المؤلفون: Xiaoxue Fan, Brian P. Griffin, Min Pu, James D. Thomas, Delos M. Cosgrove, William J. Stewart, Pieter M. Vandervoort

المصدر: Journal of the American Society of Echocardiography. 12:736-743

مصطلحات موضوعية: Male, medicine.medical_specialty, Systole, Thermodilution, Diastole, Doppler echocardiography, Sensitivity and Specificity, Severity of Illness Index, Ventricular Dysfunction, Left, Predictive Value of Tests, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Aged, Mitral regurgitation, medicine.diagnostic_test, business.industry, Mitral Valve Insufficiency, Blood flow, Stroke volume, Middle Aged, Echocardiography, Doppler, Pulmonary Veins, Predictive value of tests, Regurgitant fraction, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Blood Flow Velocity, Echocardiography, Transesophageal

الوصف: Although alteration in pulmonary venous flow has been reported to relate to mitral regurgitant severity, it is also known to vary with left ventricular (LV) systolic and diastolic dysfunction. There are few data relating pulmonary venous flow to quantitative indexes of mitral regurgitation (MR). The object of this study was to assess quantitatively the accuracy of pulmonary venous flow for predicting MR severity by using transesophageal echocardiographic measurement in patients with variable LV dysfunction. This study consisted of 73 patients undergoing heart surgery with mild to severe MR. Regurgitant orifice area (ROA), regurgitant stroke volume (RSV), and regurgitant fraction (RF) were obtained by quantitative transesophageal echocardiography and proximal isovelocity surface area. Both left and right upper pulmonary venous flow velocities were recorded and their patterns classified by the ratio of systolic to diastolic velocity: normal (/=1), blunted (1), and systolic reversal (0). Twenty-three percent of patients had discordant patterns between the left and right veins. When the most abnormal patterns either in the left or right vein were used for analysis, the ratio of peak systolic to diastolic flow velocity was negatively correlated with ROA (r = -0.74, P.001), RSV (r = -0.70, P.001), and RF (r = -0.66, P.001) calculated by the Doppler thermodilution method; values were r = -0.70, r = -0.67, and r = -0.57, respectively (all P.001), for indexes calculated by the proximal isovelocity surface area method. The sensitivity, specificity, and predictive values of the reversed pulmonary venous flow pattern for detecting a large ROA (0.3 cm(2)) were 69%, 98%, and 97%, respectively. The sensitivity, specificity, and predictive values of the normal pulmonary venous flow pattern for detecting a small ROA (0.3 cm(2)) were 60%, 96%, and 94%, respectively. However, the blunted pattern had low sensitivity (22%), specificity (61%), and predictive values (30%) for detecting ROA of greater than 0.3 cm(2) with significant overlap with the reversed and normal patterns. Among patients with the blunted pattern, the correlation between the systolic to diastolic velocity ratio was worse in those with LV dysfunction (ejection fraction50%, r = 0.23, P.05) than in those with normal LV function (r = -0.57, P.05). Stepwise linear regression analysis showed that the peak systolic to diastolic velocity ratio was independently correlated with RF (P.001) and effective stroke volume (P.01), with a multiple correlation coefficient of 0.71 (P.001). In conclusion, reversed pulmonary venous flow in systole is a highly specific and reliable marker of moderately severe or severe MR with an ROA greater than 0.3 cm(2), whereas the normal pattern accurately predicts mild to moderate MR. Blunted pulmonary venous flow can be seen in all grades of MR with low predictive value for severity of MR, especially in the presence of LV dysfunction. The blunted pulmonary venous flow pattern must therefore be interpreted cautiously in clinical practice as a marker for severity of MR.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::825ae2567a5fc540f08b8fdfa7177269Test
https://doi.org/10.1016/s0894-7317Test(99)70024-6

المؤلفون: William J. Stewart, Craig R. Asher, Maria-Anna Secknus, Gregory M. Scalia, Delos M. Cosgrove

