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Biomedical subjects

E E Salcedo

Publications and source records attributed to E E Salcedo.

At least 19 recordsLinked to original sources
PubMed1995

Anatomic explanation of mobile systolic clicks: implications for the clinical and echocardiographic diagnosis of mitral valve prolapse.

An echocardiogram (echo) is often ordered for suspected mitral valve prolapse (MVP). Using echo as the gold standard, we conducted a meticulous physical examination on 61 patients with this referral diagnosis. Ninety percent of patients with negative physical examination and echo results for MVP had physical examination findings likely to have been misinterpreted as MVP by the referring physician. Redundant portions of the mitral valve apparatus were found in 57% of patients with MVP on our physical examination but not on echo. A carefully performed physical examination (including dynamic auscultation) can exclude MVP. Not all mobile systolic clicks are associated with anatomic echo prolapse; they can be generated by redundant chordae tendineae and, in the absence of echo prolapse, probably by redundant leaflets. Patients with mobile systolic clicks should have an echo to determine the portion of the spectrum of echo prolapse present and to determine risk stratification and management.

Adult↗
PubMed1993

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

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

Aged↗
PubMed1993

Effects of mitral stenosis on pulmonary venous flow as measured by Doppler transesophageal echocardiography.

Pulmonary venous flow as assessed by transesophageal echocardiography (TEE) is influenced by changes in left atrial pressure and function. In mitral stenosis (MS), normal left atrial hemodynamics are altered because there is a prolonged decay in diastolic pressure from the left atrium to the left ventricle and atrial function may be altered because of atrial fibrillation. To assess the effect of the prolonged atrial diastolic pressure decay caused by MS on pulmonary venous flow, we studied 27 patients with MS (mitral valve range 0.7 to 2.4 cm2) by pulsed-wave Doppler TEE of the left or right upper pulmonary vein, and compared results with those of 13 normal subjects. Of the 27 subjects with MS, 61% showed a blunted systolic flow pattern and 39% showed a normal flow pattern with greater systolic to diastolic flow ratio. Patients with atrial fibrillation had a predominantly blunted pattern, whereas patients with normal sinus rhythm exhibited both blunted and normal flow patterns. Patients with MS had a lower pulmonary venous peak systolic flow velocity and a longer diastolic pressure halftime than control subjects. Pulmonary venous peak systolic flow velocity was significantly decreased in the presence of atrial fibrillation (p = 0.004). The mitral valve pressure halftime significantly correlated with pulmonary venous diastolic pressure halftime (r = 0.54; p = 0.004) mitral valve area (r = -0.46; p = 0.02). In conclusion, it was found that MS alters pulmonary venous flow patterns, showing a decreased pulmonary venous systolic flow and a prolonged diastolic flow, which may be useful in assessing the hemodynamics of MS.

Adult↗
PubMed1993

Differentiation of constrictive pericarditis from restrictive cardiomyopathy by Doppler transesophageal echocardiographic measurements of respiratory variations in pulmonary venous flow.

OBJECTIVES: The purpose of this study was to test the utility of measuring respiratory variation in pulmonary venous flow by transesophageal echocardiography. BACKGROUND: Respiratory variation of atrioventricular and central venous flow velocities by Doppler echocardiography has been used to differentiate constrictive pericarditis from restrictive cardiomyopathy. METHODS: We performed pulsed wave Doppler transesophageal echocardiography of the left or right pulmonary veins in 31 patients with diastolic dysfunction. Fourteen patients had constrictive pericarditis, and 17 had restrictive cardiomyopathy. We measured the pulmonary venous peak systolic and diastolic flow velocities and the systolic/diastolic flow ratio with transesophageal echocardiography during expiration and inspiration. The percent change in Doppler flow velocity from expiration to inspiration (%E) was calculated. RESULTS: Pulmonary venous peak systolic flow in both inspiration and expiration was greater in constrictive pericarditis than in restrictive cardiomyopathy. The %E for peak systolic flow tended to be higher in constrictive pericarditis (19% vs. 10%, p = 0.09). In contrast, pulmonary venous peak diastolic flow during inspiration was lower in constrictive pericarditis than in restrictive cardiomyopathy. The %E for peak diastolic flow was larger in constrictive pericarditis (29% vs. 16%, p = 0.008). The pulmonary venous systolic/diastolic flow ratio was greater in constrictive pericarditis in both inspiration and expiration. The combination of pulmonary venous systolic/diastolic flow ratio > or = 0.65 in inspiration and a %E for peak diastolic flow > or = 40% correctly classified 86% of patients with constrictive pericarditis. CONCLUSIONS: The relatively larger pulmonary venous systolic/diastolic flow ratio and greater respiratory variation in pulmonary venous systolic, and especially diastolic, flow velocities by transesophageal echocardiography can be useful signs in distinguishing constrictive pericarditis from restrictive cardiomyopathy.

