Role Of Two-dimensional Echocardiography Research Articles

The Role of Two-Dimensional Echocardiography in Diagnostics of Coarctation of the Aorta in Newborns

Diagnosis of neonatal coarctation of the aorta (CoA) still presents a challenge in routine practice because of absence of reliable morphologic and functional parameters for early detection of this congenital heart defect in newborns. The aim of this study is to identify easy obtainable two-dimensional echocardiographic parameters for detection of the CoA in newborns. Echocardiographic evaluation was performed in 30 newborns with CoA and 20 healthy neonates (control group). Measurements of the proximal transverse arch (PTA), distal transverse arch (DTA), isthmus, distance between the left common carotid artery (LCCA) at the origin of the left subclavian artery (LSA), were obtained by two-dimensional echocardiography. Aortic arch hypoplasia was defined using Mouleart, Karl and Mee criteria, and Z-value. Index 1 was calculated as a ratio of DTA and distance between origins LCCA-LSA, Index 2 was calculated as a ratio of the ascending aorta and the distance between LCCA-LSA origins, and Index 3 was calculated as a ratio of PTA and distance between LCCA-LSA origins. Index 1 was significantly lower in patients with CoA in comparison with control group (0.50 vs. 1.39; p≤0.01). A cut-off point at 0.39, for Index 1, showed a sensitivity of 92% and specificity of 99% for the diagnosis of neonatal CoA, while cut off points at 0.69 and 0.44, for Index 2 and Index 3, showed the highest sensitivity and specificity for the diagnosis of CoA in newborns. By using these echo indexes, two-dimensional echocardiographic aortic arch measurement becomes a simple, reliable noninvasive method for the evaluation of aortic coarctation in newborns and may lead to earlier diagnosis and subsequent surgical correction.

Cardiogenic Shock due to Huge Right Atrial Thrombus

An unusual case is reported of right atrial thrombus associated with cardiogenic shock. The role of two-dimensional echocardiography in detection of blood clots is highlighted.

The Role of Two-Dimensional Echocardiography in the Diagnosis of Ineffective Endocarditis

Two-dimensional echocardiography has had a significant impact on and is considered the technique of choice for the diagnosis and management of infective endocarditis. Over a thirty-six month period, 106 patients were evaluated by echocardiography for the possibility of endocarditis. The diagnosis of endocarditis was determined by strict clinical and laboratory criteria. All clinical histories, blood cultures, echocardiograms, and autopsy results were reviewed. Five echocardiograms were technically inadequate, resulting in a study population of 101 patients. The age of the patients ranged from forty-five days to eighty-eight years (mean fifty-seven years). The clinical manifestations of endocarditis included fever (83%), chills (60%), congestive heart failure (25%), and splenomegaly (18%). Twelve patients had preexisting valvular or congenital heart disease. Gram-positive cocci were the most common microorganisms. Complications included mitral regurgitation, subarachnoid hemorrhage, renal infarction, stroke, and a pulmonary embolus. The patients were divided into two groups: Group I consisted of 36 patients with definite vegetations by echocardiography, and Group II had 65 patients with no vegetations. In Group I, acute infective endocarditis was present in 35 patients, whereas only 4 patients had endocarditis in Group II. The sensitivity of two-dimensional echocardiography for detecting endocarditis was 90%. The specificity was 98%. The predictive accuracy for a positive test was 97%, and the predictive accuracy for a negative test was 94%. Thus, two-dimensional echocardiography appears to have a high sensitivity, specificity, and predictive value in the evaluation of patients with suspected endocarditis.

