Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
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J Am Soc Echocardiogr · Sep 1994
Assessment of right-to-left shunt flow in atrial septal defect by transesophageal color and pulsed Doppler echocardiography.
To investigate the clinical significance and problems of right-to-left (R-L) shunt flow dynamics in atrial septal defects, we performed transesophageal color and pulsed Doppler echocardiography in 30 patients with atrial septal defects of the ostium secundum type. The 30 patients consisted of 20 with a pulmonary artery systolic pressure of less than 40 mm Hg, four with a pressure of 40 to 60 mm Hg, three with a pressure of 90 mm Hg or more, two patients with pulmonic stenosis, and one patient with Ebstein's anomaly. R-L shunting was determined by the presence of a shunt flow signal across the defect during each cardiac cycle. ⋯ In two of the three patients with severe pulmonary hypertension, R-L shunting continued from atrial systole to early ventricular systole and was also observed in early diastole. R-L shunt flow was detected in patients with atrial septal defects not only with pulmonary hypertension but also without pulmonary hypertension and was influenced by the right atrial pressure in the phase of tricuspid valve closing, the volume or direction of tricuspid regurgitation, rebound flow caused by massive left-to-right shunt flow, the grade of right ventricular distensibility or the complication of pulmonary hypertension, and complications with other cardiac anomalies. Thus R-L shunt flow in patients with atrial septal defects was detected easily by transesophageal color and pulsed Doppler echocardiography because of the high efficiency of this method for its detection.
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J Am Soc Echocardiogr · Jul 1994
Case ReportsRight ventricular thrombus: an unusual manifestation of Behçet's disease.
Behcet's disease is a chronic multisystem illness in which cardiac involvement is a rare manifestation. In this unusual case a young man had symptoms that primarily related to recurrent right ventricular thrombi and pulmonary thromboemboli. Transesophageal echocardiography was useful in documenting the presence of intracardiac thrombus and establishing the diagnosis.
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J Am Soc Echocardiogr · Jul 1994
Case ReportsPosterior left ventricular pseudoaneurysm after aortic valve replacement in a patient with rheumatoid arthritis: diagnosis by transesophageal echocardiography.
A 58-year-old man with seropositive rheumatoid arthritis underwent successful aortic valve replacement because of severe aortic regurgitation. One year later, prosthetic valve endocarditis was suspected clinically and he was referred for echocardiography. ⋯ Biplane transesophageal echocardiography demonstrated the presence of a pulsatile pseudoaneurysm of the left ventricle arising posteriorly, close to the anulus of the mitral valve. There was no evidence of endocarditis.
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J Am Soc Echocardiogr · May 1994
Relationship of left atrial pressure and pulmonary venous flow velocities: importance of baseline mitral and pulmonary venous flow velocity patterns studied in lightly sedated dogs.
Prior clinical and animal studies have shown a markedly different relationship between left atrial pressure and the systolic fraction of pulmonary venous flow but have not discussed possible reasons for this discrepancy. To examine the possibility that these disparate results are due to differences in baseline mitral and pulmonary venous flow velocities, we recorded both velocities with left atrial and left ventricular pressure under different loading conditions in eight lightly sedated normal dogs. With constant atrial pacing at 85 beats/min, mean left atrial pressure was increased from 5.3 +/- 1.1 mm Hg at baseline to 16.1 +/- 1.7 mm Hg with volume and methoxamine infusion (p < 0.05). ⋯ These results are consistent with previous animal and clinical results that indicate pulmonary venous diastolic flow is closely related to early mitral flow velocity, whereas systolic flow is determined primarily by left atrial systolic function. The markedly different relationships observed between left atrial pressure and pulmonary venous systolic flow in animal and clinical studies are most likely due to different baseline flow velocity patterns and differences in left atrial systolic reserve. Future studies investigating these relationships should include data on mitral and pulmonary venous flow velocities as well as left atrial size and systolic function.
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J Am Soc Echocardiogr · Mar 1994
Comparative StudyTwo-dimensional transesophageal echocardiographic characterization of ventricular filling in real time by acoustic quantification: comparison with pulsed Doppler echocardiography.
Little is known about the accuracy of acoustic quantification (AQ) in the assessment of left ventricular diastolic filling. Therefore the objective of this study was to determine the ability of AQ applied to two-dimensional echocardiography to characterize left ventricular diastolic filling compared with Doppler echocardiography. In 80 unselected patients, AQ of left ventricular diastolic filling was performed during two-dimensional transesophageal echocardiography. ⋯ Acoustic quantification assessment of left ventricular diastolic filling accurately characterizes the distribution of diastolic filling compared with Doppler echocardiography. The presence of asynchronous systolic wall motion decreases the accuracy of the AQ method in assessing peak filling rate. The ultimate clinical application of AQ in the assessment of left ventricular diastolic filling is yet to be determined but appears promising.