Two-dimensional Echocardiographic Features Research Articles

Does Type 5 of Takayasu's Arteritis Require Subclassification?

Abstract Background Takayasu's arteritis (TA) is an inflammatory vascular disease of the young involving the large elastic arteries resulting in occlusive or ectatic changes, mainly in the aorta and its major branches as well as the pulmonary artery and its branches. Materials and Methods The authors reviewed the TA patients admitted over 2 years in their department and who underwent catheterization. They noted the clinical presentations, two-dimensional (2D) echocardiographic features, and angiogram details of all these patients. Results The study population constituted 24 patients with mean age of 28 years. Out of them, 21 (87.5%) were females. Most of the admitted TA patients presented with claudication complaints (79.2%), 37.5% patients had breathlessness, and 12.5% patients had typical stable angina symptoms. Five patients had 2D echo abnormalities, and rest of the patients had normal echocardiogram. Coronary angiogram (CAG) along with aortogram and selective peripheral arteriograms were performed of all these patients. Left main coronary artery (LMCA) disease was seen in three (12.5%) patients. Case details of two (8.3%) patients with multiple anomalous communications of the coronaries with pulmonary vasculature were described. Conclusion TA patients who came for catheterization were predominantly females, mainly involving the aorta and its main branches. In the authors’ TA series of patients, type 5 presentation was there in five (20.8%) patients (three cases of LMCA + two cases of coronary artery to pulmonary parenchymal fistulas). They propose to subclassify type 5 of TA, as they report coronary artery to pulmonary parenchymal fistulas along with the previous literature.

Two-dimensional echocardiographic features of the inferior right atrial isthmus: the role of vestibular thickness in catheter ablation of atrial flutter

The aim of this study was to examine the feasibility of transthoracic two-dimensional (2D)-echocardiography in defining the cavo-tricuspid isthmus (CTI) anatomy and its value concerning the ease of catheter ablation of isthmic atrial flutter (AF). CTI analysis was accomplished in 39 cases: 16 necropsy specimens and 23 patients. Sixteen were patients with isthmus-dependent AF and seven controls with other supraventricular re-entrant tachycardias. Two-dimensional transthoracic echocardiography and a right atrium angiogram were performed before radiofrequency catheter ablation (RFCA). The measurements of the CTI with angiography were compared with those taken with echocardiography and correlation was excellent (r= 0.91; P < 0.0001). In normal patients, the dimension of the vestibular thickness was successfully compared and validated with the histological examination of the necropsy specimens: histology median 6.8 mm, range 4.4-10.5 vs. echo median 6.2 mm, range 5.4-8.7; P: NS. Vestibular thickness was greater in complex than in simple RFCA (13.6 ± 1.9 mm vs. 10.0 ± 2.3 mm; P = 0.01). When vestibular thickness ≥11.5 mm, the ablation prone to be complex (sensitivity 83.3%, specificity 80%, positive predictive value 71.4%, and negative predictive value 88.9%). Two-dimensional transthoracic echocardiography clearly depicts the inferior isthmus and, displaying the thickness of the tricuspid vestibule, it was related with complexity of the ablation procedure in isthmus-dependent AF.

Local Intense Mosaic Pattern at Site of Flail Mitral Leaflet: Report of a New Color Doppler Sign

Color flow Doppler has been useful in diagnosing the presence and severity of mitral regurgitation (MR). We noted a hitherto unreported sign of MR due to flail mitral leaflet: intense local mosaic pattern at the site of the flail leaflet. This sign was seen well in 11 of 14 patients (79%) with the two-dimensional echocardiographic features of flail mitral leaflet, all with moderate or severe MR. In 3 other patients, the sign was absent; two of those had flail mitral leaflet with severe MR. No local mosaic pattern was seen on color Doppler in 20 other patients with MR but no flail mitral leaflet. We speculate that the focal intense mosaic color Doppler morphology may have been caused by intrusion of the flail leaflet into the MR stream, or to a Coanda-like effect of the MR jet "adhering" to the flail leaflet.

