images is a noteworthy issue in processing of these images. Cardiac motions can be estimated by optical flow (OF) computation in different regions of image which is based on the assumption that the intensity of a moving pattern remains constant in consecutive frames. However, in echocardiographic sequences, this assumption may be violated because of unique specifications of ultrasound. There are some methodsapplying the brightness variation effect in OF. Almost all of them have presented a mathematical brightness variation model globally in the images. Nevertheless, there is not a brightness variation model for echocardiographic images in these methods. Therefore, we are looking for a method to apply brightness variations locally in different regions of the image. In this study, we proposed a method to modify ausual OF technique by considering intensity variation. To evaluate this method, we implement two other OF-based methods, one usual OF method and a modified OF method applying brightness variation as a multiplier and an offset (generalized dynamic imaging model [GDIM]) and compare them with ours. These algorithms and ours were implemented on real 2D echocardiograms. Our method resulted in more accurate estimations than two others. At last, we compared our method with expert’spoint of view and observed that three distance metrics between them was appropriately smaller than other methods. The Haussdorff distance between the estimated curve defined by the proposed method and the expert defined curve is 4.81 pixels less than this distance for Lucas-Kanade and 2.28 pixels less than GDIM. PMID:23717803

  7. Calculation of aortic valve area by Doppler echocardiography: a direct application of the continuity equation.

    PubMed

    Richards, K L; Cannon, S R; Miller, J F; Crawford, M H

    1986-05-01

    The continuity equation suggests that a ratio of velocities at two different cardiac valves is inversely proportional to the ratio of cross-sectional areas of the valves. To determine whether a ratio of mitral/aortic valve orifice velocities is useful in determining aortic valve area in patients with aortic stenosis, 10 control subjects and 22 patients with predominant aortic stenosis were examined by Doppler echocardiography. The ratio of (mean diastolic mitral velocity)/(mean systolic aortic velocity), (Vm)/(Va), and the ratio of (mitral diastolic velocity-time integral)/(aortic systolic velocity-time integral), (VTm)/(VTa), were determined from Doppler spectral recordings. Aortic valve area determined at catheterization by the Gorlin equation was the standard of reference. High-quality Doppler recordings were obtained in 30 of 32 subjects (94%). Catheterization documented valve areas of 0.5 to 2.6 (mean 1.1) cm2. There was good correlation between Doppler-determined (Vm)/(Va) and Gorlin valve area (r = .90, SEE = 0.23 cm2); a better correlation was noted between (VTm)/(VTa) and Gorlin valve area (r = .93, SEE = 0.18 cm2). The data demonstrate the usefulness of Doppler alone in the determination of aortic valve area in adults with absent or mild aortic or mitral regurgitation and no mitral stenosis. Although the use of mean velocity and velocity-time integral ratios requires accurate measurement of mitral and aortic velocities, it does not require squaring of these velocities or measurement of the cross-sectional area of flow. PMID:3698240

  8. Diarrheal Disease in Show Swine 

    E-print Network

    Lawhorn, D. Bruce

    2007-02-27

    of gain. Lawsonia intracellularis is the causative bacterium. Though it is rarely the cause of diarrheal disease in show swine, veterinarians consider this organism as a potential cause when making a differ- ential diagnosis. L. intracellularis does.... TGE does not cause human disease. Clinical Diagnosis The stool of the normal pig should be firm and well- formed. When a normal show pig is on free-choice feed and water, the stool tends to loosen to the consistency of a cow patty as feed consumption...

  9. Pembrolizumab Shows Promise for NSCLC.

    PubMed

    2015-06-01

    Data from the KEYNOTE-001 trial show that pembrolizumab improves clinical outcomes for patients with advanced non-small cell lung cancer, and is well tolerated. PD-L1 expression in at least 50% of tumor cells correlated with improved efficacy. PMID:25895920

  10. The OOPSLA trivia show (TOOTS)

    Microsoft Academic Search

    Jeff Gray; Douglas C. Schmidt

    2009-01-01

    OOPSLA has a longstanding tradition of being a forum for discussing the cutting edge of technology in a fun and participatory environment. The type of events sponsored by OOPSLA sometimes border on the unconventional. This event represents an atypical panel that conforms to the concept of a game show that is focused on questions and answers related to OOPSLA themes.

  11. Managing Beef Cattle for Show

    E-print Network

    Herd, Dennis B.; Boleman, Chris; Boleman, Larry L.

    2001-11-16

    in show diets because of its rapid digestion and tendency to cause acido- sis (see the section on health). Oats are excellent for growth and development of steers or heifers. A mixture similar in nutrient content to oats can be formulated with a high...

  12. Magic Carpet Shows Its Colors

    NASA Technical Reports Server (NTRS)

    2004-01-01

    The upper left image in this display is from the panoramic camera on the Mars Exploration Rover Spirit, showing the 'Magic Carpet' region near the rover at Gusev Crater, Mars, on Sol 7, the seventh martian day of its journey (Jan. 10, 2004). The lower image, also from the panoramic camera, is a monochrome (single filter) image of a rock in the 'Magic Carpet' area. Note that colored portions of the rock correlate with extracted spectra shown in the plot to the side. Four different types of materials are shown: the rock itself, the soil in front of the rock, some brighter soil on top of the rock, and some dust that has collected in small recesses on the rock face ('spots'). Each color on the spectra matches a line on the graph, showing how the panoramic camera's different colored filters are used to broadly assess the varying mineral compositions of martian rocks and soils.

  13. Pig and the Poultry Show 

    E-print Network

    Sloan

    2009-01-01

    directed toward 1ncreasing d1gestibi11ty of the gra1n. Fitch and Wolberg (2l) found that 435 of the grain of Kansas Orange and 36K of the grain of Atlas Sorgo s1lage was voided intact in the animal's feces. Analysis of the vo1ded grains showed... whole kernels, but the starchy endosperm had been digested. Davis and Waldern (14) observed that 7. 1~~ of the kernels and 1. 2? of the whole s1lage DM appeared in the feces as whole kernels. The propor- tion of in v1tro digestible dry matter ( IVDDM...

  14. Managing Beef Cattle for Show 

    E-print Network

    Herd, Dennis B.; Boleman, Chris; Boleman, Larry L.

    2001-11-16

    . Protein supplements?Feeds such as cottonseed meal, soybean meal and linseed meal increase the protein content of the diet. Small amounts (less than 3 percent) of fish meal, dried blood meal, corn gluten meal, linseed meal and brewers or distillers grains... of nutritional ailments of acidosis, bloat and possibly founder. A big full middle on a steer can be more effectively controlled by limiting feed and water the last few weeks before show, not by elimi- nating hay from the diet. Hay should be free of mold, dust...

  15. Speckle tracking echocardiography in mature Irish Wolfhound dogs: technical feasibility, measurement error and reference intervals

    PubMed Central

    2013-01-01

    Background Two-dimensional strain measurements obtained by speckle tracking echocardiography (STE) have been reported in both humans and dogs. Incorporation of this technique into canine clinical practice requires the availability of measurements from clinically normal dogs, ideally of the same breed, taken under normal clinical conditions. The aims of this prospective study were to assess if it is possible to obtain STE data during a routine echocardiographic examination in Irish Wolfhound dogs and that these data will provide reference values and an estimation of measurement error. Methods Fifty- four healthy mature Irish Wolfhounds were used. These were scanned under normal clinical conditions to obtain in one session both standard echocardiographic parameters and STE data. Measurement error was determined separately in 5 healthy mature Irish Wolfhounds. Results Eight dogs were rejected by the software algorithm for reasons of image quality, resulting in a total of 46 dogs (85.2%) being included in the statistical analysis. In 46 dogs it was possible to obtain STE data from three scanning planes, as well as to measure the rotation of the left ventricle at two levels and thus calculate the torsion of the heart. The mean peak radial strain at the cardiac apex (RS-apex) was 45.1?±?10.4% (n?=?44), and the mean peak radial strain at the base (RS-base) was 36.9?±?14.7% (n?=?46). The mean peak circumferential strain at the apex (CS-apex) was -24.8?±?6.2% (n?=?44), and the mean peak circumferential strain at the heart base (CS-base) was -15.9?±?3.2% (n?=?44). The mean peak longitudinal strain (LS) was -16.2?±?3.0% (n?=?46). The calculated mean peak torsion of the heart was 11.6?±?5.1 degrees (n?=?45). The measurement error was 24.8%, 26.4%, 11.5%, 6.7%, 9.0% and 10 degrees, for RS-apex, RS-base, CS-apex, CS-base, LS and torsion, respectively. Conclusions It is concluded that this technique can be included in a normal echocardiographic examination in large breed dogs under clinical conditions. The usefulness of the reference values reported here, given their wide normal range, will ultimately be determined by the values that are obtained from a large numbers of diseased dogs. PMID:23680023

  16. Utility of strain echocardiography at rest and after stress testing in arrhythmogenic right ventricular dysplasia.

    PubMed

    Vitarelli, Antonio; Cortes Morichetti, Miguel; Capotosto, Lidia; De Cicco, Valentina; Ricci, Serafino; Caranci, Fiorella; Vitarelli, Massimo

    2013-05-01

    The introduction of speckle tracking imaging (STI) allowed the quantification of the regional myocardial function in the right ventricular (RV) free wall using deformation parameters. We sought to evaluate the potential utility of STI at rest and after stress to predict arrhythmogenic RV dysplasia (ARVD). We studied 19 patients with ARVD (diagnosed according to the task force criteria) and 19 healthy age- and gender-matched subjects. Both 2-dimensional and 3-dimensional echocardiography were performed. The RV and left ventricular annular peak systolic velocities were measured using tissue Doppler imaging. The RV-left ventricular peak systolic longitudinal strain (LS) was obtained in the basal, mid, and apical segments in the apical 4-chamber view using STI. An exercise stress-echocardiographic test was undertaken using bicycle ergometry with the patient in the supine position for all patients, and the indexes were assessed at peak effort. The STI measurements were determined using offline analysis programs. The 3-dimensional RV ejection fraction and strain were significantly lower in patients with ARVD than in the controls. The RV strain values at rest did not change significantly during maximum physical effort in the patients with ARVD. The receiver operating characteristic curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for the detection of ARVD were 9.35 cm/s for the RV annular peak systolic velocity (area under the curve 0.81), 42% for 3-dimensional RV ejection fraction (area under the curve 0.85), -25% for mean global RV-LS (area under the curve 0.86), -18% for the lowest peak systolic RV-LS (area under the curve 0.88), and -1.2 for peak minus baseline global change of stress RV-LS (area under the curve 0.92). In conclusion, STI at rest and during stress might enable quantitative assessment of RV function and the detection of ARVD and have potential clinical value in the treatment of these patients. PMID:23411103

  17. Hemodynamic changes of the middle hepatic vein in patients with pulmonary hypertension using echocardiography.

    PubMed

    Sun, Dan Dan; Hou, Chuan Ju; Yuan, Li Jun; Duan, Yun You; Hou, Ying; Zhou, Fang Ping

    2015-01-01

    The aim of this study was to analyze the changes of the middle hepatic vein (MHV) spectra in patients with pulmonary hypertension (PH) caused by congenital heart disease (CHD) and determine the proper parameters of MHV to predict PH. Eighty patients with CHD were included, whose pulmonary artery pressure was measured via right heart catheterization, and the MHV spectra were detected via echocardiography. The peak value of velocity (V) and velocity time integral (VTI) of the waves, including S wave, D wave and A wave, were measured at the end of inspiration. The values of the MHV parameters that were predictive of PH were evaluated and their cut-off points were determined. Compared with the control group, V of S wave (S), VTI of S wave (SVTI), V of D wave (D), VTI of D wave (DVTI) decreased and V of A wave (A), VTI of A wave (AVTI), A/S, AVTI/SVTI, A/(S+D), AVTI/ (SVTI+DVTI) increased in the PH group. These differences were statistically significant (P<0.05). A correlation analysis determined that the ratios of A/S, A/(S+D), AVTI/(SVTI+DVTI) were positively correlated with pulmonary artery mean pressure (r=0.529,0.575,0.438,P<0.001). An ROC curve analysis determined that the diagnostic effect of A/(S+D) was superior to the other two parameters. On the ROC curve, when the ratio of A/(S+D) was 0.30, the sensitivity was 85.37% and specificity was 75.00% for predicting PH. The spectral parameters of MHV, including the ratios of A/S, A/(S+D) and AVTI/(SVTI+DVTI), increased with increasing pulmonary pressure in CHD patients. When the ratio of A/(S+D) was 0.30 in MHV spectra, it had sufficient sensitivity and specificity for diagnosing PH, and this method could be used as a new non-invasive complementary echocardiographic parameter for predicting PH. PMID:25821961

  18. Phoenix Scoop Inverted Showing Rasp

    NASA Technical Reports Server (NTRS)

    2008-01-01

    This image taken by the Surface Stereo Imager on Sol 49, or the 49th Martian day of the mission (July 14, 2008), shows the silver colored rasp protruding from NASA's Phoenix Mars Lander's Robotic Arm scoop. The scoop is inverted and the rasp is pointing up.

    Shown with its forks pointing toward the ground is the thermal and electrical conductivity probe, at the lower right. The Robotic Arm Camera is pointed toward the ground.

    The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is led by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.

  19. Left ventricular radial colour and longitudinal pulsed-wave tissue Doppler echocardiography in 39 healthy domestic pet rabbits.

    PubMed

    Casamian-Sorrosal, Domingo; Saunders, Richard; Browne, William; Elliot, Sarah; Fonfara, Sonja

    2014-10-01

    This paper reports radial colour and longitudinal mitral annulus pulsed-wave tissue Doppler findings in a large cohort of healthy, adult pet rabbits. Thirty-nine rabbits (22 Dwarf Lops, 14 French Lops and three Alaskans) underwent conscious echocardiography. The median age of the rabbits was 22 months and the median weight was 2.8 kg (Dwarf Lop 2.4 kg/French Lop 6.0 kg). Adequate radial colour and longitudinal pulsed-wave tissue Doppler traces were obtained in 100% and 85% of cases, respectively. Most systolic tissue Doppler parameters were significantly higher in French Lops than in Dwarf Lops. Separation of mitral inflow diastolic waves was present in 40% of cases using conventional spectral Doppler and in >60% of cases using pulsed-wave tissue Doppler which could be beneficial when evaluating diastolic function in rabbits. This study can be used as a reference for normal echocardiographic tissue Doppler values for adult rabbits undergoing conscious echocardiography in clinical practice. PMID:25089025

  20. Isolation of novel Bacillus species showing high mosquitocidal activity against several mosquito species.

    PubMed

    Hayes, Sabrina R; Hudon, Michael; Park, Hyun-Woo

    2011-05-01

    Two novel mosquitocidal bacteria, VB17 and VB24, identified as new Bacillus species were isolated from dead mosquito larvae obtained in Florida aquatic habitats. Gas chromatographic analysis of fatty acid methyl esters (GC-FAME) and 16S rRNA sequencing indicated that VB24 is closely related to Bacillus sphaericus whereas VB17 does not have a close relationship with either Bacillus thuringiensis or B. sphaericus. Both isolates were significantly more active than B. sphaericus 2362 against Aedes taeniorhynchus, Anopheles quadrimaculatus, Culex quinquefasciatus larvae, and as active as B. sphaericus 2362 against Anopheles gambiae. Interestingly, however, both were not active against Aedes aegypti larvae, indicating some level of insecticidal specificity. PMID:21276795

  1. Human neural stem cell intracerebral grafts show spontaneous early neuronal differentiation after several weeks.

    PubMed

    Tennstaedt, Annette; Aswendt, Markus; Adamczak, Joanna; Collienne, Ursel; Selt, Marion; Schneider, Gabriele; Henn, Nadine; Schaefer, Cordula; Lagouge, Marie; Wiedermann, Dirk; Kloppenburg, Peter; Hoehn, Mathias

    2015-03-01

    Human neural stem cells (hNSCs) hold great promise for the treatment of neurological diseases. Considerable progress has been made to induce neural differentiation in the cell culture in vitro and upon transplantation in vivo [2] in order to explore restoration of damaged neuronal circuits. However, in vivo conventional strategies are limited to post mortem analysis. Here, we apply our developed first fate mapping platform to monitor neuronal differentiation in vivo by magnetic resonance imaging, bioluminescence imaging, and fluorescence imaging. Ferritin, Luciferase and GFP under neuronal-specific promoters for immature and mature neurons, respectively, were used to generate transgenic hNSCs. Differentiation-linked imaging reporter expression was validated in vitro. The time profile of spontaneous neuronal maturation after transplantation into mouse brain cortex demonstrated early neuronal differentiation within 6 weeks. Fully mature neurons expressing synaptogenesis were observed only after three months or longer. Our trimodal fate mapping strategy represents a unique non-invasive tool to monitor the time course of neuronal differentiation of transplanted stem cells in vivo. PMID:25617134

  2. Optimal timing of valve replacement in asymptomatic severe aortic stenosis.

    PubMed

    Bilen, Emine; Ipek, Gökürk; Ayhan, Huseyin; Nacar, Alper Bugra; Kasapkara, Haci Ahmet; Sani, Cenk; Basbug, Serdar; Kurt, Mustafa; Bozkurt, Engin

    2014-09-01

    Patients with asymptomatic severe aortic stenosis (AS) constitute a heterogeneous group which includes not only certain cases who are at high risk of sudden death and valve-related heart failure, but also those at low risk for these events. Degenerative AS, which includes a majority of patients with AS, is characterized by stricture of the valve, increased arterial stiffness, and diverse left ventricular response to the valvular plus arterial vascular load. In addition to using traditional primary parameters, the severity of AS and the total left ventricular load should be assessed using new measures such as energy loss index and valvulo-arterial impedance. Natriuretic peptide levels and global longitudinal strain imaging may also be used as secondary parameters to obtain information about left ventricular systolic function, although these parameters do not correlate with the severity of AS. Exercise stress testing and exercise echocardiography are also beneficial when assessing the patient if they are symptomatic, and for determining valvular and left ventricular contractile reserves. The aim of this review was to emphasize the importance of risk stratifications in asymptomatic severe AS cases, and to assess the severity of AS using not only conventional methods but also new methods on which much emphasis has been placed during recent years. PMID:25799699

  3. Combined computational and experimental approach to improve the assessment of mitral regurgitation by echocardiography.

    PubMed

    Sonntag, Simon J; Li, Wei; Becker, Michael; Kaestner, Wiebke; Büsen, Martin R; Marx, Nikolaus; Merhof, Dorit; Steinseifer, Ulrich

    2014-05-01

    Mitral regurgitation (MR) is one of the most frequent valvular heart diseases. To assess MR severity, color Doppler imaging (CDI) is the clinical standard. However, inadequate reliability, poor reproducibility and heavy user-dependence are known limitations. A novel approach combining computational and experimental methods is currently under development aiming to improve the quantification. A flow chamber for a circulatory flow loop was developed. Three different orifices were used to mimic variations of MR. The flow field was recorded simultaneously by a 2D Doppler ultrasound transducer and Particle Image Velocimetry (PIV). Computational Fluid Dynamics (CFD) simulations were conducted using the same geometry and boundary conditions. The resulting computed velocity field was used to simulate synthetic Doppler signals. Comparison between PIV and CFD shows a high level of agreement. The simulated CDI exhibits the same characteristics as the recorded color Doppler images. The feasibility of the proposed combination of experimental and computational methods for the investigation of MR is shown and the numerical methods are successfully validated against the experiments. Furthermore, it is discussed how the approach can be used in the long run as a platform to improve the assessment of MR quantification. PMID:24398572

  4. Automatic measurement of aortic annulus diameter in 3-dimensional Transoesophageal echocardiography

    PubMed Central

    2014-01-01

    Background Transcatheter aortic valve implantation involves percutaneously implanting a biomechanical aortic valve to treat severe aortic stenosis. In order to select a proper device, precise sizing of the aortic valve annulus must be completed. Methods In this paper, we describe a fully automatic segmentation method to measure the aortic annulus diameter in patients with aortic calcification, operating on 3-dimensional transesophageal echocardiographic images. The method is based on state estimation of a subdivision surface representation of the left ventricular outflow tract and aortic root. The state estimation is solved by an extended Kalman filter driven by edge detections normal to the subdivision surface. Results The method was validated on echocardiographic recordings of 16 patients. Comparison against two manual measurements showed agreements (mean ±SD) of -0.3±1.6 and -0.2±2.3 mm for perimeter-derived diameters, compared to an interobserver agreement of -0.1±2.1 mm. Conclusions With this study, we demonstrated the feasibility of an efficient and fully automatic measurement of the aortic annulus in patients with aortic disease. The algorithm robustly measured the aortic annulus diameter, providing measurements indistinguishable from those done by cardiologists. PMID:25200865

  5. Severe Aplastic Anemia (SAA)

    MedlinePLUS

    ... Email this page Print this page Severe aplastic anemia (SAA) Severe aplastic anemia (SAA) is a disease in which the bone ... make enough blood cells for the body. Aplastic anemia is rare and occurs more frequently in eastern ...

  6. Successful pregnancy achieved by assisted reproductive techniques in a woman with severe congenital bicuspid aortic valve stenosis

    Microsoft Academic Search

    Cemal Tamer Erel; Sanli Erkan; Omer Yavuz Simsek; Serdar Kucukoglu

    2007-01-01

    Objectives  To report a twin pregnancy achieved by assisted reproductive techniques in a woman with severe congenital bicuspid aortic\\u000a valve stenosis.\\u000a \\u000a \\u000a \\u000a Methods  Intracytoplasmic sperm injection and embryo transfer was performed in a 38-year-old woman with a complaint of infertility\\u000a for 8 years due to male factor and who previously had the diagnosis of severe congenital bicuspid aortic stenosis. Clinical\\u000a and echocardiography follow-up during

  7. A comparision of dobutamine stress echocardiography and adenosine Tc99m Sestamibi in pre-operative cardiac evaluation for abdominal transplant candidates

    Microsoft Academic Search

    Robert L. Scott; Mandeep R. Mehra; Myung H. Park; Hector O. Ventura; Patricia H. Uber

    2005-01-01

    Cardiovascular disease is a major cause of morbidity and mortality among abdominal transplant patients. Although many testing modalities exist for the screening of patients at risk for cardiovascular disease, there is currently no standard modality for screening potential abdominal transplant recipients.Methods: We conducted a retrospective chart review in order to compare the positive predictive values of both Dobutamine Stress Echocardiography

  8. Comparison of ability to identify left atrial thrombus by three-dimensional tomography versus transesophageal echocardiography in patients with atrial fibrillation

    Microsoft Academic Search

    Wael A. Jaber; Richard D. White; Stacie A. Kuzmiak; Janet M. Boyle; Andrea Natale; Carolyn Apperson-Hansen; James D. Thomas; Craig R. Asher

    2004-01-01

    We sought to determine the potential use of recently introduced cardiac 3-dimensional computed tomography as an alternative to transesophageal echocardiography for examination of the left atrial appendage. Our data suggest that computed tomography is a potential alternative for assessing the anatomy of the left atrial appendage and for detecting thrombi.

