Guidance Of Color Doppler Research Articles

Normal physiologic coronary flow velocity gradient across the left anterior descending artery in healthy asymptomatic subjects

Aim: Coronary flow velocity (CFV) can be obtained with transthoracic echocardiography (TTE) in the left anterior descending coronary artery (LAD). The physiologic flow velocity gradient across the different segments of LAD has not been established. This study aims to assess the normal values of resting CFV in proximal, mid, and distal LAD. Methods: In a single center, prospective, observational study design, TTE was attempted on 110 consecutive, asymptomatic middle-aged subjects (age = 55 years, 46% males) with a low likelihood of coronary artery disease (< 5%). Resting CFV in the LAD was assessed with high-end machines, dedicated coronary pre-set, and high-frequency transducers by pulsed-wave Doppler under color-Doppler guidance in the proximal, mid, and distal segments. Results: The technical success rate for CFV imaging was lowest for the proximal (101/110, 92%), intermediate for mid (106/110, 96%), and highest for the distal segment (108/110, 98%). All 3 segments were interpretable in 101 subjects. CFV was highest in proximal segments (38.6 cm/s ± 3.9 cm/s), intermediate in mid segments (34.3 cm/s ± 6.04 cm/s, P < 0.01 vs. proximal), and lowest in distal segments (28.1 cm/s ± 1.7 cm/s, P < 0.01 vs. proximal and vs. mid). Conclusions: A resting evaluation of CFV-LAD can be obtained by TTE in the large majority of consecutive subjects referred to the echocardiography laboratory. Feasibility is highest for distal and lowest for proximal-LAD segments. There is a clear physiologic gradient of CFV with decreasing values, of about 10% for each step, going from proximal to mid and distal segments of LAD. When resting CFV is considered, the site of the sampling is important to obtain comparable and physiologically meaningful data.

A clinical study of ultrasound-guided celiac plexus block

Objective To explore the clinical efficacy of celiac plexus neurolysis (CPN) for abdominal pain associated with advanced cancer under guidance of color Doppler ultrasound.Methods CPN with absolute alcohol was performed under guidance of color Doppler ultrasound.The relief of abdominal pain was observed.Results The rate of pain relief was 56.7％ on day 2,93.3％ on day 3,and 96.7％ on day 8,and 72.7％ on week 12 and 54.5％ on week 24 after treatment.Conclusions Ultrasound-guided celiac plexus block is a safe,effective approach for severe abdominal pain caused by advanced pancreatic cancer and peritoneal metastasis. Key words: Color Doppler ultrasound; Celiac plexus block; Clinical efficacy

Abstract 9721: Clinical Significance of Transthoracic Doppler Echocardiography in Patients With a Proximal Left Coronary Artery Lesion That Could Not be Evaluated With Computed Tomography Angiography

Background The aim of this study was to evaluate the clinical significance of transthoracic Doppler echocardiography (TTDE) in patients with suspected angina pectoris (AP), who had a proximal left anterior descending coronary artery (LAD) lesion that was difficult to evaluate with computed tomography coronary angiography (CTCA). Methods Among 387 consecutive patients with suspected AP who had CTCA performed, 58 had a proximal LAD lesion that was difficult to evaluate and were included in this study. These patients had TTDE and coronary angiography performed on the same day (mean age, 74±8 yrs; men, 39; Agaston score, 1110 ± 1360). Proximal left coronary flow was measured in the short axis (SAX) at the aortic root using color Doppler guidance. When coronary flow showed color aliasing, the color velocity range was gradually increased until color aliasing nearly disappeared. When color aliasing did not disappear, the color baseline was shifted until the color flow showed “isovelocity”. Using QCA-CMS analytical software, severe and moderate stenoses were defined as a %diameter stenosis > than 70% and 40-70%, respectively. Results Proximal coronary flow was detected in 45 of 58 patients. In these 45 patients, there were 5 patients with severe stenosis and 14 patients with moderate stenosis. The isovelocity in the two groups with stenosis was significantly higher than that in the group without stenosis (148±42 vs 97±48 vs 41±21 cm/s, p<0.001). ROC curve analysis showed that the optimal cut-off values of isovelocity to detect severe and moderate stenoses were > 92 cm/s (area under the curve, 0.96; sensitivity, 100%; specificity, 90%) and > 57 cm/s (area under curve, 0.92; sensitivity, 90%; specificity, 77%). Conclusion TTDE could evaluate proximal LAD stenosis with good accuracy in about 80% patients with AP, who had a proximal LAD that could not be evaluated with CTCA. This method may play a complementary role to identify latent proximal LAD stenosis.