Role of two-dimensional echocardiography, pulsed, continuous wave and color flow Doppler techniques in the assessment of ventricular septal rupture after myocardial infarction

Two-dimensional echocardiography, pulsed and continuous wave Doppler techniques were used for the evaluation of 15 consecutive patients (9 men, 6 women; mean age 71 years, range 61 to 79) with ventricular septal rupture due to acute myocardial infarction (7 anterior, 8 posterior). Standard and modified off-axis 2-dimensional echocardiographic views from parasternal, apical and subcostal windows correctly identified this defect in 14 of the 15 patients. Pulsed Doppler echocardiography confirmed the presence of left-to-right-sided shunt by showing a high-velocity, aliased, systolic flow and a low-velocity diastolic flow in the right ventricle in 14 patients. Continuous wave Doppler echocardiography showed a high-velocity systolic and lowvelocity diastolic flow signal of left-to-right shunt in 14 patients. Color flow Doppler imaging identified a left-to-right shunt in all 6 patients in whom it was performed. Doppler and 2-dimensional echocardiographic studies missed a small apical septal defect in 1 patient with anteroseptal myocardial infarction. Two-dimensional echocardiography correctly diagnosed right ventricular infarction in all 5 patients with posteroinferior infarction. Ventricular septal rupture and/or left-to-right-sided shunt was confirmed in all 15 patients by the following: surgical inspection in 11, necropsy in 3, left ventricular cineangiography in 5 and right-sided heart catheterization and oximetry data in 13 patients. Data indicate that 2-dimensional echocardiography correctly shows the precise location of septal rupture in most patients after acute myocardial infarction and allows assessment of left and right ventricular infarction and function. Pulsed, continuous wave and color flow Doppler imaging shows the presence and location of left-to-right-sided shunt and differentiates this lesion from acute mitral regurgitation. Complete Doppler and 2-dimensional echocardiographic studies make invasive and potentially hazardous left ventricular cineangiography unnecessary for the majority of patients with ventricular septal rupture.

Non‐invasive evaluation of the myopathy of coronary artery disease

International Journal of Clinical PracticeVolume 43, Issue 7 p. 249-251 Clinical Study Non-invasive evaluation of the myopathy of coronary artery disease M S Noah MD, M S Noah MD Associate Professor Cardiology Division, Department of Medicine, King Saud University, Riyadh, Saudi ArabiaSearch for more papers by this author M S Noah MD, M S Noah MD Associate Professor Cardiology Division, Department of Medicine, King Saud University, Riyadh, Saudi ArabiaSearch for more papers by this author First published: 01 July 1989 https://doi.org/10.1111/j.1742-1241.1989.tb08731.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1Bristow JD, Van Zee BE, Judkins MP. Systolic and diastolic abnormalities of the left ventricle in coronary artery disease: studies in patients with little or no enlargement of ventricular volume. Circulation 1970; 42: 219- 228. 2Linhart JW, Hildner FJ, Barold SS et al. Myocardial function in patients with coronary artery disease. Am J Cardiol 1969; 23: 379- 386. 3Yatteau RF, Peter RH, Baher VS, Bartel AG, Rosti RA, Kong Y. Ischaemic cardiomyopathy: The myopathy of coronary artery disease. Am J Cardiol 1974; 34: 520- 525. 4Burch GE, Gilles TD, Colcolough HL. Ischaemic cardiomyopathy. Am Heart J 1970; 79 (3): 291- 292. 5Burch GE, Tsui GY, Harb JM. Ischaemic cardiomyopathy. Am Heart J 1972; 83: 340- 350. 6Pantely GA, Bristow JD. Ischaemic cardiomyopathy. Prog Cardiovasc Dis. 1984; XXVII (2): 95- 114. 7Reeder GS, Seward JB, Tajik A. The role of two-dimensional echocardiography in coronary artery disease. Mayo Clin Proc 1982; 57: 247- 258. 8Saltissi S, Hockings B, Croft DN, Webb-Peplae MM. Thalium-201 myocardial imaging in patients with dilated and ischaemic cardiomyopathy. Br Heart J 1981; 46: 290- 295. 9Mundlh ED, Hawthorne JW, Buckley MJ et al. Direct coronary arterial revascularisation. Treatment of cardiac failure association with coronary artery disease. Arch Surg 1981; 103: 529- 534. 10Raftery EB, Backs DC, Oram S. Occlusive disease of the coronary arteries presenting as primary congestive cardiomyopathy. Lancet 1969; 29: 1147- 1150. 11Abbasi AS, Chakine RA, MacAlpin RN, Kattus AA. Ultrasound in the diagnosis of primary congestive cardiomyopathy. Chest 1973; 63: 937- 942. 12Shors CM, Kozul VJ, Henderson F. The differential diagnosis of congestive cardiomyopathy and ischaemic cardiomyopathy by echocardiography. Angiology 1975; 26: 723- 729. 13De Marie AN, Bommer W, Lee G, Mason DT. Value and limitations of two dimensional echocardiography. In assessment of cardiomyopathy. Am J Cardiol 1980; 46: 1224- 1231. 14Fortuin NJ, Pawsey CGK. The evaluation of left ventricular function by echocardiography. Am J Med 1977; 63: 1- 9. 15Baxley WA, Reeve TJ. Abnormal regional myocardial performance in coronary artery disease. Prog Cardiovasc Dis 1971; 13: 405- 421. 16Baur HR, Danil JA, Nelson RR. Detection of left ventricular aneurysm on two dimensional echocardiography. Am J Cardiol 1982; 50: 191- 196. 17Noah MS. Dilated cardiomyopathy in Saudi Arabia: A review of 55 cases. Trop Geog Med 1986; 38: 283- 286. 18Nakamura H, Sawada H, Aizawa T, Watanabe H, Fujii J. Comparison of echocardiographic findings in patients with coronary triple vessel disease and dilated cardiomyopathy. J Cardiogr 1985; 15 (3): 585– 593 (Engl Abstr). 19Bulkey BH, Hutchins GM, Bailey I, Struss HW, Pitt B. Thallium-201 imaging and gated cardiac blood pool scans in patients with ischaemic and idiopathic congestive cardiomyopathy. A clinical and pathological study. Circulation 1977; 55 (5): 753- 760. Volume43, Issue7July 1989Pages 249-251 ReferencesRelatedInformation