  9. Should One Use Echocardiography or Contrast Transcranial Doppler Ultrasound for the Detection of a Patent Foramen Ovale after an Ischemic Cerebrovascular Accident?

    Microsoft Academic Search

    Jean-Philippe Baguet; Gérard Besson; Frédéric Tremel; Lionel Mangin; Christelle Richardot; Jean-Michel Mallion

    2001-01-01

    Patent foramen ovale is frequently associated with embolic cerebrovascular accidents. The diagnosis of patent foramen ovale is easier since the advent of transesophageal echocardiography. However, this method is semi-invasive and is not readily available in all units. Contrast transcranial Doppler ultrasound enables the detection of the passage of a contrast material injected into a peripheral vein to the cerebral circulation

  10. Speckle-Tracking and Tissue-Doppler Stress Echocardiography in Arterial Hypertension: A Sensitive Tool for Detection of Subclinical LV Impairment

    PubMed Central

    Hensel, Kai O.; Leischik, Roman

    2014-01-01

    Early diagnosis of cardiac alterations in hypertensive heart disease is still challenging. Since such patients might have depressed global LV systolic strain or strain rate when EF is still normal, speckle-tracking echocardiography (STE) and tissue-Doppler imaging (TDI) combined with stress echocardiography might improve early diagnosis of cardiac alterations. In this prospective study standard 2D Doppler echocardiography, STE, and TDI were performed at rest and during bicycle exercise in 92 consecutive patients—46 hypertensive subjects with normal ejection fraction and 46 healthy controls. STE and TDI were used to measure global peak systolic LV circumferential strain (CS), longitudinal strain (LS), and longitudinal strain rate (SR). Mean arterial blood pressure was significantly higher in hypertensive patients at rest (100.8?mmHg SD 13.5?mmHg; P = 0.002) and during physical exercise testing (124.2?mmHg SD 13.4?mmHg; P = 0.003). Hypertensive patients had significantly reduced values of systolic CS (P = 0.001), LS (P = 0.014), and SR (P < 0.001) at rest as well as during physical exercise—CS (P < 0.001), LS (P < 0.001), and SR (P < 0.001). Using STE and TDI, reduced LV systolic strain and strain rate consistent with early cardiac alterations can be detected in patients with arterial hypertension. These findings were evident at rest and markedly pronounced during exercise echocardiography. PMID:25389528

  11. Assessment of left ventricular twist mechanics by speckle tracking echocardiography reveals association between LV twist and myocardial fibrosis in patients with hypertrophic cardiomyopathy.

    PubMed

    Zhang, Hong-Ju; Wang, Hao; Sun, Tao; Lu, Min-Jie; Xu, Nan; Wu, Wei-Chun; Sun, Xin; Wang, Wu-Gang; Lin, Qiong-Wen

    2014-12-01

    We aimed to investigate whether left ventricular (LV) twist analysis can detect the extent of myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM). This prospective case-control study recruited 81 consecutive patients with HCM examined between January 2012 and April 2013. Data of 76 patients were analyzed after excluding 5 patients whose echocardiographic images were of poor quality. Healthy volunteers (n = 46) served as controls. Both groups underwent comprehensive echocardiographic examination (i.e., Bas-Rotation, AP-Rotation, LVEF, LADs, IVST, LAVi, E/Em, LVMI, advanced LV-twist analysis by speckle tracking echocardiography) and magnetic resonance imaging. Between-group differences were analyzed by independent t test; logistic regression analysis was performed to identify effect factors. No significant differences were found between baseline characteristics of HCM and control groups (all p > 0.05). HCM patients had significantly higher Bas-Rotation, AP-Rotation, LV Twist, LVEF, LADs, IVST, LAVi, E/Em and LVMI than controls (all p < 0.0001) and significantly lower LVDd and E/A (both p < 0.001). Bas-Rotation, AP-Rotation, LV-Twist, LADs, IVST, LAVi, E/Em and LVMI were significantly higher in HCM patients with fibrosis than in those without fibrosis (p < 0.001), but no significant differences in other echocardiographic parameters were found between those with and without fibrosis. Age, Bas-Rotation, AP-Rotation, LV twist, LADs, IVST, LAVi, E/A, E/Em, and LVMI were significant effect factors for fibrosis. AUROC analysis showed that LV twist had high discriminatory power to detect extent of myocardial fibrosis (AUC 0.996, 95 % CI 0.989-1.004, p < 0.001). Left ventricular twist mechanics are associated with the extent of myocardial fibrosis. LV-twist assessment by STE may be clinically useful. PMID:25106760

  12. Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study

    NASA Technical Reports Server (NTRS)

    Kwan, Jun; Shiota, Takahiro; Agler, Deborah A.; Popovic, Zoran B.; Qin, Jian Xin; Gillinov, Marc A.; Stewart, William J.; Cosgrove, Delos M.; McCarthy, Patrick M.; Thomas, James D.

    2003-01-01

    BACKGROUND: This study was conducted to elucidate the geometric differences of the mitral apparatus in patients with significant mitral regurgitation caused by ischemic cardiomyopathy (ICM-MR) and by idiopathic dilated cardiomyopathy (DCM-MR) by use of real-time 3D echocardiography (RT3DE). METHODS AND RESULTS: Twenty-six patients with ICM-MR caused by posterior infarction, 18 patients with DCM-MR, and 8 control subjects were studied. With the 3D software, commissure-commissure plane and 3 perpendicular anteroposterior (AP) planes were generated for imaging the medial, central, and lateral sides of the mitral valve (MV) during mid systole. In 3 AP planes, the angles between the annular plane and each leaflet (anterior, Aalpha; posterior, Palpha) were measured. In ICM-MR, Aalpha measured in the medial and central planes was significantly larger than that in the lateral plane (39+/-5 degrees, 34+/-6 degrees, and 27+/-5 degrees, respectively; P<0.01), whereas Palpha showed no significant difference in any of the 3 AP planes (61+/-7 degrees, 57+/-7 degrees, and 56+/-7 degrees, P>0.05). In DCM-MR, both Aalpha (38+/-8 degrees, 37+/-9 degrees, and 36+/-7 degrees, P>0.05) and Palpha (59+/-6 degrees, 58+/-5 degrees, and 57+/-6 degrees, P>0.05) revealed no significant differences in the 3 planes. CONCLUSIONS: The pattern of MV deformation from the medial to the lateral side was asymmetrical in ICM-MR, whereas it was symmetrical in DCM-MR. RT3DE is a helpful tool for differentiating the geometry of the mitral apparatus between these 2 different types of functional mitral regurgitation.

  13. In vitro validation of real-time three-dimensional color Doppler echocardiography for direct measurement of proximal isovelocity surface area in mitral regurgitation.

    PubMed

    Little, Stephen H; Igo, Stephen R; Pirat, Bahar; McCulloch, Marti; Hartley, Craig J; Nosé, Yukihiko; Zoghbi, William A

    2007-05-15

    The 2-dimensional (2D) color Doppler (2D-CD) proximal isovelocity surface area (PISA) method assumes a hemispheric flow convergence zone to estimate transvalvular flow. Recently developed 3-dimensional (3D)-CD can directly visualize PISA shape and surface area without geometric assumptions. To validate a novel method to directly measure PISA using real-time 3D-CD echocardiography, a circulatory loop with an ultrasound imaging chamber was created to model mitral regurgitation (MR). Thirty-two different regurgitant flow conditions were tested using symmetric and asymmetric flow orifices. Three-dimensional-PISA was reconstructed from a hand-held real-time 3D-CD data set. Regurgitant volume was derived using both 2D-CD and 3D-CD PISA methods, and each was compared against a flow-meter standard. The circulatory loop achieved regurgitant volume within the clinical range of MR (11 to 84 ml). Three-dimensional-PISA geometry reflected the 2D geometry of the regurgitant orifice. Correlation between the 2D-PISA method regurgitant volume and actual regurgitant volume was significant (r(2) = 0.47, p <0.001). Mean 2D-PISA regurgitant volume underestimate was 19.1 +/- 25 ml (2 SDs). For the 3D-PISA method, correlation with actual regurgitant volume was significant (r(2) = 0.92, p <0.001), with a mean regurgitant volume underestimate of 2.7 +/- 10 ml (2 SDs). The 3D-PISA method showed less regurgitant volume underestimation for all orifice shapes and regurgitant volumes tested. In conclusion, in an in vitro model of MR, 3D-CD was used to directly measure PISA without geometric assumption. Compared with conventional 2D-PISA, regurgitant volume was more accurate when derived from 3D-PISA across symmetric and asymmetric orifices within a broad range of hemodynamic flow conditions. PMID:17493476

  14. In Vitro Validation of Real-Time Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Proximal Isovelocity Surface Area in Mitral Regurgitation

    PubMed Central

    Little, Stephen H.; Igo, Stephen R.; Pirat, Bahar; McCulloch, Marti; Hartley, Craig J.; Nosé, Yukihiko; Zoghbi, William A.

    2012-01-01

    The 2-dimensional (2D) color Doppler (2D-CD) proximal isovelocity surface area (PISA) method assumes a hemispheric flow convergence zone to estimate transvalvular flow. Recently developed 3-dimensional (3D)-CD can directly visualize PISA shape and surface area without geometric assumptions. To validate a novel method to directly measure PISA using real-time 3D-CD echocardiography, a circulatory loop with an ultrasound imaging chamber was created to model mitral regurgitation (MR). Thirty-two different regurgitant flow conditions were tested using symmetric and asymmetric flow orifices. Three-dimensional–PISA was reconstructed from a hand-held real-time 3D-CD data set. Regurgitant volume was derived using both 2D-CD and 3D-CD PISA methods, and each was compared against a flowmeter standard. The circulatory loop achieved regurgitant volume within the clinical range of MR (11 to 84 ml). Three-dimensional–PISA geometry reflected the 2D geometry of the regurgitant orifice. Correlation between the 2D-PISA method regurgitant volume and actual regurgitant volume was significant (r2 = 0.47, p <0.001). Mean 2D-PISA regurgitant volume underestimate was 19.1 ± 25 ml (2 SDs). For the 3D-PISA method, correlation with actual regurgitant volume was significant (r2 = 0.92, p <0.001), with a mean regurgitant volume underestimate of 2.7 ± 10 ml (2 SDs). The 3D-PISA method showed less regurgitant volume underestimation for all orifice shapes and regurgitant volumes tested. In conclusion, in an in vitro model of MR, 3D-CD was used to directly measure PISA without geometric assumption. Compared with conventional 2D-PISA, regurgitant volume was more accurate when derived from 3D-PISA across symmetric and asymmetric orifices within a broad range of hemodynamic flow conditions. PMID:17493476

  15. Non-invasive assessment of functional strain lines in the real human left ventricle via speckle tracking echocardiography.

    PubMed

    Evangelista, A; Gabriele, S; Nardinocchi, P; Piras, P; Puddu, P E; Teresi, L; Torromeo, C; Varano, V

    2015-02-01

    A mechanics-based analysis of data from three-dimensional speckle tracking echocardiography is proposed, aimed at investigating deformations in myocardium and at assessing shape and function of distinct strain lines corresponding to the principal strain lines of the cardiac tissue. The analysis is based on the application of a protocol of measurement of the endocardial and epicardial principal strain lines, which was already tested on simulated left ventricles. In contrast with similar studies, it is established that endocardial principal strain lines cannot be identified with any structural fibers, not even along the systolic phase and is suggested that it is due to the capacity of the endocardial surface to contrast the dilation of the left ventricle. PMID:25547026

  16. Effectiveness of late gadolinium enhancement to improve outcomes prediction in patients referred for cardiovascular magnetic resonance after echocardiography

    PubMed Central

    2013-01-01

    Background Echocardiography (echo) is a first line test to assess cardiac structure and function. It is not known if cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) ordered during routine clinical practice in selected patients can add additional prognostic information after routine echo. We assessed whether CMR improves outcomes prediction after contemporaneous echo, which may have implications for efforts to optimize processes of care, assess effectiveness, and allocate limited health care resources. Methods and results We prospectively enrolled 1044 consecutive patients referred for CMR. There were 38 deaths and 3 cardiac transplants over a median follow-up of 1.0 years (IQR 0.4-1.5). We first reproduced previous survival curve strata (presence of LGE and ejection fraction (EF)?echocardiography, CMR with LGE further improves risk stratification of individuals at risk for death or death/cardiac transplant. PMID:23324403

  17. Comparison of safety and efficacy of the early injection of atropine during dobutamine stress echocardiography with the conventional protocol.

    PubMed

    Tsutsui, Jeane M; Osório, Altamiro F F; Lario, F Abio C; Fernandes, Daniela R A; Sodre, Gustavo; Andrade, José L; Ramires, José A F; Mathias, Wilson

    2004-12-01

    Although dobutamine-atropine stress echocardiography (DASE) is an established method for evaluating patients who have coronary artery disease (CAD), it can increase test duration and a patient's exposure to large doses of dobutamine. New protocols, including the early injection of atropine during dobutamine stress echocardiography (EA-DSE), have been proposed to decrease test duration. This study compared the safety, efficacy, and accuracy of EA-DSE with those of DASE. We retrospectively evaluated 3,163 patients who underwent DASE and 1,664 patients who underwent EA-DSE over a period of 12 years. In EA-DSE, atropine at a dose 50% stenosis) was assessed in patients who underwent quantitative angiography

  18. Prognostic effect of coronary flow reserve in women versus men with chest pain syndrome and normal dipyridamole stress echocardiography.

    PubMed

    Cortigiani, Lauro; Rigo, Fausto; Gherardi, Sonia; Galderisi, Maurizio; Bovenzi, Francesco; Picano, Eugenio; Sicari, Rosa

    2010-12-15

    The aim of this study was to investigate the prognostic effect of coronary flow reserve (CFR) on left anterior descending artery (LAD) in women and men with chest pain of unknown origin and normal stress echocardiogram. The study population consisted of 1,660 patients (906 women, 754 men) with chest pain syndrome, no wall motion abnormality on echocardiogram at rest, and dipyridamole (up to 0.84 mg/kg over 6 minutes) stress echocardiogram negative for wall motion criteria. All had undergone stress echocardiography with combined evaluation of CFR on LAD by Doppler. A CFR value ?2.0 was considered abnormal. Median duration of follow-up was 19 months (interquartile range 10 to 34). Abnormal CFR was assessed in 171 women (19%) and 147 men (19%, p = 0.80). During follow-up, 80 events (20 deaths, 13 ST-elevation myocardial infarctions, and 47 non-ST-elevation myocardial infarctions) occurred. In addition, 128 patients underwent revascularization and were censored. CFR ?2.0 on LAD was independently associated with prognosis in women (hazard ratio [HR] 16.48, 95% confidence interval [CI] 7.17 to 37.85, p <0.0001) and in men (HR 6.23, 95% CI 3.42 to 11.33, p <0.0001). Antianginal therapy at time of testing (HR 2.11, 95% CI 1.14 to 3.90, p = 0.02) was also a multivariable prognostic predictor in men. Four-year event rate associated with CFR values ?2.0 and >2.0 were, respectively, 27% and 2% in women (p <0.0001) and 42% and 8% in men (p <0.0001). In conclusion, decreased CFR on LAD is associated with markedly increased risk in women and men with chest pain syndrome and a normal result of dipyridamole stress echocardiography. Conversely, preserved CFR on LAD predicts excellent survival, particularly in women. PMID:21126613

  19. Rhinosinusitis in severe asthma

    Microsoft Academic Search

    Megon Bresciani; Louis Paradis; Anne Des Roches; Hélène Vernhet; Isabelle Vachier; Philippe Godard; Jean Bousquet; Pascal Chanez

    2001-01-01

    Background: Chronic rhinosinusitis is a common comorbidity of asthma. However, sinonasal involvement in severe steroid-dependent asthma is still undefined. Objective: The aim of the study was to evaluate chronic rhinosinusitis in 35 patients with severe steroid-dependent asthma by using a clinical score and coronal computed tomography (CT) scanning. Methods: Thirty-five subjects (16 female subjects) with severe asthma requiring daily doses

  20. Loperamide in severe protracted diarrhoea

    Microsoft Academic Search

    B K Sandhu; J H Tripp; P J Milla; J T Harries

    1983-01-01

    Six infants with severe life-threatening protracted diarrhoea were treated with loperamide. Steady-state perfusion studies of the jejunum showed that in 2 of them the small intestine was in a net secretory state with respect to water, and in the others this was inferred from the fact that the diarrhoea persisted despite nothing by mouth. Loperamide resulted in a prompt and

  1. Severity of Bulimia Nervosa

    Microsoft Academic Search

    A. Hartmann; A. Zeeck; A. J. van der Kooij

    2009-01-01

    Aims: In order to identify the most important components of the severity of bulimia nervosa (as well as identifying clinical cases), we explored the relation between dimensional and categorical assessment. This was achieved by studying the performance of variables from standard instruments (measuring specific and general psychopathology) in predicting an expert rating of overall syndrome severity. Method: In total, 213

  2. Currency flaw severity. [Banknotes

    SciTech Connect

    Johnson, C.; Burnett, M.; Goodman, C.; Sherrod, R.; Schmoyer, R.; Harrison, C.; Uppuluri, R.

    1986-01-01

    A survey of currency flaw severity was carried out using 300 banknotes and 37 judges. Each judge assigned each note to one of five flaw severity categories. These categories correspond to severity grades of 1 to 5 with 1 equivalent to ''always accepted'' and 5 ''never accepted.'' An average flaw severity grade for each note was obtained by taking the mean of the severity grades assigned to that note by the 37 judges. Thus, each note has a single numerical real-number flaw grade between 1 and 5. Mathematical modeling of the currency flaw survey results is continuing with some very promising initial results. Our present model handles common excess ink and missing ink flaw types quite well. We plan to extend the model to ink level, mash, setoff and blanket impression flaw types.

  3. Dengue and Severe Dengue

    MedlinePLUS

    ... dengue is a potentially deadly complication due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or ... removing artificial man-made habitats; covering, emptying and cleaning of domestic water storage containers on a weekly ...

  4. Several notes on physics

    NASA Astrophysics Data System (ADS)

    Chen, Xiao-Fan

    2015-03-01

    Several notes on physics are presented, which include our views of quantum mechanics, general relativity, special relativity, electric charge, nonlinear electrodynamic, general transformation in hyperspace, solutions to equations of operators, superstring, shapes of particles and statistical mechanics.

  5. Management of severe acne.

    PubMed

    Zouboulis, C C; Bettoli, V

    2015-07-01

    Acne is the most common skin disease, affecting up to 95% of adolescents. Severe episodes of acne can cause considerable physical and psychological scarring, and overexpression of transforming growth factor-? can lead to formation of hypertrophic scars and keloids. The severity of acne in adolescence is associated with a positive history of severe acne in first-degree relatives, especially the mother. In most cases acne is a chronic disease, and it is often a component of systemic diseases or syndromes. All forms of severe acne require systemic treatment. The available options include oral antibiotics, hormonal antiandrogens for female patients and oral isotretinoin, as well as other combination treatments. Oral isotretinoin is the only drug available that affects all four pathogenic factors of acne. However, due to possible serious side-effects, a European directive states that oral isotretinoin should be used only as a second-line therapy in cases of severe, nodular and conglobate acne. The pharmaceutical quality of generic isotretinoin products and the obtainability of isotretinoin through e-pharmacies without prescription raise new therapeutic problems. New anti-inflammatory compounds, such as the 5-lipoxygenase inhibitor zileuton, may replace systemic antibiotics in the future, especially under the scope of antibiotic resistance prevention. This review looks into the various options and latest approaches, and factors to consider, when combating severe acne. PMID:25597508

  6. The non-invasive documentation of coronary microcirculation impairment: role of transthoracic echocardiography

    Microsoft Academic Search

    Pawel Petkow Dimitrow; Maurizio Galderisi; Fausto Rigo

    2005-01-01

    Transthoracic Doppler echocardiographic-derived coronary flow reserve is an useful hemodynamic index to assess dysfunction of coronary microcirculation. Isolated coronary microvascular abnormalities are overt by reduced coronary flow reserve despite normal epicardial coronary arteries. These abnormalities may occur in several diseases (arterial hypertension, diabetes mellitus, hypercholesterolemia, syndrome X, aortic valve disease, hypertrophic cardiomyopathy and idiopathic dilated cardiomyopathy). The prognostic role of

  7. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse.

