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1.
Am J Cardiol ; 92(5): 634-5, 2003 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-12943896

RESUMEN

We assessed aortic regurgitation (AR) severity by utilizing multiple echo-Doppler variables in comparison with AR severity by aortic root angiography. Patients were divided into 3 groups: mild, moderate, and severe. An AR index (ARI) was developed, comprising 5 echocardiographic parameters: ratio of color AR jet height to left ventricular outlet flow diameter, AR signal density from continuous-wave Doppler, pressure half-time, left ventricular end-diastolic diameter, and aortic root diameter. There was a strong correlation between AR severity by angiography and the calculated echo-Doppler ARI (r = 0.84, p = 0.0001). As validated by aortic angiography, the ARI is an accurate reflection of AR severity.


Asunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Aortografía/métodos , Cineangiografía/métodos , Ecocardiografía Doppler/métodos , Ecocardiografía Transesofágica/métodos , Índice de Severidad de la Enfermedad , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Insuficiencia de la Válvula Aórtica/clasificación , Aortografía/normas , Cineangiografía/normas , Análisis Discriminante , Ecocardiografía Doppler/normas , Ecocardiografía Transesofágica/normas , Femenino , Hemodinámica , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Sensibilidad y Especificidad , Método Simple Ciego , Volumen Sistólico , Función Ventricular Izquierda
2.
J Am Soc Echocardiogr ; 16(8): 867-70, 2003 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12878996

RESUMEN

BACKGROUND: Severe emphysema frequently is associated with elevated pulmonary artery systolic pressure. However, it is often difficult to obtain adequate tricuspid regurgitation (TR) signals for measurement of pulmonary artery systolic pressure in patients with severe emphysema. PURPOSE: This study was conducted to evaluate the usefulness of air-blood-saline mixture in measuring TR velocity in severe emphysema. METHODS: We studied 82 patients with severe emphysema (67.7 +/- 9.2 years, 57 males) who had no or mild TR on color Doppler. Contrast echocardiography studies were performed with agitated 10% air-90% saline and 10% air-10% blood-80% saline mixtures. Tracing quality and peak velocity were assessed on baseline continuous wave signals and contrast continuous wave signals with the 2 mixtures. RESULTS: With the injection of an air-saline mixture, the quality of TR tracing improved in 45 patients (P <.0001) and a higher peak TR velocity was obtained (2.46 +/- 0.37 m/s vs 2.95 +/- 0.40 m/s, P <.0001) compared with baseline echocardiography. Compared with air-saline mixture, the air-blood-saline mixture further enhanced TR tracing quality in 17 patients (P <.0001) and the peak TR velocity increased to 3.13 +/- 0.42 m/s (P <.0001). CONCLUSIONS: In patients with severe emphysema, an air-blood-saline mixture improves the quantifiable TR signals for more accurate estimation of pulmonary artery systolic pressure, even when there is minimal valve TR.


Asunto(s)
Aire , Velocidad del Flujo Sanguíneo/fisiología , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/fisiopatología , Cloruro de Sodio/sangre , Insuficiencia de la Válvula Tricúspide/diagnóstico , Insuficiencia de la Válvula Tricúspide/fisiopatología , Anciano , Anciano de 80 o más Años , Aire/análisis , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Medios de Contraste , Ecocardiografía Doppler en Color , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/fisiopatología , Índice de Severidad de la Enfermedad , Sístole/efectos de los fármacos , Sístole/fisiología , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/fisiopatología
3.
Cardiology ; 99(3): 145-52, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12824722

RESUMEN

BACKGROUND: We examined the agreement between transthoracic echocardiography (TTE) and intraoperative prepump transesophageal echocardiography (TEE) in the assessment of left-sided regurgitant lesions and echocardiographic variables associated with grading discrepancies. METHODS: The TTE and prepump TEE studies of 54 patients undergoing aortic-valve replacement for aortic stenosis were reviewed. Agreement and correlation in assessment of aortic (AR) and mitral regurgitation (MR) severity were evaluated. RESULTS: There was no significant difference between mean TTE and prepump TEE grading of MR (0.23 +/- 0.19 vs. 0.21 +/- 0.15 jet area/area of the left atrium, p = 0.49), but the correlation between the two methods was weak (r = 0.40, p = 0.003), with an exact agreement of 54%. Prepump TEE tended to grade AR as more severe (mean grade 1.43 +/- 0.94 vs. 1.24 +/- 0.75, p = 0.058). The correlation between the two methods in AR assessment was fair (r = 0.70, p = 0.0001) with an agreement of 59%. For MR and AR grading, no significant correlations between valvular regurgitation severity and blood pressure differences between preoperative TTE and prepump TEE were found. In 17% of cases, discrepancies in identifying severe mitral or aortic valve regurgitation could have affected patient management. CONCLUSIONS: There is modest agreement in MR and AR assessment between TTE and prepump TEE. Cardiologists, cardiac surgeons, and anesthesiologists must be aware of differences between these methods when using prepump TEE to guide intraoperative decisions.


Asunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Ecocardiografía Doppler en Color , Ecocardiografía Transesofágica , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Monitoreo Intraoperatorio/instrumentación , Anciano , Anciano de 80 o más Años , Insuficiencia de la Válvula Aórtica/cirugía , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Implantación de Prótesis de Válvulas Cardíacas/métodos , Hemodinámica/fisiología , Humanos , Masculino , Insuficiencia de la Válvula Mitral/cirugía , Cuidados Posoperatorios , Cuidados Preoperatorios , Estudios Retrospectivos , Sensibilidad y Especificidad , Resultado del Tratamiento
4.
J Am Coll Cardiol ; 39(1): 124-9, 2002 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-11755297

RESUMEN

OBJECTIVES: We assessed an air-blood-saline mixture for Doppler measurement of pulmonary artery systolic pressure (PASP) and the mechanism of enhancement of the Doppler signal by this mixture. BACKGROUND: Underestimation of PASP by Doppler echocardiography occurs with inadequate continuous wave (CW) signals of tricuspid regurgitation (TR). METHODS: We assessed in vitro the diameter and concentration of microbubbles of agitated air-saline mixture, air-blood-saline mixture and 10% air-10% plasma-80% saline mixture immediately, 5, 10 and 20 s after agitation. In 20 patients, PASP was estimated by Swan-Ganz catheter and CW Doppler of TR: 1) without contrast injection; 2) with intravenous injection of 10% air-90% saline; and 3) 10% blood-10% air-80% saline mixture. RESULTS: Compared to air-saline, addition of blood or plasma to the air-saline solution significantly increased the concentration of microbubbles (p < 0.001). The air-blood-saline (26.7 +/- 7.2 microm) and air-plasma-saline mixture (25.3 +/- 7.4 microm) had smaller microbubbles than air-saline mixture (31.6 +/- 8.2 microm) (p < 0.001). The correlation between Doppler- and catheter-measured PASP at baseline (r = 0.64) improved with agitated air-saline (r = 0.86). With the air-blood-saline mixture, the correlation further improved (r = 0.92) and the best limits of agreement were obtained. CONCLUSIONS: The combination of the patient's own blood is a method of making a sterile solution of numerous small microbubbles for injection into the right-sided cardiac chambers. Clinically, the air-blood-saline mixture is easily prepared at bedside and is superior to the air-saline mixture in assessing PASP in patients with inadequate CW Doppler signals.


Asunto(s)
Medios de Contraste , Ecocardiografía Doppler/métodos , Aumento de la Imagen/métodos , Arteria Pulmonar/fisiología , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Presión Sanguínea , Femenino , Humanos , Masculino , Microesferas
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