Left ventricular thrombus and systemic emboli complicating the cardiomyopathy of Duchenne's muscular dystrophy.

A 17-year-old boy with Duchenne's muscular dystrophy and congestive cardiomyopathy with a left ventricular thrombus is described. The patient presented with flank pain, and computed tomography of the abdomen revealed multiple bilateral renal infarcts. An echocardiogram delineated a left ventricular thrombus and generalized hypokinesis with a left ventricular ejection fraction of 25%.

Measurement variability of carotid atherosclerosis: real-time (B-mode) ultrasonography and angiography.

To quantify the within- and between-reader agreement of carotid B-mode ultrasonography and angiography interpretation, images from 117 patients examined by both modalities were read multiple times. Angiographic measurements were more reproducible than those of B-mode scans for all parameters except lesion width, but variations for B-mode scan measurements were similar to those for angiographic measurements. Within-reader agreement on the presence of ulceration was substantial for both modalities, whereas between-reader agreement was poor for B-mode scan and only moderate for angiography.

Doppler ultrasound in aortic stenosis: in vitro studies of pressure gradient determination.

Torricelli's equation expresses a simple relationship between fluid velocity and pressure gradient in orifice flow and is currently used in conjunction with noninvasive Doppler ultrasound to determine gradients in mitral stenosis, and aortic stenosis, as well as other cardiovascular orifices. In theory, however, the Torricelli equation overestimates the gradient in aortic stenosis and the Borda equation should be more applicable. A brief tutorial derivation of the Borda and Torricelli equations is presented.

Left coronary arterial blood flow: noninvasive detection by Doppler US.

Continuous wave (CW) and pulsed Doppler ultrasound studies with spectral analysis were used to detect the left coronary arterial blood flow in patients who were undergoing routine echocardiography. The pulmonary artery is a stable ultrasonic landmark from which detection of the blood flow can be effected. The left coronary artery can be distinguished by its blood flow toward the cardiac apex and by specific, functional flow features.

Representations of rapidly oscillating structures on the Doppler display.

In cardiovascular applications of Doppler ultrasound, oscillating structures are at times within the sample volume of the transducer. When the period of oscillation is shorter than the time window of the Fourier transform, the velocities of the structure are not resolved in time by the frequency analyzer. The resulting display can differ considerably from that obtained from structures with linear velocities.

Doppler ultrasound in orifice flow. In vitro studies of the relationship between pressure difference and fluid velocity.

The validity of an orifice equation (Torricelli's law) which expresses a simple relationship between the pressure difference across an orifice and the maximum fluid velocity in the orifice was tested in vitro. An aqueous suspension of barium sulfate particles with a polymer added to attain variations in viscosity, was forced through orifices which ranged in diameter from 0.4 to 4.

CW and pulsed Doppler echocardiography utilizing a stand-alone system.

An independent directional Doppler system operating in pulsed or continuous-wave mode and a real-time spectral analyzer with a 3 ms temporal resolution have been used to supplement conventional real-time and M-mode echocardiography. Examination techniques as well as findings in normal and abnormal hearts are presented. Continuous-wave Doppler is most useful for detection of peak frequency shifts for calculation of valvular gradients while pulsed Doppler is superior in the detection of small jets of abnormal flow and in display of spectral broadening.

Is routine angiography necessary prior to carotid endarterectomy?

The records of 111 consecutive patients undergoing evaluation for possible carotid endarterectomy at the University of Rochester were reviewed. All patients had noninvasive evaluation (oculoplethysmography-Gee and direct, continuous-wave Doppler ultrasonography) as well as selective carotid angiography. Patients were grouped by clinical presentation to ascertain the relative importance of angiography in determining the need for surgery.

Frequency-dependent angle scattering of ultrasound by liver.

Ultrasonic scattering by one specimen of normal pig liver and two specimens of abnormal human liver has been measured as a function of angle and frequency at each angular position of transmit and receive transducers which were rotated in equal and opposite directions about the axis of a cylindrically shaped tissue sample. Mean data values were determined by averaging points at like frequencies and angular positions in scans made at intervals along the axis of the specimen. Sections of the specimens were obtained throughout its length and stained to emphasize structures containing collagen and connective tissue shown by acoustic microscopy to produce sound speed variations which are known to cause scattering.

Automated water-path ultrasonic examination of scrotum.

A new method of examining the scrotum by ultrasound with an automated water-path scanner is described. This method allows immobility of the scrotum in a more acceptable and painless way than in contact scanning methods. Panoramic scans of the entire scrotum and precision tomographic plane placement are advantages over conventional techniques.

