Philip Vignon | PubMed Health

PubMed1999

Evaluation of Global and Regional Right Ventricular Function Using Automated Border Detection Techniques.

Quantitative evaluation of right ventricular (RV) function remains challenging due to the complex geometry of this chamber, which precludes the use of simple geometric assumptions. Automated border detection (ABD) techniques, which provide online changes in cardiac chamber dimensions, have been predominantly used for quantitative assessment of global as well as regional left ventricular function. Recently, acoustic quantification has been validated for quantitative evaluation of global RV function, and color kinesis has been used to objectively assess systolic and diastolic regional RV function. In this article, the main studies validating ABD for the objective assessment of global RV function and the current clinical uses of this technique are reviewed. In addition, technical guidelines and limitations of ABD techniques are described, and potential applications of color kinesis for quantitative assessment of regional systolic and diastolic RV performance are detailed. ABD techniques provide new insights into right atrial and RV systolic and diastolic properties. The clinical value of these techniques in the diagnosis, prognosis, and potential guidance of therapeutic management of RV dysfunction remains to be determined.

Journal Article↗

PubMed1999

Use of Transesophageal Echocardiography for the Assessment of Traumatic Aortic Injuries.

Acute traumatic lesions of the thoracic aorta or its branches (TLA) constitute highly lethal yet treatable injuries that are increasingly diagnosed in surviving patients. Traumatic disruptions are limited to the region of the aortic isthmus in approximately 90% of cases. Unlike aortography, usually referred as the gold standard diagnostic technique, transesophageal echocardiography (TEE) is a noninvasive imaging modality that can be rapidly performed at the patient bedside. Accordingly, TEE is being increasingly used as a first-line screening test for the evaluation of patients with suspected TLA. The TEE signs associated with TLA depend on the anatomic type of aortic disruption. After a period of validation, multiplane TEE allows accurate diagnosis of traumatic disruptions of the aortic isthmus, with a sensitivity of 88% (range, 57%-100%) and a specificity of 96% (range, 84%-100%). False-negative TEE results have been mainly attributed to lacerations of aortic branches. Accordingly, aortography must be routinely performed when a traumatic injury to brachiocephalic arteries is suspected. False-positive TEE findings have been associated with the presence of ultrasound artifacts or atherosclerotic changes that mimic TLA. Accurate determination of the depth of aortic wall tears and diagnosis of blunt cardiac injuries during the TEE study are crucial to guide patient management. The presence of TEE signs associated with imminent risk of adventitial rupture should lead to prompt surgery. The use of TEE as a first-line imaging modality simplifies the initial assessment of patients at high risk for TLA and helps guide acute management.

Journal Article↗