ORCID Profile
0000-0001-6951-6118
Current Organisations
Queensland Health
,
Royal Australasian College of Physicians
,
University of Queensland
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Publications
Genetic influences on right ventricular systolic pressure (RVSP) in chronic obstructive pulmonary disease (COPD).
Publisher: Springer Science and Business Media LLC
Date: 13-06-2012
Lack of effect of coenzyme Q on left ventricular function in patients with congestive heart failure
Publisher: Elsevier BV
Date: 05-1999
DOI: 10.1016/S0735-1097(99)00064-9
Abstract: This study evaluated the effects of oral therapy with coenzyme Q on echocardiographic and hemodynamic indexes of left ventricular function and on quality of life in patients with chronic left ventricular dysfunction. Coenzyme Q is a coenzyme for oxidative phosphorylation and an antioxidant and free radical scavenger. It has been claimed to improve symptoms, quality of life, left ventricular ejection fraction and prognosis in patients with cardiac failure. Thirty patients with ischemic or idiopathic dilated cardiomyopathy and chronic left ventricular dysfunction (ejection fraction 26 +/- 6%) were randomized to a double-blind crossover trial of oral coenzyme Q versus placebo, each for 3 months. Right heart pressures, cardiac output and echocardiographic left ventricular volumes were measured at baseline and after each treatment phase, and quality of life was assessed using the Minnesota "Living With Heart Failure" questionnaire. It was calculated that to demonstrate an increase in left ventricular ejection fraction from 25% to 30% with a standard deviation of 5% using 95% confidence intervals with a power of 80% we would require 17 patients. Twenty-seven completed both treatment phases. There was no significant difference in left ventricular ejection fraction, cardiac volumes or hemodynamic and quality of life indices after treatment with coenzyme Q or placebo, although plasma coenzyme Q levels increased from 903 +/- 345 nmol/l(-1) to 2,029 +/- 856 nmol/l(-1). In patients with left ventricular dysfunction, treatment for three months with oral coenzyme Q failed to improve resting left ventricular systolic function or quality of life despite an increase in plasma levels of coenzyme Q to more than twice basal values.
Cardiac Tamponade: Characteristic Doppler Observations
Publisher: Elsevier BV
Date: 03-1989
DOI: 10.1016/S0025-6196(12)65251-3
Abstract: Abnormal respiratory variation in diastolic filling has been reported in patients with cardiac t onade. To determine the characteristic diastolic filling abnormalities in this disorder, we recorded left ventricular isovolumic relaxation time and transvalvular and hepatic venous flow velocities by pulsed-wave Doppler echocardiography in 28 patients with pericardial effusion (16 with and 12 without cardiac t onade) and 20 normal control subjects. The phase of respiration was recorded simultaneously with all profiles. In 13 of the 16 patients with cardiac t onade, Doppler examination was repeated after pericardiocentesis. In patients with cardiac t onade, respiratory variations in transvalvular flow velocities and isovolumic relaxation time were substantially increased in comparison with values in normal subjects, patients without t onade, and those who had undergone pericardiocentesis. An exaggerated expiratory decrease in diastolic forward flow and increase in reverse flow in the hepatic vein also were characteristic of patients with cardiac t onade. Thus, Doppler echocardiography is an additional noninvasive means of detecting hemodynamic compromise in patients with pericardial effusion.
Percutaneous patent foramen ovale closure: Outcomes with the Premere and Amplatzer devices
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.CARREV.2010.06.001
Abstract: Transcatheter closure of patent foramen ovale (PFO) has rapidly evolved as the preferred management strategy for the prevention of recurrent cerebrovascular events in patients with cryptogenic stroke and presumed paradoxical embolus. There is limited outcome data in patients treated with this therapy particularly for the newer devices. Data from medical records, catheter, and echocardiography databases on 70 PFO procedures performed was collected prospectively. The cohort consisted of 70 patients (mean age 43.6 years, range 19 to 77 years), of whom 51% were male. The indications for closure were cryptogenic cerebrovascular accident (CVA) or transient ischemic attack (TIA) in 64 (91%) and peripheral emboli in two (2.8%) patients and cryptogenic ST-elevation myocardial infarction in one (1.4%), refractory migraine in one (1.4%), decompression sickness in one (1.4%), and orthodeoxia in one (1.4%) patient, respectively. All patients had demonstrated right-to-left shunting on bubble study. The procedures were guided by intracardiac echocardiography in 53%, transesophageal echocardiography in 39%, and the remainder by transthoracic echo alone. Devices used were the Amplatzer PFO Occluder (AGA Medical) (sizes 18-35 mm) in 49 (70%) and the Premere device (St. Jude Medical) in 21 (30%). In-hospital complications consisted of one significant groin hematoma with skin infection. Echocardiographic follow-up at 6 months revealed that most patients had no or trivial residual shunt (98.6%), while one patient (1.4%) had a mild residual shunt. At a median of 11 months' follow-up (range 1 month to 4.3 years), no patients (0%) experienced further CVA/TIAs or paradoxical embolic events during follow-up. PFO causing presumed paradoxical embolism can be closed percutaneously with a low rate of significant residual shunting and very few complications. Recurrent index events are uncommon at medium-term (up to 4 years) follow-up.
Effect of catheter device closure of atrial septal defect on diastolic mitral annular motion
Publisher: Elsevier BV
Date: 2003
Percutaneous ASD Closure in a Large Australian Series: Short- and Long-Term Outcomes
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.HLC.2012.05.001
Abstract: To assess the clinical and echocardiographic outcomes in patients referred for device closure of atrial septal defects in a tertiary referral hospital in Australia. A prospective follow-up study was performed on all patients who had device closure of a secundum atrial septal defect (ASD) from June 1999 to December 2007. Clinical and echocardiographic data at the time of implantation and follow-up is presented. 176 patients were referred for shunt closure of ASD. All patients had a significant shunt defined as a shunt with right heart dilatation and/or a shunt ratio of at least 1.5:1. The majority were female (67%) and the average age was 36.5 ± 22.7 years age range 3-84. The average hospital admission time was 2.5 ± 1.7 days. The average follow-up occurred at 3.7 ± 3.6 months for the first follow-up and 26.3 ± 18.2 months (range 3 months-7.8 years) for the long-term follow-up. Baseline echocardiogram findings showed the majority had a normal left ventricular ejection fraction (99%) average LVEF=63.2 ± 7.2% while the right ventricle was dilated in 61% of patients. Procedure information: The average procedure time was 94.8 ± 36.4 min. Procedural imaging was performed using Transoesophageal echocardiography (TOE) in 107 cases (61%) Intracardiac Echocardiography (ICE) in 69 (39%). Device use was as follows: Amplatzer=156 cases, Helex=18, and Starflex=2. Postprocedure shunt assessment by transthoracic echocardiography showed successful closure (no shunt or trivial shunt) in 99% cases. Two patients were referred for inpatient surgery due to a significant residual shunt in one case and an unstable device in another. One patient who had an unstable device had their device repositioned successfully. Atrial arrhythmia was the most common complication occurring in the peri-implantation period in 12 cases (6%) with four further cases at final up. The high prevalence of right ventricular dilatation in 65% patients at baseline had improved significantly at the first and long term follow-up to 2% (p=0.0001). Device closure of secundum atrial septal defects in this large Australian cohort demonstrates a high procedural success rate with a low incidence of complications in the short and long term.
Infected patent foramen ovale (PFO)
Publisher: Springer Science and Business Media LLC
Date: 08-03-2015
The Cryolife-O'brien stentless aortic porcine xenograft valve
Publisher: Hindawi Limited
Date: 09-1998
DOI: 10.1111/J.1540-8191.1998.TB01100.X
Abstract: The advantageous design of the Cryolife-O'Brien stentless porcine aortic valve permits specific quick, easy, supravalvular implantation using single layer continuous 3-0 polypropylene suture. The advantages, contraindications, and implantation errors to avoid are detailed. The use of this valve for aortic valve replacement in the elderly population has been directed to proving its efficacy and establishing its grounds for durability while maintaining all of the advantages of a stentless tissue valve. From December 1992 to September 1998, this valve was used in 240 patients (mean age 73 years: 15% > 80 years), 45% receiving associated coronary artery grafting (2.4 grafts per patient). Left ventricular (LV) myomectomy was necessary in 12% of patients. Detailed postoperative follow-up (100%) analysis included 650 serial echocardiographic studies. The 30-day mortality was low at 1.2% (3 deaths of 240 elderly patients). Ten patients had late mortality (1.5 months to 5 years), all nonvalve related. No structural failure and one only explant for endocarditis have occurred. Echocardiographic analyses have shown low mean transvalvular gradients in relationship to time (8.18 mmHg at 18 months) and to valve size (8.52 mmHg for a 23-mm host aortic annulus). Incompetence has been zero or a trace in 97% of the patients at 21/2 years. No patient over the 6 years shows valve deterioration. Six years of experience with this stentless valve in 240 elderly patients has revealed the many advantages of this safe, composite, and truly stentless device that is assembled without the need for Dacron support. Excellent sustained hemodynamics with low gradients, minimal regurgitation, and a good effective orifice have been coupled with low immediate mortality, no intrinsic valve failure, and one explant for endocarditis. Marked LV regression and minimal late valve-related complications confirm the safety and advantages of this stentless valve.
Mobile left atrial thrombus associated with mitral stenosis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-1998
Corrigendum to The Use of Computerised Simulators for Training of Transthoracic and Transoesophageal Echocardiography. The Future of Echocardiographic Training? [Heart Lung Circ. 21 (2012) 267-274]
Publisher: Elsevier BV
Date: 09-2012
Transesophageal echocardiography in an operation for pulmonary arteriovenous malformation
Publisher: Elsevier BV
Date: 1998
DOI: 10.1016/S0003-4975(97)01201-0
Abstract: Transesophageal echocardiography has been described as a useful tool in the diagnosis of pulmonary arteriovenous malformations. We describe a case in which intraoperative transesophageal echocardiography was used to aid localization and ensure complete surgical ligation.
The Relative Atrial Index (RAI)-A Novel, Simple, Reliable, and Robust Transthoracic Echocardiographic Indicator of Atrial Defects
Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.ECHO.2009.11.014
Abstract: The detection of atrial septal defects (ASDs) and other shunts is sometimes difficult on transthoracic echocardiography. In addition, the quantitative assessment of right-heart volume loading as an indicator of significant shunting can be difficult, with subjective estimation commonly used. Thus, the initial aim of this study was to test the accuracy of a simple, noninvasive index using atrial area dimensions to detect the presence of an ASD. Subsequently, the index was used to assess the degree of normalization and remodeling of atrial size following percutaneous ASD device closure. The relative atrial index (RAI) was derived from standard apical 4-chamber views as right atrial area ided by left atrial area. RAI was calculated in patients with previously diagnosed secundum atrial defects (n=219) with no concomitant lesions and then compared with those calculated in age-matched controls (n=219). 101 of the 219 patients with secundum atrial defects underwent percutaneous device closure. Measurements were obtained before and 1 day after percutaneous closure as well as in the early (mean, 124 days) and late (mean, 390 days) stages of follow-up. The mean RAI in patients with ASDs (1.23+/-0.23) was significantly higher than that in the age-matched normal control group (0.78+/-0.1) (P<.0001). The mean RAI in patients with ASD was also significantly higher than that in the general population (0.81+/-0.15) (P 0.92 predicted patients with ASDs versus matched controls with 99.1% sensitivity and 90.5% specificity. After percutaneous closure, significant atrial remodeling occurred immediately, with a reduction in the mean RAI at day 1 to 0.93+/-0.16 (P<.0001) and complete normalization at early follow-up to 0.81+/-0.12. The RAI, a novel and simple transthoracic parameter, reliably identifies patients with possible atrial shunting. The resolution of right atrial enlargement occurs remarkably early after percutaneous ASD closure, as demonstrated by this novel parameter.
