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Lissa Sugeng

Publications and source records attributed to Lissa Sugeng.

11 recordsLinked to original sources
PubMed2004

Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation: an accurate and novel approach.

OBJECTIVES: Our aim was to assess which echo-Doppler method has the best agreement with the mitral valve area (MVA) invasively evaluated by the Gorlin's formula. We also evaluated the feasibility and reproducibility of real-time three-dimensional echocardiography (RT3D) for the estimation of MVA and the Wilkins score in patients with rheumatic mitral stenosis (RMVS). BACKGROUND: Real-time three-dimensional echocardiography is a novel technique that allows us to visualize the mitral valvular anatomy in any desired plane orientation. The usefulness and accuracy of this technique for evaluating RMVS has not been established. METHODS: We studied a series of consecutive patients with RMVS from two tertiary care hospitals. Mitral valvular area was determined by conventional echo-Doppler methods and by RT3D, and their results were compared with those obtained invasively. Real-time three-dimensional echocardiography planimetry and mitral score were measured by two independent observers and then repeated by one of them. RESULTS: Eighty patients with RMVS comprised our study group (76 women; 50.6 +/- 13.9 years). Compared with all other echo-Doppler methods, RT3D had the best agreement with the invasively determined MVA (average difference between both methods and limits of agreement: 0.08 cm(2) [-0.48 to 0.6]). Interobserver variability was as good for RT3D (intraclass correlation coefficient [ICC] = 0.90) as for pressure half-time (PHT) (ICC = 0.95). For PHT and RT3D, the intraobserver variability was similar (ICC 0.92 and 0.96, respectively). Real-time three-dimensional echocardiography valvular score evaluation showed a better interobserver agreement with RT3D than with 2D echocardiography. CONCLUSIONS: Real-time three-dimensional echocardiography is a feasible, accurate, and highly reproducible technique for assessing MVA in patients with RMVS. Real-time three-dimensional echocardiography has the best agreement with invasive methods.

Echocardiography, Three-Dimensional↗
PubMed2004

Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging.

OBJECTIVES: We investigated the usefulness of echocardiographic contrast perfusion imaging in differentiating cardiac masses. BACKGROUND: Two-dimensional echocardiography is the primary diagnostic modality for cardiac masses. However, differentiation between the different types of cardiac masses may be difficult at times. We hypothesized that echocardiographic contrast perfusion imaging would differentiate the neo-vascularization of malignancies from the avascularity of thrombi and the sparse vascularity of stromal tumors. METHODS: Sixteen patients with cardiac masses underwent power-modulation imaging after echocardiographic intravenous contrast administration. Pixel intensities in the mass and an adjacent section of myocardium were analyzed visually and by dedicated software. All masses had a pathologic diagnosis or resolved after anticoagulation. In a subset of patients, video-intensity curves of contrast replenishment in the mass and myocardium over time were generated. The post-impulse steady-state pixel intensity (A) and initial rate of contrast replenishment after impulse (beta) were compared with an index of blood vessel area on pathology. RESULTS: In seven of 16 patients, contrast enhancement resulted in greater pixel intensity in the mass than in the adjacent myocardium. All of these masses were classified pathologically as malignant (n = 6) or benign and vascular (n = 1). Nine masses demonstrated decreased pixel intensity, compared with the myocardium, and were diagnosed pathologically as myxomas (n = 2) or thrombi (n = 5), or they resolved with anticoagulation (n = 2). For the subset of patients, beta correlated with the vessel area index (r = 0.60). CONCLUSIONS: Echocardiographic contrast perfusion imaging aids in the differentiation of cardiac masses. Compared with the adjacent myocardium, malignant and vascular tumors hyper-enhanced, whereas stromal tumors and thrombi hypo-enhanced.

Adult↗
PubMed2004

Harmonic imaging for endocardial visualization and myocardial contrast echocardiography during transesophageal echocardiography.

BACKGROUND: Although harmonic imaging (HI) improves endocardial visualization and is necessary for myocardial perfusion imaging, it has yet to be implemented in transesophageal echocardiography. Our goal was to determine whether HI implemented in a prototype transesophageal echocardiography probe improved endocardial visualization and allowed perfusion imaging. METHODS: In 23 patients, fundamental and harmonic images were obtained in the transgastric short-axis (TSAX) and midesophageal 4-chamber views, and reviewed for endocardial visualization by 3 readers blinded to imaging mode. In 14 additional patients, perfusion imaging was performed in the TSAX view during contrast infusion. RESULTS: HI improved overall endocardial visualization, most noticeably in the anterior and lateral segments (P <.004) in the TSAX view, and in the lateral segments (P <.01) in the midesophageal 4-chamber view. The salvage rate was 8.3% in the TSAX view and 12.6% in the midesophageal 4-chamber view. Myocardial perfusion was consistently confirmed in the inferior (86%), posterior (100%), and lateral (79%) segments, but rarely in the septal (21%), anteroseptal (0%), and anterior (14%) segments. CONCLUSION: Use of HI with transesophageal echocardiography improves endorcardial visualization and allows partial assessment of myocardial perfusion.

