Exercise and echocardiography--dynamic exercise echocardiography.
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Adult↗
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[Echocardiography. IV. Bidimentional echocardiography - methodology and utilization].
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Echocardiography↗
Apex sector echocardiography in evaluation of the right atrium in patients with mitral stenosis and atrial septal defect.
Cross-sectional echocardiography utilizing the four chamber apical view was used to evaluate right atrial dimensions as a means of detecting abnormal right heart hemodynamics in 20 patients with mitral stenosis, 5 patients with an atrial septal defect and 10 patients without heart disease. Right and left atrial dimensions on apex echocardiography were 40 mm or less in control subjects. There was a good correlation (r = 0.81) between left atrial size assessed with apex sector and M mode echocardiography. In patients with an atrial septal defect, the left atrium was of normal size on apex sector echocardiography; in patients with mitral stenosis, it was larger on apex echocardiography (59 +/- 9 mm) than on M mode echocardiography (51 +/- 8 mm). The right atrium was enlarged (54 +/- 5 mm) on apex echocardiography in all five patients with an atrial septal defect, but the right ventricle was enlarged in only four. Seventeen of 20 patients with mitral stenosis had an enlarged right atrium (53 +/- 7 mm) on apex echocardiography, whereas 15 had normal right ventricular dimensions (21 +/- 9 mm) on M mode echocardiography. Right atrial size on apex echocardiography was enlarged (54 +/- 6 mm) in 10 of 11 patients with mitral stenosis and pulmonary arterial hypertension. Thus, evaluation of the right atrial dimension with apex echocardiography may be more sensitive than M mode echocardiography in detecting early right heart involvement in specific cardiac conditions.
Adult↗
[Bidimensional echocardiography in evalulation of mitral and aortic stenosis].
The aim of this study was to compare the results of unidimensional and cross-sectional echocardiography and cardiac catheterisation in the assessment of mitral and aortic stenosis. 21 patients with mitral stenosis, 21 patients with aortic stenosis and 21 patients without valvular disease were studied by unidimensional and cross-sectional echocardiography and cardiac catheterisation. Although unidimensional echocardiography in the external cardiac investigation of choice for the qualitative diagnosis of mitral stenosis, a better assessment of the severity of the stenosis is obtained with cross-sectional echocardiography. The valve surface measured by cross-sectional echocardiography correlates well with the value obtained by catheterisation with the application of the Gorlin formula (r = 0.85). Cross-sectional echocardiography is therefore an important advance in the external assessment of mitral stenosis. The aortic valve can only be measured in one third of cases of aortic stenosis with unidimensional echocardiography, whilst this measurement can be performed in 90 p. 100 of cases with cross-sectional echocardiography. The values obtained in 9 patients with severe aortic stenosis were 3.7 +/- 0.7 mm/m2, in 7 patients with moderate aortic stenosis: 5.4 +/- 0.8 mm/m2 and in 5 patients with mild aortic stenosis: 6.8 +/- 1,2 mm/m2. There is a clear demarcation between the different groups if the average values are compared. Therefore cross-sectional echocardiography gives reliable semi-quantitative assessment of the severity of aortic stenosis.
Adult↗
One dimensional echocardiography in univentricular hearts.
1. Echocardiography is diagnostic for univentricular hearts with two AV-valves. 2. Echocardiography does not substitute catheterization and angiocardiography, it is, however, apt to optimize and to supplement invasive procedures. 3. The number, the relative size, and the function of the AV-valves can be ascertained by echocardiography. 4. The relation of the great arteries may be suggested by transducer direction and position. 5. Echocardiographic measurements are indicative of relative pulmonic flow: Therefore echocardiography should be helpful in follow up studies. 6. Valvar and valvar-subvalvar pulmonic outflow obstructions may be suggested by echocardiography. 7. Septal remnants may be recognized by echocardiography. How significant their demonstration is to outlet chamber definition has still to be clarified.
Echocardiography↗
Cross-sectional echocardiographic diagnosis of large left atrial tumor and extracardiac tumor compressing the left atrium. Limitation of M mode echocardiography in distinguishing the two lesions.
