Improvement of tricuspid regurgitation after pulmonary thromboendarterectomy

For patients with chronic thromboembolic pulmonary hypertension who undergo pulmonary thromboendarterectomy (PTE) it has not yet been systematically investigated how operation affects the severity of tricuspid regurgitation (TR). This study sought (1) to evaluate the extent of TR reversibility after operation, (2) to identify potential predictors of the reversibility of TR, and (3) to investigate the influence of geometric and hemodynamic alterations on the extent of TR severity.Thirty-nine patients (55+/-12 years) undergoing PTE without tricuspid valve repair were investigated before and 13+/-8 days after operation by Doppler color flow mapping. Geometry of the tricuspid valve as well as r…

Regurgitant flow in apparently normal valve prostheses: improved detection and semiquantitative analysis by transesophageal two-dimensional color-coded Doppler echocardiography.

In 128 patients with apparently normally functioning prosthetic valves ( n = 136) in the aortic position ( n = 79) and the mitral position ( n = 57), the prevalence of transprosthetic regurgitant flow was studied by use of transthoracic and transesophageal two-dimensional color-coded Doppler echocardiography. With the transthoracic approach, regurgitant flow was detected in early systole or diastole for 28% of the mitral prostheses and for 29% of the aortic prostheses. With transesophageal color-coded Doppler echocardiography, regurgitant jets were visualized for 95% of the mitral prostheses and for 44% of the aortic prostheses. In 40% of the Bjork-Shiley prostheses and 88% of the St. Jude …

Reversibilität von Veränderungen der links- und rechtsventrikulären Geometrie und Hämodynamik bei pulmonaler Hypertonie. Echokardiographische Charakterisierung bei Patienten vor und nach pulmonaler Thrombendarteriektomie (Reversibility of changes in left- and right ventricular geometry and hemodynamics in patients with pulmonary hypertension. Echocardiographic characteristics before and after pulmonary thrombendarterectomy)

Durch pulmonale Thrombendarteriektomie kann bei Patienten mit chronischer embolisch bedingter pulmonaler Hypertonie eine akute rechtsventrikulare Nachlastsenkung erzielt werden. Der Einflus auf die rechts- und linksventrikulare Geometrie und Hamodynamik wurde prospektiv mit Hilfe der transthorakalen Echokardiographie an einem Kollektiv von 14 Patienten (8 Frauen, 6 Manner; Alter 55 ± 20 Jahre) vor und nach 18 ± 12 Tagen postoperativ untersucht. Nach operativer Desobliteration der Pulmonalarterien fand sich eine Abnahme des invasiv bestimmten totalen pulmonalen Gefaswiderstands von 986 ± 318 auf 323 ± 280 dyn x s/cm5; p < 0,05. Der echokardiographisch erfaste systolische pulmonalarterielle D…

Identification of abscess formation in native-valve infective endocarditis using transesophageal echocardiography: implications for surgical treatment.

The object of the study was to follow patients with endocarditis-associated abscesses in order to evaluate the clinical outcome with and without surgical intervention. Transesophageal echocardiography successfully displayed the location and extent of abscess cavities in 14 patients (group A) with aortic valve endocarditis. The infective process was limited to the perivalvular tissue in two, extended into the ascending aorta in six, and included the interventricular septum, the right ventricular outflow tract, interatrial septum, and/or mitral valve annulus in six patients. The complication rate was significantly higher in group A than in group B, which consisted of 27 patients with proven s…

Farbkodierte Dopplerechokardiographie bei dilatativer Kardiomyopathie

Die dilatative Kardiomyopathie ist morphologisch durch die Dilatation, insbesondere des linken Ventrikels, und funktionell durch die eingeschrankte Ejek-tionsfraktion gekennzeichnet. Sowohl die Morphologie als auch die Ejektions-fraktion konnen mittels ein- und zweidimensionaler Echokardiographie nichtinvasiv beurteilt werden (Corya et al. 1974; Feigenbaum 1986). Durch die konventionellen Dopplerverfahren ist zusatzlich eine Erkennung und semiquantitative Schweregradabschatzung von begleitenden AV-Klappen-Insuffizienzen moglich (Abbasi et al. 1980; Keren et al. 1986). Ferner wurden Versuche einer Quantifizierung von Klappeninsuffizienzen unternommen sowie die systolische und diastolische Fu…

The presence of infection-related antiphospholipid antibodies in infective endocarditis determines a major risk factor for embolic events.

