Real-time Two-dimensional Echocardiography Research Articles

Right Ventricular Myxoma—A Case Report

From an epidemiologic perspective, cardiac myxomas are best divided into the following 2 categories: those that arise in isolation and those that arise in the setting of a syndrome (so called Carney Complex). The former account for about 90% - 95% of cases, while the later account for a minority of cases and those arise from the right or left ventricle constitute as 3% each. Real-time two-dimensional echocardiography has proved to be extremely useful in defining intracavitary masses. With two-dimensional echocardiography accurate visualization of the right ventricular body and outflow tract can be accomplished consistently. The acoustic nature and anterior location of the right ventricular myxomas make them appear as bright, mobile masses. The mobile nature of the tumor can easily be appreciated and its point of attachment, or stalk can be visualized accurately. Background of this case illustrates the transthoracic 2D echocardiographic pattern of right ventricular myxoma and its attachment by a pedicle to the anterior papillary muscle, masquerading as ball-valve thrombus and cardiac “stone” in tilted parasternal long axis-3 chamber views in a 15-year-old girl. Mahaim criteria to distinguish myxoma from organizing thrombus had been highlighted.

The history of echocardiography

Following a brief review of the development of medical ultrasonics from the mid-1930s to the mid-1950s, the collaboration between Edler and Hertz that began in Lund in 1953 is described. Using an industrial ultrasonic flaw detector, they obtained time-varying echoes transcutaneously from within the heart. The first clinical applications of M-mode echocardiography were concerned with the assessment of the mitral valve from the shapes of the corresponding waveforms. Subsequently, the various M-mode recordings were related to their anatomical origins. The method then became established as a diagnostic tool and was taken up by investigators outside Lund, initially in China, Germany, Japan and the USA and, subsequently, world-wide. The diffusion of echocardiography into clinical practice depended on the timely commercial availability of suitable equipment. The discovery of contrast echocardiography in the late 1960s further validated the technique and extended the range of applications. Two-dimensional echocardiography was first demonstrated in the late 1950s, with real-time mechanical systems and, in the early 1960s, with intracardiac probes. Transesophageal echocardiography followed, in the late 1960s. Stop-action two-dimensional echocardiography enjoyed a brief vogue in the early 1970s. It was, however, the demonstration by Bom in Rotterdam of real-time two-dimensional echocardiography using a linear transducer array that revolutionized and popularized the subject. Then, the phased array sector scanner, which had been demonstrated in the late 1960s by Somer in Utrecht, was applied to cardiac studies from the mid-1970s onwards. Satomura had demonstrated the use of the ultrasonic Doppler effect to detect tissue motion in Osaka in the mid-1950s and the technique was soon afterwards applied in the heart, often in combination with M-mode recording. The development of the pulsed Doppler method in the late 1960s opened up new opportunities for clinical innovation. The review ends with a mention of color Doppler echocardiography. (E-mail: kjell.lindstrom@elmat.lth.se

Short History of The Development of Echocardiograpy With Special Reference to That in Japan (1)

The ultrasound reflection technique was introduced into cardiology in 1953, and in 1955, the ultrasonic Doppler technique was introduced. The dawning stage of ultrasound diagnostics of the heart was the ten year period prior to 1965. During this stage, besides the afore mentioned techniques, there were only a few attempts to use ultrasound for heart diagnostics.In the next age, from about 1965 to 1975, the leading type of the cardiac ultrasound was M-mode echocardiography. M-mode echocardiography was the first generation of ultrasound diagnostics of the heart used in routine practice. This period may be called the age of M-mode echocardiography. During 1975 to 1985, the leading technique was real-time two-dimensional echocardiography, with and without the Doppler mechanism, which was the second generation in routine. This period can be called the age of the two-dimensional echocardiography. The period from 1985 to the present time may be called the age of the color Doppler, which has been the third generation of the cardiac ultrasound. However, since the middle of this last age the cardiac ultrasound has been showing the most diversification of techniques and usages. Therefore, it is uncertain whether the age division as mentioned above can be continued. The period extending over the last age and present time may be the second dawn of the cardiac ultrasound.