Coronary Circulation↗
PubMed2004

Atypical cardiac myxomas.

Atypical cardiac myxomas are a rare occurrence and may present with a variety of clinical manifestations depending on the morphology and location. We present three cases of myxomas located atypically on the left atrial appendage ridge, chordae of the mitral valve, and right atrium. Echocardiography plays a prominent role in the diagnosis and follow-up of these patients.

Adult↗
PubMed2003

Biplane stress echocardiography using a prototype matrix-array transducer.

BACKGROUND: Rapid image acquisition after cessation of exercise is essential for accurate stress echocardiography. Recently, a prototype matrix-array transducer has been developed that allows simultaneous acquisition of 2 imaging planes (biplane [BP] imaging). METHODS: In all, 19 healthy volunteers underwent 2 separate stress echocardiographic studies. Images were acquired in traditional 2-dimensional or BP format pre-exercise and postexercise. RESULTS: Total image acquisition time for 2-dimensional stress echocardiography was 38 +/- 8 seconds versus 29 +/- 8 seconds for BP imaging (P <.05). Heart rates were acquired closer to age-predicted maximum with BP imaging in the apical 3- and 2-chamber and parasternal long- and short-axis views (82%, 75%, 70%, 70% for BP vs 76%, 72%, 68%, 66% for 2-dimensional, respectively). CONCLUSION: BP imaging using a recently developed matrix-array probe allows more rapid imaging postexercise, resulting in acquisition of poststress images at higher heart rates without compromising image quality.

Acoustics↗
PubMed2003

Dynamic three-dimensional color flow Doppler: an improved technique for the assessment of mitral regurgitation.

BACKGROUND: Prior studies have reconstructed mitral regurgitant flow in three dimensions displaying gray scale renditions of the jets, which were difficult to differentiate from surrounding cardiac structures. Recently, a color-coded display of three-dimensional (3D) regurgitant flow has been developed. However, this display was unable to integrate cardiac anatomy, thereby losing spatial information, which made it difficult to determine the jet origin and its spatial trajectory. To overcome this limitation, an improved method of 3D color reconstruction of regurgitant jets obtained from color flow Doppler using a transesophageal approach was developed to allow the combined display of both color flow and gray scale information. OBJECTIVES: To demonstrate the feasibility of 3D reconstruction of regurgitant mitral flow jets using an improved method of color encoding digital data acquired by transesophageal echocardiography (TEE). METHODS: We studied 46 patients undergoing a clinically indicated TEE study. All subjects had mitral regurgitation detected on a previous transthoracic study. Atrial fibrillation or poor image quality were not used as exclusion criteria. The 3D study was performed using a commercial ultrasound imaging system with a TEE probe (Sonos 5500, Agilent Technologies). A rotational mode of acquisition was used to collect two-dimensional (2D) color flow images at 3-degree intervals over 180 degrees. Images were processed off line using the Echo-View Software (TomTec Imaging Systems). Volume-rendered 3D color flow jets were displayed along with gray scale information of the adjacent cardiac structures. RESULTS: Mitral regurgitant flow, displayed in left atrial and two longitudinal orientations, was successfully reconstructed in all patients. The time for acquisition, post-processing, and rendering ranged between 10 and 15 minutes. There were 28 centrally directed jets and 15 eccentric lesions. Eight patients in the study had periprosthetic mitral regurgitant flow. CONCLUSIONS: Three-dimensional imaging of mitral regurgitant jets is feasible in the majority of patients. This improved technique provides additional information to that obtained from the 2D examination. Particularly, in patients with paravalvular leaks 3D color flow Doppler provides information on the origin and the extent of the dehiscence, as well as insight into the jet direction. In addition, in patients with eccentric mitral regurgitation, this new modality overcomes the inherent limitations of 2D echo Doppler by depicting the full extent of the jet trajectory.

Echocardiography, Doppler, Color↗
PubMed2003

Real-time three-dimensional echocardiography using a novel matrix array transducer.

Three-dimensional echocardiography has multiple advantages over two-dimensional echocardiography, such as accurate left ventricular quantification and improved spatial relationships. However, clinical use of three-dimensional echocardiography has been impeded by tedious and time-consuming methods for data acquisition and post-processing. A newly developed matrix array probe, which allows real-time three-dimensional imaging with instantaneous on-line volume-rendered reconstruction, direct manipulation of thresholding, and cut planes on the ultrasound unit may overcome the aforementioned limitations. This report will review current methods of three-dimensional data acquisition, emphasizing the real-time methods and clinical applications of the new matrix array probe.

