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Accuracy of aortic stenosis severity assessment by Doppler echocardiography: importance of image quality  

Microsoft Academic Search

The aim of the present study was to investigate which factors could influence the accuracy of aortic stenosis severity assessment by Doppler echocardiography in an unselected population. Doppler echocardiographic determination of mean transvalvular pressure gradient and aortic valve area by continuity equation was performed in 101 patients before catheterization. According to the catheterization data, aortic stenosis was classified into 2

Jozef Bartunek; Dirk De Bacquer; Ana Clara Rodrigues; Bernard De Bruyne



Diagnostic Value of Vena Contracta Area in the Quantification of Mitral Regurgitation Severity by Color Doppler 3D Echocardiography  

PubMed Central

Background Accurate quantification of mitral regurgitation (MR) is important for patient treatment and prognosis. Three-dimensional echocardiography allows for the direct measure of the regurgitant orifice area (ROA) by 3D-guided planimetry of the vena contracta area (VCA). We aimed to (1) establish 3D VCA ranges and cutoff values for MR grading, using the American Society of Echocardiography–recommended 2D integrative method as a reference, and (2) compare 2D and 3D methods of ROA to establish a common calibration for MR grading. Methods and Results Eighty-three patients with at least mild MR underwent 2D and 3D echocardiography. Direct planimetry of VCA was performed by 3D echocardiography. Two-dimensional quantification of MR included 2D ROA by proximal isovelocity surface area (PISA) method, vena contracta width, and ratio of jet area to left atrial area. There were significant differences in 3D VCA among patients with different MR grades. As assessed by receiver operating characteristic analysis, 3D VCA at a best cutoff value of 0.41 cm2 yielded 97% of sensitivity and 82% of specificity to differentiate moderate from severe MR. There was significant difference between 2D ROA and 3D VCA in patients with functional MR, resulting in an underestimation of ROA by 2D PISA method by 27% as compared with 3D VCA. Multivariable regression analysis showed functional MR as etiology was the only predictor of underestimation of ROA by the 2D PISA method. Conclusions Three-dimensional VCA provides a single, directly visualized, and reliable measurement of ROA, which classifies MR severity comparable to current clinical practice using the American Society of Echocardiography–recommended 2D integrative method. The 3D VCA method improves accuracy of MR grading compared with the 2D PISA method by eliminating geometric and flow assumptions, allowing for uniform clinical grading cutoffs and ranges that apply regardless of etiology and orifice shape.

Zeng, Xin; Levine, Robert A.; Hua, Lanqi; Morris, Eleanor L.; Kang, Yuejian; Flaherty, Mary; Morgan, Nina V.; Hung, Judy



Diastolic dysfunction and mortality in early severe sepsis and septic shock: a prospective, observational echocardiography study  

PubMed Central

Background Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality. Methods In this prospective, observational study conducted in two intensive care units at a tertiary care hospital, 78 patients (age 53.2?±?17.1?years; 51% females; mean APACHE II score 23.3?±?7.4) with severe sepsis or septic shock underwent TTE within 6?h of ICU admission, after 18 to 32?h, and after resolution of shock. Left ventricular (LV) diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines using E, A, and e’ velocities; E/A and E/e’; and E deceleration time. Systolic dysfunction was defined as an ejection fraction?



Three-dimensional echocardiography with tissue harmonic imaging shows excellent reproducibility in assessment of left ventricular volumes  

Microsoft Academic Search

We studied the reproducibility of repeated measurements of left ventricular (LV) volumes by 2-dimensional (biplane method of disks) and 3-dimensional echocardiography (coaxial scanning) with tissue harmonic imaging. Ten healthy subjects underwent estimation of LV volumes by transthoracic echocardiography twice within 1 week by 2 different operators to investigate interexamination and operator variance. In addition, the analysis of LV volume was

W. Yong Kim; Peter Søgaard; Henrik Egeblad; Niels Trolle Andersen; Bent Ø Kristensen



Thoracic aortic atheroma severity predicts high-risk coronary anatomy in patients undergoing transesophageal echocardiography  

PubMed Central

Introduction We hypothesized a relationship between severity of thoracic aortic atheroma (AA) and prevalence of high-risk coronary anatomy (HRCA). Material and methods We investigated AA diagnosed by transesophageal echocardiography and HRCA diagnosed by coronary angiography in 187 patients. HRCA was defined as ? 50% stenosis of the left main coronary artery or significant 3-vessel coronary artery disease (? 70% narrowing). Results HRCA was present in 45 of 187 patients (24%). AA severity was grade?I in 55 patients (29%), grade II in 71 patients (38%), grade III in 52 patients (28%), grade IV in 5 patients (3%), and grade V in 4 patients (2%). The area under receiver operating characteristic curve for AA grade predicting HRCA was 0.83 (p = 0.0001). The cut-off points of AA to predict HRCA was > II grade. The sensitivity and specificity of AA > grade II to predict HRCA were 76% and 81%, respectively. After adjustment for 10 variables with significant differences by univariate regression, AA > grade II was related to HRCA by multivariate regression (odds ratio = 7.5, p< 0.0001). During 41-month follow-up, 15 of 61 patients (25%) with AA >grade II and 10 of 126 patients (8%) with AA grade ? 2 died (p= 0.004). Survival by Kaplan-Meier plot in patients with AA > grade II was significantly decreased compared to patients with AA ? grade II (p= 0.002). Conclusions AA > grade II is associated with a 7.5 times increase in HRCA and with a significant reduction in all-cause mortality.

Shen, Xuedong; Aronow, Wilbert S.; Nair, Chandra K.; Korlakunta, Hema; Holmberg, Mark J.; Wang, Fenwei; Maciejewski, Stephanie; Esterbrooks, Dennis J.



Accuracy of intraoperative transesophageal echocardiography for estimating the severity of functional mitral regurgitation.  


Although intraoperative transesophageal echocardiography (TEE) is used to guide mitral valve reconstructive procedures, the effects of hemodynamic alterations accompanying general anesthesia on mitral regurgitation (MR) are unknown. This study was performed to evaluate the effect of general anesthesia on MR jet size using TEE with color Doppler imaging in patients undergoing mitral valve surgery. Matched preoperative TEEs performed with the patient under intravenous conscious sedation, and intraoperative studies performed with the patient under general anesthesia were retrospectively reviewed in 46 patients undergoing mitral valve surgery. Patients were divided into groups based on etiology of MR, including 21 patients with myxomatous degeneration and leaflet flail, 19 patients with structurally normal leaflets and functional regurgitation due to abnormal leaflet coaptation, and 6 patients with rheumatic mitral disease. On both preoperative and intraoperative studies, regurgitation was quantified using maximal jet area and jet diameter at the vena contracta on color flow Doppler. Patients with leaflet flail and patients with functional MR had similar measures of regurgitation severity on preoperative imaging. On intraoperative imaging, regurgitant jet size was unchanged compared with preoperative studies among patients with leaflet flail (jet diameter 1.04 +/- 0.26 vs 1.10 +/- 0.28 cm, area 9.8 +/- 4.5 vs 10.1 +/- 5.2 cm2 on preoperative studies), although jet size decreased significantly in patients with functional MR (jet diameter 0.79 +/- 0.33 vs 1.10 +/- 0.29 cm [p < 0.001], area 5.7 +/- 3.5 vs 10.0 +/- 3.8 cm2 [p < 0.001] on preoperative studies). These findings were not accounted for by variation in heart rate, blood pressures, echocardiographic instrumentation, or Doppler Nyquist limit.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7653454

Bach, D S; Deeb, G M; Bolling, S F



Transesophageal echocardiography for cardiac thromboembolic risk assessment in patients with severe, symptomatic aortic valve stenosis referred for potential transcatheter aortic valve implantation.  


Stroke is a devastating complication after transcatheter aortic valve implantation (TAVI) and might partially be related to cardiac embolization. The aim of this single-center prospective study was to determine the incidence of intracardiac thrombi and left atrial spontaneous echo contrast (SEC), both known predictors of cardiac embolic stroke, in patients referred for potential TAVI. One hundred four consecutive patients with severe symptomatic aortic valve stenosis and at high or very high risk for surgery were included and underwent transesophageal echocardiography. In 11 patients (10.6%), intracardiac thrombi were detected, and 25 patients (24%) showed dense grade 2 SEC. Atrial fibrillation (p <0.0001), diastolic dysfunction (p = 0.0005), and atrial size (p = 0.0038) were related to the presence of intracardiac thrombus and/or dense SEC on multivariate analysis. In conclusion, the incidence of intracardiac thrombi and dense SEC in (very) high-risk patients with severe aortic valve stenosis referred for potential TAVI is high and can accurately be detected using transesophageal echocardiography. Systematic thromboembolic evaluation using transesophageal echocardiography is thus recommended in patients referred for TAVI. PMID:23433762

Lenders, Guy D; Paelinck, Bernard P; Wouters, Kristien; Claeys, Marc J; Rodrigus, Inez E; Van Herck, Paul L; Vrints, Christiaan J; Bosmans, Johan M



Fetal echocardiography  

PubMed Central

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

Chaubal, Nitin G.; Chaubal, Jyoti



Neuro-Behçet's disease showing severe atrophy of the cerebrum  

Microsoft Academic Search

A 38-year-old female died 6 years after the onset of what was, clinically and histopathologically, consistent with Neuro-Behçet's disease. Pathologically the cerebrum showed severe atrophy. The main changes were observed in the grey and white matter, the diencephalon and the basal ganglia by light microscopy. All these changes originated in softenings around blood vessels, especially small vessels or capillaries. These

Taihei Miyakawa; Eiichi Murayama; Motonori Deshimaru; Isao Shikai; Shiro K?zuma



Stanford study shows anxiety increases cancer severity in mice

In a new study led by researchers at the Stanford University School of Medicine, anxiety-prone mice developed more severe cancer then their calm counterparts. The study, published online April 25 in PLoS ONE, found that after hairless mice were dosed with ultraviolet rays, the nervous ones — with a penchant for reticence and risk aversion — developed more tumors and invasive cancer.


Evaluation of the Severity of Mitral Valvular Regurgitation with Doppler Echocardiography Using Proximal Flow Convergence Method  

Microsoft Academic Search

Problem statement: Valvular regurgitation is recognized as the centra l cause of morbidity and mortality. Even though the clinician can detect the presence of regurgitation by mere physical examination; diagnostic methods become inevitable while estimating the severity of valvular regurgitation and in the transformation of cardiac chambers as in reaction to the volume overload condition. Lately, a promising new technology,

Sridevi; P. V. Sridevi



Contribution of echocardiography and immediate surgery to the management of severe aortic regurgitation from active infective endocarditis.  


The timing of surgery in patients with severe aortic regurgitation and left ventricular (LV) failure, particularly when associated with active infective endocarditis (IE), is of the utmost importance. From July 1982 to May 1984, 34 patients, aged 15 to 60 years, with severe aortic regurgitation underwent immediate (within 24 hours of diagnosis) aortic valve surgery. All patients were in New York Heart Association class IV for LV failure. Eighteen patients had right-sided heart failure. Decision for immediate surgery was based on the echocardiographic demonstration of diastolic closure of the mitral valve or of vegetations on the aortic valve. Premature closure of the mitral valve was demonstrated echocardiographically in 17 patients, 13 of whom had diastolic crossover of LV and left atrial pressure tracings recorded at surgery. IE of the aortic valve was confirmed at surgery in 29 patients, 27 of whom had vegetations on echocardiography. Seven patients required replacement of both aortic and mitral valves. Antibiotic therapy for IE was started immediately after blood cultures were taken and continued for 4 to 6 weeks postoperatively. The mortality rate within 30 days of surgery was 6% for the group as a whole and 7% for those with IE. Mean follow-up period for the 32 survivors was 10.6 months. There were 2 late deaths. No patient had periprosthetic regurgitation or persistence of endocarditis. Procrastination in referral for surgery of these extremely ill patients is not justified and is likely to be associated with higher risks of morbidity and mortality. PMID:3946256

Sareli, P; Klein, H O; Schamroth, C L; Goldman, A P; Antunes, M J; Pocock, W A; Barlow, J B



Doppler echocardiography  

SciTech Connect

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

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



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

Microsoft Academic Search

To evaluate the agreement between dual-source computed tomography (DSCT) and two-dimensional transthoracic echocardiography\\u000a (2D-TTE) with respect to the assessment of global left ventricular (LV) function in patients with severe arrhythmia. With\\u000a 2D-TTE serving as the reference method, we performed both DSCT and 2D-TTE, at an interval of less than 2 days, in 54 patients\\u000a with severe arrhythmia (average heart rate difference

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



Interventional Echocardiography  

Microsoft Academic Search

As percutaneous noncoronary interventional cardiology procedures move toward an increasing complex, anatomically based paradigm,\\u000a procedural guidance with real-time echocardiography has become an important aspect of their successful performance. Traditionally,\\u000a fluoroscopy as well as angiography has been used for noncoronary procedural guidance in the catheterization laboratory, but\\u000a significant limitations exist. Fluoroscopy alone is unable to identify important anatomic structures such as

Frank E. Silvestry


Direct Measurement of Vena Contracta Area by Real-Time 3-Dimensional Echocardiography for Assessing Severity of Mitral Regurgitation  

PubMed Central

We tested the hypothesis that vena contracta (VC) cross-sectional area in patients with mitral regurgitation (MR) can be reproducibly measured by real-time three-dimensional echocardiography (RT3DE) and correlates well with volumetric effective regurgitant orifice area (EROA). Earlier MR repair requires accurate noninvasive measures, but VC area is practically difficult to image in 2D views, which are often oblique to it. 3DE can provide an otherwise unobtainable true cross-sectional view. In 45 patients with >mild MR, 44% eccentric, 2D and 3D VC areas were measured and correlated with EROA derived from regurgitant stroke volume. RT3DE VC area correlated and agreed well with EROA for both central and eccentric jets (r2=0.86, SEE=0.02 cm2, difference = 0.04±0.06 cm2, p=NS). For eccentric jets, 2DE overestimated VC width compared with 3DE (p=0.024) and correlated more poorly with EROA (r2=0.61 vs. 0.85, p<0.001), causing clinical misclassification in 45% of patients with eccentric MR. Interobserver variability for 3D VC area was 0.03 cm2 (7.5% of the mean, r=0.95); intraobserver was 0.01 cm2 (2.5%, r=0.97). In conclusion, RT3DE accurately and reproducibly quantifies vena contracta cross-sectional area in patients with both central and eccentric MR. Rapid acquisition and intuitive analysis promote practical clinical application of this central, directly visualized measure and its correlation with outcome.

Yosefy, Chaim; Hung, Judy; Chua, Sarah; Vaturi, Mordehay; Ton-Nu, Thanh-Thao; Handschumacher, Mark D.; Levine, Robert A.



Echocardiography can predict the development of severe mitral regurgitation after percutaneous mitral valvuloplasty by the Inoue technique.  


Severe mitral regurgitation (MR) following mitral balloon valvuloplasty is a major complication of this procedure. We recently described a new echocardiographic score that can predict the development of severe MR following mitral valvuloplasty with the double balloon technique. The present study was designed to test the usefulness of this score for predicting severe MR in patients undergoing the procedure using the Inoue balloon technique. From 117 consecutive patients who underwent mitral valvuloplasty using the Inoue technique, 14 (11.9%) developed severe MR after the procedure. A good quality echocardiogram before mitral valvuloplasty was available in 11 patients. These 11 patients were matched by age, sex, mitral valve area, and degree of MR before valvuloplasty with 69 randomly selected patients who did not develop severe MR after Inoue valvuloplasty. The total MR-echocardiographic (MR-echo) score was significantly greater in the severe MR group (10.5 +/- 1.4 vs 8.2 +/- 1.1; p <0.001). In addition, the component grades for the anterior leaflet (2.9 +/- 0.5 vs 2.2 +/- 0.4; p <0.001), posterior leaflet (2.6 +/- 0.7 vs 1.9 +/- 0.8), commissures (2.4 +/- 0.8 vs 2.0 +/- 0.5; p <0.05) and subvalvular apparatus (2.6 +/- 0.5 vs 1.9 +/- 0.4; p <0.001) were also higher in the MR group. Using a total score of > or = 10 as a cut-off point for predicting severe MR with the Inoue technique, a sensitivity of 82%, specificity of 91%, accuracy of 90%, and negative predictive value of 97% were obtained. Stepwise logistic regression analysis identified the MR-echo score as the only independent predictor for developing severe MR with the Inoue technique (p <0.0001). Thus, the MR-echo score can also predict the development of severe MR following mitral balloon valvuloplasty using the Inoue technique. PMID:10215286

Padial, L R; Abascal, V M; Moreno, P R; Weyman, A E; Levine, R A; Palacios, I F



Accuracy of dobutamine stress echocardiography for the diagnosis of coronary artery stenosis in patients with myocardial infarction: the impact of extent and severity of left ventricular dysfunction.  

PubMed Central

OBJECTIVES: To assess the value of dobutamine stress echocardiography (DSE) in the prediction of the extent and location of coronary artery stenosis in symptomatic patients with old myocardial infarction and to study the impact of the severity of resting wall motion abnormalities (WMA) on the diagnostic accuracy of the test. PATIENTS: One hundred and thirty two symptomatic patients with old myocardial infarction. METHODS: DSE (up to 40 micrograms/kg/min, with atropine up to 1 mg) was performed in all patients. Ischaemia was defined as new or worsened WMA. For each coronary artery, regional wall motion in the corresponding territory was classified as normal, mildly, moderately, or severely impaired according to the wall motion score index. Significant coronary stenosis was defined as > or = 50% diameter stenosis. RESULTS: A positive DSE for ischaemia occurred in 87 of 111 patients with and three of 21 patients without coronary artery stenosis (sensitivity = 78%; CI 71 to 86, specificity = 86%; CI 79 to 92, accuracy = 80%; CI 73 to 87). The accuracy for the diagnosis of individual coronary stenosis was 69% in the presence of normal wall motion and 74%, 74%, and 61% respectively when there was mild, moderate, and severe WMA in the corresponding territories (P = NS). The sensitivity was higher in presence of mild or moderate WMA (73%) than with normal wall motion (53%) or severe WMA (56%, P < 0.05 in both). In territories subtended by a stenotic artery, the regional wall motion score index was not different with or without ischaemia. CONCLUSION: DSE had a good overall accuracy for the diagnosis of coronary artery stenosis in symptomatic patients with old myocardial infarction. The presence of resting WMA did not limit DSE as a method of eliciting myocardial ischaemia and diagnosing significant coronary artery stenosis in patients with old myocardial infarctions.

Elhendy, A.; yan Domburg, R. T.; Roelandt, J. R.; Geleijnse, M. L.; Cornel, J. H.; el-Said, G. M.; Fioretti, P. M.



Human gastric cells resistant to (?)-epigallocatechin gallate show cross-resistance to several environmental pollutants  

Microsoft Academic Search

After a long-term culture in (?)-epigallocatechin gallate (EGCG, 20?M), a major constituent of green tea, human gastric AGS cells developed 2.2-fold resistance to EGCG. The resistant AGS (AGS-R) cells were cross-resistant to several N-methylcarbamate insecticides, which are among the major control agents for pest insects in Taiwan. The AGS-R cells also showed protective effects against both the cytotoxicity and DNA

S. B. Horng; H. H. Kuo; M. Y. Lin; W. W. Lin; T. C. Wang



Mitral regurgitation from papillary muscle rupture: role of transesophageal echocardiography.  


A case of a 61 year old male with lateral myocardial infarction, congestive heart failure and fever of days is presented. The exact etiology of this patient's heart failure was established with the application of transesophageal echocardiography. The transthoracic two-dimensional and Doppler echo showed a mobile echogenic density attached to the tip of the anterior mitral leaflet accompanied by moderate mitral regurgitation. Transesophageal echocardiography attributed this echogenic density to a ruptured head of the anterolateral papillary muscle, resulting in severe mitral regurgitation. Cardiac catheterization confirmed the severe mitral regurgitation and uncovered significant stenotic lesions of the coronary arteries. The resultant surgical treatment for the replacement of the mitral valve and coronary artery by-pass confirmed the rupture of the head of the anterolateral papillary muscle. It is suggested that transesophageal echocardiography is particularly capable of providing a definitive and prompt diagnosis of papillary muscle rupture. PMID:8269162

Kranidis, A; Koulouris, S; Filippatos, G; Sideris, A; Anthopoulos, L



[Malignant cardiac lymphoma. Diagnosis by echocardiography].  


The authors report a case of cardiac malignant non-Hodgkin lymphoma. The initial clinical presentation suggested recurrent angina in a patient who had undergone angioplasty of the left anterior descending artery two years previously. Echocardiography showed severe left ventricular dysfunction with apical and septal akinesia and also allowed visualisation of two oval masses in the right ventricle without dilatation of the right heart chambers. Transoesophageal echocardiography confirmed these abnormal echos which corresponded to tumour invasion of not only the right heart chambers but also the interatrial septum, the left atrial appendage and the descending thoracic aorta. Histological diagnosis of lymphoma was made from an excision biopsy of a mass in the calf muscle. The post-mortem examination confirmed the presence of a highly malignant T-cell non-Hodgkin lymphoma. The patient rapidly deteriorated and died during the first session of chemotherapy. PMID:9587448

Boey, S; Fouda-Omgba, F; Mirode, A; Tribouilloy, C; Quere, J P; Lesbre, J P



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

PubMed Central

While hippocampal atrophy is a key feature of both hippocampal sclerosis (HS) and Alzheimer's disease (AD), the pathology underlying this finding differs in these two conditions. In AD, atrophy is due primarily to loss of neurons and neuronal volume as a result of neurofibrillary tangle formation. While the etiology of HS is unknown, neuron loss in the hippocampus is severe to complete. We compared hippocampal volume and deformations from premortem MRI in 43 neuropathologically diagnosed cases of HS, AD, and normal controls (NC) selected from a longitudinal study of subcortical ischemic vascular disease (IVD Program Project). HS cases (n = 11) showed loss of neurons throughout the rostral-caudal extent of the hippocampus in one or both hemispheres. AD cases (n = 24) met NIA-Reagan criteria for high likelihood of AD. Normal control cases (n = 8) were cognitively intact and showed no significant AD or hippocampal pathology. The mean hippocampal volumes were significantly lower in HS versus AD groups (P < .001). Mean shape deformations in the CA1 and subiculum differed significantly between HS versus AD, HS versus NC, and AD versus NC (P < .0001). Additional study is needed to determine whether these differences will be meaningful for clinical diagnosis of individual cases.

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



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

SciTech Connect

A large study on cystic fibrosis (CF) is underway in Brittany (France). It is based on 902 CF patients distributed in 795 families who were or are still followed at the {open_quotes}Centre Helio-Marin{close_quotes} in Roscoff and/or were subjected to a molecular analysis at the {open_quotes}Centre de Biogenetique{close_quotes} in Brest. At present, the CF mutations have been identified in 309 patients born in Brittany, most of them of Celtic origin. A microsatellite (MS) study using IVS 17b TA, IVS 17b CA and IVS 8 CA was also completed in 63 CF patients and their parents (carriers of the {Delta}F508 mutation or the G551D mutation or the 1078delT mutation or the W846X mutation). All the 21 chromosomes carrying the 1078delT mutation had the same MS haplotype (16-21-13), which was also found on 9 of the 83 non-CF chromosomes analyzed. All the 16 chromosomes with the G551D mutation carried another MS haplotype (16-7-17), which was also found on 13.3% of the non-CF chromosomes. All the 6 chromosomes with the W846X mutation carried the 16-32-13 haplotype, also found on 6.0% of the non-CF chromosomes. Sixteen different MS haplotypes were found among the 74 chromosomes carrying the{Delta}F508 mutation, three of them representing 74.3% (55/74) of the chromosomes. These were the 23-31-13 haplotype (31/74 - 41.9%), the 17-31-13 haplotype (11/74 - 14.9%), and the 17-32-13 haplotype (13/74 - 17.6%). These results show that the CF mutations observed in Brittany are in linkage disequilibrium with the MS haplotypes. They also suggest that their presence in Brittany is the consequence of several founder effects.

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



Stress echocardiography--2010.  


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

Upadhyayula, Satyanarayana; Kapur, Kanwal Kishore


Stress echocardiography: safety and tolerability  

PubMed Central

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



Characterization of the functional properties of the neuroectoderm in mouse Cripto(-/-) embryos showing severe gastrulation defects.  


During development of the mammalian embryo, there is a complex relation between formation of the mesoderm and the neuroectoderm. In mouse, for example, the role of the node and its mesendoderm derivatives in anterior neural specification is still debated. Mouse Cripto(-/-) embryos could potentially help settle this debate because they lack almost all embryonic endoderm and mesoderm, including the node and its derivatives. In the present paper, we show that Cripto(-/-) embryos can still form functional neural stem cells that are able to differentiate and maintain a neural phenotype both in vivo and in vitro. These data suggest that signals emanating from the mesoderm and endoderm might not be essential for the formation and differentiation of neural stem cells. However, we use grafting experiments to show that the Cripto(-/-) isthmus (the secondary organizer located at the midbrain-hindbrain boundary) loses its inductive ability. We further show that the Cripto(-/-)isthmus expresses lower amounts of the isthmic signalling molecule, Fgf8. Since nearby tissues remain competent to respond to exogenously added Fgf8, this reduction in Fgf8 levels in the Cripto(-/-) isthmus is the potential cause of the loss of patterning ability in graft experiments. Overall, we interpret our data to suggest that the mammalian node and primitive streak are essential for the development of the regional identities that control the specification and formation of the secondary organizers within the developing brain. PMID:19247965

Liguori, Giovanna L; Echevarria, Diego; Bonilla, Sonia; D'Andrea, Daniela; Liguoro, Annamaria; Persico, Maria G; Martinez, Salvador



The Origin of Echocardiography  

PubMed Central

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.”

Singh, Siddharth; Goyal, Abha



Multiplane Transesophageal Echocardiography for Multiclinical Dilemmas  

PubMed Central

Introduction Transesophageal echocardiography was introduced 4 decades ago. Its use have had very limited clinical indication. Now it has become very useful clinical tool. Indications for its use are almost as indications for transthoracic echocardiography, especially to assess deeper cardiovascular structures. Transesophageal echocardiography is semi-invasive examination with small number of complications. Aim of the study To determine usefulness of transesophageal echocardiography in various cardiac conditions based in our experience. Also to encourage use of transesophageal echocardiography as reliable examination. Methods All of the patients signed a Term of Free Informed Consent, approved from Ethics Committee. We enrolled 425 patients who have done TEE in last 5 years (2006-2010) by authors. Medical history and Clinical evaluation was carefully performed by expert cardiologists. Procedures were performed in two different centers using machines, PHILIPS iE33 and Siemens accuson CV 70, with equipment attached to a multi frequency 2.5 to 3.5 MHz for TTE and 7.0 MHz for TEE multiplane transducer. TEE were performed and images were obtained according to the standard recommandations. Results The results were analyzed by a standard method of descriptive statistics using Pivot Table of Excel Office 2007. Results. We have analyzed 425 transesophageal echocardiography . The examination of the thoracic aorta in severe hypertension patients was conducted in 96 cases; atrial fibrillation in 118; aortic dissection 49 cases, aortic stenosis was evaluated in 28 cases; finding of source of emboli 36 cases; suspicion for aneurysm of the thoracic aorta in 14 cases, 11 cases with suspected endocarditis; the type of intervention for mitral valve was evaluated in 28 cases. Interatrial septum abnormalities 37 cases; and miscellaneous 18 cases. No minor or mayor complications happened. Conlusion Transesophageal echocardiography can elucidate many dubious serious conditions immediately after it is performed. So, we think that transesophageal echocardiography is very useful tool in everyday clinical use, almost without complications if it is done correctly.

Kamberi, Lulzim S.; Gorani, Daut R.; Citaku, Hajdin R.; Selmani, Hamza H.; Beqiri, Arton I.; Mustafai, Ardian I.



The clinical applications of contrast echocardiography.  


Ultrasound contrast agents are approved for opacification of the heart chambers and to improve endocardial border definition. The myocardial contrast enhancement is also very useful for assessing thickening of the myocardium and myocardial perfusion. Several multicentre and numerous single-centre trials have demonstrated the usefulness of contrast echocardiography in clinical practice. Contrast echocardiography is probably one of the best validated echocardiographic techniques. Improved accuracy of contrast-enhanced images is not restricted to patients with a poor baseline image quality. Even with an optimal baseline image quality the borders are not as well defined as after LV opacification. Usage of contrast can improve image alignment and helps to avoid off-axis scanning. Contrast studies are particularly useful when a precise measurement of LV function is needed: 1. To decide about the need of implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), 2. Follow-up of patients with moderate valvular disease and decision for surgical treatment, 3. Selection and monitoring of patients undergoing chemotherapy with cardiotoxic drugs, 4. Assessment of LV function in patients in intensive care and coronary care units. Optimal endocardial border delineation is crucial and often can be achieved only by ultrasound contrast: 1. Assessment of LV thrombi and masses, 2. Left ventricular non-compaction/apical hypertrophy, 3. Right ventricular dysplasia, right ventricular thrombus, 4. Stress echocardiography and regional wall motion assessment. Future echocardiography will be more 3D and more quantitative than current echocardiography. And contrast echocardiography has already proven its value for both applications. PMID:17481562

Olszewski, Robert; Timperley, Jon; Szmigielski, Cezary; Cezary, Szmigielski; Monaghan, Mark; Nihoyannopoulos, Petros; Nihoyannopoulis, Petros; Senior, Roxy; Becher, Harald



Correspondence of aortic valve area determination from transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterization  

Microsoft Academic Search

The correspondence of aortic valve area measurements from transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterization was determined in 100 patients with severe aortic stenosis (aortic valve area ? 0.75 cm2), moderate aortic stenosis (aortic valve area >0.75 to ? 1.2 cm2), mild aortic stenosis (aortic valve area > 1.2 to ?2.0 cm2), and nonstenotic aortic valves (aortic valve area >2.0

Chong-Jin Kim; Hans Berglund; Toshihiko Nishioka; Huai Luo; Robert J. Siegel



Echocardiography in the Assessment of Complications of Myocardial Infarction  

PubMed Central

The value of echocardiography as a tool for evaluating the prognosis of patients after myocardial infarction lies in its ability to define the region and extent of ischemic damage. Additionally, echocardiography is useful in assessing and predicting postinfarction complications. Wall motion abnormalities, pericardial effusion, left ventricular thrombi, and left ventricular aneurysms and pseudoaneurysms can be detected using echocardiography. The severity of mitral regurgitation and the location of interventricular septal repture can also be assessed using echocardiography. This diagnostic tool can provide vital information regarding the appropriate clinical management of patients after myocardial infarction. (Texas Heart Institute Journal 1991; 18:237-42) Images

Wilansky, Susan



[Transthoracic real-time three-dimensional echocardiography: clinical role, value and limitations in assessing heart valves].  


The introduction of three-dimensional echocardiography and its evolution from time-consuming and cumbersome off-line reconstruction to real-time volumetric technique (real-time three-dimensional echocardiography) are one of the most significant advances in ultrasound imaging of the heart of the past decade. This imaging modality currently provides realistic views of cardiac valves capable of demonstrating the anatomy of various heart valve diseases in a unique, noninvasive manner. In addition, real-time three-dimensional echocardiography offers completely new views of the valves and surrounding structures, and allows accurate quantification of severity of valve disease. This article reviews the advantages of real-time three-dimensional echocardiography in assessing heart valves and shows also technological limitations in order to provide the scientific basis for its clinical use. PMID:21033330

Agricola, Eustachio; Badano, Luigi P; Mele, Donato; Galderisi, Maurizio; Spoladore, Roberto; Oppizzi, Michele; Sciomer, Susanna; Nistri, Stefano; Ballo, Piercarlo; Buralli, Simona; D'Andrea, Antonello; D'Errico, Arcangelo; Losi, Maria Angela; Gardini, Chiara; Margonato, Alberto; Marino, Paolo Nicola; Mondillo, Sergio


Stress echocardiography in heart failure  

Microsoft Academic Search

Echocardiography has the ability to noninvasively explore hemodynamic variables during pharmacologic or exercise stress test in patients with heart failure. In this review, we detail some important potential applications of stress echocardiography in patients with heart failure. In patients with coronary artery disease and chronic LV dysfunction, dobutamine stress echocardiography is able to distinguish between viable and fibrotic tissue to

Eustachio Agricola; Michele Oppizzi; Matteo Pisani; Alberto Margonato



Echocardiography in NATO Aircrew.  

National Technical Information Service (NTIS)

The protocol is considered for a planned cross-sectional and a longitudinal study on echocardiography in NATO aircrew. It gives an overview of the procedures manual, technical manual, the echo data sheet, the software program, and the quality control manu...



Echocardiography. Fourth edition  

SciTech Connect

In this book the author presents an updated survey of echocardiography: equipment, techniques, examinations, evaluation and interpretation of data, and heart diseases. Doppler, M-mode, two-dimensional and contrast examinations are detailed in a way that delineates their similarities and differences.

Feigenbaum, H.



Clinical and echocardiographic predictors of left atrial clot and spontaneous echo contrast in patients with severe rheumatic mitral stenosis: a prospective study in 200 patients by transesophageal echocardiography  

Microsoft Academic Search

The objective of this study was to prospectively investigate various clinical and echocardiographic variables to predict the left atrial and left atrial appendage clot and spontaneous echo contrast in patients with severe rheumatic mitral stenosis. We studied 200 consecutive patients (112 males and 88 females; mean age 29.6±9.6 years). Left atrial clot and spontaneous echo contrast were present in 26

Kewal C Goswami; Rakesh Yadav; M. Bhaskara Rao; Vinay K Bahl; Kewal K Talwar; Subhash C Manchanda



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

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.

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



Echocardiography in transcatheter aortic valve implantation.  


Transcatheter aortic valve implantation (TAVI) has become a feasible and effective therapeutic option for patients with severe aortic stenosis and high operative risk or relative contraindications for surgical aortic valve replacement (SAVR). Patient selection plays a crucial role in the success of TAVI. Echocardiography is a mainstay during the whole process starting with the very important morphological evaluation and accurate measurement of the aortic root, followed by guiding the procedure and detecting possible complications, and ending with serial assessment of the patient's heart and the implanted prosthesis. This present article reviews the role of echocardiography before, during, and after transcatheter aortic valve implantation. PMID:23846007

Mangner, N; Schuler, G; Linke, A



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

PubMed Central

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

Martin, Maria M.; Lopez-Gallardo, Esther; Sole-Violan, Jordi; Blanquer, Jose; Labarta, Lorenzo; Diaz, Cesar; Borreguero-Leon, Juan Maria; Jimenez, Alejandro; Montoya, Julio; Ruiz-Pesini, Eduardo



Transoesophageal echocardiography in critical care.  


Echocardiography has evolved to become one of the most versatile modalities for diagnosing and guiding treatment of critically ill patients. Both transthoracic (TTE) and transesophageal echocardiography (TEE) provide real-time bedside information about a variety of structural and functional abnormalities of the heart as well as contractility, filling status and cardiac output, rendering it the method of choice for the assessment of cardiac function in the intensive care unit (ICU). Both approaches have its benefits and limitations. Although TTE remains the approach of choice, TEE has been shown to be of additional value in many instances in critically ill patients due to its ability to provide excellent visualisation of cardiac structures, its impact on patient management, and its low complication rate (2.6%). The present status of TEE in adult critical care is reviewed with special emphasis on its role as a diagnostic tool in several clinical scenarios, underlining its effects on clinical decision making but also as a monitoring adjunct. Conditions and settings in which TEE provides the most definitive diagnosis in the critically ill and injured are hemodynamically unstable patients with suboptimal TTE images or if mechanically ventilated, patients with suspected aortic dissection or aortic injury and other conditions in which TEE is superior to TTE (such as suspected endocarditis, cardiac or aortic source of emboli. The diagnostic, therapeutic and surgical impact on patient management in critically ill patients ranged from 44% to 99% (weighted mean 67.2%), 10% to 69% (weighted mean 36%), and 2% to 29% (weighted mean 14.1%), respectively, depending on patients and type of ICU. Since echocardiography provides different information than other devices for hemodynamic monitoring such as the pulmonary artery catheter the methods are therefore not competitive but rather complementary. The present body of evidence supporting the use of TEE in critically ill patients lacks prospective, randomized controlled studies focusing on end-points like cost-effectiveness, morbidity or mortality. However, present evidence as well as experience, points to the significant benefits which may be gained by the availability of echocardiography and especially TEE in ICUs, as well the necessity for a training of intensive care physicians. PMID:17095988

Hüttemann, E



Quantitation in echocardiography  

Microsoft Academic Search

Imaging of the heart is the predominant approach to cardiovascular diagnosis in current practice. Of the wide variety of cardiac\\u000a imaging techniques available, echocardiography is one of the most widely used. Standard methods of quantitation of M-mode\\u000a and two-dimensional echocardiograms yield reproducible, accurate measurements of cardiac chamber, wall, and great vessel dimensions.\\u000a Qualitative analysis of valvular appearance and motion permits

David J. Skorton; Steve M. Collins



Carcinoid Heart Disease: A Rare Cause of Right Ventricular Dysfunction Evaluation by Transthoracic 2D, Doppler and 3-D Echocardiography  

PubMed Central

Carcinoid heart disease is a rare cause of heart failure with or without right valvular heart impairments. In this study, we showed a case of carcinoid tumour with hepatic metastases inducing carcinoid heart disease. Neuroendocrine heart involvement happens for severe tricuspid valve insufficiency and plaques on right ventricular (RV) walls produced by a release of serotonin (5-HT). A patient affected by primitive ileal tumour with 5-HT-secernent hepatic metastases inducing tricuspid insufficiency is showed. Transthoracic 2-D echocardiography showed tricuspid valve regurgitation and both right atrium, RV-walls plaques and RV dilation. Continue-wave Doppler showed a characteristic "dagger shaped" spectrum of tricuspid systolic flow. RV function was evaluated with 3-D transthoracic echocardiography. In particular, RV volumes, RV ejection fraction and stroke volume were defined by this technique. 2, 3-D echocardiography and Doppler method are useful techniques to show heart valves' derangements and RV function to non-invasively detect RV impairments in carcinoid heart disease.

Cacciapuoti, Fulvio; Agrusta, Marco; Chiorazzo, Gisberta; Midolla, Arcangelo; Agrusta, Federica



Computing Myocardial Motion in 4D Echocardiography  

PubMed Central

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.

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



Computing myocardial motion in 4-dimensional echocardiography.  


We describe a novel method for computing dense 3D myocardial motion with high accuracy in four-dimensional (4D) echocardiography (3 dimensions spatial plus time). The method is based on a classic 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 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 rates. 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, and automated diagnostics. PMID:22677256

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



[Echocardiography in nephrology].  


Cardiovascular disease is the main cause of mordibity and mortality in patients with chronic kidney disease (CKD) affected by a series of risk factors (hypertension, anemia, left ventricular hypertrophy, cardiac failure and dyslipidemia). The combined presence of these factors raises the cardiovascular risk in CKD patients considerably compared with that of the general population. Nephrologists can play a role in preventing and treating these risk factors and thereby delaying the development of CKD. In preventing CKD, nephrologists who practice ultrasound techniques should have basic know how of echocardiography so that they can screen CKD patients for early referral to a cardiologist. Echocardiography is a noninvasive ultrasound technique that requires adequately trained doctors to perform it. Nephrologists who practice it need to obtain good training and postgraduate certification of competence in echocardiography. These nephrologists should team up with cardiologists rather than replace them, and at the same time be aware that they possess the basic knowledge to manage cardiovascular disease in CKD patients. PMID:23229532

Di Lullo, Luca; Granata, Antonio; Logias, Francesco; Fiorini, Fulvio; D'Amelio, Alessandro; Zamboli, Pasquale; Malaguti, Moreno; Santoboni, Alberto; Floccari, Fulvio


Stress echocardiography: technical considerations.  


Stress echocardiography has evolved into a widely practiced and accepted method for the noninvasive assessment of the status of the coronary anatomy. Furthermore, this modality incorporates the ability to assess left ventricular function, valvular structure and function, intracardiac masses, the pericardium, and hemodynamics. The extent to which this tool can reliably provide useful clinical information is dependent, in part, on optimal performance. The purpose of this report is to provide an overview of those technical considerations that can contribute to the successful operation of a stress echocardiography laboratory. Consideration is given to personnel qualifications, functional requirements of the digital acquisition/storage/replay system, functional integration of the various hardware components, characteristics of the software, physical layout of the facility, and alternatives to treadmill exercise as the stressor. A thorough understanding of the physiologic basis of stress echocardiography, coupled with optimization of resources used in its performance, enable this tool to be an extraordinarily useful and cost-efficient method for comprehensive cardiovascular assessment. PMID:11235846

Crouse, L J; Kramer, P H


Echocardiography in the emergency department.  


Point-of-care echocardiography using portable machines is an exciting development in emergency medicine. Recent improvements in ultrasound quality mean that emergency physicians are finding echocardiography useful in a variety of clinical settings. Evidence suggests that emergency physicians are able to master the skills of basic echocardiography sufficiently to improve patient care in the resuscitation scenario. Patients with clinical conditions such as breathlessness, undifferentiated shock, chest pain and cardiac arrest may benefit. There is a steep learning curve involved in acquiring these skills and the specialty needs to take care in the way that its practitioners are accredited and perform echocardiography. PMID:19164613

Wright, J; Jarman, R; Connolly, J; Dissmann, P



Carcinoid syndrome diagnosed by echocardiography.  


Right heart failure is a common presentation to both general physicians and cardiologists. Echocardiography is a useful investigation, and usually imaging of the liver is confined to helping estimate the right atrial pressure. We report a case of right heart failure where incidental imaging of the liver architecture during transoesophageal echocardiography helped in establishing the final diagnosis. PMID:19217173

Garg, Scot; Bourantas, Christos V; Nair, Rajesh K; Alamgir, Farqad



The Evolutionary Development of Echocardiography  

PubMed Central

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

Maleki, Majid; Esmaeilzadeh, Maryam



Transoesophageal echocardiography in cardiac anaesthesia  

Microsoft Academic Search

Echocardiography is the most widely used minimally invasive investigation to diagnose heart disease. Transoesophageal echocardiography (TOE) was first introduced perioperatively in the 1980s and is now an important monitoring tool for patients undergoing cardiac surgery. Because of the close proximity of the oesophagus to the heart, TOE facilitates the acquisition of high-resolution images. The TOE probe is a multiplane transducer.

Alan Ashworth; Andrew Roscoe



Cardiac disease in pregnancy: value of echocardiography.  


Cardiovascular disease in women during pregnancy poses particular challenges. It continues to be a leading cause of maternal mortality and contributes to significant morbidity. Echocardiography is essential in characterizing the extent and effects of heart disease prior to, during, and after pregnancy. By understanding the physiologic adaptation in pregnancy with increases in heart rate, blood volume, and cardiac output, and decrease in vascular resistance, one can anticipate and recognize the effects of these changes on various cardiac lesions. Cardiomyopathy, severe, obstructive valvular disease, aortic dilation due to Marfan's disease, and cyanotic congenital heart disease are poorly tolerated in pregnancy. These disorders can be readily distinguished from normal structural changes of pregnancy and their severity assessed by echocardiography. Cardiovascular disease in women of reproductive age requires careful, multidisciplinary management by obstetric and medical teams ideally beginning preconception and continuing through the postpartum period. PMID:20424969

Tsiaras, Sarah; Poppas, Athena



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

ERIC Educational Resources Information Center

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…

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



Evaluation of fetal arrhythmias by echocardiography.  

PubMed Central

The normal fetal heart shows variation in rate and rhythm. Twenty three cases that fell outside the normal patterns of variation of heart rate and rhythm were evaluated by echocardiography. Ten showed atrial or ventricular extrasystoles and these were not associated with perinatal morbidity or mortality. Seven cases showed complete heart block, two in association with structural cardiac abnormality. Six cases were of supraventricular tachycardia, five of which were successfully treated and one was delivered prematurely. It was possible to diagnose accurately the type of arrhythmia using the M-mode echocardiogram to compare the relation between atrial and ventricular contraction. Cross-sectional echocardiography allowed identification of associated structural abnormalities. Recognition that an arrhythmia is present and appropriate prenatal treatment if this is indicated will avoid unnecessary operative or premature deliveries. Images

Allan, L D; Anderson, R H; Sullivan, I D; Campbell, S; Holt, D W; Tynan, M



Contrast echocardiography 1996. A review.  

PubMed Central

Remarkable advances in the field of contrast echocardiography have been made during the last decade. Interest in ultrasound contrast agents that strengthen the backscattered ultrasound signal and improve image display has stimulated further research. Echocardiographic contrast agents providing left ventricular cavity image enhancement after intravenous injection are now available. A role for contrast echocardiography in the assessment of myocardial perfusion has been established within the invasive clinical setting. With the development of newer contrast agents and new ultrasound technology, myocardial perfusion imaging using contrast echocardiography after venous injection is no longer the unattainable "holy grail," but is fast approaching clinical applicability. Images

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



Dobutamine stress echocardiography and technetium-99m-tetrofosmin\\/fluorine 18-fluorodeoxyglucose single-photon emission computed tomography and influence of resting ejection fraction to assess myocardial viability in patients with severe left ventricular dysfunction and healed myocardial infarction  

Microsoft Academic Search

The purpose of this study was to compare 2 different techniques—dobutamine-atropine stress echocardiography (DSE) and dual-isotope simultaneous acquisition (technetium-99-m-tetrofosmin\\/fluorine 18-fluorodeoxyglucose) single-photon emission computed tomography (DISA-SPECT)—for assessment of viable myocardium. One hundred ten patients (mean age 55 ± 9 years) with left ventricular (LV) dysfunction (mean LV ejection fraction 27 ± 13%) underwent both DISA-SPECT and DSE. A 16-segment scoring model

Riccardo Rambaldi; Don Poldermans; Jeroen J Bax; Eric Boersma; Roelf Valkema; Abdou Elhendy; Wim B Vletter; Paolo M Fioretti; Jos R. T. C Roelandt; Eric P Krenning



Non-invasive assessment of the presence and severity of cardiac amyloidosis. A study in familial amyloidosis with polyneuropathy by cross sectional echocardiography and technetium-99m pyrophosphate scintigraphy  

Microsoft Academic Search

Twelve patients with familial amyloidosis with polyneuropathy were examined both by cross sectional echocardiography and by technetium-99m pyrophosphate scintigraphy to assess involvement of the heart non-invasively. All 12 patients had echocardiographic abnormalities. The most prominent findings were highly refractile myocardial echoes, thickened heart valves, and increased thickness of the heart walls. Four patients had abnormal myocardial uptake of technetium-99m pyrophosphate.

P Eriksson; C Backman; P Bjerle; A Eriksson; S Holm; B O Olofsson



Visualization of mitral valve aneurysm by transesophageal echocardiography.  


This article describes the transesophageal echocardiographic findings in a patient with pathologically proven mitral valve aneurysm. This aneurysm probably occurred as a complication of aortic valve endocarditis. Transesophageal echocardiography showed a saccular structure attached to the left atrial side of the anterior mitral leaflet with systolic expansion and diastolic collapse, and its orifice was visualized with excellent resolution. Transesophageal echocardiography is a useful diagnostic tool for evaluation of mitral valve aneurysm. PMID:10149234

Shakudo, M; Eng, A K; Applegate, P M; Bansal, R C; Wong, M; Shah, P M



Echocardiography in the sepsis syndromes  

Microsoft Academic Search

Purpose of the review  Non-invasiveness and instantaneous diagnostic capability are prominent features of the use of echocardiography in critical\\u000a care. Sepsis and septic shock represent complex situations where early hemodynamic assessment and support are among the keys\\u000a to therapeutic success. In this review, we discuss the range of applications of echocardiography in the management of the\\u000a septic patient, and propose an

Gabriele Via; Susanna Price; Enrico Storti


A cellular study of teosinte Zea mays subsp. parviglumis (Poaceae) caryopsis development showing several processes conserved in maize.  


