Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Sep 2001
Comparative StudyJet eccentricity: a misleading source of agreement between Doppler/catheter pressure gradients in aortic stenosis.
Characterization of the severity of aortic stenosis relies on accurate measurement of the pressure gradient across the valve and the valve area. Pressure gradients measured by Doppler ultrasound based on the clinical form of the Bernoulli equation often overestimate pressure gradients by catheter as the result of pressure recovery. Doppler techniques measure the velocity of the vena contracta of the stenotic jet. ⋯ Failure to take this into account could fortuitously drive Doppler and catheter measurements toward agreement because the distal pressure sensor will not record the fully recovered pressure. Therefore the pressure gradient across a stenotic valve depends on jet eccentricity. The spread of the wall jet after attachment must be characterized to develop a robust method for the prediction of pressure recovery.
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J Am Soc Echocardiogr · Aug 2001
Clinical TrialEchocardiography-guided pericardiocentesis with probe-mounted needle: report of 53 cases.
Fifty-three pericardiocentesis procedures were performed on 48 patients from 1993 to 2000 at our coronary care unit. Percutaneous puncture (anterior thoracic in 43 cases, subxiphoid in 10 cases) was performed at the site closest to the exploring probe, where the largest amount of fluid was detected. A needle carrier supported by a bracket with two fixed angulations was mounted on the probe. ⋯ No puncture of cardiac walls ever occurred in this series of patients. No major complications occurred; the incidence of minor sequelae was lower than the incidence reported by other studies on pericardiocentesis without continuous visualization. Our technique appears to be safe and easy to perform even in the presence of minimal amounts of pericardial fluid.
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J Am Soc Echocardiogr · Aug 2001
Four-year prospective study of pulmonary venous thrombosis after lung transplantation.
The objective of this study was to prospectively assess pulmonary venous anastomosis by transesophageal echocardiography after lung transplantation. Thrombus formation at the pulmonary venous anastomotic site after lung transplantation may have catastrophic consequences, including allograft failure and stroke. Eighty-seven consecutive adult lung transplant recipients underwent transesophageal echocardiography within 48 hours after surgery. ⋯ Transesophageal echocardiography is a valuable tool for detecting abnormalities of the pulmonary venous anastomosis. Thrombus size and flow velocity at the anastomotic site may guide prognosis and clinical management. Complications of the pulmonary venous anastomosis are in part technical in nature.
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J Am Soc Echocardiogr · Jul 2001
Clinical TrialMilrinone echocardiographic viability test: a pilot study.
We assessed the utility of milrinone to predict recovery of function after surgical myocardial revascularization in patients with severe baseline left ventricular systolic dysfunction caused by coronary artery disease (CAD). Prediction of viable myocardial segments that will regain function after revascularization may help in the selection of patients who will benefit from coronary artery bypass graft surgery (CABG) as well as aid in the choice of target sites for coronary revascularization. We investigated 20 consecutive patients with CAD and left ventricular ejection fraction < or = 40% who had evidence of myocardial viability by either thallium scan or dobutamine viability test and were candidates for elective CABG. ⋯ Seventy-three segments were akinetic or dyskinetic at baseline; 46 (63.0%) of these improved with milrinone. Improvement in regional wall motion after revascularization was detected in 84.8% of the segments that improved with milrinone versus only 3.7% of the segments that did not improve with milrinone. In patients with ischemic cardiomyopathy, improvement in left ventricular function (segmental wall motion and global ejection fraction) during milrinone infusion is highly predictive of improvement after CABG.
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J Am Soc Echocardiogr · Jul 2001
Clinical TrialProspective study of routine perioperative transesophageal echocardiography for elective valve replacement: clinical impact and cost-saving implications.
Transesophageal echocardiography (TEE) is widely used during heart valve replacement operations, but its clinical impact and cost-saving profile have not been studied prospectively for this indication. We investigated the clinical benefits and cost-savings of routine TEE for elective valve replacement at a regional tertiary center. We prospectively studied 300 patients (140 men; mean age [+/-SD], 66 +/- 9 years) undergoing aortic valve, mitral valve, or double-valve replacements. ⋯ Immediate reoperation (dehisced mitral valve prosthesis) and delayed extubation (suspected obstruction of an aortic valve prosthesis) were prompted by postoperative TEE. Extending an existing TEE service to routine intraoperative use saved up to $109 (US) per patient per year. Routine intraoperative TEE can provide major clinical benefit to a small proportion of patients undergoing elective valve replacement, and this can lead to cost savings, but only if the service can be provided without major capital investment.