Color Flow Mapping Research Articles

Peculiarities of ultrasound diagnostics of paraurethral glands in women of fertile age

Aim. Evaluation of ultrasound diagnostics of paraurethral glands considering their types of location in women of fertile age. Materials and methods. A gynaecological, sexological and ultrasound study of 94 women in the age from 24 to 42 (average age 31.01 ± 6.60) was carried out. Determination of paraurethral glands during ultrasound study was conducted in the format of grey scale (B-mode) using the Doppler colour flow mapping and evaluation of Doppler indices of paraurethral glands both before and after sexual stimu­lation. To optimize the paraurethral glands visual view at the beginning of examination urinary bladder was catheterized and a balloon, filled with gel, was inserted into vagina. Results. The front type of paraurethral glands location was found in the accumulation of glandular tissues in regard to the distal part of urethra in 67 (71.2 %) of the examined, back type – in the area of back urethra in 19 (20.2 %), diffuse type – along urethra in 7 (7.5 %) and absence – in 1 (1.1 %). Paraurethral glands were visualized in the form of clear isoechogenic oval formation with the following dimensions: length – 2.20 ± 0.60 cm, width – 1.52 ± 0.40 cm, thickness – 1.30 ± 0.30 cm, and volume – 4.75 ± 0.50 cm3. The diameter of vessels in the paraurethral glands area was between 0.17 cm and 0.21 cm in calm state and 0.39–0.41 cm – during stimulation. Maximum systolic speed of blood flow (Vps) in calm was 8.9–11.1 cm/sec, while in sexual stimulation it was 13.9–14.1 cm/sec, resistance index (IR) – 0.60–0.62 and 0.63–0.68, respectively, pulsation index (IP) – 1.22–1.44 and 1.61–1.72, respectively. Conclusions. The ultrasound study of vessels of paraurethral glands, when Doppler method is used according to the suggested methodology, gives the opportunity not only to identify its anatomical structure, but also to determine its types. In CDC the increase of diameter of vessels and the optimization of vessels image in the area of paraurethral glands in case of sexual stimulation were marked.

Real-Time High Frame Rate Color Flow Mapping System.

Plane wave (PW) transmission (TX) can be profitably used to improve the performance of color flow mapping (CFM) systems by increasing the autocorrelation ensemble length (EL) and/or the frame rate (FR). Although high-end scanners tend to include imaging schemes using PW TX and parallel receive beams, high frame rate (HFR) CFM has been so far experimentally implemented mostly through research platforms that transmit PWs and beamform/process the received channel data off-line. In this article, full real-time implementation of PW CFM with continuous-time clutter filtering and extended FR/EL is reported. The field-programmable gate arrays (FPGAs) and digital signal processors (DSPs) onboard the ULA-OP 256 research scanner were programmed to perform high-speed parallel beamforming and autocorrelation-based CFM processing, respectively. Different strategies were tested, in which the TX of PWs for CFM is either continuous or interleaved with the TX of packets of B-mode pulses. A fourth-order Chebyshev continuous-time high-pass filter with programmable cutoff frequency was implemented and its clutter rejection performance was positively compared with that obtained when operating on packet data. CFM FRs up to 575 were obtained. The possibility of programming the autocorrelation EL up to 64 permitted to detect flow with high sensitivity and accuracy (average relative errors down to 0.4% ± 8.4%). In vivo HFR movies are presented, showing the dynamics of flow in the common carotid artery, which highlight the presence of secondary flow components.

Echocardiographic evaluation of ventricular septal defects.

Ventricular septal defects (VSDs) are the most common forms of acyanotic congenital heart disease accounting for 37% of congenital heart disease in children. A VSD is defined by parts of the ventricular septum involved. There are four major types of VSDs: perimembranous, muscular, outlet, and inlet VSDs. Echocardiography is the most important clinical tool to help diagnose and characterize a VSD. Although most VSDs are clinically nonsignificant or close on their own, echocardiography with Doppler and color flow mapping can be used to provide accurate anatomic and hemodynamic evaluation of VSDs in order to determine if surgical or transcatheter-based intervention is needed. Hence, understanding how to use echocardiography to characterize VSDs is of crucial importance when caring for patients with adult congenital heart disease.