Blood Flow Velocity↗
PubMed1992

Effects of mitral regurgitation on pulmonary venous flow and left atrial pressure: an intraoperative transesophageal echocardiographic study.

OBJECTIVES AND BACKGROUND: Pulmonary venous flows recorded by pulsed wave Doppler transesophageal echocardiography examination can be used to assess the severity of mitral regurgitation. Pulmonary venous flows are also related to left atrial pressures; however, the determinants of these flows have yet to be characterized in the presence of mitral regurgitation. METHODS: We simultaneously recorded intraoperative pulmonary venous flows by transesophageal echocardiography and left atrial pressures by direct left atrial puncture in 16 patients with different grades of mitral regurgitation: 2+ (n = 5), 3+ (n = 4) and 4+ (n = 7). Pulmonary venous peak systolic and diastolic flow velocities and peak reversed systolic flow velocities were compared with left atrial pressure a and v waves, a-x and v-y descent values and left atrial volumes. RESULTS: Pulmonary venous systolic to diastolic flow ratios correlated with decreases in left atrial pressure a/v ratios and with increases in the v waves of patients with higher grades of mitral regurgitation. Univariate analysis revealed that the best determinants of the pulmonary venous systolic to diastolic flow ratio were the left atrial pressure v wave (r = -0.76), the v-y descent value (r = -0.73) and the a/v ratio (r = 0.71). Lower correlations were found for left atrial end-systolic (r = -0.48) and end-diastolic (r = -0.42) volumes. Reversed systolic flow was present in patients with 4+ mitral regurgitation, despite left atrial enlargement. CONCLUSIONS: Pulmonary venous flow can be used to assess the severity of mitral regurgitation and reflects the effects of mitral regurgitation severity on the left atrial pressure a and v waves.

Adult↗
PubMed1992

Evaluation of mitral leaflet motion by echocardiography and jet direction by Doppler color flow mapping to determine the mechanisms of mitral regurgitation.

OBJECTIVES: This study was designed to assess the accuracy of two-dimensional and Doppler echocardiography in determining the mechanism of mitral regurgitation, as compared with direct inspection of the valve at operation. BACKGROUND: Valve repair for mitral regurgitation offers substantial advantages over valve replacement, but it is technically more demanding and requires understanding of the mechanism of dysfunction. METHODS: We studied 286 patients undergoing mitral valve repair. Intraoperative two-dimensional echocardiography was used to classify mitral leaflet motion as excessive, normal or restricted. Doppler color flow mapping was used to evaluate the direction and origin of the mitral regurgitant jet. Two-dimensional and Doppler echocardiography were compared with intraoperative surgical determination of the mechanism of dysfunction, which also classified leaflet motion as excessive, normal or restricted. RESULTS: Two-dimensional and Doppler echocardiography accurately diagnosed the mechanism of mitral regurgitation in 123 (93%) of 132 patients with posterior leaflet prolapse or flail, 30 (94%) of 32 patients with anterior leaflet prolapse or flail, 11 (44%) of 25 patients with bileaflet prolapse or flail, 6 (75%) of 8 patients with papillary muscle elongation or rupture, 31 (91%) of 34 patients with restricted leaflet motion or rheumatic thickening, 21 (72%) of 29 patients with ventricular-annular dilation and 8 (62%) of 13 patients with a leaflet perforation or cleft. Of 13 patients with two mechanisms of dysfunction by surgical inspection, two-dimensional and Doppler echocardiography correctly diagnosed one of the two mechanisms in 12 patients (92%), and both mechanisms in 5 patients (38%). Overall, echocardiographic determination of leaflet motion and Doppler determination of jet direction accurately diagnosed the mechanism of dysfunction in 242 (85%) of 286 patients. CONCLUSIONS: Echocardiography before mitral valvuloplasty provides a dynamic appraisal of the mechanism of dysfunction, enabling the surgeon to systematically understand the dysfunction and successfully apply the correct procedures to eliminate mitral regurgitation without valve replacement.

