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Sample records for echocardiography transesophageal

  1. Artifacts in three-dimensional transesophageal echocardiography.

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    Faletra, Francesco Fulvio; Ramamurthi, Alamelu; Dequarti, Maria Cristina; Leo, Laura Anna; Moccetti, Tiziano; Pandian, Natesa

    2014-05-01

    Three-dimensional (3D) transesophageal echocardiography (TEE) is subject to the same types of artifacts encountered on two-dimensional TEE. However, when displayed in a 3D format, some of the artifacts appear more "realistic," whereas others are unique to image acquisition and postprocessing. Three-dimensional TEE is increasingly used in the setting of percutaneous catheter-based interventions and ablation procedures, and 3D artifacts caused by the metallic components of catheters and devices are particularly frequent. Knowledge of these artifacts is of paramount relevance to avoid misinterpretation of 3D images. Although artifacts and pitfalls on two-dimensional echocardiography are well described and classified, a systematic description of artifacts in 3D transesophageal echocardiographic images and how they affect 3D imaging is still absent. The aim of this review is to describe the most relevant artifacts on 3D TEE, with particular emphasis on those occurring during percutaneous interventions for structural heart disease and ablation procedures.

  2. Transesophageal echocardiography: Instrumentation and system controls

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    Mahesh Prabhu

    2012-01-01

    Full Text Available Transesophageal echocardiography (TEE is a semi-invasive, monitoring and diagnostic tool, which is used in the perioperative management of cardiac surgical and hemodynamically unstable patients. The low degree of invasiveness and the capacity to visualize and assimilate dynamic information that can change the course of the patient management is an important advantage of TEE. Although TEE is reliable, comprehensive, credible, and cost-effective, it must be performed by a trained echocardiographer who understands the indications and the potential complications of the procedure, and has the ability to achieve proper acquisition and interpretation of the echocardiographic data. Adequate knowledge of the physics of ultrasound and the TEE machine controls is imperative to optimize image quality, reduce artifacts, and prevent misinterpretation of diagnosis. Two-dimensional (2D and Motion (M mode imaging are used for obtaining anatomical information, while Doppler and Color Flow imaging are used for information on blood flow. 3D technology enables us to view the cardiac structures from different perspectives. Despite the recent advances of 3D TEE, a sharp, optimized 2D image is pivotal for the reconstruction. This article describes the relevant underlying physical principles of ultrasound and focuses on a systematic approach to instrumentation and use of controls in the practical use of transesophageal echocardiography.

  3. Atherosclerotic Aortic Plaques Detected by Transesophageal Echocardiography

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    赵云; 朱文玲; 倪超; 郭丽琳; 曾勇; 方理刚

    2002-01-01

    Objective To evaluate the predictive value of atherosclerotic aortic plaques in coronary artery disease (CAD) Methods In 50patients with suspected coronary artery disease, transesophageal echocardiography was performed to examine their thoracic aortas 2 weeks before or after coronary angiography. In the cases of coronary angiography studied, stenosis of the coronary artery ≥ 50 % was considered to be due to coronary artery disease,whereas the thickness of the intima ≥ 1.3 mm was taken to be the criteria for the presence of an atherosclerotic aortic plaque on the transesophageal echocardiographic test. Results Among the 50 patients, 37 cases were diagnosed as CAD and 13 cases were considered to be normal. The plaques of the thoracic aorta were observed in 34cases in the CAD group and 3 cases in the normal group. The sensitivity and specificity of aortic plaques for CAD were 91.9 % and 76.9%, respectively. The positive and negative predictive values of the aortic plaques for CAD were 91.9% and 76.9%, respectively. The accuracy was 88.0%. 80 percent of the patients with single- yes sel disease had thoracic aortic plaques, 92 percent of the patients with two-vessel disease and 100 percent of the patients with three-vessel disease had thoracic aortic plaques. There was a significant difference in the thickness of aortic intimas between the normal group and the CAD group. Conclusions Detectingatherosclerotic plaques in the thoracic aorta with transesophageal echocardiography may be of great value in predicting the presence and extent of coronary artery disease.

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

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

    2000-01-01

    Doppler echocardiography is commonly used in the assessment of stenotic valvular orifices. We describe the application of transesophageal echocardiography for the detection of a critical ostial left main coronary stenosis. Because preoperative coronary angiography often is not routinely performed in young patients undergoing valve surgery, application of Doppler echocardiography can potentially prevent catastrophic complications, particularly in atypical cases.

  5. Minimally invasive cardiac surgery and transesophageal echocardiography

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    Ajay Kumar Jha

    2014-01-01

    Full Text Available Improved cosmetic appearance, reduced pain and duration of post-operative stay have intensified the popularity of minimally invasive cardiac surgery (MICS; however, the increased risk of stroke remains a concern. In conventional cardiac surgery, surgeons can visualize and feel the cardiac structures directly, which is not possible with MICS. Transesophageal echocardiography (TEE is essential during MICS in detecting problems that require immediate correction. Comprehensive evaluation of the cardiac structures and function helps in the confirmation of not only the definitive diagnosis, but also the success of surgical treatment. Venous and aortic cannulations are not under the direct vision of the surgeon and appropriate positioning of the cannulae is not possible during MICS without the aid of TEE. Intra-operative TEE helps in the navigation of the guide wire and correct placement of the cannulae and allows real-time assessment of valvular pathologies, ventricular filling, ventricular function, intracardiac air, weaning from cardiopulmonary bypass and adequacy of the surgical procedure. Early detection of perioperative complications by TEE potentially enhances the post-operative outcome of patients managed with MICS.

  6. Biplane transesophageal echocardiography in the normal cat.

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    Kienle, R D; Thomas, W P; Rishniw, M

    1997-01-01

    Eight healthy, adult cats were examined with biplane transesophageal echocardiography (TEE). Cats were sedated with a combination of diazepam and propofol and were examined using a 5 mm x 80 cm pediatric biplane TEE probe. Consistent images were obtained at three imaging depths within the esophagus. The caudal position provided satisfactory short-axis images of the left ventricle and heart base. The middle position provided the best long-axis views of the left atrium, left ventricle, and aorta and allowed Doppler examination of transmitral left ventricular inflow. The cranial position provided satisfactory imaging of the aorta and pulmonary artery and allowed Doppler examination of right ventricular and left ventricular outflow. Biplane TEE provides an additional method of imaging the feline heart which is complimentary to other imaging techniques and the images obtained were similar to those reported for dogs. Although TEE offers a slight advantage over transthorcic imaging for Doppler examination, the quality of the images of heart base structures was not as consistently superior to transthoracic images in cats as reported in dogs.

  7. Modifications of Oxygen Saturation During Transesophageal Echocardiography.

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    Macor, Franco; Zottarel, Gabriella; Antonini-Canterin, Francesco; Mimo, Renata; Pavan, Daniela; Cervesato, Eugenio; Nicolosi, Gianluigi; Zanuttini, Domenico

    1997-05-01

    The present study was designed: (1) to establish the effects of transesophageal echocardiography (TEE) on arterial oxygen saturation (SAO(2)%); (2) to verify the possible clinical consequences of this phenomenon; and (3) to study the possibility of predicting modifications of SAO(2)% by clinical or hemodynamic variables or by specific factors related to the TEE procedure. We prospectively studied 116 unselected patients, aged 61 +/- 12 years, who underwent diagnostic TEE for various clinical indications. Thirty-seven patients had mitral valve disease, 19 aortic valve disease, 14 combined mitroaortic disease, 8 congenital heart disease, and 38 other cardiovascular diseases. Eight patients were affected by chronic obstructive pulmonary disease. Ninety-seven patients were sedated by 4 +/- 2 mg of diazepam IV SAO(2)% (5-min average) (Ohmeda Biox 3700 pulse oxymeter finger probe), heart rate (HR), and blood pressure (BP) were considered during baseline transthoracic examination, after pharmacological sedation but before the introduction of the probe, and finally during TEE. Neither clinical complications nor major arrhythmias were observed. Baseline SAO(2)%, HR and BP were, respectively, 93.6 +/- 3.3%, 76 +/- 14 beats/min, and 129 +/- 20/75 +/- 10 mmHg. Pharmacological sedation did not modify SAO(2)%, HR, and BP (P > 0.1). During TEE a small but significant reduction in SAO(2)% by an average of 1.2 +/- 3.2% was observed (P 0.1 for both systolic and diastolic). The changes of SAO(2)% and HR were not interrelated and were not related to the duration of the procedure and to any of the clinical and hemodynamic variables taken into consideration. TEE can induce a small but significant drop in SAO(2)% and a small increase in HR even without any clinical relevance. No clinical or hemodynamic variable or specific factors related to the TEE procedure were related to these changes.

  8. Trans-esophageal echocardiography for tricuspid and pulmonary valves

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    Prabhu Mahesh

    2009-01-01

    Full Text Available 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.

  9. CLINICAL APPLICATION OF OMNIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY

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    王国干; 刘汉英; 孟宪强; 程克正

    1996-01-01

    One hundred and twenty-four patients with heart disease (75 cases of rheumatic heart disease, 26 cases of congenital heart disease, 13 cases of aortic disease and 10 cases of other disease) were examined byOmniplane transesophageal eehoeardiography (TEE). The result showed that Omniplane TEE transducercan be rotated from 0° to 180° in probe and had the advantages o1[ broader scope, obtaining more niforma-tion, le~ stimulation to esophagus and easy to manipulate. It suggests that Omniplane TEE is a efficient technique in clinical diagnosis and can be extensively used in the future.

  10. How standard transesophageal echocardiography views change with dextrocardia.

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

    2013-01-01

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

  11. [Peculiarities of the transesophageal echocardiography in octogenarian patients].

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    Canale, Jesús M; Cardoza-Encinas, Rubén; Canale-Segovia, Andrés

    The growing trend in the absolute and relative number of elderly in the population scheme, the increasing prevalence of heart disease as people get older and the impressive technological development of ultrasound devices have all together recently contributed to promote an increasing number of transesophageal echocardiograms in older patients, however, the already published information about the distinguishing features of this diagnostic methodology in elderly patients is still scarce and seems to be insufficient. This review focuses on the already published methodological and diagnostic features related to the transesophageal echocardiography in the octogenarian -or even older patient- in order to show them in an orderly and systematic manner to provide elements that induce useful clinical criteria for the physician who attends patients in this age group in whom this diagnostic modality is now increasingly requested. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  12. Feasibility of diagnosis of postcardiotomy tamponade by miniaturized transesophageal echocardiography.

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    Hirose, Hitoshi; Gupta, Shreya; Pitcher, Harrison; Miessau, Joseph; Yang, Qiong; Yang, Jenny; Cavarocchi, Nicholas

    2014-07-01

    Pericardial tamponade after cardiac surgery is a critical diagnosis that can be difficult to diagnose using conventional cardiac monitoring. Transesophageal echocardiography can provide comprehensive information to make the diagnosis but is not always available, whereas transthoracic echocardiography has its utility limited because of the body habitus or other surgical effects. New monitoring devices, miniaturized hemodynamic transesophageal echocardiography (hTEE), which allows point of care assessment of cardiac filling and functions, may aid in diagnosis of postcardiotomy tamponade. From May 2011 to July 2013, 21 patients underwent hTEE to rule out pericardial tamponade for clinical suspicion of tamponade after open heart surgery. The hTEE images were reviewed, and the patient outcomes were analyzed. Nine patients showed no evidence of pericardial collection and did not require reexploration. Two patients showed a presence of small hematoma without ventricular compression and also did not undergo exploration. Ten patients were positive for pericardial tamponade (effusion or hematoma with ventricular compression); eight of these cases underwent emergent surgical exploration. Of the two patients who did not undergo immediate reoperation, one was managed by chest tube manipulation and the other patient underwent subsequent surgical exploration after his extensive coagulopathy was corrected by medical treatment. The diagnosis of pericardial tamponade postcardiotomy is feasible using a disposable hTEE based on our limited experience. We avoided unnecessary explorations while concomitantly made prompt diagnosis in emergent situations. The hTEE device was a valuable tool in hemodynamic management in the intensive care unit, allowing rapid evaluations. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Hypnosis for sedation in transesophageal echocardiography: a comparison with midazolam.

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    Eren, Gulay; Dogan, Yuksel; Demir, Guray; Tulubas, Evrim; Hergunsel, Oya; Tekdos, Yasemin; Dogan, Murat; Bilgi, Deniz; Abut, Yesim

    2015-01-01

    Transesophageal echocardiography (TEE), being a displeasing intervention, usually entails sedation. We aimed to compare the effects of hypnosis and midazolam for sedation in TEE. A prospective single-blinded study conducted on patients scheduled for TEE between April 2011 and July 2011 at a university in Istanbul, Turkey. A total of 41 patients underwent sedation using midazolam and 45 patients underwent hypnosis. Patients were given the State-Trait Anxiety Inventory (STAI) test for anxiety and continuous performance test (CPT) for alertness before and after the procedure. The difficulty of probing and the overall procedure rated by the cardiologist and satisfaction scores of the patients were also documented. Anxiety was found to be less and attention more in the hypnosis group, as revealed by STAI and CPT test scores (P Hypnosis proved to be associated with positive therapeutic outcomes for TEE with regard to alleviation of anxiety and maintenance of vigilance, thus providing more satisfaction compared to sedation with midazolam.

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

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    Tiago Tribolet de Abreu

    2008-02-01

    Full Text Available Tiago Tribolet de Abreu, Sonia Mateus, Cecilia Carreteiro, Jose CorreiaLaboratorio de Ultrasonografia Cardiaca e Neurovascular, Hospital do Espirito Santo-Evora, E. P. E., PortugalBackground: The role of transesophageal echocardiography (TEE in the evaluation of acute stroke patients is still ill-defined. We conducted a prospective observational study to find the prevalence of TEE findings that indicate anticoagulation as beneficial, in acute ischemic stroke patients without indication for anticoagulation based on clinical, electrocardiographic and transthoracic echocardiography (TTE findings.Methods: We prospectively studied all patients referred to our laboratory for TTE and TEE. Patients were excluded if the diagnosis was not acute ischemic stroke or if they had an indication for anticoagulation based on clinical, electrocardiographic, or TTE data. Patients with TEE findings that might indicate anticoagulation as beneficial were identified.Results: A total of 84 patients with acute ischemic stroke and without indication for anticoagulation based on clinical and electrocardiographic or TTE data were included in the study. Findings indicating anticoagulation as beneficial were found in 32.1%: spontaneous echo contrast (1.2%, complex aortic atheroma (27.4%, thrombus (8.3%, and simultaneous patent foramen ovale and atrial septal aneurysm (2.4%.Conclusions: The results of our study show that TEE can have therapy implications in 32.1% of ischemic stroke patients in sinus rhythm and with TTE with no indication for anticoagulation.Keywords: acute ischemic stroke, transesophageal echocardiography, transthoracic echocardiography, therapy

  15. Potential applications for transesophageal echocardiography in hypertrophic cardiomyopathies.

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    Widimsky, P; Ten Cate, F J; Vletter, W; van Herwerden, L

    1992-01-01

    The purpose of the present study was to evaluate the potential advantages of transesophageal echocardiography (TEE) in comparison with transthoracic echocardiography (TTE) in selected patients with hypertrophic cardiomyopathy. Ten patients with previously established or suspected diagnosis of hypertrophic cardiomyopathy were examined by TEE to solve specific clinical questions. TEE was well tolerated by all patients; no arrhythmias were seen during the procedure. The comparison of TTE and TEE showed the following: Advantages of TTE--better assessment of the left ventricle, myocardial thickness measurements available in all regions and sufficient for the diagnosis of hypertrophic cardiomyopathy in nine out of 10 patients; advantages of TEE--precise assessment of mitral valve morphology and regurgitant jets, detailed evaluation of systolic anterior motion, and subaortic membrane (not seen by TTE) recognized in one patient. Clinically, in three patients TEE influenced the management (mitral leaflet perforation, subaortic membrane, and residual mitral regurgitation after valvuloplasty). Thus TEE enables more precise diagnosis in some patients with hypertrophic cardiomyopathy and has the potential to influence their surgical management. However, for medical treatment of hypertrophic cardiomyopathy, TTE is sufficient.

  16. Transesophageal echocardiography. 3. rev. and enl. ed.; Transoesophageale Echokardiografie. Lehrbuch und Altlas zur Untersuchungstechnik und Befundinterpretation

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    Lambertz, Heinz [ECHOECUCT-Akademie, Wiesbaden (Germany); Lethen, Harald (eds.) [Internistische Intensivmedizin, Wiesbaden (Germany). Innere Medizin/Kardiologie

    2013-02-01

    The book on transesophageal echocardiography covers the following issues: Development of transesophageal echocardiography, technical advances; indications and contraindication for transesophageal echocardiography; systematic of the medical examination process; cardiac valves and valve prostheses; mitral and aortic valvuloplasty, TAVI and interventional treatment of mitral regurgitation; infectious endocarditis; one-way and effluence disturbances of the left and right ventricle; diseases of the thoracic aorta; undefined right ventricle enlargement; lung embolism, acute infarct complications; TEE during anesthesia and perioperative intensive medicine, cardiac sources of embolism; cardiac tumors, mediastinal lymph nodes; pericardiac diseases; congenital heart diseases in childhood and adulthood; catheter interventions and heart valve reconstruction; surgically corrected congenital cardiac defects; intracavitary versus transesophageal echocardiography; three-dimensional TEE; coronary diagnostics; ischemia and vitality diagnostics.

  17. Mycotic aneurysm of the descending thoracic aorta: the role of transesophageal echocardiography.

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    Joffe, I I; Emmi, R P; Oline, J; Jacobs, L E; Owen, A N; Ioli, A; Najjar, D; Kotler, M N

    1996-01-01

    Mycotic aneurysms of the aorta are prone to rupture. Thus rapid and accurate diagnosis is essential so that surgical repair can be undertaken. We report a case of mycotic aortic aneurysm caused by mitral valve endocarditis. The aneurysm situated at the junction of the thoracoabdominal aorta was readily detected by transesophageal echocardiography. Computed tomography and aortography were complementary to transesophageal echocardiography in establishing the diagnosis. The patient underwent successful repair and acute inflammation of the aneurysm was present at histologic examination.

  18. Papillary muscle rupture caused by bacterial endocarditis: role of transesophageal echocardiography.

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    Habib, G; Guidon, C; Tricoire, E; Djiane, V; Monties, J R; Luccioni, R

    1994-01-01

    A 22-year-old man had severe pulmonary congestion and required mechanical ventilation. Endocarditis was suspected because a 2/6 systolic murmur was heard at the apex and because Osler nodes were present. Transthoracic and transesophageal echocardiography allowed correct diagnosis of papillary muscle rupture causing massive mitral regurgitation. To our knowledge, this is the first reported case of papillary muscle rupture caused by bacterial endocarditis diagnosed by transthoracic and transesophageal echocardiography.

  19. ADDITIONAL VALUE OF BIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN ASSESSING THE GENESIS OF MITRAL REGURGITATION AND THE FEASIBILITY OF VALVE REPAIR

    NARCIS (Netherlands)

    PIEPER, EPG; HELLEMANS, IM; HAMER, HPM; RAVELLI, ACJ; VANDENBRINK, RBA; EBELS, T; LIE, KI; VISSER, CA

    1995-01-01

    To determine the additional diagnostic value of biplane transesophageal echocardiography (TEE) in patients undergoing mitral valve surgery, we studied 48 patients with severe mitral regurgitation. Transesophageal echocardiographic video recordings were reorganized in separate transverse and longitud

  20. The Preoperative Evaluation of Infective Endocarditis via 3-Dimensional Transesophageal Echocardiography.

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    Yong, Matthew S; Saxena, Pankaj; Killu, Ammar M; Coffey, Sean; Burkhart, Harold M; Wan, Siu-Hin; Malouf, Joseph F

    2015-08-01

    Transesophageal echocardiography continues to have a central role in the diagnosis of infective endocarditis and its sequelae. Recent technological advances offer the option of 3-dimensional imaging in the evaluation of patients with infective endocarditis. We present an illustrative case and review the literature regarding the potential advantages and limitations of 3-dimensional transesophageal echocardiography in the diagnosis of complicated infective endocarditis. A 51-year-old man, an intravenous drug user who had undergone bioprosthetic aortic valve replacement 5 months earlier, presented with prosthetic valve endocarditis. Preoperative transesophageal echocardiography with 3D rendition revealed a large abscess involving the mitral aortic intervalvular fibrosa, together with a mycotic aneurysm that had ruptured into the left atrium, resulting in a left ventricle-to-left atrium fistula. Three-dimensional transesophageal echocardiography enabled superior preoperative anatomic delineation and surgical planning. We conclude that 3-dimensional transesophageal echocardiography can be a useful adjunct to traditional 2-dimensional transesophageal echocardiography as a tool in the diagnosis of infective endocarditis.

  1. Transesophageal echocardiography in the management of burn patients.

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    Maybauer, Marc O; Asmussen, Sven; Platts, David G; Fraser, John F; Sanfilippo, Filippo; Maybauer, Dirk M

    2014-06-01

    A systematic review was conducted to assess the level of evidence for the use of transesophageal echocardiography (TEE) in the management of burn patients. We searched any article published before and including June 30, 2013. Our search yielded 118 total publications, 11 met the inclusion criteria of burn injury and TEE. Available studies published in any language were rated and included. At the present time, there are no available systematic reviews/meta-analyses published that met our search criteria. Only a small number of clinical trials, all with a limited number of patients were available. Therefore, a meta-analysis on outcome parameters was not performed. However, the major pathologic findings in burn patients were reduced left ventricular (LV) systolic and diastolic function, mitral valve vegetation, pulmonary hypertension, pericardial effusion, fluid overload, and right heart failure. The advantages of TEE include offering direct assessment of cardiac valve competency, myocardial contractility, and most importantly real time assessment of adequacy of hemodynamic resuscitation and preload in the acute phase of resuscitation, with minimal additional risk. TEE serves multiple diagnostic purposes and is being used to better understand the fluid status and cardiac physiology of the critically ill burn patient. Randomized controlled trials especially on fluid resuscitation and cardiac performance in acute burns are warranted to potentially further improve outcome.

  2. Esophageal rupture: a severe complication of transesophageal echocardiography

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    Fernando Peixoto Ferraz de Campos

    2012-12-01

    Full Text Available Since when the first transesophageal echocardiography (TEE was undertaken in 1975, technological advances have made this diagnostic modality more reliable. TEE indications became widespread in cardiac and non-cardiac surgeries, intensive care units, and ambulatory clinics. The procedure is generally considered a safe diagnostic tool, but occasionally complications do occur. The insertion and manipulation of the ultrasound probe can cause oropharyngeal, esophageal, or gastric trauma. Although rare, these complications may present a mortality rate of up to 56% depending on the treatment approach and the elapsed time to the diagnosis. The authors report a case of a 65-year-old woman submitted to attempt a TEE in order to better study or diagnose an inter-atrial communication. After 3 days of the procedure, the patient was admitted to the hospital with edema, hyperemia of the anterior face of the neck, accompanied by systemic symptoms. The imaging diagnostic work-up evidenced signs of esophageal rupture and upper mediastinal involvement, the former confirmed by upper gastrointestinal endoscopy. The patient was treated with antibiotics and cervical and mediastinal drainage, with a favorable outcome.

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

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

    1991-01-01

    Presence of a patent foramen ovale may indicate paradoxic embolism in patients with otherwise unexplained embolic disease. Transthoracic contrast echocardiography has been used as a simple technique for detecting patent foramen ovale. However, particularly in patients with poor transthoracic image quality, presence of a patent foramen ovale might be missed. Transesophageal contrast echocardiography provides superior visualization of the atrial septum and therefore is believed to improve diagnostic accuracy. The present study investigates the influence of image quality on the detection of a patent foramen ovale by both transthoracic and transesophageal contrast echocardiography.

  4. [Multiplane transesophageal echocardiography for the monitoring of cardiac surgery].

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    Pepi, M; Barbier, P; Doria, E; Tamborini, G; Berti, M; Muratori, M; Guazzi, M; Maltagliati, A; Alimento, M; Celeste, F

    1994-08-01

    Multiplane transesophageal echocardiography (TEE) allows visualization of the heart and great vessels through an infinite number of imaging planes and improves the diagnostic capabilities of mono and biplane TEE. This study was undertaken to test whether MTEE is a useful intraoperative monitoring method during cardiac surgery. Intraoperative multiplane TEE was performed in 200 patients (mean age 56 +/- 19 years) as a part of the routine clinical care. We systematically acquired cardiac images from the gastric fundus (short and long axes of the ventricles), lower esophagus (four-chamber, two-chamber, and long axis), upper esophagus (13 views concerning the aorta, pulmonary artery, left and right atrium, systemic and pulmonary veins, coronary arteries, right ventricular outflow tract), and searched for complete views of the thoracic descending aorta. All views analyzed in the preoperative (immediately before cardiopulmonary bypass), intraoperative and postoperative phases evaluating: the angle between current and 0 degree at which each view was obtained; the success rate of each view; the usefulness of the different views in providing essential additional clinical information compared to 0 degrees and 90 degrees of the traditional biplane TEE. Most views of the heart and great vessels were visualized in oblique planes, and other views were significantly improved thanks to slight angle corrections. Multiplane TEE was particularly useful in the preoperative and postoperative phases of aortic dissection (11 cases), mitral valve repair (13 cases), left ventricular aneurysmectomy (9 cases), right atrial thrombosis (1 case), positioning of left ventricular hemopump (2 cases), mitral-aortic endocarditis (3 cases), bleeding from proximal suture of an aortic heterograft (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Live three-dimensional transesophageal echocardiography in mitral valve surgery

    Institute of Scientific and Technical Information of China (English)

    MA Ning; LI Zhi-an; MENG Xu; YANG Ya

    2008-01-01

    Background Live three-dimensional transesophageal echocardiography (live-3D-TEE) is a new technique, but its clinical value is unclear at present. This study aimed to investigate the feasibility, imaging quality and accuracy of live-3D-TEE for assessing mitral valve morphology to determine if live-3D-TEE has important value in mitral valve surgery.Methods Twenty-four patients with mitral valve disease (mean age (47.1 rdiography (2D-TEE) before and after mitral valve surgery. Sensitivity, specificity, and total consistency rates of live-3D-TEE for diagnosing ruptured chordae were calculated and compared to surgeon's findings. We also compared the diagnostic accuracy of mitral valve disease between live-3D-TEE and 2D-TEE.Results Live-3D-TEE allowed visualization of the anatomic structure of the heart online and clearly identified the valvular apparatus and their defects. Sensitivity and specificity for the detection of ruptured chordae by live-3D-TEE were 87.5% and 100% respectively, and the total consistency rate was 95.8%. Additional defects not diagnosted by 2D-TEE were found in three cases (12.5%) preoperatively by live-3D-TEE. Live-3D-TEE could evaluate the function of prosthetic or native valves immediately after operation. One case was re-repaired (4.2%) using guidance by live-3D-TEE. Conclusion Live-3D-TEE enabled evaluation of mitral valve function and provided adequate valuable information before and after mitral valve surgery. We conclude that live-3D-TEE can play an important role in mitral valve surgery.

  6. Incremental Value of Three-Dimensional Transesophageal Echocardiography over the Two-Dimensional Technique in the Assessment of a Thrombus in Transit through a Patent Foramen Ovale.

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    Thind, Munveer; Ahmed, Mustafa I; Gok, Gulay; Joson, Marisa; Elsayed, Mahmoud; Tuck, Benjamin C; Townsley, Matthew M; Klas, Berthold; McGiffin, David C; Nanda, Navin C

    2015-05-01

    We report a case of a right atrial thrombus traversing a patent foramen ovale into the left atrium, where three-dimensional transesophageal echocardiography provided considerable incremental value over two-dimensional transesophageal echocardiography in its assessment. As well as allowing us to better spatially characterize the thrombus, three-dimensional transesophageal echocardiography provided a more quantitative assessment through estimation of total thrombus burden.

  7. The Heart of the Matter: Increasing Quality and Charge Capture from Intraoperative Transesophageal Echocardiography.

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    Sanford, Joseph A; Kadry, Bassam; Oakes, Daryl; Macario, Alex; Schmiesing, Cliff

    2016-04-15

    Although transesophageal echocardiography is routinely performed at our institution, there is no easy way to document the procedure in the electronic medical record and generate a bill compliant with reimbursement requirements. We present the results of a quality improvement project that used agile development methodology to incorporate intraoperative transesophageal echocardiography into the electronic medical record. We discuss improvements in the quality of clinical documentation, technical workflow challenges overcome, and cost and time to return on investment. Billing was increased from an average of 36% to 84.6% when compared with the same time period in the previous year. The expected recoupment of investment for this project is just 18 weeks.

  8. Avoiding transthoracic echocardiography and transesophageal echocardiography for patients with variable body mass indexes in infective endocarditis

    Directory of Open Access Journals (Sweden)

    Robert Sogomonian

    2016-04-01

    Full Text Available Background: Echocardiography has been a popular modality used to aid in the diagnosis of infective endocarditis (IE with the modified Duke criteria. We evaluated the necessity between the uses of either a transthoracic echocardiography (TTE or transesophageal echocardiography (TEE in patients with a body mass index (BMI greater than or equal to 25 kg/m2 and less than 25 kg/m2. Methods: A single-centered, retrospective study of 198 patients between 2005 and 2012 diagnosed with IE based on modified Duke criteria. Patients, required to be above age 18, had undergone an echocardiogram study and had blood cultures to be included in the study. Results: Among 198 patients, two echocardiographic groups were evaluated as 158 patients obtained a TTE, 143 obtained a TEE, and 103 overlapped with TEE and TTE. Out of these patients, 167 patients were included in the study as 109 (65% were discovered to have native valve vegetations on TEE and 58 (35% with TTE. TTE findings were compared with TEE results for true negatives and positives to isolate valvular vegetations. Overall sensitivity of TTE was calculated to be 67% with a specificity of 93%. Patients were further divided into two groups with the first group having a BMI ≥25 kg/m2 and the subsequent group with a BMI <25 kg/m2. Patients with a BMI ≥25 kg/m2 who underwent a TTE study had a sensitivity and specificity of 54 and 92%, respectively. On the contrary, patients with a BMI < 25 kg/m2 had a TTE sensitivity and specificity of 78 and 95%, respectively. Conclusions: Patients with a BMI <25 kg/m2 and a negative TTE should refrain from further diagnostic studies, with TEE strong clinical judgment is warranted. Patients with a BMI ≥ 25 kg/m2 may proceed directly to TEE as the initial study, possibly avoiding an additional study with a TTE.

  9. Manual Skill Acquisition During Transesophageal Echocardiography Simulator Training of Cardiology Fellows : A Kinematic Assessment

    NARCIS (Netherlands)

    Matyal, Robina; Montealegre-Gallegos, Mario; Mitchell, John D.; Kim, Han; Bergman, Remco; Hawthorne, Katie M.; O'Halloran, David; Wong, Vanessa; Hess, Phillip E.; Mahmood, Feroze

    2015-01-01

    Objective: To investigate whether a transesophageal echocardiography (TEE) simulator with motion analysis can be used to impart proficiency in TEE in an integrated curriculum-based model. Design: A prospective cohort study. Setting: A tertiary-care university hospital. Participants: TEE-naive cardio

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

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    Neeti Makhija

    2014-01-01

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

  11. Off-pump atrial septostomy with thoracoscopic scissors under transesophageal echocardiography guidance

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    Raj R Benedict

    2013-01-01

    Full Text Available Selected children with congenital heart defects undergoing palliative closed heart procedures require a cardiopulmonary bypass (CPB run only for the purpose of creating an inter-atrial communication. We report a simple technique of atrial septostomy using thoracoscopy scissors under transesophageal echocardiography guidance without the need for CPB.

  12. Modified transesophageal echocardiography of the dissected thoracic aorta; A novel diagnostic approach

    NARCIS (Netherlands)

    Jansen Klomp, Wouter W.; Peelen, Linda M.; Brandon Bravo Bruinsma, George J.; Van'T Hof, Arnoud W J; Grandjean, Jan G.; Nierich, Arno P.

    2016-01-01

    Background: Transesophageal echocardiography (TEE) is a key diagnostic modality in patients with acute aortic dissection, yet its sensitivity is limited by a "blind-spot" caused by air in the trachea. After placement of a fluid-filled balloon in the trachea visualization of the thoracic aorta become

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

    Science.gov (United States)

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

    2016-02-01

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

  14. Effect of Jaw Thrust on Transesophageal Echocardiography Probe Insertion and Concomitant Oropharyngeal Injury.

    Science.gov (United States)

    Chang, Jee-Eun; Min, Seong-Won; Kim, Chong-Soo; Lee, Jung-Man; No, Hyunjoung; Hwang, Jin-Young

    2015-10-01

    The aim of this study was to evaluate the effect of jaw thrust on transesophageal echocardiography probe insertion and concomitant oropharyngeal injury. A prospective, randomized study Medical center governed by a university hospital Forty-two adult patients undergoing cardiovascular surgery were included. After the induction of anesthesia, a transesophageal echocardiography probe was inserted using an anterior jaw lift technique (conventional group, n = 21) or a jaw thrust-assisted technique (jaw thrust group, n = 21). The incidence of oropharyngeal injury, number of insertion attempts, blood on the probe tip, and presence of persistent oropharyngeal bleeding were evaluated. In the conventional group, oropharyngeal injury occurred more frequently than in the jaw-thrust group (52.4% v 9.5%, respectively; p = 0.006). Regarding transesophageal echocardiography probe insertion, the conventional group required more attempts than the jaw-thrust group (p = 0.043). The incidence of blood on the probe tip was higher in the conventional group than in the jaw-thrust group (p = 0.020), but the presence of persistent oropharyngeal bleeding was similar between the 2 groups. The jaw-thrust maneuver facilitated the insertion of the transesophageal echocardiography probe and reduced concomitant oropharyngeal injury. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. CLINICAL ASSESSMENT OF BIPLANAR TRANSESOPHAGEAL ECHOCARDIOGRAPHY- A REPORT OF 125 CASES

    Institute of Scientific and Technical Information of China (English)

    王国干; 孟宪强; 樊朝美; 张辉; 刘醒; 刘汉英; 蔡如升

    1994-01-01

    One hundred and twenty-five patients with cardiovascular disease were examined by biplanar transesophageal echocardiography(BTEE),including 67 with rheumatic heart disease(7 monitored during operation),22 with aortic diseases,20 with congenital heart diseases,and 16 with other kinds of heart disease.The results showed that BTEE was not influenced by corpulent and pulmonary emphysema and was better than transthoracic echocardiography at imaging the interatrial septum.left atrium and left atrial appendage,thoracic aorta,and mitral artificial valve and at intraoperative monitoring.BTEE was also better than single-plane transesophageal echocardiography,because BTEE could be used to observe the heart and thoracic aorta in transverse and longitudinal planes,thus englarging the transmission"window" as well as allowing the entire lesin to be imaged.

  16. ["Introduction to transthoracic, transesophageal and real time 3Dimensional transesophageal echocardiography"].

    Science.gov (United States)

    Erb, Joachim; Mukherjee, Chirojit; Knebel, Fabian; Ender, Jörg

    2014-12-01

    Echocardiography allows assessment of cardiac anatomy and function. A tailored approach to echocardiographic assessment is essential in hemodynamic unstable patients. Standard views allow comprehensive examination and also reduce the chances to oversee unexpected findings. TTE should be first choice in emergency and intensive care medicine. TEE is standard of care in intraoperative setting. 3 D echocardiography is valuable in specific situations. Written reporting of examination is mandatory.

  17. Interventricular septal hydatid cyst: Transesophageal echocardiography as a therapeutic tool during bypass

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    Pawan Kumar Jain

    2015-01-01

    Full Text Available Cystic echinococcosis (hydatid disease arising from infestation with a larval or adult form of the Echinococcus granulosus tapeworm is endemic in certain states of India, but affecting interventricular septum (IVS solitarily is a scarce phenomenon. We present a rare case of transesophageal echocardiography guided management of IVS hydatid cyst even during cardiopulmonary bypass, which presented with a rather unusual complaint of repeated syncope.

  18. Evaluation of Acute Ischemic Mitral Regurgitation Following Cardiopulmonary Bypass Assessed by Biplane Transesophageal Echocardiography

    OpenAIRE

    Nakao, Tatsuya; Fujimoto, Keiko; Brodman, Richard F.; Oka, Yasu

    1997-01-01

    The aim of this study was to evaluate pathogenesis and outcome of acute ischemic mitral regurgitation (MR) in patients undergoing coronary artery bypass grafting (CABG) using biplane transesophageal echocardiography (TEE).   Biplane TEE was continuously monitored in a total of 96 patients who were scheduled for elective CABG surgery. Of 96 patients, 10 with no MR at stages 1 (after anesthetic induction but before skin incision) and 2 (after cardiopulmonary bypass [CPBJ and decannulation) ...

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

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    Swathy B

    2014-09-01

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

  20. Dynamic three-dimensional reconstruction of the heart by transesophageal echocardiography

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    Veiga Maria de Fátima

    1999-01-01

    Full Text Available OBJECTIVE: To evaluate echocardiography accuracy in performing and obtaining images for dynamical three-dimensional (3D reconstruction. METHODS: Three-dimensional (3D image reconstruction was obtained in 20 consecutive patients who underwent transesophageal echocardiography. A multiplanar 5 MHz transducer was used for 3D reconstruction. RESULTS: Twenty patients were studied consecutively. The following cardiac diseases were present: valvar prostheses-6 (2 mitral, 2 aortic and 2 mitral and aortic; mitral valve prolapse- 3; mitral and aortic disease - 2; aortic valve disease- 5; congenital heart disease- 3 (2 atrial septal defect- ASD - and 1 transposition of the great arteries -TGA; arteriovenous fistula- 1. In 7 patients, color Doppler was also obtained and used for 3D flow reconstruction. Twenty five cardiac structures were acquired and 60 reconstructions generated (28 of mitral valves, 14 of aortic valves, 4 of mitral prostheses, 7 of aortic prostheses and 7 of the ASD. Fifty five of 60 (91.6% reconstructions were considered of good quality by 2 independent observers. The 11 reconstructed mitral valves/prostheses and the 2 reconstructed ASDs provided more anatomical information than two dimensional echocardiography (2DE alone. CONCLUSION: 3D echocardiography using a transesophageal transducer is a feasible technique, which improves detection of anatomical details of cardiac structures, particularly of the mitral valve and atrial septum.

  1. Three-dimensional transesophageal echocardiography: Principles and clinical applications

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    Annette Vegas

    2016-01-01

    Full Text Available A basic understanding of evolving 3D technology enables the echocardiographer to master the new skills necessary to acquire, manipulate, and interpret 3D datasets. Single button activation of specific 3D imaging modes for both TEE and transthoracic echocardiography (TTE matrix array probes include (a live, (b zoom, (c full volume (FV, and (d color Doppler FV. Evaluation of regional LV wall motion by RT 3D TEE is based on a change in LV chamber subvolume over time from altered segmental myocardial contractility. Unlike standard 2D TEE, there is no direct measurement of myocardial thickening or displacement of individual segments.

  2. Transesophageal echocardiography in patients with cryptogenic cerebral ischemia

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    Dreger Henryk

    2009-03-01

    Full Text Available Abstract Background In about one third of all patients with cerebral ischemia, no definite cause can be identified (cryptogenic stroke. In many patients with initially suspected cryptogenic stroke, however, a cardiogenic etiology can eventually be determined. Hence, the aim of this study was to describe the prevalence of abnormal echocardiographic findings in a large number of these patients. Method Patients with cryptogenic cerebral ischemia (ischemic stroke, IS, and transient ischemic attack, TIA were included. The initial work-up included a neurological examination, EEG, cCT, cMRT, 12-lead ECG, Holter-ECG, Doppler ultrasound of the extracranial arteries, and transthoracic echocardiography. A multiplane transeophageal echocardiography (TEE, including i.v. contrast medium application [Echovist], Valsalva maneuver was performed in all patients Results 702 consecutive patients (380 male, 383 IS, 319 TIA, age 18–90 years were included. In 52.6% of all patients, TEE examination revealed relevant findings. Overall, the most common findings in all patients were: patent foramen ovale (21.7%, previously undiagnosed valvular disease (15.8%, aortic plaques, aortic valve sclerosis, atrial septal aneurysms, regional myocardial dyskinesia, dilated left atrium and atrial septal defects. Older patients (> 55 years, n = 291 and patients with IS had more relevant echocardiographic findings than younger patients or patients with TIA, respectively (p = 0.002, p = 0.003. The prevalence rates of PFO or ASD were higher in younger patients (PFO: 26.8% vs. 18.0%, p = 0.005, ASD: 9.6% vs. 4.9%, p = 0.014. Conclusion A TEE examination in cryptogenic stroke reveals contributing cardiogenic factors in about half of all patients. Younger patients had a higher prevalence of PFO, whereas older patients had more frequently atherosclerotic findings. Therefore, TEE examinations seem indicated in all patients with cryptogenic stroke – irrespective of age – because of

  3. An update on transesophageal echocardiography views 2016: 2D versus 3D tee views

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    Poonam Malhotra Kapoor

    2016-01-01

    Full Text Available In 1980, Transesophageal Echocardiography (TEE first technology has introduced the standard of practice for most cardiac operating rooms to facilitate surgical decision making. Transoesophageal echocardiography as a diagnostic tool is now an integral part of intraoperative monitoring practice of cardiac anaesthesiology. Practice guidelines for perioperative transesophageal echocardiography are systematically developed recommendations that assist in the management of surgical patients, were developed by Indian Association of Cardiac Anaesthesiologists (IACTA. This update relates to the former IACTA practice guidelines published in 2013 and the ASE/EACTA guidelines of 2015. The current authors believe that the basic echocardiographer should be familiar with the technical skills for acquiring 28 cross sectional imaging planes. These 28 cross sections would provide also the format for digital acquisition and storage of a comprehensive TEE examination and adds 5 more additional views, introduced for different clinical scenarios in recent times. A comparison of 2D TEE views versus 3D TEE views is attempted for the first time in literature, in this manuscript. Since, cardiac anaesthesia variability exists in the precise anatomic orientation between the heart and the oesophagus in individual patients, an attempt has been 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.

  4. Usefulness of intravenously administered fluid replenishment for detection of patent foramen ovale by transesophageal echocardiography.

    Science.gov (United States)

    Afonso, Luis; Kottam, Anupama; Niraj, Ashutosh; Ganguly, Joya; Hari, Pawan; Simegn, Mengistu; Sudhakar, Rajeev; Jacob, Sony; Chaturvedi, Seemant; Ensing, Greg J; Abraham, Theodore P

    2010-10-01

    Patent foramen ovale (PFO) is associated with cryptogenic stroke, migraine headache, decompression sickness, and platypnea-orthodeoxia syndrome. Patients undergoing transesophageal echocardiography are often hypovolemic from preprocedural fasting and might not demonstrate right to left shunting owing to insufficient right atrial pressure generation, despite provocative maneuvers. We hypothesized that volume replenishment with saline loading could potentially unmask a PFO by favorably modulating the interatrial pressure gradient. Our study sought to examine the role of pre- or intraprocedural intravenous fluid replenishment on PFO detection during transesophageal echocardiography. A total of 103 patients were enrolled. An initial series of bubble injections was performed unprovoked and then with provocative maneuvers such as the Valsalva maneuver and coughing. The patients were then given a rapid 500 ml saline bolus, and the same sequence of bubble injections was repeated. The presence, type, and magnitude of the right to left shunts were noted before and after the saline bolus. The detection rate of PFO increased from 10.6% to 26.2% after saline loading without any provocative maneuvers. When combined with provocative maneuvers (Valsalva or cough), saline loading improved the detection rate from 17.4% to 32.0%. Overall, from amongst the 103 enrolled patients, saline bolusing resulted in a de novo diagnosis of PFO in 15 patients, atrial septal aneurysm in 15, PFO coexisting with an atrial septal aneurysm in 10, and pulmonary arteriovenous fistula in 5 patients. In conclusion, saline infusion in appropriately selected patients during transesophageal echocardiography significantly enhances the detection of PFOs and pulmonary arteriovenous fistulas.

  5. Three-dimensional Transesophageal Echocardiography-guided Transcathetar Closure of Ruptured Noncoronary Sinus of Valsalva Aneurysm

    Science.gov (United States)

    Kumar, G Anil; Parimala, P S; Jayaranganath, M; Jagadeesh, A M

    2017-01-01

    Sinus of Valsalva aneurysm accounts for only 1% of congenital cardiac anomalies. Sinus of Valsalva aneurysm can cause aortic insufficiency, coronary artery flow compromise, cardiac arrhythmia, or aneurysm rupture. Three-dimensional transesophageal echocardiography (3DTEE) represents an adjunctive tool to demonstrate the ruptured sinus of Valsalva with better delineation. We present an adult patient with rupture of noncoronary sinus of Valsalva aneurysm into the right atrium (RA). 3DTEE accurately delineated the site of rupture into the RA and showed the exact size and shape of the defect, which helped in the successful transcatheter closure of the defect with a duct occluder device. PMID:28074828

  6. Role of perioperative transesophageal echocardiography in the management of adolescent truncus arteriosus: Rare case report

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    P S Nagaraja

    2015-01-01

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

  7. Esophageal Perforation: A Rare Complication of Transesophageal Echocardiography in a Patient with Asymptomatic Esophagitis

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    Kabir Ahmed

    2012-12-01

    Full Text Available Transesophageal echocardiography (TEE is a commonly used procedure in patients with suspected endocarditis. A rare but dreadful complication of this procedure is perforation of the esophagus. We report the case of an elderly female with multiple comorbidities, who presented with polyarticular septic arthritis. TEE was performed to rule out endocarditis. Though the standard procedure protocol was followed, she developed esophageal perforation. It was managed with esophageal stenting but she developed multiorgan failure and did not survive. This case highlights the potential of severe morbidity and mortality associated with TEE. Appropriate screening must be done and high-risk individuals must be identified before such procedures are attempted.

  8. Value of transesophageal echocardiography (TEE) guidance in minimally invasive mitral valve surgery.

    Science.gov (United States)

    Ender, Jörg; Sgouropoulou, Sophia

    2013-11-01

    The role of intraoperative transesophageal echocardiography (TEE) has increased tremendously since its first use in 1979. Today intraoperative TEE is a class I indication for surgical mitral valve reconstruction for evaluation of mitral valve pathology, graduation of mitral regurgitation and detection of potential risk factors as well as post-repair assessment. Real-time three-dimensional TEE offers anatomical visualization of the mitral valve apparatus, fundamental for virtual surgical planning of proper annuloplasty ring size. As minimally invasive and even off-pump techniques for mitral valve repair become more popular, image guidance by intraoperative TEE will play an essential role.

  9. Characteristics of Patent Foramen Ovale Associated with Cryptogenic Stroke: A Biplane Transesophageal Echocardiography Study

    Science.gov (United States)

    Homma, S.; DiTullio, M. R.; Sacco, R. L.; Mihalatos, D..; LiMandri, G.; Mohr, J. P.

    1994-01-01

    Patent foramen ovale is associated with ischemic stroke in patients without a clearly identifiable etiology for stroke (cryptogenic stroke). Paradoxical embolization is thought to be a potential mechanism. However, patent foramen ovale is also found in patients with known cause of stroke. Therefore, using contrast transesophageal echocardiography, we characterized the patent foramen ovale in cryptogenic stroke patients to assess morphological factors that may contribute to paradoxical embolization. Methods: Contrast transesophageal echocardiographic studies of 74 consecutive patients referred for ischemic stroke were reviewed. Twenty-three patients with patent foramen ovale were identified. These patients were classified as having strokes of determined origin or cryptogenic strokes according to criteria developed for the Stroke Data Bank of the National Institute of Neurological Disorders and Stroke. Separation of septum primum from secundum and the number of microbubbles appearing in left atrium were then quantitated. These parameters were compared between patients with cryptogenic stroke and those with known cause of stroke. Results: The patent foramen ovale dimension was significantly larger in patients with cryptogenic stroke compared with patients with an identifiable cause of stroke (2.1+/-1.7 mm versus 057+/-0.78 mm [mean+/-SD]; Ppatent foramen ovale with more extensive right-to-left inter-atrial shunting than patients with stroke of determined cause. Transesophageal echocardiographically identifiable characteristics of patent foramen ovale may be important in defining the clinical significance of individual patent foramina.

  10. Atherosclerosis of the descending aorta predicts cardiovascular events: a transesophageal echocardiography study

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    Havasi Kálmán

    2004-10-01

    Full Text Available Abstract Purpose Previous studies have shown that atherosclerosis of the descending aorta detected by transesophageal echocardiography (TEE is a good marker of coexisting coronary artery disease. The aim of our study was to evaluate whether the presence of atherosclerosis on the descending aorta during TEE has any prognostic impact in predicting cardiovascular events. Material and Methods The study group consisted of 238 consecutive in-hospital patients referred for TEE testing (135 males, 103 females, mean age 58 +/- 11 years with a follow up of 24 months. The atherosclerotic lesions of the descending aorta were scored from 0 (no atherosclerosis to 3 (plaque >5 mm and/or "complex" plaque with ulcerated or mobile parts. Results Atherosclerosis was observed in 102 patients, (grade 3 in 16, and grade 2 in 86 patients whereas 136 patients only had an intimal thickening or normal intimal surface. There were 57 cardiovascular events in the follow-up period. The number of events was higher in the 102 patients with (n = 34 than in the 136 patients without atherosclerosis (n = 23, p =2 (HR 2.4, CI 1.0–5.5 predicted hard cardiovascular events. Conclusion Atherosclerosis of the descending aorta observed during transesophageal echocardiography is a useful predictor of cardiovascular events.

  11. Role of transesophageal echocardiography in the clinical management of a patients with a giant coronary artery aneurysm.

    Science.gov (United States)

    Wolford, D C; Jost, C M; Madu, E C; Walker, W; Ramanatian, K B

    1997-06-01

    Transthoracic echocardiography (TTE) has substantial limitations for the study of abnormalities of the coronary tree. Transesophageal echocardiography (TEE) allows a more complete examination of the coronary arteries, particularly the proximal segments. This report describes the use of TEE after cardiac catheterization in the clinical management of a patient with unstable angina. While angiography first showed the giant aneurysm of the left circumflex coronary artery. TEE, by revealing an active thrombus of the lumen, prompted an immediate surgical resolution.

  12. Multiplanar transesophageal echocardiography for the evaluation and percutaneous management of ostium secundum atrial septal defects in the adult.

    Science.gov (United States)

    Sobrino, Ayax; Basmadjian, Arsène J; Ducharme, Anique; Ibrahim, Reda; Mercier, Lise-Andrée; Pelletier, Guy B; Marcotte, François; Garceau, Patrick; Burelle, Denis; O'Meara, Eileen; Dore, Annie

    2012-01-01

    The purpose of this paper is to review the usefulness of multiplanar transesophageal echocardiography before, during and after percutaneous transcatheter closure of secundum atrial septal defects. Transesophageal echocardiography imaging techniques,including their role in patient selection, procedural guidance and immediate assessment of technical success and complications are described and discussed in this review. Percutaneous transcatheter closure is indicated for ostium secundum atrial septal defects of less than 40 mm in maximal diameter. The defect must have a favorable anatomy, with adequate rims of at least 5 mm to anchor the prosthesis. Transesophageal echocardiography plays a critical role before the procedure in identifying potential candidates for percutaneous closure and to exclude those with unfavorable anatomy or associated lesions, which could not be addressed percutaneously. Transesophageal echocardiography is also important during the procedure to guide the deployment of the device. After device deployment, the echocardiographer must assess the device (integrity, position and stability), residual shunt, atrio-ventricular valve regurgitation, obstruction to systemic or venous return and pericardial effusion, in order to determine procedural success and diagnose immediate complications.

  13. Stress echocardiography in octogenarians: transesophageal atrial pacing is accurate, safe, and well tolerated.

    Science.gov (United States)

    Kobal, Sergio L; Pollick, Charles; Atar, Shaul; Miyamoto, Takashi; Aslanian, Noune; Neuman, Yoram; Tolstrup, Kirsten; Naqvi, Tasneem Z; Luo, Huai; Macrum, Bruce; Siegel, Robert J

    2006-08-01

    The feasibility and diagnostic accuracy of transesophageal pacing stress echocardiography for detection of inducible myocardial ischemia were evaluated in 161 patients 80 years of age or older (mean 84 +/- 3.9, range 80-97). The pacing time was 5.5 +/- 2.5 minutes with a total test time of 37 +/- 7 minutes. The mean achieved heart rate was 96 +/- 7% (83%-121%) of maximum predicted with an average rate pressure product of 21,560 +/- 5175 beats/min x mm Hg. There were minor adverse events in 8% of cases and no major complications occurred. Patient acceptance was high. When compared with myocardial single photon emission computed tomography, pacing stress echocardiography had a sensitivity of 89% and a specificity of 93% for the detection of myocardial ischemia, and 91% agreement (kappa = 0.80, P < .001). We demonstrate that pacing stress echocardiography is safe and accurate for detection of myocardial ischemia and, thus, a reliable substitute to exercise and pharmacologic stress testing in octogenarians.

  14. Measurement of the aortic annulus size by real-time three-dimensional transesophageal echocardiography.

    Science.gov (United States)

    Jánosi, Rolf Alexander; Kahlert, Philipp; Plicht, Björn; Wendt, Daniel; Eggebrecht, Holger; Erbel, Raimund; Buck, Thomas

    2011-04-01

    We sought to determine the level of agreement and the reproducibility of two-dimensional (2D) transthoracic (2D-TTE), 2D transesophageal (2D-TEE) and real-time three-dimensional (3D) transesophageal echocardiography (RT3D-TEE) for measurement of aortic annulus size in patients referred for transcatheter aortic valve implantation (TAVI). Accurate preoperative assessment of the dimensions of the aortic annulus is critical for patient selection and successful implantation in those undergoing TAVI for severe aortic stenosis (AS). Annulus size was measured using 2D-TTE, 2D-TEE and RT3D-TEE in 105 patients with severe AS referred for TAVI. Agreement between echocardiographic methods and interobserver variability was assessed using the Bland-Altman method and regression analysis, respectively. The mean aortic annuli were 21,7 ± 3 mm measured with 2D-TTE, 22,6 ± 2,8 mm with 2D-TEE and 22,3 ± 2,9 mm with RT3D-TEE. The results showed a small but significant mean difference and a strong correlation between the three measurement techniques (2D-TTE vs. 2D-TEE mean difference 0,84 ± 1,85 mm, r = 0,8, p annulus measured by 2D-TTE, 2D-TEE and RT3D-TEE. Thus, in patients referred for TAVI, the echocardiographic method used may have an impact on TAVI strategy.

  15. Repair of recurrent pseudoaneurysm of the mitral-aortic intervalvular fibrosa: Role of transesophageal echocardiography

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    Shreedhar S Joshi

    2014-01-01

    Full Text Available Pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF is a rare cardiac surgical condition. P-MAIVF commonly occurs as a complication of aortic and mitral valve replacement surgeries. The surgical trauma during replacement of the valves weakens the avascular mitral and aortic intervalvular area. We present a case of P-MAIVF recurrence 5 years after a primary repair. Congestive cardiac failure was the presenting feature with mitral and aortic regurgitation. In view of the recurrence, the surgical team planned for a double valve replacement. The sewing rings of the two prosthetic-valves were interposed to close the mouth of the pseudoaneurysm and to provide mechanical reinforcement of the MAIVF. Intra-operative transesophageal echocardiography (TEE helped in delineating the anatomy, extent of the lesion, rupture of one of the pseudoaneurysm into left atrium and severity of the valvular regurgitation. Post-procedure TEE confirmed complete obliteration of the pseudoaneurysm and prosthetic valve function.

  16. Ventricular septal rupture imaged with real-time three-dimensional transesophageal echocardiography: diagnosis at a glance.

    Science.gov (United States)

    Squeri, Angelo; Conti, Rita; Bosi, Stefano

    2014-01-01

    Ventricular septal rupture is a rare complication of acute myocardial infarction and its diagnosis can be really challenging especially in the case of complex lesions. Echocardiography is the technique of choice for the detection of mechanical complications following myocardial infarction. The introduction of three-dimensional echocardiography offers new imaging possibilities with precise localization and easiest definition of the defect anatomy. This information is of paramount importance in the setting of a percutaneous closure procedure. We describe a case where real-time three-dimensional transesophageal echocardiography correctly defined the complex anatomy of a postmyocardial infarction septal defect with an associated pseudoaneurysm.

  17. In-vivo continuous monitoring of mixed venous oxygen saturation by photoacoustic transesophageal echocardiography (Conference Presentation)

    Science.gov (United States)

    Li, Li; Subramaniam, Balachundhar; Aguirre, Aaron D.; Andrawes, Michael N.; Tearney, Guillermo J.

    2016-02-01

    Mixed venous oxygen saturation (SvO2), measured from pulmonary arteries, is a gold-standard measure of the dynamic balance between the oxygen supply and demand in the body. In critical care, continuous monitoring of SvO2 plays a vital role in early detection of circulatory shock and guiding goal-oriented resuscitation. In current clinical practice, SvO2 is measured by invasive pulmonary artery catheters (PAC), which are associated with a 10% risk of severe complications. To address the unmet clinical need for a non-invasive SvO2 monitor, we are developing a new technology termed photoacoustic transesophageal echocardiography (PA-TEE). PA-TEE integrates transesophageal echocardiography with photoacoustic oximetry, and enables continuous assessment of SvO2 through an esophageal probe that can be inserted into the body in a minimally invasive manner. We have constructed a clinically translatable PA-TEE prototype, which features a mobile OPO laser, a modified ultrasonography console and a dual-modality esophageal probe. Comprised of a rotatable acoustic array detector, a flexible optical fiber bundle and a light-integrating acoustic lens, the oximetric probe has an outer diameter smaller than 15 mm and will be tolerable for most patients. Through custom-made C++/Qt software, our device acquires and displays ultrasonic and photoacoustic images in real time to guide the deployment of the probe. SvO2 is calculated on-line and updated every second. PA-TEE has now been used to evaluate SvO2 in living swine. Our findings show that changing the fraction of oxygen in the inspired gas modulates SvO2 measured by PA-TEE. Statistic comparison between SvO2 measurements from PA-TEE in vivo the gold-standard laboratorial analysis on blood samples drawn from PACs will be presented.

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

    Directory of Open Access Journals (Sweden)

    Kanchi Muralidhar

    2013-01-01

    Full Text Available 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.

  19. Impact of transesophageal Echocardiography on Long Term Management of Ischemic Strike : Experience from a University Hospital

    Directory of Open Access Journals (Sweden)

    Kaul S

    1999-01-01

    Full Text Available Despite the unquestionable superiority of Transesophageal echocardiography (TEE over Transthoracic echocardiography (TTE, the impact of TEE on the long term management of cardio-embolic strokes remains uncertain. The purpose of present study was to determine the extent to which TEE, influenced the decision regarding long-term anticoagulant management of patients with ischemic stroke in a University Hospital. Between January 1992 and May 1995, TEE was performed in 122 out of 485 consecutive patients with ischemic stroke enrolled in the Maryland Stroke Data Bank. The indication to perform TEE was unexplained cerebral infarction. Twenty five patients had a possible cardiac source of embolism (CSOE detected only after a TEE out of whom 17 were placed on anticoagulant therapy. From the remaining 8 patients, 2 expired, 2 were already receiving anticoagulants for different reasons and 4 were managed with antiplatelet agents. To conclude, in 17 of 122 ischemic stroke patients (14% who underwent TEE, the decision regarding long term anticoagulation was made only because TEE revealed a cardioembolic source.

  20. Clinical impact of transesophageal echocardiography in patients with stroke without clinical evidence of cardiovascular sources of emboli

    Directory of Open Access Journals (Sweden)

    Tatani Solange Bernardes

    2001-01-01

    Full Text Available OBJECTIVE: The purpose of this study is to evaluate the impact of transeophageal echocardiography on management of patients at low-risk for cardiogenic embolism to prevent new potential cardiovascular sources of emboli. METHODS: We studied 69 patients with ischemic stroke at low-risk for cardiogenic embolism. Transeophageal echocardiography was performed to access: left atrium enlargement; communication or aneurysm of the interatrial septum; patent foramen ovale; spontaneous echo contrast or intracavitary thrombi; the presence of intraaortic atherosclerotic plaques or thrombi; significant valvar morphologic alteration or dysfunction; left ventricle enlargement, hypertrophy, or contractile abnormality. Transesophageal echocardiography altered clinical management, and we adopted anticoagulant therapy or another procedure apart from the use of acetylsalicylic acid. RESULTS: Transeophageal echocardiography detected at least one abnormality in 40 cases (58%. Clinical conduct was adjusted after the performance of transesophageal echocardiography in 11 patients (15.9%; anticoagulation was added in 10 cases and surgical correction in one patient. CONCLUSION: Transeophageal echocardiography was a very useful tool in the secondary prevention for stroke in patients at low risk for cardiogenic embolism.

  1. Analysis of right ventricular kinesis by means of transesophageal echocardiography: present problems and perspectives.

    Science.gov (United States)

    Kozàkovà, M; Palombo, C; Benanti, C; L'Abbate, A; Distante, A

    1994-03-01

    The evaluation of right ventricular (RV) kinesis by two-dimensional echocardiography represents a difficult task. Transthoracic echocardiography can visualize the RV in several projections, but the image quality and the variability of imaging views usually do not allow quantitative analysis. We investigated the potential of transesophageal echocardiography (TEE) for evaluating RV global function and regional kinesis, in 32 controls and in 16 patients with inferior myocardial infarction (MI) and asynergy involving the inferior wall of both ventricles. Good-quality images of at least one horizontal section of the RV were obtained in 73% of subjects by conventional, 90 degrees sector and in 100% of subjects by wide-angle, "panoramic" sector. Images of the RV in short-axis view at medium level were acquired and evaluated in 93% of cases, but at basal and apical levels only in 67% and 39%, respectively. The low percentage of successful detection and evaluation of the RV at apical level can be explained by prominent motion and trabeculation of the apex. Global systolic area changes (SAC) in controls attained similar values at apical and medium levels (60% and 59%, respectively), but were significantly lower (48%, P less than 0.05) at basal level. In patients with previous inferior MI and inferoposterior asynergy, global SAC were significantly (P less than 0.01) lower at medium and basal levels (32% and 27%, respectively) compared with controls. Regional kinesis of RV was assessed as segmental SAC in 12 different segments, by fixed and float system of center of cavity.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Ligation or distortion of the right circumflex artery during minimal invasive mitral valve repair detected by transesophageal echocardiography.

    Science.gov (United States)

    Ender, Joerg; Gummert, Jan; Fassl, Jens; Krohmer, Eugen; Bossert, Thorsten; Mohr, Friedrich W

    2008-04-01

    A 43-year-old male patient undergoing mitral valve repair because of severe mitral regurgitation as a result of P2 prolapse was treated with insertion of neochords and a 36 Carpentier-Edwards physio-ring. After weaning from cardiopulmonary bypass, S-T elevation in leads II, III, and aVF occurred. On transesophageal echocardiography an occlusion or distortion of the circumflex artery by ring sutures was suggested, because coronary flow was no longer detected by color Doppler. Despite stable hemodynamics an angiogram was performed, which confirmed the diagnosis of stenosis of the circumflex artery. During reoperation 4 sutures placed at the P1 segment of the mitral valve annuloplasty were corrected. Transesophageal echocardiography could detect a good flow of the circumflex artery and the electrocardiographic changes disappeared.

  3. Descending aortic mechanics and atrial fibrillation: a two-dimensional speckle tracking transesophageal echocardiography study.

    Science.gov (United States)

    Teixeira, Rogério; Monteiro, Ricardo; Dinis, Paulo; Santos, Maria José; Botelho, Ana; Quintal, Nuno; Cardim, Nuno; Gonçalves, Lino

    2016-11-24

    Vascular mechanics assessed with two-dimensional speckle tracking echocardiography (2D-STE) could be used as a new imaging surrogate of vascular stiffening. The CHA2DS2-VASc score is considered accurate as an estimate of stroke risk in non-valvular AF, although many potential stroke risk factors have not been included in this scoring method. The purpose of this research is to study the feasibility of evaluating vascular mechanics at the descending aorta in non-valvular AF patients using transesophageal 2D-STE and to analyze the association between descending aortic mechanics and stroke. We prospectively recruited a group of 44 patients referred for a transesophageal echocardiogram (TEE) in the context of cardioversion for non-valvular AF. A short-axis view of the descending aorta, one to two centimeters after the aortic arch was selected for the vascular mechanics assessment with the 2D-STE methodology. The vascular mechanics parameters analyzed were circumferential aortic strain (CAS) and early circumferential aortic strain rate (CASR). A clinical assessment was performed with focus on the past stroke history and the CHA2DS2-VASc score. The mean age of our cohort was 65 ± 13 years and 75% were men; AF was known for 2.8 ± 2.5 years and it was considered paroxystic in 41% of cases. Waveforms adequate for measuring 2D-STE were present in 85% of the 264 descending aortic wall segments. The mean CAS was 3.5 ± 1.2% and the mean CASR was 0.7 ± 0.3 s(-1). The inter- and intra-observer variability for aortic mechanics was considered adequate. The median CHA2DS2VASc score was 2 (2-3). As the score increased we noted that both the CAS (r = -0.38, P = 0.01) and the CASR (r = -0.42, P mechanics assessed with transesophageal 2D-STE.

  4. Endoscopic Ultrasound for the Detection of Left Atrial Appendage Thrombus: A Useful Technique in Patients with Transesophageal Echocardiography Contraindication

    OpenAIRE

    2016-01-01

    Endoscopic ultrasound is a diagnostic and therapeutic technique used in specialized centers for patients that have undergone digestive procedures. This technique enables highly precise real-time imaging of the digestive tract wall and surrounding organs. Endoscopic ultrasound is also useful in patients with cardiovascular diseases such as atrial fibrillation. In patients with contraindication for transesophageal echocardiography due to high risk of esophageal bleeding or complications that ma...

  5. Transesophageal echocardiography evaluation of the coronary blood flow and cardiac function in laparoscopic surgery and their correlation with operative wound

    Institute of Scientific and Technical Information of China (English)

    Xin-Sheng Chen

    2016-01-01

    Objective:To analyze the transesophageal echocardiography evaluation of the coronary blood flow and cardiac function in laparoscopic surgery and their correlation with operative wound.Methods:A total of 80 patients undergoing laparoscopic surgery in our hospital were randomly divided into standard pneumoperitoneum pressure group (12-15 mmHg) and high pneumoperitoneum pressure group (>15 mmHg) (n=40), and the differences in the levels of coronary blood flow and cardiac function parameters under transesophageal echocardiography as well as the content of stress hormones and acute phase proteins in serum were compared between two groups of patients.Results: Coronary blood flow parameters D, Q, PDV, MDV and DAR levels of standard pneumoperitoneum pressure group were significantly higher than those of high pneumoperitoneum pressure group; cardiac function parameters COLVOT, LVEF and LVFAC levels were significantly higher than those of high pneumoperitoneum pressure group; stress hormones Cor, Ang-Ⅰ, Ang-Ⅱ, NE, Glucagon and C-peptide as well as acute phase proteins CRP, YKL-40 and HMGB1 content in serum were significantly lower than those of high pneumoperitoneum pressure group while the acute phase protein PA content was significantly higher than that of high pneumoperitoneum pressure group.Conclusions:Transesophageal echocardiography can timely detect the excessive pneumoperitoneum damage in laparoscopic surgery to the coronary blood flow and cardiac function in patients, and also prevent the occurrence of excessive operative wound.

  6. Role of Transesophageal Echocardiography in the Diagnosis of Paradoxical Low Flow, Low Gradient Severe Aortic Stenosis

    Science.gov (United States)

    Abudiab, Muaz M.; Pandit, Anil

    2017-01-01

    Background and Objectives Prior studies indicate that up to 35% of cases of severe aortic stenosis (AS) have paradoxical low flow, low gradient despite preserved left ventricular ejection fraction (LVEF). However, error in left ventricular outflow tract (LVOT) diameter may lead to misclassification. Herein, we determined whether measurement of LVOT diameter by transesophageal echocardiography (TEE) results in reclassification of cases to non-severe AS. Subjects and Methods Patients with severe AS with aortic valve area (AVA) <1 cm2 by transthoracic echocardiography (TTE) within 6 months were studied. Paradoxical low flow, low gradient was defined as mean Doppler gradient (MG) <40 mm Hg and stroke volume index (SVI) ≤35 mL/m2. Preserved LVEF was defined as ≥0.50. Results Among 108 patients, 12 (15%) had paradoxical low flow, low gradient severe AS despite preserved LVEF based on TTE measurement. When LVOT diameter by TEE in 2D was used, only 5 (6.3%) patients had low flow, low gradient severe AS (p<0.001). Coefficients of variability for intraobserver and interobserver measurement of LVOT were <10%. However, the limits of agreement between TTE and TEE measurement of LVOT ranged from 0.43 cm (95% confidence interval [CI]: 0.36 to 0.5) to -0.31 cm (95% CI: -0.38 to -0.23). Conclusion TEE measured LVOT diameter may result in reclassification to moderate AS in some patients due to low prevalence of true paradoxical low flow, low gradient (PLFLG) severe AS.

  7. Cardiac impairment evaluated by transesophageal echocardiography and invasive measurements in rats undergoing sinoaortic denervation.

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    Raquel A Sirvente

    Full Text Available BACKGROUND: Sympathetic hyperactivity may be related to left ventricular (LV dysfunction and baro- and chemoreflex impairment in hypertension. However, cardiac function, regarding the association of hypertension and baroreflex dysfunction, has not been previously evaluated by transesophageal echocardiography (TEE using intracardiac echocardiographic catheter. METHODS AND RESULTS: We evaluated exercise tests, baroreflex sensitivity and cardiovascular autonomic control, cardiac function, and biventricular invasive pressures in rats 10 weeks after sinoaortic denervation (SAD. The rats (n = 32 were divided into 4 groups: 16 Wistar (W with (n = 8 or without SAD (n = 8 and 16 spontaneously hypertensive rats (SHR with (n = 8 or without SAD (SHRSAD (n = 8. Blood pressure (BP and heart rate (HR did not change between the groups with or without SAD; however, compared to W, SHR groups had higher BP levels and BP variability was increased. Exercise testing showed that SHR had better functional capacity compared to SAD and SHRSAD. Echocardiography showed left ventricular (LV concentric hypertrophy; segmental systolic and diastolic biventricular dysfunction; indirect signals of pulmonary arterial hypertension, mostly evident in SHRSAD. The end-diastolic right ventricular (RV pressure increased in all groups compared to W, and the end-diastolic LV pressure increased in SHR and SHRSAD groups compared to W, and in SHRSAD compared to SAD. CONCLUSIONS: Our results suggest that baroreflex dysfunction impairs cardiac function, and increases pulmonary artery pressure, supporting a role for baroreflex dysfunction in the pathogenesis of hypertensive cardiac disease. Moreover, TEE is a useful and feasible noninvasive technique that allows the assessment of cardiac function, particularly RV indices in this model of cardiac disease.

  8. The additional value of three-dimensional transesophageal echocardiography in complex aortic prosthetic heart valve endocarditis.

