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Biomedical subjects

W R Parry

Publications and source records attributed to W R Parry.

At least 19 recordsLinked to original sources
PubMed1991

Dilated cardiomyopathy with mitral regurgitation: decreased survival despite a low frequency of left ventricular thrombus.

Ninety-one patients with dilated cardiomyopathy were studied by two-dimensional, pulsed, and color Doppler echocardiography (1) to detect and quantify mitral regurgitation (MR), (2) to record apical flow velocities in systole and diastole, and (3) to detect the presence of left ventricular thrombi. MR was detected in 57% of the patients and thrombi were present in 40%, but the occurrence of both MR and thrombus was rare (8%). Apical flow velocity was significantly higher throughout the cardiac cycle in the group with MR (diastole 15 +/- 7 vs 9 +/- 7 cm/sec; systole 29 +/- 12 vs 16 +/- 13 cm/sec; p less than 0.001 for both), accounting for the rarity of thrombi in this group. Follow-up data on 89% of the patients showed markedly decreased survival in the group with MR (22% vs 60% at 32 +/- 6 months, p less than 0.005), and this was evident even in patients with mild MR. Thus although MR is a noninvasively obtainable marker of a large subgroup of patients with dilated cardiomyopathy "protected" from left ventricular thrombus formation, it is a sensitive marker of decreased survival.

Aged↗
PubMed1989

Flow characteristics in the dilated left ventricle with thrombus: qualitative and quantitative Doppler analysis.

In an attempt to determine whether mural thrombus in a dilated left ventricle is associated with specific flow patterns, a study was undertaken to assess qualitatively and quantitatively the flow characteristics by conventional pulsed and two-dimensional Doppler color flow examination. Forty patients with cardiomyopathy formed the study group (20 with an apical thrombus and 20 without). The groups did not differ with respect to age, gender, origin of ventricular dysfunction, ventricular size and ejection fraction. Guided by the Doppler color flow pattern, a quantitative analysis of flow velocity profile in the ventricular inflow and outflow "compartments" was performed by serial pulsed wave Doppler sampling. Inflow velocity at the ventricular apex was significantly lower in the thrombus group than in the no thrombus group (11.7 +/- 15.3 versus 28.3 +/- 10.5 cm/s, p less than 0.0001). Flow velocities were generally lower in the thrombus group at the other levels in the inflow compartment (that is, mitral anulus, leaflet tips and papillary muscle level). The systolic flow velocity at the apex was similarly significantly lower in the thrombus group than in the no thrombus group (7.1 +/- 8.1 versus 15.3 +/- 7.0 cm/s, p less than 0.001). Additionally, a higher prevalence of mitral regurgitation was noted in the no thrombus group (14 patients) than in the thrombus group (3 patients). Thus, specific abnormal flow profiles are associated with a left ventricular thrombus. Whether the abnormal flow is a primary event in the genesis of left ventricular thrombus or occurs secondary to development of the thrombus cannot be determined from this study.

Blood Flow Velocity↗
PubMed1989

Doppler evaluation of changing cardiac dynamics during Cheyne-Stokes respiration.

For the purpose of elucidating the mechanisms and/or effects of the cardiovascular changes occurring during Cheyne-Stokes respiration, we utilized Doppler echocardiography to determine intracardiac flow velocity profiles during the changing phases. Left ventricular inflow (LVI) and outflow (LVO) were examined in ten patients, nine with heart failure and one with a cerebrovascular accident. The mean LVI, peak early (E) and late diastolic (A) and LVO velocities were measured at the end of both the hyperpneic and apneic phases. The phasic hemodynamic changes observed during Cheyne-Stokes respiration by Doppler profile could be explained by the development of LV diastolic dysfunction and a decrease in LV stroke volume during the apneic phase of Cheyne-Stokes respiration. Alternatively, an increase in PCO2 during the apneic phase may increase pulmonary vascular resistance lowering preload and stroke volume, whereas during the hyperpneic phase, pulmonary vascular resistance is reduced with resultant increase in left ventricular preload and increase in stroke volume. Both theories are speculative and the precise hemodynamic changes associated with Cheyne-Stokes respiration requires further investigation.