Blood Flow Velocity↗
PubMed1992

Benefits of intraoperative echocardiography in the surgical management of hypertrophic cardiomyopathy.

OBJECTIVES: The purpose of this study was to determine the role of intraoperative echocardiography in planning the site and extent of myectomy and in ensuring adequate control of the left ventricular outflow tract gradient. BACKGROUND: Although intraoperative echocardiography has been found to be beneficial in patients undergoing valve repair, its impact on surgical decisions in patients undergoing septal myectomy for hypertrophic cardiomyopathy has not been described. METHODS: In 50 patients undergoing septal myectomy over a 5-year period, epicardial echocardiography was performed before cardiopulmonary bypass to establish the extent of outflow tract obstruction, locate its site and plan the myectomy. In 30 patients, transesophageal echocardiography was also used to corroborate data on outflow tract anatomy and examine the mitral valve. RESULTS: In 40 patients (80%) the initial myectomy resulted in a reduction of the maximal outflow tract gradient from 88 +/- 45 to 24 +/- 11 mm Hg, measured by epicardial continuous wave Doppler echocardiography. Ten patients (20%) were shown by postbypass intraoperative echocardiography to have an unsatisfactory result, based on a persistent gradient > 50 mm Hg (n = 7) or persistent mitral regurgitation of greater than moderate severity (n = 3). The postbypass two-dimensional echocardiogram was then used to direct the surgeon toward the most likely site of continued obstruction, and cardiopulmonary bypass was reinstituted to permit further myectomy (n = 9) or mitral valve repair (n = 1). After the second or subsequent period of cardiopulmonary bypass, the outflow tract gradient (26 +/- 14 mm Hg) was substantially reduced and was not significantly different from the postbypass gradient (24 +/- 11 mm Hg) in the group with initial surgical success. At postoperative follow-up (20 +/- 37 weeks), the maximal measured outflow tract gradient (22 +/- 21 mm Hg) showed no difference between patients with immediate surgical success and those requiring a second period of cardiopulmonary bypass for further resection. CONCLUSIONS: Intraoperative echocardiography proved a useful tool to guide the site and extent of septal myectomy, leading to more adequate surgical resection and to persistence of satisfactory control of the outflow tract obstruction into the early follow-up period.

Adult↗
PubMed1992

Transesophageal echocardiographic diagnosis of right-sided cardiac masses in patients with central lines.

Transesophageal echocardiography provides excellent images of intracardiac masses; however, its use among a series of patients with central venous lines has not been fully described. Nineteen patients (aged 52 +/- 16 years; 10 women) had masses detected by transesophageal echocardiography in the presence of a permanent (0.2 to 16 years) pacing wire (n = 8), and a current (n = 9) or recent (n = 2) (1 to 281 days) indwelling catheter. Transthoracic echocardiography suggested the presence of a mass in 5 patients (26%), although in only 2 cases were its findings consistent with transesophageal findings. Transesophageal echocardiography indicated the presence of a mass in or near the superior vena cava in 13 patients, in the right atrium in 6, and adjacent to the tricuspid valve in 3. Discrete masses measured 1.6 +/- 2.1 cm2 in area during transesophageal echocardiography. Eleven patients had positive blood cultures, 7 with staphylococcal species. Mass size was not significantly altered by the type of line or sepsis, but showed a weak correlation with line age (r = 0.56). Transesophageal echocardiography altered the management of 9 patients, prompting surgery (n = 3) and line removal (n = 3), and antibiotic (n = 2) or anticoagulation (n = 3) therapy.

Adult↗
PubMed1992

Prediction by postexercise fluoro-18 deoxyglucose positron emission tomography of improvement in exercise capacity after revascularization.