    Science.gov (United States)

    Tanis, Wilco; Teske, Arco J; van Herwerden, Lex A; Chamuleau, Steven; Meijboom, Folkert; Budde, Ricardo P J; Cramer, Maarten-Jan

    2015-01-01

    Two-dimensional transthoracic and transesophageal echocardiography (2DTTE and 2DTEE) may fail to detect signs of prosthetic heart valve (PHV) endocarditis due to acoustic shadowing. Three-dimensional (3D) TEE may have additional value; however, data are scarce. This study was performed to investigate the additional value of 3DTEE for the detection of aortic PHV endocarditis and the extent of the disease process. Retrospective analysis of complex aortic PHV endocarditis cases that underwent 2DTTE, 2DTEE, and 3DTEE before surgery. Echocardiograms were individually assessed by 2 cardiologists blinded for the outcome. Surgical and pathological inspection served as the reference standard for vegetations and peri-annular extensions (abscesses/mycotic aneurysms). To determine if the proximal coronary arteries were involved in the inflammatory process as well, computed tomography angiography findings were added to reference standard. Fifteen aortic PHV endocarditis cases were identified. According to the reference standard, all 15 cases had peri-annular extensions, 13 of which had a close relationship with the proximal right and/or left coronary artery. In 6 of 15 patients, a vegetation was present. Combined 2DTTE/TEE missed 1/6 vegetations and 1/15 peri-annular extensions. After addition of 3DTEE, all vegetations (6/6) and peri-annular extensions (15/15) were detected, without adding false positives. Compared to 2DTEE, in 3/15 cases, 3DTEE resulted in better delineation of the anatomical relationship of the proximal coronary arteries to the peri-annular extensions. As a result, 3DTEE had an additional value in 5/15 cases. In complex aortic, PHV endocarditis 3DTEE may have additional value compared to 2D echocardiography. © 2014, Wiley Periodicals, Inc.

  9. Diagnosis of Malignancy of Adult Mediastinal Tumors by Conventional and Transesophageal Echocardiography

    Institute of Scientific and Technical Information of China (English)

    Wei-Wei Zhou; Hong-Wei Wang; Nan-Nan Liu; Jing-Jing Li; Wei Yuan; Rui Zhao; Liang-Bi Xiang

    2015-01-01

    Background:Transesophageal echocardiography (TEE) is a well-established method for detecting and diagnosing heart tumors.In contrast,its role in assessing the presence,growth and evidence of malignant tumors originating from mediastinal sites remains unclear.The aim of this study was to compare the diagnostic impact of TEE and transthoracic echocardiography (TTE) for determining the localization,growth and malignancy of adult mediastinal tumors (MTs).Methods:In a prospective and investigator-blinded study,we evaluated 144 consecutive patients with MT lesions to assess the diagnostic impact of TEE and TTE for detecting the presence of tumors spreading both inside and outside of the heart and for determining infiltration and invasion using pathological examination results as a reference.Results:All tumor lesions were diagnosed and carefully evaluated by biopsy.Biopsy revealed malignant tumors in 79 patients and benign tumors in 65 patients.When compared to histological findings,TEE predicted malignancy from the presence of tumors spreading both inside and outside of the heart and from infiltration and invasion in 49/79 patients (62.0%).TTE predicted malignancy in only 8/79 patients (10.1%,P < 0.005).TEE visualized tumor lesions in 130 patients (90.3%) while the TTE visualized tumor lesions in 110 patients (76.4%) and was less effective at detecting MT lesions (P < 0.001).TTE and TEE could detect anterior MTs and adequately verified MTs (P > 0.05);TEE detected medium MTs better than TTE (P < 0.001).Conclusions:TEE is effective and superior to TTE for predicting the localization and growth of MTs as well as for accessing evidence of tumor malignancy.TTE and TEE were able to detect anterior MTs;TEE was able to detect medium MT better than TTE.

  10. Role of transesophageal echocardiography in percutaneous aortic valve replacement with the CoreValve Revalving system.

    Science.gov (United States)

    Berry, Colin; Oukerraj, Latifa; Asgar, Anita; Lamarche, Yoan; Marcheix, Bertrand; Denault, André Y; Laborde, Jean-Claude; Cartier, Raymond; Ducharme, Anique; Bonan, Raoul; Basmadjian, Arsène J

    2008-09-01

    Percutaneous aortic valve replacement (PAVR) is an emerging therapy for nonsurgical patients with severe aortic stenosis (AS). We examined the role of transesophageal echocardiography (TEE) in PAVR. TEE was used initially to assess the native valve and aortic root, and served as a guide during PAVR. Following prosthetic valve deployment, TEE was used to assess valve function. Eleven patients aged 82 +/- 10 years with NYHA III-IV underwent PAVR. Periprocedural TEE gave immediate information on prosthetic position and function, LV function, mitral regurgitation, pericardium, and thoracic aorta anatomy. There was excellent visual agreement between fluoroscopic and TEE images of prosthetic positioning and deployment. TEE facilitated the detection and management of procedure-related complications. Compared with pre-PAVR, AV area (0.56 +/- 0.19 cm(2) vs. 1.3 +/- 0.4 cm(2); P < 0.001) and LVEF (49 +/- 17% vs. 56 +/- 11%; P < 0.001) increased. TEE provides key anatomical and functional information, and serves as a diagnostic guide for complications, which may arise during PAVR.

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

    Science.gov (United States)

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

    2012-07-01

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

  12. Outpatient transesophageal echocardiography with intravenous propofol anesthesia in children and adolescents.

    Science.gov (United States)

    Marcus, B; Steward, D J; Khan, N R; Scott, E B; Scott, G M; Gardner, A J; Wong, P C

    1993-01-01

    Outpatient transesophageal echocardiography (TEE) was performed in 10 children and adolescents (aged 3 to 19.5 years, mean 13.5 years; weight 12 to 91 kg, mean 49 kg), including two with Down's syndrome and one with autism, for diagnostic evaluation of issues unresolved by transthoracic echo examination (TTE). Issues for TEE: evaluation for atrial septal defect (two patients); anatomy of left ventricular outflow tract obstruction (one patient); aortic valve anatomy before valvuloplasty for insufficiency (one patient); evaluation for cause of cyanosis after Fontan operation (one patient); determination of source of high-velocity intracardiac turbulence after atrioventricular septal defect repair (one patient); rule out cardiac embolic source in patient with stroke (one patient); evaluate prosthetic valve function and rule out thrombus (one patient); determination of anatomic relationship of mitral valve to a ventricular septal defect before surgery for complex cyanotic heart disease (one patient); and evaluation for aortic dissection in Marfan's syndrome (one patient). Intravenous propofol anesthesia administered without endotracheal intubation by an anesthesiologist allowed successful outpatient TEE in nine patients; midazolam-conscious sedation was used in one. Outpatient TEE resolved diagnostic issues in all patients without complication, thereby avoiding cardiac catheterization in six patients and supplementing catheterization for preoperative planning in four patients. TEE can be performed safely and effectively with propofol anesthesia in the outpatient setting in carefully selected children and adolescents to provide vital diagnostic information. However, given the invasive nature of the procedure and the use of anesthesia, outpatient pediatric TEE should be used judiciously.

  13. Manual Skill Acquisition During Transesophageal Echocardiography Simulator Training of Cardiology Fellows: A Kinematic Assessment.

    Science.gov (United States)

    Matyal, Robina; Montealegre-Gallegos, Mario; Mitchell, John D; Kim, Han; Bergman, Remco; Hawthorne, Katie M; O'Halloran, David; Wong, Vanessa; Hess, Phillip E; Mahmood, Feroze

    2015-12-01

    To investigate whether a transesophageal echocardiography (TEE) simulator with motion analysis can be used to impart proficiency in TEE in an integrated curriculum-based model. A prospective cohort study. A tertiary-care university hospital. TEE-naïve cardiology fellows. Participants underwent an 8-session multimodal TEE training program. Manual skills were assessed at the end of sessions 2 and 8 using motion analysis of the TEE simulator's probe. At the end of the course, participants performed an intraoperative TEE; their examinations were video captured, and a blinded investigator evaluated the total time and image transitions needed for each view. Results are reported as mean±standard deviation, or median (interquartile range) where appropriate. Eleven fellows completed the knowledge and kinematic portions of the study. Five participants were excluded from the evaluation in the clinical setting because of interim exposure to TEE or having participated in a TEE rotation after the training course. An increase of 12.95% in post-test knowledge scores was observed. From the start to the end of the course, there was a significant reduction (pcardiology fellows can be complemented with kinematic analyses to objectify acquisition of manual skills during simulator-based training. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Evaluation of acute ischemic mitral regurgitation following cardiopulmonary bypass assessed by biplane transesophageal echocardiography.

    Science.gov (United States)

    Nakao, T; Fujimoto, K; Brodman, R F; Oka, Y

    1997-03-01

    The aim of this study was to evaluate pathogenesis and outcome of acute ischemic mitral regurgitation (MR) in patients undergoing coronary artery bypass grafting (CABG) using biplane transesophageal echocardiography (TEE). Biplane TEE was continuously monitored in a total of 96 patients who were scheduled for elective CABG surgery. Of 96 patients, 10 with no MR at stages 1 (after anesthetic induction but before skin incision) and 2 (after cardiopulmonary bypass [CPB] and decannulation) were excluded. In the remaining 86 patients with MR between stages 1 and 2, 45 (group A) had an increase in MR, and 41 (group B) had a decrease in MR. An increase in MR at stage 2 in group A was associated with a significant increase in annular diameter (p area (p area (p areas. In 7 patients in group A, MR increased continuously until stage 3 (after sternal closure) despite treatment. In 2 of these 7 patients, pulmonary venous systolic flow (PVSF) decreased during stage 2 and persisted to stage 3. The post operative course of these 2 patients was complicated with atrial fibrillation (AF). The increase in annular diameter and worsening in RWMA in RCA and/or LCX areas are associated with acute ischemic MR following CPB. The majority of acute ischemic MR cases were resolved by pharmacological intervention. Post operative AF was noted in 2 patients with acute ischemic MR associated with persistently decreased PVSF following CPB despite treatment.

  15. Fully automated software for mitral annulus evaluation in chronic mitral regurgitation by 3-dimensional transesophageal echocardiography.

    Science.gov (United States)

    Aquila, Iolanda; Fernández-Golfín, Covadonga; Rincon, Luis Miguel; González, Ariana; García Martín, Ana; Hinojar, Rocio; Jimenez Nacher, Jose Julio; Indolfi, Ciro; Zamorano, Jose Luis

    2016-12-01

    Three-dimensional (3D) transesophageal echocardiography (TEE) is the gold standard for mitral valve (MV) anatomic and functional evaluation. Currently, dedicated MV analysis software has limitations for its use in clinical practice. Thus, we tested here a complete and reproducible evaluation of a new fully automatic software to characterize MV anatomy in different forms of mitral regurgitation (MR) by 3D TEE.Sixty patients were included: 45 with more than moderate MR (28 organic MR [OMR] and 17 functional MR [FMR]) and 15 controls. All patients underwent TEE. 3D MV images obtained using 3D zoom were imported into the new software for automatic analysis. Different MV parameters were obtained and compared. Anatomic and dynamic differences between FMR and OMR were detected. A significant increase in systolic (859.75 vs 801.83 vs 607.78 mm; P = 0.002) and diastolic (1040.60 vs. 1217.83 and 859.74 mm; P software analysis automatically calculates several significant parameters that provide a correct and complete assessment of anatomy and dynamic mitral annulus geometry and displacement in the 3D space. This analysis allows a better characterization of MR pathophysiology and could be useful in designing new devices for MR repair or replacement.

  16. Fluoroscopic balloon-guided transesophageal echocardiography in a patient with Zenker's diverticulum.

    Science.gov (United States)

    Fergus, Icilma; Bennett, Edward S; Rogers, David M; Siskind, Steven; Messineo, Frank C

    2004-05-01

    During the past 20 years, transesophageal echocardiography (TEE) became an important diagnostic technique. Indications for TEE include: defining the cause and severity of native valve disease, particularly mitral regurgitation; detecting vegetations and other sequelae of endocarditis; assessing prosthetic valve function; and identifying a potential cardiac source for emboli.(1) TEE is usually well tolerated and is associated with few adverse events. However, structural abnormalities of the esophagus such as diverticula, stenoses, tumors, and advanced varices are relative contraindications to TEE because of the technical difficulties associated with probe advancement and the risk of esophageal perforation.(2) This report describes the successful performance of TEE in a patient with a Zenker's diverticulum. The patient was severely symptomatic of atrial fibrillation and was a poor candidate for long-term anticoagulation. Therefore, it was necessary to rule out a thrombus before cardioversion. Because the Zenker's diverticulum was large, a novel approach was taken using a balloon to occlude the orifice allowing safe passage of the TEE probe.

  17. Integration of trans-esophageal echocardiography with magnetic tracking technology for cardiac interventions

    Science.gov (United States)

    Moore, John T.; Wiles, Andrew D.; Wedlake, Chris; Bainbridge, Daniel; Kiaii, Bob; Trejos, Ana Luisa; Patel, Rajni; Peters, Terry M.

    2010-02-01

    Trans-esophageal echocardiography (TEE) is a standard component of patient monitoring during most cardiac surgeries. In recent years magnetic tracking systems (MTS) have become sufficiently robust to function effectively in appropriately structured operating room environments. The ability to track a conventional multiplanar 2D TEE transducer in 3D space offers incredible potential by greatly expanding the cumulative field of view of cardiac anatomy beyond the limited field of view provided by 2D and 3D TEE technology. However, there is currently no TEE probe manufactured with MTS technology embedded in the transducer, which means sensors must be attached to the outer surface of the TEE. This leads to potential safety issues for patients, as well as potential damage to the sensor during procedures. This paper presents a standard 2D TEE probe fully integrated with MTS technology. The system is evaluated in an environment free of magnetic and electromagnetic disturbances, as well as a clinical operating room in the presence of a da Vinci robotic system. Our first integrated TEE device is currently being used in animal studies for virtual reality-enhanced ultrasound guidance of intracardiac surgeries, while the "second generation" TEE is in use in a clinical operating room as part of a project to measure perioperative heart shift and optimal port placement for robotic cardiac surgery. We demonstrate excellent system accuracy for both applications.

  18. Early detection and efficient therapy of cardiac angiosarcoma due to routine transesophageal echocardiography after cerebrovascular stroke

    Directory of Open Access Journals (Sweden)

    Dirk Vogelgesang

    2008-08-01

    Full Text Available Dirk Vogelgesang1, Johannes B Dahm2, Holm Großmann3, Andre Hippe4, Astrid Hummel5, Christian Lotze6, Silke Vogelgesang71Practice of Cardiology, Greifswald, 2Practice of Cardiology, Goettingen, 3Department of Cardiovascular Surgery, Herzzentrum Karlsburg, 4Department of Neurology, 5Department of Cardiology, 6Department of Haematology and Oncology, 7Department of Pathology, University of Greifswald, Greifswald, GermanyAbstract: Primary malignant cardiac tumors (cardiac angiosarcomas are exceedingly rare. Since there are initially nonspecific or missing symptoms, these tumors are usually diagnosed only in an advanced, often incurable stage, after the large tumor mass elicits hemodynamic obstructive symptoms. A 59-year-old female presented with symptoms of cerebral ischemia. A computed tomography (CT scan showed changes suggestive of stroke. Transesophageal echocardiography revealed an inhomogeneous, medium-echogenic, floating mass at the roof of the left atrium near the mouth of the right upper pulmonary vein, indicative of a thrombus. At surgery, a solitary tumor was completely enucleated. Histologically, cardiac angiosarcoma was diagnosed. The patient received adjuvant chemotherapy and was free of symptoms and recurrence of disease at 14 months follow-up. Due to the fortuitous appearance of clinical signs indicative of stroke, cardiac angiosarcoma was diagnosed and effectively treated at an early, nonmetastatic, and therefore potentially curable stage. Although cardiac angiosarcoma is a rare disease, it should be taken into consideration as a potential cause of cerebral embolic disease.Keywords: cardiac angiosarcoma, stroke, embolism

  19. Three-dimensional transesophageal echocardiography with agitated saline injection to differentiate between atrial septal defects and echo drop-out artifacts.

    Science.gov (United States)

    Alherbish, Aws; Shanks, Miriam; Choy, Jonathan

    2014-12-01

    The diagnosis of multiple atrial septal defects is less challenging with 3-D transesophageal echocardiography. However, the common occurrence of echo drop-out (acoustic shadow) artifacts with 3-D echocardiography can make the differentiation between a second defect and an artifact challenging. Agitated saline injection with direct visualization using 3-D echocardiography can help resolve this by allowing visualization of the bubbles crossing from true defects.

  20. Fully automated software for mitral annulus evaluation in chronic mitral regurgitation by 3-dimensional transesophageal echocardiography

    Science.gov (United States)

    Aquila, Iolanda; Fernández-Golfín, Covadonga; Rincon, Luis Miguel; González, Ariana; García Martín, Ana; Hinojar, Rocio; Jimenez Nacher, Jose Julio; Indolfi, Ciro; Zamorano, Jose Luis

    2016-01-01

    Abstract Three-dimensional (3D) transesophageal echocardiography (TEE) is the gold standard for mitral valve (MV) anatomic and functional evaluation. Currently, dedicated MV analysis software has limitations for its use in clinical practice. Thus, we tested here a complete and reproducible evaluation of a new fully automatic software to characterize MV anatomy in different forms of mitral regurgitation (MR) by 3D TEE. Sixty patients were included: 45 with more than moderate MR (28 organic MR [OMR] and 17 functional MR [FMR]) and 15 controls. All patients underwent TEE. 3D MV images obtained using 3D zoom were imported into the new software for automatic analysis. Different MV parameters were obtained and compared. Anatomic and dynamic differences between FMR and OMR were detected. A significant increase in systolic (859.75 vs 801.83 vs 607.78 mm2; P = 0.002) and diastolic (1040.60 vs. 1217.83 and 859.74 mm2; P < 0.001) annular sizes was observed in both OMR and FMR compared to that in controls. FMR had a reduced mitral annular contraction compared to degenerative cases of OMR and to controls (17.14% vs 32.78% and 29.89%; P = 0.007). Good reproducibility was demonstrated along with a short analysis time (mean 4.30 minutes). Annular characteristics and dynamics are abnormal in both FMR and OMR. Full 3D software analysis automatically calculates several significant parameters that provide a correct and complete assessment of anatomy and dynamic mitral annulus geometry and displacement in the 3D space. This analysis allows a better characterization of MR pathophysiology and could be useful in designing new devices for MR repair or replacement. PMID:27930514

  1. Transesophageal echocardiography measurements of aortic annulus diameter using biplane mode in patients undergoing transcatheter aortic valve implantation

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    Shahgaldi Kambiz

    2013-01-01

    Full Text Available Abstract Background Aortic stenosis (AS is a relevant common valve disorder. Severe AS and symptoms and/or left ventricular dysfunction (EF Aim of the study is to assess the aortic annulus diameter in patients undergoing TAVI by biplane (BP mode using transesophageal echocardiography (TEE and compare it to two-dimensional (2D transthoracic echocardiography (TTE and 2DTEE using three-dimensional (3D TEE as reference method. Methods The study population consisted of 50 patients retrospectively (24 men and 26 women, mean age 85±8 years of age who all had undergone echocardiography examination prior to TAVI. Results The mean aortic annulus diameter was 20.4±2.2 mm with TTE, 22.3±2.5 mm with 2DTEE, 22.9±1.9 mm with BP-mode and 23.1±1.9 mm with 3DTEE. TTE underestimated the mean aortic annulus diameter in comparison to transesophageal imaging modalities (p Conclusion A multi-dimensional method is preferred to assess aortic annulus diameter in TAVI patients since there is risk of underestimation using single plane. Biplane mode is the method of choice in view of speedy post-processing with no need for expensive dedicated software. Lastly, single plane methods lead to misclassification of patients as unsuitable for TAVI. This may be of major clinical importance.

  2. Characterization of the left atrial vortex flow by two-dimensional transesophageal contrast echocardiography using particle image velocimetry.

    Science.gov (United States)

    Park, Kyu-Hwan; Son, Jang-Won; Park, Won-Jong; Lee, Sang-Hee; Kim, Ung; Park, Jong-Seon; Shin, Dong-Gu; Kim, Young-Jo; Choi, Jung-Hyun; Houle, Helene; Vannan, Mani A; Hong, Geu-Ru

    2013-01-01

    This article is the first clinical investigation of the quantitative left atrial (LA) vortex flow by two-dimensional (2-D) transesophageal contrast echocardiography (2-D-TECE) using vector particle image velocimetry (PIV). The aims of this study were to assess the feasibility of LA vortex flow analysis and to characterize and quantify the LA vortex flow in controls and in patients with atrial fibrillation (AF). Thirty-five controls and 30 patients with AF underwent transesophageal contrast echocardiography. The velocity vector was estimated by particle image velocimetry. The morphology and pulsatility of the LA vortex flow were compared between the control and AF groups. In all patients, quantitative LA vortex flow analysis was feasible. In the control group, multiple, pulsatile, compact and elliptical-shaped vortices were seen in the periphery of the LA. These vortices were persistently maintained and vectors were directed toward the atrioventricular inflow. In the AF group, a large, merged, lower pulsatile and round-shaped vortex was observed in the center of the LA. In comparisons of vortex parameters, the relative strength was significantly lower in the AF group (1.624 ± 0.501 vs. 2.105 ± 0.226, p < 0.001). It is feasible to characterize and quantify the LA vortex flow by transesophageal contrast echocardiography in patients with AF, which offers a new method to obtain additional information on LA hemodynamics. The approach has the potential for early detection of the LA dysfunction and in decisions regarding treatment strategy and guiding anticoagulation treatment in patients with AF.

  3. Endoscopic Ultrasound for the Detection of Left Atrial Appendage Thrombus: A Useful Technique in Patients with Transesophageal Echocardiography Contraindication

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    Jurado-Román, Alfonso; López-Viedma, Bartolomé; Piqueras-Flores, Jesús; López-Lluva, María T.

    2016-01-01

    Endoscopic ultrasound is a diagnostic and therapeutic technique used in specialized centers for patients that have undergone digestive procedures. This technique enables highly precise real-time imaging of the digestive tract wall and surrounding organs. Endoscopic ultrasound is also useful in patients with cardiovascular diseases such as atrial fibrillation. In patients with contraindication for transesophageal echocardiography due to high risk of esophageal bleeding or complications that may require immediate intervention, endoscopic ultrasound may be a safer option for visualizing atrial chambers to rule out the presence of left atrial appendage thrombi before cardioversion. PMID:27642527

  4. Patent Foramen Ovale: Association between the Degree of Shunt by Contrast Transesophageal Echocardiography and the Risk of Future Ischemic Neurologic Events

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    Stone, David A.; Godard, Joel; Godard, Joel; Corretti, mary C.; Kittner, Steven J.; Sample, Cindy; Price, Thomas R.; Plotnick, Gary D.

    1996-01-01

    This study investigated whether there is an association between the degree of interatrial shunting across a patent foramen ovale, as determined by saline contrast transesophageal echocardiography, and the risk of subsequent systemic embolic events, including stroke. Thirty-four patients found to have patent foramen ovale during transesophageal echocardiography were divided into two groups on the basis of the maximum number of microbubbles in the left heart in any single frame after intravenous saline contrast injection: group 1 (n = 16) with a "large" degree of shunt (220 microbubbles) and group 2 (n = 18) with a "small" degree of shunt (23 but patent foramen ovale, as determined by contrast transesophageal echocardiography, are at a significantly higher risk for subsequent adverse neurologic events compared with patients with a small degree of shunt.

  5. Transesophageal Speckle-Tracking Echocardiography Improves Right Ventricular Systolic Function Assessment in the Perioperative Setting.

    Science.gov (United States)

    Markin, Nicholas W; Chamsi-Pasha, Mohammed; Luo, Jiangtao; Thomas, Walker R; Brakke, Tara R; Porter, Thomas R; Shillcutt, Sasha K

    2017-02-01

    Perioperative evaluation of right ventricular (RV) systolic function is important to follow intraoperative changes, but it is often not possible to assess with transthoracic echocardiographic (TTE) imaging, because of surgical field constraints. Echocardiographic RV quantification is most commonly performed using tricuspid annular plane systolic excursion (TAPSE), but it is not clear whether this method works with transesophageal echocardiographic (TEE) imaging. This study was performed to evaluate the relationship between TTE and TEE TAPSE distances measured with M-mode imaging and in comparison with speckle-tracking TTE and TEE measurements. Prospective observational TTE and TEE imaging was performed during elective cardiac surgical procedures in 100 subjects. Speckle-tracking echocardiographic TAPSE distances were determined and compared with the TTE M-mode TAPSE standard. Both an experienced and an inexperienced user of the speckle-tracking echocardiographic software evaluated the images, to enable interobserver assessment in 84 subjects. The comparison between TTE M-mode TAPSE and TEE M-mode TAPSE demonstrated significant variability, with a Spearman correlation of 0.5 and a mean variance in measurement of 6.5 mm. There was equivalence within data pairs and correlations between TTE M-mode TAPSE and both speckle-tracking TTE and speckle-tracking TEE TAPSE, with Spearman correlations of 0.65 and 0.65, respectively. The average variance in measurement was 0.6 mm for speckle-tracking TTE TAPSE and 1.5 mm for speckle-tracking TEE TAPSE. Using TTE M-mode TAPSE as a control, TEE M-mode TAPSE results are not accurate and should not be used clinically to evaluate RV systolic function. The relationship between speckle-tracking echocardiographic TAPSE and TTE M-mode TAPSE suggests that in the perioperative setting, speckle-tracking TEE TAPSE might be used to quantitatively evaluate RV systolic function in the absence of TTE imaging. Copyright © 2016 American Society

  6. Variations of transesophageal echocardiography practices in India: A survey by Indian College of Cardiac Anaesthesia

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    Borde, Deepak Prakash; George, Antony; Joshi, Shreedhar; Nair, Suresh; Koshy, Thomas; Gandhe, Uday; Chakravarthy, Murali

    2016-01-01

    Context: Use of perioperative transesophageal echocardiography (TEE) has expanded in India. Despite attempts to standardize the practice of TEE in cardiac surgical procedures, variation in practice and application exists. This is the first online survey by Indian College of Cardiac Anaesthesia, research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists (IACTA). Aims: We hypothesized that variations in practice of intraoperative TEE exist among centers and this survey aimed at analyzing them. Settings and Design: This is an online survey conducted among members of the IACTA. Subjects and Methods: All members of IACTA were contacted using online questionnaire fielded using SurveyMonkey™ software. There were 21 questions over four pages evaluating infrastructure, documentation of TEE, experience and accreditation of anesthesiologist performing TEE, and finally impact of TEE on clinical practice. Questions were also asked about national TEE workshop conducted by the IACTA, and suggestions were invited by members on overseas training. Results: Response rate was 29.7% (382/1222). 53.9% were from high-volume centers (>500 cases annually). TEE machine/probe was available to 75.9% of the respondents and those in high-volume centers had easier (86.9%) access. There was poor documentation of preoperative consent (23.3%) as well as TEE findings (66%). Only 18.2% of responders were board qualified. Almost 90% of the responders felt surgeons respected their TEE diagnosis. Around half of the responders felt that new intraoperative findings by TEE were considered in decision-making in most of the cases and 70% of the responders reported that surgical plan was altered based on TEE finding more than 10 times in the last year. Despite this, only 5% of the responders in this survey were monetarily awarded for performing impactful skill of TEE. Majority (57%) felt that there is no need for overseas training for Indian cardiac anesthesiologists

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

    Science.gov (United States)

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

    2015-01-01

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

  8. Transesophageal echocardiography guided cannulation for peripheral cardiopulmonary bypass during robotic cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    WANG Yao; GAO Chang-qing; WANG Gang; WANG Jia-li

    2012-01-01

    Background Minimally invasive cardiac surgery and closed chest cardiopulmonary bypass (CPB) techniques continue to evolve.Previous reports have demonstrated the benefits of fluoroscopy guided cannulation for endovascular CPB during port access cardiac surgery.However,few data are available on the role of transesophageal echocardiography (TEE) guided cannulation for peripheral CPB during robotic cardiac surgery.The purpose of this study was to evaluate TEE guided cannulation for peripheral CPB during robotic cardiac surgery.Methods We performed a retrospective analysis of intraoperative data of 129 consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB from September 2007 to August 2011,which was established using femoral arterial inflow and kinetic venous drainage by way of the femoral vein and right internal jugular vein and a transthoracic aortic cross clamp.TEE was used to guide cannulation of the inferior vena cava (IVC),superior vena cava (SVC),and ascending aorta (AAO).The success rate and the complication rate of TEE guided cannulation for peripheral CPB were evaluated and compared with the results of fluoroscopy guided cannulation in a historical control group.Results One hundred and twenty-nine consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB.There were 67 female (51.9%) and 62 male (48.1%) patients,ranging in age from 13 to 70 years (mean (43.94 ± 13.82) years) and body surface area 1.32 to 2.39 m2 (mean (1.71 ± 0.20) m2).Some 61 (47.3%) patients underwent mitral valve repair,27 (20.9%) mitral valve replacement,27 (20.9%) left atrial myxoma removal,and 14(10.9%) ventricular septal defect repair.Of the 129 patients,TEE guided cannulation of the IVC or SVC was successful in all patients (100%),and no puncture related complications occurred in all patients.Of the 129 patients,successful cannulation of the AAO was achieved in all patients (100%),and aortic

  9. Transesophageal echocardiography, more than a diagnostic tool: use during surgical ligation of coronary artery fistulae - a case report

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    Chung Ping-Chen

    2012-04-01

    Full Text Available Abstract Coronary artery fistulae (CAF are an infrequent coronary abnormality. Herein, we describe the use of intraoperative transesophageal echocardiography (TEE in the treatment of CAF. A 61 year-old woman presented with chest pain and symptoms consistent with unstable angina. Subsequent coronary angiography revealed the presence of 2 CAF, one extending from the left anterior descending artery to the pulmonary artery (PA and the other extending from the proximal right coronary artery to the PA. Surgical ligation of the CAF without coronary bypass was arranged. Intraoperative TEE was successfully employed to localize the CAF, monitor fistula blood flow and heart wall motion, and confirm successful ligation. The patient recovered without complications. This case highlights the utility of intraoperative TEE during ligation of CAF.

  10. Transesophageal echocardiography-guided thrombectomy of intracardiac renal cell carcinoma without cardiopulmonary bypass

    Science.gov (United States)

    Souki, Fouad Ghazi; Demos, Michael; Fermin, Lilibeth; Ciancio, Gaetano

    2016-01-01

    Advanced renal cell carcinoma (RCC) resection has important anesthetic management implications, particularly when tumor extends, suprahepatic, into the right atrium. Use of transesophageal echocardiogram (TEE) is essential in identifying tumor extension and guiding resection. Latest surgical approach avoids venovenous and cardiopulmonary bypass yet requires special precautions and interventions on the anesthesiologist's part. We present a case of Level IV RCC resected without cardiopulmonary bypass and salvaged by TEE guidance and detection of residual intracardiac tumor. PMID:27716710

  11. Additional value of three-dimensional transesophageal echocardiography for patients with mitral valve stenosis undergoing balloon valvuloplasty.

    Science.gov (United States)

    Langerveld, Jorina; Valocik, Gabriel; Plokker, H W Thijs; Ernst, Sjef M P G; Mannaerts, Herman F J; Kelder, Johannes C; Kamp, Otto; Jaarsma, Wybren

    2003-08-01

    The objective of this study was to validate the additional value of 3-dimensional (3D) transesophageal echocardiography (TEE) for patients with mitral valve stenosis undergoing percutaneous mitral balloon valvotomy (PTMV). Therefore, in a series of 21 patients with severe mitral valve stenosis selected for PTMV, 3D TEE was performed before and after PTMV. The mitral valve area was assessed by planimetry pre- and post-PTMV; the mitral valve volume was assessed and attention was paid to the amount of fusion of the commissures. These results were compared with findings by 2-dimensional transthoracic echocardiography using pressure half-time method for assessment of mitral valve area, and were analyzed for the prediction of successful outcome. Pre-PTMV the mitral valve area assessed by 3D TEE was 1.0 +/- 0.3 cm(2) vs 1.2 +/- 0.4 cm(2) assessed by 2-dimensional transthoracic echocardiography (P =.03) and post-PTMV it was 1.8 +/- 0.5 cm(2) vs 1.9 +/- 0.6 cm(2) (not significant), respectively. The mitral valve volume could be assessed by 3D TEE (mean 2.4 +/- 2.5 cm(3)) and was inversely correlated to a successful PTMV procedure (P <.001). The 3D TEE method enabled a better description of the mitral valvular anatomy, especially post-PTMV. We conclude that 3D TEE will have additional value over 2-dimensional echocardiography in this group of patients, for selection of patients pre-PTMV, and for analyzing pathology of the mitral valve afterward.

  12. Cleft posterior mitral valve leaflet in an adult with Turner syndrome diagnosed with the use of 3-dimensional transesophageal echocardiography.

    Science.gov (United States)

    Negrea, Stefania Luminita; Alexandrescu, Clara; Sabatier, Michel; Dreyfus, Gilles D

    2012-01-01

    Turner syndrome is a monosomy (45,X karyotype) in which the prevalence of cardiovascular anomalies is high. However, this aspect of Turner syndrome has received little attention outside of the pediatric medical literature, and the entire spectrum of cardiovascular conditions in adults remains unknown. We present the case of a 34-year-old woman who had Turner syndrome. When she was a teenager, her native bicuspid aortic valve was replaced with a mechanical prosthesis. Fifteen years later, during preoperative examination for prosthesis-patient mismatch, severe mitral regurgitation was detected, and a congenital cleft in the posterior leaflet of the mitral valve was diagnosed with use of 3-dimensional transesophageal echocardiography. The patient underwent concurrent mitral valve repair and aortic valve replacement. To our knowledge, this is the first report of a cleft in the posterior mitral valve leaflet as a cardiovascular defect observed in Turner syndrome, and the first such instance to have been diagnosed with the use of 3-dimensional echocardiography.

  13. [Value and indications of transesophageal echocardiography before cardioversion of atrial fibrillation].

    Science.gov (United States)

    Lesbre, J P

    2003-09-01

    Transoesophageal echocardiography is essential for the diagnosis of left atrial thrombosis and its precursors (dense spontaneous contrast--reduced auricular emptying velocities) and for the diagnosis of complex aortic atheroma. The sensitivity and specificity of transoesophageal echocardiography for the diagnosis of left atrial thrombus are about 100% and about 90% for that of aortic atheroma. The formal indications for transoesophageal echocardiography before cardioversion are: atrial fibrillation complicated by stroke or a recent systemic embolism: atrial fibrillation complicated by mitral valve disease as the thrombo-embolic risk is major in this context: atrial fibrillation with a high thromboembolic risk: a history of stroke, presence of cardiac failure, diabetes, permanent hypertension, a very dilated left atrium (> or = 50 mm): apparently isolated atrial fibrillation for which long term anticoagulant therapy is hoped to be avoided. On the other hand, in recent, uncomplicated, non-valvular atrial fibrillation, a common fallacy should be corrected: transoesophageal echocardiography does not improve the safety of electrical cardioversion. With similar durations of prior anticoagulant therapy. Over a 3 week period, the frequency of thromboembolic complications is the same whether or not transoesophageal echocardiography is performed before cardioversion (0.8% in both groups of the SEIDL study). With short periods of anticoagulant therapy before cardioversion, there is a higher thromboembolic complication and mortality rate (ACUTE study). The safety of cardioversion is not related to the practice of prior transoesophageal echocardiography but to strict and efficacious anticoagulation for a period of 3 weeks before cardioversion.

  14. Giant right coronary artery aneurysm with unusual physiology: Role of intraoperative transesophageal echocardiography

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    David M Orozco

    2012-01-01

    Full Text Available A 65-year-old woman presented with a history of dyspnea and atypical chest pain. She was diagnosed with a non-ST-segment elevation myocardial infarction due to a giant right coronary artery aneurysm. After a failed percutaneous embolization, she was scheduled for right coronary artery aneurysm resection, posterior descending artery revascularization and mitral valve repair. During the induction of anesthesia and institution of mechanical ventilation, the patient suffered cardiovascular collapse. The transesophageal echocardiographic examination revealed tamponade physiology owing to compression of the cardiac chambers by the unruptured aneurysm, which resolved with the sternotomy. The surgery was carried out uneventfully.

  15. Coexisting bicuspid aortic and pulmonary valves with normally related great vessels diagnosed by live/real time three-dimensional transesophageal echocardiography.

    Science.gov (United States)

    Kemaloğlu Öz, Tuğba; Karadeniz, Fatma Özpamuk; Gundlapalli, Hareesh; Erer, Betul; Sharma, Rohit K; Ahmed, Mustafa; Nanda, Navin C; Yıldırım, Aydın; Orhan, Gökçen; Öz, Ayhan; Eren, Mehmet

    2014-02-01

    Coexistence of bicuspid aortic and pulmonary valves in the same patient is a very rare entity identified mainly during surgery and postmortem. To the best of our knowledge, only one case has been diagnosed by two-dimensional echocardiography in a newborn with malposition of the great arteries but no images were presented. Here, we are reporting the first case of bicuspid pulmonary and aortic valves diagnosed by live/real time three-dimensional transesophageal echocardiography in an adult with normally related great arteries. © 2014, Wiley Periodicals, Inc.

  16. Roles of real-time three-dimensional transesophageal echocardiography in peri-operation of transcatheter left atrial appendage closure

    Science.gov (United States)

    Zhou, Qing; Song, Hongning; Zhang, Lan; Deng, Qing; Chen, Jinling; Hu, Bo; Wang, Yijia; Guo, Ruiqiang

    2017-01-01

    Abstract Left atrial appendage (LAA) closure is a new treatment option for the prevention of stroke in patients with nonvalvular atrial fibrillation (AF). Conventional 2-dimensional transesophageal echocardiography (2D TEE) has some limitations in the imaging assessment of LAA closure. Real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) allows for detailed morphologic assessment of the LAA. In this study, we aim to determine the clinical values of RT-3D TEE in the periprocedure of LAA closure. Thirty-eight persistent or paroxysmal AF patients with indications for LAA closure were enrolled in this study. RT-3D TEE full volume data of the LAA were recorded before operation to evaluate the anatomic feature, the landing zone dimension, and the depth of the LAA. On this basis, selection of LAA closure device was carried out. During the procedure, RT-3D TEE was applied to guide the interatrial septal puncture, device operation, and evaluate the occlusion effects. The patients were follow-up 1 month and 3 months postclosure. Twenty-eight (73.7%) patients with AF received placement of LAA occlusion device under RT-3D TEE. Eleven cases with single-lobe LAAs were identified using RT-3D TEE, among which 4 showed limited depth. Seventeen cases showed bilobed or multilobed LAA. Seven cases received LAA closure using Lefort and 21 using LAmbre based on the 3D TEE and radiography. The landing zone dimension of the LAA measured by RT-3D TEE Flexi Slice mode was better correlated with the device size used for occlusion (r = 0.90) than 2D TEE (r = 0.88). The interatial septal puncture, the exchange of the sheath, as well as the release of the device were executed under the guidance of RT-3D TEE during the procedure. The average number of closure devices utilized for optimal plugging was (1.11 ± 0.31). There were no clinically unacceptable residual shunts, pericardial effusion, or tamponade right after occlusion. All the patients had the device well

  17. Measurement of Atrial Septal Defect Size: A Comparative Study between Transesophageal Echocardiography and Balloon Occlusive Diameter Method

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    Bahareh Eslami

    2010-05-01

    Full Text Available Background: Transcatheter closure of atrial septal defect secundum (ASD-II has become an alternative method for surgery. We sought to compare the two-dimensional transesophageal echocardiography (TEE method for measuring atrial septal defect with balloon occlusive diameter (BOD in transcatheter ASD-II closure.Methods: A total of 39 patients (71.1% female, mean age: 35.31 ± 15.37 years who underwent successful transcatheter closure of ASD-II between November 2005 and July 2008 were enrolled in this study. Transthoracic echocardiography (TTE and TEE were performed to select suitable cases for device closure and measure the defect size before the procedure, and BOD measurement was performed during catheterization via TEE. The final size of the selected device was usually either equal to or 1 – 2 mm larger than the BOD of the defect.Results: The mean defect size obtained by TEE and BOD was 18.50 ± 5.08 mm and 22.86 ± 4.76 mm, respectively. The mean difference between the values of ASD size obtained by TEE and BOD was 4.36 ± 2.93 mm. In comparison with BOD, TEE underestimated the defect size in 94.9%, but TEE value being equal to BOD was observed in 5.1%. There was a good linear correlation between the two measurements: BOD = 0.773 × ASD size by TEE+8.562; r2 = 67.9.1%. A negative correlation was found between TEE sizing and the difference between BOD and TEE values (r = -0.394, p value = 0.013.Conclusion: In this study, BOD was larger than ASD size obtained by two-dimensional TEE. However, TEE maximal defect sizing correlates with BOD and may provide credible information in device size selection for transcatheter ASD closure.

  18. The Incidence of Patent Foramen Ovale in 1,000 Consecutive Patients: A Contrast Transesophageal Echocardiography Study

    Science.gov (United States)

    Fisher, Daniel C.; Fisher, Edward A.; Budd, Jacqueline H.; Rosen, Stacey E.; Goldman, Martin E.

    1995-01-01

    Study objective: Patent foramen ovale (PFO) is present in 10 to 35% of people and has been reported to be an important risk factor for cardioembolic cerebrovascular accidents (CVAs) and transient ischemic attacks (TIAS), especially in younger patients. While contrast transthoracic echocardiography has been used to detect PFO, contrast transesophageal echocardiography (TEE) has a greater sensitivity. Prior studies reported the incidence of PFO in patients presenting with a CVA or TIA. Design: To determine the incidence of PFO in a more general population, we reviewed 1,000 consecutive TEES performed with contrast and color Doppler for the presence of PFO and other cardioembolic risk factors, including atrial septal aneurysm (ASA), aortic plaque, atrial fibrillation (AFib), and atrial thrombi. While imaging with monoplane or biplane TEE, multiple injections of agitated saline solution were injected during cough or Valsalva maneuver to detect flow through a PFO. Patients: There were 482 male and 518 female patients with mean age of 60 + 17 years (range 11 to 93 years). Results: Patent foramen ovale was found in 9.2% of all patients and, though seen in all age groups divided by decade, the incidence in patients aged 40 to 49 years was greater than those aged 70 to 79 years (12.96% vs 6.15%',, p=0.03). Contrast TEE had a much higher detection rate than color Doppler alone. Importantly, there was no greater incidence of PFO in patients with CVA vs thos without CVA, or in male vs female patients. Also, there was a very strong correlation between the presence of ASA and PFO (p<.001). Conclusion: Thus, PFO detected by TEE, frequently seen with ASA, is seen in all age groups and does not in itself present a risk factor for CVA. The association of PFO with peripheral thrombosis and CVA needs further study.

  19. The Incidence of Patent Foramen Ovale in 1,000 Consecutive Patients: A Contrast Transesophageal Echocardiography Study

    Science.gov (United States)

    Fisher, Daniel C.; Fisher, Edward A.; Budd, Jacqueline H.; Rosen, Stacey E.; Goldman, Martin E.

    1995-01-01

    Study objective: Patent foramen ovale (PFO) is present in 10 to 35% of people and has been reported to be an important risk factor for cardioembolic cerebrovascular accidents (CVAs) and transient ischemic attacks (TIAS), especially in younger patients. While contrast transthoracic echocardiography has been used to detect PFO, contrast transesophageal echocardiography (TEE) has a greater sensitivity. Prior studies reported the incidence of PFO in patients presenting with a CVA or TIA. Design: To determine the incidence of PFO in a more general population, we reviewed 1,000 consecutive TEES performed with contrast and color Doppler for the presence of PFO and other cardioembolic risk factors, including atrial septal aneurysm (ASA), aortic plaque, atrial fibrillation (AFib), and atrial thrombi. While imaging with monoplane or biplane TEE, multiple injections of agitated saline solution were injected during cough or Valsalva maneuver to detect flow through a PFO. Patients: There were 482 male and 518 female patients with mean age of 60 + 17 years (range 11 to 93 years). Results: Patent foramen ovale was found in 9.2% of all patients and, though seen in all age groups divided by decade, the incidence in patients aged 40 to 49 years was greater than those aged 70 to 79 years (12.96% vs 6.15%',, p=0.03). Contrast TEE had a much higher detection rate than color Doppler alone. Importantly, there was no greater incidence of PFO in patients with CVA vs thos without CVA, or in male vs female patients. Also, there was a very strong correlation between the presence of ASA and PFO (pCVA. The association of PFO with peripheral thrombosis and CVA needs further study.

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

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    Hani M. Mahmoud

    2015-01-01

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

  1. Transesophageal Echocardiography and Contrast-TCD in the Detection of a Patent Foramen Ovale: Experience with 111 Patients

    Science.gov (United States)

    Klotzsch, Christof; Janben, Gerhard; Berlit, Peter

    1994-01-01

    Patent foramen ovale (PFO) is increasingly recognized in association with cryptogenic stroke. Using transesophageal echocardiography (TEE) and transcranial Doppler sonography with ultrasonic contrast medium contrast-(TCD), we evaluated the frequency of a PFO as the fundamental condition of paradoxical embolism in 111 patients after cerebral ischemia. There was a right-left shunt in 50 patients (45%) with TEE. In 31 of 40 patients with stroke of unknown etiology, a PFO was the only detectable finding associated with cerebral ischemia. Using TEE as he "gold standard," the sensitivity of contrast-TCD was 91.3%, specificity 93.8%, and the overall accuracy 92.8%. contrast-TCD failed to detect a right-left shunt in four patients, but there were four other patients with negative TEE and positive contrast-TCD. We conclude that contrast-TCD is a highly sensitive method for detecting a right-left shunt. Its advantages are low cost, its ability to detect single contrast-medium embolism, and control of the Valsalva maneuver by observing the decrease of cerebral blood flow. Evidence of PFO in cryptogenic stroke should prompt a search for a subclinical venous thrombosis as the embolic source.

  2. Real-time three-dimensional echocardiographic assessment of mitral valve: Is it really superior to 2D transesophageal echocardiography?

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    Mukherjee, Chirojit; Tschernich, Heinz; Kaisers, Udo X; Eibel, Sarah; Seeburger, Joerg; Ender, Joerg

    2011-01-01

    Aim of our study was to investigate the feasibility of use and possible additional value of real-time 3D transesophageal echocardiography (RT-3D-TEE) compared to conventional 2D-TEE in patients undergoing elective mitral valve repair. After ethical committee approval, patients were included in this prospective study. After induction of anesthesia, a comprehensive 2D-TEE examination was performed, followed with RT-3D-TEE. The intraoperative surgical finding was used as the gold standard for segmental analysis. Only such segments which were surgically corrected either by resection or insertion of artificial chords were judged pathologic. A total of 50 patients were included in this study; usable data were available from 42 of these patients . Based on the Carpentier classification, the pathology found was type I in 2 (5%) patients, type II in 39 (93%) patients and type IIIb in 1 (2%) patient. We found that 3D imaging of complex mitral disease involving multiple segments, when compared to 2D-TEE did not show any statistically significant difference.RT-3D-TEE did not show any major advantage when compared to conventional 2D-TEE for assessing mitral valve pathology, although further study in a larger population is required to establish the validity of this study.

  3. Evaluation of cardiac function during laparoscopic gastrostomy in pediatric patients with hypoplastic left heart syndrome using intraoperative transesophageal echocardiography.

    Science.gov (United States)

    Knott, E Marty; Fraser, Jason D; Alemayahu, Hanna; Drake, William B; St Peter, Shawn D; Perryman, Kathy M; Juang, David

    2014-10-01

    Patients with single ventricle physiology (SVP)--specifically, hypoplastic left heart syndrome (HLHS)--frequently need long-term enteral access; however, they are at an extremely high operative risk. Nothing has been published on the physiologic impact on single ventricle function during laparoscopy in this patient population. Therefore, we performed intraoperative transesophageal echocardiography (TEE) to study the physiologic effects of laparoscopic surgery in these patients. After Internal Review Board approval, patients with SVP undergoing laparoscopic gastrostomy were studied with intraoperative TEE, and fractional shortening was determined. Patients were separated into those with HLHS and others with SVP. Data are reported as mean ± standard deviation values. Analysis of variance was used for continuous variables. From August 2011 to February 2013, in total, 11 patients with SVP underwent laparoscopic gastrostomy, including 6 with HLHS. One of the 6 HLHS patients and 1 of the SVP patients underwent concurrent fundoplication. All patients were post-first-stage palliation; two had completed post-second stage. Fractional shortening tended to decrease during insufflation and return to baseline after desufflation. There was no 30-day mortality. Pneumoperitoneum associated with laparoscopic gastrostomy tube placement results in a reversible decrease in fractional shortening in patients with HLHS and SVP. Overall, the children tolerated pneumoperitoneum. TEE allows for real-time assessment of ventricular function and volume and may improve safety during longer procedures.

  4. Correlation between dobutamine stress transesophageal echocardiography, thallium 201-dipyridamole scintigraphy and coronary angiography in the early detection of myocardial ischemia.

    Science.gov (United States)

    Rosas-Munive, E; Abundes-Velasco, A; Villa-Godínez, G; López-Winter, J F

    1996-01-01

    In order to establish the sensitivity and specificity of transesophageal stress echocardiography with dobutamine (TEE-dobutamine) in the early detection of myocardial ischemia we studied 30 consecutive patients from the Coronary Care Unit (CCU) of the Hospital de Cardiología, Centro Médico Nacional Siglo XXI. The results were correlated with thallium-201-dipyridamole scintigraphy (TDS), and coronary angiography. Two groups were formed: Group I-20 patients, 18 females/2 males, aged 37-73 years (mean 55 years) within the first week of myocardial infarction and/or unstable angina; Group II-10 patients, five males/five females, aged 35-65 years (mean 48 years) with atypical chest pain but with high suspicion of CHD. All group I patients, and none of group II, had significant stenoses on coronary angiography. Twenty patients had a positive TDS (18 patients from group I and two from group II). Twenty one patients had a positive test with TEE-dobutamine, 20 from group I and one from group II, which yields a sensitivity of 100%, a specificity of 90%, positive predictive value of 95% and negative predictive value of 100%.

  5. A Prototype PZT Matrix Transducer With Low-Power Integrated Receive ASIC for 3-D Transesophageal Echocardiography.

    Science.gov (United States)

    Chen, Chao; Raghunathan, Shreyas B; Yu, Zili; Shabanimotlagh, Maysam; Chen, Zhao; Chang, Zu-yao; Blaak, Sandra; Prins, Christian; Ponte, Jacco; Noothout, Emile; Vos, Hendrik J; Bosch, Johan G; Verweij, Martin D; de Jong, Nico; Pertijs, Michiel A P

    2016-01-01

    This paper presents the design, fabrication, and experimental evaluation of a prototype lead zirconium titanate (PZT) matrix transducer with an integrated receive ASIC, as a proof of concept for a miniature three-dimensional (3-D) transesophageal echocardiography (TEE) probe. It consists of an array of 9 ×12 piezoelectric elements mounted on the ASIC via an integration scheme that involves direct electrical connections between a bond-pad array on the ASIC and the transducer elements. The ASIC addresses the critical challenge of reducing cable count, and includes front-end amplifiers with adjustable gains and micro-beamformer circuits that locally process and combine echo signals received by the elements of each 3 ×3 subarray. Thus, an order-of-magnitude reduction in the number of receive channels is achieved. Dedicated circuit techniques are employed to meet the strict space and power constraints of TEE probes. The ASIC has been fabricated in a standard 0.18-μm CMOS process and consumes only 0.44 mW/channel. The prototype has been acoustically characterized in a water tank. The ASIC allows the array to be presteered across ±37° while achieving an overall dynamic range of 77 dB. Both the measured characteristics of the individual transducer elements and the performance of the ASIC are in good agreement with expectations, demonstrating the effectiveness of the proposed techniques.

  6. On-line assessment of regional ventricular wall motion by transesophageal echocardiography with color kinesis during minimally invasive coronary artery bypass grafting.

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    Kotoh, K; Watanabe, G; Ueyama, K; Uozaki, M; Suzuki, M; Misaki, T; Wakasugi, M; Ito, Y

    1999-05-01

    Our objective was to determine the changes in regional ventricular wall motion during minimally invasive direct coronary artery bypass grafting by color kinesis using transesophageal echocardiography. Minimally invasive coronary artery bypass grafting was performed in 34 patients, during which transesophageal echocardiography was used. Thirteen patients had isolated disease of the left anterior descending artery. Regional ventricular wall motion was analyzed by color kinesis with the SONOS 2500 transesophageal echocardiograph (Hewlett-Packard Co, Andover, Mass). On-line assessment of regional wall motion was continued during the operation. Wall motion abnormalities during ischemia were present in 4 cases, left ventricular mid-anterior hypokinesis in 3 cases, and left ventricular apical-lateral hypokinesis in 1 case. In all cases, wall motion was maintained after bypass. In patients with total coronary occlusion, changes in wall motion did not occur during anastomosis. Color kinesis allowed us to evaluate the change in regional ventricular wall motion induced by myocardial ischemia during minimally invasive coronary artery bypass grafting both objectively and quantitatively.

  7. Automated Assessment of Right Ventricular Volumes and Function Using Three-Dimensional Transesophageal Echocardiography.

    Science.gov (United States)

    Nillesen, Maartje M; van Dijk, Arie P J; Duijnhouwer, Anthonie L; Thijssen, Johan M; de Korte, Chris L

    2016-02-01

    Assessment of right ventricular (RV) function is known to be of diagnostic value in patients with RV dysfunction. Because of its complex anatomic shape, automated determination of the RV volume is difficult and strong reliance on geometric assumptions is not desired. A method for automated RV assessment was developed using three-dimensional (3-D) echocardiography without relying on a priori knowledge of the cardiac anatomy. A 3-D adaptive filtering technique that optimizes the discrimination between blood and myocardium was applied to facilitate endocardial border detection. Filtered image data were incorporated in a segmentation model to automatically detect the endocardial RV border. End-systolic and end-diastolic RV volumes, as well as ejection fraction, were computed from the automatically segmented endocardial surfaces and compared against reference volumes manually delineated by two expert cardiologists. The results reported good performance in terms of correlation and agreement with the results from the reference volumes.

  8. Cardiovascular magnetic resonance as a reliable alternative to cardiovascular computed tomography and transesophageal echocardiography for aortic annulus valve sizing.

    Science.gov (United States)

    Faletti, Riccardo; Gatti, Marco; Salizzoni, Stefano; Bergamasco, Laura; Bonamini, Rodolfo; Garabello, Domenica; Marra, Walter Grosso; La Torre, Michele; Morello, Mara; Veglia, Simona; Fonio, Paolo; Rinaldi, Mauro

    2016-08-01

    To assess the accuracy and reproducibly of cardiovascular magnetic resonance (CMR) in the measurement of the aortic annulus and in process of valve sizing as compared to intra-operative sizing, cardiovascular computed tomography (CCT) and transesophageal echocardiography (TEE). Retrospective study on 42 patients who underwent aortic valve replacement from September 2010 to September 2015, with available records of pre surgery annulus assessment by CMR, CCT and TEE and of peri-operative assessment. In CCT and CMR, the annular plane was considered a virtual ring formed by the lowest hinge points of the valvular attachments to the aorta. In TEE the annulus was measured at the base of leaflet insertion in the mid-esophageal long-axis view using the X-plane technique. Two double-blinded operators performed the assessments for each imaging technique. Intra-operative evaluation was performed using Hegar dilators. Continuous variables were studied with within-subject ANOVA, Bland-Altman (BA) plots, Wilcoxon's and Friedman's tests; trends were explored with scatter plots. Categorical variables were studied with Fisher's exact test. The intra- and inter-operator reliability was satisfying. There were no significant differences between the annulus dimensions measured by CMR and either one of the three references. Valve sizing for CoreValve by CMR had the same good agreement with CCT and TEE, with a 78 % match rate; for SAPIEN XT the agreement was slightly better (82 %) for CCT than for TEE (66 %). MR performs well when compared to the surgical reference of intra-operative sizing and stands up to the level of the most used imaging references (CCT and TEE).

  9. Using The Descending Aortic Wall Thickness Measured In Transesophageal Echocardiography As A Risk Marker For Aortic Dissection

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    Zaher Fanari

    2015-04-01

    Full Text Available Objective: The aim of this study is to estimate whether aortic wall thickness is increased in patients with Aortic dissection (AD compared to low risk control group and can be used in addition to aortic diameter as a risk marker of AD. Background: AD occurs due to pathologies that may increase thickness of the aortic wall. Transesophageal echocardiography (TEE has the ability to visualise both the thoracic aortic wall and lumen. Aortic diameter has been used to predict aortic dissection and timing of surgery, but it is not always predictive of that risk. Methods: In 48 patients with AD who underwent TEE were examined retrospectively and compared to 48 control patients with patent foramen ovale (PFO. We measured aortic diameter at different levels, intimal/medial thickness (IMT and complete wall thickness (CMT. Demographic data and cardiovascular risk factors were reviewed. The data was analysed using ANOVA and student t test. Results: (AD patients were older [mean age 66 AD vs. 51 PFO], had more hypertension, diabetes, hyperlipidemia and Coronary artery disease. Both IMT and CMT in the descending aorta were increased in AD group [(1.85 vs. 1.43 mm; P=0.03 and 2.93 vs. 2.46 mm; p=0.01. As expected the diameter of ascending aorta was also greater in AD (4.61 vs. 2.92 cm; P=0.004. Conclusions: CMT and IMT in the descending aorta detected by TEE is greater in patients with AD when compared to control and may add prognostic data to that of aortic diameter

  10. 15. Sensitivity in visualizing vegetations in cardiac lead-induced endocarditis: A comparative study between transesophageal vs. transthoracic echocardiography

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    A. AlFagih

    2016-07-01

    Full Text Available Despite advancement in sterile cardiac device implantation techniques, wound infections and/or bacteremia remain a significant problem. The presence of a vegetation in lead-induced endocarditis (LIE is a critical factor that determines the management. Transthoracic (TTE and Transesophageal (TEE Echocardiography are two different cardiac modalities that are used for the detection of lead vegetation. However, it is not yet clear which of the two has the highest diagnostic accuracy. We aim to identify which of the two has the highest sensitivity. In addition, we aim to correlate the existence of a vegetation with blood and wound culture results. We conducted a chart review in 113 patients whom underwent lead extraction at Prince Sultan Cardiac Center in Saudi Arabia during the period of Jan, 2002 to Jul, 2015. Six patients underwent lead extraction twice, increasing the number to be a total of 119 cases. Out of the study cohort, we include 38 patients who had both TTE and TEE done prior to lead extraction. Data regarding TTE, TEE, as well as blood and wound cultures were collected from echocardiography and microbiology lab reports using a well-structured case report form.Of the study population, 21 patients (55.3% had lead vegetations visualized either by TTE or TEE. Nineteen patients had vegetations detected by TEE, compared to 6 patients only when TTE was used. The sensitivity of TEE and TTE were 90.5% (CI: 69.6–98.8% and 28.5% (95% CI: 11.3–52.1%, respectively. Blood and wound culture results showed that in the presence of a vegetation, blood cultures were positive in 55% of the cases (P = 0.036 while only 44.4% of those with vegetations had a positive wound culture (P = 0.347. TEE has higher sensitivity in detecting vegetations compared to TTE in LIE. The presence of a vegetation is more likely to be associated with a positive blood culture than a positive wound culture. Further studies ought to measure the accuracy of different

  11. Sedation for transesophageal echocardiography: comparison of propofol, midazolam and midazolam-alfentanil combination

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    Huseyin Toman

    2016-02-01

    Full Text Available Aim The administration of trans esophageal echocardiography (TEE may cause nausea, shortness of breath, agitation, emotional distress and pain in patients due to pharyngo-esophageal intubation, which may be partially relieved by sedoanalgesia. The aim of this study was to compare clinical effects of midazolam, midazolam-alfentanil combination and propofol sedation given for sedation and sedoanalgesia to patients with planned diagnostic TEE interventions. Methods This study was prospectively completed with 90 randomized adult patients in ASA risk groups I-II-III. Group M were given 2.5 mg midazolam, group MA were given 1 mg midazolam and 5 μg/kg alfentanil and group P were given 0.5 mg/kg propofol intravenous bolus. If necessary, additional doses were administered. Patients administered with TEE were evaluated in terms of additional dose requirements, Ramsey Sedation Scale (RSS, modified Aldrete Scoring (MAS, recovery time and duration of stay in the hospital. Results In the group P additional dose requirements were greater (p<0.05, as well as the duration of stay in the recovery unit and hospital were shorter (p<0.05. On insertion of the TEE probe, the RSS in the group P was clearly higher than in other groups M and MA (p<0.05. Conclusion During the TEE intervention, the use of propofol, contrary to requirements for additional dose and observation of apnea, appears to be advantageous due to providing more rapid and effective sedation depth without a need of expensive antagonist agents, and allowing early discharge of patients. Additionally, it seems that the use of midazolam combined with alfentanil, is more advantageous comparing to midazolam alone.

  12. Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of aortic atherosclerotic thrombi and ulcers.

    Science.gov (United States)

    Elsayed, Mahmoud; Bulur, Serkan; Kalla, Aditi; Ahmed, Mustafa I; Hsiung, Ming C; Uygur, Begum; Alagic, Nermina; Sungur, Aylin; Singh, Satinder; Nanda, Navin C

    2016-08-01

    We present two cases in whom live/real time three-dimensional transesophageal echocardiography (3DTEE) provided incremental value in the assessment of atherosclerotic disease in the aorta. In one patient, it identified additional atherosclerotic ulcers as well as thrombi within them which were missed by two-dimensional (2D) TEE. In both cases, the size of the large mobile atherosclerotic plaque was underestimated by 2DTEE as compared with 3DTEE. Furthermore, 3DTEE provided volume quantification of the thrombi and ulcers which is not possible by 2DTEE. The echocardiographic findings of atherosclerotic plaques were confirmed by computed tomography in one patient and by surgery in the other.

  13. Guidelines of the Indian Association of Cardiovascular and Thoracic Anaesthesiologists and Indian College of Cardiac Anaesthesia for perioperative transesophageal echocardiography fellowship examination

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    Kanchi Muralidhar

    2016-01-01

    Full Text Available During current medical care, perioperative transesophageal echocardiography (TEE has become a vital component of patient management, especially in cardiac operating rooms and in critical care medicine. Information derived from echocardiography has an important bearing on the patient′s outcome. The Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA has promoted the use of TEE during routine clinical care of patients undergoing cardiac surgery. An important mission of IACTA is to oversee training and certify anesthesiologists in the perioperative and intensive care use of TEE. The provision of "Fellowship" is by way of conducting IACTA - TEE fellowship (F-TEE examination. This has been done annually for the past 7 years using well-established curriculums by accredited national and international societies. Now, with the transformation and reconstitution of IACTA education and research cell into the newly formed Indian College of Cardiac Anaesthesia, F-TEE is bound to meet international standards. To ensure that the examinations are conducted in a transparent and foolproof manner, the guideline committee (formulated in 2010 of IACTA has taken the onus of formulating the guidelines for the same. These guidelines have been formally reviewed and updated since 2010 and are detailed here to serve as a guide to both the examinee and examiner ensuring standardization, efficiency, and competency of the IACTA F-TEE certification process.

  14. 经食道超声心动图在三尖瓣成形术中的应用%Transesophageal echocardiography in tricuspid Valve plasty

    Institute of Scientific and Technical Information of China (English)

    徐晓茜; 刘慧; 邹翰琴; 周克松; 刘志辉

    2011-01-01

    Objective To research transeaophageal echocardiography in tricuspid valve plasty.Methods 62 patients with tricuspid surgery were examined with intraoperative transesophageal echocardiography.The patients were fullly monitored with IOTEE on the entire surgical procedure.Results There were 62 cases of tricuspid annuloplasty in patients with severe regurgitation preoperatively.The reflux of 16 cases (25.8%)disappeared.There were 43 cases (69.3%) wih mild regurgitation.Conclusion Transesophageal echocardiography for tricuspid annuloplasty can solve problems in surgery, evaluate the efficacy, improve the success rate, reduce complications and avoid the second operation.%目的 探讨经食道起声心动图(TEE)在三尖瓣成形术中的应用价值.方法 对62例三尖瓣成形手术患者术中行食道超声心动图检查.TEE全程监测整个手术过程,术前观察三尖瓣及其附属结构的形态、功能及反流程度,瓣膜成形完成心脏复跳后,再次观察成形瓣膜及其附属结构的形态、功能及反流情况.结果 62例三尖瓣成形术患者术前均为重度关闭不全,成形术后16例(25.8%)反流完全消失,43例(69.3%)为轻度反漉,3例(4.8%)因无法成形,接受瓣膜置换术.结论 经食道超声心动图用于三尖瓣成形术中监测,能够及时发现、解决术中的问题,评价手术效果,提高手术成功率,减少手术并发症,避免二次手术,具有重要的临床价值.

  15. Atrial Septal Aneurysm and Patent Foramen Ovale as Risk Factors for Cryptogenic Stroke in Patients Less Than 55 Years of Age: A Study using Transesophageal Echocardiography

    Science.gov (United States)

    Cabanes, L.; Mas, J. L.; Cohen, A.; Amarenco, P.; Cabanes, P. A.; Oubary, P.; Chedru, F.; Guerin, F.; Bousser, M. G.; deRecondo, J.

    1993-01-01

    Background and Purpose: An association between atrial septal aneurysm and embolic events has been suggested. Atrial septal aneurysm has been shown to be associated with patent foramen ovale and,.in some reports, with mitral valve prolapse. These two latter cardiac disorder; have been identified as potential risk factors for ischemic stroke. The aim of this prospective study was to assess the role of atrial septal aneurysm as an independent risk factor for stroke, especially for cryptogenic stroke. Methods: We studied the prevalence of atrial septal aneurysm, patent foramen ovale, and mitral valve prolapse in 100 consecutive patients patent foramen ovale relied on transesophageal echocardiography with a contrast study and that of mitral valve prolapse, on two-dimensional transthoracic echocardiography. Results: Stepwise logistic regression analysis showed that atrial septal aneurysm (odds ratio, 4.3; 95% confidence interval, 1.3 to 14.6; P=.01) and patent foramen ovale (odds ratio, 3.9; 95% confidence interval, 1.5 to 10; P=.003) but not mitral valve prolapse were significantly associated with the diagnosis of cryptogenic stroke. The stroke odds of a patient with both atrial septal aneurysm and patent foramen ovale were 33.3 times (95% confidence interval, 4.1 to 270) the stroke odds of a patient with neither of these cardiac disorders. For a patient with atrial septal aneurysm of >lo-mm excursion, the stroke odds were approximately 8 times the stroke odds of a patient with atrial septal aneurysm of patent foramen ovale are both significantly associated with cryptogenic stroke and that their association has a marked synergistic effect. Atrial septal aneurysms of >lo-mm excursion are associated with a higher risk of stroke. (Stroke. 1993;24:1865-1873.) KEY WORDS aneurysm echocardiography foramen ovale, patent mitral valve prolapse o young adults

  16. [Systematic implementation of transthoracic echocardiography, transesophageal echocardiography and 24-hour Holter ECG for the detection of cardiac sources of embolism in patients with stroke or transient ischemic attack. A retrospective study of 220 patients].

    Science.gov (United States)

    Vinsonneau, U; Leblanc, A; Buchet, J-F; Pangnarind-Heintz, V; Le Gal, G; Rohel, G; Paleiron, N; Piquemal, M; Blanchard, C; Zagnoli, F; Paule, P

    2014-09-01

    Embolism of cardiac origin accounts for around 20% of ischemic strokes. ECG and transthoracic echocardiography (TTE) are commonly obtained during the evaluation of patient of ischemic stroke but specific indications for the transesophageal (TEE) echocardiography and 24-hour Holter ECG (Holter) remain uncertain. The aim of this study is to report the contribution of TTE, TEE and Holter performed as a routine during the evaluation of patients with ischemic stroke (IS) or transient ischemic attack (TIA). This is a retrospective single-center study of 220 patients hospitalized between 1st January 2007 and 31st December 2010 for a first IS or TIA. One hundred and forty-three IS and 77 TIA are identified. The average age of patients was 66 years (18-88 years). TTE/TEE/24-hour Holter allowed the diagnosis of cardiac sources of embolism in 135 patents (61.3%). TTE/TEE identified potential source of cardiogenic embolism in 126 patients (52.2%). Twenty four-hour Holter ECG tracked supraventricular arrhythmia in 15 patients (6.7%), 9 (4%) which had non-contributory ultrasound assessment. The systematic implementation of TTE/TEE/Holter is useful for identifying potential sources of cardiogenic embolism. The performance of TEE remains above the TTE. Holter should be recommended because it is a cost effective and non-invasive tool. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  17. The advantages of live/real time three-dimensional transesophageal echocardiography in the assessment of tricuspid valve infective endocarditis.

    Science.gov (United States)

    Sungur, Aylin; Hsiung, Ming C; Meggo Quiroz, Luis D; Oz, Tuğba Kemaloğlu; Haj Asaad, Ayman; Joshi, Deepak; Dönmez, Cevdet; Güvenç, Tolga S; Nanda, Navin C

    2014-11-01

    Currently, tricuspid valve infective endocarditis (TVIE) is encountered in daily clinical practice more frequently due to the increasing prevalence of illicit intravenous drug use and the implantation of intracardiac devices. In this study, we compared findings from intra-operative live/real time three-dimensional transesophageal echocardiograms (3DTEE) and two-dimensional transesophageal echocardiograms (2DTEE) of 10 patients who underwent surgery for native tricuspid valve (TV) endocarditis. Unlike 2DTEE, 3DTEE allowed en face visualization of the 3 TV leaflets from both, atrial and ventricular aspects, in 9 of the 10 cases. In the remaining patient, in whom 3DTEE could not identify all 3 leaflets en face, the TV was found essentially destroyed at surgery. Using 3DTEE, the number of vegetations was accurately reported when compared with the surgical record. Furthermore, the orientation of each vegetation was the same as noted in the surgical findings. 2DTEE missed the identification of vegetations in 5 patients. The attachment site of vegetations to the TV were also not characterized by 2DTEE in 5 patients. In all 10 cases, 3DTEE characterized the vegetations more accurately with larger dimensions, including those in the azimuthal axis, and volumes. In addition, a perivalvular abscess that lead to surgical intervention was identified by 3DTEE, however, missed by 2DTEE. In conclusion, 3DTEE allows en face visualization of the TV apparatus permitting accurate description of the number and dimensions of vegetations identified by our surgical standard, which ultimately informs patients' prognosis and dictates the timing and planning for surgical intervention. Its use should be in conjunction with 2DTEE when evaluating TVIE.