The evolutionary history of maize (Zea mays subsp. mays) is of general interest because of its economic and scientific importance. Here we show that many cellular traits described previously in developing caryopses of maize are also seen in its wild progenitor teosinte (Zea mays subsp. parviglumis). These features, each with a possible role in development, include (1) an early programmed cell death in the maternal placento-chalazal (P-C) layer that may lead to increased hydrolytic conductance to the developing seed; (2) accumulation of phenolics and flavonoids in the P-C layer that may be related to antimicrobial activity; (3) formation of wall ingrowths in the basal endosperm transfer layer (BETL); (4) localization of cell wall invertase in the BETL, which is attributed to the increased transport capacity of photosynthates to the sink; and (5) endoreduplication in endosperm nuclei suggested to contribute to increased gene expression and greater sink capacity of the developing seed. In maize caryopsis, these cellular traits have been previously attributed to domestication and selection for larger seed size and vigor. Given the conservation of the entire cellular program in developing teosinte caryopses described here, we suggest that these traits evolved independently of domestication and predate human selection pressure. PMID:21622300

Dermastia, Marina; Kladnik, Ales; Dolenc Koce, Jasna; Chourey, Prem S



Quadricuspid aortic valve defined by echocardiography and cardiac computed tomography.  


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

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



Quantitative assessment of aortic stenosis by three-dimensional echocardiography.  


The purpose of this study was to assess the feasibility of three-dimensional echocardiography in aortic stenosis. Planimetric determination of valve area and dynamic volume-rendered display were performed. Three-dimensional echocardiography permits display of any desired plane of the cardiac structure. Thus in the case of aortic stenosis, the plane used for planimetric evaluation can be positioned exactly through the valve orifice. Dynamic volume-rendered display may provide a spatial demonstration of the stenotic valve. In 48 patients aortic valve area was measured by planimetry. The three-dimensional data set was acquired by a workstation in the course of a multiplane transesophageal examination. Results were compared with those obtained by multiplane transesophageal two-dimensional planimetric technique and invasive measurement. A dynamic three-dimensional reconstruction was displayed. Planimetric determination of valve area was possible in 42 (88%) of 48 cases. Statistical analysis of the data acquired showed a good agreement between three-dimensional echocardiography and transesophageal echocardiography (mean difference +0.018 cm2; SD = 0.086) and between three-dimensional echocardiography and the invasive technique (mean difference +0.012 cm2; SD = 0.12). Dynamic volume-rendered display was possible in 42 of 48 cases. Three-dimensional echocardiography permits accurate and reliable determination of aortic valve area. Preoperative spatial recognition of the stenotic valve is possible by dynamic volume-rendered display. PMID:9109686

Menzel, T; Mohr-Kahaly, S; Kölsch, B; Kupferwasser, I; Kopp, H; Spiecker, M; Wagner, S; Meinert, R; Pagnia, F; Meyer, J



[Fetal echocardiography. The normal heart].  


At 20 weeks amenorrhoea, it is currently possible to determine with echocardiography whether a fetal heart, which then weighs approximately 400g with a diameter of 15 mm, is normal or not. The incidence of cardiac malformations has been estimated at 8 per 1000 fetuses. Fetal factors including retarded growth, hydramnios and arrhythmia and maternal factors including rubeola, diabetes, systemic lupus erythematosus, Rhesus incompatibility and drugs increase fetal risk. In certain cardiopathies such as aortic stenosis, coarctation, malformation of the mitral valve or left ventricle hypoplasia, the risk of recurrence in a second fetus is greatly increased. With 2D echocardiography, the apical section of the four heart cavities orients the heart in the thorax, identifies the atria and ventricles and visualizes valve movement. The origin of the aorta and the kinetics of the mitral and aortic valves are studied on the para-sternal section. TM mode reproduces the P-QRS sequence thus allowing a measurement of heart rate, the thicknesses of heart walls and septa and identifies conduction disorders. The transvalvular systolic pressures can be measured with Doppler echocardiography and pulsed Doppler quantifies blood flow through the different heart structures. Precision can be increased with colour coding. A complete echocardiography of the fetal heart should be an integral part of all examinations of fetal morphology. Usually performed between 22 and 32 weeks of amenorrhoea, echocardiography of the fetal heart requires a perfect understanding of two-dimensional Doppler modes and of three-dimensional representation of heart anatomy. PMID:8072977

Kchouk, H; Bernard, J P; Taurelle, R



Echocardiography: frontier imaging in cardiology  

PubMed Central

This article reviews the recent developments in echocardiography that have maintained this technology at the forefront of day-to-day imaging in clinical cardiology. The primary reason for most requests for imaging in cardiovascular medicine is to assess left ventricular structure and function. As our understanding of left ventricular mechanics has become more intricate, tissue Doppler and speckle tracking modalities have been developed that deliver greater insights into diagnosis of cardiomyopathy and earlier warning of ventricular dysfunction. Increased accuracy has been achieved with the dissemination of real-time three-dimensional echocardiography, which has also acquired a central role in the pre-operative assessment of patients prior to reparative valvular surgery. The use of contrast has broadened the indications for transthoracic echocardiography and has increased the accuracy of stress echocardiography, while reducing the number of patients who cannot be scanned because of a limited acoustic window. Finally, echocardiography will be seen in the future not only as a diagnostic tool in those affected by cardiovascular disease but also as a method for prediction of risk and perhaps activation of targeted treatment.

Steeds, R P



Intraoperative echocardiography and surgical treatment of traumatic pericarditis in a pregnant cow.  


Traumatic pericarditis is one of the most significant bovine cardiac diseases. The authors describe the use of intraoperative echocardiography and successful surgical treatment of a case of traumatic pericarditis. A seven-year-old Hungarian Simmental dairy cow in late pregnancy showed severe oedema of the throat region and brisket, as well as jugular distension. Cardiac auscultation demonstrated tachycardia with a normal cardiac rhythm. The heart sounds were muffled, but no cardiac murmur or splashing sounds were heard. A large amount of echogenic fluid with some strands of fibrin was seen in the pericardial and right pleural cavities by ultrasonography. Ultrasound-guided pericardiocentesis demonstrated the presence of a thick, fetid and purulent exudate. Pericardiotomy was performed in standing position with sedation and local anaesthesia. After costal resection, intraoperative echocardiography was performed. It showed an echogenic tract between the caudal pericardium and diaphragm, but no foreign body was seen. Two weeks after the surgery, the cow delivered a healthy bull-calf. Intraoperative echocardiography - not reported earlier - can be applied to evaluate the entire bovine pericardial sac and heart. The report also demonstrates that surgical treatment of traumatic pericarditis can be successful in carefully selected cases. PMID:21665571

Bakos, Zoltán; Vörös, Károly



Potential clinical perspectives of Doppler myocardial imaging and strain rate imaging during stress echocardiography.  


Stress echocardiography has become a common non-invasive test in patients with chest pain and known or suspected coronary artery disease, but, as with exercise electrocardiography, it shows several major limitations. Analysis of gray-scale images based on subjective visual interpretation of wall motion and thickening has considerable variability even among experts. Doppler myocardial imaging and strain rate imaging echocardiography provides additional information in comparison with conventional echocardiography. These techniques provide quantification of regional wall motion at rest and during stress. Quantification of both systolic and diastolic myocardial function by either Doppler myocardial imaging or strain rate imaging mapping during dobutamine stress test has been shown to be a feasible, accurate, non-invasive tool that should be considered to be a sensitive alternative to the present echocardiographic and scintigraphic imaging techniques for stress tests. Time consuming off-line analysis of color images is required in the present state of technology. However, these non-invasive techniques are rapidly evolving and expanding. Further refinements in signal processing and quantitative analysis are likely in the near future. PMID:16801809

Caso, Pio; D'Andrea, Antonello; Trambaiolo, Paolo; Di Salvo, Giovanni; Severino, Sergio; Caso, Ilaria; Ancona, Roberta; Calabrò, Paolo; Mininni, Nicola; Calabrò, Raffaele



Esophageal carcinoma and transthoracic echocardiography.  


We report a rare case of a patient with esophageal carcinoma diagnosed using transthoracic echocardiography. This examination proved to be useful in the identification of a paracardiac mediastinal mass. Images of the esophageal carcinoma, of the stent in the esophagus, and the bubbles inside the stent generated with the ingestion of a carbonated beverage, have not been previously published. Therefore, we believe our findings may be useful to other echocardiographers. PMID:23834459

Cianciulli, Tomás F; Saccheri, María C; Lax, Jorge A; Bianchi, Ricardo A; Beck, Martín A; Ferreiro, Daniel E



Dobutamine-Atropine Stress Echocardiography  

Microsoft Academic Search

Stress echocardiography is a non-invasive diagnostic test primarily used for diagnosis and prognostic stratification of patients with known or suspected coronary artery disease (CAD) [1]. The basis of the method is that stress-induced myocardial ischemia results in a cascade of events in which a reduction in regional left ventricular (LV) function occurs early [2–4] and that this phenomenon can be

Steen Carstensen



Echocardiography in Pulmonary Vascular Disease  

Microsoft Academic Search

\\u000a This chapter will focus on the principles and uses of the Doppler echocardiography (DE) examination in patients with pulmonary\\u000a vascular disease (PVD). That is, patients who have pulmonary hypertension that is related to a marked increase in the pulmonary\\u000a vascular resistance (PVR) and loss of large pulmonary artery (PA) compliance. We will also address the role of DE in the

Paul R. Forfia


Added value of real time three-dimensional echocardiography in the diagnosis of an apical right ventricular metastasis from malignant melanoma.  


In a man presenting to the emergency room with dyspnea and atypical chest pain irradiated among the scapulae, with new-onset diffuse negative T-waves on the ECG, the first clinical and diagnostic hypothesis was pulmonary embolism (PE). However, computed tomography (CT) performed in emergency was negative for PE, showing instead a marked defect in right ventricle (RV) filling. For this reason, echocardiography was performed to better investigate the nature of the space-occupying lesion, and several echocardiographic modalities were used (two-dimensional transthoracic and transesophageal echocardiography and three-dimensional [3D] transthoracic echocardiography). They revealed the presence of a mass attached to the apex of the RV, partially obstructing the inflow and outflow tracts. Cardiac magnetic resonance imaging was also performed, confirming the findings of 3D echocardiography. After that, several other diagnostic imaging techniques were used for disease staging, since the patient had a history of surgical excision of a malignant melanoma of the skin several years before. Whole-body CT, soft tissue echography and positron emission tomography revealed the widespread diffusion of the primary tumor to distant organs. For this reason, we suspected that the RV mass could also be an intracardiac metastasis from malignant melanoma, and did not perform biopsy given the bad clinical conditions and the worse prognosis of the patient. However, he was entered in an experimental therapeutic protocol with Vemurafenib because he showed B-RAF gene mutation at molecular gene analysis. PMID:23167803

Fontana, Antonella; Corsi, Davide; Viganò, Elena; Trocino, Giuseppe; Achilli, Felice



[Hyperventilation echocardiography in spastic angina pectoris diagnosing].  


Hyperventilation echocardiography is an established diagnostic test in patients with suspected variant angina pectoris. It has got sufficient sensitivity (60-80%) and specificity (85-100%). Positive hyperventilation test is rarely found, which relates to low prevalence of variant angina. The diagnostic yield of the test depends on the population selected for testing: positive result can be expected in patients with a history of typical burning chest pain, ST segment elevation/depression and/or inversions of U wave during the chest pain episode, arrhythmias related to the chest pain, coronary artery stenosis less than 50% of artery diameter, multi-vessel disease, high activity of illness at the time of hyperventilation test. We present a case of 37 years old man with typical angina pectoris at rest and non-Q myocardial infarction, in whom the coronary angiography was negative. Variant angina pectoris was diagnosed by hyperventilation echocardiography. The ECG tracings showing typical ischemic patterns during the hyperventilation test are included. PMID:23094816

Kaletová, M; Marek, D; Sovová, E; Mejtská, I; Táborský, M



Determination of aortic valve area in valvular aortic stenosis by direct measurement using intracardiac echocardiography: A comparison with the gorlin and continuity equations  

Microsoft Academic Search

Objectives. This study sought to 1) show that intracardiac echocardiography can allow direct measurement of the aortic valve area, and 2) compare the directly measured aortic valve area from intracardiac echocardiography with the calculated aortic valve area from the Gorlin and continuity equations.Background. Intracardiac echocardiography has been used in the descriptive evaluation of the aortic valve; however, direct measurement of

Gary P. Foster; Neil J. Weissman; Michael H. Picard; Phillip J. Fitzpatrick; Samuel J. Shubrooks Jr.; Stuart W. Zarich



Role of Echocardiography in Atrial Fibrillation  

PubMed Central

Atrial fibrillation (AF) is most common arrhythmia and its prevalence appears to be increasing as the population ages. Echocardiography can play a key role in risk stratification and management of patients with AF. Transthoracic echocardiography allows rapid and comprehensive assessment of cardiac anatomical structure and function. Pulmonary vein flow monitoring using echocardiography has the potential to an increasing role in the evaluation of cardiac function and AF ablation procedures. Transesophageal echocardiography also provides accurate information about the presence of a thrombus in the atria and thromboembolic risk. The novel technique of intracardiac echocardiography has emerged as a popular and useful tool in the everyday practice of interventional electrophysiology. Other imaging modalities, such as computed tomography and magnetic resonance imaging have complementary roles in risk stratification and assessment of patients with AF. Echocardiography continues to be the foundation of clinical evaluation and management of AF.

Kim, Tae-Seok



Atrial Thrombosis in Cardiac Amyloidosis: Diagnostic Contribution of Transesophageal Echocardiography  

Microsoft Academic Search

Few cases of atrial thrombosis detected by transesophageal echocardiography (TEE) in cardiac amyloidosis have been reported recently. We present the cases of 3 consecutive patients affected by AL-type cardiac amyloidosis, symptomatic for heart failure and in sinus rhythm. All patients had a cardiac restrictive pattern at Doppler examination. TEE showed left atrial thrombus in 2 patients and biatrial thrombi in

Mauro Santarone; Giovanni Corrado; Luca Mario Tagliagambe; Giovanni Foglia Manzillo; Giorgio Tadeo; Manuela Spata; Matteo Longhi



Transesophageal Echocardiography for Quantifying Size of Patent Foramen Ovale in Patients With Cryptogenic Cerebrovascular Events  

Microsoft Academic Search

Background and Purpose—Patent foramen ovale (PFO) is a risk factor for paradoxical embolism, and severe shunting and wide opening of PFO are risk factors for severe and recurrent cerebrovascular events. Neither contrast echocardiography nor 2-dimensional (2D) measurement of PFO size have been validated or compared with invasive balloon sizing. Methods—We performed transesophageal echocardiography (TEE) in 100 patients with cryptogenic stroke

Herwig W. Schuchlenz; Wolfgang Weihs; Albrecht Beitzke; Jörg-Ingolf Stein; Andreas Gamillscheg; Peter Rehak



Patients with Severe Poststroke Fatigue Show a Psychosocial Profile Comparable to Patients with Other Chronic Disease: Implications for Diagnosis and Treatment  

PubMed Central

Objective. To obtain a psychosocial profile of patients with poststroke fatigue (PSF), which could aid in optimizing treatment strategies. Methods. Eighty-eight outpatients with severe PSF measured with the Checklist Individual Strength-fatigue subscale (CIS-f) and the Fatigue Severity Scale (FSS) were selected. Depression and anxiety, psychological distress, coping, social support, and self-efficacy of this group were compared to reference groups of healthy controls and patients with other chronic diseases. Associations between psychosocial characteristics and fatigue were calculated. Results. Compared to healthy controls, patients with PSF reported more psychological distress, less problem-focused coping, and more positive social support. Minor or no differences were found in comparison with other chronic patients. The CIS-f correlated with somatic complaints and the FSS with cognitive complaints. Conclusion. Patients with PSF show a psychosocial profile comparable to patients with other chronic disease. Implications for diagnosis and treatment are discussed.

Zedlitz, Aglaia M. E. E.; Visser-Meily, Anne J. M. A.; Schepers, Vera P.; Geurts, Alexander C. H.; Fasotti, Luciano



The relevance of echocardiography heart measures for breeding against the risk of subaortic and pulmonic stenosis in Boxer dogs.  


The aims of this study were to investigate the role and relative importance of auscultation and echocardiography traits as risk factors for the diagnosis of subaortic (SubAS) and pulmonic (PS) stenosis and to estimate the heritability (h(2)) of cardiac measurements taken through echocardiography for a random sample of Italian Boxer dogs. The data were cardiovascular examination results of 1,283 Italian Boxer dogs (686 females and 597 males) enrolled in the national screening program for heart defects arranged by the Italian Boxer Club. Examinations were performed during a 6-yr period by a group of 7 veterinary cardiologists following a standard protocol. Occurrence and severity of SubAS and PS were diagnosed, taking into account clinical and echocardiography findings such as the grade of cardiac murmur, direct ultrasound imaging of the anatomic obstructive lesions, and values of aortic or pulmonary blood flow velocities. A Bayesian logistic regression analysis was performed to identify clinical and echocardiography variables related to SubAS and PS diagnosis. Estimation of variance components for clinical and echocardiography traits was performed using a mixed linear animal model, Bayesian procedures, and the Gibbs sampler. Prevalence of SubAS (PS) was 8.4% (2.2) and 10.7% (6.4) for female and male dogs, respectively. Cardiac murmur, peak velocities, and annulus areas behaved as risk factors for SubAS and PS. The risk of a positive diagnosis for SubAS was 3 times greater for dogs with aortic annulus area <2.1 cm(2) relative to dogs with areas >2.37 cm(2), 84 times greater for dogs showing aortic peak velocities >2.19 m/s relative to dogs with peak velocities <1.97 m/s, and 41 times greater for dogs with moderate to severe murmur grades relative to dogs with absent murmur. Similar results were obtained for PS. The estimated h(2) for the occurrence of cardiac defects was 23.3% for SubAS and 8.6% for PS. Echocardiography and cardiac murmur grades exhibited moderate h(2) estimates and exploitable additive genetic variation. The estimated h(2) was 36, 24, and 20% for aortic annulus area, aortic peak velocity, and cardiac murmur score, respectively. For the area of the pulmonary annulus and peak pulmonary velocity, the estimated h(2) were smaller, ranging from 9.5 to 12.8%. These measures are candidate indicator traits that might be effectively used in dog breeding to reduce the prevalence and severity of cardiac defects. PMID:21908643

Menegazzo, L; Bussadori, C; Chiavegato, D; Quintavalla, C; Bonfatti, V; Guglielmini, C; Sturaro, E; Gallo, L; Carnier, P





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[Clinical study of fetal echocardiography].  


Fetal echocardiography was studied by PUMC Hospital Xi' an and Harbin Medical University in collaboration. 320 fetuses were examined with M-mode. 2D and pulsed Doppler echocardiograph during one year. 7 cases of congenital heart disease were found including four ASD, one VSD, one complex deformity (single atrium, left ventricle undeveloped and pulmonary arteria) and one heart tumor (rhabdomyoma). Normal fetal echocardiographic and Doppler parameters were detected in 313 normal fetuses. The characteristic of abnormal fetal echo are: (1) The diameter of the arterial and ventricular chambers increased with increasing fetal age. (2) Fetal RV/LV = 1.1, RA greater than or equal to LA. (3) The thickness of the RV free wall is same as that of the LV free wall and septum. The fetal Doppler echo revealed: (1) The peak velocity of pulmonary artery in the early systole. (2) Peak A/Peak E greater than 1 in mitral and tricuspid valves Doppler spectra. The characteristic of fetal echocardiography consists of prominence of the right ventricle and high pulmonary pressure in the fetus. PMID:2620578



Fetal echocardiography in trisomy 18  

PubMed Central

Background: Previously reported pathological series suggest that cardiac malformations are universal in trisomy 18. We examined our experience of fetal echocardiography in trisomy 18 for comparison. Methods: Of 255 fetuses with trisomy 18 detected in our centre between January 1999 and June 2004, 174 were evaluated using fetal echocardiography. Our results were compared to four previous echocardiographic and four autopsy series, comprising 89 and 110 patients, respectively. Results: Of these 174 fetuses, 114 were examined between 10 and 14 weeks gestation and the remainder between 15 and 33 weeks. An increased nuchal translucency measurement was the reason for referral in most of the early cases and extracardiac anomalies in the remainder. Images were non-diagnostic in 12 cases (7%), all examined at <15 weeks gestation. Abnormal cardiac findings were detected in 118 of the remaining 162 fetuses (73%), including 15 with functional anomalies. The various heart malformations included ventricular septal defects, tetralogy of Fallot, left heart disease, and atrioventricular septal defects. In all series used for comparison, a similar diversity of disease was seen. In pathological series of trisomy 18, structural heart malformations were found in all cases, but some had lesions which would not be detectable echocardiographically in the fetus. Conclusion: Abnormal cardiac findings are detectable echocardiographically in the majority of cases of trisomy 18 examined during fetal life, but not in all. A wide spectrum of heart defects is seen. Diagnosis of heart malformations can be made reliably, even in the first trimester at the time of nuchal translucency measurement.

Moyano, D; Huggon, I; Allan, L



Reproducibility of dobutamine digital stress echocardiography.  


The aim of this study was to investigate the temporal variability and interobserver agreement of dobutamine digital stress echocardiography. We performed two dobutamine stress echocardiographic studies (dobutamine up to 40 micrograms/kg/min and atropine up to 1 mg) in 15 patients with previous myocardial infarction at a mean of 19 days apart. Two observers assessed the wall motion using a six-point score in a 16-segment model and calculated the wall motion score index at rest and at peak stress by using a quad screen display. Analysis of the wall motion was performed separately on the day after each dobutamine stress test (analysis A), and all images from the serial studies in the same patient were simultaneously retrieved and compared side-by-side in the same view (analysis B). The mean values of heart rate and blood pressure were comparable for each in the two studies except for the heart rate at rest. Regarding the presence and absence of positive findings of dobutamine stress echocardiography, interobserver agreement was 93% (70% to 99% with 95% confidence limits, kappa value 0.86) in the patients and 93% (70% to 99% with 95% confidence limits, kappa value 0.80) in the three major vascular regions with the use of analysis A. these values did not improve with the use of analysis B. The agreement of the temporal variability was 93% (70% to 99% with 95% confidence limits, kappa value 0.86) in the patients and 84% (71% to 92% with 95% confidence limits, kappa value 0.66) in the vascular regions with the use of analysis A. These values further improved with the use of analysis B. With the comparison of the wall motion score index, interobserver variability showed a correlation coefficient of 0.88 at rest and 0.90 at peak stress with analysis A and 0.78 and 0.82, respectively, with analysis B. Corresponding analysis of temporal variability showed correlation coefficients of 0.99 at rest and 0.99 at peak stress when both analysis were used. Although dobutamine digital stress echocardiography has good reproducibility and negligible interobserver variability, even if the digital quad screen format is used, it requires strict standardization of the reading criteria and the objective measurements of wall motion in the expansion of this test to the evaluation of the changes in left ventricular function during more than two serial studies in the same patient. PMID:9168356

Takeuchi, M; Sonoda, S; Miura, Y; Kuroiwa, A



Signal processing in 2 dimensional Doppler echocardiography  

Microsoft Academic Search

Summary Blood flow recordings made by 2 dimensional Doppler echocardiography can sometimes be understood more easily than conventional Doppler recordings, because of the anatomical 2 dimensional presentation. In contrast, signal processing has become more complicated and requires more explanation. In 2 dimensional Doppler echocardiography the analog ultrasonic signal received by the transducer is converted into an audible signal, which next

Hans Bot; Ben J. Delemarre; Cees A. Visser; Arend J. Dunning



Echocardiography in cardiac anaesthesia and intensive care  

Microsoft Academic Search

Echocardiography has become an essential part of cardiac anaesthesia and intensive care. The ability to perform echocardiography via the transoesophageal route allows accurate visualization of the heart, despite the presence of drains and positive-pressure ventilation, without interfering with the surgical procedure.

Marta Koertzen; Shane J. George



A Case of Kommerell's Diverticulum Initially Detected by Transesophageal Echocardiography  

PubMed Central

Kommerell's diverticulum is a rare congenital disorder characterized by typical right sided aortic arch and aberrant left subclavian artery which are usually detected by accident in asymptomatic patients. However, some of patients complain of severe symptoms caused by compression of the adjacent organs or complicated aortic dissection by the diverticulum. Early detection of the disease can lead to elective surgical correction. In this article, we report a Kommerell's diverticulum case initially detected by transesophageal echocardiography.

Lee, Seung-Jun; Lee, Seung-Hyun; Kim, Jin Ho; Lee, Hancheol; Lee, Dong-Jun; Kim, Jeong Hun; Son, Jung-Woo; Son, Jang-Won



Hand-held echocardiography: its use and usefulness  

Microsoft Academic Search

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,

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



Uvular ulceration following transoesophageal echocardiography  

PubMed Central

This report describes two episodes of significant uvular and oropharyngeal ulceration occurring during routine transoesophageal echocardiographic examination of the heart while intubated under general anaesthesia. Both patients were young and healthy and underwent anaesthesia without compromise, but experienced significant morbidity as a result of the ulceration. Uvular and oropharyngeal ulceration has been described following endoscopy and intubation, but there are few reports of ulceration following transoesophageal echocardiography. Operator skill is often a factor. Physical trauma and local ischaemia may play a role in aetiology. Patients experiencing sore throat following the procedure should be examined and observed in case of potentially fatal complications of airway compromise or uvular necrosis and infection. Particular care is required in patients undergoing day case procedures, as early discharge may lead to complications while the patient is at home.

Nijjer, Sukhjinder; Crean, Andrew; Li, Wei; Swan, Lorna



[Echocardiography in cor triatriatum dexter].  


"Cor triatriatum dexter" (CTD) is an unusual cyanotic cardiac defect in which the right atrium is subdivided into two distinct chambers due to the persistence of the "sinus venosus" valve. Two patients with CTD ho were evaluated and treatment in 1979 and 1992 are described: the first one, had total anomalous pulmonary venous return to the coronary sinus or "cor triatriatum sinister" as preoperative diagnosis based on M-mode echocardiographic findings. The presence of a membrane inside the right atrium was suspected on cineangiogram. The other one had a preoperative diagnosis of CTD. Anatomic relationships and physiological effects were established by two dimensional and Doppler ultrasonography and confirmed at cardiac catheterization and surgery. High resolution two dimensional echocardiography coupled with Doppler ultrasonography has a definite role in the study of this heart defect. PMID:8117458

Nunes, M A; Fragata, J; Lima, M



Relation between dobutamine trans-thoracic echocardiography, 99Tcm-MIBI and 18FDG uptake in chronic coronary artery disease.  


The relationships between rest conditions of myocardial asynergy, response to dobutamine administration, perfusion and glucose metabolism were examined in 12 patients with chronic coronary artery disease and left ventricular dysfunction. We evaluated (1) rest and stress myocardial perfusion by 99Tcm-methoxyisobutylisonitrile (MIBI) and single photon emission tomography (SPET), (2) rest myocardial segmental wall motion by trans-thoracic echocardiography and low-dose dobutamine, and (3) myocardial metabolism by [18F]-2-fluoro-2-deoxy-D-glucose (18-FDG) and positron emission tomography (PET), in the fasting state. The analysis was carried out on 16 left ventricular myocardial segments. The SPET studies were analysed semi-quantitatively by normalization to the peak activity. Wall motion was assessed by a visual score. An 18FDG index was determined as the tissue/blood pool radioactivity ratio in each segment. The results showed: (1) remarkably good agreement between the number of dobutamine responsive segments and 18FDG positive segments among those that were only moderately hypoperfused and hypokinetic; (2) a smaller number of dobutamine responsive segments than 18FDG positive segments among those that were hypoperfused and akinetic; and (3) the presence of 18FDG in 50% of the segments that were severely hypoperfused and akinetic or dyskinetic and without improvement with dobutamine. These results indicate that in severely hypoperfused and akinetic or dyskinetic segments, trans-thoracic echocardiography under inotropic stimulation provides little additional information compared with that obtained with rest echocardiography and perfusion studies; the assessment of 18FDG uptake provides information that is complementary to that obtained by perfusion assessment, rest and dobutamine trans-thoracic echocardiography. PMID:7478392

Lucignani, G; Landoni, C; Mengozzi, G; Palagi, C; Paolini, G; Zuccari, M; Vanoli, G; Biadi, O; Mariani, M A; Mariani, M



Myocardial contrast echocardiography with 1.5-harmonic imaging in the diagnosis of cardiac malignant lymphoma.  


We applied myocardial contrast echocardiography with 1.5-harmonic imaging to an atrioventricular groove tumor in a patient with malignant lymphoma. Contrast echocardiography initially showed one centric legion and some patchy echogenic foci within the tumor, all of which were indicative of arterial components. Subsequently, the tumor was enhanced homogenously, reflecting parenchymal hyperperfusion. These findings were consistent with previous observations of malignant lymphoma using color Doppler. We believe that myocardial contrast echocardiography could afford an important clue to the histologic diagnosis of cardiac tumors. PMID:16084343

Shimizu, Masatoshi; Takahashi, Hanayo; Tatsumi, Kazuhiro



Hyperglycemic Ins2AkitaLdlr?/? mice show severely elevated lipid levels and increased atherosclerosis: a model of type 1 diabetic macrovascular disease[S  

PubMed Central

Accelerated atherosclerosis is the leading cause of death in type 1 diabetes, but the mechanism of type 1 diabetes-accelerated atherosclerosis is not well understood, in part due to the lack of a good animal model for the long-term studies required. In an attempt to create a model for studying diabetic macrovascular disease, we have generated type 1 diabetic Akita mice lacking the low density lipoprotein receptor (Ins2AkitaLdlr?/?). Ins2AkitaLdlr?/? mice were severely hyperglycemic with impaired glucose tolerance. Compared with Ldlr?/? mice, 20-week-old Ins2AkitaLdlr?/? mice fed a 0.02% cholesterol AIN76a diet showed increased plasma triglyceride and cholesterol levels, and increased aortic root cross-sectional atherosclerotic lesion area [224% (P < 0.001) in males and 30% (P < 0.05) in females]. Microarray and quantitative PCR analyses of livers from Ins2AkitaLdlr?/? mice revealed altered expression of lipid homeostatic genes, including sterol-regulatory element binding protein (Srebp)1, liver X receptor (Lxr)?, Abca1, Cyp7b1, Cyp27a1, and Lpl, along with increased expression of pro-inflammatory cytokine genes, including interleukin (Il)1?, Il1?, Il2, tumor necrosis factor (Tnf)?, and Mcp1. Immunofluorescence staining showed that the expression levels of Mcp1, Tnf?, and Il1? were also increased in the atherosclerotic lesions and artery walls of Ins2AkitaLdlr?/? mice. Thus, the Ins2AkitaLdlr?/? mouse appears to be a promising model for mechanistic studies of type 1 diabetes-accelerated atherosclerosis.

Zhou, Changcheng; Pridgen, Brian; King, Nakesha; Xu, Jinxian; Breslow, Jan L.



Stress echocardiography: methods, indications and results  

PubMed Central

Stress echocardiography has become an important clinical tool to detect cardiac ischaemia and viability in addition to single photon emission tomography. Stress echocardiography has a high positive and negative predictive value, is less expensive than the nuclear methods and has no radiation exposure. It can easily be used in an emergency room and coronary care unit. Because of its feasibility, low cost and high diagnostic accuracy, it will become a very important technique in every hospital and will soon be a real alternative to the more time-consuming and expensive nuclear techniques. The current article gives a review of the methods of stress echocardiography. ImagesFigure 2Figure 3Figure 4

Baur, L.H.B.



Assessment of ventricular functions by tissue Doppler echocardiography in children with asthma.  


Patients with asthma develop pulmonary hypertension due to recurrent hypoxia and chronic inflammation, leading to right heart enlargement with ventricular hypertrophy. Patients with severe asthma can experience cor pulmonale later in life, but little is known about ventricular function during the early stages of the disease. This study aimed to investigate ventricular functions in asymptomatic children with asthma as detected by conventional echocardiography and tissue Doppler echocardiography (TDE). Fifty-one pediatric patients (mean age 10.4 ± 2.2 years) with asthma and 46 age- and sex-matched healthy children (mean age 10.9 ± 2.4 years) were studied. All subjects were examined by conventional echocardiography and TDE, and they had pulmonary function tests on spirometry. The right-ventricular (RV) wall was statistically (p = 0.01) thicker among asthmatic patients (4.7 ± 1.5 mm) compared with healthy children (3.6 ± 0.4 mm). However, conventional pulsed-Doppler indices of both ventricles did not differ significantly between asthmatic patients and healthy children (p > 0.05). The results of TDE examining RV diastolic function showed that annular peak velocity during early diastole (E'), annular peak velocity during late diastole (A') (16.4 ± 1.8 and 5.1 ± 1.4 cm/s, respectively), E'/A' ratio (3.2 ± 0.7), isovolumetric relaxation time (67.7 ± 10.2 ms) and myocardial performance index (48.1 % ± 7.0 %) of the lateral tricuspid annulus among asthmatic patients differed significantly (p = 0.01) from those of healthy children (13.2 ± 2.3, 8.2 ± 2.0 cm/s, 1.6 ± 0.5, 46.2 ± 8.7 ms, and 42.0 % ± 5.7 %, respectively). Only peak expiratory flow (PEF) rate from the pulmonary function tests was negatively correlated with the E'/A' ratio of the tricuspid annulus (r = -0.38, p = 0.01). This study showed that although the findings of clinical and conventional echocardiography were apparently normal in children with asthma, TDE showed subclinical dysfunction of the right ventricle, which is negatively correlated with PEF. These findings signify the diagnostic value of TDE in the early detection and monitoring of such deleterious effects among asthmatic patients. PMID:22965765

Ozdemir, Osman; Ceylan, Yasemin; Razi, Cem Hasan; Ceylan, Ozben; Andiran, Nesibe



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

Microsoft Academic Search

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

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



Management of asymptomatic intracardiac missiles using echocardiography.  


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

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



Correlation Between Epicardial Fat Thickness by Echocardiography and Other Parameters in Obese Adolescents  

PubMed Central

Background and Objectives Obesity has reached epidemic proportions globally and affects people of all ages. Recent studies have shown that visceral adipose tissue measured by magnetic resonance imaging and/or computed tomography correlates positively with epicardial adipose tissue. Epicardial fat, which is correlated to several metabolic parameters, can be assessed by echocardiography. The aim of this study was to evaluate epicardial fat thickness and other metabolic parameters in obese adolescents and investigate the correlation between epicardial fat thickness and other metabolic parameters in obese adolescents. Subjects and Methods We selected 99 subjects, between ages 15-17 years of age, to be enrolled in this study. Sixty five obese adolescents with a body mass index (BMI) >95 percentile and 34 control subjects were included in this study. Echocardiographic measurements including epicardial fat thickness as well as anthropometric and blood pressure (BP) measurements were performed. The following parameters were estimated: blood glucose, total cholesterol, triglyceride, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, aspartate aminotransferase, alanine aminotransferase, free fatty acid, interleukin-6, tumor necrosis factor-?, leptin, adiponectin and high sensitive C reactive protein. Results The obese group showed a statistically significant correlation with echocardiographic epicardial fat thickness and, BMI, waist circumference, obesity index, fat percentage, systolic BP, insulin level, leptin and adiponectin. Multivariate linear regression analysis showed epicardial fat thickness as the most significant independent parameter to correlate with obese adolescents. Conclusion These data suggest that epicardial fat thickness measured by echocardiography is a practical and accurate parameter for predicting visceral obesity.

Kim, Sung Jin; Kim, Hae Soon; Jung, Jo Won; Kim, Nam Su; Noh, Chung Il



Right atrial angiosarcoma with severe biventricular dysfunction and massive pericardial effusion.  


This paper presents the case of a 35 year-old woman with symptoms of heart failure from the last month. A physical examination at admission showed paleness, dyspnea, peripheral edema and fatigue. In a two-dimensional echocardiography and transesophageal echocardiography, normal thickness but severe left and right ventricular dysfunction with severe pericardial effusion and thickened pericardium were found. In the enlarged right atrium, an oval-shaped structure was found with features of continuity with lateral right atrial wall and also a bulging of the structure through the orifice of the tricuspid valve to the right ventricle. In the echocardiography, we did not saw any blocking of the tricuspid valve or the inflow from inferior vena cava (IVC) or superior vena cava (SVC) or coronary sinus. On the basis of the echocardiography examination and clinical presentation, tentative diagnosis of the right atrium myxoma was made. A coronary angiography revealed normal coronary arteries and no feeding of tumor by branch of right coronary artery (RCA). Surgical removal of the tumor was performed without complication. The histopathological examination confirmed the diagnosis of angiosarcoma. In the follow-up echocardiography carried out after three months, severe left ventricular (LV) and right ventricular (RV) dysfunction continued and was demonstrated. Magnetic resonance imaging revealed no lymphadenopathy or re-growth of the tumor in the mediastinum or pericardium. PMID:23585321

Sabzi, Feridoun; Dadkhah, Heidar; Shojaei, Sharam; Mahdavi, Masoume; Poormotaabed, Alireza; Javid, Nasrin; Dabiri, Samsam



Severe Pulmonary Hypertension in Primary Sjögren's Syndrome.  


A 65 year-old female with a history of xerostomia and xerophthalmia was presented with dyspnea on exertion (New York Heart Association class III). Echocardiography and cardiac catheterization demonstrated severe pulmonary hypertension (PH). Laboratory examinations showed positive anti-nuclear and anti-Ro/SS-A antibodies. Schirmer's test was positive and salivary gland scintigraphy revealed severely decreased tracer uptakes in both parotid and submandibular glands. By excluding other possible causes of PH during further examinations, she was diagnosed with severe PH associated with primary Sjögren's syndrome. Her dyspnea symptom was much improved with endothelin receptor antagonist and azathioprine. PMID:23964300

Hwang, Ji-An; Yang, Tae-Hyun; Lee, Ji-Young; Koo, Dong-Wan; Choi, In Suk; Cho, Sun-Young; Kim, Min-Sung



[3-dimensional reconstruction of multiplanar transesophageal echocardiography images: a methodologic report with case examples].  


First experience with the dynamic three-dimensional reconstruction of transesophageal echocardiographic images in more than 100 patients with various cardiac diseases are reported. Ninety different two-dimensional image planes were acquired for each reconstruction using a conventional multiplanar transducer, connected to a stepper motor and controlled by a computer-based image acquisition system with special software. Acquisition time for one data set was 2.3 +/- 0.9 min, and calculation time to achieve three-dimensional images was 20-45 min. Several cardiac structures were reconstructed and analyzed qualitatively and quantitatively (measurements of distances and areas, volume calculation by Simpson's rule). Image sequences showing three-dimensional depth by gray scale modification were generated. After image acquisition one can select any desired cut plane to achieve perspectives that cannot be obtained by two-dimensional technique. Advantages of three-dimensional echocardiography are the display and potential quantification of pathomorphology of the left ventricle and mitral valve, atrial septal defects, intracardiac masses (i.e., myxomas, vegetations), and direct spatial imaging of complex congenital heart diseases. In principle, three-dimensional data sets have advantages for the quantitative evaluation of irregular formed cardiac structures, since the three-dimensional data set is more complete than cross-sections used in conventional two-dimensional echocardiography. Currently, however, these advantages are limited by the necessity of human interaction to segment the structures of interest. PMID:7571770

Franke, A; Flachskampf, F A; Kühl, H P; Klues, H G; Job, F P; Merx, M; Krebs, W; Hanrath, P



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

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.

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



Spontaneous drainage of paravalvular abscess diagnosed by transesophageal echocardiography.  


Paravalvular abscesses, which occur in up to 30% of cases of native valve endocarditis, are being detected with increasing frequency with the use of transesophageal echocardiography. Abscesses of the mitral aortic intervalvular fibrosa have been described but only in association with native or prosthetic aortic valve endocarditis. We describe a patient with native mitral valve endocarditis complicated by an abscess in the fibrosa. A 51-year-old diabetic man presented with Staphylococcus aureus mitral valve endocarditis. A transesophageal echocardiographic study done 8 days after admission revealed two large masses at the base of the anterior mitral leaflet with extension into the fibrosa consistent with a paravalvular abscess that was not detected by precordial echocardiography. A repeat transesophageal echocardiographic study done 20 days after admission showed spontaneous drainage of the abscess and a subsequent fistula between the left atrium and left ventricle. This case highlights the important role that transesophageal echocardiography has in suspected and known cases of endocarditis. Its major advantage of delineating posterior cardiac structures allowed accurate diagnosis and serial evaluation of this previously unreported complication of endocarditis. PMID:1910838

Giannoccaro, P; Ascah, K J; Sochowski, R A; Chan, K L; Ruddy, T D


Application of Transesophageal Echocardiography in Minimally Invasive Surgical Closure of Ventricular Septal Defects  

PubMed Central

We sought both to evaluate the clinical value of transesophageal echocardiography in minimally invasive surgical closure of ventricular septal defects and to evaluate the feasibility, safety, and efficacy of the surgical occlusion procedure. We selected 49 pediatric patients who had perimembranous ventricular septal defects as determined by preoperative transthoracic echocardiographic examination. After the patients were under general anesthesia, we used transesophageal echocardiography to determine the number of defects and their positions, shapes, and sizes, these last in order to choose the appropriate occluder. Under transesophageal echocardiographic monitoring and guidance, we introduced and deployed the occluder. The evaluation of therapy was performed by means of transesophageal echocardiography immediately after occluder release. All patients underwent follow-up transthoracic echocardiography within 2 to 5 postoperative days. Satisfactory occluder deployment was achieved in 38 patients. No death occurred. No occluder displacement or valve dysfunction was observed during the last transesophageal echocardiographic study. In addition, follow-up by transthoracic echocardiography showed improvement of left ventricular dimensions and ejection fractions. Our initial experience has been encouraging. Transesophageal echocardiography plays a crucial role in performing minimally invasive surgical closure of cardiac defects. It enables the feasible, safe, and effective closure of ventricular septal defects. However, larger sample sizes and longer-term follow-up are necessary for the accurate evaluation of this procedure's safety and effectiveness as an alternative to cardiopulmonary bypass surgery and transcatheter closure of congenital cardiac defects.

Bai, Wenjuan; An, Qi; Tang, Hong



Role of echocardiography in acute pulmonary embolism.  


The difficulty in making an accurate diagnosis of acute pulmonary embolism is well known. To clarify the role of echocardiography, including Doppler echocardiography, in acute pulmonary embolism, we examined hemodynamic and echocardiographic parameters in 9 patients with acute pulmonary embolism just before and after treatment with urokinase. As hemodynamic parameters normalized after treatment, echocardiographic parameters such as deformity index of the left ventricle (LV-DI), end-diastolic dimension of the right ventricle (RVDd), the left ventricle (LVDd), the inferior vena cava, and RVDd/LVDd all significantly changed toward normal. Highly significant correlations were found between the echocardiographic and hemodynamic parameters, the best of which was between the LV-DI and systolic pulmonary artery pressure (r = -0.885, p less than 0.001). Doppler echocardiography quantitatively evaluated the grade of tricuspid regurgitation, and accurately estimated systolic pulmonary artery pressure. We conclude that echocardiography, including Doppler echocardiography, sensitively reflects the right ventricular pressure and volume overload of acute pulmonary embolism, is quite useful for its diagnosis which is often difficult, and is suitable for noninvasive follow up of these patients. PMID:2614928

Okubo, S; Miyatake, K; Nagata, S; Nakanishi, N; Yoshioka, T; Kunieda, T



LRP1b shows restricted expression in human tissues and binds to several extracellular ligands, including fibrinogen and apoE - carrying lipoproteins  

PubMed Central

Objective To investigate low-density lipoprotein receptor-related protein 1b (LRP1b) expression in human tissues and to identify circulating ligands of LRP1b. Methods and results Using two independent RT-PCR assays, LRP1b mRNA was detected in human brain, thyroid gland, skeletal muscle, and to a lesser amount in testis but absent in other tissues, including heart, kidney, liver, lung, and placenta. Circulating ligands were purified from human plasma by affinity chromatography using FLAG-tagged recombinant LRP1b ectodomains and identified by mass spectrometry. Using this technique, several potential ligands (fibrinogen, clusterin, vitronectin, histidine rich glycoprotein, serum amyloid P-component, and immunoglobulins) were identified. Direct binding of LRP1b ectodomains to fibrinogen was verified by co-immunoprecipitation. ApoE – carrying lipoproteins were shown to bind to LRP1b ectodomains in a lipoprotein binding assay. Furthermore, binding as well as internalization of very low density lipoproteins by cells expressing an LRP1b minireceptor was demonstrated. Discussion LRP1b expression in humans appears to be confined to few tissues, which could point out to specialized functions of LRP1b in certain organs. Most of the newly identified LRP1b ligands are well-known factors in blood coagulation and lipoprotein metabolism, suggesting a possible role of LRP1b in atherosclerosis.

Haas, J.; Beer, A.G.; Widschwendter, P.; Oberdanner, J.; Salzmann, K.; Sarg, B.; Lindner, H.; Herz, J.; Patsch, J.R.; Marschang, P.



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

PubMed Central

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

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



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


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

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



Quadricuspid aortic valve by using intraoperative transesophageal echocardiography  

PubMed Central

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



Update on new technologies in pediatric echocardiography.  

PubMed Central

Advances in ultrasound technology will continue to expand the utility of echocardiography in the assessment of structural and functional cardiac disease in children. Tissue Doppler imaging and dobutamine stress echocardiography are 2 promising clinical applications that are expected to become increasingly used with time. Advances in data compression technology, including JPEG and MPEG techniques, will significantly affect digital archival and transmission of echocardiograms, which also have clinical implications, particularly in the expanding use of telemedicine. Continued research and clinical experience will further define the ultimate roles of these technologies in the future. Images

Bezold, L I; Lewin, M B; Vick, G W; Pignatelli, R



Echocardiography and genetic counselling in tuberous sclerosis.  

PubMed Central

OBJECTIVE--To assess echocardiography as an investigation for the detection of occult gene carriers in tuberous sclerosis. PATIENTS--Sixty parents of children with tuberous sclerosis who had been extensively investigated for signs of the disease and 60 age and sex matched controls. PROCEDURE--Blind study by two experienced echocardiographers and blind interpretation of video recordings by an adult cardiologist. SETTING--Cardiology department of a district general hospital. RESULTS--Two parents and three controls had bright echodense areas interpreted as possible rhabdomyomas. CONCLUSIONS--In our hands echocardiography of adults is not an investigation with a high specificity for gene detection in tuberous sclerosis. Images

Webb, D W; Thomas, R D; Osborne, J P



European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography.  


The main mission statement of the European Association of Echocardiography (EAE) is 'to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular ultrasound in Europe'. As competence and quality control issues are increasingly recognized by patients, physicians, and payers, the EAE has established recommendations for training, competence, and quality improvement in echocardiography. The purpose of this document is to provide the requirements for training and competence in echocardiography, to outline the principles of quality measurement, and to recommend a set of measures for improvement, with the ultimate goal of raising the standards of echocardiographic practice in Europe. PMID:19889658

Popescu, Bogdan A; Andrade, Maria J; Badano, Luigi P; Fox, Kevin F; Flachskampf, Frank A; Lancellotti, Patrizio; Varga, Albert; Sicari, Rosa; Evangelista, Arturo; Nihoyannopoulos, Petros; Zamorano, Jose L; Derumeaux, Genevieve; Kasprzak, Jaroslaw D; Roelandt, Jos R T C



Ergonovine stress echocardiography: Recent experience and safety in our centre  

PubMed Central

AIM: To study recent experience and safety of ergonovine stress echocardiography in our centre. METHODS: In this study we collected the clinical variables of patients referred since 2002 for ergonovine stress echocardiography, in addition to indications, the results of this test, complications, blood pressure and heart rate values during the test and the number and results of tests requested before this technique. RESULTS: We performed 40 tests in 38 patients, 2 tests were carried out to verify therapy efficacy. The prevalence of classic cardiovascular risk factors was low and the most frequent indication was chest pain (57.5%). Coronary angiography was performed in 32 patients, and showed normal coronary arteries in 27 patients and non-significant stenosis in 5 cases. In 16 patients, coronary angiography was carried out after a positive or inconclusive ischemia test. Another 6 patients had a normal stress test (5 exercise electrocardiography tests and 1 nuclear imaging test). Of the 40 ergonovine stress echocardiography tests, 6 were positive (4 in the right coronary artery territory and 2 in the circumflex coronary artery territory), all of them by echocardiographic criteria, and by electrocardiographic criteria in only 3 (50%). The presence of non-significant coronary artery stenosis was more frequent in patients with positive ergonovine stress echocardiography (50% vs 6%, P = 0.038), and were related to ischemic territory. During the maximum stress stage, there was a higher systolic (130.26 ± 19.17 mmHg vs 136.58 ± 27.27 mmHg, 95% CI: -12.77 to 0.14 mmHg, P = 0.055) and diastolic blood pressure (77.89 ± 13.49 mmHg vs 83.95 ± 15.73 mmHg, 95% CI: -10.41 to -1.69 mmHg, P = 0.008) than at the baseline stage, and the same was registered with heart rate (73 ± 10.96 beats/min vs 79.79 ± 11.72 beats/min, 95% CI: -9.46 to -4.11 beats/min, P < 0.01). Nevertheless, there were only 2 hypertensive reactions during the last stage, which did not force a premature end to the test, without sustained tachy or bradyarrhythmias, and the technique was well tolerated in 58% of cases. A unique complication (2.5%) of this test was a prolonged vasospasm with a slight increase in necrosis biomarkers, however, this was without repercussion. CONCLUSION: Ergonovine stress echocardiography can be performed with safety, is well tolerated in the majority of cases, and is useful for determining the ischemia mechanism in selected cases.