Abstract OBJECTIVES The impact of infection-associated antiphospholipid antibodies (APA) on endothelial cell activation, blood coagulation and fibrinolysis was evaluated in patients with infective endocarditis with and without major embolic events. BACKGROUND An embolic event is a common and severe complication of infective endocarditis. Despite the fact that APAs are known to be associated with infectious diseases, their pathogenic role in infective endocarditis has not been clearly defined. METHODS The relationship among the occurrence of major embolic events, echocardiographic vegetation size, endothelial cell activation, thrombin generation, fibrinolysis and APA was examined in 91 patie…

Relation of endocrine and cardiac findings in acromegalics

Cardiac involvement in 32 acromegalics was related to endocrine parameters, clinical score and duration of the disease as well as compared to that of 50 controls free of cardiac disease. Stress ECG, 24h Holter monitoring and echocardiography revealed that supraventricular premature complexes did not occur more often in acromegalics than in controls, both prevalence and severity of ventricular arrhythmia, however, were higher in patients compared to controls: 15/32 (48%) acromegalics had complex ventricular arrhythmia as compared with 6/50 (12%) normal subjects (p less than 0.01). Repetitive ventricular arrhythmia was manifest in 10/32 (31%) patients but only in 4/50 (8%) controls (p less th…

Pathophysiology of Impaired Right and Left Ventricular Function in Chronic Embolic Pulmonary Hypertension

Study objectives: This study sought to evaluatethe pathophysiology of left and right heart failure in patients withchronic thromboembolic pulmonary hypertension (CTEPH) who werehospitalized to undergo pulmonary thromboendarterectomy (PTE). Design: Thirty-nine patients (16 women and 23 men;mean ± SD age, 55 ± 12 years) with severe CTEPH were examinedbefore and 13 ± 8 days after PTE by way of transthoracicechocardiography and right heart catheterization. Measurements and results: Examination resultsconfirmed in all cases that before surgery the right ventricles wereenlarged and systolic function was impaired. Moderate to severetricuspid valve regurgitation was observed. Left ventriculareccent…

Arrhythmia profile in acromegaly.

In a controlled study, the cardiac involvement and arrhythmia profile of 32 patients with acromegaly were correlated with endocrine parameters (somatomedine C, growth hormone), clinical score and duration of the disease. Data were compared with those of 50 controls free of cardiac disease. Stress ECG, 24 h Holter monitoring and echocardiography were performed. Supraventricular premature complexes occurred no more often in acromegalics than in controls. Both prevalence and severity of ventricular arrhythmia, however, were significantly higher in patients compared to controls (P less than 0.01). 15/32 (48%) acromegalic patients had complex ventricular arrhythmias (Lown III-IV) as compared wit…

Kardiopulmonale Parameter bei Hyperthyreose

Background Hyperthyroid patients often suffer from impaired exercise capacity with dyspnoea. Two well established, non-invasive methods were used to evaluate the influence of hyperthyroidism on cardiopulmonary function. Patients and methods In 42 patients with hyperthyroidism we performed spirometry and cardiopulmonary exercise testing before and after 7 days of propranolol therapy as well as in euthyroidism. Results In hyperthyroidism reduced vital capacity and 1-second capacity were observed (95.5 +/- 2.4% vs 102.6 +/- 1.5%; p = 0.0087; 89.4 +/- 2.3% vs 95.2 +/- 2.2%; p = 0.0179). No changes showed during beta-blockade. At the anaerobic threshold reduced tidal volume and enhanced respirat…

Quantitative Tissue Doppler Echocardiography: Physiological Nonuniformity of Left Ventricular Transmural Myocardial Wall-Motion Velocities and Gradients.