Echocardiography, Three-Dimensional↗
PubMed2003

Accuracy of mitral valve area measurements using transthoracic rapid freehand 3-dimensional scanning: comparison with noninvasive and invasive methods.

OBJECTIVE: The feasibility and accuracy of direct transthoracic 3-dimensional (3D) mitral valve area (MVA) measurements obtained using freehand scanning was investigated in patients with mitral stenosis. METHODS: A total of 30 patients (26 women, 4 men; aged 55 +/- 13 years) underwent a 2-dimensional (2D) and Doppler study 1 hour before percutaneous balloon mitral valvuloplasty. Transthoracic freehand data were acquired using a magnetic receiver attached to a broadband transducer, gated to electrocardiography and respiration. Volumetric MVA measurements from the left ventricle and left atrium were obtained and compared with MVA measurements derived from 2D planimetry, pressure half-time, and proximal isovelocity surface area. Invasive Gorlin MVA measurements were the gold standard for comparison. RESULTS: In all, 29 patients (97%) had 3D data allowing MVA measurements. Direct 3D measurements from the left ventricle had the least bias (0.06 +/- 0.19 cm(2)) and tightest limits of agreement (-0.44 to 0.32) compared with left atrium measurements (0.17 +/- 0.25 cm(2) and -0.67 to 0.33, respectively). The proximal isovelocity surface area method (bias: 0.09 +/- 0.34 cm(2)) was the most accurate of all 2D methods followed by pressure half-time (0.17 +/- 0.36 cm(2)) and planimetry (0.21 +/- 0.29 cm(2)). CONCLUSION: Direct 3D MVA measurements from the left ventricle using transthoracic freehand scanning are more accurate than traditional 2D methods.

Adult↗
PubMed1997

Multiplane Transthoracic Echocardiography: Image Orientation, Anatomic Correlation, and Clinical Experience with a Prototype Phased Array Multiplane Surface Probe.

Multiplane transthoracic echocardiography provides numerous sequential images by rotation of the transducer imaging array through 180 degrees with the surface probe at a fixed site. We explored the potential of this new technique with a 3.7/5-MHz prototype multiplane transthoracic probe. Echoanatomic correlations were first examined in ten explanted hearts. The transducer was then applied in 30 normal humans at transthoracic acoustic windows to determine the imaging planes available. Use of this probe in 76 patients with various cardiac disorders indicated that this probe eases the procedure of transthoracic echocardiographic examination, provides incremental information for improved delineation and understanding of cardiac pathology, and yields many novel insights to echocardiographic interpretation. Multiplane transthoracic echocardiography appears to expand the versatility of transthoracic two-dimensional echocardiography.

Journal Article↗
PubMedDate not supplied

A fantastic journey: 3D cardiac ultrasound goes live.

With a recent product introduction, live 3D echo is now clinically practical. It is already beginning to have a profound impact on the way we care for patients at The University of Chicago Medical Center. In the past, dynamic cardiac 3D rendered images were possible by sequentially acquiring 2D images and then using a workstation to input 2D images for Cartesian coordinate conversion and volume rendering. Outside research settings, this time-consuming process proved cumbersome and was simply impractical. Now that these technical and practical issues have been addressed, real-time 3D cardiac sonography has great potential to impact both patient care and throughput in a number of ways, including better pre- and post-surgical planning, improved measurement of heart function, decreased exam times, and enhanced communication between clinicians and their patients. With real-time 3D cardiac ultrasound images, clinicians will be able to better quantify size, shape and function of the heart. However, the most important contribution of real-time 3D sonography in cardiology may be improvement in locating abnormalities for surgical planning. The new technology will also provide important information regarding surgical outcomes. A great benefit to obtaining more diagnostic information and higher diagnostic confidence from real-time 3D cardiac ultrasound images is that it could lead to more rapid exam times and the reduction of patient wait times. Being able to see the whole heart makes examinations more simple and rapid, benefitting the staff and patient. The utility of this technology is unusually broad, as it is able to move beyond diagnostics into a key role in therapeutic procedures. As with any new technology, there will be a learning curve to understanding 3D imaging. Though the matrix transducer is somewhat larger than a standard 2D probe, the ergonomics are quite similar. The interface of the ultrasound unit is also very user friendly. Because real-time 3D cardiac ultrasound involves looking at the heart as if you are holding it in your hands, with the additional ability to turn it any way you want, we expect that the transition from 2D to 3D will be easily achieved.

Echocardiography, Three-Dimensional↗