PubMed Health⌕ Search

Biomedical subjects

D Kalmanson

Publications and source records attributed to D Kalmanson.

At least 37 records · Page 2Linked to original sources
PubMed1985

[Comparison of pulsed and continuous Doppler techniques for the evaluation of left ventricular stenoses].

The authors compared the data obtained with pulsed (pulsed Doppler-Scanner 3 MHz) and continuous wava Doppler (2.5 MHz), with that obtained by catheterisation in the evaluation of severity of valvular stenoses. The study material comprised 10 healthy subjects and 45 patients with mitral (21) and aortic (24 cases) stenosis, all of whom underwent catheterisation. Stenosis was graded in 3 degrees of increasing severity based on the catheter data. In addition, we studied the correlations between the transvalvular mitral and aortic pressure gradients, calculated by continuous Doppler and catheterisation, and the time of half decrease of flow measured by continuous Doppler and the mitral surface area calculated by catheterisation. No abnormality Was noted in the healthy patients. The jet of the aortic stenosis could not be recorded by continuous Doppler in 8 cases and aortic flow could not be recorded in 1 case with pulsed Doppler. The linear correlation with continuous Doppler was 0.96 (aortic transvalvular gradient for the 16 jets obtained), 0.81 (mitral transvalvular gradient), and 0.80 (time of half decrease of flow and mitral surface area calculated with catheterisation). The comparative study of the degree of severity gives the following percentages of success: mitral stenosis, 85% (pulsed Doppler) vs 71% (continuous Doppler) for mitral stenoses; aortic stenoses 83% (pulsed Doppler) vs 58% (continuous Doppler). In the 16 cases where the aortic jet was recorded properly this percentage was 87% (continuous Doppler) vs 81% (pulsed Doppler). In conclusion, the advantage of continuous Doppler over pulsed Doppler is that it provides quantitative parameters in correlation with catheter data. It is mainly used for evaluating recording the jet should significantly suggest that in elderly patients a systematic right parasternal approach in the jet should significantly reduce the failure rate observed in this study. It is of more limited value in mitral stenoses where pulsed Doppler gives more detailed information about the flow through the mitral valve. This, and the fact that pulsed Doppler can also be used for assession of aortic stenoses, illustrate the complementary nature of the two technique which should always be used together.

Adult↗
PubMed1984

Calculation of pulsed Doppler left ventricular outflow tract regurgitant index for grading the severity of aortic regurgitation.

Measurement of the spatial extent of the regurgitant jet was performed in the left ventricular outflow tract (LVOT) with a 3 MHz two-dimensional echo-pulsed Doppler device, in order to assess the severity of aortic regurgitation on a quantitative basis. The procedure included: detection of diastolic disturbances in the LVOT and mapping of these disturbances in the LVOT. Length (L) and height (H) were measured with calculation of the product (L X H) in the long-axis view and width (W) in the short-axis view with calculation of the LVOT regurgitant index (LVOTRI) as follows: ([L X H] X W). Twelve normal subjects and a group of 83 patients, including 40 patients with aortic regurgitation proved by aortography, were investigated with this procedure. Diagnostic reliability ranged between 90% for specificity and 95% for sensitivity. Correlations between the grading provided by the LVOTRI and those provided by aortography on a three-grade scale showed a correlation coefficient between 0.67 (linear model, p less than 0.01) and 0.80 (exponential model), because of the high values of the index in cases of severe regurgitation. Reliability of the LVOT investigation in aortic regurgitation requires the use of information from two combined scan planes and quantitative rather than qualitative data. Main limitations of the procedure are due to the presence of associated mitral lesions.

Adolescent↗
PubMed1984

Pulsed Doppler echocardiographic indices for assessing mitral regurgitation.

Pulsed Doppler indices were devised in order to grade the severity of mitral regurgitation on a quantitative basis. Indices were obtained by mapping the regurgitant jet by recording abnormal systolic Doppler signals detected on a "yes/no" basis using a 3 MHz pulsed Doppler velocimeter associated with a cross sectional real time ultrasonic scanner. Combined information from two echographic planes was used to take into account the geometrical three dimensional configuration of the jet. The following dimensions of the jet were measured: (a) the length and the height in the long axis view of the left atrium (long axis regurgitant index (LARI), 0.5 X length X height); (b) the width at the annulus in the short axis view (short axis regurgitant index (SARI); (c) the total regurgitant index (TRI) calculated as the product of LARI multiplied by SARI. Sixteen normal subjects and 94 patients including 46 cases of mitral regurgitation confirmed by angiography (32 of whom proceeded to surgery) were investigated. The diagnostic sensitivity was 91% and the specificity 94%. The jet was detected in 76% of cases. Indices were correlated with independently performed angiographic grading on a three point scale. The best linear correlation was obtained for the TRI; mean values were significantly increased for each grade of severity. Correlations with invasive procedures showed an 87% success rate for the Doppler prediction of the involved regurgitant leaflet(s) and of the anatomical site of the lesion at the annulus. In addition, an abnormal diastolic signal was found in five of the eight patients with ruptured chordae and also a decreased percentage of systolic shortening of the annulus diameter in patients with mitral regurgitation compared with those without.