Postmyocardial infarction pain and infarct extension in the coronary care unit: Role of two-dimensional echocardiography

Recent data suggest that patients who manifest extension of their acute myocardial infarct have a worse prognosis than do those who do not have this complication and, if identified early, may be candidates for more aggressive intervention. Serial two-dimensional echocardiography was used to diagnose myocardial infarct extension in 33 consecutive patients and its sensitivity was compared with that of electrocardiography (ECG) and serum creatine kinase determination. Infarct extension was diagnosed clinically using ECG and enzymatic criteria. The echocardiograms were scored using a weighted regional scoring system, with each segment of the left ventricle ascribed a percent of the total left ventricular mass. Abnormal regions were summed to yield a percent asynergy.In the postinfarction period, 19 episodes of acute ischemia occurred; in 9 of these episodes clinical extension was confirmed, and in 7 of the 9 episodes echocardiographic extension was detected. In the patients in whom infarct extension was documented clinically, the mean asynergy score increased from a mean of 19.2 ± 11.3% to 36.1 ± 18.2% (p < 0.01). Where no extension was detected, the asynergy score improved from the initial 31.5 ± 24.1% to 28.3 ± 21.9% (p < 0.05). The extent of the change in echocardiographic wall motion abnormality was not predicted by the amount of creatine kinase reelevation.Electrocardiography alone failed to distinguish which episodes of ischemia represented infarct extension and which did not. Greater degrees of asynergy were associated with worse in-hospital mortality. Two-dimensional echo cardiography is a useful method for detecting myocardial infarct extension providing a means of assessing functional impact and prognosis.

The Role of Two-Dimensional Echocardiography in Coronary Arlery Disease

Echocardiography is a noninvasive procedure that plays a major role in the evaluation of coronary artery disease and its complications. In this manuscript four areas will be discussed and illustrated: visualization of the coronary arteries, myocardial infarction, left ventricular function in myocardial infarction, and the complications of myocardial infarction.