A case of a left atrial fibrosarcoma arising from the posterior left atrial wall and two cases of an extracardiac tumor compressing the left atrium were studied with M mode and cross-sectional echocardiography. In all three cases, M mode echocardiography revealed a mass of echoes just behind the aorta and did not distinguish a left atrial from an extracardiac tumor. By contrast, cross-sectional echocardiography allowed direct visualization of the location, size and movement of the tumor in all three cases and contributed to distinguishing the two lesions. This study indicates that cross-sectional echocardiography is more accurate than M mode echocardiography in the differential diagnosis of a large left atrial tumor and extracardiac tumor compressing the left atrium.
Adult↗
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↗
Pitfalls and limitations of M-mode echocardiography.
Newer diagnostic applications as well as the ability of obtaining physiologic information has resulted in a greater interest in echocardiography. As with any new technique, certain classical criteria have not been found to be as specific and diagnostic as was originally believed. This review has focused on the more important clinical applications in echocardiography. We have not attampted to discuss every single clinical entity. A critical evaluation as to the sensitivity and specificity of echocardiography in each clinical application is necessary. A thorough knowledge of the basic principles of ultrasound, a familiarity with recording devices, and a realization of the pitfalls and limitations of the technique in each cardiac disorder is essential. Hazards of echocardiographic interpretation may actually hamper its development as a diagnostic tool. Before embarking on complex and sophisticated two-dimensional echocardiography, problems with regard to technique and interpretation of M-mode echocardiography must be overcome.
Aorta↗
[Two-dimensional echocardiography of ventricular aneurysm. Study of 38 cases with angiographic correlation].
This is a study of the data supplied by cross-sectional echocardiography in the diagnosis of post-infarction aneurysm. It involves 38 confirmed cases of myocardial infarction. The clinical, electrical, radiological and echocardiographic data (in M mode) were specified. Right anterior oblique ventriculography showed 21 posterior and 17 anterior aneurysms (4 antero-lateral, 5 apical, 8 antero-apical), and 14 mitral regurgitations. Cross-sectional echocardiography using a (30 degrees or 90 degrees) mechanical sector scanner allowed the study of the kinetics of 6 segments following 5 viewing angles: one longitudinal, two transversal, two apical. Each segment was classified according to its shape and motion: akinetic, dyskinetic or aneurysmal, and the papillary muscles of the mitral valve were assessed as normal or pathological (dense and motionless on the echogram). 35 of the 38 aneurysms seen at angiography, were detected by cross-sectional echocardiography; in one case the diagnosis could not be made for technical reasons; in two cases echocardiography was in favour of akinesia. An abnormal papillary muscle was observed in the 14 cases of mitral insufficiency. The causes of error in localisation were considered. In conclusion, cross-sectional echocardiography appears to be an excellent atraumatic procedure for the diagnosis of aneurysms and papillary muscle dysfunction.
Adult↗
Reliability of echocardiography in quantitating pericardial effusion: a prospective study.
A method of estimating the volume of pericardial effusion by echocardiography has used the difference between the cubed diameters at end-diastole of the pericardium and epicardium. To evaluate the reliability of this technique in quantitating the volume of pericardial effusion in a prospective study, 22 echocardiograms were obtained in six patients before and after 11 separate pericardiocenteses. The correlation coefficient between the actual volume of aspirated pericardial effusion and the echocardiographically estimated volume of aspirated pericardial effusion was r = 0.27 (P not significant). The volume of pericardial effusion aspirated was overestimated or underestimated by echocardiography by more than 100 ml in seven of 11 estimations (64 percent) and by more than 150 ml in five of 11 estimations (45 percent). Therefore, although echocardiography is the procedure of choice in diagnosing the presence of pericardial effusion, it is not an entirely accurate method of quantitating the volume of pericardial effusion. However, echocardiography can differentiate a large effusion from a moderate or small effusion.
Adult↗
Echocardiography in aortic root dissection and dilatation.
