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Biomedical subjects

H Feigenbaum

Publications and source records attributed to H Feigenbaum.

At least 91 records · Page 5Linked to original sources
PubMed1979

Comparison of M-mode and cross-sectional echocardiography in infective endocarditis.

Cross-sectional and M-mode echocardiograms were performed on 23 consecutive patients with infective endocarditis. Both M-mode and cross-sectional echocardiography identified vegetations in 18 patients, 10 of whom required valve replacement within 1 month of presentation. Cross-sectional echocardiography alone identified a vegetation in one patient with a prosthetic valve. Neither technique identified vegetations in five instances. The size and shape of a vegetation on cross-sectional echocardiography did not accurately predict the need for early valve replacement of the incidence of major peripheral emboli.

Adult↗
PubMed1979

Exercise cross-sectional echocardiography in ischemic heart disease.

We performed cross-sectional echocardiograms at rest, during supine bicycle exercise, and after sublingual nitroglycerin administration in 28 patients suspected of having ischemic heart disease. Technically adequate exercise cross-sectional echocardiograms were obtained in 20 patients (71%). Ten patients had new areas of reversible segmental dysynergy, and all 10 had significant stenoses of coronary arteries supplying areas of the heart corresponding to the location of reversible dysynergy. Six of these 10 patients also underwent exercise thallium-201 perfusion scanning, and all six had reversible perfusion defects in the area that demonstrated reversible dysynergy on exercise cross-sectional echocardiography. At least two of the remaining 10 patients who did not have reversible segmental dysynergy on exercise cross-sectional echocardiography probably experienced myocardial ischemia that we did not detect. We conclude that exercise cross-sectional echocardiography is technically difficult but feasible. The mechanical consequences of exercise-induced regional myocardial ischemia can be detected noninvasively by real-time, two-dimensional, cross-sectional echocardiography.

Adult↗
PubMed1978

Detection of myocardial scar tissue by M-mode echocardiography.

Wall thicknesses were measured and echo densities were evaluated from the left ventricular echograms of 182 patients. The echogram was considered to reflect scar tissue when 1) either the interventricular septum, the posterior left ventricular wall or the anterior left ventricular wall was less than 7 mm thick in mid-diastole and was more echo-producing than its opposing wall or another area of the same wall in a sector scan, or 2) an area of myocardium was 30% less thick than an adjacent area within a sector scan. Myocardial scarring was diagnosed by echocardiography in 52 of the 182 patients. The echocardiographic presence or absence of scarring was confirmed in 95% (173 of 182) of cases, 34 cases by microscopic examination and 139 by surgical appearance. This study shows that M-mode echocardiography is both a sensitive and specfic method for detecting myocardial scar tissue.

Coronary Angiography↗
PubMed1978

Cross-sectional echocardiographic characterization of aortic obstruction. 1. Supravalvular aortic stenosis and aortic hypoplasia.

Cross-sectional echocardiographic and cineangiographic studies of the left ventricular outflow tract and ascending aorta were performed in five patients with supravalvular aortic stenosis (four hourglass and one hypoplastic). Visualization of the area of obstruction was possible in each patient using the cross-sectional system. In each case the echocardiographically determined diameter at the level of obstruction was within 3 mm of the similar angiographic value. Assessment of the extent of the lesion was possible in four of five cases. In three of these four cases the echocardiographic measurement was within 5 mm of the angiographic measurement while in the fourth the obstruction was felt to involve the total ascending aorta by both techniques. Determination of percent decrease in LVOT diameter from the aortic anulus to the level of obstruction was useful in defining obstruction and estimating severity. Cross-sectional echocardiography is a valuable noninvasive method for evaluating the ascending aorta in patients with supravalvular aortic stenosis.

Adolescent↗
PubMed1978

Cross-sectional echocardiographic detection of aortic obstruction. 2. Coarctation of the Aorta.

Cross-sectional echocardiographic studies of the aortic arch and proximal descending aorta were performed in 18 patients with coarctation of the aorta and 20 normal subjects. In normals the aortic arch and proximal descending aorta appeared as an arcuate, echo-free structure curving across the plane of the scan. There were no localized changes in aortic diameter and the amplitude of aortic systolic pulsation was symmetrically maintained throughout the scan plane. Visualization of this region was possible in 16 of 18 patients with coarctation. In each of these cases there was a localized area of decrease in aortic diameter in the region of the left subclavian artery which corresponded to the angiographic appearance of the coarctation. In addition prominent systolic pulsation of the aortic arch proximal to the region of obstruction was evident. Cross-sectional echocardiography may offer a useful noninvasive method for direct visualization of aortic coarctation.

Adolescent↗
PubMed1978

Stroke volume calculated from the mitral valve echogram in patients with and without ventricular dyssynergy.

A formula was derived for calculating mitral valve stroke volume (MVSV) using the rate of mitral valve (MV) opening (DE slope on the MV echogram), the vertical disease between the mitral leaflet echoes early in diastole (EE), the electrocardiographic PR interval and heart rate. The formula was tested prospectively on 80 consecutive patients from whom 95 simultaneous MV echograms and either thermodilution (45) or Fick (50) cardiac outputs were obtained. Sixteen patients were normal; 54 had coronary artery disease; three had cardiomyopathy; and seven had nonrheumatic mitral regurgitation (MR). Linear regression for stroke volume was r = 0.90, SEE +/- 6, and for cardiac output r = 0.83, SEE +/- 0.5 liter for the 73 patients without MR. The presence or absence of ventricular dyssynergy did not alter statistical findings. MVSV consistently overestimated forward stroke volume for the seven patients with MR. This study shows that the MV echogram provides an accurate, widely applicable method for calculating MVSV.