Cortell, Alejandro; Marcos-Alberca, Pedro; Almeria, Carlos; Rodrigo, Jose L; Perez-Isla, Leopoldo; Macaya, Carlos; Zamorano, Jose Luis



Doxorubicin Cardiotoxicity and Cardiac Function Improvement After Stem Cell Therapy Diagnosed by Strain Echocardiography  

PubMed Central

Doxorubicin (Dox) is one of the most effective chemotherapeutic agents; however, it causes dose-dependent cardiotoxicity. Evaluation of left ventricular function relies on measurements based on M-mode echocardiography. A new technique based on quantification of myocardial motion and deformation, strain echocardiography, has been showed promising profile for early detection of cardiac dysfunction. Different therapy strategies, such as flavonoid plant extracts and stem cells, have been investigated to improve heart function in toxic cardiomyopathy. This work aimed to assess early cardiac function improvement after treatments with either flavonoid extract from Camellia sinensis or mesenchymal stem cells in Dox cardiotoxicity using strain echocardiography. Twenty Wistar rats were randomly assigned to four groups. They received water (control, Dox, Dox + stem cells) or 100 mg/kg C. sinensis extract (Dox + C. sinensis) via gavage, daily, for four weeks. Animals also received saline (control) or 5 mg/kg doxorubicin (Dox, Dox + C. sinensis, Dox + stem cells) via intraperitoneal injection, weekly, for four weeks. Stem cells were injected (3 × 106 cells) through tail vein prior the beginning of the experiment (Dox + stem cells). Animals were evaluated by hematological, electrocardiography, echocardiography, and histopathological examinations. Dox cardiotoxicity was only diagnosed with strain echocardiography, detecting a decrease in ventricular function. C. sinensis extract did not prevent ventricular dysfunction induced by Dox. However, strain echocardiography examination revealed that Dox cardiotoxicity was significantly suppressed in rats treated with stem cells. In conclusion, strain echocardiography was able to detect precocity signs of heart failure and stem cell therapy showed cardioprotection effect against Dox cardiotoxicity.

Oliveira, Maira S; Melo, Marcos B; Carvalho, Juliana L; Melo, Isabela M; Lavor, Mario SL; Gomes, Dawidson A; de Goes, Alfredo M; Melo, Marilia M



Assessment of Apical Hypertrophic Cardiomyopathy Using Transoesophageal Echocardiography  

Microsoft Academic Search

Two-dimensional echocardiography is the method of choice for imaging and diagnosis in patients with hypertrophic cardiomyopathy. However, ultrasound examination of the left ventricular apex by transthoracic echocardiography is often inadequate so that hypertrophy localised to this region may be missed. The purpose of this study was to evaluate the use of multiplane transoesophageal echocardiography in the diagnosis and assessment of

James J. Crowley; Petros S. Dardas; Leonard M. Shapiro



Determination of cardiac output by Doppler echocardiography  

Microsoft Academic Search

Cardiac output determined by Doppler echocardiography was compared with that determined by thermodilution at rest and during dobutamine infusion in 10 patients (group A) and by the Fick method at rest in 11 patients (group B). All patients had angina pectoris without valvular heart disease. Maximum spatial blood velocity and cross sectional aortic area were estimated by the Doppler technique

H Ihlen; J P Amlie; J Dale; K Forfang; S Nitter-Hauge; J E Otterstad; S Simonsen; E Myhre



Complications of transesophageal echocardiography in the ED  

Microsoft Academic Search

The complication rate of transesophageal echocardiography (TEE) performed in clinical settings outside the emergency department (ED) has been reported to be 1% to 3%. The rate of complications of performing TEE in the ED has not been established. The purpose of this study was to determine the rate of complications associated TEE with carried out on ED patients, and to

Mark A Gendreau; Wayne R Triner; Joel Bartfield



[Improved structure identification with tissue Doppler echocardiography].  


Tissue Doppler echocardiography (TDE) has been shown to be of particular value in patients with impaired myocardial function. Recently, the technique was successfully employed to localize the ventricular insertion of accessory atrioventricular pathways. The identification of abnormal cardiac structures is coming up now as a new field of clinical interest. The purpose of this study was to differentiate anomalous cardiac and aortic from native structures by physical properties of tissue motion using transesophageal TDE. Characteristic motion patterns of anomalous structures have not been described in detail and tissue Doppler findings have not been associated with clinical features up to now. Forty consecutive patients were included after anomalous cardiac or vascular structures had been detected by conventional transesophageal echocardiography (TEE). A control group consisted of 20 subjects. Rapidity of diagnosis in anomalous structures was divided into 3 categories, and TDE signals were related to particular pathology by a blinded, 2nd observer. Three different motion patterns could be defined: incoherent motion due to free oscillation of an anomalous structure which is independent of the surrounding tissue (Figure 1b); coherent motion with a phase difference meaning that motion depends on the motion of the surrounding tissue but is out of phase (Figure 2); concordant motion showing no difference in direction, velocity, or phase of motion compared with the surrounding tissue. Incoherent motion was present in endocarditic vegetations, 4th degree aortic plaques, Chiari network, valvular prolapse, intracavitary tumors, and freely oscillating thrombi as well as in normal valve leaflets and papillary muscles. Especially if endocarditic vegetations are present its incoherent motion facilitates to recognize these small structures. The colorcode of this motion pattern demarcates the vegetation reliably from the surrounding tissue (Figure 1b). Within 15 seconds vegetations could be detected in 9 (82%) vs 2 (18%) patients employing only conventional imaging. Using conventional echocardiographic approaches detection of vegetations is frequently hindered by their small size and minor echo intensity (Figure 1a). In contrast, size and echo intensity do not affect the tissue Doppler signal. Normal papillary muscles and distal portions of the mitral and tricuspid valves were demonstrated to regularly meet the criterion of incoherent tissue motion in the control group. In part, this was also observed with respect to the aortic and pulmonary valves. In valvular tissue incoherent motion was caused by passive floating, whereas papillary muscles show an active inverse motion for short time intervals. Nevertheless, physiologic incoherent motion did not lead to any false differential diagnosis. The phase difference of coherent motion results from damped oscillation. This phenomenon was visualized by tissue Doppler M-mode in 5 thrombi of the left atrial appendage (LAA) (100%) and in 1 ventricular thrombus (50% of all clots). Concordant motion was shown in 3rd degree aortic plaques and postrheumatic and calcified vegetations. These structures were found to be completely embedded or closely attached, so that their passive motion corresponded to the motion of the surrounding regular tissue. Detection and assessment of anomalous structures are based on their motion patterns which can be synchronous or asynchronous in comparison with the surrounding tissue. Another goal of this investigation was to test if the sensitivity of TEE to spontaneous echo contrast can be improved using TDE. In 21 patients presenting with left atrial dilation (left atrial diameter > 44 mm) due to mitral stenosis (n = 8), mitral regurge (n = 5), arterial hypertension (n = 5) and multiple valvular disease (n = 3) fundamental multiplane TEE and transesophageal TDE were performed with standardized gain setting. The control group consisted of 20 randomized individuals with normal left PMID:10023584

Bartel, T; Müller, S; Möhlenkamp, S; Bruch, C; Schaar, J; Erbel, R



Digital tele-echocardiography: a look inside.  


Digital tele-echocardiography (T-E) has the potentiality to allow relevant change in health care organization. The purpose of the paper is to analyze the scientific development around the digital T-E to explore the successful applications and individuate the limits which hamper the routine introduction in the National Health Care System (NHCS). A literature review was carried out by searching for studies from 1988 to 2008. The studies have been investigated according to four crucial issues: a) the employment of the digital T-E versus the traditional videotape registrations; b) the evolution of the telecommunication network and T-E; c) the quality assessment of the images after transmission; d) the economical legal and social impact of the T-E. The analysis showed a generalized increased diffusion of the digital T-E thanks to the wonderful development of the information technology. This diffusion was sometimes also accompanied by investigation studies on the diagnostic accuracy and on cost-benefit analysis with special care to the economical and social impact. The study examined some points which need to be improved to allow a better introduction of the T-E in the NHCS as a routine exam. Among these two were the most important. The first was the lacking of an easy and automatic methodology for the image quality assessment alternative to the currently used methods which are highly complex, expensive and needing a long time to be applied. The second was the lacking of a properly designed methodology for the health technology assessment in T-E, the latter, as it is well known is a very complex and heterogeneous system embedding parts from telematics, bioengineering, and medical physics. PMID:20061655

Giansanti, Daniele; Morelli, Sandra



Large Ascending Aortic Aneurysm and Severe Aortic Regurgitation in a 7yearOld Child with Marfan Syndrome and a Review of the Literature: Marfan Syndrome in Childhood  

Microsoft Academic Search

A year 7-old-girl was admitted because of dyspnea on exertion and palpitations. Her symptoms had gradually worsened for the last 6 months. She had physical features of the Marfan syndrome. Transthoracic echocardiography showed an ascending aortic aneurysm, severe aortic regurgitation and mildly dilated left ventricle. Because of marked aortic aneurysm and severe aortic regurgitation, the patient was treated with a

Mehmet Yazici; Serdar Soydinç; Vedat Davuto?lu; ?lyas Akdemir; M. Hakan Dinçkal



Tissue Doppler echocardiography - A case of right tool, wrong use  

PubMed Central

Background The developments in echocardiography or ultrasound cardiography (UCG) have improved our clinical capabilities. However, advanced hardware and software capabilities have resulted in UCG facilities of dubious clinical benefits. Is tissue Doppler echocardiography (TDE) is one such example? Presentation of the hypothesis TDE has been touted as advancement in the field of echocardiography. The striking play of colors, impressive waveforms and the seemingly accurate velocity values could be deceptive. TDE is a clear case of inappropriate use of technology. Testing the hypothesis To understand this, a comparison between flow Doppler and tissue Doppler is made. To make clinically meaningful velocity measurements with Doppler, we need prior knowledge of the line of motion. This is possible in blood flow but impossible in the complex myocardial motion. The qualitative comparison makes it evident that Doppler is best suited for flow studies. Implications of the hypothesis As of now TDE is going backwards using an indirect method when direct methods are better. The work on TDE at present is only debatable 'research and publication' material and do not translate into tangible clinical benefits. There are several advances like curved M-mode, strain rate imaging and tissue tracking in TDE. However these have been disappointing. This is due to the basic flaw in the application of the principles of Doppler. Doppler is best suited for flow studies and applying it to tissue motion is illogical. All data obtained by TDE is scientifically incorrect. This makes all the published papers on the subject flawed. Making diagnostic decisions based on this faulty application of technology would be unacceptable to the scientific cardiologist.

Thomas, George



Specificity of electrocardiography and echocardiography changes at the patients with the pulmonary embolism.  


We evaluated electrocardiographic and echocardiographic changes of 40 patients with pulmonary thrombo-embolism proved by perfusion scintigrams. ECG-changes included sinus tachycardia or absolute tachyarrhythmia de novo, changes type Q1S3T3 and changes in right precordial leads. Analyses of echocardiography included hyperkinesis and then dilatation and apical hypokinesis of right ventricule and tricuspid regurgitation with maximal transvalvular gradients. We emphasize such a sensibility of echocardiographic changes in early estimation of pulmonary thrombo-embolism severity and necessity for echocardiography as early as possible in suspected patients. PMID:17177655

Maci?-Dzankovi?, Amra; Pozderac-Memija, Meliha



"The Show"  

ERIC Educational Resources Information Center

|For the past 16 years, the blue-collar city of Huntington, West Virginia, has rolled out the red carpet to welcome young wrestlers and their families as old friends. They have come to town chasing the same dream for a spot in what many of them call "The Show". For three days, under the lights of an arena packed with 5,000 fans, the state's best…

Gehring, John



Mechanical prosthetic valve-associated strands: Pathologic correlates to transesophageal echocardiography  

Microsoft Academic Search

Echocardiographic detection of prosthetic valve-associated strands has previously been reported, but their clinical relevance is unclear. Limited data are available regarding the cause, composition, and natural history of these strands. This report presents the gross and histopathologic findings of an explanted mechanical prosthetic valve shown by transesophageal echocardiography to have several strands. The patient had not experienced prior neurologic symptoms.

John D. Rozich; William D. Edwards; Richard D. Hanna; Dawn M. Laffey; Gilbert H. Johnson; Kyle W. Klarich



Diagnostic Errors in Pediatric Echocardiography Development of Taxonomy and Identification of Risk Factors  

Microsoft Academic Search

Background—Despite increased interest in complications within pediatric cardiology, the domain of imaging-related diagnostic errors has received little attention. We developed a new taxonomy for diagnostic errors within pediatric echocardiography that categorizes errors by severity, preventability, and primary contributor. Our objectives were to examine its findings when applied to diagnostic error cases and to identify risk factors for preventable or possibly

Oscar J. Benavidez; Kimberlee Gauvreau; Kathy J. Jenkins; Tal Geva



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


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

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



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

PubMed Central

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



Signal processing in 2 dimensional Doppler echocardiography.  


Blood flow recordings made by 2 dimensional Doppler echocardiography can sometimes be understood more easily than conventional Doppler recordings, because of the anatomical 2 dimensional presentation. In contrast, signal processing has become more complicated and requires more explanation. In 2 dimensional Doppler echocardiography the analog ultrasonic signal received by the transducer is converted into an audible signal, which next is digitized and analyzed for its mean frequency and variance. Data collection and processing require application of multigating and high speed frequency analysis, generally based upon autocorrelation. Some artifacts may be perceived, such as color reversal due to aliasing, deceptively colored tissue surfaces due to beam motion, and wall motion ghost signals due to multiple reflections. Color flow imaging is appropriate for a rapid scan of the heart cavities to detect and roughly evaluate flow abnormalities. Quantification is still accomplished by switching to conventional Doppler mode. PMID:3323330

Bot, H; Delemarre, B J; Visser, C A; Dunning, A J



Usefulness of transesophageal echocardiography in the pediatric catheterization laboratory.  


Transesophageal echocardiography was performed in 51 children (aged 2 to 14 years, mean 4; weight 9 to 50 kg, mean 21) undergoing elective diagnostic or therapeutic cardiac catheterization. The interventional procedures were percutaneous balloon dilation of pulmonary (n = 8) and aortic (n = 2) valve stenosis, percutaneous closure of patent ductus arteriosus (n = 8), and attempted occlusion of Pott's anastomosis by the double umbrella device (n = 1). The diagnostic catheterizations were performed on preoperative children of whom 5 had undergone previous palliative procedures. Precise placement of the balloon across the valve, timing of balloon inflation and deflation according to real-time monitoring of ventricular function and immediate evaluation of results and complications were accomplished with transesophageal monitoring. The exact position of distal and proximal umbrellas of patent ductus occlusive devices was checked on transesophageal imaging and completeness of occlusion controlled on color Doppler. The only relevant information in the preoperative cases was the detection of a septic thrombus in a severely ill patient. With more experience and smaller probes, transesophageal echocardiography may become a new method of monitoring cardiac catheterization also in smaller children where it may reduce duration of the procedure and amount of contrast material. PMID:8498374

Tumbarello, R; Sanna, A; Cardu, G; Bande, A; Napoleone, A; Bini, R M



[Fetal echocardiography--possibilities and limits].  


Actual possibilities and limitations in fetal echocardiography (two-dimensional and impulse-Doppler technique) based on our own experiences in 53 cases are described. Morphological analysis was almost successful after the 22nd week of gestation, in 11.3% the imaging was inadequate as the result of unfavorable ultrasound viewing. In twins especially the morphological analysis of the second fetus was more difficult. Clear morphological differentiation from the important parts of the fetus heart was possible after the 30th week of gestation in the majority of cases. From 47 sonographically judgeable fetal hearts 3 were classified as malformations. One of them could be confirmed by autopsy (ventricle-septal defect combined with cor monatrium), the second case clinically/echocardiographically postpartally respectively (atrial septal defect - secundum type). On the other hand the third pathological diagnosis of fetal echocardiography (single ventricle) could not be confirmed post-natally. As the result of this preliminary study fetal echocardiography can currently provide some important clues for the selection, perinatological treatment and care in birth of the child with a potentially higher risk factor. Additionally the authors point out the possibilities of complex functional analysis of the fetal heart under different pharmacological treatment. PMID:6485473

Heublein, B; Rössler, U; Schulte, R; Bartel, J



Aortic Valve Sclerosis on Echocardiography is a Good Predictor of Coronary Artery Disease in Patients With an Inconclusive Treadmill Exercise Test  

PubMed Central

Background and Objectives The treadmill exercise test (TMT) is used as a first-line test for diagnosing coronary artery disease (CAD). However, the findings of a TMT can be inconclusive, such as incomplete or equivocal results. Aortic valve sclerosis (AVS) is known to be a good predictor of CAD. We determined the usefulness of assessing AVS on 2-dimensional (2D) echocardiography for making the diagnosis of CAD in patients with inconclusive results on a TMT. Subjects and Methods This prospective study involved 165 consecutive patients who underwent a TMT that resulted in inconclusive findings, 2D echocardiography to detect AVS, and coronary angiography to detect CAD. Following echocardiography, AVS was classified as none, mild, or severe. CAD was defined as ?70% narrowing of the luminal diameter on coronary angiography. Results CAD was more common in patients with AVS than in patients without AVS (75% vs. 47%, respectively, p<0.01). Multiple logistic regression analysis showed that AVS was the only independent predictor of CAD {odds ratio=8.576; 95% confidence interval (CI), 3.739-19.672}. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the presence of AVS for predicting CAD in a patient with an inconclusive TMT were 62%, 67%, 64%, 75%, and 53%, respectively. During a 1-year clinical follow-up, patients with and without AVS were similar in terms of event-free survival rates. Conclusion If the results of TMT for patients with chest pain on exertion are inconclusive, the presence of AVS on echocardiography is a good predictor of CAD.

Kim, Dong-Bin; Jeon, Doo-Soo; Park, Chan-Seok; Jang, Sung-Won; Park, Hoon-Joon; Kim, Pum Joon; Baek, Sang Hong; Seung, Ki-Bae; Rho, Tai-Ho; Kim, Jae-Hyung; Choi, Kyu-Bo



The role of quantitative myocardial contrast echocardiography in the study of coronary microcirculation in athlete's heart  

Microsoft Academic Search

Quantitative myocardial contrast echocardiography was performed with harmonic power Doppler analysis using the background subtraction and Levovist (Schering AG, Berlin, Germany) as contrast agent in a triggered modality. Quantitative analysis of echocontrast was performed offline with PC software, obtaining the transit curves of microbubbles through the coronary capillary system. Coronary microcirculation in athletes showed a behavior substantially comparable with control

Vitantonio Di Bello; Davide Giorgi; Alessio Bertini; Enrica Talini; Giovanna Mengozzi; Caterina Palagi; Carmela Nardi; Marco Paterni; Mario Mariani



Echocardiography-guided pacemaker programming can improve cardiac hemodynamics in patients undergoing transcatheter aortic valve replacement.  


Transcatheter aortic valve replacement (TAVR) is an effective treatment option for patients with severe aortic stenosis who are at high surgical risk because of multiple comorbidities. Many of these patients have been treated with pacemakers for concomitant conduction disease. The combination of severe aortic stenosis, cardiomyopathy, and conduction abnormalities results in a state of low cardiac output. Here, we report 2 complex TAVR cases where Doppler echocardiography was used to guide adjustment of device settings, leading to improved cardiac hemodynamic profiles. PMID:23627861

Lee, Ming-Sum; Naqvi, Tasneem Z



Transcatheter Atrial Septal Defect Closure under Transthorasic Echocardiography in Children  

PubMed Central

Objective Atrial septal defect (ASD) device closure is routinely done under the guide of transesophageal or intracardiac echocardiography which are expensive techniques and not easily affordable in developing countries. Methods Using metallic devices, we attempted 32 ASD device closures under transthoracic echocardiography. Findings Of those, 30 procedures were successful (94 %). In two patients with relatively large ASD we encountered difficulty in positioning the device. These patients were referred for surgical closure. Conclusion ASD device closure can be carried out successfully in most patients under transthoracic echocardiography in situations where transesophageal or intravenous echocardiographies are not available or affordable.

Zanjani, Keyhan Sayadpour; Zeinaloo, Aliakbar; Malekan-Rad, Elaheh; Kiani, Abdolrazagh; Bagheri, Mohammad-Mehdi



Utility of transesophageal echocardiography in infective endocarditis. A review.  

PubMed Central

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

Jessurun, C; Mesa, A; Wilansky, S



Early fetal echocardiography: ready for prime time?  


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

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



[Surgical echocardiography of the mitral valve].  


In the western world, the prevalence of mitral regurgitation-particularly that due to degenerative disease-has gradually increased despite a substantial decrease in rheumatic disease. If present, secondary ventricular dysfunction, potentially irreversible when clinically diagnosed, requires close echocardiographic follow-up in order to establish a subclinical diagnosis. Thus, echocardiography has become an essential tool in managing patients with mitral valve regurgitation. As well as assessing parameters of ventricular geometry, in the hands of an expert echocardiography offers systematic documentation of lesion in each segment, which together with the dysfunction type should give an accurate idea of the complexity involved in the valve repair. This is increasingly relevant given the growing number of asymptomatic patients referred for mitral valve surgery. Consequently, the echocardiographic study performed prior to referral is crucial to successful mitral valve repair and cardiologists, cardiac imaging experts, and surgeons should be guided by results when referring patients to specialists with the skills necessary to undertake adequate repair of the lesions found. PMID:22032935

Castillo, Javier G; Solís, Jorge; González-Pinto, Angel; Adams, David H



Early Fetal Echocardiography: Ready for Prime Time?  

PubMed Central

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

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



Repeated echocardiography: essential in the management of Staphylococcus aureus endocarditis.  

PubMed Central

Staphylococcus aureus endocarditis in a previously healthy 25 year old man is described. Repeated echocardiography recorded rapid progression of aortic root and interventricular septal involvement and, even though the patient was clinically stable, early surgery was advised with a satisfactory outcome. This case report clearly demonstrates the vital role of repeated cross-sectional echocardiography in the management of such cases. Images Figure 1

O'Sullivan, J. J.; Aherne, T.; Erwin, J.



Echocardiography in the diagnosis of right ventricular endomyocardial fibrosis  

PubMed Central

Twenty-one patients with endomyocardial fibrosis (EMF) and right ventricular involvement were studied by M-mode echocardiography. All 21 patients showed echocardiographic findings consisting of (i) increased right ventricular dimension, (ii) paradoxical septal motion, (iii) increased right ventricular outflow dimension (iv) thickening of the right ventricular anterior wall with increased right ventricular anterior wall motion, and (v) easily recordable tricuspid valve. In addition, some of the patients had posterior pericardial effusion, and fine fluttering of the tricuspid valve. EMF was diagnosed clinically in all the patients, haemodynamically and angiographically in 15 and confirmed at autopsy in one. None of these echo findings was present in two patients with constrictive pericarditis, and two patients with massive ascites due to portal hypertension. ImagesFig. 1Fig. 2Fig. 3Fig. 4

George, B. O.; Gaba, F. E.; Talabi, A. I.; Adeniyi, D. S.



Target heart rate to determine the normal value of coronary flow reserve during dobutamine stress echocardiography  

PubMed Central

Background The determination of coronary flow reserve (CFR) is an essential concept at the moment of decision-making in ischemic heart disease. There are several direct and indirect tests to evaluate this parameter. In this sense, dobutamine stress echocardiography is one of the pharmacological method most commonly used worldwide. It has been previously demonstrated that CFR can be determined by this technique. Despite our wide experience with dobutamine stress echocardiography, we ignored the necessary heart rate to consider sufficient the test for the analysis of CFR. For this reason, our main goal was to determine the velocity of coronary flow in each stage of dobutamine stress echocardiography and the heart rate value necessary to double the baseline values of coronary flow velocity in the territory of the left anterior descending (LAD) coronary artery. Methods A total of 33 consecutive patients were analyzed. The patients included had low risk for coronary artery disease. All the participants underwent dobutamine stress echocardiography and coronary artery flow velocity was evaluated in the distal segment of LAD coronary artery using transthoracic color-Doppler echocardiography. Results The feasibility of determining CFR in the territory of the LAD during dobutamine stress echocardiography was high: 31/33 patients (94%). Mean CFR was 2.67 at de end of dobutamine test. There was an excellent concordance between delta HR (difference between baseline HR and maximum HR) and the increase in the CFR (correlation coefficient 0.84). In this sense, we found that when HR increased by 50 beats, CFR was ? 2 (CI 93-99.2%). In addition, 96.4% of patients reached a CFR ? 2 (IC 91.1 - 99%) at 75% of their predicted maximum heart rate. Conclusions We found that the feasibility of dobutamine stress echocardiography to determine CFR in the territory of the LAD coronary artery was high. In this study, it was necessary to achieve a difference of 50 bpm from baseline HR or at least 75% of the maximum predicted heart rate to consider sufficient the test for the analysis of CFR.



Dynamic morphology of the secundum atrial septal defect evaluated by three dimensional transoesophageal echocardiography  

PubMed Central

OBJECTIVE—To define by three dimensional echocardiography the pattern and potential determinants of contraction of a secundum atrial septal defect through the cardiac cycle, and to evaluate the possibility of using cross sectional transthoracic and transoesophageal imaging to assess the dynamic nature of the defect.?DESIGN—Three dimensional echocardiography was performed using a multiplane transoesophageal probe on 50 patients with a secundum atrial septal defect (median age 9.8 years). Nine patients were excluded because of poor images or morphological features that precluded defect measurement. In 41 cases, defect area, long and short axis length, and distance of the attenuated anterior rim were measured in their largest and smallest dimensions.?RESULTS—Defect area changed significantly through the cardiac cycle (mean change 61%, p < 0.0001; range 17% to 86%). The defect contracted symmetrically and was not related to patient age, defect size, heart rate, Qp/Qs ratio, the presence of an aneurysmal atrial septum, or attenuated anterior rim. In all cases with an attenuated anterior rim (n = 13), the length of the rim significantly decreased (p = 0.001) during atrial systole. Dynamic changes measured by either transthoracic or transoesophageal cross sectional images did not correlate with those obtained by three dimensional imaging.?CONCLUSIONS—Three dimensional echocardiography shows dynamic features of defects in the atrial septum. This information may lead to an improved understanding of the pathophysiology of atrial shunting.???Keywords: echocardiography; atrial septal defect; congenital heart disease

Maeno, Y; Benson, L; McLaughlin, P; Boutin, C



Contrast echocardiography: contribution to diagnosis of left ventricular non-compaction cardiomyopathy.  


Left ventricular non-compaction (LVNC) is a cardiomyopathy considered to be caused by arrest of normal embryogenesis of the endocardium and myocardium. Echocardiography has been the preferred diagnostic procedure; however, the correct diagnosis is often missed or delayed due to the lack of knowledge about this uncommon disease and its similarities to other diseases of the myocardium and endocardium. Here we present two cases: an asymptomatic 39-year-old man who was considered to be suffering from dilated cardiomyopathy (DCM) for four years; and an asymptomatic 19-year-old man who was considered to be suffering from hypertrophic cardiomyopathy. In a recent echocardiography study carried out in our echo lab, we recognized the morphological diagnostic criteria of LVNC. Contrast echocardiography, a low-cost, easy, repeatable, real-time, and non-invasive technique with no ionising radiation, shows a high correlation in the diagnosis of LVNC. In echocardiography, the importance of contrast agents is twofold, as they can be considered essential for a reliable differentiation between the compacted and the non-compacted myocardium, while at the same time they allow accurate measurement of the ratio. Heightened clinical suspicion is necessary for the accurate diagnosis and management of diseases. PMID:21642078

Lampropoulos, Konstantinos M; Dounis, Vasilios G; Aggeli, Constantina; Iliopoulos, Themistoklis A; Stefanadis, Christodoulos


Myocardial perfusion by myocardial contrast echocardiography and endothelial dysfunction in obstructive sleep apnea.  


Obstructive sleep apnea is associated with increased cardiovascular morbidity and mortality. We investigated myocardial perfusion using real-time quantitative myocardial contrast echocardiography with concurrent assessment of macrovascular and microvascular endothelial dysfunction in normotensive subjects with moderate-to-severe obstructive sleep apnea, who were compared with hypertensive and healthy subjects, as well as the impact of continuous positive airway pressure treatment on obstructive sleep apnea subjects. We measured flow (hyperemia)-mediated dilation and response to glyceryl trinitrate of brachial artery (ultrasound), cutaneous perfusion responses to acetylcholine and sodium nitroprusside (laser Doppler), pulse wave velocity, and circulating endothelial and endothelial progenitor cells in a total of 108 subjects (n=36 each of matched obstructive sleep apnea, hypertension, and healthy cohorts). Subjects with obstructive sleep apnea and hypertension demonstrated abnormal myocardial perfusion (P<0.001 for both comparisons), attenuated brachial artery reactivity (P<0.001), and cutaneous perfusion responses (P<0.001) compared with healthy individuals. Both hypertensive and obstructive sleep apnea patients showed significant improvements in myocardial perfusion (P<0.01), brachial artery reactivity (P<0.001), and cutaneous perfusion responses (P<0.001) after 26 weeks of continuous positive airway pressure therapy. There were no significant differences in pulse wave velocity and endothelial cells across the 3 groups. Concomitant endothelial dysfunction and impaired myocardial perfusion are present in otherwise normal subjects with moderate-to-severe obstructive sleep apnea, and effective continuous positive airway pressure treatment reverses many of these macrovascular/microvascular abnormalities. PMID:21747042

Butt, Mehmood; Khair, Omer A; Dwivedi, Girish; Shantsila, Alena; Shantsila, Eduard; Lip, Gregory Y H



Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography  

Microsoft Academic Search

OBJECTIVESThis study was designed to address, in patients with severe ischemic left ventricular dysfunction, whether dobutamine stress echocardiography (DSE) can predict improvement of left ventricular ejection fraction (LVEF), functional status and long-term prognosis after revascularization.BACKGROUNDDobutamine stress echocardiography can predict improvement of wall motion after revascularization. The relation between viability, improvement of function, improvement of heart failure symptoms and long-term prognosis

Jeroen J. Bax; Don Poldermans; Abdou Elhendy; Jan H. Cornel; Eric Boersma; Riccardo Rambaldi; Jos R. T. C. Roelandt; Paolo M. Fioretti



Evaluation of left ventricular function and volumes in patients with ischaemic cardiomyopathy: gated single-photon emission computed tomography versus two-dimensional echocardiography  

Microsoft Academic Search

The objective of this study was to perform a head-to-head comparison between two-dimensional (2D) echocardiography and gated single-photon emission computed tomography (SPET) for the evaluation of left ventricular (LV) function and volumes in patients with severe ischaemic LV dysfunction. Thirty-two patients with chronic ischaemic LV dysfunction [mean LV ejection fraction (EF) 25%Lj%] were studied with gated SPET and 2D echocardiography.

Eleni C. Vourvouri; Don Poldermans; Jeroen J. Bax; Georgios Sianos; Fabiola B. Sozzi; Arend F. Schinkel; Johan Sutter; Georgios Parcharidis; Roelf Valkema; Jos R. Roelandt



Transesophageal Echocardiography for the Noncardiac Surgical Patient  

PubMed Central

Transesophageal echocardiography (TEE) has been established as a very valuable asset for patient monitoring during cardiac surgery. The value of perioperative TEE for patients undergoing noncardiac surgery is less clear. This article reviews the technical aspects of TEE and comments on the potential benefit of using TEE as a monitoring modality apart from cardiac surgery. Based on patient's comorbidities and/or injury pattern, TEE is a fast and minimally invasive approach to obtain important hemodynamic information, especially useful in a hemodynamically unstable patient. However, certain requirements for the use of the technique are necessary, most important the development of sufficient echocardiographic skills by the anesthesiologists. Indications, skill requirements, and possible complications of the technique are reviewed.

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



Intracardiac echocardiography in congenital heart disease.  


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

Barker, Piers C A



[Aortic regurgitation: evaluation by pulsed Doppler echocardiography].  


Ninety-one consecutive patients with aortic regurgitation, either isolated (23 subjects) or associated with other valvular diseases (68 subjects), were studied with pulsed Doppler echocardiography and subsequent aortography, and the results were compared in order to assess the value of the noninvasive technique for a semiquantitative evaluation of the degree of the aortic regurgitation. Both the noninvasive and invasive estimations were graded on a four-point scale. In the long-axis parasternal view, the outflow tract of the left ventricle was divided in four areas going from the aortic valve to the apex. Echo-Doppler grading (from + 1 to +4) was obtained by assessing the area where the abnormal diastolic flow could still be recorded. In the group as a whole, concordant degrees of the aortic insufficiency were obtained in 73 of 91 patients (r = .93; p less than .001); the degree of the aortic regurgitation was overestimated in 8 cases (9%) and underestimated in 10 cases (11%). Most of the discrepancies between the Doppler and the aortographic evaluation were found in patients with intermediate degree (+2, +3) of aortic regurgitation; the degree of discordance was never more than +1 or -1. Correlation between Doppler and aortography was higher in the subjects with pure aortic regurgitation (r = .94, p less than .001) and lower in the subgroup of the subjects with associated mitral stenosis (r = .87, p less than .001). Two-dimensional pulsed Doppler echocardiography is a simple and little time consuming technique that in selected groups of patients can be relied upon for the semiquantitated evaluation of the degree of aortic regurgitation. PMID:3758583

Montemurro, D; Ronzani, G; De Filippi, G; Gozzelino, G; Orzan, F; Presbitero, P



Clinical impact of first and early second trimester fetal echocardiography on high risk pregnancies  

PubMed Central

Objective: To evaluate the clinical impact of fetal echocardiography before 16 weeks’ gestation on the management of pregnancies with fetuses at risk of congenital heart disease. Design and setting: Observational study in a fetal medicine unit. Participants and methods: 222 consecutive women with high risk pregnancies (230 fetuses) underwent transabdominal fetal echocardiography at a median gestation of 14+1 weeks. For 10%, transvaginal scans were also performed. Criteria for normal scans were normal sequential segmental analysis, symmetrical four chamber view, normal semilunar valves, arterial outflow tracts, and ductal and aortic arches. Early scans were compared with mid-second trimester fetal echocardiography. Postmortem and postnatal data were added. Adverse pregnancy outcomes were diagnosis of a major cardiac or extracardiac abnormality, chromosomal defects, intrauterine death, or termination of pregnancy. Results: There were 21 abnormal cardiac scans (9%): 14 major structural defects (eight isolated, six with chromosomal or extracardiac abnormalities) in pregnancies resulting in three live births, one intrauterine death, and 10 terminated pregnancies. Seven scans showed asymmetry between right and left sided structures (two isolated, five with chromosomal or extracardiac abnormalities); six of the seven pregnancies were terminated. The scans were normal in 199 cases (87%). Cardiac follow up of 184 of 199 babies (93%) confirmed situs and connections. One case each of pulmonary stenosis and ventricular septal defect requiring postnatal intervention were diagnosed at later scans. In 28 of 199 (14%) babies there was a non-cardiac adverse outcome. First examination was not diagnostic for 10 (4%). Conclusion: Early fetal echocardiography in high risk pregnancies was diagnostic in 96%. Abnormal cardiac scans (isolated in 48%, major structrual defects in 67%) led to termination of pregnancy in 76%. Most cardiac scans were normal, allowing family reassurance. The high number of adverse outcomes with normal cardiac anatomy stresses the need for a multidisciplinary approach to early fetal echocardiography.

Carvalho, J S; Moscoso, G; Tekay, A; Campbell, S; Thilaganathan, B; Shinebourne, E A



A Holographic Road Show.  

ERIC Educational Resources Information Center

|Describes the viewing sessions and the holograms of a holographic road show. The traveling exhibits, believed to stimulate interest in physics, include a wide variety of holograms and demonstrate several physical principles. (GA)|

Kirkpatrick, Larry D.; Rugheimer, Mac



Cor triatriatum with persistent levoatrial cardinal vein late presented as severe mitral stenosis  

PubMed Central

Cor triatriatum is a rare congenital cardiac anomaly that usually becomes symptomatic in the first years of life. We present a 28-year-old pregnant female patient presented with shortness of breath, palpitations and decreased exercise tolerance. Transthoracic (TTE) and transesophageal (TEE) echocardiography showed cor triatriatum, features of severe mitral stenosis and atrial septal defect (ASD). The patient underwent successful surgical correction with an uneventful postoperative course.

Aliter, Hashem; Youssef, Ali; Al-Murayeh, Mushabab; Gallo, Ricardo



Intracardiac echocardiography and electroanatomic mapping in diagnosis of arrhythmogenic right ventricular dysplasia.  


A 48-year-old man with an episode of syncope and family history of sudden cardiac death was evaluated. The ECG showed negative T waves from V1 to V3 with evidence of epsilon-wave. Magnetic resonance imaging showed replacement with fibrofatty tissue in midapical regions of free wall of the right ventricle with dyskinesia. Transthoracic echocardiography revealed only mild enlargement of the middle right ventricular cavity. A programmed ventricular stimulation induced only an unsustained monomorphic ventricular tachycardia. Intracardiac echocardiography showed mild right ventricular enlargement and outflow dilatation (26 mm), microaneurysms with systolic bulging along the apical segment of the right ventricle. Bipolar voltage mapping, performed by the Carto system, detected a circumscribed low potential (<1.5 mV) area at the same level of the right ventricular apex. Cardiovascular imaging improves the detection of abnormal myocardial areas. Further studies are warranted to support this hypothesis. PMID:19786888

Ficili, Sabina; Pandozi, Claudio; Russo, Maurizio; Dottori, Serena; Cina, Alessandro; Natale, Luigi; Lavalle, Carlo; Galeazzi, Marco; Santini, Massimo



Estimation of aortic valve effective orifice area by Doppler echocardiography: effects of valve inflow shape and flow rate  

Microsoft Academic Search

BackgroundThe effective orifice area (EOA) is the standard parameter for the clinical assessment of aortic stenosis severity. It has been reported that EOA measured by Doppler echocardiography does not necessarily provide an accurate estimate of the cross-sectional area of the flow jet at the vena contracta, especially at low flow rates. The objective of this study was to test the

Damien Garcia; Philippe Pibarot; Champlain Landry; Amélie Allard; Boris Chayer; Jean G Dumesnil; Louis-Gilles Durand



Cardiac stroke volume during exercise measured by Doppler echocardiography: comparison with the thermodilution technique and evaluation of reproducibility  

Microsoft Academic Search

Cardiac stroke volume was measured simultaneously by Doppler echocardiography and thermodilution in patients with severe coronary artery disease. One group (20 patients) was examined during supine exercise at 25 W and a second group (20 patients) during sitting exercise at 25 W and 50 W. In a third group (10 patients) the reproducibility of the non-invasive stroke volume estimate was

H Ihlen; K Endresen; S Golf; S Nitter-Hauge



Coronary microcirculation evaluation with transesophageal echocardiography Doppler in type II diabetics.  


Evaluation of coronary microvascular function can be obtained through coronary flow reserve measurements. The aim of this study was to evaluate the coronary microvascular function by using transesophageal-Doppler echocardiographic assessment of coronary flow reserve. The study included 32 normotensive patients with type II diabetes mellitus (group A) of short duration (6.1+/-3.8 years) aged 55.4+/-9.4 years and 14 healthy volunteers matched for age, gender and BMI (group B). No patients had clinical evidence of coronary artery disease and all of them produced a negative recent stress ECG test. Excluded from the study were patients with anemia, left ventricular hypertrophy, arrhythmia, congenital, or acquired structural heart disease. All subjects underwent transesophageal-Doppler echocardiography. Satisfactory coronary blood flow velocity recordings could be obtained from the initial segment of the left anterior descending coronary artery in healthy volunteers and in 27 patients at baseline and 2 min after dipyridamole infusion (0.56 mg/kg, for 4 min). In the remaining 5 patients no satisfactory recordings were available. The indexes of coronary flow reserve, i.e. the ratios of dipyridamole over basal maximum and mean diastolic velocities were calculated. Dipyridamole/rest maximal coronary reserve (Table 3) was 1.946+/-0.743, while this ratio for the mean diastolic velocity was 1.969+/-0.805 in group A. The respective values for group B, were 2.811+/-0.345 (P=0.000 vs. group A) and 2.914+/-0.303 (P=0.000 vs. group A). Thus, the increase in coronary flow reserve although present in both groups, it was more impressive in the normal group. Multiple regression logistic analysis of: age, sex, smoking, glucosylated hemoglobin, duration of diabetes and type of therapy, did not show any correlation of these parameters with the above ratios. This study shows that coronary flow reserve, as measured with transesophageal echocardiography-Doppler, is severely impaired in normotensive patients with type II diabetes, with relatively short duration of the disease. PMID:9158162

Kranidis, A; Zamanis, N; Mitrakou, A; Patsilinakos, S; Bouki, T; Tountas, N; Anthopoulos, P; Raptis, S; Anthopoulos, L



A new view of an unusual pacemaker complication: role of three-dimensional transthoracic echocardiography.  


Tricuspid regurgitation (TR) produced by endocavitary leads (EL) from permanent pacemakers and implantable cardiac defibrillators is a well-known complication of this procedure. The EL may damage or interfere with tricuspid valve function causing mechanical interference of the valve leaflets leading to incomplete valve closure. It is important to recognize this mechanical complication because it could be corrected by repositioning the lead. In this case report we demonstrate how three-dimensional transthoracic echocardiography permits to obtaining an en face view, which allows simultaneous visualization of the 3 moving leaflets during the cardiac cycle, their attachment to the tricuspid annulus and the pattern of leaflet coaptation. Thus, we propose three-dimensional transthoracic echocardiography as the tool of choice to evaluate TR related to EL, to evaluate the necessity of repositioning the lead if severe regurgitation or tricuspid valve malfunction are demonstrated. PMID:23551119

Miglioranza, Marcelo Haertel; Becker, Derly; Jiménez-Nácher, José-Julio; Moya, José Luis; Golfin, Covadonga Fernandez; Zamorano, José Luis



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

NASA Astrophysics Data System (ADS)

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

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



Clinical value of Doppler echocardiography in the assessment of adults with aortic stenosis.  

PubMed Central

Continuous wave Doppler echocardiography was used to study 41 adults with clinically suspected aortic stenosis undergoing cardiac catheterisation. Non-invasive assessment of the severity of stenosis was made before catheterisation using electrocardiograms, chest radiographs, and cross sectional echocardiography in addition to clinical examination and assessment modified, where appropriate, by the result of the Doppler examination. Catheterisation gradients were obtained in 33 patients and correlated well with those obtained by Doppler examination particularly when simultaneous recordings were obtained. All patients with surgically significant stenoses were identified by non-invasive assessment including Doppler examination and overestimation was not found in any patient with a less than significant stenosis. Thus surgery can be recommended in patients with aortic stenosis without the need for previous cardiac catheterisation. Images

Simpson, I A; Houston, A B; Sheldon, C D; Hutton, I; Lawrie, T D



[Tricuspid valve morphology and function evaluated by transthoracic real-time three-dimensional echocardiography].  


Tricuspid valve (TV) morphology and function evaluation plays a key role in several cardiac diseases, including left-sided valvular diseases and heart failure. However, TV is structurally complex and, differently from aortic and mitral valves, cannot be visualized in a single two-dimensional echocardiographic view, neither transthoracic nor transesophageal (i.e., simultaneous imaging of the three TV leaflets and their attachment to the annulus is not feasible). Conversely, real-time three-dimensional transthoracic echocardiography allows complete visualization of the TV apparatus from multiple views. This can lead to an improvement of our understanding about the pathophysiological mechanisms underlying TV diseases and functional tricuspid regurgitation, and may suggest new surgical techniques in order to improve surgical outcomes. The present review focuses on the state-of-the-art of real-time three-dimensional transthoracic echocardiography in TV morphology and function evaluation with its clinical applications and limits. PMID:21033331

Esposito, Roberta; Badano, Luigi P; Muraru, Denisa; Agricola, Eustachio; Mele, Donato; Sciomer, Susanna; Nistri, Stefano; Galderisi, Maurizio; Mondillo, Sergio


The use of echocardiography in observational clinical trials: the EURECA-m registry.  


Echocardiography is the most widely used non-invasive imaging technique due to its availability, low cost, transportability and lack of ionizing radiations. However, it suffers from the main limitation of being highly subjective and operator-dependent. Furthermore, specifically, population or disease-dependent issues exist which should be addressed when this technique is applied in multicenter studies. As to the population of patients with end-stage renal disease (ESRD) maintained on chronic dialysis, indexation of echocardiographic parameters and timing of echocardiography in relationship to dialysis represent a specific, main issue that needs to be carefully considered and standardized. Scientific societies recommend the set-up of core laboratories in order to reduce inter- and intra-observer variability when an echocardiographic parameter is considered as an end-point in clinical research. Several studies have shown the superiority of interpretation given by echocardiography core-lab reading. These advantages are counterbalanced by higher costs and complexity. The EURECA-m registry by the EURECA-m working group, an ERA-EDTA initiative, aimed at promoting the scientific collaboration among professionals in the field of cardiovascular and renal medicine. The registry involves several centers in Europe and one of its aims is to measure conventional echocardiographic parameters in ESRD patients on chronic dialysis. A central reading protocol has been set up for the registry in order to give robustness to the echo studies. PMID:23048175

Sicari, Rosa; Gargani, Luna; Wiecek, Andrzej; Covic, Adrian; Goldsmith, David; Suleymanlar, Gultekin; Parati, Gianfranco; Ortiz, Alberto; Massy, Ziad; Martinez-Castelao, Alberto; Lindholm, Bengt; Heine, Gunnar H; Fliser, Danilo; Mallamaci, Francesca; London, Gerard; Zoccali, Carmine



Two dimensional echocardiography and Doppler in the right ventricular infarction.  


Two dimensional and Doppler echocardiography provide reliable and valuable information in order to evaluate right ventricular function and associated complications in patients with right ventricular infarction. Right ventricular function in right ventricular infarction. There are a number of indirect findings that may support the noninvasive diagnosis of ischemic right ventricular dysfunction and right ventricular infarction: 1. Right ventricular dilatation: A right ventricular diastolic dimension greater than 8 mm/m2 is highly indicative of ischemic right ventricular dysfunction, provided that other causes of right ventricular dilatation, but the sensitivity of this findings is low (50%), the same is true for a RVDD/LVDD ratio greater than 0.63. 2. Right ventricular contraction abnormalities: Wall motion abnormalities constitute the most sensitive and specific echocardiographic findings in the right ventricular infarction. The most common site of involvement is the posterior wall, over 32 patients with right ventricular infarction, 60% present abnormalities confined to the posterior segment; in 30% there is also abnormal contraction of the lateral wall and 10% of the cases present asyneresys of the anterior, lateral and posterior segments. Those patients with the most severe right ventricular dysfunction presented a higher number of right ventricular wall segments with abnormal wall motion. Abnormalities in right ventricular contraction may still be present after evolution and normalization of the hemodynamic data of right ventricular infarction. These findings suggest that wall motion abnormalities can be more sensitive than the hemodynamic in detecting right ventricular infarction. 3. Paradoxical septal motion: Is a common findings after right ventricular infarction and has been attributed to volume overload and alterations in right ventricular compliance, near of 50% present abnormalities of septal motion and those patients with most severe ventricular dysfunction presented most frequently abnormal septal motion. Right ventricular infarction complications. Right ventricular aneurysm: In a series of 50 consecutive patients surviving an episode of right ventricular infarction, we could only find five (10%) with a true ventricular aneurysm. The segments included always the apex and in two cases a thrombus was identified inside its cavity. Functional right ventricular aneurysm may be found in a high percentage (10/50.20%) of patients with right ventricular infarction. Right ventricular thrombi: The identification of thrombi in the right heart is more difficult than in the left ventricle, due to the trabeculation of the right ventricular wall. We could only find 6 cases, in a series of 50 patients studied by two dimensional echocardiography. In all of the cases the ventricular wall adjacent to the thrombus presents contraction abnormalities.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2202344

García-Fernandez, M A; López-Sendón, J



Neovascularized myxoma-causing abnormal blood flow in the left atrium diagnosed by transesophageal echocardiography.  


