Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Sep 2002
Correlation between measured inferior vena cava diameter and right atrial pressure depends on the echocardiographic method used in patients who are mechanically ventilated.
In patients who are mechanically ventilated, the correlation between inferior vena cava diameter (IVCD) measurements and mean right atrial pressure (RAP) varies in the literature. The purpose of this study was to test if the correlation between IVCD and RAP measurement in patients who are critically ill depends on the transthoracic echocardiography (TTE) methodology used. Twenty patients who were critically ill, sedated, and required respiratory support were prospectively studied by TTE during mechanical ventilation in a controlled mode. ⋯ Mean bias between the 2 TTE methods (Bland-Altman analysis) was 1.6 mm (SD +/- 2.03 mm). In conclusion, this study confirms that variation of correlation between TTE IVCD measurement and RAP depends on the ultrasonographic methodology used and the timing of measurement during the cardiac cycle. IVCD at end-expiration and end-diastole, with ECG synchronization, using the M-mode (IVCD-MM) correlates more satisfactory with RAP than with IVCD at end-expiration, without ECG synchronization, using the 2-dimensional long-axis view, in patients during mechanical ventilation.
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Paradoxical embolism is an uncommon but clinically important phenomenon. Elements of diagnosis include the presence of: (1) a venous thrombus, (2) an arterial embolus, (3) a communication between the right and left heart, and (4) a thrombus traversing such a communication. ⋯ A transesophageal echocardiogram with contrast should be considered in cases where paradoxical embolism is a possibility. We present a case in which a "thrombus-in-transit" was imaged across the interatrial septum in a patient with a patent foramen ovale, deep venous thrombosis, and an embolic cerebrovascular stroke.
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J Am Soc Echocardiogr · Sep 2002
Severe aortic valve stenosis with preserved and reduced systolic left ventricular function: diagnostic usefulness of the Tei index.
In patients with severe aortic valve stenosis (AS), the onset of heart failure is associated with increased mortality and higher operative risk. Heart failure may result from either systolic, diastolic, or "overall" left ventricular dysfunction. The index "isovolumic contraction time and isovolumic relaxation time divided by ejection time" was shown to be a sensitive indicator of "overall" cardiac dysfunction in patients with dilated cardiomyopathy and cardiac amyloidosis. We sought to define the role of the Tei index in patients with severe AS and to validate this index against conventional measures of systolic and diastolic LV function. ⋯ The Tei index is significantly increased in patients with severe AS and depressed overall cardiac LV function. In AS patients with predominant diastolic dysfunction, in whom systolic function is preserved, the index is decreased in comparison with control patients. The index differentiates between symptomatic AS patients with depressed and less symptomatic AS patients with preserved systolic LV function, and may thus provide relevant information in the work-up and care of such patients.
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We report the diagnosis of intracoronary air embolism by transesophageal echocardiography in 2 patients undergoing open heart surgery. The sudden appearance of inferior wall akinesis with increased brightness of the area immediately after removal of the aortic cross clamp and spontaneous resolution of the abnormalities support the diagnosis of intracoronary air embolism.