African green monkey origin of the atypical cytopathic 'stealth virus' isolated from a patient with chronic fatigue syndrome.

Background: A cytomegalovirus-like 'stealth virus' had previously been isolated from a patient with the chronic fatigue syndrome (CFS).

Objective: To determine the original derivation of this virus.

Study Design: DNA sequencing of cloned regions of the virus was performed and the sequences were compared using BLASTN and FASTA analyses against the entire GenBank database.

Idiopathic restrictive cardiomyopathy in childhood: diagnostic features and clinical course.

Objective: To describe the clinical course and outcome of children with idiopathic restrictive cardiomyopathy (IRCM) and to present the Doppler echocardiographic features of this disease in childhood.

Design: We reviewed the Mayo Clinic patient database for the period from 1975 to 1993 to identify children who underwent assessment for IRCM.

Material And Methods: Clinical records and diagnostic studies, including two-dimensional (2-D), M-mode, and Doppler echocardiograms, were reviewed for each patient.

Right ventricular dysplasia: the Mayo Clinic experience.

Objective: To determine the initial clinical manifestations and echocardiographic features of right ventricular dysplasia as encountered in a major cardiovascular referral center in the United States.

Design: We conducted a retrospective study of cases of right ventricular dysplasia diagnosed at the Mayo Clinic between January 1978 and January 1993.

Material And Methods: In an institutional data-base search, we identified 20 patients with right ventricular dysplasia.

Biplane intraoperative transesophageal echocardiography in congenital heart disease.

Objective: To evaluate the accuracy, value, and safety of biplane intraoperative transesophageal echocardiography (TEE) in patients with congenital cardiac malformations.

Design: We reviewed the results of the first 104 consecutive biplane intraoperative TEE examinations performed during the repair of congenital heart defects at the Mayo Clinic.

Material And Methods: TEE results were analyzed for accuracy of diagnosis, effect on the surgical procedure, and associated complications.

Biplane and multiplane transesophageal echocardiography: evaluation of congenital heart disease.

Congenital heart disease can be a diagnostic challenge. Transesophageal echocardiography (TEE) has markedly extended the diagnostic power of the ultrasound examination. Outpatient TEE is most useful in the assessment of adult congenital heart disease.

Effective mitral regurgitant orifice area: clinical use and pitfalls of the proximal isovelocity surface area method.

Objectives: We attempted to determine the accuracy and pitfalls of calculating the mitral regurgitant orifice area with the proximal isovelocity surface area method in a clinical series that included patients with valvular prolapse and eccentric jets.

Background: The effective regurgitant orifice area, a measure of lesion severity of mitral regurgitation, can be calculated by the proximal isovelocity surface area method, the accuracy and pitfalls of which have not been established.

Methods: In 119 consecutive patients with isolated mitral regurgitation, effective regurgitant orifice area was measured by the proximal isovelocity surface area method and compared with measurements simultaneously obtained by quantitative Doppler and quantitative two-dimensional echocardiography.

Echocardiography in the emergency room: is it feasible, beneficial, and cost-effective?

Echocardiography in the emergency room presents exciting practice possibilities that can facilitate prompt and reliable diagnostic evaluations in patients with suspected cardiovascular emergencies. Echocardiography has the diagnostic potentials to evaluate the entire spectrum of cardiovascular abnormalities short of delineating coronary anatomy and evaluation of the conduction system. By reliably assessing the global and regional function, visualizing the cardiovascular structures from multiple tomographic planes, and quantitating hemodynamic abnormalities, echocardiography should be able to assist emergency room physician's evaluation and triage of the patients with chest pain syndrome, unexplained dyspnea, hypotension, shock, chest trauma, and cardiac arrest, whereby hopefully minimizing the unnecessary admission to the hospital and facilitating inhospital evaluation of the admitted patients with echocardiographic information.

Congenital heart disease: wide-field, three-dimensional, and four-dimensional ultrasound imaging.

The next significant advance for cardiovascular ultrasound will be the introduction of clinical three-dimensional (3-D) imaging. With increasing computer power and software and hardware, 3-D ultrasound imaging will become a reality over the next few years. Of all cardiovascular abnormalities, congenital heart disease is one of the most logical entities to lend itself to wide-field and 3-D presentation.

Stress echocardiography. Part I. Exercise echocardiography: techniques, implementation, clinical applications, and correlations.

Objective: To describe the techniques and applications of exercise echocardiography.

Design: We review pertinent experimental and clinical studies from the literature and present our experience with the first 2,000 patients who underwent exercise echocardiography in our laboratory.

Material And Methods: The indications for and contraindications to exercise echocardiography and the advantages, limitations, and accuracy of this procedure in comparison with other techniques for detecting coronary artery disease are discussed.

Stress echocardiography. Part II. Dobutamine stress echocardiography: techniques, implementation, clinical applications, and correlations.

Objective: To describe the rationale, methods, and clinical applications for dobutamine stress echocardiography.

Design: We review our experience with the first 1,000 Mayo Clinic patients who underwent this procedure and discuss studies from the literature that have assessed the accuracy of dobutamine stress echocardiography in determining the presence and extent of coronary artery disease.

Material And Methods: The Mayo protocol for dobutamine stress echocardiography is presented, and the indications for use of this test and comparisons of sensitivity and specificity with other tests are summarized.

Congenital absence of the pericardium: echocardiography as a diagnostic tool.