Adult↗
PubMed1984

Quantification of left to right shunt in atrial septal defect using systolic time intervals derived from pulsed Doppler velocimetry.

Systolic time intervals derived from Doppler velocimetry measurements were used instead of direct pulmonary to systemic flow ratio measurements in adults with atrial septal defect to quantify left to right atrial shunts. Thirteen normal subjects and 25 patients with uncomplicated atrial septal defect confirmed by cardiac catheterisation were studied. The pulmonary to systemic flow ratio (Qp:Qs) expressing the shunt size was determined by the Fick method; in normal subjects the Qp:Qs ratio was assumed to be equal to 1.0. The pulsed Doppler analogue velocity recording of flow in the pulmonary artery and the ascending aorta was taken as indicating the ejection time of each ventricle and the Q wave of the electrocardiogram as indicating the onset of systole. From these measurements the ratios of the pre-ejection periods to the ejection times (haemodynamic ratio) were calculated for each ventricle and the ratios of each variable (pre-ejection period, ejection time, and haemodynamic ratio) were calculated for both ventricles. Significant differences were found between the normal subjects and the patients with atrial septal defect for all these ratios. When the Doppler findings and the Fick measurements of Qp:Qs were compared the best linear correlation coefficient was for the left to right haemodynamic ratio. It is concluded that the use of a ratio involving several variables, such as the pre-ejection period and the ejection time for both ventricles, improves the reliability of this method, which appears to be applicable in adults.

Adult↗
PubMed1983

New indexes for assessing aortic regurgitation with two-dimensional Doppler echocardiographic measurement of the regurgitant aortic valvular area.

Direct examination of the aortic orifice at the level of the aortic valves (aortic valvular orifice area, AVOA) in the short-axis plane was performed with a 3 MHz two-dimensional pulsed Doppler echocardiographic apparatus. The AVOA was mapped with the Doppler gate to detect or rule out the presence of a regurgitant aortic valvular area (RAVA) established by recording of abnormal diastolic Doppler signals on a "yes or no" basis. A group of 12 normal subjects and 83 patients, including 40 patients with aortic regurgitation proven by aortography, were investigated with this procedure. In the 38 patients with aortic regurgitation diagnosed by Doppler echocardiography (diagnostic sensitivity 95%, specificity 100%), planimetric measurements of the RAVA and AVOA were performed with calculation of two indexes: the RAVA/square meter of body surface area and the RAVA/AVOA ratio. These indexes correlated well with independently performed angiographic grading on a three-point scale (r = .87 for the RAVA, .88 for the RAVA/AVOA; p less than .001), with highest significance of differences in mean values among each grade of severity found for the RAVA/AVOA (p less than .001). In addition, Doppler echocardiography identified the anatomic valvular site of the lesion, and we confirmed the site during surgery.

Adolescent↗
PubMed1982

Non-invasive diagnosis and assessment of tricuspid regurgitation and stenosis using one and two dimensional echo-pulsed Doppler.

Twenty normal subjects and 82 patients with valvular heart disease, whose lesions were independently assessed either by cardiac catheterisation and/or at operation, were studied using the pulsed Doppler technique combined with either one or two dimensional echocardiography. Of these, 41 patients had tricuspid lesions, including 40 with regurgitation and nine with stenosis. The tricuspid analogue flow velocity trace and the Doppler frequency spectrum (time interval histogram) were recorded. Characteristic differences were found between the records from subjects with and without tricuspid lesions. In subjects with tricuspid regurgitation there was a systolic negative wave on the analogue velocity display and broadening of the time interval histogram. In subjects with tricuspid stenosis there was an abnormal pattern, and significantly increased duration of the diastolic wave on the analogue velocity trace, again with broadening of the time interval histogram. Sensitivity and specificity ranged between 85 and 95%. The calculated ratio between the measured amplitudes of the systolic and diastolic waves correlated well with independently performed grading of the regurgitation on a three point scale in 85% of cases. Grading of the severity of tricuspid stenosis on a three point scale based on studies of the diastolic Doppler velocity anomalies was the same in 85% of cases as the grading based on established invasive techniques. The addition of two dimensional echocardiography to the pulsed Doppler technique increased the sensitivity for mild lesions.

Adolescent↗
PubMed1981

Localization of the origin of systolic clicks using echo-pulsed Doppler technique.

Echo-pulsed doppler (EPD) studies were performed in 2 surgically controlled patients with systolic clicks. The recorded blood samples documented the click to be originated in the right atrium, at the site of the prolapsed anterior tricuspid leaflet in 1 case of heroin-induced tricuspid acute endocarditis. In the second patient suffering from aortic valve disease, an ejection click was recorded, and could be demonstrated by using EPD, to originate from the aortic leaflet at its time of maximal excursion. EPD apears to be a safe, noninvasive method to solve the problem of the origin of systolic clicks.