Echocardiographic evaluation of cardiac abnormalities in Duchenne's dystrophy and myotonic muscular dystrophy.

Routine echocardiographic examinations were performed on 53 individuals with muscular dystrophy (29 with myotonic muscular dystrophy [MMD] and 24 with Duchenne's dystrophy [DD]). Five of 29 (17%) with MMD and six of 24 (25%) with DD had typical mitral valve prolapse evidenced by echocardiography. All patients with DD and mitral valve prolapse had severe thoracic skeletal deformities, while none with MMD and mitral valve prolapse had such abnormalities.

New techniques in cardiac imaging with ultrasound: state of the art.

Two-dimensional real-time ultrasonic imaging in the diagnosis of acquired and congenital cardiac lesions is reviewed. This technique provides anatomically correct cross-sectional images and demonstrates movements of valve leaflets and segments of heart walls. The imaging of blood flow through the use of ultrasonic contrast agents and the application of pulsed Doppler principles is also reviewed, and future trends are discussed.

Limitations in the echocardiographic assessment of aortic root dimensions in the presence of aortic valve disease.

Aortic root M-mode echocardiograms were evaluated in 79 patients who had aortic valve replacement. Echocardiographic measurements of aortic root dimensions correlated poorly with surgical estimates. Inclusion of a portion of the sinuses of Valsalva in the former set of estimates probably accounts for this discrepancy.

Echogenic fluid: a pitfall in the ultrasonographic diagnosis of cystic lesions.

Although it is well known that biliary sludge can produce fine diffuse echoes within the gallbladder, it is less commonly appreciated that other cystic structures may contain echogenic fluid and therefore be mistaken sonographically for solid lesions. In this article three cases of splenic cysts and one case each of pyrometrocolpos, hydroureter, and pyonephrosis presented with diffuse fine echoes in the fluid. Three of these cases were misinterpreted as a result of this echogenic appearance.

Ultrasonic detection of myocardial infarction by amplitude analysis.

Myocardial infarctions were produced in dogs by occluding the left anterior descending artery; the dogs were killed at varying times, from 30 minutes to 8 days. Prior to sacrifice, Thioflavin S was injected intravenously. The excised heart was scanned by a B-scanner interfaced with a computer that permitted quantification of signal amplitude.

Bilateral atrial myxomas. Echocardiographic considerations.

In this report we describe a patient with bilateral atrial myxomas, which were diagnosed preoperatively by echocardiography and angiography, and successfully removed. The excised tumor mass consisted of mobile right and left atrial myxomas connected by a common stalk which passed through the atrial septum, collectively resembling the shape of a dumbbell. Preoperative echocardiographic and angiographic observations were instrumental in planning the surgical approach, and correlated well with intraoperative findings and with the anatomic configuration of the intact pathologic specimen.

Systolic flutter of the mitral valve.

Systolic flutter of the mitral valve was observed in 11 cases during the past 3-1/2 years. All patients had mitral regurgitation due to mitral valve prolapse or flail leaflets, and nine of the 11 (82%) had prior or concurrent bacterial endocarditis. Systolic flutter is uncommon in the absence of endocarditis and was observed in only two of 15 patients (13%) with proven chordae tendinae or papillary muscle rupture without historical and pathological evidence of infection involving the mitral valve.

Ultrasonic assessment of transposition of the great vessels.

Echocardiography can provide important diagnostic information that identifies the transposition complexes, evaluates relative pressure levels in the pulmonic and systemic circuits, describes subpulmonic obstruction, and identifies some associated congenital anomalies. Following the Mustard procedure, baffle dysfunction may be recognized, and the function of the procine heterograft used in the Rastelli procedure studied. Echocardiography can also demonstrate other congenital cardiac defects that may mimic transposition of the great vessels or reveal normal cardiac and great vessel anatomy and function that can reliably rule out the transposition complexes.

The relationship between aortic valve closure and aortic root motion.

The minimum interval between aortic valve closure and the onset of posterior motion of the posterior aortic wall (C--PW) was obtained from M-mode echographic studies in normal subjects and patients with mitral regurgitation (MR), rheumatic mitral stenosis (MS), mixed rheumatic MS and MR, pure aortic stenosis (AS), and pure aortic insufficiency. Three-fourths of the patients with MR and 2/3 of those with AS had short C--PW intervals. Short C--PW intervals are probably the result of early mitral valve opening with rapid LA emptying, whereas slow emptying due to dilated, relatively inert left atria may account for normal C--PW intervals in patients with MR.