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Biomedical subjects

H E Winer

Publications and source records attributed to H E Winer.

At least 19 recordsLinked to original sources
PubMed2000

Diagnosis of a giant coronary aneurysm with multiple imaging modalities.

Echocardiography demonstrated an 8-cm mass adjacent to the right side of the heart in a 79-year-old man with a history of hypertension and a repaired abdominal aortic aneurysm. The results of Doppler echocardiography and magnetic resonance imaging suggested the diagnosis of an unusually large coronary artery aneurysm, and this was confirmed with coronary angiography. At surgery, the 8- to 10-cm coronary aneurysm was resected, and the patient made an uneventful recovery.

Aged↗
PubMed1998

Utility of three-dimensional echocardiography during balloon mitral valvuloplasty.

OBJECTIVES: We investigated the role of three-dimensional echocardiography in assessing mitral valve anatomy in greater detail in patients immediately before and after balloon mitral valvuloplasty (BMV). BACKGROUND: Three-dimensional echocardiography is a recently developed, evolving imaging technique that allows visualization of intracardiac structures from any perspective. METHODS: We studied 19 patients undergoing BMV using transesophageal echocardiography (TEE) (Chicago, Illinois) to image the mitral valve. The TEE was interfaced to a TomTec three-dimensional workstation that allows electrocardiographic and respiratory cycle gated image acquisition. The acquired images are digitized, and after postprocessing a three-dimensional image is reconstructed. The mitral valve was viewed "en-face" as if looking up from the left ventricle. RESULTS: The mean mitral valve area (by pressure half-time from the Doppler of the two-dimensional echocardiogram) increased after BMV from 0.86+/-0.06 cm2 to 2.07+/-0.10 cm2, p < 0.0001. This was similar to the mitral valve areas obtained by planimetry from the three-dimensional images. The three-dimensional reconstructions showed a complete commissural split in 10 patients and partial splitting in 9 patients. In three of the eight patients who had an increase in the amount of mitral regurgitation secondary to BMV, the three-dimensional reconstructions were able to detect tears within the valve leaflet. One leaflet tear actually extended up to the mitral valve annulus and was associated with the only case of severe mitral regurgitation. CONCLUSIONS: The three-dimensional echocardiographic reconstruction enabled visualization of the mitral valve so that commissural splitting and leaflet tears not seen on the two-dimensional echocardiogram became visible.

Adolescent↗
PubMed1991

Comparison of cardiac catheterization and Doppler echocardiography in the decision to operate in aortic and mitral valve disease.

Clinical decisions utilizing either Doppler echocardiographic or cardiac catheterization data were compared in adult patients with isolated or combined aortic and mitral valve disease. A clinical decision to operate, not operate or remain uncertain was made by experienced cardiologists given either Doppler echocardiographic or cardiac catheterization data. A prospective evaluation was performed on 189 consecutive patients (mean age 67 years) with valvular heart disease who were being considered for surgical treatment on the basis of clinical information. All patients underwent cardiac catheterization and detailed Doppler echocardiographic examination. Three sets of two cardiologist decision makers who did not know patient identity were given clinical information in combination with either Doppler echocardiographic or cardiac catheterization data. The combination of Doppler echocardiographic and clinical data was considered inadequate for clinical decision making in 21% of patients with aortic and 5% of patients with mitral valve disease. The combination of cardiac catheterization and clinical data was considered inadequate in 2% of patients with aortic and 2% of patients with mitral valve disease. Among the remaining patients, the cardiologists using echocardiographic or angiographic data were in agreement on the decision to operate or not operate in 113 (76% overall). When the data were analyzed by specific valve lesion, decisions based on Doppler echocardiography or catheterization were in agreement in 92%, 90%, 83% and 69%, respectively, of patients with aortic regurgitation, mitral stenosis, aortic stenosis and mitral regurgitation. Differences in cardiac output determination, estimation of valvular regurgitation and information concerning coronary anatomy were the main reasons for different clinical management decisions. These results suggest that for most adult patients with aortic or mitral valve disease, alone or in combination, Doppler echocardiographic data enable the clinician to make the same decision reached with catheterization data.

Adult↗
PubMed1986

Superior vena caval blood flow velocities in adults: a Doppler echocardiographic study.