Two-dimensional echocardiography in the older child

The role of two-dimensional echocardiography in the management of any congenital cardiovascular anomaly depends on the lesion's natural history and surgical alternatives. Diagnostic assessment of subaortic stenosis and postoperative follow-up of Fontan and Mustard/Senning procedures and tetralogy of Fallot reconstruction illustrate the application of two-dimensional echocardiography to the management of these problems in the older child. Two-dimensional echocardiography displays the static anatomic as well as dynamic functional sequels of left ventricular outflow obstruction. Detailed anatomic display of Fontan reconstruction is compromised by its somewhat unpredictable spatial organization. Combining two-dimensional imaging with gated pulsed Doppler techniques, however, supplements limited anatomic definition with flow profile data specific to the varied surgical interpretations of the Fontan principle. In a similar manner, combined imaging after Senning/Mustard procedures permits detailed anatomic and hemodynamic interrogation of pulmonary and systemic venous return to the neo-left and neo-right atria. The limitations of cardiac ultrasound imaging of the older child after tetralogy of Fallot reconstruction offer some insight into the future directions that are necessary in the application of this imaging technique. Imaging of these patients is compromised by the prosthetic material, which compromises the assessment of right ventricular outflow pulmonary artery reconstruction and ventricular septal closure. Although gated pulsed Doppler echocardiography overcomes some of these limitations, better tissue characterization in the presence of bioprosthetic material is necessary.

Role of two-dimensional echocardiography in the prediction of in-hospital complications after acute myocardial infarction

To evaluate prospectively the prognostic value of two-dimensional echocardiography after acute myocardial infarction, two-dimensional echocardiography was performed on 61 consecutive patients who were admitted to the hospital with this condition. A left ventricular wall motion score index was derived from analysis of regional wall motion; an index of 2.0 or more within 12 hours of admission identified patients at high risk for pump failure, malignant ventricular arrhythmia or death. These complications occurred in 24 of 27 patients with an initial wall motion score index of 2.0 or more, but in only 6 of 34 with an initial index of less than 2.0 (p less than 0.0005). Of the 47 patients who were in Killip class I on admission, complications developed in 11 (79%) of the 14 with an initial index of 2.0 or more, but in only 6 (18%) of the 33 with an initial index of less than 2.0. After acute myocardial infarction, early determination of the wall motion score index by two-dimensional echocardiography is useful for identifying patients at high risk for complications and is especially valuable in the subset of patients who initially seem to be in stable condition as judged from clinical variables.

The modern diagnosis of cardiac myxoma: role of two-dimensional echocardiography.

We reviewed our experience with the diagnosis of cardiac myxoma in 10 patients seen between 1960 and 1981. At surgery, large myxomas (greater than 5 cm) were found in the left atrium in 6 patients, right atrium in 3, and right ventricle in 1. The correct preoperative diagnosis was made in 9 patients: clinically in 3 and at catheterization and angiocardiography in 6. Diagnoses were falsely negative in 3/13 (23%) catheterizations and 2/10 (20%) angiocardiograms. Echocardiography (echo) was positive in 5/5 (100%). Gated blood-pool scans confirmed a right atrial myxoma in 1 patient. The interval between onset of symptoms and surgery was 30.5 months, (range, 2-120) and was not significantly different in the eras before and after echo. The age at diagnosis exceeded 40 years in 9 patients and was not significantly less in the echo era. The size and site of the tumor at surgery agreed with findings on M-mode echo (n=5) or two-dimensional (2-D) echo (n=2), but the size (85 vs. 88 cm3) and mass (81 vs. 88 g) of the tumors were similar in the 2 eras. Although 2-D echo facilitates the preoperative diagnosis of cardiac myxoma, earlier patient referral of suspicious cases for 2-D echo is still necessary.

Value of two-dimensional echocardiography in the diagnosis of pericardial cysts

Four adult patients with pericardial cysts were studied by two-dimensional echocardiography. In all cases echocardiography demonstrated a round echo-free structure, of varying size, related to one of the cardiac chambers, from which it was separated by a definite wall of echoes. M-mode echocardiography in the three cases in which it was performed, failed to yield the diagnosis. This report assesses the importance of two-dimensional echocardiography and its greater reliability and sensitivity compared with: (1) M-mode echo in identifying pericardial tumors and establishing their relationships to nearby cardiac structures, and (2) standard chest X-ray in differentiating solid masses from cysts and in defining the characteristics of cysts walls. Particular stress is laid on the role of two-dimensional echo cardiography leading directly to surgery in patient number 4, who had a teratoma and in whom early surgery was essential. The high sensitivity and the ability of the technique to differentiate solid from cystic masses and to define their relationships with cardiac chambers make it a reliable method for assessing pericardial cysts.

