Impact of left ventricular hypertrophy late after aortic valve replacement for aortic stenosis on cardiovascular morbidity and mortality.

Aims: The goal of this study was to assess the prevalence of left ventricular (LV) hypertrophy in patients with aortic stenosis late (>6 months) after aortic valve replacement and its impact on cardiac-related morbidity and mortality.

Methods And Results: In a single tertiary centre, echocardiographic data of LV muscle mass were collected. Detailed information of medical history and angiographic data were gathered.

Increased central body fat deposition precedes a significant rise in resting blood pressure in male offspring of essential hypertensive parents: a 5 year follow-up study.

Objectives: As long as offspring of essential hypertensive parents (OHyp) are lean, their blood pressure usually remains within normal limits. The mechanism(s) transforming this 'genetically dysregulated normotension' into hypertension are unclear. We hypothesized that OHyp are not only genetically prone to develop hypertension, but may also have a particular propensity to accumulate central body fat.

Serial evaluation of perfusion defects in patients with a first acute myocardial infarction referred for primary PTCA using intravenous myocardial contrast echocardiography.

Aims: To investigate whether myocardial contrast echocardiography using Sonazoid could be used for the serial evaluation of the presence and extent of myocardial perfusion defects in patients with a first acute myocardial infarction treated with primary PTCA, and specifically, (1) to evaluate safety and efficacy of myocardial contrast echocardiography to detect TIMI flow grade 0--2, (2) to evaluate the success of reperfusion and (3) to predict left ventricular recovery after 4 weeks follow-up.

Methods And Results: Fifty-nine patients underwent serial myocardial contrast echocardiography, immediately before primary PTCA (MCE1), 1 h (MCE2) and 12--24 h after PTCA (MCE3). A perfusion defect was observed in 21 of 24 patients (88%) with anterior acute myocardial infarction.

Diastolic dysfunction precedes myocardial hypertrophy in the development of hypertension.

Background: Left ventricular (LV) hypertrophy and impaired diastolic function may occur early in systemic hypertension, but longitudinal studies are missing.

Methods: We performed an echocardiographic follow-up study in young initially normotensive male offspring of hypertensive (OHyp) (n = 25) and normotensive (ONorm) (n = 17) parents. Blood pressure (BP), LV mass, and mitral inflow were determined at baseline and after 5 years.

Transesophageal echocardiography to evaluate success of transcatheter closure of large secundum atrial septal defects in adults using the buttoned device.

Objectives: To determine the success rate of transcatheter closure of secundum atrial septal defects (ASDs) in adults and to characterize anatomical structures predisposing to unsatisfactory results.

Patients And Methods: Preinterventional and follow-up transesophageal echocardiography of 17 consecutive patients treated with a Sideris buttoned device was reviewed. Residual jet size of 5 mm or smaller was considered an adequate result; jet size larger than 5 mm was inadequate.

Influence of the ultrasound contrast agent Levovist on human nailfold capillary microcirculation.

Little is known about the behavior of ultrasound contrast microbubbles in human capillaries. The evaluation of circulatory effects of echo contrast media may bring valuable information for the interpretation of echo contrast phenomena in the human myocardium. In 12 healthy volunteers (aged 31 +/- 6.

Influence of left ventricular relaxation on the pressure half time of aortic regurgitation.

Background: The severity of aortic regurgitation can be estimated using pressure half time (PHT) of the aortic regurgitation flow velocity, but the correlation between regurgitant fraction and PHT is weak.

Aim: To test the hypothesis that the association between PHT and regurgitant fraction is substantially influenced by left ventricular relaxation.

Methods: In 63 patients with aortic regurgitation, subdivided into a group without (n = 22) and a group with (n = 41) left ventricular hypertrophy, regurgitant fraction was calculated using the difference between right and left ventricular cardiac outputs.

Evaluation of coronary bypass flow with color-Doppler and magnetic resonance imaging techniques: comparison with intraoperative flow measurements.