Superior vena caval blood flow velocity was measured in 30 normal adults (age 20-65, mean 36 yr). The flow velocities were measured by pulsed Doppler echocardiography, using a Duplex system with the transducer at the right supraclavicular fossa, approximating a 0 degrees Doppler angle. Four distinct flow waveforms were found during each cardiac cycle: A, a small retrograde flow during right atrial contraction (peak flow velocity 12.4 +/- 2.2 cm/s); B, a small antegrade flow during right atrial relaxation (15.7 +/- 5.0 cm/s); S, a large antegrade flow during ventricular systole (35.2 +/- 7.3 cm/s); and D, a large antegrade flow during ventricular diastole (23.2 +/- 3.1 cm/s). The wave duration was inversely related to heart rate. The peak flow velocities of the S and D waves were inversely related to the patients' ages. This study provides recognition of the pattern and range of normality essential to extension of this noninvasive technique to the diagnosis of pathological conditions.

Adult↗
PubMed1985

Echocardiographic findings after tricuspid valvectomy.

Resection of the tricuspid valve without prosthetic replacement has successfully been performed in patients with tricuspid valvular endocarditis. Using M-mode, two-dimensional, and Doppler echocardiograms, we studied four patients who underwent tricuspid valvectomy. All patients had previous history of intravenous drug abuse and staphylococcal endocarditis with tricuspid valvular involvement. In all patients, M-mode and two-dimensional echocardiograms showed that the tricuspid valve was absent. The right ventricle was dilated, and the interventricular septum had paradoxical motion in each patient. In each patient the right atrium was dilated, and with each ventricular systole, it expanded and its short axis increased by 20 to 33 percent. This caused shift of the interatrial septum toward the left atrium, with compression of its cavity. Doppler echocardiographic studies showed retrograde flow during systole in the right atrium, inferior vena cava, and hepatic vein. Echocardiographic findings in patients with tricuspid valvectomy correlate with the pathophysiologic findings of this condition.

Adult↗
PubMed1984

Left ventricular outflow obstruction: a complication of mitral valvuloplasty.

Thirty-two patients with severe mitral regurgitation underwent Carpentier mitral valvuloplasty. Postoperatively, three of these patients developed clinical and echocardiographic evidence of left ventricular outflow tract obstruction. None of these patients had asymmetric septal hypertrophy or preoperative echocardiographic demonstration of systolic anterior motion of the mitral valve. Outflow obstruction postoperatively was caused by systolic anterior motion of the mitral valve. Because this potential complication of Carpentier mitral valvuloplasty produced significant hemodynamic effects in two patients, echocardiography should be routinely performed after this operation.

Echocardiography↗
PubMed1983

Echocardiographic evaluation of Carpentier mitral valvuloplasty.

Carpentier's technique for reconstructive mitral valve surgery is an alternative to mitral valve replacement in patients with mitral regurgitation. The procedure involves reconstruction of the mitral valve and insertion of a ring into the mitral anulus. To study the results of this operation, pre- and postoperative M-mode, two-dimensional (2DE), and Doppler echocardiography were performed on 13 patients with severe, symptomatic mitral regurgitation, who underwent reconstructive mitral surgery. A significant clinical improvement was noted in all patients. This correlated with the hemodynamic and angiographic improvement in six of the patients who underwent postoperative cardiac catheterization. Postoperative echocardiography showed that the mitral valve E-F slope decreased from 129 +/- 30 mm/sec preoperatively to 53 +/- 13 mm/sec postoperatively (p less than 0.001). The mitral valve excursion decreased from 28 +/- 6 mm preoperatively to 19 +/- 2 mm postoperatively. The left ventricular minor axis shortening decreased from 32 +/- 9% to 28 +/- 6%. In seven patients the mitral valve area decreased from 4.5 +/- 0.9 cm2 to 2.8 +/- 0.5 cm2 (p less than 0.005). In each patient a new echocardiographic finding was observed: two parallel dense linear echoes from the prosthetic ring were noted on M-mode echocardiography near the base of the mitral valve. 2DE visualized the entire ring. Doppler echocardiography suggested moderate or severe mitral regurgitation in eight of eight patients studied preoperatively. Postoperatively 10 of 11 patients had no Doppler echocardiography finding of mitral regurgitation.