Tissue Doppler echocardiography (TDE) is a new method by which transmural myocardial function can be studied noninvasively. In order to investigate physiology and reproducibility, 24 young, healthy volunteers were examined by M-mode TDE. Nonuniformity of transmural tissue layer velocities became apparent: Subendocardial and subepicardial velocities of the anteroseptal myocardial wall (AW) were 3.5 +/- 0.7 and 1.3 +/- 0.5 cm/sec (P < 0.0001, t-test), whereas in the posterolateral wall (PW) values of 3.6 +/- 0.6 and 1.2 +/- 0.4 cm/sec (P < 0.0001, t-test), respectively, were revealed. The ratios, termed "myocardial velocity gradients" as a new indicator of left ventricular performance, were 3…

Verlaufsbeobachtung von Patienten mit chronischer Aortenklappeninsuffizienz unter ACE-Hemmer-Therapie (Follow-up of patients with chronic severe aortic regurgitation)

In dieser Untersuchung wurde der Einflus einer 3monatigen ACE-Hemmer-Therapie mit Cilazapril (2,5–5 mg) bei 13 Patienten mit chronischer Aortenklappeninsuffizienz spiroergometrisch und echokardiographisch untersucht. Nach 3monatiger Therapie sanken der linksventrikulare enddiastolische Diameter-Index von 3,5 auf 3,1 cm/m2 (p = 0,005), der linksventrikulare endsystolische Diameter-Index von 2,3 auf 2,0 cm/m2 (p = 0,005). Der Wallstress reduzierte sich von 174 auf 150 dyn/cm2 (p = 0,01). Die linksventrikulare Muskelmasse nahm um 14% ab, von anfangs 570 g (= 295 g/m2) auf 488 g (= 253 g/m2) (p < 0,05). Die von apikal gemesesene Jetflache reduzierte sich von 10,1 auf 8,1 cm2 (p < 0,05). Weder d…

Value and limitations of transesophageal echocardiography in the evaluation of aortic prostheses.

Results of 34 transesophageal (TEE) studies in patients with suspected aortic prosthetic dysfunction were compared with transthoracic echocardiographic (TTE) results and to anatomic findings. Mass lesions noted at surgery (autopsy) were correctly described in 93% by TEE versus 43% by TTE. Abscesses were detected in 88% by TEE versus 18% by TTE. Bioprosthetic degeneration was visualized in 88% versus 38% and prosthetic obstruction correctly identified in 75% versus 50% by TEE and TTE, respectively. Anatomic aortic regurgitant lesions were identified in 96% by TEE versus 77% by TTE, whereas the correct origin was detected in 88% of cases by TEE versus 54% of cases by TTE. TEE provides valuabl…

Assessment of the Tricuspid Valve Morphology by Transthoracic Real-Time-3D-Echocardiography

Aim: To demonstrate the feasibility of transthoracic three-dimensional real-time echocardiography (3D-TTE) supplemental to routine assessments of the tricuspid valve and to analyze interrater agreement. Methods: Twenty healthy subjects and 74 patients with right ventricular failure were examined with conventional 2D and additionally 3D-TTE (SONOS 7500, Philips, Netherlands). The 3D exams were performed and recorded by one of two raters. The recordings were evaluated offline and independently by both raters for visualization of morphological and functional features of the tricuspid valve according to a subjective 3-point scale. Statistical analyses were performed for interrater agreement and…

Diagnosis of aortic dissection: the value of transesophageal echocardiography.

Using the transesophageal approach the descending part of the aorta can be imaged by two-dimensional enchocardiography in cross sections comparable to computer tomograms. The value of combined transesophageal and transthoracic echocardiography was evaluated in 53 patients who were studied consecutively from 1983 to 1986 with symptoms of aortic dissection and compared with computed tomography, angiography, surgery and/or autopsy. In all patients the transthoracic aorta could be visualized and the dissection could be classified according to DeBakey: in 9 of 29 patients (34%) type I dissection, in 4 (14%) type II dissection and in 16 (55%) type III dissection was found. Operation was carried o…

Prognostication of post-infarct chronic heart failure: superiority of clinical assessment vs. cardiopulmonary and left ventricular function analysis.