Myxomas are the most common primary cardiac tumor, and neovascularization of cardiac myxoma has been shown in previous case reports. However, it is seldom reported that abnormal blood flow spurted from a neovascularized myxoma into the cardiac chamber. In this unusual case report, we present a left atrial myxoma in a 44-year-old woman with atypical angina. Transesophageal echocardiography (TEE) revealed several small blood streams spurting from the surface of massively vascularized myxoma into the left atrium. Coronary angiography showed a feeding artery which arose from the right coronary artery and supplied the left atrial myxoma, with no evidence of coronary artery stenosis. This case demonstrated that TTE might be helpful for confirming the neovascularization of myxoma in the left atrium and finding the abnormal blood flow that spurts from the neovascularized myxoma. We speculate that the abnormal blood flow spurting from the neovascularized myxoma into the left atrium may have caused a coronary steal phenomenon thus resulting in myocardial ischemia. PMID:23002715

Wang, Xiaobing; Ren, Weidong; Yang, Jun



Trans-esophageal echocardiography for tricuspid and pulmonary valves.  


Transesophageal echocardiography has been shown to provide unique information about cardiac anatomy, function, hemodynamics and blood flow and is relatively easy to perform with a low risk of complications. Echocardiographic evaluation of the tricuspid and pulmonary valves can be achieved with two-dimensional and Doppler imaging. Transesophageal echocardiography of these valves is more challenging because of their complex structure and their relative distance from the esophagus. Two-dimensional echocardiography allows an accurate visualization of the cardiac chambers and valves and their motion during the cardiac cycle. Doppler echocardiography is the most commonly used diagnostic technique for detecting and evaluating valvular regurgitation. The lack of good quality evidence makes it difficult to recommend a validated quantitative approach but expert consensus recommends a clinically useful qualitative approach. This review ennumerates probe placement, recommended cross-sectional views, flow patterns, quantitative equations including the clinical approach to the noninvasive quantification of both stenotic and regurgitant lesions. PMID:19602749

Prabhu, Mahesh R


Contrast echocardiography in Boxer dogs with and without aortic stenosis  

Microsoft Academic Search

ObjectivesThe aim of this study was to investigate whether contrast echocardiography could enhance the subcostal Doppler signal for aortic flow measurements and achieve myocardial opacification, in Boxer dogs with and without AS.

Katja Höglund; Claudio Bussadori; Oriol Domenech; Jens Häggström; Danitza Pradelli; Clarence Kvart



Usefulness of pharmacologic stress echocardiography in a chest pain center.  


We tested the value of a stress echocardiography-based algorithm used in a chest pain center. The algorithm had superlative negative predictive value for cardiac events, allowing an early discharge. PMID:11090800

Orlandini, A; Tuero, E; Paolasso, E; Vilamajó, O G; Díaz, R



Acute cardiac rupture during dobutamine-atropine echocardiography stress test.  


We report an acute cardiac rupture during dobutamine-atropine echocardiography stress test on the sixth day after admission for an inferoposterior acute myocardial infarction complicated with mild pericardial effusion. PMID:10668020

Orlandini, A D; Tuero, E I; Diaz, R; Vilamajó, O A; Paolasso, E A



Massive pulmonary embolism immediately diagnosed by transthoracic echocardiography and treated with tenecteplase fibrinolysis  

Microsoft Academic Search

We report the case of a 75-year-old woman with new onset dyspnoea, hypotension, and right bundle branch block. Transthoracic\\u000a echocardiography (TTE) showed a thrombus in the right pulmonary artery and acute pulmonary embolism was diagnosed. The patient\\u000a immediately underwent fibrinolysis with tenecteplase, with prompt recovery of clinical conditions and ECG anomalies. Bedside\\u000a TTE might be helpful for immediate diagnosis of

Natale Daniele Brunetti; Riccardo Ieva; Michele Correale; Luisa De Gennaro; Pier Luigi Pellegrino; Ezio Dioguardi; Francesca Bux; Matteo Di Biase



Transesophageal Echocardiography for Monitoring Segmental Wall Motion During Off-Pump Coronary Artery Bypass Surgery  

Microsoft Academic Search

In this prospective, observational study, we evaluated whether transesophageal echocardiography allows for monitoring left ventricular segmental wall motion dur- ing cardiac displacement for off-pump coronary artery bypass (OPCAB) surgery. On the basis of a pilot study that showed frequent loss of transgastric views during OPCAB surgery, we analyzed only midesophageal views. The midesophageal 4-chamber view, 2-chamber view, and long-axis view

Jianwen Wang; Miodrag Filipovic; Ainars Rudzitis; Isabelle Michaux; Karl Skarvan; Peter Buser; Atanas Todorov; Franziska Bernet; Manfred D. Seeberger



Prognostic value of dobutamine stress echocardiography in patients with diabetes  

Microsoft Academic Search

OBJECTIVE: The aim of this study was to assess the incremental value of\\u000a dobutamine stress echocardiography (DSE) for the risk stratification of\\u000a diabetic patients who are unable to perform an adequate exercise stress\\u000a test. Exercise capacity is frequently impaired in patients with diabetes.\\u000a The role of pharmacologic stress echocardiography in the risk\\u000a stratification of diabetic patients has not been well

FABIOLA B. SOZZI; ABDOU ELHENDY; A. F. Schinkel; E. C. Vourvouri; J. J. Bax; Sutter de J; A. Borghetti; D. Poldermans; J. R. T. C. Roelandt; Domburg van R. T



Effects of Prolonging Peak Dobutamine Dose During Stress Echocardiography  

Microsoft Academic Search

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

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



Canadian guidelines for training in adult perioperative transesophageal echocardiography  

PubMed Central

PURPOSE To establish Canadian guidelines for training in adult perioperative transesophageal echocardiography (TEE). METHODS Guidelines were established by the Canadian Perioperative Echocardiography Group with the support of the cardiovascular section of the Canadian Anesthesiologists’ Society in conjunction with the Canadian Society of Echocardiography. Guidelines for training in echocardiography by the American Society of Echocardiography, the American College of Cardiology and the Society of Cardiovascular Anesthesiologists were reviewed, modified and expanded to produce the 2003 Quebec expert consensus for training in perioperative echocardiography. The Quebec expert consensus and the 2005 guidelines for the provision of echocardiography in Canada formed the basis of the Canadian training guidelines in adult perioperative TEE. RESULTS Basic, advanced and director levels of expertise were identified. The total number of echocardiographic examinations to achieve each level of expertise remains unchanged from the 2002 American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists guidelines. The increased proportion of examinations personally performed at basic and advanced levels, as well as the level of autonomy at the basic level suggested by the Quebec expert consensus are retained. These examinations may be performed in a perioperative setting and are not limited to intraoperative TEE. Training ‘on-the-job’, the role of the perioperative TEE examination, the requirements for maintenance of competence and the duration of training are also discussed for each level of training. The components of a TEE report and comprehensive TEE examination are also outlined. CONCLUSION The Canadian guidelines for training in adult perioperative TEE reflect the unique Canadian practice profile in perioperative TEE and address the training requirements to obtain expertise in this field.

Beique, Francois; Ali, Mohamed; Hynes, Mark; MacKenzie, Scott; Denault, Andre; Martineau, Andre; MacAdams, Charles; Sawchuk, Corey; Hirsch, Kristine; Lampa, Martin; Murphy, Patricia; Honos, Georges; Munt, Bradley; Sanfilippo, Anthony; Duke, Peter



Doppler echocardiography in athletes from different sports  

PubMed Central

Background Studies have shown cardiac changes induced by intense and regular physical activity. The purpose of this study was to evaluate cardiac structures and function in soccer players, cyclists and long-distance runners, and compare them with non-athlete controls. Material/Methods Cardiac structural, systolic, and diastolic function parameters in 53 athletes and 36 non-athlete controls were evaluated by Doppler echocardiography. Results Athletes presented higher left atrial volume, left ventricular (LV) thickness, and LV and right ventricular (RV) diastolic diameters (LVDD and RVDD, respectively) compared to non-athletes. Left atrium and LVDD were higher in cyclists than runners, and RVDD was higher in cyclists than soccer players. LV mass index was higher in athletes, and cyclists had higher values than runners and soccer players. LV systolic function did not differ significantly between groups. The only altered index of LV diastolic function was a higher E/A ratio in cyclists compared to controls. There was no difference in LV E/E’ ratio. RV systolic function evaluated by tissue Doppler imaging was higher in cyclists and soccer players than runners. There were no conclusive differences in RV diastolic function. Conclusions Soccer players, runners and cyclists had remodeling of left and right ventricular structures compared to controls. Cardiac remodeling was more intense in cyclists than runners and soccer players.

Moro, Andre Santos; Okoshi, Marina Politi; Padovani, Carlos Roberto; Okoshi, Katashi



Long term survival of patients with raised pulmonary arterial systolic pressure utilizing echocardiography--a five-year prospective study  

PubMed Central

Background Pulmonary arterial systolic pressure (PASP) can be estimated with transthoracic echocardiography. However, the significance of raised PASP on routine echocardiography is uncertain. In this study, we evaluated the mortality and hospitalization rates of subjects with raised PASP in a cohort of patients referred directly by their general practitioners for routine outpatient (open access) echocardiography for further analysis of suspected heart failure. Results A total of 485 subjects were referred for open access echocardiography at our hospital in 2002. A cohort of 209/485 (43%) consecutive subjects with measurable tricuspid regurgitation were followed for a minimum of five years investigating hospitalization rates and survival. Some 62 of 209 (30%) subjects had pulmonary hypertension (PH). Subjects with PH were significantly more likely to have four or more hospital admissions (22% vs. 8%; P < 0.01) and > 30 days of cumulative hospital stay over five years (29% vs. 13%; P < 0.01). PH was significantly associated with mortality (P = 0.003), while moderate to severe PH was an independent predictor of mortality (hazard ratio: 4.31; 95% confidence interval (95% CI): 1.51–12.30). Records from the Office of National Statistics revealed that subjects with PH were more likely to have chronic lung diseases recorded as immediate or contributory causes of death (50% vs. 14%; P < 0.05). Conclusions PASP ? 36 mmHg on routine echocardiography is associated with recurrent hospital admissions, prolonged hospitalizations and increased cause of mortality. Therefore, the diagnosis of PH on echocardiography deserves further clinical evaluation, with future studies designed at defining a suitable diagnostic strategy.

Tan, Maw Pin; Bansal, Sushil K; Wynn, Nu Nu; Umerov, Murad; Gillham, Angela; Henderson, Alison; Hildreth, Anthony; Junejo, Shahid



Simultaneous analysis of wall motion and coronary flow reserve of the left anterior descending coronary artery by transthoracic doppler echocardiography during dipyridamole stress echocardiography  

Microsoft Academic Search

BackgroundCoronary flow reserve (CFR) can be measured in the left anterior descending artery (LAD) by dipyridamole transthoracic Doppler echocardiography (DTTDE). This information may critically improve the diagnostic accuracy of dipyridamole stress echocardiography, which is limited by moderate sensitivity.

Jorge Lowenstein; Cristian Tiano; Gustavo Marquez; Cecilia Presti; Cristina Quiroz



Head to head comparison of 2D vs real time 3D dipyridamole stress echocardiography.  


Real-time three-dimensional (RT-3D) echocardiography has entered the clinical practice but true incremental value over standard two-dimensional echocardiography (2D) remains uncertain when applied to stress echo. The aim of the present study is to establish the additional value of RT-3D stress echo over standard 2D stress echocardiography. We evaluated 23 consecutive patients (age = 65 +/- 10 years, 16 men) referred for dipyridamole stress echocardiography with Sonos 7500 (Philips Medical Systems, Palo, Alto, CA) equipped with a phased - array 1.6-2.5 MHz probe with second harmonic capability for 2D imaging and a 2-4 MHz matrix-phased array transducer producing 60 x 70 volumetric pyramidal data containing the entire left ventricle for RT-3D imaging. In all patients, images were digitally stored in 2D and 3D for baseline and peak stress with a delay between acquisitions of less than 60 seconds. Wall motion analysis was interpreted on-line for 2D and off-line for RT-3D by joint reading of two expert stress ecocardiographist. Segmental image quality was scored from 1 = excellent to 5 = uninterpretable. Interpretable images were obtained in all patients. Acquisition time for 2D images was 67 +/- 21 sec vs 40 +/- 22 sec for RT-3D (p = 0.5). Wall motion analysis time was 2.8 +/- 0.5 min for 2D and 13 +/- 7 min for 3D (p = 0.0001). Segmental image quality score was 1.4 +/- 0.5 for 2D and 2.6 +/- 0.7 for 3D (p = 0.0001). Positive test results was found in 5/23 patients. 2D and RT-3D were in agreement in 3 out of these 5 positive exams. Overall stress result (positive vs negative) concordance was 91% (Kappa = 0.80) between 2D and RT-3D. During dipyridamole stress echocardiography RT-3D imaging is highly feasible and shows a high concordance rate with standard 2D stress echo. 2D images take longer time to acquire and RT-3D is more time-consuming to analyze. At present, there is no clear clinical advantage justifying routine RT-3D stress echocardiography use. PMID:18570640

Varnero, Silvia; Santagata, Patricia; Pratali, Lorenza; Basso, Massimiliano; Gandolfo, Alfredo; Bellotti, Paolo



Analysis of microvascular integrity, contractile reserve, and myocardial viability after acute myocardial infarction by dobutamine echocardiography and myocardial contrast echocardiography  

Microsoft Academic Search

The purpose of this study was to evaluate, in postinfarction dysfunctioning myocardium, the relative potential of myocardial contrast and low-dose dobutamine echocardiography in detecting myocardial viability, and the relation between microvascular integrity, contractile reserve, and functional recovery at follow-up. Twenty-four patients with recent myocardial infarction were studied before hospital discharge with low-dose dobutamine and myocardial contrast echocardiography. In the dysfunctioning

Sabino Iliceto; Leonarda Galiuto; Alfredo Marchese; Daniela Cavallari; Paolo Colonna; Giuseppina Biasco; Paolo Rizzon



Magnetic resonance pharmacological stress for detecting coronary disease. Comparison with echocardiography.  


Stress testing is the cornerstone in the diagnosis of patients with suspected coronary artery disease (CAD). Although exercise ECG remains the primary approach for the detection of ischemia in patients with chest pain syndromes, its sensitivity and specificity is limited and exercise ECG does not provide detailed information about the localisation and extent of CAD. Stress echocardiography has been used for the detection of ischemia for more than a decade and has become an increasingly popular noninvasive method for the detection of CAD. In experienced hands wall motion analysis based on stress echocardiography has proved to be as sensitive and specific for the detection of myocardial ischemia as scintigraphic techniques. Recent technical improvements, namely the availability of ultrafast imaging sequences with a significant reduction of imaging time have initiated several studies which examined the combination of pharmacological stress and magnetic resonance imaging (MRI) for the detection of suspected CAD. The most well developed stress-MRI technique is wall motion imaging during dobutamine stress. This technique is analogous to stress echocardiography, but MRI has the inherent advantages of better resolution, higher reproducibility and true long and short axis imaging with contiguous parallel slices. However, the clinical impact of MRI for the diagnosis of CAD is still low. Further technical developments including real time imaging and a reliable automated quantitative analysis of left ventricular function are required before stress-MRI becomes a serious challenge to stress-echocardiography in the clinical arena. Currently, only a few MRI facilities and physicians are dedicated to pharmacological stress testing with MRI and the future clinical impact of this promising technique will depend on its potential to provide information beyond myocardial function including perfusion, metabolism and coronary anatomy in form of a "one-stop"-shop for the cardiac patient. PMID:10948776

Baer, F M; Crnac, J; Schmidt, M; Jochims, M; Theissen, P; Schneider, C; Schicha, H; Erdmann, E



Transoesophageal echocardiography and central line insertion.  


We investigated the potential utility of transoesophageal echocardiography (TOE) in facilitating central venous catheter (CVC) insertion in patients undergoing cardiac surgery. Thirty five patients undergoing elective cardiac surgery and CVC insertion were prospectively included in the observational, single-centre clinical investigation. Following induction of general anaesthesia and tracheal intubation, the TOE probe was inserted and the bicaval view obtained prior to CVC insertion (site at discretion of the anaesthesiologist). Prospectively collected data included site and sequence of CVC insertion attempts, information regarding ease of guidewire insertion, whether or not guidewire was visualized via TOE, and other pertinent information. In 1 patient, the TOE bicaval view could not be readily obtained because of right atrial (RA) distortion. In 31 patients, the TOE bicaval view was obtained and CVC access was successful at the site of first choice (guidewire visualized in all). Three patients had noteworthy CVC insertions. In one, CVC insertion was difficult despite visualization ofguidewire in the RA. In another, multiple guidewire insertions met with substantial resistance and without visualization of guidewire in the RA. One patient was found to have an unanticipated large mobile superior vena cava thrombus that extended into the RA, which changed clinical management by prompting initial CVC insertion into the femoral vein (potentially avoiding morbidity associated with thrombus dislodgement). Our prospective observational clinical study indicates that routine use of TOE during CVC insertion may help avoid potential complications associated with this intervention. If both CVC insertion and TOE are going to be used in the same patient, the benefits of TOE should be maximized by routine visualization of the bicaval view during guidewire insertion. PMID:17644885

Chaney, Mark A; Minhaj, Mohammed M; Patel, Komal; Muzic, David



Analysis of blood flow in pulmonary hypertension with the pulsed Doppler flowmeter combined with cross sectional echocardiography  

Microsoft Academic Search

Blood flow patterns were analysed at nine points in the pulmonary area using the pulsed Doppler technique combined with cross-sectional echocardiography in 53 patients with heart disease and 10 healthy subjects. In subjects with a normal pulmonary artery pressure the blood flow pattern in systole showed a gradual acceleration and deceleration with a rounded summit in mid systole, designated the

M Okamoto; K Miyatake; N Kinoshita; H Sakakibara; Y Nimura



The contribution of echocardiography in the management of thrombo-embolic disease.  


To evaluate the contribution of echocardiography on the management of acute pulmonary embolism (A.P.E.) a study was carried out on 84 patients. For each of them echocardiography was performed: (a) the M mode shows an increase in RVDD/LVDD quotient correlated with the gravity of the A.P.E.; (b) the two dimensional mode allows 9 times the discovery of a thrombus which could be: static and broad based 6 cases or mobile, large sized 3 cases. So echocardiography can be systematically and initially be proposed for any patient suspected of having A.P.E.; (c) the absence of increase in RVDD/LVDD ratio 0.33 exclude the possibility of a serious A.P.E. and it is possible to postpone the pulmonary angiogram. On the contrary the increase of the RVDD/LVDD ratio must lead to the angiographic exploration due to the seriousness of A.P.E.: (d) the discovery of a mobile, large sized thrombus with hight embolic potential makes the catheterism of the right cavities dangerous and lead to an emergency embolectomy because of the high risks of a new A.P.E. PMID:3429969

Bouvier, J L; Benichou, M; Elias, A; Le Corff, G; Serradimigni, A


[Cardiac transplantation: role of echocardiography in the diagnosis of rejection].  


Sixteen patients surviving orthotopic cardiac transplantation were studied by M-Mode and two dimensional echocardiography (ECHO) on the same day of cardiac biopsy during (n = 138) a mean follow-up of 6.2 +/- 4 months (range 1-4 months). The following parameters were measured: right ventricular end diastolic internal diameter (RVdD) left ventricular end diastolic internal diameter (LVdD), interventricular septum (IVS) and posterior wall (PW) diastolic thickness, myocardial mass (MM); LV cross sectional area (CSA) and ejection fraction (EF). LV and RV wall motion, pericardial effusion and myocardial echogenicity (brightness) were evaluated by inspection. Every ECHO was compared with the previous one for qualitative and quantitative changes. In the absence of rejection, analysis of the data during the first postoperative week showed the following results: mean EF = 51 +/- 6.8%, dilated overloaded RV (30.4 +/- 4.8 mm), various amount of pericardial effusion; FE increased significantly (55.3 +/- 4%; p less than 0.001) and RVdD decreased (26.6 +/- 5mm; p less than 0.001) after the 2nd week and remained stable thereafter, while pericardial effusion decreased or disappeared. The mean values of the remaining ECHO parameters did not very significantly during the follow-up.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3049205

Ciliberto, G R; Cataldo, G; Gronda, E; Mangiavacchi, M; Alberti, A; Faletra, F; Pezzano, A; de Maria, R; Bonacina, E; Pellegrini, A



Platypnea-orthodeoxia due to osteoporosis and severe kyphosis: a rare cause for dyspnea and hypoxemia  

PubMed Central

Platypnea orthodeoxia is a rare disorder characterized by dyspnea and arterial desaturation, exacerbated by the upright position and relieved when the subject is recumbent. We report the case of a 79-year old woman admitted to hospital with dyspnea who was thought to have restrictive ventilatory impairment due to osteoporosis and severe kyphosis. Interestingly, the dyspnea was aggravated in the upright position, whereas the symptoms improved in the supine position. Arterial blood gas analysis confirmed orthodeoxia. The lung function test showed only a mild obstructive and restrictive ventilation disorder. Echocardiography revealed a patent foramen ovale and an aneurysm of the atrial septum protruding into the left atrium, despite normal right atrial pressure. Transesophageal echocardiography showed a prominent Eustachian valve guiding a blood flow from the inferior vena cava directly onto the atrial septum, thereby pushing open the patent foramen ovale. Contrast-enhanced echocardiography confirmed a spontaneous right-to-left shunt through the patent foramen ovale. It was assumed that the platypnea-orthodeoxia was caused by a prominent Eustachian valve redirected to the patent foramen ovale as a result of severe osteoporosis with subsequent thoracic kyphosis and a change in the position of the entire heart. The patient underwent permanent transcatheter closure of the patent foramen ovale after hemodynamic assessment had confirmed a significant right-to-left shunt through it. After the procedure the arterial oxygen pressure increased significantly in the upright position and dyspnea improved.

Teupe, Claudius H.J.; Groenefeld, Gerian C.



Contrast echocardiography in critical care: echoes of the future? A review of the role of microsphere contrast echocardiography.  


Echocardiography is an important diagnostic modality in the critical care setting. It is a safe, non-invasive bedside investigation that provides important cardiac structural, functional and haemodynamic information. However, in up to 25% of scans, the images are non-diagnostic, which can have a significant impact on patient diagnosis and management. Contrast echocardiography, using contrast microspheres coupled with contrast-specific ultrasound imaging modalities, overcomes many of the limitations that cause suboptimal echocardiograms in the critical care environment. These microspheres are haemodynamically inert and have the same intravascular rheology as red blood cells. By using the differential oscillating properties of myocardium and microspheres, contrast echocardiography can enhance the blood pool-myocardial interface, thus improving endocardial definition. Consequently, this technique can be used to improve the accuracy, feasibility and reproducibility of transthoracic echocardiography. The technique is well accepted and indicated for improving the image quality in suboptimal scans, and for the assessment of global and regional left ventricular (LV) function and LV ejection fraction. It also has a significant role to play in enhancing LV morphology (for conditions such as apical hypertrophic cardiomyopathy, pseudoaneurysm and non-compaction), assessing intracardiac masses and evaluating LV thrombus. Contrast echocardiography is of benefit in various clinical settings, particularly the critical care setting. Here it can salvage a non-diagnostic transthoracic echocardiogram, thus avoiding an alternative, more invasive investigation, while remaining a truly bedside, non-invasive investigative procedure. Future applications for contrast echocardiography could include use as a perfusion modality, enhancement of three-dimensional echocardiography, and targeted delivery of gene therapy. PMID:21355829

Platts, David G; Fraser, John F



Comparative recognition of left ventricular thrombi by echocardiography and cineangiography.  

PubMed Central

Studies performed in 47 patients, 11 of whom underwent surgery for aneurysmectomy and 36 of whom underwent cardiac transplantation, were reviewed to assess the diagnostic accuracies of cross sectional echocardiography and cineangiography in detecting left ventricular mural thrombi and the effect of anticoagulation treatment on the incidence of such thrombi. Cross sectional echocardiography in 37 patients and cineangiography in 26 (16 patients were examined by both methods) were analysed independently by sets of two observers experienced in the respective methods. All four observers were blinded to the pathological or surgical findings regarding mural thrombus. Mural thrombus was confirmed by pathological investigation in 14 of 47 (30%) cases; 11 of these 14 patients had intra-aneurysmal thrombi. The negative predictive value was quite good for both methods, but cross sectional echocardiography had a superior positive predictive value. This was due both to detailed soft tissue resolution by cross sectional echocardiography and to overdetection of mural thrombi by cineangiography in cases of aneurysms without mural thrombi. Mural thrombi were present in three of 20 patients with preceding anticoagulation and in 10 of 19 patients without anticoagulation. The results emphasise that cross sectional echocardiography is more reliable than cineangiography in recognising thrombi. Images

Takamoto, T; Kim, D; Urie, P M; Guthaner, D F; Gordon, H J; Keren, A; Popp, R L



[Real-time three-dimensional echocardiography: current applications, advantages and limits for the evaluation of the left ventricle].  


In the last decades the introduction and development of echocardiography allowed a significant improvement in the diagnosis as well as in the morphological and functional evaluation of several heart diseases, and today many therapeutic decisions are taken based on the results of the echocardiographic examination. One of the most important development in the field of echocardiography is three-dimensional imaging, which has evolved from the slow and labor-intense off-line reconstruction techniques to the faster and simpler real-time volumetric imaging, which has the potential to be integrated in routine clinical practice. One of the major proven advantages of real-time three-dimensional echocardiography is the evaluation of left ventricular volume, mass and function, which is achieved by eliminating the need for geometric modeling and the errors caused by foreshortened views. In this review we discuss the state-of-the-art and anticipate future developments of real-time three-dimensional echocardiography that are relevant to its application to the left ventricle. PMID:19771748

Mele, Donato; Agricola, Eustachio; Galderisi, Maurizio; Sciomer, Susanna; Nistri, Stefano; Ballo, Piercarlo; Buralli, Simona; D'Andrea, Antonello; D'Errico, Arcangelo; Losi, Maria Angela; Mondillo, Sergio



The Diane Rehm Show  

NSDL National Science Digital Library

The Diane Rehm Show has its origins in a mid-day program at WAMU in Washington, D.C. Diane Rehm came on to host the program in 1979, and in 1984 it was renamed "The Diane Rehm Show". Over the past several decades, Rehm has played host to hundreds of guests, include Archbishop Desmond Tutu, Julie Andrews, and President Bill Clinton. This website contains an archive of her past programs, and visitors can use the interactive calendar to look through past shows. Those visitors looking for specific topics can use the "Topics" list on the left-hand side of the page, or also take advantage of the search engine. The show has a number of social networking links, including a Facebook page and a Twitter feed.


[Real-time multiplane echocardiography. Current applications, limits and perspectives].  


Echocardiography is the most commonly used imaging technique in current clinical cardiology practice and is usually performed using a monoplane approach. In recent years new matrix-array transducers have become available that allow the real-time simultaneous display of two or more echocardiographic scanning planes from the same acoustic window. This multiplane approach is particularly interesting as it may reduce, during the examination, the number of probe movements and consequently facilitate image acquisition. In some clinical applications, moreover, the multiplane approach improves both accuracy and reproducibility of echocardiography. This review evaluates the state of the art of multiplane echocardiography and discusses possible clinical applications, advantages and limitations of this technique. PMID:21355334

Mele, Donato; Galderisi, Maurizio; Badano, Luigi; Agricola, Eustachio; Nistri, Stefano; Sciomer, Susanna; Ballo, Piercarlo; Buralli, Simona; D'Andrea, Antonello; D'Errico, Arcangelo; Losi, Maria Angela; Mondillo, Sergio



Unexpected co-arctation of aorta detected by transesophageal echocardiography during patent ductus arteriosus ligation.  


In the presence of a large patent ductus arteriosus (PDA), aortic co-arctation (CoA) cannot be diagnosed clinically because PDA masks the clinical features. This condition impedes the identification of CoA by transthoracic echcocardiography. However, the closure of PDA can result in a severe clinical condition that causes a patient with undiagnosed CoA to suffer from shock and multi-organ failure. In this article, a case of PDA was presented, in which transesophageal echocardiography provided full information that could be used as reference to identify and define CoA during PDA ligation surgery. PMID:23681889

Liu, Fei; Hsiung, Ming-chon; Song, Haibo; Dian, Ke; Tang, Hong; Liu, Jin



Haemodynamic Monitoring Using Echocardiography in the Critically Ill: A Review  

PubMed Central

Physicians caring for the critically ill are now expected to acquire competence in echocardiography. It has become an indispensable diagnostic and monitoring tool in acute care settings where it is generally accepted to have therapeutic impact. There are a number of indications for a critical care echocardiographic study, and the most important queries include those pertaining left and right ventricular function and filling status. Focused examinations are increasing in popularity and provide a means for systematic study, and can be easily learned and practiced by novices. This paper addresses the indications, therapeutic impact, and some of the most common questions that can be answered using echocardiography the in critically ill patient.

Chew, Michelle S.



The Role of Transesophageal Echocardiography in the Intraoperative Period  

PubMed Central

The goal of hemodynamic monitoring and management during major surgery is to guarantee adequate organ perfusion, a major prerequisite for adequate tissue oxygenation and thus, end-organ function. Further, hemodynamic monitoring should serve to prevent, detect, and to effectively guide treatment of potentially life-threatening hemodynamic events, such as severe hypovolemia due to hemorrhage, or cardiac failure. The ideal monitoring device does not exist, but some conditions must be met: it should be easy and operator-independently to use; it should provide adequate, reproducible information in real time. In this review we discuss in particular the role of intraoperative use of transesophageal echocardiography (TOE). Although TOE has gained special relevance in cardiac surgery, its role in major non cardiac surgery is still to be determined. We particularly focus on its ability to provide measurements of cardiac output (CO), and its role to guide fluid therapy. Within the last decade, concepts oriented on optimizing stroke volume and cardiac output mainly by fluid administration and guided by continuous monitoring of cardiac output or so called functional parameters of cardiac preload gained particular attention. Although they are potentially linked to an increased amount of fluid infusion, recent data give evidence that such pre-emptive concepts of hemodynamic optimization result in a decrease in morbidity and mortality. As TOE allows a real time direct visualization of cardiac structures, other potentially important advantages of its use also outside the cardiac surgery operation room can be postulated, namely the ability to evaluate the anatomical and functional integrity of the left and the right heart chambers. Finally, a practical approach to TOE monitoring is presented, based on a local experience.

Gouveia, Veronica; Marcelino, Paulo; Reuter, Daniel A



The mitral valve: characterisation by real-time three-dimensional transesophageal echocardiography. Current status.  


The complex anatomy of mitral valve demands precise and sophisticated imaging during any intervention .Transesophageal echocardiography has been the most frequently used modality. With the advent of three-dimensional echocardiography a more comprehensive description of the mitral valve is now possible. This review aims to discuss the framework for imaging the mitral valve by three-dimensional echocardiography; its current status and the limitations of three-dimensional echocardiography in its current platform. PMID:22616339

Pau, Biswajit; Omar, Ashok K



A Randomized Controlled Trial of Enteral versus Parenteral Feeding in Patients with Predicted Severe Acute Pancreatitis Shows a Significant Reduction in Mortality and in Infected Pancreatic Complications with Total Enteral Nutrition  

Microsoft Academic Search

Background: Infectious complications are the main cause of late death in patients with acute pancreatitis. Routine prophylactic antibiotic use following a severe attack has been proposed but remains controversial. On the other hand, nutritional support has recently yielded promising clinical results. The aim of study was to compare enteral vs. parenteral feeding for prevention of infectious complications in patients with

Maxim S. Petrov; Mikhail V. Kukosh; Nikolay V. Emelyanov



Comparison of contrast echocardiography versus cardiac catheterization for detection of pulmonary arteriovenous malformations.  


Because clinical diagnosis of pulmonary arteriovenous malformations (AVMs) is difficult and cardiac catheterization invasive, contrast echo has been used to aid in the diagnosis. Correlation between contrast echo and catheterization data in these patients remains poorly defined. We examined the ability to detect pulmonary AVMs by contrast echocardiography, pulmonary angiography, and pulmonary vein saturations in patients who have undergone cavopulmonary (Glenn) shunts. Pulmonary vein saturations were obtained from catheterization reports. Blinded observers reviewed angiographic and contrast echo data retrospectively in 27 patients who had undergone a Glenn shunt and in 19 controls with biventricular hearts. Contrast echo was positive in 68 of 99 lungs (69%). Angiography showed AVMs in 65 of 98 lungs (66%). Pulmonary vein desaturation was found in 13 of 45 lungs sampled (29%). Only 10 of 38 lungs with positive contrast echo had pulmonary vein desaturation, but only 1 patient had pulmonary vein desaturation without positive contrast echo. The degree of desaturation did not correlate with severity of contrast echo return; 6 of 11 patients with 3+ contrast echo studies had normal pulmonary vein saturations. In a control group of patients with biventricular hearts, only 1 of 19 (5.3%) contrast echos was weakly positive. Contrast echo correlates poorly with angiography and pulmonary vein saturation for evaluation of AVMs. Contrast echo is extremely sensitive and often positive despite normal pulmonary vein saturation. Assessment of pulmonary vein desaturation in 100% oxygen may improve its sensitivity and correlation with contrast echo. Additional studies are needed to follow patients with mildly positive contrast echo studies to enable determination of their clinical relevance. PMID:11809429

Feinstein, Jeffrey A; Moore, Phillip; Rosenthal, David N; Puchalski, Michael; Brook, Michael M



Use of echocardiography in the management of congestive heart failure in the community  

Microsoft Academic Search

Objectives. We evaluated the use and the impact of echocardiography in patients receiving an initial diagnosis of congestive heart failure in Olmsted County, Minnesota, in 1991.Background. The American College of Cardiology\\/American Heart Association clinical practice guidelines recommend echocardiography in all patients with suspected congestive heart failure. No data are available on use and impact of echocardiography in management of congestive

Michele Senni; Richard J Rodeheffer; Christophe M Tribouilloy; Jonathan M Evans; Steven J Jacobsen; Kent R Bailey; Margaret M Redfield



Assessment of Myocardial Function in Pediatric Patients with Operated Tetralogy of Fallot: Preliminary Results with 2D Strain Echocardiography  

Microsoft Academic Search

The global myocardial function in patients after repair of tetralogy of Fallot (TOF) can be assessed by cardiovascular magnetic\\u000a resonance (CMR) and measurement of B-type natriuretic peptides. Two-dimensional echocardiography-derived strain and strain\\u000a rate (2D strain) facilitate the assessment of regional myocardial function. We evaluated myocardial function in 16 children\\u000a with residual severe pulmonary valve regurgitation and right ventricular (RV) volume

Walter Knirsch; Ali Dodge-Khatami; Alexander Kadner; Oliver Kretschmar; Johannes Steiner; Petra Böttler; Deniz Kececioglu; Paul Harpes; Emanuela R. Valsangiacomo Buechel



[Echocardiography and cardiac localizations of rheumatoid polyarthritis in Africans].  


A lot of european authors demonstrate that echocardiography is the best examination to objective cardiac localizations in rhumatoïd arthritis (RA). Leleu, in a recent publication thinks that the rarity of systemic localizations during RA in Africans is characteristic. The authors examine the last 15 patients. They never find cardiac involvement and this seems to confirm the clinical impression about 50 previous cases. PMID:6097789

Monnier, A; Dienot, B; Delmarre, B; Leleu, J P; Ekra, A; Beda, B Y


Prognostic value of exercise echocardiography in diabetic patients  

Microsoft Academic Search

BACKGROUND: Coronary artery disease (CAD) is the leading cause of death in diabetic patients. Although exercise echocardiography (EE) is established as a useful method for diagnosis and stratification of risk for CAD in the general population, there are few studies on its value as a prognostic tool in diabetic patients. The purpose of this investigation was to evaluate the value

Joselina LM Oliveira; José AS Barreto-Filho; Carla RP Oliveira; Thaiana A Santana; Fernando D Anjos-Andrade; Érica O Alves; Adão C Nascimento-Junior; Thiago JS Góes; Nathalie O Santana; Francis L Vasconcelos; Martha A Barreto; Argemiro D'Oliveira Junior; Roberto Salvatori; Manuel H Aguiar-Oliveira; Antônio CS Sousa



Transesophageal Echocardiography for Detecting Intracardiac Thrombi in Embolic Stroke  

Microsoft Academic Search

The authors studied 56 patients with cardioembolic stroke to search for intracardiac thrombi by use of transesophageal and transthoracic echocardiography. Forty consecutive patients were examined within four weeks of stroke onset and the remaining 16 in the chronic stage. They also performed ultrafast computed tomography in 9 of them. Underlying heart disease was present in all subjects. Anticoagulant therapy had

Kazunori Toyoda; Masahiro Yasaka; Seiki Nagata; Nobushige Yamashita; Satoshi Imakita; Takenori Yamaguchi



Accurate Localization of Mitral Regurgitant Defects Using Multiplane Transesophageal Echocardiography  

Microsoft Academic Search

Background. Appropriate patient selection for surgical repair of the mitral valve depends on the specific location and mechanism of regurgitation, which, in turn, has necessitated a more detailed method to accurately describe mitral pathology. This study tests a strategy of using multiplane transesophageal echocardiography to systematically localize mitral regurgitant defects and compares these results with the surgical findings.Methods. Fifty patients

Gary P. Foster; Eric M. Isselbacher; Geoffrey A. Rose; David F. Torchiana; Cary W. Akins; Michael H. Picard



Salmonella aortitis with pseudoaneurysm formation diagnosed by transesophageal echocardiography.  


A case of Salmonella aortitis with pseudoaneurysm formation involving the descending thoracic aorta is described. Transesophageal echocardiography (TEE) was instrumental in establishing the diagnosis and leading to a successful surgical intervention. A high index of suspicion is required to make a timely diagnosis of Salmonella aortitis, and TEE should be considered in cases of possible thoracic involvement. PMID:8943452

Kures, P; Soble, J


Stress echocardiography for risk assessment of diabetic patients  

PubMed Central

Coronary artery disease in patients suffering from diabetes mellitus will become an increasing problem in the future. Because diabetic patients benefit from treatment of symptomatic but also asymptomatic coronary artery disease, early diagnosis is warranted. The diagnostic techniques used to detect ischaemia, with a focus on stress echocardiography, are described. ImagesFigure 1

Baur, L.H.B.; Graal, M.



Intracardiac echocardiography: computerized detection of left ventricular borders  

Microsoft Academic Search

A semi-automated method for two- and three-dimensional analysis of intracardiac echocardiography (ICE) images and image sequences is reported based on detection of epicardial and endocardial borders using graph searching. The border detection method was applied to 50 ICE images acquired in vivo in five dogs and to 108 images in 16 volumetric ICE image sequences from eight cadaveric pig hearts.

Milan Sonka; Weidong Liang; Prapti Kanani; John Allan; Steve DeJong; Richard Kerber; Charles McKay



Prognostic value of echocardiography after acute myocardial infarction  

Microsoft Academic Search

Echocardiography is useful for risk stratification and assessment of prognosis after myocardial infarction, which is the focus of this review. Various traditional echocardiographic parameters have been shown to provide prognostic information, such as left ventricular volumes and ejection fraction, wall motion score index, mitral regurgitation and left atrial volume. The introduction of tissue Doppler imaging and speckle-tracking strain imaging has

S A Mollema; G Nucifora; J J Bax



Echocardiography, pulmonary artery catheterization, and radionuclide cineangiography in septic shock  

Microsoft Academic Search

Building on their prior contributions to the elucidation of myocardial dysfunction in sepsis [1-3], Jardin and colleagues present in this issue of Intensive Care Medicine a comparative analysis of measurements by echocardiography and pulmonary artery catheterization in 32 patients with septic shock [4]. Three principal findings are reported. First, invasive assessment of pulmonary artery occlusion pressure (PAOP), as a surrogate

R. E. Cunnion; Ch. Natanson



Transoesophageal echocardiography in cardiac anaesthesia and intensive care  

Microsoft Academic Search

Transoesophageal echocardiography (TOE) is being increasingly used throughout the field of anaesthesia and intensive care and nowhere has its impact been greater than in cardiac practice. This article outlines the main uses for TOE in current practice and explores the different ways in which it may affect anaesthetic and surgical management. Use of TOE for diagnostic purposes includes the assessment

A. Shaw



Fatal pheochromocytoma crisis precipitated by dobutamine stress echocardiography  

Microsoft Academic Search

The safety of dobutamine stress echocardiography (DSE) has been demonstrated in multiple studies with a major complication rate of ,1%. Specifically, ventricular tachycardia during DSE has a reported inci- dence of 0.3%, and has been bound to be of no prognostic significance in patients without obstructive coronary artery disease. We report a unique case of fatal pheochromocytoma crisis precipitated by

Prabhdeep S. Sethi; William Hiser; Hasan Gaffar; Leng Jiang; Ashequl Islam; Nitin Bhatnagar; Mara Slawsky


Quantitative angiographic measurements of isolated left anterior descending coronary artery stenosis correlation with exercise echocardiography and technetium-99m 2-methoxy isobutyl isonitrile single-photon emission computed tomography  

Microsoft Academic Search

Objectives. This study sought to assess the value of quantitative coronary arteriography in predicting an ischemic response at exercise echocardiography and technetium-99m 2-methoxy isobutyl isonitrile (mibi) single-photon emission computed tomography (SPECT) in patients with single-vessel disease of the left anterior descending coronary artery.Background. The relation between severity of coronary stenosis and ischemic response to exercise echocardiography and perfusion scintigraphy in

Mariarosaria Arnese; Alessandro Salustri; Paolo M. Fioretti; Jan H. Cornel; Eric Boersma; Ambroos E. M. Reijs; Pim J. de Feyter; Jos R. T. C. Roelandt



Diagnostic triage and the role of natriuretic peptide testing and echocardiography for suspected heart failure: an appropriateness ratings evaluation by UK GPs  

PubMed Central

Background Some UK GPs are acquiring access to natriuretic peptide (NP) testing or echocardiography as diagnostic tests for heart failure. This study developed appropriateness ratings for the diagnostic application of these tests in routine general practice. Aim To develop appropriateness ratings for the diagnostic application of NP testing or echocardiography for heart failure in general practice. Design and setting An appropriateness ratings evaluation in UK general practice. Method Four presenting symptoms (cough, bilateral ankle swelling, dyspnoea, fatigue), three levels of risk of cardiovascular disease (low, intermediate, high), and dichotomous categorisations of cardiovascular/chest examination and electrocardiogram result, were used to create 540 appropriateness scenarios for patients in whom NP testing or echocardiography might be considered. These were rated by a 10-person expert panel, consisting of GPs and GPs with specialist interests in cardiology, in a two-round RAND Appropriateness Method. Results Onward referral for NP testing or echocardiography was rated as an appropriate next step in 217 (40.2%) of the 540 scenarios; in 194 (35.9%) it was rated inappropriate. The ratings also show where NP testing or echocardiography were ranked as equivalent next steps and when one test was seen as the more appropriate than the other. Conclusion NP testing should be the routine test for suspected heart failure where referral for diagnostic testing is considered appropriate. An abnormal electrocardiogram status makes referral to echocardiography an accompanying, or more appropriate, next step alongside NP testing, especially in the presence of dyspnoea. Abnormal NP testing should subsequently be followed up with referral for echocardiography.

Campbell, Stephen M; Fuat, Ahmet; Summerton, Nick; Lancaster, Neil; Hobbs, FD Richard



A new intracavitary lesion at echocardiography and MR: a case of mistaken identity.  


Atrial myxomas often show contrast enhancement following administration of intravenous gadolinium, whereas thrombus appears as a hypointense structure, typically without any contrast enhancement. This case report presents a diagnostic challenge involving a recently developed left atrial mass in which echocardiography and cardiac MRI provided discordant results. While the morphological characteristics of the new left atrial lesion were suggestive of myxoma, the signal characteristics and behavior following intravenous gadolinium at MR, and, in particular, the rapid interval appearance of the lesion, prompted consideration for left atrial thrombus. Subsequent intra-operative and histopathologic evaluation proved the mass to be a left atrial myxoma. PMID:23712831

Pandit, Anil; Panse, Prasad M; Aryal, Aashrayata; Gruden, James F; Gotway, Mike



Real-time three-dimensional dobutamine stress echocardiography in assessment of ischemia: comparison with two-dimensional dobutamine stress echocardiography  

Microsoft Academic Search

OBJECTIVESThis study was designed to test the feasibility and efficacy of using real-time three-dimensional echocardiography (RT-3D) to detect ischemia during dobutamine-induced stress (DSE) and compares the results with conventional two-dimensional echocardiography (2D).BACKGROUNDReal-time three-dimensional echocardiography, a novel imaging technique, offers rapid acquisition with multiple simultaneous views of the left ventricle (LV). These features make it attractive for application during stress.METHODSOf 279

Masood Ahmad; Tianrong Xie; Marti McCulloch; Gerard Abreo; Marschall Runge



Quantification of mitral valve stenosis by three-dimensional transesophageal echocardiography.  


The aim of this study was the evaluation of the diagnostic potentials of transesophageal 3D- echocardiography in the determination of mitral valve stenosis. 54 patients were investigated by transthoracic and multiplane transesophageal echocardiography. In 41 patients cardiac catheterization was performed. 3D- echocardiographic data acquisition was performed by automatic transducer rotation at 2 degree increments over a span of 180 degrees. The transesophageal probe was linked to an ultrasound unit and to a 3D- workstation capable of ECG- and respiration gated data acquisition, postprocessing and 2D/3D image reconstruction. The mitral valve was visualized in sequential cross-sectional planes out of the 3D data set. The spatial position of the planes was indicated in a reference image. In the cross-sectional plane with the narrowest part of the leaflets the orifice area was measured by planimetry. For topographic information a 3D view down from the top of the left atrium was reconstructed. Measurements were compared to conventional transthoracic planimetry, to Doppler-echocardiographic pressure half time and to invasive data. The mean difference to transthoracic planimetry, pressure half time and to invasive measurements were 0.3 +/- 0.1 cm2, 0.2 +/- 0.1 cm2 and 0.1 +/- 0.1 cm2, respectively. Remarkable differences between the 3D- echocardiographic and the 2D- or Doppler- echocardiographic methods were observed in patients with severe calcification or aortic regurgitation. In 22% of the patients the 3D data set was not of diagnostic quality. New diagnostic information from a 3D view of the mitral valve could be obtained in 69% of the patients. Thus, although image quality is limited, 3D- echocardiography provides new topographic information in mitral valve stenosis. It allows the use of a new quantitative method, by which image plane positioning errors and flow-dependent calculation is avoided. PMID:8993986

Kupferwasser, I; Mohr-Kahaly, S; Menzel, T; Spiecker, M; Dohmen, G; Mayer, E; Oelert, H; Erbel, R; Meyer, J



Effects of velocity distribution, diameter measurement and velocity tracing on the accuracy of cardiac output measurement by pulsed doppler echocardiography in the aortic annulus of pigs  

Microsoft Academic Search

The accuracy of cardiac output measurement by pulsed Doppler echocardiography can be affected by several factors, such as the velocity distribution, the measurement of diameter and the method of tracing the pulsed Doppler flow spectrum. This experimental study was designed to find the most accurate way of measuring cardiac output in consideration of all these factors. In 10 open-chest normal

Yu-Qing Zhou; Svein Faerestrand; Sigurd Birkeland; Knut Matre; Paul Husby; Mai-Elin Koller



Longitudinal study of echocardiography-derived tricuspid regurgitant jet velocity in sickle cell disease.  