Visual Assessment of the Right Ventricle during Real-Time Two-Dimensional Echocardiography in Patients with Chronic Obstructive Lung Disease

Visual Assessment of the Right Ventricle during Real-Time Two-Dimensional Echocardiography in Patients with Chronic Obstructive Lung Disease

Primary failure of Hancock porcine bioprosthetic valves: two dimensional echocardiographic assessment.

To reveal the process of primary failure of the Hancock porcine bioprosthetic heart valve, a real-time two-dimensional echocardiography was undertaken. There were 75 cases (84 valves) with 26 in the aortic valve position, 39 in the mitral valve position, 9 in both the aortic and mitral valve positions, and 1 in the tricuspid valve position. The subjects comprised 35 males and 40 females, whose ages ranged from 18 to 65 years with a mean of 44.7 years. Valvular changes such as thickened valve cusps or abnormal valve movement were observed in 27 (32%) of the 84 valves; more specifically, in 5 (14.3%) of the 35 aortic valves and in 22 (45.8%) of the 48 mitral valves, indicating that valvular changes occurred most frequently in the mitral valve position (p less than 0.01). In the period between valve replacement surgery and the appearance of valvular changes, no significant difference was noted between aortic and mitral valve bioprostheses. The duration ranged from 14.5 to 74.5 months with a mean of 50.2 months. Valvular changes were evident in more than 50% of the valve bioprostheses implanted 6 or more years ago. In the mitral valve position, valve cusp changes appeared more frequently at the anterior cusp than at the inner and outer cusps. The frequency was 17 cases at the anterior cusp, 6 at the inner and 9 at the outer. In 7 of the 11 cases followed up after the appearance of valvular changes, an increase in the changes was recognized 7.5 to 29.5 months (a mean of 16.4 months) later.(ABSTRACT TRUNCATED AT 250 WORDS)

Early clinical evaluation of a new Björk-Shiley valve prosthesis with integral monostrut.

We evaluated preliminary results of valve replacement with a new Björk-Shiley valve prosthesis with integral monostrut. Sixty-five valves were implanted in 56 patients (18 aortic, 30 mitral, 7 double, 1 triple). The age of the patients ranged from 30 to 62 years, and they were followed up for 7-17 months (mean, 12.5 months). There were three operative deaths (5.3%) not related to the prosthesis and no late deaths. Minor cerebral thromboembolism occurred in one patient 2 weeks after surgery despite anticoagulant therapy. Intraoperative transvalvular pressure gradients across the 23-mm aortic and 27-mm mitral valve prostheses were insignificant. Real-time two-dimensional echocardiography revealed no regurgitation at the moment of valve closure in 20 randomly selected patients. Though the data accumulated so far are still relatively incomplete and the follow-up periods short, the clinical results obtained here were satisfactory, warranting further use of this new Björk-Shiley valve prosthesis with integral monostrut for longer follow-up studies.

Cold pressor test during two-dimensional echocardiography: Usefulness in detection of patients with coronary disease

We assessed the feasibility and value of the cold pressor test (CPT) during real-time two-dimensional echocardiography (2DE) in patients with suspected coronary artery disease and normal resting left ventricular wall motion. Twenty patients were studied without knowledge of angiographic findings that demonstrated no significant coronary artery disease in seven (group 1) and significant coronary lesions in 13 (group 2). The increments in physiologic parameters (heart rate, systolic blood pressure, and double product) were not significantly different in both groups. CPT-induced wall motion abnormalities were identified echocardiographically in nine patients in group 2 and in one patient in group 1 (sensitivity 69% and specificity 86%). None of the patients in our study developed chest pain, ST changes, or ectopy during the test. It is concluded that 2DE combined with the CPT is valuable in identifying patients with coronary artery disease who show no left ventricular asynergy at rest.