P1551 Transthoracic two-dimensional echocardiographic features of inferior isthmus: the thickness of the vestibule predicts the complexity of ablation procedure in patients with atrial flutter

P1551 Transthoracic two-dimensional echocardiographic features of inferior isthmus: the thickness of the vestibule predicts the complexity of ablation procedure in patients with atrial flutter

Diagnosis of Atypical Kawasaki Diseases in Early Stage by Echocardiography

Objective: To improve the diagnostic ability of atypical Kawasaki Diseases in early stage. Methods: Two-dimensional echocardiographic features of 24 cases with atypical Kawasaki disease in last two years were analyzed in retrospect. All the children in our study only have 3 or 4 items in the diagnostic standard revised by Japanese MCLS Research Committee in 1984. ATL HDI 5000 and/or HP 5500 color Doppler ultrasound system with transducer frequency of 3∼8 MHz were used to scan the sick children. The internal diameter and shape of coronary arteries were focused in the following views: short axis of aorta, short axis of LV at mitral level, atypical longistudinal view of LV, longistudinal view of right ventricular inlet and outlet view, et al. The qualification of coronary dilatation was classified according to the “Guidelines for coronary lesion in KD” reported by Kato, based on the changes of coronary artery in coronary angiography. Results: Four kinds of two-dimensional echocardiographic features of Kawasaki diseases are described as follow. (1) Normal coronary arteries in diameter with thickening arterial wall, enhancing wall echo, and blurred internal cavity. (2) Stenosis of coronary arteries with thickening arterial wall and enhancing wall echo. (3) Slight dilation of coronary arteries with thickening arterial wall and enhancing wall echo. (4) Severe dilation of coronary arteries and coronary aneurysms developed. Conclusion: Echocardiography is of great values in diagnosing Kawasaki disease at early stage of Kawasaki disease, which plays an important role in releasing coronary arteries injure.

Two-dimensional and doppler echocardiographic features in new onset diastolic heart failure: A community based study Horng H. Chen, John G. Lainchbury, Michele Senni, Magaret M. Redfield. Mayo Clinic, Rochester, MN

Two-dimensional and doppler echocardiographic features in new onset diastolic heart failure: A community based study Horng H. Chen, John G. Lainchbury, Michele Senni, Magaret M. Redfield. Mayo Clinic, Rochester, MN

Absent Pulmonary Valve: Echocardiographic Features.

Congenital absence of the pulmonary valve, a rare anomaly, is characterized by absent or rudimentary pulmonary valve, often with annular stenosis, and aneurysmal dilatation of the pulmonary arteries. This defect is most commonly an accompaniment of tetralogy of Fallot but occasionally occurs alone. Four patients with this abnormality were examined by two-dimensional echocardiography at the Mayo Clinic. Doppler echocardiography provided hemodynamic assessment of the magnitude of outflow obstruction and valve regurgitation. The two-dimensional echocardiographic and Doppler features of absent or rudimentary pulmonary valve provided diagnostic information sufficient to proceed directly to surgical correction.

Tricuspid papillary fibroelastoma causing syncopal episodes

Tricuspid papillary fibroelastoma causing syncopal episodes

Transaortic video-assisted excision of a left ventricular papillary fibroelastoma

Transaortic video-assisted excision of a left ventricular papillary fibroelastoma

Cardiac Papillary Fibroelastoma: A Treatable Cause of Transient Ischemic Attack and Ischemic Stroke Detected by Transesophageal Echocardiography

Transesophageal echocardiography (TEE) is used frequently in patients with cerebrovascular ischemia. On TEE, a typical appearance of a cardiac fibroelastoma is that of a pedunculated, mobile mass attached to a leaflet of a valve. Surgical excision of the lesion may lead to resolution of the symptoms and prevent further cerebrovascular ischemic events; valve replacement is seldom necessary. Herein we describe three patients with cerebral or ocular ischemia in whom histologic study confirmed a cardiac papillary fibroelastoma after initial detection by TEE. Cardiac papillary fibroelastomas should be considered in the differential diagnosis of transient ischemic attack and stroke, even in cases of recurrent events in the same vascular distribution. Although the use of echocardiography in the evaluation of stroke and transient ischemic attack is controversial, TEE must be considered in patients in whom the cause of cerebrovascular ischemia is unclear after noninvasive neurovascular studies or transthoracic echocardiography, even if the patient's cardiac history and the findings on physical examination are normal.