Although echocardiography-derived tricuspid regurgitant jet velocity (TRV) is associated with increased mortality in sickle cell disease (SCD), its rate of increase and predictive markers of its progression are unknown. We evaluated 55 subjects (median age: 38 years, range: 20-65 years) with at least two measurable TRVs, followed for a median of 4·5 years (range: 1·0-10·5 years) in a single-centre, prospective study. Thirty-one subjects (56%) showed an increase in TRV, while 24 subjects (44%) showed no change or a decrease in TRV. A linear mixed effects model indicated an overall rate of increase in the TRV of 0·02 m/s per year (P = 0·023). The model showed that treatment with hydroxycarbamide was associated with an initial TRV that was 0·20 m/s lower than no such treatment (P = 0·033), while treatment with angiotensin converting enzyme inhibitors and angiotensin receptor blockers was associated with an increase in the TRV (P = 0·006). In summary, although some patients have clinically meaningful increases, the overall rate of TRV increase is slow. Treatment with hydroxycarbamide may decrease the progression of TRV. Additional studies are required to determine the optimal frequency of screening echocardiography and the effect of therapeutic interventions on the progression of TRV in SCD. PMID:23829561

Desai, Payal C; May, Ryan C; Jones, Susan K; Strayhorn, Dell; Caughey, Melissa; Hinderliter, Alan; Ataga, Kenneth I



Echocardiography by the non-cardiologist: a curriculum for the fast track strategy.  


A formal echocardiographic approach in a general intensive care unit requires a 24 hour availability of an expert in echocardiography, who could not be easily found. Therefore, a goal-directed echocardiogram strategy specifically tailored to the intensivist should be created. The concept of goal-directed echocardiography (GDE) has been incompletely evaluated and it is necessary to find a curriculum program to grant proficiency. We propose the Fast-Track Echocardiographic Strategy (FTES) program to accomplish both objectives. All medical associations of echocardiography agree that extensive training and experience are needed to acquire and interpret a formal echocardiogram, however, to answer the five questions of FTES a simpler curriculum program would be enough. The aim of this review study was to propose a curriculum to teach non-cardiologist physicians intensivist (NCPI) to use a GDE such as FTES. A search for published literature, from 1999 until June 2008, in English and French languages in Medline was undertaken in order to find out the most relevant and contemporary studies in this area. Strength of evidence of the articles found was based on five strengths of evidence. A framework for published medical research's critical appraisal and a checklist for sources of bias were used for assessment of studies quality. In overall, all studies showed it was possible to teach NCPI to use a GDE examination. After a critical appraisal of the literature, we proposed FTES program to grant proficiency to NCPI in a GDE, to be used in hemodynamic unstable critically ill patients (hypotension with or without hypoxemia), to answer five simple questions, in order to define an hemodynamic profile and consequently be able to optimize their treatments. In conclusion, probably FTES program should at least be considered. PMID:22863481

Côrte-Real, Hugo; França, Carlos



Reliability of Echocardiography in the Diagnosis of Right Ventricular Hypertrophy  

PubMed Central

The right ventricular (RV) wall thickness and dimension were measured by the technique of echocardiography in 62 patients. Thirty-six of these patients died, and the RV wall thickness was measured at necropsy for comparison with the echocardiographic measurements. The necropsy RV wall thickness measured 3.3 ± 0.6 mm in patients without right ventricular hypertrophy (RVH) and 5.9 ± 0.9 mm in patients with RVH (P<.01). The echocardiographic measurements of the diastolic RV wall thickness correlated well with the necropsy measurements of the RV wall thickness (r=.83). The sensitivity and specificity of the echocardiographic criteria in detecting RVH was superior to the electrocardiographic (ECG) criteria. Furthermore, the echocardiographic technique was useful in evaluating RVH in 18 patients with an abnormal ECG due to right or left bundle branch block or myocardial infarction. We conclude that echocardiography is reliable in diagnosing RVH. ImagesFigure 1Figure 5

Prakash, Ravi



Spatial compounding of large sets of 3D echocardiography images  

NASA Astrophysics Data System (ADS)

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

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



Use of adenosine echocardiography for diagnosis of coronary artery disease  

SciTech Connect

Two-dimensional echocardiography combined with exercise is sensitive and specific in the detection of coronary artery disease (CAD) by demonstrating transient abnormalities in wall motion. Frequently, however, patients cannot achieve maximal exercise because of various factors. Pharmacologic stress testing with intravenous adenosine was evaluated as a means of detecting CAD in a noninvasive manner. Patients with suspected CAD underwent echocardiographic imaging and simultaneous thallium 201 single-photon emission computed tomography during the intravenous administration of 140 micrograms/kg/min of adenosine. An increase in heart rate, decrease in blood pressure, and increase in double product were observed during adenosine administration. Initial observations revealed that wall motion abnormalities were induced by adenosine in areas of perfusion defects. The adenosine infusion was well tolerated, and symptoms disappeared within 1 to 2 minutes after termination of the infusion. Therefore preliminary observations suggest that adenosine echocardiography appears to be useful in the assessment of CAD.

Zoghbi, W.A. (Section of Cardiology Baylor College of Medicine, Methodist Hospital, Houston, TX (USA))



Ventricular remodeling and function: insights using murine echocardiography  

PubMed Central

Summary Extracellular matrix disturbances play an important role in the development of ventricular remodeling and failure. Genetically modified mice with abnormalities in the synthesis and degradation of extracellular matrix have been generated, in particular mice with deletion or overexpression of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs). Echocardiography is ideally suited to serially evaluate left ventricular (LV) size and function, thus defining the progression of LV remodeling and failure. This Review describes the echocardiographic parameters that may provide insights into the development of ventricular remodeling and heart failure. The application of echocardiography to study LV remodeling and function after myocardial infarction and LV pressure-overload in wild-type mice and mice deficient or overexpressing MMPs or TIMPs is then detailed. Finally, using the example of mice deficient in nitric oxide synthase 3, a cautionary example is given illustrating discrepancies between the cardiac echocardiographic phenotype and modifications of the extracellular matrix.

Scherrer-Crosbie, Marielle; Kurtz, Baptiste



Investigation of the thoracic aorta in cholesterol embolism by transoesophageal echocardiography  

PubMed Central

Objectives—To examine the thoracic aorta of patients with severe cholesterol embolism (CE) by transoesophageal echocardiography (TOE).?Methods—The thoracic aorta of 20 consecutive patients with CE was compared with that in a control population matched for age and risk factors by TOE. Patients were prescribed steroids after CE was diagnosed. Follow up is reported and compared with results in the literature.?Results—Aortic plaques and debris were more common in patients with CE than in the control population (p < 0.001 and p < 0.0001, respectively). The mean (SD) number of aortic plaques in the CE patients was 2.6 (0.7). This aortic atheroma was found predominantly in the descending aorta. One patient died during a mean (SD) follow up of 24 (10) months.?Conclusions—Aortic atheroma, as detected by TOE, should be considered as the main source of CE. In addition, the prognosis in our series, in which steroids were systematically prescribed, is much better than in others reported in the literature.?? Keywords: aortic atheroma;  transoesophageal echocardiography;  cholesterol embolism

Ferrari, E; Taillan, B; Drai, E; Morand, P; Baudouy, M



Practice guidelines for perioperative transesophageal echocardiography: Recommendations of the Indian association of cardiovascular thoracic anesthesiologists.  


Transoesophageal Echocardiography (TEE) is now an integral part of practice of cardiac anaesthesiology. Advances in instrumentation and the information that can be obtained from the TEE examination has proceeded at a breath-taking pace since the introduction of this technology in the early 1980s. Recognizing the importance of TEE in the management of surgical patients, the American Societies of Anesthesiologists (ASA) and the Society of Cardiac Anesthesiologists, USA (SCA) published practice guidelines for the clinical application of perioperative TEE in 1996. On a similar pattern, Indian Association of Cardiac Anaesthesiologists (IACTA) has taken the task of putting forth guidelines for transesophageal echocardiography (TEE) to standardize practice across the country. This review assesses the risks and benefits of TEE for several indications or clinical scenarios. The indications for this review were drawn from common applications or anticipated uses as well as current clinical practice guidelines published by various society practicing Cardiac Anaesthesia and cardiology . Based on the input received, it was determined that the most important parts of the TEE examination could be displayed in a set of 20 cross sectional imaging planes. These 20 cross sections would provide also the format for digital acquisition and storage of a comprehensive TEE examination. Because variability exists in the precise anatomic orientation between the heart and the esophagus in individual patients, an attempt was made to provide specific criteria based on identifiable anatomic landmarks to improve the reproducibility and consistency of image acquisition for each of the standard cross sections. PMID:24107693

Muralidhar, Kanchi; Tempe, Deepak; Chakravarthy, Murali; Shastry, Naman; Kapoor, Poonam Malhotra; Tewari, Prabhat; Gadhinglajkar, Shrinivas V; Mehta, Yatin


Syncope caused by cardiac asystole during dobutamine stress echocardiography.  

PubMed Central

Syncope caused by cardiac asystole during dobutamine stress echocardiography occurred in a 60 year old woman presenting with chest pain and a non-diagnostic exercise test. Cardiac asystole was not associated with myocardial ischemia and was attributed to a powerful cardioinhibitory vagal reflex elicited by the stimulation by the drug of cardiac and aortic mechanoreceptors. Cardiac asystole was promptly reversed by the administration of atropine with no significant sequelae.

Lanzarini, L.; Previtali, M.; Diotallevi, P.



The use of echocardiography in Wolff–Parkinson–White syndrome  

Microsoft Academic Search

Endocardial mapping and radiofrequency catheter ablation are well established modalities for the diagnosis and treatment of\\u000a patients with Wolff–Parkinson–White (WPW) syndrome associated with tachyarrhythmias. However, the electrophysiologic techniques\\u000a are invasive, require radiation exposure, and lack spatial resolution of cardiac structures. A variety of echocardiographic\\u000a techniques have been investigated as a non-invasive alternative for accessory pathway localization. Conventional M-mode echocardiography\\u000a can

Qiangjun Cai; Mossaab Shuraih; Sherif F. Nagueh


Oral contrast echocardiography for the diagnosis of left atrial encroachment.  


The differential diagnosis of masses encroaching on the left atrium may be challenging. We describe a case in which contrast echocardiography using a carbonated drink provided a rapid and simple way to clarify the diagnosis of an incidental mass causing extrinsic compression of the left atrium. Given its simplicity and availability, we believe that it should be considered as a first line tool for clarifying the diagnosis in cases of echocardiographic evidence of left atrial encroachment of unknown origin. PMID:19017321

Bouzas-Mosquera, Alberto; Alvarez-García, Nemesio; Peteiro, Jesús; García-Bueno, Lourdes; Castro-Beiras, Alfonso



Evaluation of ultrasound lung comets by hand-held echocardiography  

PubMed Central

Background Ultrasound lung comets (ULCs) are a clinically useful sign of extravascular lung water. They require very limited technology (2 D-echo), and a short learning curve. The aim of the present study is to compare ULCs information obtained by experienced echocardiologists using a full feature echocardiographic platform and by inexperienced sonographers using a hand-held echocardiography system. Methods 20 consecutive in-hospital patients underwent, within 15' and in random order, 2 ultrasound examinations for ULCs by 2 observers with different specific expertise and different technology: 1) "high-tech veteran": ULCs assessment with full feature echocardiographic platform (HP Sonos 7500 Philips Medical Systems, Andover, MA, USA) by a trained echocardiologist, with ?2 years expertise in ULCs assessment and accredited by the European Association of Echocardiography; 2) and a "low-tech beginner": ULCs assessment with hand-held echocardiography (Optigo; Philips, Andover, MA) by an echocardiographer with very limited (30') dedicated training on ULCs assessment. In each patient, ULC score was obtained by summing the number of comets from each of the scanning spaces in the anterior right and left hemithorax, from the second to the fifth intercostal space. Results There was a significant, tight correlation (r = .958, p < 0.001) between the 2 observations in the same patient by "high-tech veteran" and "low-tech beginner". Conclusion ULCs are equally reliable in the hands of highly experienced echocardiologists using full feature echocardiographic platforms and in the hands of absolute beginners with miniaturized, compact, and battery-equipped echocardiographic systems. From the technological and expertise viewpoint, ULCs are the "kindergarten" of echocardiography, ideally suited for bedside evaluation of patients with both known or suspected heart failure.

Bedetti, G; Gargani, L; Corbisiero, A; Frassi, F; Poggianti, E; Mottola, G



Non-dilated cardiomyopathy in Nigerians evaluated by echocardiography.  


Non-dilated cardiomyopathy (NDCM), a condition said to be uncommon, has been found to occur in 4.6% of cases undergoing echocardiography in our centre. Its echocardiographic features have been given (normal cavity dimensions, reduced contractility, thick walls) and clinical implications highlighted. Since it is not an entirely innocuous state, patients should, when discovered, be followed up closely. This would afford clinicians the opportunity to determine factors that lead to stability or deterioration of DCM. PMID:9684031

Okeahialam, B N; Anjorin, F I



Oesophageal perforation complicating intraoperative transoesophageal echocardiography: suspicion can save lives.  


Oesophageal injury is an extremely rare complication of intra-operative transoesophageal echocardiography (TOE) associated with cardiac surgery. We report a case of delayed presentation (19 days after surgery) of oesophageal injury that was likely due to TOE following an aortic valve replacement. Lack of suspicion led to a delay in diagnosis but the patient fortunately survived. We advocate that in the event of postoperative hydropneumothorax, the differential diagnosis must include iatrogenic oesophageal injury from transoesophageal echo. PMID:20494972

Elsayed, Hany; Page, Richard; Agarwal, Seema; Chalmers, John



Comparison of adenosine echocardiography, with and without isometric handgrip, to exercise echocardiography in the detection of ischemia in patients with coronary artery disease  

Microsoft Academic Search

This study was undertaken to evaluate whether adenosine echocardiography is comparable to exercise echocardiography in the detection of ischemia in patients with suspected coronary artery disease and to assess whether the addition of handgrip exercise to adenosine enhances the induction of ischemia in these patients. Accordingly, 67 patients with suspected or known coronary artery disease referred for exercise testing underwent

Cyril B. Tawa; William B. Baker; Neal S. Kleiman; Anatole Trakhtenbroit; Ranley Desir; William A. Zoghbi



Hyperventilation and cold-pressor stress echocardiography combined with automated functional imaging non-invasively detected vasospastic angina.  


A 47-year-old male presented with chest discomfort while sleeping. The patient was suspected of having vasospastic angina (VSA) and underwent hyperventilation and cold-pressor stress echocardiography. No chest pain, ECG changes or decreased wall motion was found. However, automated function imaging (AFI) showed decreased peak systolic strain at the apex and postsystolic shortening at both the apex and inferior wall, which was not found before the test. The provocation test revealed 99% stenosis in the right coronary artery #2 at a dose of 50 ?g acetylcholine and 90% stenosis in the left coronary artery #8 at a dose of 100 ?g. The patient was thus diagnosed as having VSA. The present case demonstrates the usefulness of AFI combined with hyperventilation and cold-pressor stress echocardiography as a screening examination for VSA. PMID:22798093

Suzuki, Kengo; Akashi, Yoshihiro J; Mizukoshi, Kei; Kou, Seisyou; Takai, Manabu; Izumo, Masaki; Shimozato, Takashi; Hayashi, Akio; Ohtaki, Eiji; Nobuoka, Sachihiko; Miyake, Fumihiko



Hyperventilation and cold-pressor stress echocardiography combined with automated functional imaging non-invasively detected vasospastic angina  

PubMed Central

A 47-year-old male presented with chest discomfort while sleeping. The patient was suspected of having vasospastic angina (VSA) and underwent hyperventilation and cold-pressor stress echocardiography. No chest pain, ECG changes or decreased wall motion was found. However, automated function imaging (AFI) showed decreased peak systolic strain at the apex and postsystolic shortening at both the apex and inferior wall, which was not found before the test. The provocation test revealed 99% stenosis in the right coronary artery #2 at a dose of 50 ?g acetylcholine and 90% stenosis in the left coronary artery #8 at a dose of 100 ?g. The patient was thus diagnosed as having VSA. The present case demonstrates the usefulness of AFI combined with hyperventilation and cold-pressor stress echocardiography as a screening examination for VSA.

Suzuki, Kengo; Akashi, Yoshihiro J; Mizukoshi, Kei; Kou, Seisyou; Takai, Manabu; Izumo, Masaki; Shimozato, Takashi; Hayashi, Akio; Ohtaki, Eiji; Nobuoka, Sachihiko; Miyake, Fumihiko



The use of echocardiography in the critically ill; the role of FADE (Fast Assessment Diagnostic Echocardiography) training.  


Echocardiography (echo) is a powerful technique that permits direct visualization and assessment of all the cardiac structures and assessment of the patients' haemodynamic status at the bedside. Echo allows detection of valvular disease, evaluation of ventricular function and the pericardium, detection of intracardiac/intrapulmonary shunts, and can be used to calculate flows and relative pressures between the cardiac chambers. This rapid point-of-care haemodynamic evaluation provides information to guide therapeutic interventions, including volume resuscitation, instigation of vasoactive therapy and/or referral for specialist cardiac/surgical intervention. Although there is abundant evidence in the cardiology literature regarding the use of echo, data in the critical care arena is less well defined, but emerging. The use of echo by intensive care doctors is likely to become routine, and therefore training for intensivists in this technique needs to be developed and supported. The Portuguese Working Group on Echocardiography has developed a skill-based program, FADE (Focused Assessment Diagnostic Echocardiography) in order to train clinicians in the use of bedside ultrasound as a diagnostic and monitoring tool for the critically ill. PMID:22758617

Marum, Susan; Price, Susanna



The Use of Echocardiography in the Critically Ill; The Role of FADE (Fast Assessment Diagnostic Echocardiography) Training  

PubMed Central

Echocardiography (echo) is a powerful technique that permits direct visualization and assessment of all the cardiac structures and assessment of the patients’ haemodynamic status at the bedside. Echo allows detection of valvular disease, evaluation of ventricular function and the pericardium, detection of intracardiac/intrapulmonary shunts, and can be used to calculate flows and relative pressures between the cardiac chambers. This rapid point-of-care haemodynamic evaluation provides information to guide therapeutic interventions, including volume resuscitation, instigation of vasoactive therapy and/or referral for specialist cardiac/surgical intervention. Although there is abundant evidence in the cardiology literature regarding the use of echo, data in the critical care arena is less well defined, but emerging. The use of echo by intensive care doctors is likely to become routine, and therefore training for intensivists in this technique needs to be developed and supported. The Portuguese Working Group on Echocardiography has developed a skill-based program, FADE (Focused Assessment Diagnostic Echocardiography) in order to train clinicians in the use of bedside ultrasound as a diagnostic and monitoring tool for the critically ill.

Marum, Susan; Price, Susanna



Therapy for Severe Vasculitis Shows Long-Term Effectiveness  


... sites by the National Center for Advancing Translational Sciences and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, components of NIH, and by the Arthritis Foundation. The identifier for the study Rituximab ...


Head to head comparisons of two modalities of perfusion adenosine stress echocardiography with simultaneous SPECT  

PubMed Central

Background Real-time perfusion (RTP) contrast echocardiography can be used during adenosine stress echocardiography (ASE) to evaluate myocardial ischemia. We compared two different types of RTP power modulation techniques, angiomode (AM) and high-resolution grayscale (HR), with 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) for the detection of myocardial ischemia. Methods Patients with known or suspected coronary artery disease (CAD), admitted to SPECT, were prospectively invited to participate. Patients underwent RTP imaging (SONOS 5500) using AM and HR during Sonovue® infusion, before and throughout the adenosine stress, also used for SPECT. Analysis of myocardial perfusion and wall motion by RTP-ASE were done for AM and HR at different time points, blinded to one another and to SPECT. Each segment was attributed to one of the three main coronary vessel areas of interest. Results In 50 patients, 150 coronary areas were analyzed by SPECT and RTP-ASE AM and HR. SPECT showed evidence of ischemia in 13 out of 50 patients. There was no significant difference between AM and HR in detecting ischemia (p = 0.08). The agreement for AM and HR, compared to SPECT, was 93% and 96%, with Kappa values of 0.67 and 0.75, respectively (p < 0.001). Conclusion There was no significant difference between AM and HR in correctly detecting myocardial ischemia as judged by SPECT. This suggests that different types of RTP modalities give comparable data during RTP-ASE in patients with known or suspected CAD.

Gudmundsson, Petri; Shahgaldi, Kambiz; Winter, Reidar; Dencker, Magnus; Kitlinski, Mariusz; Thorsson, Ola; Ljunggren, Lennart; Willenheimer, Ronnie B



Robust myocardial motion tracking for echocardiography: variational framework integrating local-to-global deformation.  


This paper proposes a robust real-time myocardial border tracking algorithm for echocardiography. Commonly, after an initial contour of LV border is traced at one or two frames from the entire cardiac cycle, LV contour tracking is performed over the remaining frames. Among a variety of tracking techniques, optical flow method is the most widely used for motion estimation of moving objects. However, when echocardiography data is heavily corrupted in some local regions, the errors bring the tracking point out of the endocardial border, resulting in distorted LV contours. This shape distortion often occurs in practice since the data acquisition is affected by ultrasound artifacts, dropouts, or shadowing phenomena of cardiac walls. The proposed method is designed to deal with this shape distortion problem by integrating local optical flow motion and global deformation into a variational framework. The proposed descent method controls the individual tracking points to follow the local motions of a specific speckle pattern, while their overall motions are confined to the global motion constraint being approximately an affine transform of the initial tracking points. Many real experiments show that the proposed method achieves better overall performance than conventional methods. PMID:23554841

Ahn, Chi Young



The grade of worsening of regional function during dobutamine stress echocardiography predicts the extent of myocardial perfusion abnormalities  

PubMed Central

AIM—To evaluate the angiographic, myocardial perfusion, and wall motion abnormalities in patients with severe compared with mild worsening of regional function during dobutamine stress echocardiography (DSE) for evaluation of myocardial ischaemia.?METHODS—147 patients with significant coronary artery disease and new or worsening wall motion abnormalities during DSE were enrolled. Left ventricular function was evaluated using a 16 segment/4 grade score model where 1 = normal and 4 = dyskinesis. Simultaneous sestamibi SPECT myocardial perfusion imaging was performed in all patients.?RESULTS—Severe worsening of regional function (an increase in wall motion score of two grades or more in ? 1 segment) was detected in 37 patients, while 110 patients had mild worsening (an increase in wall motion score of no more than one grade in ? 1 segment). Patients with severe worsening of regional function had more stenotic coronary arteries (2.31 (0.8) v 1.97 (0.8) (mean (SD)) (p <0.05), a higher prevalence of left anterior descending coronary artery disease (95% v 73%) (p < 0.05), a higher resting wall motion score index (1.71 (0.42) v 1.51 (0.40) (p = 0.01), and more stress perfusion defects (3.8 (1.5) v 2.8 (1.5) (p < 0.001) compared with patients with mild worsening. Multivariate analysis identified the number of stress perfusion defects (p < 0.005, ?2 = 8.8) and the number of ischaemic segments on echocardiography (p < 0.05, ?2 = 4.3) as independent variables associated with severe worsening of regional function.?CONCLUSIONS—The grade of worsening of regional function during DSE predicts the underlying extent of myocardial perfusion abnormalities. The occurrence of severe worsening of regional function is associated with variables known to predict worse prognosis in patients with coronary artery disease.???Keywords: coronary artery disease; myocardial perfusion; ventricular function; echocardiography

Elhendy, A; van Domburg, R T; Bax, J; Poldermans, D; Nierop, P; Geleijnse, M; Roelandt, J



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

SciTech Connect

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

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



Echocardiography to measure fitness of elite runners.  


We evaluated the echocardiograms of 134 male and 54 female elite runners who competed over different distances to observe cardiac enlargement and differences among athletes engaged in different types of training, and to relate the echographic dimension with running performance. In male runners, left ventricular (LV) internal diameter at end diastole (LVIDd), LV mass, and left atrial diameter were increased by the length of distance ( P < .001) whereas right ventricular diameter was increased only in marathon runners. In female runners, this association was found when LVIDd, LV mass, and left atrial diameter were adjusted for body surface area ( P < .001). Wall thickness was not related to distance running. Abnormal LV dilation was associated with a low LV ejection fraction for the higher values of LVIDd, but not for the higher indexed LVIDd values. In male runners, LVIDd was associated with 100 m ( r = -0.67, P < .01), 10,000 m ( r = -0.70, P < .001), and marathon ( r = -0.54, P < .001) and in female runners with a 400-m ( r = -0.84, P < .001) race time. These results show that sprint- and endurance-trained runners had an eccentric hypertrophy and that it is necessary to establish a new upper limit of abnormal cavity dilatation as indexed LVIDd. The normal systolic function and the relationship between LVIDd and performance indicate that LV enlargement in elite runners is a physiologic adaptation and that echocardiographic assessment can be used to determine the fitness of runners. PMID:15891751

Legaz Arrese, Alejandro; Serrano Ostáriz, Enrique; González Carretero, Mariano; Lacambra Blasco, Isaac



Cross-sectional echocardiography in hypoplastic left ventricle: Echocardiographic—angiographic—anatomic correlations  

Microsoft Academic Search

Summary  Although M-mode echocardiography has become a valuable tool in the noninvasive diagnosis of hypoplastic left ventricle (HLV),\\u000a it may not resolve all diagnostic uncertainty. This study compares the findings of M-mode echocardiography, cross-sectional\\u000a echocardiography, and autopsy in a group of 20 infants with HLV. M-mode echocardiograms alone were obtained in eight infants;\\u000a five of these children underwent cardiac catheterization, and

Lothar W. Lange; David J. Sahn; Hugh D. Allen; Theron W. Ovitt; Stanley J. Goldberg



Head to head comparison of 2D vs real time 3D dipyridamole stress echocardiography  

Microsoft Academic Search

Real-time three-dimensional (RT-3D) echocardiography has entered the clinical practice but true incremental value over standard two-dimensional echocardiography (2D) remains uncertain when applied to stress echo. The aim of the present study is to establish the additional value of RT-3D stress echo over standard 2D stress echocardiography. We evaluated 23 consecutive patients (age = 65 ± 10 years, 16 men) referred

Silvia Varnero; Patricia Santagata; Lorenza Pratali; Massimiliano Basso; Alfredo Gandolfo; Paolo Bellotti



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

PubMed Central

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

Barasch, E; Wilansky, S



Multimodality imaging for assessment of myocardial viability: nuclear, echocardiography, MR, and CT.  


The assessment of myocardial viability may be an important component of the evaluation of patients with coronary artery disease and left ventricular dysfunction. The primary goal of viability assessment in such patients is to guide therapeutic decisions by determining which patients would most likely benefit from revascularization. In patients with chronic coronary artery disease, left ventricular dysfunction may be a consequence of prior myocardium infarction, which is an irreversible condition, or reversible ischemic states such as stunning and hibernation. Imaging techniques utilize several methods to assess myocardial viability: left ventricular function, morphology, perfusion, and metabolism. Each technique (echocardiography, nuclear imaging, magnetic resonance imaging, and x-ray computed tomography) has the ability to assess one or more of these parameters. This article describes how each of these imaging modalities can be used to assess myocardial viability, and reviews the relative strengths and limitations of each technique. PMID:22231930

Arrighi, James A; Dilsizian, Vasken



Stress Echocardiography for the Diagnosis of Coronary Artery Disease  

PubMed Central

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:"> or at 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: Objective The objective of the analysis is to determine the diagnostic accuracy of stress echocardiography (ECHO) in the diagnosis of patients with suspected coronary artery disease (CAD) compared to coronary angiography (CA). Stress Echocardiography Stress ECHO is a non-invasive technology that images the heart using ultrasound. It is one of the most commonly employed imaging techniques for investigating a variety of cardiac abnormalities in both community and hospital settings. A complete ECHO exam includes M-mode, 2-dimensional (2-D) images and Doppler imaging. In order to diagnosis CAD and assess whether myocardial ischemia is present, images obtained at rest are compared to those obtained during or immediately after stress. The most commonly used agents used to induce stress are exercise and pharmacological agents such as dobutamine and dipyridamole. The hallmark of stress-induced myocardial ischemia is worsening of wall motion abnormalities or the development of new wall motion abnormalities. A major challenge for stress ECHO is that the interpretation of wall motion contractility and function is subjective. This leads to inter-observer variability and reduced reproducibility. Further, it is estimated that approximately 30% of patients have sub-



Assessment of left ventricular function using dobutamine stress echocardiography and myocardial scintigraphy in valvular heart disease.  


To assess the left ventricular (LV) function in valvular heart disease, we employed the preoperative dobutamine stress echocardiography and the myocardial scintigraphy. During the past 13 years, 37 of 324 the patients showed LV dysfunction with the % fractional shortening (%FS) of 25% or less in the preoperative echocardiogram. These patients were retrospectively divided into two groups; Group A (n = 21): %FS has improved late after operation; Group B (n = 16): %FS has deteriorated or LV failure occurred. The mean follow-up period was 84 +/- 54 months after valve surgery. No significant differences were observed in the preoperative characteristics and operative variables between these two groups. The dobutamine stress test had been performed in 8 patients in Group A and 9 patients in Group B preoperatively, and the maximum increase ratio of %FS (delta %FS) was used for assessment. Seven patients in Group A had showed delta %FS of more than 9%, while all patients in Group B had showed delta %FS of less than 9%. Myocardial scintigraphy was performed in 11 patients of them, and another 22 patients with %FS of above 25% acted as the control group. The Defect Score, which was defined as the sum of defect scales in 25 LV segments, showed a significant difference between 11 patients with LV dysfunction and control group. The distribution of the Defect Score in each myocardial segment, showed significantly higher in the posterior and inferior LV segments. In addition, the perfusion defect on myocardial imaging was initiated in the junction between the septal and LV free wall, and extended from the posterior to the lateral wall along with deterioration of LV function. In conclusion, preoperative dobutamine stress echocardiography proved to be very useful for prediction of the postoperative LV function, and myocardial scintigraphy might be indicative of LV function even in valvular heart disease. PMID:10487034

Ozaki, N; Sugimoto, T; Okada, M



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

PubMed Central

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 (TVE) to evaluate atrial electromechanical function in young, healthy volunteers. Subjects and methods We studied 37 healthy individuals: 28 men and nine women with a mean age of 29 years (range 20–47). Standard two-dimensional (2-D) and Doppler echocardiograms with superimposed TVE images were performed. Standard echocardiographic images were digitized during three consecutive cardiac cycles in cine-loop format for off-line analysis. Several indices of regional atrial electrical and mechanical function were derived from both 2-D and TVE modalities. Results Some TVE-derived variables indirectly reflected the atrial electrical activation that follows the known activation process as revealed by invasive electrophysiology. Regionally, the atrium shows an upward movement of its walls at the region near the atrio-ventricular ring with a reduction of this movement towards the upper levels of the atrial walls. The atrial mechanical function as assessed by several TVE-derived indices was quite similar in all left atrium (LA) walls. However, all such indices were higher in the right (RA) than the LA. There were no correlations between the 2-D- and TVE-derived variables expressing atrial mechanical function. Values of measurement error and repeatability were good for atrial mechanical function, but only acceptable for atrial electrical function. Conclusion TVE may provide a simple, easy to obtain, reproducible, repeatable and potentially clinically useful tool for quantifying atrial electromechanical function.

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



Television Quiz Show Simulation  

ERIC Educational Resources Information Center

|This article explores the simulation of four television quiz shows for students in China studying English as a foreign language (EFL). It discusses the adaptation and implementation of television quiz shows and how the students reacted to them.|

Hill, Jonnie Lynn



Cost-effectiveness of stress echocardiography and nuclear perfusion imaging.  


Cost-effectiveness analysis is a method of comparing societal economic value of 2 different strategies. Ideally, it defines accurate test-related (direct and downstream) costs and appropriately converts differential patient outcomes into a dollar value. The likelihood that cost-effectiveness analysis translated into a policy-making tool will enhance health care and/or control costs is dependent on the validity of numerous assumptions about relative costs, patient outcomes, and generalizability of the literature to regional capabilities. The purpose of this report is to review the concept of cost-effectiveness analysis as it applies to stress echocardiography and stress myocardial perfusion imaging for selected patient subsets. PMID:11153508

Chee, N K; Bateman, T M


[Echocardiography as a first diagnostic step in kidney tumours].  


Intracardiac tumours are usually found after clinical symptoms lead to a positive imaging study, or as an incidental finding of imaging study, usually echocardiography. Cardiac tumours range from non-neoplastic lesions to high grade malignancies. The majority of primary cardiac tumours are myxomas (in 75% cases) or sarcomas (about 10% cases). In this paper we present cases of 2 patients with right atrial tumour, extending from renal carcinoma, invading renal vein and inferior vena cava into right atrium. Two different therapeutic strategies were undertaken in those patients. PMID:21850637

Szymczyk, Ewa; Lipiec, Piotr; Michalski, B?a?ej; Sadowski, Jerzy; Wierzbicki, Karol; Kasprzak, Jaros?aw D



The benefits of 3D-4D fetal echocardiography  

PubMed Central

ABSTRACT In the last decade 3D and live 3D ultrasound or the so called 4D (3D/4D) in examination of the fetal heart evolved very rapidly with the development of the new technique called Spatiotemporal Image Corelation – STIC, which enables the aquisition of a volume data concomitent with the beating heart. It appears that 3D/4D ultrasound in fetal echocardiography may make an important contribution to the diagnosis of congenital heart disease, to interdisciplinary management, to parental counseling and to medical personal training.

Ionescu, Cringu



The Great Cometary Show  

NASA Astrophysics Data System (ADS)

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



Potential advantage of flash echocardiography for digital subtraction of B-mode images acquired during myocardial contrast echocardiography.  


Optimal assessment of myocardial perfusion with contrast echocardiography by using B-mode imaging often requires image alignment and background subtraction, which are time consuming and need extensive expertise. Flash echocardiography is a new technique in which primary images are gated to the electrocardiogram and secondary images are obtained by transmitting ultrasound pulses in rapid succession after each primary image. Myocardial opacification is seen in the primary image and not in the secondary images because of ultrasound-induced bubble destruction. Because the interval between the primary and first few secondary images is very short, cardiac motion between these images should be minimal. Therefore we hypothesized that 1 or more secondary images could be subtracted from the primary image without the need for image alignment. The ability of ultrasound to destroy microbubbles was assessed by varying the sampling rate, line density, and mechanical index in 6 open-chest dogs. The degree of translation between images was quantified in the x and y directions with the use of computer cross-correlation. At sampling rates of 158 Hz or less and a mechanical index of more than 0.6, videointensity rapidly declined to baseline levels by 25 ms. Significant translation between images was noted only at intervals of more than 112 ms. It is concluded that flash echocardiography can be used for digital subtraction of baseline from contrast-enhanced B-mode images without image alignment. Background subtraction is therefore feasible on-line, potentially eliminating the need for off-line image processing in the future. PMID:9950966

Pelberg, R A; Wei, K; Kamiyama, N; Sklenar, J; Bin, J; Kaul, S



Beyond Show and Tell.  

ERIC Educational Resources Information Center

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…

Krovetz, Martin; And Others



Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease  

PubMed Central

OBJECTIVES: The prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease according to disease severity has not yet been established. The aim of this study was to assess the prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease patients according to disease severity. METHODS: The study included 25 mild/moderate chronic obstructive pulmonary disease patients and 25 severe/very severe chronic obstructive pulmonary disease patients. All participants underwent clinical evaluation, spirometry and electrocardiography/echocardiography. RESULTS: Electrocardiography and echocardiography showed Q-wave alterations and segmental contractility in five (10%) patients. The most frequent echocardiographic finding was mild left diastolic dysfunction (88%), independent of chronic obstructive pulmonary disease stage. The proportion of right ventricular overload (p<0.05) and blockage of the anterosuperior division of the left bundle branch were higher in patients with greater obstruction. In an echocardiographic analysis, mild/moderate chronic obstructive pulmonary disease patients showed more abnormalities in segmental contractility (p<0.05), whereas severe/very severe chronic obstructive pulmonary disease patients showed a higher prevalence of right ventricular overload (p<0.05), increased right cardiac chamber (p<0.05) and higher values of E-wave deceleration time (p<0.05). Age, sex, systemic arterial hypertension, C-reactive protein and disease were included as independent variables in a multiple linear regression; only disease severity was predictive of the E-wave deceleration time [r2?=?0.26, p?=?0.01]. CONCLUSION: Chronic obstructive pulmonary disease patients have a high prevalence of left ventricular diastolic dysfunction, which is associated with disease severity. Because of this association, it is important to exclude decompensated heart failure during chronic obstructive pulmonary disease exacerbation.

de Oliveira Caram, Laura Miranda; Ferrari, Renata; Naves, Cristiane Roberta; Tanni, Suzana Erico; Coelho, Liana Sousa; Zanati, Silmeia Garcia; Minicucci, Marcos Ferreira; Godoy, Irma



Supporting the early use of echocardiography in blunt chest trauma  

PubMed Central

This case reports a very unusual mechanism of cardiac rupture following an episode of multiple blunt chest trauma. The patient, a professional jockey, was trampled by horses, and although shocked on hospital admission, he did not present with signs and symptoms that were consistent with cardiogenic shock. This case highlights the difficult and subjective nature of clinical examination in emergency situations when dealing with cases of acute cardiac tamponade. It further emphasises the lack of sensitivity of traditional trauma imaging and investigative approaches such as the standard anteroposterior chest X-ray and electrocardiogram. The diagnosis of acute cardiac tamponade was not made until tertiary-care-centre arrival, when ultrasound technology in the form of bedside echocardiography was used, facilitating emergency surgery to repair a ruptured left ventricle. It is hoped that the sharing of this case will alert fellow clinicians to this uncommon but possible mechanism of cardiac rupture and subsequent tamponade, encourage the early use of echocardiography at the bedside in hypotensive blunt chest trauma cases and reinforce the principles of the Advanced Trauma Life Support course in treating trauma victims.



[Role of echocardiography after cardiac surgery during rehabilitation].  


In this review, specific aspects and implications of echocardiography in patients who had undergone recent cardiac surgery will be analysed. This imaging method, which is fully effective in clinical practice, actually possesses diagnostic characteristics, which during assessments of patients, are found to be noninvasive and easily repeatable. They are of great value amongst this particular group of patients for discovering any possible complications from the surgical procedures. Technical problems and methodology will be described regarding the specificity of the patient during the early days after cardiac surgery (for instance the difficulties of executing in certain post-operative conditions such as pain, injuries or worsening of acoustic window). Informative contribution and specific assessment in patients following myocardial revascularisation surgery, reconstructive or valvular replacement surgery, and left ventricle or thoracic aorta surgery will be analysed. The role of echocardiography in the identification and monitoring of the main complications related to the operation will also be described. The increasing diagnostic potential and assessment of the investigation is thanks to its systematic use which lasts for the intensive phase of cardiac rehabilitation, but assumes specific and adequate operator competence for optimum use in clinical examinations. PMID:12827833

Calisi, Pasqualina; Griffo, Raffaele



The transesophageal echocardiography simulator based on computed tomography images.  


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

Piórkowski, Adam; Kempny, Aleksander



Objective structured assessment of technical competence in transthoracic echocardiography: a validity study in a standardised setting  

PubMed Central

Background Competence in transthoracic echocardiography (TTE) is unrelated to traditional measures of TTE competence, such as duration of training and number of examinations performed. This study aims to explore aspects of validity of an instrument for structured assessment of echocardiographic technical skills. Methods The study included 45 physicians with three different clinical levels of echocardiography competence who all scanned the same healthy male following national guidelines. An expert in echocardiography (OG) evaluated all the recorded, de-identified TTE images blindly using the developed instrument for assessment of TTE technical skills. The instrument consisted of both a global rating scale and a procedure specific checklist. Two scores were calculated for each examination: A global rating score and a total checklist score. OG rated ten examinations twice for intra-rater reliability, and another expert rated the same ten examinations for inter-rater reliability. A small pilot study was then performed with focus on content validity. This pilot study included nine physicians who scanned three patients with different pathologies as well as different technical difficulties. Results Validity of the TTE technical skills assessment instrument was supported by a significant correlation found between level of expertise and both the global score (Spearman 0.76, p<0.0001) and the checklist score (Spearman 0.74, p<0.001). Both scores were able to distinguish between the three levels of competence that were represented in the physician group. Reliability was supported by acceptable inter- and intra-rater values. The pilot study showed a tendency to improved scores with increasing expertise levels, suggesting that the instrument could also be used when pathologies were present. Conclusions We designed and developed a structured assessment instrument of echocardiographic technical skills that showed evidence of validity in terms of high correlations between test scores on a normal person and the level of physician competence, as well as acceptable inter- and intra-rater reliability scores. Further studies should, however, be performed to determine the adequate number of assessments needed to ensure high content validity and reliability in a clinical setting.



Management issues during HeartWare left ventricular assist device implantation and the role of transesophageal echocardiography.  


Left ventricular assist devices (LVAD) are increasingly used for mechanical circulatory support of patients with severe heart failure, primarily as a bridge to heart transplantation. Transesophageal echocardiography (TEE) plays a major role in the clinical decision making during insertion of the devices and in the post-operative management of these patients. The detection of structural and device-related mechanical abnormalities is critical for optimal functioning of assist device. In this review article, we describe the usefulness of TEE for optimal perioperative management of patients presenting for HeartWare LVAD insertion. PMID:24107692

Patangi, Sanjay Orathi; George, Anthony; Pauli, Henning; O'Leary, Denis; Roysam, Chandrika; Butt, Tanveer; Schueler, Stephan; Prabhu, Mahesh; Macgowan, Guy


Star Show Classroom Activity  

NSDL National Science Digital Library

In this lesson from Math Machines, the class will "plan and conduct a simulated astronomical observing session to photgraph a variety of star types." The instructor will set up several "stars" around the classroom, and students will then set up a telescope location and estimate the altitude and azimuth to photograph each star. A participant handout (including worksheet) and facilitator notes are made available for download in DOC file format. Links to calculator programs are also included.

Thomas, Fred



The usefulness of contrast during exercise echocardiography for the assessment of systolic pulmonary pressure  

PubMed Central

Background The systolic pulmonary artery pressure (PAPs) can be accurately estimated, non-invasively, using continuous-wave Doppler (CWD) ultrasound measurement of the peak velocity of a tricuspid regurgitant (TR) jet. However, it is often difficult to obtain adequate tricuspid regurgitation signals for measurement of PAPs, what could lead to its underestimation. Therefore, utilization of air-blood-saline contrast has been implemented for the improvement of Doppler signal in several clinical contexts. It is now recommended in the evaluation of patients with pulmonary hypertension. Physical activity is severely restricted in patients with PAH, being exertional dypnea the most typical symptom. Exercise stress echo-Doppler imaging allows assessment of the response to exercise. It is an excellent screening test for patients with suspected PAH. Our purpose was to evaluate the value and accuracy of agitated saline with blood contrast echocardiography, in the improvement of the Doppler signal, to quantify PAPs during treadmill exercise-echocardiography. Purpose To evaluate the value of contrast echocardiography, using agitated saline with blood, in the improvement of the Doppler signal used to quantify the pulmonary artery systolic pressure during exercise. Methods From a total of 41 patients (pts), we studied 38 pts (93%), 35 women, aged 54 ± 12 years-old. 27 with the diagnosis of systemic sclerosis, 10 with history of pulmonary embolism and one patient with a suspected idiopathic PAH, who were referred to the Unity of Heart Failure and Pulmonary Hypertension for screening of PAH. According to the Unity protocol, a transthoracic echocardiogram was made, in left decubitus (LD), with evaluation of right ventricle-right atria gradient (RV/RAg). A peripheral venous access was obtained, with a 3-way stopcock and the patients were placed in orthostatism (O), with a new evaluation of RV/RAg. Exercise echocardiography (EE) was begun, with evaluation of RV/RAg at peak exercise (P) and afterwards agitated saline (8 cc with 1 cc of air and 1 cc of blood) was injected, followed by a new evaluation of RV/RAg (PC) and then the interruption of the EE. Pulmonary Hypertension was diagnosed when RV/RAg at the end of the exercise was superior to 40 mmHg. Results The quality of Doppler signal was deteriorated in 5 pts, maintained in 6 pts and improved in 26 pts, with the use of contrast. In one patient, an interventricular septal defect was diagnosed. In 6 pts, a Doppler signal was only obtained with the use of contrast. In 15 pts, a RV/RAg superior to 40 mmHg was only obtained with the use of contrast. Of these, 9 have already been submitted to right heart cathetherism, that confirmed the diagnosis of pulmonary hypertension in 5 of them (56%). RV/RAg (P) was 44 ± 11 mmHg and RV/RAg (PC) was 54 ± 11 mmHg, p < 0,001. Conclusion 1. The method is applicable in a large number of patients. 2. RV/RA gradients obtained at peak exercise are higher with the use of contrast, and the clinical meaning of this difference should be evaluated in a larger number of pts submitted to right heart cathetherism. The high number of false positives should lead to a higher diagnostic threshold. 3. This method seems to have relevant clinical value in the diagnosis of pulmonary arterial hypertension.

Lopes, Luis R; Loureiro, Maria J; Miranda, Rita; Almeida, Sofia; Almeida, Ana R; Cordeiro, Ana; Cotrim, Carlos; Carrageta, Manuel



Second harmonic imaging improves sensitivity of dobutamine stress echocardiography for the diagnosis of coronary artery disease  

Microsoft Academic Search

Objective Our purpose was to assess the value of second harmonic imaging compared with fundamental imaging for the diagnosis of coronary artery disease during dobutamine stress echocardiography. Patients and Methods Sixty-four patients underwent dobutamine stress echocardiography with both fundamental imaging and second harmonic imaging. Coronary angiography was performed within 3 months. Ischemia was defined as new or worsening wall motion

Fabiola B. Sozzi; Don Poldermans; Jeroen J. Bax; Eric Boersma; Wim B. Vletter; Abdou Elhendy; Alberico Borghetti; Jos R. T. C. Roelandt



Role of Intraoperative Transesophageal Echocardiography in Patients Having Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

BackgroundPrevious studies have shown that intraoperative transesophageal echocardiography provides important preoperative and postoperative information in various cardiac and noncardiac surgeries that may alter patient management and outcome. The role of intraoperative transesophageal echocardiography in patients in whom isolated coronary artery bypass graft surgery is anticipated has been reported only in small selected groups. This study was designed to prospectively evaluate

Fatema E. Qaddoura; Martin D. Abel; Karen L. Mecklenburg; Krishnaswamy Chandrasekaran; Hartzell V. Schaff; Kenton J. Zehr; Thoralf M. Sundt; Roger L. Click



Early Echocardiography Can Predict Cardiac Events in Emergency Department Patients With Chest Pain  

Microsoft Academic Search

Study Objective: Accurate diagnosis in emergency department patients with possible myocardial ischemia is problematic. Two-dimensional echocardiography has a high sensitivity for identifying patients with myocardial infarction (MI); however, few studies have investigated its diagnostic ability when used acutely in ED patients with possible myocardial ischemia. Therefore we investigated the ability of ED echocardiography for predicting cardiac events in patients with

Michael C Kontos; James A Arrowood; Walter HJ Paulsen; JV Nixon



Dipyridamole echocardiography for diagnosis of coexistent coronary artery disease in hypertrophic cardiomyopathy  

Microsoft Academic Search

The recognition of coexistent coronary artery disease (CAD) in patients with hypertrophic cardiomyopathy may be difficult by noninvasive testing based upon electrocardiographic changes or perfusion defects. Dipyridamole-stress echocardiography has proved a sensitive and highly specific test for noninvasive diagnosis of CAD in various patient subsets. To establish the feasibility, safety, and diagnostic accuracy of dipyridamolestress echocardiography in patients with hypertrophic

Ettore Lazzeroni; Eugenio Picano; Claudio Dodi; Letizia Morozzi; Gian P. Chiriatti; Giuseppe Botti



Intracardiac echocardiography: an ideal guiding tool for device closure of interatrial communications  

Microsoft Academic Search

Background This study sought to evaluate safety and radiation exposure when using intracardiac echocardiography (ICE) in comparison to transesophageal echocardiography (TEE) in order to guide transcatheter closure of interatrial communications. Methods Eighty patients (44 males, 36 females, mean age 46, SD 13 years) undergoing device closure of atrial septal defect (nZ 12) or patent foramen ovale (n Z 68) had

Thomas Bartel; Thomas Konorza; Ulrich Neudorf; Tiko Ebralizea; Holger Eggebrecht; Achim Gutersohn; Raimund Erbel


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

Microsoft Academic Search

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

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



Dobutamine stress Doppler echocardiography: reproducibility and physiologic left ventricular filling patterns  

Microsoft Academic Search

Qualitatively, dobutamine stress echocardiography has become an established procedure. Quantitative results are in great demand but this is still difficult due to limited endo- and epicardial border definition. Transmitral Doppler variables are strictly quantitative and less subjective. Furthermore, ischemic alterations precede systolic ones (ischemic cascade). There are preliminary reports of the utility of dobutamine stress Doppler echocardiography, but proof of

Uwe Nixdorff; Stefan Wagner; Raimund Erbel; Susanne Mohr-Kahaly; Peter Weitzel; Klaus Rieger; Jürgen Meyer



Use of Echocardiography to Assess Function of hDAF-Transgenic Pig Cardiac Xenografts  

Microsoft Academic Search

The current standard of hand palpation may not be a sensitive method to detect rejection in heterotopic heart xenotransplants (HHTx). We sought to assess the use of echocardiography to detect rejection of pig heart xenografts. Four cynomolgus monkeys received HHTx from hDAF-transgenic pigs. Immunosuppression was cyclophosphamide induction, cyclosporine, steroids, sodium mycophenolate, ?Gal trisaccharide polymer, ±soluble complement receptor type 1. Echocardiography

M. C. Y. Chan; M. Stalder; T. T. Lam; T. Tye; D. C. Borie; R. E. Morris



Intravenous myocardial contrast echocardiography predicts recovery of dysynergic myocardium early after acute myocardial infarction  

Microsoft Academic Search

OBJECTIVESWe aimed to ascertain whether triggered intravenous myocardial contrast echocardiography (MCE) can predict functional recovery in patients with acute myocardial infarction (AMI) and to determine the optimal triggering interval in this setting.BACKGROUNDDetection of myocardial viability early after AMI has both therapeutic and prognostic implications. Myocardial contrast echocardiography using intracoronary injections of contrast can detect viable myocardium, but there is little

Jonathan M. A Swinburn; Avijit Lahiri; Roxy Senior



[Correlation of the transaortic gradient determined with doppler echocardiography versus catheterization in patients with aortic stenosis].  


