Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Aug 1990
Transesophageal echocardiography in children with congenital heart disease: an initial experience.
Transesophageal echocardiography with a single plane (transverse axis), dedicated pediatric probe was performed prospectively in 25 anesthetized children undergoing routine cardiac catheterization or intracardiac surgery, to assess the potential role of this technique in the initial diagnosis, perioperative management and postoperative follow-up of children with congenital heart disease. The group ranged in age from 1 year to 14.8 years (mean 6.1) and weight from 6.5 to 52 kg (mean 22.4). Studies were successful in all patients and no complications were encountered. ⋯ Problem areas for single plane transesophageal imaging were the apical interventricular septum, the right ventricular outflow tract and the left pulmonary artery. The intraoperative use of transesophageal echocardiography allowed assessment of the surgical repair and monitoring of ventricular function and volume status while the patient was weaned from cardiopulmonary bypass. Transesophageal echocardiography in pediatric patients is of additional value in three main areas: 1) the precise morphologic diagnosis of congenital heart disease, 2) perioperative monitoring, and 3) postsurgical follow-up.
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J. Am. Coll. Cardiol. · Aug 1990
Case ReportsRight atrial compression in postoperative cardiac patients: detection by transesophageal echocardiography.
Four patients developed hypotension after heart surgery. Hemodynamic measurements revealed elevated right atrial pressure with normal pulmonary capillary wedge pressure. ⋯ At reoperation atrial compression by an organized hematoma was found and in each instance successfully drained. Thus, transesophageal echocardiography is superior to transthoracic echocardiography in evaluating critically ill postoperative hypotensive patients and can differentiate isolated right atrial tamponade from other causes of hemodynamic deterioration such as prosthetic valve dysfunction or left ventricular systolic dysfunction, or both.
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J. Am. Coll. Cardiol. · Jul 1990
Color Doppler echocardiographic evaluation of patients with a flail mitral leaflet.
Chordal rupture with a subsequent flail mitral valve leaflet is now the most common cause of pure mitral regurgitation. To describe the Doppler color flow findings in flail mitral leaflet and the determinants of these findings, Doppler color flow mapping and conventional Doppler echocardiography were performed in 31 consecutive patients presenting with a flail mitral leaflet. In the 23 patients with a posterior flail leaflet, a distinctive highly eccentric and turbulent jet directed toward the posterior wall of the aorta was noted. ⋯ Thus, patients with a flail mitral valve leaflet have distinctive Doppler color flow findings. A highly eccentric and turbulent jet directed posteriorly to the aorta may contribute to a systematic underestimation of severe mitral regurgitation by conventional Doppler color flow criteria. The use of pulsed Doppler ultrasound to calculate regurgitant fraction in patients with a flail mitral valve leaflet may be helpful in reliably assessing the degree of mitral regurgitation.
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J. Am. Coll. Cardiol. · May 1990
Randomized Controlled Trial Clinical TrialInfective endocarditis, 1983-1988: echocardiographic findings and factors influencing morbidity and mortality.
The echocardiograms and clinical records of 70 patients with infective endocarditis seen between 1983 and 1988 were examined to evaluate the role of two-dimensional and Doppler echocardiography in the diagnosis of infective endocarditis and identify risk factors for morbidity and mortality. A blinded observer reviewed the echocardiograms for the presence and size of vegetations and the severity of the valvular regurgitation. Vegetations were identified in 54 (78%) of 69 technically satisfactory echocardiograms. ⋯ No patient with less than or equal to 1+ regurgitation (n = 8) died or required valve surgery for heart failure, but three of the eight patients did undergo surgery for mycotic aneurysm, recurrent embolism or paravalvular abscess. In patients without embolism before echocardiography, there was a trend toward a greater incidence of subsequent embolism in those with vegetations greater than 10 mm in size (26% [8 of 31] compared with 11% [2 of 18] with vegetations less than or equal to 10 mm) (p = 0.19). By multivariate analysis, risk factors for in-hospital death (n = 7) were an infected prosthetic valve (p less than 0.007), systemic embolism (p less than 0.02) and infection with Staphylococcus aureus (p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Am. Coll. Cardiol. · May 1990
Exercise responses in patients with congenital heart disease after Fontan repair: patterns and determinants of performance.
After a Fontan repair for congenital heart disease, 42 patients underwent graded supine bicycle exercise tests at levels relevant to normal daily activities. Results were compared with those of 28 age-matched normal control subjects. At rest, the cardiac index, stroke index and systolic blood pressure were comparable in both groups, but increases with exercise were smaller in the patients with a Fontan circulation. ⋯ Multivariate analysis demonstrated that impairment of ventricular contractility, only when severe, predicted limited performance. There was no evidence of increased afterload, particularly in the poor performers. Therefore, ventricular filling, which is determined primarily by the pulmonary vascular bed, appears to be a major determinant of functional result after a Fontan repair.