Determination of left ventricular ejection fraction by visual estimation during real-time two-dimensional echocardiography

It has been shown that the measured reduction in the cross-sectional area of the left ventricle (LV), as viewed in the short axis, closely approximates its ejection fraction (EF). We assessed the reliability of using two-dimensional echocardiography (2DE) to visually estimate the EF during real-time viewing, without the need of digitizers, planimetry, or calculations. Twenty-five adult hospitalized patients with either suspected or known cardiac disease were evaluated prospectively. Each patient also had gated nuclear angiography during the same admission, and 14 had cardiac catheterization with left ventriculography. The EF was determined by 2DE using a visual estimate of the percent area reduction of the LV cavity in the short-axis view at the level of the papillary muscles. All 2 DE studies were read by two or more blinded reviewers, with a value for the EF to the nearest 2.5% determined by consensus. These values correlated closely to the values determined in all 25 patients with gated nuclear angiography ( r = 0.927) and the 14 patients who had left ventriculography ( r = 0.935). We believe that this method of visually estimating the LVEF will enable echocardiographers to easily use 2 DE for a reliable and instantaneous assessment of ventricular function, without the need of sophisticated analytical equipment.

Real-Time Two-Dimensional Echocardiography in Differentiating Vascular from Nonvascular Mediastinal Lesions

We evaluated the ability of two-dimensional echocardiography to differentiate vascular from nonvascular causes of radiologic mediastinal masses or widening. In 22 patients with a radiologic mass, two-dimensional echo detected a mass in 11 patients, an aortic aneurysm in four patients, left ventricular pseudoaneurysm in four patients, and marked pulmonary artery dilatation in three patients. In 36 patients with mediastinal widening, two-dimensional echocardiography detected an aneurysm in 28 and a mass in four patients; it was normal in four patients. Two-dimensional echocardiography can differentiate vascular from nonvascular radiologic mediastinal abnormalities.

Two-dimensional echocardiographic identification of intracardiac leiomyomatosis

We are reporting the first case of an intracardiac leiomyoma visualized by real-time two-dimensional echocardiography (2DE). A 52-year-old white female was referred for evaluation of presumed mitral stenosis. In 1965, a 7.5 k.g uterine leiomyoma with invasion of pelvic veins was surgically removed. In 1967, she was noted to have ventricular ectopic beats, bilateral leg edema, and cardiomegaly on chest x-ray. Six years later, calcifications within the cardiac silhouette were first observed on chest x-ray. In 1979 and 1980, several episodes of lightheadedness occurred which were thought to be related to supraven-

Left ventricular inflow obstruction and atrial septal deffect: Diagnosis by real time two-dimensional echocardiography

This report describes the usefulness of real time two-dimensional echocardiography in the diagnosis of left ventricular inflow obstruction associated with atrial septal defect. Echocardiographically, left ventricular inflow obstruction was at the level of the mitral valve in case one, mitral and subvalvular in cases 2 and 3 and supravalvular in case 4 (left atrial membrane). In all patients the defect was of the secundum variety and was seen as a constant discontinuity in the atrial septal image. The diagnosis was confirmed in all patients by cardiac catheterization, surgery or autopsy.

Two-dimensional echocardiographic identification of multiple cardiac tumors in a newborn

Abstract We describe identification of multiple intracardiac tumors in a newborn by real time two-dimensional echocardiography. All three tumors were successfully resected.

Regional left ventricular ejection fraction from real-time two-dimensional echocardiography

We studied regional left ventricular contraction patterns and ejection fraction from real-time two-dimensional echocardiograms in 8 normal subjects, 11 patients with coronary artery disease and 2 with congestive cardiomyopathy. The ventricle was divided into 12 regions and for each region, we calculated ejection fraction using a method which integrated the incremental volumes of a series of hemicylinders constructed within that region. The data obtained were displayed graphically to provide a detailed picture of regional ventricular function. Normal subjects had a uniform regional ventricular pattern (regional ejection fraction 54–74%). In patients with coronary disease, we found varying degrees of regional ventricular contraction abnormalities. In congestive cardiomyopathy global hypokinesis was present, and regional ejection fraction was reduced in all areas (11–39%). The study showed that two-dimensional echocardiography is a useful non-invasive bedside technique which may provide detailed quantitative information relating to regional left ventricular contraction abnormalities.

Idiopathic mitral valve prolapse-analysis by real-time two-dimensional echocardiography.