Six patients with aortic root dissection proved by angiography, surgery or autopsy, and six patients with aortic root dilatation were studied by echocardiography. Echocardiography was diagnostic in five or six patients with dissection and suggestive in the sixth, disclosing anterior and posterior dissection in three, anterior dissection in one and posterior dissection in one. The recording of a double echo in the aorta was the diagnostic feature. Angiography was diagnostic in four of the six patients, yielded a false negative result in one and was not performed in one. Six patients with dilatation had an enlarged aortic root by echocardiography. Left ventricular size, stroke volume, ejection fraction, aortic regurgitant flow and velocity of circumferential fiber shortening were calculated in 11 patients. Echocardiography was extremely helpful in the diagnosis, management and follow-up in patients with aortic dissection or dilatation.
Aortic Aneurysm↗
Contribuiton of M-mode echocardiography to cardiac diagnosis. An assessment in 1,000 successive patients.
The contribution of M-mode echocardiography to cardiac diagnosis was evaluated in a series of 1,000 successive patients. Among subjects in whom a presumptive clinical diagnosis had been made, echocardiography demonstrated totally unexpected findings in 10 per cent, supported the clinical diagnosis in 50 per cent and was entirely within normal limits in 19 per cent. Among patients with evidence of heart disease but no firm clinical diagnosis, echocardiography established the diagnosis in 23 per cent, including 20 per cent of all patients referred for evaluation of chest pain or arrhythmia of unclear etiology. "Missed" clinical diagnosis frequently involved patients with mitral valve prolapse, congestive cardiomyopathy, pericardial disease or asymmetrical septal hypertrophy of the heart. This study quantifies the amount of independent information contributed by echocardiography to cardiac diagnosis and demonstrates that this technic provides data of important clinical relevance in a surprisingly large number of cardiac patients.
Adult↗
Infradiaphragmatic total anomalous pulmonary venous connection to portal vein. Diagnostic implications of echocardiography.
A case of total anomalous pulmonary venous connection to the portal vein is described. The diagnosis was suspected clinically, supported by the echocardiogram, and confirmed by cardiac catheterisation, angiocardiography, and contrast echocardiography. An echo-free space lying behind the left atrium initially was thought to represent the common pulmonary vein. However, contrast echocardiography showed that this space was not the anomalous vein but probably an artefact. This paper shows that the origins of intracardiac echoes cannot always be assumed from a simple comparison of echocardiography with angiocardiographic or necropsy findings. In some cases it is necessary to introduce a marker into the echocardiogram which unequivocally originates from, and, therefore, localises, the structure under examination. Contrast echocardiography provides such a marker.
Angiocardiography↗
Echocardiography in uraemic pericarditis with effusion.
Serial chest radiology and echocardiography were performed in seven patients undergoing chronic haemodialysis who developed pericarditis. Echocardiography was helpful in making an early diagnosis of a pericardial effusion in the absence of specific clinical or radiological signs of an effusion. It also enabled changes in the thickness of a pericardial effusion to be detected, which was of value when clinical features suggestive of cardiac tamponade occurred during dialysis, and showed that the effusion could increase in size despite the use of regional heparinisation for dialysis. Resolution of a pericardial effusion could be defined accurately using echocardiography, whereas this was not possible clinically or radiologically. It is concluded that serial echocardiography is a good method of monitoring a pericardial effusion in dialysis patients.
Adult↗
Echocardiography of left ventricular masses.
The M-mode and two-dimensinal real-time echocardiographic findings in 10 patients with left ventricular masses are discussed. Two patients had left ventricular tumors and eight had left ventricular thrombi. In all cases the diagnosis was confirmed by angiography or surgery. The intracavitary and intramural left ventricular tumors were detected both by M-mode and two-dimensional echocardiography . M-mode echocardiography, however, did not detect the left ventricular thrombus in all instances. Two-dimensional echocardiography was able to identify the four large and inhomogeneous left ventricular thrombi but did not clearly identify four cases of smaller mural thrombi. Echocardiography techniques useful in detection of left ventricular masses are discussed.