Between 1982 and 1992, 10 patients who underwent echocardiography at the Mayo Clinic were found to have congenital absence of the pericardium. Clinical, electrocardiographic, chest roentgenographic, echocardiographic, computed tomographic, and magnetic resonance imaging features were reviewed in this patient group. The characteristic features of this entity are reviewed.

Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm.

Background: Because not much is known about the longterm results of surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA), we reviewed our entire 37-year experience with this condition.

Methods And Results: From August 1956 through September 1993, 31 patients aged 3 to 54 years (median age, 29 years) underwent surgical correction of RSVA. Aneurysms originated in the right (n = 24) and noncoronary (n = 7) sinuses and entered the right ventricle in 21 patients and the right atrium in 10.

Three-dimensional reconstruction of color Doppler jets in the human heart.

A computer algorithm has been developed for segmentation and three-dimensional (3D) reconstruction of Doppler color-flow images. The algorithm enables the user to select a range of velocities, represented by colors, for segmentation and subsequent 3D reconstruction. The reconstructed flows are assigned a color palette and merged with the volume-rendered gray-scale image to produce a 3D image containing both flow and anatomic information.

Overestimation of severity of ischemic/functional mitral regurgitation by color Doppler jet area.

Color Doppler jet analysis is widely used to characterize the degree of mitral regurgitation (MR), but the validity of this approach in patients with ischemic or functional MR has not been established. It was hypothesized that color Doppler jet area overestimates the magnitude of MR of ischemic or functional origin. The severity of isolated MR in 170 patients was measured by using Doppler/echocardiography.

Diagnostic performance of two-dimensional versus three-dimensional transesophageal echocardiographic images of selected pathologies evaluated by receiver operating characteristic analysis.

Unlabelled: The sensitivity and specificity of 2-D and 3-D echocardiographic images for the detection of selected morphological abnormalities were compared using receiver operating characteristic (ROC) analysis. Five experienced clinical echocardiographers blinded to the patients' diagnoses evaluated the 20 original static 2-D image sets and 20 corresponding 3-D reconstructions using a five point categorical scale that ranged from definitely abnormal to definitely normal. The ROC curve for the 3-D images was significantly (P < 0.

Transesophageal echocardiography.

To describe the role of transesophageal echocardiography (TEE) in the diagnosis of various cardiac pathologic conditions, we reviewed the currently accepted clinical applications, the contraindications to the procedure, and the potential complications. The Mayo Clinic experience with 7,134 TEE examinations during a 6-year period (1988 through 1993) was summarized, and TEE results reported in the literature were reviewed. TEE has a substantially higher yield than transthoracic echocardiography (TTE) for diagnosis of direct and indirect sources of cardioembolism.

Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons.

Objective: To determine standard left ventricular Doppler measurements in a large reference group of various ages to reflect the senescence process.

Design: We prospectively studied the influence of aging on left ventricular diastolic filling by performing Doppler echocardiography in 117 normal healthy volunteers.

Material And Methods: Transthoracic pulsed-wave Doppler echocardiographic studies of pulmonary venous flow and left ventricular inflow were done in the 53 male and 64 female study subjects.

Back to basic bedside ministering.

I have to question whether the 'academics' who are forcing this so-called professionalism onto nurses either know or remember what it is like to be in the real world of hands-on nursing.

Effective regurgitant orifice area: a noninvasive Doppler development of an old hemodynamic concept.

Objectives: The purpose of this study was to determine the feasibility, relation to other methods and significance of the effective regurgitant orifice area measurement.

Background: Assessment of the severity of valvular regurgitation (effective regurgitant orifice area) has not been implemented in clinical practice but can be made by Doppler echocardiography.

Methods: Effective regurgitant orifice area was calculated by Doppler echocardiography as the ratio of regurgitant volume/regurgitant jet time-velocity integral and compared with color flow Doppler mapping, angiography, surgical classification, regurgitant fraction and variables of volume overload.

Feasibility of generating hemodynamic pressure curves from noninvasive Doppler echocardiographic signals.

Objectives: This study was designed to determine the feasibility of Doppler generation of accurate, complete right ventricular and pulmonary artery pressure curves in patients with Doppler-measurable tricuspid and pulmonary regurgitation.

Background: Doppler-derived flow velocities have been used to assess right ventricular systolic pressure; pulmonary artery systolic, diastolic and mean pressures, and left ventricular systolic and diastolic pressures. Instantaneous gradient across any area of discrete narrowing is accurately derived using the simplified Bernoulli equation (4V2).

Diagnostic role of Doppler echocardiography in constrictive pericarditis.

Objectives: This study was conducted to assess the diagnostic role of Doppler echocardiography in constrictive pericarditis.

Background: It has been observed that patients with constrictive pericarditis have a characteristic Doppler pattern of respiratory variation in ventricular filling and central venous flow velocities. However, the observation was based on a small number of patients with known diagnosis.

Distinguishing right from left: a standardized technique for fetal echocardiography.

Improved echocardiographic equipment and increasing experience have led to accurate and reliable prenatal diagnosis of congenital defects and arrhythmias. However, without a standard convention for acquisition and presentation of fetal images, distinguishing the right side of the fetus from the left side can be difficult and confusing. This article proposes a standard method of image acquisition and presentation that allows confident determination of the fetal right/left axis by easily identified anatomic landmarks.