The purpose of this report is to evaluate the reliability of a non-invasive estimation of a transaortic gradient in patients with valvular aortic stenosis by doppler echocardiography. We compared the transvalvular gradients obtained by cardiac catheterization (invasive) versus the estimation by non-invasive technique such as continuous-wave doppler in 30 consecutive patients with valvular aortic stenosis. When compared the peak velocity (Vmax) of the aortic jet versus the gradient obtained by cardiac catheterization we found a correlation coefficient (r) of 0.83 and when compared the gradient obtained by both methods we found an r value of 0.85. These results show that the calculations of aortic gradient by echo-doppler, are reliable. Besides this method allowed us to establish the correct diagnosis and to follow up these patients. PMID:1854227

Illescas, J; Enciso, R; Vidrio, M; de la Torre, N; Baduí, E


Ventricular structure and function in children with sickle cell disease using conventional and tissue Doppler echocardiography.  


Conventional 2-dimensional, M-mode, and spectral Doppler echocardiographic techniques have documented abnormal ventricular function in adults with sickle cell disease (SCD), but assessments in children are conflicting. Tissue Doppler echocardiography (TDE) provides additional information about myocardial function. Two-dimensional, M-mode, tricuspid regurgitation jet velocity (TRJV) data, and tissue Doppler echocardiographically derived myocardial velocity measurements of left ventricular (LV) and right ventricular function were taken from children with SCD compared to those of similar healthy historical controls and correlated with clinical characteristics and hemoglobin levels. Compared to 55 controls, 54 children with SCD (mean age 14.2 years, range 6 to 21) had a larger left ventricle, greater LV mass, and higher LV fractional shortening; 30% had increased pulmonary artery pressure (TRJV ?2.5 m/s). Conventional echocardiographic measurements of LV systolic function and spectral Doppler measurements of LV and right ventricular diastolic function were essentially normal, but TDE indicated that 31% of SCD children had evidence of LV diastolic dysfunction (peak early diastolic velocity of LV inflow Doppler/peak early diastolic velocity at lateral mitral valve annulus >8), a finding that correlated with lower hemoglobin levels. Although decreasing hemoglobin levels in children with SCD correlated with LV hypertrophy, LV dilation, and LV diastolic dysfunction, long-term transfusion or hydroxyurea therapy did not affect these measurements. In conclusion, 1/3 of children with SCD had tissue Doppler echocardiographic evidence of LV diastolic dysfunction, which was correlated with hemoglobin levels. Adding serial assessments of ventricular function with TDE to conventional echocardiography may detect early cardiac changes, especially in children with severe anemia. PMID:22341365

Eddine, Ahmad Charaf; Alvarez, Ofelia; Lipshultz, Steven E; Kardon, Richard; Arheart, Kristopher; Swaminathan, Sethuraman



Valvular heart disease and 3-dimensional echocardiography: ready for prime-time?  

PubMed Central

Significant advances in 3-dimensional echocardiography (3DE) technology have ushered its use into clinical practice. The recent advent of real-time 3DE using matrix array transthoracic and transesophageal transducers has resulted in improved image spatial resolution, and therefore, enhanced visualization of the patho-morphological features of the cardiac valves. Three-dimensional echocardiography provides unique perspectives of valvular structures by presenting “en face” views of valvular structures, allowing for a better understanding of the topographical aspects of pathology, and a refined definition of the spatial relationships of intracardiac structures. Three-dimensional echocardiography makes available indices not described by 2D echocardiography and has been demonstrated to be superior to 2D echocardiography in a variety of valvular disease scenarios. In this review, we discuss the incremental role of 3DE in evaluating valvular anatomic features, volumetric quantification, pre-surgical planning, intra-procedural guidance, and post-procedural assessment of valvular heart disease.

Moura, Luis M; de Isla, Leopoldo Perez



Do Elephants Show Empathy?  

Microsoft Academic Search

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

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



What Do Maps Show?  

ERIC Educational Resources Information Center

|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…

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


Shakespearean Slide Shows.  

ERIC Educational Resources Information Center

|Presents a condensed method for involving students in the kind of theatrical problem-solving that transforms a script to a play. Describes how to incorporate a "human slide show" into the class. Notes that students must read plays not just to understand events, but to make artistic choices about how to stage the action so that an audience…

Flynn, Rosalind M.



Btu accounting: Showing results  

Microsoft Academic Search

In the preceding article in this series last month, the author showed how to calculate the energy consumed to make a pound of product. To realize a payoff, however, the results must be presented in graphs or tables that clearly display what has happened. They must call attention to plant performance and ultimately lead to more efficient use of energy.



Stage a Water Show  

ERIC Educational Resources Information Center

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

Frasier, Debra



ISU Demonstration Road Show  

NSDL National Science Digital Library

The Idaho State University Department of Physics conducts science demonstration shows at SE Idaho schools. Four different presentations are currently available; "Forces and Motion", "States of Matter", "Electricity and Magnetism", and "Sound and Waves". Student activities and descriptions of the demonstrated material are also provided.

Shropshire, Steven



Preventive health care, 1999 update: 2. Echocardiography for the detection of a cardiac source of embolus in patients with stroke  

Microsoft Academic Search

Objective: To develop guidelines for the use of echocardiography in the investiga- tion of patients with stroke. Options: (1) Routine transthoracic echocardiography (TTE); (2) routine trans- esophageal echocardiography (TEE); (3) routine TTE followed by TEE if the TTE findings are noncontributory; (4) selective TTE or TEE in patients with cardiac disease who would not otherwise receive anticoagulant therapy. Outcomes: This

Moira K. Kapral; Frank L. Silver; Toronto Toronto; Clinical Epidemiology


Sensitivity of transthoracic versus transesophageal echocardiography for the detection of native valve vegetations in the modern era  

Microsoft Academic Search

Background: Thirteen years ago, transthoracic echocardiography (TTE) was found to be less sensitive than transesophageal echocardiography (TEE) for native valve vegetations. Since then, harmonic imaging and other advances have improved TTE. How this affects the sensitivity of TTE is unknown. Methods: Fifty patients with echocardiography-diagnosed endocarditis had TTE and TEE examinations on high-end machines. These were matched for date of

Harmony R. Reynolds; Michael A. Jagen; Paul A. Tunick; Itzhak Kronzon



Viewing television talk shows  

Microsoft Academic Search

We examined how motivation, audience activity, and attitudes influenced the likelihood of watching societal?issue and relational topics on television talk programs. Path analysis supported differences in ritualized and instrumental motives for watching talk shows. Information and exciting?entertainment motivation predicted greater’ realism of, affinity with, involvement with, and intent to watch talk television. Pass?time motivation predicted reduced affinity with and intent

Alan M. Rubin; Mary M. Step



The Truman Show  

Microsoft Academic Search

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

Rolf F. Nohr


Abnormal ventricular activation and repolarisation during dobutamine stress echocardiography in coronary artery disease  

PubMed Central

Objective—To assess possible ECG changes caused by dobutamine stress and their relation to wall motion disturbances in patients with coronary artery disease.?Design—Prospective recording and analysis of 12 lead ECG at rest and during each stage of dobutamine stress echocardiography, and correlation with wall motion changes.?Setting—A tertiary referral centre for cardiac disease equipped with non-invasive facilities for pharmacological stress tests.?Subjects—27 patients, mean (SD) age 60 (8) years, with documented evidence of coronary artery disease in whom dobutamine stress echo was clinically indicated, and 17 controls of similar age.?Results—In controls, all ECG intervals shortened with increasing heart rate but in the patient group only PR and QT intervals shortened while QRS duration broadened and QTc interval prolonged progressively. In the 27 patients, 16 developed chest pain, 15 with reduced left ventricular long axis systolic excursion (p < 0.001), and all showed reduced peak lengthening rate; ST segment shift appeared in 16, 13 of whom developed chest pain, but did not correlate with reduction of either systolic long axis excursion or peak lengthening rate; QRS duration broadened in 20, 16 with reduction of long axis excursion (p < 0.02) which was more often seen at the septum (p < 0.005); QTc interval prolonged in 19, all of whom had associated reduction of peak long axis lengthening rate (p < 0.02).?Conclusions—QRS duration and QTc interval both normally shorten with dobutamine stress, while in coronary artery disease they both lengthen: changes in QRS duration correlate with systolic and QTc interval with diastolic left ventricular wall motion disturbances. ST segment shift also occurred in most patients, but without consistent correlation with wall motion abnormalities. It was thus less discriminating than the other two abnormalities in this respect.?? Keywords: long axis;  QRS duration;  QTc interval;  stress echocardiography;  coronary artery disease

O'Sullivan, C; Henein, M; Sutton, R; Coats, A; Sutton, G; Gibson, D



Strain and strain rate echocardiography findings in children with asymptomatic congenital aortic stenosis.  


The aim of our study was to evaluate myocardial functions with strain/strain rate echocardiography in asymptomatic patients having congenital aortic stenosis (CAS) with normal cardiac functions as determined by conventional echocardiographic techniques and comparing them with those of healthy controls. A total of 58 patients with various degrees of isolated CAS and 52 healthy controls were enrolled in this study. Conventional and two-dimensional speckle tracking (2DSTE) echocardiography were performed. Global longitudinal strain (LS) (-23.1 ± 3.6 and -23.8 ± 4.7), and longitudinal strain rate (LSR) (-1.49 ± 0.32 and -1.76 ± 0.39) values were lower, whereas circumferential strain (CS) (-25.9 ± 4.7 and -22.8 ± 6.4) and circumferential strain rate (CSR) (-1.82 ± 0.46 and -1.69 ± 0.49) values were greater in the patient group than in the control subjects. The difference was significant for global LSR and CS (p < 0.05) values. Regional analysis showed lower LS values in the basal part of the left-ventricular (LV) free wall and lower LSR values in the basal parts of both of the septum and free wall in the patient group (p < 0.05). CS values in the anteroseptal, posterior, and inferior walls were significantly greater in the patients (p < 0.05). 2DSTE detects subtle alterations in myocardial function in asymptomatic children with CAS. Impairment of LV long-axis function occurred earlier and was more prominent in basal parts of the interventricular septum and the free wall of the left ventricle. PMID:23314915

Dogan, Vehbi; Öcal, Burhan; Orun, Utku Arman; Ozgur, Senem; Y?lmaz, Osman; Keskin, Mahmut; Ceylan, Ozben; Karademir, Selmin; ?enocak, Filiz



Hemodynamic changes during laparoscopic cholecystectomy monitored with transesophageal echocardiography.  


Although pneumoperitoneum has been well tolerated in a predominantly healthy population, there is concern that an increased intraperitoneal pressure may be poorly tolerated in patients with marginal cardiopulmonary function. The purpose of this study was to demonstrate noninvasively the hemodynamic effects of carbon dioxide pneumoperitoneum utilizing biplane transesophageal echocardiography. Fourteen otherwise-healthy patients undergoing nonemergent laparoscopic cholecystectomy were studied using bi-plane transesophageal echocardiography under a standardized anesthetic protocol utilizing isoflurane, fentanyl, and vecuronium bromide. End-tidal CO2, oxygen saturation, cardiac rhythm, temperature, and blood pressure were monitored noninvasively. Minute ventilatory volume was adjusted as needed to keep end-tidal CO2 less than 38 mmHg. Data were recorded at baseline, following abdominal insufflation to 15 mmHg with CO2, with head-up tilt of 20 degrees, following exsufflation, and with the patient level. Significance was determined using a paired Student t-test. Insufflation to 15 mmHg decreased cardiac index (C.I.) by 3% (3.34 to 3.23 l/min/m2) while both heart rate (HR) and mean arterial pressure (MAP) increased (by 7% and 16%), respectively, and stroke volume index decreased by 10% (from 51.6 to 46.6 ml/beat/m2). Head-up tilt of 20 degrees further decreased CI to 2.98 l/min/m2 (-11%) and SVI to 40.3 ml/beat/m2 (-22%) while HR increased by a total of 14% and MAP by 19%. As laparoscopic techniques are applied to a broader population, the impact of small but significant decrements in cardiac function become increasingly important. This study demonstrates that the combination of CO2 pneumoperitoneum and the reverse Trendelenburg position does adversely effect cardiac output. PMID:7597579

Dorsay, D A; Greene, F L; Baysinger, C L



NPR: The Picture Show  

NSDL National Science Digital Library

National Public Radio's "The Picture Show" photo blog is a great way to avoid culling through the thousands of less interesting and engaging photographs on the web. With a dedicated team of professionals, this blog brings together different posts that profile various sets of photographs that cover 19th century war in Afghanistan, visual memories of WWII, unpublished photographs of JFK's presidential campaign, and abandoned buildings on the islands in Boston Harbor. Visitors can search through previous posts, use social media features to share the photo features with friends, and also sign up to receive new materials via their RSS feed. There's quite a nice mix of material here, and visitors can also comment on the photos and recommend the collection to friends and others.


Egg: the Arts Show  

NSDL National Science Digital Library

"Egg is a new TV show about people making art across America" from PBS. This accompanying Website presents excerpts from sixteen episodes of the series, with three more "hatching soon," such as Close to Home, profiling three photographers: Jeanine Pohlhaus, whose pictures document her father's struggle with mental illness; Gregory Crewdson's photos of Lee, Massachusetts; and Joseph Rodriguez's photos of Hispanics in New York City. Excerpts include video clips, gallery listings where the artists' work can be seen, and short interviews with artists. Some episodes also offer "peeps," glimpses of material not shown on TV, such as the Space episode's peep, Shooting Stars, that provides directions for astrophotography, taking photographs of star trails. Other sections of the site are airdates, for local listings; see and do usa, where vacationers can search for art events at their destinations; and egg on the arts, a discussion forum.


American History Picture Show  

NSDL National Science Digital Library

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 ...

Bennion, Ms.



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

PubMed Central

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.

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



Comparative study of cardiac anatomic measurements obtained by echocardiography and dual-source computed tomography.  


The aim of this study was to verify the accuracy of echocardiography by dual-source computed tomography (DSCT). Seven normal beagles underwent DSCT and echocardiography. Echocardiographic measurements were obtained according to the American Society of Echocardiography guidelines. The DSCT images were reconstructed onto the same echocardiographic image plane by using a reconstruction program, and then anatomical measurements were obtained. Nonparametric analysis was used for verifying the significance of each of the measured parameters. The anatomical measurements obtained using echocardiography and DSCT were not significant (P>0.05), and the difference between the measurements obtained using both the methods were within 95% confidence intervals except those for interventricular septal thickness and left ventricular posterior wall thickness in end diastole. The reasons for these differences were considered to be the adjacent structures such as papillary muscles or chordae tendineae that may have influenced the echocardiographic findings, lower far-field image quality of echocardiography, low test-retest reproducibility of echocardiography, high-quality images of DSCT minimizing the motion artifact and the retrospective ECG gating technique of DSCT that offered an adequate timing decision for the systolic and diastolic phase during cardiac movement. Although there were differences in the measurements of interventricular septal thickness and left ventricular posterior wall thickness in end diastole obtained using echocardiography and DSCT, we could conclude that echocardiographic measurement is as accurate and reliable as DSCT for cardiac anatomical assessment. PMID:22850528

Park, Nohwon; Lee, Miyoung; Lee, Ahra; Lee, Seungyeon; Lee, Soyun; Song, Sunhye; Jung, Joohyun; Eom, Kidong



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

PubMed Central

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

Kamp, O.



Age- and Gender-Related Changes in Ventricular Performance in Wild-Type FVB/N Mice as Evaluated by Conventional and Vector Velocity Echocardiography Imaging: A Retrospective Study.  


Detailed studies in animal models to assess the importance of aging animals in cardiovascular research are rather scarce. The increase in mouse models used to study cardiovascular disease makes the establishment of physiologic aging parameters in myocardial function in both male and female mice critical. Forty-four FVB/N mice were studied at multiple time points between the ages of 3 and 16 mo using high-frequency echocardiography. Our study found that there is an age-dependent decrease in several systolic and diastolic function parameters in male mice, but not in female mice. This study establishes the physiologic age- and gender-related changes in myocardial function that occur in mice and can be measured with echocardiography. We report baseline values for traditional echocardiography and advanced echocardiographic techniques to measure discrete changes in cardiac function in the commonly employed FVB/N strain. PMID:23791351

Koch, Sheryl E; Haworth, Kevin J; Robbins, Nathan; Smith, Margaret A; Lather, Navneet; Anjak, Ahmad; Jiang, Min; Varma, Priyanka; Jones, W Keith; Rubinstein, Jack



Screening Adult Survivors of Childhood Cancer for Cardiomyopathy: Comparison of Echocardiography and Cardiac Magnetic Resonance Imaging  

PubMed Central

Purpose To compare two-dimensional (2D) echocardiography, the current method of screening for treatment-related cardiomyopathy recommended by the Children's Oncology Group Guidelines, to cardiac magnetic resonance (CMR) imaging, the reference standard for left ventricular (LV) function. Patients and Methods Cross-sectional, contemporaneous evaluation of LV structure and function by 2D and three-dimensional (3D) echocardiography and CMR imaging in 114 adult survivors of childhood cancer currently median age 39 years (range, 22 to 53 years) exposed to anthracycline chemotherapy and/or chest-directed radiation therapy. Results In this survivor population, 14% (n = 16) had an ejection fraction (EF) less than 50% by CMR. Survivors previously undiagnosed with cardiotoxicity (n = 108) had a high prevalence of EF (32%) and cardiac mass (48%) that were more than two standard deviations below the mean of normative CMR data. 2D echocardiography overestimated the mean EF of this population by 5%. Compared with CMR, 2D echocardiography (biplane method) had a sensitivity of 25% and a false-negative rate of 75% for detection of EF less than 50%, although 3D echocardiography had 53% and 47%, respectively. Twelve survivors (11%) had an EF less than 50% by CMR but were misclassified as ? 50% (range, 50% to 68%) by 2D echocardiography (biplane method). Detection of cardiomyopathy was improved (sensitivity, 75%) by using a higher 2D echocardiography cutoff (EF < 60%) to detect an EF less than 50% by the reference standard CMR. Conclusion CMR identified a high prevalence of cardiomyopathy among adult survivors previously undiagnosed with cardiac disease. 2D echocardiography demonstrated limited screening performance. In this high-risk population, survivors with an EF 50% to 59% by 2D echocardiography should be considered for comprehensive cardiac assessment, which may include CMR.

Armstrong, Gregory T.; Plana, Juan Carlos; Zhang, Nan; Srivastava, Deokumar; Green, Daniel M.; Ness, Kirsten K.; Daniel Donovan, F.; Metzger, Monika L.; Arevalo, Alejandro; Durand, Jean-Bernard; Joshi, Vijaya; Hudson, Melissa M.; Robison, Leslie L.; Flamm, Scott D.



Applicability, limitations and downstream impact of echocardiography utilization based on the Appropriateness Use Criteria for transthoracic and transesophageal echocardiography.  


To evaluate impact of echocardiography on patient management based on published transthoracic echocardiography (TTE) Appropriate Use Criteria (AUC). A prospective analysis of 170 consecutive outpatients who underwent TTE over a period of 2 months. Echo studies were classified into appropriate (A), inappropriate (I), or uncertain (U) based on the 2007/2011 AUC. A fourth group of studies which were not addressed by the 2007 AUC and therefore have unclassifiable category (UC) were also included in the analysis. The impact of AUC categorized echo results on patient management were evaluated by review of patient records in the ensuing 2 months. Based on 2007 AUC, 77% (131/170) were A, 9% were I, and 14% were UC category. Echo studies classified as A were more likely to be associated with new and major findings, (P = 0.034) and (P = 0.028) respectively when compared to all other studies. Furthermore, patient care intervention as defined in the study protocol was significantly associated with A studies as opposed to I and UC studies (P = 0.004). A studies were also more likely to have an impact on patient management when compared to other studies (P = 0.022). When studies were re-evaluated based on the 2011 AUC, all prior UC studies were now included in the U group in the new AUC of 2011, and there was no change in A or I study classification. This study demonstrates that the 2007/2011 AUC are helpful in evaluating practice patterns in a majority of outpatients undergoing TTE. Implementing AUC have a direct clinical impact as A studies are significantly more likely to reveal new and major findings, and more likely to result in a patient care intervention based on the echo findings. PMID:22231468

Alqarqaz, Mohammad; Koneru, Jayanth; Mahan, Meredith; Ananthasubramaniam, Karthik



Determination of Hemodynamic Parameters Using Doppler Two-dimensional Echocardiography: A Searching Tool for Therapeutic Optimization in Patients with Congestive Heart Failure on an Outpatient Care Follow-up  

Microsoft Academic Search

. Therefore, a careful follow-up with individualized treatment directed to the specific and current situation of each patient can have medium- and long-term benefits in the outpatient care of chronic patients with moderate to severe congestive heart failure. In this article, we report the potential applications of methods, such as echocardiography, for the optimized management of patients with congestive heart

Dora V. Palombini; Luis E. Rohde; Leticia Crestana; Lívia Goldraich; Marta Pereira Lima


Comprehensive imaging including three-dimensional echocardiography of an infected, ruptured sinus of valsalva aneurysm.  


A 30-year-old man presented with fevers and fatigue. Blood cultures grew Streptococcus mitis in 4/4 bottles. Transthoracic three-dimensional echocardiography revealed an anterior coronary sinus of Valsalva (SOV) aneurysm with fistula formation into the right ventricle with vegetation on the fistulous tract, and a bicuspid aortic valve without vegetation. Transesophageal echocardiography confirmed these findings. After parenteral antibiotic treatment, the patient went for successful repair of the fistula, with the imaging findings confirmed at surgery. This case represents a rare complication of a ruptured SOV aneurysm, with excellent delineation of cardiac anatomy using transthoracic three-dimensional echocardiography. PMID:18001366

Medina, Hector M; Vazquez, Jacobo; Pritchett, Allison; Lakkis, Nasser; Dokainish, Hisham



Left Ventricular Mass in 169 Healthy Children and Young Adults Assessed by Three-Dimensional Echocardiography  

Microsoft Academic Search

The aims of this study were to establish normal values of left ventricular (LV) mass in children and young adults using three-dimensional\\u000a echocardiography (3-DE) and to compare 3-DE LV mass estimates with those obtained by conventional echocardiographic methods.\\u000a We studied 169 healthy subjects aged 2–27 years by digitized 3-D, two-dimensional (2-D), and M-mode echocardiography. 3-D\\u000a echocardiography was performed by using

T. Poutanen; E. Jokinen



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

PubMed Central

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

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



European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies.  


In view of the European Association of Echocardiography (EAE) mission statement "To promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular ultrasound in Europe" and the increasing demand for standardization and quality control, the EAE have established recommendations and guidelines for standardization of echocardiography performance, data acquisition (images, measurements and morphologic descriptors), digital storage and reporting of echocardiographic studies. The aim of these recommendations is to provide a European consensus document on the minimum acceptable requirements for the clinical practice of echocardiography today and thus improve the quality and consistency of echocardiographic practice in Europe. PMID:18579482

Evangelista, Arturo; Flachskampf, Frank; Lancellotti, Patrizio; Badano, Luigi; Aguilar, Rio; Monaghan, Mark; Zamorano, José; Nihoyannopoulos, Petros



[Standardized findings in echocardiography using WWW: EchoBefundSystem].  


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

Schweikart, O; Metzger, F



Clinical application of three-dimensional echocardiography: past, present and future  

PubMed Central

Significant advances in three-dimensional echocardiography have made this modality a powerful diagnostic tool in the cardiology clinic. It can provide accurate and reliable measurements of chamber size and function, including the quantification of left ventricular mechanical dyssynchrony to guide patient selection for cardiac resynchron-isation therapy. Furthermore, three-dimensional echocardiography offers novel views and comprehensive anatomic definition of valvular and congenital abnormalities, improving diagnosis and preoperative planning. In addition, it is extremely useful in monitoring the effectiveness of surgical or percutaneous transcatheter interventions. As its efficacy for more and more clinical applications is demonstrated, it is clear that three-dimensional echocardiography has become part of the routine clinical diagnostic armamentarium. In this article, we describe the development of three-dimensional echocardiography over the last decades, review the scientific evidence for its current clinical use and discuss potential future applications. (Neth Heart J 2009;17:18-24.)

Kleijn, S.A.; Kamp, O.



The Evolving Concepts of Haemodynamic Support: From Pulmonary Artery Catheter to Echocardiography and Theragnostics  

PubMed Central

Echocardiography is a non-invasive tool, aimed towards the anatomical and functional characterization of the heart. In Intensive Care it is considered nowadays as a necessary tool for patient evaluation. However, the information obtained using echocardiography is not the same as provided by other means, namely the invasive ones. In recent years there has been a significant evolution in the general concepts of haemodynamic support for the critically ill patient. In this new environment, echocardiography has gained particular relevance. In this text the new positioning of echocardiography in the light of the new concepts for hemodynamic support is described, as well as, the need for a specific formative program directed towards Intensive Care physicians. A new generation of biomarkers can also add relevant information and start a new era in haemodynamic support. They may help to further characterize the disease process, identifying patients at risk, as well as, characterize specific organ failure as well as monitoring therapy.

Figueiredo, Antonio; Germano, Nuno; Guedes, Pedro; Marcelino, Paulo



Left atrial longitudinal strain parameters predict postoperative persistent atrial fibrillation following mitral valve surgery: a speckle tracking echocardiography study.  


Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with increased morbidity, mortality, and prolonged hospital stay. Speckle tracking echocardiography (STE) has been applied recently for evaluation of LA function. The purpose of this study was to examine whether left atrial longitudinal strain measured by STE is a predictor for the development of POAF following mitral valve surgery for severe mitral regurgitation. We studied 53 patients undergoing mitral valve surgery in sinus rhythm at the time of surgery. Echocardiography with evaluation of LA strain by STE was performed. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Patients who did not develop POAF were taken as group 1 and those who had POAF constituted group 2. The echocardiographic and clinical predictors of POAF were investigated. POAF occurred in 28.3% of subjects. Mean age, LAVi and BNP were found higher in group 2 while peak atrial longitudinal strain (PALS) (13.9 ± 3.8% vs. 24.8 ± 7.3%; P < 0.001), peak atrial contraction strain (PACS) (7.6 ± 1.95% vs. 11.3 ± 3.5%; P < 0.001) were significantly lower. By multivariate logistic regression analysis, PALS and LAVi were independent predictor of POAF development. LA longitudinal strain was found to predict POAF in patients undergoing mitral valve surgery. It could be used to better identify patients at greater risk of developing POAF, and thus to guide in risk stratification and to take appropriate intensive prophylactic therapy. PMID:23600893

Candan, Ozkan; Ozdemir, Nihal; Aung, Soe Moe; Dogan, Cem; Karabay, Can Yucel; Gecmen, Cetin; Omaygenç, Onur; Güler, Ahmet



Role of Echocardiography in Evaluation of Patients With Staphylococcus aureus Bacteremia: Experience in 103 Patients  

Microsoft Academic Search

Objectives. The purpose of this prospective study was to examine the role of echocardiography in patients with Staphylococcus aureus bacteremia (SAB).Background. The reported incidence of infective endocarditis (IE) among patients with SAB varies widely. Distinguishing patients with uncomplicated bacteremia from those with IE is therapeutically and prognostically important, but often difficult.Methods. One hundred-three consecutive patients undergoing both transthoracic (TTE) echocardiography

Vance G Fowler; Jennifer Li; G. Ralph Corey; Jerry Boley; Kieren A Marr; Ajay K Gopal; Li Kuo Kong; Geoffrey Gottlieb; Carolyn L Donovan; Daniel J Sexton; Thomas Ryan



Diagnosis of patent foramen ovale with multiplane transesophageal echocardiography in adult cardiac surgical patients  

Microsoft Academic Search

Objective: To evaluate multiplane transesophageal echocardiography (TEE) for detection of patent foramen ovale (PFO) and to compare multiplane TEE with visual inspection (VI) for PFO detection.Design: A prospective observational study.Setting: University hospital (single institution).Participants: Patients presenting for cardiac surgery requiring TEE.Interventions: Multiplane TEE including 2 atrial views with color-flow Doppler (CFD) and contrast echocardiography (CE) with a provocative respiratory maneuver

John G. Augoustides; Stuart J. Weiss; Justin Weiner; Joshua Mancini; Joseph S. Savino; Albert T. Cheung



Incremental prognostic value of troponin I and echocardiography in patients with acute pulmonary embolism  

Microsoft Academic Search

Background To test the hypothesis that troponin I and echocardiography have an incremental prognostic value in patients with pulmonary embolism (PE). Methods and results In 91 patients with acute PE, echocardiography was performed within 4 h of admission. Troponin I levels were obtained on admission and 12 h thereafter. The 0.06 µg\\/l troponin I cut-off level was identified as the

Nils Kucher; Dieter Wallmann; Angelo Carone



Multimodality Cardiac Stress Testing: Combining Real-Time 3Dimensional Echocardiography and Myocardial Perfusion SPECT  

Microsoft Academic Search

Earlyexperienceisdescribedinimplementinganewmultimodal- ity stress test for accurate correlation of complementary func- tional and perfusion information from real-time 3-dimensional (3D) echocardiography and SPECT, respectively. The proposed new multimodality stress test has the potential for simulta- neously improving sensitivity and specificity in the detection of early coronary artery disease (CAD). Methods: Pre- and post- stress real-time 3D echocardiography and SPECT images were acquired

Vivek Walimbe; Wael A. Jaber; Mario J. Garcia; Raj Shekhar


Acute pulmonary artery thromboembolism treated with thrombolysis: diagnostic and monitoring uses of transoesophageal echocardiography.  

PubMed Central

The central pulmonary arteries and any thrombus within them can be imaged by transoesophageal echocardiography. Its use is reported in the diagnosis and subsequent management of a patient with acute pulmonary embolism, whose response to thrombolytic treatment was monitored by further transoesophageal studies. Transoesophageal echocardiography may be a valuable primary diagnostic procedure in patients who seem to have sustained a significant pulmonary embolus and require urgent intervention. Images

Rittoo, D; Sutherland, G R



Acute pulmonary artery thromboembolism treated with thrombolysis: diagnostic and monitoring uses of transoesophageal echocardiography.  


The central pulmonary arteries and any thrombus within them can be imaged by transoesophageal echocardiography. Its use is reported in the diagnosis and subsequent management of a patient with acute pulmonary embolism, whose response to thrombolytic treatment was monitored by further transoesophageal studies. Transoesophageal echocardiography may be a valuable primary diagnostic procedure in patients who seem to have sustained a significant pulmonary embolus and require urgent intervention. PMID:8518074

Rittoo, D; Sutherland, G R



Usefulness of transesophageal echocardiography in unexplained cerebral ischemia.  


Two-hundred seventy consecutive patients with "unexplained cerebral ischemia" were studied with transesophageal echocardiography to determine the value of this test in identifying potential cardiac sources of cerebral embolism. The findings of this group were compared with those of 772 consecutive patients undergoing transesophageal echocardiographic evaluation for indications other than cerebral ischemia. This study also examined this group of patients with unexplained cerebral ischemia to determine differences in relation to underlying cardiac rhythm and patient age. Intracardiac thrombus, atrial septal aneurysm, patent foramen ovale, spontaneous left atrial contrast and protruding debris in the thoracic aorta were found more often in patients with unexplained cerebral ischemia. Wall motion abnormalities of the left ventricle, as well as mild to moderate valvular lesions including mitral valve prolapse, were found to be similar in both groups. Spontaneous left atrial contrast, as well as mild to moderate valvular abnormalities, were found more often in patients with atrial fibrillation (22% of the group with unexplained cerebral ischemia). However, the presence of intracardiac thrombus was no more frequent in patients with atrial fibrillation than in those with normal sinus rhythm. Patients aged > 50 years were found to have atrial fibrillation and larger left atrial size more often than their younger cohorts, as well as a greater incidence of valvular abnormalities and left ventricular wall motion abnormalities. Mitral valve prolapse was seen more frequently in the younger cohort of patients. PMID:8256742

Labovitz, A J; Camp, A; Castello, R; Martin, T J; Ofili, E O; Rickmeyer, N; Vaughn, M; Gomez, C R



Limitations and Potential Clinical Application on Contrast Echocardiography  

PubMed Central

Myocardial contrast echocardiography (MCE) is a relatively simple myocardial perfusion imaging technique which should be used in different clinical settings. The ability of MCE to provide a comprehensive assessment of cardiac structure, function, and perfusion is likely to make it the technique of choice for non-invasive cardiac imaging. Contrast agents are encapsulated microbubbles (MB) filled with either air or high-molecular-weight gas. They are innocuous, biologically inert and when administered intravasculary, the sound backscatter from the blood poll is enhanced because MB have the enormous reflective ability due to a large acoustic impedance mismatch between the bubble gas and surrounding blood. MCE is an ideal imaging tool for the assessment of left heart contrast and the myocardial microcirculation. MCE detects contrast MB at the capillary level within the myocardium and, thus, has the potential to assess tissue viability and the duration of the contrast effect. MCE was equivalent to SPECT for the detection of CAD with a tendency toward higher sensitivity of MCE compared with SPECT in microvascular disease and CAD. MCE is also a bedside technique that can be used early in patients presenting with acute heart failure to rapidly assess LV function (regional and global) and perfusion (rest and stress).

Modonesi, Elisa; Balbi, Manrico; Bezante, Gian Paolo



Visualization of the central pulmonary arteries by biplane transesophageal echocardiography  

PubMed Central

It is suggested that transesophageal echocardiography (TEE), by detecting thromboemboli in the proximal parts of the pulmonary arteries, is useful in the diagnosis of pulmonary embolism. However, the data on visualization of the pulmonary arteries are limited. The extent of the pulmonary arteries that can be precisely visualized during biplane TEE was assessed in 51 consecutive patients (23 female, 28 male, aged 56.6±12.5 years) without structural heart disease. The main pulmonary artery and the right pulmonary artery were detected in 96.1% and 94.1% of patients, respectively. Although the proximal part of the left pulmonary artery was found in only 47.0% of patients, its distal part was visualized in 92.2%. During TEE, proximal parts of the lobar arteries on both sides were visualized in 88.2% of patients. Thus, the central pulmonary arteries including proximal parts of the lobar branches can be precisely visualized by biplane TEE in the majority of patients. Only the proximal part of the left pulmonary artery is difficult to assess.

Pruszczyk, P; Torbicki, A; Kuch-Wocial, A; Szulc, M; Styczynski, G; Bochowicz, A; Kostrubiec, M



Bubble contrast echocardiography in detecting pulmonary arteriovenous malformations after modified Fontan operations.  


The development of pulmonary arteriovenous malformations is a well-known complication after Fontan operations, and may result in significant morbidity due to increasing arterial desaturation. We compared the use of bubble contrast echocardiography and pulmonary angiography in detecting such malformations. We also examined which anatomical and haemodynamic variables were associated with their development. Our study includes 20 patients who had undergone modified Fontan procedures, 10 with atriopulmonary and 10 with total cavopulmonary connections, in Gothenburg between 1980 and 1991. All patients underwent cardiac catheterisation and pulmonary angiography. Bubble contrast echocardiography was performed at the same time, with injection of agitated polygelin colloid solution (Haemaccel, Hoechst) into the right and left pulmonary arteries, respectively. Transoesophageal echocardiography was used to detect the appearance of bubble contrast in the pulmonary venous atrium. The aim was also to evaluate the role of hepatic venous blood. Of the 20 patients, 9 (45%) had a positive contrast echocardiography study, compared with only 2 (10%) detected by pulmonary angiography. Patients with positive contrast echocardiography had a significantly lower arterial oxygen saturation than those with negative studies, both at rest (88% vs 95%, p < 0.01) and during exercise testing (78% vs 89%, p = 0.01). Bubble contrast echocardiography is much more sensitive in detecting pulmonary arteriovenous malformations than pulmonary angiography. By injecting echo contrast into the right and left pulmonary arteries, the method can be made highly selective. Pulmonary arteriovenous malformations develop much more frequently in patients with the Fontan circulation than previously reported. PMID:11727905

Larsson, E S; Solymar, L; Eriksson, B O; de Wahl Granelli, A; Mellander, M



Use of hand-held echocardiography to facilitate the management of cardiac disease in older people.  


Access to echocardiography remains suboptimal for many older patients; hand-held echocardiography may improve access to this investigation. New methods of service provision may, however, not always result in appropriate use by clinicians. The aim of this study was to test whether the provision of hand-held echocardiography in a geriatric medicine service results in appropriate requests and changes in patient management. The methodology involved in this, was a prospective study of 100 patients referred for hand-held echocardiography in a geriatric medicine service. Information on reason for request, time from request to study, medical history, echocardiography history and medication were collected. Clinicians were asked how results had changed management 7-14 days after the investigation. The mean age of participating patients was 82.6 years. Echo requests were deemed appropriate in 93% of cases. Median time from request to echo was three days for inpatients and 14 days for outpatients. Fifty percent (50/100) of echos led to a change in cardiovascular management; a total of 75 separate changes in cardiovascular management resulted. Seventy-six percent of changes were deemed appropriate; 10% inappropriate and insufficient information was present for 14% of decisions. Provision of hand-held echocardiography allowed rapid investigation of patients for selected abnormalities. Requests were appropriate and appropriate changes to patient management occurred in most patients. PMID:21515528

Sumukadas, Deepa; Witham, Miles D; Gillespie, Neil D



Clinical implications of the morphological features of central pulmonary artery thromboemboli shown by transoesophageal echocardiography.  

PubMed Central

OBJECTIVES--To illustrate the use of transoesophageal echocardiography in the detection of the morphological features of central pulmonary artery thromboemboli and their clinical implications. DESIGN--Review of five cases of central pulmonary artery thromboemboli detected by transoesophageal echocardiography. SETTING--University teaching hospital. PATIENTS--Five patients (three men and two women) admitted under general medical units. RESULTS--Central pulmonary artery thromboemboli were detected by the use of transoesophageal echocardiography in all the patients presented. Presentations were acute, subacute, or chronic. The morphological features of the thromboemboli on transoesophageal echocardiography were used to correlate with the time course of the illness, and to guide treatment. Two patients received thrombolytic treatment, one patient was treated with anticoagulation alone, and two patients had inferior vena caval filters implanted. CONCLUSIONS--Transoesophageal echocardiography is an alternative diagnostic tool in the detection of central pulmonary artery thromboemboli. Morphological features of central pulmonary thromboemboli on echocardiography can provide useful information that may help to guide treatment. Images

Chan, R K; Johns, J A; Calafiore, P



Assessment of left ventricular function by real-time 3-dimensional echocardiography compared with conventional noninvasive methods.  


Quantitative assessment of left ventricular ejection fraction is an essential component of cardiac evaluation. We performed real-time 3-dimensional echocardiography in 56 consecutive patients who underwent multigated radionuclide angiography. Thirteen patients were excluded for the following reasons: 5 for large size of left ventricle required for image acquisition, 5 for suboptimal image quality in real-time 3-dimensional echocardiography, and 3 for atrial fibrillation. Finally, we compared left ventricular ejection fraction assessed by real-time 3-dimensional echocardiography and conventional 2-dimensional echocardiography with that obtained by multigated radionuclide angiography in 43 patients. Left ventricular ejection fraction was determined by real-time 3-dimensional echocardiography with the use of parallel plane-disks and sector plane-disks summation methods. A good correlation was obtained between both real-time 3-dimensional echocardiography methods and multigated radionuclide angiography (r = 0.87 and 0.90, standard error of estimate = 3.7% and 4.2%), whereas the relation between the 2-dimensional echocardiography method and radionuclide angiography demonstrated a significant departure from the line of identity (P <.001). In addition, interobserver variability was significantly lower (P <.05) for the real-time 3-dimensional echocardiography methods than that by the 2-dimensional echocardiography method. Real-time 3-dimensional echocardiography may be used for quantification of left ventricular function as an alternative to conventional methods in patients with adequate image quality. PMID:11287890

Takuma, S; Ota, T; Muro, T; Hozumi, T; Sciacca, R; Di Tullio, M R; Blood, D K; Yoshikawa, J; Homma, S



Evaluation of the elastic properties of the thoracic descending aorta with strain-rate measurement with transesophageal echocardiography: its correlation with the left ventricular diastolic function assessed with transthoracic echocardiography.  


Arterial stiffening may contribute to secondary myocardial dysfunction. The aim of this study was to assess the stiffness of the thoracic descending aorta (TDA) by performing strain-rate measurements with transesophageal echocardiography (TEE) and to examine the relation of the findings to left ventricular (LV) function. Eight patients (group I) without risk factors for arteriosclerosis and 52 patients (group II) with a high risk of arteriosclerosis underwent transthoracic echocardiography (TTE) and TEE simultaneously. The values of distensibility of the TDA (-SR) in groups I and II were -11.7 +/- 2.4 and -4.6 +/- 2.5, respectively (p<0.001), and the values of the recoil of the TDA (+SR) were 20.5 +/- 8.2 and 6.8 +/- 5.0, respectively (p<0.001). The LV ejection fraction showed no relation with -SR or +SR, but LV diastolic function (e' and E/e') was correlated with +SR (p=0.002 and p=0.046, respectively). Strain-rate measurements obtained with TEE were useful for evaluating impairment of the elastic properties of the TDA and the pathophysiologic mechanisms underlying the arterial-ventricular relationship. PMID:20610898

Honma, Hiroshi; Ohno, Tadaaki; Fujimoto, Hiroyuki; Matsuzaki, Tsuyako; Murata, Hiroshige; Mizuno, Kyoichi



Role of Transthoracic Doppler Echocardiography in Patients With a Proximal Left Coronary Artery Lesion That Cannot be Diagnosed by Computed Tomography Angiography.  


The diagnosis of lesions with severe calcium or in-stent stenosis using coronary computed tomography angiography (CCTA) is still difficult. The aim of the present study was to evaluate the accuracy of transthoracic Doppler echocardiography (TTDE) in patients with suspected angina pectoris, who had a proximal left coronary artery (LCA) site that could not be evaluated by CCTA. Fifty-eight patients were evaluated. The proximal LCA was defined as the left main coronary artery and proximal left anterior descending coronary artery. All patients underwent TTDE and had coronary angiography performed as a reference method. We measured the proximal left coronary flow velocity (CFV) by both color and pulse Doppler methods. Proximal coronary flow was detected in 45 (78%) of 58 patients. CFVs measured by both methods were significantly greater in the group with severe stenosis (percent diameter stenosis >70%) than in the groups with moderate stenosis (percent diameter stenosis 40% to 70%) or without stenosis (color Doppler: 148 ± 42 cm/s, 89 ± 40 cm/s, and 41 ± 22 cm/s, respectively, p <0.05; pulse Doppler: 143 ± 61 cm/s, 82 ± 33 cm/s, and 39 ± 17 cm/s, respectively, p <0.05). Receiver operating characteristic curve analysis showed that the optimal CFV cut-off values obtained by color and pulse Doppler to diagnose severe stenosis were 92 cm/s (sensitivity, 100%; specificity, 90%) and 81 cm/s (sensitivity, 100%; specificity, 85%), respectively. In conclusion, TTDE could diagnose proximal LCA stenosis with good accuracy in patients who could not be evaluated by CCTA. PMID:23768467

Higashi, Haruhiko; Okayama, Hideki; Saito, Makoto; Morioka, Hiroe; Aono, Jun; Yoshii, Toyofumi; Sumimoto, Takumi; Hiasa, Go; Nishimura, Kazuhisa; Inoue, Katsuji; Ogimoto, Akiyoshi; Higaki, Jitsuo



Impact of Afterload on the Assessment of Severity of Aortic Stenosis  

PubMed Central

BACKGROUND Aortic stenosis (AS) is increasingly diagnosed in current aging society. Echocardiography is the most important tool in the assessment of AS and its severity. However, load-dependency of Doppler measurement could affect the accuracy of AS severity assessment. We tried to evaluate the impact of afterload on the assessment of AS severity by modification of afterload using pneumatic compression (Pcom). METHODS Forty patients diagnosed as moderate or severe AS [effective orifice area of aortic valve (EOAAV) by continuity equation of < 1.5 cm2] were consecutively enrolled. Patients with severely uncontrolled hypertension, severe left ventricular (LV) dysfunction, and other significant valve disease were excluded. Comprehensive echocardiography was performed at baseline to assess AS severity. Then, pneumatic compression of the lower extremities by 100 mmHg was applied to increase LV afterload. After 3 minutes, echocardiography was repeated to assess AS severity. RESULTS Mean blood pressure was significantly increased under Pcom (p < 0.001), while heart rate remained unchanged. Peak aortic valve velocity (Vmax) was slightly, but significantly decreased under Pcom (p = 0.03). However, Doppler velocity index and EOAAV by continuity equation were not affected by Pcom. CONCLUSION AS severity assessment by echocardiography was not dependent on the change of LV afterload imposed by Pcom. AV Vmax was slightly decreased with LV afterload increment, but these changes were too small to alter treatment plan of AS patients. EOAAV and Doppler velocity index are more stable parameters for AS severity assessment.

Kim, Hyung-Kwan; Sohn, Dae-Won



Early Left Atrial Mechanics and Volume Abnormalities in Subjects with Prehypertension: A Real Time Three-Dimensional Echocardiography Study.  