Objectives: After coronary artery bypass surgery, patency and flow assessment is based on invasive methods such as angiography and intravascular ultrasound or flow wire techniques. The aim of the study was to compare intraoperative transit time flow measurements of coronary bypass grafts with early postoperative color-Doppler and MR-imaging assessment.

Methods: In 22 patients (62+/-8.

Left heart bypass in the pig with a centrifugal pump using cannulae prepared for percutaneous placement.

A rapid and efficient circulatory support system may save a patient in cardiogenic shock. Left heart bypass with percutaneous and trans-septal placement of the aspiration cannula simplifies the circuit and eliminates the need for an oxygenator. In this pre-clinical study we assessed left heart bypass support with a centrifugal pump using new cannulae prepared for percutaneous placement (14 F arterial catheter and 16 F left atrial aspiration line) in 5 anaesthetized pigs.

Successful conservative treatment of nontyphoid salmonella endocarditis involving a bioprosthetic valve.

We report a first case of Salmonella enteritidis endocarditis involving a bioprosthetic aortic valve. Despite additional native tricuspid valve involvement, the clinical course was favorable using an antibiotic regimen of ciprofloxacin and netilmicin. Although Salmonella prosthetic valve endocarditis is considered an indication for surgical replacement of the prosthesis, this case indicates that prolonged treatment with fluoroquinolones may be an alternative provided that the hemodynamic situation is stable.

Quantitation of mitral regurgitation using the systolic/diastolic pulmonary venous flow velocity ratio.

Objectives: The purpose of this study was to test the hypothesis that pulmonary venous flow velocity ratios during systole and diastole in patients with mitral regurgitation (MR) correctly predict the quantitative degree of MR.

Background: Pulmonary venous flow velocity measurements have thus far been used only for the qualitative assessment of MR. Recent studies have evaluated this method using transesophageal echocardiography against semiquantitative references.

Midazolam premedication improves tolerance of transesophageal echocardiography.

Patient premedication for transesophageal echocardiography (TEE) is still under debate, especially the use of sedatives. We performed a double-blind, placebo-controlled study to clarify the efficacy of low-dose intravenous midazolam as premedication for TEE. Placebo or midazolam (< or =50 kg, 2.

Normotensive offspring of hypertensive parents: no evidence of left ventricular diastolic dysfunction in a cross-sectional study.

Left ventricular filling alterations occur early in the development of systemic hypertension. We tested the hypothesis that alteration of diastolic filling might be present in a normotensive population with increased genetic risk for hypertension in the absence of increased left ventricular mass. In a blinded study we compared 31 lean, normotensive offspring of hypertensive parents having normal left ventricular mass (risk group) with 30 matched individuals without family history of hypertension (control group).

[Non-surgical closure of type-II atrial-septal defect and patent foramen ovale].

In the past the standard therapy for significant atrial septal defect was surgical closure. In the presence of a patent foramen ovale with otherwise unexplained (cryptogenic) cerebral embolism, the therapy was oral anticoagulation or antiplatelet therapy. Surgery was considered only in the event of recurrence.

[Transesophageal echocardiography].

An outstanding image quality and detail resolution are characteristics of the transesophageal echocardiographic approach. Transesophageal echocardiography however, is more expensive than transthoracic echocardiography and semi-invasive. Indeed a restricted use is warranted for situations where the additional information obtained is decisive for further patient management.

Destruction of contrast microbubbles during ultrasound imaging at conventional power output.

Inhomogenous opacification of cardiac chambers has been frequently observed after intravenous administration of long-persisting echocardiographic contrast agents. We observed this phenomenon to be most pronounced at high acoustic powers with incomplete opacification of the left ventricular apex and left ventricular outflow tract. Reducing the acoustic energy to which the contrast was exposed by decreasing transmit power or intermittently suspending insonification resulted in homogenous opacification of the entire left ventricular cavity.