  18. Feasibility of measuring superior mesenteric artery blood flow during cardiac surgery under hypothermic cardiopulmonary bypass using transesophageal echocardiography: An observational study

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    Naveen G Singh

    2016-01-01

    Full Text Available Background: Abdominal complications being rare but results in high mortality, commonly due to splanchnic organ hypoperfusion during the perioperative period of cardiac surgery. There are no feasible methods to monitor intraoperative superior mesenteric artery blood flow (SMABF. Hence, the aim of this study was to evaluate the feasibility and to measure SMABF using transesophageal echocardiography (TEE during cardiac surgery under hypothermic cardiopulmonary bypass (CPB. Methodology: Thirty-five patients undergoing elective cardiac surgery under CPB were enrolled. Heart rate, mean arterial pressure (MAP, cardiac output (CO, SMABF, superior mesenteric artery (SMA diameter, superior mesentric artery blood flow over cardiac output (SMA/CO ratio and arterial blood lactates were recorded at three time intervals. T0: before sternotomy, T1: 30 min after initiation of CPB and T2: after sternal closure. Results: SMA was demonstrated in 32 patients. SMABF, SMA diameter, SMA/CO, MAP and CO-decreased significantly (P 0.05 between T0 and T2. Lactates increased progressively from T0 to T2. Conclusion: Study shows that there is decrease in SMABF during CPB and returns to baseline after CPB. Hence, it is feasible to measure SMABF using TEE in patients undergoing cardiac surgery under hypothermic CPB. TEE can be a promising tool in detecting and preventing splanchnic hypoperfusion during perioperative period.

  19. Transesophageal Echocardiography, 3-Dimensional and Speckle Tracking Together as Sensitive Markers for Early Outcome in Patients With Left Ventricular Dysfunction Undergoing Cardiac Surgery.

    Science.gov (United States)

    Kumar, Alok; Puri, Goverdhan Dutt; Bahl, Ajay

    2017-10-01

    Speckle tracking, when combined with 3-dimensional (3D) left ventricular ejection fraction, might prove to be a more sensitive marker for postoperative ventricular dysfunction. This study investigated early outcomes in a cohort of patients with left ventricular dysfunction undergoing cardiac surgery. Prospective, blinded, observational study. University hospital; single institution. The study comprised 73 adult patients with left ventricular ejection fraction speckle tracking and 3D left ventricular ejection fraction were computed using transesophageal echocardiography. Mean prebypass global longitudinal strain and 3D left ventricle ejection fraction were significantly lower in patients with postoperative low-cardiac-output syndrome compared with patients who did not develop low cardiac output (global longitudinal strain -7.5% v -10.7% and 3D left ventricular ejection fraction 29% v 39%, respectively; p < 0.0001). The cut-off value of global longitudinal strain predicting postoperative low-cardiac-output syndrome was -6%, with 95% sensitivity and 68% specificity; and 3D left ventricular ejection fraction was 19% with 98% sensitivity and 81% specificity. Preoperative left ventricular global longitudinal strain (-6%) and 3D left ventricular ejection fraction (19%) together could act as predictor of postoperative low-cardiac-output states with high sensitivity (99.9%) in patients undergoing cardiac surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Accurate placement of the distal end of a ventriculoatrial shunt with the aid of real-time transesophageal echocardiography. Technical note.

    Science.gov (United States)

    Machinis, Theofilos G; Fountas, Kostas N; Hudson, John; Robinson, Joe Sam; Troup, E Christopher

    2006-07-01

    Ventriculoatrial (VA) shunts remain a valid option for the treatment of hydrocephalus, especially in patients in whom ventriculoperitoneal (VP) shunts fail. Correct positioning of the distal end of the catheter in the right atrium is of paramount importance for maintaining shunt patency and reducing the incidence of VA shunt-associated morbidity. The authors present their experience with real-time transesophageal echocardiography (TEE) monitoring for the accurate placement of the distal catheter of a VA shunt. Four patients underwent conversion of a VP shunt to a VA shunt under the guidance of intraoperative fluoroscopy and TEE between May 2003 and December 2004. After induction of general anesthesia, the TEE transducer was advanced into the esophagus. A cervical incision was made and the external jugular vein was visualized. An introducer was passed through an opening in the jugular vein and a guidewire was placed through the introducer. Under continuous TEE guidance, the guidewire was carefully advanced into the superior vena cava. A distal shunt catheter overlying a J-wire was then passed to the superior vena cava, again under TEE guidance. The catheter was advanced to the right atrium after removing the guidewire. Final visualization with TEE and fluoroscopy revealed a good position of the catheter in the right atrium in all four cases. The mean duration of the operation was 91 minutes (range 65-120 minutes) and the mean operative blood loss was 23 ml (range 10-50 ml). No procedure-related complication was noted. Real-time TEE is a safe and simple technique for the accurate placement of the distal catheter of a VA shunt.

  1. Impact of electrical cardioversion for atrial fibrillation on left atrial appendage function and spontaneous echo contrast: characterization by simultaneous transesophageal echocardiography.

    Science.gov (United States)

    Grimm, R A; Stewart, W J; Maloney, J D; Cohen, G I; Pearce, G L; Salcedo, E E; Klein, A L

    1993-11-01

    This study assessed the function of the left atrial appendage in the pericardioversion period to gain insights into mechanisms involved in thromboembolism after cardioversion of atrial fibrillation. Systemic embolization associated with electrical cardioversion of atrial fibrillation is thought to originate from the left atrium or left atrial appendage, or both. However, the mechanism involved is poorly understood. We studied left atrial appendage function with transesophageal echocardiography in 20 patients with atrial fibrillation before and after successful electrical cardioversion. We measured left atrial appendage emptying and filling velocities by pulsed wave Doppler echocardiography, characterized Doppler emptying patterns, measured atrial appendage areas and assessed the presence or absence of spontaneous echo contrast or thrombus. Organized left atrial appendage function returned in 16 (80%) of 20 patients immediately after cardioversion. Atrial appendage emptying velocities before cardioversion were greater in patients without (0.39 +/- 0.02 m/s) than in those with (0.25 +/- 0.12 m/s) spontaneous echo contrast (p = 0.045). Furthermore, emptying velocities before cardioversion were significantly greater than late diastolic emptying velocities after cardioversion (0.31 +/- 0.15 vs. 0.14 +/- 0.12 m/s, p = 0.0001), as well as in both the group with (0.25 +/- 0.12 vs. 0.13 +/- 0.13 m/s, p = 0.001) and the group without (0.39 +/- 0.02 vs. 0.15 +/- 0.12 m/s, p = 0.01) spontaneous echo contrast. In addition, left atrial and atrial appendage spontaneous echo contrast developed in 4 of 20 patients and increased in intensity in 3 of 20 patients in the immediate postcardioversion period. Organized left atrial appendage function returns in most patients immediately after cardioversion of atrial fibrillation. However, its function is impaired compared with that before cardioversion. Furthermore, spontaneous echo contrast increased in 7 (35%) of 20 patients after

  2. HypnosIS to faciLitate trans-Esophageal echocardiograPhy Tolerance: The I-SLEPT study.

    Science.gov (United States)

    Corman, Isabelle; Bouchema, Yasmina; Miquel, Béatrice; Rousseau, Hélène; Bouvier, Dominique; Voilmy, Nicolas; Beauvais, Florence; Cohen-Solal, Alain; Vicaut, Eric; Logeart, Damien; Tournoux, François

    2016-03-01

    Trans-oesophageal echocardiography (TOE) is one of the major diagnostic tests in cardiovascular medicine, but the procedure is associated with some discomfort for the patient. To determine the additive value of hypnosis as a means of improving patient comfort during TOE. We randomly assigned 98 patients with non-emergency indications for TOE to a 30-minute hypnosis session combined with topical oropharyngeal anaesthesia (HYP group) or topical oropharyngeal anaesthesia only (CTRL group) before the procedure. The primary efficacy endpoint was the level of patient discomfort assessed using a visual analogue scale (VAS). The VAS score was significantly reduced in the HYP group compared with the CTRL group (6 [5; 8] vs. 7 [5; 9]; P=0.046). No statistically significant differences were observed in terms of procedure failure (HYP group 2.2% vs. CTRL group 3.9%; P=1.00) and procedure length (HYP group 7 [5; 11] minutes vs. CTRL group 8 [7; 11] minutes; P=0.29). However, the patients' subjective estimations of the length of the procedure were significantly shorter in the HYP group than in the CTRL group (8 [5; 10] vs. 10 [10; 20] minutes; PHypnosis is an efficient alternative or complementary method for improving patient comfort during TOE. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  3. Long-term follow-up after left atrial appendage occlusion with comparison of transesophageal echocardiography versus computed tomography to guide medical therapy and data about postclosure cardioversion.

    Science.gov (United States)

    Berte, Benjamin; Jost, Christine Attenhofer; Maurer, Dominik; Fäh-Gunz, Anja; Pillois, Xavier; Naegeli, Barbara; Pfyffer, Monica; Sütsch, Gabor; Scharf, Christoph

    2017-07-04

    The use of left atrial appendage (LAA) occluders in atrial fibrillation is increasing. There are few data on the comparison between transesophageal echocardiography (TEE) and computed tomography (MDCT) assessing peridevice flow and outcome of electrical cardioversion (ECV) in these patients. Single-center prospective registry from 2009 to 2015 including all LAA occluders to analyze success and complications during implantation and follow-up. Patients having ≥1 ECV were further analyzed. TEE was performed during implantation and at 6 weeks. In a subgroup of 77 patients, we compared MDCT with TEE at 6 weeks. Overall, 135 patients (69 ± 9 years; 70% male; CHA2 DS2 -VASc score: 3.6 ± 1.4; HAS-BLED score: 2.5 ± 0.6) received a LAA occluder (Watchman, n = 73; ACP-1, n = 59; Amulet, n = 3; PVI + LAA occluder, n = 91; and LAA occluder only, n = 44). Device implantation was successful in 131 (97%). Eight patients (5.9%) had major periprocedural complications (ischemic stroke/transient ischemic attacks, n = 4, tamponade, n = 2, device thrombosis, n = 2, Dressler syndrome, n = 1). The periprocedural complication rate was similar between concomitant procedure and LAA occluder only (8/91 vs. 5/44; P = 0.6). Twelve patients (9%) died (procedure-related, n = 2; 1%) during follow-up of 44 months (IQR: 43). MDCT (n = 77) at 6 weeks showed similar peridevice flow compared to TEE (TEE: 1.5 ± 1.9 mm vs. MDCT: 1.1 ± 2.2 mm, P = 0.25). Thromboembolic events occurred in 3 patients (CVA, n = 1; TIA, n = 2) during follow-up. In total, 41 ECV were performed in 26 patients (1.6 ± 0.9/patient), 13 months (IQR: 24) after implantation (<1 month: n = 8). No ECV-related clinical complications were observed. LAA occlusion is feasible with an acceptable safety profile and few events during long-term follow-up. ECV after LAA occlusion is feasible. MDCT could help to evaluate peridevice flow. © 2017 Wiley Periodicals, Inc.

  4. The evaluation of the value of transesophageal echocardiography(TEE) in mitral valve repair%经食管超声心动图在二尖瓣成形术中的应用价值

    Institute of Scientific and Technical Information of China (English)

    李佳

    2013-01-01

    目的 探讨经食管超声心动图在二尖瓣成形术中的应用价值.方法 术前18例二尖瓣关闭不全患者均常规经胸超声心动图检查,术中经食管超声心动图监测,并即刻评价二尖瓣成形术的效果.结果 本组18例中16例一次性手术实施成功.1例术中监测发现反流2级后再次实施成形后成功,1例术中监测发现反流3级后改行二尖瓣置换术.结论 经食管超声心动图在二尖瓣成形术中具有非常重要的临床应用价值.%Objective The intraoperative assessment and evaluation of the transesophageal echocardiography (TEE) in mitral valvuloplasty.Methods Before the operation,18 patients with mitral regurgitation were underwent conventional transthoracic echocardiography (TEE),then the result was evaluated by transesophageal echocardiography(TEE) on the immediate effects on mitral valvuloplasty.Results Among 18 cases with the mitral regurgitation,the results show that the 16 patients with TEE 0 and 1 patient with TEE 1 were treated successfully,while 1 patient with TEE 3 needed mitral valve replacement because of failure repair.Conclusion TEE play an important role in mitral valve repair.

  5. Value of systolic pulmonary venous flow reversal and color Doppler jet measurements assessed with transesophageal echocardiography in recognizing severe pure mitral regurgitation

    NARCIS (Netherlands)

    Pieper, EPG; Hellemans, IM; Hamer, HPM; Ravelli, ACJ; Cheriex, EC; Tijssen, JGP; Lie, KI; Visser, CA

    1996-01-01

    We evaluated the value of color and pulsed Doppler transesophageal echocardiographic parameters and of V waves in estimating the severity of mitral regurgitation (MR) in 62 consecutive patients (38 men and 24 women, aged 39 to 80 years) with angiographically proven chronic pure MR (15 grade I/II, 47

  6. Ecocardiografía transesofágica intraoperatoria en la cirugía de las cardiopatías congénitas Intraoperative transesophageal echocardiography in congenital heart diseases surgery

    Directory of Open Access Journals (Sweden)

    Francisco Javier Ozores Suárez

    2010-06-01

    , indicada por ecocardiografía transesofágica, es más probable en los pacientes con mayor riesgo quirúrgico.INTRODUCTION. The intraoperative transesophageal echocardiography is very used in pediatric cardiovascular surgery. The aim of present paper was to determine its impact on the surgery immediate results after a previous experience of authors with this type of procedure. METHODS. Reports of intraoperative transesophageal echocardiography in 231 consecutive patients between August, 2004 and December, 2007were retrospectively analyzed. Authors determined the incidence of new diagnoses before cannulation, the impact of the transesophageal echocardiography prior decannulation and the relation between to take up again the extracorporeal circulation assessed from the intraesophageal echocardiographic study and the surgical risk of patients, according to the RACHS-2 scale. Also, we specified exactly the case incidence in which the study before decannulation doesn't identified significant residues. RESULTS. The impact of examination before cannulation was of 2,6% and that of echocardiography carried out before decannulation was of 10,82%. A second run of extracorporeal circulation signaled by a transesophageal echocardiography before decannulation was more frequent in neonatal and valvular surgery and in the arteriosus truncus leading to significant residual pressure gradient, residual short circuit and valvular regurgitation. The 2, 3 and 4 RACHS-1 categories showed the risk to take up again the extracorporeal circulation of 2,7; 2,25 and 11,5 times regarding the 1 category, respectively. CONCLUSIONS. The beneficial effect of the transesophageal echocardiography use in the transoperative period of pediatric cardiovascular surgery was confirmed and it was demonstrated the need of to take up again the extracorporeal circulation by a second time to correct the significant residues indicated by transesophageal echocardiography, is more probable in patients with a great surgical

  7. Transesophageal echocardiogram causing denture dislodgement with upper airway partial obstruction.

    Science.gov (United States)

    Ahmed, Najeeb; Shaikh, Azim

    2009-06-01

    A 30-year-old female was evaluated with transesophageal echocardiography to exclude an atrial septal defect. The patient denied having dentures or partial dentures during her pre-procedure history and immediately prior to the procedure. Following the transesophageal echocardiography it was discovered that the patient had a partial airway obstruction caused by dislodgement of her partial dentures. The case illustrates the importance of not only asking patients if they have dentures, partial dentures, or any dental appliances, but also manually checking and directly looking into patients' mouths prior to transesophageal echocardiography for any dental appliances.

  8. 食管超声监测下非胸腔镜辅助Nuss手术85例分析%Non-thoracoscopic Nuss procedure for correcting pectus excavatum with trans-esophageal echocardiography monitoring

    Institute of Scientific and Technical Information of China (English)

    徐冰; 牟玲; 李文华; 刘文英

    2016-01-01

    目的 探讨食管超声监测下非胸腔镜辅助Nuss手术的手术方法和治疗经验.方法 2011年8月至2014年8月本院对适合的漏斗胸病例采用食管超声监测下非胸腔镜辅助Nuss手术矫治漏斗胸,共85例患儿,其中男61例,女24例.年龄7岁8个月至17岁5个月,平均13岁2个月.胸廓指数(Haller index)在3.6~14.2之间,平均4.1.79例为初次漏斗胸手术,6例为复发漏斗胸,64例患儿置入1根钢板,21例置入2根钢板.结果 85例患儿均顺利完成手术,无术中严重并发症发生.手术时间28~70 min,平均40 min;出血量10~40ml,平均15ml.全部患儿术后未出现伤口感染,恢复顺利,术后5~7 d出院,平均6d.本组22例患儿术后钢板安置满3年已手术移除钢板.85例均获随访,随访时间14~38个月,平均23个月.患儿疼痛消失,活动量增加,无不适表现,患儿和家属满意矫形效果.结论 使用食管超声监测,术中能够比较清楚的反映术中心脏大血管及心包的状态,可以有效的发现并避免术中严重的并发症,食管超声在漏斗胸手术中为一种有效的监测手段.%Objective To review our experiences of correcting pectus excavatum through Nuss procedure with non-thoracoscopic assistance trans-esophageal echocardiography monitoring.Methods A total of 85 patients of pectus excavatum underwent Nuss procedure with non-thoracoscopic assistance trans-esophageal echocardiography monitoring.There were 61 boys and 24 girls with an average age of 158 (92-209) months,including first pectus excavaturm operation (n =79) and postoperative recurrence after traditional pectus excavatum correction (n =6).The mean Haller index was4.1 (3.6-14.2).And the number of bar was 1 (n=64)and2 (n=21).Results All operations were successful without any severe complication.The mean operative duration was 40 (28-70) min,mean hemorrhagic volume 15 (10-40) ml and mean time from operation to discharge 6 (5-7) days.And the bars were removed in 22

  9. Echocardiography is dispensable in uncomplicated Staphylococcus aureus bacteremia

    National Research Council Canada - National Science Library

    Khatib, Riad; Sharma, Mamta

    2013-01-01

    Current Staphylococcus aureus bacteremia (SAB) practice guidelines stratify treatment duration according to the likelihood of complications and recommend transesophageal echocardiography (TEE) in all cases...

  10. Comparison of diagnostic and therapeutic value of transesophageal echocardiography, intravascular ultrasonic imaging, and intraluminal phased-array imaging in aortic dissection with tear in the descending thoracic aorta (type B).

    Science.gov (United States)

    Bartel, Thomas; Eggebrecht, Holger; Müller, Silvana; Gutersohn, Achim; Bonatti, Johannes; Pachinger, Otmar; Erbel, Raimund

    2007-01-15

    Transesophageal echocardiography (TEE) and conventional intravascular ultrasound (IVUS) have limited capabilities in type B aortic dissection. To evaluate its diagnostic value, intraluminal phased-array imaging (IPAI) was compared with IVUS and TEE. In 23 patients with type B aortic dissection, IPAI was tested with respect to its ability to depict true lumen (TL) and false lumen (FL), to localize which abdominal arteries originate from the TL and FL, and to identify all entries and reentries. After the completion of TEE, 2 additional examiners performed angiography and positioned an AcuNav catheter inside the TL. An IVUS catheter was then introduced into the TL by a fourth examiner. All examiners were blinded to one another. Four additional patients with type B aortic dissection developed peripheral malperfusion due to TL collapse. Transvenous IPAI was used to guide emergency fenestration of the intimal flap. TL and FL could be equally well identified by all diagnostic methods. IPAI detected more entries than IVUS (3.0 +/- 1.2 vs 0.8 +/- 0.5, p 90% of the abdominal side branches. In all patients with peripheral malperfusion, successful emergency intimal flap fenestration was safely guided by IPAI. In conclusion, in the detailed diagnostic evaluation of type B aortic dissection, IPAI is superior to IVUS and TEE in detecting communications between the TL and FL. IPAI is also highly useful as a guiding tool for emergency intimal flap fenestration.

  11. Aortic Root Rupture during Transcatheter Aortic Valve Implantation in a Patient with Idiopathic Thrombocytopenic Purpura: Utility of Transesophageal Echocardiography in Early Detection and Description of a Semiconservative Surgical Management Approach.

    Science.gov (United States)

    Chandrasekhar, Jaya; Ruel, Marc; Nicholson, Donna; Labinaz, Marino

    2016-12-01

    An 87-year-old man with idiopathic thrombocytopenic purpura and platelet count of 56 × 10(9)/L underwent transesophageal echocardiography (TEE)-guided transcatheter aortic valve implantation using a femoral approach. Post valve deployment, a new pericardial effusion was noted which was successfully drained. Despite this, the patient became hypotensive needing vasopressor support with reaccumulation of pericardial fluid. Emergent sternotomy was performed and a perforation of the right ventricular apex was noted which was sealed with a pledgeted suture. Continued bleeding prompted further exploration; the aorta was seen to be mottled in conjunction with clear aortic root hematoma on TEE and a diagnosis of root rupture was made. This was semiconservatively managed without conversion to a full aortic root repair or replacement procedure. Multiple sutures were applied to the periaortic space and the bleeding sealed with use of BioGlue (Cryolife Inc., Kennesaw, GA) and Surgicel (Ethicon Inc., Somerville, NJ). The postoperative course was stable and the patient remained well at 3-month follow-up.

  12. 全机器人心脏外科手术中经食管超声心动图的应用%Intraoperative transesophageal echocardiography in robot-assisted minimally invasive cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    王瑶; 高长青; 杨明; 肖苍松; 王刚; 王加利; 李佳春; 沈岩松

    2011-01-01

    目的 探讨术中经食管超声心动图(transesophageal echocardiography,TEE)在全机器人心脏外科手术中的作用.方法 2007年1月至2011年3月,对接受全机器人心脏外科手术的193例患者行术中TEE检查,其中房间隔缺损111例,黏液样退行性变(瓣叶脱垂或连枷样瓣叶)所致二尖瓣反流51例,心房黏液瘤31例.TEE应用于:(1)体外循环(CPB)转机前,进一步明确病变性质及其发生部位;(2)建立外周CPB时,引导下、上腔静脉内插管及升主动脉内灌注针的置放;(3)心脏复跳后,即刻评价手术效果及有无手术相关并发症.结果 以术中所见为标准,TEE诊断病变性质及其发生部位总的准确性分别为100%和98.8%.下、上腔静脉内插管及升主动脉内灌注针均置于适当位置,TEE引导置管成功率为100%.心脏复跳后,TEE显示所有患者手术均获成功,无手术相关并发症.结论 术中TEE在全机器人心脏外科手术中不可缺少.%Objective To delineate the utility and results of intraoperative transesophageal echocardiography (TEE) in the evaluation of patients undergoing robot-assisted cardiac surgery. Methods Intraoperative TEE was performed in 193 patients undergoing robot-assisted procedures in cardiac surgery over a period of 4 years. (1) Before CPB, a comprehensive TEE was performed to document the lesions and their precise localization. ( 2 ) During establishment of peripheral CPB, a arterial cannula was placed percutaneously into the right internal jugular vein and passed into the superior vena cava; a venous cannula was inserted into the right common femoral vein and passing it into the inferior vena cava with its tip just inferior to the inferior vena cava-right atrium junction; a arterial perfusion cannula was passed into the ascending aorta with its tip approximately 3 cm from the aortic valve under TEE guidance. (3) After weaning from CPB, TEE was performed to evaluate the efficiency of the procedure. Results (1) The

  13. Accuracy of renal blood flow assessment by transesophageal echocardiography during carbon dioxide pneumoperitoneum%经食管超声心动图监测腹腔镜手术患者肾血流量的准确性

    Institute of Scientific and Technical Information of China (English)

    戴双波; 杨平亮; 刘斌

    2010-01-01

    Objective To determine the accuracy of renal blood flow assessment by transesophageal echocardiography (TEE) during carbon dioxide (CO2) pneumoperitoneum.Methods The left renal arterial diameter (RAD) and the Doppler velocity time integral (VTI) were measured by TEE before peumoperitoneum (T0, baseline), at 1, 5, 10, 15, 20 and 30 min of pneumoperitoneum and 1 and 5 min after deflation in 35 patients undergoing elective laparoscopic cholecystectomy. The left renal blood flow (LRBF) and the left renal blood perfusion resistance (LRPR) were calculated according to the following formulae: LRBF = 1/4π x RAD2 x VTI x HR, LRPR = MAP/LRBF.Three months later, the TEE images of 10 cases were randomly selected and reviewed by the same and another research team member to check the repeatability and consistency of the LRBF determination during operation, respectively. The quality of the TEE images was evaluated by another specialist.Results Before pneumoperitoneum, 94% of the TEE images were rated as satisfactory. There was no significant difference between the qualities of the TEE images obtained before and during pneumoperitoneum. The variabilities between the RADs measured by TEE during and 3 months after operation were 9.28% by the same team member and 8.71% by another team member. The variabilities between the VTIs measured by TEE during and 3 months after operation were 5.61% by the same team member and 6.25% by another team member. The linear regression analysis of the LRBF showed that the slope and the intercept were 1.05 and 31.4 ml/min respectively by the same member and 0.92 and 47.3 ml/min respectively by another member. The LRBF was decreased during pneumoperitoneum and the LRPR was increased.Conclusion TEE can be used to accurately monitor the changes in renal blood flow during CO2 pneumoperitoneum.

  14. Quantification of aortic valve area at 256-slice computed tomography: Comparison with transesophageal echocardiography and cardiac catheterization in subjects with high-grade aortic valve stenosis prior to percutaneous valve replacement

    Energy Technology Data Exchange (ETDEWEB)

    Klass, Oliver, E-mail: oliver.klass@uniklinik-ulm.de [University Hospital of Ulm, Department of Diagnostic and Interventional Radiology, Steinhoevelstr. 9, 89075 Ulm (Germany); Walker, Matthew J.; Olszewski, Mark E. [Philips Healthcare, CT Clinical Science, Cleveland, OH (United States); Bahner, Johannes; Feuerlein, Sebastian; Hoffmann, Martin H.K.; Lang, Alexandra [University Hospital of Ulm, Department of Diagnostic and Interventional Radiology, Steinhoevelstr. 9, 89075 Ulm (Germany)

    2011-10-15

    Purpose: The purpose of this study was to compare planimetric aortic valve area (AVA) measurements from 256-slice CT to those derived from transesophageal echocardiography (TEE) and cardiac catheterization in high-risk subjects with known high-grade calcified aortic stenosis. Methods and materials: The study included 26 subjects (10 males, mean age: 79 {+-} 6; range, 61-88 years). All subjects were clinically referred for aortic valve imaging prior to percutaneous aortic valve replacement from April 2008 to March 2009. Two radiologists, blinded to the results of TEE and cardiac catheterization, independently selected the systolic cardiac phase of maximum aortic valve area and independently performed manual CT AVA planimetry for all subjects. Repeated AVA measurements were made to establish CT intra- and interobserver repeatability. In addition, the image quality of the aortic valve was rated by both observers. Aortic valve calcification was also quantified. Results: All 26 subjects had a high-grade aortic valve stenosis (systolic opening area <1.0 cm{sup 2}) via CT-based planimetry, with a mean AVA of 0.62 {+-} 0.18. In four subjects, TEE planimetry was precluded due to severe aortic valve calcification, but CT-planimetry was successfully performed with a mean AVA of 0.46 {+-} 0.23 cm{sup 2}. Mean aortic valve calcium mass score was 563.8 {+-} 526.2 mg. Aortic valve area by CT was not correlated with aortic valve calcium mass score. A bias and limits of agreement among CT and TEE, CT and cardiac catheterization, and TEE and cardiac catheterization were -0.07 [-0.37 to 0.24], 0.03 [-0.49 to 0.55], 0.12 [-0.39 to 0.63] cm{sup 2}, respectively. Differences in AVA among CT and TEE or cardiac catheterization did not differ systematically over the range of measurements and were not correlated with aortic valve calcium mass score. Conclusion: Planimetric aortic valve area measurements from 256-slice CT agree well with those derived from TEE and cardiac catheterization in

  15. Authentication of Radial Versus Femoral Arterial Pressure Waveform-Derived Cardiac Output With Transesophageal Echocardiography-Derived Cardiac Output Measurements in Patients Undergoing On-Pump Coronary Bypass Surgery.

    Science.gov (United States)

    Maddali, Madan Mohan; Waje, Niranjan Dilip; Sathiya, Panchatcharam Murthi

    2017-08-01

    The aim of this study was to ascertain if arterial waveform-derived cardiac output measurements from radial and femoral cannulation sites were reliable as compared with transesophageal echocardiography (TEE)-derived cardiac output (CO) values, and which of the CO measurements derived from radial and the femoral arterial pressure waveforms closely tracked simultaneously measured TEE-derived CO values. This study also aimed to ascertain if cardiopulmonary bypass (CPB) would impact the accuracy of arterial pressure-derived CO values from either of the 2 sites. A prospective observational study. Tertiary care cardiac center. Cardiac surgical patients undergoing on-pump primary coronary artery bypass surgery. Waveform-derived CO monitoring through radial and femoral artery cannulation using a FloTrac/Vigileo system. Twenty-seven consecutive cardiac surgical patients undergoing on-pump primary coronary artery bypass surgery were included in the study. Cardiac output was measured sequentially by the arterial pressure waveform analysis method from radial and femoral arterial sites and compared with simultaneously measured TEE-derived CO. Cardiac output data were obtained in triplicate at 6 predefined time intervals: before and after sternotomy, 5, 15, and 30 minutes after separation from CPB and prior to shifting the patient out of the operating room. The overall bias of the study was 0.11 and 0.27, the percentage error was 19.31 and 18.45, respectively, for radial and femoral arterial waveform-derived CO values as compared with TEE-derived CO measurements. The overall precision as compared with the TEE-derived CO values was 16.94 and 15.95 for the radial and femoral cannulation sites, respectively. The bias calculated by the Bland-Altman method suggested that CO measurements from the radial arterial site were in closer agreement with TEE-derived CO values at all time periods, and the relation was not affected by CPB. However, percentage error and precision calculations

  16. Simulator-based Transesophageal Echocardiographic Training with Motion Analysis A Curriculum-based Approach

    NARCIS (Netherlands)

    Matyal, Robina; Mitchell, John D.; Hess, Philip E.; Chaudary, Bilal; Bose, Ruma; Jainandunsing, Jayant S.; Wong, Vanessa; Mahmood, Feroze

    Background: Transesophageal echocardiography (TEE) is a complex endeavor involving both motor and cognitive skills. Current training requires extended time in the clinical setting. Application of an integrated approach for TEE training including simulation could facilitate acquisition of skills and

  17. Simulator-based Transesophageal Echocardiographic Training with Motion Analysis A Curriculum-based Approach

    NARCIS (Netherlands)

    Matyal, Robina; Mitchell, John D.; Hess, Philip E.; Chaudary, Bilal; Bose, Ruma; Jainandunsing, Jayant S.; Wong, Vanessa; Mahmood, Feroze

    2014-01-01

    Background: Transesophageal echocardiography (TEE) is a complex endeavor involving both motor and cognitive skills. Current training requires extended time in the clinical setting. Application of an integrated approach for TEE training including simulation could facilitate acquisition of skills and

  18. Application of the transthoracic occlusion surgery of atrial septal defect under the guidance of transesophageal echocardiography%食管超声引导下经胸房间隔缺损封堵术的应用研究

    Institute of Scientific and Technical Information of China (English)

    李奎; 张郁林; 辜志英; 周波; 杨卫东; 黄烨; 张秉宜

    2015-01-01

    目的:探讨食管超声引导下经胸房间隔缺损封堵术的可行性及其优越性。方法:选取我科2009年9月至2014年8月经胸及经食管超声诊断为房间隔缺损患者共54例为试验组,选取同期行体外循环下房缺修补术31例患者为对照组,应用SPSS 16.0统计软件在手术时间、呼吸机辅助时间、术后住院天数、伤口大小及心理认可状况方面进行对比研究。结果:试验组手术时间(81.13±15.91) min,呼吸机辅助时间(193.67±72.74) min,伤口大小(3.41±1.13) cm,术后住院天数(3.37±0.49) d,心理认可状况54例均良好。对照组手术时间(109.13±18.19) min,呼吸机辅助时间(425.06±40.67) min,伤口大小(10.78±1.37) cm,术后住院天数(9.61±1.69) d。患者心理认可状况:良好8例,一般10例,较差13例。各项对比结果试验组明显优于对照组( P<0.05)。结论:食管超声引导下经胸房间隔缺损封堵术既缩短手术时间和呼吸机辅助时间,降低术后住院天数和费用,又符合美容要求,患者心理认可状况良好,是一种安全可行的手术方法。%Objective: To explore the feasibility and advantage of the transthoracic occlusion surgery of atrial septal defect ( ASD ) under the guidance of transesophageal echocardiography ( TEE ) .Methods: In experimental group,fifty-four patients with ASD were examined by transthoracic echocardiography and TEE from September 2009 to August 2014 in our hospital.In control group, thirty-one patients were eligible for repairing of ASD under cardiopulmonary bypass.For the comparative study, we used SPSS 16.0 to study these indicators: the operation time, the breathing machine auxiliary time, the postoperative hospitalization days, the wound length and psychological recognition.Results: In experimental group, the operation time was ( 81.13 ±15.91 ) min, the breathing

  19. Biplane transesophageal color-flow Doppler imaging in assessing severity of mitral regurgitation : Influence of hemodynamic circumstances and mechanism of regurgitation

    NARCIS (Netherlands)

    Pieper, EPG; Hellemans, IM; Hamer, HPM; Ravelli, ACJ; Jaarsma, W; Breekland, A; Lie, KI; Visser, CA

    1996-01-01

    Objective: To determine the value of biplane transesophageal echocardiography in the assessment of severity of mitral regurgitation compared with left ventricular angiography. Design: Prospective study of consecutive patients. Setting: Two university hospitals, one community hospital. Participants:

  20. Mudança de conduta cirúrgica motivada pela ecocardiografia transesofágica intraoperatória Cambio de conducta quirúrgica motivada por la ecocardiografía transesofágica intraoperatoria Changes in surgical conduct due to the results of intraoperative transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Alexander Alves da Silva

    2010-04-01

    ón.BACKGROUND AND OBJECTIVES: Transesophageal echocardiography (TEE is extremely useful in surgeries like valvuloplasty, of the thoracic aorta, and correction of congenital cardiopathies. The low degree of invasiveness and the capacity to aggregate information that can change the course of the surgery are among the advantages of TEE. The objective of this report was to present a case in which the surgical conduct was changed due to a new diagnosis provided by intraoperative transesophageal echocardiography, and to emphasize the importance of using the transesophageal echo in surgeries to correct congenital cardiopathies. CASE REPORT: A 28-year old female, ASA II, with a history of dyspnea progressing from medium to small efforts was referred by another department for elective surgical correction of stenosis of the pulmonary valve diagnosed by transthoracic echocardiography. Intraoperative transesophageal echocardiography showed patent foramen ovale, infundibular stenosis of the right ventricular outlet, and perimembranous subaortic interventricular communication (IVC of 0.4 cm with left to right shunt. After beginning ECC, the above mentioned diagnoses were confirmed and the surgery included closure of the foramen ovale and IVC, and resection of the infundibular stenosis. Intraoperative intercurrences were not observed and the patient was intubated when she was transferred to the intensive care unit. CONCLUSIONS: Transesophageal echocardiography is extremely useful in patients undergoing surgical correction of congenital cardiopathies because, besides helping the hemodynamic management, it can provide new information capable of improving the final result of the surgery.

  1. Endocarditis trombótica no bacteriana bivalvular asociada a cáncer y ecocardiograma transesofágico Bivalvular non bacterial thrombotic endocarditis associated with cancer and transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Marcelo Zylberman

    2006-06-01

    Full Text Available La endocarditis trombótica no bacteriana es la causa más frecuente de accidente cerebrovascular isquémico en pacientes con cáncer. En estos pacientes se hallaron vegetaciones valvulares hasta en el 9% de las autopsias. Sin embargo, la afección bivalvular es poco frecuente, observándose en el 9% de las endocarditis trombóticas. Se presenta una paciente con cáncer de ovario que presentó afasia e imágenes compatibles con isquemia cerebral. El ecocardiograma transtorácico fue normal. El ecocardiograma transesofágico evidenció vegetaciones en las válvulas aórtica y mitral. Se enfatiza la importancia de sospechar endocarditis trombótica no bacteriana en enfermos con cáncer y embolismo sistémico y en la escasa frecuencia de afección bivalvular.Non bacterial thrombotic endocarditis is the most frequent cause of ischemic stroke in cancer patients. Up to 9% of autopsies of cancer patients show non infectious valvular masses. However, bivalvular involvement is not frequently occurring in 9% of non bacterial thrombotic endocarditis. We report a patient with ovarian cancer who presented aphasia. The MRI was compatible with cerebral ischemia. The transthoracic echocardiogram was normal and a transesophageal echocardiogram showed vegetations in aortic and mitral valves. We emphasize the importance of suspecting non bacterial thrombotic endocarditis in patients with cancer and systemic embolism and the low frequency of bivalvular involvement.

  2. The Experience of Anesthesia and the Practice of Transesophageal Echocardiography in Thoracoscopy-assisted Mitral Valve Surgery%胸腔镜直视微创二尖瓣手术24例麻醉体会

    Institute of Scientific and Technical Information of China (English)

    卢静; 兰志勋; 蔡兵; 胡云霞; 苏文杰

    2015-01-01

    目的:总结胸腔镜直视微创二尖瓣手术的麻醉经验,并评价经食道超声在术中的应用价值。方法:24例行胸腔镜直视微创二尖瓣手术的患者,以咪唑安定、依托咪酯、顺式阿曲库铵和舒芬太尼麻醉诱导,以丙泊酚与瑞芬太尼,间断给予舒芬太尼、咪唑安定、顺式阿曲库铵及吸入七氟醚作麻醉维持。术前以经食道超声评价病变特征、确定手术类型,术中指导上腔静脉引流管的放置,术后监测心脏排气,评价手术效果。结果:24例患者均成功完成手术,其中行二尖瓣置换术者17例,二尖瓣成形术7例。2例患者食道超声术中监测二尖瓣成形不满意,改为瓣膜置换术成功。未出现瓣周漏、血肿、空气栓塞等并发症。结论:对胸腔镜直视下微创二尖瓣手术患者,选择合适的麻醉方式,并全程进行经食道超声监测,能为手术成功提供充分保障、避免并发症。%Objective :To discuss the experience of anesthesia and the clinical practice of transesophageal echocardio‐graphy (TEE) in thoracoscopy‐assisted mitral valve surgery .Methods :24 patients who underwent thoracoscopy‐assis‐ted mitral valve surgery were retrospectively analyzed .The induction of anesthesia was performed with midazolam , etomidate ,cis‐atracurium and sufentanil ,and the anesthesia was maintained with propofol and remifentanil .TEE was used to determine the lesion characteristics ,guide operation ,monitor the air exhaust and evaluate the effect of opera‐tion .Results:17 patients underwent mitral valve replacement and 7 patients underwent mitral valvuloplasty successful‐ly .2 patients underwent mitral valve replacement due to dissatisfied repair effect based on TEE evaluation .No compli‐cations were found in all patients .Conclusion:Appropriate anesthesia programs contributed to the process of operation and TEE guidance provided detailed information during

  3. The application value of real-time 3-dimensional transesophageal echocardiography in aortic valve implantation%三维经食管超声心动图在经导管主动脉瓣植入术中的应用研究

    Institute of Scientific and Technical Information of China (English)

    赵维鹏; 潘翠珍; 魏来; 潘文志; 周达新; 舒先红

    2016-01-01

    目的:探讨三维经食管超声心动图在经导管主动脉瓣植入术中的应用价值。方法对16例严重主动脉瓣病变患者分别经由两种不同手术入径行经导管主动脉瓣植入术( transcatheter aortic valve implantation,TAVI ),其中7例重度主动脉瓣狭窄(主动脉瓣狭窄面积<1.0 cm2,主动脉瓣口最大流速≥4 m/s,平均跨瓣压差≥40 mmHg)和1例人工生物主动脉瓣中重度反流患者行经股动脉TAVI,另外4例重度主动脉瓣狭窄和4例重度主动脉瓣反流患者行经心尖TAVI,术前均行常规经胸超声心动图检查及三维经食管超声心动图检查,术中三维经食管超声心动图监测,术后常规经胸超声心动图随访。结果经股动脉TAVI组:所有患者均成功经导管植入人工生物主动脉瓣,其中1例患者术中发现心包填塞合并升主动脉夹层分离。经心尖TAVI组:所有患者均成功植入人工生物主动脉瓣,无并发症发生。 CT和经食管三维超声心动图测量主动脉瓣环最大径、最小径、瓣环面积及狭窄瓣口数据的比较,二者相关性良好,r值分别为0.99(瓣环最大径)、0.97(瓣环最小径)、0.98(瓣环面积)、0.99(狭窄瓣口面积);术前连续性方程测量的狭窄瓣口面积与CT及3D-TEE比较,二者相关性良好,r值均为0.99。结论三维经食管超声心动图能快速、准确地测量主动脉瓣环的大小及评价主动脉的解剖结构,并且能实时引导、监测经导管人工生物主动脉瓣的植入。%Objective To investigate the application value of 3-dimensional transesophageal echocardiography in aortic valve implantation.Methods We performed transcathet aortic valve implantations ( TAVI) to 16 patients with severe aortic stenosis through two different surgical accesses.Of these patients, 7 severe aortic stenosis (AVA<1.0 cm2, peak aortic valve velocity≥4.0m/s, and mean aortic

  4. Ecocardiografia transesofágica e diagnóstico intraoperatório de veia cava superior esquerda persistente Ecocardiografía transesofágica y diagnóstico intraoperatorio de vena cava superior izquierda persistente Transesophageal echocardiography and intraoperative diagnosis of persistent left superior vena cava

    Directory of Open Access Journals (Sweden)

    Alexander Alves da Silva

    2009-12-01

    persistent left superior vena cava has an incidence of 0.5% in the normal population, but in patients with congenital cardiopathy its incidence ranges from 3% to 10%. The objective of this report was to present a case of intraoperative diagnosis with transesophageal echocardiography and to emphasize the importance of its routine use in surgical procedures for correction of congenital cardiopathies. CASE REPORT: This is a 16-year old male patient, ASA II, with a diagnosis of superior sinus venosus interatrial communication (IAC with partial anomalous drainage of the pulmonary veins scheduled for the surgical correction of the cardiopathy. After induction of general anesthesia, transesophageal echocardiography (TEE showed initially a dilation of the right cardiac chambers, a 17-mm superior sinus venosus IAC, anomalous drainage of the right superior pulmonary vein draining into the right superior vena cava (SVC, and dilation of the coronary sinus raising the possibility of persistent left superior vena cava. To confirm this suspicion, 10 mL of NS (works as a contrast in echocardiography were injected in the venous access of the left arm, and microbubbles crossing the coronary sinus were observed immediately afterwards confirming the diagnosis of persistent left superior vena cava. CONCLUSIONS: Routine intraoperative transesophageal echocardiography in patients with congenital cardiopathy is a fundamental auxiliary method, not only for the surgeon, often having direct influence on the surgical technique used, but also for the anesthesiologist, who can get useful information for the hemodynamic management of the patient.

  5. Can contrast-enhanced multi-detector computed tomography replace transesophageal echocardiography for the detection of thrombogenic milieu and thrombi in the left atrial appendage. A prospective study with 124 patients; Kann die kontrastmittelverstaerkte Mehrzeilen-Computertomografie die transoesophageale Echokardiografie bei der Detektion von thrombogenem Milieu und Vorhofohrthromben ersetzen? Eine prospektive Studie mit 124 Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Homsi, R.; Luetkens, J.A.; Schild, H.H.; Naehle, C.P. [Bonn Univ. (Germany). Dept. of Radiology; Nath, B. [SHG-KLliniken Voelklingen (Germany). Dept. of Medicine I - Cardiology; Schwab, J.O. [Bonn Univ. (Germany). Dept. of Medicine I - Cardiology

    2016-01-15

    To assess the diagnostic value of contrast-enhanced multi-detector computed tomography (MD-CT) for identifying patients with left atrial appendage (LAA) thrombus or circulatory stasis. 124 patients with a history of atrial fibrillation and/or cerebral ischemia (83 men, mean age 58.6 ± 12.4 years) and with a clinical indication for MD-CT of the heart and for transesophageal echocardiography (TEE) were included in the study. LAA thrombus or thrombogenic milieu was visually identified in TEE and MD-CT. In addition, MD-CT was analyzed quantitatively measuring the Hounsfield units (HU) of the left atrium (LA), the LAA and the ascending aorta (AA), and calculating the HU ratios LAA/AA (HU [LAA/AA]) und LAA/LA (HU [LAA/LA]). Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated. The prevalence of a thrombus or thrombogenic milieu as assessed by TEE was 21.8 %. The HU ratio was lower in patients with thrombus or thrombogenic milieu (HU [LAA/AA]: 0.590 ± 0.248 vs. 0.909 ± 0.141; p < 0.001 und HU [LAA/LA] 0.689 ± 0.366 vs. 1.082 ± 0.228; p < 0.001). For the diagnosis of thrombus or a thrombogenic milieu, visual analysis yielded a sensitivity of 81.5 %, a specificity of 96.9 %, a PPV of 87.5 % and a NPV of 95.2 %. By combining visual and quantitative analysis with one criterion being positive, the specificity decreased to 91.8 %, the sensitivity to 77.8 %, the PPV to 72.4 %, and the NPV to 94.9 %. Visual analysis of the LAA in the evaluation of thrombus or thrombogenic milieu yields a high NPV of 95.1 % and may especially be useful to rule out LAA thrombi in patients with contraindications for TEE. Additional calculation of HU ratios did not improve the diagnostic performance of MD-CT.

  6. Simulation for transthoracic echocardiography of aortic valve

    Science.gov (United States)

    Nanda, Navin C.; Kapur, K. K.; Kapoor, Poonam Malhotra

    2016-01-01

    Simulation allows interactive transthoracic echocardiography (TTE) learning using a virtual three-dimensional model of the heart and may aid in the acquisition of the cognitive and technical skills needed to perform TTE. The ability to link probe manipulation, cardiac anatomy, and echocardiographic images using a simulator has been shown to be an effective model for training anesthesiology residents in transesophageal echocardiography. A proposed alternative to real-time reality patient-based learning is simulation-based training that allows anesthesiologists to learn complex concepts and procedures, especially for specific structures such as aortic valve. PMID:27397455

  7. 实时三维经食管超声心动图在二尖瓣脱垂手术中的应用价值%Clinical values of intraoperative real-time three-dimensional transesophageal echocardiography for surgery in patients with mitral valve prolapse

    Institute of Scientific and Technical Information of China (English)

    许立龙; 赵博文; 李世岩; 钱希明; 何启才; 毛彦恺; 余婵; 潘美

    2012-01-01

    Objective To investigate the value of the intraoperative real-time three-dimensional transesophageal echocardiography (RT 3D-TEE) in therapeutic application of surgery for the mitral valve prolapse.Methods Thirty-five patients underwent surgical treatment were diagnosed as mitral valve prolapse by 2-dimensional transthoracic echocardiography (2D-TTE),with or without ruptured chordae tendineae.RT 3D-TEE was performed for assessing the segment of prolapse and its complications before cardiopulmonary bypass and after heart resuscitation respectively.The echocardiographic results were compared with the surgical findings.Results The accuracy of RT 3D-TEE to identify segments with prolapse was significantly higher than that of 2D-TTE (91.4% vs 82.9%,P =0.003).RT 3D-TEE was more accurate than 2D-TTE for identifying ruptured chordae tendineae,vegetation and thrombus since higher sensitivity,specificity and Youden index.Among all 35 patients,valvuloplasty was performed in 28 cases,whereas,only 7 cases underwent replacement of prosthetic valves.Three patients were benefited by accurate evaluation of therapeutic effect using RT 3D-TEE in time.Conclusions Intraoperative RT 3D-TEE can be used to provide “ surgical view”,acquired adequate valuable information of mitral valve,and more reliable functional and anatomical assessment of the mitral valve components and its geometry.Suitable surgical intervention can be designed for improving outcomes of patients.%目的 探讨术中实时三维经食管超声心动图(RT 3D-TEE)在二尖瓣脱垂患者外科手术治疗中的应用价值.方法 选择经胸超声心动图(2D-TTE)诊断为二尖瓣脱垂(伴或不伴腱索断裂),并进行外科手术治疗的35例患者,于麻醉后体外循环之前行RT 3D-TEE检查,将2D-TTE及RT 3D-TEE结果与术中所见进行比较.并在手术完成心脏复跳后即刻再次进行检查,评价手术疗效.结果 与手术医师术中发现相比较,术中RT 3D-TEE判断

  8. The application of the transesophageal echocardiography in the circular monitoring of the perioperative period infants with septis shock%经食管超声心动图在婴幼儿感染性休克围手术期循环监测中的应用

    Institute of Scientific and Technical Information of China (English)

    王怀贞; 宋兴荣; 彭亮明; 陈柳妹; 雷东旭

    2016-01-01

    目的:探讨经食管超声心动图(TEE)在婴幼儿围术期发生感染性休克时进行循环监测并指导治疗的临床应用效果。方法回顾性分析2013年3月至2014年5月间,收治的发生感染性休克的围术期患儿48例,随机将其分为观察组和对照组各24例。两组患儿均采用动脉穿刺置管监测血压,经颈内静脉穿刺监测中心静脉压,行血气分析、监测患儿的周围循环及记录尿量,根据实时数据,采用早期目标导向性治疗( EGDT);观察组在此基础上行经食管超声心动图以连续观察心脏收缩舒张功能及前、后负荷,并根据上述辅助检查结果及时调整补液及用药方案。观察并比较两组围术期患儿经治疗3 h 后的心率、中心静脉压、动脉血压、血乳酸水平、血气分析及尿量,评估两组患儿的复苏情况。结果两组患儿经过治疗,心率、平均动脉压、中心静脉压、血气分析、血乳酸水平及尿量均较治疗前有明显改善( P <0.05);观察组的治疗效果显著优于对照组( P <0.05)。结论经食管超声心动图可连续、准确地监测心脏的收缩、舒张功能,评估外周循环阻力,指导围术期婴幼儿感染性休克的治疗,具有创伤小、操作性强、准确性高等优点,对感染性休克的治疗重要的临床意义。%Objective To investigate the clinical effect of the transesophageal echocardiography in the circular monitoring of the periopera-tive period infants with septic shock. Methods 48 cases of patients(≤3 years old)who had a septis shock during the perioperative period from March 2013 to May 2014 in our hospital were selected as the study objects,they were randomly divided into the observation group and the control group(24 cases in each group). The blood pressure was monitored by arterial puncture and the central venous pressure by jugularis interna vein puncture in two groups. The blood gas

  9. Three-dimensional Echocardiography in Valvular Heart Disease.

    Science.gov (United States)

    Kurklinsky, Andrew; Mankad, Sunil

    2012-01-01

    Recent technologic advances in 3-dimensional (3D) echocardiography, using parallel processing to scan a pyramidal volume, have allowed for a superior ability to describe valvular anatomy using both transthoracic and transesophageal echocardiography. Although still in evolution and at an early phase of adaptation with respect to its clinical application, 3D echocardiography has emerged as an important clinical tool in the assessment of valvular heart disease. 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. The information gained from 3D echocardiography has especially made an impact in guiding clinical decisions in the evaluation of mitral valve (MV) disease. The decision of early surgery in degenerative MV disease is based on the suitability of repair, and the suitability of repair is generally based on echocardiography. The superior understanding of MV anatomy afforded by 3D echocardiography has been shown to be quite valuable in this setting. This review will describe the contemporary use of 3D echocardiography in the assessment of valvular heart disease, including MV, aortic, tricuspid, and prosthetic valve abnormalities. This article illustrates how 3D echocardiography can complement current echocardiography techniques in the management of valvular heart disease.

  10. Transesophageal echocardiography evaluation of tricuspid and pulmonic valves

    Directory of Open Access Journals (Sweden)

    Aneeta Bhatia

    2016-01-01

    Full Text Available The tricuspid is the lost valve and the pulmonary being the most anterior, is not visualized well on TEE; The Pulmonary valve is a semilunar valve that separates the right ventricle from the pulmonary artery. It is situated anterior and superior to the aortic valve, almost at right angle to the aortic valve and parallel to the beam of the ultrasound.

  11. Transesophageal Echocardiographically-Confirmed Pulmonary Vein Thrombosis in Association with Posterior Circulation Infarction.

    LENUS (Irish Health Repository)

    Kinsella, Justin A

    2010-01-01

    Pulmonary venous thromboembolism has only been identified as a cause of stroke with pulmonary arteriovenous malformations\\/fistulae, pulmonary neoplasia, transplantation or lobectomy, and following percutaneous radiofrequency ablation of pulmonary vein ostia in patients with atrial fibrillation. A 59-year-old man presented with a posterior circulation ischemic stroke. \\'Unheralded\\' pulmonary vein thrombosis was identified on transesophageal echocardiography as the likely etiology. He had no further cerebrovascular events after intensifying antithrombotic therapy. Twenty-eight months after initial presentation, he was diagnosed with metastatic pancreatic adenocarcinoma and died 3 months later. This report illustrates the importance of doing transesophageal echocardiography in presumed \\'cardioembolic\\' stroke, and that potential \\'pulmonary venous thromboembolic\\' stroke may occur in patients without traditional risk factors for venous thromboembolism. Consideration should be given to screening such patients for occult malignancy.

  12. Transesophageal echo diagnosis of perioperative unusual transient left ventricular apical ballooning syndrome

    Directory of Open Access Journals (Sweden)

    Hugo Andrés Mantilla

    2016-01-01

    Full Text Available Stress cardiomyopathy, or Takotsubo syndrome, is a widely recognized cardiac pathology with a clinical presentation similar to acute coronary syndrome and related to physical or emotional stress. Perioperatively, it is challenging to identify it given the variety of forms and scenarios in which it can present. We describe a 22-year-old patient with an atypical presentation of Takotsubo syndrome during anesthesia induction, which highlights the usefulness of transesophageal echocardiography for the initial diagnosis.

  13. Transesophageal echo diagnosis of perioperative unusual transient left ventricular apical ballooning syndrome

    Science.gov (United States)

    Mantilla, Hugo Andrés; Montes, Felix Ramón; Amaya, William F.

    2016-01-01

    Stress cardiomyopathy, or Takotsubo syndrome, is a widely recognized cardiac pathology with a clinical presentation similar to acute coronary syndrome and related to physical or emotional stress. Perioperatively, it is challenging to identify it given the variety of forms and scenarios in which it can present. We describe a 22-year-old patient with an atypical presentation of Takotsubo syndrome during anesthesia induction, which highlights the usefulness of transesophageal echocardiography for the initial diagnosis. PMID:27716708

  14. 经食管实时三维超声在主动脉瓣狭窄患者瓣环径定量中的应用%Application of the real-time three-dimensional transesophageal echocardiography in the quantification of aortic anuulus diameter in patients with aortic stenosis

    Institute of Scientific and Technical Information of China (English)

    孔令秋; 唐红; 魏薪; 康彧; 任奔; 宋海波

    2013-01-01

    目的 探讨经食管实时三维超声心动图(RT-3D TEE)在主动脉瓣狭窄患者主动脉瓣环径定量分析中的应用价值.方法 65例因重度主动脉瓣狭窄行外科手术者,术中采集主动脉根部RT-3D TEE图像,运用瓣环定量软件重建主动脉瓣环,生成瓣环参数并计算基于此的瓣环径(3D-A-AAD、3D-C-AAD),并将其与外科测瓣器测值(IO-AAD)进行一致性分析.结果 基于三维瓣环参数的主动脉瓣环径3D-A-AAD和3D-C-AAD分别为(22.4±2.1)mm、(23.4±1.9)mm.二者测值与术IO-AAD[(23.4±2.2)mm]相比,差异均无统计学意义(P<0.05),与3D-A-AAD相比,3D-C-AAD与IO-AAD的一致性较好.结论 RT-3D TEE及瓣环定量分析软件不仅能重建主动脉瓣环三维形态,还可用作瓣环径定量分析工具.%Objective To investigate the application of real-time three-dimensional transesophageal echocardiography (RT-3D TEE) in quantification of the aortic anuulus diameter in patients with severe aortic stenosis.Methods RT-3D TEE image of aortic root was get perioperatively in 65 patients with sever aortic valve stenosis during the surgery procedure.The aortic annulus was reconstructed in the quantitative analysis software to generate the parameters of 3-dimensional area based aortic anuulus diameter(3D-AAAD) and 3-dimensional circumference based aortic anuulus diameter(3D-C-AAD).The parameters was compared with intraoperative aortic anuulus diameter(IO-AAD),which was get by the standard cylindrical valve sizer.Results The three dimensional form of the aortic annulus was related to the number of the valves.The value of 3D-C AAD and 3D-A-AAD were (22.4 ± 2.1) mm,(23.4 ± 1.9) mm,no significant difference could be detected between them and the IO-AAD (P < 0.05).The 3D-C-AAD had a better agreements with IO-AAD than 3D-A-AAD.Conclusions RT-3D TEE can reconstruct the three dimensional sharp of aortic anuulus,and can be used as quantitative tools to calculate its diameter.

  15. 经食管超声心动图引导下微创小切口室间隔缺损封堵治疗%Transcatheter closure of ventricular septal defects through minimally invasive port -access surgery guided by transesophageal echocardiography

    Institute of Scientific and Technical Information of China (English)

    侯永波; 王国祥; 谭胜; 刘金东

    2015-01-01

    目的:总结经食管超声心动图(TEE)引导下,微创经胸室间隔缺损(VSD)封堵治疗的临床经验。方法11例 VSD 患者接受微创经胸封堵治疗,年龄3~6岁,体重12~65 kg,VSD 直径3~8 mm。手术在 TEE 引导,胸骨下段小切口微创下进行,于右心室表面选择适当的穿刺点,建立输送轨道并完成 VSD 封堵。术后密切随访1~6个月。结果11例中9例一次性安放成功,2例首次安放有残余分流,术中更换大号伞;心内操作时间10~36 min,平均(21±12)min。全部患者均于术后4~5天出院,随访1~6个月,效果良好。11例患者均无心律失常、残余分流等并发症发生。结论TEE 引导下微创经胸 VSD 封堵是一种安全有效的治疗方法,但远期结果有待进一步观察。%Abstrat: Objectve To summarize the clinical experience of transcatheter closure of ventricular septal defects (VSD) through minimally invasive port -access surgery guided by transesophageal echocardiography (TEE).Methods A total of 11 patients aged from 3 to 6, weighting 12 kg to 65 kg were subjected to transcatheter closure of VSD with a diameter ranging from 3 mm to 8 mm.The surgery was performed under the guidance of TEE, where a small transthoracic incision was made.A proper site was chosen at the surface of the right ventricle for punctuation, in order to establish de-livery pathway.Patients were closely followed up for 1 to 6 months.Results Among the patients were nice ones who successfully completed the surgery at one time.Residual shunts were seen in two cases which required the replacement of larger occluders.The time of intracardiac procedures was 10 -36 min [(21 ±12)min].All patients were discharged 4 to 5 days after operation.During fellow -up period, neither arrhythmia nor residual shunt occurred.Conclusion Tran-sthoracic minimally invasive closure is a safe and efficient method for the treatment of VSD.Meanwhile, long -term fel

  16. Quantificação de insuficiência protética mitral por diferentes métodos de avaliação pela ecocardiografia transesofágica Quantification of mitral prosthesis regurgitation by transesophageal echocardiography. Evaluation of different methods

    Directory of Open Access Journals (Sweden)

    Cláudio Henrique Fischer

    1998-12-01

    Full Text Available OBJETIVO: Avaliar os diferentes métodos de quantificação de insuficiência mitral (IM ao ecocardiograma transesofágico (ETE em pacientes com suspeita clínica de disfunção de prótese mitral. MÉTODOS: Foram estudados 15 pacientes, divididos em dois grupos, conforme a presença ou não de IM expressiva (grau importante ao cateterismo cardíaco (Cate. A IM foi quantificada ao ETE pelos seguintes métodos, habitualmente empregados para IM de valvas nativas: avaliação subjetiva do jato regurgitante ao mapeamento de fluxo a cores, avaliação objetiva com base na área absoluta do jato regurgitante e na sua área relativa (área do jato/área do átrio esquerdo (AE, e avaliação baseada na presença de fluxo sistólico reverso em veia pulmonar. RESULTADOS: A IM foi predominantemente de origem transprotética (14 pacientes e de distribuição excêntrica (11 pacientes. Observou-se concordância estatisticamente significante (p7cm² e relativa (área de jato >35% da área do AE não mostraram concordância significante com o Cate, com nítida subestimação ao ETE pela área relativa. Houve, porém, concordância significante, quando considerado como IM expressiva, jato cuja área relativa foi >30% da área do AE. CONCLUSÃO: O ETE identificou adequadamente as IM protéticas angiograficamente expressivas, particularmente pelos métodos subjetivo e de fluxo sistólico reverso em veia pulmonar. É necessário cautela na utilização de critérios baseados na área do jato regurgitante, em virtude da subestimação da área na presença de jato excêntrico, freqüente em disfunção de prótese mitral.PURPOSE: To evaluate the different methods for grading mitral regurgitation (MR by transesophageal echocardiography (TEE in patients with clinical suspicion of mitral prosthesis dysfunction. METHODS: Cardiac catheterization (Cath was performed in 15 patients for grading the severity of prosthetic MR, divided in two groups based on the presence or

  17. Pediatric echocardiography laboratory organization and clinical productivity.

    Science.gov (United States)

    Lai, Wyman W; Srivastava, Shubhika; Cohen, Meryl S; Frommelt, Peter C; Allada, Vivek

    2013-10-01

    The American Society of Echocardiography's Committee on Pediatric Echocardiography Laboratory Productivity (C-PELP) was formed to study the organizational and productivity issues particular to academic pediatric echocardiography laboratories. After much deliberation, the committee chose studies per physician full-time equivalent per day --the average number of studies interpreted per day by a full-time echocardiography physician dedicated to the laboratory -as the primary measure of physician productivity. A survey was sent to 74 North American pediatric echocardiography laboratory directors. The aims of the survey were to (1) determine the annual laboratory volume and types of echocardiographic studies performed, (2) define the average number of studies performed by a pediatric cardiac sonographer in a year, (3) assess the productivity of echocardiography physicians, and (4) identify factors (programmatic or laboratory related) that affect clinical productivity. There were 54 responses to the C-PELP 2011 survey. The average number of studies per physician full-time equivalent per day was 15.0 + 4.5 (median, 13.8; range, 6.2 -27.1), and the average number of studies performed per year by a sonographer was 1,297 + 326 (median, 1,279; range 717 -2,475). These figures were not adjusted for case complexity, time requirement for transesophageal echocardiography, level of expertise, or availability of sonographer assistance. Moreover, the issues of study quality and accuracy were not addressed. The C-PELP 2011 survey gathered important information on the current organization and staffing of academic pediatric echocardiography laboratories, but the committee did not attempt to craft guidelines or recommendations on staffing requirements. The results of the survey, however, should provide a framework for additional investigation into the optimal structure and staffing of pediatric echocardiography laboratories. Copyright © 2013 American Society of Echocardiography

  18. 经食管超声心动图用于累及右心的下腔静脉瘤栓切除术的临床价值%Clinical value of transesophageal echocardiography for surgical resection of inferior vena caval tumor thrombus with cardiac extension

    Institute of Scientific and Technical Information of China (English)

    陈唯韫; 朱斌; 刘兴荣; 张超纪; 马国涛; 苗齐; 黄宇光

    2014-01-01

    本院2010年3月至2013年12月在经食管超声心动图(TEE)术中监测下完成了6例累及右心的下腔静脉瘤栓切除术.6例患者术前检查均显示下腔静脉瘤栓延伸至右心.麻醉诱导后TEE发现,其中3例与术前检查结果有差别,故调整外科决策,决定不使用体外循环,在TEE密切监测下切开下腔静脉完整取出瘤栓.另3例患者TEE结果与术前类似,在体外循环下行瘤栓切除术.根据TEE结果,调整麻醉管理,特别是血流动力学管理方案,调整容量以及血管活性药的使用.手术切除后TEE检查均未见残余瘤栓,但是在3例右心严重受累患者均观察到重度三尖瓣返流.术后随访未见TEE使用相关并发症.本文总结报道了TEE在累及右心的下腔静脉瘤栓切除术中的应用,TEE提供的信息可纠正、优化外科决策和麻醉管理,评估手术效果,具有重要的临床应用价值.%Inferior vena caval (IVC) tumor thrombus with cardiac extension is a very rare phenomenon,which proliferates fast and could be very challenging to the surgery.This paper was designed to investigate the clinical value of transesophageal echocardiography (TEE) for the surgical resection of IVC tumor thrombus extending into right cardiac cavities.Six cases from our medical institute,preoperatively diagnosed as IVC tumor thrombus with cardiac extension and scheduled for the surgical resection,were retrospectively analyzed.In addition to real-time and dynamic monitoring,comprehensive TEE exams were performed for all the patients respectively after anesthesia induction,namely before tumor resection and after tumor resection.Cardiac extension was defined by the preoperative finding of cardiac mass originated from IVC tumor thrombus by transthoracic echocardiography,computerized tomography or CT angiography.In all the cases,intraoperative TEE provided an accurate and excellent view of the IVC tumor thrombus.For case three,the IVC tumor thrombus was found at the IVC

  19. Transesophageal color Doppler evaluation of obstructive lesions using the new "Quasar" technology.

    Science.gov (United States)

    Fan, P; Nanda, N C; Gatewood, R P; Cape, E G; Yoganathan, A P

    1995-01-01

    Due to the unavoidable problem of aliasing, color flow signals from high blood flow velocities cannot be measured directly by conventional color Doppler. A new technology termed Quantitative Un-Aliased Speed Algorithm Recognition (Quasar) has been developed to overcome this limitation. Employing this technology, we used transesophageal color Doppler echocardiography to investigate whether the velocities detected by the Quasar would correlate with those obtained by continuous-wave Doppler both in vitro and in vivo. In the in vitro study, a 5.0 MHz transesophageal transducer of a Kontron Sigma 44 color Doppler flow system was used. Fourteen different peak velocities calculated and recorded by color Doppler-guided continuous-wave Doppler were randomly selected. In the clinical study, intraoperative transesophageal echocardiography was performed using the same transducer 18 adults (13 aortic valve stenosis, 2 aortic and 2 mitral stenosis, 2 hypertrophic obstructive cardiomyopathy and 1 mitral valve stenosis). Following each continuous-wave Doppler measurement, the Quasar was activated, and a small Quasar marker was placed in the brightest area of the color flow jet to obtain the maximum mean velocity readout. The maximum mean velocities measured by Quasar closely correlated with maximum peak velocities obtained by color flow guided continuous-wave Doppler in both in vitro (0.53 to 1.65 m/s, r = 0.99) and in vivo studies (1.50 to 6.01 m/s, r = 0.97). We conclude that the new Quasar technology can accurately measure high blood flow velocities during transesophageal color Doppler echocardiography. This technique has the potential of obviating the need for continuous-wave Doppler.

