Reproducibility of tissue Doppler parameters of asynchrony in patients with advanced LV dysfunction.

Aims: To assess the reproducibility of tissue Doppler myocardial velocities in patients with dilated ventricles and markedly reduced systolic function (ejection fraction <35%).

Methods And Results: Forty-one patients referred for cardiac resynchronization therapy (CRT) were evaluated using tissue Doppler echocardiography. The inter and intra-individual reproducibility of peak systolic myocardial velocities and the intra-ventricular delay in three apical projections was assessed by repeated evaluation of each registered data set.

[Sporting activities following total hip and knee arthroplasty].

The expectations of total joint replacement are constantly increasing: Freedom of pain and mobility used to be the primary goal, while nowadays it is longevity despite heavy loading and intense sporting activity. A preoperative sportive patient expects to be able to perform his favorite sporting activities like hiking, swimming and cycling, but also the more demanding skiing, tennis and jogging, for example, after surgery. The aim of this article is to illustrate what level of sporting activities can be performed by patients with total joint replacement.

Use of intracardiac echocardiography to guide implantation of a left atrial appendage occlusion device (PLAATO).

Background: Over 90% of thrombi in atrial fibrillation (AF) originate from the left atrial appendage (LAA). Patients with contraindications to anticoagulation are potential candidates for LAA occlusion using the Percutaneous Left Atrial Appendage Transcatheter Occlusion system (PLAATO, ev3 Inc., Plymouth, MN).

Role of echocardiography in percutaneous occlusion of the left atrial appendage.

Unlabelled: Percutaneous occlusion of the left atrial appendage (LAA) is a modern alternative for the treatment of patients with atrial fibrillation (AF) and with a high risk of stroke who are not eligible for long-term anticoagulation therapy. Echocardiography plays a significant role in selecting patients, guiding the procedure, and in the post-procedural follow-up.

Objectives And Methods: To test the role of transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) in facilitating and shortening the procedure.

Pacemaker and ICD lead extraction with electrosurgical dissection sheaths and standard transvenous extraction systems: results of a randomized trial.

Aims: The purpose of this prospective randomized study was to evaluate the safety and efficacy of transvenous pacemaker and implantable cardioverter-defibrillator (ICD) lead extraction with an electrosurgical dissection sheath (EDS) system in a single-centre experience. Methods Over 10 years, 462 patients have undergone transvenous lead extraction in our institution. From these, 120 consecutive patients (with 161 leads) were randomized to either radiofrequency (RF) current supported extraction or standard countertraction lead removal (60 patients in each arm, 96 men and 24 women).

Influence of load changes on tricuspid inflow.

In healthy subjects, the right ventricular filling pattern estimated from tricuspid valve inflow is highly load-dependent. This can be clearly demonstrated by changes of Doppler inflow tracings recorded during tidal breathing at rest. The aim of our study was to test the magnitude of tricuspid inflow changes during more pronounced load changes induced by specific maneuvers.

[Infectious endocarditis as a complication of cardiac pacemakers requiring emergency removal of the stimulating electrode].

Case report describes a patient with permanent pacemaker (implanted in childhood) who has developed infectious endocarditis with bacterial vegetation on the stimulation electrode while no febrile condition occurred and laboratory tests showed no inflammation. The course of the disease was affected by the previous inappropriate outpatient treatment of an infection in the suture after the pacemaker exchange. It should be noted that echocardiographic examination was essential for both the diagnostics and the choice of strategy.

[Cardiac bradyarrhythmia ].

Permanent cardiac pacing was introduced in 1958 and till the end of 70s this method saved lives in particular of the patients with advanced atrioventricular block. The implantation technique has changed from complicated thoracotomy to endovasal approaches. The introduction of physiological AV sequenced atrioventricular pacing marked a significant progress in this field.

[Hyperhomocysteinemia. A risk factor for the development of vascular diseases not associated with lipid levels].

Background: Elevated total homocysteine plasma levels are considered a significant factor of vascular damage. As they are encountered in more than half the patients with atherosclerotic vascular damage the importance as a lipid-dependent or lipid-independent risk factor in the promotion of pathophysiological processes is discussed.

Methods And Results: In a group of 100 healthy subjects and 529 patients with indication for an aortocoronary or peripheral arterial bypass and in patients from the lipid clinic the mutual relation between total plasma homocysteine levels and selected indicators of the lipid metabolism was investigated.

[Incidence and changes in mitral regurgitation in balloon valvotomy of the mitral valve. A color Doppler study].

The objective of the work was a detailed examination of the incidence and changes of mitral regurgitation (MR) in conjunction with percutaneous transluminal valvotomy of the mitral valve (VMCH). Using coloured Doppler mapping, the authors examined a total of 40 patients before and in the course of one week after VMCH. They assessed the number of regurgitation jets the site of their development, the timing and haemodynamic impact of MR.

[The effect of isometric loading on diastolic left ventricular filling in healthy individuals studied by the Doppler technic].

The authors examined by Doppler echocardiography 30 subjects aged 21-30 years, exposed during examination to an isometric load by using a manual balloon dynamometer. The authors investigated different indicators of left ventricular filling during diastole and their indexes which evaluate indirectly the left ventricular diastolic function. The assessed correlations of some indicators with the quantitative expression of the isometric load (double product) were as follows: peak speed E - r = 0.

