Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialA prospective, randomized, blinded comparison of multiplane and biplane transesophageal echocardiographic techniques.
Although multiplane transesophageal echocardiography has become an accepted diagnostic technique, there is a paucity of literature directly comparing the diagnostic yield of multiplane and biplane transesophageal examinations. This study was designed to compare the ability of multiplane and biplane transesophageal echocardiographic techniques to visualize intracardiac structures. Complete multiplane and biplane transesophageal studies were performed on each of 50 patients (100 total studies) referred to the echocardiography laboratory for elective transesophageal echocardiography. ⋯ Several individual structures were visualized significantly better (p < 0.05) by the multiplane technique, including the left upper pulmonary vein, fossa ovalis, left main coronary artery, and proximal ascending aorta. The subjective score of overall adequacy of the study for addressing the clinical indication showed a strong trend (p < 0.06) in favor of the multiplane technique, with higher scores in 11 of 50 multiplane studies versus three of 50 biplane studies when the two techniques were compared in individual patients. Therefore multiplane transesophageal echocardiography provides superior overall visualization of intracardiac structures compared with biplane studies, particularly for the left upper pulmonary vein, fossa ovalis, left main coronary artery, and ascending aorta.
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J Am Soc Echocardiogr · Nov 1996
Doppler echocardiographic index for assessment of global right ventricular function.
Echocardiographic assessment of right ventricular function remains difficult and challenging. However, there is considerable clinical need for a simple, reproducible, and reliable parameter of right ventricular function in patients with right-sided heart disease. The purpose of this study was to assess the clinical value of a Doppler-derived index, combining systolic and diastolic intervals of the right cycle, in assessing global right ventricular function in patients with primary pulmonary hypertension. ⋯ It is well known that right ventricular systolic and diastolic dysfunction coexist in patients with primary pulmonary hypertension. This article reports the use of an easily obtainable Doppler-derived index that combines elements of systolic and diastolic function. This index appears to be a useful noninvasive means that correlates with symptoms and survival in patients with primary pulmonary hypertension.
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J Am Soc Echocardiogr · Nov 1996
The role of transthoracic echocardiography in the management of patients seen in an outpatient cardiology clinic.
Transthoracic two-dimensional (2D) Doppler echocardiography may provide new or additional information in patients, but it is often not known whether the results alter the treatment plan. We investigated whether results of clinically indicated 2D echocardiography were different from the physician's clinical examination or led to changes in management in 200 consecutive outpatients seen in a university-based clinic. A questionnaire was completed by the physician regarding physical findings and treatment plan before 2D echocardiography was performed. ⋯ Results of 2D echocardiography obviated the need for further cardiac evaluation, surgery, or procedures in 30 patients, avoiding additional patient charges of $125,754.00. In contrast, results of 2D echocardiography led to the need for further evaluation, surgery, or procedures in 32 patients, resulting in additional patient charges of $70,860.00. In conclusion, 2D echocardiography provides new or additional information that results in changes in management strategy in one third of patients, and 2D echocardiography offers relative cost savings by avoiding additional procedures.
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J Am Soc Echocardiogr · Nov 1996
Case ReportsToxic methemoglobinemia after topical anesthesia for transesophageal echocardiography.
Topical benzocaine spray is an anesthetic agent that is commonly used during transesophageal echocardiography (TEE). This agent is believed to be relatively safe because of very low systemic absorption. We report a case of toxic methemoglobinemia induced by benzocaine use for pharyngeal anesthesia during TEE. Physicians who perform TEE and use benzocaine or other topical anesthetics need to be familiar with this potential complication and have the necessary treatment readily available.
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J Am Soc Echocardiogr · Sep 1996
Comparative StudyAortic flow velocity patterns in chronic aortic regurgitation: implications for Doppler echocardiography.
Aortic regurgitation is associated with retrograde diastolic flow in the aorta. Echocardiographic quantitative analysis of the magnitude of the flow reversal is believed to provide an estimate of severity of regurgitant disease despite variations in flow profiles. The purpose of this study was to evaluate the uniformity of flow patterns in the aorta of patients with aortic regurgitation and to investigate the relationship between these profiles and the echocardiographic estimates of flow reversal. ⋯ The best descending aortic Doppler echocardiographic parameter for predicting ascending aortic regurgitant fraction was the end-diastolic velocity (end-diastolic velocity = 32.2 cm/sec. ascending aortic regurgitant fraction + 1.4 cm/sec; r = 0.94; p < 0.001). Pulsedwave Doppler sampling of descending aortic flow reflects severity of aortic regurgitant disease, in part the result of more uniform blood-velocity profiles in the descending aorta compared with the ascending aorta. The Doppler end-diastolic velocity in the descending aorta is a useful parameter of severity of aortic regurgitation.