[Decompensated valve failure: the revival of balloon valvuloplasty - percutaneous valve intervention].

Calcified aortic stenosis is the dominating valve disease. Patients affected are most commonly elderly people, who often show associated comorbidities like reduced left ventricular function, impaired renal function, and pulmonary hypertension. The risk of open heart surgery is elevated.

Myocardial Infarction associated with methadone and/or dihydrocodeine.

Chest pain and myocardial infarction occurring in young people with angiographically normal coronary arteries is well documented. Opiates have a cardioprotective effect and are used in acute heart attacks. We described a 22-year-old opioid addicted male patient who suffered a myocardial infarction following the consumption of methadone and dihydrocodeine.

[Primary systemic amyloidosis with cardiac manifestations].

History And Findings: A Vietnamese woman, now 68 years old, had for ten years been known to have a monoclonal lambda light-chain gammopathy. Two years before the present admission her resting ECG had shown absent R waves in V2 to V4, first-degree A-V block and preterminal negative T waves. Results of left heart catheterization and echocardiography were essentially normal.

Reproducibility of myocardial contrast echocardiography in human studies.

Experimental and clinical studies were performed to assess the ability of myocardial contrast echocardiography for quantitation of regional myocardial blood flow. To evaluate whether myocardial contrast echocardiography is a reproducible technique in humans, 18 nonselected patients undergoing coronary angiography were studied. A total of 107 intracoronary injections into either the left or the right coronary artery were analyzed by computer assisted videodensitometry for peak intensity, contrast decay half-time, and area under the curve.

[Myocardial contrast echocardiography for the follow-up after percutaneous transluminal coronary angioplasty].

Myocardial contrast echocardiography was performed, before and after successful elective percutaneous transluminal angioplasty (PTCA) of a main coronary artery, in 35 patients (31 men, 4 women; mean age 56 +/- 6 years). After intracoronary injection of microbubbles-containing 2 ml iopromide, contrast half-life (t/2) and maximal echo-intensity (Imax) in the myocardial region supplied by the target vessel were measured. While t/2 decreased from 8.

Short-term effects of oral enoximone on hemodynamics, exercise capacity, anaerobic threshold, and arrhythmias in congestive heart failure.

Enoximone, a phosphodiesterase-inhibitor, is a potent inotropic vasodilator agent that causes a marked improvement in hemodynamics in patients with congestive heart failure. The acute effects of oral enoximone on rest and exercise hemodynamics, ejection fraction, aerobic metabolism, exercise capacity, and arrhythmias were studied in 11 patients with moderate to moderately severe dilative cardiomyopathy after 8 days of enoximone (100 mg tid) in addition to baseline therapy (diuretics and digitalis). The cardiac index increased from 2.

[Intraoperative contrast echocardiography using sonicated iopromide (Ultravist 370) for imaging the post-bypass myocardial region].

In order to minimize the rate of inadequate myocardial revascularizations, an intraoperative evaluation of regional myocardial perfusion could have practical impact. Current bypass flow measurements have inherent limitations and can determine only epicardial blood flow. To analyze regional graft-dependent myocardial blood flow an echocardiographic short-axis view of the left ventricle was performed intraoperatively in 11 patients undergoing elective coronary artery bypass surgery.

[Myocardial contrast echocardiography with sonicated iopromide (Ultravist 370) before and after coronary angioplasty].

Thirty-one patients (3 female, 28 male, mean age 56 years) were investigated with myocardial contrast echocardiography before and after successful PTCA (= less than 30% residual stenosis) of one major coronary artery. 2 ml of sonicated lopromid (Ultravist 370, microbubble-size 6 +/- 4 microns) were injected into the coronary vessel. Before, during and after injection a short-axis view or an apical four chamber view was obtained and recorded on videotape.

Intraoperative myocardial contrast echocardiography for assessment of regional bypass perfusion.