    PubMed

    Cameli, Matteo; Lisi, Matteo; Righini, Francesca Maria; Massoni, Alberto; Natali, Benedetta Maria; Focardi, Marta; Tacchini, Damiana; Geyer, Alessia; Curci, Valeria; Di Tommaso, Cristina; Lisi, Gianfranco; Maccherini, Massimo; Chiavarelli, Mario; Massetti, Massimo; Tanganelli, Piero; Mondillo, Sergio

    2013-02-15

    In patients with severe mitral regurgitation (MR) referred for cardiac surgery, left atrial (LA) remodeling and enlargement are accompanied by mechanical stress, mediated cellular hypertrophy, and interstitial fibrosis that finally lead to LA failure. Speckle tracking echocardiography is a novel non-Doppler-based method that allows an objective quantification of LA myocardial deformation, becoming useful for LA functional analysis. We conducted a study to evaluate the relation between the traditional and novel atrial indexes and the extent of ultrastructural alterations, obtained from patients with severe MR who were undergoing surgical correction of the valvular disease. The study population included 46 patients with severe MR, referred to our echocardiographic laboratory for a diagnostic examination before cardiac surgery. The global peak atrial longitudinal strain (PALS) was measured in all subjects by averaging all atrial segments. LA tissue samples were obtained from all patients. Masson's trichrome staining was performed to assess the extent of the fibrosis. The LA endocardial thickness was measured. A close negative correlation between the global PALS and grade of LA myocardial fibrosis was found (r = -0.82, p <0.0001), with poorer correlations for the LA indexed volume (r = 0.51, p = 0.01), LA ejection fraction (r = 0.61, p = 0.005), and E/E' ratio (0.14, p = NS). Of these indexes, global PALS showed the best diagnostic accuracy to detect LA fibrosis (area under the curve 0.89), and it appears to be a strong and independent predictor of LA fibrosis. Furthermore, we also demonstrated an inverse correlation between the global PALS and LA endocardial thickness (r = -0.66, p = 0.0001). In conclusion, in patients with severe MR referred for cardiac surgery, impairment of LA longitudinal deformation, as assessed by the global PALS, correlated strongly with the extent of LA fibrosis and remodeling. PMID:23211360

  8. Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion

    PubMed Central

    Haberka, Maciej; Tabor, Zbigniew; Finik, Maciej; G?sior, Zbigniew

    2014-01-01

    Introduction Left ventricular remodeling (LVR) is the most prognostically important consequence of acute myocardial infarction (AMI). The aim of the study was to assess the value of speckle tracking echocardiography in the prediction of left ventricular remodeling in patients after AMI and primary coronary angioplasty (PCI). Material and methods Eighty-eight patients (F/M = 31/57 patients; 63.6 ±11 years old) with coronary artery disease (CAD) and successful PCI were enrolled and divided into group I with ST-elevation myocardial infarction or non-ST elevation myocardial infarction and group II with stable angina pectoris. Conventional and speckle tracking echocardiography was performed 3 days (baseline), 30 days and 90 days after PCI. Patients were divided into 2 groups based on the presence of LVR (increase of LV end-diastolic and/or end-systolic volume > 20%) at 3 months follow-up. Results At initial presentation, 2-chamber longitudinal strain (9.4 ±3.5% vs. –11.6 ±3.6%, p < 0.04) and 4-chamber transverse strain (10.4 ±8.2% vs. 15.6 ±8%, p < 0.003) were lower in the LVR+ group compared to the LVR– group. LV wall motion score index did not differ between the two groups. After 30 days, circumferential apical and basal strain (–15.58 ±8.9% vs. –25.53 ±8.8%, p < 0.001; –15.02 ±5.6 vs. –19.78 ±6.3, p < 0.008), radial apical strain (9.96 ±8.4% vs. 14.15 ±5.5%, p < 0.03), 4-chamber longitudinal strain (–8.7 ±5.8% vs. –13.47 ±3.9%, p < 0.005), 4-chamber transverse strain (10.5 ±8.1% vs. 16.7 ±8.3%, p < 0.03), apical rotation (3.84 ±2.5° vs, 5.66 ±3.2°, p < 0.04) and torsion (6.15 ±4.1° vs. 8.98 ±4.6°, p < 0.03) were significantly decreased in the LVR+ group compared to the LVR– group. According to ROC analysis, circumferential apical strain > –15.92% (sensitivity 93%, specificity 59%, positive predictive value 90%) was the most powerful predictor of remodeling after primary PCI in AMI. Conclusions Our results suggest that impaired indices of LV deformation detected 3 days and 30 days after AMI may provide important predictive value in LV remodeling and patients’ follow-up. PMID:25624844

  9. Severe Accidental Hypothermia Center.

    PubMed

    Darocha, Tomasz; Kosi?ski, Sylweriusz; Jarosz, Anna; Ga??zkowski, Robert; Sadowski, Jerzy; Drwi?a, Rafa?

    2015-08-01

    Hypothermic patients may be rewarmed using passive or active techniques. In case of severe accidental hypothermia (temperature<28°C) and stage III/IV according to the Swiss Staging System, standard methods might not be effective and aggressive treatment is needed. Extracorporeal membrane oxygenation (ECMO) has proved to be both effective and safe in such cases. The Department of Anesthesiology and Intensive Care, John Paul II Hospital, Cracow, Poland, established the Severe Accidental Hypothermia Center, which provides 24?h on-call to consult and accept patients who need ECMO implantation for profound hypothermia rewarming. Our center is so far the only one in Poland and can accept patients from south-east Poland. Most importantly, it collaborates with all prehospital medical services, namely, with 115 Ambulances, Polish Medical Air Rescue, Mountain Rescue Services, and all 28 Emergency Departments in the area. Severe Accidental Hypothermia Center is a solution for advanced treatment of patients with accidental hypothermia requiring ECMO implantation. PMID:25304125

  10. Severe acute asthma.

    PubMed

    Racusin, Diana Alex; Fox, Karin Anneliese; Ramin, Susan Marie

    2013-08-01

    Asthma is common among women of reproductive age and affects between 4% and 8% of pregnant women. Pregnancy outcomes are correlated to the degree of asthma severity and control. Approximately one-third of pregnant women with asthma remain stable, a third will have improvement of their asthma, and a third will have worsening of the disease. Pregnant women with severe asthma are at markedly increased risk of maternal and perinatal morbidity and mortality, preeclampsia, low-birth weight infants, and preterm delivery. A severe asthma exacerbation in a pregnant woman may be clinically daunting, however immediate intervention with appropriate supplemental oxygenation, medical therapy, and intubation if necessary can be life-saving. A focus on maternal well-being and pulmonary function in a pregnant asthmatic is essential to ensure optimal outcomes for both mother and her fetus. This article will provide an overview of asthma management, particularly in the acute care setting. PMID:23916022

  11. 2D-Speckle Tracking Echocardiography Contributes to Early Identification of Impaired Left Ventricular Myocardial Function in Patients with Chronic Kidney Disease

    Microsoft Academic Search

    Ping Yan; Haiming Li; Chuanming Hao; Haiming Shi; Yong Gu; Guoqian Huang; Jing Chen

    2011-01-01

    Background\\/Aims: Our aim was to investigate left ventricular (LV) physiology and short-axis and long-axis regional LV myocardial function throughout the cardiac cycle with 2D-speckle tracking echocardiography (2D-STE) in patients with chronic kidney disease. Methods: The study population consisted of 40 maintenance hemodialysis patients (hemodialysis group), 20 uremic patients hospitalized for creation of primary arteriovenous fistula (nondialysis group), and a control

  12. Evaluation of the effect of myocardial perfusion after percutaneous coronary intervention in coronary artery disease by using intracoronary myocardial contrast echocardiography and two other angiographic techniques

    Microsoft Academic Search

    Hong Wang; Lan Huang; Jun Jin; Yaoming Song; Zhaohua Geng; Xuejun Yu; Jun Qin; Gang Zhao; Yunhua Gao; Zheng Liu; Li Yang

    2007-01-01

    Detection of abnormal myocardial perfusion is crucial to the prognosis of patients with coronary artery disease (CAD) after\\u000a they have undergone percutaneous coronary intervention (PCI). The objective of this study is to evaluate the effect of myocardial\\u000a perfusion by three different methods—intra-coronary myocardial contrast echocardiography (ICMCE), corrected thrombolysis in\\u000a myocardial infarction frame count (CTFC), and coronary blood flow velocity (BFV)—and

  13. Measurement of Atrial Septal Defect Size: A Comparative Study Between Three-Dimensional Transesophageal Echocardiography and the Standard Balloon Sizing Methods

    Microsoft Academic Search

    W. Zhu; Q.-L. Cao; J. Rhodes; Z. M. Hijazi

    2000-01-01

    .   Atrial septal defect (ASD) size measurement is of paramount importance for the successful deployment of a transcatheter septal\\u000a occluder. The stretched balloon diameter (SBD) has long been regarded as the gold standard for selection of the size of any\\u000a device. Three-dimensional (3-D) transesophageal echocardiography (TEE) can visualize the overall structure of the atrial septum,\\u000a therefore rendering an accurate size

  14. Plant species descriptions show signs of disease.

    PubMed Central

    Hood, Michael E; Antonovics, Janis

    2003-01-01

    It is well known that diseases can greatly influence the morphology of plants, but often the incidence of disease is either too rare or the symptoms too obvious for the 'abnormalities' to cause confusion in systematics. However, we have recently come across several misinterpretations of disease-induced traits that may have been perpetuated into modern species inventories. Anther-smut disease (caused by the fungus Microbotryum violaceum) is common in many members of the Caryophyllaceae and related plant families. This disease causes anthers of infected plants to be filled with dark-violet fungal spores rather than pollen. Otherwise, their vegetative morphology is within the normal range of healthy plants. Here, we present the results of a herbarium survey showing that a number of type specimens (on which the species name and original description are based) in the genus Silene from Asia are diseased with anther smut. The primary visible disease symptom, namely the dark-violet anthers, is incorporated into the original species descriptions and some of these descriptions have persisted unchanged into modern floras. This raises the question of whether diseased type specimens have erroneously been given unique species names. PMID:14667368

  15. Quantification of Left Ventricular Linear, Areal and Volumetric Dimensions: A Phantom and in Vivo Comparison of 2-D and Real-Time 3-D Echocardiography with Cardiovascular Magnetic Resonance.

    PubMed

    Polte, Christian L; Lagerstrand, Kerstin M; Gao, Sinsia A; Lamm, Carl R; Bech-Hanssen, Odd

    2015-07-01

    Two-dimensional echocardiography and real-time 3-D echocardiography have been reported to underestimate human left ventricular volumes significantly compared with cardiovascular magnetic resonance. We investigated the ability of 2-D echocardiography, real-time 3-D echocardiography and cardiovascular magnetic resonance to delineate dimensions of increasing complexity (diameter-area-volume) in a multimodality phantom model and in vivo, with the aim of elucidating the main cause of underestimation. All modalities were able to delineate phantom dimensions with high precision. In vivo, 2-D and real-time 3-D echocardiography underestimated short-axis end-diastolic linear and areal and all left ventricular volumetric dimensions significantly compared with cardiovascular magnetic resonance, but not short-axis end-systolic linear and areal dimensions. Underestimation increased successively from linear to volumetric left ventricular dimensions. When analyzed according to the same principles, 2-D and real-time 3-DE echocardiography provided similar left ventricular volumes. In conclusion, echocardiographic underestimation of left ventricular dimensions is due mainly to inherent technical differences in the ability to differentiate trabeculated from compact myocardium. Identical endocardial border definition criteria are needed to minimize differences between the modalities and to ensure better comparability in clinical practice. PMID:25837423

  16. Diagnostic Value of Transthoracic Echocardiography in Patients with Coarctation of Aorta: The Chinese Experience in 53 Patients Studied between 2008 and 2012 in One Major Medical Center

    PubMed Central

    Wang, Xinfang; Dong, Nianguo; Lv, Qing; Li, Ke; Yuan, Li; Wang, Jing; Xie, Mingxing

    2015-01-01

    Although aortography is well known as the “gold standard” for the diagnosis of coarctation of aorta (CoA), the method is invasive, expensive and not readily accepted by some patients. Ultrasound diagnosis for CoA is non-invasive, inexpensive, readily accepted by every patient, and can be repeated as frequently as necessary. The purpose of this presentation is to evaluate the applicability of transthoracic echocardiography for the diagnosis of CoA. The echocardiographic appearances of 53 patients with CoA who had undergone surgery during a 5-year period from January 2008 to October 2012 were analyzed retrospectively, and the results were compared with findings at surgery. Fifty-three patients with CoA include six with isolated CoA and 47 of CoA associated with other cardiac anomalies. Of the 53 operated patients, 48 were correctly diagnosed preoperatively by echocardiography, while two were misdiagnosed as interrupted aortic arch and the diagnosis were missed in three other patients. Thus the diagnostic accuracy rate was 90.6%, and the misdiagnosis rate was 9.4%. Preoperative echocardiographic evaluation offers very satisfactory anatomic assessment in most patients with CoA. It makes preoperative angiography unnecessary. Thus transthoracic echocardiography should be the first-line method for the diagnosis of coarctation of the aorta. PMID:26030197

  17. Diagnostics of Severe PCVAD

    Technology Transfer Automated Retrieval System (TEKTRAN)

    About 2 years ago case reports in Eastern Canada described a syndrome of an acute onset of high mortality in finishing age pigs. Within a year this syndrome had spread westward in Canada and was reported in several states in the U.S. Although diagnostic investigations into these cases have detecte...

  18. Severe acute respiratory syndrome

    Microsoft Academic Search

    Y Guan; K Y Yuen; J S M Peiris

    2004-01-01

    Severe acute respiratory syndrome (SARS) was caused by a previously unrecognized animal coronavirus that exploited opportunities provided by 'wet markets' in southern China to adapt to become a virus readily transmissible between humans. Hospitals and international travel proved to be 'amplifiers' that permitted a local outbreak to achieve global dimensions. In this review we will discuss the substantial scientific progress

  19. A Proposed Maneuver to Guide Transseptal Puncture Using Real-Time Three-Dimensional Transesophageal Echocardiography: Pilot Study

    PubMed Central

    Mahmoud, Hani M.; Al-Ghamdi, Mohammed A.; Ghabashi, Abdullah E.; Anwar, Ashraf M.

    2015-01-01

    Aim of Study. To assess the feasibility of a new proposed maneuver “RATLe-90” using real-time three-dimensional transesophageal echocardiography (RT-3DTEE) for anatomically oriented visualization of the interatrial septum (IAS) in guiding the transseptal puncture TSP. Methods. The study included 20 patients (mean age, 60.2 ± 6.7 years; 60% males) who underwent TSP for different indications. RT-3DTEE was used to guide TSP. The proposed maneuver RATLe-90 (Rotate-Anticlockwise-Tilt-Left-90) was applied in all cases to have the anatomically oriented en face view of the IAS from the right atrial (RA) aspect. Having this anatomically oriented view, we guided the TSP catheter towards the proper puncture site according to the planned procedure. Results. Using the RATLe-90 maneuver, the anatomically oriented en face view of the IAS from the RA was obtained in all patients. We were able to guide the puncture catheter to the proper puncture site on the IAS. The 3D images obtained were clearly understood by both echocardiographers and interventionists. The RATLe-90 maneuver acquisition time was 19.9 ± 1.6 seconds. The time-to-tent was 64.8 ± 16.3 seconds. Less TEE probe manipulations were needed while guiding the TSP. Conclusions. Application of RT3D-TEE during TSP using RATLe-90 maneuver is feasible with shorter fluoroscopy time and minimizing TEE probe manipulations. PMID:26106503

  20. Evaluation of cerebral-cardiac syndrome using echocardiography in a canine model of acute traumatic brain injury

    PubMed Central

    Qian, Rong; Yang, Weizhong; Wang, Xiumei; Xu, Zhen; Liu, Xiaodong; Sun, Bing

    2015-01-01

    Previous studies have confirmed that traumatic brain injury (TBI) can induce general adaptation syndrome (GAS), which subsequently results in myocardial dysfunction and damage in some patients with acute TBI; this condition is also termed as cerebral-cardiac syndrome. However, most clinicians ignore the detection and treatment of myocardial dysfunction, and instead concentrate only on the serious neural damage that is observed in acute TBI, which is one of the most important fatal factors. Therefore, clarification is urgently needed regarding the relationship between TBI and myocardial dysfunction. In the present study, we evaluated 18 canine models of acute TBI, by using real-time myocardial contrast echocardiography and strain rate imaging to accurately evaluate myocardial function and regional microcirculation, including the strain rate of the different myocardial segments, time-amplitude curves, mean ascending slope of the curve, and local myocardial blood flow. Our results suggest that acute TBI often results in cerebral-cardiac syndrome, which rapidly progresses to the serious stage within 3 days. This study is the first to provide comprehensive ultrasonic characteristics of cerebral-cardiac syndrome in an animal model of TBI.

  1. Acoustic output measured by thermal and mechanical indices during fetal echocardiography at the time of the first trimester scan.

    PubMed

    Nemescu, Dragos; Berescu, Anca

    2015-01-01

    We measured acoustic output, expressed as the thermal index (TI) and mechanical index (MI), during fetal echocardiography at the time of the first trimester scan. TI and MI were retrieved from the saved displays during gray-mode, high-definition color flow Doppler and pulsed-wave Doppler (tricuspid flow) ultrasound examinations of the fetal heart and from the ductus venosus assessment. A total of 399 fetal cardiac examinations were evaluated. There was a significant increase in TI values from B-mode studies (0.07 ± 0.04 [mean ± SD]) to color flow mapping (0.2 ± 0.0) and pulsed-wave Doppler studies (0.36 ± 0.05). The TI from ductus venosus assessment (0.1 ± 0.01) was significantly lower than those from Doppler examinations of the heart. MI values from B-mode scans (0.65 ± 0.12) and color flow mapping (0.71 ± 0.11) were comparable, although different, and both values were higher than those from pulsed-wave Doppler tricuspid evaluation (0.39 ± 0.03). There were no differences in MI values from power Doppler assessment between the tricuspid flow and ductus venosus. Safety indices were remarkably stable and were largely constant, especially for color Doppler (TI), tricuspid flow (MI) and ductus venosus assessment (TI, MI). We acquired satisfactory Doppler images and/or signals at acoustic levels that were lower than the actual recommendations and never reached a TI of 0.5. PMID:25438839

  2. Artemether for severe malaria

    PubMed Central

    Esu, Ekpereonne; Effa, Emmanuel E; Opie, Oko N; Uwaoma, Amirahobu; Meremikwu, Martin M

    2014-01-01

    Background In 2011 the World Health Organization (WHO) recommended parenteral artesunate in preference to quinine as first-line treatment for people with severe malaria. Prior to this recommendation, many countries, particularly in Africa, had begun to use artemether, an alternative artemisinin derivative. This review evaluates intramuscular artemether compared with both quinine and artesunate. Objectives To assess the efficacy and safety of intramuscular artemether versus any other parenteral medication in treating severe malaria in adults and children. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE and LILACS, ISI Web of Science, conference proceedings and reference lists of articles. We also searched the WHO clinical trial registry platform, ClinicalTrials.gov and the metaRegister of Controlled Trials (mRCT) for ongoing trials up to 9 April 2014. Selection criteria Randomized controlled trials (RCTs) comparing intramuscular artemether with intravenous or intramuscular antimalarial for treating severe malaria. Data collection and analysis The primary outcome was all-cause death.Two authors independently assessed trial eligibility, risk of bias and extracted data. We summarized dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD), and presented both measures with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses and assessed the quality of the evidence using the GRADE approach. Main results We included 18 RCTs, enrolling 2662 adults and children with severe malaria, carried out in Africa (11) and in Asia (7). Artemether versus quinine For children in Africa, there is probably little or no difference in the risk of death between intramuscular artemether and quinine (RR 0.96, 95% CI 0.76 to 1.20; 12 trials, 1447 participants, moderate quality evidence). Coma recovery may be about five hours shorter with artemether (MD -5.45, 95% CI -7.90 to -3.00; six trials, 358 participants, low quality evidence), and artemether may result in fewer neurological sequelae, but larger trials would be needed to confirm this (RR 0.84, 95% CI 0.66 to 1.07; seven trials, 968 participants, low quality evidence). Artemether probably shortens the parasite clearance time by about nine hours (MD -9.03, 95% CI -11.43 to -6.63; seven trials, 420 participants, moderate quality evidence), and may shorten the fever clearance time by about three hours (MD -3.73, 95% CI -6.55 to -0.92; eight trials, 457 participants, low quality evidence). For adults in Asia, treatment with intramuscular artemether probably results in fewer deaths than treatment with quinine (RR 0.59, 95% CI 0.42 to 0.83; four trials, 716 participants, moderate quality evidence). Artemether versus artesunate Artemether and artesunate have not been directly compared in randomized trials in African children. For adults in Asia, mortality is probably higher with intramuscular artemether (RR 1.80, 95% CI 1.09 to 2.97, two trials,494 participants, moderate quality evidence). Authors' conclusions Although there is a lack of direct evidence comparing artemether with artesunate, artemether is probably less effective than artesunate at preventing deaths from severe malaria. In circumstances where artesunate is not available, artemether is an alternative to quinine. PLAIN LANGUAGE SUMMARY Artemether injection for treating people with severe malaria In this review, researchers from The Cochrane Collaboration examined the effects of treating people that have severe malaria with artemether injected intramuscularly, and compared it to treatment with other antimalarial drugs given intramuscularly or intravenously. After searching for relevant trials up to 9 April 2014, we included 18 randomized controlled trials that recruited 2662 adults and children and were conducted mainly in Africa and Asia. What is severe malaria and how might artemether injection reduce deaths Severe malaria is caused by infection with the Plasmodium parasite, which

  3. Three?Dimensional Echocardiography and 2D?3D Speckle?Tracking Imaging in Chronic Pulmonary Hypertension: Diagnostic Accuracy in Detecting Hemodynamic Signs of Right Ventricular (RV) Failure

    PubMed Central

    Vitarelli, Antonio; Mangieri, Enrico; Terzano, Claudio; Gaudio, Carlo; Salsano, Felice; Rosato, Edoardo; Capotosto, Lidia; D'Orazio, Simona; Azzano, Alessia; Truscelli, Giovanni; Cocco, Nino; Ashurov, Rasul

    2015-01-01

    Background Our aim was to compare three?dimensional (3D) and 2D and 3D speckle?tracking (2D?STE, 3D?STE) echocardiographic parameters with conventional right ventricular (RV) indexes in patients with chronic pulmonary hypertension (PH), and investigate whether these techniques could result in better correlation with hemodynamic variables indicative of heart failure. Methods and Results Seventy?three adult patients (mean age, 53±13 years; 44% male) with chronic PH of different etiologies were studied by echocardiography and cardiac catheterization (25 precapillary PH from pulmonary arterial hypertension, 23 obstructive pulmonary heart disease, and 23 postcapillary PH from mitral regurgitation). Thirty healthy subjects (mean age, 54±15 years; 43% male) served as controls. Standard 2D measurements (RV–fractional area change–tricuspid annular plane systolic excursion) and mitral and tricuspid tissue Doppler annular velocities were obtained. RV 3D volumes and global and regional ejection fraction (3D?RVEF) were determined. RV strains were calculated by 2D?STE and 3D?STE. RV 3D global?free?wall longitudinal strain (3DGFW?RVLS), 2D global?free?wall longitudinal strain (GFW?RVLS), apical?free?wall longitudinal strain, basal?free?wall longitudinal strain, and 3D?RVEF were lower in patients with precapillary PH (P<0.0001) and postcapillary PH (P<0.01) compared to controls. 3DGFW?RVLS (hazard ratio 4.6, 95% CI 2.79 to 8.38, P=0.004) and 3D?RVEF (hazard ratio 5.3, 95% CI 2.85 to 9.89, P=0.002) were independent predictors of mortality. Receiver operating characteristic curves showed that the thresholds offering an adequate compromise between sensitivity and specificity for detecting hemodynamic signs of RV failure were 39% for 3D?RVEF (AUC 0.89), ?17% for 3DGFW?RVLS (AUC 0.88), ?18% for GFW?RVLS (AUC 0.88), ?16% for apical?free?wall longitudinal strain (AUC 0.85), 16 mm for tricuspid annular plane systolic excursion (AUC 0.67), and 38% for RV?FAC (AUC 0.62). Conclusions In chronic PH, 3D, 2D?STE and 3D?STE parameters indicate global and regional RV dysfunction that is associated with RV failure hemodynamics better than conventional echo indices. PMID:25792128

  4. Modelling runway incursion severity.

    PubMed

    Wilke, Sabine; Majumdar, Arnab; Ochieng, Washington Y

    2015-06-01

    Analysis of the causes underlying runway incursions is fundamental for the development of effective mitigation measures. However, there are significant weaknesses in the current methods to model these factors. This paper proposes a structured framework for modelling causal factors and their relationship to severity, which includes a description of the airport surface system architecture, establishment of terminological definitions, the determination and collection of appropriate data, the analysis of occurrences for severity and causes, and the execution of a statistical analysis framework. It is implemented in the context of U.S. airports, enabling the identification of a number of priority interventions, including the need for better investigation and causal factor capture, recommendations for airfield design, operating scenarios and technologies, and better training for human operators in the system. The framework is recommended for the analysis of runway incursions to support safety improvements and the methodology is transferable to other areas of aviation safety risk analysis. PMID:25819211

  5. Severe Snowstorm in Lesotho

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Some snow isn't an unexpected occurrence in the mountainous terrain of the small country of Lesotho, a small, roughly circular country located between Free State Province and Eastern Cape Province in the Republic of South Africa. But over the weekend of July 20, 2002, a severe snow storm dumped several feet of snow in the Drakensbueg Mountains, and turned many parts of the country into disaster areas. According to news reports, at least 22 people died and many more were stranded in mountain towns and camping areas, often without fuel or electricity, or food and water. This image was acquired by the Moderate Resolution Imaging Spectroradiometer (MODIS) on July 25, 2002. Credits: Image by Jesse Allen, based on data from the MODIS Rapid Response Team, NASA-GSFC

  6. Tropical Severe Local Storms

    NSDL National Science Digital Library

    2014-09-14

    The module provides a brief overview of severe local storms in the tropics. Basic ingredients for thunderstorms and assessment of thunderstorm potential from soundings are described. Then properties and hazards of ordinary thunderstorms, multicellular thunderstorms, supercells are reviewed. Conditions conducive to supercell formation in the tropics are examined along with methods of identifying them in radar and satellite images. Supercell and non-supercell tornado properties and formation are described. Finally, tornadoes, waterspouts, and dust devils properties are compared.