The extent of ischemic and hibernating myocardium, which may be detected by increased postexercise uptake of fluoro-18 deoxyglucose (FDG) using positron emission tomography, may determine the degree of functional benefit after revascularization. This study examined the influence of the amount of this FDG-avid myocardium on changes in left ventricular function and exercise parameters after revascularization. Echocardiography and exercise testing were performed before and after intervention in 23 patients who had undergone positron emission tomography for the evaluation of myocardial perfusion (using rubidium-82), and postexercise FDG imaging in the fasting state. Follow-up echocardiography (22 +/- 14 weeks after revascularization) was compared with preoperative FDG activity in 7 myocardial regions per patient. Systolic function improved after intervention in 19 of 26 malperfused, dysfunctional FDG-avid regions (73%), and did not improve in 35 of 47 dysfunctional regions without increased FDG uptake (74%). The influence of the amount of FDG-avid tissue on changes in functional state was examined by comparing 9 patients with multiple (greater than or equal to 2) FDG-avid regions with the remainder. Those with multiple FDG-avid regions demonstrated improvement in peak rate-pressure product (20 +/- 4 to 26 +/- 4 x 10(3), p less than 0.02), and percentage of maximal heart rate achieved at peak (84 +/- 10% to 93 +/- 6%, p = 0.04), neither of which changed significantly in the remaining patients. Exercise capacity increased from 5.6 +/- 2.7 to 7.5 +/- 1.7 METS in the group with multiple FDG-avid regions; this increase of 55 +/- 18% exceeded the increase of 13 +/- 10% in the remainder (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Cardiac tumors: diagnosis and management.

The first step towards the diagnosis of cardiac neoplasia is made when the clinician considers the diagnosis. While the classically described signs and symptoms of left-atrial myxomas are noteworthy, the vast majority of patients present with symptomatology that is less specific--either of a constitutional nature, or related to right- or left-sided congestion. Likewise, the physical examination may rarely disclose classic auscultatory signs, but is more likely to confirm the presence of the right- or left-sided congestion inferred from history. Peripheral, embolic, or vasculitis lesions should raise suspicion of the diagnosis. Nevertheless, the majority of patients will be diagnosed by the unexpected detection of a tumor at the time of echocardiography. Transthoracic echocardiography remains the procedure of choice in screening for cardiac neoplasia. It has excellent sensitivity for intracavitary and endocardial lesions. Myocardial lesions are also well imaged. Pericardial lesions, with or without extension into contiguous structures, are poorly visualized and, here, magnetic resonance imaging is unquestionably the superior investigative approach. Further, a limited degree of tissue characterization is possible with the latter technology. Transesophageal echocardiography is ideally suited for the examination of suspected tumors involving the atria, interatrial septum, superior vena cava, atrioventricular valves and, to a lesser extent, the ventricles. These three imaging modalities clearly complement one another and the choice of application will depend upon factors including the patient's transthoracic echogenicity, the availability of magnetic resonance imaging or transesophageal echocardiography, cost, and the physical status of the patient.

Angiocardiography↗
PubMed1992

Accuracy and limitations of exercise echocardiography in a routine clinical setting.

Despite the high reported accuracy of exercise echocardiography in the detection of coronary artery disease, factors that compromise its sensitivity and specificity are less clear. This study examined the results of 179 post-treadmill stress echocardiograms in 150 consecutive patients who also underwent cardiac catheterization and in 29 normal persons at low risk for coronary artery disease. Of 114 patients who had significant coronary stenoses at angiography, 96 had an abnormal exercise echocardiogram (overall sensitivity 84%). False negative results correlated with the performance of submaximal exercise, single-vessel disease and moderate (50% to 70% diameter) stenoses. After the exclusion of seven patients performing submaximal exercise, the sensitivity was 90%. In 54 patients without previous infarction performing maximal exercise, the sensitivity was 87%, higher in patients with multivessel coronary disease (96%) than in those with single-vessel disease (79%). After the exclusion of patients with nondiagnostic results, due either to the performance of submaximal stress or the presence of electrocardiographic (ECG) changes at rest, exercise echocardiography had a higher sensitivity than did exercise electrocardiography (87% vs. 63%, p = 0.01). In 36 patients without significant coronary disease, exercise echocardiography had an overall specificity of 86%. After the exclusion of patients with a nondiagnostic test, exercise echocardiography had a specificity of 82% compared with 74% specificity for exercise electrocardiography (p = NS). Similarly, of the 29 normal subjects, 93% had a normal exercise echocardiogram and 97% had a normal exercise ECG (p = NS). Similarly, of the 29 normal subjects, 93% had a normal exercise echocardiogram and 97% had a normal exercise ECG (p = NS). Age, gender, body weight and image quality did not significantly influence the accuracy of exercise echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Metabolic responses of hibernating and infarcted myocardium to revascularization. A follow-up study of regional perfusion, function, and metabolism.