Percutaneous balloon mitral valvuloplasty: Analysis of echocardiographic and other variables related to outcome

To determine whether mitral valve (MV) morphology influences the result of balloon mitral valvuloplasty (BMV) for mitral stenosis, two-dimensional echocardiography was performed before BMV in 53 patients and in 25 normal controls. The two-dimensional echocardiographic features of MV leaflets: thickness, length and motion, diastolic MV excursion, chordal length, MV annular diameter (MVAnD), subvalvular distance ratio (SDR), and effective balloon dilating area (EBDA) and diameter (EBDD) were then correlated to the immediate post-BMV mitral valve area (MVA). For the total patient population, post-BMV MVA increased from 0.76 ± 0.24 to 1.91 ± 0.59 cm 2 ( p < 0.0001) and mean diastolic transmitral gradient decreased from 20.1 ± 6.15 to 5.8 ± 3.29 mm ( p < 0.0001). The patients were divided into two groups on the basis of post-BMV MVA. Group I had post-BMV MVA <2.0 cm 2 and group II had post-BMV MVA ≥2.0 cm 2. A statistically significant difference was noted in SDR (0.33 ± 0.057 vs 0.45 ± 0.042, p < 0.0001); mid-MV anulus to tip of papillary muscle (PM) distance (20.0 ± 3.8 vs 27.9 ± 4.54 mm, p < 0.0001); chordal length (4.3 ± 3.6 vs 9.8 ± 3.9 mm, p < 0.0001); diastolic MV excursion (15.5 ± 2.6 vs 18.2 ± 4.2 mm, p < 0.01); leaflet mobility ( p < 0.05); and EBDA (4.4 ± 0.6 vs 4.9 ± 0.5 cm 2, p < 0.01). On discriminant function analysis of all the echocardiographic variables, the SDR had the strongest discriminating power, followed by mid-MV anulus to tip of PM distance, EBDD MVAnD , and EBDA/body surface area (BSA), and had an accuracy of 90.6% for correctly differentiating two groups. We conclude that quantitative assessment of SDR, mid-MV anulus to tip of PM distance, EBDD MVAnD by two-dimensional echocardiography, and EBDA BSA are helpful in predicting the immediate outcome of BMV.

Serial Doppler echocardiographic follow-up of left ventricular diastolic function in cardiac amyloidosis

A spectrum of left ventricular diastolic filling abnormalities noted on Doppler echocardiography has been demonstrated in patients with cardiac amyloidosis. To determine how these filling abnormalities evolve over time and the significance of any change, serial pulsed wave Doppler studies of left ventricular inflow were performed over 12.6 ± 4.9 months in 41 consecutive patients (36 men and 15 women. mean age 59 ± 11 years) with typical two-dimensional echocardiographic features of cardiac involvement. The measurements were peak left ventricular inflow in early diastole (E) and atrial contraction (A) velocities, E/A ratio. deceleration time and isovolumetric relaxation time.Patients were classified by mean left ventricular wall thickness into an early group (<15 mm) of 24 patients and an advanced group (≥15 mm) of 17 patients. The total group showed an increased E/A ratio (1.7 ± 0.9 versus 1.4 ± 0.9, p = 0.009) and decreased deceleration time (164 ± 57 versus 174 ± 51 ms. p = 0.11) at follow up compared with baseline study. The early group showed significant changes in the E/A ratio (1.6 ± 1.0 versus 1.2 ± 0.7, p = 0.001) between the two studies.Seven patients (29%) in the early group showed a change from an abnormal relaxation or “normal” pattern to one of restriction, coincident with increased symptoms in six of these patients. Fifteen (88%) of the 17 patients in the advanced group did not show significant changes in the measures during the follow-up study, but these patients already showed a restrictive pattern.Thus, significant changes in serial left ventricular flow velocity variables occur during short-term follow-up evaluation, predominantly in the early group with cardiac amyloidosis.

Two-dimensional Echocardiographic Features of Double Outlet Left Ventricle

In a cyanotic newborn infant, the diagnosis of double outlet left ventricle was made from the two-dimensional echocardiographic examination. The diagnosis was later confirmed at cardiac catheterization and surgery. The parasternal and subcostal views were especially useful for identification of the origin of both great arteries from the morphologic left ventricle. A review of the medical literature since 1967 revealed 77 cases of double outlet left ventricle, most of which were diagnosed only at surgery or postmortem examination. The anatomic features demonstrated with two-dimensional echocardiography in this case are representative of the findings cited most often in the cases reported in the medical literature.