المصدر: Journal of the American Society of Echocardiography. 12:231-236

مصطلحات موضوعية: Male, Cardiac function curve, Aortic valve, medicine.medical_specialty, Aortic Valve Insufficiency, Cardiac Output, Low, Regurgitation (circulation), Intracardiac injection, law.invention, Ventricular Dysfunction, Left, Postoperative Complications, law, Internal medicine, Mitral valve, Catheterization, Peripheral, Cardiac valve, Cardiopulmonary bypass, Humans, Minimally Invasive Surgical Procedures, Mitral Valve Stenosis, Transplantation, Homologous, Ventricular Function, Medicine, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Cardiac Output, Internal Mammary-Coronary Artery Anastomosis, Ultrasonography, Interventional, Heart Valve Prosthesis Implantation, Mitral regurgitation, Cardiopulmonary Bypass, Intraoperative Care, business.industry, Air, Mitral Valve Insufficiency, Aortic Valve Stenosis, Middle Aged, Surgery, medicine.anatomical_structure, Aortic Valve, cardiovascular system, Cardiology, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal

الوصف: The minimally invasive procedure is a new surgical technique that uses a small sternal incision. Because of limited surgical exposure, removal of intracavitary air and visual assessment of cardiac function are not possible. We studied the utility of intraoperative transesophageal echocardiography (IOE) before and after cardiopulmonary bypass in 112 patients (mean age 53.1 ± 15.2 years, 74 males) who underwent minimally invasive valvular surgery. Surgical procedures included 52 isolated mitral valve procedures (49 repairs, 3 prostheses), 58 isolated aortic valve procedures (16 repairs, 26 prostheses, 16 homografts), and 2 combined aortic and mitral valve repairs. Prepump IOE was useful to confirm valve dysfunction and assist determination of arterial cannulation site. Postpump IOE identified intracardiac air in all patients, which was defined as extensive in 58 (52%) cases. Postoperatively, new left ventricular dysfunction was noted in 22 (20%) patients, more often in the group with extensive air by IOE (17 [30%] of 58 patients) compared with those without extensive air (5 [10%] of 54 patients, P = .01). Second pump runs were required in 7 (6%) of 112 patients: 3 cases of residual aortic regurgitation, 1 case of residual mitral regurgitation, and 3 cases with new ventricular dysfunction. No deaths occurred. We conclude that IOE is essential in minimally invasive valvular surgery because it detects problems that require immediate remedy. IOE allows real-time assessment of ventricular filling, ventricular and valvular function, and intracardiac air. (J Am Soc Echocardiogr 1999;12:231-6.)

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5764340deaa2f54eb72be87577ff760aTest
https://doi.org/10.1016/s0894-7317Test(99)70036-2

المؤلفون: Dave P. Miller, Allan L. Klein, Delos M. Cosgrove, Gerald I. Cohen, Carol I. Duffy, William J. Stewart

المصدر: Journal of the American Society of Echocardiography. 9:508-515

مصطلحات موضوعية: Adult, Male, Aortic valve, medicine.medical_specialty, Adolescent, Aortic Valve Insufficiency, Perforation (oil well), Regurgitation (circulation), complex mixtures, symbols.namesake, Aortic valve repair, Internal medicine, Humans, Medicine, Eccentric, Radiology, Nuclear Medicine and imaging, Child, Aged, Aged, 80 and over, Jet (fluid), Mitral regurgitation, business.industry, Middle Aged, equipment and supplies, Echocardiography, Doppler, Color, medicine.anatomical_structure, Echocardiography, Aortic Valve, Child, Preschool, cardiovascular system, Cardiology, symbols, Female, Cardiology and Cardiovascular Medicine, business, Doppler effect, circulatory and respiratory physiology

الوصف: The character of the color flow Doppler jet provides information on the mechanism and pathologic elements of valve dysfunction. This has been useful in the evaluation of mitral regurgitation, a repairable problem, but has not been described comprehensively for the aortic valve. The purpose of our study was to correlate the color flow Doppler characteristics of the aortic regurgitant jet and two-dimensional echocardiographic findings of valve mobility with surgical pathology. Prepump intraoperative echocardiography and color flow Doppler echocardiography were performed on 124 patients with aortic regurgitation and used to categorize leaflet motion as excessive, restricted, or normal, jet direction as eccentric or central, and jet origin between the cusps as eccentric, central, or diffuse. Bicuspid disease and tricuspid aortic valve prolapse were associated with excessive valve mobility and eccentric jet direction and origin. Conversely, annular dilation, rheumatic disease, sclerosis, and perforation were associated with normal or reduced cusp mobility and a central jet direction and origin (p = 0.001). Overall, an eccentric jet direction occurred in 69% of patients with excessive cusp mobility, whereas 71% of patients with normal or reduced cusp mobility had a central jet (p = 0.001). Therefore color flow Doppler determination of the eccentricity of regurgitant jet direction and origin is useful in predicting the mechanism and disease of aortic valve dysfunction. These observations may suggest the presence of prolapse and thus the potential for aortic valve repair.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6b18baadf85f3c30113ca111ad83a42bTest
https://doi.org/10.1016/s0894-7317Test(96)90122-4