Adolescent↗
PubMed1983

Cardiac tamponade by loculated pericardial hematoma: limitations of M-mode echocardiography.

Three patients developed cardiac tamponade after heart surgery. Pericardial effusion was not identified by M-mode echocardiography. Two patients underwent two-dimensional echocardiography which showed compression of the right atrium by a localized mass. At reoperation, atrial compression by a loculated effusion or hematoma was found and successfully relieved. When cardiac tamponade is suggested by the clinical setting, but not supported by M-mode echocardiography, the presence of a loculated effusion should be considered and evaluated by a two-dimensional echocardiographic study.

Adult↗
PubMed1983

Diastolic atrial compression: a sensitive echocardiographic sign of cardiac tamponade.

Nine patients with clinical and hemodynamic evidence of cardiac tamponade underwent M-mode and two-dimensional echocardiography. Pericardial effusion was documented in each patient. Four patients demonstrated respiratory variation in ventricular volumes in association with paradoxical pulse. Right ventricular compression was present in seven. In five patients, echocardiography demonstrated diastolic left atrial compression. In all nine patients, the apical four chamber view revealed diastolic right atrial compression. Drainage of 450 to 1,800 cc of pericardial fluid relieved the cardiac tamponade and eliminated the echocardiographic findings associated with this disorder. These observations suggest that the echocardiographic findings of atrial compression is a sensitive sign of cardiac tamponade.

Adolescent↗
PubMed1983

Sterile, caseous mitral anular abscess.

Echocardiography identified three patients with a mitral anular mass. Fluoroscopy demonstrated a faint, homogeneous intracardiac calcific density in each patient. Cardiac catheterization and angiography were performed and showed no left ventricular inflow or outflow obstruction. One patient died suddenly and two patients had cardiac surgery (one for mitral regurgitation and another for constrictive pericarditis). Examination demonstrated that each mass was nonencapsulated, sterile and acellular and contained cholesterol, calcium and fatty acids. The clinical significance and cause of these masses are unclear at present.

Abscess↗
PubMed1983

Unusual clinical and echocardiographic features of severe isolated pulmonic insufficiency.

A 57-year-old psoriatic man had severe, isolated pulmonic regurgitation, with intractable right sided failure. Echocardiography showed flail pulmonic leaflet and premature opening of the valve. Cardiac catheterization documented severe pulmonic regurgitation. The right ventricular end-diastolic pressure was elevated above the pulmonary artery diastolic pressure, thus explaining the echocardiographic finding. The patient was treated successfully by pulmonic valve replacement.

Arthritis↗
PubMed1980

Echocardiographic observations of paradoxic pulse without pericardial disease.

Echocardiograms were obtained in 10 normal patients and in 11 patients with respiratory insufficiency due to chronic obstructive lung disease (8) and to thoracic poliomyelitis (3). Only the eight patients with obstructive lung disease had paradoxic pulse. No patient had pericardial disease. The left ventricular internal dimension, stroke volume, and the mitral valve E-F slope and D-E excursion were measured. The inspiratory to expiratory ratio of each measurement was significantly lower in patients with obstructive lung disease than in normal subjects. The patients with thoracic poliomyelitis demonstrated almost no respiratory change in these measurements. The magnitude of the change in the measured factors probably relates to the degree of negativity of intrathoracic pressure during respiration. The inspiratory reduction of mitral valve motion and left ventricular internal dimension is not specific to tamponade but may be seen in patients who exhibit paradoxic pulse due to other conditions.

Cardiac Tamponade↗
PubMed1980

Two-dimensional echocardiography in mitral annulus calcification.

Mitral annular calcification, established by fluoroscopy, was studied by M-mode and two-dimensional echocardiography in 18 patients. M-mode echocardiography revealed the typical dense, linear echo of mitral annular calcification, but not its extent. Two-dimenstional echocardiography demonstrated a dense, elipsoidal echo at the junction of the left atrium and ventricle in the long axis view, and an area of calcification below the mitral valve in the short axis view. These patterns were not seen in 20 control patients without mitral annular calcification by fluoroscopy. Two-dimensional echocardiography establishes the site and extent of mitral annular calcification, minimizes the potential for diagnostic error associated with M-mode echocardiography, and is superior to M-mode echocardiography for the recognition of mitral annular calcification.

Aged↗