Clinical Effectiveness of Multiple-Drug Injection Treatment in Unruptured Ectopic Pregnancies

To study the effect of local interventional treatment of unruptured ectopic pregnancies with multiple-drug injection guided by color Doppler sonography. In this retrospective analysis, 49 patients with an unruptured ectopic pregnancy were treated with two different local injection methods administered under sonographic guidance. The patients were divided into single-drug (n = 23) and multiple-drug (n = 26) injection groups, and they received a locally administered injection of methotrexate alone or a combination including methotrexate, hemocoagulase, antibiotics, and anti-inflammatory drugs, respectively. Overall, local injection treatment was successful in 44 patients. The 5 patients with failed treatment underwent laparotomy about 1 week after single-drug injection. Serum β-human chorionic gonadotropin (β-hCG ) levels, ectopic pregnancy mass sizes, blood flow at various points after treatment, the incidence of pelvic bleeding, and the time for serum β-hCG levels to return to normal and the mass to resolve were analyzed in the remaining 44 patients. Single-drug treatment was successful in 18 patients; 10 of 23 had low to moderate pelvic bleeding after treatment, and 5 were referred for surgery. All 26 patients were successfully treated by multiple-drug injection. Only 2 patients had a small amount of pelvic bleeding. Differences between groups were statistically significant (P < .05) for surgery rates, the incidence of pelvic bleeding, transient increases in serum β-hCG levels, mean days to normal β-hCG levels, mean days of mass resolution, and mean mass diameters 1 to 6 weeks after treatment. Local multiple-drug injection under color Doppler guidance is a new, safe, and effective method for treating unruptured ectopic pregnancies. It accelerates the serum β-hCG decline and facilitates mass resolution. This regimen is associated with a very low rate of pelvic bleeding, improves the success rate of conservative treatment, and, therefore, has value as an important clinical application.

Usefulness of the MOSAIC (measurement of stenosis by aliasing coronary flow) method using transthoracic color Doppler echocardiography in unstable angina patients

BackgroundThe aim of this study was to investigate the significance of the MOSAIC (measurement of stenosis by aliasing coronary flow) method for the detection of proximal left coronary stenosis in patients with unstable angina (UA) using transthoracic Doppler echocardiography (TTDE). MethodsPatients (n=107) with UA were evaluated. Proximal left coronary flow was sought in the short axis (SAX) at the aortic root level using color Doppler guidance. When detected coronary flow showed color aliasing, the color velocity range was gradually increased until color aliasing nearly disappeared. Then, the color baseline was shifted until the color flow showed “isovelocity”. ResultsProximal coronary flow was detected in 86 (80.4%) of 107 patients. In these 86 patients, an optimal cutoff value of isovelocity≥47.5cm/s predicted significant coronary stenosis (percent diameter stenosis≥70%) of the proximal left anterior descending (AHA segment 6) or left main coronary artery with a sensitivity of 88%, specificity of 97%, positive predictive value of 98%, and negative predictive value of 86%. In all 107 patients, the same cutoff value predicted significant coronary stenosis with a sensitivity of 78%, specificity of 98%, positive predictive value of 98%, and negative predictive value of 81%. ConclusionsThe MOSAIC method may play a complementary role in expeditious risk stratification and decision making in patients with UA.

Abstract 6117: Significance of Flow Aliasing in the Proximal Left Coronary Artery on Transthoracic Color Doppler Echocardiography in Patients with Unstable Angina

Background: Noninvasive coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) has been validated and utilized at the bedside. However, because this method requires pharmaceutical provocation, it has some risk especially for patients suspected of acute coronary syndrome. Color aliasing of coronary flow on TTDE in the short axis (SAX) view at the aortic root level suggests that flow acceleration produced by stenosis is occasionally observed during screening in patients with chest pain. The aim of this study was to investigate the clinical significance of flow aliasing on TTDE in the SAX view at the aortic root in patients with unstable angina. Methods: Patients (n=104) with unstable angina were evaluated. Proximal left coronary flow was sought in the SAX view at the aortic root level under color Doppler guidance at a color velocity range of ±19 cm/sec. When detected coronary flow showed color aliasing, the color velocity range was gradually raised until color aliasing nearly disappeared. Then, the color baseline was shifted until color flow showed isovelocity. AHA segment 6 on the coronary angiogram obtained within 24 hours was defined as the proximal left anterior descending artery (LAD). Results: Color aliasing was observed in 49 of 104 patients. In 14 of these 49 patients, there was significant stenosis (≥50% luminal reduction) in the left main coronary artery (LMCA) and 25 had significant stenosis in the proximal LAD. In patients with flow aliasing, a cut-off value of isovelocity ≥33.0 cm/sec predicted significant coronary stenosis with a sensitivity of 90%, specificity of 80%, positive predictive value of 95%, and negative predictive value of 67%. In all 104 patients, the cut-off value predicted significant coronary stenosis with a sensitivity of 60%, specificity of 96%, positive predictive value of 95%, and negative predictive value of 66%. Conclusion: Detection of flow aliasing by TTDE in the SAX view is a promising method for noninvasive diagnosis of LMCA and proximal LAD stenosis. This method may be useful for expeditious risk stratification and decision making in patients with unstable angina.

Puncture angle choice of ultrasound guided automatic kidney biopsy in 518 cases

Objective To elevate the achievement rate of kidney biopsy puncture through the analysis of puncture angle choice of ultrasound guided automatic kidney biopsy in 518 patients. Methods Under the guidance of color Doppler ultrasound,using the 3.5MHz probe with probe holder,we performed kidney biopsy in the degrees of 40°(group X),45°(group Y),60°(group Z) and 70°(group P) with the horizontal plane. Resnlts The total achievement ratio is 100 %. The one time success rate in group Y and group Z is 100 % (group Y, 164/164 ; group Z, 186/186) ;group X is 4.8% (22/46) ;group P is 84.4% (103/122).Conclusion The automatic kidney biopsy an- gle under the guidance of ultrasound should be between 45° and 60° with the horizontal plane which is safe and has higher achievement ratio. In the meantime, complications can be avoided. Key words: Ultrasonography; Kidney; Biopsy; Angle