Effects of Age on Left Ventricular Dimensions and Filling Dynamics in 117 Normal Persons
Publisher: Elsevier BV
Date: 03-1994
DOI: 10.1016/S0025-6196(12)61059-3
Abstract: To determine standard left ventricular Doppler measurements in a large reference group of various ages to reflect the senescence process. We prospectively studied the influence of aging on left ventricular diastolic filling by performing Doppler echocardiography in 117 normal healthy volunteers. Transthoracic pulsed-wave Doppler echocardiographic studies of pulmonary venous flow and left ventricular inflow were done in the 53 male and 64 female study subjects. For analysis, the study subjects were arbitrarily classified into two groups: those younger than 50 years of age (group 1 N = 61) and those 50 years old or older (group 2 N = 56). A striking difference was found in pulmonary venous flow and left ventricular inflow between group 1 and group 2 subjects. Group 2 had increased pulmonary venous peak systolic flow velocity (71 +/- 9 versus 48 +/- 9 cm/s), decreased peak diastolic flow velocity (38 +/- 9 versus 50 +/- 10 cm/s), increased peak atrial reversal flow velocity (23 +/- 4 versus 19 +/- 4 cm/s), and increased percentage of forward flow in systole (65 +/- 7 versus 55 +/- 8%) in comparison with group 1. In group 2, peak early filling velocity (62 +/- 14 versus 72 +/- 14 cm/s) and ratio of early filling to atrial filling (1.1 +/- 0.3 versus 1.9 +/- 0.6) were lower and peak atrial filling velocity (59 +/- 14 versus 40 +/- 10 cm/s) was higher than in group 1. Deceleration time (210 +/- 36 versus 179 +/- 20 ms) and isovolumic relaxation time (90 +/- 17 versus 76 +/- 11 ms) were prolonged in group 2 in comparison with group 1. This study confirms the major influence of the aging process on left ventricular diastolic function in a large series of normal subjects. This physiologic factor should be considered in Doppler assessment of left ventricular diastolic filling in future studies.
Comprehensive Doppler assessment of right ventricular diastolic function in cardiac amyloidosis
Publisher: Elsevier BV
Date: 1990
DOI: 10.1016/0735-1097(90)90183-P
Abstract: To assess right ventricular diastolic function in cardiac amyloidosis, pulsed wave Doppler ultrasound measurements of right ventricular inflow velocities and superior vena cava and hepatic vein flow velocities with respiratory monitoring were performed in 41 patients with primary systemic amyloidosis and two-dimensional echocardiographic features of cardiac involvement. Right ventricular diastolic function was abnormal in 31 (76%) of these patients, the major abnormality being a short deceleration time (less than 150 ms) in 21 (68%), suggesting restriction. In contrast, 7 (23%) of the 31 patients had a decreased ratio of early (E) and late (A) diastolic peak flow velocities and a prolonged deceleration time (greater than 240 ms), suggesting abnormal relaxation. The patients were classified into two groups on the basis of right ventricular free wall thickness: group 1, less than 7 mm and group 2, greater than or equal to 7 mm. Compared with normal values, group 1 showed an increased peak late flow velocity (44 +/- 19 versus 39 +/- 6 cm/s p less than 0.01) and a decreased E/A velocity ratio (1.1 +/- 0.4 versus 1.5 +/- 0.3 p less than 0.01). Group 2 showed a markedly shortened deceleration time (151 +/- 37 versus 225 +/- 28 ms p less than 0.01), characteristic of restriction. In the overall group, superior vena cava peak flow velocity was decreased in systole and increased in diastole and flow reversals during inspiration were increased compared with normal values. Hepatic venous flow velocities were similar to those in the superior vena cava except for larger flow reversals in the hepatic vein. Thus, in cardiac amyloidosis, right ventricular diastolic function is abnormal. There is a spectrum of right ventricular filling abnormalities and the restrictive filling pattern is seen only in the advanced stages of the disease.
Outdoor time and dietary patterns in children around the world
Publisher: Oxford University Press (OUP)
Date: 19-04-2018
Abstract: Whether outdoor time is linked to dietary patterns of children has yet to be empirically tested. The objective of this study was to examine the association between outdoor time and dietary patterns of children from 12 countries around the world. This multinational, cross-sectional study included 6229 children 9–11 years of age. Children self-reported the time that they spent outside before school, after school and on weekends. A composite score was calculated to reflect overall daily outdoor time. Dietary patterns were assessed using a food frequency questionnaire, and two components were used for analysis: healthy and unhealthy dietary pattern scores. On average, children spent 2.5 h outside per day. After adjusting for age, sex, parental education, moderate-to-vigorous physical activity, screen time and body mass index z-score, greater time spent outdoors was associated with healthier dietary pattern scores. No association was found between outdoor time and unhealthy dietary pattern scores. Similar associations between outdoor time and dietary patterns were observed for boys and girls and across study sites. Greater time spent outside was associated with a healthier dietary pattern in this international s le of children. Future research should aim to elucidate the mechanisms behind this association.
A Rare Case of a Giant Coronary Sinus with Focal Aneurysm Secondary to Multiple Fistulous Connections Arising from a Dilated, Tortuous Left Circumflex Coronary Artery
Publisher: Elsevier BV
Date: 06-2018
Multi-modality imaging in the assessment of a metastatic cardiac rhabdomyosarcoma presenting with recurrent ventricular tachycardia
Publisher: Oxford University Press (OUP)
Date: 10-10-2014
DOI: 10.1093/EHJCI/JET183
Congenital mitral stenosis by multimodality cardiac imaging
Publisher: Wiley
Date: 24-02-2009
DOI: 10.1111/J.1540-8175.2008.00779.X
Abstract: This vignette illustrates a classic case of congenital mitral stenosis (Ruckman-VanPraagh type 1) presenting in adulthood and demonstrates the benefits of multimodality cardiac imaging prior to successful surgical intervention.
ePLAR - The echocardiographic Pulmonary to Left Atrial Ratio - A novel non-invasive parameter to differentiate pre-capillary and post-capillary pulmonary hypertension
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.IJCARD.2016.03.035
Abstract: Right heart catheterisation is the gold-standard for differentiating pre-capillary pulmonary hypertension (high mean pulmonary artery pressure, normal pulmonary wedge pressure) from post-capillary physiology (elevated pulmonary wedge pressure). The new non-invasive parameter, ePLAR (echocardiographic Pulmonary to Left Atrial Ratio) is calculated from the maximum tricuspid regurgitation continuous wave Doppler velocity (m/s) ided by the transmitral E-wave:septal mitral annular Doppler Tissue Imaging e'-wave ratio (TRVmax/E:e'). Pulmonary hypertension patients (mean pulmonary artery pressure>25mmHg, n=133, 66 male, average 65.0±16.8years) were classified by right heart catheterisation as pre-capillary or post-capillary [sub ided into isolated post-capillary (diastolic pulmonary gradient <7mmHg) or combined pre- and post-capillary cases]. The ePLAR values of these groups were compared to each other and to a population s le of 16,356 population reference echocardiograms. ePLAR values for the normal reference population of 16,356 echocardiograms (age 56±16.6years) were 0.30±0.09m/s. Pre-capillary pulmonary hypertension patients (n=35, 26 male, PAPsys 63.9±16.6mmHg, PAPdiast 24.1±7.3mmHg, PAPmean 37.9±9.4mmHg, PCWP 10.6±2.7mmHg) had significantly higher ePLAR values than post-capillary cases (n=98, 40 male, PAPsys 59.9±17.6mmHg, PAPdiast 25.0±7.4mmHg, PAPmean 38.1±9.8mmHg, PCWP 23.5±6.4mmHg)-ePLAR 0.44±0.22m/s vs 0.20±0.11m/s (p<0.001). ePLAR values were significantly lower in isolated post-capillary pulmonary hypertension than in combined pre- and post-capillary cases (0.18±0.08m/s vs 0.28±0.18m/s, p<0.001). ePLAR is a simple echocardiographic parameter which can accurately differentiate the smaller subset of patients with pre-capillary pulmonary hypertension from the more common post-capillary aetiology. The use of this easily obtained echocardiographic parameter has the potential to enhance non-invasive triage of patients for specific pulmonary vasodilator therapy.
3-D Transoesophageal echocardiography for guiding percutaneous stenting of pulmonary vein stenosis
Publisher: Oxford University Press (OUP)
Date: 06-03-2015
DOI: 10.1093/EHJCI/JEV041
Echocardiography for the clinician: A practical update
Publisher: Wiley
Date: 07-2010
DOI: 10.1111/J.1445-5994.2010.02167.X
Abstract: Echocardiography is the mainstay of cardiovascular diagnostics, and is the most performed test for the evaluation of cardiac function. Critical and costly management decisions are based on quantification of left ventricular volumes and ejection fraction. Recent advances in echocardiography, such as microsphere contrast echocardiography for left ventricular opacification and perfusion imaging, three-dimensional transthoracic and trans-oesophageal imaging, strain and tissue Doppler imaging, all contribute to improving accuracy and reproducibility of these important measurements. Such techniques are now routinely available on standard echocardiography equipment in Australian centres for daily use. Hand-carried ultrasound devices have been developed, which are portable, are affordable and offer increased availability of echocardiography to the wider community. Clinicians should be actively encouraged to adopt these technologies to improve the diagnostic quality and reproducability of echocardiography for our patients. This article provides an overview of important recent advances in echocardiographic imaging with an emphasis on their role in clinical practice today.
Evaluation of Prosthetic Heart Valves
Publisher: Wiley
Date: 28-09-2009
Genetic variants of proteins from the renin angiotensin system are associated with pressure load cardiac hypertrophy
Publisher: Wiley
Date: 07-1996
DOI: 10.1111/J.1440-1681.1996.TB02788.X
Abstract: 1. The relationship between the angiotensinogen (AGT) T 174 M, angiotensin converting enzyme (ACE) insertion/deletion (I/D) and the angiotensin II type 1 receptor (AT 1 ) genetic markers and left ventricular hypertrophy was examined in normal subjects and those with aortic stenosis. 2. Subjects with aortic stenosis had higher left ventricular systolic pressure and relative wall thickness (RWT) compared with normal. However, within aortic stenosis subjects, left ventricular RWT did not correlate with left ventricular systolic pressure or with aortic valve area. 3. In subjects with aortic stenosis, left ventricular RWT was higher in those with ACE DD ( P .05) or AGT T 174 M ( P .06) compared with those with the ACE II or ID genotype or AGT TT 174 genotype. No relationship was observed with any of the AT 1 alleles. The ACE and AGT genetic markers independently predicted left ventricular RWT in aortic stenosis. No association was observed between these genotypes and left ventricular RWT in normal subjects. 4. The data suggest that the AGT T 174 M and ACE I/D genotypes may act together to influence the degree of hypertrophy in subjects with aortic stenosis. 5. In patients with aortic stenosis, genetic variants of proteins from the renin angiotensin system may be at least as important as left ventricular systolic pressure in determining the degree of left ventricular hypertrophy and could therefore explain the clinical variation observed in the progression to cardiac dysfunction.
