Spontaneous echocardiographic contrast within an unruptured sinus of Valsalva aneurysm: a potential embolic source diagnosed by transesophageal echocardiography.

A 75-year-old male patient had an unexplained transient ischemic attack. Transesophageal echocardiography revealed a large, unruptured Sinus of Valsalva aneurysm which contained spontaneous echo contrast. This finding represents a potential source of embolism.

The effect of the ingestion of ethanol on obstruction of the left ventricular outflow tract in hypertrophic cardiomyopathy.

Background: Ethanol causes vasodilation, which might have an adverse effect, due to increased obstruction of the left ventricular outflow tract, in patients with hypertrophic obstructive cardiomyopathy. We assessed the hemodynamic effects of the ingestion of ethanol, in an amount commonly consumed socially, in patients with hypertrophic cardiomyopathy.

Methods: We performed echocardiography in 36 patients before and several times after the ingestion of either 50 ml of 40 percent ethanol or an isocaloric placebo with the aroma of rum.

Evaluation and management of cholesterol embolization and the blue toe syndrome.

The blue toe syndrome is characterized by tissue ischemia secondary to cholesterol crystal or atherothrombotic embolization leading to occlusion of small vessels. Embolization occurs typically from an ulcerated atherosclerotic plaque located in the aorto-iliac-femoral arterial system. Clinical presentation can range from a cyanotic toe to a diffuse multiorgan systemic disease that can mimic other systemic illness.

Incomplete occlusion of left ventricular aneurysms after endoventricular aneurysmorrhaphy: diagnosis by echocardiography and ventriculography.

Surgical treatment of left ventricular aneurysms have recently focused on maintaining normal left ventricular geometry by using a circular patch repair to exclude the aneurysmal cavity (endoaneurysmorrhaphy). We describe two patients who underwent this procedure and were subsequently found by echocardiography and angiography to have a residual communication between the left ventricular cavity and the aneurysm which contained thrombus. This finding may have implications regarding the optimal hemodynamic result of the surgery and the risk of thromboembolism.

Intracardiac shunts.

Unsuspected intracardiac shunts can be a cause of acute deterioration in critically ill patients. Shunts can be acquired or congenital conditions that become symptomatic only with changed physiologic conditions. Transesophageal echocardiography is an excellent tool for the diagnosis of intracardiac shunts.

Transesophageal Echocardiography in Thoracic Aortic Atherosclerosis.

Transesophageal echocardiography opened a new window to the thoracic aorta and for the first time permitted in vivo imaging of aortic atherosclerotic disease. The technique is useful in assessing the extent of the disorder, its complications, and possible treatment modalities. It will also be useful in the assessment of the progression as well as the possible regression of the disorder with appropriate (dietary or chemical) therapy.

Sequential external counterpulsation: an adjunctive therapy for patients with chronic coronary artery disease and left ventricular dysfunction.

We assessed the clinical and haemodynamic improvement with 3 weeks of sequential external counterpulsation (SECP) therapy in 23 patients with chronic coronary artery disease (CAD) and left ventricular (LV) dysfunction who were refractory to maximal tolerated doses of medical therapy and in whom intervention or surgery was not contemplated. All patients were subjected to one-hour duration of SECP for 3 weeks. SECP is a new noninvasive tool which increases coronary artery filling utilizing external pressure in a sequential manner from calf to thigh.

Aortic dissection with flap prolapse into the left ventricle.

Transesophageal echocardiography provided an accurate diagnosis of intimal flap prolapse into the left ventricle in all 6 of our patients. This complication of AD is a newly recognized and uncommonly discerned cause of severe AR.

Intraaortic mass after repair of an aortic dissection.

After graft repair of an ascending aortic aneurysm, a patient was seen by us with a chest x-ray film indicating a retained foreign body. Mediastinal exploration had been unrevealing. Transesophageal echocardiography demonstrated the nature and exact location of the foreign body and therefore was instrumental in directing its retrieval.

Valve strands are strongly associated with systemic embolization: a transesophageal echocardiographic study.

Objectives: We attempted to determine the prevalence of strands on native and prosthetic valves, as detected by transesophageal echocardiography, and to assess the relative risk for systemic emboli associated with these strands.

Background: Fine threadlike strands, seen on native and prosthetic valves by transesophageal echocardiography, have been implicated in systemic embolization.

Methods: During a 2-year period, 1,559 patients underwent transesophageal echocardiography at our center.

Transesophageal versus transthoracic echocardiography in the evaluation of right atrial tumors.

The purpose of this study was to define the contribution of transesophageal echocardiography to the diagnosis of right atrial tumors in a large series of patients with this rare finding. Transesophageal echocardiography (TEE) has been found to be valuable in evaluating patients with intracardiac masses and has been shown to be superior to transthoracic echocardiography (TTE) in evaluating left heart masses. Between 1989 and 1993, 23 patients with either known tumors elsewhere or right atrial masses that were detected on TTE were evaluated with TEE.

Systolic aortic regurgitation: a hemodynamic challenge for the clinician.

Aortic regurgitation is considered a diastolic phenomenon. We describe a case in which premature beats resulted in a left ventricular systolic pressure that was lower than the aortic pressure, and thus aortic regurgitation continued throughout the systole of the premature beat. This sequence of events was clearly demonstrated by Doppler echocardiography.

Transesophageal echocardiographic diagnosis of right atrial thrombi associated with the antiphospholipid syndrome.

Thromboembolic disorders are a hallmark of the antiphospholipid antibody syndrome. We describe a patient with IgM antiphospholipid antibodies associated with pulmonary emboli and in situ thrombosis within an otherwise normal right atrium. Echocardiography, particularly the transesophageal study, proved invaluable in providing a diagnosis and guiding our patient's evaluation and treatment.

Endoventricular remodeling of left ventricular aneurysm. Functional, clinical, and electrophysiological results.

Background: Recent advances in surgical techniques for the repair of left ventricular aneurysms (LVAs) include the use of an endoventricular patch to exclude the aneurysm cavity. This technique has replaced conventional linear plication of the aneurysm. The endoventricular patch technique remodels the left ventricular cavity to a more physiological geometry that improves function.

Absent right and persistent left superior vena cava without other congenital anomaly: a rare combination diagnosed by transesophageal echocardiography.

A 70-year old man with a history of anorexia, weight loss, and progressive shortness of breath was studied by transesophageal echocardiography. In addition to a mass occupying the right ventricular outflow tract, a rare congenital heart anomaly was discovered serendipitously: persistent left superior vena cava, absent right superior vena cava, and no other congenital abnormality. The echocardiographic findings were confirmed by computed tomographic scanning and later during heart surgery performed to resect the malignant tumor.

Left ventricular hypertrophy is more prevalent in patients with systemic hypertension with extracranial carotid arterial disease than in patients with systemic hypertension without extracranial carotid arterial disease.

The mechanism of the association between LV hypertrophy and ECAD is unknown and needs to be investigated. Whether LV hypertrophy in patients with systemic hypertension is a marker for ECAD or contributes to ECAD needs to be investigated. The association between LV hypertrophy and significant ECAD was independent of the level of blood pressure in our patients.

Echocardiographic evaluation of the coronary sinus.

The purpose of this study was to compare transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in the evaluation of the coronary sinus and its blood flow. Forty patients were studied by TTE and TEE. The distal coronary sinus and its right atrial communication could be identified in 21 of 40 by TTE, and in all patients by TEE.