BACKGROUND: The presence of persistent myocardial uptake of 18F-deoxyglucose (FDG) within hypoperfused, dysfunctional segments has been shown to predict the recovery of regional contractile function after revascularization. The spectrum of metabolic responses of such hibernating tissue to revascularization is less clear. METHODS AND RESULTS: Sixteen patients with previous infarction were studied before and after revascularization by myocardial perfusion imaging using 82Rb positron emission tomography, digitized two-dimensional echocardiography, and imaging of postexercise FDG uptake. Hibernation was identified in 35 of 85 segments showing perfusion and wall motion disturbances before intervention. At follow-up (4.9 +/- 2.6 months after revascularization), hibernating segments were characterized by reduction of wall motion score (p less than 0.001), improvement of perfusion (p less than 0.001), and reduction of FDG activity (p less than 0.001). Of the 35 hibernating segments, however, 10 still had abnormal elevation of FDG uptake (greater than 2 SD above normal) without differing from other hibernating segments with respect to postoperative perfusion or wall motion score. Segments with persistently abnormal metabolism were characterized before intervention by more severe malperfusion (p less than 0.01) and greater FDG activity (p less than 0.01). CONCLUSIONS: Although wall motion and perfusion improve with revascularization of hibernating tissue, myocardial metabolism remains abnormal in a significant proportion of segments. These segments are characterized by more extensive perfusion and metabolic changes before revascularization.

Deoxyglucose↗
PubMed1991

Comparison of transcranial Doppler ultrasound and transesophageal contrast echocardiography in the detection of interatrial right-to-left shunts.

Transesophageal contrast echocardiography is an effective but semiinvasive technique for the detection of interatrial right-to-left shunts. Transcranial Doppler ultrasound is an alternative noninvasive method, but may be limited by false-positive diagnoses due to intrapulmonary shunting. This study examined the accuracy of transcranial Doppler for the detection of shunt lesions. Transcranial Doppler of the right middle cerebral artery was performed simultaneously with transesophageal and transthoracic contrast echocardiography in 32 patients using agitated saline contrast during normal respiration and Valsalva. Transesophageal contrast echocardiography diagnosed an interatrial right-to-left shunt in 13 patients and intrapulmonary shunting in 6 patients. Transcranial Doppler identified all 13 interatrial right-to-left shunts and an intrapulmonary shunt in 3 of 6 patients. Absence of a shunt was confirmed by transcranial Doppler in 12 of 12 patients. Transcranial Doppler had a sensitivity of 100% (13 of 13), specificity of 100% (18 of 18) and accuracy of 100% (31 of 31) for prediction of an interatrial right-to-left shunt by transesophageal contrast echocardiography. In comparison, transthoracic contrast echocardiography had a sensitivity of 54% (7 of 13), specificity of 94% (17 of 18) and accuracy of 77% (24 of 31). Thus, transcranial Doppler is highly accurate for detection of an interatrial right-to-left shunt and not compromised by physiologic intrapulmonary shunts, whereas transthoracic contrast echocardiography lacks sensitivity. Transcranial Doppler may be useful as an alternative to transesophageal study, where the primary indication for transesophageal echocardiography is exclusion of an interatrial right-to-left shunt.

Adult↗
PubMed1991

Identification of ischemic and hibernating myocardium: feasibility of post-exercise F-18 deoxyglucose positron emission tomography.

The identification of ischemic and hibernating myocardium facilitates the selection of patients most likely to benefit from revascularization. This study examined the feasibility of metabolic imaging, using post-exercise F-18 deoxyglucose positron emission tomography (FDG-PET) for the diagnosis of both ischemia and hibernation in 27 patients with known coronary anatomy. Normal post-exercise FDG uptake was defined in each patient by reference to normal resting perfusion and normal coronary supply. Abnormal elevation of FDG (ischemia or hibernation) was compared in 13 myocardial segments in each patient, with the results of dipyridamole stress perfusion imaging performed by rubidium-82 positron emission tomography (Rb-PET). Myocardial ischemia was diagnosed by either FDG-PET or Rb-PET in 34 segments subtended by significant local coronary stenoses. Increased FDG uptake was present in 32/34 (94%) and a reversible perfusion defect was identified by Rb-PET in 22/34 (65%, p less than .01). In 3 patients, ischemia was identified by metabolic imaging alone. In 16 patients with previous myocardial infarction, perfusion defects were present at rest in 89 regions, 30 of which (34%) demonstrated increased FDG uptake, consistent with the presence of hibernation. Increased post-exercise FDG uptake appears to be a sensitive indicator of ischemia and myocardial hibernation. This test may be useful in selecting post-infarction patients for revascularization.

