Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Apr 2009
Minimal sedation second dose strategy with intranasal midazolam in an outpatient pediatric echocardiographic setting.
Anxiety and movement in children during transthoracic echocardiography (TTE) can compromise study quality and reliability. Minimal sedation is often required. Intranasal midazolam (INM), used in various procedures, is an excellent sedative. Optimal INM dosing strategies for uncooperative children undergoing TTE are largely unknown, including second-dose INM strategies, introduced to maximize the potential for successful sedation and minimize risk. The purpose of this retrospective review was to evaluate the effectiveness of a second-dose INM minimal sedation strategy recently adopted at the Children's Hospital of Pittsburgh. ⋯ A second-dose INM strategy was effective in achieving satisfactory minimal sedation in children undergoing TTE. The results of this study also suggest that only a small proportion of patients would benefit from a one-dose INM strategy.
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J Am Soc Echocardiogr · Apr 2009
Comparative StudyLeft ventricular filling pressure estimation at rest and during exercise in patients with severe aortic valve stenosis: comparison of echocardiographic and invasive measurements.
The Doppler index of left ventricular (LV) filling (E/e') is recognized as a noninvasive measure for LV filling pressure at rest but has also been suggested as a reliable measure of exercise-induced changes. The aim of this study was to investigate changes in LV filling pressure, measured invasively as pulmonary capillary wedge pressure (PCWP), at rest and during exercise to describe the relation with E/e' in patients with severe aortic stenosis. ⋯ E/e' is well correlated with PCWP at rest. However, E/e' cannot be used to detect exercise-induced changes in PCWP in patients with severe aortic stenosis. Using the ratio of E during exercise to e' at rest may result in a better estimate of the increase in PCWP during exercise.
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J Am Soc Echocardiogr · Apr 2009
Review of complications in a series of patients with known gastro-esophageal varices undergoing transesophageal echocardiography.
The presence of gastroesophageal varices is considered a relative contraindication to performing transesophageal echocardiography (TEE), but this is based on expert opinion, and there is limited data to support this recommendation. The aim of this study was to review the complications and benefit of performing TEE in patients with known gastroesophageal varices. ⋯ Although the presence of known esophageal varices was previously thought to be a contraindication to performing TEE, the results of this study show that TEE without transgastric views can be performed without serious complications in patients with grade 1 or 2 esophageal varices who have not experienced recent variceal hemorrhages. Additionally, there is a definite benefit, as all of the clinical questions were successfully answered.
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J Am Soc Echocardiogr · Apr 2009
Tissue Doppler imaging measurement of left ventricular systolic function in children: mitral annular displacement index is superior to peak velocity.
Doppler tissue imaging (DTI)-derived mitral annular systolic peak S-wave velocity (S') correlates with left ventricular (LV) ejection fraction (EF). The authors hypothesized that DTI mitral annular displacement, which is equal to the velocity-time integral of the DTI S' wave, might be superior to S' to analyze LV systolic function. Because S' varies with age, it was expressed as Sz, the z-score variance from normal S' for each subject. Because displacement varies with heart size, it was expressed as a displacement index, or the DTI S'-wave velocity-time integral divided by the end-diastolic distance from the mitral annulus to the LV apex. The aims of this study were to (1) measure the accuracy, sensitivity, specificity, and positive and negative predictive values of displacement index compared with Sz to detect systolic dysfunction; (2) compare displacement index with other quantitative parameters of longitudinal systolic function, including color DTI-derived strain and two-dimensional speckle-tracking echocardiography (2D)-derived mitral annular displacement and strain; and (3) determine the effects of age, heart rate (HR), and body surface area (BSA) on displacement index. ⋯ Displacement index is linearly related to EF and also to other parameters of longitudinal systolic function. Displacement index has some advantages over Sz for assessing ventricular systolic function and should prove useful in measuring longitudinal and global LV systolic function.