  7. Diagnostic accuracy of contrast echocardiography during adenosine stress for detection of abnormal myocardial perfusion: a prospective comparison with technetium-99 m sestamibi single-photon emission computed tomography.

    PubMed

    Abdelmoneim, Sahar S; Bernier, Mathieu; Dhoble, Abhijeet; Moir, Stuart; Hagen, Mary E; Ness, Sue Ann C; Pellikka, Patricia A; Abdel-Kader, Samir S; Mulvagh, Sharon L

    2010-03-01

    Myocardial contrast echocardiography (MCE) utilizes compressible microbubbles behaving similarly to red blood cells. Destruction of microbubbles and observation of the gradual refill into the myocardium are key to evaluating perfusion using real-time MCE. We aimed to assess the feasibility and diagnostic accuracy of qualitative MCE utilizing a 17-segment model for localization of myocardial perfusion abnormalities compared with simultaneous technetium-99 m sestamibi single-photon emission computed tomography (SPECT). From July 2005 through August 2007, 97 patients with known or suspected coronary artery disease underwent simultaneous SPECT and realtime MCE during adenosine stress. Qualitative MCE and tracer uptake were analyzed visually using a 17-segment model in a blinded manner. Diagnostic accuracy and 95% confidence interval (CI) were determined. Myocardial contrast echocardiography was completed in 91 patients (age, mean [SD], 69.3 [10.9] years; body mass index, 30.0 [6.3]; 59 males [65%]). Myocardial contrast echocardiography analysis was feasible in 88 (97%) patients (261 of 264 [99%] territories; 1299 of 1497 [87%] segments). At patient level, MCE sensitivity was 88% (95% CI, 79%-94%); specificity was 85% (77%-90%). For disease detection in individual coronary territories, sensitivity and specificity were 84% (71%-92%) and 79% (72%-84%) for the left anterior descending artery; 62% (38%-80%) and 88% (83%-91%) for the left circumflex artery; and 73% (57%-82%) and 94% (89%-97%) for the right coronary artery. For MCE combined with wall-motion analysis, concordance with SPECT improved from 80% to 86%. Myocardial contrast echocardiography interobserver concordance was 81% (kappa [SE], 0.611 [0.78]). Myocardial contrast echocardiography accuracy was comparable in patients classified in accordance with presence of diabetes mellitus, myocardial infarction, hypertension, or percutaneous coronary intervention. Improved MCE specificity in detecting perfusion defects was seen in patients with no history of coronary bypass graft surgery (P = 0.005). Real-time MCE with a 17-segment model for analysis has good feasibility and accuracy in evaluation of myocardial perfusion during adenosine stress. PMID:20339973

  8. Management of severe hypospadias

    PubMed Central

    Catti, Massimo; Demède, Delphine; Valmalle, Anne-Frédérique; Mure, Pierre-Yves; Hameury, Frédéric; Mouriquand, Pierre

    2008-01-01

    Many classifications of hypospadias have been published, mainly based on the position of the ectopic meatus, which is an insufficient criterion to define the severity of this malformation. What really marks the proximal landmark of this malformation is the level of division of the corpus spongiosum, which is always proximal to the ectopic meatus. In this article, we will focus on the most severe forms of hypospadias which include those with a proximal division of corpus spongiosum (below the midshaft), important chordee and a poor development of the ventral radius, reflecting a marked hypovirilization of the genital tubercle, and cripple hypospadias resulting from several previous failed surgical procedures. The principle of hypospadias surgery will be reviewed together with the outcome of the current surgical techniques. Furthermore, common complications will be outlined. There is no minor or major hypospadias and all forms require a solid experience of the surgeon, as minor looking hypospadias may turn out to be far more complex to repair than they appear once the ventral radius of the penis has been dissected. PMID:19468403

  9. Treatment of severe malaria.

    PubMed Central

    Warrell, D A

    1989-01-01

    In the treatment of severe Plasmodium falciparum infection antimalarial drugs should, ideally, be given by controlled rate intravenous infusion until the patient is able to swallow tablets. In cases where infection has been acquired in a chloroquine resistant area, and where it has broken through chloroquine prophylaxis or where the geographical origin or species are uncertain, quinine is the treatment of choice. When access to parenteral quinine is likely to be delayed, parenteral quinidine is an effective alternative. A loading dose of quinine is recommended in order to achieve therapeutic plasma concentrations as quickly as possible. In the case of chloroquine sensitive P. falciparum infection, chloroquine, which can be given safely by slow intravenous infusion, may be more rapidly effective and has fewer toxic effects than quinine. There is limited experience with parenteral administration of pyrimethamine sulphonamide combinations such as Fansidar, and resistance to these drugs has developed in South East Asia and elsewhere. Mefloquine and halofantrine cannot be given parenterally. Qinghaosu derivatives are not readily available and have not been adequately tested outside China. Supportive treatment includes the prevention or early detection and treatment of complications, strict attention to fluid balance, provision of adequate nursing for unconscious patients and avoidance of harmful ancillary treatments. Anaemia is inevitable and out of proportion to detectable parasitaemia. Hypotension and shock ('algid malaria') are often attributable to secondary gram-negative septicaemia requiring appropriate antimicrobial therapy and haemodynamic resuscitation. Many patients with severe falciparum malaria are hypovolaemic on admission to hospital and require cautious fluid replacement. Failure to rehydrate these patients may lead to circulatory collapse, lactic acidosis, renal failure and severe hyponatraemia.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2693726

  10. Severe Staphylococcus lugdunensis keratitis.

    PubMed

    Inada, N; Harada, N; Nakashima, M; Shoji, J

    2015-02-01

    We report a severe case of Staphylococcus lugdunensis (S. lugdunensis) keratitis presenting as suppurative keratitis in a 77-year-old woman. The patient's chief complaint was eye pain and decreased visual acuity in her right eye. Suppurative keratitis with a severe corneal abscess was diagnosed by a slit-lamp ophthalmic examination. The causative organism was identified as S. lugdunensis by bacterial culture, using a corneal abrasion specimen. She was treated with an intravenous drip infusion of ceftazidime and instillation of gentamicin sulfate ophthalmic solution (six times daily) and ofloxacin ophthalmic ointment (once daily before bedtime) as empiric therapy. Her hospital course was complicated by a corneal perforation of her right eye. The antibiotic susceptibility for S. lugdunensis was sensitive, but with a slightly high MIC for antibiotics used in empiric therapy. The therapeutic drug was changed to levofloxacin ophthalmic solution. The corneal abscess left a scar after healing. Representative causative organisms of suppurative keratitis include Pseudomonas aeruginosa and Streptococcus pneumoniae, but care must be taken in cases involving rare causative organisms. Empiric therapy is necessary for rapidly progressing suppurative keratitis, but a detailed examination of the causative organism is important for therapeutic planning before empiric therapy. PMID:25082203

  11. Bedside Echocardiography for Undifferentiated Hypotension: Diagnosis of a Right Heart Thrombus

    PubMed Central

    Kenny, James F.; Zhong, Xun; Brown, Cara; Das, Devjani; Royall, Brock; Kapoor, Monica

    2015-01-01

    A free-floating right heart thrombus is often a harbinger of a massive pulmonary embolism and must be diagnosed and treated rapidly in order to avoid significant adverse sequelae. We present the case of an 84-year-old female who presented with two days of dyspnea and was hypotensive on arrival. Bedside ultrasound was performed by the emergency physician and showed a large, mobile right heart thrombus leading to immediate administration of a thrombolytic. In this case, bedside ultrasound was utilized to help further delineate clinical care in a progressively worsening patient, leading to a potentially lifesaving treatment. PMID:25671037

  12. University of Florida Bee College Honey Show

    E-print Network

    Jawitz, James W.

    University of Florida Bee College Honey Show A REMINDER TO JUDGES 1. Judging will begin promptly or the Honey Show Manager only. 3. The Show will provide color grading glasses if required, towel, basin equipment (see judges checklist). For cake judging, knifes will be provided by the Honey Show Manager. 4

  13. [Diastolic function of the left ventricle in aortic valve stenosis. Doppler echocardiography].

    PubMed

    Habib, G; Vittot, P; Cornen, A; Boulain, L; Bonnet, J L; Djiane, P; Luccioni, R

    1992-06-01

    Doppler echocardiographic parameters of LV diastolic function (isovolumic relaxation time, E wave velocity, ratio of E/A wave velocities, mitral valve pressure half time) were compared to catheter data in 35 patients (average age 67 years) with pure or dominant aortic stenosis (mean gradient: 65 +/- 30 mmHg). The isovolumic relaxation time was prolonged in most patients (m = 103 +/- 23 ms) and seemed uninfluenced by any haemodynamic parameter. There was a positive correlation between pressure half time and ejection fraction (r = 0.41, p = 0.02) and a negative correlation with pulmonary capillary pressure (r = -0.61, p < 0.01). The E and E/A ratio were negatively correlated with the ejection fraction (r = -0.41 and -0.52) and positively correlated with pulmonary capillary pressure (r = 0.46 and 0.62). The Doppler parameters were independant of the patients' age, severity of stenosis and degree of left ventricular hypertrophy. Patients with normal pulmonary capillary pressure (< 15 mmHg, N = 19) had abnormal diastolic filling with low E wave velocities (71 +/- 28 cm/s) and E/A ratios (0.9 +/- 0.6) and prolonged half pressure times (96 +/- 37 ms). Conversely, patients with high pulmonary capillary pressures (> 15 mmHg, N = 16) had normal or high E wave velocities (107 +/- 31 cm/s) and E/A ratios (1.5 +/- 0.6) and normal or shortened isovolumic relaxation times (62 +/- 22 ms).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1417407

  14. Dobutamine stress echocardiography in patients undergoing orthotopic liver transplantation: a pooled analysis of accuracy, perioperative and long term cardiovascular prognosis.

    PubMed

    Nguyen, Peter; Plotkin, Jeff; Fishbein, Thomas M; Laurin, Jacqueline M; Satoskar, Rohit; Shetty, Kirti; Taylor, Allen J

    2013-12-01

    Pre-transplant evaluation for orthotopic liver transplantation (OLT) commonly includes a cardiac evaluation using dobutamine stress echocardiography (DSE). We performed a quantitative systematic review assessing DSE's use in detecting coronary artery disease (CAD) and predicting perioperative and long term cardiac events in patients undergoing OLT. Published studies in pubmed were accessed using keyword searches and bibliographic review. Included studies evaluated the use of DSE in patients undergoing OLT, including its accuracy for detection of CAD, and in predicting perioperative and long term cardiac prognosis for both hard (myocardial infarction, cardiac death, cardiac arrest, and asystole) and soft cardiac events (all other events that were cardiovascular in nature). We calculated DSE's sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) in the above areas. We identified 7 studies, including a total of 580 patients, which included 4 accuracy studies (n = 110 patients), 4 perioperative studies, and 3 long term studies. Accuracy for CAD included a sensitivity of 0.32, specificity of 0.78, PPV of 0.37, and NPV of 0.75. Accuracy for prediction of perioperative hard and soft cardiac events was a sensitivity of 0.20 and 0, specificity of 0.99 and 0.99, PPV of 0.33 and 0, and NPV of 0.98 and 0.89, respectively. For long term hard and soft cardiac events, sensitivity was 0.5 and 0, specificity 0.99 and 0.98, PPV 0.33 and 0, and NPV 0.99 and 0.96, respectively. DSE has a limited accuracy for the detection of CAD in candidates for OLT. However, among those patients selected for OLT, the negative predictive value of DSE for both perioperative and long term cardiac events is high. PMID:23974907

  15. Left ventricular adaptation to high altitude: speckle tracking echocardiography in lowlanders, healthy highlanders and highlanders with chronic mountain sickness.

    PubMed

    Dedobbeleer, Chantal; Hadefi, Alia; Pichon, Aurelien; Villafuerte, Francisco; Naeije, Robert; Unger, Philippe

    2015-04-01

    Hypoxic exposure depresses myocardial contractility in vitro, but has been associated with indices of increased cardiac performance in intact animals and in humans, possibly related to sympathetic nervous system activation. We explored left ventricular (LV) function using speckle tracking echocardiography and sympathetic tone by spectral analysis of heart rate variability (HRV) in recently acclimatized lowlanders versus adapted or maladapted highlanders at high altitude. Twenty-six recently acclimatized lowlanders, 14 healthy highlanders and 12 highlanders with chronic mountain sickness (CMS) were studied. Control measurements at sea level were also obtained in the lowlanders. Altitude exposure in the lowlanders was associated with slightly increased blood pressure, decreased LV volumes and decreased longitudinal strain with a trend to increased prevalence of post-systolic shortening (p = 0.06), whereas the low frequency/high frequency (LF/HF) ratio increased (1.62 ± 0.81 vs. 5.08 ± 4.13, p < 0.05) indicating sympathetic activation. Highlanders had a similarly raised LF/HF ratio, but no alteration in LV deformation. Highlanders with CMS had no change in LV deformation, no significant increase in LF/HF, but decreased global HRV still suggestive of increased sympathetic tone, and lower mitral E/A ratio compared to healthy highlanders. Short-term altitude exposure in lowlanders alters indices of LV systolic function and increases sympathetic nervous system tone. Life-long altitude exposure in highlanders is associated with similar sympathetic hyperactivity, but preserved parameters of LV function, whereas diastolic function may be altered in those with CMS. Altered LV systolic function in recently acclimatized lowlanders may be explained by combined effects of hypoxia and changes in loading conditions. PMID:25665685

  16. Efficient feature-based 2D/3D registration of transesophageal echocardiography to x-ray fluoroscopy for cardiac interventions

    NASA Astrophysics Data System (ADS)

    Hatt, Charles R.; Speidel, Michael A.; Raval, Amish N.

    2014-03-01

    We present a novel 2D/ 3D registration algorithm for fusion between transesophageal echocardiography (TEE) and X-ray fluoroscopy (XRF). The TEE probe is modeled as a subset of 3D gradient and intensity point features, which facilitates efficient 3D-to-2D perspective projection. A novel cost-function, based on a combination of intensity and edge features, evaluates the registration cost value without the need for time-consuming generation of digitally reconstructed radiographs (DRRs). Validation experiments were performed with simulations and phantom data. For simulations, in silica XRF images of a TEE probe were generated in a number of different pose configurations using a previously acquired CT image. Random misregistrations were applied and our method was used to recover the TEE probe pose and compare the result to the ground truth. Phantom experiments were performed by attaching fiducial markers externally to a TEE probe, imaging the probe with an interventional cardiac angiographic x-ray system, and comparing the pose estimated from the external markers to that estimated from the TEE probe using our algorithm. Simulations found a 3D target registration error of 1.08(1.92) mm for biplane (monoplane) geometries, while the phantom experiment found a 2D target registration error of 0.69mm. For phantom experiments, we demonstrated a monoplane tracking frame-rate of 1.38 fps. The proposed feature-based registration method is computationally efficient, resulting in near real-time, accurate image based registration between TEE and XRF.

  17. A Propensity Score-Matching Analysis of Transthoracic Echocardiography and Abdominal Ultrasonography for the Detection of Abdominal Aortic Aneurysms

    PubMed Central

    Kato, Takao; Ishida, Seiko; Miyamoto, Shoichi; Iura, Tamae; Ban, Yoko; Fujikawa, Jun; Nakane, Eisaku; Izumi, Toshiaki; Haruna, Tetsuya; Ueyama, Koji; Nohara, Ryuji; Inoko, Moriaki

    2015-01-01

    INTRODUCTION We previously reported that the prevalence of abdominal aortic aneurysms (AAAs) was higher in patients undergoing scheduled transthoracic echocardiography (TTE) than in patients undergoing abdominal ultrasonography (AUS); however, intergroup patient backgrounds differed significantly in that report. PURPOSE We tested the hypothesis that TTE could detect AAA as effectively as AUS. DESIGN A propensity score-matching analysis of a cross-sectional study was adopted as the design for this study. METHODS We enrolled 7,619 and 15,433 patients scheduled to undergo TTE with additional evaluation of abdominal aorta at the end of the routine study and AUS, respectively, from 2009 to 2010 in our hospital, as reported. A propensity score for profiles of patients who underwent TTE or AUS was developed to adjust for potential confounding bias. Consequently, 4,388 patients in each group were matched for analyses. RESULTS In propensity-matched patients, AAA was detected in 59 patients of the TTE group and in 48 patients of the AUS group; the prevalence of AAA detection did not differ significantly between TTE and AUS groups (P = 0.331). Positive associations were observed between AAA detection and male sex (adjusted odds ratio [OR]: 3.25; 95% confidence interval [CI], 2.05–5.15; P < 0.001), older age (adjusted OR: 1.029; 95% CI: 1.01–1.04; P < 0.001), and the presence of ischemic heart disease (adjusted OR: 1.78; 95% CI: 1.04–3.03; P = 0.033) and hypertension (adjusted OR: 2.16; 95% CI: 1.38–3.37; P = 001). CONCLUSION TTE detected AAA with comparable efficacy as AUS in propensity-matched groups who underwent scheduled TTE and AUS. PMID:25861228

  18. Assessment of internal mammary artery and saphenous vein graft patency and flow reserve using transthoracic Doppler echocardiography

    NASA Technical Reports Server (NTRS)

    Chirillo, F.; Bruni, A.; Balestra, G.; Cavallini, C.; Olivari, Z.; Thomas, J. D.; Stritoni, P.

    2001-01-01

    OBJECTIVE: To investigate transthoracic Doppler echocardiography in the identification of coronary artery bypass graft (CABG) flow for assessing graft patency. DESIGN: The initial study group comprised 45 consecutive patients with previous CABG undergoing elective cardiac catheterisation for recurrent ischaemia. The Doppler variables best correlated with angiographic graft patency were then tested prospectively in a further 84 patients (test group). SETTING: Three tertiary referral centres. INTERVENTIONS: Flow velocities in grafts were recorded at rest and during hyperaemia induced by dipyridamole (0.56 mg/kg/4 min), under the guidance of transthoracic colour Doppler flow mapping. Findings on transthoracic Doppler were compared with angiography. MAIN OUTCOME MEASURES: Feasibility of identifying open grafts by Doppler and diagnostic accuracy for Doppler detection of significant (>/= 70%) graft stenosis. RESULTS: In the test group the identification rate for mammary artery grafts was 100%, for saphenous vein grafts to left anterior descending coronary artery 91%, for vein grafts to right coronary artery 96%, and for vein grafts to circumflex artery 90%. Coronary flow reserve (the ratio between peak diastolic velocity under hyperaemia and at baseline) of < 1.9 (95% confidence interval 1.83 to 2.08) had 100% sensitivity, 98% specificity, 87.5% positive predictive value, and 100% negative predictive value for mammary artery graft stenosis. Coronary flow reserve of < 1.6 (95% CI 1.51 to 1.73) had 91% sensitivity, 87% specificity, 85.4% positive predictive value, and 92.3% negative predictive value for significant vein graft stenosis. CONCLUSIONS: Transthoracic Doppler can provide non-invasive assessment of CABG patency.

  19. Measurement by phase severance

    SciTech Connect

    Noyes, H.P.

    1987-03-01

    It is claimed that the measurement process is more accurately described by ''quasi-local phase severance'' than by ''wave function collapse''. The approach starts from the observation that the usual route to quantum mechanics starting from the Hamilton-Jacobi equations throws away half the degrees of freedom, namely, the classical initial state parameters. To overcome this difficulty, the full set of Hamilton-Jacobi equations is interpreted as operator equations acting on a state vector. The measurement theory presented is based on the conventional S-matrix boundary condition of N/sub A/ free particles in the distant past and N/sub B/ free particles in the distant future and taking the usual free particle wave functions, multiplied by phase factors.

  20. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians.