Coronary Disease↗
PubMed1991

Transesophageal Doppler echocardiography of pulmonary venous flow: a new marker of mitral regurgitation severity.

Pulmonary venous flow varies with different cardiac conditions. Flow patterns in response to mitral regurgitation have not been well studied, but flows may vary enough to differentiate among different grades of regurgitation. Accordingly, pulmonary venous flow velocities were recorded in 50 consecutive patients referred for outpatient (n = 26) or intraoperative (mitral valve repair; n = 24) echocardiographic examination for mitral regurgitation. Recordings were made of right and left upper pulmonary veins with pulsed wave Doppler transesophageal echocardiography. Mitral regurgitation was graded from 1+ to 4+ by an independent observer using transesophageal color flow mapping. The results of cardiac catheterization performed 5 weeks earlier in 43 of the patients were also graded for mitral regurgitation by an independent observer. Pulmonary venous flow patterns, the presence of reversed systolic flow and peak systolic and diastolic flow velocities were compared with the severity of mitral regurgitation indicated by each technique. Of the 28 patients with 4+ regurgitation by transesophageal color flow mapping, 26 (93%) had reversed systolic flow. The sensitivity of reversed systolic flow in detecting 4+ mitral regurgitation by transesophageal color flow mapping was 93% and the specificity was 100%. The sensitivity and specificity of reversed systolic flow in detecting 4+ mitral regurgitation by cardiac catheterization were 86% and 81%, respectively. Discordant flows were observed in 9 (24%) of 38 patients; the left vein usually showed blunted systolic flow and the right showed reversed systolic flow. In 22 intraoperative patients, there was "normalization" of pulmonary venous systolic flow after mitral valve repair in the postcardiopulmonary bypass study compared with the prebypass study after the mitral regurgitant leak was corrected.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1991

Doppler color flow image size: dependence on instrument settings.

Doppler color flow imaging provides important qualitative information about the location and spatial distribution of intracardiac blood flow. However, the effect of instrument-related variables on the size of color Doppler images requires further definition. Flow of a silicone particle solution was established in a tube or cylinder and scanned as color gain, pulse repetition frequency, depth, and transducer frequency were varied. The diameter of Doppler color flow images were measured during constant laminar or disturbed flow parallel to the ultrasound beam and during laminar flow perpendicular to the ultrasound beam. The diameter of color Doppler images of laminar flow perpendicular and parallel to the beam varied directly with color gain. Diameter varied inversely with transducer frequency for laminar flow parallel to the transducer and inversely with pulse repetition frequency for laminar flow perpendicular to the transducer. The diameter of laminar flow parallel to the transducer varied directly with the depth of the flow area below the transducer. The size of the color flow dropout of laminar flow exactly perpendicular to the ultrasound beam varied directly with transducer frequency and inversely with gain. During disturbed flow parallel to the transducer, the diameter of the image varied directly with gain and inversely with transducer frequency and pulse repetition frequency. Instrument settings have a significant impact on the size of color Doppler images. Understanding the effects of changes in these variables is important for reliable diagnostic use of Doppler color flow imaging.

Blood Flow Velocity↗
PubMed1991

Transcranial Doppler ultrasound identifies patients with right-to-left cardiac or pulmonary shunts.

We performed transcranial Doppler ultrasound (TCD) and transesophageal contrast echocardiography simultaneously in four patients. In one patient with a patent foramen ovale and another patient with pulmonary A-V fistulae, we detected micro air bubbles in the right middle cerebral artery three to five cardiac cycles after their appearance in the left atrium following intravenous injection of contrast. In two patients without right-to-left shunts, we did not detect air bubbles in the left atrium or middle cerebral artery following injection of contrast. These results show that TCD can identify patients with right-to-left cardiac or pulmonary shunts.

Adult↗