The application of ultrasonography to select tactics for treatment of women of reproductive age with uterine leiomyoma

Objective. To study the condition of the pelvic organs in women of reproductive age with uterine leiomyoma UL, depending on the type of treatment based on ultrasonographic monitoring.Materials and methods. 299 women of reproductive age were examined. Patients were divided into 3 groups: 1 group consisted of 159 women with uterine leiomyoma (UL) who underwent surgical treatment, 2 group – 120 women with UL who underwent conservative treatment, 3 control group consisted of 20 healthy women of reproductive age. In order to obtain the most complete information about the size of the uterus, the structure and topography of myomas, the features of their vascularization, patients underwent ultrasound before and 3 months after treatment.Results. Ultrasound examination of the average parameters of the uterine body in the main groups showed an excess of these indicators relative to the control group (3.2 times in group 1 and 1.3 times in group 2). Uterine volume was greater in women of group 1 compared with women of groups 2 and 3 (p <0.05). In most cases, in 139 (49.0%) women of the main groups, the localization of fibroids was intramural with central growth, without changing the configuration of the uterus from the outside and was not deformed cavity. Whereas, intramural nodes with centripetal growth deformed the uterine cavity in 39 (14.0%) cases, and centrifugal - in 100 (36.0%) subjects - its contour. Mixed and central types of angioarchitectonics were characteristic of women with the largest uterine sizes. In dynamic ultrasound examination in women after conservative myomectomy who did not receive hormone therapy, the level of myometrial perfusion was higher than in those who received gonadotropin-releasing hormones before and after treatment, which may be more prognostically favorable for UL recurrence. Women in group 2 after receiving conservative treatment had a positive tendency to reduce the volume of the uterus and fibroids.Conclusions. Ultrasound diagnostics can be considered a highly informative, non-invasive method that helps to identify the presence, location, structure, size of the myoma, the presence of concomitant pathology of the pelvic organs, as well as in addition to Doppler color flow mapping and pulsed Doppler blood allows us to detect the presence of tumor blood circulation. Echographic and Doppler evaluation of uterine leiomyoma with peculiarities of vascularization in the diagnostic algorithm helps to differentiate the choice of the method of treatment (conservative or surgical).

Feasibility of intracardiac echocardiography for assessment of renal blood flow in humans

Abstract Background Intracardiac echocardiography (ICE) is routinely used for guiding cardiac ablation procedures. However, the potential of ICE for measurement of renal artery (RA) blood flow (RABF) has not been fully exploited. Aims To investigate the feasibility of ICE for the assessment of RABF and to evaluate its reproducibility in humans. Methods The study included 15 patients undergoing catheter ablation of atrial fibrillation guided by ICE (age: 61±14 years, body mass index: 30±5 kg/m2, left ventricular ejection fraction: 57±6%, serum creatinine: 80±29 μmol/l). During sinus rhythm, the ICE probe was withdrawn from the right atrium to the inferior vena cava until the right RA with its ostium became visible. Blood flow in the RA was visualized by colour flow mapping. The RA diameter was measured at 10 mm from the ostium. RABF at this location was measured by pulse wave Doppler. Velocity-time integral (VTI) was delineated manually and averaged over five consecutive beats. RABF was calculated by the formula: RABF = (RA radius)2 x π x VTI x heart rate. To assess reproducibility of the method, the ICE probe was repositioned in the right atrium and the measurement of RABF was repeated by the same operator. Results The right RA was visualized in all 15 patients. No procedure-related clinical complications occurred. The mean RA radius was 2.5±0.4 mm. In all cases, the angle of incidence during the measurement of VTI was <5°. The mean RABF was 403±163 and 399±156 ml/min during the first and the second measurement, respectively (p=0.7 by a paired t-test, coefficient of variation 5,3±3,8%; see Figure for Bland-Altman plot). Conclusions This study demonstrated that measurement of RABF by ICE is feasible and has reasonable intra-observer reproducibility. The method can be used to study RABF during various interventions and hemodynamic conditions. Figure 1. Intra-individual reproducibility Funding Acknowledgement Type of funding source: None