[Clinical interpretation of the character of mitral valve flow in relation to diastolic properties of the left ventricle].

Based on their own experience and data in the literature the authors describe the Doppler method of evaluation of properties of the left ventricle. In patients with early disorders of the diastolic function, when above all relaxation of the left ventricle is affected, a reduced rate of early diastolic filling (E) is a typical finding. There is also compensatory increase in the rate of filling during auricular contraction (A) with the appropriate increase of the A/E ratio and the ratio of rate velocity integrals (TVIA/TVIE).

[The dipyridamole echocardiography test combined with isometric loading in the diagnosis of syndrome "X"].

Syndrome "X" comprises a heterogeneous group of patients with normal coronarographic findings whose repeatedly occurring chest pain is of ischaemic origin, similarly as angina pectoris in patients with CHD. One of the signs of ischaemic etiology of pain in these patients is significant depression of the ST interval on the ECG during ergometry. We were interested to know whether the depression of the ST interval and angina pectoris which develop during a load are associated also with a transient disorder of left ventricular local kinetics.

[2-dimensional echocardiography in the evaluation of right ventricular volume and function. Comparison with echocardiography].

Using two-dimensional echocardiography (ECHO), the authors examined within one week preceding right-sided catheterization of the right ventricle (RV) 44 patients. Of three tested ECHO techniques for calculation of right ventricular volumes and/or function the best correlations were obtained by the method of evaluation of area-length of the right ventricle from two orthogonal projections (apical 4-cavity and subcostal with visualization of the outflow portion of the RV). The following correlations were assessed: telediastolic volume--r = 0.

Three echocardiographic methods in right ventricular function evaluation.

We employed two-dimensional echocardiography for the assessment of right ventricular (RV) volumes and/or function in a series of 44 patients. The results of three different echocardiographic approaches were compared with the data obtained from single-plane RV angiography following ultrasound within a 7-day interval. Only the echocardiographic area length method with two orthogonal imaging planes employed (apical 4-chamber and subcostal projections) yielded the beneficial results.

Doppler echocardiographic assessment of the diastolic properties of the cardiac ventricle in ischaemic heart disease.

The authors offer their experience with diastolic function assessment using Doppler echocardiography in ischaemic heart disease. Information on the diastolic properties of the ventricle is obtained from recordings of the blood flow velocity curve in mitral and tricuspid valve orifices. Doppler echocardiography, allowing to monitor the velocity curve of ventricular filling, represents one of the most modern techniques of examination.

The effect of acute and chronic nitrate administration in precapillary and postcapillary pulmonary hypertension.

The effect of nitrates was monitored in 16 patients with precapillary, and in 12 patients with postcapillary pulmonary hypertension (PH). The patients had haemodynamic examination on acute administration of 10 mg of isosorbide nitrate (ID) in infusion and after 2-month therapy with 120 mg of isosorbide dinitrate retard daily. Acute ID administration decreased filling pressure of both ventricles, pulmonary and aortic pressure, pulmonary and systemic resistance and increased blood flow.

[Estimation of systolic pressure in the right ventricle (pulmonary artery) using Doppler and its importance in the detection of pulmonary hypertension].

Using the pulsed Doppler system with a high reparative frequency (HPRF), the authors made within 1 hour and 3 days after diagnostic right-sided catheterization 38 measurements of the trans-tricuspid pressure gradient in 31 consecutive patients. To the gradient calculated from the absolute velocity of flow through the jet of tricuspid regurgitation the authors added two different arbitrarily determined pressure values in the right atrium to obtain the systolic pressure in the right ventricle--RVSP (which assuming the absence of an obstruction between the right ventricle and pulmonary artery equals the systolic pressure in this artery). The calculated RVSP from the Doppler assessment correlated highly significantly with the directly manometrically obtained values of the same indicator (r = 0.

Long-term effect of isosorbide dinitrate and nifedipine, singly and in association, in patients with chronic heart failure.

The effect of 2-month treatment with isosorbide dinitrate (120 mg day-1), nifedipine (2 x 20 mg day-1) and their combination has been assessed in 16 patients with mild to moderate chronic cardiac failure. Isosorbide dinitrate decreased right atrial (-23%), pulmonary wedge (-20%) and pulmonary arterial (-17%) pressures but did not significantly change either cardiac output or systemic and pulmonary vascular resistance. Nifedipine increased cardiac output (+13%) and decreased systemic and pulmonary vascular resistance (both -17%) with no change of pressures.

[Noninvasive quantification of the severity of aortic defects using the Doppler method].

Using Doppler method (HPRF and CW regime), the authors assessed the peak velocity of flow in an aortal spurt in 41 patients with aortal stenosis. For calculation of the transaortal pressure gradient they used a modified Bernoulli equation. The values of the calculated gradients were compared with those obtained by direct manometric assessment during catheterization of the heart after an interval of several hours to five days.

[Long-term fate of intraventricular thrombi after myocardial infarct].

Using two-dimensional echocardiography, the authors followed up 30 patients where in the course of treatment of acute myocardial infarction an intraventricular thrombus developed. A benign character (i. e.