    PubMed

    Douglas, Pamela S; Garcia, Mario J; Haines, David E; Lai, Wyman W; Manning, Warren J; Patel, Ayan R; Picard, Michael H; Polk, Donna M; Ragosta, Michael; Parker Ward, R; Weiner, Rory B

    2011-03-01

    The American College of Cardiology Foundation (ACCF), in partnership with the American Society of Echocardiography (ASE) and along with key specialty and subspecialty societies, conducted a review of common clinical scenarios where echocardiography is frequently considered. This document combines and updates the original transthoracic and transesophageal echocardiography appropriateness criteria published in 2007 (1) and the original stress echocardiography appropriateness criteria published in 2008 (2). This revision reflects new clinical data, reflects changes in test utilization patterns,and clarifies echocardiography use where omissions or lack of clarity existed in the original criteria.The indications (clinical scenarios)were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of the original appropriate use criteria (AUC).The 202 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9,to designate appropriate use(median 7 to 9), uncertain use(median 4 to 6), and inappropriate use (median 1 to 3). Ninety-seven indications were rated as appropriate, 34 were rated as uncertain, and 71 were rated as inappropriate. In general,the use of echocardiography for initial diagnosis when there is a change in clinical status or when the results of the echocardiogram are anticipated to change patient management were rated appropriate. Routine testing when there was no change in clinical status or when results of testing were unlikely to modify management were more likely to be inappropriate than appropriate/uncertain.The AUC for echocardiography have the potential to impact physician decision making,healthcare delivery, and reimbursement policy. Furthermore,recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. PMID:21338862

  1. New Hampshire Guide 4-H Dog Shows

    E-print Network

    New Hampshire, University of

    New Hampshire Guide to 4-H Dog Shows UNH Cooperative Extension 4-H Youth Development Moiles House cooperating. #12;NH Guide to 4-H Dog Shows i Table of Contents INTRODUCTION .................................................................................................................................2 Purpose of the 4-H Dog Project

  2. Flat Globe: Showing the Changing Seasons

    NSDL National Science Digital Library

    Jesse Allen

    1998-09-09

    SeaWiFS false color data showing seasonal change in the oceans and on land for the entire globe. The data is seasonally averaged, and shows the sequence: fall, winter, spring, summer, fall, winter, spring (for the Northern Hemisphere).

  3. Inside Gun Shows What Goes On

    E-print Network

    Leistikow, Bruce N.

    Inside Gun Shows What Goes On When Everybody Thinks Nobody's Watching Epilogue #12;Inside Gun Shows;Epilogue In February 2010, I attended a Crossroads of the West gun show at the Arizona State Fairgrounds here an update on each of the Phoenix obser- vations made in the photo-essay portion of Inside Gun

  4. Inside Gun Shows What Goes On

    E-print Network

    Leistikow, Bruce N.

    Preface Inside Gun Shows What Goes On When Everybody Thinks Nobody's Watching #12;#12;Inside Gun-Violence Effort. She put gun shows on my radar and is an ace straw-purchase spotter. Thanks also to Barbara Claire a great public institution. He was right. #12;Contents Preface Executive Summary Gun Shows in Context How

  5. Inside Gun Shows What Goes On

    E-print Network

    Nguyen, Danh

    Inside Gun Shows What Goes On When Everybody Thinks Nobody's Watching Executive Summary #12;Inside Gun Shows What Goes on When Everybody Thinks Nobody's Watching Garen Wintemute, MD, MPH Violence;Executive Summary Gun shows are surrounded by controversy. On the one hand, they are important economic

  6. Transthoracic echocardiography as an alternative major guidance to angiography during transcatheter closure of patent ductus arteriosus: technical feasibility and clinical relevance.

    PubMed

    Chen, Wanhua; Yan, Xiaoping; Huang, Yu; Sun, Xudong; Zhong, Ling; Li, Jinguo; Chen, Hua; Zhong, Huiying; Chen, Lianglong

    2015-01-01

    The conventional transcatheter closure of patent ductus arteriosus (PDA) requires femoral artery puncture and angiography for duct anatomic and shunting estimation. If such estimation can be replaced by transthoracic echocardiography (TTE), the procedure will be further simplified, with fewer invasions. This study aimed to examine whether TTE can serve as an alternative to aorta angiography and as a major guidance for transcatheter duct closure. The study enrolled 298 consecutive patients (71 males and 227 females) with PDA. In the study, TTE with combined two-dimensional echocardiography (2DE) imaging and color-coded flow imaging (CDFI) was performed to measure the minimal shunting width (MSW) as the estimated minimal duct size for selection of an Amplatzer duct occluder (ADO) and to monitor the transcatheter duct closure intraprocedurally. The MSW was validated against the duct-stretched diameter (SDD), against the minimal waist diameter of the conical part of a released occluder measured by X-ray spot picture after successful duct closure (SDC), and against the size of the finally used ADO (SADO). Good correlation was found between MSW and SDD [SDD (mm) = 1.31 MSW; r = 0.89; p < 0.01] and between MSW and SADO [SADO (mm) = 1.71 MSW; r = 0.88; p < 0.01]. Of 296 patients who received occlusion using MSW as the reference for selection of the occluder, SDC was attained in 288 (97.3%), 5 (1.7%), and 2 (0.7%) patients, respectively, at the first, second (1 ADO replacement), and third (2 ADO replacements) occluding attempt. Acute occluder dislodgement occurred in one patient (0.3%). At the 12-month follow-up assessment, no major complications were found, and the total immediate or 12-month SDC was 99.7%. Echocardiography as an alternative major guidance to angiography for transcatheter duct closure is technically feasible, and TTE guidance can further simplify the procedure, with fewer invasions and potential complications. PMID:25070385

  7. [Comparison of two indices of arterial distensibility: temporal apparitions of Korotkoff sounds and pulse wave velocy. A Doppler echocardiography and ambulatory blood pressure monitoring study].

    PubMed

    Abassade, P; Baudouy, P Y; Gobet, L; Lhosmot, J P

    2001-01-01

    Arterial distensibility, one of the factors influencing afterload, plays a role in the development of left ventricular hypertrophy. The QKd, the delay before the perception of the Korotkoff sounds, is an index of arterial distensibility available from ambulatory blood pressure monitoring. The pulse wave velocity (PWV), another index of arterial distensibility, can be measured by Doppler echocardiography. The aim of this study was to compare these two indices with haemodynamic parameters of arterial distensibility and to determine their relationship to left ventricular geometry and function. Sixty-two consecutive patients, with and without cardiac disease, underwent simultaneous Doppler echocardiography and ambulatory blood pressure monitoring. A correlation was observed between QKd and PWV (N = 53, p = 0.007, r = 0.37). The QKd and PWV were correlated to the absolute index of arterial distensibility (systolic index/pulse pressure) (N = 51, p < 0.001, r = 0.48). QKd was correlated with indices of left ventricular function such as EF (N = 55, p < 0.001, r = 0.66) or the systolic pressure/end systolic dimension ratio (N = 54, p < 0.001, r = 0.75). When the ejection time was subtracted from QKd, only the end systolic pressure/end systolic dimension remained significantly correlated (N = 37, p = 0.005, r = 0.40). The authors conclude that PWV and QKd were correlated and were also correlated with indices of arterial distensibility. QKd is a composite index of left ventricular function and arterial distensibility. Doppler echocardiography and ambulatory blood pressure monitoring provide a non-invasive assessment of the aorta/LV couple. PMID:11233477

  8. The right ventricle under pressure: evaluating the adaptive and maladaptive changes in the right ventricle in pulmonary arterial hypertension using echocardiography (2013 Grover Conference series)

    PubMed Central

    Hatton, Nathan; Ryan, John J.

    2015-01-01

    Abstract The importance of the right ventricle (RV) in pulmonary arterial hypertension (PAH) has been gaining increased recognition. This has included a reconceptualization of the RV as part of an RV–pulmonary circulation interrelated unit and the observation that RV function is a major determinant of prognosis in PAH. Noninvasive imaging of RV size and function is critical to the longitudinal management of patients with PAH, and continued understanding of the pathophysiology of pulmonary vascular disease relies on the response of the RV to pulmonary vascular remodeling. Echocardiography, in particular the newer echocardiographic measurements and techniques, allows easy, readily accessible means to assess and follow RV size and function. PMID:25992269

  9. This image, looking due south shows the central part of ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    This image, looking due south shows the central part of the north wing of the building, a 2 story facade. In the foreground are several utility chases which span this elevation of the building - Department of Energy, Mound Facility, Electronics Laboratory Building (E Building), One Mound Road, Miamisburg, Montgomery County, OH

  10. Altered ventricular mechanics after 60 min of high-intensity endurance exercise: insights from exercise speckle-tracking echocardiography.

    PubMed

    Stewart, Glenn M; Yamada, Akira; Haseler, Luke J; Kavanagh, Justin J; Koerbin, Gus; Chan, Jonathan; Sabapathy, Surendran

    2015-04-15

    Transient reductions in myocardial strain coupled with cardiac-specific biomarker release have been reported after prolonged exercise (>180 min). However, it is unknown if 1) shorter-duration exercise (60 min) can perturb cardiac function or 2) if exercise-induced reductions in strain are masked by hemodynamic changes that are associated with passive recovery from exercise. Left ventricular (LV) and right ventricular global longitudinal strain (GLS), LV torsion, and high-sensitivity cardiac troponin T were measured in 15 competitive cyclists (age: 28 ± 3 yr, peak O2 uptake: 4.8 ± 0.6 l/min) before and after a 60-min high-intensity cycling race intervention (CRIT60). At both time points (pre- and post-CRIT60), strain and torsion were assessed at rest and during a standardized low-intensity exercise challenge (power output: 96 ± 8 W) in a semirecumbent position using echocardiography. During rest, hemodynamic conditions were different from pre- to post-CRIT60 (mean arterial pressure: 96 ± 1 vs. 86 ± 2 mmHg, P < 0.001), and there were no changes in strain or torsion. In contrast, during the standardized low-intensity exercise challenge, hemodynamic conditions were unchanged from pre- to post-CRIT60 (mean arterial pressure: 98 ± 1 vs. 97 ± 1 mmHg, not significant), but strain decreased (left ventricular GLS: -20.3 ± 0.5% vs. -18.5 ± 0.4%, P < 0.01; right ventricular GLS: -26.4 ± 1.6% vs. -22.4 ± 1.5%, P < 0.05), whereas LV torsion remained unchanged. Serum high-sensitivity cardiac troponin T increased by 345% after the CRIT60 (6.0 ± 0.6 vs. 20.7 ± 6.9 ng/l, P < 0.05). This study demonstrates that exercise-induced functional and biochemical cardiac perturbations are not confined to ultraendurance sporting events and transpire during exercise that is typical of day-to-day training undertaken by endurance athletes. The clinical significance of cumulative exposure to endurance exercise warrants further study. PMID:25637550

  11. The Language of Show Biz: A Dictionary.

    ERIC Educational Resources Information Center

    Sergel, Sherman Louis, Ed.

    This dictionary of the language of show biz provides the layman with definitions and essays on terms and expressions often used in show business. The overall pattern of selection was intended to be more rather than less inclusive, though radio, television, and film terms were deliberately omitted. Lengthy explanations are sometimes used to express…

  12. International Plowing Match & Farm Machinery Show

    NSDL National Science Digital Library

    The 1995 International Plowing Match & Farm Machinery Show in Ontario, Canada has a site of the Web. The IPM is a non-profit organization of volunteers which annually organizes Canada's largest farm machinery show. The event is commercial and educational. Thousands of school children and educators attend and participate in organized educational activities.

  13. Collegiate Cattle Growers 2012 Jackpot Show

    E-print Network

    Guerriero, Vince

    Collegiate Cattle Growers 2012 Jackpot Show February 18-19 At the U of A Ag Center Campbell Ave the evening before the show from 6 to 7 pm Make payment out to: Collegiate Cattle Growers Association Mail to: University of Arizona of Animal Sciences Attn. Collegiate Cattle Growers P.O. Box 210038, Tucson, AZ 85721

  14. End-of-Semester Barbecue Talent Show

    E-print Network

    Pilyugin, Sergei S.

    Highlights End-of-Semester Barbecue Talent Show Scholarship Winners St. Francis Food Drive eating, have fun tubing or canoeing, playing soccer, volleyball, and other games. This is the last Ceremony. Details will be in next week's Weekly. Talent Show Dress Rehearsal Dress Rehearsal: All acts MUST

  15. Salton Sea Satellite Image Showing Fault Slip

    USGS Multimedia Gallery

    Landsat satellite image (LE70390372003084EDC00) showing location of surface slip triggered along faults in the greater Salton Trough area. Red bars show the generalized location of 2010 surface slip along faults in the central Salton Trough and many additional faults in the southwestern section of t...

  16. SWINE PROSPECT SHOW Sunday, Dec. 7, 2014

    E-print Network

    Watson, Craig A.

    BARN WARS SWINE PROSPECT SHOW Sunday, Dec. 7, 2014 Indian River County Fairgrounds 7955 58th Ave. Checks need to be made out to: Indian River County 4-H. Mail to: Indian River County 4-H Attn: Prospect to all of the rules and regulations set forth by Barn Wars Prospect Show. Exhibitor's Signature: Date

  17. High-resolution echocardiography

    NASA Technical Reports Server (NTRS)

    Nathan, R.

    1979-01-01

    High resolution computer aided ultrasound system provides two-and three-dimensional images of beating heart from many angles. System provides means for determining whether small blood vessels around the heart are blocked or if heart wall is moving normally without interference of dead and noncontracting muscle tissue.

  18. Indications for Fetal Echocardiography

    Microsoft Academic Search

    M. Small; J. A. Copel

    2004-01-01

    Congenital heart disease is one of the most common congenital malformations diagnosed in liveborns. As more women undergo prenatal diagnosis, the need for screening fetal echocadiography increases. The fetal, maternal, and familial indications for fetal echocadiography are outlined in order to improve the identification of women in greatest need for this screening modality.

  19. Sweet Concepts Inc.: Trade Show Marketing

    Microsoft Academic Search

    Mark Parry; Melanie Jones

    Brooks West of Sweet Concepts has recently adopted a new brand strategy for Butterfields, the company's line of hard candy. West must decide how the new branding stragtegy should affect his trade show marketing program.

  20. Do dogs (Canis familiaris) show contagious yawning?

    PubMed

    Harr, Aimee L; Gilbert, Valerie R; Phillips, Kimberley A

    2009-11-01

    We report an experimental investigation into whether domesticated dogs display contagious yawning. Fifteen dogs were shown video clips of (1) humans and (2) dogs displaying yawns and open-mouth expressions (not yawns) to investigate whether dogs showed contagious yawning to either of these social stimuli. Only one dog performed significantly more yawns during or shortly after viewing yawning videos than to the open-mouth videos, and most of these yawns occurred to the human videos. No dogs showed significantly more yawning to the open-mouth videos (human or dog). The percentage of dogs showing contagious yawning was less than chimpanzees and humans showing this behavior, and considerably less than a recently published report investigating this behavior in dogs (Joly-Mascheroni et al. in Biol Lett 4:446-448, 2008). PMID:19452178

  1. Nutrition and Feeding of Show Poultry 

    E-print Network

    Cartwright, A. Lee

    2003-11-03

    The championship potential of a chicken or turkey is determined by genetics, but proper nutrition can help an animal achieve that genetic potential. This publication outlines four principles critical to developing a nutrition program for show...

  2. Incident Response Planning for Selected Livestock Shows 

    E-print Network

    Tomascik, Chelsea Roxanne

    2012-02-14

    was to determine local officials' perceptions and awareness of incident planning and response pertaining to selected livestock shows. Little research has been completed in this area; therefore, this foundational study was needed. The objectives of this study...

  3. System Generator Tips Show sample time colors

    E-print Network

    System Generator Tips · Show sample time colors · FormatPort/Signal DisplaysSample Time Colors/stop the simulation · Give subsystems and their ports meaningful names · Mask subsystems you'll use again · Using too

  4. New Drug Shows Promise Against Psoriasis

    MedlinePLUS

    ... nlm.nih.gov/medlineplus/news/fullstory_153105.html New Drug Shows Promise Against Psoriasis Ixekizumab appeared to ... the disease clearing up, but people on the new drug also reporting a marked improvement in their ...

  5. The Moscow Show of Dissident Art

    ERIC Educational Resources Information Center

    Millet, Stephen M.

    1975-01-01

    Author described a show of dissident art held in Moscow on September 29, 1974, and contrasted the government's efforts to control artistic freedom with the determination of Russian artists to resist such imposition. (RK)

  6. World's Population Is Getting Sicker, Study Shows

    MedlinePLUS

    ... nlm.nih.gov/medlineplus/news/fullstory_152968.html World's Population Is Getting Sicker, Study Shows People lose ... largest analysis of trends in health around the world for the years 1990 to 2013, the journal ...

  7. Early Intervention Shows Promise in Treating Schizophrenia

    MedlinePLUS

    ... 153483.html Early Intervention Shows Promise in Treating Schizophrenia Programs that emphasize resiliency, education and job support ... health of patients in the early stages of schizophrenia, new research reveals. The finding, reported in the ...

  8. Ebola Treatment Shows Promise in Monkey Study

    MedlinePLUS

    Ebola Treatment Shows Promise in Monkey Study Antiviral drug cured animals with advanced infections, researchers say To ... HealthDay News) -- An experimental drug being tested on Ebola victims in Sierra Leone has proven effective in ...

  9. Depressed Systemic Arterial Compliance is Associated with the Severity of Heart Failure Symptoms in Moderate-to-Severe Aortic Stenosis: a Cross-Sectional Retrospective Study

    PubMed Central

    Kruszelnicka, Olga; Chmiela, Mark; Bobrowska, Beata; ?wierszcz, Jolanta; Bhagavatula, Seetha; Bednarek, Jacek; Surdacki, Andrzej; Nessler, Jadwiga; Hryniewiecki, Tomasz

    2015-01-01

    Background: Patients with aortic stenosis (AS) may develop heart failure even in the absence of severe valve stenosis. Our aim was to assess the contribution of systemic arterial properties and the global left ventricular afterload to graded heart failure symptoms in AS. Methods: We retrospectively reviewed medical records of 157 consecutive subjects (mean age, 71±10 years; 79 women and 78 men) hospitalized owing to moderate-to-severe degenerative AS. Exclusion criteria included more than mild aortic insufficiency or disease of another valve, atrial fibrillation, coronary artery disease, severe respiratory disease or anemia. Heart failure symptoms were graded by NYHA class at admission. Systemic arterial compliance (SAC) and valvulo-arterial impedance (Zva) were derived from routine echocardiography and blood pressure. Results: Sixty-one patients were asymptomatic, 49 presented mild (NYHA II) and 47 moderate-to-severe (NYHA III-IV) heart failure symptoms. Mild symptoms were associated with lower SAC and transvalvular gradients, while more severe exercise intolerance coincided with older age, lower systolic blood pressure, smaller aortic valve area and depressed ejection fraction. By multiple ordinal logistic regression, the severity of heart failure symptoms was related to older age, depressed ejection fraction and lower SAC. Each decrease in SAC by 0.1 ml/m² per mmHg was associated with an increased adjusted odds ratio (OR) of a patient being in one higher category of heart failure symptoms graded as no symptoms, mild exercise intolerance and advanced exercise intolerance (OR: 1.16 [95% CI, 1.01-1.35], P=0.045). Conclusions: Depressed SAC may enhance exercise intolerance irrespective of stenosis severity or left ventricular systolic function in moderate-to-severe AS. This finding supports the importance of non-valvular factors for symptomatic status in AS. PMID:26180511

  10. 2012 Severe Weather Awareness Guide

    E-print Network

    Meyers, Steven D.

    Florida's 2012 Severe Weather Awareness Guide 2012 Severe Weather Awareness Guide F L O R I D A D I of Emergency Management #12;Florida's Severe Weather Awareness Guide 2 Florida is affected by many natural. That is why I am proud to present the 2012 Severe Weather Awareness Guide. By reading this guide you can learn

  11. Educational Outreach: The Space Science Road Show

    NASA Astrophysics Data System (ADS)

    Cox, N. L. J.

    2002-01-01

    The poster presented will give an overview of a study towards a "Space Road Show". The topic of this show is space science. The target group is adolescents, aged 12 to 15, at Dutch high schools. The show and its accompanying experiments would be supported with suitable educational material. Science teachers at schools can decide for themselves if they want to use this material in advance, afterwards or not at all. The aims of this outreach effort are: to motivate students for space science and engineering, to help them understand the importance of (space) research, to give them a positive feeling about the possibilities offered by space and in the process give them useful knowledge on space basics. The show revolves around three main themes: applications, science and society. First the students will get some historical background on the importance of space/astronomy to civilization. Secondly they will learn more about novel uses of space. On the one hand they will learn of "Views on Earth" involving technologies like Remote Sensing (or Spying), Communication, Broadcasting, GPS and Telemedicine. On the other hand they will experience "Views on Space" illustrated by past, present and future space research missions, like the space exploration missions (Cassini/Huygens, Mars Express and Rosetta) and the astronomy missions (Soho and XMM). Meanwhile, the students will learn more about the technology of launchers and satellites needed to accomplish these space missions. Throughout the show and especially towards the end attention will be paid to the third theme "Why go to space"? Other reasons for people to get into space will be explored. An important question in this is the commercial (manned) exploration of space. Thus, the questions of benefit of space to society are integrated in the entire show. It raises some fundamental questions about the effects of space travel on our environment, poverty and other moral issues. The show attempts to connect scientific with community thought. The difficulty with a show this elaborate and intricate is communicating on a level understandable for teenagers, whilst not treating them like children. Professional space scientists know how easy it is to lose oneself in technical specifics. This would, of course, only confuse young people. The author would like to discuss the ideas for this show with a knowledgeable audience and hopefully get some (constructive) feedback.

  12. Influence of involvement of anterior leaflet versus posterior leaflet on residual regurgitation as assessed by transesophageal echocardiography in patients undergoing valve repair for mitral regurgitation due to mitral valve prolapse

    PubMed Central

    2009-01-01

    Background Repair of anterior leaflet prolapse is technically more challenging and this might influence outcomes as compared to the repair of posterior leaflet prolapse in patients undergoing surgical correction of mitral regurgitation. We investigated the association of anterior leaflet prolapse with minor residual mitral regurgitation (MR) in patients with mitral valve prolapse (MVP) who underwent valve repair. Methods Eligible for this study were consecutive patients with severe MR due to MVP, who underwent mitral valve repair with residual MR by postpump transesophageal echocardiography ?2+ during a 20-month period at Pasquinucci Hospital, Massa. Patients undergoing other cardiovascular surgical interventions were excluded. Two groups were defined according to the involvement of mitral valve leaflets: group 1, consisting of patients with anterior leaflet prolapse (isolated or not); and group 2, consisting of patients with isolated posterior leaflet prolapse. Results A total of 70 patients (18 in group 1 and 52 in group 2) were analyzed. Patients in group 2 were younger than those in group 1, but the difference was not significant (P = 0.052). There were no significant differences between the 2 study groups with respect to other variables. The proportion of patients with residual MR 1+/2+ was higher in group 1 than in group 2 (61.1% vs. 32.7%, respectively; P = 0.034). In a logistic regression model, anterior leaflet prolapse was an independent predictor of residual MR 1+/2+ (odds ratio, 4.0; 95% confidence interval, 1.14 to 14.04; P = 0.03). Conclusion In our study population, patients with anterior leaflet prolapse had a higher proportion of residual MR 1+/2+ as compared to those with posterior leaflet prolapse after repair of mitral valve. PMID:19922602

  13. Quantification of stenotic mitral valve area and diagnostic accuracy of mitral stenosis by dual-source computed tomography in patients with atrial fibrillation: comparison with cardiovascular magnetic resonance and transthoracic echocardiography.