Cardiac Catheterization↗
PubMed1978

Determination of mitral valve area by cross-sectional echocardiography.

Cross-sectional echocardiograms of the mitral valve orifice were recorded in 37 patients with mitral stenosis. Twenty-seven had pure mitral stenosis, and 10 had associated mitral regurgitation. Mitral valve area in patients with pure mitral stenosis measured from cross-sectional echocardiography was highly correlated (r = 0.89) with that calculated with the Gorlin formula using the pressure gradient and Fick cardiac output. With mitral regurgitation, mitral valve area by cross-sectional echocardiography correlated well (r = 0.90) with that calculated from the pressure gradient and cineangiographic stroke output. In two cases, direct pathologic measurements of mitral valve area agreed exactly with the cross-sectional echocardiographic measurement. Correlation between the mitral E-F slope and mitral valve area by cross-sectional echocardiography (r = 0.56) and catheterization (r = 0.49) was less reliable. Cross-sectional echocardiographic measurement of the mitral valve area correlates well with catheterization in patients with pure mitral stenosis and those with associated regurgitation.

Adult↗
PubMed1977

Principles of echocardiography.

Echocardiography is basically a diagnostic procedure whereby images of the heart are produced using ultrasound. It can be considered a natural means of sensing one's environment in that this basic technic is used by several animals as sonar. The manner in which the images are created is in many ways similar to light. With the standard M-mode examination one obtains a one-dimensional view of the heart whereby distance is plotted against time on a strip chart recorder. Cross-sectional or two-dimensional echocardiography plots distance against distance, and one more accurately recreates a spatially oriented heart on either movie film or videotape. All the availability information thus far indicates that echocardiography offers very little, if any, hazard to the patient.

Echocardiography↗
PubMed1977

Systolic thickening and thinning of the septum and posterior wall in patients with coronary artery disease, congestive cardiomyopathy, and atrial septal defect.

Echocardiographic septal and posterior wall thicknesses and the percent change with systole were measured in 146 patients with the following diagnoses: acute myocardial infarction (40), chronic coronary artery disease (49), congestive cardiomyopathy (8), atrial septal defect (20), and no cardiac disease (29). Mean diastolic thicknesses for the groups of patients with coronary artery disease and congestive cardiomyopathy were not significantly different from normal although there were abnormal values for individual patients within each group. Mean diastolic thickness of the septum was greater than normal for the group with atrial septal defect (P less than 0.02). Wall thinning with systole was associated with acute infarction or ischemia (P less than 0.0001); decreased thickening (less than normal) commonly occurred in patients with acute myocardial infarction, chronic coronary artery disease, and congestive cardiomyopathy. Patients with atrial septal defect had normal thickening with abnormal motion. Results of this study show that 1) systolic thinning is indicative of an acute event; 2) abnormal changes in systolic wall thickening occur commonly in patients with coronary artery disease or congestive cardiomyopathy; and 3) abnormal wall motion may occur without abnormal wall thickening, as the echoes of patients with atrial septal defect indicate.

Acute Disease↗
PubMed1977

Cross-sectional echocardiographic examination of the interatrial septum.

The interatrial septum has not been readily appreciated by M-mode echocardiography. Cross-sectional echocardiography has the capability of recording the shape and location of the interatrial septum. Real-time cross-sectional echograms using a mechanically oscillating transducer were obtained on 100 consecutive patients. Echocardiographic examination of the left atrium and aorta was obtained in a plane perpendicular to the long axis of the atria. In 15 normal patients and 17 patients with atrial septal defects (ASD) and 51 patients with other forms of heart disease, the interatrial septum was recorded as a linear echo from the aorta to the posterior wall of the left atrium. In six patients who had ostium primum ASDs, the echoes from the interatrial septum disappeared near its expected junction with the interventricular septum. Drop out of echoes in the mid portion of the septum was noted in those patients who had ostium secundum atrial septal defects but this could not be differentiated from normal. These preliminary data indicate that examination of the interatrial septum is feasible and may be specific in those few patients examined so far with ostium primum atrial septal defect. The ability to locate and record the shape of the interatrial septum could have many investigate and clinical uses.

Adolescent↗
PubMed1977

Premature pulmonary valve opening.

Premature opening of the pulmonary valve (opening independent of atrial or ventricular systole) was originally described in a case of sinus of Valsalva rupture into the right atrium. Since that time we have observed five additional cases in which the pulmonary valve opened prematurely. Entities encountered included: 1) constrictive pericarditis; 2) Loeffler's endocarditis; 3) Ebstein's anomaly with tricuspid regurgitation; 4) tricuspid regurgitation following tricuspid valvulectomy, and 5) pulmonary regurgitation accompanied by atrial septal defect. In the first two cases, premature pulmonary valve opening is felt to be due to restriction of diastolic filling of the right ventricle with subsequent early diastolic rise in pressure equalling or exceeding pulmonary artery diastolic pressure. In the latter three cases, the increased volume of blood entering the right ventricle again appeared to result in a rapid rise in initial right ventricular diastolic pressure and to produce premature opening of the pulmonary valve. Premature pulmonary valve opening, therefore, does not appear specific for any particular clinical entity but reflects the relative pressures in the right ventricle and pulmonary artery during diastole.

Adult↗