The intraoperative determination of the success of surgical myocardial revascularization remains problematic because of major limitations in all currently used methods. To assess the regional blood flow of the bypass graft-dependent myocardial segments, 2 ml of sonicated iopromid (a nonionic x-ray contrast medium) was injected into the bypass graft in the beating heart. Simultaneously electromagnetic flow measurements were performed.

Myocardial contrast echocardiography: examination of intracoronary injections, microbubble diameters, and video-intensity decay.

Contrast echocardiographic assessment of blood flow within the myocardium requires standardization of contrast agents and echo image analysis. Sonicated contrast solutions containing small and relatively stable microbubble ultrasound reflectors were injected into coronary arteries of five dogs, and a newly developed computer assisted densitometric analysis of myocardial echo intensity decay was examined. The sonicated solutions included sorbitol 70%, dextrose 70%, and dextrose 50%, and myocardial contrast echo data were analyzed by applying an exponential decay index (T-1/2) to the digitized time intensity curves obtained with videodensitometric techniques.

Early differentiation of infarcted and noninfarcted reperfused myocardium in dogs by quantitative analysis of regional myocardial echo amplitudes.

This study tests the hypothesis that ischemic but viable reperfused myocardium can be differentiated from infarcted reperfused myocardium by regional analysis of myocardial echo amplitudes. In eight closed-chest, anesthetized dogs, the left anterior descending coronary artery was occluded for 3 hours, followed by 1 hour of reperfusion, and sacrifice. Infarct size was measured by the triphenyl tetrazolium chloride technique in a 1-cm-thick mid-left ventricular transverse slice, and matched with a corresponding end-diastolic two-dimensional echo short-axis cross-section.

Physical factors influencing quantitation of two-dimensional contrast echo amplitudes.

Measurement errors that may interfere with quantitation by the new myocardial contrast two-dimensional echocardiographic technique were examined in a simplified in vitro model consisting of a 50 cc blood-filled balloon with supplemental controlled injection of 0.2 to 2.6 cc of sonicated dextrose 70%.

Computer methods for myocardial contrast two-dimensional echocardiography.

Two computer-aided videodensitometric methods that may be used in conjunction with two-dimensional contrast echocardiography were examined to quantify the time course of echographic opacification in the myocardium after experimental injections of contrast agents (hand-agitated Renografin-saline and sonicated sorbitol 70% solutions) into the left main coronary artery. Echographic studies of myocardial cross sections were digitized with an image processing computer using a 128 X 128 resolution matrix. Both stop frame and continuous cycle modes of acquisition were performed.

Two-dimensional contrast echocardiography. II. Transpulmonary studies.

A method using contrast two-dimensional echocardiography for left ventricular chamber and myocardial opacification from a right-sided pulmonary capillary wedge position is described. A total of 152 studies were carried out in nine mongrel dogs. Four different catheters with different catheter tip cross-sectional areas (varying from 0.

Two-dimensional contrast echocardiography. I. In vitro development and quantitative analysis of echo contrast agents.

To facilitate the passage of echo contrast agents through the microcirculation and the echocardiographic study of myocardial perfusion, ultrasonic energy (sonication) was employed to produce contrast agents consisting of relatively uniform, stable and small (less than 10 mu diameter) gaseous microbubbles suspended in liquid solutions. The size and persistence of the microbubbles was verified by light microscopy and an in vitro system were employed for comparative assessment of peak echo amplitude and echo persistence characteristics of various contrast agents. The study indicated that although a variety of hand-agitated and sonicated contrast agents provided satisfactory echo intensities, sonication was clearly superior to the hand-agitation method, because sonication produced smaller, more uniform and more stable microbubbles that may be suitable for myocardial contrast echocardiography.

Validation of a computerized edge detection algorithm for quantitative two-dimensional echocardiography.

An edge detection algorithm used in conjunction with digitized two-dimensional echocardiograms was applied to validate computerized two-dimensional echocardiographic (2DE) quantitation of cross-sectional areas of canine left ventricular chambers. Images were enhanced by space-time smoothing and dynamic range expansion, after which automatic edge detection was performed by convolving a Laplacian operator with the enhanced image. In an in vitro study of 29 myocardial slabs, computer-derived 2DE measurements of short-axis sections of the left ventricle were compared with manually derived 2DE data and validated against direct measurements of intraluminal areas of myocardial slabs.

