0000000000075236
AUTHOR
S. Genth
Transthoracic and transesophageal echocardiography to diagnose ventricular septal rupture
BACKGROUND Rapid and accurate diagnosis of ventricular septal rupture (VSR) remains difficult, and the monitoring of hemodynamic deterioration is a prerequisite for the institution of adequate therapy. The timing of surgical repair is a matter of controversy. METHODS Transthoracic, transesophageal, color Doppler, and contrast echocardiography were evaluated in 17 patients with VSR in whom the diagnosis was confirmed by catheterization, surgery, or necropsy. RESULTS Routine transthoracic echocardiography visualized VSR in four out of 17 patients and, with additional views, in 12 out of 17 patients. Color Doppler echocardiography identified the rupture in 15 out of 16, and contrast echocardio…
The influence of Albunex on the pulmonary circulation in patients with pulmonary hypertension or left heart failure.
To determine the safety of the ultrasound contrast agent Albunex, its influence on right and left heart haemodynamics in patients with pulmonary artery hypertension or left heart failure was assessed after intravenous injection. Patients with a left ventricular ejection fraction smaller than 40% or a systolic pulmonary artery pressure greater than 40 mmHg received 0.08 and 0.22 ml.kg -1 Albunex and 10 ml albumin in random order during right heart catheterization and transthoracic echocardiography. Right atrial, systolic and diastolic pulmonary artery and capillary wedge pressures were measured at 3 min and 5 min and cardiac output at 5 min after the intravenous injection of Albunex and cont…
Left ventricular volume determination using colour superpositioning of contrast echocardiograms
Abstract Objective: To delineate the endocardium, selective colouring of contrast regions in left ventricular contrast echocardiograms was performed using digital image processing. Methods: Volume determinations were performed in end-diastolic and end-systolic frames before and after the injection of contrast agent into the left ventricle and were compared to cineventriculograms in 30 patients by two independent investigators. Results: The mean end-diastolic volume measured was 114 ± 44 ml in the native, 235 ± 79 ml in the contrast, 175 ± 70 ml in the color-superimposed (observer 1), and 187 ± 79 ml in the cineventriculographic images. Thus, native echocardiograms underestimated angiographi…
Contrast echocardiography of the left ventricle an independent predictor of pulmonary artery pressure?
To test the hypothesis that left heart opacification is dependent on pulmonary artery pressure, we analyzed consecutively 12 patients with normal and 8 patients with abnormal pulmonary artery pressure with a new lung capillary stable echo contrast agent. Patients underwent contrast echocardiographic examination within 6 hours before right and left heart catheterization with 200 mg/ml and 400 mg/ml SHU 508A intravenously. The mean pulmonary artery pressure was 15.4 mmHg in the patients with normal pulmonary artery pressures and 46.4 mmHg in the patients with pulmonary hypertension (p0.000). Echocardiograms were video-intensitometrically analyzed for intensity maximum (MAX), half-time of vide…
Left atrial thrombi despite anticoagulant and antiplatelet therapy
To investigate risk factors for embolization in patients with echocardiographically detected left atrial thrombi and to evaluate thrombus development, we examined 29 patients with transesophageal and transthoracic echocardiography at two points during a follow-up of 18 months. We compared patients with a history of possible arterial embolization (n = 13) with those without (n = 16) in regard to age, gender, left atrial dilatation, localization of the thrombus in the left atrial cavity, spontaneous echo contrast, and atrial fibrillation. Eight patients were treated with aspirin, 20 with phenprocoumon. Only left atrial spontaneous contrast was associated with thromboembolism (10/15 patients w…
Diagnosis of papillary muscle rupture after acute myocardial infarction by transthoracic and transesophageal echocardiography.
The sensitivity of transthoracic echocardiography to visualize the structural abnormality of papillary muscle rupture (PMR) after acute myocardial infarction can be anticipated to average about 50%; therefore, we evaluated five patients exhibiting the condition with both transthoracic and transesophageal echocardiography. The use of the two imaging techniques resulted in the fact that no instance of PMR was missed. Using transthoracic echocardiography in two patients and transesophageal echocardiography in four, the ruptured papillary muscle was visualized directly. Mitral insufficiency as an indirect sign was observed in all patients. In one patient the papillary muscle rupture developed i…
Comparison of antiplatelet effects of aspirin, ticlopidine, or their combination after stent implantation.
Background —This study was performed to analyze the influence of either aspirin, ticlopidine, or their combination on platelet activation and aggregation parameters after stent implantation. Methods and Results —Sixty-one patients with successful implantation of a single Palmaz-Schatz stent in a native coronary artery were randomly assigned to either group A (aspirin 300 mg/d+ticlopidine 2×250 mg/d), group B (ticlopidine 2×250 mg/d), or group C (aspirin 300 mg/d). Platelet activation was evaluated on days 1, 7, and 14 by flow cytometry measurement of expression of CD62p (p-selectin) and the binding of fibrinogen to the platelet surface glycoprotein IIb/IIIa receptor. Platelet aggregation w…