Space-occupying lesions of the myocardium: Role of two-dimensional echocardiography in detection of cardiac tumors in children

Four patients with space-occupying myocardial lesions were studied using electronically focused high-resolution two-dimensional echocardiography. In two patients with clusters of high-intensity echoes at various depths on the epicardial surface, histology confirmed the diagnosis of lymphosarcoma, showing patchy, malignant infiltrates of different thickness. The remaining two patients had very different features: the lesions appeared to be intrinsic to the posterior left ventricular wall. One patient who had arrhythmias and a small encapsulated noncontractile mass had a histologically proved rhabdomyoma. In the second patient fibroma was histologically confirmed. In these two patients the position of the lesions was confirmed by angiocardiography. Two-dimensional echocardiography greatly improved delineation of space-occupying cardiac masses and is an accurate method for confirming the presence of such lesions.

Role of two-dimensional echocardiography in the evaluation of patients with ventricular septal rupture postmyocardial infarction

In 18 consecutive patients with a new murmur following acute myocardial infarction (AMI), examination by two-dimensional echocardiography (2DE) correctly excluded ventricular septal defects (VSD) in eight patients and enabled direct visualization of the VSD in 10 patients. In three patients, 2DE was the first technique to establish the diagnosis. In all patients with VSD, 2DE diagnosis was confirmed by catheterization, surgery, and/or postmortem examination. In six patients with VSD, 2DE contrast studies were performed and were positive. 2DE enabled localization of the VSD in all patients (five inferior, five anterior). To evaluate left ventricular (LV) function, a 2DE wall motion index (WMI) was calculated using an 11 segment model of the LV. While there was no difference (p greater than 0.2) in AMI-VSD survivors versus nonsurvivors in age, kinase, and AVO2 difference, there was no overlap in WMI (p = 0.004) of survivors (0.80 +/- 0.36) versus nonsurvivors (1.66 +/- 0.19). Thus 2DE allows accurate detection and localization of postmyocardial infarction VSD and enables determination of prognosis of these patients.

Role of two-dimensional echocardiography in evaluation of patients with post myocardial infarction ventricular septal defect

Role of two-dimensional echocardiography in evaluation of patients with post myocardial infarction ventricular septal defect

The complementary roles of M-mode echocardiography and scintigraphy in the evaluation of adults with suspected left-to-right shunts. Additional observations on the role of two-dimensional echocardiography.

We sought to determine the relative clinical abilities and roles of echocardiography and scintigraphy in left-to-right shunt diagnosis. M-mode echocardiographic and scintigraphic studies were analyzed in 37 adults presenting diagnostic difficulties with suspected left-to-right shunts. The historic, physical, radiographic and electrocardiographic data were frequently ambiguous. An enlarged right ventricle on M-mode echocardiography was a sensitive (100%) but not specific (55%) indicator of atrial septal defect (ASD). M-mode lacked sensitivity for ventricular septal defect (VSD) and patent ductus arteriosus (PDA). In a few studies, two-dimensional echocardiography provided additional specific and clinically important anatomic information. Scintigraphic analysis demonstrated complete diagnostic accuracy and excellent localizing and quantitative abilities in all patients studied. Because it is extremely sensitive to ASD, free of any exposure to radioactivity, entirely noninvasive and may be simply and visually analyzed, echocardiography is the study of choice in the preliminary evaluation of patients presenting diagnostic difficulty with suspected ASD. Scintigraphy is the study of choice in the preliminary evaluation of patients presenting diagnostic difficulty with suspected VSD and PDA and is the logical response to the finding of echocardiographic right ventricular enlargement when the diagnosis remains in doubt.

The role of two-dimensional echocardiography in the evaluation of congenital heart disease.

The role of two-dimensional echocardiography in the evaluation of congenital heart disease.