The streptozotocin-diabetic rat as a model of the chronic complications of human diabetes
Publisher: Elsevier BV
Date: 2003
DOI: 10.1046/J.1444-2892.2003.00160.X
Abstract: Diabetes in humans induces chronic complications such as cardiovascular damage, cataracts and retinopathy, nephropathy and polyneuropathy. The most common animal model of human diabetes is streptozotocin (STZ)-induced diabetes in the rat. This project assessed cardiovascular, ocular and neuropathic changes over a period of 24 weeks post STZ administration in rats. STZ-diabetic rats (n = 96) showed stable signs of diabetes (hyperglycaemia, increased water and food intake with no increase in bodyweight): 52% of untreated STZ-diabetic rats (n = 50) survived 24 weeks after STZ administration. STZ-diabetic rats were normotensive with slowly developing systolic and diastolic dysfunction and an increased ventricular stiffness. Ventricular action potential durations were markedly prolonged. STZ-diabetic rats developed stable tactile allodynia. Cataracts developed to presumed blindness at 16 weeks but proliferative retinopathy was not observed even after 24 weeks. The chronic STZ-diabetic rat mimics many but not all of the chronic complications observed in the diabetic human. The chronic STZ-diabetic rat may be a useful model to test therapeutic approaches for amelioration of chronic diabetic complications in humans.
Echocardiographic assessment of cardiac structure and function in rats
Publisher: Elsevier BV
Date: 2002
DOI: 10.1046/J.1444-2892.2002.00148.X
Abstract: Echocardiography is used in humans to characterise the structure and function of the heart, yet is relatively uncommon in studies on the rat, the most commonly used model of human cardiovascular disease. The aim of this study was to show that echocardiography in rats provides useful information on cardiac changes occurring in thyroid dysfunction and can also be used to characterise cardiac abnormalities. Transthoracic echocardiography and Doppler techniques with high frequency, high frame rate imaging were used to define cardiac dimensions and function in 240 Wistar rats and cardiac abnormalities in Wistar and spontaneously hypertensive rats (SHR). Echocardiographic assessment of left ventricular dimensions and function and aortic flows was technically feasible in almost all adult Wistar rats and SHR, including those with thyroid dysfunction and cardiac abnormalities. Pulsed-wave Doppler profiles of mitral inflows to estimate diastolic function were less reliably obtained. Echocardiography is a powerful technique for non-invasive and serial determination of cardiac structure and function in rat models of human cardiovascular disease.
Fenestrated Atrial Septal Aneurysm: Diagnosis by Transesophageal Echocardiography
Publisher: Elsevier BV
Date: 11-1990
DOI: 10.1016/S0894-7317(14)80368-4
Abstract: The diagnosis of atrial septal defect by transthoracic echocardiography remains difficult in a small subset of patients because of either suboptimal acoustic windows or unusual anatomy, for ex le, fenestrated defects. We report the case of a 55-year-old woman with a fenestrated atrial septal aneurysm that was incompletely visualized by transthoracic echocardiography. Subsequent transesophageal echocardiography demonstrated three defects within the atrial septal aneurysm with left-to-right shunting across each defect. Normal pulmonary venous connections were also defined. All echocardiographic findings were confirmed at surgery. This case demonstrates the additional diagnostic accuracy of transesophageal echocardiography for detecting disease of the atrial septum.
Contrast microsphere enhancement of the tricuspid regurgitant spectral Doppler signal - Is it still necessary with contemporary scanners?
Publisher: Elsevier BV
Date: 12-2017
Two-dimensional echocardiographic findings in systemic sarcoidosis
Publisher: Elsevier BV
Date: 02-1989
DOI: 10.1016/0002-9149(89)90323-8
Abstract: The records of 88 patients with systemic sarcoidosis who underwent 2-dimensional echocardiography were reviewed to define the typical echocardiographic abnormalities in patients with clinical evidence of cardiac involvement. Twelve patients (14%) had echocardiographic evidence of left ventricular systolic dysfunction attributed to cardiac sarcoidosis (segmental hypokinesis in 8 patients and global hypokinesis in 4 patients). A high incidence of congestive heart failure (9 of 12) and conduction system disease (7 of 12) was characteristic of these patients. The remaining 76 patients had normal echocardiograms or abnormalities attributed to nonsarcoid sources. In 8 (11%) of these 76 patients, there were significant clinically unexplained conduction abnormalities likely related to sarcoidosis.
Early Experience of Transaortic TAVI-The Future of Surgical TAVI?
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.HLC.2012.11.002
Abstract: Trans-catheter aortic valve implantation (TAVI) is now a well recognised procedure for the high risk surgical patient with native or bioprosthetic aortic valve stenosis. Transfemoral and transapical implantation techniques are well described. With increasing referral of more marginal transapical patients, we describe our experience of a transaortic TAVI approach which we believe reduces the postoperative wound pain, respiratory complications, operative risk and hospital stay. Patients referred for surgical TAVI underwent trans-catheter aortic valve implantation via an upper sternotomy and direct cannulation of the ascending aorta. Thirteen patients with a mean age of 81 years underwent transaortic Edwards SAPIEN valve implantation. There was no in hospital mortality in our series. One patient required insertion of a permanent pacemaker for complete heart block. There were no aortic cannulation complications. The transaortic TAVI approach provides good exposure of the distal ascending aorta, a familiar cannulation site for cardiac surgeons. Our initial experience demonstrates the approach to be a safe technique with the potential for faster and less complicated recovery in patients undergoing surgical TAVI procedures. With further experience and greater acceptance, the transaortic approach may ultimately become the procedure of choice for patients unsuitable for a transfemoral approach.
Use of three-dimensional speckle-tracking echocardiography for quantitative assessment of global left ventricular function: A comparative study to three-dimensional echocardiography
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.ECHO.2013.11.002
Abstract: The aim of this study was to determine whether global strains derived from three-dimensional (3D) speckle-tracking echocardiography (STE) are as accurate as left ventricular (LV) ejection fraction (LVEF) obtained by two-dimensional (2D) and 3D echocardiography in the quantification of LV function. Two-dimensional and 3D echocardiography and 2D and 3D STE were performed in 88 patients (LVEF range, 17%-79%). Two-dimensional and 3D global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain, and global area strain were quantified and correlated with LV function determined by 2D and 3D echocardiographic LVEF. Reproducibility, feasibility, and duration of study to perform 3D STE were assessed by independent, blinded observers. A total of 78 patients (89%) underwent 3D STE. All 3D speckle-tracking echocardiographic parameters had strong correlations with assessment of LV function determined by 2D and 3D echocardiographic LVEF. Three-dimensional GCS was the best marker of LV function (r = -0.89, P < .0001). Subgroup analysis demonstrated that 3D speckle-tracking echocardiographic parameters were particularly useful in identifying LV dysfunction (LVEF < 50%). Receiver operating characteristic curve analysis demonstrated areas under the curve of 0.97 for 3D GCS, 0.96 for 3D global radial strain, 0.95 for 3D global area strain, and 0.87 for 3D GLS. An optimal 3D GCS cutoff value of magnitude < -12% predicted LV dysfunction (LVEF obtained by 2D echocardiography < 50%) with 92% sensitivity and 90% specificity. There was good correlation between 2D GLS and 3D GLS (r = 0.85, P < .001 mean difference, -1.7 ± 6.5%). Good intraobserver, interobserver, and test-retest agreements were seen with 3D STE. Time for image acquisition to postprocessing analysis was significantly reduced with 3D STE (3.7 ± 1.0 minutes) compared with 2D STE (4.6 ± 1.5 min) (P < .05). Global strain by 3D STE is a promising novel alternative to quantitatively assess LV function. Three-dimensional STE is reproducible, feasible, and time efficient.
Arg389Gly-β1-adrenergic receptors determine improvement in left ventricular systolic function in nonischemic cardiomyopathy patients with heart failure after chronic treatment with carvedilol
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2007
The role of echocardiography in the management of patients supported by extracorporeal membrane oxygenation
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.ECHO.2011.11.009
Abstract: Extracorporeal life support can be viewed as a spectrum of modalities based on modifications of a cardiopulmonary bypass circuit to provide cardiac and respiratory support, which can be used for extended periods, from hours to several weeks. Extracorporeal membrane oxygenation (ECMO) is among the most frequently used forms of extracorporeal life support. It can be configured for venovenous blood flow, to provide adequate oxygenation and carbon dioxide removal in isolated refractory respiratory failure, or in a venoarterial configuration, when support is required for cardiac and/or respiratory failure. Echocardiography plays a fundamental role throughout the entire journey of a patient supported on ECMO. It provides information that assists in patient selection, guides the insertion and placement of cannulas, monitors progress, detects complications, and helps in determining cardiac recovery and the weaning of ECMO support. Although there are extensive published data regarding ECMO, particularly in the pediatric population, there is a paucity of data outlining the role of echocardiography in guiding the management of adult patients supported by ECMO. ECMO is likely to become an increasingly used form of cardiorespiratory support within the critical care setting. Hence, clinicians and sonographers who work within echocardiography departments at institutions with ECMO programs require specific skills to image these patients.
Doppler tissue echocardiographic features of cardiac amyloidosis
Publisher: Elsevier BV
Date: 11-2002
Abstract: The purpose of the study was to assess whether quantification of myocardial involvement by Doppler tissue echocardiography (DTE) enhances the accuracy of echocardiographic characterization of cardiac amyloidosis (CA). A group of 36 patients with CA (mean age 58 +/- 13 years 22 male) and 40 age-matched control patients were studied. Patients with CA were ided into CA-1 subgroup with nonrestrictive (n = 22) and CA-2 with restrictive left ventricular (LV) filling pattern (n = 14). Peak lateral and medial mitral annulus velocities by pulsed wave DTE were measured in systole, early diastole, and late diastole. Using color M-mode DTE of the LV posterior wall, mean myocardial velocities (MMV) and myocardial velocity gradient (MVG) were measured during ventricular ejection, early and late isovolumic relaxation (IVR), rapid ventricular filling, and atrial contraction. In both CA-1 and CA-2 groups, mitral annulus velocities, MMV, and all MVG were lower than those measured in control patients, with the exception of peak late diastolic annulus velocities at lateral side and MMV in atrial contraction. MVGs in both early IVR and rapid ventricular filling were lower in the CA-1 as compared with the CA-2 group. Late IVR-MVG was negative in control patients and positive in patients with CA indicating a faster movement of the subendocardium rather than the subepicardium during late IVR in patients with CA (0.88 +/- 0.50 s(-1) vs -0.40 +/- 1.59 s(-1) P <.001). The following parameters: peak early diastolic annulus velocities at lateral side < or = -12 cm/s, peak early diastolic annulus velocities at medial side < or = -10 cm/s, early IVR-MMV < or = -2.5 cm/s, early IVR-MVG or = 0.5 s(-1) differentiated patients with CA from control patients with an overall accuracy of 0.82, 0.83, 0.81, 0.87, and 0.81, respectively. In patients with CA, reduction in early IVR-MMV was independent of patients' age and LV mass. DTE indices proved helpful in differentiating patients with CA from control patients including those patients with CA who had borderline conventional echocardiographic features and nonrestrictive LV filling pattern.