Mitral valve prolapse is diagnosed in real-time two-dimensional echocardiograms when there are discrepancies in the coaptation zone of the anterior mitral leaflet and the posterior mitral leaflet. Out of the 100 cases of mitral valve prolapse diagnosed in this way, 65 had prolapsed anterior mitral leaflets, 28 prolapsed posterior mitral leaflets and 7 prolapses of both the anterior and posterior mitral leaflets. In addition to the cases with mitral valve prolapse 23 cases of ruptured chordae tendineae of the mitral valve, including 15 cases which had undergone surgery, were investigated. The frequent site of mitral valve prolapse was the posteromedial commissure in the anterior leaflet and the posteromedial and anterolateral commissures in the posterior leaflet. These sites coincide with those where rupture of the chordae tendineae of the mitral valve was apt to occur. An investigation of the relation between age and mitral valve prolapse showed that the number of cases of prolapsed anterior leaflet did not increase with age, but there was an age-related increase in the number of cases of prolapsed posterior leaflets. It was also found that the degree of the prolapse progressed with age. Many of the cases of ruptured chordae tendineae of the mitral valve were in their forties or fifties, and there appeared to be some relation between the progress of the prolapse and age. Mitral regurgitant murmurs were recorded on phonocardiograms, and the severer the degree, the wider the range of the prolapse. Mitral regurgitation was more likely to occur in cases of prolapsed posterior leaflets than in those with prolapsed anterior leaflets, even if the degree and the range of the prolapse were mild.

Two-dimensional echocardiographic recognition of abnormal changes in the myocardium.

<h2>Abstract</h2> The advent of real time two-dimensional echocardiography has made it possible to study myocardial echo patterns in detail and relate them to tissue pathology. Based on the available literature and our experience, we have described various types of myocardial echo patterns and their distribution in different cardiac entities. The mechanism of myocardial echo patterns and their potential clinical applications are reviewed.

Air embolism during neurosurgical operations in the sitting position. Efficacy of real-time two-dimensional echocardiography

When a sitting operation is performed, early detection and prevention of air embolism are important. Air flow into the right heart system was monitored by a real-time two-dimensional echocardiograph in combination with a video-recorder. The heart was observed from the apical four chamber view by a ditector placed under the xiphisternum and directed towards the base of heart. The echocardiography showed two types of air flow; one was the single-bubble type in which several bubbles flowed from the right atrium to the right ventricle, and the other was the stormy-bubble type in which a great number of air bubbles flowed en masse. The single-bubble type was observed during surgery involving the skin, muscle, or bone, and the air flow in this type could be interrupted by electrocoagulation, bone wax, etc. The stormy-bubble type was noted during surgery involving the muscle or dura mater. The air flow from the dura mater was most frequently observed. Retroflexion of the dura mater and then electrocoagulation would be required to prevent the air flow from the cut end of the dura mater. If electrocoagulation does not control the air flow from the cut end of the muscle, massive muscle suture by thick threads could prevent the air flow. Air flow into the right heart system in a sitting operation was more frequent than has previously been believed, and a small amount of air flow was noted even during minor surgery. Therefore, application of. a sitting operation should be carefully undertaken. Ultrasonic tomographic monitoring of the heart was useful in the early detection of air embolism because of its non-invasive technique and its high sensitivity.

Real-time two-dimensional echocardiography

The rapid growth in technology after the demonstration of the clinical utility of M-mode echocardiography has led to instruments providing two-dimensional noninvasive ultrasound examinations of the heart and other organs in real time, with high resolution. These techniques now provide images with a wealth of diagnostic, anatomic, and physiologic information. The clinical application of this technology over the past three or four years in many medical centers represents a most profound change in diagnostic pediatric cardiology, providing noninvasively derived information which can be used to decrease the morbidity and mortality of diagnosis and serial follow-up of children with serious congenital heart disease.

Dissecting aneurysm of the ventricular septum following acute myocardial infarction: Diagnosis by real time two-dimensional echocardiography

Dissecting aneurysm of the ventricular septum following acute myocardial infarction: Diagnosis by real time two-dimensional echocardiography

Diagnosis of pacing catheter perforation by real time two-dimensional echocardiography

Diagnosis of pacing catheter perforation by real time two-dimensional echocardiography

Evaluation of pacing function by real time two-dimensional echocardiography

Evaluation of pacing function by real time two-dimensional echocardiography