Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
-
J Am Soc Echocardiogr · Mar 2006
ReviewUltrasound lung comets: a clinically useful sign of extravascular lung water.
Assessment of extravascular lung water is a challenging task for the clinical cardiologist and an elusive target for the echocardiographer. Today chest x-ray is considered the best way to assess extravascular lung water objectively, but this requires radiology facilities and specific reading expertise, uses ionizing energy, and poses a significant logistic burden. Recently, a new method was developed using echocardiography (with cardiac probes) of the lung. ⋯ Functionally, ULCs are a sign of distress of the alveolar-capillary membrane, often associated with reduced ejection fraction and increased pulmonary wedge pressure. The ULC sign is quantitative, reproducible, and ideally suited to complement conventional echocardiography in the evaluation of heart failure patients in the emergency department (for the differential diagnosis of dyspnea), in-hospital evaluation (for tailoring diuretic therapy), home care (with portable ultrasound), and stress echocardiography lab (as a sign of acute pulmonary congestion during stress). In conclusion, ULCs represent a useful, practical, and appealingly simple way to image directly extravascular lung water.
-
J Am Soc Echocardiogr · Nov 2005
ReviewSubvalvular left ventricular outflow obstruction for patients undergoing aortic valve replacement for aortic stenosis: echocardiographic recognition and identification of patients at risk.
Persistently high gradients after aortic valve replacement (AVR), potentially caused by prosthesis-patient mismatch or superimposed but unrecognized nonvalvular obstruction, are associated with adverse clinical outcomes. Concomitant valvular and subvalvular left ventricular outflow obstruction was first hypothesized in 1957, and identified and further characterized in the 1960s, before the availability of echocardiography. ⋯ As such, subvalvular left ventricular outflow obstruction complicating valvular aortic stenosis is a potentially preventable cause of persistently high gradients that remains relatively frequently encountered after AVR. This review is intended to draw attention to this phenomenon, to describe its mechanisms, and to provide guidance for its preoperative or intraoperative recognition using echocardiographic imaging techniques, with the goal that recognition and appropriate intervention at the time of AVR will decrease its clinical impact.
-
J Am Soc Echocardiogr · Jul 2004
ReviewStrain and strain rate imaging: a new clinical approach to quantifying regional myocardial function.
On the basis of color Doppler myocardial motion data, 1-dimensional regional natural strain rate and strain curves can now be calculated by comparing local myocardial velocity profiles. Such deformation data sets may be an important, new, and more sensitive approach to quantifying both regional radial and long-axis function of the left or right ventricle in both acquired and congenital heart disease. The normal ranges of regional velocity, strain rate, and strain values have already been determined in both adults and children. This review will focus both on the potential clinical applications of these new ultrasound-based deformation parameters and the current limitations inherent in implementing the technique in everyday practice.
-
J Am Soc Echocardiogr · Mar 2004
ReviewA practical approach to the echocardiographic evaluation of diastolic function.
A number of recent community-based epidemiologic studies suggest that 40% to 50% of the cases of heart failure have preserved left ventricular systolic function. Although diastolic heart failure is often not well clinically recognized, it is associated with marked increases in morbidity and all-cause mortality. Doppler echocardiography has emerged as the principal clinical tool for the assessment of left ventricular diastolic function. ⋯ Unfortunately, these Doppler flow variables are significantly influenced by loading conditions and, therefore, the results from these standard techniques can be inconclusive. Recently, color M-mode and Doppler tissue imaging have emerged as new modalities that are less affected by preload and, thus, provide a strong complementary role in the assessment of diastolic function. This review will discuss the diastolic properties of the left ventricle, Doppler echocardiographic evaluation, and grading of diastolic dysfunction.
-
J Am Soc Echocardiogr · Apr 1997
ReviewDiagnosis and treatment of iatrogenic femoral artery pseudoaneurysm: a review.
A pseudoaneurysm is a pulsatile hematoma that communicates with an artery through a disruption in the arterial wall. Femoral pseudoaneurysm is a common complication of invasive procedures. It occurs in 0.1% to 0.2% of diagnostic angiograms and 3.5% to 5.5% of interventional procedures. ⋯ Larger femoral pseudoaneurysms may lead to complications including rupture and compression of the adjacent femoral vein (with resulting venous thrombosis) or of the femoral nerve. Treatment may be surgical. However, recently it has been shown that direct, noninvasive compression of the pseudoaneurysm stops the blood flow in the communication and leads to pseudoaneurysm clotting and obliteration.