HIDDEN DANGER: A RARE ANOMALOUS CORONARY ARTERY

SESSION TITLE: Medical Student/Resident Imaging Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Anomalous aortic origin of a coronary artery (AAOCA) in the general population is quite rare. Generally, they are typically seen in 1-2% of the population that undergo coronary angiography. Although overall rare, these anomalies have a risk of sudden cardiac death (SCD), which is largely unknown, so it is important to properly evaluate them if seen in practice. CASE PRESENTATION: The patient is a 75-year-old woman with a past medical history of severe aortic stenosis who presented for a left heart cardiac catheterization prior to planned aortic valve replacement. Subsequent catheterization revealed evidence of an anomalous right coronary artery as seen in Figure 1. Consequently, coronary computed tomography (CT) was advised to further delineate the anatomy prior to aortic valve replacement in order to mitigate risks of surgery. The CT determined that this anomalous right coronary artery coursed in between the pulmonary artery and the aorta. A heart team discussion was started about performing a transcatheter aortic valve replacement (TAVR) versus a surgical aortic valve replacement. The patient was deemed a high risk due to the anomalous course of the right coronary artery and was subsequently sent for a single vessel bypass with a saphenous vein graft (SVG) to the distal RCA and a surgical aortic valve replacement. DISCUSSION: Overall, there is no typical way that patients present with AAOCA. Most are found incidentally on an echocardiogram or computed tomography (CT) angiogram that is performed for another reason, such as a heart murmur. The best method to identify AAOCA is a transthoracic echocardiogram with doppler color flow mapping due to availability, cost-effectiveness, and lack of radiation exposure as compared to coronary angiography. If needed, coronary CT angiography or cardiac MRI can be used to obtain better visualization of the coronary artery anatomy to confirm the diagnosis. For our patient, due to the high risk location, the heart team recommended a coronary artery bypass graft (CABG) along with a surgical aortic valve replacement. TAVR is typically chosen over surgical aortic valve replacement due to comparable outcomes with the benefit of TAVR not requiring open heart surgery. However, CABG requires an open heart surgery, so it was agreed that surgical aortic valve replacement would result in better outcomes since the patient requires an invasive surgery either way. CONCLUSIONS: This case highlights the importance of delineating the anatomy prior to going to percutaneous valve replacement in the setting of anomalous coronary arteries. Surgical intervention is recommended for those with signs of myocardial ischemia, but intervention in asymptomatic patients depends on interarterial course. AAOCA with an intramural course is associated with SCD due to ischemia and arrhythmias, so it is important to choose the correct surgical approach. Reference #1: Angelini, P. (2007). Coronary Artery Anomalies. Circulation, 115(10), 1296-1305. doi:10.1161/circulationaha.106.618082 Reference #2: Brothers, J. A., Frommelt, M. A., Jaquiss, R. D., Myerburg, R. J., Fraser, C. D., & Tweddell, J. S. (2017). Expert consensus guidelines: Anomalous aortic origin of a coronary artery. The Journal of Thoracic and Cardiovascular Surgery, 153(6), 1440-1457. doi:10.1016/j.jtcvs.2016.06.066 DISCLOSURES: No relevant relationships by Akash Patel, source=Web Response No relevant relationships by Sagar Patel, source=Web Response

Diagnostic value of multiparametric ultrasound and the EU-TIRADS system for differentiation of focal thyroid lesions

Background. Over the last 15 years, there have been many recommendations for the management of patients with thyroid nodules, based on the assessment of various ultrasound (US) criteria in B-mode. In 2020, the EUTIRADS system (2017) was included in Russian Clinical Practice Guidelines. Shear wave elastography (SWE) increases the diagnostic efficacy of ultrasonic B-mode examination of thyroid nodules and can be recommended for inclusion in the existing classification system. Objective. To assess the diagnostic efficacy of multiparametric US combining SWE and color flow mapping in differentiating between benign and malignant thyroid nodules to define their stage according to the EUTIRADS system for deciding on the need for fine-needle aspiration biopsy. Material and methods. A total of 150 thyroid nodules from 116 patients were analyzed. Lesions were then classified according to the EU-TIRADS system, SWE with an assessment of the color map and tissue stiffness was performed (Emean). In all tumors, cytological and histological (in operated patients) verification was carried out. Results. After B-mode US with color flow mapping, differentiation of palpable thyroid abnormalities by the EUTIRADS system was carried out. 78 nodules were classified as EU-TIRADS 2 (52%), 42 – EU-TIRADS 3 (28%), 26 – EU-TIRADS 4 (17.3%), 4 – EU-TIRADS 5 (2.7%). On cytological examination 42 tumor nodules were detected. Of these, 6 (14.3%) cases were reported as papillary thyroid carcinoma, 36 (85.7%) as follicular neoplasm, 22 (61%) among the last prove to be follicular carcinoma. Qualitative and quantitative evaluation of elastograms was performed. Benign nodules were colored primarily in blue, while suspicious for malignancy revealed red areas of different size. Elasticity index in benign nodules was 24.3 ± 5.63 kPa for colloid goiter, 27.8 ± 6.35 kPa for cellular goiter; in suspicious for malignancy – 80.9 ± 50.9 kPa for follicular neoplasm, 114 ± 56.8 kPa – for papillary thyroid cancer. The stiffness cutoff value for malignancy indicated with ROC-analysis was estimated as 45.4 kPa. Mean elasticity index (kPa) was significantly higher in suspicious for malignancy nodules than in benign nodules (р < 0.05). Of 120 (80%) nodules, primarily assessed as benign and defined as EU-TIRADS 2 and 3, 18 (12%) nodules after SWE revealed areas of high stiffness exceeding the cutoff value. After that, these nodules were transferred to EU-TIRADS 4 and 5, and these stages require fine-needle aspiration. Of these, 11 (7.3%) cases were reported as follicular neoplasm, 6 (4%) among the last prove to be follicular thyroid carcinoma. Conclusion. Using multiparametric approach with SWE will give the opportunity to classify correctly the nodule according to the EU-TIRADS and to identify greater number of thyroid tumors for fine-needle aspiration. SWE made it possible to increase the specificity of US using the EU-TIRADS system. The characteristics of the SWE score were: sensitivity = 81%, specificity = 90.3%, positive predictive value = 88%, negative predictive value = 91%, and accuracy of comprehensive study = 88.4%.