The aim of this study was to evaluate left atrial (LA) volume and mechanical functions by real time three-dimensional echocardiography (RT3DE) in prehypertensive subjects. The study included 54 (34 male and 20 female) prehypertensive subjects and 36 (14 male and 22 female) healthy control subjects. Transthoracic echocardiography and RT3DE were performed in all patients. Interventricular septum thickness and isovolumetric relaxation time were significantly higher in prehypertensives than in controls (10.7 ± 0.7 vs. 10.1 ± 0.8 P = 0.001 and 89.9 ± 10 vs. 82.4 ± 11 P = 0.002, respectively). LA maximum volume, volume before atrial contraction, total and active stroke volume, total and active emptying fractions, expansion index, and LA max volume index were significantly higher in prehypertensives when compared with controls (P < 0.0001 for all). However, the passive emptying fraction was significantly lower in prehypertensives than controls (45.7 ± 5.6 vs. 48.6 ± 4.1, P = 0.006), and the minimum LA volume between the two groups was similar. The main finding of this study was that although LA volume and LA active systolic functions were significantly increased in prehypertensive people, there was a reduction in passive LA systolic functions. These parameters may be important in showing hemodynamic and structural changes in cardiac tissue caused by prehypertension. PMID:22931064

Aktürk, Erdal; Ermis, Necip; Ya?mur, Jülide; Acikgoz, Nusret; Kurto?lu, Ertu?rul; Cansel, Mehmet; Eyüpkoca, Ferhat; Pekdemir, Hasan; Ozdemir, Ramazan



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


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

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



Experience of newly constructed echocardiography-database with video clips and color still images at the Echocardiography Lab of Nepal Medical College Teaching Hospital  

Microsoft Academic Search

Reporting system after performing echocardiography is very poor in almost all hospitals of Nepal. Special but simple attempt effort has been introduced to transfer analog video images and color still images of echocardiographic investigation into a desk top computer using a locally available imported video capture system, Snazzi Movie Studio S4. Analog video signals are converted into MPEG2 and still

B Shrestha; S Dhungel


Assessing Epicardial Substrate Using Intracardiac Echocardiography During VT Ablation  

PubMed Central

Background Intracardiac echocardiography (ICE) has played a limited role in defining the substrate for ventricular tachycardia (VT). The purpose of this study was to assess whether ICE could identify abnormal epicardial substrate in patients (pts) with nonischemic cardiomyopathy (NICM) and VT. Methods and Results We studied 18 pts with NICM and recurrent VT who had abnormal echogenicity identified on ICE imaging. Detailed LV endocardial (ENDO) and epicardial (EPI) electroanatomic mapping was performed in all pts. Low voltage areas (< 1.0mV) in the epicardium were analyzed. ICE imaging in the NICM group was compared to a control group of 30 pts with structurally normal hearts who underwent ICE imaging for other ablation procedures. In 18 pts (53 ± 13 years, 17 men) with NICM (EF: 37 ± 13%) increased echogenicity was identified in the lateral LV by ICE imaging. LV ENDO electroanatomic mapping identified normal voltage in 9 pts and at least one, confluent low voltage area [6.6 cm2 (minimum 2.1 to maximum 31.7 cm2)] in 9 pts (5 posterolateral LV and 4 perivalvular LV). Detailed EPI mapping revealed areas of low voltage [39 cm2 (minimum 18.5 to maximum 96.3 cm2)] and abnormal, fractionated electrograms (EGMs) in all 18 pts (15 posterolateral LV and 3 lateral LV). In all pts, the EPI scar identified by electroanatomic mapping correlated with the echogenic area identified on ICE imaging. ICE imaging identified no areas of increased echogenicity in the control group. Conclusions ICE imaging identified increased echogenicity in the lateral wall of the LV that correlated to abnormal EPI substrate. These findings suggest that ICE imaging may be useful to identify EPI substrate in NICM.

Bala, Rupa; Ren, Jian-Fang; Hutchinson, Mathew D.; Desjardins, Benoit; Tschabrunn, Cory; Gerstenfeld, Edward P.; Deo, Rajat; Dixit, Sanjay; Garcia, Fermin C.; Cooper, Joshua; Lin, David; Riley, Michael P.; Tzou, Wendy S.; Verdino, Ralph; Epstein, Andrew E.; Callans, David J.; Marchlinski, Francis E.



Effect of hydration on cavity obliteration during dobutamine stress echocardiography.  


The purpose of this study was to determine whether it is possible to prevent or delay the onset of midventricular cavity obliteration during a dobutamine stress test with standard hydration. Left ventricular (LV) intracavitary obstruction has been reported as the mechanism for hypotension seen in approximately 20% of patients undergoing dobutamine stress echocardiography. In addition, it has been proposed that administration of a normal saline bolus prior to dobutamine infusion may avert the dynamic ventricular obstruction. We performed a standard graded dobutamine stress echocardiogram before and after fluid loading with 10 ml/kg of normal saline in 10 mongrel dogs. Measurements were made of left atrial pressure, aortic pressure, and the area of the LV cavity at the papillary muscle level throughout each infusion. Although hydration produced an increase in baseline left atrial pressure (5.7 +/- 3.2 to 8.1 +/- 2.7 mmHg, p < 0.01) and systolic blood pressure (128 +/- 18 to 139 +/- 22 mmHg, p = 0.03), there was no significant change in pre-dobutamine heart rate or systolic area. With dobutamine infusion, there was a similar change in heart rate, systolic blood pressure, diastolic area, and systolic area (SA) at each dose of dobutamine regardless of hydration status. In addition, the dose at which cavity obliteration occurred was not altered by hydration (p = NS). Although all dogs developed cavity obliteration (SA < 1.0 cm2) with dobutamine infusion, none experienced hypotension. In this canine model, cavity obliteration does not lead to systemic hypotension and cannot be prevented or delayed by volume loading. PMID:7704979

Weissman, N J; Nidorf, S M; Weyman, A E; Picard, M H



Intracardiac Echocardiography Evaluation in Secundum Atrial Septal Defect Transcatheter Closure  

SciTech Connect

Purpose: This study was designed to assess the balloon sizing maneuvers and deployment of an Amplatzer Septal Occluder (ASO). In addition, intraprocedural balloon sizing was compared with off-line intracardiac echocardiographic measurements. Methods: The intracardiac echocardiography (ICE) measurements were: maximum transverse and longitudinal atrial septal defect (ASD) diameters in the aortic valve and four-chamber planes;area of the ASD and its equivalent circle diameter. Thirteen consecutive patients underwent transcatheter implantation of an ASO device using ICE guidance under local anesthesia. The device matching the balloon sizing diameter of the defect was implanted. Qualitative ICE assessment of the ASO devices implanted was performed off line. Results: The mean equivalent circle diameter predicted by ICE was 24.40 {+-} 5.61 mm and was significantly higher(p 0.027) than the ASD measured by balloonsizing (21.38 {+-} 5.28 mm). Unlike previous studies we did not find any correlation between the two measurements (correlation coefficient = 0.47). Only four of the 13 patients had optimal device positioning as shown by the qualitative ICE evaluation, whereas the remaining nine patients had inadequate device placement. This resulted in a waist diameter that was an average 26.1% undersized in seven patients and 12.7% oversized in two patients. Five of the seven patients with an undersized device had ASO-atrial septum misalignment with leftward device deviation. Conclusion: The ICE images allowed careful measurement of the dimensions of the ASD and accurately displayed the spatial relations of the ASO astride the ASD.Moreover, use of the ICE measurement led to selection of a different size of device in comparison with those of balloon sizing. The clinical benefit of this new approach needs to be rigorously tested.

Zanchetta, Mario; Pedon, Luigi; Rigatelli, Gianluca; Carrozza, Antonio; Zennaro, Marco; Di Martino, Roberta [Department of Cardiovascular Disease, Cittadella General Hospital, Cittadella, Padua (Italy); Onorato, Eustaquio [Operative Unit ofCardiology, Clinica S. Rocco, Ome, Brescia (Italy); Maiolino, Pietro [Department of Cardiovascular Disease, Cittadella General Hospital, Cittadella, Padua (Italy)



Real time three-dimensional stress echocardiography advantages and limitations.  


The role of two-dimensional stress echocardiography (2D-SE) is well established for diagnosis and prognosis of patients with known or suspected coronary artery disease. 2D-SE has its limitations as multiple views of the left ventricle (LV) must be obtained within 90 seconds of peak stress from more than window to completely visualize all LV segments. 2D-SE is operator-dependent and requires advanced skills to match the same myocardial segments during stress. LV foreshortening is a frequently encountered problem in 2D-SE that may result in false negative studies. Real time three-dimensional SE (RT-3D-SE) can overcome many limitations of 2D-SE. In 3D-SE, overall wall motion of the entire LV is assessed simultaneously in different planes. 3D images can be displayed in multiplane or multislice views for ease of comparison with greater accuracy and interobserver agreement when compared to 2D. 3D-SE is quantitative, provides rapid image acquisition, requires lower level of operator skills, and avoids LV foreshortening by correct alignment of imaging planes. 3D-SE is easily applied during pharmacologic stress and is feasible during exercise-induced stress. Despite these advantages, 3D has lower temporal and spatial resolution than 2D and requires longer analysis time. With advances in transducer technology, smaller matrix footprints, and automated softwares, 3D full LV volume image acquisition can be obtained with a single beat that is less prone to artifacts. We will discuss the current application of RT-3D-SE, highlight the pros and cons of 3D-SE over conventional 2D-SE, and review major studies on 3D-SE and future implications. PMID:22283201

Abusaid, Ghassan H; Ahmad, Masood



Referral for Fetal Echocardiography is Associated with Increased Maternal Anxiety  

PubMed Central

Background Referral for fetal echocardiography is an acute stressor that may induce significant maternal anxiety. To promote good clinical management of expectant mothers in this situation, including adequate screening for possible psychiatric interventions, data is needed regarding the psychosocial functioning of women scheduled for fECHO procedures. Objective To investigate the association between fECHO and maternal anxiety. Methods Pregnant women answered two questionnaires prior to first fECHO. The Spielberger State-Trait Anxiety Inventory (STAI) assessed how subjects feel “now” (state) versus how they “usually feel” (trait). Separate state and trait anxiety scores were calculated; scores were compared between the study cohort and a gestational age-matched historical cohort of 31 pregnant women who did not undergo fECHO. A second questionnaire developed by the investigators ascertained pregnancy specific concerns and characteristics. Results 40 subjects were enrolled. The mean state score of the fECHO cohort (42.1±15.1) differed from the historical cohort (32.8±11.3; p=0.006); however there was no difference between trait scores (34.7±10.8 vs. 35.4 ±12.8; p=0.8). A multivariate linear regression model controlling for race and maternal age demonstrated that fECHO was a strong independent predictor of maternal state anxiety score (p=0.004, ?=10.4). Conclusions Pregnant women presenting for fECHO report high anxiety levels compared with women not presenting for fECHO. Clinician awareness and sensitivity is recommended and further investigation of modifiers of anxiety in this high risk group should be explored.

Rosenberg, Katherine B.; Monk, Catherine; Kleinman, Charles S.; Glickstein, Julie S.; Levasseur, Stephanie M.; Simpson, Lynne L.; Williams, Ismee A.



Acute regional improvement of myocardial function after interventional transfemoral aortic valve replacement in aortic stenosis: A speckle tracking echocardiography study  

PubMed Central

Background Transcatheter aortic valve implantation (TAVI) is a promising therapy for patients with severe aortic stenosis (AS) and high perioperative risk. New echocardiographic methods, including 2D Strain analysis, allow the more accurate measurement of left ventricular (LV) systolic function. The goal of this study was to describe the course of LV reverse remodelling immediately after TAVI in a broad spectrum of patients with symptomatic severe aortic valve stenosis. Methods Thirty consecutive patients with symptomatic aortic valve stenosis and preserved LVEF underwent transfemoral aortic valve implantation. We performed echocardiography at baseline and one week after TAVI. Echocardiography included standard 2D and Doppler analysis of global systolic and diastolic function as well as 2D Strain measurements of longitudinal, radial and circumferential LV motion and Tissue Doppler echocardiography. Results The baseline biplane LVEF was 57 ± 8.2%, the mean pressure gradient was 46.8 ± 17.2 mmHg and the mean valve area was 0.73 ± 0.27 cm2. The average global longitudinal 2D strain of the left ventricle improved significantly from -15.1 (± 3.0) to -17.5 (± 2.4) % (p < .001). This was reflected mainly in improvement in the basal and medial segments while strain in the apex did not change significantly [-11.6 (± 5.2) % to -15.1 (± 5.5) % (p < .001), -13.9 (± 5.1) % to -16.8 (± 5.6) % (p < .001) and -19.2 (± 7.0) % to -20.0 (± 7.2) % (p = .481) respectively]. While circumferential strain [-18.1 (± 5.1) % vs. -18.9 (± 4.2) %, p = .607], radial strain [36.5 (± 13.7) % vs. 39.7 (± 17.2) %, p = .458] and the LVEF remained unchanged after one week [57.0 (± 8.2) % vs. 59.1 (± 8.1) %, p = .116]. Conclusion There is an acute improvement of myocardial longitudinal systolic function of the basal and medial segments measured by 2D Strain analysis immediately after TAVI. The radial, circumferential strain and LVEF does not change significantly in all patients acutely after TAVI. These data suggest that sensitive new echo methods can reliably detect early regional changes of myocardial function after TAVI before benefits in LVEF are detectable.



"Show me" bioethics and politics.  


Missouri, the "Show Me State," has become the epicenter of several important national public policy debates, including abortion rights, the right to choose and refuse medical treatment, and, most recently, early stem cell research. In this environment, the Center for Practical Bioethics (formerly, Midwest Bioethics Center) emerged and grew. The Center's role in these "cultural wars" is not to advocate for a particular position but to provide well researched and objective information, perspective, and advocacy for the ethical justification of policy positions; and to serve as a neutral convener and provider of a public forum for discussion. In this article, the Center's work on early stem cell research is a case study through which to argue that not only the Center, but also the field of bioethics has a critical role in the politics of public health policy. PMID:17926217

Christopher, Myra J



Severe Weather  

ERIC Educational Resources Information Center

Educating the public about safety issues related to severe weather is part of the National Oceanic and Atmospheric Administration's (NOAA) mission. This month's insert, Severe Weather, has been created by NOAA to help educate the public about hazardous weather conditions. The four types of severe weather highlighted in this poster are hurricanes,…

Forde, Evan B.



Severe Weather  

ERIC Educational Resources Information Center

Educating the public about safety issues related to severe weather is part of the National Oceanic and Atmospheric Administration's (NOAA) mission. This article deals with a poster entitled, "Severe Weather," that has been created by NOAA to help educate the public about hazardous weather conditions. The four types of severe weather highlighted in…

Forde, Evan B.



Severe Weather  

ERIC Educational Resources Information Center

|Educating the public about safety issues related to severe weather is part of the National Oceanic and Atmospheric Administration's (NOAA) mission. This month's insert, Severe Weather, has been created by NOAA to help educate the public about hazardous weather conditions. The four types of severe weather highlighted in this poster are hurricanes,…

Forde, Evan B.



Severe Weather  

ERIC Educational Resources Information Center

|Educating the public about safety issues related to severe weather is part of the National Oceanic and Atmospheric Administration's (NOAA) mission. This article deals with a poster entitled, "Severe Weather," that has been created by NOAA to help educate the public about hazardous weather conditions. The four types of severe weather highlighted…

Forde, Evan B.



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

SciTech Connect

111In-labeled platelet scintigraphy and two-dimensional echocardiography were performed in 40 dogs to determine the ability of the two techniques to detect left atrial appendage thrombi. Thrombi were induced in 33 dogs that were classified into two groups, acute or chronic, according to the time of labeled-platelet injection after thrombus induction. In the acute group (17 dogs), platelets were injected 24 hours after thrombus induction. In the chronic group (16 dogs), platelets were injected 4-8 days after thrombus induction. Sham thoracotomies were performed on seven additional control dogs who did not receive thrombin injections. Analog and blood pool-corrected 111In-labeled platelet scintigraphy images were obtained 4-72 hours later. Closed-chest two-dimensional echocardiography was performed before thoracotomy and repeated at the time of scintigraphy. The location and size of each thrombus were verified at autopsy. Two-dimensional echocardiography detected three of 17 acute (mean volume, 1.2 +/- 1.0 cc) and three of 10 chronic (mean volume, 0.4 +/- 0.3 cc; p less than 0.025) left atrial appendage thrombi. 111In-labeled platelet scintigraphy detected all 17 acute thrombi but only two of 10 chronic thrombi. The measured radioactivity levels of the excised thrombi were 1,949 +/- 1,665 cpm/clot/dose in group 1 and 228 +/- 213 cpm/clot/dose in group 2 (p less than 0.005). In this model, 111In-labeled platelet scintigraphy was able to detect acute left atrial appendage thrombi that could not be identified by two-dimensional echocardiography. Both techniques showed poor sensitivity for detection of chronic thrombi. The decline in sensitivity of 111In-labeled platelet scintigraphy for detection of older thrombi is probably due to diminished labeled-platelet incorporation.

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



[The application of 2-dimensional echocardiography to the control of the location of the electrode catheter during endocardial cardiography].  


Modern methods for treatment of ventricular tachycardia require the exact knowledge of the position of the electrode catheter during intracardiac electrophysiological investigations. X-ray positioning in several projections facilitates the localisation of tachycardia with an accuracy of 4-8 cm2. From eight cadaver hearts schematic diagrams of the right ventricle for two dimensional echocardiography were derived. Endocardiac ventriculocartography under sonographic control was applied in 27 patients 45 times. With this method we were able to detect the electrode catheter in 42 of 45 (93%) patients effectively. Sonographic control facilitates not only the localisation of tachycardia without radiation burden but also its correlation with anatomic ventricular structure which is not possible by roentgenology. 3 negative results were due to negative echoes. In 3 of 5 cases the fulguration of the ventricular tachycardia focus under echo control was possible. Sonographic check up therefore is predilection method for endocardiac ventricular cardiography and can be recommended. PMID:2236546

Laucjavicius, A L; Aidetis, A S; Aganauskene, J A; Montvila, Z I; Serpitis, P S; Baver, B I; Bartusjaviciene, A S



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


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

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



Mitral regurgitation in hypertrophic cardiomyopathy. Non-invasive study by two dimensional Doppler echocardiography.  

PubMed Central

Mitral regurgitation and its haemodynamic features were investigated non-invasively in cases of hypertrophic cardiomyopathy by means of two dimensional Doppler echocardiography. There were 28 patients, 14 of whom showed systolic anterior motion (SAM) of the mitral echo; the other 14 did not. The following results were obtained. (1) Mitral regurgitation was detected by the Doppler technique in all cases with systolic anterior motion of the mitral echo and in half of those without it. (2) Doppler signals of mitral regurgitation started immediately after the first heart sound. (3) Mitral regurgitant flow was often distributed from the entire mitral orifice over the entire or the posterior half of the left atrium in the cases with systolic anterior motion. In the cases without systolic anterior motion the regurgitation was usually localised near the mitral orifice. These features differ from those of regurgitation usually seen in rheumatic mitral valve disease and idiopathic mitral valve prolapse. (4) The Doppler technique and left ventriculography were equally efficient in detecting mitral regurgitation. (5) The early systolic component of the murmur of hypertrophic myopathy is considered to result in the main from concomitant mitral regurgitation, but not from turbulent blood flow in the left ventricular outflow tract, so that in cases with mitral regurgitation as a complication, mitral regurgitation may also contribute to the development of the midsystolic portion of the systolic murmur, while the main origin of this portion of the murmur is the left ventricular outflow obstruction. Images

Kinoshita, N; Nimura, Y; Okamoto, M; Miyatake, K; Nagata, S; Sakakibara, H



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

SciTech Connect

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

Kinsella, J.P.; Morrow, W.R.; Gerstmann, D.R.; Taylor, A.F.; deLemos, R.A. (Wilford Hall U.S.A.F. Medical Center, San Antonio, TX (USA))



Recurrence of Congenital Heart Disease in Cases with Familial Risk Screened Prenatally by Echocardiography  

PubMed Central

Objectives. To evaluate the recurrence of congenital heart disease (CHD) in pregnant women with familial risk who had been referred for fetal echocardiography. Material and Methods. 1634 pregnancies from 1483 women with familial history of CHD in one or more relatives were studied. Fetal cardiologic diagnosis was compared with postnatal findings at 6 months or at autopsy. Results. Total recurrence rate of CHD was 3.98%, 4.06% in single familial risk, 2.9% in double, and 5% in multiple risk. It was 3.5% in case of one previously affected child; 4.5% with 2 children; 5.2% with the mother alone affected and 7,5% with father alone affected and 3.5% with a single distant relative. Exact concordance of CHD was found in 21.5% and a partial concordance in 20% of cases. Conclusions. Our data show a higher recurrence rate of CHD than previously published data and high relative risk ratios compared to normal population.

Fesslova, Vlasta; Brankovic, Jelena; Lalatta, Faustina; Villa, Laura; Meli, Valerio; Piazza, Luciane; Ricci, Cristian



Effects of Bariatric Surgery on Early Myocardial Alterations in Adult Severely Obese Subjects  

Microsoft Academic Search

Objective:Aim of this study was to investigate the effect of weight loss on structural and functional myocardial alterations in severely obese subjects treated with bariatric surgery. Patients and Methods: Thirteen severely obese patients (2 males and 11 females) were enrolled in the study. All subjects underwent conventional 2D color Doppler echocardiography. The new ultrasonic techniques used were: (a) integrated backscatter

Vitantonio Di Bello; Ferruccio Santini; Andrea Di Cori; Andrea Pucci; Enrica Talini; Caterina Palagi; Maria Grazia Delle Donne; Alessandro Marsili; Paola Fierabracci; Rocco Valeriano; Giovanna Scartabelli; Monica Giannetti; Marco Anselmino; Aldo Pinchera; Mario Mariani



Echocardiography in acute infectious myocarditis: relation to clinical and electrocardiographic findings.  


Multidirectional M-mode echocardiography (echo) was used to investigate functional and structural changes of the heart in 68 consecutive patients with acute or subacute infectious myocarditis. Forty patients had mild myocardial involvement evident by gradually changing ST-segment or T-wave alterations (not responsive to beta blockade) in serial ECGs; 21 patients also had loud S3 gallop and palpable paradoxical cardiac pulsations, and 7 patients had severe congestive heart failure. Echo revealed regional changes in the left ventricular (LV) contraction in all patients with acute myocarditis. The site and size of the asynergic wall motion abnormalities correlated with both the clinical severity of the disease and the location of the T-wave inversions in the ECG. In mild myocarditis hypokinesia only was noted in 1 to 3 sites (mean 2.3) of 11 recorded LV sites (21%). In moderate myocarditis, the local asynergic change was mainly akinesia and more widespread, being surrounded by hypokinetic regions (3.8 of 11 sites, 35% of the LV sites). In congestive heart failure, the hypokinetic or akinetic segments affected almost the entire left ventricle (7.6 of 11 sites, 69% of the LV sites) (p less than 0.001 between the groups). In the last group, all patients had strong "fibrotic" echoes, in contrast to mild myocarditis (13%). In mild infectious myocarditis the contraction disturbance of the asynergic regions also generated a peculiar "quivering" pattern with thin echo lines. In the uninvolved segments, hyperkinesia was observed in most patients. The LV end-diastolic diameters in the 3 groups were 51 +/- 5, 58 +/- 4 and 65 +/- 5 mm (p less than 0.05), respectively.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6711435

Nieminen, M S; Heikkilä, J; Karjalainen, J



New approaches in small animal echocardiography: imaging the sounds of silence  

PubMed Central

Systolic and diastolic dysfunction of the left ventricle (LV) is a hallmark of most cardiac diseases. In vivo assessment of heart function in animal models, particularly mice, is essential to refining our understanding of cardiovascular disease processes. Ultrasound echocardiography has emerged as a powerful, noninvasive tool to serially monitor cardiac performance and map the progression of heart dysfunction in murine injury models. This review covers current applications of small animal echocardiography, as well as emerging technologies that improve evaluation of LV function. In particular, we describe speckle-tracking imaging-based regional LV analysis, a recent advancement in murine echocardiography with proven clinical utility. This sensitive measure enables an early detection of subtle myocardial defects before global dysfunction in genetically engineered and rodent surgical injury models. Novel visualization technologies that allow in-depth phenotypic assessment of small animal models, including perfusion imaging and fetal echocardiography, are also discussed. As imaging capabilities continue to improve, murine echocardiography will remain a critical component of the investigator's armamentarium in translating animal data to enhanced clinical treatment of cardiovascular diseases.

Ram, Rashmi; Mickelsen, Deanne M.; Theodoropoulos, Catherine



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


The accuracy of bioptome placement for endomyocardial biopsy was evaluated using standard fluoroscopic guidance and compared simultaneously with two-dimensional echocardiography in six healthy subadult grizzly bears (Ursus arctos horribilis). Despite perceived adequate positioning of the bioptome toward the septum when judged using fluoroscopy, only one out of the six placements were actually positioned in the right ventricular apex toward the septum when evaluated using two-dimensional echocardiography. The bioptome was readily relocated to the right ventricular apex/septal location by echocardiography. The forceps were easily visualized at all times and the open cups were readily directed into the desired location for biopsy. Based on a subjective score for tissue quantity from 1 to 4 (poor to excellent), biopsies collected by echocardiographic-guided technique had a mean score of 3.4, while biopsies collected by fluoroscopic-guided technique had a mean score of 1.8. In summary, this study suggests that endomyocardial biopsy locations can be accurately positioned using two-dimensional echocardiography with the advantages of less radiation, lower procedural costs, and direct visualization of the sampling site. Clear definition of endocardial surface as afforded by echocardiography may enhance tissue sample quality and lower potential complications from this procedure. PMID:15869156

Nelson, O Lynne; Robbins, Charles T


Immediate echocardiography in the management of acute respiratory exacerbations of cardiopulmonary disease. A prospective study.  


This prospective study was done to determine whether immediate echocardiography, to implicate or exclude a cardiac basis for breathlessness, can improve the management of acute dyspnea. One hundred ninety-six consecutive patients admitted to the hospital with a chief complaint of dyspnea were randomized to receive or not receive an echocardiogram within 24 hours of admission. Most patients randomized to echo and control groups had cardiac or pulmonary disease and were comparable in their other clinical characteristics. Predefined study end points included the following: change in diagnosis or treatment; performance of additional diagnostic cardiopulmonary studies; and duration of hospitalization (the principal end point). Changes in diagnosis or treatment during hospitalization were as infrequent among patients randomized to echo as among control patients. Echocardiography independently confirmed the clinical diagnosis in 72 percent of echo-randomized patients. Even when echo findings conflicted with the clinical diagnosis, the diagnosis and management plan rarely changed. Additional cardiac or pulmonary studies were ordered as frequently among patients randomized to echocardiography as among those randomized to control. The mean duration of hospital stay also did not differ between the two groups, and no clinical parameter served to predict which subgroup of patients might benefit from echocardiography. Although echocardiography can be expeditiously obtained during respiratory exacerbations of cardiopulmonary disease, indiscriminate echo does not necessarily hasten or alter the treatment of such patients. PMID:2323246

Kudenchuk, P J; Hosenpud, J D; McDonald, R W; Solin, R C



Dobutamine stress echocardiography versus quantitative technetium-99m sestamibi SPECT for detecting residual stenosis and multivessel disease after myocardial infarction  

PubMed Central

OBJECTIVE—To compare the relative accuracy of dobutamine stress echocardiography (DSE) and quantitative technetium-99m sestamibi single photon emission computed tomography (mibi SPECT) for detecting infarct related artery stenosis and multivessel disease early after acute myocardial infarction.?DESIGN—Prospective study.?SETTING—University hospital.?METHODS—75 patients underwent simultaneous DSE and mibi SPECT at (mean (SD)) 5 (2) days after a first acute myocardial infarct. Quantitative coronary angiography was performed in all patients after imaging studies.?RESULTS—Significant stenosis (> 50%) of the infarct related artery was detected in 69 patients. Residual ischaemia was identified by DSE in 55 patients and by quantitative mibi SPECT in 49. The sensitivity of DSE and mibi SPECT for detecting significant infarct related artery stenosis was 78% and 70%, respectively, with a specificity of 83% for both tests. The combination of DSE and mibi SPECT did not change the specificity (83%) but increased the sensitivity to 94%. Mibi SPECT was more sensitive than DSE for detecting mild stenosis (73% v 9%; p = 0.008). The sensitivity of DSE for detecting moderate or severe stenosis was greater than mibi SPECT (97% v 74%; p = 0.007). Wall motion abnormalities with DSE and transient perfusion defects with mibi SPECT outside the infarction zone were sensitive (80% v 67%; NS) and highly specific (95% v 93%; NS) for multivessel disease.?CONCLUSIONS—DSE and mibi SPECT have equivalent accuracy for detecting residual infarct related artery stenosis of ? 50% and multivessel disease early after acute myocardial infarction. DSE is more predictive of moderate or severe infarct related artery stenosis. Combined imaging only improves the detection of mild stenosis.???Keywords: myocardial infarction; dobutamine echocardiography; single photon emission computed tomography; SPECT; myocardial ischaemia

Lancellotti, P; Benoit, T; Rigo, P; Pierard, L



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

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.

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



Floating aortic thrombus in systemic aspergillosis and detection by transesophageal echocardiography.  


After immunosuppressive treatment for a colitis ulcerosa, a 49-yr-old man developed signs of systemic aspergillosis with subsequent septic shock and encephalitis. For recurrent signs of thromboembolism, transesophageal echocardiography was performed and revealed a large floating thrombus of the aortic arch. Despite appropriate antibiotic treatment, the patient died a few days later suffering from adult respiratory distress syndrome. The appearance of aortic thrombi concomitant to systemic fungal infection rarely has been reported. The present case is the first report of in vivo detection of large vessel involvement in systemic aspergillosis by transesophageal echocardiography. In our opinion, transesophageal echocardiography is the method of choice for bedside diagnosis of this rare complication in critically ill patients. PMID:12394967

Grothues, Frank; Welte, Tobias; Grote, Hans J; Roessner, Albert; Klein, Helmut U



Detection of left ventricular apical thrombus with three-dimensional transesophageal echocardiography.  


OBJECTIVE. Left ventricular (LV) thrombosis persists as a clinical challenge in echocardiographic diagnosis and is an important risk factor for perioperative embolic events in cardiac surgery. Appropriate detection and monitoring when thrombus is suspected is critical in surgical planning and in avoiding catastrophic patient outcomes. CASE PRESENTATION. The authors present a case of a laminated LV apical thrombus, which was discovered intraoperatively by real-time 3-dimensional (3D) transesophageal echocardiography. CLINICAL CHALLENGES. The clinical challenges were (a) LV thrombosis impact on surgical management, (b) key echocardiographic challenges in diagnosing LV thrombosis, and (c) role of 3D echocardiography in the diagnostic algorithm. CONCLUSION. Because of the lack of a gold standard, 2D transthoracic echocardiography remains the imaging modality of choice in assessment; however, there is increasing evidence that 3D technology can be more accurate in intracardiac mass detection and should be considered in the diagnostic algorithm. PMID:21875887

Puskas, Ferenc; Cleveland, Joseph C; Singh, Ramesh; Weitzel, Nathaen S; Reece, T Brett; Shull, Robert; Salcedo, Ernesto E; Seres, Tamas



Speckle-tracking echocardiography: a new technique for assessing myocardial function.  


Speckle-tracking echocardiography has recently emerged as a quantitative ultrasound technique for accurately evaluating myocardial function by analyzing the motion of speckles identified on routine 2-dimensional sonograms. It provides non-Doppler, angle-independent, and objective quantification of myocardial deformation and left ventricular systolic and diastolic dynamics. By tracking the displacement of the speckles during the cardiac cycle, strain and the strain rate can be rapidly measured offline after adequate image acquisition. Data regarding the feasibility, accuracy, and clinical applications of speckle-tracking echocardiography are rapidly accumulating. This review describes the fundamental concepts of speckle-tracking echocardiography, illustrates how to obtain strain measurements using this technique, and discusses their recognized and developing clinical applications. PMID:21193707

Mondillo, Sergio; Galderisi, Maurizio; Mele, Donato; Cameli, Matteo; Lomoriello, Vincenzo Schiano; Zacà, Valerio; Ballo, Piercarlo; D'Andrea, Antonello; Muraru, Denisa; Losi, Mariangela; Agricola, Eustachio; D'Errico, Arcangelo; Buralli, Simona; Sciomer, Susanna; Nistri, Stefano; Badano, Luigi



Hand-carried cardiac ultrasound (HCU) device: Recommendations regarding new technology. A report from the Echocardiography Task Force on New Technology of the Nomenclature and Standards Committee of the American Society of Echocardiography  

Microsoft Academic Search

The newest introduction to echocardiography is a hand-carried ultrasound (HCU) device. It is a small echocardiographic machine that typically weighs less than 6 lb and can obtain echocardiographic images and data. However, neither the device nor the context of the examination fulfills the criteria for a comprehensive or complete echocardiographic examination. The American Society of Echocardiography believes that HCU will

James B. Seward; Pamela S. Douglas; Raimund Erbel; Richard E. Kerber; Itzhak Kronzon; Harry Rakowski; L. David J. Sahn; Eric J. Sisk; A. Jamil Tajik; Samuel Wann



Current role of contrast echocardiography in the diagnosis of cardiovascular diseases.  


The use of contrast echocardiography (CE) in cardiovascular medicine has grown significantly over the last 15 years. Depending on the site of injection, contrast enhancement of the right- or left-sided cardiac chambers or myocardium now can be achieved. Contrast echocardiography can improve the evaluation of patients with valvular heart disease by enhancing the Doppler signal; CE also improves detection of intracardiac or intrapulmonary shunts. In patients with coronary artery disease, enhancement of the endocardial blood-tissue boundary allows for improved visualization of endocardial wall motion, assessment of wall thickening, and calculation of ejection fraction. Contrast echocardiography promises to delineate myocardial perfusion and has the potential for quantitating coronary flow and assessing myocardial viability. These applications may add important physiologic information to the anatomic information readily available from noncontrast echocardiography. Because it can be rapidly performed at the bedside, CE may be a valuable tool for use with inpatients with acute myocardial ischemia. When CE has been used after recanalization of occluded coronary arteries, the assessment of myocardial salvage conveys information concerning reflow, stunning, and prognosis, and in the case of an angioplasty it provides immediate information regarding the success of the procedure. Contrast echocardiography can also assess myocardial areas at risk of irreversible damage and the presence or absence of collateral flow. When performed with transesophageal or epicardial echocardiography in the operating room, CE is emerging as a valuable tool in the assessment of cardioplegia distribution and graft patency as well as in the delineation of the regional supply of each graft. With the continued development of newer contrast agents and refinement of ultrasound imaging equipment, the applications of CE will continue to grow. PMID:9383600

Pérez, J E



Aortic ring abscess and mitral valve aneurysm in aortic valvular endocarditis: enhanced diagnosis with transesophageal echocardiography.  


Aortic ring abscess and mitral valve aneurysms complicating infective endocarditis have previously been described as surgical or autopsy findings. More recently, transesophageal echocardiography has been shown to be more sensitive than standard transthoracic echocardiography or other imaging modalities in detecting each of these complications. Since aortic ring abscess and mitral valve aneurysms virtually mandate surgical intervention, their early detection may be crucial. This report describes a 35-year-old male with congenitally abnormal aortic valve which became infected and in whom both an aortic ring abscess and mitral valve aneurysm occurred. These findings are discussed and the pertinent literature is reviewed. PMID:7889443

Geiger-Dow, J E; Knight, J L; Sanfilippo, A J



Multiplanar visualization in 3D transthoracic echocardiography for precise delineation of mitral valve pathology.  


A novel multiplanar reformatting (MPR) technique in three-dimensional transthoracic echocardiography (3D TTE) was used to precisely localize the prolapsed lateral segment of posterior mitral valve leaflet in a patient symptomatic with mitral valve prolapse (MVP) and moderate mitral regurgitation (MR) before undergoing mitral valve repair surgery. Transesophageal echocardiography was avoided based on the findings of this new technique by 3D TTE. It was noninvasive, quick, reproducible and reliable. Also, it did not need the time-consuming reconstruction of multiple cardiac images. Mitral valve repair surgery was subsequently performed based on the MPR findings and corroborated the findings from the MPR examination. PMID:18186784

Kuppahally, Suman S; Paloma, Allan; Craig Miller, D; Schnittger, Ingela; Liang, David



Echocardiography, Natriuretic Peptides, and Risk for Incident Heart Failure in Older Adults  

PubMed Central

Objectives To examine the potential utility of echocardiography and NT-proBNP for heart failure (HF) risk stratification in concert with a validated clinical HF risk score in older adults. Background Without clinical guidance, echocardiography and natriuretic peptides have suboptimal test characteristics for population-wide HF risk stratification. However, the value of these tests has not been examined in concert with a clinical HF risk score. Methods We evaluated the improvement in 5-year HF risk prediction offered by adding an echocardiographic score or/and NT-proBNP levels to the clinical Health ABC HF Risk Score (base model) in 3752 participants of the Cardiovascular Health Study (age, 72.6±5.4 years; 40.8% men; 86.5% white). The echocardiographic score was derived as the weighted sum of independent echocardiographic predictors of HF. We assessed changes in Bayesian information criterion (BIC), C index, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). We examined also the weighted NRI across baseline HF risk categories under multiple scenarios of event versus nonevent weighting. Results Reduced left ventricular ejection fraction, abnormal E/A ratio, enlarged left atrium, and increased left ventricular mass, were independent echocardiographic predictors of HF. Adding the echocardiographic score and NT-proBNP levels to the clinical model improved BIC (echocardiography: ?43, NT-proBNP: ?64.1, combined: ?68.9; all p<0.001) and C index (baseline 0.746; echocardiography: +0.031, NT-proBNP: +0.027, combined: +0.043; all p<0.01) and yielded robust IDI (echocardiography: 43.3%, NT-proBNP: 42.2%, combined: 61.7%; all p<0.001), and NRI (based on Health ABC HF risk groups; echocardiography: 11.3%; NT-proBNP: 10.6%, combined: 16.3%; all p<0.01). Participants at intermediate risk by the clinical model (5% to 20% 5-yr HF risk; 35.7% of the cohort) derived the most reclassification benefit. Echocardiography yielded modest reclassification when used sequentially after NT-proBNP. Conclusions In older adults, echocardiography and NT-proBNP offer significant HF risk reclassification over a clinical prediction model, especially for intermediate risk individuals.

Kalogeropoulos, Andreas P.; Georgiopoulou, Vasiliki V.; deFilippi, Christopher R.; Gottdiener, John S.; Butler, Javed



Tissue doppler echocardiography detects preclinical markers of cardiac lesion in MDS patients  

PubMed Central

Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder of elderly people. Cardiac dysfunction is a marker of grim prognosis in MDS. We evaluated cardiac dysfunction of MDS patients with or without transfusion dependency by tissue doppler echocardiography. We found the average values of ventricular end-systolic and end-diastolic volumes in transfusion dependency MDS group higher than others. These results were strongly correlated to hemoglobin levels. Tissue Doppler Echocardiography should be routinely performed in MDS patients to detect preclinical cardiac alterations and prevent more heart insults in this group of chronic anemic aged patients.



Cor triatriatum dexter in an adult diagnosed by transesophageal echocardiography: a case report.  


Cor triatriatum dexter is a rare congenital heart malformation in which a persistent right sinus venosus valve divides the right atrium into two chambers. Before echocardiography, this anomaly has been rarely diagnosed before surgery or death. This is a case of cor triatriatum dexter in an adult with lifelong exertional cyanosis and dyspnea. A definitive diagnosis of cor triatriatum dexter with associated heart defects was best made by transesophageal echocardiography at 47 years of age. Subsequent surgical intervention confirmed all of the echocardiographic findings and successful correction of the defects was performed. PMID:8611301

Dobbertin, A; Warnes, C A; Seward, J B


Casimir experiments showing saturation effects  

SciTech Connect

We address several different Casimir experiments where theory and experiment disagree. First out is the classical Casimir force measurement between two metal half spaces; here both in the form of the torsion pendulum experiment by Lamoreaux and in the form of the Casimir pressure measurement between a gold sphere and a gold plate as performed by Decca et al.; theory predicts a large negative thermal correction, absent in the high precision experiments. The third experiment is the measurement of the Casimir force between a metal plate and a laser irradiated semiconductor membrane as performed by Chen et al.; the change in force with laser intensity is larger than predicted by theory. The fourth experiment is the measurement of the Casimir force between an atom and a wall in the form of the measurement by Obrecht et al. of the change in oscillation frequency of a {sup 87}Rb Bose-Einstein condensate trapped to a fused silica wall; the change is smaller than predicted by theory. We show that saturation effects can explain the discrepancies between theory and experiment observed in all these cases.

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



Cardiac involvement in Churg-Strauss syndrome shown by echocardiography.  

PubMed Central

To define the range of cardiac involvement in the Churg-Strauss syndrome, M mode, continuous wave Doppler, and cross sectional echocardiograms were recorded in twelve patients with the disorder. The M mode recordings were digitised and the cross sectional images were recorded with standardised gain settings to determine regional myocardial echo amplitude. Left ventricular end diastolic and end systolic dimensions were increased above the normal 95% confidence interval in four patients, three of whom showed a depressed shortening fraction. Mitral regurgitation was present in six patients; this was severe enough to need valve replacement in two. Mean echo amplitude in both the septum and the posterior wall was significantly increased above normal by a mean (SD) of 4.87 (2.57) dB, suggesting the presence of myocardial fibrosis. There was no evidence of subendocardial involvement as there is in other hypereosinophilic syndromes. Mitral regurgitation is common in the Churg-Strauss syndrome. This cannot be ascribed to involvement of the cusps or chordae and it occurs even when ventricular function is well preserved. It is suggested that mitral regurgitation is caused by diffuse myocardial fibrosis. Images Fig 2

Morgan, J M; Raposo, L; Gibson, D G



Comparison of Multidetector-Row Computed Tomography to Echocardiography and Fluoroscopy for Evaluation of Patients With Mechanical Prosthetic Valve Obstruction  

Microsoft Academic Search

For evaluation of prosthetic heart valve obstruction echocardiography and fluoroscopy provide primarily functional information but may not unequivocally establish the cause of dysfunction. Our objective was to evaluate whether multidetector-row computed tomographic (MDCT) imaging could detect the morphologic substrate for such functional abnormalities. Thirteen patients with 15 prosthetic valves, in whom prosthetic valve obstruction was suspected from echocardiography or fluoroscopy

Petr Symersky; Ricardo P. J. Budde; Mathias Prokop



Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native cardiac valves  

Microsoft Academic Search

Some studies describe an increased risk for emboli in infective endocarditis patients with large (>10 mm) and mobile vegetations. Other studies fail to demonstrate the above relation. Most studies have been performed using transthoracic echocardiography or with a monoplane transesophageal approach. The present study examines whether distinctive characteristics of vegetative lesions detected by transthoracic and multiplane transesophageal echocardiography are predictive

Stefano De Castro; Giuseppina Magni; Sergio Beni; Domenico Cartoni; Marco Fiorelli; Mario Venditti; Steven L. Schwartz; Francesco Fedele; Natesa G. Pandian



View of hospital district, showing cannon in foreground, showing building ...  

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

View of hospital district, showing cannon in foreground, showing building H1 at left, showing building H72 in background; camera facing north. - Mare Island Naval Shipyard, East of Nave Drive, Vallejo, Solano County, CA


A Case of Balanced Type Double Aortic Arch Diagnosed Incidentally by Transthoracic Echocardiography in an Asymptomatic Adult Patient  

PubMed Central

A 36-year-old male patient with no remarkable medical history was admitted to our hospital for a health check up. On chest radiography, bilateral aortic notches at the level of aortic arch were shown suggesting aortic arch anomaly without any clinical symptoms. Two aortic arches were almost same-in-size on suprasternal view of transthoracic echocardiography. In addition, multidetector computed tomography showed balanced type double aortic arch forming a complete vascular ring which encircled the trachea and esophagus. The trachea was slightly compressed by the vascular ring whereas the esophagus was intact. Nevertheless, the pulmonary function test was normal. The patient was discharged from hospital with instructions for periodic follow-up.

Seo, Han Seok; Park, Yong Hyun; Lee, Ju Hyoung; Hur, So Chong; Ko, Yu Jin; Park, So Yeon; Kim, Jun Hwan; Kim, Young Jung; Kim, So Yon



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

NASA Astrophysics Data System (ADS)

Computer assisted diagnosis using analysis of medical images is an area of active research in health informatics. This paper proposes a technique for indication of heart diseases by using information related to shapes of the left ventricle (LV). LV boundaries are tracked from echo-cardiography images taken from LV short axis view, corresponding to two disease conditions viz. dilated cardiomyopathy and hypertrophic cardiomyopathy, and discriminated from the normal condition. The LV shapes are modeled using shape histograms generated by plotting the frequency of normalized radii lengths drawn from the centroid to the periphery, against a specific number of bins. A 3-layer neural network activated by a log-sigmoid function is used to classify the shape histograms into one of the three classes. Experimentations on a dataset of 240 images show recognition accuracies of the order of 80%.

Das, Shaoli; Parekh, Ranjan



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

SciTech Connect

Computer assisted diagnosis using analysis of medical images is an area of active research in health informatics. This paper proposes a technique for indication of heart diseases by using information related to shapes of the left ventricle (LV). LV boundaries are tracked from echo-cardiography images taken from LV short axis view, corresponding to two disease conditions viz. dilated cardiomyopathy and hypertrophic cardiomyopathy, and discriminated from the normal condition. The LV shapes are modeled using shape histograms generated by plotting the frequency of normalized radii lengths drawn from the centroid to the periphery, against a specific number of bins. A 3-layer neural network activated by a log-sigmoid function is used to classify the shape histograms into one of the three classes. Experimentations on a dataset of 240 images show recognition accuracies of the order of 80%.

Das, Shaoli; Parekh, Ranjan [School of Education Technology, Jadavpur University, Kolkata 700032 (India)



Novel spatiotemporal voxel interpolation with multibeat fusion for 3D echocardiography with irregular data distribution  

NASA Astrophysics Data System (ADS)

We developed a novel multi-beat image fusion technique using a special spatiotemporal interpolation for sparse, irregularly sampled data (ISI). It is applied to irregularly distributed 3D cardiac ultrasound data acquired with a fast rotating ultrasound (FRU) transducer. ISI is based on Normalized Convolution with Gaussian kernels tuned to irregular beam data spacing over cardiac phase (?), and beam rotation (?) and elevation angles (?). Methods: images are acquired with the FRU transducer developed in our laboratory, a linear phased array rotating mechanically continuously at very high speed (240-480rpm). High-quality 2D images are acquired at ~100 frames/s over 5-10 seconds. ECG is recorded simultaneously. Images are irregularly distributed over ? and ?, because rotation is not synchronized to heartrate. ISI was compared quantitatively to spatiotemporal nearest neighbor interpolation (STNI) on synthetic (distance function) data of a pulsating ellipsoid for 32 angles (?) and 37 phases (?). ISI was also tested qualitatively on 20 in-vivo cardiac image sets and compared to classical temporal binning with trilinear voxel interpolation, at resolutions of 256*256*400 for 16 phases. Results: From the synthetic data simulations, ISI showed absolute distance errors (mean+/-SD) of 1.23 +/- 1.52mm; considerably lower than for STNI (3.45 +/- 3.03mm). For in-vivo images, ISI voxel sets showed reduced motion artifacts, suppression of noise and interpolation artifacts and better delineation of endocardium. Conclusions: ISI improves the quality of 3D+T images acquired with a fast rotating transducer in simulated and in-vivo data. It may also be useful for similar spatiotemporal irregularly distributed data, e.g. freehand 3D echocardiography.

Bosch, Johan G.; van Stralen, Marijn; Voormolen, Marco M.; Krenning, Boudewijn J.; Lancée, Charles T.; Reiber, Johan H. C.; van der Steen, Anton F. W.; de Jong, Nico



Echocardiography and right ventricular function in NKF stage III cronic kidney disease: Ultrasound nephrologists' role.  