Aged↗
PubMed1988

Pulsed, continuous, and color flow Doppler echocardiographic assessment of normal and abnormal Ionescu-Shiley pericardial valves.

We studied the value of pulsed, continuous, and color flow Doppler echocardiography for identifying normal and abnormal function in 51 Ionescu-Shiley bovine pericardial valves. In 15 patients with clinically normal functioning mitral valves, the peak and mean pressure gradients as calculated by the modified Bernoulli equation were 8.5 +/- 4.9 mmHg (mean +/- SD) and 2.6 +/- 2.9 mmHg, respectively. The mitral valve area as calculated by the pressure half-time method was 2.2 +/- 0.6 cm2. In 18 patients with normally functioning aortic valves, the peak and mean pressure gradients were 22.9 +/- 9.0 mmHg and 11.1 +/- 5.0 mmHg, respectively. In five patients with suspected mitral prosthetic dysfunction, two-dimensional and Doppler echocardiography showed: two had mitral stenosis with a mean gradient of 14.2 mmHg and mean mitral valve area of 1.0 cm2, two had severe mitral regurgitation, and one was thickened but nonstenotic. In 13 patients with suspected aortic prosthetic dysfunction, two-dimensional and Doppler echocardiography showed: two patients had markedly thickened leaflets and mean aortic gradient of 41.5 mmHg, two patients had mild aortic regurgitation, four patients had severe aortic regurgitation, and five patients had systolic murmurs secondary to pathology unrelated to the prosthetic aortic valve. Of the three patients with severe aortic regurgitation who had color Doppler, the site and direction of the regurgitant jet was correctly identified in all compared to intraoperative assessment. Pulsed, continuous, and color flow Doppler are useful as noninvasive techniques in assessing Ionescu-Shiley valve hemodynamics and function.

Academic Medical Centers↗
PubMed1987

Noninvasive evaluation of mid-left ventricular obstruction by two-dimensional and Doppler echocardiography and color flow Doppler echocardiography.

Three patients with midventricular obstruction resulting from three different pathophysiologic mechanisms and differing anatomic bases for the development of obstruction are presented. In the first patient, a membrane-like structure appeared to cause some fixed obstruction, but a superimposed dynamic component to the obstruction was also evident. Papillary muscle hypertrophy with approximation of the papillary muscles during systole was the mechanism in the second patient. In the third patient, apical infarction with hyperdynamic contraction of the mid- and basal portions of the myocardium appeared to be the pathophysiologic mechanism. Color flow Doppler echocardiography was particularly useful in localizing the site of obstruction and allowed further evaluations by pulsed and continuous-wave Doppler techniques to precisely determine pressure gradients.

Blood Pressure↗
PubMed1986

The complementary role of magnetic resonance imaging, Doppler echocardiography, and computed tomography in the diagnosis of dissecting thoracic aneurysms.

Non-ECG gated MRI was compared with 2DE and/or CT scans in 10 patients with dissecting aneurysms proven by angiography and/or surgery. Patient ages ranged from 48 to 85 years (mean 69.6). Six had DeBakey type I dissections and four had DeBakey type III dissections. MRI was diagnostic for aortic dissection in nine cases and suggestive in the tenth. 2DE was diagnostic in six out of nine patients, suggestive in two patients, and nondiagnostic in one patient. CT was diagnostic in the three cases in which it was employed. MRI demonstrated a dilated ascending aorta with thickened walls in all type I dissections as well as an intimal flap and slow flow in the false channel in four patients. In the other two patients with type I dissection, MRI detected the intimal flap in the descending aorta but not in the ascending aorta, whereas 2DE revealed the ascending aortic intimal flap in both of these patients and CT showed it in one of them. In the type III dissections, MRI demonstrated a thickened wall and thrombus in the lumen in all four cases, and the intimal flap in three out of the four. 2DE excluded ascending aortic involvement in all three type III dissections. Six other patients with fusiform dilated ascending aortas had no evidence of dissection by MRI, 2DE, and aortography. Thus, non-ECG gated MRI alone or in combination with 2DE and/or CT is useful in the diagnosis of dissecting thoracic aneurysm and in assessing the extent of the dissection. In addition, the differentiation of dissecting aneurysms of the aorta from fusiform dilatation of the aorta is made possible by these noninvasive techniques.