Extracorporeal membrane oxygenation: Indications and contraindications
Publisher: Elsevier BV
Date: 06-2012
Feasibility of perflutren microsphere contrast transthoracic echocardiography in the visualization of ventricular endocardium during venovenous extracorporeal membrane oxygenation in a validated ovine model
Publisher: Wiley
Date: 24-07-2015
DOI: 10.1111/ECHO.12695
Abstract: Transthoracic echocardiography (TTE) during extra corporeal membrane oxygenation (ECMO) is important but can be technically challenging. Contrast-specific TTE can improve imaging in suboptimal studies. These contrast microspheres are hydrodynamically labile structures. This study assessed the feasibility of contrast echocardiography (CE) during venovenous (VV) ECMO in a validated ovine model. Twenty-four sheep were commenced on VV ECMO. Parasternal long-axis (Plax) and short-axis (Psax) views were obtained pre- and postcontrast while on VV ECMO. Endocardial definition scores (EDS) per segment were graded: 1 = good, 2 = suboptimal 3 = not seen. Endocardial border definition score index (EBDSI) was calculated for each view. Endocardial length (EL) in the Plax view for the left ventricle (LV) and right ventricle (RV) was measured. Summation EDS data for the LV and RV for unenhanced TTE (UE) versus CE TTE imaging: EDS 1 = 289 versus 346, EDS 2 = 38 versus 10, EDS 3 = 33 versus 4, respectively. Wilcoxon matched-pairs rank-sign tests showed a significant ranking difference (improvement) pre- and postcontrast for the LV (P < 0.0001), RV (P < 0.0001) and combined ventricular data (P < 0.0001). EBDSI for CE TTE was significantly lower than UE TTE for the LV (1.05 ± 0.17 vs. 1.22 ± 0.38, P = 0.0004) and RV (1.06 ± 0.22 vs. 1.42 ± 0.47, P = 0.0.0006) respectively. Visualized EL was significantly longer in CE versus UE for both the LV (58.6 ± 11.0 mm vs. 47.4 ± 11.7 mm, P < 0.0001) and the RV (52.3 ± 8.6 mm vs. 36.0 ± 13.1 mm, P < 0.0001), respectively. Despite exposure to destructive hydrodynamic forces, CE is a feasible technique in an ovine ECMO model. CE results in significantly improved EDS and increased EL.
Quantification of mitral regurgitation orifice area by 3-dimensional echocardiography: Comparison with effective regurgitant orifice area by PISA method and proximal regurgitant jet diameter
Publisher: Elsevier BV
Date: 11-2002
DOI: 10.1016/S0167-5273(02)00196-1
Abstract: The evaluation of mitral regurgitation (MR) by 3-dimensional (3D) echo has generally been performed by reconstruction of Doppler regurgitant jets but there are little data on measuring anatomic regurgitant orifice area (AROA) directly from 3D mitral valve (MV) reconstructions. Transoesophageal echo (TOE) 3D images were acquired from 38 unselected patients (age 59+/-11 years, ten in atrial fibrillation) with various degrees of MR. In all patients MV was reconstructed en face from the left atrium (LA) and the left ventricle (LV). AROA was measured by planimetry from 3D pictures and compared to the effective regurgitant orifice area (EROA) by proximal isovelocity surface area and proximal MR jet width from 2D echo. AROA was measured in 95% of patients from LA, 89% from LV and in 84% from both LA and LV. Good correlation was found between EROA and AROA measured from both LA (r=0.97, P<0.0001) and LV (r=0.87, P<0.0001). The mean difference between LA-AROA and EROA was -3.01+/-6.12 mm(2) and -7.18+/-13.84 mm(2) for LV-AROA (P<0.01, respectively). An acceptable correlation was found between the proximal MR jet width and AROA from LA (r=0.71, P<0.0001) and LV perspective (r=0.68, P or=25 mm(2) differentiated mild MR (graded 1-2) from moderately severe (graded 3-4) with 80-90% accuracy. 3D TOE provides important quantitative information on both the mechanism and the severity of MR in an unselected group of patients. AROA enables quantification of MR with excellent agreement with the accepted clinical method of proximal flow convergence.
The Prognostic Value of Echocardiographic Wall Motion Score Index in ST-Segment Elevation Myocardial Infarction
Publisher: Hindawi Limited
Date: 10-11-2022
DOI: 10.1155/2022/8343785
Abstract: Background. When compared to left ventricular ejection fraction (LVEF), previous studies have suggested the superiority of wall motion score index (WMSI) in predicting cardiac events in patients who have suffered acute myocardial infarction. However, there are limited studies assessing WMSI and mortality in ST-segment elevation myocardial infarction (STEMI). We aimed to compare the prognostic value of WMSI in a cohort of STEMI patients treated with primary percutaneous coronary intervention (PCI). Methods. A comparison of WMSI, LVEF, and all-cause mortality in STEMI patients treated with primary PCI between January 2008 and December 2020 was performed. The prognostic value of WMSI, LVEF, and traditional risk scores (TIMI, GRACE) were compared using multivariable logistic regression modelling. Results. Among 1181 patients, 27 died within 30-days (2.3%) and 49 died within 12 months (4.2%). WMSI ≥1.8 was associated with poorer survival at 12-months (9.2% vs 1.5% p 0.001 ). When used as the only classifier for predicting 12-month mortality, the discriminatory ability of WMSI (area under the curve (AUC): 0.77 95% CI: 0.68–0.84) was significantly better than LVEF (AUC: 0.71 95% CI: 0.61–0.79 p = 0.034 ). After multivariable modelling, the AUC was comparable between models with either WMSI (AUC: 0.89 95% CI: 0.85–0.94) or LVEF (AUC: 0.87 95% CI: 0.83–0.92 p 0.08 ) yet performed significantly better than TIMI (AUC: 0.71 95% CI: 0.62–0.79 p 0.001 ), or GRACE (AUC: 0.63 95% CI: 0.54–0.71 p 0.001 ) risk scores. Conclusions. When examined in idually, WMSI is a superior predictor of 12-month mortality over LVEF in STEMI patients treated with primary PCI. When examined in multivariable predictive models, WMSI and LVEF perform very well at predicting 12-month mortality, especially when compared to existing STEMI risk scores.
Intervendor consistency and reproducibility of left ventricular 2D global and regional strain with two different high-end ultrasound systems
Publisher: Oxford University Press (OUP)
Date: 20-06-2017
DOI: 10.1093/EHJCI/JEW120
Abstract: We aimed to assess intervendor agreement of global (GLS) and regional longitudinal strain by vendor-specific software after EACVI/ASE Industry Task Force Standardization Initiatives for Deformation Imaging. Fifty-five patients underwent prospective dataset acquisitions on the same day by the same operator using two commercially available cardiac ultrasound systems (GE Vivid E9 and Philips iE33). GLS and regional peak longitudinal strain were analyzed offline using corresponding vendor-specific software (EchoPAC BT13 and QLAB version 10.3). Absolute mean GLS measurements were similar between the two vendors (GE -17.5 ± 5.2% vs. Philips -18.9 ± 5.1%, P = 0.15). There was excellent intervendor correlation of GLS by the same observer [r = 0.94, P < 0.0001 bias -1.3%, 95% CI limits of agreement (LOA) -4.8 to 2.2%). Intervendor comparison for regional longitudinal strain by coronary artery territories distribution were: LAD: r = 0.85, P < 0.0001 bias 0.5%, LOA -5.3 to 6.4% RCA: r = 0.88, P < 0.0001 bias -2.4%, LOA -8.6 to 3.7% LCX: r = 0.76, P < 0.0001 bias -5.3%, LOA -10.6 to 2.0%. Intervendor comparison for regional longitudinal strain by LV levels were: basal: r = 0.86, P < 0.0001 bias -3.6%, LOA -9.9 to 2.0% mid: r = 0.90, P < 0.0001 bias -2.6%, LOA -7.8 to 2.6% apical: r = 0.74 P < 0.0001 bias -1.3%, LOA -9.4 to 6.8%. Intervendor agreement in GLS and regional strain measurements have significantly improved after the EACVI/ASE Task Force Strain Standardization Initiatives. However, significant wide LOA still exist, especially for regional strain measurements, which remains relevant when considering vendor-specific software for serial measurements.
The long-term outcomes of transcoronary ablation of septal hypertrophy compared to surgical myectomy in patients with symptomatic hypertrophic obstructive cardiomyopathy.
Publisher: Wiley
Date: 31-08-2014
DOI: 10.1002/CCD.25134
Abstract: The aim of this study was to compare the long-term outcomes of transcoronary ablation of septal hypertrophy (TASH) with open surgical myomectomy (SM) in patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM). We reviewed patients who underwent either procedure at our institution. The demographics, clinical outcomes, echocardiographic parameters, and complications were compared. Seventy patients with HOCM were treated with either TASH (n = 47, 26 male) or SM (n = 23, 10 male). Compared to those treated with SM, patients undergoing TASH were older (57+/- 14.7 years versus 47 +/- 20.6 years, P = 0.021) and more symptomatic. A higher proportion of patients had syncope as a presenting feature in the TASH group compared to the SM group (57.5% vs. 17.4%, P = 0.002) respectively. They were also more likely to be in New York Heart Association (NYHA) class III/IV compared to the patients who underwent SM (85.1% vs. 39.1% P < 0.001). Patients were followed for a mean period of 43 months (TASH) and 46 months (SM). Repeat procedures were more common in the TASH group (17% vs. 0%, P = 0.04) but mitral valve replacement was more common in the SM group (0% vs. 8.7%, P = 0.105). Symptom improvement, the rate of complications and all cause mortality rates were similar in both groups. TASH compares favorably with surgical myectomy with regard to symptom resolution, rate of complications and mortality in a tertiary referral centre and should be seen as an attractive alternative to surgical myectomy in the appropriate patient population.
Accuracy of quantitative echocardiographic measures of right ventricular function as compared to cardiovascular magnetic resonance
Publisher: Elsevier BV
Date: 09-2016
Age-related Prevalence of Valvular Regurgitation in Normal Subjects: A Comprehensive Color Flow Examination of 118, Volunteers
Publisher: Elsevier BV
Date: 1990
DOI: 10.1016/S0894-7317(14)80299-X
Abstract: We prospectively assessed the influence of aging on the prevalence of valvular regurgitation by using color flow imaging. One hundred eighteen healthy volunteers (21 to 82 years old) had a two-dimensional Doppler echocardiographic study that included color flow imaging to assess valvular regurgitation and that was semiquantitated by mapping the dimensions of the color flow regurgitant jet in orthogonal views. The subjects were ided into two groups: group 1 consisted of subjects who were younger than 50 years old (n = 61), and group 2 consisted of subjects who were at least 50 years old (n = 57). Mitral regurgitation was detected in 57 (48%) of the 118 subjects: 24 subjects (39%) in group 1 and 33 subjects (58%) in group 2. The severity of mitral regurgitation was trivial to mild. Aortic regurgitation was detected in 13 (11%) of the 118 subjects, all in group 2. The severity was trivial to mild. Tricuspid regurgitation was detected in 77 (65%) of the 118 subjects: 35 (57%) in group 1 and 42 (74%) in group 2. The severity was trivial to mild. Pulmonary regurgitation was detected in 24 (31%) of 78 subjects: nine (22%) in group 1 and 15 (41%) in group 2. The severity was trivial. These findings suggest that valvular regurgitation of a trivial or mild degree is a frequent finding in normal subjects and that it increases with age.
