Novel imaging strategies for the detection of prosthetic heart valve obstruction and endocarditis.

Prosthetic heart valve (PHV) dysfunction remains difficult to recognise correctly by two-dimensional (2D) transthoracic and transoesophageal echocardiography (TTE/TEE). ECG-triggered multidetector-row computed tomography (MDCT), 18-fluorine-fluorodesoxyglucose positron emission tomography including low-dose CT (FDG-PET) and three-dimensional transoesophageal echocardiography (3D-TEE) may have additional value. This paper reviews the role of these novel imaging tools in the field of PHV obstruction and endocarditis.

Morphological and mechanical properties of the posterior leaflet chordae tendineae in the mitral valve.

A number of studies have investigated the morphological and mechanical properties of the chordae tendineae of the mitral valve, providing comparisons between basal, marginal, and strut chordae and between chordae at the anterior and posterior leaflets. This study contributes to the literature by comparing the failure load of the chordae tendineae attached to the three posterior leaflet scallops, the anterolateral scallop (P1), middle scallop (P2), and posteromedial scallop (P3) of the mitral valve. In all, 140 chordae isolated from 23 porcine hearts were tested.

Qualitative observation of left ventricular multiphasic septal motion and septal-to-lateral apical shuffle predicts left ventricular reverse remodeling after cardiac resynchronization therapy.

A multiphasic septal motion and typical septal-to-lateral apical shuffle of the left ventricle can be observed echocardiographically in some patients with left branch bundle block. The relation of both with left ventricular (LV) dyssynchrony according to tissue Doppler and LV reverse remodeling after cardiac resynchronization therapy was investigated. Fifty-three patients (37 men; age 68+/-8 years) with ischemic (n=26) or idiopathic (n=27) cardiomyopathy, baseline QRS duration 171+/-30 ms, LV ejection fraction 21+/-7%, and LV end-diastolic volume 257+/-91 ml were studied.

Diagnostic accuracy of transesophageal echocardiography during cardiopulmonary resuscitation.

Objectives: We sought to establish the diagnostic accuracy of transesophageal echocardiography (TEE) during cardiopulmonary resuscitation.

Background: Because of its bedside diagnostic capabilities, excellent cardiac images and lack of interference with resuscitation efforts, TEE is ideally suited to determine the cause of a circulatory arrest that is not due to severe arrhythmia. However, the diagnostic accuracy of TEE during resuscitation is unknown.

Pathogenesis of mitral regurgitation in acute myocardial infarction: importance of changes in left ventricular shape and regional function.

The pathogenesis of mitral regurgitation (MR) was determined by quantitative echocardiography in 188 patients with acute myocardial infarction (AMI) within 48 hours after admission. MR was classified, by using color Doppler, as significant (grades 3 to 4) or trivial (grades 0 to 2). Left ventricular (LV) function (global and regional), volume, and shape, as well as mitral valvular features, were measured and analyzed by stepwise logistic regression.

The orientation of the bi-leaflet CarboMedics valve in the mitral position determines left ventricular spatial flow patterns.

Objectives: In the mitral annulus bi-leaflet mechanical valves can be oriented in two ways: the anatomical orientation with the hinge line parallel to a line through the commissures of the native valve (90 degrees). The influence of this orientation on the left ventricular spatial flow pattern and valve leaflet opening was investigated in pigs.

Methods: In 9 pigs a CarboMedics mitral valve prosthesis was implanted in the ) degree position and in 9 pigs in the 90 degree orientation.

Office, nurse, basal and ambulatory blood pressure as predictors of hypertensive target organ damage in male and female patients.

The objective of this study was to assess the value of two substitutes for ambulatory blood pressure (BP) monitoring: nurse-measured BP and BP measured by an automated device during 1 h resting in the clinic (basal BP). Hypertensive patients in an academic out-patients clinic were selected consecutively. We compared the relation of indices of early target organ damage (echocardiographically determined left ventricular mass index (LVMI) and urinary albumin excretion (expressed as albumin/creatinine ratio: ACR) to physician measured and nurse measured basal and ambulatory BP.

Usefulness of combined two-dimensional echocardiography and transesophageal atrial stimulation early after acute myocardial infarction.

Transesophageal atrial stimulation (TRAS) was combined with 2-dimensional echocardiography in 69 consecutive patients on days 3 to 5 (mean 3.3) of their first, uncomplicated myocardial infarction, to determine if inducible remote asynergy (i.e.

Usefulness of mitral regurgitation in protecting against left ventricular thrombus after acute myocardial infarction.

In conclusion, we documented an increased incidence of LV thrombus in patients with MR after AMI.

Doppler left ventricular flow pattern versus conventional predictors of left ventricular thrombus after acute myocardial infarction.