A Novel Aortic Regurgitation Model from Cusp Prolapse with Hemodynamic Validation Using an Ex Vivo Left Heart Simulator.

Although ex vivo simulation is a valuable tool for surgical optimization, a disease model that mimics human aortic regurgitation (AR) from cusp prolapse is needed to accurately examine valve biomechanics. To simulate AR, four porcine aortic valves were explanted, and the commissure between the two largest leaflets was detached and re-implanted 5mm lower to induce cusp prolapse. Four additional valves were tested in their native state as controls. All valves were tested in a heart simulator while hemodynamics, high-speed videography, and echocardiography data were collected. Our AR model successfully reproduced cusp prolapse with significant increase in regurgitant volume compared with that of the controls (23.2 ± 8.9 versus 2.8 ± 1.6ml, p = 0.017). Hemodynamics data confirmed the simulation of physiologic disease conditions. Echocardiography and color flow mapping demonstrated the presence of mild to moderate eccentric regurgitation in our AR model. This novel AR model has enormous potential in the evaluation of valve biomechanics and surgical repair techniques. Graphical Abstract.

DOPPLER ASSESSMENT OF TROPHOBLASTIC BLOOD FLOW TO PREDICT ADVERSE PREGNANCY OUTCOME

Objective. To evaluate the diagnostic utility of trophoblastic blood flow Doppler parameters in predicting an adverse pregnancy outcome.Material and methods. This was a retrospective study of 218 pregnancies of women between 8 and 11 weeks’ gestation. Depending on the pregnancy outcome, patients were divided into 4 clinical groups. All women underwent an ultrasound examination using Voluson S8, Voluson E8 with high-quality grey scale, color flow mapping and pulsed-wave Doppler modes. We used a program for obstetric research with the following instrument settings: 100 MHz Doppler frequency, thermal index (TI) was <1, mechanical index (MI) was 1. The examination time did not exceed 20 minutes. There was no radiation exposure. Transvaginal and transabdominal sonographies were performed.Results. To form a risk group for an adverse fetal outcome due to fetoplacental insufficiency, it is necessary to identify ultrasound markers of inadequate placental perfusion by means of a Doppler study of fetoplacental blood flow. For this purpose, we examined 218 pregnancies of women between 8 and 11 weeks’ gestation to determine the diagnostic utility of various parameters: resistivity index, pulsatility index, systolic/diastolic ratio and chorionic vascularization index (k, %). We received results proving high sensitivity (76.9%) and specificity (89.7%) of the chorionic vascularization index (k, %), as well as low specificity (54.7%) and high sensitivity (81.5%) of trophoblastic blood flow resistivity index.Conclusion. Thus, the chorionic vascularization index (k, %) is of high diagnostic utility for predicting an adverse fetal outcome.

Regarding the efficacy of low-level laser therapy in infrared spectrum in male secretory infertility

The aim of study was to assess the effect of low-level laser therapy (LLLT) in infrared spectrum on the main sperm parameters, sperm DNA fragmentation, MAR-test in men with nonobstructive pathozoospermia.
 Patients and methods. The study included 50 men from 23 to 40 years old (average age 31.0 5.4), suffering from secretory infertility. Physical examination, semen analysis, MAR-test, sperm DNA fragmentation analysis, male hormone panel, assessment of prostate microbiocenosis, testes and prostate tumor markers, ultrasound examination with color flow mapping were performed. After the examination patients had a course of LLLT in infrared spectrum on a Rubin-C device. 10 laser therapy procedures were carried out every two days with active luminescence for 3 minutes of both testicles. Control examination was done immediately after the LLLT, within one and two months.
 Results. Increase in sperm concentration (by an average of 25%), active mobile sperm forms (by an average of 25%), morphologically normal sperm forms (by an average of 58%) was noticed after the LLLT. MAR-test decreased by an average of 69% after the therapy. From 10 patients with initially increased sperm DNA fragmentation level, in 9 patients its level became normal after the treatment. Increase in concentration of total and free testosterone in blood plasma was noticed within one month after the LLLT. As a result of the treatment pregnancies developed in 11 (22%) out of 50 couples.
 Conclusions. LLLT in infrared spectrum improves sperm quality in patients with secretory infertility, decreases MAR-test level, normalizes sperm DNA-fragmentation level, increases chances of pregnancy in reproductive cycle, which allows to recommend this method as preparation for assisted reproductive technologies.