Transposition of the great arteries with posterior aorta: Detection by two-dimensional echocardiography

Two-dimensional echocardiographic features in a case of transposition of the great arteries (TGA) with the posterior aorta are described. The unusual arrangement of the great arteries and the presence of bilateral conuses and aortic-mitral fibrous continuity were clearly demonstrated by angiocardiography and then confirmed at surgery.

Relation of echocardiographic morphology of the mitral apparatus to mitral regurgitation in mitral valve prolapse: Assessment by Doppler color flow imaging

Few data exist regarding the relationship of valvular anatomy and coaptation to the presence of mitral regurgitation (MR) in patients with mitral valve prolapse (MVP). Therefore this study was undertaken to assess the ability of two-dimensional echocardiographic features of mitral valve morphology to predict the presence, direction, and magnitude of MR as assessed by color Doppler flow imaging. MR was present in 21 of 46 patients with MVP on two-dimensional echocardiography. Echocardiograms were specifically evaluated for leaflet apposition, leaflet morphology, and mitral anulus diameter. Color flow images were analyzed for presence of MR, direction of the regurgitant jet, and area encompassing the largest jet visible in any view. Abnormal mitral leaflet coaptation on two-dimensional echocardiography was strongly associated with the presence of MR (p = 0.003), being present in 15 of 21 patients with as compared with 5 of 25 patients without MR. Similarly, mitral leaflet thickness and MR were closely associated (p = 0.0035), with the latter being present in 9 of 30 patients with normal and 12 of 16 patients with excessive leaflet thickness. MR jet direction tended to be anterior to central with posterior leaflet prolapse and posterior or central with anterior leaflet prolapse (p = 0.02). Maximal jet area of MR tended to be larger in patients with compared with those without mitral annular dilatation (5.4 +/- 2.3 versus 2.1 +/- 1.9 cm2, p = 0.001), and in those with abnormal rather than normal leaflet thickness (4.5 +/- 2.7 versus 2.0 +/- 1.6 cm2, p = 0.009). Thus the presence, direction, and size of MR jets in MVP are related to structural abnormality of the mitral apparatus on echocardiography.

Two-dimensional and Doppler echocardiographic features of coronary arteriovenous fistula. Report of three cases.

Two-dimensional (2-D) and Doppler echocardiographic features of three cases of coronary arteriovenous fistula (CAVF) were analyzed. The final diagnosis was confirmed by coronary angiography in each case. In cases 1 and 2, the CAVF arose from the right coronary artery and drained into the right atrium and right ventricle, respectively. The origin and draining site of the CAVF could be visualized by 2-D echocardiograms. The Doppler studies revealed a unidirectional flow within the lumen of the CAVF. In case 3, with a small CAVF originating from both the right coronary artery and left circumflex artery draining into the main pulmonary artery, no abnormal vascular structure could be detected by the 2-D echocardiogram; with Doppler study, a diastolic as well as systolic flow signal directed toward the distal pulmonary artery could be detected.

Comprehensive Doppler assessment of right ventricular diastolic function in cardiac amyloidosis

To assess right ventricular diastolic function in cardiac amyloidosis, pulsed wave Doppler ultrasound measurements of right ventricular inflow velocities and superior vena cava and hepatic vein flow velocities with respiratory monitoring were performed in 41 patients with primary systemic amyloidosis and two-dimensional echocardiographic features of cardiac involvement. Right ventricular diastolic function was abnormal in 31 (76%) of these patients, the major abnormality being a short deceleration time (<150 ms) in 21 (68%), suggesting restriction. In contrast, 7 (23%) of the 31 patients had a decreased ratio of early (E) and late (A) diastolic peak flow velocities and a prolonged deceleration time (>240 ms), suggesting abnormal relaxation.The patients were classified into two groups on the basis of right ventricular free wall thickness: group 1, <7 mm and group 2, ≥7 mm. Compared with normal values, group 1 showed an increased peak late flow velocity (44 ± 19 versus 39 ± 6 cm/s; p < 0.01) and a decreased E/A velocity ratio (1.1 ± 0.4 versus 1.5 ± 0.3; p < 0.01). Group 2 showed a markedly shortened deceleration time (151 ± 37 versus 225 ± 28 ms; p < 0.01), characteristic of restriction.In the overall group, superior vena cava peak flow velocity was decreased in systole and increased in diastole and flow reversals during inspiration were increased compared with normal values. Hepatic venous flow velocities were similar to those in the superior vena cava except for larger flow reversals in the hepatic vein.Thus, in cardiac amyloidosis, right ventricular diastolic function is abnormal. There is a spectrum of right ventricular filling abnormalities and the restrictive filling pattern is seen only in the advanced stages of the disease.