TAPSE measurement during echocardiography is a well known measure of right heart systo-diastolic function. Low TAPSE means reduced cranio-caudal excursion of tricuspidal annulus, sign of both reduced ejection fraction and reduced distensibility of right ventricle. It is a good prognostic index for cardiac mortality risk in CHF patients, adding significant prognostic information to NYHA stadiation. Nephrologists do not always fully aware of right ventricular function in their patients affected by chronic renal failure (CRF), even if this datum is probably crucial in vascular access policy. Our study was designed to study right ventricle function and TAPSE on 202 patients affected by moderate chronic renal failure, free from overt pulmonary hypertension. TAPSE, PAPs, right chambers diameters, classical Framingham factors, estimated glomerular filtration rate were recorded. TAPSE was reduced (<23 mm) in 43% of patients enrolled, while dilated right chambers were present in 24%. PAPs exceeded 30 mmHg in 29% of patients. Echocardiographic signs of left ventricular hypertrophy were found in 36% of patients. The ejection fraction was normal in all patients. Statistical analysis showed a significant indirect correlation between TAPSE and PAPs and between TAPSE and tele-diastolic diameters and volumes of the right ventricle, while a direct correlation was observed between TAPSE and Framingham score. TAPSE showed a bimodal distribution, with a subpopulation "low TAPSE - high PAPs", next to a population characterized by normal values ??for both parameters. A reduction in compliance and systolic function of the right heart chambers is quite early and frequent in course of CKD, a fact that the nephrologist should take in due consideration, managing blood volume or planning vascular access for hemodialysis. PMID:23730390

Floccari, F; Granata, A; Rivera, R; Marrocco, F; Santoboni, A; Malaguti, M; Andrulli, S; Di Lullo, L



Echocardiography and right ventricular function in NKF stage III cronic kidney disease: Ultrasound nephrologists' role?  

PubMed Central

TAPSE measurement during echocardiography is a well known measure of right heart systo-diastolic function. Low TAPSE means reduced cranio-caudal excursion of tricuspidal annulus, sign of both reduced ejection fraction and reduced distensibility of right ventricle. It is a good prognostic index for cardiac mortality risk in CHF patients, adding significant prognostic information to NYHA stadiation. Nephrologists do not always fully aware of right ventricular function in their patients affected by chronic renal failure (CRF), even if this datum is probably crucial in vascular access policy. Our study was designed to study right ventricle function and TAPSE on 202 patients affected by moderate chronic renal failure, free from overt pulmonary hypertension. TAPSE, PAPs, right chambers diameters, classical Framingham factors, estimated glomerular filtration rate were recorded. TAPSE was reduced (<23 mm) in 43% of patients enrolled, while dilated right chambers were present in 24%. PAPs exceeded 30 mmHg in 29% of patients. Echocardiographic signs of left ventricular hypertrophy were found in 36% of patients. The ejection fraction was normal in all patients. Statistical analysis showed a significant indirect correlation between TAPSE and PAPs and between TAPSE and tele-diastolic diameters and volumes of the right ventricle, while a direct correlation was observed between TAPSE and Framingham score. TAPSE showed a bimodal distribution, with a subpopulation “low TAPSE – high PAPs”, next to a population characterized by normal values ??for both parameters. A reduction in compliance and systolic function of the right heart chambers is quite early and frequent in course of CKD, a fact that the nephrologist should take in due consideration, managing blood volume or planning vascular access for hemodialysis.

Floccari, F.; Granata, A.; Rivera, R.; Marrocco, F.; Santoboni, A.; Malaguti, M.; Andrulli, S.; Di Lullo, L.



Intracardiac Echocardiography Guided Transeptal Catheter Injection of Microspheres for Assessment of Cerebral Microcirculation in Experimental Models  

PubMed Central

The use of microspheres for the determination of regional microvascular blood flow (RMBF) has previously used different approaches. This study presents for the first time the intracardiac injection of microspheres using transeptal puncture under intracardiac echocardiography guidance. Five Merino sheep were instrumented and cardiovascularly supported according to local guidelines. Two catheter sheaths into the internal jugular vein facilitated the introduction of an intracardiac probe and transeptal catheter, respectively. Five million colour coded microspheres were injected into the left atrium via this catheter. After euthanasia the brain was used as proof of principle and the endpoint for determination of microcirculation at different time points. Homogeneous allocation of microspheres to different regions of the brain was found over time. Alternate slices from both hemispheres showed the following flow ranges: for slice 02; 0.57–1.02?mL/min/g, slice 04; 0.45–1.42?mL/min/g, slice 06; 0.35–1.87?mL/min/g, slice 08; 0.46–1.77?mL/min/g, slice 10; 0.34–1.28?mL/min/g. A mixed effect regression model demonstrated that the confidence interval did include zero suggesting that the apparent variability intra- and intersubject was not statistically significant, supporting the stability and reproducibility of the injection technique. This study demonstrates the feasibility of the transeptal injection of microspheres, showing a homogeneous distribution of blood flow through the brain unchanged over time and has established a new interventional model for the measurement of RMBF in ovine models.

Bellapart, Judith; Dunster, Kimble R.; Diab, Sara; Platts, David G.; Raffel, Christopher; Maybauer, Marc O.; Barnett, Adrian; Boots, Robert James; Fraser, John F.



Asymptomatic Obese Hypertensives and Need of Routine Echocardiography for Left Ventricular Mass Assessment and Treatment  

PubMed Central

Background: Echocardiographic determination of Left Ventricle Mass (LVM) – an important marker of cardiovascular disease, has been given a lot of importance in clinical diagnosis and in planning of treatment. Clinically asymptomatic compensated hypertensives show some pathological findings which are indicative of left ventricular dysfunction. Methods: The study population of 106 males, after a detailed clinical examination, were evaluated by echocardiography and were classified as per the body mass index classification of WHO Western Pacific Region in 2000 for Asian population. Fasting blood samples were taken to estimate blood sugar and lipid profile. Results: It was observed that subjects in normal range of body mass index <45 years (23.68%) and >45 years (16.1%), subjects of overweight <45 years (15.7%) and >45 years (10.29%) and obese I and II<45 years (60.52%) and >45 years (73.52%). The comparison between left ventricular mass which was indexed to height2.7 in subjects who were <45 years and >45years was observed to be statistically significant (p<0.03). On comparing LVM/ht2.7 of normal BMI group with that of those with higher BMIs, it was noted to be significantly different (p<0.009), which was suggestive of adverse effects of increasing BMI on LVM. It was also observed that persons with increased BMIs showed changes in left ventricular geometry – 30.13% had concentric hypertrophy, 17.80% had concentric remodeling, 8.21% had eccentric hypertrophy and that 38.35% had normal left ventricle geometry. Conclusion: The present study therefore, indicated that it was better to do an echocardiographic screening of asymptomatic subjects who had even a marginal increase in blood pressure and BMI, to diagnose potential cardiac dysfunction.

Garg, Bindu; Yadav, Nirmal; Vardhan, Harsha; De, A.K.



Functional pulmonary atresia - a sign of severe right ventricular failure  

Microsoft Academic Search

Background. Functional pulmonary atresia (funPA) was reported in fetuses and newborns with severe Ebstein anomaly. Few anecdotal reports described this condition with normal heart anatomy. Aims. To explain pathophysiological mechanisms leading to funPA. Methods and results. Echocardiography results were evaluated in 12 cases of funPA: 7 fetuses and 1 newborn with Ebstein anomaly, and 4 with normal heart anatomy: 3



[Severe cardiac failure in Kearns-Sayre syndrome].  


Mitochondrial disorders are a group of diseases that can affect virtually all organ systems. A 19 year old man was seen in 1993 with neurologic abnormalities consisting of impaired function of muscles, diplopia, progressive loss of vision, impaired phonation and swallowing, during the last 10 years. Physical examination disclosed moderate wasting of the four limb muscles, mild motor weakness of neck muscles, symmetrical hyporeflexia, cerebellar dysfunction, severe external ophtalmoplegia and ptosis. Fundii oculi examination showed retinitis pigmentosa. The electromyogram demonstrated myopathic changes with normal nerve conduction velocities. The cerebrospinal fluid was normal, except for a mild increase in lactic acid. Histochemical study of a muscle biopsy specimen demonstrated ragged red fibers and increase of the subsarcolemal oxidative activity of mitochondriae. The diagnosis of Kearns-Sayre disease was confirmed and he was discharged advising physical therapy. On February 1995, he was again admitted, this time with right cardiac failure and worsening of all his previous symptoms and signs. He complained of myalgias and his muscle weakness was more striking on clinical examination. Echocardiography showed biventricular dilatation and left ventricular hypertrophy with preserved systolic function. A new muscle biopsy revealed an heteroplasmic deletion of 5 Kb with 80% of mutant mitochondrial DNA. In brief, we report a patient with the clinical phenotype of Kearns-Sayre syndrome who presented an acute congestive cardiac failure due to cardiomyopathy, an association which has seldom been, reported in the literature. PMID:9435373

Consalvo, D; Villegas, F; Villa, A M; Köhler, G; Molina, H; Benchuga, E; Chamoles, N; Sanz, O P; Sica, R E



Exercise echocardiography and thallium-201 single-photon emission computed tomography stress test for 5- and 10-year prognosis of mortality and specific cardiac events  

Microsoft Academic Search

Limited data suggest that stress myocardial perfusion imaging and stress echocardiography have similar prognostic value for composite cardiac events. However, it is not known whether exercise echocardiography and stress thallium are similar in their prediction of specific cardiac events, eg, death, sudden death, myocardial infarction, unstable angina, and congestive heart failure. A total of 206 patients undergoing stress echocardiography and

Azizul Hoque; Mohammed Maaieh; Rita A. Longaker; Marcus F. Stoddard



Systemic absorption and toxicity from topically administered lidocaine during transesophageal echocardiography  

Microsoft Academic Search

This report describes the cases of three patients who had central nervous system toxicity from locally administered lidocaine during transesophageal echocardiography. Parenteral sedation was not employed. Serum levels of lidocaine were obtained after the procedure in all three patients, who recovered spontaneously and suffered no permanent ill effects. Medical conditions such as congestive heart failure and diminished hepatic function or

Satish C. Sharma; Pamela R. Rama; Gregory L. Miller; Elizabeth B. Coccio; Linda J. Coulter



Reduced neuropsychological dysfunction using epiaortic echocardiography and the exclusive Y graft  

Microsoft Academic Search

Background. To examine the effect of screening the aorta for atheroma before aortic manipulation and use of exclusive Y graft revascularization on the incidence of neuropsychological dysfunction after coronary artery bypass.Methods. Aortic atheroma was detected using epiaortic and transesophageal echocardiography. Atheroma avoidance was facilitated by use of the exclusive Y graft technique, which has no aortic coronary anastomoses. In the

Alistair G Royse; Colin F Royse; Andrew E Ajani; Emma Symes; Paul Maruff; Steven Karagiannis; Richard P Gerraty; Leeanne E Grigg; Stephen M Davis



Dobutamine stress echocardiography for assessing coronary artery disease after transplantation in children  

Microsoft Academic Search

Objectives. The purpose of this study was to determine the feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography (DSE) for evaluating posttransplant coronary artery disease (TxCAD) in children, and to determine the frequency of selected cardiac events after normal or abnormal DSE.Background. Posttransplant coronary artery disease is the most common cause of graft loss (late death or retransplantation) after

Ranae L Larsen; Patricia M Applegate; Daniel A Dyar; Paulo A Ribeiro; Sharon D Fritzsche; Neda F Mulla; Girish S Shirali; Micheal A Kuhn; Richard E Chinnock; Pravin M Shah



Diagnostic value of transoesophageal echocardiography in suspected haemodynamically significant pulmonary embolism  

PubMed Central

OBJECTIVE—To assess the value of transoesophageal echocardiography (TOE) for diagnosing suspected haemodynamically significant pulmonary embolism and signs of right ventricular overload at standard echocardiography.?METHODS—113 consecutive patients (58 male; 55 female), mean (SD) age 53.6 (13.3) years, in whom there was clinical suspicion of pulmonary embolism and right ventricular overload on transthoracic echocardiography, underwent TOE in addition to routine diagnostic procedures to identify pulmonary artery thrombi.?RESULTS—TOE revealed thrombi in 32 of 51 patients who had suspected acute pulmonary embolism and in 31 of 62 with suspected chronic pulmonary embolism. In one patient a pulmonary angiosarcoma rather than chronic pulmonary embolism was found at surgery. The diagnosis of pulmonary embolism was confirmed in 77 patients by scintigraphy, spiral computed tomography, angiography, or necropsy (reference methods). While TOE failed to provide a diagnosis of pulmonary embolism in 15 of these 77 patients, no false positive findings were reported (sensitivity 80.5%, specificity 97.2%). In 11 and 26 cases, respectively, the thrombi were confined to the left or right pulmonary artery. Bilateral thrombi were found in 25 patients. Mobile thrombi were observed only in acute pulmonary embolism (in 19 of 32 patients). No complications of TOE were noted.?CONCLUSIONS—TOE permits visualisation of pulmonary arterial thrombi, confirming the diagnosis in the majority of patients with pulmonary embolism and right ventricular overload. This may be useful for prompt decision making in patients with haemodynamic compromise considered for thrombolysis or embolectomy.???Keywords: pulmonary embolism; transoesophageal echocardiography

Pruszczyk, P; Torbicki, A; Kuch-Wocial, A; Szulc, M; Pacho, R



Dobutamine stress echocardiography in the prediction of acute or chronic myocardial infarction  

Microsoft Academic Search

Background We assessed the value of dobutamine stress echocardiography (DSE) in predicting cardiac events in patients with acute or chronic myocardial infarction (MI), and we studied the association between DSE and these events. Methods and Results Two hundred sixty-six patients (mean [±SD] age 65.3 ± 11.4 years) with acute (n = 139) or chronic (n = 127) MI were recruited

Wen-Jin Cherng; Chao-Hung Wang; Ming-Jui Hung; Shih-Yi Chung



Optimal criteria for the diagnosis of coronary artery disease by dobutamine stress echocardiography  

Microsoft Academic Search

The diagnosis of coronary artery disease (CAD) on the basis of inducible ischemia in ?2, rather than ?1, segments was suggested to improve specificity of dobutamine stress echocardiography (DSE). However, the impact of using these criteria on the sensitivity and accuracy of DSE was not studied. We studied the accuracy of DSE (up to 40 ?g\\/kg\\/min) for the diagnosis of

Abdou Elhendy; Ron T van Domburg; Jeroen J Bax; Don Poldermans; Peter R Nierop; Jaroslaw D Kasprzak; Jos R. T. C Roelandt



Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?  

Microsoft Academic Search

Stress echocardiography and myocardial perfusion imaging are commonly used noninvasive imaging modalities for the evaluation of ischaemic heart disease. Both modalities have proved clinically useful in the entire spectrum of coronary artery disease. Both techniques can detect coronary artery disease and provide prognostic information. Both techniques can identify low-risk and high-risk subsets among patients with known or suspected coronary artery

A. F. L. Schinkel; J. J. Bax; M. L. Geleijnse; A. A. Elhendy; D. Poldermans; J. R. T. C. Roelandt; H. Boersma



Gender Differences in the Accuracy of Dobutamine Stress Echocardiography for the Diagnosis of Coronary Artery Disease  

Microsoft Academic Search

The accuracy of dobutamine stress echocardiography (DSE) for the diagnosis of coronary artery disease (CAD) has not been yet evaluated in women. We studied the effect of gender on the accuracy of DSE for the diagnosis of CAD in 306 consecutive patients (210 men and 96 women) with limited exercise capacity and suspected myocardial ischemia who underwent coronary angiography within

Abdou Elhendy; Marcel L Geleijnse; Ron T van Domburg; Peter R Nierop; Don Poldermans; Jeroen J Bax; Folkert J TenCate; Youssef F. M Nosir; M. Mohsen Ibrahim; Jos R. T. C Roelandt



Role of Intraoperative Transesophageal Echocardiography in Patients Having Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

Results. New prebypass findings were found in 10% of patients, and the surgical plan was altered in 3.4% of patients. New postbypass findings were found in 3.2% of patients, altering the surgical plan in 2% of patients. Conclusions. This large consecutive, nonselected, pro- spective study reveals the significant impact of intraop- erative transesophageal echocardiography in patients having coronary artery bypass

Fatema E. Qaddoura; Martin D. Abel; Karen L. Mecklenburg; Krishnaswamy Chandrasekaran; Hartzell V. Schaff; Kenton J. Zehr; Thoralf M. Sundt; Roger L. Click



Long-Term Prediction of Mortality in Elderly Persons by Dobutamine Stress Echocardiography  

Microsoft Academic Search

Background. Dobutamine stress echocardiography (DSE) was shown to provide incremental prognostic information. However, its role in the prediction of mortality in elderly persons is not well defined. We assessed the value of DSE in the prediction of mortality and hard cardiac events during long-term follow-up in patients older than 65 years. Methods. We studied 1434 patients .65 years old (mean

Elena Biagini; Abdou Elhendy; Arend F. L. Schinkel; Vittoria Rizzello; Jeroen J. Bax; Fabiola B. Sozzi; Miklos D. Kertai; Ron T. van Domburg; Boudewijn J. Krenning; Angelo Branzi; Claudio Rapezzi; Maarten L. Simoons; Don Poldermans



Usefulness of Ergonovine Echocardiography in Patients with Acute Coronary Syndrome and Suspected Variant Angina  

Microsoft Academic Search

Background and Objectives:It is well known that coronary spasm can cause acute coronary syndrome (ACS, such as unstable angina or acute myocardial infarction as well as variant angina. However, the role of coronary spasm as an initial presentation in ACS is difficult to demonstrate. Therefore, we investigated the validity and safety of ergonovine echocardiography in ACS with normal coronary angiogram

Tae Ho Park; Moo Hyun Kim; Eun Hee Park; Ki Tae Kang; Seong Geun Kim; Se Jun Jang; Su Hun Lee; Kwang Soo Cha; Young Dae Kim; Jong Seong Kim


An unexpected surgical complication of ventricular assist device implantation identified by transesophageal echocardiography: a case report  

Microsoft Academic Search

Ventricular assist devices are used for circulatory support for patients with cardiogenic shock and refractory heart failure. Although early and late complications of left ventricular assist devices have been reported, we report a rare surgical complication of a left ventricular assist device implantation. This unexpected surgical complication was accurately identified by transesophageal echocardiography.

Min Pu; Edward R Stephenson; William R Davidson; Benjamin C Sun



Echocardiography-based left ventricular mass estimation. How should we define hypertrophy?  

Microsoft Academic Search

Left ventricular hypertrophy is an important risk factor in cardiovascular disease and echocardiography has been widely used for diagnosis. Although an adequate methodologic standardization exists currently, differences in measurement and interpreting data is present in most of the older clinical studies. Variability in border limits criteria, left ventricular mass formulas, body size indexing and other adjustments affects the comparability among

Murilo Foppa; Bruce B Duncan; Luis EP Rohde



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

Microsoft Academic Search

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

John R. Stratton; James L. Ritchie; Glen W. Hamilton; Karl E. Hammermeister; Laurence A. Harker



Diagnosis of patent foramen ovale by transesophageal echocardiography and correlation with autopsy findings  

Microsoft Academic Search

Transesophageal echocardiography (TEE) is accepted as the method of choice for the diagnosis of a patent foramen ovale (PFO). However, direct anatomic confirmation regarding the presence or absence of a PFO on transesophageal imaging has been obtained in only a limited number of patients. Consequently, this study was performed to assess the diagnostic accuracy of contrast and color Doppler TEE

Birke Schneider; Tomasz Zienkiewicz; Viola Jansen; Thomas Hofmann; Harald Noltenius; Thomas Meinertz



Myocardial Strain by Doppler Echocardiography Validation of a New Method to Quantify Regional Myocardial Function  

Microsoft Academic Search

Background—Myocardial strain is a measure of regional deformation, and by definition, negative strain means shortening and positive strain, elongation. This study investigates whether myocardial strain can be measured by Doppler echocardiography as the time integral of regional velocity gradients, using sonomicrometry as reference method. Methods and Results—In 13 anesthetized dogs, myocardial longitudinal strain was measured on apical images as the

Stig Urheim; Thor Edvardsen; Hans Torp; Bjørn Angelsen; Otto A. Smiseth


Cor triatriatum dexter assessed by three-dimensional echocardiography reconstruction in two adult patients.  


Cor triatriatum dexter is a rare congenital anomaly caused by persistence of the right valve of the embryonic sinus venosus, and this results in septation of the right atrium. Three-dimensional echocardiography is a novel technique that can be used to identify and characterize this entity. Here, we report two women with cor triatriatum dexter. PMID:17894580

Lee, Young-Soo; Kim, Kee-Sik; Lee, Jin-Bae; Kean-Ryu, Jae; Choi, Ji-Yong; Chang, Sung-Gug



The Evaluation of Diagnostic Validity of ECG for the Subendocardial Infarction by Myocardial Contrast Echocardiography  

Microsoft Academic Search

Background and Objectives: : ::The pathological findings of Non-Q wave myocardial infarction (NQMI on ECG did not always correspond to subendocardial infarction (SEMI. The purpose of this study was to evaluate the diagnostic validity of ECG for SEMI by myocardial contrast echocardiography (MCE in the patients with acute myocardial infarction (AMI. Materials and Methods: : : :The study population was

Jeong Kee Seo; Keum-Soo Park; Jun Kwan; Mee Young Kwon; Don Lee; Sung Sik Yang; Eui Soo Hong; Hyo Jung Lee; Dea Hyeok Kim; Seong Wook Cho; Woo Hyung Lee



The incidence of dysphagia in pediatric patients after open heart procedures with transesophageal echocardiography  

Microsoft Academic Search

BackgroundPediatric patients who undergo open heart operations may be at risk for the development of dysphagia because of interventions such as intubation and transesophageal echocardiography. Although the occurrence of dysphagia after cardiac surgical procedures in adults is reported to be 3% to 4%, the incidence in children and adolescents has not been documented. This study was undertaken to determine the

Lisa M Kohr; Margaret Dargan; Amy Hague; Suzanne P Nelson; Elise Duffy; Carl L Backer; Constantine Mavroudis



Myocardial ischemia due to coronary artery spasm during dobutamine stress echocardiography  

Microsoft Academic Search

Dobutamine stress echocardiography (DSE) is a useful and safe provocation test for myocardial ischemia. Until now, the test has been focused only on the organic lesion in the coronary artery, and positive DSE has indicated the presence of significant fixed coronary artery stenosis. The aim of the present study is to examine whether myocardial ischemia due to coronary spasm is

Hiroaki Kawano; Hiromi Fujii; Takeshi Motoyama; Kiyotaka Kugiyama; Hisao Ogawa; Hirofumi Yasue



Gated Myocardial Perfusion Tomography for the Assessment of Left Ventricular Function and Volumes: Comparison with Echocardiography  

Microsoft Academic Search

The purpose of this study was to evaluate left ventricular volumes and function by gated SPECT using different tracers and proto cols in comparison with quantitative echocardiography. Gated myocardial perfusion scintigraphy permits simultaneous assess ment of left ventricular perfusion, function and volumes. Informa tion is scanty regarding the accuracy of absolute left ventricular volumes measurements by this technique. Methods: We

Eduardo Cwajg; Jucylea Cwajg; Zuo-Xiang He; Wayne S. Hwang; Felix Keng; Sherif F. Nagueh; Mario S. Verani


Measurement of peak rates of left ventricular wall movement in man. Comparison of echocardiography with angiography  

Microsoft Academic Search

Estimates of peak systolic and diastolic rates of left ventricular wall movement were made in 23 patients by echocardiography and angiocardiography. Echocardiographic measurements were calculated as the rate of change of the transverse left ventricular dimension, derived continuously throughout the cardiac cycle. These were compared with similar plots of transverse left ventricular diameter, in the same patients, derived from digitized

D G Gibson; D J Brown



Echocardiography Doppler in pulmonary embolism: Right ventricular dysfunction as a predictor of mortality rate  

Microsoft Academic Search

To test the hypothesis that right ventricular (RV) systolic dysfunction at the time of diagnosis of pulmonary embolism (PE) is a predictor of mortality rate, 126 consecutive patients with PE were examined with echocardiography Doppler (ED) on the day of diagnosis. RV function was assessed by evaluation of wall motion on a four-point scale. The material was divided into two

Ary Ribeiro; Per Lindmarker; Anders Juhlin-Dannfelt; Hans Johnsson; Lennart Jorfeldt



Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome  

Microsoft Academic Search

Background & Aims: Two modalities, contrast echocardiography and lung perfusion scan, are used to identify intrapulmonary vascular dilatation and diagnose hepatopulmonary syndrome (HPS), but a comparison of these two procedures has not been performed. The aim of this study was to compare the use of these diagnostic modalities in detecting intrapulmonary vascular dilatation and diagnosing HPS. Methods: Forty consecutive outpatients

Gary A. Abrams; Carl C. Jaffe; Paul B. Hoffer; Henry J. Binder; Michael B. Fallon



Development of the left ventricular hypertrophy and dilation in adolescent ice hockey players evaluated with echocardiography  

Microsoft Academic Search

Computerized echocardiography at rest was used to follow up the dynamics of left heart enlargement in adolescent ice hockey players aged 11 to 15 years. The first year of strength?endurance training did not lead to any remarkable change of echocardiographic parameters of the left heart ventricular size. A slight tendency to left ventricular hypertrophy appeared after 2 years of training,

Dušan Meško; Alexander Jurko; Mojmír Vrlík; Moniká Novomeská; Eugen Horniak; Dagmar Dzurenková



Transoesophageal Echocardiography in Patients without Arterial and Major Cardiac Sources of Embolism: Difference between Stroke Subtypes  

Microsoft Academic Search

We studied the records of 175 consecutive patients referred to our neurologic ward between January 1994 and February 2000 with a diagnosis of ischaemic cerebrovascular disease (ICVD) (stroke or transient ischaemic attack – TIA) who underwent transoesophageal echocardiography (TEE). We excluded patients with large vessel disease, high-risk embolic cardiopathies and other rare causes of stroke. According to clinical and neuroimaging

P. Cerrato; D. Imperiale; L. Priano; L. Mangiardi; M. Morello; A. M. Marson; F. Carrà; G. Barberis; B. Bergamasco



Normal arterial blood gas in a patient with saddle pulmonary artery embolus: diagnosis by transesophageal echocardiography.  

PubMed Central

This article describes a patient with a large, main pulmonary artery thromboembolus with normal arterial blood gas results, including normal alveolar-arterial oxygen gradient. The diagnosis was established using transesophageal echocardiography and confirmed with pulmonary angiography. The patient subsequently underwent anticoagulation and eventually was discharged without complications. Images Figure

Mabee, S. W.; Mabee, C. L.; Pacht, E. R.



Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary Thromboembolism  

PubMed Central

Introduction: Pulmonary embolism (PE) is a life-threatening illness with high morbidity and mortality. Echocardiography (ECG) plays an important role in the early identification of right ventricular (RV) dysfunction, making it a helpful tool in identifying hemodynamically stable patients affected by PE with a higher mortality risk. The purpose of this study was to evaluate if one or more ECG indexes could predict a short-term evolution towards RV dysfunction. Methods: We selected all patients consecutively admitted to the Careggi Hospital Emergency Department with the clinical suspicion of PE, confirmed by computed tomography angiography prior to enrollment. Subsequently, properly trained emergency physicians acquired a complete ECG to measure RV morphological and functional indices. For each patient, we recorded if he or she received a fibrinolytic treatment, a surgical embolectomy or heparin therapy during the emergency department (ED) stay. Then, every patient was re-evaluated with ECG, by the same physician, after 1 week in our intensive observation unit and 1 month as outpatient in our ED regional referral center for PE. Results: From 2002 to 2007, 120 consecutive patients affected by PE were evaluated by echocardiography at the Careggi Hospital ED. Nine patients (8%) were treated with thrombolytic therapy. Six died within 1 week and 4 abandoned the study, while the remaining 110 survived and were re-evaluated by ECG after 1 week and 1 month. The majority of the echocardiographic RV indexes improve mostly in the first 7 days: Acceleration Time (AT) from 78±14 ms to 117±14 ms (p<0.001), Diameter of Inferior Vena Cava (DIVC) from 25±6 mm to 19±5 mm (p<0.001), Tricuspid Annular Plane Systolic Excursion (TAPSE) from 16±6 mm to 20±6 mm (p<0.001). Pulmonary Artery Systolic Pressure (PASP) showed a remarkable decrease from 59±26 mmHg to 37±9 mmHg, (p<0.001). The measurements of the transverse diameters of both ventricles and the respective ratio showed a progressive normalization with a reduction of RV diameter, an increase of Left Ventricular (LV) diameter and a decrease of RV/LV ratio over time. To evaluate the RV function, the study population was divided into 3 groups based on the TAPSE and PASP mean values at the admission: Group 1 (68 patients) (TAPSE+/ PASP?), Group 2 (12 patients) (TAPSE?/PASP?), and Group 3 (30 patients) (TAPSE?/PASP+). Greater values of AT, minor RV diameter, greater LV diameter and a lesser RV/LV ratio were associated with a short-term improvement of TAPSE in the Group 2. Instead, in Group 3 the only parameter associated with short-term improvement of TAPSE and PASP was the treatment with thrombolytic therapy (p<0.0001). Conclusion: Greater values of AT, minor RV diameter, greater LV diameter and a lesser RV/LV ratio were associated with a short-term improvement of TAPSE?/PASP? values. Patients with evidence of RV dysfunction (TAPSE?/PASP+), may benefit from thrombolytic therapy to improve a short- term RV function. After 1 month, also a decreased DIVC predicted improved RV function.

Zanobetti, Maurizio; Converti, Cristiano; Conti, Alberto; Viviani, Gabriele; Guerrini, Elisa; Boni, Vanessa; Vicidomini, Sonia; Poggioni, Claudio; Guzzo, Aurelia; Coppa, Alessandro; Bigiarini, Sofia; Innocenti, Francesca; Pini, Riccardo



Real-time three-dimensional transthoracic echocardiography in daily practice: initial experience  

PubMed Central

Aim of the work To evaluate the feasibility and possible additional value of transthoracic real-time three-dimensional echocardiography (RT3D-TTE) for the assessment of cardiac structures as compared to 2D-TTE. Methods 320 patients (mean age 45 ± 8.4 years, 75% males) underwent 2D-TTE and RT3D-TTE using 3DQ-Q lab software for offline analysis. Volume quantification and functional assessment was performed in 90 patients for left ventricle and in 20 patients for right ventricle. Assessment of native (112 patients) and prosthetic (30 patients) valves morphology and functions was performed. RT3D-TTE was performed for evaluation of septal defects in 30 patients and intracardiac masses in 52 patients. Results RT3D-TTE assessment of left ventricle was feasible and reproducible in 86% of patients while for right ventricle, it was (55%). RT3D-TTE could define the surface anatomy of mitral valve optimally (100%), while for aortic and tricuspid was (88% and 81% respectively). Valve area could be planimetered in 100% for the mitral and in 80% for the aortic. RT3D-TTE provided a comprehensive anatomical and functional evaluation of prosthetic valves. RT3D-TTE enface visualization of septal defects allowed optimal assessment of shape, size, area and number of defects and evaluated the outcome post device closure. RT3D-TTE allowed looking inside the intracardiac masses through multiple sectioning, valuable anatomical delineation and volume calculation. Conclusion Our initial experience showed that the use of RT3D-TTE in the assessment of cardiac patients is feasible and allowed detailed anatomical and functional assessment of many cardiac disorders.



Transthoracic echocardiography for the diagnosis of left ventricular thrombosis in the postoperative care unit  

PubMed Central

Introduction Transthoracic echocardiography (TTE) is a reliable, noninvasive imaging method that is useful in the evaluation of cardiovascular thrombosis. We conducted a retrospective study of all the echocardiograms from patients in the postoperative care unit to assess the role of TTE in thrombus identification in the left ventricle. Methods This retrospective database evaluation included all echocardiograms during a 14-month period. The echocardiographic examination protocol included the subcostal four-chamber view, the apical four-chamber view, the apical two-chamber view and the parasternal view, along the long and short axes in both spontaneously and mechanically ventilated patients. All echocardiograms were obtained within the 48 hours immediately following surgery. Results In total, 160 postoperative echocardiograms were obtained from 160 patients and resulted in the detection of five cases of left ventricular thrombosis. Subgroup analysis showed that 21 and 35 of the 160 patients examined had either dilated or ischemic cardiomyopathy, respectively. In these patients, preoperative echocardiograms had been obtained recently prior to surgery and were negative for left ventricular thrombus. In three of 35 patients with ischemic cardiomyopathy and two of 21 patients with dilated cardiomyopathy, thrombus was identified in the left ventricle. The thrombi were mobile, uncalcified and pedunculated and were located in the apex of the left ventricle. In addition, no clinical consequences of the left ventricular thrombi were recorded. Conclusions Low-flow conditions in heart chambers due to ischemic or dilated cardiomyopathy in conjunction with the hypercoagulability caused by perioperative prothrombotic factors may lead to thrombotic events in the left ventricle.



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

PubMed Central

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.



Coronary flow reserve: measurement with transthoracic Doppler echocardiography is reproducible and comparable with positron emission tomography.  


Detection of early vascular changes indicated by lowered coronary flow reserve (CFR) would allow early treatment and prevention of atherosclerosis. The purpose of this study was to test whether it is possible to reproducibly measure CFR with transthoracic Doppler echocardiography (TTE) in healthy volunteers. We measured CFR using dipyridamole infusion in ten healthy male volunteers with two methods: TTE and positron emission tomography (PET) with oxygen-15-labelled water (group A). However, CFR was assessed twice with TTE in eight healthy male volunteers (group B) to study the reproducibility of this method. We compared CFRs obtained using TTE flow measurements in the left anterior descending coronary artery (LAD) and PET flow measurements in the corresponding myocardial area. Coronary flow in LAD could be measured in all subjects using TTE. By TTE, an average CFR based on peak diastolic flow velocity (PDV) was 2.72 +/- 1.16, mean diastolic flow velocity (MDV) 2.56 +/- 1.06 and velocity time integral (VTI) 1.87 +/- 0.49. The results were reproducible in two repeated TTE studies (coefficient of variation in MDV 6.1 +/- 4.3%, n=8). By PET, CFR was 2.52 +/- 0.84. CFR assessed by TTE correlated closely with that measured by PET (MDV r=0.942, P<0.001; PDV r=0.912, P<0.002 and VTI r=0.888, P<0.006) and intraclass correlation was 0.929 (MDV) and tolerance limits for differences of CFRs was -0.78 to 0.72. We show that CFR measured by TTE has an excellent correlation with CFR measured by PET. We also found that TTE measurements of CFR were highly reproducible. PMID:11168305

Saraste, M; Koskenvuo, J; Knuuti, J; Toikka, J; Laine, H; Niemi, P; Sakuma, H; Hartiala, J



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

PubMed Central

Background Patients with a myocardial bridge (MB) and no significant obstructive coronary artery disease (CAD) may experience angina presumably from ischemia, but noninvasive assessment has been limited and the underlying mechanism poorly understood. This study seeks to correlate a novel exercise echocardiography (EE) finding for MBs with invasive structural and hemodynamic measurements. Methods and Results Eighteen patients with angina and an EE pattern of focal end?systolic to early?diastolic buckling in the septum with apical sparing were prospectively enrolled for invasive assessment. This included coronary angiography, left anterior descending artery (LAD) intravascular ultrasound (IVUS), and intracoronary pressure and Doppler measurements at rest and during dobutamine stress. All patients were found to have an LAD MB on IVUS. The ratios of diastolic intracoronary pressure divided by aortic pressure at rest (Pd/Pa) and during dobutamine stress (diastolic fractional flow reserve [dFFR]) and peak Doppler flow velocity recordings at rest and with stress were successfully performed in 14 patients. All had abnormal dFFR (?0.75) at stress within the bridge, distally or in both positions, and on average showed a more than doubling in peak Doppler flow velocity inside the MB at stress. Seventy?five percent of patients had normalization of dFFR distal to the MB, with partial pressure recovery and a decrease in peak Doppler flow velocity. Conclusions A distinctive septal wall motion abnormality with apical sparing on EE is associated with a documented MB by IVUS and a decreased dFFR. We posit that the septal wall motion abnormality on EE is due to dynamic ischemia local to the compressed segment of the LAD from the increase in velocity and decrease in perfusion pressure, consistent with the Venturi effect.

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



[The various forms of left ventricular hypertrophy: diagnostic value of echocardiography].  


Left ventricular hypertrophy is a non-specific physiological or maladaptive cardiac response to a large array of stimuli mediated by exercise and numerous cardiac and systemic diseases. The precise characterization and quantification of left ventricular hypertrophy may allow a more timely diagnosis of the underlying condition. The clinical reference standard to assess left ventricular hypertrophy is echocardiography, but a comprehensive description of how to approach this frequent finding in clinical practice is lacking. The current review systematically describes the typical echocardiographic patterns of important types of cardiac hypertrophy using both established and advanced imaging modalities. In hypertrophic obstructive cardiomyopathy a markedly reduced regional systolic function is found in the prominent thickened septum, whereas in essential arterial hypertension a typical concentric left ventricular hypertrophy with a less prominent basal septal bulge is present. The echocardiographic characteristics of cardiac amyloidosis are ventricular hypertrophy with sparkling granular myocardial texture and a small epicardial effusion. In addition, the strain rate curve for longitudinal function shows a typically reduced function which reaches maximum already in early systole. The typical feature of Friedreich cardiomyopathy is concentric left ventricular hypertrophy and sparkling granular texture with preserved regional systolic function. In Fabry cardiomyopathy a prominent papillary muscle is presented and a typical strain rate curve can be extracted from the basal lateral wall, indicating replacement fibrosis. Prominent hypertrabecularisation (ratio of non-compacted to compacted myocardium >2) in the apical and mid left ventricular segments is typical for non-compaction cardiomyopathy. Knowledge of these typical echocardiographic features enables the cardiologist to distinguish between the different hypertrophic entities, thus paving the way to early diagnosis. PMID:21246178

Weidemann, F; Störk, S; Herrmann, S; Ertl, G; Niemann, M



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

PubMed Central

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

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



Real-time three-dimensional dobutamine stress echocardiography for coronary artery disease diagnosis: validation with coronary angiography  

PubMed Central

Objective To compare real?time three?dimensional echocardiography (RT3DE) with two?dimensional dobutamine stress echocardiography (2DE) for the detection of myocardial ischaemia, with angiographic validation of the results. Methods 56 patients (mean (SD) age 64.5 (6.2) years, 38 males), referred for coronary angiography, were examined by 2DE and RT3DE during the same dobutamine stress protocol. Results All 56 patients completed the stress protocol uneventfully. The mean (SD) acquisition time for the necessary views to evaluate all segments was 26.3 (2.5)?s for RT3DE and 58.8 (3.7)?s for 2DE (p<0.001). At peak stress, RT3DE had a higher wall?motion score index (1.25 (0.24) by 2DE, 1.30 (0.27) by RT3DE; p?=?0.014). The regional wall?motion score for the four apical segments at peak stress was compared; it was 1.35 (0.55) by 2DE and 1.52 (0.69) by RT3DE (p?=?0.003). The diagnostic parameters of 2DE versus RT3DE were: sensitivity 73% vs 78%, specificity 93% vs 89% and overall accuracy 86% vs 85%, respectively. In the left anterior descending artery territory, in particular, where RT3DE had higher regional wall?motion scores, it showed a tendency towards higher sensitivity (85% vs 78%), although this difference did not achieve statistical significance. Conclusion RT3DE identifies wall?motion abnormalities more readily in the apical region than 2DE, which may explain the tendency towards higher sensitivity in the left anterior descending artery territory. RT3DE results were validated using angiography as reference and findings indicate diagnostic equivalence to 2DE, with the advantage of considerable shorter acquisition times.

Aggeli, Constadina; Giannopoulos, Georgios; Misovoulos, Platon; Roussakis, George; Christoforatou, Euaggelia; Kokkinakis, Christos; Brili, Stela; Stefanadis, Christodoulos



Spectrum of congenital heart disease in a tropical environment: an echocardiography study.  

PubMed Central

Echocardiography is a major mode of cardiovascular imaging with versatile applications. Modern two-dimensional echocordiographic techniques provide a comprehensive means for evaluating virtually all forms of congenital heart disease (CHD) found in both adults and children. CHD is an abnormality in cardiocirculatory structure or function that is present at birth, even if it is discovered much later. We set out to describe the spectrum of CHD using echocardiography in two centers in Kano, northern Nigeria. In this retrospective study, transthoracic echocardiography (TTE) data collected from two echocardiography laboratories in Kano over a period of 48 months (June 2002 to May 2006) were reviewed. Patients with diagnosis of congenital heart disease were selected. Information obtained from the records included the age, gender, clinical diagnosis and echocardiographic findings. One-hundred-twenty-two patients had CHD, making 9.3% of the 1312 patients with abnormal echocardiograms. There were 73 males and 49 females (ratio 1.5:1); and their ages ranged from nine days to 35 years. Forty-one (33.6%) children presented for echocardiography before the age of one year, and 69% presented before the age of five years. Thirteen (10.6%) were > or =18 years. Ventricular septal defect (VSD) was the most common echocardiographic diagnosis present in 56 patients (45.9%). Thirty-two (26.2%) had tetralogy of Fallot, and 15 (12.3%) had atrial septal defect (ASD). Ten (8.2%) had endocardial cushion defect, and nine (7.4%) had other congenital heart abnormalities. Coarctation of the aorta and aortic stenosis were rare. CHD is a common cardiovascular problem in our setting, and a number of patients were diagnosed in adulthood. With increasing availability of echocardiographic facilities, more cases of CHD are likely to be identified early.

Sani, Mahmoud U.; Mukhtar-Yola, Mariya; Karaye, Kamilu M.



Asia: Showing the Changing Seasons  

NSDL National Science Digital Library

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

Allen, Jesse; Newcombe, Marte; Feldman, Gene



Transesophageal echocardiography of the left ventricular outflow tract, aortic valve and ascending aorta in Boxer dogs with heart murmurs.  


The study was aimed at evaluating the anatomy of the left ventricular outflow tract, aortic valve, and ascending aorta by means of multiplane transesophageal echocardiography in Boxer dogs with left basilar heart murmurs and at comparing two-dimensional (2D) transthoracic to transesophageal echocardiography for the diagnosis of subaortic stenosis in this breed. Twenty-eight Boxers were included in the study and allocated to four groups according to physical and routine transthoracic 2D and Doppler echocardiography findings: group A--dogs with low grade (I-II/VI) heart murmurs without overt evidence of aortic stenosis (14 dogs); group B--dogs with type 1 subaortic stenosis (seven dogs); group C--dogs with type 2 subaortic stenosis (five dogs); group D--dogs with type 3 subaortic stenosis (two dogs). Anatomic lesions were not discovered by transesophageal echocardiography in dogs belonging to group A. Transesophageal imaging confirmed the type of subaortic stenosis, as graded by transthoracic echocardiography, in diseased animals (groups BCD). Morphologic information obtained by transesophageal echocardiography in Boxer dogs was similar to that obtained by transthoracic echocardiography. PMID:16700184

Quintavalla, Cecilia; Pradelli, Danitza; Domenech, Oriol; Bussadori, Claudio



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

28. MAP SHOWING LOCATION OF ARVFS FACILITY AS BUILT. SHOWS LINCOLN BOULEVARD, BIG LOST RIVER, AND NAVAL REACTORS FACILITY. F.C. TORKELSON DRAWING NUMBER 842-ARVFS-101-2. DATED OCTOBER 12, 1965. INEL INDEX CODE NUMBER: 075 0101 851 151969. - Idaho National Engineering Laboratory, Advanced Reentry Vehicle Fusing System, Scoville, Butte County, ID


Comparison of anticoagulant and anti-inflammatory responses using enoxaparin versus unfractionated heparin for transesophageal echocardiography-guided cardioversion of atrial fibrillation.  


The Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) II study compared enoxaparin with unfractionated heparin (UFH) as bridging therapy in patients with atrial fibrillation >2 days in duration who underwent transesophageal echocardiography-guided cardioversion. In the present study, the anticoagulant and anti-inflammatory effects of enoxaparin and UFH were compared at prespecified time points. In a randomized substudy of 155 patients from 17 clinical sites, the anticoagulant activity of enoxaparin (n = 76) was compared with that of UFH (n = 79). Blood samples were drawn at enrollment, on day 2, and on day 4 in the 2 groups. Blood samples were evaluated for anticoagulant activity by measuring the activated partial thromboplastin time, anti-Xa, anti-IIa, and tissue factor pathway inhibitor levels. In addition, levels of coagulation activation (by thrombin antithrombin complex) and inflammation (by highly sensitive C-reactive protein) were measured. The results of this substudy showed that the anti-Xa levels in the 2 groups increased on day 2. Similar increases in anti-Xa were observed on day 4. The anti-Xa levels and tissue factor pathway inhibitor levels were higher in the enoxaparin group compared with the UFH group on days 2 and 4. However, as expected, the anti-IIa levels in the UFH group were higher. In addition, markers of coagulation activation and inflammation were increased in patients with atrial fibrillation. Treatment with enoxaparin significantly decreased thrombin antithrombin complex levels compared with treatment with UFH. Highly sensitive C-reactive protein levels were also decreased after treatment in the 2 groups. In conclusion, the ACUTE II study showed that the use of enoxaparin for bridging therapy in patients with atrial fibrillation who underwent transesophageal echocardiography-guided cardioversion resulted in a more predictable and stronger anticoagulant response than that observed with UFH. Markers of inflammation were also decreased in the 2 groups. PMID:18805108

Hoppensteadt, Debra; Fareed, Jawed; Klein, Allan L; Jasper, Susan E; Apperson-Hansen, Carolyn; Lieber, Elizabeth A; Katz, William E; Malouf, Joseph F; Stoddard, Marcus F; Pape, Linda A



Impact of Acute Biventricular Pacing on Left Ventricular Performance and Volumes in Patients with Severe Heart Failure  

Microsoft Academic Search

Objectives: We used tissue velocity imaging (TVI) and three-dimensional echocardiography to evaluate the effect of acute biventricular pacing on left ventricular (LV) performance and volumes in patients with severe heart failure and bundle branch block. Background: Biventricular pacing causes acute hemodynamic improvement in patients with severe heart failure, and QRS duration has been used as a predictor of improved resynchronization.

Peter Søgaard; Won Yong Kim; Henrik Kjaerulf Jensen; Peter Mortensen; Anders Kirstein Pedersen; Bent Østergaard Kristensen; Henrik Egeblad



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

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

Thomas D Scholz; Michael G Kienzle



Assessment of myocardial viability in patients with acute myocardial infarction by two-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography.  


It is clinically important to determine the myocardial viability of regional wall motion abnormality segments in patients with acute myocardial infarction (AMI). The purpose of this study was to ascertain the ability and value of a combination of speckle tracking echocardiography (STE) and low dose dobutamine stress echocardiography (LDDSE) for the evaluation of viable myocardium in patients with AMI. Forty-two hospitalized patients with AMI and left ventricular systolic dysfunction (left ventricular ejection fraction <50%) were underwent STE in conjunction with LDDSE and dual isotope simultaneous acquisition single photon emission computed tomography (DISA-SPECT). Percutaneous coronary intervention (PCI) was performed subsequently in all patients. STE was used to measure radial, circumferential, and longitudinal end-systolic strain and peak systolic strain rate. The movement of each segment was observed by routine echocardiography 1, 3, and 6 months after PCI, and its improvement over time was the criterion of viable myocardium. The sensitivity, specificity and accuracy of DISA-SPECT for the assessment of viable myocardium were 83.6, 74.4, and 80.7%, respectively. Among the radial, circumferential, and longitudinal strain and strain rate parameters, only longitudinal strain (LS) and longitudinal strain rate (LSr) at rest and LDDSE emerged as independent predictors of viable myocardium, When combining LS and LSr at LDDSE, the sensitivity, specificity and accuracy for the assessment of viable myocardium rose to 89.8, 90.2 and 89.9%, respectively. The sensitivity of STE in conjunction with LDDSE was similar to DISA-SPECT for detecting viable myocardium in patients with AMI, but the specificity and accuracy of STE performed with LDDSE were higher than DISA-SPECT. PMID:23358919

Gong, Lei; Li, Dongye; Chen, Junhong; Wang, Xiaoping; Xu, Tongda; Li, Wenhua; Ren, Shaoyang; Wang, Cheng



Severe Weather  

NSDL National Science Digital Library

Educating the public about safety issues related to severe weather is part of the National Oceanic and Atmospheric Administration's (NOAA) mission. The National Weather Service (NWS)--which is part of NOAA and its parent agency, the Department of Commerce--is charged with the critical responsibility of observing and reporting the weather and with issuing forecasts and warnings of weather and floods in the interest of national safety and economy. Through a massive network of weather-monitoring and reporting stations around the globe, including land, sea, air, and space-borne instruments, NWS scientists constantly assimilate all of the reliable weather data available. Much of this data are then used in numerical computer models of the atmosphere that help to accurately describe and interpret current conditions and produce the best possible forecasts of future weather.

Forde, Evan B.