The safety profile of perflutren microsphere contrast echocardiography during rest and stress imaging: Results from an Australian multicentre cohort
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.HLC.2013.05.637
Abstract: Contrast enhanced echocardiography (CEE) is utilised when sub-optimal image quality results in non-diagnostic echocardiograms. However, there have been numerous safety notices issued by regulatory authorities regarding rare but potentially serious adverse reactions (AR). This multi-centre, retrospective analysis was performed to assess the short-term safety of CEE in a broad range of indications. All CEE performed over 58 months at three institutions were assessed for AR within 30 min. A total of 5956 CEE were performed in 5576 patients. A total of 4903 were stress CEE and 1053 resting CCE. Bolus administration in 5719, infusion in 237 cases 89.9% of CCE were outpatients. Commonest CEE indication was functional stress testing (82.3%). There were 16 AR related to CEE (0.27%). All AR were mild, transient and all patients made a full recovery. No cases of serious anaphylaxis or death within 30 min of contrast administration. Comparing those with and without an AR, there were no significant differences in age, gender, BMI, LVEF, patient location, exam type or RVSP. There was a slightly increased likelihood of an AR during infusion versus bolus dosing (p = 0.02). CEE is a safe investigation in a broad range of indications and clinical scenarios. AR are very rare, mild and transient.
Systemic Air Embolization Originating from a Pleural Air Leak via a Left Ventricular Assist Device Cannula Anastomosis Site
Publisher: Elsevier BV
Date: 03-2023
DOI: 10.1016/J.ECHO.2009.08.022
Abstract: A patient presented with cardiogenic shock, and a left ventricular assist device (LVAD) was inserted. Transthoracic echocardiography demonstrated air in the left side of the heart whenever the patient coughed. A chest x-ray and computed tomography of the chest did not reveal a pneumothorax. Air appeared to enter the left atrium (LA) around the LA cannula. The working diagnosis was a right pleural tear with intermittent passage of air from the pleural space (supra-atmospheric during coughing) into the LA (around the cannula), which contained a large-bore LVAD cannula on -40 mm Hg suction. This was confirmed by inserting a right-sided chest drain, and no air appeared during coughing. This case demonstrates an unusual complication of LVAD use (systemic air embolization) and highlights the point of variable physiology during dynamic versus static imaging procedures.
Obstructive mechanical valve thrombosis: utility of 3D trans-oesophageal echocardiography
Publisher: Oxford University Press (OUP)
Date: 09-10-2015
DOI: 10.1093/EHJCI/JEU204
The Feasibility and Clinical Utility of Microsphere Contrast-enhanced Transthoracic Echocardiography in Adult Congenital Heart Disease
Publisher: Computers, Materials and Continua (Tech Science Press)
Date: 18-02-2015
DOI: 10.1111/CHD.12254
Abstract: Transthoracic echocardiography (TTE) plays a key role in adult congenital heart disease (ACHD). However, a significant number of studies are nondiagnostic due to poor image quality. Enhancement of the blood pool-tissue interface with contrast-enhanced TTE (CE-TTE) can improve image quality in suboptimal studies. The aim of this analysis was to evaluate feasibility and clinical utility of CE-TTE in the assessment of patients with ACHD. A retrospective analysis of all CE-TTE performed in ACHD patients at our institution from August 2007 to May 2014 was performed. Endocardial definition scores (EDS) for each segment in the right and left ventricles were graded pre- and postcontrast imaging, as 1 = good, 2 = suboptimal, 3 = not seen. The endocardial border definition score index (EBDSI) was also calculated pre- and postcontrast imaging. Twenty patients with ACHD had 24 CE. Summation data for all ventricular EDS for unenhanced TTE vs. CE-TTE imaging was: EDS 1 = 136 vs. 314, EDS 2 = 119 vs. 72, EDS 3 = 162 vs. 31, respectively. Wilcoxon matched-pairs rank-signed test showed a significant ranking difference (improvement) pre- and postcontrast for the combined ventricular data (P < .0001) and the in idual left and right ventricular data (all P < .0001). The EBDSI for combined ventricular data using CE-TTE was significantly lower than for noncontrast imaging (1.23 ± 0.49 vs. 2.06 ± 0.62, P < .0001). There was one minor contrast adverse reaction. CE-TTE resulted in significantly improved right and left ventricular endocardial definition and improved EDBSI. CE-TTE should be viewed as an additional imaging technique that is available to help assess patients with ACHD, especially those with nondiagnostic images.
Non-tropical endomyocardial fibrosis associated with sarcoidosis
Publisher: Oxford University Press (OUP)
Date: 29-10-2014
DOI: 10.1093/EHJCI/JET198
Non-toxigenic Corynebacterium diphtheriae var gravis endocarditis of the aortic valve
Publisher: Elsevier BV
Date: 05-1997
A classic yet unusual case: The full spectrum of bicuspid aortic valve disease
Publisher: Oxford University Press (OUP)
Date: 20-10-2014
DOI: 10.1093/EHJCI/JET157
ANGIOTENSIN‐CONVERTING ENZYME AND ANGIOTENSINOGEN GENES IN PATTERNS OF LEFT VENTRICULAR HYPERTROPHY AND IN DIASTOLIC DYSFUNCTION
Publisher: Wiley
Date: 07-1995
DOI: 10.1111/J.1440-1681.1995.TB02036.X
Abstract: 1. The association of different patterns of left ventricular hypertrophy and diastolic dysfunction with angiotensin converting enzyme (ACE) genotypes or angiotensinogen dinucleotide repeat alleles were studied in human subjects. 2. Three abnormal patterns of hypertrophy (remodelled, eccentric and concentric) were associated with a history of hypertension. The presence of remodelled or concentric hypertrophy was associated with diastolic dysfunction. 3. There was no difference between the frequencies of the ACE genotypes in normotensive and hypertensive subjects, in subjects with normal ventricles and those with different patterns of left ventricular hypertrophy, nor in subjects with normal and abnormal diastolic function. Similarly, there was no difference between the relative frequencies of AGT alleles in the same clinical subgroups. 4. We conclude that in this population of hospital patients, variants of the ACE and AGT genes do not contribute to the presence of different patterns of hypertrophy or to diastolic dysfunction.
Anterior ECG changes following iatrogenic dissection of the right coronary artery into the aortic root: Exclusion of left coronary obstruction with transoesophageal echocardiography
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.CARREV.2012.10.005
Abstract: One of the most troublesome complications of percutaneous coronary intervention (PCI) or angiography is retrograde dissection of the artery into the aortic root. We report a case involving the right coronary artery (RCA) which was treated with prompt deployment of stents. Recurrent chest pain and ST segment elevation in V(2-4) mimicked the ECG appearance of acute anterior infarction and prompted concern that the dissection had extended to impair flow in the left coronary artery (LCA). Transoesophageal echocardiography (TOE) demonstrated that the aortic root dissection had been contained and that the LCA was not compromised.
Left ventricular endocardial definition enhancement using perflutren microsphere contrast echocardiography during peripheral venoarterial extracorporeal membranous oxygenation
Publisher: Wiley
Date: 10-2010
DOI: 10.1111/J.1540-8175.2010.01184.X
Abstract: Contrast echocardiography provides incremental benefit in patients with nondiagnostic imaging, particularly in the intensive care setting. There are minimal data regarding its use in patients on mechanical cardiac support devices. This case highlights the additional diagnostic information provided with contrast-enhanced imaging in a patient with shock, supported by a peripherally cannulated extra-corporeal membranous oxygenation (ECMO) device. The signal persistence was reduced compared to the conventional setting, as anticipated but the concentration of perflutren microspheres remained sufficient to provide satisfactory endocardial definition, despite passage through a centrifugal pump. There was no adverse affect on the patient's cardiorespiratory status or ECMO function.
Transesophageal echocardiographic abnormalities in a case of cardiac sarcoidosis
Publisher: Elsevier BV
Date: 05-2001
Abstract: Sarcoidosis is a granulomatous disease that may involve multiple organ systems, including the heart. Manifestations include atrial and ventricular arrhythmias, conduction abnormalities, congestive cardiac failure, pericarditis, and sudden death. Whereas cardiac involvement is a relatively common finding at autopsy, antemortem diagnosis is often missed because the clinical manifestations are nonspecific, and the sensitivity and specificity of investigations are low. We report a case of a 62-year-old woman who had clinically significant cardiac sarcoidosis associated with echocardiographic abnormalities that had not been reported previously in association with this condition.
Doppler characterization of left ventricular diastolic function in cardiac amyloidosis
Publisher: Elsevier BV
Date: 04-1989
DOI: 10.1016/0735-1097(89)90254-4
Abstract: Sixty-four patients with primary systemic amyloidosis-53 with two-dimensional echocardiographic features of cardiac involvement (Group I) and 11 without cardiac involvement (Group II)--underwent Doppler echocardiographic assessment of left ventricular diastolic function. Pulsed wave Doppler recordings of left ventricular inflow velocities and pulmonary vein flow velocities with respiratory monitoring in these patients were compared with findings in a normal group. Patients in Group I showed striking abnormalities of left ventricular diastolic filling when classified into subgroups by mean left ventricular wall thickness: early greater than 12 but less than 15 mm advanced greater than or equal to 15 mm. In early amyloidosis, relaxation was abnormal, with decreased peak early velocity (75 +/- 20 versus 86 +/- 16 cm/s p less than 0.01), increased late velocity (71 +/- 22 versus 56 +/- 13 cm/s p less than 0.01), decreased early to late velocity ratio (1.2 +/- 0.6 versus 1.6 +/- 0.5 p less than 0.01) and prolonged isovolumic relaxation time (87 +/- 15 versus 73 +/- 13 ms p less than 0.01) compared with normal values. In advanced amyloidosis, there was a restrictive filling pattern with a markedly shortened deceleration time (148 +/- 50 versus 199 +/- 32 ms p less than 0.001), decreased pulmonary vein peak systolic flow velocity (34 +/- 16 versus 54 +/- 12 cm/s p less than 0.01) and increased diastolic flow velocity (55 +/- 20 versus 44 +/- 12 cm/s p less than 0.01) compared with normal values. Group and the subgroup with early amyloidosis had similar flow velocity patterns. Thus, this study documents that in cardiac amyloidosis, a spectrum of diastolic filling abnormalities exists the restrictive filling pattern is seen only in the advanced stages.
Transcatheter valve-in-valve replacement of degenerated bioprosthetic aortic valves: a single Australian Centre experience.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.CARREV.2014.10.004
Abstract: Patients with degenerated surgical bioprosthetic valves may be at high risk for further surgery because of age, comorbidities and the difficulties of repeat procedures. Percutaneous valve-in-valve implantation offers what may be a simpler and safer procedure. From May 2009 to March 2014 at the Prince Charles Hospital 1625 patients underwent surgical aortic valve replacement while 262 underwent transcatheter aortic valve implantation. Twelve patients had valve-in-valve implants for degenerated bioprosthetic aortic valves. These implants were deployed successfully without major valvular or paravalvular regurgitation. There were no periprocedural deaths, myocardial infarcts, neurological events or major vascular complications. Two patients died after 1624 and 1319days. Median survival for the remainder is 581days they are stable with New York Heart Association class I/II functional status although 4 have a degree of patient-prosthesis mismatch, one has moderate aortic regurgitation and one required surgery for a late aortic dissection. Transcatheter valve-in-valve implantation is safe and effective treatment for patients with failed bioprosthetic aortic valves for whom reoperation is considered to be hazardous.