  20. Quantification study of mitral valve with real-time three-dimensional transesophageal echocardiography before mitral valve replacement%实时三维超声心动图对二尖瓣置换术前瓣膜结构的定量研究

    Institute of Scientific and Technical Information of China (English)

    郎瑞; 冯天鹰; 哈斯

    2014-01-01

    目的 应用经食管实时三维超声心动图(RT-3D-TEE)对风湿性二尖瓣关闭不全行置换术的患者进行二尖瓣对合参数的对比研究.方法 风湿性二尖瓣关闭不全患者16例(风湿组;其中合并轻度狭窄者4例),其中男性6例,女性10例;年龄43~ 67岁,平均年龄53.4岁.正常对照组17例,其中男性7例,女性10例;年龄29 ~ 54岁,平均年龄43.1岁.分别行RT-3D-TEE检查并进行二尖瓣定量分析(MVQ).结果 风湿组在体二尖瓣对合面积为(160.69±50.44)mm2,术后离体瓣膜的对合面积为(163.97±59.58) mm2;对照组MVQ在体二尖瓣对合面积为(296.30±37.31) mm2.两组在体二尖瓣对合面积差异有显著统计学意义(t=8.82,P=0.000 00).MVQ所测二尖瓣对合面积与离体对合面积具有良好的相关性(r=0.892,P< 0.01).Altman-Bland绘图分析结果表明,二者具有较好的一致性,两者的差值为-1.73±8.28,95%的置信区间为(-18.04,14.46).风湿组左心室舒张早期及收缩末期瓣膜面积均较对照组增大(P<0.05),对合面积及对合指数减小(P<0.01).结论 RT-3D-TEE可以实时检测二尖瓣的立体结构,MVQ所测二尖瓣对合参数可以较好地反映二尖瓣的实际对合程度,为二尖瓣病变手术方案的制定及术后疗效的预测提供理论依据.%Objective To compare the mitral valve involution parameters in patients before and after mitral valve replacement by rheumatic mitral insufficiency using real-time three-dimensional transesophageal echocardiography(RT-3D-TEE).Methods A total of 16 patients with rheumatic mitral insufficiency(rheumatic group,and 4 cases combined mild stenosis) were enrolled,which included 6 males and 10 females,aged 43-67 years old with mean age of 53.4.The 17 healthy subjects was set as control group,included 7 males and 10 females,aged 29-54 years old with mean age of 43.1.The correlation parameters of mitral leaflets and annulars were obtained by mitral valve quantitative(MVQ) procedure

  1. Utilidade da ecocardiografia transeofageana durante hipotensão arterial grave em cirurgia não cardíaca Utilidad de la ecocardiografía transeofageana durante hipotensión arterial severa en cirugía no cardiaca Utility of transesophageal echocardiography during severe hypotension in non-cardiac surgery

    Directory of Open Access Journals (Sweden)

    Cabrera Schulmeyer

    2010-10-01

    ortopédicas fueron las más frecuentes. En todos los pacientes, la ETE fue útil para la determinación de la etiología de la hipotensión arterial severa. La Hipovolemia fue diagnosticada en 18 pacientes (42%. Una baja fracción de eyección (FE BACKGROUND AND OBJECTIVES: Severe and refractory hypotension is an infrequent perioperative situation during non-cardiac surgery, but determining its etiology is essential for successful management and therapy. METHODS: Adults undergoing non-cardiac surgery were prospectively enrolled in this study. Severe hypotension was defined as a drop from 30% of baseline systolic arterial pressure unresponsive to adequate fluids administration and to ephedrine, according to the anasthesiologist criteria. A multiplanar transesophageal echocardiography (TEE probe was inserted, prior to any other invasive hemodynamic monitor. RESULTS: Forty two adults (68 ± 12 years were studied, 84% during elective non-cardiac surgery. Abdominal (open and laparoscopic, thoracic and orthopaedic surgeries were performed most frequently. In all patients, TEE was useful for determining the etiology of severe hypotension. Hypovolemia was diagnosed in 18 patients (42%. Low ejection fraction (EF < 30% was detected in 5 cases and was successfully treated with vasoactive drugs. Dynamic left ventricular outflow tract obstruction, associated with systolic anterior motion of the mitral valve, was diagnosed in 5 patients; in another 6 patients severe embolism was detected during hip and knee surgery. Myocardial ischemia causing persistent hypotension was detected in 5 patients; in 3 patients, cardiac tamponade was the etiology of severe hypotension. Two patients died; both had severe myocardial ischemia. CONCLUSIONS: Perioperative TEE was performed quickly, proving to be a useful technique in the context of hypotension during non-cardiac surgery. The heart and great vessels could be observed directly and functionally evaluated. Thus, the etiology of severe

  2. 基于三维经食管超声的3D打印模型指导左心耳封堵的可行性研究%Guidance of three-dimensional printing model of left atrial appendage derived from transesophageal echocardiography for left atrial appendage closure

    Institute of Scientific and Technical Information of China (English)

    宋宏宁; 周青; 邓倾; 陈金玲; 张兰; 何发智; 潘一腾; 刘育; 郭瑞强

    2016-01-01

    Objective To investigate the feasibility of three dimensional printing left atrial appendage(LAA) models from three dimensional transesophageal echocardiography (3D-TEE) volume-rendered data and its value for guiding the placement of LAA occlusion device.Methods Ten patients with non-valvular atrial fibrillation (AF) were underwent TEE before LAA occlusion.3D full volume data and routine two dimensional images of the LAA were acquired.The 3D-TEE data were post-processed by grey values inverted imaging and threshold segmentation to create volume rendered images of the LAA in STL format.The cardiac chamber model and the cardiac wall model of the LAA were printed out by 3D printer for the LAA morphology evaluation and measurement.Preoperative rehearsal was carried out on the printed 3D LAA models.Results In all the patients,3D-TEE full volume data of the LAA were successfully reprocessed and printed out.In terms of the LAA morphology classification based on cardiac chamber models there were 5 chicken wing,3 windsock and 2 cauliflower.And there were 4 single-lobed,3 bi-lobed and 3 multi-lobed.The maximal ostium diameter and the depth of the main anchoring lobe were (20.30 ±3.53)mm and (28.26 ± 5.51)mm respectively,which were concordant well with the measurements of 2D-TEE and CT.The LAmbre and the Lefort occlusion device could be implanted into the 3D LAA models for occlusion planning before the procedure.Occlusion success rate was 100%.Conclusions 3D-TEE full volume data is feasible and capable of creating LAA 3D models.3D models of LAA derived from 3D-TEE have promising value in guiding the LAA occlusion procedure.%目的 探讨应用三维经食管超声(3D-TEE)心腔容积成像进行左心耳3D打印的技术可行性及该技术对左心耳封堵的指导价值.方法 10例因非瓣膜性心房颤动进行经导管左心耳封堵患者,术前行经食管超声心动图检查,采集左心耳二维图像及三维容积图像.对三维DICOM数据进行后处理

  3. Trombose de prótese biológica mitral: importância do ecocardiograma transesofágico no diagnóstico e acompanhamento pós-tratamento Bioprosthetic mitral valve thrombosis: importance of transesophageal echocardiography in the diagnosis and follow-up after treatment

    Directory of Open Access Journals (Sweden)

    Adelino Parro Jr

    2004-04-01

    Full Text Available OBJETIVO: Descrever os achados clínicos e ecocardiográficos de trombose em prótese biológica mitral e o valor do ecocardiograma transesofágico (ETE no diagnóstico e monitoração da lise do trombo. MÉTODOS: Foram estudados ao ETE 111 pacientes com prótese biológica mitral, e incluídos 4 de 7 com suspeita de trombo nestas próteses (idade média = 60,2±10,2 anos; 2 homens. O diagnóstico pôde ser confirmado pela realização seriada do ETE e pela evolução clínica. Investigaram-se os aspectos morfológicos dos folhetos da prótese, e presença e característica das massas ecogênicas anexas. Foram obtidos o gradiente médio pela prótese e a área valvar. RESULTADOS: O diagnóstico de trombo em prótese biológica mitral foi realizado 48,7±55,2 meses após a cirurgia. Dois pacientes apresentaram acidente vascular encefálico isquêmico no pós-operatório imediato. O gradiente médio global estava elevado (11,4±3 mmHg e a área valvar reduzida (1,24±0,3cm². Ao ETE, em todos foram evidenciadas massas ecogênicas em face ventricular esquerda da prótese biológica mitral, sugestivas de trombo. No ETE seriado (136±233 dias, houve desaparecimento do trombo em dois casos e redução do trombo nos outros dois, após tratamento. O gradiente médio reduziu para 6,2±3 mmHg (p=0,004; IC 95%, e a área valvar aumentou para 2,07±0,4 (p=ns. CONCLUSÃO: O ETE mostrou-se útil na detecção de trombo em prótese biológica mitral e eficaz na monitoração do tratamento, em todos casos.OBJECTIVE: To report the clinical and echocardiographic findings of bioprosthetic mitral valve thrombosis and the value of transesophageal echocardiography (TEE in its diagnosis and monitoring of thrombolysis. METHODS: One hundred and eleven patients with mitral bioprostheses underwent TEE, and 4 out of 7 suspected of having a thrombus on these prostheses were included in the study (mean age = 60.2±10.2 years; 2 men. The diagnosis was confirmed with serial

  4. Stress echocardiography

    NARCIS (Netherlands)

    A. Salustri (Alessandro)

    1993-01-01

    textabstractIn the studies reported in this thesis, stress echocardiography (either with exercise or with pharmacological agents) and myocardial perfusion scintigraphy have been performed in different groups of patients and in different clinical conditions. Some practical aspects on the protocols of

  5. Stress echocardiography

    NARCIS (Netherlands)

    A. Salustri (Alessandro)

    1993-01-01

    textabstractIn the studies reported in this thesis, stress echocardiography (either with exercise or with pharmacological agents) and myocardial perfusion scintigraphy have been performed in different groups of patients and in different clinical conditions. Some practical aspects on the protocols

  6. 经颅多普勒增强实验结合经食管超声鉴别肺动静脉瘘与卵圆孔未闭所致隐源性卒中的研究%The Significance of Contrast Transcranial Doppler Combined with Transesophageal Echocardiography in the Differential Diagnosis of Cryptogenic Stroke with Pulmonary Arteriovenous Fistula and Patent Foramen Ovale

    Institute of Scientific and Technical Information of China (English)

    董培; 潘华

    2016-01-01

    目的:探讨经颅多普勒增强实验(contrast transcranial Doppler,cTCD)结合经食管超声(transesophageal echocardiography,TEE)对于鉴别肺动静脉瘘(pulmonary arteriovenous fistula,PAVF)与卵圆孔未闭(patent foramen ovale,PFO)所致隐源性卒中的意义。方法收集4例隐源性卒中患者(PAVF组2例,PFO组2例)的临床资料,行cTCD、TEE检查,比较两组的检查结果差异。结果 PAVF组cTCD结果显示患者平静呼吸时即见雨帘样栓子信号,Valsalva动作(Valsalva maneuver, VM)后栓子数量变化不明显;TEE彩色多普勒(color Doppler flow image,CDFI)未见异常,右心声学造影VM后5个心动周期左房内肺静脉开口处见大量微泡。PFO组cTCD结果显示,一例平静呼吸时可见4个栓子,VM后雨帘样栓子信号,VM作用消失后第40个心动周期有2个栓子信号。一例平静呼吸时无栓子信号,VM后可见>50个栓子信号,VM作用消失后无栓子信号。TEECDFI示原发隔继发隔间裂隙左向右过隔血流,右心声学造影VM后2~3个心动周期卵圆孔附近的左心房内见数个微气泡。结论 cTCD结合TEE鉴别诊断PFO和PAVF敏感性高,易于操作。二者主要鉴别点在于cTCD平静呼吸时是否出现大量栓子及是否受VM影响。%Objective To explore the significance of contrast transcranial Doppler (cTCD) combined with transesophageal echocardiography (TEE) in the differential diagnosis of cryptogenic stroke with pulmonary arteriovenous ifstula and patent foramen ovale. Methods Detailed clinical information were collected. TEE and cTCD were performed in 4 patients with cryptogenic stroke (2 patients with pulmonary arteriovenous fistula [PAVF] and 2 patients with patent foramen ovale [PFO]) to compare the difference in test results. Results cTCD in 2 patients with PAVF showed the following characteristics: detection of massive microembolic signals (curtain pattern) during regular

  7. Simulation-based training in echocardiography.

    Science.gov (United States)

    Biswas, Monodeep; Patel, Rajendrakumar; German, Charles; Kharod, Anant; Mohamed, Ahmed; Dod, Harvinder S; Kapoor, Poonam Malhotra; Nanda, Navin C

    2016-10-01

    The knowledge gained from echocardiography is paramount for the clinician in diagnosing, interpreting, and treating various forms of disease. While cardiologists traditionally have undergone training in this imaging modality during their fellowship, many other specialties are beginning to show interest as well, including intensive care, anesthesia, and primary care trainees, in both transesophageal and transthoracic echocardiography. Advances in technology have led to the development of simulation programs accessible to trainees to help gain proficiency in the nuances of obtaining quality images, in a low stress, pressure free environment, often with a functioning ultrasound probe and mannequin that can mimic many of the pathologies seen in living patients. Although there are various training simulation programs each with their own benefits and drawbacks, it is clear that these programs are a powerful tool in educating the trainee and likely will lead to improved patient outcomes. © 2016, Wiley Periodicals, Inc.

  8. Usefulness of three-dimensional echocardiography in the assessment of valvular involvement in Loeffler endocarditis.

    Science.gov (United States)

    Hernandez, Carlos M; Arisha, Mohammed J; Ahmad, Amier; Oates, Ethan; Nanda, Navin C; Nanda, Anil; Wasan, Anita; Caleti, Beda E; Bernal, Cinthia L P; Gallardo, Sergio M

    2017-07-01

    Loeffler endocarditis is a complication of hypereosinophilic syndrome resulting from eosinophilic infiltration of heart tissue. We report a case of Loeffler endocarditis in which three-dimensional transthoracic and transesophageal echocardiography provided additional information to what was found by two-dimensional transthoracic echocardiography alone. Our case illustrates the usefulness of combined two- and three-dimensional echocardiography in the assessment of Loeffler endocarditis. In addition, a summary of the features of hypereosinophilic syndrome and Loeffler endocarditis is provided in tabular form. © 2017, Wiley Periodicals, Inc.

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

    Directory of Open Access Journals (Sweden)

    Vitulano N

    2015-05-01

    Full Text Available Nicola Vitulano, Vincenzo Pazzano, Gemma Pelargonio, Maria Lucia Narducci Institute of Cardiology, Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy Abstract: The development of new imaging tools helps in better investigation of cardiac structures and function by showing detailed images during interventional procedures. Intracardiac echocardiography plays a pivotal role as an intraoperative real-time imaging tool during invasive cardiac procedures. Initially, this echocardiographic technique was particularly useful when transthoracic image quality was insufficient and to avoid general anesthesia for transesophageal imaging. Nowadays, intracardiac echocardiography is routinely used in several cardiac invasive laboratories to support several types of procedures, such as extraction and implantation of cardiac devices, electrophysiological mapping, ablation, and endomyocardial biopsies. This review gives an overview of the basic principles of intracardiac echocardiography and examines its applications in the different settings of invasive cardiology. Keywords: ICE, cardiovascular imaging, electrophysiology, invasive cardiology

  10. Intracardiac echocardiography.

    Science.gov (United States)

    Bruce, C J; Friedman, P A

    2002-10-01

    This article describes currently available intracardiac ultrasound (ICE) technology contrasting it with intravascular ultrasound (IVUS) highlighting their differences. Clinical applications in the electrophysiologic and cardiac catheterization laboratory are discussed and current limitations addressed. Intracardiac echocardiography (ICE) is possible because lower frequency transducers (in contrast to higher frequency IVUS devices) have been miniaturized and mounted onto catheters capable of percutaneous insertion into the heart. These lower frequency transducers are capable of enhanced tissue penetration, permitting high-resolution 2D "whole heart" imaging. Also, with the introduction of the newest phased array transducer, Doppler hemodynamic data in addition to high resolution imaging can also be obtained. ICE facilitates electrophysiologic procedures by guiding transseptal catheterization, enabling endocardial anatomy visualization and targeting of arrhythmogenic substrate, ensuring optimal ablation electrode/tissue contact and promptly diagnosing procedural complications. Promising non-electrophysiologic applications include guidance of percutaneous closure of septal defects, percutaneous mitral balloon valvuloplasty and complex cardiac biopsy. Current limitations include monoplanar imaging, narrow field of view, and relatively large size of the catheter. Intra-cardiac imaging is now a clinical tool and has the potential to play an important role in diagnostic and therapeutic interventional procedures. Further refinement and miniaturization of these transducers, through continued technological progress, will make way for primary operator controlled, integrated ultrasound-guided interventional devices.

  11. Transesophageal Ultrasonography for Lung Cancer Staging

    DEFF Research Database (Denmark)

    Konge, Lars; Annema, Jouke; Vilmann, Peter

    2013-01-01

    Accurate mediastinal nodal staging is essential for patients with resectable non-small-cell lung cancer and is achieved by combined endobronchial ultrasound and transesophageal endoscopic ultrasound (EUS). Training requirements for EUS-guided fine-needle aspiration (FNA) for lung cancer staging...

  12. Transesophageal Ultrasonography for Lung Cancer Staging

    DEFF Research Database (Denmark)

    Konge, Lars; Annema, Jouke; Vilmann, Peter

    2013-01-01

    Accurate mediastinal nodal staging is essential for patients with resectable non-small-cell lung cancer and is achieved by combined endobronchial ultrasound and transesophageal endoscopic ultrasound (EUS). Training requirements for EUS-guided fine-needle aspiration (FNA) for lung cancer staging...

  13. American Society of Echocardiography

    Science.gov (United States)

    American Society of Echocardiography Join Ase Member Portal Log In Membership Member Portal Log In Join ASE Renew Benefits Rates FASE – Fellow of the American Society of Echocardiography Member Referral Program FAQs Initiatives Advocacy ...

  14. The search for endocarditis in patients with candidemia: a systematic recommendation for echocardiography? A prospective cohort.

    Science.gov (United States)

    Fernández-Cruz, A; Cruz Menárguez, M; Muñoz, P; Pedromingo, M; Peláez, T; Solís, J; Rodríguez-Créixems, M; Bouza, E

    2015-08-01

    Most current guidelines do not recommend systematic screening with echocardiography in patients with candidemia, as Candida infective endocarditis (CIE) is considered an uncommon disease. During the study period, we recommended echocardiography systematically to all candidemic patients that did not have contraindications and accepted to participate in the study. We intended to assess the incidence of unrecognized CIE in adult patients with candidemia. Our institution is a tertiary teaching hospital in which we follow all patients with candidemia. From January 2007 to October 2012, echocardiography was systematically recommended to suitable candidates. We recorded 263 cases of candidemia in adult patients. Echocardiography was not performed in 76 of these patients for the following reasons: patients had died when blood cultures became positive (17), patients were critically or terminally ill (38), or the patient or physician refused the procedure (21). The remaining 187 patients constitute the basis of this report. CIE was diagnosed in 11 cases (4.2 % of the whole candidemic population and 5.9 % of the population with echocardiographic study). The results of transthoracic echocardiography (TTE) suggested infective endocarditis (IE) in 5/172 patients (2.9 %), and the result of transesophageal echocardiography (TEE) was positive in 10/87 (11.5 %). Among 11 confirmed cases of CIE, the disease was clinically unsuspected in three patients. At least 4.2 % of all candidemic patients have CIE. CIE is frequently clinically unsuspected and echocardiography is required to demonstrate a high proportion of cases.

  15. Dose efetiva de sedação em ecocardiograma transesofágico: relação com idade, área de superfície e função do ventrículo esquerdo Dosis efectiva de sedación en ecografía transesofágica: relación con edad, área de superficie y función del VI Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function

    Directory of Open Access Journals (Sweden)

    Guilherme Moreira José

    2009-12-01

    ón de eyección del ventrículo izquierdo, estudiamos dos grupos: GA: 55%. En el análisis estadístico utilizamos el test de Kruskal-Wallis para correlación con edad y fracción de eyección del ventrículo izquierdo, y correlación lineal simple para área de superficie corporal. RESULTADOS: En el estudio de la edad, las dosis medias de sedación necesarias fueron significativamente menores en el G3 y G4 (p BACKGROUND: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case. OBJECTIVE: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction. METHODS: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml, meperidine 1 mg (1 ml and distilled water (7.5 ml. Four age groups were analyzed: G1: 65 years. Body surface area was calculated using the formula {[(height x 1000.725] x (weight0.425 x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: 55%. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area. RESULTS: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01. The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01. The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null. CONCLUSION: The mean dose of sedatives required was lower in older individuals and in those with left ventricular systolic dysfunction. No correlation with body surface area was found.

  16. Clinical Stress Echocardiography

    NARCIS (Netherlands)

    S.E. Karagiannis

    2007-01-01

    textabstractTwo-dimensional echocardiography is a commonly used non-invasive method for the assessment of left ventricular function. It provides precise information on both global and segmental myocardial function by displaying endocardial motion and wall thickening. Dobutamine stress

  17. Emerging role of transesophageal echocardiography in severe chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ashwin Songara

    2016-07-01

    Results: There were 0% patient with poor echo window in COPD grade 1, 18.18% in grade 2, 42.2% and 39.39% in grade 3 and grade 4 respectively. P-value obtained was statistically significant P <0.001. Out of 33 COPD patients with poor echo window, In grade 3 and grade 4, 64.2% and 76.9% patients had TEE findings respectively while in grade1 and grade 2 0% and 33.33% patient had TEE finding. Conclusions: TTE though is an excellent tool for diagnosing pulmonary artery hypertension in COPD patients, has its limitation especially in severe COPD cases due to poor echo window which may give false negative results. So TEE should be recommended in all those severe COPD cases that have poor echo window. [Int J Res Med Sci 2016; 4(7.000: 2564-2568

  18. Measurements of cardiac output obtained with transesophageal echocardiography and pulmonary artery thermodilution are not interchangeable

    DEFF Research Database (Denmark)

    Møller-Sørensen, H; Graeser, K; Hansen, K L

    2014-01-01

    was placed in the following successive positions: supine, head-down tilt, head-up tilt, supine, supine with phenylephrine administration, pace heart rate 80 beats per minute (bpm), pace heart rate 110 bpm. TEE CO and PAC CO were measured simultaneously. The agreement was analysed by Bland-Altman plots...

  19. Transesophageal echocardiography in the assessment of coronary arteries; Echokardiografia przezprzelykowa w ocenie proksymalnych odcinkow naczyn wiencowych

    Energy Technology Data Exchange (ETDEWEB)

    Adamek-Kosmider, A.; Kasprzak, J.; Kosmider, M.; Krzeminska-Pakula, M. [Akademia Medyczna, Lodz (Poland)

    1993-12-31

    The study was undertaken to assess the usefulness of TEE for evaluation of morphology and flow in coronary arteries. TEE (2D, spectral and color Doppler imaging) and coronary angiography were performed in 75 patients - 41 with valvular heart disease and 34 with ischemic heart disease. Proximal coronary artery stenosis was detected by coronarography in 11 pts (9-left main coronary artery, 2-right coronary artery). TEE visualization of proximal coronary arteries was possible in all pts. Echocardiographic features of artery stenosis were: the narrowing of the vessel in 2D image (9 pts), high flow velocity spectral Doppler (4 pts, mean 135 cm/s vs 55 cm/s in normal arteries) and mosaic, turbulent flow in color Doppler (10 pts). Sensitivity and specificity of TEE for coronary artery stenosis detection was respectively 81%/98% for 2D imaging and 90%/100% for color Doppler. TEE is a new, noninvasive and safe method for the evaluation of proximal coronary arteries. Detection of LMCA stenosis prior to atheterization may enhance the safety of coronary angiography. (author) 21 refs, 8 figs

  20. Impact of perioperative transesophageal echocardiography on tetralogy of fallot total repair

    Directory of Open Access Journals (Sweden)

    Yasmin Abdel Razek

    2014-03-01

    Conclusion: TEE imaging is a safe, feasible, and accurate tool for anatomical, hemodynamic, and functional assessment in patients with TOF during surgical repair. TEE offers the advantage of permitting visualization of the operative procedure in real time and provides guidance for the surgeon in making decisions inside the operating room.

  1. Imaging of the distal ascending aorta using modified transesophageal echocardiography in cardiac surgery

    NARCIS (Netherlands)

    van Zaane, B.

    2009-01-01

    Epiaortic ultrasound scanning of the ascending aorta is a safe and useful method to detect atherosclerosis in patients undergoing cardiac surgery. The use of epiaortic ultrasound can lead to modifications of the surgical technique, which effectively reduces the post-operative incidence of stroke in

  2. Impact of transesophageal echocardiography during transseptal puncture on atrial fibrillation ablation

    Directory of Open Access Journals (Sweden)

    İsmail Erden, MD

    2016-06-01

    Conclusions: TEE-guided TP for AF ablation is associated with shorter fluoroscopy time, shorter total cryoablation time, and shorter total procedural time. Importantly, TEE-guided TP facilitates cryoablation of the inferior pulmonary veins.

  3. Three-dimensional echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Buck, Thomas [University Hospital Essen (Germany). West German Heart Center; Franke, Andreas [Klinikum Region Hannover - Klinikum Siloah, Hannover (Germany). Dept. of Cardiology, Angiology and Intensive Care Medicine; Monaghan, Mark J. (eds.) [King' s College Hospital, London (United Kingdom)

    2011-07-01

    Presents tips and tricks for beginners and experts Provides educational material for 3D training courses Features comprehensively illustrated cases Includes an accompanying DVD with video clips of all sample cases Three-dimensional echocardiography is the most recent fundamental advancement in echocardiography. Since real-time 3D echocardiography became commercially available in 2002, it has rapidly been accepted in echo labs worldwide. This book covers all clinically relevant aspects of this fascinating new technology, including a comprehensive explanation of its basic principles, practical aspects of clinical application, and detailed descriptions of specific uses in the broad spectrum of clinically important heart disease. The book was written by a group of well-recognized international experts in the field, who have not only been involved in the scientific and clinical evolution of 3D echocardiography since its inception but are also intensively involved in expert training courses. As a result, the clear focus of this book is on the practical application of 3D echocardiography in daily clinical routine with tips and tricks for both beginners and experts, accompanied by more than 150 case examples comprehensively illustrated in more than 800 images and more than 500 videos provided on a DVD. In addition to an in-depth review of the most recent literature on real-time 3D echocardiography, this book represents an invaluable reference work for beginners and expert users of 3D echocardiography. - Tips and tricks for beginners and experts - Educational material for 3D training courses - Comprehensively illustrated cases - DVD with video clips of all sample cases.

  4. Role of echocardiography in diagnosis and management of complete papillary muscle rupture caused by myocardial infarction

    Directory of Open Access Journals (Sweden)

    Josip Vincelj

    2015-08-01

    Full Text Available Aim To evaluate the usefulness of echocardiography in the diagnosis of complete rupture of papillary muscle. Methods Transthoracic (TTE and transesophageal echocardiography (TEE was performed with the ATL 3000 HDI Ultrasound Inc (Bothell, WA, USA with a 2.5 MHz transducer and 5-7 MHz multiplane phased array transducer. We are reporting about two patients (a 45 and a 51-year old male with complete ruptures of papillary muscle following acute myocardial infarction (AMI. Results Both patients were previously treated with fibrinolysis in their local hospitals, 400 and 300 km, respectively, away from our hospital. Massive mitral regurgitation developed in both followed by rapid deterioration of hemodynamic state and severe heart failure, because of which both were transferred by helicopter to the Coronary Care Unit of our clinic. The diagnosis of complete papillary muscle rupture was confirmed in both patients by TTE and TEE. Due to the significant deterioration in their hemodynamic state, vasoactive drugs and intra-aortic balloon pump support were applied. Both patients then underwent mitral valve replacement, accompanied by concomitant coronary artery bypass grafting in one case. Conclusion Transesophageal echocardiography is a more accurate and rapid diagnostic method in patients with mechanical complications of AMI than TTE.

  5. 采用斑点追踪食道超声观察经冠状动脉灌注舒芬太尼对2型糖尿病患者非体外循环冠脉旁路移植术后早期左心室功能失调的影响%Effect on the left ventricular dysfunction in the early postoperative period following off-pump coronary artery bypass grafting of type 2 diabetes mellitus underlying sufentanil coronary perfusion against ischemia-reperfusion injury by speckle tracking transesophageal echocardiography

    Institute of Scientific and Technical Information of China (English)

    鲁显福; 刘训芹; 顾尔伟

    2012-01-01

    背景 采用经斑点追踪食道超声(speckle tracking transesophageal echocardiography,STTE)记录左心室长轴平均收缩峰值应变(averaged global longitudinal peak systolic strain,aGLPS)值、观察舒芬太尼后处理对2型糖尿病-心血管病共病患者与单纯心血管病患者行非体外循环冠脉旁路移植(off-pump coronary artery bypass grafting,OPCABG)术后早期左心室功能失调的影响.方法 择期单纯心血管病患者(CVD组)与2型糖尿病-心血管疾病共病患者(T2DM-CVD组)各20例,择期施行OPCABG手术,术中经冠脉内灌注舒芬太尼(0.2 μg/kg)行缺血心肌后处理(Suf-PostC);经二维食道超声采集STTE/aGLPS,采用FloTrac/Vigileo及Philips M6多功能监测仪行心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)、每搏量(SV)、左心室射血分数(LVEF).观察并测算给药后各时间点aGLPS(T0,Suf-PoC0 min;T1,Suf-PoC30 min;T2,Suf-PoC2 h;T3,SufPoC4 h;T4,Suf-PoC6 h).结果 两组患者术前除血糖外一般情况均无统计学差异;但在Suf-PoC2 h以后(冠脉全部复通后,T2-T4期),两组患者LVEF值均较术前明显改善(P<0.05);T2DM-CVD组[aGLPST0:(-13.4±2.2)%,aGLPST1:(-17.0±2.4)%,aGLPST2:( -17.3±3.1)%,aGLPST3:(-14.6±2.6)%,aGLPST4:( -14.7±1.7)%],CVD组[aGLPST0:(-13.1±2.4)%,aGLPST1:(-16.4±3.1)%,aGLPST2:( -19.6±3.4)%,aGLPST3:( -20.3±2.6)%,aGLPST4:(-20.4±1.9)%],两组患者aGLPS值在(T2~T4)期行同一时间点下的各组绝对数值比较差异有统计学意义(P<0.05). 结论 采用STTE记录aGLPS能够定量监测OPCABG患者术中左心室收缩功能;2型糖尿病削弱舒芬太尼后处理对于心肌缺血/再灌注损伤所起保护效应的临床研究仍需进一步积累资料.%Objective To assess sufentanil postconditioning against ischemia-reperfusion injury whether left ventricular systolic deformation in the early postoperative period could be estimated by speckle tracking transesophageal

  6. Advanced Three-Dimensional Echocardiography

    NARCIS (Netherlands)

    B. Ren (Ben)

    2014-01-01

    markdownabstract__Abstract__ During the development of echocardiography, 3D echocardiography imaging represents a major innovation in cardiovascular ultrasound (Figure 1). Advancements in computer and transducer technologies permit real-time 3D acquisition and presentation of cardiac

  7. Clinical Stress Echocardiography

    NARCIS (Netherlands)

    S.E. Karagiannis

    2007-01-01

    textabstractTwo-dimensional echocardiography is a commonly used non-invasive method for the assessment of left ventricular function. It provides precise information on both global and segmental myocardial function by displaying endocardial motion and wall thickening. Dobutamine stress echocardiograp

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

    Science.gov (United States)

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

    2016-04-01

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

  9. Fully automatic detection of salient features in 3-d transesophageal images.

    Science.gov (United States)

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

    2014-12-01

    Most automated segmentation approaches to the mitral valve and left ventricle in 3-D echocardiography require a manual initialization. In this article, we propose a fully automatic scheme to initialize a multicavity segmentation approach in 3-D transesophageal echocardiography by detecting the left ventricle long axis, the mitral valve and the aortic valve location. Our approach uses a probabilistic and structural tissue classification to find structures such as the mitral and aortic valves; the Hough transform for circles to find the center of the left ventricle; and multidimensional dynamic programming to find the best position for the left ventricle long axis. For accuracy and agreement assessment, the proposed method was evaluated in 19 patients with respect to manual landmarks and as initialization of a multicavity segmentation approach for the left ventricle, the right ventricle, the left atrium, the right atrium and the aorta. The segmentation results revealed no statistically significant differences between manual and automated initialization in a paired t-test (p > 0.05). Additionally, small biases between manual and automated initialization were detected in the Bland-Altman analysis (bias, variance) for the left ventricle (-0.04, 0.10); right ventricle (-0.07, 0.18); left atrium (-0.01, 0.03); right atrium (-0.04, 0.13); and aorta (-0.05, 0.14). These results indicate that the proposed approach provides robust and accurate detection to initialize a multicavity segmentation approach without any user interaction. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  10. Impedance to transesophageal atrial pacing: significance regarding power sources.

    Science.gov (United States)

    Kerr, C R; Chung, D C; Wickham, G; Jameson, M; Vorderbrugge, S

    1989-06-01

    Transesophageal stimulation is an expeditious method of atrial pacing. Using pulse widths of 10 msec results in reduction of current requirement to values that are usually less than 15 mA. An unknown variable in transesophageal atrial pacing has been impedance. In this study, we investigated the impedance to transesophageal atrial pacing in ten patients using a stimulator with a 63 V power source capable of delivering constant current to 20 mA against an impedance of 2,000 ohms. A bipolar electrode was used to deliver stimuli with a current of 15 mA. Voltage across a known resistance and current were measured on an oscilloscope and the impedance was calculated. Pacing thresholds were also performed and ranged from 6.2 to 16.5 mA (mean 9.4 +/- 2.9 mA, SD). Impedance varied between 720 and 2,670 ohms (mean 1,750 +/- 540 ohms). The stimulator used to measure impedance in man and two other commercially available stimulators were bench tested against known resistances of 500 to 2,000 ohms. The other stimulators with power sources of 12.5 and 15 V had attenuation of the delivered current at resistances of between 1,000 and 2,000 ohms. Thus, this study has demonstrated that transesophageal atrial pacing incurs impedances two to five times greater than incurred with intracardiac pacing leads. Therefore stimulators with high power sources are required to deliver the programmed current against these impedances.

  11. A rare localization in right-sided endocarditis diagnosed by echocardiography: A case report

    Directory of Open Access Journals (Sweden)

    Beaufils Philippe

    2003-08-01

    Full Text Available Abstract Background Right-sided endocarditis occurs predominantly in intravenous drug users, patients with pacemakers or central venous lines and with congenital heart diseases. The vast majority of cases involve the tricuspid valve. Case presentation A case of a 31-year-old woman with intravenous drug abuse who had a right-sided vegetation attached to the muscular bundle of the right ventricle is presented. Transthoracic echocardiography revealed a vegetation in the right ventricular outflow tract. Transesophageal echocardiography clearly showed that the 1.8 cm vegetation was not adherent to the pulmonary valve but attached to a muscular bundle. Conclusions Our case points to an unusual location of right-sided endocarditis in intravenous drug users. It confirms that TTE remains an easy and highly sensitive first-line examination for the diagnosis of right-sided endocarditis.

  12. Healed perivalvular abscess: Incidental finding on transthoracic echocardiography

    Directory of Open Access Journals (Sweden)

    Vishnu Datt

    2014-01-01

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

  13. Modern Use of Echocardiography in Transcatheter Aortic Valve Replacement: an Up-Date.

    Science.gov (United States)

    Caldararu, Cristina; Balanescu, Serban

    2016-12-01

    Echocardiography is the cornerstone in the diagnosis of any valvular heart disease. The accurate diagnosis of aortic stenosis, the left ventricle function and the other heart valves evaluation are currently done by ultrasound alone. Prosthetic valve choice and dimensions prior to implantation can be done solely by proper use of echocardiography. The emergence of new methods to cure aortic stenosis such as trans-catheter aortic valve replacement (TAVR) emphasized the diagnostic value of cardiac ultrasound. The usefulness of echocardiography in TAVR can be divided in the baseline assessment (common to patients treated by conventional surgery), intra-procedural guidance of valve deployment and post-procedural follow-up. In the baseline diagnostic work-up echocardiography should allow proper assessment of low-gradient severe aortic stenosis and especially of "low-flow, low-gradient" aortic stenosis, as far the benefit of any valve intervention in these cases may be overshadowed by persistent ventricular dysfunction. "Classic" TAVR is performed with a trans-esophageal echocardiography probe in place, but recently intracardiac echocardiography (ICE) was advocated to reduce the need for general anesthesia. "Minimalist TAVR approach" recommends no echo-guidance and valve implantation by angiography alone. Post-TAVR echo assessment should allow prompt recognition of early complications and the severity of para-valvular leaks. Long term follow-up by echocardiography assesses prosthetic valve function, left ventricular functional recovery and the impact of the procedure on associated conditions (mitral regurgitation, pulmonary hypertension or tricuspid regurgitation). This article emphasizes the role of the cardiologist with ultrasound skills in the assessment of patients addressed to TAVR.

  14. [Stress echocardiography: development and significance].

    Science.gov (United States)

    Attenhofer, C; Ritter, M; Jenni, R

    1994-08-27

    Exercise electrocardiography is still the primary method used in the non-invasive assessment of coronary artery disease. Stress echocardiography is now being increasingly used as a more sensitive adjunct technique to assess ischemia. Ischemia provoked by stress can induce reversible wall motion abnormalities which are disclosed by cross-sectional 2-dimensional echocardiography and standard projections. The types of stress used are physical exercise (bicycle, treadmill), atrial pacing or pharmacologic stimulation. In the latter, the catecholamine dobutamine has emerged as preferable to the vasodilators dipyridamole and adenosine. The diagnostic accuracy of dobutamine stress echocardiography is comparable to that of bicycle or treadmill exercise echocardiography, but dobutamine stress echocardiography is technically simpler and can be performed in patients unable to exercise. Its sensitivity in diagnosing ischemic or viable myocardium is comparable to that of nuclear methods, MRI or PET. In contrast to nuclear methods, stress echocardiography is however free of radiation. In the assessment of patients with coronary artery disease, stress echocardiography has been shown to be valuable for diagnosis, preoperative risk stratification and determination of prognosis. Furthermore, low dose dobutamine echocardiography can be used to detect viable myocardium. Despite these very promising aspects of the method, there are recognized disadvantages and limitations: stress echocardiography is very time-consuming and operator-dependent; its sensitivity correlates strongly with the number of studies performed; analysis of wall motion is performed qualitatively on a purely subjective level, and hence lacks the objectivity of a quantitative approach. These factors emphasize the need for intensive research to render stress echocardiographic analysis more objective. Automatic boundary detection of left ventricular endocardium, color-Doppler-based tissue imaging and three

  15. Changes in Mitral Annular Geometry after Aortic Valve Replacement: A Three-Dimensional Transesophageal Echocardiographic Study

    Science.gov (United States)

    Mahmood, Feroze; Warraich, Haider J.; Gorman, Joseph H.; Gorman, Robert C.; Chen, Tzong-Huei; Panzica, Peter; Maslow, Andrew; Khabbaz, Kamal

    2014-01-01

    Background and aim of the study Intraoperative real-time three-dimensional transesophageal echocardiography (RT-3D TEE) was used to examine the geometric changes that occur in the mitral annulus immediately after aortic valve replacement (AVR). Methods A total of 35 patients undergoing elective surgical AVR under cardiopulmonary bypass was enrolled in the study. Intraoperative RT-3D TEE was used prospectively to acquire volumetric echocardiographic datasets immediately before and after AVR. The 3D echocardiographic data were analyzed offline using TomTec® Mitral Valve Assessment software to assess changes in specific mitral annular geometric parameters. Results Datasets were successfully acquired and analyzed for all patients. A significant reduction was noted in the mitral annular area (-16.3%, p <0.001), circumference (-8.9% p <0.001) and the anteroposterior (-6.3%, p = 0.019) and anterolateral-posteromedial (-10.5%, p <0.001) diameters. A greater reduction was noted in the anterior annulus length compared to the posterior annulus length (10.5% versus 62%, p <0.05) after AVR. No significant change was seen in the non-planarity angle, coaptation depth, and closure line length. During the period of data acquisition before and after AVR, no significant change was noted in the central venous pressure or left ventricular end-diastolic diameter. Conclusion The mitral annulus undergoes significant geometric changes immediately after AVR Notably, a 16.3% reduction was observed in the mitral annular area. The anterior annulus underwent a greater reduction in length compared to the posterior annulus, which suggested the existence of a mechanical compression by the prosthetic valve. PMID:23409347

  16. Pacing stress echocardiography

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    Agrusta Marco

    2005-12-01

    Full Text Available Abstract Background High-rate pacing is a valid stress test to be used in conjunction with echocardiography; it is independent of physical exercise and does not require drug administration. There are two main applications of pacing stress in the echo lab: the noninvasive detection of coronary artery disease through induction of a regional transient dysfunction; and the assessment of contractile reserve through peak systolic pressure/ end-systolic volume relationship at increasing heart rates to assess global left ventricular contractility. Methods The pathophysiologic rationale of pacing stress for noninvasive detection of coronary artery disease is obvious, with the stress determined by a controlled increase in heart rate, which is a major determinant of myocardial oxygen demand, and thereby tachycardia may exceed a fixed coronary flow reserve in the presence of hemodynamically significant coronary artery disease. The use of pacing stress echo to assess left ventricular contractile reserve is less established, but promising. Positive inotropic interventions are mirrored by smaller end-systolic volumes and higher end-systolic pressures. An increased heart rate progressively increases the force of ventricular contraction (Bowditch treppe or staircase phenomenon. To build the force-frequency relationship, the force is determined at different heart rate steps as the ratio of the systolic pressure (cuff sphygmomanometer/end-systolic volume index (biplane Simpson rule. The heart rate is determined from ECG. Conclusion Two-dimensional echocardiography during pacing is a useful tool in the detection of coronary artery disease. Because of its safety and ease of repeatability noninvasive pacing stress echo can be the first-line stress test in patients with permanent pacemaker. The force-frequency can be defined as up- sloping (normal when the peak stress pacing systolic pressure/end-systolic volume index is higher than baseline and intermediate stress

  17. Feasibility of endoscopic transesophageal thoracic sympathectomy (with video).

    Science.gov (United States)

    Turner, Brian G; Gee, Denise W; Cizginer, Sevdenur; Konuk, Yusuf; Karaca, Cetin; Willingham, Field; Mino-Kenudson, Mari; Morse, Christopher; Rattner, David W; Brugge, William R

    2010-01-01

    Thoracoscopic sympathectomy is the preferred surgical treatment for patients with disabling palmar hyperhidrosis. Current methods require a transthoracic approach to permit ablation of the thoracic sympathetic chain. To develop a minimally invasive, transesophageal endoscopic technique for a sympathectomy in a swine model. Nonsurvival animal study. Animal trial at a tertiary care academic center. This study involved 8 healthy Yorkshire swine. After insertion of a double-channel gastroscope, a Duette Band mucosectomy device was used to create a small esophageal mucosal defect. A short, 5-cm submucosal tunnel was created by using the tip of the endoscope and biopsy forceps. Within the submucosal space, a needle-knife was used to incise the muscular esophageal wall and permit entry into the mediastinum and chest. The sympathetic chain was identified at the desired thoracic level and was ablated or transected. The animals were killed at the completion of the procedure. Feasibility of endoscopic transesophageal thoracic sympathectomy. The sympathetic chain was successfully ablated in 7 of 8 swine, as confirmed by gross surgical pathology and histology. In 1 swine, muscle fibers were inadvertently transected. On average, the procedure took 61.4+/-24.5 minutes to gain access to the chest, whereas the sympathectomy was performed in less than 3 minutes in all cases. One animal was killed immediately after sympathectomy, before the completion of the observation period, because of hemodynamic instability. Nonsurvival series, animal study. Endoscopic transesophageal thoracic sympathectomy is technically feasible, simple, and can be performed in a porcine model. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  18. Making three-dimensional echocardiography more tangible: a workflow for three-dimensional printing with echocardiographic data

    Directory of Open Access Journals (Sweden)

    Azad Mashari MD

    2016-12-01

    Full Text Available Three-dimensional (3D printing is a rapidly evolving technology with several potential applications in the diagnosis and management of cardiac disease. Recently, 3D printing (i.e. rapid prototyping derived from 3D transesophageal echocardiography (TEE has become possible. Due to the multiple steps involved and the specific equipment required for each step, it might be difficult to start implementing echocardiography-derived 3D printing in a clinical setting. In this review, we provide an overview of this process, including its logistics and organization of tools and materials, 3D TEE image acquisition strategies, data export, format conversion, segmentation, and printing. Generation of patient-specific models of cardiac anatomy from echocardiographic data is a feasible, practical application of 3D printing technology.

  19. Case report of latex aerosolization from a transesophageal echocardiogram machine.

    Science.gov (United States)

    Muller, Barbara A; Steelman, Victoria J

    2004-01-01

    Aerosolized natural rubber latex proteins produce latex sensitization and can cause acute allergic reactions in susceptible individuals. The objective of this study is to describe measures that should be taken to ensure a latex-safe hospital environment. A case of latex-induced anaphylaxis prompted a survey of air quality in acute care areas of a major tertiary health care center that had eliminated the use of powder-free latex gloves years earlier. Six air samples were collected using pre- and postcalibrated sampling pumps operating at 2.7 L/minute. Samples were collected in duplicate on three-piece 37-mm Teflon filters in open-faced cassettes and tested for latex allergen by inhibition immunoassay. All samples had less than the detection limit > 5 ng/m3 for aerosolized latex except for the echocardiogram suite where the transesophageal echocardiogram machine was located. After thorough cleaning of the suite and echocardiogram machine, subsequent air sampling showed no detectable latex aerosolization particles. Follow-up investigation to discover the source of contamination revealed that the department performing routine maintenance on the echocardiogram equipment used powdered latex gloves obtained outside the hospital. Employees who are latex allergic may experience symptoms even in an environment of powder-free, nonlatex gloves. The site was a contaminated transesophageal echocardiogram machine. Institutional policies should be in place to monitor employee complaints and address allergic reactions to latex.

  20. The Value of Contrast Echocardiography

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    Shannon C. Treiber

    2016-01-01

    Full Text Available Purpose: There is much evidence-based research proving the effectiveness of contrast echocardiography, but there are still questions and concerns about its specific uses. This study tested the effectiveness of contrast echocardiography in defining the left ventricular endocardial border. Methods: From 30 patients, a total of 60 echocardiograms –– 30 with and 30 without use of contrast –– were retrospectively reviewed by four blinded cardiologists with advanced training in echocardiography. No single cardiologist reviewed contrast and noncontrast images of the same patient. Each set of 30 echocardiograms was then studied for wall-motion scoring. Visualization of left ventricular wall segments and a global visualization confidence level of interpretation were recorded. Results: Of all wall segments (N = 510, 91% were visualized in echocardiograms with use of contrast, whereas 75% of the walls were visualized in echocardiograms without contrast (P < 0.001. Of 30 examinations, 17 contrast echocardiograms were read with high confidence compared to 6 without contrast use (P = 0.004. The number of walls visualized with contrast was increased in 18 patients (60%, whereas noncontrast echocardiograms yielded more visualized walls in 6 patients (20%, P = 0.002. Conclusions: This study demonstrates that contrast is valuable to echocardiographic imaging. Its use should be supported throughout echocardiography clinics and encouraged in certain patients for whom resting and stress echocardiography results without contrast often prove uninterpretable.

  1. Evaluation of a second-generation microtransesophageal echocardiography transducer and software.

    Science.gov (United States)

    Frank, Lowell H; Chelliah, Anjali; Sable, Craig A

    2014-10-01

    Transesophageal echocardiographic imaging of small infants has been limited because of equipment size. A newer miniaturized transducer has allowed for the imaging of even the smallest patients but has been limited by intermittent poor image quality because of hardware durability. A second generation of the transducer was developed to address this problem. The aim of this study was to evaluate the performance and durability of the second-generation transducer over multiple uses and to compare the image quality from the modified transducer and new software preset to the original transducer. Patients undergoing transesophageal echocardiography (TEE) based on clinical indications with the original or second-generation transducers were included in the study. All studies were reviewed for image quality and unacceptable image degradation, which was defined as imaging quality inadequate for clinical use. Study review was performed by two echocardiographers. Using the original transducer, 37 studies were performed with a mean patient weight of 3.46±0.89 kg (range 2.1-5.7). Using the second-generation transducer, 65 studies were performed with a mean patient weight of 4.87±2.05 kg (range 2.2-13.8). Image quality was clinically inadequate in 8 of the 35 studies with the original transducer and in zero with the second generation (Ptransducer allows for effective use of TEE even in the smallest infants and avoids the mechanical failures associated with the first-generation release. © The Author(s) 2014.

  2. Esophageal Perforation due to Transesophageal Echocardiogram: New Endoscopic Clip Treatment

    Directory of Open Access Journals (Sweden)

    John Robotis

    2014-07-01

    Full Text Available Esophageal perforation due to transesophageal echocardiogram (TEE during cardiac surgery is rare. A 72-year-old female underwent TEE during an operation for aortic valve replacement. Further, the patient presented hematemesis. Gastroscopy revealed an esophageal bleeding ulcer. Endoscopic therapy was successful. Although a CT scan excluded perforation, the patient became febrile, and a second gastroscopy revealed a big perforation at the site of ulcer. The patient's clinical condition required endoscopic intervention with a new OTSC® clip (Ovesco Endoscopy, Tübingen, Germany. The perforation was successfully sealed. The patient remained on intravenous antibiotics, proton pump inhibitors and parenteral nutrition for few days, followed by enteral feeding. She was discharged fully recovered 3 months later. We clearly demonstrate an effective, less invasive treatment of an esophageal perforation with a new endoscopic clip.

  3. Transesophageal echocardiography for incremental value of Amplatezer cribriform septal occluder for percutaneous transcatheter closure of complex septal defects: Case series

    Directory of Open Access Journals (Sweden)

    Shen Kou Tsai

    2017-06-01

    Conclusion: Our patients with complex septal defects were successfully treated by transcatheter closure using an Amplazter cribriform septal occluder device with careful planning based on patient presentation and close interdisciplinary collaboration. RT 3D color Doppler TEE provided precise information for the selection of the appropriate occluder device and facilitated the procedure by guiding the catheter through the often challenging patient anatomy.

  4. Three-Dimensional Echocardiography of the Aortic Valve: Feasibility, Clinical Potential, and Limitations.

    Science.gov (United States)

    Kasprzak, Jaroslaw D.; Salustri, Alessandro; Roelandt, Jos R.T.C.; Ten Cate, Folkert J.

    1998-02-01

    OBJECTIVES: The purpose of our study was to assess the feasibility and potential clinical utility of three-dimensional echocardiography for evaluation of the aortic valve. BACKGROUND: The value of three-dimensional echocardiographic assessment of the aortic valve has not been established yet. METHODS: The study group comprised 32 patients (11 women, 21 men), mean age 56.1 (range 20-82). Seven morphologically normal valves, 5 homografts, 6 mechanical prostheses, and 14 valves of abnormal morphology were evaluated. Images were acquired during a routine multiplane transesophageal echocardiographic examination (rotational scan with 2 degrees interval, respiration, and electrocardiogram [ECG] gating) and postprocessed off-line. A selection of reconstructed cutplanes (anyplane mode) and volume-rendered three-dimensional views of aortic valve anatomy were analyzed by two observers and compared with two-dimensional echocardiography findings. RESULTS: The quality of reconstructions was scored excellent when permitting unrestricted assessment of aortic valve anatomy with optimized planimetric measurements (19 patients, 59%), adequate when aortic valve was partially visualized (7 patients, 22%), or inadequate when no assessment was possible (6 patients, 19%, including 5 with prosthetic valves). Three-dimensional echocardiography provided additional information in ten (31%) patients as compared with the two-dimensional echocardiographic findings. CONCLUSIONS: It can be concluded that three-dimensional echocardiographic reconstruction of the aortic valve is feasible, with excellent or adequate quality in 81% of patients, more frequently in native than in prosthetic valves, P < 0.05. Morphologic information additional to that provided by two-dimensional echocardiography is obtained in a significant proportion of patients.

  5. Transesophageal cardioversion of atrial flutter and atrial fibrillation using an electric balloon electrode system

    Institute of Scientific and Technical Information of China (English)

    郑方胜; 祁学文; 刘海峰; 康宁宁

    2003-01-01

    Objective To determine the feasibility and efficiency of terminating atrial flutter (AFL) and atrial fibrillation (AF) using synchronous low-energy shocks delivered through a novel transesophageal electric balloon electrode system.Methods By using a novel electric balloon electrode system, we attempted 91 transesophageal cardioversions in 52 patients, to treat 53 episodes of AFL and 38 episodes of AF.Results Of the 40 patients of AFL that failed to respond to drug therapy, 37 (92.5%) were successfully countershocked to sinus rhythm by transesophageal cardioversion, with a mean energy of (22.70±4.50) J (20-30 J). Of the 19 patients in AF, transesophageal cardioversion was successful in 16 (84.2%) cases, requiring a mean delivered energy of (17.38±8.58) J (3-30 J). There were no complications such as heart block or ventricular fibrillation, and no evidence of esophageal injury. Conclusions Transesophageal cardioversion using an electric balloon electrode system is an effective and feasible method for the treatment of AFL and AF. It requires low energy and no anesthesia, leads to less trauma, and shows a high cardioversion success rate that may prove valuable in the management of tachyarrhythmias.

  6. Maternal psychological impact of fetal echocardiography.

    Science.gov (United States)

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

    2002-02-01

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

  7. Role of echocardiography for catheter-based management of valvular heart disease.

    Science.gov (United States)

    Shiota, Takahiro

    2017-01-01

    Catheter-based treatment of valvular heart disease, such as transvalvular aortic valve replacement (TAVR) or mitral clip procedure, has been increasingly accepted as a treatment choice for the past several years. Such new treatment options have been changing the management of patients with valvular heart disease drastically while socio-economic factors regarding their application need to be taken into consideration. The use of echocardiography, including transesophageal echocardiography (TEE), for such catheter-based treatments is essential for the success of the procedures. Severe hypotension after TAVR is a life-threatening emergency. Rapid assessment and diagnosis in the catheterization or hybrid laboratory is essential for safety and a positive outcome. Possible diagnoses in this critical situation would include severe left ventricular dysfunction due to coronary obstruction, cardiac tamponade, aortic rupture, acute severe aortic and/or mitral valve regurgitation, and hypovolemia due to bleeding. Although new types of TAVR valves reduce para-valvular aortic regurgitation (AR) significantly, it is still important to judge the severity of para-valvular AR correctly in the laboratory. As for mitral clip procedure, TEE is vital for guiding and monitoring the entire process. Accurate identification of the location and the geometry of the regurgitant orifice is necessary for proper placement of the clip. Real-time 3D TEE provides helpful en face view of the mitral valve and clip together to this end. Residual mitral regurgitation (MR) after the first clip is not uncommon. Quick and precise imaging of the residual MR (location and severity) with TEE is extremely important for the interventionist to place the second clip and possibly third clip properly. After the completion of the clip procedure, mitral valve stenosis and also iatrogenic atrial septal defect need to be checked by TEE. Echocardiography, especially TEE, is also vital for the success of other newer trans

  8. Left Atrial Appendage Closure Guided by Integrated Echocardiography and Fluoroscopy Imaging Reduces Radiation Exposure.

    Directory of Open Access Journals (Sweden)

    Christiane Jungen

    Full Text Available To investigate whether percutaneous left atrial appendage (LAA closure guided by automated real-time integration of 2D-/3D-transesophageal echocardiography (TEE and fluoroscopy imaging results in decreased radiation exposure.In this open-label single-center study LAA closure (AmplatzerTM Cardiac Plug was performed in 34 consecutive patients (8 women; 73.1±8.5 years with (n = 17, EN+ or without (n = 17, EN- integrated echocardiography/fluoroscopy imaging guidance (EchoNavigator® [EN]; Philips Healthcare. There were no significant differences in baseline characteristics between both groups. Successful LAA closure was documented in all patients. Radiation dose was reduced in the EN+ group about 52% (EN+: 48.5±30.7 vs. EN-: 93.9±64.4 Gy/cm2; p = 0.01. Corresponding to the radiation dose fluoroscopy time was reduced (EN+: 16.7±7 vs. EN-: 24.0±11.4 min; p = 0.035. These advantages were not at the cost of increased procedure time (89.6±28.8 vs. 90.1±30.2 min; p = 0.96 or periprocedural complications. Contrast media amount was comparable between both groups (172.3±92.7 vs. 197.5±127.8 ml; p = 0.53. During short-term follow-up of at least 3 months (mean: 8.1±5.9 months no device-related events occurred.Automated real-time integration of echocardiography and fluoroscopy can be incorporated into procedural work-flow of percutaneous left atrial appendage closure without prolonging procedure time. This approach results in a relevant reduction of radiation exposure.ClinicalTrials.gov NCT01262508.

  9. A transesophageal phased array transducer for ultrasonic imaging of the heart

    NARCIS (Netherlands)

    C.T. Lancée (Charles)

    1987-01-01

    textabstractIn this thesis the development of a miniaturized phased array ultrasound transducer is described. The application of this transducer in the field of echocardiology is devoted to transesophageal cross-sectional scanning of the heart and its great vessels. The enormous increase in diagnost

  10. A transesophageal phased array transducer for ultrasonic imaging of the heart

    NARCIS (Netherlands)

    C.T. Lancée (Charles)

    1987-01-01

    textabstractIn this thesis the development of a miniaturized phased array ultrasound transducer is described. The application of this transducer in the field of echocardiology is devoted to transesophageal cross-sectional scanning of the heart and its great vessels. The enormous increase in

  11. Cardiac shear-wave elastography using a transesophageal transducer: application to the mapping of thermal lesions in ultrasound transesophageal cardiac ablation.

    Science.gov (United States)

    Kwiecinski, Wojciech; Bessière, Francis; Colas, Elodie Constanciel; N'Djin, W Apoutou; Tanter, Mickaël; Lafon, Cyril; Pernot, Mathieu

    2015-10-21

    Heart rhythm disorders, such as atrial fibrillation or ventricular tachycardia can be treated by catheter-based thermal ablation. However, clinically available systems based on radio-frequency or cryothermal ablation suffer from limited energy penetration and the lack of lesion's extent monitoring. An ultrasound-guided transesophageal device has recently successfully been used to perform High-Intensity Focused Ultrasound (HIFU) ablation in targeted regions of the heart in vivo. In this study we investigate the feasibility of a dual therapy and imaging approach on the same transesophageal device. We demonstrate in vivo that quantitative cardiac shear-wave elastography (SWE) can be performed with the device and we show on ex vivo samples that transesophageal SWE can map the extent of the HIFU lesions. First, SWE was validated with the transesophageal endoscope in one sheep in vivo. The stiffness of normal atrial and ventricular tissues has been assessed during the cardiac cycle (n = 11) and mapped (n = 7). Second, HIFU ablation has been performed with the therapy-imaging transesophageal device in ex vivo chicken breast samples (n  =  3), then atrial (left, n = 2) and ventricular (left n = 1, right n = 1) porcine heart tissues. SWE provided stiffness maps of the tissues before and after ablation. Areas of the lesions were obtained by tissue color change with gross pathology and compared to SWE. During the cardiac cycle stiffness varied from 0.5   ±   0.1 kPa to 6.0   ±   0.3 kPa in the atrium and from 1.3   ±   0.3 kPa to 13.5   ±   9.1 kPa in the ventricles. The thermal lesions were visible on all SWE maps performed after ablation. Shear modulus of the ablated zones increased to 16.3   ±   5.5 kPa (versus 4.4   ±   1.6 kPa before ablation) in the chicken breast, to 30.3   ±   10.3 kPa (versus 12.2   ±   4.3 kPa) in the atria and to 73.8

  12. The echocardiography of replacement heart valves

    Science.gov (United States)

    2016-01-01

    This is a practical description of how replacement valves are assessed using echocardiography. Normal transthoracic appearances including normal variants are described. The problem of differentiating normal function, patient–prosthesis mismatch and pathological obstruction in aortic replacement valves with high gradients is discussed. Obstruction and abnormal regurgitation is described for valves in the aortic, mitral and right-sided positions and when to use echocardiography in suspected infective endocarditis. The roles of transoesophageal and stress echocardiography are described and finally when other imaging techniques may be useful. PMID:27600454

  13. Fetal echocardiography in ectopia cordis.

    Science.gov (United States)

    Repondek-Liberska, M; Janiak, K; Wloch, A

    2000-01-01

    Ectopia cordis is an extremely rare congenital abnormality occurring in 5.5 to 7.9 per 1 million live births with high lethality. Between January 1995 and October 1997 eight cases of ectopia cordis were diagnosed at our institute before birth. On the basis of echocardiography the fetal heart anatomy was categorized as either normal heart anatomy (NHA; n = 3) or congenital heart defect (CHD; n = 5). In the majority of cases (seven of eight) other abnormalities were present. Some reports have described ectopia cordis being diagnosed in the first trimester of pregnancy. In our study group the average gestational age at diagnosis was 26 weeks. The prenatal diagnosis of isolated ectopia cordis is easy; counseling the patient, the perinatal management including term, place, and method of delivery, and optimal care of the newborn are more difficult. Ectopia cordis is a malformation that pediatricians rarely encounter, even at pediatric cardiology centers. Much more frequently it is a problem for sonographers and obstetricians; however, pediatric cardiologists should be aware of diagnostic algorithm for such cases, especially when additional abnormalities are present.

  14. Transoesophageal echocardiography during liver transplantation

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  15. Depth-resolved registration of transesophageal echo to x-ray fluoroscopy using an inverse geometry fluoroscopy system

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    Hatt, Charles R. [Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Tomkowiak, Michael T.; Dunkerley, David A. P.; Slagowski, Jordan M. [Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Funk, Tobias [Triple Ring Technologies, Inc., Newark, California 94560 (United States); Raval, Amish N. [Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53792 (United States); Speidel, Michael A., E-mail: speidel@wisc.edu [Departments of Medical Physics and Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States)

    2015-12-15

    Purpose: Image registration between standard x-ray fluoroscopy and transesophageal echocardiography (TEE) has recently been proposed. Scanning-beam digital x-ray (SBDX) is an inverse geometry fluoroscopy system designed for cardiac procedures. This study presents a method for 3D registration of SBDX and TEE images based on the tomosynthesis and 3D tracking capabilities of SBDX. Methods: The registration algorithm utilizes the stack of tomosynthetic planes produced by the SBDX system to estimate the physical 3D coordinates of salient key-points on the TEE probe. The key-points are used to arrive at an initial estimate of the probe pose, which is then refined using a 2D/3D registration method adapted for inverse geometry fluoroscopy. A phantom study was conducted to evaluate probe pose estimation accuracy relative to the ground truth, as defined by a set of coregistered fiducial markers. This experiment was conducted with varying probe poses and levels of signal difference-to-noise ratio (SDNR). Additional phantom and in vivo studies were performed to evaluate the correspondence of catheter tip positions in TEE and x-ray images following registration of the two modalities. Results: Target registration error (TRE) was used to characterize both pose estimation and registration accuracy. In the study of pose estimation accuracy, successful pose estimates (3D TRE < 5.0 mm) were obtained in 97% of cases when the SDNR was 5.9 or higher in seven out of eight poses. Under these conditions, 3D TRE was 2.32 ± 1.88 mm, and 2D (projection) TRE was 1.61 ± 1.36 mm. Probe localization error along the source-detector axis was 0.87 ± 1.31 mm. For the in vivo experiments, mean 3D TRE ranged from 2.6 to 4.6 mm and mean 2D TRE ranged from 1.1 to 1.6 mm. Anatomy extracted from the echo images appeared well aligned when projected onto the SBDX images. Conclusions: Full 6 DOF image registration between SBDX and TEE is feasible and accurate to within 5 mm. Future studies will focus on

  16. Endoscopic transesophageal biopsy in the posterior mediastinum using submucosal tunneling technology and novel homemade instruments.

    Science.gov (United States)

    Qin, ZhiChu; Linghu, En Qiang; Zhai, Ya Qi; Li, HuiKai

    2014-09-01

    This animal study was performed to evaluate the feasibility and safety of endoscopic transesophageal biopsy by using submucosal tunneling technology novel homemade instruments in the posterior mediastinum. In six survival pigs, a mid-esophageal mucosal incision and a 10-cm submucosal tunnel was created. The endoscope attached to homemade decompression tube was passed through the muscular layers into the posterior mediastinal space. The mediastinal compartment, lung, descending thoracic aorta, vertebra, and exterior surface of the esophagus will be identified, and mediastinal living tissue as lymph node biopsy will also be accomplished. During two survival weeks, blood test and temperature monitoring and chest radiograph and endoscopic examination were performed. The procedure was successfully completed in all six pigs. Mediastinal structures could be identified without difficulty by the transesophageal tunneling approach. Tissue as lymph nodes and pleural biopsy under direct visualization were easily accomplished. One pig died after operation due to an unexplained pneumothorax. At necropsy, apparent atelectasis was noted in the right lobe. After applying homemade drainage tube attached to the syringe, one pig with pneumothorax soon had restoration. There were no apparent ill effects in the survival pigs. Endoscopic transesophageal biopsy in the posterior mediastinum using a novel tunneling technology can provide excellent visualization of mediastinal structures. These procedures could be performed safely in pigs with short-term survival. Further study about immediate complications will be needed with a larger sample size and longer survival time.

  17. Planimetric Measurement of the Regurgitant Orifice Area Using Multidetector CT for Aortic Regurgitation: a Comparison with the Use of Echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Min Hee; Choe, Yeon Hyeon; Cho, Soo Jin; Park, Seung Woo; Park, Pyo Won; Oh, Jae K. [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2010-04-15

    This study compared the area of the regurgitant orifice, as measured by the use of multidetector-row CT (MDCT), with the severity of aortic regurgitation (AR) as determined by the use of echocardiography for AR. In this study, 45 AR patients underwent electrocardiography- gated 40-slice or 64-slice MDCT and transthoracic or transesophageal echocardiography. We reconstructed CT data sets during mid-systolic to enddiastolic phases in 10% steps (20% and 35-95% of the R-R interval), planimetrically measuring the abnormally opened aortic valve area during diastole on CT reformatted images and comparing the area of the aortic regurgitant orifice (ARO) so measured with the severity of AR, as determined by echocardiography. In the 14 patients found to have mild AR, the ARO area was 0.18{+-} 0.13 cm{sup 2} (range, 0.04-0.54 cm{sup 2}). In the 15 moderate AR patients, the ARO area was 0.36 {+-} 0.23 cm{sup 2} (range, 0.09-0.81 cm{sup 2}). In the 16 severe AR patients, the ARO area was 1.00 {+-} 0.51 cm{sup 2} (range, 0.23-1.84 cm{sup 2}). Receiver-operator characteristic curve analysis determined a sensitivity of 85% and a specificity of 82%, for a cutoff of 0.47 cm{sup 2}, to distinguish severe AR from less than severe AR with the use of CT (area under the curve = 0.91; 95% confidence interval, 0.84-1.00; p < 0.001). Planimetric measurement of the ARO area using MDCT is useful for the quantitative evaluation of the severity of aortic regurgitation.

  18. 2010 Canadian Cardiovascular Society/Canadian Society of Echocardiography Guidelines for Training and Maintenance of Competency in Adult Echocardiography.

    Science.gov (United States)

    Burwash, Ian G; Basmadjian, Arsene; Bewick, David; Choy, Jonathan B; Cujec, Bibiana; Jassal, Davinder S; MacKenzie, Scott; Nair, Parvathy; Rudski, Lawrence G; Yu, Eric; Tam, James W

    2011-01-01

    Guidelines for the provision of echocardiography in Canada were jointly developed and published by the Canadian Cardiovascular Society and the Canadian Society of Echocardiography in 2005. Since their publication, recognition of the importance of echocardiography to patient care has increased, along with the use of focused, point-of-care echocardiography by physicians of diverse clinical backgrounds and variable training. New guidelines for physician training and maintenance of competence in adult echocardiography were required to ensure that physicians providing either focused, point-of-care echocardiography or comprehensive echocardiography are appropriately trained and proficient in their use of echocardiography. In addition, revision of the guidelines was required to address technological advances and the desire to standardize echocardiography training across the country to facilitate the national recognition of a physician's expertise in echocardiography. This paper summarizes the new Guidelines for Physician Training and Maintenance of Competency in Adult Echocardiography, which are considerably more comprehensive than earlier guidelines and address many important issues not previously covered. These guidelines provide a blueprint for physician training despite different clinical backgrounds and help standardize physician training and training programs across the country. Adherence to the guidelines will ensure that physicians providing echocardiography have acquired sufficient expertise required for their specific practice. The document will also provide a framework for other national societies to standardize their training programs in echocardiography and will provide a benchmark by which competency in adult echocardiography may be measured.

  19. Advanced techniques in echocardiography in small animals.

    Science.gov (United States)

    Chetboul, Valérie

    2010-07-01

    Transthoracic echocardiography has become a major imaging tool for the diagnosis and management of canine and feline cardiovascular diseases. During the last decade, more recent advances in ultrasound technology with the introduction of newer imaging modalities, such as tissue Doppler imaging, strain and strain rate imaging, and 2-dimensional speckle tracking echocardiography, have provided new parameters to assess myocardial performance, including regional myocardial velocities and deformation, ventricular twist, and mechanical synchrony. An outline of these 4 recent ultrasound techniques, their impact on the understanding of right and left ventricular function in small animals, and their application in research and clinical settings are given in this article.

  20. Three-dimensional echocardiography in valve disease.

    Science.gov (United States)

    Colombo, Chiara; Tamborini, Gloria; Pepi, Mauro; Alimento, Marina; Fiorentini, Cesare

    2007-01-01

    This review covers the role of three-dimensional (3D) echocardiography in the diagnosis of heart valve disease. Several factors have contributed to the evolution of this technique, which is currently a simple and routine method: rapid evolution in probe and computer technologies, demonstration that 3D data sets allowed more complete and accurate evaluation of cardiac structures, emerging clinical experience indicating the strong potential particularly in valve diseases, volume and function of the two ventricle measurements and several other fields. This report will review current and future applications of 3D echocardiography in mitral, aortic and tricuspid valve diseases underlying both qualitative (morphologic) and quantitative advantages of this technique.

  1. Automated analysis of 3D echocardiography

    NARCIS (Netherlands)

    Stralen, Marijn van

    2009-01-01

    In this thesis we aim at automating the analysis of 3D echocardiography, mainly targeting the functional analysis of the left ventricle. Manual analysis of these data is cumbersome, time-consuming and is associated with inter-observer and inter-institutional variability. Methods for reconstruction o

  2. Dynamic 3D echocardiography in virtual reality.

    NARCIS (Netherlands)

    A.E. van den Bosch (Annemien); A.H.J. Koning (Anton); F.J. Meijboom (Folkert); J.S. McGhie (Jackie); M.L. Simoons (Maarten); P.J. van der Spek (Peter); A.J.J.C. Bogers (Ad)

    2005-01-01

    textabstractBACKGROUND: This pilot study was performed to evaluate whether virtual reality is applicable for three-dimensional echocardiography and if three-dimensional echocardiographic 'holograms' have the potential to become a clinically useful tool. METHODS: Three-dimensional echocardiographic d

  3. Recent advances in echocardiography for valvular heart disease.

    Science.gov (United States)

    Hahn, Rebecca

    2015-01-01

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

  4. Dobutamine stress echocardiography: a review and update

    Directory of Open Access Journals (Sweden)

    Gilstrap LG

    2014-04-01

    Full Text Available Lauren Gray Gilstrap,1 R Sacha Bhatia,2 Rory B Weiner,3 David M Dudzinski3 1Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA; 2Institute for Health Systems Solutions, Women's College Hospital, Toronto, ON, Canada; 3Cardiology Division, Massachusetts General Hospital, Boston, MA, USA Abstract: Stress echocardiography is a noninvasive cardiovascular diagnostic test that provides functional and hemodynamic information in the assessment of a number of cardiac diseases. Performing stress echocardiography with a pharmacologic agent such as dobutamine allows for simulation of increased heart rate and increased myocardial physiologic demands in patients who may be unable to exercise due to musculoskeletal or pulmonary comorbidities. Dobutamine stress echocardiography (DSE, like exercise echocardiography, has found its primary application in ischemic heart disease, with roles in identification of obstructive epicardial coronary artery disease, detection of viable myocardium, and assessment of the efficacy of anti-ischemic medical therapy in patients with known coronary artery disease. DSE features prominently in the evaluation and management of valvular heart disease by helping to assess the effects of mitral and aortic stenoses, as well as a specific use in differentiating true severe valvular aortic stenosis from pseudostenosis that may occur in the setting of left ventricular systolic dysfunction. DSE is generally well tolerated, and its side effects and contraindications generally relate to consequences of excess inotropic and/or chronotropic stimulation of the heart. The aim of this paper is to review the indications, contraindications, advantages, disadvantages, and risks of DSE. Keywords: stress echocardiography, dobutamine, coronary artery disease, myocardial ischemia

  5. Speckle Tracking Imaging in Normal Stress Echocardiography.

    Science.gov (United States)

    Leitman, Marina; Tyomkin, Vladimir; Peleg, Eli; Zyssman, Izhak; Rosenblatt, Simcha; Sucher, Edgar; Gercenshtein, Vered; Vered, Zvi

    2017-04-01

    Exercise stress echocardiography is a widely used modality for the diagnosis and follow-up of patients with coronary artery disease. During the last decade, speckle tracking imaging has been used increasingly for accurate evaluation of cardiac function. This work aimed to assess speckle-tracking imaging parameters during nonischemic exercise stress echocardiography. During 2011 to 2014 we studied 46 patients without history of coronary artery disease, who completed exercise stress echocardiography protocol, had normal left ventricular function, a nonischemic response, and satisfactory image quality. These exams were analyzed with speckle-tracking imaging software at rest and at peak exercise. Peak strain and time-to-peak strain were measured at rest and after exercise. Clinical follow-up included a telephone contact 1 to 3 years after stress echo exam, confirming freedom from coronary events during this time. Global and regional peak strain increased following exercise. Time-to-peak global and regional strain and time-to-peak strain adjusted to the heart rate were significantly shorter in all segments after exercise. Rest-to-stress ratio of time-to-peak strain adjusted to the heart rate was 2.0 to 2.8. Global and regional peak strain rise during normal exercise echocardiography. Peak global and regional strain occur before or shortly after aortic valve closure at rest and after exercise, and the delay is more apparent at the basal segments. Time-to-peak strain normally shortens significantly during exercise; after adjustment to heart rate it shortens by a ratio of 2.0 to 2.8. These data may be useful for interpretation of future exercise stress speckle-tracking echocardiography studies. © 2016 by the American Institute of Ultrasound in Medicine.

