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Biomedical subjects

W R Parry

Publications and source records attributed to W R Parry.

At least 37 records · Page 2Linked to original sources
PubMed1980

Two dimensional echocardiography in congenital heart disease.

Two dimensional echocardiography has enhanced the ability of the clinician to define accurately intracardiac anatomy and great vessel relations. By visualizing relations of the great arteries and determining ventricular situs in the parasternal short axis planes and by assessing the relation of the great arteries to ventricles atrioventricular (A-V) valves and the interventricular septum in the parasternal and apical long axis view, complex congenital heart disorders can readily be differentiated. The subcostal approach allows accurate identification and localization of interatrial and interventricular septal defects. Utilizing the apical parasternal four chambered or subcostal four chambered view, complex malformations of the A-V valves such as complete endocardial cushion defect and Ebstein's anomaly can readily be appreciated. The suprasternal approach has allowed direct visualization of a coarcted aortic segment. The differentiation of left and right ventricular outflow obstruction is also possible. In some patients, it is possible to achieve an accurate diagnosis with two dimensional echocardiography alone. In others, two dimensional echocardiography provides accurate and detailed information with regard to spatial anatomy and valve morphology so that invasive studies can be performed more expeditiously, with less contrast agent and hence with greater safety. With regard to future developments, better resolution capability with newer instrumentation and combined two dimensional echocardiography with Doppler blood flowmeter studies may provide even greater diagnostic accuracy in the evaluation of patients with congenital heart disorders.

Aorta↗
PubMed1980

Statistical comparison of M mode and two dimensional echocardiographic diagnosis of flail mitral leaflets.

Forty-five patients who had surgical therapy for pure mitral insufficiency were evaluated prospectively with both M mode and two dimensional echocardiography; 26 patients (Group I) had a flail mitral valve leaflet, and 19 patients (Group II) had intact chordae tendineae. The M mode echocardiographic criteria of a flail valve (systolic left atrial echoes, systolic mitral valve flutter, diastolic mitral flutter and chaotic paradoxic diastolic posterior leaflet motion) were compared statistically with the two dimensional echocardiographic criterion (loss of systolic leaflet coaptation). The presence of one M mode echocardiographic finding had a sensitivity of 60 percent, a specificity of 53 percent, a predictive accuracy of 63 percent and a predictive value of 50 percent. The sensitivity (96 percent), specificity (84 percent), predictive accuracy (89 percent) and predictive value (94 percent) of the two dimensional echocardiogram were statistically superior to those of the M mode study (p less than 0.05 or better for each criterion). Thus, two dimensional echocardiography is distinctly superior to M mode echocardiography in the diagnosis of flail mitral valve leaflets.

Chordae Tendineae↗
PubMed1980

Pseudoaneurysm of the left ventricle complicated by Salmonella typhimurium infection. Recognition by two-dimensional echocardiography.

A patient is described with a large posterior left ventricular pseudoaneurysm complicated by Salmonella typhimurium infection. M-mode echocardiography displayed a massive echo-free space behind the posterior left ventricular wall, and two-dimensional echocardiography specifically defined the orifice and saccular contour of the false aneurysm. These findings were confirmed by cardiac catheterization and surgery. The unusual features of Salmonella endovascular infection and the noninvasive methods to detect left ventricular pseudoaneurysms are reviewed.

Echocardiography↗
PubMed1980

Two-dimensional echocardiographic recognition of left ventricular pseudoaneurysm.

Five consecutive patients with proved left ventricular pseudoaneurysm (PA) and 22 patients with true aneurysm (TA) were studied by two-dimensional echocardiography (2DE). In four of the five patients with PA, 2DE successfully displayed the PA. The unique 2DE characteristics of PA include: (1) a sharp discontinuity of the endocardial image at the site of the PA communication with the left ventricular cavity; (2) a saccular or globular contour of the PA chamber; and (3) the presence of a relatively narrow orifice in comparison with the diameter of the PA fundus. In addition, 2DE detected the presence of thrombotic material within the extraventricular chamber in three of four cases. By deriving the ratios of the end-systolic orifice to diameter measurements for the patients with PA (0.37 +/- 0.07) compared with TA (1.00 +/- 0.08), we found that 2DE reliably differentiated PA from TA (p < 0.001). We conclude that 2DE is a useful noninvasive method for revealing left ventricular PAs and for distinguishing PA from TA. Considering the high risk of spontaneous rupture associated with pseudoaneurysms, this noninvasive capability is of paramount clinical importance.

Echocardiography↗
PubMed1979

Lutembacher's syndrome: recognition by echocardiography.

The typical echocardiographic features of mitral stenosis in association with an enlarged right ventricle and abnormal septal motion are generally consistent with pulmonary hypertension and functional tricuspid regurgitation. In the absence of clinical and echocardiographic features of pulmonary hypertension, the combination of mitral stenosis and "volume overload" of the right ventricle should alert the clinician to the diagnosis of Lutembacher's syndrome. This report discusses a patient with these echocardiographic findings in whom the diagnosis of Lutembacher's syndrome was confirmed by cardiac catheterization.

Echocardiography↗
PubMed1979

Comparison of two-dimensional and M-mode echocardiography in the evaluation of patients with infective endocarditis.