Aged↗
PubMed1986

Magnetic resonance imaging and two-dimensional echocardiography. Alternative approach to aortography in diagnosis of aortic dissecting aneurysm.

Unrecognized acute dissection of the aorta requires rapid and accurate diagnosis for appropriate management. The "gold standard" for diagnosis has been invasive angiography, but this diagnosis can be achieved noninvasively via two-dimensional echocardiography, computed tomographic scanning, and magnetic resonance imaging. Two patients are described in whom echocardiography and magnetic resonance imaging were complementary diagnostic aids. The advantages and disadvantages of echocardiography, computed tomographic scanning, magnetic resonance imaging, and aortography in aortic dissection are discussed. It is anticipated that a combination of noninvasive diagnostic aids will eliminate the need for invasive angiography in many instances in the future.

Aged↗
PubMed1986

Geriatric cardiology: managing the most common nonischemic disorders.

Two-dimensional echocardiography is the method of choice for calculation of left ventricular mass, especially in patients with abnormal left ventricular geometry and segmental disease. Predominating diastolic abnormalities may be responsible for signs and symptoms of heart failure in some patients. These patients should not be treated in the conventional manner, but require special treatment with beta blockers or calcium-channel blocking agents.

Aged↗
PubMed1986

Noninvasive evaluation of cardiac valve prostheses.

Noninvasive techniques are particularly helpful in evaluating the function of mechanical prostheses and tissue valves. Combined phonocardiography with M-mode echocardiography, cinefluoroscopy, and Doppler echocardiography are the most useful noninvasive techniques in differentiating normal from abnormal metallic prosthetic valve function. The intensity of the opening and closing clicks and associated murmurs will depend on the type of prosthetic valve, the heart rate and rhythm, and the underlying hemodynamic status. Arrhythmias and/or conduction disturbances may produce motion patterns that mimic the echocardiographic signs of malfunctioning prosthetic valves. Two-dimensional echocardiography is of limited help in assessing patients with metallic prosthetic valves because of reverberating artifacts and side lobe echoes. However, 2-D echo is extremely useful in excluding underlying left ventricular dysfunction. In addition, 2-D echo allows the determination of the precise alignment of the prosthetic valves so that optimal M-mode evaluation of the disc or poppet motion can be undertaken. Two-dimensional echocardiography also allows diagnosis of pericardial effusion and exclusion of other valvular abnormalities. Differentiation of thrombus formation or tissue ingrowth from paravalvular regurgitation or dehiscence is possible by echophonocardiography, Doppler echocardiography, and cinefluoroscopy. Doppler echocardiography is the most sensitive noninvasive technique in diagnosing paravalvular leaks. In addition, significant obstruction across a prosthetic valve can be determined by calculation of maximal gradient across the obstructed orifice using Doppler echocardiography. The differentiation between "benign physiological regurgitation" from true "pathological regurgitation" by Doppler is not always possible. Disc variance is a potentially serious and lethal problem with the older Beall valves and can be detected readily by a combination of echophonocardiography, cinefluoroscopy, and Doppler echocardiography. With regard to bioprosthetic valves, 2-D echo is superior to M-mode in detecting primary valve failure. In addition, detection of vegetations, valve alignment, ring and individual leaflet motion can be readily accomplished by 2-D echo. When considering the value of noninvasive techniques in prosthetic valve function, it is essential to recognize that the patients must serve as their own control in the follow-up assessment.

Arrhythmias, Cardiac↗
PubMed1981

Two-dimensional echocardiographic identification of surgically correctable complications of acute myocardial infarction.

The appearance of a new, loud systolic murmur in a patient with congestive heart failure after an acute myocardial infarction suggests a surgically correctable cause of the heart failure. Using two-dimensional echocardiography, we studied 14 patients who presented in this manner. Four patients had rupture of a papillary muscle with a flail mitral valve. All four had surgery; three survived. Five patients had fibrosis of the posteromedial papillary muscle. All five had surgery; three survived. Five patients had a ventricular septal defect. Three of the five had surgery; one survived. Two-dimensional echocardiography is useful in studying patients with a new systolic murmur and congestive heart failure after acute myocardial infarction to detect surgically correctable structural defects.