  6. Quality of Cardiopulmonary Resuscitation When Directing the Area of maximal Compression by Transesophageal Echocardiography During Cardiac Arrest in Swine (Sus scrofa)

    Science.gov (United States)

    2013-12-30

    at 20mins CPP was measured over the duration of the experiment ROSC was defined as a regular cardiac rhythm with SBP >60 for 1min...69.2) 0 (0.00) No ROSC 4 (30.8) 13 ( 100 ) * * * p=0.032 p=0.002 pɘ.001 Figure 1. CPP at baseline, during VF arrest, BLS, and ACLS

  7. Split-bolus single-phase cardiac multidetector computed tomography for reliable detection of left atrial thrombus. Comparison to transesophageal echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Staab, W.; Zwaka, P.A.; Sohns, J.M.; Schwarz, A.; Lotz, J. [University Medical Center Goettingen Univ. (Germany). Inst. for Diagnostic and Interventional Radiology; Sohns, C.; Vollmann, D.; Zabel, M.; Hasenfuss, G. [Goettingen Univ. (Germany). Dept. of Cardiology and Pneumology; Schneider, S. [Goettingen Univ. (Germany). Dept. of Medical Statistics

    2014-11-15

    Evaluation of a new cardiac MDCT protocol using a split-bolus contrast injection protocol and single MDCT scan for reliable diagnosis of LA/LAA thrombi in comparison to TEE, optimizing radiation exposure and use of contrast agent. A total of 182 consecutive patients with drug refractory AF scheduled for PVI (62.6% male, mean age: 64.1 ± 10.2 years) underwent routine diagnostic work including TEE and cardiac MDCT for the evaluation of LA/LAA anatomy and thrombus formation between November 2010 and March 2012. Contrast media injection was split into a pre-bolus of 30 ml and main bolus of 70 ml iodinated contrast agent separated by a short time delay. In this study, split-bolus cardiac MDCT identified 14 of 182 patients with filling defects of the LA/LAA. In all of these 14 patients, abnormalities were found in TEE. All 5 of the 14 patients with thrombus formation in cardiac MDCT were confirmed by TEE. MDCT was 100% accurate for thrombus, with strong but not perfect overall results for SEC equivalent on MDCT.

  8. Exercise echocardiography for structural heart disease.

    Science.gov (United States)

    Izumo, Masaki; Akashi, Yoshihiro J

    2016-03-01

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

  9. Application of Contrast Echocardiography in Invasive Cardiology

    Directory of Open Access Journals (Sweden)

    Mustafa Bulut

    2010-12-01

    Full Text Available Contrast echocardiography by rendering better imaging of the borders of cardiac chambers is a useful tool for evaluating cardiac function, mass, myocardial vascularization, microvascular structure (small vessel vasculature and viability. Contrast was first started to be used for patients with suboptimal image quality. It can be used in detecting defects in myocardial blood supply in patients with chest pain and determining the success of interventionalprocedures. It can also be of help in demonstrating myocardial viability after reperfusion treatment in patients who had myocardial infarction. It is expected to be used more widely in invasive cardiology for decision making, guiding and determining the success of the procedures. Advances in imaging techniques , development of contrast materials for evaluation of left system, contrast echocardiography may become a routine clinical practice.

  10. Echocardiography diagnosis of myocardial infarction complications

    Directory of Open Access Journals (Sweden)

    N.D. Oryshchyn

    2016-03-01

    Full Text Available Diagnosis and management of myocardial infarction complications are discussed in this article. These complications are associated with high level of mortality and surgery is a main treatment method. High level of suspicion and early diagnosis are essential for appropriate treatment and improvement of prognosis. Echocardiography is a main diagnostic method. Analysis of literature about contemporary management of mechanical complications of myocardial infarction has been performed, case reports are presented.

  11. Application of Contrast Echocardiography in Invasive Cardiology

    OpenAIRE

    2010-01-01

    Contrast echocardiography by rendering better imaging of the borders of cardiac chambers is a useful tool for evaluating cardiac function, mass, myocardial vascularization, microvascular structure (small vessel vasculature) and viability. Contrast was first started to be used for patients with suboptimal image quality. It can be used in detecting defects in myocardial blood supply in patients with chest pain and determining the success of interventionalprocedures. It can also be of help in de...

  12. Dobutamine stress echocardiography: a review and update

    OpenAIRE

    Gilstrap LG; Bhatia RS; Weiner RB; Dudzinski DM

    2014-01-01

    Lauren Gray Gilstrap,1 R Sacha Bhatia,2 Rory B Weiner,3 David M Dudzinski3 1Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA; 2Institute for Health Systems Solutions, Women's College Hospital, Toronto, ON, Canada; 3Cardiology Division, Massachusetts General Hospital, Boston, MA, USA Abstract: Stress echocardiography is a noninvasive cardiovascular diagnostic test that provides functional and hemodynamic information in the assessment of a number of cardiac...

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

    Directory of Open Access Journals (Sweden)

    Bai Zhigang

    2011-07-01

    Full Text Available Abstract 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

  14. A ecocardiografia com contraste no diagnóstico de dilatações vasculares intrapulmonares em candidatos ao transplante hepático Contrast echocardiography in the diagnosis of intrapulmonary vascular dilations in candidates for liver transplantation

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Pavarino

    2004-06-01

    intracardiac communications, who underwent transthoracic echocardiography with second harmonic imaging. Thirty-two of them underwent consecutive transesophageal study. The result of contrast echocardiography was considered positive when the presence of contrast was detected in the left cardiac chambers with a delay of 4 to 6 cardiac cycles after initial opacification of the right cardiac chambers. RESULTS: The prevalence of intrapulmonary vascular dilations was 53.9% (41/76 patients. The sensitivity, specificity, positive and negative predictive values, and accuracy of transthoracic echocardiography as compared with those of transesophageal echocardiography for confirming pulmonary vascular abnormalities in patients with liver disease were, respectively, 75%, 100%, 100%, 80%, and 87.5%. The degree of arterial oxygenation showed no correlation with the occurrence of a positive echocardiographic study. Arterial hypoxemia (PaO2 < 70 mm Hg was observed in 9 (15.9% of the 76 patients. The echocardiographic study was positive in 37 (55.2% of the 67 nonhypoxemic patients and in 4 (44.4% of the 9 hypoxemic ones. CONCLUSION: Contrast echocardiography proved to be effective, easy, and safe to use in candidates for liver transplantation. Transthoracic echocardiography may be used in the diagnostic routine of intrapulmonary vascular dilations, the transesophageal study being reserved for inconclusive cases with clinical suspicion.

  15. Customized CT angiogram planning for intraoperative transesophageal echography-guided endovascular exclusion of thoracic aorta penetrating ulcer.

    Science.gov (United States)

    Piazza, Michele; Lupia, Mario; Grego, Franco; Antonello, Michele

    2015-04-01

    The technique is demonstrated in a 78-year-old man; the preoperative CT angiogram showed a descending thoracic aorta ulcer of 5.9 cm in maximum diameter and 3.8 cm longitudinal extension. A ZTEG-2P-36-127-PF (Cook Medical) single tubular endograft was planned to be deployed. From the preoperative CT angiogram we planned to land 4.7 cm above the midline of the descending thoracic aorta ulcer and 8.0 cm below. In the operating room, under radioscopic vision the centre of the transesophageal echography probe was used as marker to identify the correspondent midline of the descending thoracic aorta ulcer and a centimeter-sized pigtail catheter in the aorta was used to calculate the desired length above and below the ulcer midline. The endograft was introduced and placed in the desired position compared to the transesophageal echography probe and the catheter; under transesophageal echography vision the graft was finally deployed. The CT angiogram at 1 month showed the correct endograft position, descending thoracic aorta ulcer exclusion with no signs of endoleak. In selected cases, this method allows planning in advance safe stent graft positioning and deployment totally assisted by transesophageal echography, with no risk of periprocedural contrast-related renal failure and reduced radiation exposure for the patient and operators.

  16. Comparing transesophageal Doppler corrected systolic flow time versus central venous pressure as a guide for fluid resuscitation in septic shock

    Directory of Open Access Journals (Sweden)

    Walid Hamimy

    2016-04-01

    Conclusion: Transesophageal aortic Doppler is a simple, non-invasive tool of guiding fluid therapy in patients with severe sepsis and septic shock. FTC change was a better predictor of fluid responsiveness than CVP in septic shock. There was higher significant difference in SV after resuscitation when using FTC as guidance.

  17. Intracardiac Echocardiography From the Left Atrium for Procedural Guidance of Transcatheter Left Atrial Appendage Occlusion.

    Science.gov (United States)

    Korsholm, Kasper; Jensen, Jesper Møller; Nielsen-Kudsk, Jens Erik

    2017-08-24

    The aim of this study was to compare the efficacy and safety of intracardiac echocardiography (ICE) from the left atrium (LA) with transesophageal echocardiography (TEE) for procedural guidance of transcatheter left atrial appendage occlusion (LAAO). TEE with general anesthesia is the current gold standard to guide LAAO. By the use of ICE from the LA, LAAO can be performed in local anesthesia and may potentially have advantages over TEE. A single-center, cohort study of patients undergoing LAAO with the Amplatzer Cardiac Plug or Amulet (St. Jude Medical, St. Paul, Minnesota). Procedures were guided by ICE from the LA with local anesthesia (n = 109) or TEE using general anesthesia (n = 107). All patients had pre-procedural cardiac computed tomography. Efficacy outcomes were technical success, procedural success, and peridevice leakage at TEE 8 weeks after LAAO. Safety outcome was a composite of periprocedural complications. Technical success was achieved in 99% of both the TEE and ICE group. Procedural success was similar between groups: 94.4% success rate in the TEE-guided group, and 94.5% in the ICE-guided group. Major periprocedural complications occurred in 4.7% of the TEE group and 1.8% of the ICE group. Rate and degree of peridevice leak did not differ between groups at follow-up. Turnover time in the catheter laboratory, and contrast use were reduced with ICE. LA ICE to guide LAAO as compared with TEE appears to be effective and safe, without increased procedure-related complications. The rate of peridevice leak is low and similar to TEE-guided procedures. Time spent in the catheterization room may decrease substantially. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Routine Cine-CMR for Prosthesis Associated Mitral Regurgitation – A Multicenter Comparison to Echocardiography

    Science.gov (United States)

    Simprini, Lauren A.; Afroz, Anika; Cooper, Mitchell A.; Klem, Igor; Jensen, Christoph; Kim, Raymond J.; Srichai, Monvadi B.; Heitner, John F.; Sood, Michael; Chandy, Elizabeth; Shah, Dipan J.; Lopez-Mattei, Juan; Biederman, Robert W.; Grizzard, John D.; Fuisz, Anthon; Ghafourian, Kambiz; Farzaneh-Far, Afshin; Weinsaft, Jonathan

    2016-01-01

    Background/Aim MR is an important complication after PMV. Transthoracic echocardiography is widely used to screen for native MR, but can be limited with PMV. Cine-CMR holds potential to non-invasively assess regurgitant severity based on MR-induced inter-voxel dephasing. This study evaluated routine cine-CMR for visual assessment of prosthetic mitral valve (PMV) associated mitral regurgitation (MR). Methods Routine cine-CMR was performed at 9 sites. A uniform protocol was used to grade MR based on jet size in relation to the left atrium (mild 2/3): MR was graded in each long axis orientation, with overall severity based on cumulative grade. Cine-CMR was also scored for MR density and pulmonary vein systolic flow reversal (PSFR). Visual interpretation was compared to quantitative analysis in a single center (derivation) cohort, and to transesophageal echocardiography (TEE) in a multicenter (validation) cohort. Results The population comprised 85 PMV patients (59% mechanical, 41% bioprosthetic). Among the derivation cohort (n=25), quantitative indices paralleled visual scores, with stepwise increases in jet size and density in relation to visually graded MR severity (both p=0.001): Patients with severe MR had nearly a 3-fold increase in quantitative jet area (p=0.002), and 2-fold increase in density (p=0.04) than did others. Among the multicenter cohort, cine-CMR and TEE (Δ=2±3 days) demonstrated moderate agreement (κ=0.44); 64% of discordances differed by ≤ 1 grade (Δ=1.2±0.5). Using a TEE reference, cine-CMR yielded excellent diagnostic performance for severe MR (sensitivity, negative predictive value=100%). Patients with visually graded severe MR also had more frequent PVSFR (pcine-CMR. Conclusions Cine-CMR is useful for assessment of PMV-associated MR, which manifests concordant quantitative and qualitative changes in size and density of inter-voxel dephasing. Visual MR assessment based on jet size provides an accurate non-invasive means of screening for

  19. Routine cine-CMR for prosthesis-associated mitral regurgitation: a multicenter comparison to echocardiography.

    Science.gov (United States)

    Simprini, Lauren A; Afroz, Anika; Cooper, Mitchell A; Klem, Igor; Jensen, Christoph; Kim, Raymond J; Srichai, Monvadi B; Heitner, John F; Sood, Michael; Chandy, Elizabeth; Shah, Dipan J; Lopez-Mattei, Juan; Biederman, Robert W; Grizzard, John D; Fuisz, Anthon; Ghafourian, Kambiz; Farzaneh-Far, Afshin; Weinsaft, Jonathan

    2014-09-01

    Mitral regurgitation (MR) is an important complication after prosthetic mitral valve (PMV) implantation. Transthoracic echocardiography is widely used to screen for native MR, but can be limited with PMV. Cine-cardiac magnetic resonance (CMR) holds the potential for the non-invasive assessment of regurgitant severity based on MR-induced inter-voxel dephasing. The study aim was to evaluate routine cine-CMR for the visual assessment of PMV-associated MR. Routine cine-CMR was performed at nine sites. A uniform protocol was used to grade MR based on jet size in relation to the left atrium (mild 2/3). MR was graded in each long-axis orientation, with overall severity based on cumulative grade. Cine-CMR was also scored for MR density and pulmonary vein systolic flow reversal (PVSFR). Visual interpretation was compared to quantitative analysis in a single-center (derivation) cohort, and to transesophageal echocardiography (TEE) in a multicenter (validation) cohort. The population comprised 85 PMV patients (59% mechanical valves, 41% bioprostheses). Among the derivation cohort (n = 25), quantitative indices paralleled visual scores, with stepwise increases in jet size and density in relation to visually graded MR severity (both p = 0.001). Patients with severe MR had an almost three-fold increase in quantitative jet area (p = 0.002), and a two-fold increase in density (p = 0.04) than did other patients. Among the multicenter cohort, cine-CMR and TEE (Δ =. 2 ± 3 days) demonstrated moderate agreement (κ = 0.44); 64% of discordances differed by ≤ 1 grade (Δ = 1.2 ± 0.5). Using a TEE reference, cine-CMR yielded excellent diagnostic performance for severe MR (sensitivity, negative predictive value = 100%). Patients with visually graded severe MR also had more frequent PVSFR (p cine-CMR. Cine-CMR is useful for the assessment of PMV-associated MR, which manifests concordant quantitative and qualitative changes in size and density of inter-voxel dephasing. Visual MR

  20. The use of echocardiography in acute cardiovascular care

    DEFF Research Database (Denmark)

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

    2014-01-01

    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described....

  1. The use of echocardiography in acute cardiovascular care

    DEFF Research Database (Denmark)

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

    2015-01-01

    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described....

  2. The use of echocardiography in acute cardiovascular care

    DEFF Research Database (Denmark)

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

    2015-01-01

    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiac care scenarios are also described....

  3. Echocardiography as a Research and Clinical Tool in Veterinary Medicine

    OpenAIRE

    Allen, D G

    1982-01-01

    Echocardiography is the accepted term for the study of cardiac ultrasound. Although a relatively new tool for the study of the heart in man it has already found wide acceptance in the area of cardiac research and in the study of clinical cardiac disease. Animals had often been used in the early experiments with cardiac ultrasound, but only recently has echocardiography been used as a research and clinical tool in veterinary medicine. In this report echocardiography is used in the research of ...

  4. Recent advances in echocardiography for nuclear medicine physician

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Geu Ru; Shin, Dong Gu [Yeungnam University College of Medicine, Daegu (Korea, Republic of)

    2005-10-15

    Echocardiography is one of the most frequently used techniques for diagnosing cardiovascular diseases. Over the last twenty years, technological advances have enabled the application of high-quality imaging. Important recent developments have occurred in echocardiography that are already being used clinically. Equipment and hardware is now available to produce real time three-dimensional and contrast enhanced imaging. Tissue Doppler and stress echocardiography have provided potential benefit to analyze hemodynamic information of heart. This review discusses each of these new developments and their potential impact on the practice of echocardiography and cardiology in general.

  5. Predicting and measuring fluid responsiveness with echocardiography

    Directory of Open Access Journals (Sweden)

    Ashley Miller

    2016-06-01

    Full Text Available Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart–lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid esuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately.

  6. Intraoperative transesophageal echocardiographic assessment of left ventricular Tei index in congenital heart disease

    Directory of Open Access Journals (Sweden)

    Shanthi Sivanandam

    2015-01-01

    Full Text Available Background: Use of the Tei index has not been described to assess myocardial function before or after surgery in pediatric patients. This study was designed to evaluate the left ventricular (LV function using the Tei index pre- and post-cardiopulmonary bypass in patients with lesion that result in a volume loaded right ventricle (RV. Methods: Retrospective data on 55 patients who underwent repair of a cardiac defect were analyzed. Patients with volume overload RV (n = 15 were compared to patients without volume overload but with other cardiac defects (n = 40. We reviewed pre- and post-operative LV myocardial performance index (Tei index. Tei index was obtained from transesophageal Doppler echocardiogram. Results: Patients with right heart volume overload, the mean preoperative Tei index was 0.6, with a postoperative mean decrease of 0.207 (P = 0.014. Patients without right heart volume overload, the mean preoperative Tei was 0.48 with no significant postoperative change (P = 0.82. Conclusion: Pre- and post-operative transesophageal echocardiogram assessment provides an easy and quick way of evaluating LV function intra-operatively using LV Tei index. Preoperative LV Tei index was greater in the RV volume overload defects indicating diminished LV global function. This normalized in the immediate postoperative period, implying an immediate improvement in LV function. In patients without right heart volume load, consist of other cardiac defects, demonstrated no changes in the pre- and post-operative LV Tei. This implies that LV function was similar after the surgery.

  7. A novel platform device for rodent echocardiography.

    Science.gov (United States)

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

    2007-06-06

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

  8. Generalized tetany: an unusual complication during dobutamine stress echocardiography.

    Science.gov (United States)

    Abbas, Amr E; Loftis, Rochelle; Lester, Steven J; Crawford, Michael B; Appleton, Christopher P

    2002-11-01

    Dobutamine stress echocardiography is a frequently used noninvasive method for the evaluation of inducible myocardial ischemia, myocardial viability, and preoperative cardiac risk. Although its clinical safety has been validated, side effects and complications especially with the coadministration of atropine can occur. We report a case of generalized tetany in a 49-year-old woman undergoing dobutamine stress echocardiography.

  9. Advanced quantitative echocardiography in arrhythmogenic right ventricular cardiomyopathy

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Hastrup Svendsen, Jesper; Sogaard, Peter

    2007-01-01

    of global and regional function, but the diagnostic potential remains to be assessed. METHODS: Twenty patients with previously established ARVC were evaluated by 3-dimensional echocardiography and DTI, and compared with 32 age- and sex-matched control subjects. RESULTS: Using 3-dimensional echocardiography...

  10. Color M-mode and pulsed wave tissue Doppler echocardiography

    DEFF Research Database (Denmark)

    Møller, J E; Søndergaard, E; Poulsen, S H;

    2001-01-01

    To assess the association between color M-mode flow propagation velocity and the early diastolic mitral annular velocity (E(m)) obtained with tissue Doppler echocardiography and to assess the prognostic implications of the indexes, echocardiography was performed on days 1 and 5, and 1 and 3 months...

  11. Automated analysis of three-dimensional stress echocardiography

    NARCIS (Netherlands)

    K.Y.E. Leung (Esther); M. van Stralen (Marijn); M.G. Danilouchkine (Mikhail); G. van Burken (Gerard); M.L. Geleijnse (Marcel); J.H.C. Reiber (Johan); N. de Jong (Nico); A.F.W. van der Steen (Ton); J.G. Bosch (Johan)

    2011-01-01

    textabstractReal-time three-dimensional (3D) ultrasound imaging has been proposed as an alternative for two-dimensional stress echocardiography for assessing myocardial dysfunction and underlying coronary artery disease. Analysis of 3D stress echocardiography is no simple task and requires considera

  12. Advances in the Evaluation of Cardiovascular Function by Echocardiography

    NARCIS (Netherlands)

    A. Nemes (Attila)

    2007-01-01

    textabstractThe aim of this thesis was to study the advances in the evaluation of cardiovascular function by 2D and real-time 3D stress echocardiography and vascular stiffness measurements. Stress echocardiography is a widely used non-invasive stress modality for the detection of coronary artery dis

  13. MODERN POSSIBILITIES OF SPECKLE TRACKING ECHOCARDIOGRAPHY IN CLINICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    V. S. Nikiforov

    2017-01-01

    Full Text Available Speckle-tracking echocardiography is promising modern technique for evaluation of structural and functional changes in the myocardium. It evaluates the indicator of global longitudinal myocardial deformation, which is more sensitive than ejection fraction to early changes of left ventricular contractility. The diagnostic capabilities of speckle tracking echocardiography are reflected in clinical recommendations and consensus statements of European Society of Cardiology (ESC, European Association of Cardiovascular Imaging (EACVI and American Society of Echocardiography (ASE. The aim of this paper is describe basic principles of speckle tracking echocardiography and clinical applications of this new technology. Attention is paid to the use of speckle tracking echocardiography in such heart pathologies as heart failure, coronary heart disease and myocardial infarction, left ventricular hypertrophy in arterial hypertension, hypertrophic cardiomyopathy and amyloidosis of the heart, valvular heart disease, constrictive pericarditis and cancer therapy-induced cardiotoxicity.

  14. Application of Echocardiography on Transgenic Mice with Cardiomyopathies

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    G. Chen

    2012-01-01

    Full Text Available Cardiomyopathies are common cardiac disorders that primarily affect cardiac muscle resulting in cardiac dysfunction and heart failure. Transgenic mouse disease models have been developed to investigate the cellular mechanisms underlying heart failure and sudden cardiac death observed in cardiomyopathy cases and to explore the therapeutic outcomes in experimental animals in vivo. Echocardiography is an essential diagnostic tool for accurate and noninvasive assessment of cardiac structure and function in experimental animals. Our laboratory has been among the first to apply high-frequency research echocardiography on transgenic mice with cardiomyopathies. In this work, we have summarized our and other studies on assessment of systolic and diastolic dysfunction using conventional echocardiography, pulsed Doppler, and tissue Doppler imaging in transgenic mice with various cardiomyopathies. Estimation of embryonic mouse hearts has been performed as well using this high-resolution echocardiography. Some technical considerations in mouse echocardiography have also been discussed.

  15. Intraoperative Diagnosis of Stanford Type A Dissection by Transesophageal Echocardiogram in a Patient Presenting for Renal Transplantation

    OpenAIRE

    Hand, William R.; Ikonomidis, John S.; Bratton, Charles F.; Thomas M. Burch; McEvoy, Matthew D.

    2011-01-01

    A 48-year-old patient with hypertensive end-stage renal disease presented for cadaveric renal transplantation. On physical exam, a previously undocumented diastolic murmur was heard loudest at the left lower sternal border. The patient had a history of pericardial effusions and reported “a feeling of chest fullness” when lying flat. As such, a transesophageal echocardiogram (TEE) was performed after induction of anesthesia to evaluate the pericardial space and possibly determine the etiology ...

  16. Stress echocardiography in patients with morbid obesity

    Directory of Open Access Journals (Sweden)

    Benoy N Shah

    2016-06-01

    Full Text Available The incidence of significant obesity is rising across the globe. These patients often have a clustering of cardiovascular risk factors and are frequently referred for noninvasive cardiac imaging tests. Stress echocardiography (SE is widely used for assessment of patients with known or suspected coronary artery disease (CAD, but its clinical utility in morbidly obese patients (in whom image quality may suffer due to body habitus has been largely unknown. The recently published Stress Ultrasonography in Morbid Obesity (SUMO study has shown that SE, when performed appropriately with ultrasound contrast agents (whether performed with physiological or pharmacological stress, has excellent feasibility and appropriately risk stratifies morbidly obese patients, including identification of patients who require revascularization. This article reviews the evidence supporting the use of echocardiographic techniques in morbidly obese patients for assessment of known or suspected CAD and briefly discusses other noninvasive modalities, including magnetic resonance and nuclear techniques, comparing and contrasting these techniques against SE.

  17. Sensitivity of transesophageal electrophysiologic study in children with supraventricular tachycardia on electrocardiography.

    Science.gov (United States)

    Akin, Alper; Özer, Sema; Karagöz, Tevfık; Aykan, Hayrettın Hakan; Gülgün, Mustafa; Özkutlu, Süheyla; Alehan, Dursun; Çelıker, Alpay

    2014-08-01

    The aim of this study was to evaluate the inducibility of tachycardia by transesophageal electrophysiologic study (TEEPS) in patients with documented supraventricular tachycardia (SVT) on electrocardiography and to investigate the accuracy of TEEPS records by comparing with intracardiac electrophysiologic study (IEPS). The TEEPS records of patients having documented electrocardiography during SVT were reviewed. The results of TEEPS in 43 of 85 patients were compared with results of IEPS for compatibility of diagnosis. A total 85 patients, 46 male and 39 female, mean weight 35.1 kg (36-87), aged 1 month-17 years, were included. Tachycardia was induced by TEEPS in 79 of 85 patients with documented electrocardiography (sensitivity 92.9%). IEPS for diagnosis or ablation was conducted in 40 patients having inducible tachycardia and three of six who had no inducible tachycardia by TEEPS. Tachycardia was induced by IEPS in 39 of 40 (97.5%) patients who had inducible tachycardia and two of three who had no inducible tachycardia by TEEPS. Mechanisms of tachycardias were similar in 97.5% of patients (37/39) who had inducible tachycardia in TEEPS and IEPS. One of the patients with atrioventricular reentry tachycardia by TEEPS was diagnosed as atrioventricular nodal reentry tachycardia (AVNRT) and the other one was diagnosed as atypical AVNRT and atrial tachycardia by IEPS. The rates of inducibility and mechanisms of tachycardias by TEEPS in children having documented SVT were similar with those obtained from IEPS. ©2014 Wiley Periodicals, Inc.

  18. Clinical assessment of transthoracic echocardiography skills: a generalizability study

    DEFF Research Database (Denmark)

    Nielsen, Dorte Guldbrand; O'Neill, Lotte; Jensen, Signe

    2015-01-01

    Context: Transthoracic echocardiography (TTE) is a widely used cardiac imaging technique that all cardiologists should be able to perform competently. Traditionally, TTE competence has been assessed by unstructured observation or in test situations separated from daily clinical practice. An objec...

  19. Intra-cardiac echocardiography in alcohol septal ablation

    DEFF Research Database (Denmark)

    Cooper, Robert M; Shahzad, Adeel; Newton, James;

    2015-01-01

    Alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy reduces left ventricular outflow tract gradients. A third of patients do not respond; inaccurate localisation of the iatrogenic infarct can be responsible. Transthoracic echocardiography (TTE) using myocardial contrast can b...

  20. Speckle tracking echocardiography in acute lupus myocarditis: comparison to conventional echocardiography

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    Riëtte Du Toit

    2017-07-01

    Full Text Available Aims: Lupus myocarditis occurs in 5–10% of patients with systemic lupus erythematosus (SLE. No single feature is diagnostic of lupus myocarditis. Speckle tracking echocardiography (STE can detect subclinical left ventricular dysfunction in SLE patients, with limited research on its utility in clinical lupus myocarditis. We report on STE in comparison to conventional echocardiography in patients with clinical lupus myocarditis. Methods and results: A retrospective study was done at a tertiary referral hospital in South Africa. SLE patients with lupus myocarditis were included and compared to healthy controls. Echocardiographic images were reanalyzed, including global longitudinal strain through STE. A poor echocardiographic outcome was defined as final left ventricular ejection fraction (LVEF <40%. 28 SLE patients fulfilled the criteria. Global longitudinal strain correlated with global (LVEF: r = −0.808; P = 0.001 and regional (wall motion score: r = 0.715; P < 0.001 function. In patients presenting with a LVEF ≥50%, global longitudinal strain (P = 0.023, wall motion score (P = 0.005 and diastolic function (P = 0.004 were significantly impaired vs controls. Following treatment, LVEF (35–47% (P = 0.023 and wall motion score (1.88–1.5 (P = 0.017 improved but not global longitudinal strain. Initial LVEF (34%; P = 0.046 and global longitudinal strain (−9.5%; P = 0.095 were lower in patients with a final LVEF <40%. Conclusions: This is the first known report on STE in a series of patients with clinical lupus myocarditis. Global longitudinal strain correlated with regional and global left ventricular function. Global longitudinal strain, wall motion score and diastolic parameters may be more sensitive markers of lupus myocarditis in patients presenting with a preserved LVEF ≥50%. A poor initial LVEF and global longitudinal strain were associated with a persistent LVEF <40%. Echocardiography is a non-invasive tool with diagnostic and

  1. Obtaining the biomechanical behavior of ascending aortic aneurysm via the use of novel speckle tracking echocardiography.

    Science.gov (United States)

    Alreshidan, Mohammed; Shahmansouri, Nastaran; Chung, Jennifer; Lash, Vynka; Emmott, Alexander; Leask, Richard L; Lachapelle, Kevin

    2017-04-01

    Ex vivo measurement of ascending aortic biomechanical properties may help understand the risk for rupture or dissection of dilated ascending aortas. A validated in vivo method that can predict aortic biomechanics does not exist. Speckle tracking transesophageal echocardiography (TEE) has been used to measure ventricular stiffness; we sought to determine whether speckle TEE could be adapted to estimate aortic stiffness in vivo and compare these findings with those obtained by ex vivo tissue measurements. A total of 17 patients undergoing ascending aortic resection were recruited to with a mean aortic diameter was 56.16 ± 15 mm. Intraoperative speckle TEE tracking analysis was used to calculate aortic stiffness index using the following equation: β2=ln(SBP/DBP)/AoS, where β2 is the stiffness index; SBP is systolic blood pressure; DBP is diastolic blood pressure; and AoS is the circumferential strain. Ex vivo stiffness was obtained by mechanical tissue testing according to previously described methods. The aortic ring at the pulmonary trunk was divided into 4 equal quadrants. The in vivo stiffness index for the inner curvature, anterior wall, outer curvature, and posterior wall were 0.0544 ± 0.0490, 0.0295 ± 0.0199, 0.0411 ± 0.0328, and 0.0502 ± 0.0320, respectively. The mean ex vivo 25% apparent stiffness for inner curvature, anterior wall, outer curvature, and posterior wall were 0.0616 ± 0.0758 MPa, 0.0352 ± 0.00992 MPa, 0.0405 ± 0.0199 MPa, and 0.0327 ± 0.0106 MPa, respectively. The patient-matched ex vivo 25% apparent stiffness and in vivo stiffness index were not significantly different (P = .8617, 2-way analysis of variance with repeated measures). The use of speckle TEE appears to be a promising technique to estimate ex vivo mechanical properties of the ascending aortic tissue. Copyright © 2016 The American Association for Thoracic Surgery. All rights reserved.

  2. Dobutamine stress echocardiography in healthy adult male rats

    OpenAIRE

    Couet Jacques; Roussel Élise; Drolet Marie-Claude; Lachance Dominic; Plante Eric; Arsenault Marie

    2005-01-01

    Abstract Background Dobutamine stress echocardiography is used to investigate a wide variety of heart diseases in humans. Dobutamine stress echocardiography has also been used in animal models of heart disease despite the facts that the normal response of healthy rat hearts to this type of pharmacological stress testing is unknown. This study was performed to assess this normal response. Methods 15 normal adult male Wistar rats were evaluated. Increasing doses of dobutamine were infused intra...

  3. Transoesophageal echocardiography: What a neuroanaesthesiologist should know?

    Directory of Open Access Journals (Sweden)

    Minati Choudhury

    2015-01-01

    Full Text Available Transoesophageal echocardiography (TEE is a semi invasive imaging modality rapidly gained credence and popularity in the cardiothoracic centers worldwide by mid 1990s. It has also been found to be useful in some noncardiac surgical procedures, in particular in the management of neurosurgical patients and haemodynamically unstable patients in intensive care units (ICUs. The principal goal of basic transoesophageal echocardiographic examination encompass a broad range of anatomic imaging including the diagnosis of air embolism, causes of haemodynamic instability, ventricular size and function, volume status, and complications from invasive procedures, as well as the clinical impact or etiology of pulmonary dysfunction in ICU. TEE is relatively cheap and semi-invasive, but it should not be used as a stand-alone device but as a tool which provides data in addition to the data acquired from other forms of monitoring. The establishment of TEE in perioperative neuro anaesthetic care though recent, may result in a significant change in the role of the anaesthetsiologist who, using TEE can provide new information which may change the course and the outcome of surgical procedures.

  4. Echocardiography in chronic liver disease: systematic review.

    Science.gov (United States)

    Mota, Vitor Gomes; Markman Filho, Brivaldo

    2013-04-01

    Doppler echocardiography (Echo) is a non-invasive method of excellent accuracy to screen portopulmonary hypertension (PPH) and to assess intrapulmonary shunts (IPS) in chronic liver disease (CLD). In the past decade, Echo proved to play a fundamental role in the diagnosis of cirrhotic cardiomyopathy (CCM). To perform a systematic review of relevant articles on the subject 'Echo in CLD'. In November 2011, a systematic review was performed in the PubMed, LILACS and SciELO databases, and the characteristics of the studies selected were reported. The search based on descriptors and free terms obtained 204 articles (179 in Pubmed, 21 in LILACS, and 1 in SciELO). Of those 204 articles, 22 were selected for systematic review. A meta-analysis could not be performed because of the heterogeneity of the articles. Echo should be part of CLD stratification for screening PPH, IPS and CCM, because, most of the time, such complications are diagnosed only when patients are already waiting for a liver transplant.

  5. Dynamic 3D echocardiography in virtual reality

    Directory of Open Access Journals (Sweden)

    Simoons Maarten L

    2005-12-01

    Full Text Available Abstract Background This pilot study was performed to evaluate whether virtual reality is applicable for three-dimensional echocardiography and if three-dimensional echocardiographic 'holograms' have the potential to become a clinically useful tool. Methods Three-dimensional echocardiographic data sets from 2 normal subjects and from 4 patients with a mitral valve pathological condition were included in the study. The three-dimensional data sets were acquired with the Philips Sonos 7500 echo-system and transferred to the BARCO (Barco N.V., Kortrijk, Belgium I-space. Ten independent observers assessed the 6 three-dimensional data sets with and without mitral valve pathology. After 10 minutes' instruction in the I-Space, all of the observers could use the virtual pointer that is necessary to create cut planes in the hologram. Results The 10 independent observers correctly assessed the normal and pathological mitral valve in the holograms (analysis time approximately 10 minutes. Conclusion this report shows that dynamic holographic imaging of three-dimensional echocardiographic data is feasible. However, the applicability and use-fullness of this technology in clinical practice is still limited.

  6. Microlesions induced by microcavitation during contrast echocardiography

    Science.gov (United States)

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

    2001-05-01

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

  7. Usefulness and limitations of transthoracic echocardiography in heart transplantation recipients

    Directory of Open Access Journals (Sweden)

    Galderisi Maurizio

    2008-01-01

    Full Text Available Abstract Transthoracic echocardiography is a primary non-invasive modality for investigation of heart transplant recipients. It is a versatile tool which provides comprehensive information about cardiac structure and function. Echocardiographic examinations can be easily performed at the bedside and serially repeated without any patient's discomfort. This review highlights the usefulness of Doppler echocardiography in the assessment of left ventricular and right ventricular systolic and diastolic function, of left ventricular mass, valvular heart disease, pulmonary arterial hypertension and pericardial effusion in heart transplant recipients. The main experiences performed by either standard Doppler echocardiography and new high-tech ultrasound technologies are summarised, pointing out advantages and limitations of the described techniques in diagnosing acute allograft rejection and cardiac graft vasculopathy. Despite the sustained efforts of echocardiographic technique in predicting the biopsy state, endocardial myocardial biopsies are still regarded as the gold standard for detection of acute allograft rejection. Conversely, stress echocardiography is able to identify accurately cardiac graft vasculopathy and has a recognised prognostic in this clinical setting. A normal stress-echo justifies postponement of invasive studies. Another use of transthoracic echocardiography is the monitorisation and the visualisation of the catheter during the performance of endomyocardial biopsy. Bedside stress echocardiography is even useful to select appropriately heart donors with brain death. The ultrasound monitoring is simple and effective for monitoring a safe performance of biopsy procedures.

  8. Usefulness of an accelerated transoesophageal stress echocardiography in the preoperative evaluation of high risk severely obese subjects awaiting bariatric surgery

    Directory of Open Access Journals (Sweden)

    Tessier Michel

    2010-07-01

    Full Text Available Abstract Background Severe obesity is associated with an increased risk of coronary artery disease (CAD. Bariatric surgery is an effective procedure for long term weight management as well as reduction of comorbidities. Preoperative evaluation of cardiac operative risk may often be necessary but unfortunately standard imaging techniques are often suboptimal in these subjects. The purpose of this study was to demonstrate the feasibility, safety and utility of transesophageal dobutamine stress echocardiography (TE-DSE using an adapted accelerated dobutamine infusion protocol in severely obese subjects with comorbidities being evaluated for bariatric surgery for assessing the presence of myocardial ischemia. Methods Subjects with severe obesity [body mass index (BMI >40 kg/m2] with known or suspected CAD and being evaluated for bariatric surgery were recruited. Results Twenty subjects (9M/11F, aged 50 ± 8 years (mean ± SD, weighing 141 ± 21 kg and with a BMI of 50 ± 5 kg/m2 were enrolled in the study and underwent a TE-DSE. The accelerated dobutamine infusion protocol used was well tolerated. Eighteen (90% subjects reached their target heart rate with a mean intubation time of 13 ± 4 minutes. Mean dobutamine dose was 31.5 ± 9.9 ug/kg/min while mean atropine dose was 0.5 ± 0.3 mg. TE-DSE was well tolerated by all subjects without complications including no significant arrhythmia, hypotension or reduction in blood arterial saturation. Two subjects had abnormal TE-DSE suggestive of myocardial ischemia. All patients underwent bariatric surgery with no documented cardiovascular complications. Conclusions TE-DSE using an accelerated infusion protocol is a safe and well tolerated imaging technique for the evaluation of suspected myocardial ischemia and cardiac operative risk in severely obese patients awaiting bariatric surgery. Moreover, the absence of myocardial ischemia on TE-DSE correlates well with a low operative risk of cardiac event.

  9. Single trans-septal access technique for left atrial intracardiac echocardiography to guide left atrial appendage closure.

    Science.gov (United States)

    Aguirre, Daniel; Pincetti, Christian; Perez, Luis; Deck, Carlos; Alfaro, Mario; Vergara, Maria Jesus; Maluenda, Gabriel

    2017-08-24

    This registry aimed to describe the safety and feasibility of a single trans-septal (TS) access technique for left intracardiac echocardiography (ICE) guidance of left-atrial appendage (LAA) closure procedure. LAA closure is currently accepted as an alternative to oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (NVAF) who are at high-risk for bleeding. Currently, LAA closure procedure is typically performed under trans-esophageal echocardiogram (TEE) guidance. Although, ICE has the advantage of not requiring profound sedation/anesthesia, ICE-LAA imaging quality is often limited from the right atrium requiring double TS access. Twenty-two patients with NVAF underwent LAA closure using the Amplatzer Amulet™ device (St Jude Medical) under ICE guidance from the left atrium. The ICE AcuNav catheter (Biosense Webster) and the Amulet delivery sheath were advanced into the LA through single TS puncture technique. The population was predominately male (59.1%) with a mean age of 74 ± 9.3 years, at high-risk for stroke (mean CHADS2 score of 3.8 ± 1.1) and bleeding (mean HAS BLED score of 3.5 ± 1.3). The Amplatzer Amulet(TM) device was successfully implanted in all patients. No procedural related complications including device embolization were noted. No major cardiovascular events occurred and all patients were discharged alive. At 30-day follow-up all patients remained alive, free of ischemic stroke and with no residual leak or device thrombus on TEE. This initial experience suggests that LAA occlusion with the Amplatzer Amulet device using ICE guidance from the left atrium via a single trans-septal technique is feasible and safe. © 2017 Wiley Periodicals, Inc.

  10. Novel System for Real-Time Integration of 3-D Echocardiography and Fluoroscopy for Image-Guided Cardiac Interventions: Preclinical Validation and Clinical Feasibility Evaluation

    Science.gov (United States)

    Housden, R. James; Ma, Yingliang; Rajani, Ronak; Gao, Gang; Nijhof, Niels; Cathier, Pascal; Bullens, Roland; Gijsbers, Geert; Parish, Victoria; Kapetanakis, Stamatis; Hancock, Jane; Rinaldi, C. Aldo; Cooklin, Michael; Gill, Jaswinder; Thomas, Martyn; O'neill, Mark D.; Razavi, Reza; Rhode, Kawal S.

    2014-01-01

    Real-time imaging is required to guide minimally invasive catheter-based cardiac interventions. While transesophageal echocardiography allows for high-quality visualization of cardiac anatomy, X-ray fluoroscopy provides excellent visualization of devices. We have developed a novel image fusion system that allows real-time integration of 3-D echocardiography and the X-ray fluoroscopy. The system was validated in the following two stages: 1) preclinical to determine function and validate accuracy; and 2) in the clinical setting to assess clinical workflow feasibility and determine overall system accuracy. In the preclinical phase, the system was assessed using both phantom and porcine experimental studies. Median 2-D projection errors of 4.5 and 3.3 mm were found for the phantom and porcine studies, respectively. The clinical phase focused on extending the use of the system to interventions in patients undergoing either atrial fibrillation catheter ablation (CA) or transcatheter aortic valve implantation (TAVI). Eleven patients were studied with nine in the CA group and two in the TAVI group. Successful real-time view synchronization was achieved in all cases with a calculated median distance error of 2.2 mm in the CA group and 3.4 mm in the TAVI group. A standard clinical workflow was established using the image fusion system. These pilot data confirm the technical feasibility of accurate real-time echo-fluoroscopic image overlay in clinical practice, which may be a useful adjunct for real-time guidance during interventional cardiac procedures. PMID:27170872

  11. Reliability of transesophageal pacing in the assessment of sinus node function in patients with sick sinus syndrome.

    Science.gov (United States)

    Alboni, P; Paparella, N; Cappato, R; Pedroni, P; Candini, G C; Antonioli, G E

    1989-02-01

    The purpose of this study was to find out whether transesophageal pacing could be utilized for assessment of sinus node function in patients with sick sinus syndrome (SSS). In 17 patients with SSS (study group) we compared the results of sinus node tests obtained both in the basal state and after pharmacological autonomic blockade by endocavitary stimulation and, 24 hours later, by transesophageal pacing. In another group of 17 patients with SSS (control group), we compared the results obtained by two endocavitary studies. In "study group", sinus cycle length (SCL) and corrected sinus node recovery time (CSRT) did not show significant differences between the two studies both in the basal state and after autonomic blockade, whereas sinoatrial conduction time (SACT) was more prolonged during esophageal pacing (P less than 0.01). In "control group", sinus node measures did not show significant differences between the two studies. In the "study group," the following coefficients of correlation were obtained in the basal state; SCL, r = 0.65, CSRT, r = 0.57, SACT, r = 0.52 and after autonomic blockade: SCL, r = 0.95, CSRT, r = 0.62 and SACT, r = 0.53. In the basal state, the correlation for SCL and CSRT between the two studies was lower in the "study group" than in the "control group" (P less than 0.05), whereas after autonomic blockade the correlation for sinus node measures did not show significant differences between the two groups of patients. These data suggest that transesophageal study influences the autonomic tone regulating the sinus node; however, it is not responsible for important variations in sinus node measures.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. FETAL ECHOCARDIOGRAPHY: A STUDY OF CLINICAL OUTCOME

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    Rajanish

    2014-01-01

    Full Text Available BACKGROUND : S tructural abnormalities of the heart and great vessels are fairly common congenital lab normalities with the incidenceof8 in 1000 live births. With the advent of real time scanners fetal cardia can atomy can be analyze d echocardiographically. The earlier diagnosis will make an impact on clinical management of fetus with congenital heart disease. It helps intimely triage and optimal management of specific congenital heart disease either structural , functional orarrhythmia . OBJECTIVES : This study was conducted to note the spectrum of congenital heart diseases detected on fetal echo in pregnant mothers referred with high risk for CHD sand to assess the outcome of prenatally detected congenital heart diseases. MATERIAL S AND METHODS : T he study is aprospective descriptive study conducted in a tertiary care pediatric hospital in Mumbai over period of one year . P regnant mothers were referred for fetal echo , where pregnancy was considered as high risk for CHDs due to maternal , fetalfactorsorabnormallevel 1 scan.Fetal echowas performed by a trained pediatric cardiologistat 18 to 20 week of gestation using HP sonos 2000 echocardiographicmachinewith3/3.5 Hz transducer. Cardiac lesionsandoutcome of pregnancy was noted by postnatal follow - up of patients. RESULTS : A total of 170 patients underwent fetal echo , 13 patients have not delivered and 48 were lost to follow - up. Fetal echo was normal in 130(76.4% and abnormalities were detected in 40(23.5%.Structural anomalies were seen in 24(14.1% , arrhythmia in 5(2.9% and functional abnormalities in 11(6.4%.On outcome analysis84 (77.1% arealive , IUD /terminationof pregnancyoccurred in 18(16.5% , neonatal death in 6 (5.5% , infant death in 1 (0.9%. CONCLUSIONS : All ranges of CHDs can be diagnosed by fetal echocardiography . O utcome of prenatally detected complex congenital heart disease is poor ; nonetheless earlier detection provides a n opportunity for early interventions and

  13. Digital tele-echocardiography: a look inside

    Directory of Open Access Journals (Sweden)

    Daniele Giansanti

    2009-12-01

    Full Text Available 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 heterogeneus system embedding parts from telematics, bioengineering, and medical physics.

  14. Digital tele-echocardiography: a look inside.

    Science.gov (United States)

    Giansanti, Daniele; Morelli, Sandra

    2009-01-01

    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.

  15. Estimation of circumferential fiber shortening velocity by echocardiography.

    Science.gov (United States)

    Ruschhaupt, D G; Sodt, P C; Hutcheon, N A; Arcilla, R A

    1983-07-01

    The M-mode and two-dimensional echocardiograms of 40 young patients were analyzed to compare the mean circumferential fiber shortening velocity (Vcf) of the left ventricle calculated separately by two methods. The mean circumferential fiber shortening velocity was derived from the M-mode echocardiogram as minor axis shortening/ejection time and derived from the two-dimensional echocardiogram as actual circumference change/ejection time. With computer assistance, circumference was determined from the short-axis two-dimensional echocardiographic images during end-diastole and end-systole. Good correlations were obtained between the left ventricular diameter derived by M-mode echocardiography and the vertical axis during end-diastole (r = 0.79) and end-systole (r = 0.88) derived by two-dimensional echocardiography. Likewise, high correlations were noted between diameter and circumference in end-diastole (r = 0.89) and end-systole (r = 0.88). However, comparison of Vcf obtained by M-mode echocardiography with that obtained by two-dimensional echocardiography showed only fair correlation (r = 0.68). Moreover, the diameter/circumference ratio determined in end-diastole and end-systole differed significantly (p less than 0.001), possibly owing to the change in geometry of the ventricular sector image during systole. Although Vcf derived by M-mode echocardiography is a useful index of left ventricular performance, it does not truly reflect the circumference change during systole.

  16. Application of echocardiography in resynchronization treatment of heart failure patients

    Institute of Scientific and Technical Information of China (English)

    DAI Hai-long; GUANG Xue-feng; XIAO Zhi-cheng; ZHANG Ming

    2012-01-01

    Objective To review the updated research progress about the application of echocardiography in resynchronization treatment of chronic heart failure patients.Data sources The data used in this review were from PubMed,published in English and using the key terms "heart failure","echocardiography" and "cardiac resynchronization therapy".Study selection Relevant articles were reviewed and selected to address the stated purpose.Results Increasing numbers of studies have suggested the importance of echocardiography in resynchronization treatment of chronic heart failure patients.Echocardiography can evaluate atrioventricular,inter- and intra-ventricular mechanical dyssynchrony before cardiac resynchronization therapy (CRT),as a guidance to assess the optimal left ventricular (LV) pacing location,optimize the atrioventricular and interventricular delays and predict response to CRT.Conclusions Echocardiography is both non invasive and easily repeatable,and plays a crucial role in appraisal of heart synchronism,instruction of actuator placement,optimization of the device procedure,and prediction of the response to CRT.Chin Med J 2012; 125(19):3548-3555

  17. What every radiologist should know about paediatric echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Sorantin, Erich, E-mail: erich.sorantin@medunigraz.at [Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 34, A-8036 Graz (Austria); Heinzl, Bernd [Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Medical University Graz, Auenbruggerplatz 34, A-8036 Graz (Austria)

    2014-09-15

    Congenital heart defects (CHD) occur in less than one percent of all newborns. Echocardiography represents the imaging modality of choice for morphological and functional assessment. In childhood the different CHD types can be diagnosed trustfully and can be performed bedside. In the follow-up of CHD cross sectional imaging plays an important role and therefore it is essential for the radiologist to know the features, challenges and limitations of echocardiography. Within this review article a systematic approach for morphological and functional assessment of the heart will is given along with representative example images. In addition, typical echocardiographic findings in common CHD is presented. In older children, adolescents and grown-ups with CHD (GUCH) echocardiography suffers from limitations – partially due to skeletal deformations and lung emphysema. In particular right ventricular function assessment is not always possible by echocardiography. Therefore strengths and limitations of echocardiography will be discussed the role of cardiac magnetic resonance imaging (cMRI) and cardiac computed tomography (cCT) emphasized.

  18. Electrocardiography and echocardiography in athletic heart imagining

    Directory of Open Access Journals (Sweden)

    D Biały

    2003-03-01

    Full Text Available The aim of the study was evaluation of electrocardiographic and echocardiographic parameters in athletes. „Athletic heart” characteristics were compared with fit persons’ heart. 96 athletes participated in the study. Sportsmen were divided into: static (S, dynamic (D and composite (SD exercise groups and Polish (I, European (II, World (III champions. 30 students from Sport Academy formed the control group (K. Electrocardiographic and echocardiographic examination were performed in everyone. As regards the type of exercise, the end-systolic left ventricular (LV dimension was smaller in S in comparison with D and SD (28.9 vs 32.2 and 32.68 mm; P<0.05. LV mass was bigger in D in comparison with K (273.2 vs 218.6 g; P<0.05. Medium Pulmonary Artery Pressure (MPAP in S and SD was lower in respect to D and K (11.75; 11.08 vs 15.52; 17.43 mm Hg; P<0.05. We observed lower heart rate in D, SD in comparison with K (58.64; 60.54 vs 68.8; P<0.05, bigger R wave amplitude in V5 (RV5 (21.65; 23.5 vs 15.03 mm; P<0.05 and V6 (RV6 (23.5 vs 15.3 mm; P<0.05 in group S in respect to K. LV mass was bigger in III than in K (261.3 vs 218.6 g; P<0.05. MPAP was lower in I and II in comparison with K (11.42; 13.13 vs 17.43 mmHg; P<0.05. HR was lower in categories I, II than in K (61.32; 60.13 vs 68.8; P<0.05, RV5 was bigger in I in comparison with K (19.5 vs 15.03 mm; P<0.05. The electrocardiography and echocardiography proves to find some significant differences between athletic and fit persons’ heart especially as concerns MPAP, RV5, RV6 values.

  19. Assessment of right ventricular systolic function by tissue Doppler echocardiography

    DEFF Research Database (Denmark)

    Kjærgaard, Jesper

    2012-01-01

    myocardial velocities, but no changes in SR, strain or isovolumic acceleration could be observed [II and III]. Tissue Doppler echocardiography of the RV free wall in non-massive pulmonary embolism quantifies degree of RV dysfunction, and supports the existence of the McConnell sign of mid-ventricular RV...... structure including significant dilatation, but is well tolerated with only mild reduction in measures of global RV systolic function as estimated by 2D echocardiography in an experimental animal model. Regional RV myocardial function is also only mildly reduced. Also no differences in global or regional RV......This thesis summarizes a series of studies performed in order to assess the clinical usefulness of a novel echocardiographic technology that allows non-invasive assessment of regional right ventricular myocardial velocities and deformation: tissue Doppler echocardiography. While the technology...

  20. Recommendations for fetal echocardiography in twin pregnancy in 2016

    Directory of Open Access Journals (Sweden)

    Leszczyńska Katarzyna

    2016-01-01

    Full Text Available Progress in the fields of fetal cardiology and fetal surgery have been seen not only in singleton pregnancies but also in multiple pregnancies. Proper interpretation of prenatal echocardiography is critical to clinical decision making, family counseling and perinatal management for obstetricians, maternal fetal medicine specialists, neonatologists and pediatric cardiologists. Fetal echocardiography is one of the most challenging and time-consuming prenatal examinations to perform, especially in multiple gestations. Performing just the basic fetal exam in twin gestations may take an hour or more. Thus, it is not practical to perform this exam in all cases of multiple gestations. Therefore our review and recommendations are related to fetal echocardiography in twin gestation.

  1. The Optimum Level of Sevoflurane in Pediatric Echocardiography.

    Science.gov (United States)

    Conghai, Fan; Fengchao, Zhang; Chengjing, Shan; Cheng, Wen; Yunji, Wang; Xiaobo, Li

    2015-11-01

    Sevoflurane is shown to be safe and effective in pediatric echocardiography. This study explores the optimum level in pediatric echocardiography. One hundred and twenty children, with an age range of 35 days-3 years, were included in this study. The children with severe cyanotic congenital heart disease or severe pneumonia, which was Grade I or II according to the American College of Physicians Guideline Grading, were excluded. All children received the anesthesia with sevoflurane. The inhalation anesthesia level decreased from 2.5 to 1.0 %, with a decrement of 0.5 %. The induction time (T0), echocardiography time (T1), and time to awakening (T2) in each child were recorded, and the changes in the blood pressure, heart rate, breath, and oxygen saturation in each child were also monitored. The Ramsay scale scoring during anesthesia and the case number of failure in echocardiography in each group were also recorded. When the level of sevoflurane inhalation was maintained at 1.0 %, the childrens' scores were low, including 8 incompliant children, and p sevoflurane inhalation level increased. When the sevoflurane inhalation increased to 1.5 %, the children could sleep with stable blood pressure, and no dysphoria occurred during the echocardiography. When the sevoflurane inhalation level increased to 2.5 %, the Ramsay scores did not increase. However, the T2 significantly increased (p blood pressure and heart rate in each group did not change significantly. With the premise of safety and efficacy in children, the optimum level of sevoflurane in pediatric echocardiography was 1.5-2.0 %.

  2. Acute right ventricular dysfunction: real-time management with echocardiography.

    Science.gov (United States)

    Krishnan, Sundar; Schmidt, Gregory A

    2015-03-01

    In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the increased use of point-of-care ultrasonography and a decline in the use of pulmonary artery catheters, echocardiography can be the ideal tool for evaluation and to guide hemodynamic and respiratory therapy. We review the epidemiology of right ventricular failure in critically ill patients; echocardiographic parameters for evaluating the right ventricle; and the impact of mechanical ventilation, fluid therapy, and vasoactive infusions on the right ventricle. Finally, we summarize the principles of management in the context of right ventricular dysfunction and provide recommendations for echocardiography-guided management.

  3. Stress echocardiography in valvular heart disease: a current appraisal.

    Science.gov (United States)

    Naji, Peyman; Patel, Krishna; Griffin, Brian P; Desai, Milind Y

    2015-03-01

    Stress echocardiography is increasingly used in the management of patients with valvular heart disease and can aid in evaluation, risk stratification and clinical decision making in these patients. Evaluation of symptoms, exercise capacity and changes in blood pressure can be done during the exercise portion of the test, whereas echocardiographic portion can reveal changes in severity of disease, pulmonary artery pressure and left ventricular function in response to exercise. These parameters, which are not available at rest, can have diagnostic and prognostic importance. In this article, we will review the indications and diagnostic implications, prognostic implications, and clinical impact of stress echocardiography in decision making and management of patients with valvular heart disease.

  4. Role of Speckle Tracking Echocardiography in Dilated Cardiomyopathy: A Review

    Science.gov (United States)

    Virk, Hafeez Ul Hasan; Khalid, Muhammad; Rahman, Zia; Sitwala, Puja; Schoondyke, Jeffrey; Al-Balbissi, Kais

    2017-01-01

    Dilated cardiomyopathy (DCM) is an important cause of the heart failure. Timely diagnosis and optimal management decrease morbidity and mortality in heart failure patients. Although transthoracic echocardiography is used as the diagnostic test of choice in these patients, new modalities like speckle tracking echocardiography (STE) have promising results in diagnosing these patients in the earlier course of the disease. Advancements in cardiac imaging are expected as more clinical studies on the role of STE in different cardiac diseases that emerge. In this review article, we will discuss the basics of STE and its role in diagnosing DCM. PMID:28744419

  5. Stress echocardiography for the diagnosis of coronary artery disease: an evidence-based analysis.

    Science.gov (United States)

    2010-01-01

    In July 2009, the Medical Advisory Secretariat (MAS) began work on Non-Invasive Cardiac Imaging Technologies for the Diagnosis of Coronary Artery Disease (CAD), an evidence-based review of the literature surrounding different cardiac imaging modalities to ensure that appropriate technologies are accessed by patients suspected of having CAD. This project came about when the Health Services Branch at the Ministry of Health and Long-Term Care asked MAS to provide an evidentiary platform on effectiveness and cost-effectiveness of non-invasive cardiac imaging modalities.After an initial review of the strategy and consultation with experts, MAS identified five key non-invasive cardiac imaging technologies for the diagnosis of CAD. Evidence-based analyses have been prepared for each of these five imaging modalities: cardiac magnetic resonance imaging, single photon emission computed tomography, 64-slice computed tomographic angiography, stress echocardiography, and stress echocardiography with contrast. For each technology, an economic analysis was also completed (where appropriate). A summary decision analytic model was then developed to encapsulate the data from each of these reports (available on the OHTAC and MAS website).The Non-Invasive Cardiac Imaging Technologies for the Diagnosis of Coronary Artery Disease series is made up of the following reports, which can be publicly accessed at the MAS website at: www.health.gov.on.ca/mas">www.health.gov.on.ca/mas or at www.health.gov.on.ca/english/providers/program/mas/mas_about.htmlSINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY FOR THE DIAGNOSIS OF CORONARY ARTERY DISEASE: An Evidence-Based AnalysisSTRESS ECHOCARDIOGRAPHY FOR THE DIAGNOSIS OF CORONARY ARTERY DISEASE: An Evidence-Based AnalysisSTRESS ECHOCARDIOGRAPHY WITH CONTRAST FOR THE DIAGNOSIS OF CORONARY ARTERY DISEASE: An Evidence-Based Analysis64-Slice Computed Tomographic Angiography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis

  6. Exercise echocardiography in asymptomatic survivors of childhood cancer treated with anthracyclines

    DEFF Research Database (Denmark)

    Sieswerda, Elske; Kremer, Leontien C M; Vidmar, Suzanna

    2010-01-01

    BACKGROUND: Exercise echocardiography reveals abnormalities in asymptomatic childhood cancer survivors who previously have been treated with anthracyclines. We determined the added value of monitoring childhood cancer survivors with exercise echocardiography compared to monitoring with resting ec...

  7. Association of heart failure hospitalizations with combined electrocardiography and echocardiography criteria for left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Gerdts, Eva; Okin, Peter M; Boman, Kurt

    2012-01-01

    The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain.......The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain....

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

    Directory of Open Access Journals (Sweden)

    Heloisa Amaral Gaspar

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-09-01

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

  10. Stress-echocardiography in idiopathic dilated cardiomyopathy: instructions for use

    Directory of Open Access Journals (Sweden)

    Neskovic Aleksandar N

    2005-02-01

    Full Text Available Abstract A number of studies have suggested that stress-echocardiography may be used for prognostic stratification in patients with idiopathic dilated cardiomyopathy. There is no consensus on which protocol or which measurements of left ventricular contractile reserve to use. The most frequently used protocol is low-dose dobutamine stress-echocardiography, and most commonly used measures of left ventricular systolic performance are ejection fraction, wall motion score index and cardiac power output. Stress-echocardiography has been shown to predict improvement in cardiac function in patients with recently diagnosed dilated cardiomyopathy, as well as to predict which patients will benefit from the treatment with beta-blockers. Most importantly, stress-echocardiography can identify patients with worse prognosis in terms of cardiac death and need for transplantation. Additionally, contractile reserve is closely correlated with maximal oxygen consumption and can even be used for further stratification in patients with maximal oxygen consumption between 10 and 14 ml/kg/min. Future studies are needed for head-to-head comparison of various protocols in an attempt to make standardization in the assessment of patients with dilated cardiomyopathy.

  11. Differential Diagnosis of Cardiac Malposition by Fetal Echocardiography

    Institute of Scientific and Technical Information of China (English)

    Ying WU; Feng TAO; Tao LIU; Ling ZANG; Shi-long LIU

    2009-01-01

    Objectives To explore the method and operating skill of fetal echocardiography in diagnosing cardiac malposition. Methods 91 consecutive fetuses were studied (control: 50 cases, cardiac malposition : 41 cases) between 2003 and 2008. The position of fetal heart was evaluated according to the fetal posture and the visceral situs by fetal routine scan-ning. The detailed echocardiography should be performed in the differential diagnosis of cardiac lesions when the heart was found to be abnormal position. Results In the control group, all fetuses were levocardia. 39 cases of cardiac mal-positions were detected by fetal echocardiography, included 25 fetuses with dextrocardia, 6 mesocard, 5 with levover-sion of heart, 3 common heart of conjoined twins and 2 extrathorax heart. Two of dextroversion were missed by fetal routine scanning, but found by autopsy or operation after birth. Conclusions When the abnormal visceral situs was found by fetal routine scanning, there is exceedingly high incidence of cardiac malpositions. Proficiently operating skill of fetal echocardiography is helpful to detect abnormal fetal cardiac position.

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

    Directory of Open Access Journals (Sweden)

    Nedeljkovic Milan

    2003-06-01

    Full Text Available Abstract Objective The aim of this study was to evaluate the diagnostic potential of low-dose adenosine stress echocardiography in detection of myocardial viability. Background Vasodilation through low dose dipyridamole infusion may recruit contractile reserve by increasing coronary flow or by increasing levels of endogenous adenosine. Methods Forty-three patients with resting dyssynergy, due to previous myocardial infarction, underwent low-dose adenosine (80, 100, 110 mcg/kg/min in 3 minutes intervals echocardiography test. Gold standard for myocardial viability was improvement in systolic thickening of dyssinergic segments of ≥ 1 grade at follow-up. Coronary angiography was done in 41 pts. Twenty-seven patients were revascularized and 16 were medically treated. Echocardiographic follow up data (12 ± 2 months were available in 24 revascularized patients. Results Wall motion score index improved from rest 1.55 ± 0.30 to 1.33 ± 0.26 at low-dose adenosine (p Conclusion Low-dose adenosine stress echocardiography test has high diagnostic potential for detection of myocardial viability in the group of patients with left ventricle dysfunction due to previous myocardial infarction. Low dose adenosine stress echocardiography may be adequate alternative to low-dose dobutamine test for evaluation of myocardial viability.

  13. Update of the echocardiography core syllabus of the European Association of Cardiovascular Imaging (EACVI).

    Science.gov (United States)

    Cosyns, Bernard; Garbi, Madalina; Separovic, Jadranka; Pasquet, Agnes; Lancellotti, Patrizio

    2013-09-01

    The update of the Echocardiography Core Syllabus of European Association of Cardiovascular Imaging (EACVI) is now available online. The Echocardiography Core Syllabus enumerates the elements of knowledge to be taught, represents a framework for the development of local training curricula and provides expected learning outcomes to the echocardiography learner.

  14. Computer-based training in two-dimensional echocardiography using an echocardiography simulator.

    Science.gov (United States)

    Weidenbach, Michael; Wild, Florentine; Scheer, Kathrin; Muth, Gerhard; Kreutter, Stefan; Grunst, Gernoth; Berlage, Thomas; Schneider, Peter

    2005-04-01

    Two-dimensional (2D) echocardiography is a user-dependent technique that poses some inherent problems to the beginner. The first problem for beginners is spatial orientation, especially the orientation of the scan plane in reference to the 3-dimensional (3D) geometry of the heart. The second problem for beginners is steering of the ultrasound probe. We have designed a simulator to teach these skills. On a computer screen a side-by-side presentation of a 3D virtual reality scene on the right side and a 2D echocardiographic view on the left side is given. The virtual scene consists of a 3D heart and an ultrasound probe with scan plane. The 2D echocardiographic image is calculated from 3D echocardiographic data sets that are registered with the heart model to achieve spatial and temporal congruency. The displayed 2D echocardiographic image is defined and controlled by the orientation of the virtual scan plane. To teach hand-eye coordination we equipped a dummy transducer with a 3D tracking system and placed it on a dummy torso. We have evaluated the usability of the simulator in an introductory course for final-year medical students. The simulator was graded realistic and easy to use. According to a subjective self-assessment by a standardized questionnaire the aforementioned skills were imparted effectively.

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

    Science.gov (United States)

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

    2003-01-01

    Objective The aim of this study was to evaluate the diagnostic potential of low-dose adenosine stress echocardiography in detection of myocardial viability. Background Vasodilation through low dose dipyridamole infusion may recruit contractile reserve by increasing coronary flow or by increasing levels of endogenous adenosine. Methods Forty-three patients with resting dyssynergy, due to previous myocardial infarction, underwent low-dose adenosine (80, 100, 110 mcg/kg/min in 3 minutes intervals) echocardiography test. Gold standard for myocardial viability was improvement in systolic thickening of dyssinergic segments of ≥ 1 grade at follow-up. Coronary angiography was done in 41 pts. Twenty-seven patients were revascularized and 16 were medically treated. Echocardiographic follow up data (12 ± 2 months) were available in 24 revascularized patients. Results Wall motion score index improved from rest 1.55 ± 0.30 to 1.33 ± 0.26 at low-dose adenosine (p < 0.001). Of the 257 segments with baseline dyssynergy, adenosine echocardiography identified 122 segments as positive for viability, and 135 as necrotic since no improvement of systolic thickening was observed. Follow-up wall motion score index was 1.31 ± 0.30 (p < 0.001 vs. rest). The sensitivity of adenosine echo test for identification of viable segments was 87%, while specificity was 95%, and diagnostic accuracy 90%. Positive and negative predictive values were 97% and 80%, respectively. Conclusion Low-dose adenosine stress echocardiography test has high diagnostic potential for detection of myocardial viability in the group of patients with left ventricle dysfunction due to previous myocardial infarction. Low dose adenosine stress echocardiography may be adequate alternative to low-dose dobutamine test for evaluation of myocardial viability. PMID:12812523

  16. Intraoperative Diagnosis of Stanford Type A Dissection by Transesophageal Echocardiogram in a Patient Presenting for Renal Transplantation

    Directory of Open Access Journals (Sweden)

    William R. Hand

    2011-01-01

    Full Text Available A 48-year-old patient with hypertensive end-stage renal disease presented for cadaveric renal transplantation. On physical exam, a previously undocumented diastolic murmur was heard loudest at the left lower sternal border. The patient had a history of pericardial effusions and reported “a feeling of chest fullness” when lying flat. As such, a transesophageal echocardiogram (TEE was performed after induction of anesthesia to evaluate the pericardial space and possibly determine the etiology and severity of the new murmur. The TEE revealed a Stanford Type A aortic dissection. The renal transplant was cancelled (organ reassigned within region, and the patient underwent an urgent ascending and proximal hemiarch aortic replacement. This case demonstrates the importance of a thorough physical exam and highlights the utility of TEE for noncardiac surgical cases.

  17. SPY Imaging Assessment Correlates With Transesophageal Echocardiogram Assessment of Ventricular Function During Off-Pump Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Anderson, Curtis A; Kypson, Alan P; Hudson, Wes; Ferguson, Bruce; Rodriguez, Evelio

    2008-05-01

    Intraoperative assessment of graft anastomoses is commonly performed after off-pump coronary artery bypass grafting (OPCAB). The SPY imaging system allows intraoperative graft assessment. We document correlation between intraoperative SPY images and wall motion abnormality by transesophageal echocardiogram (TEE) during OPCAB. A 79-year-old female underwent OPCAB. Intraoperative graft patency assessment was performed with the SPY and left ventricular wall motion was assessed by TEE. SPY imaging demonstrated poor flow trough the distal vein graft anastomosis to the posterior descending artery, which correlated with a new posterior wall motion hypokinesis. After graft revision, SPY imaging demonstrated good distal flow and the TEE demonstrated normalization of the left ventricular posterior wall motion. SPY technology allows the surgeon to accurately assess graft patency intraoperatively and allows immediate correction of a technical problem.

  18. Atrial fibrillation in rats induced by rapid transesophageal atrial pacing during brief episodes of asphyxia: A new in vivo model

    DEFF Research Database (Denmark)

    Haugan, K.; Lam, Henrik Rye; Knudsen, C. B.;

    2004-01-01

    Non-pharmacological in vivo models of atrial fibrillation (AF) have been developed in large animals only. We aimed to develop and characterize a new small animal non-pharmacological in vivo model of AF. AF was induced by transesophageal atrial burst pacing during 35 seconds periods of asphyxia...... was associated with a marked profibrillatory effect. Increasing gap junction intracellular communication using the antiarrhythmic peptide analogue AAP 10 did not affect AF duration. Basal plasma level of epinephrine and norepinephrine were increased 5- to 20-fold relative to values reported by others......, but unchanged following 35 seconds of asphyxia. The results from our study demonstrate that the rat model shares several clinical key characteristics with human AF: (1) hemodynamic response to AF; (2) increased autonomic tone; (3) antiarrhythmic effects of clinically used drugs; (4) profibrillatory effect...

  19. Can simulation help to answer the demand for echocardiography education?

    Science.gov (United States)

    Clau-Terré, Fernando; Sharma, Vivek; Cholley, Bernard; Gonzalez-Alujas, Teresa; Galiñanes, Manuel; Evangelista, Artur; Fletcher, Nick

    2014-01-01

    There has been a recent explosion of education and training in echocardiography in the specialties of anesthesiology and critical care. These devices, by their impact on clinical management, are changing the way surgery is performed and critical care is delivered. A number of international bodies have made recommendations for training and developed examinations and accreditations.The challenge to medical educators in this area is to deliver the training needed to achieve competence into already over-stretched curricula.The authors found an apparent increase in the use of simulators, with proven efficacy in improving technical skills and knowledge. There is still an absence of evidence on how it should be included in training programs and in the accreditation of certain levels.There is a conviction that this form of simulation can enhance and accelerate the understanding and practice of echocardiography by the anesthesiologist and intensivists, particularly at the beginning of the learning curve.

  20. Entropy-based straight kernel filter for echocardiography image denoising.

    Science.gov (United States)

    Rajalaxmi, S; Nirmala, S

    2014-10-01

    A new filter has been proposed with the aim of eliminating speckle noise from 2D echocardiography images. This speckle noise has to be eliminated to avoid the pseudo prediction of the underlying anatomical facts. The proposed filter uses entropy parameter to measure the disorganized occurrence of noise pixel in each row and column and to increase the image visibility. Straight kernels with 3 pixels each are chosen for the filtering process, and the filter is slided over the image to eliminate speckle. The peak signal-to-noise ratio (PSNR) is obtained in the range of 147 dB, and the root mean square error (RMSE) is very low of approximately 0.15. The proposed filter is implemented on 36 echocardiography images, and the filter has the competence to illuminate the actual anatomical facts without degrading the edges.