Influence of mitral valve morphology on double-balloon catheter balloon valvuloplasty in patients with mitral stenosis. Analysis of factors predicting immediate and 3-month results.

To determine if mitral valve morphology influences the results of double-balloon catheter balloon valvuloplasty (CBV) for mitral stenosis, two-dimensional echocardiography was performed in 33 patients before CBV. The two-dimensional echocardiographic features of leaflet motion, leaflet thickness, subvalvular disease, and commissural calcium and 14 pre-CBV clinical and hemodynamic variables were then correlated to the immediately post-CBV mitral valve area (MVA). At 3 months after CBV, the two-dimensional echocardiographic features of patients with a 25% or greater decrease in MVA were analyzed to determine whether mitral valve morphology had influenced early results. Leaflet motion had a significant relation with the immediately post-CBV MVA (r = 0.67, y = 4.5x + 0.29, and SEE = 0.45). Leaflet thickness had a weak and negative relation (r = -0.48, y = -0.17x + 2.6, and SEE = 0.53) with the immediately post-CBV MVA. Subvalvular disease and commissural calcium had no significant relation to the immediately post-CBV MVA. When leaflet motion and leaflet thickness were considered as grades of mild, moderate, and severe and assigned a score of 0-2, patients with more severe disease (total score, 3 or 4) had a significant lower MVA immediately after CBV (1.4 +/- 0.4 cm2) than patients with moderate disease (score, 1-2; MVA, 2.0 +/- 0.5 cm2; p less than 0.05) or mild disease (score, 0; MVA, 2.6 +/- 0.6 cm2; p less than 0.05). In 96% of patients with a total score of 0-2, the immediately post-CBV MVA was more than 1.4 cm2, whereas only 29% of patients with a total score of 3-4 had an immediately post-CBV MVA of more than 1.4 cm2. Analysis of all two-dimensional echocardiographic features showed that leaflet motion score had the strongest influence on the post-CBV MVA (p less than 0.001). When all two-dimensional echocardiographic, clinical, and hemodynamic variables were included, leaflet motion, effective balloon dilating area, and cardiac output were the strongest predictors of the immediate post-CB MVA.(ABSTRACT TRUNCATED AT 400 WORDS)

Doppler characterization of left ventricular diastolic function in cardiac amyloidosis

Sixty-four patients with primary systemic amyloidosis—53 with two-dimensional echocardiographic features of cardiac involvement (Group I) and 11 without cardiac involvement (Group II)—underwent Doppler echocardiographic assessment of left ventricular diastolic function. Pulsed wave Doppler recordings of left ventricular inflow velocities and pulmonary vein flow velocities with respiratory monitoring in these patients were compared with findings in a normal group.Patients in Group I showed striking abnormalities of left ventricular diastolic filling when classified into subgroups by mean left ventricular wall thickness: early >12 but <15 mm; advanced ≥15 mm. In early amyloidosis, relaxation was abnormal, with decreased peak early velocity (75 ± 20 versus 86 ± 16 cm/s; p < 0.01), increased late velocity (71 ± 22 versus 56 ± 13 cm/s; p < 0.01), decreased early to late velocity ratio (1.2 ± 0.6 versus 1.6 ± 0.5; p < 0.01) and prolonged isovolumic relaxation time (87 ± 15 versus 73 ± 13 ms; p < 0.01) compared with normal values. In advanced amyloidosis, there was a restrictive filling pattern with a markedly shortened deceleration time (148 ± 50 versus 199 ± 32 ms; p < 0.001), decreased pulmonary vein peak systolic flow velocity (34 ± 16 versus 54 ± 2 cm/s; p < 0.01) and increased diastolic flow velocity (55 ± 20 versus 44 ± 12 cm/s; p < 0.01) compared with normal values. Group II and the subgroup with early amyloidosis had similar flow velocity patterns.Thus, this study documents that in cardiac amyloidosis, a spectrum of diastolic filling abnormalities exists; the restrictive filling pattern is seen only in the advanced stages.

Doppler and Two-dimensional Echocardiographic Features of Sinus of Valsalva Aneurysm

Doppler and Two-dimensional Echocardiographic Features of Sinus of Valsalva Aneurysm