Comparison of fluoroscopic versus real-time three-dimensional transthoracic echocardiographic guidance of endomyocardial biopsies
Publisher: Oxford University Press (OUP)
Date: 24-03-2010
DOI: 10.1093/EJECHOCARD/JEQ036
Abstract: Fluoroscopic-guided right ventricular (RV) endomyocardial biopsy (EMBx) is the conventional method for obtaining myocardial s les to assess for rejection following heart transplantation. This study was designed to assess the feasibility and accuracy of guiding RV sheath and bioptome tip position using real-time three-dimensional echocardiography (RT3DE). Forty EMBx procedures were performed in 21 patients. Five procedures were in a native heart and 35 were performed following cardiac transplantation. A RV long sheath was positioned toward the mid to distal interventricular septum using fluoroscopy. RT3DE was used to correlate sheath tip position with fluoroscopic position. Bioptome tip visualization and position against the endocardium was assessed using RT3DE. Sheath tip location was repositioned in 18 cases (46%) following assessment using RT3DE, due to alignment toward the apex (9) and mid (5) or distal RV (4) free wall. The bioptome tip could be clearly visualized using RT3DE in 83% of passes. In 35% of passes, the bioptome tip was repositioned using RT3DE guidance to improve the s ling site. RT3DE-guided EMBx was feasible in the majority of patients and resulted in sheath repositioning in 46% of patients and bioptome tip reorientation in 35% of cases.
Mitral valve bio-prosthesis and annuloplasty thrombosis during extracorporeal membrane oxygenation: case series
Publisher: Oxford University Press (OUP)
Date: 24-04-2020
Abstract: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a well-recognized form of haemodynamic support for patients with refractory cardiogenic shock, who are unable to be weaned off cardiopulmonary bypass. Thrombosis or bleeding from cannula sites or surgical wounds are the leading cause of morbidity and mortality in these patients, and presents a delicate balance of anticoagulation during management of patients undergoing circulatory support. In this case series, we discuss three cases of patients undergoing mitral valve replacements or repair with thrombosis of their new bio-prosthesis in the immediate post-operative setting. All three patients were supported with VA-ECMO post-operatively, and thrombosis occurred despite anticoagulation. During extracorporeal membrane oxygenation, the reduced flow throughout the heart increases the risk of intra-cardiac thrombosis. This is of particular importance in the context of mitral valve replacements and repairs, where the bio-prosthesis is an additional risk factor for thrombosis. Our cases demonstrate the morbidity and mortality of such complications, with the likely aetiology being low transvalvular flow in a newly inserted valve combined with the pro-thrombotic state created by the VA-ECMO circuit.
RENIN AND ANGIOTENSIN‐CONVERTING ENZYME GENOTYPES IN PATIENTS WITH ESSENTIAL HYPERTENSION AND LEFT VENTRICULAR HYPERTROPHY
Publisher: Wiley
Date: 03-1994
DOI: 10.1111/J.1440-1681.1994.TB02497.X
Abstract: 1. The associations between left ventricular hypertrophy (LVH) and specific alleles of the renin and angiotensin-converting enzyme (ACE) genes were studied in patients with essential hypertension and normal blood pressure. 2. LVH was present in 42% of those with essential hypertension (n = 72) and 17% of those with normal blood pressure (n = 44). 3. The frequency of each renin allele was the same in hypertensive and in normotensive patients. Renin allele frequencies were also the same for those with LVH and those with normal cardiac mass. When only hypertensives were considered, renin alleles were in the same proportion for the groups with and without LVH. Similarly, ACE alleles were not associated with essential hypertension nor with elevated cardiac mass. 4. We conclude that, in this population, variations in the renin or ACE genes do not contribute significantly to the development of LVH or to essential hypertension.
Left atrial appendage closure for non-valvular atrial fibrillation.
Publisher: Elsevier BV
Date: 04-2012
Reproducibility of regional and global longitudinal strains derived from two-dimensional speckle-tracking and Doppler tissue imaging between expert and novice readers during quantitative dobutamine stress echocardiography
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.ECHO.2014.04.016
Abstract: Longitudinal strain (LS) is a quantitative parameter that adds incremental value to wall motion analysis. The aim of this study was to compare the reproducibility of LS derived from Doppler tissue imaging and speckle-tracking between an expert and a novice strain reader during dobutamine stress echocardiography (DSE). Forty-one patients (mean age, 65 ± 15 years mean ejection fraction, 58 ± 11%) underwent DSE per clinical protocol. Global LS derived from speckle-tracking and regional LS derived from both speckle-tracking and Doppler tissue imaging were measured twice by an expert strain reader and also measured twice by a novice strain reader. Intraobserver and interobserver analyses were performed using intraclass correlation coefficients (ICC), Bland-Altman analysis, and absolute difference values (mean ± SD). Global LS measured by the expert strain reader demonstrated high intraobserver measurement reproducibility (rest: ICC = 0.95, absolute difference = 5.5 ± 4.9% low dose: ICC = 0.96, absolute difference = 5.7 ± 3.7% peak dose: ICC = 0.87, absolute difference = 11.4 ± 8.4%). Global LS measured by the novice strain reader also demonstrated high intraobserver reproducibility (rest: ICC = 0.97, absolute difference = 4.1 ± 3.4% low dose: ICC = 0.94, absolute difference = 5.4 ± 5.9% peak dose: ICC = 0.94, absolute difference = 6.1 ± 4.8%). Global LS also showed high interobserver agreement between the expert and novice readers at all stages of DSE (rest: ICC = 0.90, absolute difference = 8.5 ± 7.5% low dose: ICC = 0.90, absolute difference = 8.9 ± 7.1% peak dose: ICC = 0.87, absolute difference = 10.8 ± 8.4%). Of all parameters studied, LS derived from Doppler tissue imaging had relatively low interobserver and intraobserver agreement. Global LS is highly reproducible during all stages of DSE. This variable is a potentially reliable and reproducible measure of myocardial deformation.
A lethal pedigree of hypertrophic cardiomyopathy associated with mild left ventricular hypertrophy
Publisher: Wiley
Date: 12-1996
DOI: 10.1111/J.1445-5994.1996.TB00638.X
Abstract: Disposable paper cups are widely used in daily life and most of them are landfilled or incinerated after use, resulting in a serious ecological hazard and significant waste of resources due to the usage of thin polyethylene (PE) as their inner coating. Hence, converting these common solid domestic wastes into high-value added materials is attractive and meaningful. In this study, transparent cellulose-based films were achieved from old bamboo-based disposable paper cups after pretreatment through using the room ionic liquid 1-allyl-3-methylimidazolium chloride (AmimCl) as solvent. The cellulose-based film with a dense texture demonstrated a relatively nice mechanical and UV-shielding performances, and its tensile strength was as high as 48 MPa, much higher than that of commercial polyethylene (PE, 12 MPa) film. Thus, the resultant cellulose-based film showed a great potential in the packaging field. Besides, the flexible paper plastic composites (PPC) were also fabricated from the rest thin PE coating with the stuck fibers, and it was found that PPC showed excellent mechanical property and hydrophobicity. Consequently, a feasible and eco-friendly process of recycling and reusing waste disposable paper cups was developed to achieve a complete utilization and valorization of waste disposable paper cups.
Surgical repair of a large coronary artery aneurysm with arteriovenous fistula
Publisher: Elsevier BV
Date: 05-2006
Usefulness of Mitral Valve Prosthetic or Bioprosthetic Time Velocity Index Ratio to Detect Prosthetic or Bioprosthetic Mitral Valve Dysfunction
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.AMJCARD.2017.07.026
Abstract: This study aimed to investigate the utility of transthoracic echocardiographic (TTE) Doppler-derived parameters in detection of mitral prosthetic dysfunction and to define optimal cut-off values for identification of such dysfunction by valve type. In total, 971 TTE studies (647 mechanical prostheses 324 bioprostheses) were compared with transesophageal echocardiography for evaluation of mitral prosthesis function. Among all prostheses, mitral valve prosthesis (MVP) ratio (ratio of time velocity integral of MVP to that of left ventricular outflow tract odds ratio [OR] 10.34, 95% confidence interval [95% CI] 6.43 to 16.61, p<0.001), E velocity (OR 3.23, 95% CI 1.61 to 6.47, p<0.001), and mean gradient (OR 1.13, 95% CI 1.02 to 1.25, p=0.02) provided good discrimination of clinically normal and clinically abnormal prostheses. Optimal cut-off values by receiver operating characteristic analysis for differentiating clinically normal and abnormal prostheses varied by prosthesis type. Combining MVP ratio and E velocity improved specificity (92%) and positive predictive value (65%) compared with either parameter alone, with minimal decline in negative predictive value (92%). Pressure halftime (OR 0.99, 95% CI 0.98 to 1.00, p=0.04) did not differentiate between clinically normal and clinically abnormal prostheses but was useful in discriminating obstructed from normal and regurgitant prostheses. In conclusion, cut-off values for TTE-derived Doppler parameters of MVP function were specific to prosthesis type and carried high sensitivity and specificity for identifying prosthetic valve dysfunction. MVP ratio was the best predictor of prosthetic dysfunction and, combined with E velocity, provided a useful parameter for determining likelihood of dysfunction and need for further assessment.
The Use of Computerised Simulators for Training of Transthoracic and Transoesophageal Echocardiography. The Future of Echocardiographic Training?
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.HLC.2012.03.012
Abstract: Echocardiography is the commonest form of non-invasive cardiac imaging but due to its methodology, it is operator dependent. Numerous advances in technology have resulted in the development of interactive programs and simulators to teach trainees the skills to perform particular procedures, including transthoracic and transoesophageal echocardiography. Forty trainee sonographers assessed a computerised mannequin echocardiographic simulator and were taught how to obtain an apical two-chamber (A2C) view and image the superior vena cava (SVC). Forty-two attendees at a TOE simulator workshop assessed its utility and commented on perceived future use, using defined criteria. One hundred percent and 88% of sonographers found the simulator useful in obtaining the SVC or A2C view respectively. All users found it easy to use and the majority found it helped with image acquisition and interpretation. Attendees of the TOE training day assessed the simulator with 100% finding it easy to use, as well as the augmented reality graphics benefiting image acquisition. Ninety percent felt that it was realistic. This study revealed that both trainee sonographers and TOE proceduralists found the simulation process was realistic, helped in image acquisition and improved assessment of spatial relationships. Echocardiographic simulators may play an important role in the future training of echocardiographic skills.