  1. Role of echocardiography in the treatment of cardiac tamponade.

    Science.gov (United States)

    Chandraratna, P A N; Mohar, Dilbahar S; Sidarous, Peter F

    2014-08-01

    Accumulation of fluid within the pericardial sac results in elevation of intrapericardial pressure with consequent cardiac compression or tamponade. Cardiac tamponade is a life-threatening condition which requires urgent evacuation of pericardial effusion (PE). Current pericardial evacuation techniques and approaches are varied. Echocardiography provides valuable insights into identifying patients who are suitable candidates and further facilitates pericardiocentesis by improving guidance techniques. Several previous publications have provided excellent reviews of the pathophysiology of cardiac tamponade. We review the clinical presentation and role of echocardiography for diagnosis of tamponade. We focus on medical and surgical approaches for the removal of PE. Moreover, as the clinical and hemodynamic consequences of PE depend on the volume and the rate of accumulation of PE, we review the various scenarios of "small" PE resulting in cardiac tamponade.

  2. The Interplay between Fasting Glucose, Echocardiography, and Biomarkers

    DEFF Research Database (Denmark)

    Pareek, Manan

    2017-01-01

    preventive setting, remains incomplete. Phenotypical heterogeneity may be even greater among subjects with hyperglycemic conditions, i.e., prediabetes and diabetes, which is worrisome, given the dramatic global rise in mean fasting glucose levels, and the strong association with adverse cardiovascular...... subclinical changes to manifest disease include echocardiography and circulating biomarkers. Objectives 1) To examine whether greater fasting plasma glucose (FPG) levels were associated with left ventricular mass (LVM), geometric pattern, diastolic function, and concentrations of N-terminal prohormone...... from the three categories defined by baseline FPG, i.e., normal fasting glucose, impaired fasting glucose, and diabetes, including use of anti-diabetic medication. Blood samples for cardiovascular biomarker assessments were drawn at the time of echocardiography and kept frozen until analysis. Outcome...

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

    Science.gov (United States)

    Broxvall, Mathias; Emilsson, Kent; Thunberg, Per

    2012-06-01

    Time resolved three-dimensional (3D) echocardiography generates four-dimensional (3D+time) data sets that bring new possibilities in clinical practice. Image quality of four-dimensional (4D) echocardiography is however regarded as poorer compared to conventional echocardiography where time-resolved 2D imaging is used. Advanced image processing filtering methods can be used to achieve image improvements but to the cost of heavy data processing. The recent development of graphics processing unit (GPUs) enables highly parallel general purpose computations, that considerably reduces the computational time of advanced image filtering methods. In this study multidimensional adaptive filtering of 4D echocardiography was performed using GPUs. Filtering was done using multiple kernels implemented in OpenCL (open computing language) working on multiple subsets of the data. Our results show a substantial speed increase of up to 74 times, resulting in a total filtering time less than 30 s on a common desktop. This implies that advanced adaptive image processing can be accomplished in conjunction with a clinical examination. Since the presented GPU processor method scales linearly with the number of processing elements, we expect it to continue scaling with the expected future increases in number of processing elements. This should be contrasted with the increases in data set sizes in the near future following the further improvements in ultrasound probes and measuring devices. It is concluded that GPUs facilitate the use of demanding adaptive image filtering techniques that in turn enhance 4D echocardiographic data sets. The presented general methodology of implementing parallelism using GPUs is also applicable for other medical modalities that generate multidimensional data.

  4. Portopulmonary hypertension: Improved detection using CT and echocardiography in combination

    Energy Technology Data Exchange (ETDEWEB)

    Devaraj, Anand [Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, London (United Kingdom); Loveridge, Robert; Bernal, William; Willars, Christopher; Wendon, Julia A.; Auzinger, Georg [King' s College Hospital NHS Foundation Trust, The Institute of Liver Studies, King' s Health Partners, King' s College London, London (United Kingdom); Bosanac, Diana; Stefanidis, Konstantinos; Desai, Sujal R. [King' s College Hospital NHS Foundation Trust, Department of Radiology, King' s Health Partners, King' s College London, London (United Kingdom)

    2014-10-15

    To establish the relationship between CT signs of pulmonary hypertension and mean pulmonary artery pressure (mPAP) in patients with liver disease, and to determine the additive value of CT in the detection of portopulmonary hypertension in combination with transthoracic echocardiography. Forty-nine patients referred for liver transplantation were retrospectively reviewed. Measured CT signs included the main pulmonary artery/ascending aorta diameter ratio (PA/AA{sub meas}) and the mean left and right main PA diameter (RLPA{sub meas}). Enlargement of the pulmonary artery compared to the ascending aorta was also assessed visually (PA/AA{sub vis}). CT measurements were correlated with right-sided heart catheter-derived mPAP. The ability of PA/AA{sub vis} combined with echocardiogram-derived right ventricular systolic pressure (RVSP) to detect portopulmonary hypertension was tested with ROC analysis. There were moderate correlations between mPAP and both PA/AA{sub meas} and RLPA{sub meas} (r{sub s} = 0.41 and r{sub s} = 0.42, respectively; p < 0.005). Compared to transthoracic echocardiography alone (AUC = 0.59, p = 0.23), a diagnostic algorithm incorporating PA/AA{sub vis} and transthoracic echocardiography-derived RVSP improved the detection of portopulmonary hypertension (AUC = 0.8, p < 0.0001). CT contributes to the non-invasive detection of portopulmonary hypertension when used in a diagnostic algorithm with transthoracic echocardiography. CT may have a role in the pre-liver transplantation triage of patients with portopulmonary hypertension for right-sided heart catheterisation. (orig.)

  5. Pacemaker optimization guided by echocardiography in cardiac resynchronization therapy

    Directory of Open Access Journals (Sweden)

    Trifunović Danijela

    2009-01-01

    Full Text Available Introduction. Cardiac resynchronization therapy (CRT or biventricular pacing is a contemporary treatment in the management of advanced heart failure. Echocardiography plays an evolving and important role in patient selection for CRT, follow-up of acute and chronic CRT effects and optimization of device settings after biventricular pacemaker implantation. In this paper we illustrate usefulness of echocardiography for successful AV and VV timing optimization in patients with CRT. A review of up-to-date literature concerning rationale for AV and VV delay optimization, echocardiographic protocols and current recommendations for AV and VV optimization after CRT are also presented. Outline of Cases. The first case is of successful AV delay optimization guided by echocardiography in a patient with dilated cardiomyopathy treated with CRT is presented. Pulsed blood flow Doppler was used to detect mitral inflow while programming different duration of AV delay. The AV delay with optimal transmittal flow was established. The optimal mitral flow was the one with clearly defined E and A waves and maximal velocity time integral (VTI of the mitral flow. Improvement in clinical status and reverse left ventricle remodelling with improvement of ejection fraction was registered in our patient after a month. The second case presents a patient with heart failure caused by dilated cardiomyopathy; six months after CRT implantation the patient was still NYHA class III and with a significantly depressed left ventricular ejection fraction. Optimization of VV interval guided by echocardiography was undertaken measuring VTI of the left ventricular outflow tract (LVOT during programming of different VV intervals. The optimal VV interval was determined using a maximal LVOT VTI. A month after VV optimization our patient showed improvement in LV ejection fraction. Conclusion. Optimal management of patients treated with CRT integrate both clinical and echocardiographic follow

  6. Usefulness of echocardiography in preparticipation screening of competitive athletes.

    Science.gov (United States)

    Grazioli, Gonzalo; Merino, Beatriz; Montserrat, Silvia; Vidal, Bàrbara; Azqueta, Manel; Pare, Carles; Sarquella-Brugada, Georgia; Yangüas, Xavier; Pi, Ramon; Til, Lluis; Escoda, Jaume; Brugada, Josep; Sitges, Marta

    2014-09-01

    Despite the established diagnostic value of the electrocardiogram in preparticipation screening of athletes, some cardiac structural changes can be missed, particularly in early disease stages. The aim of this study was to evaluate the prevalence of cardiac structural changes via the systematic use of echocardiography in preparticipation screening of competitive athletes. Professional athletes or participants in a competitive athletic program underwent a screening that included family and personal medical history, physical examination, electrocardiography, exercise testing, and Doppler echocardiography. A total of 2688 athletes (67% men; mean age [standard deviation], 21 [10] years) were included. Most of the echocardiographic evaluations (92.5%) were normal and only 203 (7.5%) showed changes; the most frequent change was left ventricular hypertrophy, seen in 50 athletes (1.8%). Cessation of athletic activity was indicated in 4 athletes (0.14%): 2 for hypertrophic cardiomyopathy (electrocardiography had shown changes that did not meet diagnostic criteria), 1 pectus excavatum with compression of the right ventricle, and 1 significant pulmonary valve stenosis; the rest of the changes did not entail cessation of athletic activity and only indicated periodic monitoring. Although rare, some cardiac structural changes can be missed on physical examination and electrocardiography; in contrast, they are easily recognized with echocardiography. These findings suggest the use of echocardiography in at least the first preparticipation screening of competitive athletes to improve the effectiveness of programs aimed at preventing sudden death in athletes. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  7. Dobutamine stress echocardiography in healthy adult male rats

    Directory of Open Access Journals (Sweden)

    Couet Jacques

    2005-10-01

    Full Text Available Abstract Background Dobutamine stress echocardiography is used to investigate a wide variety of heart diseases in humans. Dobutamine stress echocardiography has also been used in animal models of heart disease despite the facts that the normal response of healthy rat hearts to this type of pharmacological stress testing is unknown. This study was performed to assess this normal response. Methods 15 normal adult male Wistar rats were evaluated. Increasing doses of dobutamine were infused intravenously under continuous imaging of the heart by a 12 MHz ultrasound probe. Results Dobutamine stress echocardiography reduced gradually LV diastolic and systolic dimensions. Ejection fraction increased by a mean of +24% vs. baseline. Heart rate increased progressively without reaching a plateau. Changes in LV dimensions and ejection fraction reached a plateau after a mean of 4 minutes at a constant infusion rate. Conclusion DSE can be easily performed in rats. The normal response is an increase in heart rate and ejection fraction and a decrease in LV dimensions. A plateau in echocardiographic measurements is obtained after 4 minutes of a constant infusion rate in most animals.

  8. Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Jürgen Biermann

    2012-01-01

    Full Text Available Accurate delineation of the variable left atrial anatomy is of utmost importance during anatomically based ablation procedures for atrial fibrillation targeting the pulmonary veins and possibly other structures of the atria. Intracardiac echocardiography allows real-time visualisation of the left atrium and adjacent structures and thus facilitates precise guidance of catheter-based ablation of atrial fibrillation. In patients with abnormal anatomy of the atria and/or the interatrial septum, intracardiac ultrasound might be especially valuable to guide transseptal access. Software algorithms like CARTOSound (Biosense Webster, Diamond Bar, USA offer the opportunity to reconstruct multiple two-dimensional ultrasound fans generated by intracardiac echocardiography to a three-dimensional object which can be merged to a computed tomography or magnetic resonance imaging reconstruction of the left atrium. Intracardiac ultrasound reduces dwell time of catheters in the left atrium, fluoroscopy, and procedural time and is invaluable concerning early identification of potential adverse events. The application of intracardiac echocardiography has the great capability to improve success rates of catheter-based ablation procedures.

  9. Role of echocardiography in diagnosis of pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Srbinovska Kostovska Elizabeta

    2013-07-01

    Full Text Available Pulmonary hypertension (PH is a progressive process that leads to right ventricular (RV overload, hypertrophy, dilatation and RV failure. In cases with chronic heart failure, this condition is associated with more severe symptoms and worse outcomes.Transthoracic echocardiography can give several parameters which correlate with right heart haemodynamics, and should be performed in a case of suspected PH. Several parameters are important for estimation of the RV function, which can be reason for poor outcome: right atrial and ventricular dimensions and volumes, functional area changes, tricuspid annular plane systolic excursion (TAPSE, myocardial performance index, infe- rior vena cava size and collapsibility, S velocity estimated by Tissue Doppler Imaging, and additional information obtained from the advance echocardiograpic techniques, like strain, strain rate, three-dimensional echocardiography. Estimation of PH based on Doppler echo- cardiography measurements is not suitable for screening of mild, asymptomatic PH. Echocardiography can be recommended as a screening tool for specific diseases, follow up PH, and assessment when right heart catheterization is indicated.

  10. [Constant-frequency trans-esophageal electric atrial stimulation for evaluation of the severity of illness in patients with stenocardia and the anti-angina effect of erinit].

    Science.gov (United States)

    Gasilin, V S; Sidorenko, B A; Lazarev, I A; Smirnov, M Iu

    1990-12-01

    Constant-frequency transesophageal atrial pacing was used in 87 patients with coronary heart disease concurrent with stable angina pectoris of various functional classes (I-IV). This technique, as a bicycle ergometric test, allows one to assess the functional class of patients with angina and to ascertain the antianginal effect of agents, which was exemplified by erinit given in doses of 80 and 120 mg.

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

    Science.gov (United States)

    Marum, Susan; Price, Susanna

    2011-08-01

    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.

  12. Transesophageal thoracic echocardiograpy combined with contrast transcranial Doppler detection of small patent foramen ovale and right-to-left shunt%TEE联合cTCD检测小型卵圆孔未闭RLS

    Institute of Scientific and Technical Information of China (English)

    张玉顺; 何璐; 成革胜; 何旭梅; 杜亚娟

    2013-01-01

    AIM:To compare the abilities of transesophageal echocardiography (TEE) and contrast transcranial Doppler (cTCD) to detect a right-to-left shunt (RLS) and small patent foramen ovale (PFO).METHODS:A total of 32 patients (18 males and 14 females) ages 16 to 52 years (mean 35.4 ± 14.6)years with small PFO were evaluated.Among the patients,21cases were due to cryptogenic stroke,five cases to transient ischemic attack and five cases were attributable to migraine.Cryptogenic stroke with infarcted lesions was confirmed by CT or MRI without other identifiable causes such as aorta and cerebral vascular disease or left ventricular system disease.Average diameter of PFO was < 2 mm,and atrial septum aneurysm may not be identified.RESULTS:Average diameter of PFO in 32 patients was 0.6-2.0mm (1.4 ± 0.5) mm by TEE without RLS by color Doppler.Degree of RLS was evaluated by cTCD and included four cases (12.5%) of grade Ⅰ,11 cases (34.4%) of grade Ⅱ,nine cases (28.2%) of grade Ⅲ and eight cases (25%) of grade Ⅳ.In all cases,4/32 cases (12.5%) were without RLS,20 cases (62.5%) with RLS after Valsalva maneuver and eight cases (25%) with RLS at rest.In 32 patients there were 28 cases of transcatheter closure treatment in which cTCD Ⅲ in > 17 cases were successfully completed interventional therapy.Mean operative time was (23.5 ± 7.3) min.In five patients with cTCD level Ⅱ,< 10 microemboli signals did not have successful closure.Six cases of 10-20 mlcroemboli signals were successfully occluded,but the average operative time was (65.5 ± 18.4) min,obviously longer than in the cTCD level Ⅲ group (P < 0.01).CONCLUSIONS:Simultaneous determination of the PFO size and RLS volume is needed in order to accurately reflect the clinical status of the PFO paradoxical embolism.%目的:探讨经食管超声心动图(transesophageal echocardiography,TEE)联合经颅多普勒超声声学造影(contrast transcranial Doppler,cTCD

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

    National Research Council Canada - National Science Library

    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

    2011-01-01

    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...

  14. Atrial fibrillation in rats induced by rapid transesophageal atrial pacing during brief episodes of asphyxia: a new in vivo model.

    Science.gov (United States)

    Haugan, Ketil; Lam, Henrik Rye; Knudsen, Carsten Boye; Petersen, Jørgen Søberg

    2004-07-01

    Non-pharmacological in vivo models of atrial fibrillation (AF) have been developed in large animals only. We aimed to develop and characterize a new small animal non-pharmacological in vivo model of AF. AF was induced by transesophageal atrial burst pacing during 35 seconds periods of asphyxia in anesthetized male Sprague-Dawley rats. AF was reproducibly induced in 81% of the rats. The presence of AF was associated with an increased heart rate, and a decreased blood pressure. Treatment with amiodarone, D,L-sotalol, flecainide, and propranolol all reduced duration of AF, whereas verapamil treatment was associated with a marked profibrillatory effect. Increasing gap junction intracellular communication using the antiarrhythmic peptide analogue AAP10 did not affect AF duration. Basal plasma level of epinephrine and norepinephrine were increased 5- to 20-fold relative to values reported by others, but unchanged following 35 seconds of asphyxia. The results from our study demonstrate that the rat model shares several clinical key characteristics with human AF: (1) hemodynamic response to AF; (2) increased autonomic tone; (3) antiarrhythmic effects of clinically used drugs; (4) profibrillatory effect of verapamil. Relative to existing models of AF in larger animals, this model offers rapid, predictive, and inexpensive testing of antiarrhythmic/profibrillatory effects of new drugs.

  15. Preventing complicated transseptal puncture with intracardiac echocardiography: case report

    Directory of Open Access Journals (Sweden)

    Temesvári András

    2005-03-01

    Full Text Available Abstract Background Recently, intracardiac echocardiography emerged as a useful tool in the electrophysiology laboratories for guiding transseptal left heart catheterizations, for avoiding thromboembolic and mechanical complications and assessing the ablation lesions characteristics. Although the value of ICE is well known, it is not a universal tool for achieving uncomplicated access to the left atrium. We present a case in which ICE led to interruption of a transseptal procedure because several risk factors for mechanical complications were revealed. Case presentation A case of a patient with paroxysmal atrial fibrillation and atrial flutter, and distorted intracardiac anatomy is presented. Intracardiac echocardiography showed a small oval fossa abouting to an enlarged aorta anteriorly. A very small distance from the interatrial septum to the left atrial free wall was seen. The latter two conditions were predisposing to a complicated transseptal puncture. According to fluoroscopy the transseptal needle had a correct position, but the intracardiac echo image showed that it was actually pointing towards the aortic root and most importantly, that it was virtually impossible to stabilize it in the fossa itself. Based on intracardiac echo findings a decision was made to limit the procedure only to ablation of the cavotricuspid isthmus and not to proceed further so as to avoid complications. Conclusion This case report illustrates the usefulness of the intracardiac echocardiography in preventing serious or even fatal complications in transseptal procedures when the cardiac anatomy is unusual or distorted. It also helps to understand the possible mechanisms of mechanical complications in cases where fluoroscopic images are apparently normal.

  16. Reliability of quantitative echocardiography in adult sheep and goats

    Directory of Open Access Journals (Sweden)

    Hallowell Gayle D

    2012-09-01

    Full Text Available Abstract Background Echocardiography is a non-invasive method for assessment of the ovine and caprine heart. Complete reference ranges for cardiac dimensions and time indices for both species are not currently available and reliability of these measurements has not been evaluated. The objectives for this study are to report reliability, normal cardiac dimensions and time indices in a large group of adult sheep and goats. Fifty-one adult sheep and forty adult goats were recruited. Full echocardiographic examinations were performed in the standing unsedated animal. All animals underwent echocardiography four times in a 72-hour period. Echocardiography was performed three times by one author and once by another. Images were stored and measured offline. Technique and measurement repeatability and reproducibility and any differences due to animal or day were evaluated. Reference ranges (mean ± 2 standard deviations were calculated for both species. Results Majority of the images obtained were of good to excellent quality. Image acquisition was straightforward with 5.4% of animals demonstrating a small scanning window. Reliability was excellent for majority of dimensions and time indices. There was less variation in repeatability when compared with reproducibility and differences were greater for technique than for measurements. Dimensions that were less reliable included those for right ventricular diameter and left ventricular free wall. There were many differences in cardiac dimensions between sheep and goats. Conclusions This study has demonstrated that specific reference ranges are required for these two species. Repeatability and reproducibility were excellent for the majority of cardiac dimensions and time indices suggesting that this technique is reliable and valuable for examination of clinical cases over time and for longitudinal research studies.

  17. Evaluation of diastolic function in hypertensive using echocardiography

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    Yamini Lavanya

    2015-09-01

    Results: The trans-mitral inflow parameters on Doppler echocardiography such as E wave deceleration time (DT, isovolumetric relaxation time (IVRT and early to late transmitral peak flow velocities ratio (E/A were significantly different in hypertensive subjects on treatment having normal ejection fraction, when compared to normotensive subjects. We observed a decrease in E/A ratio and increase in DT, IVRT with hypertension. Conclusions: From the present study it can be concluded that hypertension is significantly associated with diastolic dysfunction of heart, even in subjects with normal systolic function. [Int J Res Med Sci 2015; 3(9.000: 2274-2279

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

    Science.gov (United States)

    Mitchell, Katharyn Jean; Schwarzwald, Colin Claudio

    2016-03-01

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

  19. Speckle tracking echocardiography in mature Irish Wolfhound dogs

    DEFF Research Database (Denmark)

    Westrup, Ulrik; McEvoy, Fintan

    2013-01-01

    Two-dimensional strain measurements obtained by speckle tracking echocardiography (STE) have been reported in both humans and dogs. Incorporation of this technique into canine clinical practice requires the availability of measurements from clinically normal dogs, ideally of the same breed, taken...... under normal clinical conditions.The aims of this prospective study were to assess if it is possible to obtain STE data during a routine echocardiographic examination in Irish Wolfhound dogs and that these data will provide reference values and an estimation of measurement error....

  20. 经胸和经食管超声心动图诊断卵圆孔未闭的对比研究%Comparative Study on Diagnosis of Patent Foramen Ovale with Transthoracic and Transesophageal Echocardiography

    Institute of Scientific and Technical Information of China (English)

    倪显达; 卢中秋; 徐湘挺; 管丽洁; 谷笑蓉; 胡元平

    2004-01-01

    目的对比研究经胸超声心动图TTE和经食管超声心动图TEE对卵圆孔未闭(patent foramen ovale,PFO)的诊断方法和诊断价值,及对卵圆孔未闭的临床意义.方法运用经胸及经食管超声心动图检查,诊断卵圆孔未闭24例,根据患者有无合并其他心脏疾患及合并的心脏疾患的血流动力学特点将患者分为卵圆孔未闭组及卵圆孔开放组.结果经胸超声心动图通过CDFI观察房水平的穿隔血流对卵圆孔未闭的诊断准确率为58.3%.经食管超声心动图检查能对所有患者做出正确诊断.卵圆孔未闭组可见卵圆孔瓣上缘与继发隔之间裂缝,CDFI显示源于卵圆孔瓣与继发隔交界边缘处的穿隔血流;卵圆孔开放组可见卵圆孔瓣上缘与继发隔之间出现回声缺失,但卵圆孔瓣尚完整,CDFI于缺口处探及垂直于房间隔的穿隔分流束.结论经食管超声心动图是目前卵圆孔未闭诊断金标准的首选方法.卵圆孔未闭可导致反常栓塞,应予以积极治疗.

  1. Valvoplastia mitral percutânea em paciente gestante guiada apenas pelo ecocardiograma transesofágico Percutaneous mitral valvuloplastry in a pregnant woman guided only by the transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    José A. Mangione

    2007-03-01

    Full Text Available A estenose da válvula mitral é a lesão de válvula mais comum durante a gravidez. Apesar de um tratamento clínico eficaz e de uma anatomia valvular favorável, de acordo com o critério de Wilkins e Block [score de Wilkins-Block], a intervenção percutânea em pacientes sintomáticas mostra-se muito importante. Nessas pacientes, recomenda-se evitar ao máximo a exposição aos raios X para proteger o feto dos efeitos deletérios da radiação ionizante. Neste relato de caso, uma paciente de 24 anos, grávida, com grave estenose mitral (área valvular de 0,9 cm², foi submetida com sucesso a um tratamento percutâneo com ETE-guiado, sem o uso de raios X.Mitral valve stenosis is the most common valve lesion in pregnancy. In spite of an optimized clinical treatment and a favorable valve anatomy according to Wilkins and Block score, in symptomatic patients, percutaneous intervention is shown to be of great importance. In these patients, avoiding x-ray exposure as much as possible is recommended so as to protect the fetus from the deleterious effects of ionizing radiation. In this case report, a 24-year old pregnant patient with severe mitral stenosis (valve area of 0.9 cm² was successfully submitted to a TEE-guided percutaneous treatment, without the use of x-ray.

  2. EchoComTEE - a simulator for transoesophageal echocardiography.

    Science.gov (United States)

    Weidenbach, M; Drachsler, H; Wild, F; Kreutter, S; Razek, V; Grunst, G; Ender, J; Berlage, T; Janousek, J

    2007-04-01

    Transoesophageal echocardiography (TOE) requires extensive hands-on training, and it is for this purpose we have designed EchoComTEE, a simulator for TOE. It consists of a manikin and dummy probe; according to the position of the dummy probe (tracked by an electromagnetic sensor), two-dimensional (2D) images are calculated from three-dimensional (3D) data sets. Echocardiographic images are presented side-by-side with a virtual scene consisting of a 3D heart, probe tip and image plane. In this way the trainee is provided with visual feed-back of the relationship between echocardiogram and image plane position. We evaluated the simulator using a standardised questionnaire. Twenty-five experts and 31 novice users participated in the study. Most experts graded the simulator as realistic and all recommended its use for training. Most novice users felt the simulator supported spatial orientation during TOE and, as anaesthetists often do not have training in transthoracic echocardiography, in this group the TOE simulator might be particularly useful.

  3. Advanced echocardiography and clinical surrogates to risk stratify and manage patients with structural heart disease

    NARCIS (Netherlands)

    Debonnaire, Philippe Jean Marc Rita

    2016-01-01

    Part I focuses on the potential role of 3-dimensional echocardiography. At first a clinical risk score model for prediction of outcome in patients undergoing TAVI is presented (Chapter 2). Second the role of 3D-echocardiography is explored in depth in patients with mitral valve disease. Different no

  4. Advanced echocardiography and clinical surrogates to risk stratify and manage patients with structural heart disease

    NARCIS (Netherlands)

    Debonnaire, Philippe Jean Marc Rita

    2016-01-01

    Part I focuses on the potential role of 3-dimensional echocardiography. At first a clinical risk score model for prediction of outcome in patients undergoing TAVI is presented (Chapter 2). Second the role of 3D-echocardiography is explored in depth in patients with mitral valve disease. Different

  5. Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction

    DEFF Research Database (Denmark)

    Haugaa, Kristina H; Grenne, Bjørnar L; Eek, Christian H;

    2013-01-01

    The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI).......The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI)....

  6. The best of 2005 in echocardiography back from EuroEcho 9 – Florence, Italy

    Directory of Open Access Journals (Sweden)

    Sicari Rosa

    2006-02-01

    Full Text Available Abstract The ninth edition of the congress of the European Association of Echocardiography (EAE (former working group of Echocardiography held in Florence has just finished with a great success of participant attendance (2.842 and abstract submissions. Hot topics at EuroEcho 9 were: 1-live 3-dimensional echocardiography and surgical decision making; in pediatric cardiology; in resynchronization therapy 2- stress echocardiography beyond wall motion: from valve diseases to contractility to coronary flow reserve to diastolic function; 3- pulmonary cardiogenic interstitial thickening recognized by ultrasonic lung comets; 4- the "proven clinical inefficacy" of the many technologies sold as breakthrough: color kinesis, tissue characterization, strain rate, tissue Doppler, applied to stress echocardiography.

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

    Science.gov (United States)

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

    2015-11-01

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

  8. Increased clutter level in echocardiography due to specular reflection

    Science.gov (United States)

    Fatemi, Ali; Torp, Hans; Aakhus, Svend; Rodriguez-Molares, Alfonso

    2017-03-01

    State-of-the-art echocardiography allows to correctly diagnose most of cardiovascular diseases. An unknown source of clutter, however, hinders the visualization of the heart in some cases. We believe this clutter is caused by the ultrasound beam being partially reflected by the ribs into the elevation direction, so that structures outside the imaging plane are displayed on top of the heart image as clutter noise. We conducted in vitro experiments in a water tank using a synthetic ventricle and pig ribs. By partially blocking the probe with the ribs in the elevation direction, objects outside the imaging plane were rendered in the B-mode image, which confirms that the ribs can behave as specular reflectors. In addition, we succeeded in reproducing clutter noise using a piece of polystyrene to simulate the reflections from the lungs. This indicates that the origin of the clutter noise in echocardiograms can be reverberation coming from the lungs via specular reflection at the ribs.

  9. Echocardiography and heart failure: a glimpse of the right heart.

    Science.gov (United States)

    Pleister, Adam; Kahwash, Rami; Haas, Garrie; Ghio, Stefano; Cittadini, Antonio; Baliga, Ragavendra R

    2015-01-01

    The catastrophic consequences for patients in the settings of certain clinical conditions such as acute right ventricular infarction or massive pulmonary embolism with right heart failure illustrate the essential role that the right ventricle plays in sustaining life. With the development of more sophisticated diagnostic imaging technologies at the end of the last century and the dawn of this century, the importance of the right ventricle has been clearly demonstrated. The continued and evolving nature of our understanding of the right ventricle was emphasized in 2006, when the National Heart, Blood, and Lung Institute formed a working group focused on developing a better understanding of the right ventricle in both healthy and disease states. The objective of this review paper is to examine the right ventricle structure and function and describe the role of echocardiography in the evaluation of the right ventricle and right heart failure. Special focus will be on echocardiographic images and major society guidelines. © 2014, Wiley Periodicals, Inc.

  10. Imaging Aortic Regurgitation: The Incremental Benefit of Speckle Tracking Echocardiography

    Science.gov (United States)

    Garg, Pankaj; Yassin, Firas; Leischik, Roman

    2015-01-01

    Aortic regurgitation (AR) affects global left ventricular mechanics. However, limited literature is available on how it may affect regional longitudinal strain. We present a case where severe AR jet is thrashing the anterior-septal wall and reducing its overall longitudinal performance most likely secondary to increased wall shear stress in diastole. This new insight into patho-physiological process using deformation study may have supplementary impact in decision making for surgical intervention. Transthoracic echocardiography is the primary imaging modality for the assessment of AR as it offers evaluation of severity of AR, aetiology of AR, left ventricular (LV) dilatation, LV systolic function, left ventricular mass, diastolic function and global strain. This case highlights the regional disturbances in longitudinal strain in eccentric AR. PMID:27006711

  11. Low Prevalance of Major Events Adverse to Exercise Stress Echocardiography

    Science.gov (United States)

    Andrade, Stephanie Macedo; Telino, Caio José Coutinho Leal; Sousa, Antônio Carlos Sobral; de Melo, Enaldo Vieira; Teixeira, Carla Carolina Cardoso; Teixeira, Clarissa Karine Cardoso; Santana, Jaquiele Santos; Mota, Igor Larchert; de Matos, Carlos José Oliveira; Oliveira, Joselina Luzia Menezes

    2016-01-01

    Background: Stress echocardiography is well validated for diagnosis and risk stratification of coronary artery disease. Exercise stress echocardiography (ESE) has been shown to be the most physiological among the modalities of stress, but its safety is not well established. Objective: To study the complications related to ESE and clinical and echocardiographic variables most commonly associated with their occurrence. Methods: Cross-sectional study consisting of 10250 patients submitted to ESE for convenience, from January 2000 to June 2014. Cardiac Arrhythmias (CA) were the most frequent complications observed during the examination. The volunteers were divided into two groups according to the occurrence of CA during ESE: G1 group, composed of patients who have CA, and G2 formed by individuals who did not show such complication. Results: Group G1, consisting of 2843 patients (27.7%), and Group G2 consisting of 7407 patients (72.3%). There was no death, acute myocardial infarction, ventricular fibrillation or asystole. Predominant CAs were: supraventricular extrasystoles (13.7%), and ventricular extrasystoles (11.5%). G1 group had a higher mean age, higher frequency of hypertension and smoking, larger aortic roots and left atrium (LA) and lower ejection fraction than G2. G1 group also had more ischemic changes (p < 0.001). The predictor variables were age (RR 1.04; [CI] 95% from 1.038 to 1.049) and LA (RR 1.64; [CI] 95% from 1.448 to 1.872). Conclusion: ESE proved to be a safe modality of stress, with non-fatal complications only. Advanced age and enlargement of the left atrium are predictive of cardiac arrhythmias. PMID:27355587

  12. Repeated bedside echocardiography in children with respiratory failure

    Directory of Open Access Journals (Sweden)

    Jehlicka Petr

    2011-04-01

    Full Text Available Abstract Background The aim of this study was to verify the benefits and limitations of repeated bedside echocardiographic examinations in children during mechanical ventilation. For the purposes of this study, we selected the data of over a time period from 2006 to 2010. Methods A total of 235 children, average age 3.21 (SD 1.32 years were included into the study and divided into etiopathogenic groups. High-risk groups comprised: Acute lung injury and acute respiratory distress syndrome (ALI/ARDS, return of spontaneous circulation after cardiopulmonary resuscitation (ROSC, bronchopulmonary dysplasia (BPD, cardiomyopathy (CMP and cardiopulmonary disease (CPD. Transthoracic echocardiography was carried out during mechanical ventilation. The following data were collated for statistical evaluation: right and left ventricle myocardial performance indices (RV MPI; LV MPI, left ventricle shortening fraction (SF, cardiac output (CO, and the mitral valve ratio of peak velocity of early wave (E to the peak velocity of active wave (A as E/A ratio. The data was processed after a period of recovery, i.e. one hour after the introduction of invasive lines (time-1 and after 72 hours of comprehensive treatment (time-2. The overall development of parameters over time was compared within groups and between groups using the distribution-free Wilcoxons and two-way ANOVA tests. Results A total of 870 echocardiographic examinations were performed. At time-1 higher average values of RV MPI (0.34, SD 0.01 vs. 0.21, SD 0.01; p Conclusion Echocardiography complements standard monitoring of valuable information regarding cardiac load in real time. Chest excursion during mechanical ventilation does not reduce the quality of the acquired data.

  13. On-orbit prospective echocardiography on International Space Station crew.

    Science.gov (United States)

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

    2011-05-01

    A prospective trial of echocardiography was conducted on six crew members onboard the International Space Station. The main objective was to determine the efficacy of remotely guided tele-echocardiography, including just-in-time e-training methods and determine what is "space normal" echocardiographic data. Each crew member operator (n = 6) had 2-hour preflight training. Baseline echocardiographic data were collected 55-167 days preflight. Similar equipment was used in each 60-minute in-flight session (mean microgravity exposure--114 days [34--190]). On-orbit ultrasound (US) operators used an e-learning system within 24 hours of these sessions. Expert assistance was provided using US video downlink and two-way voice. Testing was repeated 5-16 days after landing. Separate ANOVA was used on each echocardiographic variable (n = 33). Within each ANOVA, three tests were made: (a) effect of mission phase (preflight, in-flight, postflight); (b) effect of echo technician (two technicians independently analyzed the data); (c) interaction between mission phase and technician. Eleven rejections of the null hypothesis (mission phase or technician or both had no effect) were found that could be considered for possible follow up. Of these, eight rejections were for significant technician effects, not space flight. Three rejections of the null hypothesis (aortic valve time velocity integral, mitral E-wave velocity, and heart rate) were attributable to space flight but determine to not be clinically significant. No rejections were due to the interaction between technician and space flight. Thus, we found no consistent clinically significant effects of long-duration space flight on echocardiographic variables of the given group of subjects. © 2011, Wiley Periodicals, Inc.

  14. Four-dimensional echocardiography area strain combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis.

    Science.gov (United States)

    Deng, Yan; Peng, Long; Liu, Yuan-Yuan; Yin, Li-Xue; Li, Chun-Mei; Wang, Yi; Rao, Li

    2017-07-28

    The aim of this prospective study was to assess the diagnosis value of four-dimensional echocardiography area strain (AS) combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis. Based on treadmill exercise load status, two-dimensional conventional echocardiography and four-dimensional echocardiography area strain were performed on patients suspected coronary artery disease before coronary angiogram. Thirty patients (case group) with mild left anterior descending coronary artery stenosis (stenosis coronary artery stenosis according to the coronary angiogram results were prospectively enrolled. All the patients had no left ventricular regional wall motion abnormality in two-dimensional echocardiography at rest and exercise stress. There was no significant difference in the 16 segmental systolic peak AS at rest between two groups. After exercise stress, the peak systolic ASrest-stress at mid anterior wall (-7.00%±10.90% vs 2.80%±23.69%) and mid anterolateral wall (-4.40%±18.81% vs 8.80%±19.16%) were decreased, while increased at basal inferolateral wall (14.00%±19.27% vs -5.60%±15.94%) in case group compared with control group (Pcoronary artery stenosis, the area strain was decreased at involved segments, while compensatory increased at noninvolved segments after exercise stress. Four-dimensional echocardiography area strain combined with exercise stress echocardiography could sensitively find left ventricular regional systolic function abnormality in patients with mild single vessel coronary artery stenosis, and locate stenosis coronary artery accordingly. © 2017, Wiley Periodicals, Inc.

  15. Saline contrast echocardiography for the detection of patent foramen ovale in hypoxia: a validation study using intracardiac echocardiography.

    Science.gov (United States)

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

    2014-04-01

    Although the "3 beat rule" is widely utiized to discriminate patent foramen ovale (PFO)-mediated right-to-left shunt (RTLS) from intrapulmonary RTLS using saline contrast transthoracic echocardiography (SCE), SCE diagnostic performance has yet to be validated using an invasive intracardiac standard. Percutaneous PFO occluder placement was recently shown to ameliorate hypoxia in patients with suspected PFO-mediated RTLS. We evaluated the ability of SCE to predict PFO presence and size using intracardiac echocardiography (ICE) as a gold standard in a hypoxic cohort. Sixty-three hypoxic patients with suspected PFO-mediated RTLS who underwent SCE at rest, with Valsalva maneuver, and with cough prior to ICE were evaluated retrospectively. PFO RTLS was defined by ICE findings including PFO anatomy, RTLS by saline contrast and color Doppler, and probe patency. SCE shunt severity and timing of left heart saline target appearance were compared to the presence of ICE-defined PFO RTLS. Forty-seven patients (75%) met criteria for PFO-mediated RTLS. A 4 beat cutoff for resting SCE provided optimal diagnostic performance for detection of PFO-mediated RTLS with a 71% sensitivity, 94% specificity, and 97% positive predictive value (PPV). Valsalva and cough maneuvers improved sensitivity compared to rest SCE (89% and 80%, respectively). Valsalva SCE shunt severity more accurately predicted PFO size than resting SCE. In contrast to the widely accepted "3 beat rule," resting SCE for the detection of PFO RTLS in a hypoxic population performs optimally using a 4-cycle cutoff with both excellent specificity and PPV. © 2013, Wiley Periodicals, Inc.

  16. DOBUTAMINE STRESS-ECHOCARDIOGRAPHY: POSSIBILITY OF CLINICAL USAGE IN CARDIOLOGY PRACTICE

    Directory of Open Access Journals (Sweden)

    M. A. Saidova

    2016-01-01

    Full Text Available Currently stress-echocardiography or so-called burden echocardiography is essential method of patient examination to reveal latent ischemic heart disease (IHD. That is one of the mostly informative non-invasive methods of IHD diagnosis as well as efficacy evaluation of coronary angioplasty, surgical and pharmacological treatments of IHD. Dobutamine usage as a stress-agent at burden echocardiography allows evaluating not only ischemia but a myocardial vitality in post infarction area as well as clarify severity of valve stenosis, pulmonary hypertension and extent of latent obstruction of exhaust duct of the left ventricle. Method possibilities are presented as well as test protocol, main indications and contraindications.

  17. 3-dimensional echocardiography and its role in preoperative mitral valve evaluation.

    Science.gov (United States)

    Andrawes, Michael N; Feinman, Jared W

    2013-05-01

    Echocardiography plays a key role in the preoperative evaluation of mitral valve disease. 3-dimensional echocardiography is a relatively new development that is being used more and more frequently in the evaluation of these patients. This article reviews the available literature comparing the use of this new technology to classic techniques in the assessment of mitral valve pathology. The authors also review some of the novel insights learned from 3-dimensional echocardiography and how they may be used in surgical decision making and planning.

  18. Targeted neonatal echocardiography services: need for standardized training and quality assurance.

    LENUS (Irish Health Repository)

    Finan, Emer

    2014-10-01

    Targeted neonatal echocardiography refers to a focused assessment of myocardial performance and hemodynamics directed by a specific clinical question. It has become the standard of care in many parts of the world, but practice is variable, and there has been a lack of standardized training and evaluation to date. Targeted neonatal echocardiography was first introduced to Canada in 2006. The purpose of this study was to examine the characteristics of targeted neonatal echocardiography practice and training methods in Canadian neonatal intensive care units (NICUs).

  19. Respiratory influence on left atrial volume calculation with 3D-echocardiography

    DEFF Research Database (Denmark)

    Sørgaard, Mathias; Linde, Jesper J; Ismail, Hafsa;

    2016-01-01

    BACKGROUND: Left atrial volume (LAV) estimation with 3D echocardiography has been shown to be more accurate than 2D volume calculation. However, little is known about the possible effect of respiratory movements on the accuracy of the measurement. METHODS: 100 consecutive patients admitted...... with chest pain were examined with 3D echocardiography and LAV was quantified during inspiratory breath hold, expiratory breath hold and during free breathing. RESULTS: Of the 100 patients, only 65 had an echocardiographic window that allowed for 3D echocardiography in the entire respiratory cycle. Mean...

  20. DOBUTAMINE STRESS-ECHOCARDIOGRAPHY: POSSIBILITY OF CLINICAL USAGE IN CARDIOLOGY PRACTICE

    Directory of Open Access Journals (Sweden)

    M. A. Saidova

    2009-01-01

    Full Text Available Currently stress-echocardiography or so-called burden echocardiography is essential method of patient examination to reveal latent ischemic heart disease (IHD. That is one of the mostly informative non-invasive methods of IHD diagnosis as well as efficacy evaluation of coronary angioplasty, surgical and pharmacological treatments of IHD. Dobutamine usage as a stress-agent at burden echocardiography allows evaluating not only ischemia but a myocardial vitality in post infarction area as well as clarify severity of valve stenosis, pulmonary hypertension and extent of latent obstruction of exhaust duct of the left ventricle. Method possibilities are presented as well as test protocol, main indications and contraindications.

  1. Comparison of the Effects of Sevoflurane, Desflurane and Totally Intravenous Anaesthesia with Propofol on Haemodynamic Variables Using Transesophageal Doppler

    Directory of Open Access Journals (Sweden)

    Selen Osmanagaoglu

    2008-01-01

    Full Text Available Sevoflurane and desflurane inhalation anaesthetics are in routine use providing more rapid recovery than pre-existing inhalation anaesthetics. We wanted to compare the effect of different anaesthetic agents on haemodynamic parameters with using transesophageal echo-Doppler in ASA I-II patients. A total of 45 American Society of Anes-thesiologists (ASA physical status I-II patients age between 18-65 scheduled for elective major abdominal surgery were admitted to this prospective randomized study and divided into three groups. Induction of anaesthesia was provided with 1µgkg -1 fentanyl, 6-8 mgkg -1 thiopenthal and 0.1 mgkg -1 vecuronium in sevoflurane (Group S, n=15, and desflurane (Group D, n=15, and 1µgkg -1 remifentanil, 2mgkg -1 propofol, and 0.1 mgkg -1 vecuronium in totally intrave-nous anaesthesia (TIVA group (Group T; n=15. For maintenance of anaesthesia, patients received an infusion of 0.15 µgkg -1 min remifentanil, 4-6 mgkg -1 h -1 propofol, sevoflurane 2%, or desflurane 6% at 1.0 MAC. Bispectral index (BIS values of 40-60 were targeted during operation. After endotracheal intubation, the haemodynamic and respira-tory parameters, and BIS were recorded 5 min after the intubation (T 0 , 30 min after the intubation (T 1 , 60 min after the intubation (T 2 and before the extubation (T 3 with using haemodynamic monitoring (Hemosonic 100. After induction of anaesthetic agents, heart rate (HR increased significantly in desflurane group (Group D compared with group sevoflurane (Group S and TIVA (Group T groups at 5 min after the intubations, 30 min after the intubations, 60 min after the intubations and compared with group sevoflurane before the extubation. The Stroke Volume (SV values increased significantly at the 5th minute intubation in Group S as compared to the Group D and in Group D as compared to the Group T. Compared with Group D, maximum acceleration (Acc increased significanly in Group T before extubation. The BIS values were

  2. Guidelines for the provision of echocardiography in Canada: recommendations of a joint Canadian Cardiovascular Society/Canadian Society of Echocardiography Consensus Panel.

    Science.gov (United States)

    Sanfilippo, Anthony J; Bewick, David; Chan, K L; Cujec, Bibiana; Dumesnil, J G; Honos, George; Munt, Brad; Sasson, Zion; Tam, James; Tomlinson, Charles; Aboguddah, Ayman; Ahmed, Shaheeda; Ali, Mohamed; Arsenault, Marie; Ascah, Kathryn; Ashton, Tom; Baird, Michael; Basmadjian, Arsene; Beique, Francois; Blakeley, Michael; Blais, Marie-Josee; Burggraf, Gary; Burwash, Ian; Cochrane, Jessica; Fagan, Susan; Giannoccaro, Peter; Hughes, William; Jones, Alan; Jue, John; Koilpillai, Chris; Leblanc, Marie-Helene; Londry, Colleen; Morgan, Dennis; O'Reilly, Michael; Sawchuk, Corey; Siu, Samuel; Sochowski, Randy; Tremblay, Guy; Welikovitch, Lisa; Yu, Eric

    2005-07-01

    Recognizing the central role of echocardiographic examinations in the assessment of most cardiac disorders and the need to ensure the provision of these services in a highly reliable, timely, economical and safe manner, the Canadian Cardiovascular Society and Canadian Society of Echocardiography undertook a comprehensive review of all aspects influencing the provision of echocardiographic services in Canada. Five regional panels were established to develop preliminary recommendations in the five component areas, which included the echocardiographic examination, the echocardiographic laboratory and report, the physician, the sonographer and indications for examinations. Membership in the panels was structured to recognize the regional professional diversity of individuals involved in the provision of echocardiography. In addition, a focus group of cardiac sonograhers was recruited to review aspects of the document impacting on sonographer responsibilities and qualification. The document is intended to be used as a comprehensive and practical reference for all of those involved in the provision of echocardiography in Canada.

  3. Clinical utility of digital dobutamine stress echocardiography in the noninvasive evaluation of coronary artery disease.

    Science.gov (United States)

    Madu, E C; Ahmar, W; Arthur, J; Fraker, T D

    1994-05-23

    Exercise electrocardiography is an established mode of evaluation for patients with suspected coronary artery disease. It also provides prognostic information and guides therapeutic management in patients with established disease. However, some patients are unable to exercise because of orthopedic problems, neurologic diseases, peripheral vascular disease, or deconditioning. In the past, these patients have been referred for angiography to help assess their disease. Recently, however, new techniques to assess myocardial perfusion and/or function, including stress echocardiography, have been used in the noninvasive assessment of coronary artery disease in this group of patients. Echocardiography has been used in combination with different drugs, including dobutamine, dipyridamole, and adenosine. Dobutamine is probably the single most studied drug for stress echocardiography. Dobutamine stress echocardiography is a safe, feasible, and valuable technique for evaluating coronary artery disease.

  4. The role of 3D and speckle tracking echocardiography in cardiac amyloidosis: a case report.

    Science.gov (United States)

    Nucci, E M; Lisi, M; Cameli, M; Baldi, L; Puccetti, L; Mondillo, S; Favilli, R; Lunghetti, S

    2014-01-01

    Cardiac amyloidosis (CA) is a disorder characterized by amyloid fibrils deposition in cardiac interstitium; it results in a restrictive cardiomyopathy with heart failure (HF) and conduction abnormalities. The "gold standard" for diagnosis of CA is myocardial biopsy but possible sampling errors and procedural risks, limit it's use. Magnetic resonance (RMN) offers more information than traditional echocardiography and allows diagnosis of CA but often it's impossible to perform. We report the case of a man with HF and symptomatic bradyarrhythmia that required an urgent pacemaker implant. Echocardiography was strongly suggestive of CA but wasn't impossible to perform an RMN to confirm this hypothesis because the patient was implanted with a definitive pacemaker. So was performed a Speckle Tracking Echocardiography (STE) and a 3D echocardiography: STE allows to differentiate CA from others hypertrophic cardiomyopathy by longitudinal strain value eco 3D and STE for early diagnosis of CA, especially when RMN cannot be performed.

  5. Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus V; Høst, Ulla; Arpi, Magnus;

    2011-01-01

    Staphylococcus aureus infective endocarditis (IE) is a critical medical condition associated with a high morbidity and mortality. In the present study, we prospectively evaluated the importance of screening with echocardiography in an unselected S. aureus bacteraemia (SAB) population....

  6. The Role of Echocardiography in Coronary Artery Disease and Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Maryam Esmaeilzadeh

    2015-10-01

    Full Text Available Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardial effusion.Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea.This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction

  7. [Nursing care for patients undergoing pharmacological stress echocardiography: implications for clinical practice].

    Science.gov (United States)

    de Goes, Marta Georgina Oliveira; Lautert, Liana; Lucena, Amália Fátima

    2012-06-01

    The study aim was both to identify signs and symptoms previous to and during the pharmacological stress echocardiography test and to describe the nurse's role and nursing care principles for this exam. This is a descriptive study, carried out in cardiac care unit in a University Hospital in Porto Alegre, RS. Two hundred forty-six records of patients submitted to stress echocardiography were retrospectively reviewed, according to four different pharmacological schedules. The statistical comparison showed that signs and symptoms were related to the type of drug used during the exam, namely: typical angina, precordial ache, tiredness, headache and premature complexes. These results enabled a better understanding of pharmacological stress echocardiography and the instrumentalization of nurses in order to plan individualized and qualified nursing care assistance. Aside from helping develop nursing practices for the pharmacological stress echocardiography test this knowledge could also be used by nurses who carry out their activities in institutions that use this diagnostic method.

  8. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging

    National Research Council Canada - National Science Library

    Amundsen, Brage H; Helle-Valle, Thomas; Edvardsen, Thor; Torp, Hans; Crosby, Jonas; Lyseggen, Erik; Støylen, Asbjørn; Ihlen, Halfdan; Lima, João A C; Smiseth, Otto A; Slørdahl, Stig A

    2006-01-01

    The aim of this study was to validate speckle tracking echocardiography (STE) as a method for angle-independent measurement of regional myocardial strain, using sonomicrometry and magnetic resonance imaging (MRI...

  9. Comparison of echocardiography and angiography in determining the cause of severe aortic regurgitation.

    Science.gov (United States)

    DePace, N L; Nestico, P F; Kotler, M N; Mintz, G S; Kimbiris, D; Goel, I P; Glazier-Laskey, E E; Ross, J

    1984-01-01

    To assess the accuracy of echocardiography in determining the cause of aortic regurgitation M mode and cross sectional echocardiography were compared with angiography in 43 patients with predominant aortic regurgitation. Each patient had all three investigations performed during the same admission to hospital. In each instance, the cause of aortic regurgitation was confirmed at surgery or necropsy. Seventeen patients had rheumatic aortic valve disease, 13 bacterial endocarditis with a perforated or partially destroyed cusp, five a bicuspid aortic valve (four with a history of endocarditis), and eight aortic regurgitation secondary to aortic root dilatation or aneurysm. Overall sensitivity of echocardiography and aortography was 84% in determining the cause of aortic regurgitation. Thus, rheumatic valve disease and endocarditis appear to be the most common causes of severe aortic regurgitation in this hospital based population. Furthermore, echocardiography is a sensitive non-invasive technique for determining the cause of aortic regurgitation and allows differentiation of valvular from root causes of aortic regurgitation.

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

    Directory of Open Access Journals (Sweden)

    Gus Mitsopoulos

    2015-01-01

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

  11. Echocardiographic Evaluation of Cardiac Function in Ischemic Rats: Value of M-Mode Echocardiography

    OpenAIRE

    Darbandi Azar, Amir; Tavakoli, Fatemeh; Moladoust, Hassan; Zare, Asghar; Sadeghpour, Anita

    2014-01-01

    Background: Echocardiography is a well-established diagnostic tool for a safe, reproducible and accurate evaluation of cardiac anatomy, hemodynamics and function in clinical practice. Objectives: We sought to demonstrate the efficacy and feasibility of M-mode echocardiography to evaluate cardiac structure and function in normal and MI-induced adult rats. Materials and Methods: All animal procedures were approved by the ethics committee of Tehran University of Medical Sciences and the investig...

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

    OpenAIRE

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

    2013-01-01

    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 investig...

  13. Dobutamine Stress Echocardiography Safety in Chagas Disease Patients

    Directory of Open Access Journals (Sweden)

    Daniela do Carmo Rassi

    Full Text Available Abstract Background: A few decades ago, patients with Chagas disease were predominantly rural workers, with a low risk profile for obstructive coronary artery disease (CAD. As urbanization has increased, they became exposed to the same risk factors for CAD of uninfected individuals. Dobutamine stress echocardiography (DSE has proven to be an important tool in CAD diagnosis. Despite being a potentially arrhythmogenic method, it is safe for coronary patients without Chagas disease. For Chagas disease patients, however, the indication of DSE in clinical practice is uncertain, because of the arrhythmogenic potential of that heart disease. Objectives: To assess DSE safety in Chagas disease patients with clinical suspicion of CAD, as well as the incidence of arrhythmias and adverse events during the exam. Methods: Retrospective analysis of a database of patients referred for DSE from May/2012 to February/2015. This study assessed 205 consecutive patients with Chagas disease suspected of having CAD. All of them had their serology for Chagas disease confirmed. Results: Their mean age was 64±10 years and most patients were females (65.4%. No patient had significant adverse events, such as acute myocardial infarction, ventricular fibrillation, asystole, stroke, cardiac rupture and death. Regarding arrhythmias, ventricular extrasystoles occurred in 48% of patients, and non-sustained ventricular tachycardia in 7.3%. Conclusion: DSE proved to be safe in this population of Chagas disease patients, in which no potentially life-threatening outcome was found.

  14. Soluble Suppression of Tumorigenicity 2 and Echocardiography in Sepsis.

    Science.gov (United States)

    Yang, Hyun Suk; Hur, Mina; Kim, Hanah; Magrini, Laura; Marino, Rossella; Di Somma, Salvatore

    2016-11-01

    Soluble suppression of tumorigenicity 2 (sST2) has emerged as a biomarker of cardiac stretch or remodeling, and has demonstrated a role in acutely decompensated heart failure. However, its role in sepsis-induced cardiac dysfunction is still unknown. We explored whether sST2 serum concentration reflects either systolic or diastolic dysfunction as measured by Doppler echocardiography. In a total of 127 patients with sepsis, correlations between sST2 and blood pressure, left ventricular (LV) ejection fraction, LV diastolic filling (ratio of early transmitral flow velocity to early diastolic mitral annulus velocity), and resting pulmonary arterial pressure were evaluated. Correlations between sST2 and other sepsis biomarkers (high-sensitivity C-reactive protein [hs-CRP] and procalcitonin) were also examined. sST2 showed a moderate correlation with mean arterial pressure (r=-0.3499) but no correlation with LV ejection fraction, diastolic filling, or resting pulmonary hypertension. It showed moderate correlations with hs-CRP and procalcitonin (r=0.2608 and r=0.3829, respectively). sST2 might have a role as a biomarker of shock or inflammation, but it cannot reflect echocardiographic findings of LV ejection fraction or diastolic filling in sepsis.

  15. COMPARISON OF CARDIAC BIOMARKERS AND ECHOCARDIOGRAPHY IN DIAGNOSING MYOCARDITIS

    Directory of Open Access Journals (Sweden)

    Nimi Bharathan

    2017-03-01

    Full Text Available BACKGROUND Conventional methods used to diagnose or rule out myocarditis is not useful in detecting cardiac myocyte injury in clinically suspected cases. Endomyocardial biopsy and histopathological examination is not feasible in most government hospitals in India. Sensitive parameters have yet to be found out. The study was conducted to find out whether diagnosis of myocarditis in clinically suspected cases can be done by measurement of serum levels of cardiac troponinI (cTnI and MB isoform of creatine kinase (CK-MB. MATERIALS AND METHODS 19 patients with clinically suspected myocarditis were screened for CK-MB activity and cTnI. Echocardiography, ECG and IgM for leptospirosis were also checked in these patients. RESULTS cTnI was elevated in 10 out of 19 patients with clinically suspected myocarditis. CK-MB was elevated in 7 patients. CONCLUSION Elevation of cTnI level in blood can be taken as an indicator of cardiac muscle cell injury in suspected cases of myocarditis.

  16. Complications during pharmacological stress echocardiography: a video-case series

    Directory of Open Access Journals (Sweden)

    Bigi Riccardo

    2005-09-01

    Full Text Available Abstract Background Stress echocardiography is a cost-effective tool for the modern noninvasive diagnosis of coronary artery disease. Several physical and pharmacological stresses are used in combination with echocardiographic imaging, usually exercise, dobutamine and dipyridamole. The safety of a stress is (or should be a major determinant in the choice of testing. Although large scale single center experiences and multicenter trial information are available for both dobutamine and dipyridamole stress echo testing, complications or side effects still can occur even in the most experienced laboratories with the most skilled operators. Case presentation We decided to present a case collection of severe complications during pharmacological stress echo testing, including a ventricular tachycardia, cardiogenic shock, transient ischemic attack, torsade de pointe, fatal ventricular fibrillation, and free wall rupture. Conclusion We believe that, in this field, every past complication described is a future complication avoided; what happens in your lab is more true of what you read in journals; and Good Clinical Practice is not "not having complications", but to describe the complications you had.

  17. Dobutamine Stress Echocardiography Safety in Chagas Disease Patients

    Science.gov (United States)

    Rassi, Daniela do Carmo; Vieira, Marcelo Luiz Campos; Furtado, Rogerio Gomes; Turco, Fabio de Paula; Melato, Luciano Henrique; Hotta, Viviane Tiemi; Nunes, Colandy Godoy de Oliveira; Rassi Jr., Luiz; Rassi, Salvador

    2017-01-01

    Background A few decades ago, patients with Chagas disease were predominantly rural workers, with a low risk profile for obstructive coronary artery disease (CAD). As urbanization has increased, they became exposed to the same risk factors for CAD of uninfected individuals. Dobutamine stress echocardiography (DSE) has proven to be an important tool in CAD diagnosis. Despite being a potentially arrhythmogenic method, it is safe for coronary patients without Chagas disease. For Chagas disease patients, however, the indication of DSE in clinical practice is uncertain, because of the arrhythmogenic potential of that heart disease. Objectives To assess DSE safety in Chagas disease patients with clinical suspicion of CAD, as well as the incidence of arrhythmias and adverse events during the exam. Methods Retrospective analysis of a database of patients referred for DSE from May/2012 to February/2015. This study assessed 205 consecutive patients with Chagas disease suspected of having CAD. All of them had their serology for Chagas disease confirmed. Results Their mean age was 64±10 years and most patients were females (65.4%). No patient had significant adverse events, such as acute myocardial infarction, ventricular fibrillation, asystole, stroke, cardiac rupture and death. Regarding arrhythmias, ventricular extrasystoles occurred in 48% of patients, and non-sustained ventricular tachycardia in 7.3%. Conclusion DSE proved to be safe in this population of Chagas disease patients, in which no potentially life-threatening outcome was found. PMID:28099588

  18. Augmented reality simulator for training in two-dimensional echocardiography.

    Science.gov (United States)

    Weidenbach, M; Wick, C; Pieper, S; Quast, K J; Fox, T; Grunst, G; Redel, D A

    2000-02-01

    In two-dimensional echocardiography the sonographer must synthesize multiple tomographic slices into a mental three-dimensional (3D) model of the heart. Computer graphics and virtual reality environments are ideal to visualize complex 3D spatial relationships. In augmented reality (AR) applications, real and virtual image data are linked, to increase the information content. In the presented AR simulator a 3D surface model of the human heart is linked with echocardiographic volume data sets. The 3D echocardiographic data sets are registered with the heart model to establish spatial and temporal congruence. The heart model, together with an animated ultrasound sector represents a reference scenario, which displays the currently selected two-dimensional echocardiographic cutting plane calculated from the volume data set. Modifications of the cutting plane within the echocardiographic data are transferred and visualized simultaneously and in real time within the reference scenario. The trainee can interactively explore the 3D heart model and the registered 3D echocardiographic data sets by an animated ultrasound probe, whose position is controlled by an electromagnetic tracking system. The tracking system is attached to a dummy transducer and placed on a plastic puppet to give a realistic impression of a two-dimensional echocardiographic examination.

  19. Teles-operated echocardiography using a robotic arm and an internet connection.

    Science.gov (United States)

    Arbeille, Philippe; Provost, Romain; Zuj, Kathryn; Dimouro, Dominique; Georgescu, Monica

    2014-10-01

    The objective was to design and validate a method of tele-operated echocardiography. The method was tested in a hospital facility with an expert sonographer located in a room 10 m away from the patient. An ultrasound probe, fixed to a motorized probe holder, was located on the patient by a non-sonographer and was remotely controlled by the expert sonographer via an Internet connection. Scans were performed on 41 cardiac patients. The quality of the cardiac views obtained using tele-echocardiography was lower than that of reference echocardiography, but generated similar measurements in 93%-100% of the cases. Bland-Altman plots and statistical comparison of tele- and reference echocardiography measures revealed no differences (p > 0.05). Of the 71 valve leaks or aortic stenoses present, 61 (86%) were detected using tele-echocardiography. These results indicate that tele-echocardiography provided reliable diagnoses and acceptable measurements in 86% and 93% of cases, respectively, with no false-positive diagnoses being reported. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  20. Thromboembolism Prevention via Transcatheter Left Atrial Appendage Closure with Transeosophageal Echocardiography Guidance

    Directory of Open Access Journals (Sweden)

    John Palios

    2014-01-01

    Full Text Available Atrial fibrillation (AF is an independent risk factor for stroke. Anticoagulation therapy has a risk of intracerebral hemorrhage. The use of percutaneous left atrial appendage (LAA closure devices is an alternative to anticoagulation therapy. Echocardiography has a leading role in LAA closure procedure in patient selection, during the procedure and during followup. A comprehensive echocardiography study is necessary preprocedural in order to identify all the lobes of the LAA, evaluate the size of the LAA ostium, look for thrombus or spontaneous echo contrast, and evaluate atrial anatomy, including atrial septal defect and patent foramen ovale. Echocardiography is used to identify potential cardiac sources of embolism, such as atrial septal aneurysm, mitral valve disease, and aortic debris. During the LAA occlusion procedure transeosophageal echocardiography provides guidance for the transeptal puncture and monitoring during the release of the closure device. Procedure-related complications can be evaluated and acceptable device release criteria such as proper position and seating of the occluder in the LAA, compression, and stability can be assessed. Postprocedural echocardiography is used for followup to assess the closure of the LAA ostium. This overview paper describes the emerging role of LAA occlusion procedure with transeosophageal echocardiography guidance as an alternative to anticoagulation therapy in patients with AF.

  1. Foramen ovale permeable y ataque criptogénico: Papel de la ecocardiografía y estado del arte Patent foramen ovale and cryptogenic stroke: Echocardiography role and state of the art

    Directory of Open Access Journals (Sweden)

    Mario H Jaramillo U

    2008-08-01

    have been speculations regarding the potential role of right-to-left intracardiac shunts as a path for paradoxical embolisms that result in ischemic cerebral disease. Transesophagic echocardiography with peripheral venous injection of saline contrast has shown to be the preferred method for the diagnosis of patent foramen ovale and right-to-left shunt. Prospective studies using acetylsalicylic acid or warfarin have not shown significant reduction of recurrent strokes. Even though both surgical and percutaneous closure of the patent foramen ovale have shown to decrease the rate of subsequent embolic episodes, their indication remains under discussion, at least until the appearance of randomized clinical trials, now under development. However, the cases of recurrent paradoxical embolism and those in professional scuba divers, both with intra-atrial septum aneurysm and an associated patent foramen ovale, are the only unequivocal indications for percutaneous closure. Successful closure, defined by transesophagic echocardiography, seems to predict lack of recurrent embolic events. As the complication rate of device implantation may decrease and these devices become technologically simple, percutaneous closure will prevail over surgical closure.

  2. 超声心动图在主动脉瓣狭窄经导管主动脉瓣植入术中的应用价值%Evaluation of echocardiography in patients with aortic stenosis undergoing transcatheter aortic valve implantation

    Institute of Scientific and Technical Information of China (English)

    刘盈盈; 李卫萍; 陆清声; 张勇学

    2012-01-01

    目的 探讨超声心动图在主动脉瓣狭窄患者经导管主动脉瓣植入术中的作用.方法 3例重度主动脉瓣瓣膜狭窄患者接受经导管主动脉瓣人工瓣膜植入术.使用Philips iE33型彩色多普勒超声诊断仪,配备经胸探头S5-1和经食道探头S7-2,X7-2t.超声观察内容包括明确主动脉瓣膜病变范围和程度,测量主动脉瓣环前后径,人工瓣膜植入术后瓣膜功能等.结果 3例患者经导管主动脉瓣植入术均取得了成功,人工瓣膜位置稳定,常规超声心动图3例患者术前经胸超声心动图与术中经食管超声心动图诊断相符,跨瓣压差较术前明显下降,主动脉瓣瓣上流速明显下降,瓣周漏瞬时反流量平均约1.2 mL.结论 经导管主动脉瓣人工瓣膜植入术在治疗严重主动脉瓣瓣膜狭窄中方法可行,效果良好:超声心动图在这项工作中具有重要的辅助作用.%Objectives To explore the value of echocardiography in patients with aortic stenosis who underwent transcatheter aortic valve implantation (TAVI). Methods Three patients with serious aortic stenosis underwent TAVI. Philips iE33 color Doppler ultrasound diagnostic instrument was used, equipped with chest probe S5-1 and transesophageal probe S7-2,X7-2t, Aortic valve lesions area and degree, aortic valve size, artificial valve function after implantation were observed. Results TAVI for all the subjects succeeded. Artificial valve position was stable, Transthoracic echocardiography was consistent with transesophageal echocardiography. Pressure gradient and aortic velocity declined obviously, and paravalvular leaks regurgitation averaged at L2 mL. Conclusions TAVI may be feasible and effective for patients with serious aortic stenosis, in which echocardiography plays an auxiliary role.

  3. Three-dimensional echocardiography in congenital heart disease : an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

    NARCIS (Netherlands)

    Simpson, John; Lopez, Leo; Acar, Philippe; Friedberg, Mark; Khoo, Nee; Ko, Helen; Marek, Jan; Marx, Gerald; McGhie, Jackie; Meijboom, Folkert|info:eu-repo/dai/nl/136537367; Roberson, David; Van den Bosch, Annemien; Miller, Owen; Shirali, Girish

    2016-01-01

    Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good

  4. Three-dimensional Echocardiography in Congenital Heart Disease : An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

    NARCIS (Netherlands)

    Simpson, John; Lopez, Leo; Acar, Philippe; Friedberg, Mark K; Khoo, Nee S; Ko, Helen; Marek, Jan; Marx, Gerald; McGhie, Jackie S; Meijboom, Folkert|info:eu-repo/dai/nl/136537367; Roberson, David; van den Bosch, Annemien E; Miller, Owen; Shirali, Girish

    2017-01-01

    Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good

  5. Three-dimensional Echocardiography in Congenital Heart Disease : An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

    NARCIS (Netherlands)

    Simpson, John; Lopez, Leo; Acar, Philippe; Friedberg, Mark K; Khoo, Nee S; Ko, Helen; Marek, Jan; Marx, Gerald; McGhie, Jackie S; Meijboom, Folkert; Roberson, David; van den Bosch, Annemien E; Miller, Owen; Shirali, Girish

    2017-01-01

    Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good ac

  6. Three-dimensional echocardiography in congenital heart disease : an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

    NARCIS (Netherlands)

    Simpson, John; Lopez, Leo; Acar, Philippe; Friedberg, Mark; Khoo, Nee; Ko, Helen; Marek, Jan; Marx, Gerald; McGhie, Jackie; Meijboom, Folkert|info:eu-repo/dai/nl/136537367; Roberson, David; Van den Bosch, Annemien; Miller, Owen; Shirali, Girish

    2016-01-01

    Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good ac

  7. Three-dimensional echocardiography in congenital heart disease : an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

    NARCIS (Netherlands)

    Simpson, John; Lopez, Leo; Acar, Philippe; Friedberg, Mark; Khoo, Nee; Ko, Helen; Marek, Jan; Marx, Gerald; McGhie, Jackie; Meijboom, Folkert; Roberson, David; Van den Bosch, Annemien; Miller, Owen; Shirali, Girish

    2016-01-01

    Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good ac

  8. Assessment of Myocardial Perfusion and Systolic Function in Patients with Coronary Artery Disease after Coronary Artery Bypass Surgery by Myocardial Contrast Echocardiography and Two-dimensional Strain Echocardiography

    Institute of Scientific and Technical Information of China (English)

    Rong LIU; Youbin DENG; Xiaojun BI; Yani LIU; Li XIONG; Liuping CHEN

    2009-01-01

    The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echo-cardiography (RT-MCE) combined with two-dimensional strain echocardiography was assessed.Twenty patients underwent intravenous RT-MCE by intravenous injections of Sono Vue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months af-ter coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitu-dinal strain three months after bypass surgery was significantly higher than that before operation [(-15.78±5.91)% vs (-10.45±8.31)%, P0.05]. It was con-cluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of re-gional systolic function. The combination of myocardial perfusion with two-dimensional strain echocar-diography can more accurately assess the curative effectiveness of coronary artery bypass surgery.

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

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    Pardo Moira

    2007-01-01

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

  10. An Experimental Study of Myocardial Viability with Myocardial Contrast Echocardiography

    Institute of Scientific and Technical Information of China (English)

    张稳柱; 查道刚; 成官迅; 杨绍青; 刘伊丽

    2001-01-01

    Background Myocardial blood flow(MBF) can be quantified with myocardial contrast echocardiography (MCE) during a venous in fusion of microbubble. A minimal MBF is required to maintain cell membrane integrity and myocardial viability in ischemic condition. Thus, we hypothesized that MCE could be used to assess myocardial viability by the determination of MBF. Methods and Results MCE was performed at 4 hours after ligation of proximal left anterior descending coronary artery in 7dogs with constant venous infusions of microbubbles.The video intensity versus pulsing interval plots derived from each myocardial pixel were fitted to an exponential function: y=A(1-e-βt), where y is Ⅵ at pulsing interval t, A reflects rnicrovascular cross- sectional area (or myocardial blood volume), and β reflects mean myocardial microbubble velocity. The product of A · β represents MBF. MBF was also obtained by radiolabeled microsphere method servered as reference.MBF derived by radiolabeled microsphere- method in the regions of normal, ischemia and infarction was 1.5±0.3, 0.7±0.3, 0.3±0.2mL·min-1· g-1respectively. The product of A · β obtained by MCE in those regions was 52. 46 ± 15.09, 24.36 ± 3.89, 3.74± ± 3.80 respectively. There was good correlation between normalized MBF and the normalized A · β (r =0. 81, P = 0. 001 ). Conclusions MCE has an ability to determine myocardial viability in myocardial in farction canine model.

  11. Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension.