Acute Disease↗
PubMed1981

Real-time inferior vena caval ultrasonography: normal and abnormal findings and its use in assessing right-heart function.

We studied the inferior vena cava (IVC) as an index of right-heart function in 111 patients. A two-dimensional echocardiographic sector was used to visualize the IVC, and its M-mode cursor was used to generate a time-motion record of the IVC size and pulsation. Normal subjects had a small presystolic A wave (less than 125% of the end-diastolic IVC dimension), a small systolic V wave (less than 140% of the end-diastolic IVC dimension), and a 50% inspiratory decrease in IVC dimension. The A wave was absent in patients with atrial fibrillation. When normalized for body surface area, mean end-diastolic IVC dimension correlated with mean right atrial pressure (r = 0.72, p less than 0.001). An A wave greater than or equal to 125% of end-diastolic IVC dimension was recorded in 71% of patients with sinus rhythm and an elevated right ventricular end-diastolic pressure of 10 mm Hg or greater, but in no patient with right ventricular end-diastolic pressure of less than 10 mm Hg (p less than 0.001). A V wave greater than or equal to 140% of end-diastolic IVC dimension was recorded in 75% of patients with severe tricuspid insufficiency, but in no patient with mild or no tricuspid insufficiency (p less than 0.001). The inspiratory decrease in IVC dimension correlated with radionuclide right ventricular ejection fraction (r = 0.75, p less than 0.001); no respiratory variation in end-diastolic IVC dimension occurred in patients with significant right ventricular dysfunction (right ventricular ejection less than 25%) or in patients with constrictive pericarditis.

Blood Pressure↗
PubMed1981

Rapidly progressing, massive mitral annular calcification. Occurrence in a patient with chronic renal failure.

Calcification of the mitral annulus developed in a patient while undergoing dialysis. The rapid onset of events corresponded to the onset of end-stage renal failure and uncontrolled secondary hyperparathyroidism. Sequential echocardiograms verified the progression of calcification of the annulus as well as the valve. A new systolic and diastolic murmur and reduced valve orifice on two-dimensional echocardiography suggested acquired nonrheumatic mitral stenosis and insufficiency. We propose that metastatic calcium deposition rather than long-term hypertensive and degenerative effects was the predominant mechanism for massive calcification of the annulus and valve. It is suggested that M-mode echocardiography be used sequentially to follow both the occurrence and progression of calcification of the mitral annulus or valve in patients with chronic renal failure, secondary hyperparathyroidism, or both.

Calcinosis↗
PubMed1981

Dissecting aortic aneurysm associated with a midsystolic click.

A midsystolic click occurred in a patient with a type 1 dissecting aneurysm. The mechanism of production of the systolic click may be related to rapid deceleration of blood against the intimal flap. Combined phonocardiography and echocardiography (using a new second right intercostal space approach) proved to be helpful in differentiating this sound from an aortic and pulmonary ejection click. In addition, other causes of midsystolic clicks, such as mitral and tricuspid valve prolapse, were excluded.

Aged↗
PubMed1980

M mode and two dimensional echocardiography in mitral and aortic regurgitation: pre- and postoperative evaluation of volume overload of the left ventricle.

Both M mode and two dimensional echocardiography are useful in determining the origin of mitral regurgitation. Two dimensional echocardiography appears to be superior to M mode echocardiography in the diagnosis of a flail leaflet, papillary muscle dysfunction and cleft mitral valve. It is possible to differentiate valvular causes from myocardial causes of regurgitation. Unfortunately, the severity of mitral regurgitation is difficult to quantify with either the M mode or the two dimensional technique. Echocardiography does allow differentiation of acute forms of mitral and aortic regurgitation from chronic volume overload of the left ventricle. Rupture of chordae tendineae is the most common cause of acute mitral regurgitation, and two dimensional echocardiography is 96 percent sensitive in its detection. Bacterial endocarditis, flail aortic valve and dissecting aneurysm as causes of acute aortic regurgitation can be detected with two dimensional echocardiography. Systolic left ventricular cavity dimension, percent fractional shortening and ejection fraction are important variables in predicting optimal time for surgery in patients with chronic aortic and mitral regurgitation. The noninvasive technique of echocardiography may be especially useful in decision making in the asymptomatic patient.

Aortic Valve Insufficiency↗