Fetal Echo: Application of Four Chamber View and Additional Views in Obstetrics Anomaly Scan and Third Trimester Low-Risk Pregnancy

This article presents a step-wise process to evaluate fetal cardiac anatomy by the radiologist and the pediatric cardiologist, to become more familiar while assessing the four chamber view including the views for the outflow tracts. The additional views include bicaval view, three-vessel view (3VV), three- vessel trachea view (3VT), and aortic arch view. M-mode, color flow mapping and pulse Doppler ultrasound are useful to evaluate cardiac anatomy and function. If the heart does not look normal, the patient should be referred to dedicated fetal echo centre for detailed evaluation. Ductus venosus Doppler, cardiovascular profile score and visualization of thymus in 3-vessel view have also been described in brief.

P1461 Concomitant potential cardioembolic sources in a patient with an acute ischemia of the limb

Abstract Introduction Transesophageal echocardiography (TEE) is the gold standard exam to look for a cardioembolic source in a patient with an otherwise unexplained suspected systemic ischemic event. Purpose: This clinical case aims to illustrate the importance of a thorough TEE evaluation in the presence of a suspected systemic emboli, and to not neglect thoracic aorta evaluation when a potential intracardiac cause has been detected. Case presentation: We present the case of a 55-year-old man, obese (BMI 30kg/m2), active smoker, with no past medical history or medication, and whose father died from an unspecified cardiovascular cause at 45 years-old. He was admitted to the hospital because of an acute ischemia of the right lower limb, for which he underwent urgent percutaneous femoral embolectomy of the limb, with success. During hospitalization, he was referred for a TEE, which showed valves and cavities with no evidence of potential embolic sources. However, he had a thin and hypermobile atrial septum, with no obvious defect after color flow mapping, but with a patent foramen oval (PFO) that was detected after agitated saline injection associated with a Valsalva maneuver, with the passage of 5-25 microbubbles (grade 2/4 shunt) and an atrial septum aneurysm (ASA), with an excursion of the fossa ovalis towards the left atrium of 10.1mm (Figure 1). The ascending aorta was normal, but the descending aorta depicted 2 hypermobile masses, 1 starting at 35cm from the dental arch (transversal area: 0,52cm2), the longest (7cm) starting at 32cm and ending at the aortic arch (transversal area: 1,76cm2). An angio-CT was immediately performed, which depicted an atheromatous calcified plaque in the terminal portion of the aortic arch, giving rise to the image suggestive of thrombus, and extending for about 6cm to the medium third of the descending thoracic aorta. The remaining portions of the aorta and iliac arteries depicted diffuse atheromatous and partially calcified plaques (Figure 2). The patient was submitted to an urgent thoracic endovascular aortic repair with a 26x10cm prosthesis implantation with occlusion of the left subclavian artery and an adequate final clinical result. Syphilis and auto-immune disease were excluded and a diffuse atheromatous disease of the aorta was assumed as the cause of the thrombus and the embolic event. After 16 days, he was discharged asymptomatic and with no signs of chronic ischemia, treated with oral anticoagulation with rivaroxabano, high-dose statin and strict smoking cessation. Conclusion: Cardioembolic source is a heterogeneous entity. In this patient, 2 potential cardioembolic sources were detected: while the PFO and ASA are minor or unclear risk sources of emboli, TEE also allowed for the detection of a large thrombus arising from an atherosclerotic calcified plaque in the thoracic aorta, which was considered a major risk source, thus implying urgent surgery to obviate the risk of further embolic events. Abstract P1461 Figure. Fig.1.POF and ASA;Fig.2.Aortic Thrombus

354 Incidence and Implication of Persistently Positive Agitated Saline Contrast Studies (ASCS) at 6 Months Post-transcatheter Patent Foramen Ovale (PFO) Closure - Is the Juice Worth the Squeeze?