    Science.gov (United States)

    Broderick-Forsgren, Kathleen; Davenport, Clemontina A; Sivak, Joseph A; Hargett, Charles William; Foster, Michael C; Monteagudo, Andrew; Armour, Alicia; Rajagopal, Sudarshan; Arges, Kristine; Velazquez, Eric J; Samad, Zainab

    2017-09-01

    This retrospective study evaluated the diagnostic characteristics of a combination of echocardiographic parameters for pulmonary hypertension (PH). Right ventricular systolic pressure (RVSP) estimation by echocardiography (echo) is used to screen for PH. However, the sensitivity of this method is suboptimal. We hypothesized that RVSP estimation in conjunction with other echo parameters would improve the value of echo for PH. The Duke Echo database was queried for adult patients with known or suspected PH who had undergone both echo and right heart catheterization (RHC) within a 24 h period between 1/1/2008 and 12/31/2013. Patients with complex congenital heart disease, heart transplantation, ventricular assist device, or on mechanical ventilation at time of study were excluded. Diagnostic characteristics of several echo parameters (right atrial enlargement, pulmonary artery (PA) enlargement, RV enlargement, RV dysfunction, and RVSP) for PH (mean PA pressure 25 mmHg on RHC) were evaluated among 1007 patients. RVSP ≥40 had a sensitivity of 77% (accuracy 77), while RVSP ≥35 had the highest sensitivity at 88% (81% accuracy). PA enlargement had the lowest sensitivity at 17%. The area under the curve (AUC) for RVSP was 0.844. A model including RVSP, RA, PA, RV enlargement and RV dysfunction had a higher AUC (AUC = 0.87) than RVSP alone. The value of echo as a screening test for PH is improved by a model incorporating a lower RVSP in addition to other right heart parameters. These findings need to be validated in prospective cohorts.

  12. Application value of echocardiography in perventricular device closure of ventricular septal defect%超声心动图在微创外科室间隔缺损封堵治疗中的应用价值

    Institute of Scientific and Technical Information of China (English)

    康彧; 唐红; 白文娟; 安琪; 赁可; 宋海波

    2011-01-01

    目的 探讨超声心动图在微创外科室间隔缺损(VSD)封堵治疗中的应用价值.方法 经胸超声心动图(TTE)筛选拟行微创外科VSD封堵治疗患者169例,术中经食管超声心动图(TEE)再次评估,对具备封堵条件者进行实时引导和监控.术后3~5 d及3、6、12个月 TTE随访.结果 术中TEE评估对15例不适宜封堵者直接改行VSD修补术.行微创封堵术154例,成功137例,成功率88.9%;封堵失败改行VSD修补术17例.术中即刻观察10例有微量残余分流,3例主动脉瓣有微量反流,7例三尖瓣反流较术前减轻或消失,11例三尖瓣出现少量反流.术后TTE随访封堵器无移位,4例残余分流消失,1例三尖瓣反流较术前略有加重,左心室重构改善.结论 超声心动图在微创外科VSD封堵的术前诊断、术中监控及术后效果评价中均发挥了重要作用.%Objective To explore the application value of echocardiography in perventricular device closure of ventricular septal defect ( VSD ). Methods One hundred and sixty - nine patients with VSD were selected by transthoracic echocardiography ( TTE ) and prepared to receive off pump surgical treatment-perventricular device closure. All the patients were re-evaluated in cardiac surgical procedures by transesophageal echocardiography ( TEE ). The patients suitable to the perventricular device closure were guided and observed. After operation, 3 ~5d,3,6,12 months follow-up were performed by TTE. Results Fifteen cases were not suitable to the device closure by intraoperative TEE re-evaluation and were directly repaired under cardiopulmonary bypass. 137 of 154 cases treated with perventricular device closure were succeeded( 137/154, 88.9% ), 17 cases were failed and received the repair surgery. TEE was performed immediately after occluder release. The tricuspid regurgitation was decreased or disappeared in 7 patients, while the closure caused new mild tricuspid regurgitation in 11 patients, and there were 10

  13. Student tutors for hands-on training in focused emergency echocardiography – a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kühl Matthias

    2012-10-01

    Full Text Available Abstract Background Focused emergency echocardiography performed by non-cardiologists has been shown to be feasible and effective in emergency situations. During resuscitation a short focused emergency echocardiography has been shown to narrow down potential differential diagnoses and to improve patient survival. Quite a large proportion of physicians are eligible to learn focused emergency echocardiography. Training in focused emergency echocardiography usually comprises a lecture, hands-on trainings in very small groups, and a practice phase. There is a shortage of experienced echocardiographers who can supervise the second step, the hands-on training. We thus investigated whether student tutors can perform the hands-on training for focused emergency echocardiography. Methods A total of 30 volunteer 4th and 5th year students were randomly assigned to a twelve-hour basic echocardiography course comprising a lecture followed by a hands-on training in small groups taught either by an expert cardiographer (EC or by a student tutor (ST. Using a pre-post-design, the students were evaluated by an OSCE. The students had to generate two still frames with the apical five-chamber view and the parasternal long axis in five minutes and to correctly mark twelve anatomical cardiac structures. Two blinded expert cardiographers rated the students’ performance using a standardized checklist. Students could achieve a maximum of 25 points. Results Both groups showed significant improvement after the training (p Conclusions Hands-on training by student tutors led to a significant gain in echocardiography skills, although inferior to teaching by an expert cardiographer.

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

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    Ana Carla Pereira de Araujo

    2014-11-01

    Full Text Available Background: Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective: To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods: This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1 or positive (G2 for myocardial ischemia. The endpoints analyzed were all-cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results: G2 comprised 205 patients (23.7%. During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 - 6.01; p = 0.016. The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 - 6.53; p = 0.022 and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively. Conclusion: Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia.

  15. Exercise echocardiography and multidetector computed tomography for the evaluation of acute chest pain.

    Science.gov (United States)

    Mas-Stachurska, Aleksandra; Miró, Oscar; Sitges, Marta; de Caralt, Teresa M; Perea, Rosario J; López, Beatriz; Sánchez, Miquel; Paré, Carles; Bosch, Xavier; Ortiz-Pérez, José T

    2015-01-01

    Up to 4% of patients with acute chest pain, normal electrocardiogram, and negative troponins present major adverse cardiac events as a result of undiagnosed acute coronary syndrome. Our aim was to compare the diagnostic performance of multidetector computed tomography and exercise echocardiography in patients with a low-to-intermediate probability of coronary artery disease. We prospectively included 69 patients with acute chest pain, normal electrocardiogram, and negative troponins who underwent coronary tomography angiography and exercise echocardiography. Patients with coronary stenosis ≥ 50% or Agatston calcium score ≥ 400 on coronary tomography angiography or positive exercise echocardiography, or with inconclusive results, were admitted to rule out acute coronary syndrome. An acute coronary syndrome was confirmed in 17 patients (24.6%). This was lower than the suspected 42% based on coronary tomography angiography (P<.05) and not significantly different than the suspected 29% based on the results of exercise echocardiography (P=.56). Exercise echocardiography was normal in up to 37% of patients with pathological findings on coronary tomography angiography. The latter technique provided a higher sensitivity (100% vs 82.3%; P=.21) but lower specificity (76.9% vs 88.4%; P=.12) than exercise echocardiography for the diagnosis of acute coronary syndrome, although without reaching statistical significance. Increasing the stenosis cutoff point to 70% increased the specificity of coronary tomography angiography to 88.4%, while maintaining high sensitivity. Coronary tomography angiography offers a valid alternative to exercise echocardiography for the diagnosis of acute coronary syndrome among patients with low-to-intermediate probability of coronary artery disease. A combination of both techniques could improve the diagnosis of acute coronary syndrome. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Catena Emanuele

    2008-10-01

    Full Text Available Abstract Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described. Obtaining competence in ICU echocardiography may be achieved in different ways – either through completion of an appropriate fellowship/training scheme, or, where not available, via a staged approach designed to train the practitioner to a level at which they can achieve accreditation. Here, peri-resuscitation focused echocardiography represents the entry level – obtainable through established courses followed by mentored practice. Next, a competence-based modular training programme is proposed: theoretical

  17. Role of Echocardiography in the Diagnostic Assessment and Etiology of Heart Failure in Older Adults: Opacify, Quantify, and Rectify.

    Science.gov (United States)

    Gupta, Vedant A; Nanda, Navin C; Sorrell, Vincent L

    2017-07-01

    Echocardiography allows the assessment of systolic and diastolic function and identifies many of the common causes of heart failure (HF). Patients with minimally symptomatic or unsuspected left ventricular systolic dysfunction may be identified and receive the benefits of angiotensin-converting enzyme inhibitor therapy. Echocardiography is also for assessing prognosis and can be used serially to evaluate treatment. Ventricular filling pressures, pulmonary artery pressures, and cardiac output can be sequentially determined. The authors believe that all patients with HF should receive careful assessment echocardiography. The authors believe using echocardiography is especially valuable in the elderly. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Left Atrial Dysfunction in the Pathogenesis of Cryptogenic Stroke: Novel Insights from Speckle-Tracking Echocardiography.

    Science.gov (United States)

    Leong, Darryl P; Joyce, Emer; Debonnaire, Philippe; Katsanos, Spyridon; Holman, Eduard R; Schalij, Martin J; Bax, Jeroen J; Delgado, Victoria; Marsan, Nina Ajmone

    2017-01-01

    Myocardial strain analysis by speckle-tracking echocardiography, which can detect subtle abnormalities in left atrial (LA) function, may offer unique insights into LA pathophysiology in patients with cryptogenic stroke (CS). The aim of this study was to investigate whether LA reservoir strain by speckle-tracking echocardiography, as a measure of LA compliance, is impaired in patients with CS and no history of atrial fibrillation. A retrospective case-control study of 742 patients (mean age, 59 ± 13 years; 54% men; 371 with CS and 371 control subjects) was conducted. LA reservoir strain was quantified using speckle-tracking echocardiography. LA strain was significantly lower among patients with CS than control subjects (30 ± 7.3% vs 34 ± 6.7%, P speckle-tracking echocardiography, is associated with CS independent of other cardiovascular risk factors. These findings suggest a potential role for LA strain to risk-stratify patients in the prevention of stroke. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  19. Detection of heart disease by open access echocardiography: a retrospective analysis of general practice referrals.

    Science.gov (United States)

    Chambers, John; Kabir, Saleha; Cajeat, Eric

    2014-02-01

    Heart disease is difficult to detect clinically and it has been suggested that echocardiography should be available to all patients with possible cardiac symptoms or signs. To analyse the results of 2 years of open access echocardiography for the frequency of structural heart disease according to request. Retrospective database analysis in a teaching hospital open access echocardiography service. Reports of all open access transthoracic echocardiograms between January 2011 and December 2012 were categorised as normal, having minor abnormalities, or significant abnormalities according to the indication. There were 2343 open access echocardiograms performed and there were significant abnormalities in 29%, predominantly valve disease (n = 304, 13%), LV systolic dysfunction (n = 179, 8%), aortic dilatation (n = 80, 3%), or pulmonary hypertension (n = 91, 4%). If echocardiography had been targeted at a high-risk group, 267 with valve disease would have been detected (compared to 127 with murmur alone) and 139 with LV systolic dysfunction (compared to 91 with suspected heart failure alone). Most GP practices requested fewer than 10 studies, but 6 practices requested over 70 studies. Open access echocardiograms are often abnormal but structural disease may not be suspected from the clinical request. Uptake by individual practices is patchy. A targeted expansion of echocardiography in patients with a high likelihood of disease is therefore likely to increase the detection of clinically important pathology.

  20. Evaluation of Myocardial Viability after Myocardial Infarction with Intravenous Real-time Myocardial Contrast Echocardiography

    Institute of Scientific and Technical Information of China (English)

    Weihui SHENTU; Yuhan WU; Youbin DENG; Runqing HUANG; Peng LI; Xiang WEI; Haoyi YANG; Yun ZHANG; Li XIONG; Fen YU

    2008-01-01

    The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography. Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Viable myocardium was defined by evident improvement of segmental wall motion 3 months after coronary revascularization. Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions: homogeneous opacification; partial or reduced opaciflcation or subendocardial contrast defect; contrast defect. The former two conditions were used as the standard to define the viable myocardium. The results showed that 109 abnormal wall motion segments were detected among 18 patients with myocardial infarction, including 47 segments of hypokinesis, 56 segments of akinesis and 6 segments of dyskinesis. The wall motion of 2 segments with hypokinesis before coronary revascularization which showed homogeneous opacification, 14 of 24 segments with hypokinese and 20 of 24 segments with akinese before coronary revascularization which showed partial or reduced opaciflcation or subendocardial contrast defect was improved 3 months after coronary revascularization. In our study, the sensitivity and specificity of evaluation of myocardial viability after myocardial infarction by intravenous real-time myocardial contrast echocardiography were 94.7% and 78.9%, respectively. It was concluded that intravenous real-time myocardial contrast echocardiography could accurately evaluate myocardial viability after myocardial infarction.

  1. Multidetector CT evaluation of total anomalous pulmonary venous connections: comparison with echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Ki Ho; Choo, Ki Seok [Pusan National University Hospital, Department of Radiology, Medical Institute, Pusan (Korea); Lim, Soo Jin [Kim Hae Joong Ang Hospital, Department of Cardiology, Kimhae (Korea); Lee, Hyoung Doo; Park, Ji Ae; Jo, Min Jung [Pusan National University Hospital, Department of Paediatrics, Pusan (Korea); Sung, Si Chan; Chang, Yun Hee [Pusan National University Hospital, Department of Thoracic and Cardiovascular Surgery, Pusan (Korea); Jeong, Dong Wook [Pusan National University Hospital, Department of Family Medicine, Pusan (Korea); Kim, Siho [Dong-A University Hospital, Department of Thoracic and Cardiovascular Surgery, Pusan (Korea)

    2009-09-15

    Although echocardiography is the first-line imaging modality in the diagnosis of total anomalous pulmonary venous connection (TAPVC), multidetector CT (MDCT) could have advantages in the diagnosis of TAPVC in certain cases. To compare MDCT with echocardiography in the evaluation of TAPVC. Enrolled in the study were 23 patients with surgically proven TAPVC. The echocardiography and MDCT findings were independently interpreted by a paediatric cardiologist and cardiac radiologist in terms of: (1) the drainage site of the common pulmonary vein, (2) stenosis of the vertical vein, and (3) the course of the atypical vessel into the systemic vein in the case of vertical vein stenosis. The findings from both modalities were correlated with the results obtained at surgery (n=22) or autopsy (n=1). In all patients, MDCT correctly depicted the drainage site of the common pulmonary vein, stenosis of the vertical vein and the course of the atypical vessel into the systemic vein (sensitivity 100%, specificity 100%). The specificity of echocardiography was 100% for the three defined findings. The sensitivity of echocardiography, however, was 87%, 71% and 0%, respectively. MDCT can facilitate the diagnosis of TAPVC in certain cases. (orig.)

  2. Simplified single plane echocardiography is comparable to conventional biplane two-dimensional echocardiography in the evaluation of left atrial volume: a study validated by three-dimensional echocardiography in 143 individuals.

    Science.gov (United States)

    Vieira-Filho, Normando G; Mancuso, Frederico J N; Oliveira, Wercules A A; Gil, Manuel A; Fischer, Cláudio H; Moises, Valdir A; Campos, Orlando

    2014-03-01

    The left atrial volume index (LAVI) is a biomarker of diastolic dysfunction and a predictor of cardiovascular events. Three-dimensional echocardiography (3DE) is highly accurate for LAVI measurements but is not widely available. Furthermore, biplane two-dimensional echocardiography (B2DE) may occasionally not be feasible due to a suboptimal two-chamber apical view. Simplified single plane two-dimensional echocardiography (S2DE) could overcome these limitations. We aimed to compare the reliability of S2DE with other validated echocardiographic methods in the measurement of the LAVI. We examined 143 individuals (54 ± 13 years old; 112 with heart disease and 31 healthy volunteers; all with sinus rhythm, with a wide range of LAVI). The results for all the individuals were compared with B2DE-derived LAVIs and validated using 3DE. The LAVIs, as determined using S2DE (32.7 ± 13.1 mL/m(2)), B2DE (31.9 ± 12.7 mL/m(2)), and 3DE (33.1 ± 13.4 mL/m(2)), were not significantly different from each other (P = 0.85). The S2DE-derived LAVIs correlated significantly with those obtained using both B2DE (r = 0.98; P < 0.001) and 3DE (r = 0.93; P < 0.001). The mean difference between the S2DE and B2DE measurements was <1.0 mL/m(2). Using the American Society of Echocardiography criteria for grading LAVI enlargement (normal, mild, moderate, severe), we observed an excellent agreement between the S2DE- and B2DE-derived classifications (κ = 0.89; P < 0.001). S2DE is a simple, rapid, and reliable method for LAVI measurement that may expand the use of this important biomarker in routine echocardiographic practice.

  3. Assessment of Left Ventricular Myocardial Viability by 3-Dimensional Speckle-Tracking Echocardiography in Patients With Myocardial Infarction.

    Science.gov (United States)

    Ran, Hong; Zhang, Ping-Yang; Zhang, You-Xiang; Zhang, Jian-Xin; Wu, Wen-Fang; Dong, Jing; Ma, Xiao-Wu

    2016-08-01

    To determine whether 3-dimensional (3D) speckle-tracking echocardiography could provide a new way to assess myocardial viability in patients with myocardial infarction (MI). Forty-five patients with MI underwent routine echocardiography, 2-dimensional (2D) speckle-tracking echocardiography, and 3D speckle-tracking echocardiography. Radionuclide myocardial perfusion/metabolic imaging was used as a reference standard to define viable and nonviable myocardia. Among 720 myocardial segments in 45 patients, 368 showed abnormal motion on routine echocardiography; 204 of 368 were categorized as viable on single-photon emission computed tomography/positron emission tomography (SPECT/PET), whereas 164 were defined as nonviable; 300 normal segments on SPECT/PET among 352 segments without abnormal motion on routine echocardiography were categorized as a control group. The radial, longitudinal, 3D, and area strain on 3D speckle-tracking echocardiography had significant differences between control and nonviable groups (P speckle-tracking echocardiography between viable and nonviable groups. Although there was no significant difference in circumferential strain between the groups, radial and longitudinal strain from 3D speckle-tracking echocardiography decreased significantly in the nonviable group. Moreover, 3D and area strain values were lower in the nonviable segments than the viable segments. By receiver operating characteristic analysis, radial strain from 3D speckle-tracking echocardiography with a cutoff of 11.1% had sensitivity of 95.1% and specificity of 53.4% for viable segments; longitudinal strain with a cutoff of 14.3% had sensitivity of 65.2% and specificity of 65.7%; 3D strain with a cutoff of 17.4% had sensitivity of 70.6% and specificity of 77.2%; and area strain with a cutoff of 23.2% had sensitivity of 91.5% and specificity of 82.8%. Three-dimensional speckle-tracking echocardiography might have potential for detection of myocardial viability in patients with

  4. Transthoracic Doppler echocardiography – noninvasive diagnostic window for coronary flow reserve assessment

    Directory of Open Access Journals (Sweden)

    Dimitrow Paweł

    2003-04-01

    Full Text Available Abstract This review focuses on transthoracic Doppler echocardiography as noninvasive method used to assess coronary flow reserve (CFR in a wide spectrum of clinical settings. Transthoracic Doppler echocardiography is rapidly gaining appreciation as popular tool to measure CFR both in stenosed and normal epicardial coronary arteries (predominantly in left anterior descending coronary artery. Post-stenotic CFR measurement is helpful in: functional assessment of moderate stenosis, detection of significant or critical stenosis, monitoring of restenosis after revascularization. In the absence of stenosis in the epicardial coronary artery, decreased CFR enable to detect impaired microvascular vasodilatation in: reperfused myocardial infarct, arterial hypertension with or without left ventricular hypertrophy, diabetes mellitus, hypercholesterolemia, syndrome X, hypertrophic cardiomyopathy. In these diseases, noninvasive transthoracic Doppler echocardiography allows for serial CFR evaluations to explore the effect of various pharmacological therapies.

  5. Predicting Cardiotoxic Effects of Carbon Monoxide Poisoning Using Speckle Tracking Echocardiography.

    Science.gov (United States)

    Saraçoğlu, Erhan; Vuruşkan, Ertan; Kılıç, Salih; Çekici, Yusuf; Onur, Bahaeddin; Arslan, Yavuz; Kılıç, Ertuğrul; Aykut, Ömer

    2017-10-06

    Carbon monoxide (CO) poisoning could cause significant cardiac injury. This study aimed to evaluate patients with CO poisoning by using speckle tracking echocardiography (STE), a potentially more sensitive technique, to identify left systolic ventricular dysfunction for the first time in the literature. Seventy-two patients who were exposed to CO poisoning were studied. Blood collection and echocardiography were performed at admission and after patients' discharge on days 10-15 (mean 12 days). Global longitudinal strain (GLS) and global circumferential strain (GCS) were calculated using STE. In order to find the normal strain levels and to compare it to the patient with CO poisoning, 35 healthy subjects were included in the study. Left ventricular ejection fraction was analyzed according to Simpson's method. Patients were divided into two groups based on their LVEF values. LVEF Speckle tracking echocardiography has the potential of demonstrating subtle LV systolic dysfunction even in CO poisoning patients with preserved EF.

  6. Echocardiography-based left ventricular mass estimation. How should we define hypertrophy?

    Science.gov (United States)

    Foppa, Murilo; Duncan, Bruce B; Rohde, Luis E P

    2005-06-17

    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 these studies and may influence both the clinical and epidemiologic use of echocardiography in the investigation of the left ventricular structure. We are going to review the most common measures that have been employed in left ventricular hypertrophy evaluation in the light of some recent population based echocardiographic studies, intending to show that echocardiography will remain a relatively inexpensive and accurate tool diagnostic tool.

  7. Echocardiography-based left ventricular mass estimation. How should we define hypertrophy?

    Directory of Open Access Journals (Sweden)

    Rohde Luis EP

    2005-06-01

    Full Text Available Abstract 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 these studies and may influence both the clinical and epidemiologic use of echocardiography in the investigation of the left ventricular structure. We are going to review the most common measures that have been employed in left ventricular hypertrophy evaluation in the light of some recent population based echocardiographic studies, intending to show that echocardiography will remain a relatively inexpensive and accurate tool diagnostic tool.

  8. Identification of viable myocardium early after acute myocardial infarction under beta-blockade by enoximone echocardiography.

    Science.gov (United States)

    Natale, E; Minardi, G; Wang, F; Tubaro, M; Giovannini, E; Vajola, S F; Milazzotto, F

    1997-04-01

    The influence of the beta-blocker metoprolol on the capacity either of low-dose dobutamine echocardiography or the recently introduced enoximone echocardiography to detect viable dysfunctioning myocardium after myocardial infarction was investigated. Initial clinical experience would suggest that the phosphodiesterase III inhibitor enoximona could be an alternative pharmacological stimulation, inducing an increase in contractility in the presence or absence of beta-receptor stimulation. Ten patients with a baseline low-dose dobutamine-echocardiographic test (up to 10 micrograms/kg/min) positive for myocardial viability in > or = 1 segment(s), performed 4-5 days after a first acute myocardial infarction treated with rtPA, were randomized after the administration of intravenous metoprolol (15 mg in three 5-mg boluses) either to dobutamine (up to 15 micrograms/kg/min) or to an enoximone intravenous bolus (1 mg/kg over 5 min) under echocardiographic monitoring, in a crossover sequence, with a 24-h interval. The infarct related artery was patent (TIMI grade 2 o 3) in all the patients. Follow-up echocardiograms were performed 5-7 weeks later. Resting asynergy was found in 40 segments; of these, 17 were viable. All the viable segments remained unresponsive during the post-metoprolol dobutamine infusion, while improved their contractility during enoximone echocardiography. Two patients suffering from early post-infarction angina underwent coronary angioplasty successfully. Eight out of ten patients (2 revascularized and 6 not) showed contractile recovery in a total of 14 segments at the follow-up echocardiogram. Sensitivity, specificity and overall accuracy in predicting reversible dysfunction after acute myocardial infarction for enoximone echocardiography were 93, 85, and 88%, respectively. Our results support the value of enoximone echocardiography in the identification of myocardial viability after myocardial infarction, in patients treated with beta-blockers, which

  9. Echocardiography integrated ACLS protocol versus con-ventional cardiopulmonary resuscitation in patients with

    Directory of Open Access Journals (Sweden)

    Chardoli Mojtaba

    2012-11-01

    Full Text Available 【Abstract】Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA cardiac arrest and pre-dicting the resuscitation outcomes. Methods: In this prospective interventional study, pa-tients presenting with PEA cardiac arrest were randomized into two groups. In Group A, ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity, right ventricle dilation, left ventricle function, peri-cardial effusion/tamponade and IVC size along with the ad-vanced cardiac life support (ACLS protocol. Patients in Group B solely underwent ACLS protocol without applying echocardiography. The presence or absence of mechanical ventricular activity (MVA and evidences of PEA reversible causes were recorded. The return of spontaneous circulation (ROSC and death were evaluated in both groups. Results: One hundred patients with the mean age of (58±6.1 years were enrolled in this study. Fifty patients (Group A had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR. Among them, 7 pa-tients (14% had pericardial effusion, 11 (22% had hypovolemia, and 39 (78% were revealed the presence of MVA. In the pseudo PEA subgroup (presence of MVA, 43% had ROSC (positive predictive value and in the true PEA subgroup with cardiac standstill (absence of MVA, there was no recorded ROSC (negative predictive value. Among patients in Group B, no reversible etiology was detected. There was no significant difference in resuscitation results between Groups A and B observed (P=0.52. Conclusion: Bedside echocardiography can identify some reversible causes of PEA. However, there are no sig-nificant changes in survival outcome between the echo group and those with traditional CPR. Key words: Heart arrest; Echocardiography; Car-diopulmonary resuscitation

  10. Three-dimensional Echocardiography of Right Ventricular Function Correlates with Severity of Pediatric Pulmonary Hypertension.

    Science.gov (United States)

    Jone, Pei-Ni; Patel, Sonali S; Cassidy, Courtney; Ivy, David Dunbar

    2016-12-01

    Right ventricular function and biomarkers of B-type natriuretic peptide (BNP) and N-Terminal pro-BNP (NT pro-BNP) are used to determine the severity of right ventricular failure and outcomes from pulmonary hypertension. Real-time three-dimensional echocardiography (3DE) is a novel quantitative measure of the right ventricle and decreases the geometric assumptions from conventional two-dimensional echocardiography (2DE). We correlated right ventricular functional measures using 2DE and single-beat 3DE with biomarkers and hemodynamics to determine the severity of pediatric pulmonary hypertension. We retrospectively evaluated 35 patients (mean age 12.67 ± 5.78 years) with established pulmonary hypertension who had echocardiograms and biomarkers on the same day. Ten out of 35 patients had hemodynamic evaluation within 3 days. 2DE evaluation included tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index from tissue Doppler imaging (RV TDI MPI), and right ventricular fractional area change (FAC). Three-dimensional echocardiography evaluation included right ventricular ejection fraction (EF), end-systolic volume, and end-diastolic volume. The quality of the 3DE was graded as good, fair, or poor. Pearson correlation coefficients were utilized to evaluate between biomarkers and echocardiographic parameters and between hemodynamics and echocardiography. Three-dimensional echocardiography and FAC correlated significantly with BNP and NT pro-BNP. TAPSE and RV TDI MPI did not correlate significantly with biomarkers. 3D right ventricular EF correlated significantly with hemodynamics. Two-dimensional echocardiography did not correlate with hemodynamics. Single-beat 3DE is a noninvasive, feasible tool in the quantification of right ventricular function and maybe more accurate than conventional 2DE in evaluating severity of pulmonary hypertension. © 2016 Wiley Periodicals, Inc.

  11. Abnormal echocardiography in patients with type 2 diabetes and relation to symptoms and clinical characteristics

    DEFF Research Database (Denmark)

    Jørgensen, Peter Godsk; Jensen, Magnus Thorsten; Mogelvang, Rasmus

    2016-01-01

    OBJECTIVES: We aimed to determine the prevalence of echocardiographic abnormalities and their relation to clinical characteristics and cardiac symptoms in a large, contemporary cohort of patients with type 2 diabetes. RESULTS: A total of 1030 patients with type 2 diabetes participated....... Echocardiographic abnormalities were present in 513 (49.8%) patients, mainly driven by a high prevalence of diastolic dysfunction 178 (19.4%), left ventricular hypertrophy 213 (21.0%) and left atrial enlargement, 200 (19.6%). The prevalence increased markedly with age from 31.1% in the youngest group (... with abnormal echocardiography along with dyspnoea and characteristic chest pain (p patients with abnormal echocardiography. CONCLUSION: Echocardiographic abnormalities...

  12. Clinical application of echocardiography in detection of foetal arrhythmia:a retrospective study of 451 foetuses

    Institute of Scientific and Technical Information of China (English)

    赵博文; 张松英; 潘美; 徐海珊; 寿金朵; 吕江红; 汤富刚; 范妙英; 范晓明; 林莎

    2004-01-01

    @@Foetal arrhythmia is defined as any irregular foetal cardiac rhythm or regular rhythm at a rate outside the reference range of 120 to 160 beats/minute. Foetal echocardiography permits accurate determination of the structural characteristics and the nature of the arrhythmia in foetuses. It is particularly indicated for mothers from high-risk groups. Management of diagnosed heart disease, including foetal arrhythmia, leads either to the termination of pregnancy or to optimal postnatal care of baby and mother. This retrospective study examined the application of foetal echocardiography in the diagnosis of foetal arrhythmia and its clinical significance.

  13. Dobutamine Stress Echocardiography Safety in Chagas Disease Patients.

    Science.gov (United States)

    Rassi, Daniela do Carmo; Vieira, Marcelo Luiz Campos; Furtado, Rogerio Gomes; Turco, Fabio de Paula; Melato, Luciano Henrique; Hotta, Viviane Tiemi; Nunes, Colandy Godoy de Oliveira; Rassi, Luiz; Rassi, Salvador

    2017-02-01

    A few decades ago, patients with Chagas disease were predominantly rural workers, with a low risk profile for obstructive coronary artery disease (CAD). As urbanization has increased, they became exposed to the same risk factors for CAD of uninfected individuals. Dobutamine stress echocardiography (DSE) has proven to be an important tool in CAD diagnosis. Despite being a potentially arrhythmogenic method, it is safe for coronary patients without Chagas disease. For Chagas disease patients, however, the indication of DSE in clinical practice is uncertain, because of the arrhythmogenic potential of that heart disease. To assess DSE safety in Chagas disease patients with clinical suspicion of CAD, as well as the incidence of arrhythmias and adverse events during the exam. Retrospective analysis of a database of patients referred for DSE from May/2012 to February/2015. This study assessed 205 consecutive patients with Chagas disease suspected of having CAD. All of them had their serology for Chagas disease confirmed. Their mean age was 64±10 years and most patients were females (65.4%). No patient had significant adverse events, such as acute myocardial infarction, ventricular fibrillation, asystole, stroke, cardiac rupture and death. Regarding arrhythmias, ventricular extrasystoles occurred in 48% of patients, and non-sustained ventricular tachycardia in 7.3%. DSE proved to be safe in this population of Chagas disease patients, in which no potentially life-threatening outcome was found. Até poucas décadas atrás, os pacientes chagásicos eram predominantemente trabalhadores rurais, com baixo perfil de risco para doença obstrutiva coronária. Com a crescente urbanização, passaram a ter os mesmos fatores de risco para doença aterosclerótica que indivíduos não infectados. O ecocardiograma sob estresse com dobutamina (EED) é uma importante ferramenta no diagnóstico de coronariopatia. É referido, porém, como um método potencialmente arritmogênico, mas

  14. Effect of catheter-based renal denervation on left ventricular function, mass and (un)twist with two-dimensional speckle tracking echocardiography

    NARCIS (Netherlands)

    L. Feyz (Lida); B.M. van Dalen (Bas); M.L. Geleijnse (Marcel); N.M. van Mieghem (Nicolas); R.T. van Domburg (Ron); J. Daemen (Joost)

    2017-01-01

    markdownabstractBackground: Speckle tracking echocardiography (STE) is an echocardiography modality that is able to measure left ventricular (LV) characteristics, including rotation, strain and strain rate. Strain measures myocardial fibre contraction and relaxation. This study aims to assess the

  15. Computed tomography and echocardiography in patients with acute pulmonary embolism: part 1: correlation of findings of right ventricular enlargement.

    Science.gov (United States)

    Wake, Nicole; Kumamaru, Kanako K; George, Elizabeth; Bedayat, Arash; Ghosh, Nina; Gonzalez Quesada, Carlos; Rybicki, Frank J; Gerhard-Herman, Marie

    2014-01-01

    To evaluate the correlation between the computed tomography (CT)-derived right ventricle (RV) to left ventricle (LV) diameter ratio and the RV size determined by echocardiography in patients with acute pulmonary embolism. Consecutive CT pulmonary angiography examinations (August 2003 to May 2010) from a single, large, urban teaching hospital were retrospectively reviewed. For a cohort of 777 subjects who underwent echocardiography within 48 hours of the CT acquisition, the qualitative RV size (divided into 5 categories) extracted from the echocardiography report was correlated with the CT-derived RV/LV diameter ratio. There was moderate correlation (Spearman rank correlation coefficient=0.54, Psize as determined by echocardiography. The correlation coefficient and the concordance rate were inversely related to the time difference between the acquisitions of the 2 modalities. CT and echocardiography findings to assess the RV size after acute pulmonary embolism have moderate correlation.

  16. A ecocardiografia com contraste no diagnóstico de dilatações vasculares intrapulmonares em candidatos ao transplante hepático Contrast echocardiography in the diagnosis of intrapulmonary vascular dilations in patients eligible for liver transplantation

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Pavarino

    2004-04-01

    Full Text Available OBJETIVO: Determinar a importância da ecocardiografia com contraste no diagnóstico de dilatações vasculares intrapulmonares (DVP em portadores de doenças hepáticas crônicas, candidatos ao transplante. MÉTODOS: O ecocardiograma transtorácico (ETT com imagem em segunda harmônica foi realizado em 76 pacientes, dos quais, 32 foram submetidos consecutivamente ao estudo transesofágico (ETE. O contraste ecocardiográfco foi obtido por microbolhas geradas pela injeção de solução salina agitada, em acesso venoso periférico. Considerou-se como positivo quando detectada a presença anormal de contraste em câmaras cardíacas esquerdas, com um atraso de 4 a 6 ciclos cardíacos, após opacificação inicial das câmaras direitas. RESULTADOS: O diagnóstico de DVP foi realizado em 53,9% dos pacientes (41/76. A sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia do ETT em relação ao ETE foi respectivamente de 75%, 100%, 100%, 80% e 87,5%. O ecocardiograma foi positivo em 37 (55,2% dos 67 pacientes não hipoxêmicos e em 4 (44,4% dos 9 hipoxêmicos. Não foi observada qualquer repercussão hemodinâmica cardiológica decorrente do shunt intrapulmonar. CONCLUSÃO: A ecocardiografia com contraste mostrou-se eficaz, de utilização fácil e segura para o rastreamento e identificação de alterações vasculares intrapulmonares em candidatos ao transplante hepático.OBJECTIVE: To determine the importance of contrast echocardiography in the diagnosis of intrapulmonary vascular dilations (PVD in patients with severe hepatic diseases, eligible for transplantation. METHODS: Transthoracic ecocardiography (TTE with second harmonic imaging was performed in 76 patients, among them 32 patients were consecutively undergone to a transesophageal study (ETE. Echocardiographic contrast was obtained from microbubbles derived from the injection of agitated saline solution, in venous peripheral access. Abnormal presence of

  17. 感染性心内膜炎患者超声心动图诊断价值分析%The Clinical Diagnosis Value of Echocardiography in Patients with Infective Endocarditis

    Institute of Scientific and Technical Information of China (English)

    李洪琳; 王丽

    2015-01-01

    Objective:To investigate the clinical diagnosis value of echocardiogram in patients with in-fective endocarditis .Method: The data of 64 patients with suspected infective endocarditis treated in our hospital between January 2009 and January 2015 were retrospectively analyzed , the detection of infective en-docarditis -associated complications and excrescences was compared by transthoracic echocardiography (TTE) and by transesophageal echocardiography (TEE), and the sensitivities and specificities of TTE and TEE in diagnosis of various pathological changes in patients with endocardium involved were compared .Re-sult:Excrescences were detected by TTE in 31 patients (48.44%) and by TEE in 49 patients (76.56%), and the difference in detection rate between the two detection methods was statistically significant ( P0.05); when taking TEE as the diagnostic criterion of infective endocarditis, the sensitivity and specificity of TTE detection were 63.27%and 86.67%, respectively.Con-clusion:Echocardiography has important clinical significances in diagnosis of infective endocarditis .TEE is more sensitive for the detection of infective endocarditis , but TTE can also provide positive evidence , and TTE is the first choice for diagnosis of infective endocarditis currently .%目的:探讨分析超声心动图对感染性心内膜炎患者临床诊断价值。方法:回顾性分析2009年1月至2015年1月我院收治的疑似为感染性心内膜炎患者64例,比较经胸超声心动图( TTE)以及经食管超声心动图( TEE )对感染性心内膜相关并发症以及赘生物的检出情况,比较TTE与TEE诊断患者心内膜受累各种病理变化的特异性以及敏感性。结果:TTE 检出赘生物31例(48.44%)、TEE检出赘生物49例(76.56%),两种检测方式对赘生物的检出率具有统计学差异(P<0.05);TTE检出平均赘生物的大小显著低于TEE检出赘生物的大小( P<0.05);在瓣周脓肿

  18. Right Atrial Appendage Aneurysm in a Newborn Diagnosed with Fetal Echocardiography

    Science.gov (United States)

    Yartaşı Tik, Elif; Öztarhan, Kazım; Dedeoğlu, Reyhan; Çetinkaya, Merih

    2016-01-01

    Right atrial appendage aneurysm is a very rare condition which can be asymptomatic or can cause arrhythmia or life-threatening thromboembolism. We report a case of newborn with right atrial appendage aneurysm who was diagnosed with fetal echocardiography. Anticoagulant therapy was applied to prevent thromboembolism and he is still going on follow-up without any complaint. PMID:27703828

  19. The influence of transoesophageal echocardiography on intra-operative decision making - A European multicentre study

    NARCIS (Netherlands)

    Kolev, N; Brase, R; Swanevelder, J; Oppizzi, M; Riesgo, MJ; van der Maaten, JMAA; Abiad, MG; Guarracino, F; Zimpfer, M

    1998-01-01

    The role of transoesophageal echocardiography (TOE) in anaesthesia remains controversial because it is a rapidly evolving technique with few proven benefits and considerable cost. Recently, the Society of Cardiovascular Anaesthesiologists has published practice guidelines for the use of peri-operati

  20. The Role of Stress Echocardiography in Valvular Heart Disease: A Current Appraisal.

    Science.gov (United States)

    Gentry Iii, James L; Phelan, Dermot; Desai, Milind Y; Griffin, Brian P

    2017-04-11

    Stress echocardiography is a widely available, safe, low-cost, versatile imaging modality which is becoming increasingly recognized as a valuable tool in the assessment of patients with native and prosthetic left-sided valvular heart disease. It provides a quantitative assessment to help guide clinical decision-making when discordance exists between symptoms and severity of valve disease. Exercise (treadmill or bicycle) remains the preferred stress modality, but pharmacological augmentation with dobutamine can be used if needed. Low-dose dobutamine stress echocardiography is specifically valuable in patients with low-flow, low-gradient aortic stenosis when attempting to differentiate true severe aortic stenosis from pseudo-severe aortic stenosis. Stress echocardiography not only identifies high-risk features that indicate need for earlier surgery, it also provides useful information for the peri- and postoperative period, including long-term outcome, risk stratification to guide monitoring frequency, and offers guidance for eligibility in competitive sports participation. As research continues to expand the utility of stress echocardiography in the management of patients with valvular heart disease, future research should focus on the recognition of newer parameters identifying high-risk features including subsequent validation in a large population.

  1. Ekhokardiografi Endokardiosis Penyakit Katup Mitral Jantung Anjing (ECHOCARDIOGRAPHY OF ENDOCARDIOSIS MITRAL VALVE HEART DISEASE IN DOGS

    Directory of Open Access Journals (Sweden)

    Deni Noviana

    2013-08-01

    Full Text Available Endocardiosis is a disease commonly found in Pomeranian dog characterized by progressive myxomatousdegeneration of the atrio-ventricular valves especially in the mitral valve. The purpose of this study was todefine the diagnose and severeity of this disease on the Pomeranian by using brightness mode, motion mode,dan color flow Doppler echocardiography technique. Echocardiography was performed on 8 Pomeranianconsisting of 6 males and 2 females with age range of 2-14 years. Brightness mode echocardiography wasused to see the echotexture of endocardium, mitral valve, and the valve movement. The results showedendocardium thickening, along with chronic fibrosis and nodular thickening of the anterior and posteriormitral valve leaflet. Three out of seven cases showed prolapsed of the mitral valve. Motion modeechocardiography was performed in order to measure left ventricle internal dimension, myocardium thickness,fractional shortening, left atrial and aortic dimension. The results showed myocardium thickening, alongwith left atrial enlargement. Color flow Doppler echocardiography was used to confirm the mitral valveregurgitation. Three of seven cases showed the presence of regurgitation signed by turbulence color of theprolapsed mitral valve. Based on the degree of severity, scoring system used in this study, endocardiosis canbe divided into three types that are mild, moderate and severe.

  2. Assessment of quantitative hypertrophy scores in hypertrophic cardiomyopathy : Magnetic resonance imaging versus echocardiography

    NARCIS (Netherlands)

    Posma, JL; Blanksma, PK; vanderWall, EE; Hamer, HPM; Mooyaart, EL; Lie, KI

    1996-01-01

    To compare the diagnostic value of spin-echo magnetic resonance (MR) imaging and transthoracic echocardiography in quantitative assessment of the extent of hypertrophy in patients with hypertrophic cardiomyopathy (HCM), we examined 52 consecutive patients with HCM. The Spirito-Maron and Wigle hypert

  3. Assessment of myocardial strain and strain rate by tissue doppler echocar-diography

    Directory of Open Access Journals (Sweden)

    Ekimova N.A.

    2013-03-01

    Full Text Available The objective of the article is to review the current data on the method of quantitative evaluation of cardiac mechanics — assessment of myocardial strain and strain rate according to the results of the tissue Doppler echocardiography and prospects of its clinical application.

  4. The influence of transoesophageal echocardiography on intra-operative decision making - A European multicentre study

    NARCIS (Netherlands)

    Kolev, N; Brase, R; Swanevelder, J; Oppizzi, M; Riesgo, MJ; van der Maaten, JMAA; Abiad, MG; Guarracino, F; Zimpfer, M

    1998-01-01

    The role of transoesophageal echocardiography (TOE) in anaesthesia remains controversial because it is a rapidly evolving technique with few proven benefits and considerable cost. Recently, the Society of Cardiovascular Anaesthesiologists has published practice guidelines for the use of peri-operati

  5. Influence of arterial compliance on presence and extent of ischaemia during stress echocardiography

    Science.gov (United States)

    Haluska, B A; Matthys, K; Fathi, R; Rozis, E; Carlier, S G; Marwick, T H

    2006-01-01

    Objective To seek an association between total arterial compliance (TAC) and the extent of ischaemia at stress echocardiography. Design Cohort study. Setting Regional cardiac centre. Methods 255 consecutive patients (147 men; mean (SD) age 58 (8)) presenting for stress echocardiography for clinical indications were studied. Wall motion score index (WMSI) was calculated and ischaemia was defined by an inducible or worsening wall motion abnormality. Peak WMSI was used to reflect the extent of dysfunction (ischaemia or scar), and ΔWMSI was indicative of extent of ischaemia. TAC was assessed at rest by simultaneous radial applanation tonometry and pulsed wave Doppler in all patients. Results Ischaemia was identified by stress echocardiography in 65 patients (25%). TAC was similar in the groups with negative and positive echocardiograms (1.08 (0.41) v 1.17 (0.51) ml/mm Hg, not significant). However, the extent of dysfunction was associated with TAC independently of age, blood pressure, risk factors, and use of a β blocker. Moreover, the extent of ischaemia was determined by TAC, risk factors, and use of a β blocker. Conclusion While traditional cardiovascular risk factors are strong predictors of ischaemia on stress echocardiography, TAC is an independent predictor of the extent of ischaemia. PMID:16365349

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

    NARCIS (Netherlands)

    A.H. Curiale (Ariel H.); G. Vegas-Sanchez-Ferrero (Gonzalo); J.G. Bosch (Hans); S. Aja-Fernández (Santiago)

    2015-01-01

    textabstractThe strain and strain-rate measures are commonly used for the analysis and assessment of regional myocardial function. In echocardiography (EC), the strain analysis became possible using Tissue Doppler Imaging (TDI). Unfortunately, this modality shows an important limitation: the angle

  7. Acute myocarditis with normal wall motion detected with 2D speckle tracking echocardiography

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    Thomas Sturmberger

    2016-05-01

    Full Text Available We present the case of a 26-year-old male with acute tonsillitis who was referred for coronary angiography because of chest pain, elevated cardiac biomarkers, and biphasic T waves. The patient had no cardiovascular risk factors. Echocardiography showed no wall motion abnormalities and no pericardial effusion. 2D speckle tracking revealed distinct decreased regional peak longitudinal systolic strain in the lateral and posterior walls. Ischemic disease was extremely unlikely in view of his young age, negative family history regarding coronary artery disease, and lack of regional wall motion abnormalities on the conventional 2D echocardiogram. Coronary angiography was deferred as myocarditis was suspected. To confirm the diagnosis, cardiac magnetic resonance tomography (MRT was performed, showing subepicardial delayed hyperenhancement in the lateral and posterior walls correlating closely with the strain pattern obtained by 2D speckle tracking echocardiography. With a working diagnosis of acute myocarditis associated with acute tonsillitis, we prescribed antibiotics and nonsteroidal anti-inflammatory drugs. The patient’s clinical signs resolved along with normalization of serum creatine kinase (CK levels, and the patient was discharged on the third day after admission. Learning points: • Acute myocarditis can mimic acute coronary syndromes. • Conventional 2D echocardiography lacks specific features for detection of subtle regional wall motion abnormalities. • 2D speckle tracking expands the scope of echocardiography in identifying myocardial dysfunction derived from edema in acute myocarditis.

  8. Evaluation of Subclinical Left Ventricular Systolic Dysfunction in Chronic Asymptomatic Alcoholics by Speckle Tracking Echocardiography

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    Murathan Kucuk

    2017-01-01

    Full Text Available By using two-dimensional speckle tracking echocardiography, we aimed to investigate the structural and functional changes on myocardium in chronic asymptomatic alcoholics without any cardiovascular disease. Forty-one consecutive asymptomatic male alcoholics who were admitted to the outpatient alcoholism unit and 30 age matched healthy male volunteers selected as the control group were enrolled in the study. The study group were investigated by using standard two-dimensional echocardiography and speckle tracking echocardiography. The left ventricular (LV global longitudinal strain and LV global circumferential strain were significantly lower in alcoholics when compared with control subjects. There was no difference in global radial strain between the two groups. To demonstrate the effect of total life time dose of ethanol (TLDE on echocardiographic abnormalities, we assessed the correlation analysis. There was a nonsignificant weak correlation between global LV circumferential strain and TLDE (r=0.27, p=0.083. Speckle tracking echocardiography derived left ventricular systolic function was impaired in chronic alcoholic patients when compared with healthy controls.

  9. Cardiovascular Complications in Chronic Obstructive Pulmonary Disease with Reference to 2D Echocardiography Findings

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    Vikram B Vikhe

    2013-08-01

    Results: Emphysema and chronic bronchitis was present in 38% and 62% respectively. Echocardiographic evidence of cor-pulmonale and pulmonary hypertension was found in 70% of the patients. Conclusions: Echocardiography is more sensitive than electrocardiography in detecting PAH and right ventricular dysfunction in COPD. [Natl J Med Res 2013; 3(4.000: 385-388

  10. Comparison of magnetic resonance imaging and echocardiography in determination of cardiac dimensions in normal subjects.

    Science.gov (United States)

    Friedman, B J; Waters, J; Kwan, O L; DeMaria, A N

    1985-06-01

    No data exist regarding the ability of magnetic resonance imaging to assess cardiac size and performance in human beings. Therefore, measurements of cardiac dimensions by magnetic resonance imaging were compared with those obtained by two-dimensional echocardiography in 21 normal subjects. Magnetic resonance transverse cardiac sections were obtained during electrocardiographic gating using a spin echo pulse sequence. In normal subjects, magnetic resonance imaging yielded a range of values for cardiac dimensions having a similar standard deviation as that of two-dimensional echocardiography. Diastolic measurements of the aorta, left atrium, left ventricle and septum obtained by magnetic resonance imaging correlated well with those obtained by two-dimensional echocardiography (r = 0.82, 0.78, 0.81 and 0.75, respectively). The correlation coefficient of r = 0.35 observed for the posterior wall thickness was not surprising in view of the narrow range of normal values. Only a general correlation (r = 0.53) existed for the right ventricular diastolic dimension; this was probably related to the difficulty in obtaining representative measurements due to the complex geometry of this chamber. Failure of systolic dimension measurements by magnetic resonance imaging to correlate with those obtained by echocardiography is probably related to limitations of electrocardiographic gating, especially of determining the exact end-systolic frame. Although technically complex at present, magnetic resonance imaging does provide an additional noninvasive technique for measurement of cardiac size.

  11. Comparison of septal strain patterns in dyssynchronous heart failure between speckle tracking echocardiography vendor systems

    NARCIS (Netherlands)

    van Everdingen, Wouter M; Paiman, Marie-Louise; van Deursen, Caroline J M; Cramer, MJ; Vernooy, Kevin; Delhaas, Tammo; Prinzen, Frits W

    2015-01-01

    AIM: To analyze inter-vendor differences of speckle tracking echocardiography (STE) in imaging cardiac deformation in patients with dyssynchronous heart failure. METHODS AND RESULTS: Eleven patients (all with LBBB, median age 60.7 years, 9 males) with implanted cardiac resynchronization therapy devi

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

    NARCIS (Netherlands)

    A.H. Curiale (Ariel H.); G. Vegas-Sanchez-Ferrero (Gonzalo); J.G. Bosch (Johan); S. Aja-Fernández (Santiago)

    2015-01-01

    textabstractThe strain and strain-rate measures are commonly used for the analysis and assessment of regional myocardial function. In echocardiography (EC), the strain analysis became possible using Tissue Doppler Imaging (TDI). Unfortunately, this modality shows an important limitation: the angle b

  13. The role of echocardiography in Staphylococcus aureus bacteraemia at Auckland City Hospital.

    Science.gov (United States)

    Gow, Nicholas; Lowe, Boris S; Freeman, Joshua; Roberts, Sally

    2015-06-12

    Current guidelines recommend echocardiography in all episodes of Staphylococcus aureus bacteraemia (SAB). This study aimed to determine whether a very low-risk group of patients with SAB could be found in whom echocardiography was of no incremental diagnostic value for the diagnosis of infective endocarditis. Using the ANZCOSS dataset, we identified 574 eligible episodes of adult SAB at Auckland District Health Board (ADHB) between 2007 and 2012, and retrospectively obtained additional microbiological and clinical data. Prevalence of IE was determined using the modified Duke's criteria for diagnosis of IE. Multivariate logistic regression analysis was used to determine whether risk factors were independently associated with IE, and we also assessed their negative predictive value (NPV). Transthoracic and/or transoesophageal echocardiography was performed in 370 (65%) episodes of SAB. The prevalence of clinically definite and clinically possible IE was 5.6% and 8.5%, respectively. Thirty day all-cause mortality was 11.7%. The factors with the highest NPV when absent in hospital-acquired SAB were non central venous line-associated bacteraemia (100%), persistent bacteraemia (96%), and presence of a prosthetic valve or cardiac rhythm management (CRM) device (95%). When none of these three criteria were present the NPV was 100% (99-100%). A group of very low risk patients was found in our study: central line-associated SAB without prosthetic valves / CRM devices and without persistent bacteraemia. These patients had no episodes of IE and echocardiography is of no incremental diagnostic benefit.

  14. Assessment of quantitative hypertrophy scores in hypertrophic cardiomyopathy : Magnetic resonance imaging versus echocardiography

    NARCIS (Netherlands)

    Posma, JL; Blanksma, PK; vanderWall, EE; Hamer, HPM; Mooyaart, EL; Lie, KI

    1996-01-01

    To compare the diagnostic value of spin-echo magnetic resonance (MR) imaging and transthoracic echocardiography in quantitative assessment of the extent of hypertrophy in patients with hypertrophic cardiomyopathy (HCM), we examined 52 consecutive patients with HCM. The Spirito-Maron and Wigle hypert

  15. [Digital revolution in the echocardiography laboratory. Current status and future perspectives] .

    Science.gov (United States)

    Badano, L P; Di Chiara, A; Werren, M; Sabbadini, C; Fioretti, P M

    2000-12-01

    Echocardiography is changing from an operative modality in which most images are stored in analog fashion on videotape into one with most data stored digitally. This transition is accelerating today, fueled by several factors. First, there is widespread recognition of the value of digital storage of echocardiograms, including random access to studies as well as to images within a study, side-by-side comparison with prior studies, easier quantification, and multiplication and remote transmission of images without degradation. Second, continuous improvement of the cost/performance ratio of modern computers makes routine digital echocardiography both feasible and affordable. Finally, the formulation and acceptance within the industry of the DICOM image formatting standard for echocardiography. The acceptance of this standard allows the echo-labs around the world to be free to choose individual echo-machines on the basis of their individual merits for their laboratories with the assurance that these machines will be able to communicate with each other by an internationally agreed upon standard. Advantages of digital echocardiography are overwhelming and there is little doubt that this approach will be essential for the proper utilization of this technique. The technology will undoubtedly continue to change. Those who are waiting for it to be perfected may be waiting for a long time.

  16. Is pre-discharge echocardiography indicated for asymptomatic neonates with a heart murmur? A retrospective analysis.

    Science.gov (United States)

    Al-Ammouri, Iyad; Ayoub, Fares; Dababneh, Rima

    2016-08-01

    The purpose of this study was to determine whether a murmur detected on routine pre-discharge examination of asymptomatic newborn children in the first 48 hours of life warrants further investigation with echocardiography. We conducted a retrospective review of all echocardiography studies of neonates born at Jordan University Hospital between August, 2007 and June, 2014. Findings on physical examination as well as the indication of the echocardiographic studies were reviewed. We included asymptomatic neonates for whom echocardiographic studies were carried out due to the sole indication of a heart murmur on routine pre-discharge neonatal physical examination. Of 309 asymptomatic newborns with murmurs on pre-discharge examination, echocardiography revealed 68 (22%) cases of CHD, with 18 (6%) designated as significant heart disease with anticipated intervention during infancy or childhood. The most common abnormality was ventricular septal defect occurring in 36 cases. Critical heart diseases detected included hypoplastic left heart syndrome in two and aortic valve stenosis in four newborns. Although most asymptomatic neonates with heart murmurs have normal hearts, a small percentage may have significant heart disease. The decision to refer an asymptomatic newborn with a murmur for echocardiography before discharge from the hospital remains controversial and must be supported by other evidence such as murmur characteristics and local trends in parental compliance with follow-up well-baby visits.

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

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    Rousse Maria G

    2011-04-01

    Full Text Available Abstract 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

  18. Real-time three-dimensional speckle tracking echocardiography: technical aspects and clinical applications

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    Sorrentino R

    2016-11-01

    Full Text Available Regina Sorrentino, Roberta Esposito, Enrica Pezzullo, Maurizio Galderisi Department of Advanced Biomedical Sciences, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, Naples, Italy Abstract: Three-dimensional speckle tracking echocardiography (3D STE is a novel technique for the quantification of cardiac deformation based on tracking of ultrasonic speckles in gray scale full-volume 3D images. Developments in ultrasound technologies have made 3D speckle tracking widely available. Two-dimensional echocardiography has intrinsic limitations regarding estimation of left ventricular (LV volumes, ejection fraction, and LV mechanics, due to its inherent foreshortening errors and dependency on geometric models. The development of 3D echocardiography has improved reproducibility and accuracy. Data regarding the feasibility, accuracy, and clinical applications of 3D STE are rapidly assembling. From the tracking results, 3D STE derives several parameters, including longitudinal, circumferential and radial strain, as well as a combined assessment of longitudinal and circumferential strain, termed area strain. 3D STE can also quantify LV rotational movements such as rotation, twist, and torsion. 3D STE provides a better insight on global and regional myocardial deformation. Main applications include detection of subclinical myocardial involvement in heart failure, arterial hypertension, dyssynchrony, and ischemic heart disease. Emerging areas of application include a large spectrum of heart-involving systemic conditions, such as prediction of rejection in heart transplant patients, early detection of cardiotoxicity in patients receiving chemotherapy for cancer, and deeper physiological understanding of LV contraction mechanics in different types of athletes. Aim of this review is to discuss background, technical acquisition and processing aspects as well as recognized and developing clinical applications of this emerging

  19. A Natural Language Processing Tool for Large-Scale Data Extraction from Echocardiography Reports

    Science.gov (United States)

    Jonnalagadda, Siddhartha R.

    2016-01-01

    Large volumes of data are continuously generated from clinical notes and diagnostic studies catalogued in electronic health records (EHRs). Echocardiography is one of the most commonly ordered diagnostic tests in cardiology. This study sought to explore the feasibility and reliability of using natural language processing (NLP) for large-scale and targeted extraction of multiple data elements from echocardiography reports. An NLP tool, EchoInfer, was developed to automatically extract data pertaining to cardiovascular structure and function from heterogeneously formatted echocardiographic data sources. EchoInfer was applied to echocardiography reports (2004 to 2013) available from 3 different on-going clinical research projects. EchoInfer analyzed 15,116 echocardiography reports from 1684 patients, and extracted 59 quantitative and 21 qualitative data elements per report. EchoInfer achieved a precision of 94.06%, a recall of 92.21%, and an F1-score of 93.12% across all 80 data elements in 50 reports. Physician review of 400 reports demonstrated that EchoInfer achieved a recall of 92–99.9% and a precision of >97% in four data elements, including three quantitative and one qualitative data element. Failure of EchoInfer to correctly identify or reject reported parameters was primarily related to non-standardized reporting of echocardiography data. EchoInfer provides a powerful and reliable NLP-based approach for the large-scale, targeted extraction of information from heterogeneous data sources. The use of EchoInfer may have implications for the clinical management and research analysis of patients undergoing echocardiographic evaluation. PMID:27124000

  20. Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Mojtaba Chardoli; Farhad Heidari; Helaleh Rabiee; Mahdi Sharif-Alhoseini; Hamid Shokoohi; Vafa Rahimi-Movaghar

    2012-01-01

    Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA) cardiac arrest and predicting the resuscitation outcomes.Methods: In this prospective interventional study,patients presenting with PEA cardiac arrest were randomized into two groups.In Group A,ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity,right ventricle dilation,left ventricle function,pericardial effusion/tamponade and ⅣC size along with the advanced cardiac life support (ACLS) protocol.Patients in Group B solely underwent ACLS protocol without applying echocardiography.The presence or absence of mechanical ventricular activity (MVA) and evidences of PEA reversible causes were recorded.The return of spontaneous circulation (ROSC) and death were evaluated in both groups.Results: One hundred patients with the mean age of (58±6.1) years were enrolled in this study.Fifty patients (Group A) had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR).Among them,7 patients (14%) had pericardial effusion,11 (22%) had hypovolemia,and 39 (78%) were revealed the presence of MVA.In the pseudo PEA subgroup (presence of MVA),43% had ROSC (positive predictive value) and in the true PEA subgroup with cardiac standstill (absence of MVA),there was no recorded ROSC (negative predictive value).Among patients in Group B,no reversible etiology was detected.There was no significant difference in resuscitation results between Groups A and B observed (P=0.52).Conclusion: Bedside echocardiography can identify some reversible causes of PEA.However,there are no significant changes in survival outcome between the echo group and those with traditional CPR.

  1. Speckle tracking echocardiography in patients with septic shock: a case control study (SPECKSS).

    Science.gov (United States)

    Ng, Pauline Yeung; Sin, Wai Ching; Ng, Andrew Kei-Yan; Chan, Wai Ming

    2016-05-14

    Sepsis-induced myocardial dysfunction is a well-recognized condition and confers worse outcomes in septic patients. Echocardiographic assessment by conventional parameters such as left ventricular ejection fraction (LVEF) is often affected by ongoing changes in preload and afterload conditions. Novel echocardiographic technologies such as speckle tracking echocardiography (STE) have evolved for direct assessment of the myocardial function. We investigate the measurement of myocardial strain by speckle tracking echocardiography for the diagnosis of sepsis-induced myocardial dysfunction. This is a case-control study at a university-affiliated medical intensive care unit. Consecutive adult medical patients admitted with a diagnosis of septic shock were included. Patients with other causes of myocardial dysfunction were excluded. They were compared to age-matched, gender-matched, and cardiovascular risk-factor-matched controls, who were admitted to hospital for sepsis but did not develop septic shock. Transthoracic echocardiography was performed on all patients within 24 hours of diagnosis, and a reassessment echocardiogram was performed in the study group of patients upon recovery. Patients with septic shock (n = 33) (study group) and 29 matched patients with sepsis but no septic shock (control group) were recruited. The mean sequential organ failure assessment (SOFA) score for the study and control groups were 10.2 and 1.6, respectively (P Speckle tracking echocardiography can detect significant left ventricular impairment in patients with septic shock, which was not otherwise detectable by conventional echocardiography. The reversible nature of myocardial dysfunction in sepsis was also demonstrable. This echocardiographic technique is useful in the diagnosis and monitoring of sepsis-induced myocardial dysfunction.

  2. Diagnosis of coronary vasospasm in patients with clinical presentation of unstable angina pectoris using ergonovine echocardiography.

    Science.gov (United States)

    Song, J K; Park, S W; Kang, D H; Lee, C W; Choi, K J; Hong, M K; Kim, J J; Kim, Y H; Park, S J

    1998-12-15

    Although coronary vasospasm can contribute to the development of unstable angina, the definite diagnostic method has not been established. The purpose of this study was to determine if ergonovine echocardiography (detection of regional wall motion abnormality during bedside ergonovine challenge) after angiographic confirmation of insignificant fixed disease would be useful and safe in detecting coronary vasospasm in patients with unstable angina. After control of chest pain with medications in patients admitted to the coronary care unit under the tentative diagnosis of unstable angina, diagnostic coronary angiography was performed. All patients with normal or insignificant fixed disease underwent ergonovine echocardiography after discontinuation of medications for 4+/-1 days. Among 208 consecutive patients enrolled for this study, 75% (156 of 208) showed significant fixed disease in the angiography. Ergonovine echocardiography was performed in 52 patients with insignificant disease, and coronary vasospasm was documented in 33 (63%, 33 of 52). No serious procedure-related arrhythmia or myocardial infarction occurred. Esophageal motility disorder and hypertrophic cardiomyopathy were diagnosed in 6 and 3 patients, respectively. Chest pain of undetermined etiology was the final diagnosis at discharge in 10 patients (5%, 10 of 208); among them chest pain redeveloped in 2 patients, and repeated ergonovine echocardiography revealed positive results. Our data suggest that among patients with the clinical presentation of unstable angina, coronary vasospasm is the main cause of myocardial ischemia in a considerable number of patients with a normal or near-normal angiogram, and ergonovine echocardiography after confirmation of absence of significant fixed disease is useful and safe for noninvasive diagnosis of coronary vasospasm in this setting.

  3. Comparison of sestamibi, thallium, echocardiography and PET for the detection of hibernating myocardium

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    Barrington, S.F.; Hallett, W.A.; O' Doherty, M.J.; Nunan, T.O. [Clinical PET Centre, Guys and St Thomas' s Hospitals, SE1 7EH, London (United Kingdom); Chambers, J.; Roxburgh, J.C. [Cardiothoracic Centre, Guys and St Thomas' s Hospitals, London (United Kingdom)

    2004-03-01

    The detection of hibernating myocardium is important because revascularisation results in improved function and prognosis in patients with hibernation but not in those with non-viable myocardium. The primary aim of this study was to compare the diagnostic accuracy of four techniques with respect to hibernation in the same study population with 6-12 months of follow-up. Twenty-five males underwent rest-stress sestamibi and delayed (>18 h) thallium scintigraphy, high-dose dobutamine stress echocardiography and nitrogen-13 ammonia/fluorine-18 fluorodeoxyglucose (NH{sub 3}/FDG) positron emission tomography (PET). The pre-operative ejection fraction was 36.2% ({+-}7.3%). Follow-up was 8.1 ({+-}2.8) months. Using postoperative improvement in wall motion on echocardiography as the gold standard, 6/34 dysfunctional vascular territories were hibernating. The mean uptake of all tracers was significantly higher in hibernating than in non-viable territories (P<0.05). Normal perfusion or mismatch on PET (FDG>NH{sub 3} uptake) and the pattern of response to dobutamine on echocardiography were also predictive of recovery (P<0.001 and P=0.02 respectively). Univariate logistic regression identified sestamibi, ammonia and FDG as independent predictors of hibernation. FDG-PET was, however, the only independent predictor using multivariate analysis. The nuclear techniques had high negative predictive values (NPV) of {>=}95% but lower positive predictive values (PPV) of 45%-75% as compared with echocardiography, which had an NPV of 87% and a PPV of 100%. PET was the most powerful predictor of hibernation although the combination of a technique with a high PPV (echocardiography) and a high NPV (PET or sestamibi) may represent the optimal clinical choice. (orig.)

  4. Assessment of mitral valve reserve capacity before and after percutaneous balloon valvuloplasty with isoproterenol stress echocardiography

    Institute of Scientific and Technical Information of China (English)

    LIU Pin-ming; FU Xiang-yang; L(U) Jun-hao; WU Qun; Yang Fu-qing

    2002-01-01

    Objective: To explore whether successful valvuloplasty increases mitral valve reserve capacity in patients with mitral stenosis. Methods: Thirty-eight patients with pure rheumatic mitral stenosis underwent isoproterenol stress echocardiography before and after successful percutaneous balloon valvuloplasty. The mitral valve area (by direct planimetry of two-dimensional echocardiography), mean transmitral pressure gradient (by continuous-wave Doppler echocardiography), and cardiac output (by M-mode echocardiography)were measured at rest and under isoproterenol infusion to achieve heart rate of different stages. Results :Between the measurements before and after valvuloplasty, significant differences were observed in the mitral valve area (0. 91±0.28 vs 1.87±0.23 cm2, P<0.01), mean transmitral pressure gradient (12.5±6.3 vs 3. 9±1.9 mmHg, P<0. 01) and cardiac output (3.93±1.44 vs 4. 73±1.01 L/min, P<O. 05) at rest. Before valvuloplasty, the mean transmitral pressure gradient increased significantly (P<0. 01) as heart rate increased, but there were no significant differences in the measurements of mitral valve area and cardiac output (both P>0. 05). In contrast, there was a significant increase after valvuloplasty in the mean transmitral pressure gradient (P<0. 01), but both mitral valve area and cardiac output further increased (both P<0. 01) as beart rate increased. Moreover, valvuloplasty decreased the mean transmitral pressure gradient at peak heart rate from 23.0 ±4. 5 to 7.75 ±2. 30 mmHg (P<0.01) under submaximal stress. Conclusion:Successful percutaneous balloon valvuloplasty soon causes a significant increase of mitral valve reserve capacity in patients with mitral stenosis, which is conspicuously manifested under condition of hemodynamic stress.Stress echocardiography provides a safe, feasible and non-invasive means of assessing the reserve capacity.

  5. Predictive significance of residual ischemia proved by dobutamine stress: Echocardiography test in patients early after the first uncomplicated myocardial infarction

    Directory of Open Access Journals (Sweden)

    Karanović Nevena

    2004-01-01

    Full Text Available Background. To evaluate the long-term prognostic value of dobutamine stress-echocardiography (ECG test for new coronary events (new episodes of angina pectoris, cardiac-related deaths, and reinfarctions early after the first uncomplicated myocardial infarction. Methods. Dobutamine stress-echocardiography tests were performed in all of 104 patients 10-20 days after the first myocardial infarction. Patients were followed-up for 36 (29 ± 7 months. Kaplan-Meier cumulative survival curves were tested by Breslow test (Log Rank. Results. Two cardiac deaths (1.92%, nine nonfatal myocardial infarctions (8.65%, and three cases of recurrent angina pectoris (2.88% occurred during the prospective follow-up. Cumulative survival curves showed that in patients with negative findings of dobutamine stress-echocardiography test, survival time without significant events was 35.31 months, while in the group with positive findings of dobutamine stress-echocardiography test it was 30.91 months (log Rank 7.22; p<0.01. Prognostic value of dobutamine stress-echocardiography test was analyzed by Cox regression model and was 2.92, meaning that the risk of significant events was 2.92 times higher in the group of patients with positive findings of dobutamine stress-echocardiography test. Conclusion. Patients with negative findings of dobutamine stress-echocardiography test were with significantly higher possibility of surviving without significant events in comparison with the patients in whom the findings of dobutamine stress-echocardiography test were positive. In combination with clinical signs and ECG results, the results of dobutamine stress-echocardiography test improved prognostic value in the patients with the first uncomplicated myocardial infarction, and in that way influenced the strategy of their further treatment.

  6. Absolute assessment of aortic valve stenosis by planimetry using cardiovascular magnetic resonance imaging: Comparison with transoesophageal echocardiography, transthoracic echocardiography, and cardiac catheterisation

    Energy Technology Data Exchange (ETDEWEB)

    Reant, Patricia [Department of Cardiology and Echocardiography, Hopital Cardiologique Haut-Leveque, Bordeaux-Pessac (France); University of Victor Segalen, F33076 Bordeaux (France)]. E-mail: patreant@free.fr; Lederlin, Mathieu [Department of Radiology, Hopital Cardiologique Haut-Leveque, Bordeaux-Pessac (France); University of Victor Segalen, F33076 Bordeaux (France); Lafitte, Stephane [Department of Cardiology and Echocardiography, Hopital Cardiologique Haut-Leveque, Bordeaux-Pessac (France); University of Victor Segalen, F33076 Bordeaux (France); Serri, Karim [Department of Cardiology and Echocardiography, Hopital Cardiologique Haut-Leveque, Bordeaux-Pessac (France); University of Victor Segalen, F33076 Bordeaux (France); Montaudon, Michel [Department of Radiology, Hopital Cardiologique Haut-Leveque, Bordeaux-Pessac (France); University of Victor Segalen, F33076 Bordeaux (France); Inserm E356, F33076 Bordeaux (France); Corneloup, Olivier [Department of Radiology, Hopital Cardiologique Haut-Leveque, Bordeaux-Pessac (France); University of Victor Segalen, F33076 Bordeaux (France); Roudaut, Raymond [Department of Cardiology and Echocardiography, Hopital Cardiologique Haut-Leveque, Bordeaux-Pessac (France); University of Victor Segalen, F33076 Bordeaux (France); Laurent, Francois [Department of Radiology, Hopital Cardiologique Haut-Leveque, Bordeaux-Pessac (France); University of Victor Segalen, F33076 Bordeaux (France); Inserm E356, F33076 Bordeaux (France)

    2006-08-15

    Objective: The aims of this study were to investigate absolute assessment of aortic valve area (AVA), before surgery for aortic stenosis, using cardiovascular magnetic resonance (CMR) in comparison with transoesophageal echocardiography (TEE) and with effective AVA indirectly obtained by routine techniques i.e. transthoracic echocardiography (TTE) and cardiac catheterisation. Materials and methods: Absolute AVA planimetry was performed by TEE and CMR steady state free precession sequences obtained through the aortic valvular plane. Effective AVA was calculated by the continuity equation in TTE and by cardiac catheterisation (Gorlin formula). Results: Thirty-nine patients with aortic valve stenosis, mean age 71.7 {+-} 7.6 years, with a mean AVA of 0.93 {+-} 0.31 cm{sup 2} as measured by TEE, were enrolled in the study. Mean differences were: between CMR and TEE planimetry: d = 0.01 {+-} 0.14 cm{sup 2}, between CMR and cardiac catheterisation: d = 0.05 {+-} 0.13 cm{sup 2}, between CMR and TTE: d = 0.10 {+-} 0.17 cm{sup 2}, between TTE and TEE: d = 0.10 {+-} 0.18 cm{sup 2}, between TTE and cardiac catheterisation: d 0.06 {+-} 0.16 cm{sup 2}, and between TEE and cardiac catheterisation: d = 0.07 {+-} 0.13 cm{sup 2}. Mean intraobserver and interobserver differences of CMR planimetry were d = 0.02 {+-} 0.07 cm{sup 2} and d = 0.03 {+-} 0.14 cm{sup 2}, respectively. Conclusion: CMR planimetry of the AVA is a noninvasive and reproducible technique to evaluate stenotic aortic valves and can be used as an alternative to echocardiography or cardiac catheterisation.