Accuracy of biplane transesophageal echocardiography in detecting left atrial thrombus
Publisher: Elsevier BV
Date: 02-1996
The Role of 3D Transesophageal Echocardiography During Percutaneous Closure of Paravalvular Mitral Regurgitation
Publisher: Elsevier BV
Date: 06-2009
Biventricular diastolic behaviour in patients with hypertrophic and hereditary hemochromatosis cardiomyopathies
Publisher: Oxford University Press (OUP)
Date: 10-2004
The role of Doppler left ventricular filling indexes and Doppler tissue echocardiography in the assessment of cardiac involvement in hereditary hemochromatosis
Publisher: Elsevier BV
Date: 09-2002
Abstract: Although cardiac dysfunction in hereditary hemochromatosis (HHC) can be evaluated by conventional echocardiography, findings are often not specific. To test the hypothesis that the assessment of (1) conventional Doppler left ventricular filling indexes and (2) intrinsic elastic properties of the myocardium by Doppler tissue echocardiography can both enhance the accuracy of echocardiographic diagnosis of cardiac involvement in HHC, a group of 18 patients with HHC (mean age 50 +/- 17 years) and 22 age-matched healthy subjects were studied. The following indexes were characteristic for HHC: (1) the duration of atrial reversal measured from pulmonary venous flow (ms) was longer (118 +/- 20 vs 90 +/- 16 P <.001) (2) systolic lateral mitral, early-diastolic medial mitral, and early-diastolic lateral tricuspid annular velocities were reduced by 23%, 31%, and 13%, respectively (3) late-diastolic mean myocardial velocity and myocardial velocity gradient (MVG) were also reduced by 22% and 34%, respectively. Late-isovolumic relaxation (late-IVR) MVG (s(-1)) was positive in HHC as opposed to negative in healthy subjects (1.72 +/- 0.85 vs -0.89 +/- 1.15 P <.001) indicating impaired early-diastolic subepicardial relaxation in HHC. The assessment of atrial reversal flow duration, the difference in duration between A-wave and atrial reversal flow, and the presence of positive late IVR-MVG findings were the most accurate variables to differentiate patients with HHC from healthy subjects (80%, 67%, 94% sensitivity and 90%, 95%, 86% specificity, respectively).
Outcomes of transcatheter aortic valve implantation in high surgical risk and inoperable patients with aortic stenosis: a single Australian Centre experience.
Publisher: Wiley
Date: 2016
DOI: 10.1111/IMJ.12938
Abstract: Degenerative aortic stenosis is the most common valvular heart disease in the elderly, and many patients are not suitable for aortic valve replacement surgery. Transcatheter aortic valve implantation (TAVI) is a new therapeutic option for selected patients at high risk for surgery. To evaluate the safety and efficacy of TAVI in Australian patients. This is a prospective study of patients undergoing TAVI for severe symptomatic aortic stenosis at The Prince Charles Hospital, Brisbane, Australia between August 2008 and July 2013. Patients were at high risk of surgical aortic valve replacement, or inoperable, as deemed by a multidisciplinary 'heart team'. Outcomes include procedural success and complications, 30-day and 1-year mortality and stroke, combined end-points as outlined by the Valve Academic Research Consortium 2 consensus document. Two hundred and nine patients underwent TAVI during the study period. The mean age was 83.7 ± 6.7 years, and 101 (48%) were men. The valve systems utilised were as follows: Edwards-SAPIEN valve in 104 (49.5%), Medtronic CoreValve in 86 (41.2%) and Boston Scientific Lotus valve in 19 (9.3%) patients. Thirty-day and 1-year mortality rates were 5.7% and 11.5% respectively. Thirty-day and 1-year stroke rates were 4.3% and 6.2% respectively. The composite end-points of device success, early safety and clinical efficacy occurred in 80.4%, 27.3% and 68.4%. TAVI with various valve systems, delivered through several approaches, is feasible in high surgical risk and inoperable patients with severe aortic stenosis, with acceptable outcomes at short-term and intermediate-term follow up.
Feasibility of pulmonary valve imaging using three-dimensional transthoracic echocardiography
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.ECHO.2010.06.015
Abstract: The pulmonary valve (PV) is rarely visualized in short axis with conventional two-dimensional transthoracic echocardiography (TTE). Thus, the true incidence of abnormal PV morphology in patients undergoing TTE is unknown. This study sought to evaluate the feasibility of using three-dimensional echocardiography in the morphologic assessment of the PV in short-axis. A total of 200 consecutive patients referred for routine TTE were prospectively evaluated (mean age 64 ± 16 years 113 males). Live3D and full-volume 3D (FV3D) were performed with the feasibility of visualizing PV morphology assessed. McNemar's test was used as a nonparametric comparator between Live3D and FV3D results and to assess for any significant learning curve. Chi-square test was used to determine the association between variables. PV morphology detection rates were significantly different (P < .0001) between Live3D (60%) and FV3D (23%). The optimal plane for Live3D was the parasternal view (99%), using zoom over the PV and rotating to a short-axis image. PV short-axis cusp detection using Live3D was dependent on the initial two-dimensional PV image quality (P < .0001). Live3D is feasible in evaluating PV short-axis morphology and provides incremental value in the TTE examination.
Update on echocardiography in the management of infective endocarditis
Publisher: Springer Science and Business Media LLC
Date: 29-04-2012
DOI: 10.1007/S11908-012-0262-8
Abstract: Echocardiography is the major imaging modality used for the diagnosis of infective endocarditis (IE). It is also useful in detecting the complications of IE which often necessitate surgical intervention and strongly influence patient outcomes. Transesophageal echocardiography (TEE), with proven superiority over transthoracic echocardiography (TTE) for the detection of vegetations and complications such as abscess, should be performed in the vast majority of cases especially when TTE image quality is poor or implanted devices are present. Three-dimensional (3D) TEE provides enhanced display of anatomic-spatial relationships allowing more precise delineation of complex pathology, particularly of the mitral valve and annulus. Importantly, echocardiographic findings can be non-specific and should always be interpreted in the context of the pre-test probability of IE based on careful clinical assessment. IE remains a challenging disease associated with variable clinical presentations, and high mortality. Whenever IE is suspected, echocardiography should be utilized early for both diagnosis and detection of complications.
Direct visualization of septal perforator coronary arterial blood flow during perflutren microsphere contrast echocardiography
Publisher: Oxford University Press (OUP)
Date: 11-06-2009
DOI: 10.1093/EJECHOCARD/JEP075
Abstract: A 62-year-old female with supraventricular tachycardia underwent a contrast echocardiogram to assess left ventricular structure and function due to sub-optimal images on conventional imaging. Multi-pulse, phase inversion, low mechanical index imaging was used (left ventricular opacification), combined with bolus dosing of a perflutren microsphere (Definity). In the parasternal short-axis view, during contrast imaging, flow within a septal coronary artery could be directly visualized. The corresponding coronary angiogram demonstrated prominent septal perforators arising from the LAD artery. By exploiting the non-linear oscillation properties of microbubbles and the linear oscillation properties of tissue, at low MI, contrast-specific imaging has the ability to enhance the contrast signal while suppressing the myocardial signal. This form of contrast imaging has high temporal and spatial resolution, enabling visualization of relatively small structures in real time. Clinical relevance of this finding includes the ability to enhance coronary blood flow evaluation, which would have utility in those studies where spectral Doppler is being used to evaluate coronary blood flow and coronary flow reserve and it may be beneficial in the identification of septal perforator arteries that should be injected with alcohol during percutaneous septal ablation for the management of hypertrophic obstructive cardiomyopathy.
Multisite Arterial Thrombosis: Synchronous or Metachronous?
Publisher: Elsevier BV
Date: 05-2012
Contrast echocardiography in australian clinical practice
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.HLC.2010.02.001
Abstract: The second-generation contrast agent Definity (a perflutren microsphere) became available in Australia in mid-2007. We describe the introduction of contrast echocardiography into a high-volume quaternary teaching hospital, performing over 16,000 echocardiograms per year. Workflow protocols were developed for patient selection, contrast administration, and image acquisition and analysis. Data were prospectively collected for all contrast cases. Endocardial definition scores were derived by three independent observers before and after contrast administration, and statistically compared. 161 patients received contrast in the first 12 months of the contrast program. There was statistically significant improvement in endocardial definition scores after contrast administration (p=0.0001), and reduction in inter-observer variability of wall motion assessment. A number of clinically significant findings (pseudoaneurysm, non-compaction, thrombus) were detected on contrast echo that were not apparent on standard 2D imaging. Adverse events were rare (0.6%) with no life-threatening events. The introduction of a second-generation contrast agent into clinical workflow in a hospital echocardiography department resulted in a statistically significant improvement in endocardial definition, and safely provided diagnostic imaging in cases which were otherwise non-diagnostic. Inter-observer variability was reduced, and diagnostic yield increased. These results reflect previously published data, and indicate that contrast echocardiography is feasible in Australian clinical practice.
Unusual case of acute posteromedial papillary muscle rupture after acute anterior myocardial infarction
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.HLC.2013.07.005
Abstract: Papillary muscle rupture is now a rare complication of acute myocardial infarction. Posteromedial papillary muscle rupture is more common than anterolateral papillary muscle rupture. The posteromedial papillary muscle is usually supplied from a branch of the right coronary artery. We present a case of posteromedial papillary muscle rupture due to an isolated left anterior descending artery lesion. This was diagnosed on the fifth day post infarction. The patient progressed to mitral valve replacement and coronary artery bypass grafting to the left anterior descending artery. We believe this unusual arterial supply to the posteromedial papillary muscle is due to an apex forming left anterior descending artery coupled with an apically located posteromedial papillary muscle.
Three-dimensional echocardiography: Historical development and current applications
Publisher: Elsevier BV
Date: 05-2001
Abstract: Three-dimensional (3D) echocardiography facilitates spatial recognition of intracardiac structures, potentially enhancing diagnostic confidence of conventional echocardiography. The accuracy of 3D images has been validated in vitro and in vivo. In vitro, a detail 1.0 mm in dimension and 2 details separated by 1.0 mm can be identified from a volume-rendered 3D image. In vitro 3D volume measurements are underestimated by approximately 4.0 mL. In vivo, left ventricular volume measurements correlate highly with both cineventriculography (limits of agreement +/-18 mL for end diastole and +/-10 mL for end systole) and magnetic resonance imaging, including measurements for patients with functionally single ventricles. Studies on congenital heart lesions have shown good accuracy and good reproducibility of dynamic "surgical" reconstructions of septal defects, aortoseptal continuity, atrioventricular junction, and both left and right ventricular outflow tract morphology. Transthoracic 3D echocardiography was shown feasible in 81% to 96% of patients with congenital heart defects and provided additional information to that available from conventional echocardiography in 36% of patients, mainly in more detailed description of mitral valve morphology, aortoseptal continuity, and atrial septum. In patients with mitral valve insufficiency, 3D echocardiography was shown to be accurate in the quantification of the dynamic mechanism of mitral regurgitation and in the assessment of mitral commissures in patients with mitral stenosis. This includes not only valve tissue reconstruction but also color flow intracardiac jets. Three-dimensional reconstructions of the aortic valve were achieved in 77% of patients, with an accuracy of 90%. In conclusion, the role of 3D echocardiography, which continues to evolve, shows promise in the assessment of congenital and acquired heart disease.
3-D assessment of infective endocarditis with anterior mitral valve perforation and flail posterior leaflet
Publisher: Elsevier BV
Date: 04-2015
Noninvasive cardiac output measurement in heart failure subjects on circulatory support
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
DOI: 10.1213/ANE.0B013E318193174B
Abstract: Pulmonary artery catheter (PAC) thermodilution is commonly used in the perioperative cardiac surgical intensive care unit for measurement and management of central hemodynamics despite questions about effectiveness, difficulty of use, and safety. USCOM is a noninvasive continuous wave Doppler device for direct measurement of cardiac output (CO) and is an alternative to PAC. USCOM validation has predominantly been in the cardiac surgical intensive care unit against PAC, despite the recognized limitations in reliability of the method. We compared USCOM CO measurements with the CardioWest, an orthotopic total artificial heart (TAH), in heart failure (HF) subjects during controlled interventions. CO, stroke volume (SV), and heart rate (HR) were measured in a blinded fashion using the CardioWest and the USCOM device in TAH HF patients. Five-hundred eight paired measures from 18 examinations of seven subjects were acquired as flow was varied by the CardioWest controller. Bland-Altman analysis was used to compare agreement. Mean values and standard deviations (+/-SD) for CO, SV, and HR by CardioWest and USCOM were 7.33 +/- 0.46 and 7.34 +/- 0.51 L/min, 56.2 +/- 3.8 and 56.6 +/- 3.8 mL, and 131 +/- 3 and 130 +/- 4 bpm, respectively. CO ranged from 5.2 to 9.3 L/min. The mean differences between methods for CO, SV, and HR were -0.01 +/- 0.23 L/min, -0.34 +/- 1.97 mL, and 0.9 +/- 2.3 bpm, respectively, with mean percentage differences of -0.3%, -0.6%, and 0.7%. The percentage limits of agreement for CO, SV, and HR were 6.4%, 7.1%, and 3.6%. USCOM is a feasible and accurate method for noninvasive measurement and monitoring of CO in TAH HF patients and may have a wider application in diagnosis and management of cardiovascular disease.