Quantitation of regional cardiac function by two-dimensional echocardiography. I. Patterns of contraction in the normal left ventricle.

Regional differences in wall motion and wall thickening were quantitated in the normal left ventricle using two-dimensional echocardiography (2-D echo). Using a computer-aided system, the left ventricle was subdivided in a standardized manner into 40 segments of five 2-D echo short-axis cross sections from the mitral valve level to the low left ventricle or apex. Measurements of sectional and segmental cavity areas, muscle areas and endocardial as well as epicardial perimeters, allowed assessment of contractile function using such indexes as endocardial systolic fractional area change (FAC), wall thickening (WTh), and circumferential fiber shortening (shortening).

Real time computerization of two-dimensional echocardiography.

A computerized system was developed for real time acquisition, enhanced processing, analysis, and display of cross-sectional images of the left ventricle derived by two-dimensional echocardiography (2DE). The new methodology couples a standard medical imaging computer system to the video output of any current 2DE unit, uses a 128 x 128 or 64 x 64 matrix window and stores the real time 30 frames/sec digitized images on a magnetic disk. Computerized beat-to-beat and frame-by-frame processing employs space-time smoothing the automatic detection of endocardial interfaces by standard threshold and second derivative techniques.

[Left ventricular volumes by cross-sectional echocardiography in the dog: a comparison with biplane angiocardiography (author's transl)].

Using apical long axis and precordial short axis views, left ventricular end-diastolic and end-systolic volumes and ejection fraction were determined by cross-sectional echocardiography and compared with biplane angiocardiography. 10 anesthetized, closed chest dogs were first studied in the control state. Inferior vena cava was occluded by a balloon-inflated catheter, measurements were repeated.

Quantitative two dimensional echocardiography during bicycle exercise in normal subjects.

A quantitative two dimensional echocardiographic study was conducted in 10 normal subjects performing bicycle exercise in a supine position. Standardized two dimensional echocardiographic short axis and apical views of the left ventricle were analyzed to derive left ventricular sectional areas and length. Over a range of exercise heart rates from 108 to 152 beats/min, satisfactory two dimensional echocardiographic views and measurements were obtained for quantitative assessment of sectional and global left ventricular function.

Two-dimensional echocardiographic assessment of left ventricular stroke volume: experimental correlation with thermodilution and cineangiography in normal and ischemic states.

Left ventricular stroke volumes derived by two-dimensional echocardiography (2D echo) were compared with thermodilution and cineangiography measurements in closed-chest dogs before andone hour after proximal LAD occlusion. Stroke volume was calculated from end-diastolic and end-systolic volumes reconstructed by two models: 1) Simpson's rule employing left ventricular length and five short-axis cross-sectional areas; 2) a simplified volume formula (V = 5/6 area . length), utilizing a single short-axis area at either the mitral valve or midpapillary muscle level.

[Reno-cardiac interactions in kidney failure (author's transl)].

The high incidence of cardiac complications in endstage renal failure is not only related to the chronic pressure load of the left ventricle, although the proportion of patients with elevated blood pressure increases from 53 to 81% as reno-parenchymal disease progresses. Other factors as anemia, hyperparathyroidism, autonomic neuropathy and retention of electrolytes, metabolic products of toxins may cause damage to the heart. It is a matter of discussion whether uremia itself causes cardiomyopathy.

[Echocardiographic dimensions of the left ventricle during ergometric exercise: results in normal subjects (author's transl)].

10 healthy men aged 18 to 32 years underwent M-mode-echocardiographic studies at rest, during exercise and recovery. Semisupine bicycle exercise was performed using work loads of 25, 50, 75, and 100 W with measurements taken every minute. With increasing exercise, heart rate rose significantly (p less than 0.