Objectives: The value of Doppler-derived left ventricular spatial flow patterns in predicting left ventricular thrombus formation after myocardial infarction was compared with that of conventional clinical and echocardiographic variables.

Background: Assessment of left ventricular thrombosis risk after myocardial infarction is important because of potential embolic sequelae that are reduced by oral anticoagulant agents.

Methods: Clinical, two-dimensional and Doppler echocardiographic data were prospectively obtained in 104 patients with acute myocardial infarction within 48 h of admission.

Recombinant endotoxin-binding protein (rBPI23) attenuates endotoxin-induced circulatory changes in humans.

In the present study the protective effect of a recombinant endotoxin-binding protein rBPI23 on the circulatory changes in experimental endotoxemia in humans was investigated. In a controlled, blinded crossover study, eight volunteers were challenged twice with an intravenous bolus injection of endotoxin (40 EU/kg body weight), and concurrently received either rBPI23 (1 mg/kg) or placebo (human serum albumin, 0.2 mg/kg).

Doppler echocardiographic evaluation of left ventricular diastolic function after surgical correction of atrial septal defect during childhood.

Transmitral flow was studied using Doppler echocardiography with the A/E ratio as a parameter of left ventricular diastolic function in 21 patients (ages 2.5-30.0 years) who had undergone early surgical correction of an isolated secundum type atrial septal defect (ASD) compared to a healthy cohort of 21 subjects.

Mitral valve anatomy and morphology: relevance to mitral valve replacement and valve reconstruction.

An endoscope was used to study the anatomy and morphology of the native mitral valve inside an isolated pig heart working under physiological conditions. Annulus motion, valve leaflet function, and the anatomy of the chords and branching pattern are described. Anatomical and functional details relevant to mitral valve reconstruction and valve replacement are outlined.

Left atrial appendage blood flow determined by transesophageal echocardiography in healthy subjects.

Transesophageal echocardiography was performed in 46 healthy subjects to define characteristics of normal left atrial appendage blood flow. Three different flow wave patterns were observed that were heart rate dependent (p < 0.01).

Free vortex ring formation in the left atrium originating in the left auricle.

An 80-year-old woman was evaluated by transesophageal echocardiography after coronary artery bypass surgery and subsequent cardioembolic stroke. In addition to spontaneous echo contrast demonstrating a counterclockwise rotating blood flow pattern, we observed free vortex ring formation in the left atrium, originating in the left auricle. To our knowledge, this is the first reported case of abnormal free vortex ring type flow pattern in the left atrium.

Prediction of apical thrombus formation in acute myocardial infarction based on left ventricular spatial flow pattern.

The predictive value of the left ventricular spatial flow pattern for thrombus formation was determined in 62 patients with acute myocardial infarction. A normal flow pattern by pulsed Doppler echocardiography was characterized by 1) simultaneous onset of blood motion at the mitral valve and apical level, and 2) a discontinuous Doppler signal along the lateral wall and interventricular septum. The flow pattern was assessed by these criteria, within 24 h after the onset of complaints and after 6 and 12 weeks.

Determinants of the occurrence of vortex rings in the left ventricle during diastole.

This study employs classical inviscid fluid dynamics theory to investigate whether LV diastolic inflow volume and the size of the LV play a role in vortex ring formation. Fluid injection across an orifice into a large container results in the generation of a vortex ring having a constant size and speed. Relations between the vortex size and speed and the injection were obtained by applying conservation laws regarding kinetic energy, impulse and vorticity; the initial state was computed using a bolus injection model, and the final state by using the Kelvin vortex model.

Early Indium-111 antimyosin scintigraphy for assessment of regional wall motion asynergy on discharge after myocardial infarction.

To assess the relation between early Indium-111 monoclonal antimyosin antibody scintigraphy and degree of regional asynergy on discharge, 38 patients with a first acute myocardial infarct were studied (18 anterior, 20 inferoposterior infarctions). In 21 patients thrombolytic therapy was administered. On the first day of myocardial infarction, 80 MBq Indium-111 Antimyosin was injected.

Predictive value of indium-111 antimyosin uptake for improvement of left ventricular wall motion after thrombolysis in acute myocardial infarction.

In 21 patients treated with thrombolysis for acute myocardial infarction (AMI), the degree of myocardial uptake of indium-111 monoclonal antimyosin antibodies injected within 24 hours after onset of AMI was compared with the degree and extent of regional asynergy on admission and discharge, as assessed by 2-dimensional echocardiography. On the first day of AMI, 80 MBq of indium-111 antimyosin was injected and planar images were made 24 hours later. Indium-111 antimyosin uptake was evaluated for count density index (count density of infarct zone/left lung count density) in the left anterior oblique projection, in which the infarction zone was well displayed in all patients.