Adult↗
Determination of right atrial and right ventricular size by two-dimensional echocardiography.
No data are available on determining right atrial and right ventricular size by two-dimensional echocardiography. We performed two-dimensional echocardiograms on eight human right-heart casts obtained at autopsy and on 50 patients who underwent complete left- and right-heart catheterization. Measurement of individual dimensions of the long and short axes of the right atrium and ventricle from right heart casts closely correlated with the volume of these structures as determined by water displacement. Further, individual dimensions by cross-sectional echo correlated well with actual casts dimensions. Subsequently, echocardiographic measurements of right atrial and ventricular long and short axes were obtained in the apical four-chambered view in a group of normals and compared with a group of patients with right ventricular volume overload states. Mean values for right atrial short-axis and long-axis measurements were greater in right ventricular volume overload patients than in normals: 6.5 +/- 0.3 vs 3.6 +/- 0.1 cm, and 6.0 +/- 0.3 vs 4.2 +/- 0.1 cm, respectively (both p less than 0.001). In addition, measurements of both individual dimensions as well as planed area of the right ventricle were greater in right ventricular volume overload patients than in normals: maximal short axis 6.1 +/- 0.3 vs 3.5 +/- 0.2 cm, mid-short axis 6.1 %/- 0.4 vs 2.8 +/- 0.2 cm, and area 40 +/- 2.6 vs 18 +/- 1.2 cm2 (all p less than 0.001). There were no differences in right ventricular long-axis measurement. Two-dimensional echocardiography provided better separation of normals from right ventricular volume overload patients than did M-mode techniques. Thus, two-dimensional echocardiography, with the apical four-chambered view, enables accurate visualization of the right atrium and ventricle in almost all patients. Futher, measurements of right atrial and right ventricular size by two-dimensional echocardiography readily distinguish normal patients from those with right ventricular volume overload.
Adolescent↗
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↗
Detection of the site and extent of the left ventricular asynergy in myocardial infarction by echocardiography and B-scan imaging.
The left ventricular wall motions in 53 patients with myocardial infarction and 14 normal subjects were studied by echocardiography and B-scan imaging (ultrosono-cardiokymography, ultrasono-cardiotomography). (1) Abnormal left ventricular wall motions corresponding to the electrocardiographic sites of infarction were seen in the echocardiograms in 80 % of total patients and 100 % of acute cases. Exaggerated wall motion in opposing noninfarcted areas was seen in 50 % of acute cases and 10 % of old cases. Quantitative analysis of asynergy could be made by comparing PWE, SE and those ratios to EDD-ESD of infarcted hearts with those of normal hearts. (2) In acute myocardial infarction, abnormal motions of left ventricular wall are marked in acute phase and diminished in extent gradually in recovery phase. But in some cases, echo-demonstrated segmental dyskinesis did not disappear in recovery phase, possibly due to the presence of irreversible myocardial damage. (3) Echographic thickness of the infarcted wall was less increased then normals or was not increased during systole and decreased when bulged out in some cases, indicating the existence of necrotized muscle. Moreover, multiple echoes sometimes seen between endocardial and epicardial echoes of infarcted myocardium were considered to display the fibrosis of the infarcted myocardium. (4) Abnormal echocardiographic motions of septum and posterior wall were observed in some cases who had no electrocardiographic abnormalities which suggest septal or posterior wall involvement. Echocardiography could detect another affected area of the left ventricle which could not be detected by electrocardiography. (5) Echocardiography in combination with B-scan imaging (UCKG, UCTG) can detect not only the location, but also the size and extent of myocardial infarction. (6) The results of this study indicate that echocardiography and B-scan imaging (UCKG, UCTG) are sensitive methods in detecting the size and location of asynergy and making a precise diagnosis of myocardial infarction. But it is necessary to distinguish abnormal septal and posterior wall motions observed in right ventricular volume overload, complete LBBB or PMD(COCM) from those of myocardial infarction.
Echocardiography↗