Early experience with the new Masters series of St. Jude Medical heart valve: in vivo hemodynamic and clinical results in patients with narrowed aortic annulus.

Background And Aims Of The Study: Aortic valve replacement in the small aortic root results in a heart-prosthesis mismatch in a significant number of patients. The new Masters series of St. Jude Medical (SJM) valves represents the company's most recent innovation, combining the beneficial Hemodynamic Plus (HP) characteristics with rotatability.

Early and late outcome of operated and non-operated acute dissection of the descending aorta.

Objective: At present debate continues concerning the optimal mode of treatment for type B dissections. Controversies are mainly due to discordant results regarding survival following medical or surgical treatment. We assessed early and long-term outcome of acute dissection of the descending aorta treated by emergency aortic replacement, medical treatment or delayed surgery.

[Atrial septum defect and open foramen ovale. Diagnosis, clinical aspects and therapy using a catheter technique].

The purpose of this report is to describe the pathophysiology and clinical symptoms of atrial septal defects with emphasis on right ventricular failure and the risk of paradoxical embolism in the setting of a patent foramen ovale. The diagnosis of both the atrial septal defects and the patent foramen ovale, usually is made by echocardiography. Percutaneous transcatheter occlusion of an atrial septal defect and a patent foramen ovale has gained interest for some years as a treatment alternative to surgical closure.

[Catheter closure in atrial septal defects and open foramen ovale using the Sideris buttoned device].

Percutaneous nonsurgical closure is an alternative to surgical repair of a significant atrial septal defect (ASD) or a patent foramen ovale (PFO) associated with systemic embolism without other cause. We report the results of the first 35 patients (19 ASDs, 16 PFOs) in whom transcatheter closure was attempted. Diagnosis and follow-up were based on transesophageal echocardiography in the majority of cases.

Cardioprotection in patients undergoing chemo- and/or radiotherapy for neoplastic disease. A pilot study.

Objectives: To assess the cardioprotective efficiency of an antioxidant regimen (vitamins E, C and N-acetylcysteine) in patients receiving high dose chemo- and/or radiotherapy for malignant disease.

Methods: Prospective, placebo controlled, randomized and double blinded pilot study involving 13 patients receiving chemotherapy and 12 patients receiving radiotherapy.

Results: In patients receiving antioxidants, left ventricular ejection fraction did not change (63 +/- 4% to 63 +/- 4%).

Early in vivo experience with the Hemodynamic Plus St. Jude Medical heart valves in patients with narrowed aortic annulus.

Background: Small aortic orifice primarily resulted in heart prosthesis mismatch in a significant number of patients. The Hemodynamic Plus (HP) series of St. Jude Medical heart valves represents an interesting innovation, allowing a larger valve orifice area with an equivalent tissue annulus diameter.

Second harmonic imaging of an intravenously administered echocardiographic contrast agent: Visualization of coronary arteries and measurement of coronary blood flow.

Objectives: This study sought to evaluate the potential of second harmonic contrast echocardiography to assess coronary vasculature.

Background: Newer transpulmonary ultrasound contrast agents capable of resonance phenomena detected by harmonic imaging may theoretically be able to demonstrate blood flow in the myocardium.

Methods: Transthoracic B-mode images and Doppler were obtained using a prototype second harmonic ultrasound system after femoral vein injection of AF0145 (10 to 40 mg) in 13 closed chest dogs (mean weight 25.

[Cardioprotection in chemo- and radiotherapy for malignant diseases--an echocardiographic pilot study].

Aim: Pilot study, examining the cardioprotective effect of an antioxidant regimen in patients with malignancies receiving high dose chemo- or radiotherapy.

Patients And Methods: 14 patients with chemotherapy and 10 patients with radiotherapy were randomized in a double-blind fashion (placebo versus vitamin E and C and N-acetylcysteine). Systolic and diastolic echocardiographic parameters were determined before and within three weeks of treatment completion.