    PubMed

    Kim, Song Soo; Ko, Sung Min; Song, Meong Gun; Chee, Hyun Kun; Kim, Jun Suk; Hwang, Hweung Kon; Lee, Jae-Hwan

    2015-06-01

    This study aimed to evaluate the utility of dual-source computed tomography (DSCT) for quantification of the mitral valve area (MVA) in patients with atrial fibrillation (AF) and mitral stenosis (MS) and to compare the results of DSCT with those of cardiovascular magnetic resonance (CMR) and transthoracic echocardiography (TTE). One hundred-two patients with AF and MS who had undergone electrocardiography-gated DSCT, TTE and CMR prior to operation were retrospectively enrolled. The MVA was planimetrically determined by DSCT, CMR, and TTE, as well as by Doppler TTE using the pressure half-time method (TTE-PHT). Agreement, relationship between measurements, and the highest accuracy were evaluated using Bland-Altman, Pearson correlation, and receiver operating characteristic analyses. The MVA on DSCT (mean, 1.27 ± 0.27 cm(2)) was significantly larger than that on CMR (1.15 ± 0.28 cm(2), P < 0.05), TTE-planimetry and TTE-PHT (1.16 ± 0.28 and 1.07 ± 0.30 cm(2), respectively; P < 0.05). TTE-planimetry had better correlation with planimetry on DSCT and CMR (r = 0.65 and 0.67, respectively; P < 0.05) than TTE-PHT (r = 0.51 and 0.55, respectively; P < 0.05). Using an MVA of 1.0 cm(2) on TTE-planimetry and TTE-PHT as the reference, the optimal thresholds for detecting severe MS on DSCT was 1.19 cm(2). The planimetry of the MVA measured by DSCT may be a reliable, alternative method for the quantification of MS in patients with AF. PMID:25011534

  14. Liquid Crystal Research Shows Deformation By Drying

    NASA Technical Reports Server (NTRS)

    2003-01-01

    These images, from David Weitz's liquid crystal research, show ordered uniform sized droplets (upper left) before they are dried from their solution. After the droplets are dried (upper right), they are viewed with crossed polarizers that show the deformation caused by drying, a process that orients the bipolar structure of the liquid crystal within the droplets. When an electric field is applied to the dried droplets (lower left), and then increased (lower right), the liquid crystal within the droplets switches its alignment, thereby reducing the amount of light that can be scattered by the droplets when a beam is shone through them.

  15. INTRODUCTION Mitotic metaphase chromosomes show sister chromatids

    E-print Network

    Villefranche sur mer

    . Meiosis I bivalents, as mitotic chromosomes, show sister-chromatid centromere and arm cohesions cohesion during meiosis I, and then release centromere cohesion during meiosis II (for review see Moore and Orr- Weaver, 1998). Consequently, this sequential loss of cohesion during meiosis might be precisely

  16. Olaparib shows promise in multiple tumor types.

    PubMed

    2013-07-01

    A phase II study of the PARP inhibitor olaparib (AstraZeneca) for cancer patients with inherited BRCA1 and BRCA2 gene mutations confirmed earlier results showing clinical benefit for advanced breast and ovarian cancers, and demonstrated evidence of effectiveness against pancreatic and prostate cancers. PMID:23847380

  17. The object-oriented trivia show (TOOTS)

    Microsoft Academic Search

    Jeff Gray; Jules White

    2010-01-01

    OOPSLA has a longstanding tradition of being a forum for discussing the cutting edge of technology in a fun and participatory environment. The type of events sponsored by OOPSLA sometimes border on the unconventional. This event represents an atypical panel that conforms to the concept of a game show that is focused on questions and answers related to SPLASH, OOPSLA,

  18. George Arcement Shows Locations of USGS Streamgages

    USGS Multimedia Gallery

    USGS Louisiana Water Science Center Director George Arcement shows the locations of USGS' streamgage network to WAFB Meteorologist Jay Grymes.  USGS maintains more than 30 real-time streamgages throughout the area affected by the 2011 Flood. In addition, more than 50 non-real-time gages were...

  19. 2014 NORTHWEST MICHIGAN ORCHARD & VINEYARD SHOW

    E-print Network

    2014 NORTHWEST MICHIGAN ORCHARD & VINEYARD SHOW Grand Traverse Resort January 14-15 Costs Wing Drosophila and Other Invasive Vineyard Bugs: Should We Be Concerned? Dr. Rufus Isaacs, MSU Dept. of Entomology 9:40 ­ 10:00 Use of Compost Tea in the Vineyard Dr. Annemiek Schilder, MSU Dept. of Plant

  20. Children's Art Show: An Educational Family Experience

    ERIC Educational Resources Information Center

    Bakerlis, Julienne

    2007-01-01

    In a time of seemingly rampant budget cuts in the arts in school systems throughout the country, a children's art show reaps many rewards. It can strengthen family-school relationships and community ties and stimulate questions and comments about the benefits of art and its significance in the development of young children. In this photo essay of…

  1. Show Them You Really Want the Job

    ERIC Educational Resources Information Center

    Perlmutter, David D.

    2012-01-01

    Showing that one really "wants" the job entails more than just really wanting the job. An interview is part Broadway casting call, part intellectual dating game, part personality test, and part, well, job interview. When there are 300 applicants for a position, many of them will "fit" the required (and even the preferred) skills listed in the job…

  2. Press Release End of Year Show 2013

    E-print Network

    Stell, John

    Press Release End of Year Show 2013 Published 4 th July Record numbers of guests attended our End press coverage, featuring live on BBC1's Look North on the Private View evening. Alex Dodgson BA (Hons) Fine Art third year student performed live, using his body as a canvas and encouraging visitors

  3. SHOW YOUR ARTWORKTHIS SPRING COLOR AND DESIGN

    E-print Network

    Portman, Douglas

    . Students are warmly encouraged to submit up to three pieces for consideration. Choices for the show pm on Saturday, March 10 with the submission sheet filled out. Early submissions are encouraged! Help-276-8959 mag.rochester.edu, magcw@mag.rochester.edu Please fill out this form and return it by March 10, 2012

  4. More Dangerous Ebola Strain Unlikely, Study Shows

    MedlinePLUS

    More Dangerous Ebola Strain Unlikely, Study Shows Researchers compared virus samples that were 9 months apart, and found normal mutating rate ... 26, 2015 THURSDAY, March 26, 2015 (HealthDay News) -- Ebola likely won't mutate into a strain that ...

  5. Aerial photo shows Launch Complex 39 Area

    NASA Technical Reports Server (NTRS)

    2000-01-01

    This aerial photo captures many of the facilities involved in Space Shuttle launches. At center is the Vehicle Assembly Building (VAB). The curved road on the near side is the newly restored crawlerway leading into the VAB high bay 2, where a mobile launcher platform/crawler-transporter currently sits. The road restoration and high bay 2 are part of KSC's Safe Haven project, enabling the storage of orbiters during severe weather. The road circles around the Orbiter Processing Facility 3 (OPF-3) at left center. OPF1 and OPF-2 are just below the curving road. The crawlerway also extends from the east side of the VAB out to the two launch pads, only one visible to the left of the VAB. In the distance is the Atlantic Ocean. To the right of the far crawlerway is the turn basin, into which ships tow the barge for offloading new external tanks from Louisiana.

  6. Do dogs ( Canis familiaris ) show contagious yawning?

    Microsoft Academic Search

    Aimee L. Harr; Valerie R. Gilbert; Kimberley A. Phillips

    2009-01-01

    We report an experimental investigation into whether domesticated dogs display contagious yawning. Fifteen dogs were shown\\u000a video clips of (1) humans and (2) dogs displaying yawns and open-mouth expressions (not yawns) to investigate whether dogs\\u000a showed contagious yawning to either of these social stimuli. Only one dog performed significantly more yawns during or shortly\\u000a after viewing yawning videos than to

  7. Learning helicopter control through “teaching by showing”

    Microsoft Academic Search

    James F. Montgomery; George A. Bekey

    1998-01-01

    A model-free “teaching by showing” methodology is developed to train a fuzzy-neural controller for an autonomous robot helicopter. The controller is generated and tuned using training data gathered while a teacher operates the helicopter. A hierarchical behavior-based control architecture is used, with each behavior implemented as a hybrid fuzzy logic controller (FLC) and general regression neural network controller (GRNNC). The

  8. Map showing depth to bedrock, Anchorage, Alaska

    USGS Publications Warehouse

    Glass, R.L.

    1988-01-01

    Knowledge of the physical and hydrologic characteristics of geologic materials is useful in determining the availability of groundwater for public and domestic supply and the suitability of areas for on-site septic systems. A generalized map of the Anchorage area shows the approximate distance from land surface to the top of the bedrock surface. Four depth zones are shown. The depths were determined from lithologic data contained in drillers ' logs. (USGS)

  9. 54. View from ground level in building no. 105 showing ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    54. View from ground level in building no. 105 showing lower radar scanner switch at open port door. Note incoming waveguide and control switch at lower left of photograph and note several waveguides leaving top of scanner switch around the circumference of switch. - Clear Air Force Station, Ballistic Missile Early Warning System Site II, One mile west of mile marker 293.5 on Parks Highway, 5 miles southwest of Anderson, Anderson, Denali Borough, AK

  10. Bariatric Surgery for Severe Obesity

    MedlinePLUS

    ... resources ??. Alternate Language URL Bariatric Surgery for Severe Obesity Page Content Bariatric Surgery for Adults Bariatric Surgery ... especially if they have a disease linked to obesity. Severe obesity is a chronic condition that is ...

  11. Desferrioxamine shows different potentials for enhancing 5-aminolaevulinic acid-based photodynamic therapy in several cutaneous cell lines

    Microsoft Academic Search

    Jiabin Yang; Yumin Xia; Xiaoming Liu; Shan Jiang; Layuan Xiong

    2010-01-01

    Protoporphyrin IX (PpIX) is the photosensitizer in 5-aminolaevulinic acid (ALA)-based photodynamic therapy (PDT). Its further\\u000a bioconversion to heme requires iron and can be suppressed by iron chelators such as desferrioxamine (DFO). To investigate\\u000a the effectiveness of DFO in enhancing PpIX-based PDT in skin tissue, we selected fibroblasts, HaCat cells and Hep-2 cells\\u000a as targets co-cultured with ALA, that have different

  12. Radar Signatures for Severe Convective Weather

    NSDL National Science Digital Library

    2014-09-14

    This resource is intended for use as a job aid by operational weather forecasters in live warning situations and as a reference tool to better understand some aspects of severe thunderstorm warning events. Thumbnail images show typical representatives for sixteen radar reflectivity and velocity signatures as well as three primary severe storm types. Each signature links to content describing detection techniques and conceptual and diagnostic information to help determine storm severity. The majority of the examples shown are southern hemisphere storms in Australia; examples from the northern hemisphere are noted.

  13. SEVERITY MEASUREMENTS FOR ROLLOVER CRASHES

    Microsoft Academic Search

    Kennerly H Digges; Ana Maria Eigen

    One of the confounding factors in analyzing rollover crashes and in designing countermeasures for rollovers is the lack of a standard measure of crash severity. This paper examines NASS CDS 1997 to 2002 in order to determine rollover crash severity metrics and to recommend additional data elements to assist in determining rollover severity. For belted occupants and unbelted ejected occupants

  14. Boron aluminum crippling strength shows improvement

    NASA Technical Reports Server (NTRS)

    Otto, O. R.; Bohlmann, R. E.

    1974-01-01

    Results are presented from an experimental program directed toward improving boron aluminum crippling strength. Laminate changes evaluated were larger filament diameter, improved processing, shape changes, adding steel-aluminum cross plies, reduced filament volume in corners, adding boron aluminum angle plies, and using titanium interleaves. Filament diameter and steel-aluminum cross plies have little effect on crippling. It is shown that better processing combined with appropriate shape changes improved crippling over 50 percent at both room temperature and 600 F. Tests also show that crippling improvements ranging from 20 to 40 percent are achieved using angle plies and titanium interleaves.

  15. Latest European coelacanth shows Gondwanan affinities.

    PubMed

    Cavin, Lionel; Forey, Peter L; Buffetaut, Eric; Tong, Haiyan

    2005-06-22

    The last European fossil occurrence of a coelacanth is from the Mid-Cretaceous of the English Chalk (Turonian, 90 million years ago). Here, we report the discovery of a coelacanth from Late Cretaceous non-marine rocks in southern France. It consists of a left angular bone showing structures that imply close phylogenetic affinities with some extinct Mawsoniidae. The closest relatives are otherwise known from Cretaceous continental deposits of southern continents and suggest that the dispersal of freshwater organisms from Africa to Europe occurred in the Late Cretaceous. PMID:17148159

  16. Diagnostic value of 18F-FDG PET in the assessment of myocardial viability in coronary artery disease: A comparative study with 99mTc SPECT and echocardiography

    PubMed Central

    Al Moudi, Mansour; Sun, Zhong-Hua

    2014-01-01

    Objective To investigate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in the assessment of myocardial viability in patients with known coronary artery disease (CAD) when compared to 99mTc single photon emission computed tomography (SPECT) and echocardiography, with invasive coronary angiography as the gold standard. Methods Thirty patients with diagnosed CAD met the selection criteria, with 10 of them (9 men, mean age 59.5 ± 10.5 years) undergoing all of these imaging procedures consisting of SPECT and PET, echocardiography and invasive angiography. Diagnostic sensitivity of these less invasive modalities for detection of myocardial viability was compared to invasive coronary angiography. Inter- and intra-observer agreement was assessed for diagnostic performance of SPECT and PET. Results Of all patients with proven CAD, 50% had triple vessel disease. Diagnostic sensitivity of SPECT, PET and echocardiography was 90%, 100% and 80% at patient-based assessment, respectively. Excellent agreement was achieved between inter-observer and intra-observer agreement of the diagnostic value of SPECT and PET in myocardial viability (k = 0.9). Conclusion 18F-FDG PET has high diagnostic value in the assessment of myocardial viability in patients with known CAD when compared to SPECT and echocardiography. Further studies based on a large cohort with incorporation of 18F-FDG PET into patient management are warranted. PMID:25278972

  17. Statistics of severe tornadoes and severe tornado outbreaks

    NASA Astrophysics Data System (ADS)

    Malamud, B. D.; Turcotte, D. L.

    2012-09-01

    The standard measures of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. In this study we consider severe tornadoes, which we define as L?10 km, in the continental USA (USA Storm Prediction Center Severe Weather Database). We find that for the period 1982-2011, for individual severe tornadoes (L?10 km): (i) There is a strong linear scaling between the number of severe tornadoes in a year and their total path length in that year. (ii) The cumulative frequency path length data suggests that, not taking into account any changing trends over time, we would expect in a given year (on average) one severe tornado with a path length L?115 km and in a decade (on average) one severe tornado with a path length L?215 km. (iii) The noncumulative frequency-length statistics of severe tornado touchdown path lengths, 20severe tornadoes in a convective day (12:00-12:00 UTC), LD, as a measure of the strength of a 24-h USA tornado outbreak. We find that: (i) For 1982-2011, the number of severe tornadoes in a USA convective day outbreak has a strong power-law relationship (exponent 0.80) on the convective day total path length, LD. (ii) For 1952-2011, the cumulative frequency path length data for severe tornado outbreaks suggests that we would expect in a given year (on average) one daily severe tornado outbreak with total path length LD?480 km and in a decade (on average) one daily severe tornado outbreak with a total path length LD?1200 km. (iii) For 1982-2011, the noncumulative frequency-length statistics of tornado outbreaks, 10severe tornadoes (L?10 km) during two tornado outbreaks, 27 April 2011 (67 severe tornadoes) and 25 May 2011 (16 severe tornadoes), and find similar statistical distributions with robust scaling. We believe that our robust scaling results provide evidence that touchdown path lengths can be used as quantitative measures of the systematic properties of severe tornadoes and severe tornado outbreaks.

  18. Show Me the Invisible: Visualizing Hidden Content

    PubMed Central

    Geymayer, Thomas; Steinberger, Markus; Lex, Alexander; Streit, Marc; Schmalstieg, Dieter

    2014-01-01

    Content on computer screens is often inaccessible to users because it is hidden, e.g., occluded by other windows, outside the viewport, or overlooked. In search tasks, the efficient retrieval of sought content is important. Current software, however, only provides limited support to visualize hidden occurrences and rarely supports search synchronization crossing application boundaries. To remedy this situation, we introduce two novel visualization methods to guide users to hidden content. Our first method generates awareness for occluded or out-of-viewport content using see-through visualization. For content that is either outside the screen’s viewport or for data sources not opened at all, our second method shows off-screen indicators and an on-demand smart preview. To reduce the chances of overlooking content, we use visual links, i.e., visible edges, to connect the visible content or the visible representations of the hidden content. We show the validity of our methods in a user study, which demonstrates that our technique enables a faster localization of hidden content compared to traditional search functionality and thereby assists users in information retrieval tasks. PMID:25325078

  19. Usefulness of tissue Doppler imaging for assessing left ventricular filling pressure in patients with stable severe systolic heart failure.

    PubMed

    Gellen, Barnabas; Canoui-Poitrine, Florence; Lesault, Pierre-François; Le Thuaut, Aurélie; Lim, Pascal; Gueret, Pascal; Guendouz, Soulef; Pongas, Dionyssis; Teiger, Emmanuel; Dubois-Randé, Jean-Luc; Hittinger, Luc; Damy, Thibaud

    2013-11-15

    The ratio of early transmitral blood flow velocity over tissue Doppler early diastolic mitral annulus velocity (E/e') was found unreliable for estimating pulmonary capillary wedge pressure (PCWP) in patients with decompensated systolic heart failure (HF). The objective of this study was to test its reliability in stable HF. Therefore, 130 consecutive patients with a left ventricular (LV) ejection fraction of <35% and stable HF underwent right-sided cardiac catheterization and transthoracic echocardiography with measurement of transmitral flow velocities (E, A) and mitral annulus velocities during systole (s') and diastole (e'). Mean age was 56 ± 11 years and mean LV ejection fraction was 28 ± 8%; 48% had PCWP of >15 mm Hg. E/e'septal correlated more strongly with PCWP (r = 0.53) compared with E/e'lateral (r = 0.41) and E/e'mean (r = 0.50; all p values <0.001). The area under the receiver operating characteristic curve (AUC) of E/e' ratios for PCWP estimation was 0.79 (95% confidence interval [CI] 0.70 to 0.87) for E/e'septal, 0.72 (95% CI 0.63 to 0.82) for E/elateral, and 0.79 (95% CI 0.70 to 0.87) for E/emean (all p values <0.0001). AUCs of E/eseptal and E/emean did not vary with s'septal, QRS width, or resynchronization. Using a cutoff of 8, negative predictive value of E/e'septal was 89% and negative likelihood ratio of 0.15. E/e'lateral showed good diagnostic performance only in patients with s'lateral of >4.5 cm/s (n = 77, 59%; AUC = 0.82; 95% CI 0.71 to 0.92; s'lateral of ?4.5 cm/s: AUC = 0.54; 95% CI 0.38 to 0.70; p = 0.005). In conclusion, e' is useful for estimating LV filling pressure in stable severe systolic HF. E/e'septal showed good diagnostic performance for detecting normal filling pressures. PMID:24012031

  20. Color Voyager 2 Image Showing Crescent Uranus

    NASA Technical Reports Server (NTRS)

    1990-01-01

    This image shows a crescent Uranus, a view that Earthlings never witnessed until Voyager 2 flew near and then beyond Uranus on January 24, 1986. This planet's natural blue-green color is due to the absorption of redder wavelengths in the atmosphere by traces of methane gas. Uranus' diameter is 32,500 miles, a little over four times that of Earth. The hazy blue-green atmosphere probably extends to a depth of around 5,400 miles, where it rests above what is believed to be an icy or liquid mixture (an 'ocean') of water, ammonia, methane, and other volatiles, which in turn surrounds a rocky core perhaps a little smaller than Earth.

  1. Microbiological and environmental issues in show caves.

    PubMed

    Saiz-Jimenez, Cesareo

    2012-07-01

    Cultural tourism expanded in the last half of the twentieth century, and the interest of visitors has come to include caves containing archaeological remains. Some show caves attracted mass tourism, and economical interests prevailed over conservation, which led to a deterioration of the subterranean environment and the rock art. The presence and the role of microorganisms in caves is a topic that is often ignored in cave management. Knowledge of the colonisation patterns, the dispersion mechanisms, and the effect on human health and, when present, over rock art paintings of these microorganisms is of the utmost importance. In this review the most recent advances in the study of microorganisms in caves are presented, together with the environmental implications of the findings. PMID:22806150

  2. Survey shows successes, failures of horizontal wells

    SciTech Connect

    Deskins, W.G.; McDonald, W.J. [Maurer Engineering Inc., Houston, TX (United States); Reid, T.B. [Dept. of Energy, Bartlesville, OK (United States)

    1995-06-19

    Industry`s experience now shows that horizontal well technology must be applied thoughtfully and be site-specific to attain technical and economic success. This article, based on a comprehensive study done by Maurer Engineering for the US Department of Energy (DOE), addresses the success of horizontal wells in less-publicized formations, that is, other than the Austin chalk. Early excitement within the industry about the new technology reached a fever pitch at times, leaving some with the impression that horizontal drilling is a panacea for all drilling environments. This work gauges the overall success of horizontal technology in US and Canadian oil and gas fields, defines the applications where horizontal technology is most appropriate, and assesses its impact on oil recovery and reserves.