Prognostication of congestive heart failure post-myocardial infarction (MI) is important for decision making. We sought of a head-to-head comparison between the prognostic implication of clinical, cardiopulmonary, and left ventricular (LV) function assessment.Retrospectively, 100 consecutive post-MI patients (MI history 1418+/-1668 days ago) were stratified by NYHA functional classification system, cardiopulmonary exercise testing (CPX) [oxygen consumption at maximal exercise (VO(2max)) and at the anaerobic threshold (VO(2AT)) resulting in the Weber classification], and LV function analysis by M-mode and two-dimensional echocardiography [LV end-diastolic and -systolic diameter index (LVDDI …

Intraventrikuläre Obstruktionen bei der Dobutamin-Streßechokardiographie: Determinanten ihrer Entstehung und klinische Folgen (Dynamic intraventricular obstruction during dobutamine stress echocardiography. Determinants of the phenomenon and clinical consequences)

Die Dobutamin-Stresechokardiographie (DSE) fuhrt zu einer starken Hyperkontraktilitat des Myokards bei Tachykardie und Vesodilatation. Diese Effekte konnen zu einer unphysiologischen Abnahme des endsystolischen Volumenindex (ESVI) mit Obstruktion des linksventrikularen Ausflustraktes (LVOT) fuhren. Bei 100 Patienten (Pat.), die sich einer DSE (5–40) μg/kg/min) unterzogen, wurde die kontinuierliche Dopplerregistrierung (DW-Doppler) vor Infusion und bei maximaler Herzfrequenz durchgefuhrt. Eine dynamische, spat-systolische, Flusakzeleration auf mehr als 2 Meter/Sekunde (m/s) unter maximaler Stimulation wurde als systolische Obstruktion des LVOT interpretiert. Manifestationsfaktoren systolisch…

Color-Doppler Flow Mapping of the Heart in Normal Subjects

Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis

Infective endocarditis is associated with significant morbidity and mortality, with valvular destruction and congestive heart failure being more common in patients with echocardiographically discernible vegetations. The transoesophageal approach affords consistently high quality images with excellent structural resolution. Two-hundred and eighty-one patients with clinically suspected infective endocarditis were studied, to evaluate the prognostic value of ascertaining the site of vegetations. Among them were 118 patients with vegetations attached to the aortic or mitral valve. These patients were followed for a mean period of 14 months. Mitral valve vegetations were associated with a signif…

Detection of Strands in Native Aortic Valves by Transesophageal Echocardiography

Prevalence and echocardiographic characteristics of strands on the leaflets of native aortic valves were examined. According to our data, the strands we found in 39% of patients are most likely Lambl's excrescences.

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

Qualitatively, dobutamine stress echocardiography has become an established procedure. Quantitative results are in great demand but this is still difficult due to limited endo- and epicardial border definition. Transmitral Doppler variables are strictly quantitative and less subjective. Furthermore, ischemic alterations precede systolic ones (ischemic cascade). There are preliminary reports of the utility of dobutamine stress Doppler echocardiography, but proof of reproducibility and left ventricular filling patterns are still lacking. Fourteen healthy volunteers (10 men, 4 women, median age 25.9 years, range 21-32 years) were investigated according to the usual dobutamine stress echocardio…

Assessment of cardiac performance using Tei indices in patients undergoing pulmonary thromboendarterectomy.

This study was designed to evaluate left and right ventricular performance using Tei indices in patients with severe chronic thromboembolic pulmonary hypertension undergoing pulmonary thromboendarterectomy (PTE). The Doppler-derived indices are easily measurable indicators of ventricular function based on nongeometric assessment, which helps overcome some of the difficulties entailed in the geometric assessment of left ventricular (LV) and right ventricular (RV) function in pulmonary hypertension.The indices were derived for 24 patients (aged 54+/-14 years) before and after PTE. Calculation of these indices was based on the duration of two time intervals using the formula (A - B)/B, where A…

Normalwerte für die Dobutamin-Streßechokardiographie*

UNLABELLED Dobutamine stress echocardiography having established itself as a sensitive method for diagnosing coronary heart disease, even in the absence of normative values, the physiological haemodynamics as well as the physiological values for global and regional left ventricular myocardial function were measured. TEST PERSONS AND METHODS 14 healthy subjects (ten men, four women; median age 25 [range 21-32] years) underwent dobutamine stress echocardiography according to an internationally practised dosage steps protocol (5-40 micrograms/kg/min with additional 0.5 mg atropine at 40 micrograms). RESULTS Maximal infusion rate achieved a serum dobutamine level of 1.67 micrograms/ml with mini…

Exercise echocardiography for the evaluation of patients after nonsurgical coronary artery revascularization.