  7. Assessment of myocardial viability in patients with acute myocardial infarction by two-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography.

    Science.gov (United States)

    Gong, Lei; Li, Dongye; Chen, Junhong; Wang, Xiaoping; Xu, Tongda; Li, Wenhua; Ren, Shaoyang; Wang, Cheng

    2013-06-01

    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.

  8. Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography.

    Science.gov (United States)

    Simpson, John; Lopez, Leo; Acar, Philippe; Friedberg, Mark K; Khoo, Nee S; Ko, H Helen; Marek, Jan; Marx, Gerald; McGhie, Jackie S; Meijboom, Folkert; Roberson, David; Van den Bosch, Annemien; Miller, Owen; Shirali, Girish

    2017-01-01

    Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good acoustic windows and the non-invasive nature of the technique. The aim of this paper is to provide a review of the optimal application of 3DE in CHD including technical considerations, image orientation, application to different lesions, procedural guidance, and functional assessment. Copyright © 2016 European Society of Cardiology. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Mara Graziele Maciel Silveira

    2015-05-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  11. Isoproterenol Stress Echocardiography in Assessing Mitral Valve Area Reserve before and after Percutaneous Balloon Valvuloplasty

    Institute of Scientific and Technical Information of China (English)

    刘品明; 傅向阳; 吕俊豪; 吴群; 杨福庆

    2001-01-01

    Objective To determine whether successful valvuloplasty causes an increase of mitral valve area reserve in patients with mitral stenosis, isoproterenol stress echocardiography was used to compare mitral valve area and hemodynamic changes between pre- and post- valvuloplasty under conditions of increased cardiac work. Methods Thirtyeight patients with pure rheumatic mitral stenosis who had received successful percutaneous balloon valvulo plasty underwent isoproterenol stress echocardiography pre- and post- valvuloplasty. Mitral valve area (by direct planimetry of two- dimensional echocardiography), mean transmitral pressure gradient (by continuous-wave Doppler echocardiography), and cardiac output (by M -mode echocardiography) were measured at rest and under isoproterenol stress to achieve heart rate of different stages. Results Mitral valve area (0. 91± 0. 28 to 1. 87±0.23cm2, P <0.01), mean transmitral pressure gradient ( 12.5 ± 6. 3 to 3.9 ± 1.9mmHg, P < 0.01 ) and cardiac output (3.93 ± 1.44to 4. 73 ± 1.01 L/min, P < 0.05) at rest between pre - and post -valvuloplasty were significantly different.Pre-valvuloplasty, as heart rate increased under stress, mean transmitral pressure gradient increased significantly ( P < 0.01 ), but there were no significant differences in the measurements of mitral valve area and cardiac output (both P > 0.05). In contrast, as heart rate increased post- valvuloplasty, there was a significant increase in mean transmitral pressure gradient (P < 0.01), but both mitral valve area and cardiac output further increased significantly (both P < 0. 01) . Moreover, valvuloplasty decreased mean transmitral pressure gradient at peak heart rate from 23.0 ± 4. 5 to 7.75 ± 2.30 mmHg ( P < 0.01 ) under submaximal stress. Conclusions Successful percu taneous balloon valvuloplasty soon causes a significant increase of mitral valve area reserve in patients with mitral stenosis, which is markedly manifested under conditions of

  12. Recommendations for standards in transthoracic two-dimensional echocardiography in the dog and cat. Echocardiography Committee of the Specialty of Cardiology, American College of Veterinary Internal Medicine.

    Science.gov (United States)

    Thomas, W P; Gaber, C E; Jacobs, G J; Kaplan, P M; Lombard, C W; Moise, N S; Moses, B L

    1993-01-01

    Recommendations are presented for standardized imaging planes and display conventions for two-dimensional echocardiography in the dog and cat. Three transducer locations ("windows") provide access to consistent imaging planes: the right parasternal location, the left caudal (apical) parasternal location, and the left cranial parasternal location. Recommendations for image display orientations are very similar to those for comparable human cardiac images, with the heart base or cranial aspect of the heart displayed to the examiner's right on the video display. From the right parasternal location, standard views include a long-axis four-chamber view and a long-axis left ventricular outflow view, and short-axis views at the levels of the left ventricular apex, papillary muscles, chordae tendineae, mitral valve, aortic valve, and pulmonary arteries. From the left caudal (apical) location, standard views include long-axis two-chamber and four-chamber views. From the left cranial parasternal location, standard views include a long-axis view of the left ventricular outflow tract and ascending aorta (with variations to image the right atrium and tricuspid valve, and the pulmonary valve and pulmonary artery), and a short-axis view of the aortic root encircled by the right heart. These images are presented by means of idealized line drawings. Adoption of these standards should facilitate consistent performance, recording, teaching, and communicating results of studies obtained by two-dimensional echocardiography.

  13. What is the most cost-effective strategy to screen for left ventricular systolic dysfunction: natriuretic peptides, the electrocardiogram, hand-held echocardiography, traditional echocardiography, or their combination?

    Science.gov (United States)

    Galasko, Gavin I W; Barnes, Sophie C; Collinson, Paul; Lahiri, Avijit; Senior, Roxy

    2006-01-01

    To assess the screening characteristics and cost-effectiveness of screening for left ventricular systolic dysfunction (LVSD) in community subjects. A total of 1392 members of the general public and 928 higher risk subjects were randomly selected from seven community practices. Attending subjects underwent an ECG, N-terminal pro-brain natriuretic peptide (NTproBNP) serum levels, and traditional echocardiography (TE). A total of 533 consecutive subjects underwent hand-held echocardiography (HE). The screening characteristics and cost-effectiveness (cost per case of LVSD diagnosed) of eight strategies to predict LVSD (LVSD cost-effective, screening low-risk subjects least cost-effective. TE screening was the least cost-effective strategy. NTproBNP screening gave similar cost savings to ECG screening; HE screening greater cost-savings, and HE screening following NTproBNP or ECG pre-screening the greatest cost-savings, costing approximately 650 Euros per case of LVSD diagnosed in high-risk subjects (63% cost-savings vs.TE). Thus several different modalities allow cost-effective community-based screening for LVSD, especially in high-risk subjects. Such programmes would be cost-effective and miss few cases of LVSD in the community.

  14. Evaluation of Right Ventricular Function by Tissue Doppler Echocardiography in Asthmatic Children

    Directory of Open Access Journals (Sweden)

    Mehdi Ghaderian

    2016-11-01

    Full Text Available BackgroundAsthma is the most chronic inflammatory disorder of the airways in children and asthmatic patients can experience cardiac dysfunction, pulmonary hypertension and finally cor pulmonale later in life. We aimed to investigate Right Ventricular (RV functions in asthmatic children by conventional and tissue Doppler echocardiography (TDE.Materials and Methods Pulmonary function tests, conventional and TDE examinations were performed on 42 asthmatic and 42 age- and gender matched healthy controls subjects (n=42.Results Compared with healthy children the RV wall was statistically thicker among asthmatic patients (P= 0.01. Conventional echocardiography had not significant difference between cases and controls, but TDE had significant difference between these two groups. Peak E’ velocity, A’ velocity, E’/A’ ratio and S’ in lateral and medial sites of tricuspid annulus valve, were significantly differ from control group in our patients (P

  15. Serial measurements of exercise performance in pediatric heart transplant patients using stress echocardiography.

    Science.gov (United States)

    Yeung, Joanne P; Human, Derek G; Sandor, George G S; De Souza, Astrid M; Potts, James E

    2011-05-01

    Heart transplantation is an increasingly acceptable therapeutic option for children with end-stage and complex congenital heart disease. With advances in surgery, immunosuppression, and follow-up care, functional outcomes need to be evaluated. We report the results of serial exercise testing performed using stress echocardiography in a cohort of pediatric HTP. HTP (n = 7) exercised on a semi-recumbent ergometer to volitional fatigue. Echocardiography-Doppler measurements, HR, and blood pressure were taken at rest and during staged exercise. Results were compared with healthy CON (n = 12). HTP did significantly less work during exercise (940 vs. 1218 J/kg, p HTP had a lower SF at peak exercise (48% vs. 52%, p HTP. HTP are able to exercise safely; however, their exercise tolerance is reduced, and hemodynamics and contractility are diminished. Over time, their hemodynamics and left ventricular function have remained relatively constant.

  16. Pneumoperitoneum diagnosed as an incidental finding using focus assessed transthoracic echocardiography: a case report

    DEFF Research Database (Denmark)

    Laursen, Christian Borbjerg

    2010-01-01

    Introduction In this case report we describe how pneumoperitoneum was diagnosed in a patient admitted with acute chest pain, as an incidental finding using focus assessed transthoracic echocardiography (FATE). Case report A 79-year-old male smoker with arterial hypertension was admitted to a coro......Introduction In this case report we describe how pneumoperitoneum was diagnosed in a patient admitted with acute chest pain, as an incidental finding using focus assessed transthoracic echocardiography (FATE). Case report A 79-year-old male smoker with arterial hypertension was admitted...... to a coronary unit with a sudden onset of constant left sided thoracic pain. At position 1 (subcostal) of the FATE protocol, the heart and liver could not be visualised. Instead the peritoneum could be seen as a hyperechoic stripe, corresponding horizontal reverberation artefacts was visible under...... in extracardial diseases can directly ensure the patients a quicker diagnosis and treatment....

  17. Pneumoperitoneum diagnosed as an incidental finding using focus assessed transthoracic echocardiography: a case report

    DEFF Research Database (Denmark)

    Laursen, Christian Borbjerg

    2010-01-01

    Introduction In this case report we describe how pneumoperitoneum was diagnosed in a patient admitted with acute chest pain, as an incidental finding using focus assessed transthoracic echocardiography (FATE). Case report A 79-year-old male smoker with arterial hypertension was admitted to a coro......Introduction In this case report we describe how pneumoperitoneum was diagnosed in a patient admitted with acute chest pain, as an incidental finding using focus assessed transthoracic echocardiography (FATE). Case report A 79-year-old male smoker with arterial hypertension was admitted...... the peritoneal line. Based on these findings, a conventional X-ray image of the abdomen was taken with the patient in the left lateral decubitus position, confirming the diagnosis of pneumoperitoneum. Conclusion This demonstrates how systematic use of FATE combined with knowledge of sonographic patterns...... in extracardial diseases can directly ensure the patients a quicker diagnosis and treatment....

  18. Combination of contrast with stress echocardiography: A practical guide to methods and interpretation

    Directory of Open Access Journals (Sweden)

    Marwick Thomas H

    2004-08-01

    Full Text Available Abstract Contrast echocardiography has an established role for enhancement of the right heart Doppler signals, the detection of intra-cardiac shunts, and most recently for left ventricular cavity opacification (LVO. The use of intravenously administered micro-bubbles to traverse the myocardial microcirculation in order to outline myocardial viability and perfusion has been the source of research studies for a number of years. Despite the enthusiasm of investigators, myocardial contrast echocardiography (MCE has not attained routine clinical use and LV opacification during stress has been less widely adopted than the data would support. The purpose of this review is to facilitate an understanding of the involved imaging technologies that have made this technique more feasible for clinical practice, and to guide its introduction into the practice of the non-expert user.

  19. [Diagnostic imaging in acute pulmonary embolism. The use of spiral computed tomography, lung scintigraphy and echocardiography].

    Science.gov (United States)

    Hess, Søren; Madsen, Poul Henning; Jørgensen, Henrik Boel; Høilund-Carlsen, Poul Flemming

    2005-10-10

    Acute pulmonary embolism is an underdiagnosed and potentially lethal condition. Treatment may be lifesaving but is associated with severe side effects. Thus, reliable diagnostic imaging is essential. We conducted a literature review on the use of spiral computed tomography, lung scintigraphy and echocardiography in acute pulmonary embolism and identified 562 articles, of which 16 original papers met our inclusion criteria. From these, we concluded that none of the modalities is applicable in every situation. Spiral computed tomography can confirm the diagnosis but cannot rule out subsegmental embolism. With lung scintigraphy, perfusion imaging alone is probably sufficient and suited to both confirming and ruling out the diagnosis. Echocardiography should be reserved for patients with an emergent need for treatment and cannot rule out the diagnosis.

  20. [Intraoperative evaluation of mitral valve reconstruction using two-dimensional contrast echocardiography].

    Science.gov (United States)

    Viossat, J; Chauvaud, S; Mihaileanu, S; Pillière, R; Sicre, P; Schnebert, B; Abbou, B; Lafont, A; Julien, J; Marino, J P

    1986-09-01

    20 patients who underwent reconstructive surgery for mitral regurgitation were peroperatively investigated by contrasted bidimensional echocardiography using intraventricular injection of 20 ml of physiologic saline. Before the valvuloplasty, the peroperative quantitation of mitral leakage was in all cases closely correlated with the data obtained preoperatively. After the mitral reparation, three groups of patients could be observed: group I (12 cases): absent or minimal regurgitation (0-+); group II (5 cases): moderate mitral regurgitation (++); group III (3 cases): marked regurgitation ( - +) necessitating an immediate ECC. In two cases it was possible to improve successfully the valvular function, in the third case valvular replacement was necessary. The correlation between the data of peroperative contrasted echography at one hand and the clinical examination and the postoperative paraclinical investigations on the other hand was excellent in all cases. Thus the contrasted bidimensional peroperative echocardiography represents a reliable method for predicting the immediate results of mitral reconstructive surgery.

  1. Usefulness of speckle tracking echocardiography in hypertensive crisis and the effect of medical treatment.

    Science.gov (United States)

    Alam, Mahboob; Zhang, Lily; Stampehl, Mark; Lakkis, Nasser; Dokainish, Hisham

    2013-07-15

    The acute impact of hypertensive crisis, and changes after treatment, on left ventricular (LV) systolic and diastolic function using comprehensive echocardiography, including speckle tracking, has not been well characterized. Thirty consecutive patients admitted to the hospital from the emergency room with hypertensive crisis underwent Doppler echocardiography at baseline and after blood pressure optimization. The mean age of the patients was 54 ± 13 years, with 19 men (63%). The most common presenting symptoms included dyspnea (70%), chest pain (43%), and altered mental status (13%). Mean systolic and diastolic blood pressures at presentation were 198 ± 12 and 122 ± 12 mm Hg, decreasing to 143 ± 15 and 77 ± 12 mm Hg (p hypertensive crisis and significantly improved after medical treatment. LV diastolic function, assessed using conventional and speckle-tracking parameters, was also depressed and significantly improved after treatment.

  2. Radial and longitudinal strain and strain rate assessed by speckle-tracking echocardiography in dogs with myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Zois, Nora Elisabeth; Tidholm, A.; Nägga, K.M.;

    2012-01-01

    Assessment of left ventricular (LV) function using conventional echocardiographic methods is difficult in mitral regurgitation (MR) owing to altered hemodynamic loading conditions. Newer methods such as speckle-tracking echocardiography (STE) provide assessment of LV strain (St) and strain rates ...

  3. Prenatal diagnosis of thoracic ectopia cordis by real-time fetal cardiac magnetic resonance imaging and by echocardiography.

    Science.gov (United States)

    Moniotte, Stéphane; Powell, Andrew J; Barnewolt, Carol E; Annese, David; Geva, Tal

    2008-01-01

    Ectopia cordis is a rare congenital defect commonly associated with intra- and extra-cardiac anomalies. This report highlights the complimentary use of echocardiography and cardiac magnetic resonance imaging for detailed prenatal characterization of the anomaly at 23-week gestation.

  4. Interobserver, intraobserver and intrapatient reliability scores of myocardial strain imaging with 2-d echocardiography in patients treated with anthracyclines.

    NARCIS (Netherlands)

    Mavinkurve-Groothuis, A.M.C.; Weijers, G.; Groot-Loonen, J.J.; Pourier, M.S.; Feuth, A.B.; Korte, C.L. de; Hoogerbrugge, P.M.; Kapusta, L.

    2009-01-01

    Myocardial strain imaging with 2-D echocardiography is a relatively new noninvasive method to assess myocardial deformation. To determine the interobserver, intraobserver and intrapatient reliability scores, we evaluated myocardial strain measurements of 10 asymptomatic survivors of childhood cancer

  5. Speckle-tracking echocardiography for predicting outcome in chronic aortic regurgitation during conservative management and after surgery

    DEFF Research Database (Denmark)

    Olsen, Niels Thue; Søgaard, Peter; Larsson, Henrik B W

    2011-01-01

    Objectives The aim of this study was to test myocardial deformation imaging using speckle-tracking echocardiography for predicting outcomes in chronic aortic regurgitation. Background In chronic aortic regurgitation, left ventricular (LV) dysfunction must be detected early to allow timely surgery....... Speckle-tracking echocardiography has been proposed for this purpose, but the clinical value of this method in aortic regurgitation has not been established. Methods A longitudinal study was performed in 64 patients with moderate to severe aortic regurgitation. Thirty-five patients were managed...... conservatively with frequent clinical visits and sequential echocardiography and followed for an average of 19 ± 8 months, while 29 patients underwent surgery for the valve lesion and were followed for 6 months post-operatively. Baseline LV function by speckle-tracking and conventional echocardiography...

  6. Comparison of multidetector-row computed tomography to echocardiography and fluoroscopy for evaluation of patients with mechanical prosthetic valve obstruction.

    NARCIS (Netherlands)

    Symersky, P.; Budde, R.P.; Mol, B.A. de; Prokop, M.

    2009-01-01

    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

  7. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: Aortic and pulmonary regurgitation (native valve disease)

    NARCIS (Netherlands)

    P. Lancellotti (Patrizio); C. Tribouilloy (Christophe); A. Hagendorff (Andreas); L. Moura (Luis); B.A. Popescu (Bogdan); E. Agricola (Eustachio); J.L. Monin; L. Pié rard (Luc); L. Badano (Luigi); J.L. Zamorano (Jose); R. Sicari (Rosa); A. Vahanian (Alec); J.R.T.C. Roelandt (Jos)

    2010-01-01

    textabstractValvular regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular regurgitation. The echocardiographic assessment of valvular regurgitation should integrate qu

  8. Early detection of myocardial dysfunction in children with mitochondrial disease: An ultrasound and two-dimensional strain echocardiography study

    NARCIS (Netherlands)

    Marcus, K.A.; Barends, M.; Morava, E.; Feuth, T.; Korte, C.L. de; Kapusta, L.

    2011-01-01

    BACKGROUND: Myocardial dysfunction in children diagnosed with mitochondrial disease is an ominous sign and has been associated with substantial increased mortality rates. Early detection of cardiac involvement would therefore be desirable. Two dimensional strain echocardiography (2DSTE) has proven t

  9. Synchronicity of systolic deformation in healthy pediatric and young adult subjects: a two-dimensional strain echocardiography study.

    NARCIS (Netherlands)

    Marcus, K.A.; Janousek, J.; Barends, M.E.; Weijers, G.; Korte, C.L. de; Kapusta, L.

    2012-01-01

    Two-dimensional speckle tracking echocardiography (2DSTE) offers valuable information in the echocardiographic assessment of ventricular myocardial function. It enables the quantification and timing of systolic ventricular myocardial deformation. In addition, 2DSTE can be used to identify mechanical

  10. Performance of two-dimensional Doppler echocardiography for the assessment of infarct size and left ventricular function in rats.

    Science.gov (United States)

    Nozawa, E; Kanashiro, R M; Murad, N; Carvalho, A C C; Cravo, S L D; Campos, O; Tucci, P J F; Moises, V A

    2006-05-01

    Although echocardiography has been used in rats, few studies have determined its efficacy for estimating myocardial infarct size. Our objective was to estimate the myocardial infarct size, and to evaluate anatomic and functional variables of the left ventricle. Myocardial infarction was produced in 43 female Wistar rats by ligature of the left coronary artery. Echocardiography was performed 5 weeks later to measure left ventricular diameter and transverse area (mean of 3 transverse planes), infarct size (percentage of the arc with infarct on 3 transverse planes), systolic function by the change in fractional area, and diastolic function by mitral inflow parameters. The histologic measurement of myocardial infarction size was similar to the echocardiographic method. Myocardial infarct size ranged from 4.8 to 66.6% when determined by histology and from 5 to 69.8% when determined by echocardiography, with good correlation (r = 0.88; P echocardiography (r = -0.87; P rats.

  11. The transesophageal echo probe may contribute to esophageal injury after catheter ablation for paroxysmal atrial fibrillation under general anesthesia: a preliminary observation.

    Science.gov (United States)

    Kumar, Saurabh; Brown, Gregor; Sutherland, Fiona; Morgan, John; Andrews, David; Ling, Liang-Han; McLELLAN, Alex J A; Lee, Geoffrey; Robinson, Timothy; Heck, Patrick; Halloran, Karen; Morton, Joseph; Kistler, Peter; Kalman, Jonathan M; Sparks, Paul B

    2015-02-01

    The transesophageal echo probe (TEE) is commonly used before and during atrial fibrillation (AF) ablation under general anesthesia (GA). We sought to determine the potential contribution of the TEE probe to esophageal injury after pulmonary vein isolation (PVI) alone for paroxysmal AF. Seventy-six patients undergoing PVI with TEE, PVI/TEE, 16 undergoing PVI without TEE (PVI/No TEE), and 27 undergoing TEE without any left atrial ablation (TEE/No LA ablation) under GA were included. Posterior wall ablation was power (20-25 W) and time limited (electrogram attenuation or ≤30 s). Esophageal capsule endoscopy (n = 206) was performed pre- and post-procedure and at 2 weeks. Esophageal lesions were seen in 30% of PVI/TEE, 0% of patients in the PVI/No TEE (P = 0.009), and 22% of TEE/No LA ablation groups (P = 0.47 vs. PVI/TEE). There were no instances of esophageal bleeding, perforation, or need for gastrointestinal intervention. Self-resolving dysphagia was the only reported symptom (5%). All lesions healed within 2 weeks. There was no significant difference in the location or morphological appearance of esophageal lesions seen in the PVI/TEE versus TEE/No LA ablation groups. Esophageal lesions were seen in 30% of patients undergoing PVI alone under GA with use of TEE and in a similar proportion (22%) of patients undergoing TEE in the absence of left atrial ablation. This study makes the preliminary observation that one must be cognizant of the TEE probe as a potential contributor to esophageal injury after AF ablation. Larger studies are needed to confirm these findings. © 2014 Wiley Periodicals, Inc.

  12. Ruptured Sinus of Valsalva Aneurysm Initially Misdiagnosed as Ventricular Septal Defect by Echocardiography

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    GR Rezaian

    2009-06-01

    Full Text Available Aneurysms of sinus of valsalva are rare cardiac lesions and most of them are in congenital origin. The malformation consists of a separation or lack of fusion between the media of the aorta and the annulus fibrosis of the aortic valve. The structure becomes aneurysmal and may rupture to form a fistula. We present a case of ruptured sinus of valasalva aneurysm in a 25-year-old man. The diagnosis was made by echocardiography and confirmed at operation.

  13. Stress echocardiography in warmblood horses: comparison of dobutamine/atropine with treadmill exercise as cardiac stressors.

    Science.gov (United States)

    Gehlen, Heidrun; Marnette, Silke; Rohn, Karl; Stadler, Peter

    2006-01-01

    The purpose of this study was to determine whether the combination of dobutamine and atropine causes cardiac stress equivalent to treadmill exercise. Therefore, electrocardiography and echocardiography were performed on 10 warmblood horses before, during, and after different cardiac stress tests. Stressors consisted of a standardized treadmill exercise and combined administration of dobutamine (7.5 microg/kg/min) and atropine (5 microg/kg). Maxima heart rates were achieved during the treadmill exercise (175 +/- 10 bpm). After exercise, a rapid decrease in heart rate was observed. Subsequently, a stress echocardiography for which a heart rate >100 bpm was required could only be performed within 1 minute after exercise. The mean heart rate during echocardiography was 136 +/- 8 bpm after exercise. The combination of dobutamine and atropine also resulted in a significant increase in heart rate, up to 141 +/- 20 bpm. Maxima heart rate was significantly higher during the treadmill exercise, but the decrease in heart rate was significantly slower after dobutamine and atropine administration. Over a period of 7.9 minutes, the mean heart rate was 123 +/- 8 bpm during dobutamine and atropine administration. Consequently, the combination of both drugs offered sufficient time for detailed examinations. Overall, echocardiographic examination identified a decrease in left ventricular (LV) dimensions, an increase in LV wall thickness, and a decrease in stroke volume after the treadmill exercise and during pharmacologic stress testing compared with baseline. Changes in echocardiographic variables generally were more pronounced during dobutamine and atropine administration. Similar to stress echocardiography in humans, in horses the combination of dobutamine and atropine is useful to produce an increase in heart rate comparable with what is achieved with exercise but without the need of increasing dobutamine dosage.

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

    Science.gov (United States)

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

    2009-08-01

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

  15. Hemodynamic stress echocardiography in patients supported with a continuous-flow left ventricular assist device

    DEFF Research Database (Denmark)

    Andersen, Mads; Gustafsson, Finn; Madsen, Per Lav

    2010-01-01

    Functional assessment of continuous-flow left ventricular assist devices (LVADs) is usually performed with the patient at rest. This study compared echocardiographic indices of contraction and filling pressure with invasive measures in 12 ambulatory LVAD patients undergoing symptom-limited bicycl...... parallel with cardiac output) and diastolic E/e' ratio decreased (correlating inversely with diastolic pulmonary artery pressure). These findings emphasize the potential role of exercise echocardiography in studying exercise hemodynamics in LVAD patients....

  16. Acute hemodynamic effect of inhaled iloprost in pulmonary artery hypertension evaluated with echocardiography

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    Miranda Rita

    2007-11-01

    Full Text Available Abstract Doppler echocardiography is useful in the initial evaluation and long-term follow-up of patients with pulmonary artery hypertension. Aerosolised iloprost has been shown to reduce pulmonary pressure immediately after inhalation. We report the echocardiographic findings in a patient with severe pulmonary hypertension, before and after the inhalation of aerosolized iloprost. These findings illustrate the acute influence of iloprost in right and left ventricular hemodynamics and morphology. These findings were reproduced in subsequent echocardiographic evaluations.

  17. THE SPEKL-TREKING PREDICTIVE VALUE OF THE ECHOCARDIOGRAPHY AT THE ACUTE MYOCARDIAL INFARCTION

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    N. A. Kosheleva

    2016-01-01

    Full Text Available Speckle-tracking echocardiography is a non-invasive method  for assessment of myocardial deformation, which is closely associated with its regional and global function. Although it is not yet introduced into clinical practice, deformation parameters are actively studied in different clinical conditions, particularly in acute myocardial infarction. Numerous studies show deformation  impairment may have important prognostic value at patients with a acute myocardial infarction.

  18. Feasibility and observer reproducibility of speckle tracking echocardiography in congenital heart disease patients.

    Science.gov (United States)

    Mokhles, Palwasha; van den Bosch, Annemien E; Vletter-McGhie, Jackie S; Van Domburg, Ron T; Ruys, Titia P E; Kauer, Floris; Geleijnse, Marcel L; Roos-Hesselink, Jolien W

    2013-09-01

    The twisting motion of the heart has an important role in the function of the left ventricle. Speckle tracking echocardiography is able to quantify left ventricular (LV) rotation and twist. So far this new technique has not been used in congenital heart disease patients. The aim of our study was to investigate the feasibility and the intra- and inter-observer reproducibility of LV rotation parameters in adult patients with congenital heart disease. The study population consisted of 66 consecutive patients seen in the outpatient clinic (67% male, mean age 31 ± 7.7 years, NYHA class 1 ± 0.3) with a variety of congenital heart disease. First, feasibility was assessed in all patients. Intra- and inter-observer reproducibility was assessed for the patients in which speckle tracking echocardiography was feasible. Adequate image quality, for performing speckle echocardiography, was found in 80% of patients. The bias for the intra-observer reproducibility of the LV twist was 0.0°, with 95% limits of agreement of -2.5° and 2.5° and for interobserver reproducibility the bias was 0.0°, with 95% limits of agreement of -3.0° and 3.0°. Intra- and inter-observer measurements showed a strong correlation (0.86 and 0.79, respectively). Also a good repeatability was seen. The mean time to complete full analysis per subject for the first and second measurement was 9 and 5 minutes, respectively. Speckle tracking echocardiography is feasible in 80% of adult patients with congenital heart disease and shows excellent intra- and inter-observer reproducibility. © 2013, Wiley Periodicals, Inc.

  19. [Echocardiography during ergometric tests in subjects with stable effort angina (author's transl)].

    Science.gov (United States)

    Fedele, F; Arata, L; Giannico, S; Pastore, L R; Di Renzi, L; Penco, M; Agati, L; Dagianti, A

    1981-01-01

    The feasibility of echocardiography in detecting left ventricle wall motion abnormalities, their location and their spontaneous or therapeutic regression, was assessed performing monodimensional and two-dimensional echocardiography in 35 patients with stable effort angina, without previous AMI. A control group of 10 normal subjects was also studied. The Authors evaluated echocardiographic findings on subjects at rest, during supine bicycle exercise and after sublingual nitroglycerin administration, defining the quality of wall motion as normal, hypokinetic, akinetic or dyskinetic in M-mode, and normal or asynergic in 2-D. They also analyzed, in M-mode, some echocardiographic indices of regional left ventricle function (IVSE, PWE, VIVS, VPW, delta TS, delta TP), and, in 2-D, the percent of systo-diastolic endocardial outline changes versus standard references in 7 sectors of left ventricle (anterior, lateral, inferior, septal in short-axis, septal, postero-lateral in long-axis, and apical) by means of a HP 9845B Computer, interfaced to a Digitizer. The percentage of feasibility of exercise echocardiography has been 60% in M-Mode, and 70% in 2-D. Mono and two-dimensional findings were normal in all patients at rest, whereas, during exercise, 57% of them, in M-mode, and 88% in 2-D, showed segmental contraction abnormalities. The Authors conclude that exercise echocardiography, though technically difficult, is feasible, Both M-mode and 2-D involve peculiar advantages or disadvantages. They provide, however, a valuable tool in detecting the mechanical consequences of exercise-induced regional myocardial ischemia and may be applicable in patients with equivocal exercise test.

  20. [Results and perspectives of the use of echocardiography and ultrasonic scanning of the heart].

    Science.gov (United States)

    Mukharliamov, N M; Belenkov, Iu N; AT'KOV, O Iu; Nasrulaeva, M M; Krol, V A

    1975-06-01

    The results of echocardiography and ultrasonic scanning of the heart in over 600 patients with ischaemic heart disease, hypertension, heart diseases and other pathology are presented. The high diagnostic value of these techniques in terms of detection of acquired and congenital heart failures, exsudative pericardites, left atrial tumors is demonstrated. The methods permit to evaluate myocardial hypertrophy, left ventricular dilatation, and to reveal myocardial contractility disorders at their early stages. The prospects of the employment of ultrasonic techniques in cardiological practice are analysed.

  1. Feasibility of physiologist-led stress echocardiography for the assessment of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Jamal N Khan

    2017-07-01

    Full Text Available Background: Physiologist-led stress echocardiography (PLSE services provide potential for expansion of SE services and increased productivity for cardiologists. There are however no published data on the feasibility of PLSE. We sought to assess the feasibility, safety and robustness of PLSE and cardiologist-led stress echocardiography (CLSE for coronary artery disease (CAD assessment. Methods: Retrospective analysis of 898 patients undergoing PLSE or CLSE for CAD assessment using exercise or dobutamine stress over 24 months. PLSE involved 2 cardiac physiologists (exercise or 1 physiologist plus 1 cardiac nurse (dobutamine. A cardiology registrar was present in the echocardiography department during PLSE in case of medical complications. CLSE involved 1 physiologist and 1 trainee cardiologist who analysed the study and reviewed findings with an imaging cardiologist. Sixteen-segment wall motion scoring (WMS, WMSI analysis was performed. Feasibility (stressor, image quality, proportion of completed studies, agreement with imaging cardiologist analysis and safety (complication rate were compared for PLSE and CLSE. Results: The majority of studies were CLSE (56.2% and used dobutamine (68.7%. PLSE more commonly used exercise (69.2%. Overall, 96% of studies were successfully completed (>14 diagnostic segments in 98%, P = 0.899 PLSE vs CLSE. Commencement of PLSE was associated with an increase in annual SE’s performed for CAD assessment. Complication rates were comparably very low for PLSE and CLSE (0.8% vs 1.8%, P = 0.187. There was excellent agreement between PLSE and CLSE WMS interpretation of 480 myocardial segments at rest (κ = 0.87 and stress (κ = 0.70 and WMSI (ICCs and Pearson’s r >0.90, zero Bland–Altman mean bias. Conclusion: This to our knowledge is the first study of the feasibility of PLSE. PLSE performed by well-trained physiologists is feasible and safe in contemporary practice. PLSE and CLSE interpretation of stress

  2. [Asymptomatic myxoma of the tricuspid valve septal leaflet].

    Science.gov (United States)

    Jedliński, Ireneusz; Jamrozek-Jedlińska, Maria; Bugajski, Paweł; Kalawski, Ryszard; Poprawski, Kajetan; Słomczyński, Marek

    2012-01-01

    We presented a case of asymptomatic myxoma of the tricuspid valve septal leaflet. The tumour was diagnosed accidentally during rutine transthoracic echocardiography and confirmed by transesophageal echocardiography. It was resected and the septal leaflet repaired during surgery.

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

    DEFF Research Database (Denmark)

    Kim, Won Yong; Søgaard, Peter; Egeblad, Henrik;

    2001-01-01

    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 echocard......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...

  4. Effect of streptozotocin-induced diabetes on myocardial blood flow reserve assessed by myocardial contrast echocardiography in rats

    OpenAIRE

    Weytjens Caroline; Garbar Christian; Degaillier Céline; Hernot Sophie; Droogmans Steven; Cosyns Bernard; Roosens Bram; Schoors Danny; Lahoutte Tony; Franken Philippe R; Van Camp Guy

    2008-01-01

    Abstract The role of structural and functional abnormalities of small vessels in diabetes cardiomyopathy remains unclear. Myocardial contrast echocardiography allows the quantification of myocardial blood flow at rest and during dipyridamole infusion. The aim of the study was to determine the myocardial blood flow reserve in normal rats compared with Streptozotocin-induced diabetic rats using contrast echocardiography. Methods We prospectively studied 40 Wistar rats. Diabetes was induced by ...

  5. Performance of two-dimensional Doppler echocardiography for the assessment of infarct size and left ventricular function in rats

    OpenAIRE

    Nozawa E.; Kanashiro R.M.; Murad N.; Carvalho A.C.C.; Cravo S.L.D.; Campos O.; Tucci P.J.F.; Moises V.A.

    2006-01-01

    Although echocardiography has been used in rats, few studies have determined its efficacy for estimating myocardial infarct size. Our objective was to estimate the myocardial infarct size, and to evaluate anatomic and functional variables of the left ventricle. Myocardial infarction was produced in 43 female Wistar rats by ligature of the left coronary artery. Echocardiography was performed 5 weeks later to measure left ventricular diameter and transverse area (mean of 3 transverse planes), i...

  6. The diagnostic value of transthoracic echocardiography for eosinophilic myocarditis: A single center experience from China.

    Science.gov (United States)

    Xie, Mingxing; Cheng, Tsung O; Fei, Hongwen; Ren, Pingping; He, Yale; Wang, Xinfang; Lu, Qing; Han, Wei; Li, Ke; Li, Ling; Yang, Yali; Chen, Oudi

    2015-12-15

    The aim of this study is to explore the value of transthoracic echocardiography in the diagnosis of eosinophilic myocarditis. The echocardiographic characteristics of nine patients with eosinophilic myocarditis in our hospital between January 2004 and January 2012 were retrospectively reviewed. In our study, four of the nine patients were diagnosed to have small pericardial effusion. The obliteration of the apical cavity was observed in five of the nine patients. There were six patients with both mitral and tricuspid regurgitation, one patient with only mitral regurgitation, and one patient with only tricuspid regurgitation. Transthoracic echocardiography showed that the diameters of the left and right atria were both increased in eight of the nine patients. The diameter of the left ventricle was increased in five patients, and the right ventricular diameter was increased in four patients. The left ventricular ejection fraction was decreased in two of the nine patients. Five of the nine patients had pulmonary hypertension, and one patient had severe pulmonary hypertension. Transthoracic echocardiography is the primary method for the diagnosis of eosinophilic myocarditis and is also useful in follow-up of the disease.

  7. [Limitation of myocardial expansion in late thrombolysis evaluated by two-dimensional echocardiography].

    Science.gov (United States)

    Romero, M A; Espinosa Vázquez, A; Ramos Corrales, M A; Solorio, S; Lepe Montoya, L; Badui, E; Ocampo, S; Carrillo, A M

    1996-01-01

    Myocardial expansion in acute myocardial infarction (AMI) is present in about 45% of the patients within the first 72 hours. This is associated with ventricular aneurysm formation, myocardial rupture, heart failure and early death. Experimental studies in animals with AMI have used late reperfusion to decrease the incidence of expansion with success. The present is a prospective, longitudinal, open and randomized study in 21 patients with anterior AMI, to evaluate if the late reperfusion (6 to 12 hours) can decrease the incidence of myocardial expansion graded quantitatively with bidimensional echocardiography. Two groups were made: group A (n = 12) who received thrombolysis with streptokinase 1.5 mill. IU plus oral aspirin 150 mg OD (n = 9). Both groups had the same characteristics of AMI and functional class of Killip and Kimball (I-II class). Intrahospital treatment was given freely in both groups. The expansion was evaluated with bidimensional echocardiography used Jugdutt's method. In group A, expansion was present in 25% of the cases, while in group B was 66.6% (p < 0.0005). The distortion area, distortion peak, septal thickness and large asynergic segment were more sensitive parameters to identify myocardial expansion. Our results are similar to some experimental studies. We conclude that late thrombolysis can be useful in decreasing the incidence of myocardial expansion. Bidimensional echocardiography is a useful, fast and safe method to identify myocardial expansion.

  8. Cardiovascular assessment of patients with Ullrich-Turner's Syndrome on Doppler echocardiography and magnetic resonance imaging

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    Castro Ana Valéria Barros de

    2002-01-01

    Full Text Available OBJECTIVE: To assess the cardiovascular features of Ullrich-Turner's syndrome using echocardiography and magnetic resonance imaging, and to correlate them with the phenotype and karyotype of the patients. The diagnostic concordance between the 2 methods was also assessed. METHODS: Fifteen patients with the syndrome were assessed by echocardiography and magnetic resonance imaging (cardiac chambers, valves, and aorta. Their ages ranged from 10 to 28 (mean of 16.7 years. The karyotype was analyzed in 11 or 25 metaphases of peripheral blood lymphocytes, or both. RESULTS: The most common phenotypic changes were short stature and spontaneous absence of puberal development (100%; 1 patient had a cardiac murmur. The karyotypes detected were as follows: 45,X (n=7, mosaics (n=5, and deletions (n=3. No echocardiographic changes were observed. In regard to magnetic resonance imaging, coarctation and dilation of the aorta were found in 1 patient, and isolated dilation of the aorta was found in 4 patients. CONCLUSION: The frequencies of coarctation and dilation of the aorta detected on magnetic resonance imaging were similar to those reported in the literature (5.5% to 20%, and 6.3% to 29%, respectively. This confirmed the adjuvant role of magnetic resonance imaging to Doppler echocardiography for diagnosing cardiovascular alterations in patients with Ullrich-Turner's syndrome.

  9. Imaging in repaired tetralogy of Fallot with a focus on recent advances in echocardiography.

    Science.gov (United States)

    Larios, Guillermo; Friedberg, Mark K

    2017-09-01

    Imaging is essential for the management of adults with repaired tetralogy of Fallot (rToF). Echocardiography and cardiac magnetic resonance imaging are the central modalities to assess rToF. Here we review recent literature on imaging rToF, focusing on echocardiography and advances in assessment of cardiac mechanics. Several two-dimensional, three-dimensional, and Doppler echo parameters have been proposed to assess pulmonary regurgitation, right ventricular volumes and ejection fraction, but most of them still have important limitations in their feasibility and reliability compared to cardiac magnetic resonance (CMR). Myocardial deformation imaging to study ventricular and atrial mechanics, regional function, ventricular-ventricular interactions, and electro-mechanical dyssynchrony has yielded insights into the pathophysiologic mechanisms of right ventricular and left ventricular dysfunction; thereby predicting clinical outcomes and exercise capacity, allowing among others, evaluation of the impact of pulmonary valve replacement (PVR). Emerging technologies are expected to further our understanding of the drivers of dysfunction and guide indications and timing of PVR. Echocardiography and CMR have complementary and overlapping roles in rToF and contribute to our understanding of its pathophysiology and management.

  10. Successful surgical removal of the large retrocardiac mass. The usefulness of CT scan and intraoperative echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Minoru; Abe, Toshio; Murase, Mitsuya; Nogaki, Hideitsu; Takeuchi, Eiji (Nagoya Univ. (Japan). Faculty of Medicine)

    1983-04-01

    Computed tomography had proved useful in identifying cardiac lesion, especially space taking lesion. A 53-year-old man, who had open mitral commissurotomy eight years ago, has been regarded as the patient with an unresectable tumor of the left ventricle by echocardiography during about five years before this operation. However, the finding of cardiac CT scan in this patient led to excision of the mass. The patient was operated on through the left fifth intercostal space incision without extracorporeal circulation. The pericardium was densely adherent to the heart. We could not tell the border between the mass and the myocardium. Therefore, it was too difficult to incise the mass without injury to the myocardium or the coronary artery. After embarrassment, intraoperative echocardiography was performed. Intraoperative echocardiography demonstrated the size and the location of the mass, and its relation to the myocardiom, which resulted in successful removal of the mass. The removed mass was old hematoma of 300 gr in weight. In this paper, the usefulness of CT and intraoperative echocardiograpy was described and the origin of this hematoma was discussed.

  11. [Congenital heart disease: Recent technical advances in three-dimensional echocardiography].

    Science.gov (United States)

    Karsenty, Clement; Hadeed, Khaled; Acar, Philippe

    2017-05-01

    The recent technical advances allow the use in practice of three-dimensional echocardiography in children especially through the new high frequency matrix probe. It is difficult or even impossible to hold breathing during children' acquisition so to avoid motion full volume artifact, one beat and live 3D modes are suitable. 3D echocardiography is more accurate than 2D to assess the size, location, and relationship with surrounding structures of atrial and ventricular septal defects and thus helps in the therapeutic decision. 3D echocardiography enables to guide precisely percutaneous procedure. The morphology of the valve leaflets, chordal support apparatus, papillary muscle and the annulus are particularly well described in 3D and allows assessment of the regurgitation before repair and after as well for the common valve of the atrioventricular septal defect or in the Ebstein anomaly. Complex heart diseases such as double outlet right ventricle are suitable to a tridimensional assessment to plan surgical strategy. 3D printing, fusion imaging in cathlab and automated volume quantification embody recent innovations of new techniques in congenital heart disease. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  12. Current Status of 3-Dimensional Speckle Tracking Echocardiography: A Review from Our Experiences

    Science.gov (United States)

    Ishizu, Tomko; Aonuma, Kazutaka

    2014-01-01

    Cardiac function analysis is the main focus of echocardiography. Left ventricular ejection fraction (LVEF) has been the clinical standard, however, LVEF is not enough to investigate myocardial function. For the last decade, speckle tracking echocardiography (STE) has been the novel clinical tool for regional and global myocardial function analysis. However, 2-dimensional imaging methods have limitations in assessing 3-dimensional (3D) cardiac motion. In contrast, 3D echocardiography also has been widely used, in particular, to measure LV volume measurements and assess valvular diseases. Joining the technology bandwagon, 3D-STE was introduced in 2008. Experimental studies and clinical investigations revealed the reliability and feasibility of 3D-STE-derived data. In addition, 3D-STE provides a novel deformation parameter, area change ratio, which have the potential for more accurate assessment of overall and regional myocardial function. In this review, we introduced the features of the methodology, validation, and clinical application of 3D-STE based on our experiences for 7 years. PMID:25031794

  13. Quantification of mechanical dyssynchrony in growth restricted fetuses and normal controls using speckle tracking echocardiography (STE).

    Science.gov (United States)

    Krause, Kristina; Möllers, Mareike; Hammer, Kerstin; Falkenberg, Maria Karina; Möllmann, Ute; Görlich, Dennis; Klockenbusch, Walter; Schmitz, Ralf

    2017-10-26

    To evaluate longitudinal mechanical dyssynchrony in normally grown fetuses by speckle tracking echocardiography (STE) and to compare longitudinal mechanical dyssynchrony in fetal growth restriction (FGR) with normal controls. A prospective study was performed on 30 FGR and 62 normally grown fetuses, including 30 controls matched by gestational age, using STE and a transversal four-chamber view. Data analysis was carried out with a high frame rate of about 175 frames/s. Dyssynchrony was analyzed offline with QLab 9 (Philips Medical Systems, Andover, MA, USA) as time differences between peaks in strain of both ventricles and the septum. Inter- and intraventricular and intraseptal dyssynchrony were obtained and inter- and intraobserver reliability was analyzed. Longitudinal mechanical dyssynchrony was feasible in all cases, with high inter- and intraobserver reliability. Levels of inter- and intraventricular dyssynchrony were higher in the FGR than in the control group. Speckle tracking echocardiography (STE) is a reliable technique for cardiac function assessment in the fetal heart. Interventricular dyssynchrony could be a potential parameter for early detection of subclinical myocardial dysfunction before other parameters demand intervention. The future clinical role of longitudinal mechanical dyssynchrony needs to be verified in larger studies and with a technique customized for prenatal echocardiography.

  14. Two-dimensional speckle tracking echocardiography: standardization efforts based on synthetic ultrasound data.

    Science.gov (United States)

    D'hooge, Jan; Barbosa, Daniel; Gao, Hang; Claus, Piet; Prater, David; Hamilton, Jamie; Lysyansky, Peter; Abe, Yasuhiko; Ito, Yasuhiro; Houle, Helene; Pedri, Stefano; Baumann, Rolf; Thomas, James; Badano, Luigi P

    2016-06-01

    Speckle tracking echocardiography has already demonstrated its clinical potential. However, its use in routine practice is jeopardized by recent reports on high inter-vendor variability of the measurements. As such, the European Association of CardioVascular Imaging (EACVI) and the American Society of Echocardiography (ASE) set up a standardization task force, which was joined by all manufacturers of echocardiographic equipment as well as by companies offering software solutions only, with the ambition to tackle this problem by standardization and quality assurance (QA). In this study, a first step towards QA of all commercially available tracking solutions based on computer-generated ultrasound images is presented. The accuracy of the products was acceptable with relative errors below 10% and intra-vendor reproducibility within 5%. Whether these results can be extrapolated to the clinical setting is the topic of an ongoing study of the EACVI/ASE/Industry Task Force to standardize deformation imaging. This study was an important first step in the development of generally accepted tools for QA of speckle tracking echocardiography. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  15. Computed tomography, radiology and echocardiography in cats naturally infected with Aelurostrongylus abstrusus.

    Science.gov (United States)

    Lacava, Giuseppe; Zini, Eric; Marchesotti, Federica; Domenech, Oriol; Romano, Francesca; Manzocchi, Simone; Venco, Luigi; Auriemma, Edoardo

    2017-04-01

    Objectives The aims of the study were to describe the radiographic and computed tomographic features in cats naturally infected with Aelurostrongylus abstrusus, and to identify signs of pulmonary hypertension with echocardiography. Methods Fourteen cats positive on Baermann test for A abstrusus were included in the study. All cats underwent thoracic radiography, CT and echocardiography. Results The most common clinical signs were coughing (10/14) and dyspnoea (5/14). Radiographic findings included a generalised unstructured interstitial pulmonary pattern (8/14), mixed bronchointerstitioalveolar pattern (3/14) and bronchointerstitial pattern with bronchial wall thickening (3/14). Sternal lymphadenopathy was detected on thoracic radiographs in six cats. On CT, features were mixed bronchointerstitioalveolar pattern with ground-glass appearance in six cats, interstitioalveolar with multiple pulmonary nodules in five, interstitial ground-glass infiltrates in three, regional lymph node enlargement in 11 (10 sternal, three cranial mediastinal and three tracheobronchial lymph nodes) and subpleural thickening in four. None of the thoracic radiographs revealed subpleural thickening. In all cases, pulmonary vessels were normal in terms of size, shape and attenuation on both radiography and CT. Pulmonary hypertension and cardiac abnormalities were not observed in any cat during echocardiography. Conclusions and relevance CT provided a more thorough characterisation of pulmonary and mediastinal lesions compared with thoracic radiographs in cats naturally infected with A abstrusus. Although feline aelurostrongylosis has been previously associated with histopathological lesions in lung arteries, in this cohort clinical evidence of pulmonary hypertension was not documented.

  16. Teaching the basics of echocardiography in the undergraduate: Students as mentors.

    Science.gov (United States)

    Arias Felipe, A; Doménech García, J; Sánchez Los Arcos, I; Luordo, D; García Sánchez, F J; Villanueva Martínez, J; Forero de la Sotilla, A; Villena Garrido, V; Torres Macho, J; García de Casasola Sánchez, G

    To analyse the ability of medical students to incorporate the practical teaching of basic echocardiography planes using a peer mentoring design. Thirty-six medical students previously trained in obtaining echocardiography planes (mentors) taught the other 5th-year students (n=126). The teaching methodology included three stages: theory (online course), basic training (three 15h sessions of practical experience in ultrasound and at least 20 echocardiographic studies per mentor) and objective structured clinical assessment (OSCA), which scored the appropriateness of the basic ultrasound planes and the correct identification of 16 cardiac structures. The students' weighted mean score in the OSCA was 8.66±1.98 points (out of 10). Only 10 students (8.4%) scored less than 5, and 15 (12.6%) scored less than 7. Fifty students (42%) scored 10 points. The most easily identified structure was the left ventricle in the short-axis parasternal plane, with 89.9% of correct answers. The most poorly identified structure was the mitral valve in the subxiphoid plane, with 69.7% of correct answers. Peer mentoring-based teaching achieves an appropriate level of training in obtaining basic echocardiography planes. The training period is relatively short. The peer mentoring system can facilitate the implementation of teaching on basic aspects of ultrasound to a large number of undergraduate students. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  17. A New Method for Pseudo-increasing Frame Rates of Echocardiography Images Using Manifold Learning.

    Science.gov (United States)

    Gifani, Parisa; Behnam, Hamid; Sani, Zahra Alizadeh

    2011-05-01

    Increasing frame rate is a challenging issue for better interpretation of medical images and diagnosis based on tracking the small transient motions of myocardium and valves in real time visualization. In this paper, manifold learning algorithm is applied to extract the nonlinear embedded information about echocardiography images from the consecutive images in two dimensional manifold spaces. In this method, we presume that the dimensionality of echocardiography images obtained from a patient is artificially high and the images can be described as functions of only a few underlying parameters such as periodic motion due to heartbeat. By this approach, each image is projected as a point on the reconstructed manifold; hence, the relationship between images in the new domain can be obtained according to periodicity of the heart cycle. To have a better tracking of the echocardiography, images during the fast motions of heart we have rearranged the similar frames of consecutive heart cycles in a sequence. This provides a full view slow motion of heart movement through increasing the frame rate to three times the traditional ultrasound systems.

  18. Heart wall motion analysis by dynamic 3D strain rate imaging from tissue Doppler echocardiography

    Science.gov (United States)

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

    2002-04-01

    The knowledge about the complex three-dimensional (3D) heart wall motion pattern, particular in the left ventricle, provides valuable information about potential malfunctions, e.g., myocardial ischemia. Nowadays, echocardiography (cardiac ultrasound) is the predominant technique for evaluation of cardiac function. Beside morphology, tissue velocities can be obtained by Doppler techniques (tissue Doppler imaging, TDI). Strain rate imaging (SRI) is a new technique to diagnose heart vitality. It provides information about the contraction ability of the myocardium. Two-dimensional color Doppler echocardiography is still the most important clinical method for estimation of morphology and function. Two-dimensional methods leads to a lack of information due to the three-dimensional overall nature of the heart movement. Due to this complex three-dimensional motion pattern of the heart, the knowledge about velocity and strain rate distribution over the whole ventricle can provide more valuable diagnostic information about motion disorders. For the assessment of intracardiac blood flow three-dimensional color Doppler has already shown its clinical utility. We have developed methods to produce strain rate images by means of 3D tissue Doppler echocardiography. The tissue Doppler and strain rate images can be visualized and quantified by different methods. The methods are integrated into an interactively usable software environment, making them available in clinical everyday life. Our software provides the physician with a valuable tool for diagnosis of heart wall motion.

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

    Science.gov (United States)

    Khraiche, Diala; Ben Moussa, Nidhal

    2016-02-01

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

  20. Progressive development of pulmonary hypertension leading to right ventricular hypertrophy assessed by echocardiography in rats.

    Science.gov (United States)

    Kato, Yosuke; Iwase, Mitsunori; Kanazawa, Hiroaki; Kawata, Natsuki; Yoshimori, Yukie; Hashimoto, Katsunori; Yokoi, Toyoharu; Noda, Akiko; Takagi, Kenzo; Koike, Yasuo; Nishizawa, Takao; Nishimura, Masahiko; Yokota, Mitsuhiro

    2003-07-01

    The present study aimed to evaluate the development of pulmonary hypertension by serial echocardiography, including measurements of pulmonary artery (PA) flow velocities, and correlate echocardiographic indices with pathological findings in rats administered monocrotaline (MCT). MCT (60 mg/kg body weight) or physiologic saline was administered to a total of 9 male Wistar rats at the age of 4 weeks (MCT group: n = 4, control group: n = 5, respectively). Echocardiography was performed serially until the age of 8 weeks. The ratio of right ventricular (RV) outflow tract dimensions to aortic dimensions increased progressively in the MCT group and became significantly greater than that of the control group after the age of 6 weeks. Peak PA velocity (Peak V) in the MCT group was significantly less than that of the control group at the ages of 7 and 8 weeks. The ratio of acceleration time to ejection time (AT/ET) in PA flow waveforms declined progressively and was significantly less than that of the control group after the age of 6 weeks. The ratio of RV weight to body weight (RVW/BW) in the MCT group was significantly greater than that of the control group. Both AT/ET ratio and Peak V were significantly inversely correlated with RVW/BW ratio. Furthermore, these echocardiographic findings were also significantly inversely correlated with the mean cross-sectional RV myocyte area. In conclusion, the progressive development of pulmonary hypertension leading to RV hypertrophy can be evaluated appropriately by echocardiography including PA flow Doppler indices in rats.

  1. Assessment of segmental myocardial viability using regional 2-dimensional strain echocardiography.

    Science.gov (United States)

    Migrino, Raymond Q; Zhu, Xiaoguang; Pajewski, Nicholas; Brahmbhatt, Tejas; Hoffmann, Raymond; Zhao, Ming

    2007-04-01

    We determined whether 2-dimensional strain echocardiography can identify viable from infarcted myocardium in a rat ischemia-reperfusion model. A total of 16 male Sprague-Dawley rats underwent left anterior descending coronary artery occlusion for 12 or 30 minutes followed by 60-minute reperfusion. Short-axis 2-dimensional strain echocardiography was performed at the mid-ventricle 60 minutes post-reperfusion. Post-sacrifice, triphenyl tetrazolium chloride was infused to the coronary circulation. Regional end-systolic radial and circumferential strain, and time to peak strain, were measured using software in all 96 segments and correlated with areas of infarct in corresponding histologic slices. Segments with greater than 50% area of infarct had lower end-systolic radial and circumferential strain and longer time to peak strain versus areas with 50% or less strain or no infarct. Extent of infarct correlates with radial and circumferential strain. End-systolic radial strain less than 2% has 88% sensitivity and 95% specificity for detecting infarcted area greater than 50%. Two-dimensional strain echocardiography-derived strain is useful in distinguishing infarcted from viable myocardium.

  2. Right ventricular involvement in patients with inferior myocardial infarction, correlation of electrocardiographic findings with echocardiography data.

    Science.gov (United States)

    Javed, Sumbul; Rajani, Ali Raza; Govindaswamy, Pushparani; Radaideh, Ghazi Ahmed; Abubaraka, Harb Ahmed; Qureshi, Tariq Ilyas; Arshad, Hassaan Bin

    2017-03-01

    To determine the right ventricular involvement in patients with inferior myocardial infarction by echocardiography in relation to electrocardiographic findings. This observational, prospective study was conducted at Rashid Hospital, Dubai, the United Arab Emirates, from January to September 2013, and comprised patients with inferior myocardial infarction. All patients aged above 18 years were included. Right ventricular myocardial infarction was defined by the electrocardiographic criteria of > 1mV ST elevation in V4R-V5R leads. RV infarction was assessed on echocardiography by fractional area change, tricuspid annular plane systolic excursion and tricuspid annular systolic velocity by tissue Doppler imaging. SPSS 21 was used for data analysis. Of the 73 patients, there were 68(93%) men and 5(7%) women. The three modalities used to assess the right ventricular infarction showed right ventricular involvement in 36(49.3%) cases by fractional area change, 28(38.4%) cases by tricuspid annular plane systolic excursion and 31(42.5%) cases by tissue Doppler imaging in patients with inferior myocardial infarction. Tissue Doppler imaging and right ventricular function showed low degree of negative correlation (p=0.16) while the correlation between tricuspid annular plane systolic excursion and right ventricular function showed significant positive correlation (pright ventricular infarction by echocardiography helped to diagnose right ventricular infarction in greater number of cases compared to surface electrocardiogram.

  3. Intraoperative perfusion contrast echocardiography. Initial experience during coronary artery bypass grafting.

    Science.gov (United States)

    Kabas, J S; Kisslo, J; Flick, C L; Johnson, S H; Craig, D M; Stanley, T E; Smith, P K

    1990-03-01

    Intraoperative evaluation of the effectiveness of myocardial revascularization has been limited by an inability to assess regional myocardial perfusion. Microbubbles of sonicated diatrizoate sodium and diatrizoate meglumine (Renografin) have been an effective echocardiographic contrast agent and have been employed clinically during cardiac catheterization. This recent development in contrast-enhanced two-dimensional echocardiography permits real-time imaging of transmural myocardial blood flow but has not been evaluated in the operating room. This study represents the initial surgical application of this directed technique and was designed to evaluate the safety and efficacy of intraoperative perfusion contrast echocardiography in assessing the results of coronary artery bypass grafting. Twenty men with significant coronary artery disease ranging in age from 49 to 73 years were studied. Direct contrast agent injection into completed saphenous vein bypass grafts caused the myocardium supplied by each graft to be well delineated and provided a tomographic view of contrast distribution. The enhanced region was well correlated with the size and distribution of the native vessel. Rapid contrast washout (less than 20 seconds) indicated satisfactory regional perfusion. Contrast echocardiography prolonged the operation less than 10 minutes and did not result in any perioperative complications.

  4. Assessment of left ventricular non-compaction in adults: side-by-side comparison of cardiac magnetic resonance imaging with echocardiography.

    Science.gov (United States)

    Thuny, Franck; Jacquier, Alexis; Jop, Bertrand; Giorgi, Roch; Gaubert, Jean-Yves; Bartoli, Jean-Michel; Moulin, Guy; Habib, Gilbert

    2010-03-01

    Two-dimensional echocardiography images obtained at end-diastole and end-systole and cardiac magnetic resonance (CMR) images obtained at end-diastole represent the three imaging methodologies validated for diagnosis of left ventricular non-compaction (LVNC). No study has compared these methodologies in assessing the magnitude of non-compaction. To compare two-dimensional echocardiography with CMR in the evaluation of patients with suspected LVNC. Sixteen patients (48+/-17 years) with LVNC underwent echocardiography and CMR within the same week. Echocardiography images obtained at end-diastole and end-systole were compared in a blinded fashion with those obtained by CMR at end-diastole to assess non-compaction in 17 anatomical segments. All segments could be analysed by CMR, whereas only 238 (87.5%) and 237 (87.1%) could be analysed by echocardiography at end-diastole and end-systole, respectively (p=0.002). Among the analysable segments, a two-layered structure was observed in 54.0% by CMR, 42.9% by echocardiography at end-diastole and 41.4% by echocardiography at end-systole (p=0.006). Similar distribution patterns were observed with the two echocardiographic methodologies. However, compared with echocardiography, CMR identified a higher rate of two-layered structures in the anterior, anterolateral, inferolateral and inferior segments. Echocardiography at end-systole underestimated the NC/C maximum ratio compared with CMR (p=0.04) and echocardiography at end-diastole (p=0.003). No significant difference was observed between CMR and echocardiography at end-diastole (p=0.83). Interobserver reproducibility of the NC/C maximum ratio was similar for the three methodologies. CMR appears superior to standard echocardiography in assessing the extent of non-compaction and provides supplemental morphological information beyond that obtained with conventional echocardiography.

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

    Directory of Open Access Journals (Sweden)

    Ataei A

    2012-07-01

    Full Text Available Mehrnoush Toufan,1 Babak Kazemi,1 Fariborz Akbarzadeh,1 Amin Ataei,1 Majid Khalili21Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Azerbaijan National Academy of Sciences, Baku, AzerbaijanBackground: Over the last two decades, morphological cardiac changes induced by athletic conditioning have been of great interest. Therefore, several studies have been orchestrated to delineate electrocardiography (ECG, echocardiography, and heart rate variability (HRV findings in athletes.Purpose: To assess the ECG, echocardiography, and HRV in a group of dynamic and static type athletes.Methods: Fifty professional athletes (20 static and 30 dynamic exercise athletes and 50 healthy nonathletes (control group were recruited. Standard 12-lead ECG and transthoracic echocardiography was performed on all athletes and the control group. Through echocardiography, variables including left ventricular (LV end-diastolic/systolic diameter, LV mass, and left atrial volume index were measured. In addition, both the athletes and the control group underwent ECG Holter monitoring for 15 minutes and several parameters related to HRV (time and frequency domain were recorded.Results: The most common ECG abnormalities among the athletes were sinus bradycardia and incomplete right bundle branch block. LV end-diastolic diameter and left atrial volume index were significantly greater in the dynamic athletes (P < 0.001. LV end-systolic diameter was significantly lower in the static group (P < 0.001. LV mass of the dynamic and static athletes was significantly greater than that of the controls (P < 0.001. Among the ECG Holter monitoring findings, the dynamic athletes had lower systolic blood pressure than the controls (P = 0.01. Heart rate was lowest in the control group (P < 0.001.Conclusion: The most common ECG abnormalities among adolescent Iranian athletes were sinus bradycardia and incomplete right bundle branch block. Static exercise seemed

  6. Echocardiography derived three-dimensional printing of normal and abnormal mitral annuli

    Directory of Open Access Journals (Sweden)

    Feroze Mahmood

    2014-01-01

    Full Text Available Aims and Objectives: The objective of this study was to assess the clinical feasibility of using echocardiographic data to generate three-dimensional models of normal and pathologic mitral valve annuli before and after repair procedures. Materials and Methods: High-resolution transesophageal echocardiographic data from five patients was analyzed to delineate and track the mitral annulus (MA using Tom Tec Image-Arena software. Coordinates representing the annulus were imported into Solidworks software for constructing solid models. These solid models were converted to stereolithographic (STL file format and three-dimensionally printed by a commercially available Maker Bot Replicator 2 three-dimensional printer. Total time from image acquisition to printing was approximately 30 min. Results: Models created were highly reflective of known geometry, shape and size of normal and pathologic mitral annuli. Post-repair models also closely resembled shapes of the rings they were implanted with. Compared to echocardiographic images of annuli seen on a computer screen, physical models were able to convey clinical information more comprehensively, making them helpful in appreciating pathology, as well as post-repair changes. Conclusions: Three-dimensional printing of the MA is possible and clinically feasible using routinely obtained echocardiographic images. Given the short turn-around time and the lack of need for additional imaging, a technique we describe here has the potential for rapid integration into clinical practice to assist with surgical education, planning and decision-making.

  7. Echocardiography derived three-dimensional printing of normal and abnormal mitral annuli.

    Science.gov (United States)

    Mahmood, Feroze; Owais, Khurram; Montealegre-Gallegos, Mario; Matyal, Robina; Panzica, Peter; Maslow, Andrew; Khabbaz, Kamal R

    2014-01-01

    The objective of this study was to assess the clinical feasibility of using echocardiographic data to generate three-dimensional models of normal and pathologic mitral valve annuli before and after repair procedures. High-resolution transesophageal echocardiographic data from five patients was analyzed to delineate and track the mitral annulus (MA) using Tom Tec Image-Arena software. Coordinates representing the annulus were imported into Solidworks software for constructing solid models. These solid models were converted to stereolithographic (STL) file format and three-dimensionally printed by a commercially available Maker Bot Replicator 2 three-dimensional printer. Total time from image acquisition to printing was approximately 30 min. Models created were highly reflective of known geometry, shape and size of normal and pathologic mitral annuli. Post-repair models also closely resembled shapes of the rings they were implanted with. Compared to echocardiographic images of annuli seen on a computer screen, physical models were able to convey clinical information more comprehensively, making them helpful in appreciating pathology, as well as post-repair changes. Three-dimensional printing of the MA is possible and clinically feasible using routinely obtained echocardiographic images. Given the short turn-around time and the lack of need for additional imaging, a technique we describe here has the potential for rapid integration into clinical practice to assist with surgical education, planning and decision-making.

  8. Three-dimensional echocardiography in congenital heart disease: an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography.

    Science.gov (United States)

    Simpson, John; Lopez, Leo; Acar, Philippe; Friedberg, Mark; Khoo, Nee; Ko, Helen; Marek, Jan; Marx, Gerald; McGhie, Jackie; Meijboom, Folkert; Roberson, David; Van den Bosch, Annemien; Miller, Owen; Shirali, Girish

    2016-10-01

    Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good acoustic windows and the non-invasive nature of the technique. The aim of this paper is to provide a review of the optimal application of 3DE in CHD including technical considerations, image orientation, application to different lesions, procedural guidance, and functional assessment. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  9. Evaluation of commissural malalignment of aortic-pulmonary sinus using cardiac CT for arterial switch operation: comparison with transthoracic echocardiography

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    Bang, Ji Hyun; Park, Jeong-Jun [Asan Medical Center, University of Ulsan College of Medicine, Divisions of Pediatric Cardiac Surgery, Seoul (Korea, Republic of); Goo, Hyun Woo [Asan Medical Center, University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of)

    2017-05-15

    There are limited data regarding the influence of commissural malalignment of the aortic-pulmonary sinus on the arterial switch operation. To compare diagnostic accuracy between cardiac CT and echocardiography for evaluating commissural malalignment of aortic-pulmonary sinus in children with complete transposition of the great arteries and to seek potential clinical implication of commissural malalignment on the arterial switch operation. In 37 patients (35 boys; median age: 8 days, range: 3-80 days) with complete transposition of the great arteries who had tricuspid semilunar valves and underwent an arterial switch operation, the degree of the commissural rotation of the aortic-pulmonary sinus was assessed on cardiac CT (n=37) and echocardiography (n=35). With surgical finding as a reference, cardiac CT was compared with echocardiography in identifying commissural malalignment in 35 patients. The influence of the height difference between the semilunar valves measured by cardiac CT on the identification of commissural malalignment with cardiac CT and echocardiography was evaluated. The impact of commissural malalignment on coronary transfer techniques was evaluated. In operative findings, the commissures of the semilunar valves were aligned in 24 patients and malaligned in 13. With surgical findings as a reference, cardiac CT showed higher, but not statistically significant (P>0.05), sensitivity (91.7% vs. 75.0%), specificity (87.0% vs. 78.3%) and accuracy (88.6% vs. 77.1%) for the diagnosis of the malalignment than echocardiography. The measured height difference between the semilunar valves did not affect the identification of the malalignment with cardiac CT and echocardiography. The surgical malalignment group showed a higher requirement of modified coronary transfer techniques than the surgical aligned group (11/13 vs. 11/24, P=0.03). Cardiac CT and echocardiography appear useful for evaluating commissural malalignment of the semilunar valves in patients with

  10. The repeatability and characteristics of right ventricular longitudinal strain imaging by speckle-tracking echocardiography in healthy dogs.

    Science.gov (United States)

    Morita, T; Nakamura, K; Osuga, T; Yokoyama, N; Khoirun, N; Morishita, K; Sasaki, N; Ohta, H; Takiguchi, M

    2017-08-01

    To assess the repeatability and characteristics of echocardiographic indices of the right ventricular (RV) function derived from speckle-tracking echocardiography. Fourteen laboratory Beagles and 103 privately owned dogs without cardiac disease were involved in this study. Right ventricular longitudinal strain, strain rate, and a strain-related index for assessing RV dyssynchrony derived from speckle-tracking echocardiography were obtained by two different observers using five Beagles. Within-day, between-day, and interobserver coefficients of variation and the intraclass correlation coefficient of speckle-tracking echocardiography indices were determined. Both speckle-tracking echocardiography and conventional indices of RV function, including the peak velocity of systolic tricuspid annular motion, tricuspid annulus plane systolic excursion, fractional area change, and the Tei index, were obtained from 14 Beagles and 103 privately owned dogs. Relationships between echocardiographic indices and the body weight, heart rate, age, and sex were estimated by regression analysis. Speckle-tracking echocardiographic indices showed good within-day repeatability, between-day and interobserver repeatability were moderate to good. In large dogs, RV longitudinal strain, strain rate, and fractional area change were significantly decreased, while the index of RV dyssynchrony, systolic tricuspid annular motion, tricuspid annulus plane systolic excursion, and the Tei index were increased. All speckle-tracking and conventional echocardiographic indices were correlated with the body weight. The speckle-tracking echocardiography indices were highly repeatable and body weight affected speckle-tracking echocardiography indices in dogs. Further studies are needed to apply s