Successful treatment of incessant atrial flutter with excision of congenital giant right atrial aneurysm diagnosed by transesophageal echocardiography
Publisher: Elsevier BV
Date: 04-1995
Early and Late Cardiac Perforation by Amplatzer Atrial Septal Defect and Patent Foramen Ovale Devices
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.ECHO.2009.06.013
Abstract: Cardiac perforation and device erosion are infrequent but potentially lethal complications of percutaneous occluder device insertion. Transthoracic and transesophageal echocardiography (TEE) and gated cardiac computed tomography are useful in detecting this complication. In particular, TEE can detect characteristic features to confirm the diagnosis before rapid surgical correction. Deficient superior-anterior rim and encroachment of the occluder device on the posterior atrial wall are risk factors for device erosion. TEE performed before device insertion with awareness of manufacturer's guidelines for atrial geometry and device sizing may reduce the occurrence of this serious complication.
The role of left and right ventricular early diastolic Doppler tissue echocardiographic indices in the evaluation of acute rejection in orthotopic heart transplant
Publisher: Elsevier BV
Date: 02-2005
DOI: 10.1016/J.ECHO.2004.09.021
Abstract: The aim was to evaluate whether Doppler tissue echocardiographic early diastolic indices of both the right and left ventricle (LV) may assist in the detection of acute heart transplant (HT) rejection. In all, 44 consecutive patients with HT (mean age 52.0 +/- 9.6 years, 39 men) were ided into group 1 with no rejection (histopathology grade or = 3A). In group 2, echocardiographic examinations were performed before (A), during (B), and after (C) acute rejection. Although patients with HT in group 2B compared with group 1 had lower early diastolic velocities at medial/septal (E Med ) and tricuspid/lateral (E Tric ) annulus, as a result of substantial data overlapping this finding did not allow for the detection of patients with acute rejection. In group 2B, both onsets of E Med and E Tric were delayed and LV early diastolic mitral/lateral annulus velocities (E Mitr ) markedly preceded E Tric (E Tric -E Mitr 68 +/- 45 milliseconds for group 2B vs 7 +/- 43 milliseconds for group 1 and 14 +/- 40 milliseconds for group 2A P < .01). Additionally, patients with HT in group 2B had pathologically positive late isovolumic relaxation myocardial velocity gradient of LV posterior wall compared with group 1 or group 2A (1.5 +/- 1.4 s -1 vs -0.3 +/- 2.0 s -1 or 0.3 +/- 1.8, respectively P < .01). Late isovolumic relaxation myocardial velocity gradient greater than 0.1 s -1 and timing differences between onsets of: (1) mitral early diastolic velocity (E wave) and E Med greater than -35 milliseconds and (2) E Tric -E Mitr greater than 15 milliseconds allowed for the distinction of patients with acute HT rejection (group 2B vs 1) with sensitivity and specificity greater than 0.80. For patients with HT and acute rejection abnormal Doppler tissue echocardiographic indices may be caused by both: (1) altered early diastolic untwist of the oblique LV fibers and (2) the delay in early diastolic right ventricular relaxation. Late isovolumic relaxation myocardial velocity gradient and early diastolic timing intervals (mitral E wave-E Med and E Tric -E Mitr ) are promising new echocardiographic markers that can be used in the surveillance for acute rejection in patients with HT.
Haemodynamics and left ventricular mass regression: A comparison of the stentless, stented and mechanical aortic valve replacement
Publisher: Oxford University Press (OUP)
Date: 05-1998
DOI: 10.1016/S1010-7940(98)00058-X
Abstract: Our objective was to compare the degree of change in hemodynamics and left ventricular mass (LVM) regression after aortic valve replacement (AVR) with stentless, stented and mechanical valves. Patients greater than 59 years of age had AVR for aortic stenosis with the stentless xenograft (Cryolife-O'Brien, CLOB), stented xenograft (Carpentier-Edwards, C-E) or mechanical valve (ATS). One-hundred and forty-two patients received stentless, 40 stented, and 69 mechanical valves (mean age 74 +/- 6 vs. 72 +/- 7 and 67 +/- 6 years, respectively). Serial echocardiography was performed. The left ventricular outflow tract diameter was similar pre-operatively in the stentless versus the stented versus the mechanical groups (2.2 +/- 0.4 vs. 2.3 +/- 0.2 vs. 2.2 +/- 0.3 cm P, n.s). The effective orifice area was larger immediately post-operatively in the stentless versus the stented or the mechanical group (2.4 +/- 0.4 vs. 2.0 +/- 0.6 vs. 2.0 +/- 0.7 cm2, P = 0.0001 for both comparisons). The peak aortic gradient at 6 months was significantly less in the stentless versus the stented and mechanical groups (15 +/- 7 vs. 25 +/- 9 vs. 22 +/- 9 mmHg, P < 0.0001). LVM regressed over 6 months in all subgroups: stentless 272 +/- 64 g vs. 220 +/- 72 g, P = 0.0001, stented 257 +/- 58 vs. 230 +/- 74 g, P = 0.02, and mechanical 267 +/- 95 vs. 204 +/- 54 g, P = 0.003. The reduction in LVM was greater in the stentless versus the stented (P = 0.05) but similar to the mechanical group. AVR with the stentless xenograft results in superior hemodynamics compared to the stented and mechanical valve replacements. AVR in all three groups leads to a significant regression of left ventricular hypertrophy within 6 months. However the reduction in LVM is greater in subjects with stentless and mechanical valves, which may have prognostic significance.
Primary aortic valve replacement with cryopreserved aortic allograft: An echocardiographic follow-up study of 570 patients
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2002
Abstract: Background — Despite the many advantages of an aortic allograft valve (AAV) over a prosthetic aortic valve, its durability is suboptimal. The aims of the present study were to document characteristic features of AAV dysfunction and to investigate factors influencing the development of such dysfunction. Methods and Results — A group of 570 patients (mean age, 48±16 years) with a cryopreserved AAV underwent a follow-up echocardiographic study (mean time after surgery, 6.8 years range, 1.0 to 22.9 years). Significant AAV regurgitation was present in 14.7% of patients, and AAV stenosis was present in 3.2%. The root replacement subgroup had the smallest number of patients with significant AAV regurgitation (5.0%) compared with the subcoronary (23.0%) or the inclusion cylinder technique subgroup (14.7%). After 10 to 15 years after AAV replacement, grade ≥2 AAV dysfunction was present in 40% of patients in the subcoronary subgroup, but no significant dysfunction was observed in patients in the root replacement subgroup ( P .001). Smaller host aortic annulus size in both subcoronary (coefficient, −0.145 P =0.013) and root replacement subgroups (coefficient, −0.249 P =0.011) was associated with more frequent AAV dysfunction (grade ≥2). In addition, significant AAV dysfunction was more frequent when patients were younger (coefficient, −0.020 P =0.015) in the subcoronary subgroup and the donor was older (coefficient, 0.054 P =0.019) in the root replacement subgroup. Conclusions — The present study indicates that the root replacement technique is associated with less frequent AAV degeneration. Our findings should help in establishing more strict selection criteria for surgical replacement procedure type and patient/donor factors for AAV replacement and, therefore, could lead to improve AAV longevity.
Tri-leaflet mitral valve variant of hypertrophic obstructive cardiomyopathy: Comprehensive assessment with 3-D transesophageal echocardiography
Publisher: Elsevier BV
Date: 12-2015
Intracardiac echo guided valvuloplasty of a stenotic tricuspid prosthetic valve in a patient with idiopathic hypereosinophilic syndrome
Publisher: Wiley
Date: 28-03-2006
DOI: 10.1111/J.1540-8175.2006.00214.X
Abstract: A 52-year-old male with idiopathic hypereosinophilic syndrome (HES) was transferred to our institution following the development of acute respiratory failure and shock. He had previously undergone tricuspid valve replacement with bioprosthetic valves on two occasions: the initial surgery for severe native tricuspid valve stenosis and the redo surgery for severe prosthetic valve stenosis and regurgitation. Conventional imaging assessment using transoesophageal echocardiography was suboptimal and comprehensive assessment of prosthetic valve function was aided by the use of intracardiac echocardiography (ICE). ICE provided high quality 2D imaging of the prosthesis demonstrating thrombus-like material coating the inner surfaces of the prosthetic valve stents effectively forming a tunnel-like obstruction. Unusual hemodynamics secondary to severe tricuspid stenosis were demonstrated by CW Doppler with intermittent "signal fusion" resulting from blunted respiratory variation in the markedly elevated right atrial pressure relative to right ventricular pressure. Successful balloon valvuloplasty was performed with ICE proving highly valuable in guiding balloon position as well as monitoring the efficacy of the subsequent inflations.
Continuous wave Doppler echocardiographic measurement of prosthetic valve gradients: A simultaneous Doppler-catheter correlative study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-1989
Abstract: Studies correlating prosthetic valve gradients determined by continuous wave Doppler echocardiography with gradients obtained by cardiac catheterization have, to date, been limited to patients with mitral and tricuspid prostheses or have compared nonsimultaneous measurements. Simultaneous Doppler and catheter pressure gradients in 36 patients (mean age, 63 +/- 13 years) with 42 prosthetic valves (20 aortic, 20 mitral, one tricuspid, and one pulmonary) were studied. Catheter gradients were obtained using a dual-catheter technique. The simultaneous pressure tracings and Doppler flow velocity profiles were digitized at 10-msec intervals to derive the corresponding maximal and mean gradients. The correlation between the maximal Doppler gradient and the simultaneously measured maximal catheter gradient was 0.94 (SEE = 6), and that between the Doppler gradient and the simultaneously measured mean catheter gradient was 0.96 (SEE = 3). There were no significant differences in correlation between gradients for the 32 mechanical valves (maximal gradients: r = 0.95, SEE = 6 mean gradients: r = 0.96, SEE = 3) and the 10 bioprosthetic valves (maximal gradients: r = 0.89, SEE = 6 mean gradients: r = 0.93, SEE = 3). In patients with mitral prostheses, Doppler gradients correlated well with the corresponding catheter gradients obtained with direct measurement of left atrial pressure (maximal gradients: r = 0.96, SEE = 2 mean gradients: r = 0.97, SEE = 1.2). A close correlation between corresponding Doppler and catheter gradients also was found in patients with aortic prostheses (maximal gradients: r = 0.94, SEE = 6 mean gradients: r = 0.94, SEE = 3). Thus, continuous wave Doppler echocardiography can accurately predict the pressure gradient across prosthetic valves.
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