Objectives. The purpose of this study was to demonstrate the accuracy of stress echocardiography for detecting the progression of coronary artery disease after nonsurgical revascularization. Background. The expanding role of nonsurgical coronary revascularization procedures mandates the development of sensitive noninvasive techniques for tbe detection of recurrent ischemia. Methods. Bicycle stress echocardiography was performed in a series of 86 patients 6.5 ±1.3 months after a revascularization procedure. Seven patients were excluded from analysis because of poor echocardiographic image quality. Results. Digital analysis achieved a sensitivity of 83% for the entire group and a specificity …

914 Contrast enhanced live 3D echo in acute myocardial infarction determines accurate left ventricular wall motion and volumes compared to cardiac MR imaging

Impaired Cardiopulmonary Exercise Capacity in Patients With Hyperthyroidism

Hyperthyroidism (H) has been implicated as a primary cause of decreased exercise tolerance. To our knowledge, analysis of respiratory gas exchange, an efficient noninvasive method in evaluating cardiopulmonary capacity, has not been performed in patients with H.Using cardiopulmonary exercise testing, 12 consecutive women with Graves' H were examined and controlled in euthyroidism (E). Eighteen women with E, in whom cardiac catheterization had ruled out heart disease, served as control subjects (C).The ventilatory anaerobic threshold was determined by means of the V-slope method. Ergometry was performed with patients in a semisupine position using a continuous ramp protocol of 20 W/min. Echo…

Improved Assessment of Pathological Regurgitation in Patients with Prosthetic Heart Valves by Multiplane Transesophageal Echocardiography

The aim of this study was to evaluate the diagnostic increment of individually optimized axes in the assessment of pathological prosthetic valve regurgitation. Forty-two patients with pathologically regurgitant prostheses in the aortic (n = 21), mitral (n = 15), and tricuspid (n = 6) positions were examined by multiplane transesophageal echocardiography. The investigation was performed utilizing the transverse axis first, the longitudinal axis second, and the intermediate axes afterwards. The presence of regurgitation, the differentiation between trans- and perivalvular origin, and the localization of perivalvular leakages at the sewing ring were evaluated. Findings in the biplane and inter…

Aortic intramural hemorrhage visualized by transesophageal echocardiography: Findings and prognostic implication

Abstract Objectives. This study describes the transesophageal echocardiographic and follow-up findings in patients with aortic intramural hemorrhage. Background. Localized aortic intramural hemorrhage resulting in layered thickening of the aortic wall seems to represent a variant of acute aortic dissection without communication or a typical moving intimal flap. In autopsy studies this variant, attributed to a rupture of the van vasorum, has been described in 5% to 10% of patients with dissection. Methods. In a prospective transesophageal echocardiographic study in patients with aortic dissection performed between 1986 and 1991, the diagnosis of intramural hemorrhage was established in 15 of…

258 Right heart wall motion and volume analysis in severe chronic pulmonary hypertension using realtime three dimensional echocardiography compared to MR imaging

Clinical and morphological characteristics in Streptococcus bovis endocarditis: a comparison with other causative microorganisms in 177 cases

Aim—To compare the clinical and morphological characteristics of patients with Streptococcus bovis endocarditis with those of patients with endocarditis caused by other microorganisms. Methods—177 consecutive patients (Streptococcus bovis, 22; other streptococci, 94; staphylococci, 44; other, 17) with definite infective endocarditis according to the Duke criteria were included. All patients underwent transthoracic and transoesophageal echocardiography. In 88 patients, findings from surgery/necropsy were obtained. Results—S bovis endocarditis was associated with older patients, with a higher mortality (p = 0.04), and with a higher rate of cardiac surgery (p < 0.001) than other microorganisms…

Quantification of mitral valve stenosis by three-dimensional transesophageal echocardiography