  3. Surveys show support for green 'activities'.

    PubMed

    Baillie, Jonathan

    2012-03-01

    Two independently conducted surveys on sustainability - one into the 'views and values' of NHS 'leaders', and the other questioning the public about the importance of the 'green agenda' in the NHS, and their opinions on how the service might most effectively reduce its carbon footprint, form the basis of Sustainability in the NHS: Health Check 2012, a new NHS Sustainable Development Unit (NHS SDU) publication. As HEJ editor Jonathan Baillie reports, the new document also presents updated data on the 'size' of the carbon footprint of the NHS in England, showing that, although good work by a number of Trusts in the past two years has seen healthcare-generated carbon emissions start to 'level off', the biggest contributors have been the current health service spending review, and the increased national availability of renewable energy. PMID:22515017

  4. Mesenchymal stem cells show radioresistance in vivo

    PubMed Central

    Singh, Sarvpreet; Kloss, Frank R; Brunauer, Regina; Schimke, Magdalena; Jamnig, Angelika; Greiderer-Kleinlercher, Brigitte; Klima, Günter; Rentenberger, Julia; Auberger, Thomas; Hächl, Oliver; Rasse, Michael; Gassner, Robert; Lepperdinger, Günter

    2012-01-01

    Abstract Irradiation impacts on the viability and differentiation capacity of tissue-borne mesenchymal stem cells (MSC), which play a pivotal role in bone regeneration. As a consequence of radiotherapy, bones may develop osteoradionecrosis. When irradiating human bone-derived MSC in vitro with increasing doses, the cells’ self-renewal capabilities were greatly reduced. Mitotically stalled cells were still capable of differentiating into osteoblasts and pre-adipocytes. As a large animal model comparable to the clinical situation, pig mandibles were subjected to fractionized radiation of 2 ? 9 Gy within 1 week. This treatment mimics that of a standardized clinical treatment regimen of head and neck cancer patients irradiated 30 ? 2 Gy. In the pig model, fractures which had been irradiated, showed delayed osseous healing. When isolating MSC at different time points post-irradiation, no significant changes regarding proliferation capacity and osteogenic differentiation potential became apparent. Therefore, pig mandibles were irradiated with a single dose of either 9 or 18 Gy in vivo, and MSC were isolated immediately afterwards. No significant differences between the untreated and 9 Gy irradiated bone with respect to proliferation and osteogenic differentiation were unveiled. Yet, cells isolated from 18 Gy irradiated specimens exhibited a reduced osteogenic differentiation capacity, and during the first 2 weeks proliferation rates were greatly diminished. Thereafter, cells recovered and showed normal proliferation behaviour. These findings imply that MSC can effectively cope with irradiation up to high doses in vivo. This finding should thus be implemented in future therapeutic concepts to protect regenerating tissue from radiation consequences. PMID:21762375

  5. Severe Weather Forecast Decision Aid

    NASA Technical Reports Server (NTRS)

    Bauman, William H., III; Wheeler, Mark M.; Short, David A.

    2005-01-01

    This report presents a 15-year climatological study of severe weather events and related severe weather atmospheric parameters. Data sources included local forecast rules, archived sounding data, Cloud-to-Ground Lightning Surveillance System (CGLSS) data, surface and upper air maps, and two severe weather event databases covering east-central Florida. The local forecast rules were used to set threat assessment thresholds for stability parameters that were derived from the sounding data. The severe weather events databases were used to identify days with reported severe weather and the CGLSS data was used to differentiate between lightning and non-lightning days. These data sets provided the foundation for analyzing the stability parameters and synoptic patterns that were used to develop an objective tool to aid in forecasting severe weather events. The period of record for the analysis was May - September, 1989 - 2003. The results indicate that there are certain synoptic patterns more prevalent on days with severe weather and some of the stability parameters are better predictors of severe weather days based on locally tuned threat values. The results also revealed the stability parameters that did not display any skill related to severe weather days. An interactive web-based Severe Weather Decision Aid was developed to assist the duty forecaster by providing a level of objective guidance based on the analysis of the stability parameters, CGLSS data, and synoptic-scale dynamics. The tool will be tested and evaluated during the 2005 warm season.

  6. Statistics of Severe Tornadoes and Severe Tornado Outbreaks

    NASA Astrophysics Data System (ADS)

    Malamud, B. D.; Turcotte, D. L.

    2012-04-01

    The standard measures of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. In this study we consider 4,061 severe tornadoes (defined as L? 10 km) in the continental USA for the time period 1981-2010 (USA Storm Prediction Center Severe Weather Database). We find for individual severe tornadoes: (i) The noncumulative frequency-length statistics of severe tornado touchdown path lengths, 20 < L < 200 km, is well approximated by an inverse power-law relationship with exponent near 3. (ii) There is a strong linear scaling between the number of severe tornadoes in a year and their total path lengths in that year. We then take the total path length of severe tornadoes in a day, LD, as a measure of the strength of a 24-hour USA tornado outbreak. We find that: (i) On average, the number of days per year with at least one continental USA severe tornado (path length L? 10 km) has increased 16% in the 30-year period 1981-2010. (ii) The daily numbers of severe tornadoes in a USA outbreak have a strong power-law relationship (exponent 0.87) on their daily total path lengths, LD, over the range 20 < LD

  7. Statistical Scaling of Severe Tornadoes and Severe Tornado Outbreaks

    NASA Astrophysics Data System (ADS)

    Turcotte, D. L.; Malamud, B. D.

    2012-12-01

    The standard measures of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. Here we consider severe tornadoes, which we define as L ? 10 km, in the continental USA (USA Storm Prediction Center Severe Weather Database). We find that for the period 1982-2011, for individual severe tornadoes (L ? 10 km): (i) There is a strong linear scaling between the number of severe tornadoes in a year and their total path lengths in that year. (ii) The cumulative path length data suggests that the longest severe tornado path length (or greater) expected in a year (on average) is L = 115 km and in a decade (on average) is L = 215 km. (iii) The noncumulative frequency-length statistics of severe tornado touchdown path lengths, 20 < L < 200 km, is well approximated by an inverse power-law relationship with exponent near 3. We then take the total path length of severe tornadoes in a convective day (12:00-12:00 UTC), LD, as a measure of the strength of a 24-hour USA tornado outbreak. We find that: (i) For 1982-2011, the numbers of severe tornadoes in a USA convective day outbreak have a strong power-law relationship (exponent 0.80) with their convective day total path lengths, LD, over the range 20 < LD < 1000 km/dy. (ii) For 1952-2011, the cumulative severe tornado outbreak path length data suggests that the longest daily outbreak path length total (or greater) expected in a year (on average) is LD = 480 km and in a decade (on average) is LD = 120 km. (iii) For 1982-2011, the noncumulative frequency-length statistics of tornado outbreaks, 10 < LD <1000 km/dy, is well approximated by an inverse power-law relationship with exponent near 1.8. Finally, we consider the frequency path-length scaling of severe tornadoes (L ? 10 km) during two tornado outbreaks, 27 April 2011 (67 severe tornadoes) and 25 May 2011 (16 severe tornadoes), and find similar statistical distributions with robust scaling. We believe that our robust scaling results provide evidence that touchdown path lengths can be used as quantitative measures of the systematic properties of severe tornadoes and severe tornado outbreaks.

  8. Statistics of Severe Tornadoes and Severe Tornado Outbreaks

    NASA Astrophysics Data System (ADS)

    Malamud, B. D.; Turcotte, D. L.

    2011-12-01

    The standard measure of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. In this study we consider 4,061 severe tornadoes, with L ? 10 km, in the continental USA for the period 1981-2010 (Storm Prediction Center Severe Weather Database). We find for individual severe tornadoes: (i) The noncumulative frequencies, f(L), have a strong power-law relationship on severe tornado path lengths, L. (ii) The dependence of the number of severe tornadoes in a year on the total length in that year also exhibits strong power-law scaling. We then take the total path length of severe tornadoes in a day, LD, as a measure of the strength of a 24-hour USA tornado outbreak. We find that: (i) The number of days on which USA outbreaks occur has increased 15% in the 30-year period considered over the continental USA. (ii) The numbers of severe tornadoes in a USA outbreak, ND, have a strong power-law relationship on total 24-hour path lengths, LD. (iii) The noncumulative frequencies, f(LD), have a strong power-law relationship on severe tornado path lengths, LD. We believe that our robust scaling results provide evidence that touchdown lengths might be used as quantitative measures of the systematic properties of severe tornadoes and severe tornado outbreaks.

  9. Statistics of severe tornadoes and severe tornado outbreaks

    NASA Astrophysics Data System (ADS)

    Malamud, B. D.; Turcotte, D. L.

    2012-03-01

    The standard measures of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. In this study we consider 4061 severe tornadoes (defined as L?10 km) in the continental USA for the time period 1981-2010 (USA Storm Prediction Center Severe Weather Database). We find for individual severe tornadoes: (i) The noncumulative frequency-length statistics of severe tornado touchdown path lengths, 20 < L < 200 km, is well approximated by an inverse power-law relationship with exponent near 3. (ii) There is a strong linear scaling between the number of severe tornadoes in a year and their total path lengths in that year. We then take the total path length of severe tornadoes in a day, LD, as a measure of the strength of a 24-hour USA tornado outbreak. We find that: (i) On average, the number of days per year with at least one continental USA severe tornado (path length L?10 km) has increased 16% in the 30-year period 1981-2010. (ii) The daily numbers of severe tornadoes in a USA outbreak have a strong power-law relationship (exponent 0.87) on their daily total path lengths, LD, over the range 20 < LD < 1000 km dy-1. (iii) The noncumulative frequency-length statistics of tornado outbreaks, 10 < LD < 1000 km dy-1, is well approximated by an inverse power-law relationship with exponent near 1.7. We believe that our robust scaling results provide evidence that touchdown path lengths can be used as quantitative measures of the systematic properties of severe tornadoes and severe tornado outbreaks.

  10. Indexes of severity: conceptual development.

    PubMed Central

    Krischer, J P

    1979-01-01

    A discussion of severity index development is presented in relation to conceptual issues in index definition, analytic issues in index formulation and validation issues in index application. The CHOP index is discussed along with six severity indexes described in an earlier paper dealing with underlying concepts to illustrate the material presented. Replies are provided to specific questions raised in an accompanying paper discussing the Injury Severity Score. This conceptual material is presented to provide a foundation for severity index development, to suggest criteria to be used in their formulation and testing, and to identify analyses that can lead to the successful selection and application of an index for a defined purpose. PMID:468553

  11. Severe peripheral airway obstruction after inhalation burn

    Microsoft Academic Search

    N. Jaspar; M. Bracamonte; R. Sergysels

    1982-01-01

    In a patient recovering from an acute airway burn, after blast, late functional results showed severe peripheral airway obstruction despite a normal X-ray and minimal complaints. This suggests the possible development ofbronchiolitis obliterans after burn injury of the peripheral airways.

  12. Mesangiolytic glomerulopathy in severe congestive heart failure

    Microsoft Academic Search

    Haruyoshi Yoshida; Masatomo Yashiro; Ping Liang; Eri Muso; Eiji Takeuchi; Toshihide Shimada; Ken-Ichi Sekita; Takahiko Ono; Kazuro Kanatsu; Taketoshi Sugiyama; Chuichi Kawai; Shigetake Sasayama

    1998-01-01

    Mesangiolytic glomerulopathy in severe congestive heart failure. To study the glomerular morphological abnormalities in congestive heart failure (CHF), we analyzed 27 autopsy cases without other causes of renal disease. Their mean age was 59 years, and they showed mild prerenal azotemia. They had generally been treated with digitalis and diuretics, and a few of them with captopril or nifedipine. The

  13. Severe mitral regurgitation due to left atrial aneurysm corrected by endoatrial patch plasty.

    PubMed

    Parachuri, V Rao; Banakal, Sanjaykumar C; Appajaiah, Chiran B

    2009-03-01

    Congenital aneurysm of the body of the left atrium causing severe mitral incompetence is extremely rare. The cause of mitral incompetence has been attributed to a distortion of the mitral annulus by the aneurysm, or to coexisting pathology in the mitral valve apparatus. Surgical techniques to treat this condition include excision of the aneurysm along with mitral valve repair or replacement. Herein is described the case of a 30-year-old man with large aneurysm of the left atrial body and severe mitral regurgitation (MR) treated by endoatrial patch plasty. The mitral incompetence was due to prolapse of the posterior mitral annulus into the neck of the aneurysm. Under cardiopulmonary bypass, the neck of the aneurysm was closed using a Dacron patch. Endoaneurysmorrhaphy with a Dacron patch effectively restored the mitral competence and simultaneously excluded the aneurysm from the left atrium. To further strengthen the posterior mitral annulus, a mitral annuloplasty was added using a rigid Carpentier-Edwards ring. The patient was anticoagulated with warfarin for six weeks after surgery. Transthoracic echocardiography performed at a six-month follow up confirmed the absence of any residual aneurysm or MR. To the authors' knowledge, this is the first case of left atrial aneurysm with severe MR to be treated in this way. PMID:19455888

  14. The Impact of Plant Enemies Shows a Phylogenetic Signal

    PubMed Central

    Gilbert, Gregory S.; Briggs, Heather M.; Magarey, Roger

    2015-01-01

    The host ranges of plant pathogens and herbivores are phylogenetically constrained, so that closely related plant species are more likely to share pests and pathogens. Here we conducted a reanalysis of data from published experimental studies to test whether the severity of host-enemy interactions follows a similar phylogenetic signal. The impact of herbivores and pathogens on their host plants declined steadily with phylogenetic distance from the most severely affected focal hosts. The steepness of this phylogenetic signal was similar to that previously measured for binary-response host ranges. Enemy behavior and development showed similar, but weaker phylogenetic signal, with oviposition and growth rates declining with evolutionary distance from optimal hosts. Phylogenetic distance is an informative surrogate for estimating the likely impacts of a pest or pathogen on potential plant hosts, and may be particularly useful in early assessing risk from emergent plant pests, where critical decisions must be made with incomplete host records. PMID:25893581

  15. Tinnitus severity, loudness, and depression

    Microsoft Academic Search

    ROBERT L. FOLMER; SUSAN E. GRIEST; MARY B. MEIKLE; WILLIAM H. MARTIN

    1999-01-01

    Answers to questionnaires filled out by 436 patients who visited our tinnitus clinic were analyzed. Patients were asked to report the presence or absence of depression and to rate the loudness and severity of their tinnitus. Responses to questions about tinnitus loudness and severity from 121 patients who reported current depression were compared with responses from 285 patients who reported

  16. Severe hyponatremia and Schmidt's syndrome.

    PubMed

    Wehbe, Edgard; Grant, Michael E

    2008-06-01

    Severe hyponatremia, defined by a sodium concentration of below 115 meq/l, is rarely reported with Schmidt's syndrome. We report a 43-year-old woman diagnosed with Schmidt's syndrome during the workup for severe hyponatremia as well a review of all the reported cases. The Medline database from 1960 to 2007 and relevant references of selected articles were searched. Search terms included hyponatremia, hypothyroidism, autoimmune thyroid disease, adrenal insufficiency, adrenal failure, Schmidt's syndrome and autoimmune polyendocrine syndrome type 2. The search was restricted to the English language, human subjects, and patients with a serum sodium concentration of below 115 meq/l. Seven cases were reported including this report. Severe hyponatremia seems to be found more often in patients with severe hypothyroidism. To our knowledge this is the first case to describe the occurrence of severe hyponatremia with normal thyroid function test and normal baseline cortisol level. PMID:18283521

  17. Modeling forest fire severity in California, USA

    NASA Astrophysics Data System (ADS)

    Keyser, A.; Westerling, A. L.

    2009-12-01

    A long history of fire suppression in the western United States has interrupted the fire regimes of many forest types. This interruption has significantly changed forest structure and ecological function and led to increasingly uncharacteristic fires in terms of size and severity. Identifying areas at risk for fires whose severity is outside the natural fire regime will allow for targeted fuel reduction and mitigation to preserve ecosystem integrity. The probability of large fire occurrence has been successfully predicted and forecast using hydro-climate variables and statistical modeling techniques. We are employing similar statistical techniques to test the potential for predicting and forecasting forest fire severity for California, USA under current and future climate scenarios. We have a mapped fire severity dataset for forest fires spanning twenty-two years (1984-2006) for California as well as a suite of topographic and vegetation data layers from the Landfire project. Our hydro-climate dataset was developed using the VIC hydrologic model with the LDAS parameterization; we thus used the LDAS 1/8° grid to sample our fire severity, topographic and vegetation datasets. Initial exploratory analyses of the hydro-climate data show that low fractional fire severity is positively correlated to cumulative precipitation for the 12-month prior period and the 12-month period ending 6-month prior to the month of the fire, while moderate to high fractional severity is negatively correlated. Relationships opposite in sign, but comparative in magnitude, were found for cumulative adjusted moisture deficit for 12 months prior to the month of fire and the 12-month period ending 6 months prior to the fire. Additionally, fire area was positively correlated to both cumulative moisture deficit variables. Current year March and April snow water equivalent were negatively correlated to moderate and high fractional fire severity. Using only hydro-climate data predictors, we were able to predict high severity fraction (fraction of the fire in the high severity category relative to fire size) using a third order polynomial regression with the following independent variables: one year moisture deficit, average relative humidity, monthly average temperature, mean elevation, the latter three for month of fire. These relationships are expected as we know that fuel moisture is an important control on potential fire severity and all will affect fuel moisture content. We also know that vegetation, fuels, and topography affect potential fire severity. We will add these data layers to the aforementioned hydro-climate variables to improve our predictive capability. A refined prediction model will be presented with forecast of potential changes in fire severity under climate change scenarios.

  18. Closeup view of portion of swingspan truss showing members and ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Close-up view of portion of swing-span truss showing members and their pin connections at joints. The vertical member (hanger) shown is a portion of a small secondary truss added in each subdivided panel to help support the bottom chord. The track timber ties span the distance (16'-0') center to center of trusses, rest on the bottom chord and support the track. Note: Several of the members shown are eyebars. - Bridgeport Swing Span Bridge, Spanning Tennessee River, Bridgeport, Jackson County, AL

  19. Fracture/Severance of Materials

    NASA Technical Reports Server (NTRS)

    Schimmel, Morry L. (Inventor); Bement, Laurence J. (Inventor); DuBrucq, Glenn F., Jr. (Inventor); Klein, Edward A. (Inventor)

    1998-01-01

    A method for severing or weakening materials is discussed. Explosive cords are placed in grooves on the upper surface of the material to be severed or weakened. The explosive cords are initiated simultaneously to introduce explosive shock waves into the material. These shock waves progress toward the centerline between the explosive cords and the lower surface of the material. Intersecting and reflected waves produce a rarefaction zone on the centerline to fail the material in tension. A groove may also be cut in the lower surface of the material to aid in severing or weakening the material.

  20. Mapping of mitral regurgitant defects by cardiovascular magnetic resonance in moderate or severe mitral regurgitation secondary to mitral valve prolapse

    PubMed Central

    Gabriel, Ruvin S; Kerr, Andrew J; Raffel, Owen C; Stewart, Ralph A; Cowan, Brett R; Occleshaw, Christopher J

    2008-01-01

    Purpose In mitral valve prolapse, determining whether the valve is suitable for surgical repair depends on the location and mechanism of regurgitation. We assessed whether cardiovascular magnetic resonance (CMR) could accurately identify prolapsing or flail mitral valve leaflets and regurgitant jet direction in patients with known moderate or severe mitral regurgitation. Methods CMR of the mitral valve was compared with trans-thoracic echocardiography (TTE) in 27 patients with chronic moderate to severe mitral regurgitation due to mitral valve prolapse. Contiguous long-axis high temporal resolution CMR cines perpendicular to the valve commissures were obtained across the mitral valve from the medial to lateral annulus. This technique allowed systematic valve inspection and mapping of leaflet prolapse using a 6 segment model. CMR mapping was compared with trans-oesophageal echocardiography (TOE) or surgical inspection in 10 patients. Results CMR and TTE agreed on the presence/absence of leaflet abnormality in 53 of 54 (98%) leaflets. Prolapse or flail was seen in 36 of 54 mitral valve leaflets examined on TTE. CMR and TTE agreed on the discrimination of prolapse from flail in 33 of 36 (92%) leaflets and on the predominant regurgitant jet direction in 26 of the 27 (96%) patients. In the 10 patients with TOE or surgical operative findings available, CMR correctly classified presence/absence of segmental abnormality in 49 of 60 (82%) leaflet segments. Conclusion Systematic mitral valve assessment using a simple protocol is feasible and could easily be incorporated into CMR studies in patients with mitral regurgitation due to mitral valve prolapse. PMID:18400088

  1. Sequential Treatments for Severe Phobia

    ERIC Educational Resources Information Center

    Mahoney, Michael J.

    1971-01-01

    Sequential treatment involving systematic desensitization and relaxation, symbolic (film), live, and participant modeling were employed in the successful alleviation of a severe snake phobia. Implications are discussed regarding the utility of programs attuned to the needs of individual patients. (Author)

  2. Severe Weather 101: Flood Basics

    MedlinePLUS

    Severe Weather 101 Flood Basics What is flooding? Flooding is an overflowing of water onto land that is normally dry. Floods can happen during heavy rains, when ocean waves come on shore, when snow melts too fast, ...

  3. Severe Asthma with Fungal Sensitization

    Microsoft Academic Search

    Ritesh Agarwal

    A new phenotype of asthma has been described recently, namely severe asthma with fungal sensitization (SAFS). SAFS can be\\u000a conceptualized as a continuum of fungal sensitization, with asthma at one end and allergic bronchopulmonary aspergillosis\\u000a at the other. It is diagnosed by the presence of severe asthma, fungal sensitization, and exclusion of allergic bronchopulmonary\\u000a aspergillosis. Because of the paucity of

  4. Caveolin-1/3 double-knockout mice are viable, but lack both muscle and non-muscle caveolae, and develop a severe cardiomyopathic phenotype.