Transcatheter PFO closure following cryptogenic stroke is performed to prevent recurrent paradoxical embolisation. ASCS during follow-up transthoracic echocardiography (TTE) is routinely undertaken post-procedure to assess for residual right-to-left shunting (RLS). A positive “bubble” study may indicate incomplete device closure/endothelization, or undiagnosed co-existent shunt, however the clinical relevance remains undefined. To determine the incidence of positive ASCS at 6 months post-PFO device closure following cryptogenic stroke and its predictive value for recurrent thromboembolic events. A retrospective review of all TTEs performed at 6 months post-transcatheter PFO closure with an Amplatzer device was undertaken. In patients with a positive ASCS, medical records were then audited for any documented cerebral embolic related re-presentations. 86 patients (49% females; mean age 42±9 yrs.) were included. 30 (35%) cases were positive ASCS, of which 14 (47%) were early (Bubbles in the left heart within <5 cardiac cycles) suggestive of atrial level shunting and 16 (53%) were late (>5 cardiac cycles) implying concomitant extra-cardiac shunting. 2 patients had evidence of peri-closure device shunting on colour flow mapping without the need for ASCS. Over a median follow-up of 3.3 yrs., only 1 patient with any evidence of a residual inter-atrial or intra-pulmonary connection suffered a recurrent stroke. A positive ASCS 6-months after PFO device closure, indicative of persistent RLS, is relatively common. This in isolation does not appear to translate into significant repeat thromboembolic complications. Larger prospective studies with serial ASCS and longer-term follow-up may be useful for further validation.

P670 RV function in adult patients with repaired tetralogy of Fallot: assessment by three-dimensional echocardiography, comparison to CMR findings and relationship to pulmonary artery distensibility

Abstract Purpose The purpose of this study was to examine right ventricular (RV) function by three-dimensional speckle-tracking echocardiography (3DSTE) in patients after correction of tetralogy of Fallot (TF), the accuracy of 3DSTE compared to cardiovascular magnetic resonance (CMR) findings and assess pulmonary arterial (PA) distensibility in order to achieve a more comprehensive understanding of the matching between RV performance and PA load. Methods Twenty-one patients (mean age 39 ± 16 years) with repaired TF and twenty-one age-matched healthy subjects selected as controls were studied. CMR findings were available in 14 patients. RV volumes, RV ejection fraction (RVEF) and RV longitudinal and circumferential strains were calculated by three-dimensional echocardiography and three-dimensional speckle tracking echocardiography. The main pulmonary artery was interrogated by color, pulsed, and continuous-wave Doppler. Pulmonary regurgitation (PR) was assessed by color-flow mapping and graded as none, mild, or greater than mild using the measurement of the regurgitant jet width in relation to the outflow tract diameter. Right pulmonary artery (PA) was visualized from suprasternal view by two-dimensional echocardiography. Tissue Doppler Imaging (TDI) mode was activated in B-mode imaging to examine arterial motion, then mode was changed to color-mode with the beam line aligned perpendicular to the superior and inferior walls of the right PA. PA distensibility and strain were determined. Data analysis was performed offline. Results Overall, 3D RVEF and RV longitudinal strain were reduced in TF patients compared to the control group. Nine patients had moderate or moderate-to-severe PR. PA strain and distensibility were decreased (p = 0.003) compared with controls, both in the presence and absence of PR. PA strain had a positive correlation with RVEF (r = 0.79, p &amp;lt; 0.005) and RV strain (r = 0.82, p &amp;lt; 0.001). RV end-diastolic and end-systolic volumes by 3DE correlated with the respective parameters by CMR (r = 0.88,p &amp;lt; 0.001 and r = 0.87,p &amp;lt; 0.005 respectively). Patients with moderate-to-severe PR had more prominent PA strain changes (p = 0.02). Conclusions Three-dimensional right ventricular ejection fraction and RV strain are impaired in patients with repaired TF, in agreement with CMR data. Reduced PA strain is associated with reduced RV 3DSTE parameters and is more pronounced in the presence of pulmonary regurgitation.