The aim of this study was the evaluation of the diagnostic potentials of transesophageal 3D- echocardiography in the determination of mitral valve stenosis. 54 patients were investigated by transthoracic and multiplane transesophageal echocardiography. In 41 patients cardiac catheterization was performed. 3D- echocardiographic data acquisition was performed by automatic transducer rotation at 2 degree increments over a span of 180 degrees. The transesophageal probe was linked to an ultrasound unit and to a 3D- workstation capable of ECG- and respiration gated data acquisition, postprocessing and 2D/3D image reconstruction. The mitral valve was visualized in sequential cross-sectional planes…

Three-Dimensional Echocardiographic Evaluation of Aortic and Mitral Valve Stenosis

Dynamic volume rendered three-dimensional echocardiography allows the spatial recognition of anatomy and function of the aortic and mitral valves with acceptable image quality. The aortic valve can be best visualized in a view from the ascending aorta down to the valve level, thus allowing an overview of the aortic aspect of the valve in a surgeon's perspective in ∼ 80% of patients. Planimetric measurement of the aortic valve area was possible in 88% of patients, and there is no systematic overestimation or underestimation of aortic valve area compared with two-dimensional echocardiography and catheterization. The entire valvular circumference of the mitral valve can be assessed from both a…

Aortic dissection detected by transoesophageal echocardiography

The diagnostic value of transoesophageal echocardiography was evaluated in 24 patients with aortic dissection and compared to transthoracic two-dimensional echocardiography, computer tomography, aortography, surgery and autopsy. Using transoesophageal echocardiography we found in 5 patients a type I dissection, in 5 patients a type II and in 14 patients a type III dissection. Transthoracic two-dimensional echocardiography was positive in 3/5 type I, 2/5 in type II and 2/14 in type III dissections. Computer tomography was unable to demonstrate an intimal flap in 1/2 patients with type I, 2/3 type II and 1/11 type III dissections. Aortography was negative in 1/4 type I, 3/5 type II and 3/12 p…

Direct measurement of left ventricular outflow tract by transthoracic real-time 3D-echocardiography increases accuracy in assessment of aortic valve stenosis.

Evaluation of aortic valve stenosis is a major clinical application of echocardiography. The widely employed continuity equation requires determination of the left ventricular outflow tract (LVOT) area. We aimed at testing whether direct area measurement in a volume data set is superior to conventional calculation from the LVOT diameter.We performed LVOT measurement in 20 normal subjects and 83 patients with moderate to severe aortic stenosis with a transthoracic real-time three-dimensional echocardiography (3D-TTE) technique in two systolic frames. The off-line 3D-evaluation allows full choice of section planes within the acquired volume data set. The aortic valve area was calculated from …

292 Rate of complications in the follow-up of patent foramen ovale occluder therapy 1998–2003: role of realtime 3D and transesophageal studies

Quantitative versus qualitative Beurteilung der linksventrikulären Funktion — Praktikabilität und Limitationen

Die Prognose des Patienten mit koronarer Herzkrankheit ist entscheidend von den Volumina des linken Herzens und der Ejektionsfraktion abhangig (17, 32). Ein nichtinvasiver Zugang zu diesen Parametern ist daher fur die Risikostratifizierung und Verlaufsbeurteilung unter Therapie von grosem klinischen Wert. Einen solchen Zugang bietet die zweidimensionale Echokardiographie. Seit ihrer Einfuhrung in die Klinik Ende der siebziger Jahre besteht jedoch eine noch immer andauernde Auseinandersetzung uber die Frage, ob es moglich ist, eine exakte Quantifizierung der linksventrikularen Funktion mittels zweidimensionaler Echokardiographie vorzunehmen, oder ob nur eine mehr qualitative Beurteilung mogl…

Diagnostic value of transesophageal echocardiography in patients with coronary artery disease and mitral insufficiency

Any diagnosis of mitral regurgitation must always include the etiology. The clinical history is only rarely informative, as are chest x-ray examinations. The ECG is of value to diagnose coronary artery disease with or without previous myocardial infarction — but further differentiation is not possible. During heart catheterization mitral insufficiency can be diagnosed and quantified according to Seller’s classification [1]. A differentiation of etiology is only rarely possible. Rheumatic heart disease and mitral valve prolapse can be differentiated.

Effects of prostaglandin E1 and buflomedil on left ventricular function in patients with severe chronic occlusive arterial disease: a prospective, randomized, double-blind trial.