    PubMed

    Park, David S; Woodman, Scott E; Schubert, William; Cohen, Alex W; Frank, Philippe G; Chandra, Madhulika; Shirani, Jamshid; Razani, Babak; Tang, Baiyu; Jelicks, Linda A; Factor, Stephen M; Weiss, Louis M; Tanowitz, Herbert B; Lisanti, Michael P

    2002-06-01

    The caveolin gene family consists of caveolins 1, 2, and 3. Caveolins 1 and 2 are co-expressed in many cell types, such as endothelial cells, fibroblasts, smooth muscle cells and adipocytes, where they form a heteroligomeric complex. In contrast, the expression of caveolin-3 is muscle-specific. Thus, the expression of caveolin-1 is required for caveolae formation in non-muscle cells, while the expression of caveolin-3 drives caveolae formation in striated muscle cell types (cardiac and skeletal). To create a truly caveolae-deficient mouse, we interbred Cav-1 null mice and Cav-3 null mice to generate Cav-1/Cav-3 double-knockout (Cav-1/3 dKO) mice. Here, we report that Cav-1/3 dKO mice are viable and fertile, despite the fact that they lack morphologically identifiable caveolae in endothelia, adipocytes, smooth muscle cells, skeletal muscle fibers, and cardiac myocytes. We also show that these mice are deficient in all three caveolin gene products, as caveolin-2 is unstable in the absence of caveolin-1. Interestingly, Cav-1/3 dKO mice develop a severe cardiomyopathy. At 2 months of age, analysis of Cav-1/3 dKO hearts via gated magnetic resonance imaging reveals a dramatic increase in left ventricular wall thickness, as compared with Cav-1-KO, Cav-3 KO, and wild-type mice. Further functional analysis of Cav-1/3 dKO hearts via transthoracic echocardiography demonstrates hypertrophy and dilation of the left ventricle, with a significant decrease in fractional shortening. As predicted, Northern analysis of RNA derived from the left ventricle of Cav-1/3 dKO mice shows a dramatic up-regulation of the atrial natriuretic factor message, a well-established biochemical marker of cardiac hypertrophy. Finally, histological analysis of Cav-1/3 dKO hearts reveals hypertrophy, disorganization, and degeneration of the cardiac myocytes, as well as chronic interstitial fibrosis and inflammation. Thus, dual ablation of both Cav-1 and Cav-3 genes in mice leads to a pleiotropic defect in caveolae formation and severe cardiomyopathy. PMID:12057923

  5. Caveolin-1/3 Double-Knockout Mice Are Viable, but Lack Both Muscle and Non-Muscle Caveolae, and Develop a Severe Cardiomyopathic Phenotype

    PubMed Central

    Park, David S.; Woodman, Scott E.; Schubert, William; Cohen, Alex W.; Frank, Philippe G.; Chandra, Madhulika; Shirani, Jamshid; Razani, Babak; Tang, Baiyu; Jelicks, Linda A.; Factor, Stephen M.; Weiss, Louis M.; Tanowitz, Herbert B.; Lisanti, Michael P.

    2002-01-01

    The caveolin gene family consists of caveolins 1, 2, and 3. Caveolins 1 and 2 are co-expressed in many cell types, such as endothelial cells, fibroblasts, smooth muscle cells and adipocytes, where they form a heteroligomeric complex. In contrast, the expression of caveolin-3 is muscle-specific. Thus, the expression of caveolin-1 is required for caveolae formation in non-muscle cells, while the expression of caveolin-3 drives caveolae formation in striated muscle cell types (cardiac and skeletal). To create a truly caveolae-deficient mouse, we interbred Cav-1 null mice and Cav-3 null mice to generate Cav-1/Cav-3 double-knockout (Cav-1/3 dKO) mice. Here, we report that Cav-1/3 dKO mice are viable and fertile, despite the fact that they lack morphologically identifiable caveolae in endothelia, adipocytes, smooth muscle cells, skeletal muscle fibers, and cardiac myocytes. We also show that these mice are deficient in all three caveolin gene products, as caveolin-2 is unstable in the absence of caveolin-1. Interestingly, Cav-1/3 dKO mice develop a severe cardiomyopathy. At 2 months of age, analysis of Cav-1/3 dKO hearts via gated magnetic resonance imaging reveals a dramatic increase in left ventricular wall thickness, as compared with Cav-1-KO, Cav-3 KO, and wild-type mice. Further functional analysis of Cav-1/3 dKO hearts via transthoracic echocardiography demonstrates hypertrophy and dilation of the left ventricle, with a significant decrease in fractional shortening. As predicted, Northern analysis of RNA derived from the left ventricle of Cav-1/3 dKO mice shows a dramatic up-regulation of the atrial natriuretic factor message, a well-established biochemical marker of cardiac hypertrophy. Finally, histological analysis of Cav-1/3 dKO hearts reveals hypertrophy, disorganization, and degeneration of the cardiac myocytes, as well as chronic interstitial fibrosis and inflammation. Thus, dual ablation of both Cav-1 and Cav-3 genes in mice leads to a pleiotropic defect in caveolae formation and severe cardiomyopathy. PMID:12057923

  6. Asymptomatic myotonia congenita unmasked by severe hypothyroidism.

    PubMed

    Passeri, Elena; Sansone, Valeria A; Verdelli, Chiara; Mendola, Marco; Corbetta, Sabrina

    2014-04-01

    Myotonia congenita is an inherited muscle disorder sustained by mutations in the skeletal muscle chloride channel gene CLCN1. Symptoms vary from mild to severe and generalized myotonia and worsen with cold, stressful events and hormonal fluctuations. Here we report the case of a young woman who sought medical attention because of subacute onset of diffuse and severe limb myotonia. CLCN1 gene sequencing showed a heterozygous transversion (T550M), two polymorphisms and one silent mutation. Thyroid function screening revealed severe hypothyroidism. She was placed on l-thyroxine replacement therapy which dramatically improved myotonia. We conclude that hypothyroidism unmasked a genetically determined, clinically asymptomatic chloride channelopathy. Diagnostic work-up in patients with clinically isolated myotonia should not be limited to genetic screening of non-dystrophic or dystrophic myotonias. Considering the high prevalence of hypothyroidism in females, systematic thyroid function screening by looking for additional hypothyroid symptoms and serum TSH levels measurement is mandatory in these patients. PMID:24530047

  7. Severity of cardiomyopathy associated with adenine nucleotide translocator-1 deficiency correlates with mtDNA haplogroup

    PubMed Central

    Strauss, Kevin A.; DuBiner, Lauren; Simon, Mariella; Zaragoza, Michael; Sengupta, Partho P.; Li, Peng; Narula, Navneet; Dreike, Sandra; Platt, Julia; Procaccio, Vincent; Ortiz-González, Xilma R.; Puffenberger, Erik G.; Kelley, Richard I.; Morton, D. Holmes; Narula, Jagat; Wallace, Douglas C.

    2013-01-01

    Mutations of both nuclear and mitochondrial DNA (mtDNA)–encoded mitochondrial proteins can cause cardiomyopathy associated with mitochondrial dysfunction. Hence, the cardiac phenotype of nuclear DNA mitochondrial mutations might be modulated by mtDNA variation. We studied a 13-generation Mennonite pedigree with autosomal recessive myopathy and cardiomyopathy due to an SLC25A4 frameshift null mutation (c.523delC, p.Q175RfsX38), which codes for the heart-muscle isoform of the adenine nucleotide translocator–1. Ten homozygous null (adenine nucleotide translocator–1?/?) patients monitored over a median of 6 years had a phenotype of progressive myocardial thickening, hyperalaninemia, lactic acidosis, exercise intolerance, and persistent adrenergic activation. Electrocardiography and echocardiography with velocity vector imaging revealed abnormal contractile mechanics, myocardial repolarization abnormalities, and impaired left ventricular relaxation. End-stage heart disease was characterized by massive, symmetric, concentric cardiac hypertrophy; widespread cardiomyocyte degeneration; overabundant and structurally abnormal mitochondria; extensive subendocardial interstitial fibrosis; and marked hypertrophy of arteriolar smooth muscle. Substantial variability in the progression and severity of heart disease segregated with maternal lineage, and sequencing of mtDNA from five maternal lineages revealed two major European haplogroups, U and H. Patients with the haplogroup U mtDNAs had more rapid and severe cardiomyopathy than those with haplogroup H. PMID:23401503

  8. Fatal coronary artery disease in an infant with severe mucopolysaccharidosis type I.

    PubMed

    van den Broek, Leonie; Backx, Ad P C M; Coolen, Hans; Wijburg, Frits A; Wevers, Ron; Morava, Eva; Neeleman, Chris

    2011-05-01

    A previously healthy 10-month-old boy was referred to our hospital because of coarse facial features that were suggestive of lysosomal storage disease. Apart from noisy respiration, there was no medical history. Elevated levels of urinary glycosaminoglycans and complete deficiency of leukocyte ?-l-iduronidase indicated severe mucopolysaccharidosis type I. A chest radiograph revealed a markedly enlarged heart, and echocardiography revealed hypertrophic cardiomyopathy. While hematopoietic stem cell transplantation was being planned, progressive cardiac failure developed with a striking hypokinesia of the left-ventricle free wall. In combination with ischemic changes on the electrocardiogram, this was suggestive of coronary artery disease. Results of coronary echo Doppler interrogation were inconclusive, and intravascular ultrasound in this little infant was not feasible. Despite the patient's small size, a successful selective coronary angiography was performed and revealed diffuse narrowing of the left coronary artery with collateral flow from the right coronary artery. Enzyme-replacement therapy was started immediately in an attempt to improve myocardial performance. Evaluation after 3 months, however, revealed complete obliteration of the left coronary main stem with diffuse hypokinesia/akinesia of the left ventricle. At the age of 13 months the boy died of terminal cardiac failure. This case report illustrates the importance of considering early development of coronary artery disease in children with severe mucopolysaccharidosis type I and cardiomyopathy. PMID:21464194

  9. Using Image Processing to Determine Emphysema Severity

    NASA Astrophysics Data System (ADS)

    McKenzie, Alexander; Sadun, Alberto

    2010-10-01

    Currently X-rays and computerized tomography (CT) scans are used to detect emphysema, but other tests are required to accurately quantify the amount of lung that has been affected by the disease. These images clearly show if a patient has emphysema, but are unable by visual scan alone, to quantify the degree of the disease, as it presents as subtle, dark spots on the lung. Our goal is to use these CT scans to accurately diagnose and determine emphysema severity levels in patients. This will be accomplished by performing several different analyses of CT scan images of several patients representing a wide range of severity of the disease. In addition to analyzing the original CT data, this process will convert the data to one and two bit images and will then examine the deviation from a normal distribution curve to determine skewness. Our preliminary results show that this method of assessment appears to be more accurate and robust than the currently utilized methods, which involve looking at percentages of radiodensities in the air passages of the lung.

  10. Performance of Different Scan Protocols of Fetal Echocardiography in the Diagnosis of Fetal Congenital Heart Disease: A Systematic Review and Meta-Analysis

    PubMed Central

    Li, Yifei; Hua, Yimin; Fang, Jie; Wang, Chuan; Qiao, Lina; Wan, Chaomin; Mu, Dezhi; Zhou, Kaiyu

    2013-01-01

    Objective The rapid progress in fetal echocardiography has lead to early detection of congenital heart diseases. Increasing evidences have shown that prenatal diagnosis could be life saving in certain cases. However, there is no agreement on which protocol is most adaptive diagnostic one. Thus, we use meta-analysis to conduct a pooled performance test on 5 diagnostic protocols. Methods We searched PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials and WHO clinical trails registry center to identify relevant studies up to August, 2012. We performed meta-analysis in a fixed/random-effect model using Meta-disc 1.4. We used STATA 11.0 to estimate the publication bias and SPSS 17.0 to evaluate variance. Results We use results from 81 studies in 63 articles to analyze the pooled accuracy. The overall performance of pooled sensitivities of spatiotemporal image correlation (STIC), extend cardiac echography examination (ECEE) and 4 chambers view + outflow tract view + 3 vessels and trachea view (4 CV+OTV+3 VTV) were around 0.90, which was significant higher than that of 4 chambers view + outflow tract view or 3 vessels and trachea view (4 CV+OTV/3 VTV) and 4 chambers view (4 CV). Unfortunately the pooled specificity of STIC was 0.92, which was significant lower than that of other 4 protocols which reached at 1.00. The area under the summary receiver operating characteristic curves value of STIC, ECEE, 4 CV+OTV+3 VTV, 4 CV+OTV/3 VTV and 4 CV were 0.9700, 0.9971, 0.9983, 0.9929 and 0.9928 respectively. Conclusion These results suggest a great diagnostic potential for fetal echocardiography detection as a reliable method of fetal congenital heart disease. But at least 3 sections view (4 CV, OTV and 3 VTV) should be included in scan protocol, while the STIC can be used to provide more information for local details of defects, and can not be used to make a definite diagnosis alone with its low specificity. PMID:23750263

  11. Strain and strain rate by speckle-tracking echocardiography correlate with pressure-volume loop-derived contractility indices in a rat model of athlete's heart.

    PubMed

    Kovács, Attila; Oláh, Attila; Lux, Árpád; Mátyás, Csaba; Németh, Balázs Tamás; Kellermayer, Dalma; Ruppert, Mihály; Török, Marianna; Szabó, Lilla; Meltzer, Anna; Assabiny, Alexandra; Birtalan, Ede; Merkely, Béla; Radovits, Tamás

    2015-04-01

    Contractile function is considered to be precisely measurable only by invasive hemodynamics. We aimed to correlate strain values measured by speckle-tracking echocardiography (STE) with sensitive contractility parameters of pressure-volume (P-V) analysis in a rat model of exercise-induced left ventricular (LV) hypertrophy. LV hypertrophy was induced in rats by swim training and was compared with untrained controls. Echocardiography was performed using a 13-MHz linear transducer to obtain LV long- and short-axis recordings for STE analysis (GE EchoPAC). Global longitudinal (GLS) and circumferential strain (GCS) and longitudinal (LSr) and circumferential systolic strain rate (CSr) were measured. LV P-V analysis was performed using a pressure-conductance microcatheter, and load-independent contractility indices [slope of the end-systolic P-V relationship (ESPVR), preload recruitable stroke work (PRSW), and maximal dP/dt-end-diastolic volume relationship (dP/dtmax-EDV)] were calculated. Trained rats had increased LV mass index (trained vs. control; 2.76 ± 0.07 vs. 2.14 ± 0.05 g/kg, P < 0.001). P-V loop-derived contractility parameters were significantly improved in the trained group (ESPVR: 3.58 ± 0.22 vs. 2.51 ± 0.11 mmHg/?l; PRSW: 131 ± 4 vs. 104 ± 2 mmHg, P < 0.01). Strain and strain rate parameters were also supernormal in trained rats (GLS: -18.8 ± 0.3 vs. -15.8 ± 0.4%; LSr: -5.0 ± 0.2 vs. -4.1 ± 0.1 Hz; GCS: -18.9 ± 0.8 vs. -14.9 ± 0.6%; CSr: -4.9 ± 0.2 vs. -3.8 ± 0.2 Hz, P < 0.01). ESPVR correlated with GLS (r = -0.71) and LSr (r = -0.53) and robustly with GCS (r = -0.83) and CSr (r = -0.75, all P < 0.05). PRSW was strongly related to GLS (r = -0.64) and LSr (r = -0.71, both P < 0.01). STE can be a feasible and useful method for animal experiments. In our rat model, strain and strain rate parameters closely reflected the improvement in intrinsic contractile function induced by exercise training. PMID:25617359

  12. Severe cutaneous adverse drug reactions

    PubMed Central

    Verma, Rajesh; Vasudevan, Biju; Pragasam, Vijendran

    2013-01-01

    Severe cutaneous drug reactions are one of the commonest medical challenges presenting to an emergency room in any hospital. The manifestations range from maculopapular rash to severe systemic symptoms like renal failure and cardiovascular compromise. Toxic epidermal necrolysis, erythroderma, drug rash with eosinophilia and systemic symptoms, acute generalised exanthematous pustulosis and drug induced vasculitis are the common cutaneous drug reactions which can have severe morbidity and even mortality. Careful history taking of the lag period after drug intake and associated symptoms, along with detailed examination of the skin, mucosa and various systems, help in early diagnosis of these reactions. Early stoppage of the incriminating drug, specific therapy including corticosteroids, cyclosporine and intravenous immunoglobulin depending on the case along with supportive therapy and local measures help in salvaging most patients. An overview of these important cutaneous drug reactions along with their management is being reviewed in this article. PMID:24600147

  13. Cardiac dysfunction following brain death after severe pediatric traumatic brain injury: A preliminary study of 32 children

    PubMed Central

    Krishnamoorthy, Vijay; Prathep, Sumidtra; Sharma, Deepak; Fujita, Yasuki; Armstead, William; Vavilala, Monica S.

    2015-01-01

    Background: Cardiac dysfunction after brain death has been described in a variety of brain injury paradigms but is not well understood after severe pediatric traumatic brain injury (TBI). Cardiac dysfunction may have implications for organ donation in this patient population. Materials and Methods: We conducted a retrospective cohort study of pediatric patients with severe TBI, both with and without a diagnosis of brain death, who underwent echocardiography during the first 2 weeks after TBI, between the period of 2003–2011. We examined cardiac dysfunction in patients with and without a diagnosis of brain death. Results: In all, 32 (2.3%) of 1,413 severe pediatric TBI patients underwent echocardiogram evaluation. Most patients had head abbreviated injury score 5 (range 2–6) and subdural hematoma (34.4%). Ten patients with TBI had brain death compared with 22 severe TBI patients who did not have brain death. Four (40%) of 10 pediatric TBI patients with brain death had a low ejection fraction (EF) compared with 1 (4.5%) of 22 pediatric TBI patients without brain death who had low EF (OR = 14, P = 0.024). Conclusions: The incidence of cardiac dysfunction is higher among pediatric severe TBI patients with a diagnosis of brain death, as compared to patients without brain death. This finding may have implications for cardiac organ donation from this population and deserves further study.

  14. Animations of Severe Weather Annual Cycle

    NSDL National Science Digital Library

    National Severe Storm Laboratory

    This collection of Java applets uses animated maps of the United States to illustrate the probability of severe weather for each week of an average year. The maps help to illustrate how the likelihood of tornados changes over the course of a year and how the chances of tornados vary by region. Maps are available to show the probability of any tornado, or the probability of only significant and violent tornados.

  15. The clinical management in extremely severe COPD.

    PubMed

    Ambrosino, Nicolino; Simonds, Anita

    2007-08-01

    Chronic obstructive pulmonary disease (COPD) affects 6% of the general population and is the fourth-leading cause of death in the United States with severe and very severe disease accounting for 15% and 3% of physician diagnoses of COPD. Guidelines make few recommendations regarding providing the provision of care for the most severe stages of disease, namely Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV with chronic respiratory failure. The effectiveness of inhaled drug therapy in very severe patients has not been assessed yet. Health care systems in many countries include public funding of long-term oxygen therapy for eligible candidates. Currently, there is little evidence for the use of mechanical ventilatory support in the routine management of hypercapnic patients. Pulmonary rehabilitation should be considered as a significant component of therapy, even in the most severe patients. Although Lung Volume Reduction Surgery has been shown to improve mortality, exercise capacity, and quality of life in selected patients, this modality is associated with significant morbidity and an early mortality rate in the most severe patients. Despite significant progress over the past 25 years, both short- and long-term outcomes remain significantly inferior for lung transplantation relative to other "solid" organ recipients. Nutritional assessment and management is an important therapeutic option in patients with chronic respiratory diseases. Morphine may significantly reduce dyspnoea and does not significantly accelerate death. No consistent improvement in dyspnoea over placebo has been shown with anxiolytics. Supplemental oxygen during exercise reduces exertional breathlessness and improves exercise tolerance of the hypoxaemic patient. Non-invasive ventilation has been used as a palliative treatment to reduce dyspnoea. Hypoxaemic COPD patients, on long-term oxygen therapy, may show reduced health-related quality of life, cognitive function, and depression. Only a small proportion of patients with severe COPD discuss end-of-life issues with their physicians. PMID:17383170

  16. Bronchoscopic interventions for severe COPD.

    PubMed

    Browning, Robert F; Parrish, Scott; Sarkar, Saiyad; Krimsky, William; Turner, J Francis; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Courcoutsakis, Nikolaos; Madesis, Athanasios; Diplaris, Konstantinos; Karaiskos, Theodoros; Zarogoulidis, Paul

    2014-10-01

    Chronic obstructive pulmonary disease (COPD) causes severe handicap among smokers. Most patients have to remain under continuous oxygen therapy at home. Moreover, respiratory infections are very common among these patients and vaccination is obligatory against influenza. Emphysema and bronchiectasis are observed with computed tomography (CT) and in several situations these parenchymal damages are responsible for pneumothorax in one case and pseudomonas aeroginosa infection. Novel mini-invasive techniques are used currently for emphysema treatments which are described extensively throughout our current work. PMID:25337396

  17. National Severe Weather Workshop 2005

    NSDL National Science Digital Library

    The National Severe Weather Workshop 2005 is "a national forum for emergency management and media to exchange information and techniques for public safety during severe weather." The website supplies the tentative agenda for the three-day conference March 3-5, which includes many speeches from NOAA's weather partners in Norman. Interested visitors can find information on registration materials, opportunities to exhibit, and lodging. While information is not yet available on the planning members, users can find links to the sponsors and a notice about free radar and spotter training.

  18. Showing and Telling Farming: Agricultural Shows and Re-Imaging British Agriculture

    ERIC Educational Resources Information Center

    Holloway, Lewis

    2004-01-01

    Some actors in the ''mainstream'' agricultural sector are beginning to engage in strategies of influencing public perceptions of farming, responding to public anxieties over industrialised agriculture and to a supposed separation of non-farming publics from food production. This paper focuses on agricultural shows as sites and events central to…

  19. Comparative study of rest technetium-99m sestamibi SPET and low-dose dobutamine stress echocardiography for the early assessment of myocardial viability after acute myocardial infarction: importance of the severity of the infarct-related stenosis

    Microsoft Academic Search

    Marc J. Claeys; Frank E. Rademakers; Chris J. Vrints; Bruno Krug; Johan M. Bosmans; Viviane Conraads; Leo L. Bossaert; Jo P. Snoeck; Pierre P. Blockx

    1996-01-01

    Rest technetium-99m sestamibi single-photon emission tomography (SPET) has been shown to under-estimate viability in some patients with chronic ischaemic myocardial dysfunction. The present study was designed to appraise the value of99mTc-sestamibi as a viability tracer in patients with a recent myocardial infarction and to determine factors that might influence its accuracy in assessing infarct size. Therefore, rest99mTc-sestamibi SPET, low-dose dobutamines

  20. Global myocardial perfusion and diastolic function are impaired to a similar extent in patients with type 2 diabetes mellitus and in patients with coronary artery disease—evaluation by contrast echocardiography and pulsed tissue Doppler

    Microsoft Academic Search

    V. Dounis; T. Siegmund; A. Hansen; J. Jensen; P.-M. Schumm-Draeger; H. von Bibra

    2006-01-01

    Aims\\/hypothesis  Using modern echocardiography, we quantified the extent of global myocardial function and perfusion abnormalities in patients with type 2 diabetes and compared this with the hypothetically similar extent of impairments in patients with coronary artery disease (CAD).Subjects and methods  This case–control study (66 patients) compared four age-matched groups: control, type 2 diabetic, CAD, and diabetic subjects with CAD (DCAD) and left