Ventricular Septal Defects and Rates of Spontaneous Closure

Research Article| January 01 2020 Ventricular Septal Defects and Rates of Spontaneous Closure AAP Grand Rounds (2020) 43 (1): 7. https://doi.org/10.1542/gr.43-1-7 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Ventricular Septal Defects and Rates of Spontaneous Closure. AAP Grand Rounds January 2020; 43 (1): 7. https://doi.org/10.1542/gr.43-1-7 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: ventricular septal defect, echocardiography Source: Zhao QM, Niu C, Liu F, et al. Spontaneous closure rates of ventricular septal defects (6,750 consecutive neonates). Am J Cardiol. 2019; 124(4): 613– 617; doi: https://doi.org/10.1016/j.amjcard.2019.05.022Google Scholar Investigators from the Children’s Hospital of Fudan University (CHFU), China, and the Royal Hospital for Children, Scotland, conducted a prospective cohort study to assess the incidence of spontaneous closure of ventricular septal defects (VSDs) in infants. Newborns born at 1 of 3 maternity facilities in China during the February–July 2011 study period were enrolled. All newborns received echocardiography before discharge. Newborns with a VSD also received echocardiography at 3, 6, and 12 months of age and then annually until age 7, or until spontaneous closure or surgical intervention, whichever came first. After 6 months of age, newborns with VSDs had follow-up at the Pediatric Heart Center at the CHFU, where standard of care includes surgical or interventional therapy only for infants with VSDs with clinical symptoms or presentation of left heart overload. Demographics and clinical characteristics (gender, birthweight, and gestational age) were collected at enrollment. The primary exposure variable was VSD at birth, classified as perimembranous, muscular, or doubly committed juxta-arterial (DCJA). Size of the VSD was categorized as <4mm or ≥4mm. Muscular VSDs were further categorized into midseptal, apical, posteroinferior, and anterosuperior. The primary outcome variable was spontaneous closure of the VSD by age 7, defined as the absence of color flow mapping on echocardiography. Investigators assessed the proportion of infants with VSD, the proportion with spontaneous closure, and the time to spontaneous closure by VSD type. There were 6,750 newborns born during the study period, all of whom received echocardiography at birth. VSDs were detected in 113 (1.67%), the majority of which were muscular (64%). One patient with a VSD was lost to follow-up. Overall, spontaneous closure occurred in 88 of the 112 of infants with VSD who had complete follow-up data: 18 of 35 (51%) infants with perimembranous VSD, 70 of 72 (97%) infants with muscular VSD, and 0 of 6 infants with DCJA. Factors associated with persistence of VSD were perimembranous (vs muscular) site and size ≥4 mm (vs <4 mm). There was no significant difference in time to spontaneous closure among those with different types of muscular VSDs. The investigators conclude that VSDs are uncommon and that most close spontaneously. Dr Spar has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. VSDs are the most common congenital heart defect (CHD), occurring in 40% of patients with CHDs.1 Previous studies have reported a prevalence of VSDs in the population ranging from 2.5–3.9 per 1,000 live births.2,3 Spontaneous closure of VSDs can occur in up to 90% of defects, mostly with smaller defects.4 Even in those with clinically significant VSDs, closure can occur in 25% (mostly small- to medium-sized VSDs).4 Large shunts can lead to... You do not currently have access to this content.

AIUM Practice Parameter for the Performance of Fetal Echocardiography.

AIUM Practice Parameter for the Performance of Fetal Echocardiography.

168 Comparison of different Doppler ultrasound settings for pregnancy diagnosis based on corpus luteum perfusion at 21 days after AI in beef cattle

Colour Doppler ultrasonography of the corpus luteum (CL) can be used for early pregnancy diagnosis to improve reproductive efficiency and increase the use of AI in beef cattle. The objective of the present study was to determine the diagnostic performance of different Doppler ultrasonography settings for pregnancy diagnosis based on CL perfusion at 21 days after fixed-time AI in beef heifers and cows. Yearling Angus-cross heifers (n=25) and suckled Angus-cross cows (n=84) aged 2-13 years were submitted to a 5-day CO-Synch + controlled internal drug release (CIDR) and timed AI at 60 or 72h after CIDR removal for heifers and cows, respectively. Animals were evaluated by a single operator using colour Doppler ultrasonography (Esaote MyLab Delta) at Day 21. Three settings for colour flow mapping (720, 960, and 1500Hz) and one setting for power Doppler (960Hz), which differed in pulse repetition frequency, were evaluated. The other settings remained unchanged with a probe frequency of 6.3MHz, wall filter of 3, and gain of 61. The pregnancy status (pregnant or non-pregnant) of cows and heifers was determined at 21 days following insemination using colour Doppler ultrasonography. Cows and heifers were considered to be pregnant if the CL blood flow area covered &amp;gt;10% of the periphery of the CL and contained at least two colour internal tracts penetrating towards the centre of the CL. Cattle were evaluated using transrectal B-mode ultrasonography on Day 35 to determine actual pregnancy status. Differences between diagnostic performance variables were evaluated using logistic regression, and setting, category (heifer or cow), and the interaction were included as fixed effects. Pregnancies per AI at Day 35 after fixed-time AI were 47.7% (52/109). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for pregnancy diagnosis at Day 21 for each setting are included in Table 1. There were no differences in sensitivity and NPV between settings (P&amp;gt;0.9), category (P&amp;gt;0.9), or the interaction (P&amp;gt;0.9). There was no effect of setting (P&amp;gt;0.5) or category×setting interaction (P&amp;gt;0.8) on specificity and PPV. There was, however, an effect of category (P&amp;lt;0.01). Colour Doppler ultrasonography had less specificity (59.1% compared with 90.2%) and PPV (75% compared with 89.3%) in heifers than in cows. In conclusion, colour Doppler ultrasonography settings that were evaluated did not affect the diagnostic performance for pregnancy diagnosis at Day 21 after AI, although, numerically the colour flow mapping at 960Hz appears to maximise diagnostic accuracy. In addition, the false-positive rate was greater in heifers, which warrants further research. Table 1.Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for pregnancy diagnosis for four colour Doppler ultrasound settings (colour flow mapping (CFM) at 720, 960, and 1500Hz and power Doppler (PWD) at 960Hz) at 21 days after fixed-time AI Item CFM720 CFM960 CFM1500 PWD960 Sensitivity,% 100 100 92.3 100 Specificity,% 80.7 87.7 87.7 80.7 PPV,% 82.5 88.1 87.3 82.5 NPV,% 100 100 92.6 100