المؤلفون: William Stewart, James D. Thomas, Dominic Y. Leung, Delos M. Cosgrove, Brian P. Griffin, Thomas H. Marwick

المصدر: Journal of the American Society of Echocardiography. 8:377

مصطلحات موضوعية: medicine.medical_specialty, Mitral valve repair, Ventricular function, business.industry, Internal medicine, medicine.medical_treatment, Cardiology, Medicine, Radiology, Nuclear Medicine and imaging, Systolic function, Cardiology and Cardiovascular Medicine, business

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::86b2e828c2e7b8244f9d63bb818f4115Test
https://doi.org/10.1016/s0894-7317Test(05)80192-0

المؤلفون: Min Pu, William J. Stewart, Delos M. Cosgrove, James D. Thomas, Brian P. Griffin, Pieter M. Vandervoort

المصدر: Journal of the American Society of Echocardiography. 8:351

مصطلحات موضوعية: medicine.medical_specialty, Mitral regurgitation, business.industry, Internal medicine, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, Convergence (relationship), Cardiology and Cardiovascular Medicine, business

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::5151bb8d4c601b8119faeb584a865578Test
https://doi.org/10.1016/s0894-7317Test(05)80088-4

المؤلفون: Secknus, Maria-Anna, Asher, Craig R., Scalia, Gregory M., Cosgrove, Delos M., Stewart, William J.

المصدر: Journal of the American Society of Echocardiography; April 1999, Vol. 12 Issue: 4 p231-236, 6p

مستخلص: The minimally invasive procedure is a new surgical technique that uses a small sternal incision. Because of limited surgical exposure, removal of intracavitary air and visual assessment of cardiac function are not possible. We studied the utility of intraoperative transesophageal echocardiography (IOE) before and after cardiopulmonary bypass in 112 patients (mean age 53.1 ± 15.2 years, 74 males) who underwent minimally invasive valvular surgery. Surgical procedures included 52 isolated mitral valve procedures (49 repairs, 3 prostheses), 58 isolated aortic valve procedures (16 repairs, 26 prostheses, 16 homografts), and 2 combined aortic and mitral valve repairs. Prepump IOE was useful to confirm valve dysfunction and assist determination of arterial cannulation site. Postpump IOE identified intracardiac air in all patients, which was defined as extensive in 58 (52%) cases. Postoperatively, new left ventricular dysfunction was noted in 22 (20%) patients, more often in the group with extensive air by IOE (17 [30%] of 58 patients) compared with those without extensive air (5 [10%] of 54 patients, P= .01). Second pump runs were required in 7 (6%) of 112 patients: 3 cases of residual aortic regurgitation, 1 case of residual mitral regurgitation, and 3 cases with new ventricular dysfunction. No deaths occurred. We conclude that IOE is essential in minimally invasive valvular surgery because it detects problems that require immediate remedy. IOE allows real-time assessment of ventricular filling, ventricular and valvular function, and intracardiac air. (J Am Soc Echocardiogr 1999;12:231-6.)

المؤلفون: Klein, Allan L., Stewart, William C., Cosgrove, Delos M., Mick, Matthew J., Salcedo, Ernesto

المصدر: Journal of the American Society of Echocardiography; September-October 1990, Vol. 3 Issue: 5 p412-415, 4p

مستخلص: This report describes a patient who became hypoxic and hypotensive while awaiting cardiac surgery. An urgent transesophageal echocardiogram in the operating room showed a mass at the junction of the main and right pulmonary arteries consistent with thrombus. The thrombus was removed surgically, and the patient then had a successful aortic valve replacement. Transesophageal echocardiography is therefore useful in the evaluation of the critically ill patient.