Echocardiography
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Case Reports Comparative Study
Transesophageal echocardiography in aortopulmonary communications.
The assessment of congenital aortopulmonary communications by transthoracic echocardiography may be suboptimal, particularly postoperatively, due to limited acoustic windows. We performed intraoperative transesophageal echocardiograms in six patients with eight proven systemic-pulmonary communications. Diagnosis included truncus arteriosus (1), aortopulmonary window (1), Waterston anastomosis (3), central Gore-Tex shunt (1), and modified left Blalock-Taussig shunt (2). All communications were accurately demonstrated by transesophageal echocardiography (TEE). The transesophageal technique also provided an assessment of the size of the aortopulmonary communications and the proximal pulmonary arteries. In addition, the gradient across some of the communications could be accurately estimated utilizing the high pulse repetition frequency Doppler. On the other hand, only two of the seven aortopulmonary communications were detected by transthoracic echocardiography. Postoperatively, transesophageal imaging demonstrated unobstructed conduit in five of five patients who underwent conduit repair, as well as intact closure of aortopulmonary communications and concomitant closure of ventricular septal defects.
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This article describes the transesophageal echocardiographic findings in a patient with pathologically proven mitral valve aneurysm. This aneurysm probably occurred as a complication of aortic valve endocarditis. Transesophageal echocardiography showed a saccular structure attached to the left atrial side of the anterior mitral leaflet with systolic expansion and diastolic collapse, and its orifice was visualized with excellent resolution. Transesophageal echocardiography is a useful diagnostic tool for evaluation of mitral valve aneurysm.
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Case Reports
Diagnosis of ruptured sinus of Valsalva aneurysms: potential value of transesophageal echocardiography.
Two patient cases are reported in which an aneurysm of the right coronary sinus of Valsalva ruptured into the right ventricular outflow tract, near the crux of the heart. Transthoracic two-dimensional echocardiography and transesophageal echocardiography using Doppler color flow mapping allowed accurate preoperative assessment of the left-to-right shunt, which was subsequently confirmed by contrast aortography and surgery.
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Intravascular and intracardiac ultrasound imaging using high-frequency ultrasound catheters has a number of potential applications in pediatric cardiology. This article reviews the current difficulties associated with interventional procedures for congenital heart lesions, the feasibility of intravascular ultrasound imaging in children, and its potential applications.
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Valve conservation surgery represents an exciting advance in the evolution of valve surgery. Recent studies have shown the significant advantages of mitral valve repair over valve replacement. While there are significant advantages for valve repair, the surgeon requires a greater understanding of the mechanism of valvular dysfunction prior to repair and requires an accurate means to assess the adequacy of the repair in the operating room immediately following the repair. Intraoperative echocardiography with color flow Doppler mapping provides immediate and accurate assessment of cardiac anatomy, hemodynamics, and valve integrity. These data are vital for optimal intraoperative surgical decision making. Intraoperative echocardiography has an important role in the evaluation in patients undergoing surgery to the aortic valve and left ventricular outflow tract by the delineation of presence and mechanism of left ventricular outflow tract obstruction, the quantification of severity of the left ventricular outflow tract gradient, the severity and mechanism of aortic regurgitation, the distribution and severity of left ventricular hypertrophy, and identification of associated lesions such as mitral regurgitation. Aortic valve conservation surgery is more complex than mitral valve surgery. The surgical techniques for aortic valve repair have been slower to evolve than mitral repair with a much smaller percentage of patients currently suitable for valve repair. However, with the aid of intraoperative echocardiography, the future shows similar promise that has already been fulfilled with mitral valve repair. Even in its infancy, intraoperative echocardiography has become indispensable to the innovative cardiac surgeon. However, without consideration of adequate echocardiographic training, incorrect echocardiography diagnoses can lead to inappropriate surgical decisions.