M-mode and two-dimensional echocardiographic evaluation of infectious endocarditis and its complications was reviewed. In 21 consecutive patients with clinical endocarditis, 22 valves were involved (12 aortic, 5 mitral and 5 tricuspid). M-mode echocardiography detected vegetations in 10 patients (four aortic, two mitral and four tricuspid) and detected complications of endocarditis in 2 patients (one aortic root abscess and one flail aortic cusp). Two-dimensional echocardiography detected vegetations in 9 patients (four aortic, one mitral and four tricuspid) and detected complications in ten patients (five flail aortic cusps, one aortic root abscess, one sinus on Valsalva aneurysm, two flail mitral leaflets and one flail tricuspid valve). Thus, although M-mode and two-dimensional echocardiography had a similar ability to detect actual vegetations, two-dimensional echocardiography was superior to M-mode echocardiography in diagnosing complications of the destructive process.

Aortic Valve↗
PubMed1979

Two dimensional echocardiographic recognition of the descending thoracic aorta.

Two dimensional echocardiography was used to identify the descending thoracic aorta in 106 subjects. In 12 of these subjects, contrast injection techniques were used to identify this structure as it descended posteriorly adjacent to the atrioventricular groove. The course of the descending thoracic aorta was mapped using both the long axis and transverse axis views. The normal descending thoracic aorta (26 subjects) measured 10 +/- 1.4 mm/m2 during diastole. Unusual M mode echocardiographic patterns of the descending aorta may be confused with other disease states; they are clarified with the two dimensional study. The size and appearance of the descending aorta in different types of cardiovascular disease, including aortic aneurysm, in 80 patients are described. It is anticipated that two dimensional echocardiography will prove to be a useful method of studying patients with aortic disease.

Adult↗
PubMed1979

Wide splitting of the first heart sound secondary to tricuspid valve endocarditis. A phonocardiographic-echocardiographic study.

A patient is described with tricuspid valve endocarditis in whom the vegetation interfered with valve closure resulting in marked wide splitting of the first heart sound. M-mode and two-dimensional echocardiographic studies detected the presence of a vegetation. Simultaneous phonocardiographic and echocardiographic studies documented the marked delay in tricuspid valve closure and differentiated wide splitting of the first heart sound from other causes of early and mid-systolic sounds. Following pulmonary embolization, the first heart sound returned to normal. Echocardiographic disappearance of the vegetation of the tricuspid valve was also noted. Regrowth of the vegetation again produced the abnormal phonocardiographic and echocardiographic findings.

Adult↗
PubMed1979

Survival of patients with aortic valve endocarditis. The prognostic implications of the echocardiogram.

The clinical and prognostic implications of the echocardiogram were assessed in 32 patients with clinical aortic valve endocarditis. Seventeen patients had an echocardiographic diagnosis of a vegetation, a flail cusp, or a root abscess (group 1). Ten group 1 patients had embolic episodes. Eight group 1 patients were treated surgically and all survived, while nine group 1 patients were treated medically and two survived. Eleven patients had echocardiographic aortic valve sclerosis (group 2). One group 2 patient had an embolic episode. Six group 2 patients were treated surgically and four survived, while five group 2 patients were treated medically and three survived. Four patients had normal aortic valve echograms (group 3). One group 3 patient had an embolic episode. All group 3 patients were treated medically and survived.

Aortic Valve↗
PubMed1978

Two-dimensional echocardiographic recognition of ruptured chordae tendineae.

Real-time, phased-array, two-dimensional echocardiographic studies identified ruptured chordae tendineae in five patients: four patients had a flail mitral valve and one had flail mitral and tricuspid valves. The characteristic abnormality was a rapid systolic motion of the involved leaflet beyond the line of valve closure into the atrium. The maximal abnormal systolic motion was greatest at the tip of the leaflet with a loss of the normal coaptation point. By contrast, the two-dimensional echocardiographic feature of mitral valve prolapse is an abnormal systolic motion that is maximal in the body of the leaflet with intact leaflet coaptation. Thus, two-dimensional echocardiography can identify flail mitral and tricuspid valves and is useful in distinguishing ruptured chorade from valvular prolapse.

Adult↗
PubMed1978

Systolic anterior motion of the mitral valve in the absence of asymmetric septal hypertrophy.

Asymmetric septal hypertrophy (ASH) is considered the unifying link in the spectrum of hypertrophic cardiomyopathies. ASH and mitral valve systolic anterior motion (SAM) are the two most important echocardiographic criteria for the diagnosis of idiopathic hypertrophic subaortic stenosis (IHSS). Ten patients found have SAM without ASH were studied. Septal thickness, thickening, and excursion were normal. Seven patients had left ventricular ejection times (LVET) measured before and after amyl nitrite inhalation. In six of them, corrected LVET increased by more than 40 msec. Four patients underwent diagnostic cardiac catheterization. Resting or provocable left ventricular outflow tract (LVOT) gradients were demonstrable in all four patients. The echocardiographic features in patients with SAM alone, ASH and SAM, and ASH alone were compared. compared. LVOT measurements in patients with SAM alone (2.2 +/- .4 cm) and ASH and SAM (2.1 +/- .5 cm) were similar and narrower than in patients with ASH alone (2.8 +/- .5 cm, P less than 0.001). Ejection fractions in patients with SAM alone (79 +/- 10%) were greater than in patients with ASH and SAM (66 +/- 16%, P less than 0.02) or ASH alone (60 +/- 15%, P less than 0.001). Thus, dynamic left ventricular outflow obstruction can exist in the absence of echocardiographic ASH. LVOT width and abnormal LV ejection dynamics may contribute to the LVOT obstruction with or without the presence of ASH.

Adolescent↗