Adult↗
PubMed1980

Non-invasive diagnosis and assessment of aortic valve disease and evaluation of aortic prosthesis function using echo pulsed Doppler velocimetry.

Non-invasive recording of aortic blood flow velocity patterns in the ascending aorta and in the arch of the aorta was performed in 12 normal subjects, 38 patients with confirmed aortic valve disease, and 13 patients with aortic prostheses using pulse echo Doppler velocity recordings. In normal subjects, the velocity recordings correlated well with those obtained by other authors using invasive procedures. In patients with aortic valve disease, specific abnormalities of the velocity curves were found to correlate well both with the type of lesion (stenosis or regurgitation) and its severity on a three-point scale. Both sensitivity and specificity were found to range between 80 and 94 per cent. A less accurate grading of severity was obtained from patients with aortic regurgitation by the detection of turbulence in the left ventricular outflow tract than from the appearance of the aortic velocity curves. In the studies of patients with aortic prostheses, anomalies of the velocity pattern could be found in the ascending aorta in 53 per cent but no abnormalities of timing was found. In spite of some technical limitations, pulse echo Doppler velocity recordings provide a new non-invasive, reliable, and reproducible approach in assessing the presence and severity of aortic lesions and demonstrating flow abnormalities produced by prostheses.

Adolescent↗
PubMed1980

[Pulsed echo-Doppler diagnosis and evaluation of tricuspid valve, and interventricular and interatrial communication insufficiencies. Flowmeter study of shunts].

A group of 44 patients with a total of 48 cardiac lesions ( 22 tricuspid incompetence - TI - , 12 ventricular septal defect - VSD - and 14 atrial septal defect - ASD - , and two control groups of 20 normals and 23 patients with other cardiac disease , were studied by pulsed Doppler echocardiography ( PDE ) . The flow patterns recorded in the normal right heart were identical to those recorded previously during catheterisation . TI was diagnosed by the presence of an abnormal negative systolic wave usually associated with widening of the time interval histogram with a specificity of 82 % and a sensitivity of 86 % . An acceptable semi-quantative assessment of the severity of regurgitation was obtained in 83 % by comparing the amplitude of the negative systolic wave with that of the positive diastolic wave . Shunts were diagnosed by detecting septal or tricuspid turbulence with a sensitivity of 83 % and a specificity of 90 % . A satisfactory assessment of the size of the shunt was obtained in 90 % of diagnosed cases by assessing the pulmonary and infundibular flow patterns . A systolic wave starting with isometric contractions , followed by positive early and late diastolic waves and some intermediary negative oscillations of variable amplitude were recorded along the right side of the interventricular septum in 75 % of VSDs . In 78 % cases of ASD a large late systolic - early diastolic wave overriding the second heart sound , followed by positive mid and late diastolic waves of variable size , according to the heart rate , were recorded in the right atrium . In conclusion , PDE recording of blood flow patterns and turbulence in the right heart is a useful non-invasive method of diagnosis and assessment of these three cardiac lesions . It provides a valuable contribution towards the physiopathological study of shunt patterns in atrial and ventricular septal defects .

Adult↗
PubMed1979

[Echocardiographic diagnosis of 4 cases of tricuspid valve endocarditis].

Four tricuspid endocarditis cases are reported. Echocardiography found, four times, large vegetations on the tricuspid leaflets leading to the diagnosis. The degree of tricuspid insuffisancy was appreciated by the RV/LV ratio. Successive echos have permitted to survey the evolution and specially to establish a clear decrease of abnormal tricuspid echoes succeeding to pulmonary embolisms. In the four cases, surgery confirmed the diagnosis.

Adolescent↗
PubMed1979

[Noninvasive diagnosis of ventricular septal defects using echo-pulsed Doppler velocimetry, localization, evaluation of the shunt and the associated lesions].

A preliminary study of 15 patients with ventricular septal defect demonstrates that Echo-Doppler velocimetry allows the non-invasive diagnosis of this malformation in 80% of the cases, as well as its localisation and detection of associated lesions; tin addition evaluation of the shunt is made feasible by non invasive recording of the flow velocity curves of the shunt and of the pulmonary artery according to a technique derived from the basic one. This method turns out to be essential for establishing the aetiological diagnosis of left parasternal systolic murmurs.

Adolescent↗
PubMed1977

[Non-invasive exploration of valvular heart disease using Pulsed Doppler Flowmetry with echography (author's transl)].

A new method for diagnosing and assessing valvular heart disease is proposed, based on the analysis of transvalvular, pulmonary artery and aortic flow velocity curves recorded transcutaneously using Pulsed Doppler-echography. The normal tracings are presented and anomalies of the curves disclosed in 97 patients are analysed. It is concluded that this new, simple, non-invasive and repetable method is useful for diagnosing and assessing valvular heart disease, within limitations which are discussed.

Blood Flow Velocity↗