In this study, the effect of a course of prostaglandin E ( 1 ) (60 microg/d intravenously [i.v.]) or buflomedil (150 mg/d i.v.) treatment on parameters of left ventricular systolic function was investigated by echocardiography in patients of comparatively advanced age with severe peripheral occlusive arterial disease (Fontaine's stage III or IV). The study population was 20 patients, 12 men and 8 women, between 51 and 85 years of age (average age, 73. 7 years), with multiple coexisting medical conditions. These patients were no longer suitable candidates for other forms of interventional or surgical treatment. The patients were treated with prostaglandin E ( 1 ) or buflomedil in the dosages…

Prevalence of myxomatous mitral valve prolapse in patients with lymphocytic thyroiditis

Abstract In conclusion, given the cardiac (mitral regurgitation, endocarditis, thromboembolic complications, arrhythmic sudden death) and neurologic (cerebral embolic event) complications of the pathologic forms of MVP, 6,8 physicians should look carefully for myxomatous involvement of the mitral valve and prolapse in patients with autoimmune thyroid diseases. Patients should be monitored and prophylactic antibiotic treatment recommended when appropriate.

Diagnosis of culture-negative endocarditis: The role of the Duke criteria and the impact of transesophageal echocardiography

Abstract Background The Duke criteria have been shown to be more sensitive than the von Reyn criteria in the diagnosis of culture-positive endocarditis but to date have not been fully validated for culture-negative endocarditis (CNE). The aim of this study was (1) to compare the diagnostic accuracy of the Duke criteria versus clinical judgment and the von Reyn criteria in CNE and (2) to assess the diagnostic impact of transesophageal echocardiography (TEE) on the Duke criteria in CNE. Methods The study group consisted of 49 patients with suspected CNE in whom the presence (n = 32) or absence (n = 17) of endocarditis was confirmed by surgery, autopsy, or both. All patients underwent transtho…

Arrhythmieprofil und Herzfrequenz bei Hyperthyreose

Arrhythmia profiles and heart rates, obtained by 24-hour ECG monitoring, were analysed in 48 patients with hyperthyroidism before (T3 level: 331 +/- 108 ng/100 ml, heart rate: 95 +/- 13/min), during (T3 level: 202 +/- 98 ng/100 ml, heart rate: 85 +/- 11/min) and after (T3 level: 149 +/- 41 ng/100 ml, heart rate: 79 +/- 9/min) antithyroid treatment. 50 persons in whom organic heart disease has been excluded by invasive and noninvasive tests served as controls. Only 6% of patients had repetitive ventricular arrhythmias (Lown group IV) before treatment (controls: 4%; P greater than 0.05). Supraventricular extrasystoles were common both before and after treatment (P less than 0.001), especially…

Use of transoesophageal echocardiography in the diagnosis of abscess in infective endocarditis

Transoesophageal echocardiography is invaluable clinically since it accurately images abscess cavities or aneurysms. It provides the information about the site and extension of abscesses which is needed by surgeons to time and define surgical intervention. Early diagnosis is advantageous, and abscesses should be expected in 5%-30% of patients with echocardiographically discernible vegetations. Since there is no 'abscess typical' organism, transoesophageal echocardiographic examination is helpful at the first indication of infective endocarditis, to identify high-risk patients. Involvement of the aortic valve, growth in the size of vegetations, and the presence of spontaneous echo contrast a…

Quantitative Assessment of Right Ventricular Volumes in Severe Chronic Thromboembolic Pulmonary Hypertension using Transthoracic Three-dimensional Echocardiography: Changes due to Pulmonary Thromboendarterectomy

Evaluation of a three-dimensional reconstruction method to show the changes of right ventricular volume and systolic function when patients undergo pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.In the examination of 11 patients (four female, seven male; age 56+/-10 years) before and after pulmonary thromboendarterectomy, end-diastolic and end-systolic right ventricular volumes were determined as a sum total of the calculated volumes of derived parallel slices of the right ventricle. Using a Tomtec workstation and a Vingmed CFM 800 echocardiography device, the acquired data were ECG-and respiration-triggered in the course of transthoracic examination, usin…

Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

Follow-up of 18 patients with aortic dissection (five with type I, one with type II, 11 with type III dissection according to DeBakey) by transesophageal, two-dimensional and color-coded Doppler echocardiography showed a persistence of the false lumen in five of seven patients (71%) after surgery and in nine of 11 patients (82%) after medical therapy. In two patients treated with surgery, the dissected part of the aorta had been resected, whereas in two patients treated medically, a progressive and complete obliteration of the false lumen was observed. In the false lumen, thrombus formation was absent in four, localized in four, and progressive in six patients. Flow within the false lumen c…

Left ventricular function analyzed by Doppler and echocardiographic methods in short-term hypothyroidism

Abstract In conclusion, a significant reversible decrease in contractility and an impaired diastolic relaxation was demonstrated in patients with short-term hypothyroidism. This must be considered in patients with preexisting heart disease.

Quantitative assessment of aortic stenosis by three-dimensional echocardiography

The purpose of this study was to assess the feasibility of three-dimensional echocardiography in aortic stenosis. Planimetric determination of valve area and dynamic volume-rendered display were performed. Three-dimensional echocardiography permits display of any desired plane of the cardiac structure. Thus in the case of aortic stenosis, the plane used for planimetric evaluation can be positioned exactly through the valve orifice. Dynamic volume-rendered display may provide a spatial demonstration of the stenotic valve. In 48 patients aortic valve area was measured by planimetry. The three-dimensional data set was acquired by a workstation in the course of a multiplane transesophageal exam…

Assessment of successful valve reconstruction by intraoperative transesophageal echocardiography (TEE)

In 17 patients (10 patients with mitral insufficiency, 5 patients with tricuspid regurgitation, 2 patients with mitral stenosis) the result of valve reconstruction was evaluated by intraoperative two-dimensional transesophageal contrast-echocardiography (TEE). Therefore, 1–2 cc of an agitated contrast-medium (GelifundolR) were injected into the left or right ventricle. The result of reconstruction was assessed by the extent of regurgitant microbubbles into the left or right atrium. A successful valve repair could be demonstrated in 15 patients without or with only minimal regurgitation of contrast-fluid. In one patient residual severe mitral insufficiency after valve reconstruction could on…

Transthoracic three-dimensional echocardiographic volumetry of distorted left ventricles using rotational scanning

The purpose of this study was to evaluate the relation of transthoracic three- and two-dimensional echocardiographic left ventricular volumetry to cineventriculographic volumetry. Twenty-five patients with distorted left ventricles were included in the study. To demonstrate the impact of acquiring data by rotational scanning, we performed three- and two-dimensional echocardiography in 36 latex ventricles with data acquisition in different areas of the ultrasound sectors. Interobserver and intraobserver variability were calculated to test for reproducibility. The three-dimensional imaging system consisted of a rotation motor device, a transthoracic 2.5 MHz transducer, a conventional ultrasou…

Value of echocardiography in patient follow-up after surgically corrected type A aortic dissection.

Background To identify patients (pts) at risk of late complications, follow-up after surgery for type A aortic dissection is essential. We assessed the value of echocardiography to monitor patients after surgery for type A aortic dissection. Methods 80 out of 108 pts operated between 1989 and 1999 for type A aortic dissection survived surgery. 62 pts with at least one TEE, CT or MRI examinations during follow-up were included in this study. All pts had transthoracic echocardiography (TTE), 53 transesophageal echocardiography (TEE), 51 had CT, and 39 had MRI. Results At the first follow-up, 12 of 48 pts with aortic valve sparing surgery presented with aortic insufficiency >I degrees detected…

Three-dimensional imaging of cardiac mass lesions by transesophageal echocardiographic computed tomography.

Three-dimensional echocardiography is a new imaging technique that allows more realistic visualization of cardiac morphology. This study presents data about the diagnostic potentials of this technique concerning cardiac mass lesions, as well as its feasibility in clinical application. After the conventional investigation, multiple cross-sectional images were obtained during automatic forward advancement of a monoplane transducer mounted on a transesophageal probe. Three-dimensional reconstruction and volume determination were performed off line. Twenty-four patients were studied. In 14 cases results of echocardiographic computed tomography (echo-CT) were compared with those of monoplane/bip…