Helical Blood Flow in Hemodynamically Significant Carotid Stenosis.

To define helical blood flow (HBF) characteristics in hemodynamically significant atherosclerotic stenosis of the internal carotid artery (ICA) by means of duplex scanning. Twenty-five hemodynamically significant (65.0% [range, 63.0%-69.0%]) carotid stenoses were examined in 23 patients. The severity of the stenosis was calculated by the European Carotid Surgery Trial grading method by transverse section scanning in the B-mode. Rotational components were estimated in color flow mapping by transverse-section scanning of a vessel at the most narrowed site, as well as in the prestenotic and poststenotic segments. A quantitative evaluation of HBF was performed on the basis of pulsed wave Doppler imaging of longitudinal and transverse sections of the arterial lumen. Helical blood flow was most often (68%) registered in the poststenotic segment of the ICA as a single vortex (52%) or double vortices (16%). At the most narrowed site, HBF was registered in 48% of the cases (44% single vortex and 4% double vortices), whereas in the prestenotic segment of the blood vessel, it was registered in only 16% of the cases (8% single vortex and 8% double vortices). The time-averaged maximum blood flow velocities at the most narrowed site were 88.5 cm/s (25th-75th percentiles, 73.8-127.8 cm/s) for the axial component and 33.1 cm/s (22.7-40.9 cm/s) for the rotational component. The calculated summary velocity of motion of the blood particles in helical paths was 92.2 cm/s (75.7-144.2 cm/s). It has been shown that HBF can be registered by Doppler ultrasound in atherosclerotic stenosis, and its registration rate increases while passing through the narrowed segment of the ICA.

Clutter Filtering for Diagnostic Ultrasound Color Flow Imaging

Clutter filtering plays an important role in constructing a quality color flow map in ultrasound Doppler imaging. Signals from slow-moving tissues and vessel walls are clutter as they often mix with reflections from blood and should be suppressed for the further correct estimation of flow parameters. Their complete suppression in color flow imaging is difficult, because these signals on average are 40-60 dB more powerful than the signals from blood, the length of the Doppler sequence is very short, and there is always a demand for a real-time operation. This article provides a general model of the Doppler signal and discusses filters based on polynomial and adaptive regression, empirical mode decomposition, and prospective combined approaches to blood flow filtering.

Ultrasonic Vascular Vector Flow Mapping for 2-D Flow Estimation

A vascular vector flow mapping (VFM) method visualizes 2-D cardiac flow dynamics by estimating the radial component of flow from the Doppler velocities and wall motion velocities using the mass conservation equation. Although VFM provides 2-D flow, the algorithm is applicable only to bounded regions. Here, a modified VFM algorithm, vascular VFM, is proposed so that the velocities are estimated regardless of the flow geometry. To validate the algorithm, a phantom mimicking a carotid artery was fabricated and VFM velocities were compared with optical particle image velocimetry (PIV) data acquired in the same imaged plane. The validation results indicate that given optimal beam angle condition, VFM velocitiy is fairly accurate, where the correlation coefficient R between VFM and PIV velocities is 0.95. The standard deviation of the total VFM error, normalized by the maximum velocity, ranged from 8.1% to 16.3%, whereas the standard deviation of the measured input errors ranged from 8.9% to 12.7% for color flow mapping and from 4.5% to 5.9% for subbeam calculation. These results indicate that vascular VFM is reliable as its accuracy is comparable to that of conventional Doppler-flow images.