RESUMO
BACKGROUND: Abdominal aortic aneurysm (AAA) is associated with atherosclerosis elsewhere. Thoracic aortic atheromas (ATHs) seen on transesophageal echocardiography (TEE) are an important cause of stroke and peripheral embolization. The purposes of this study were to determine whether an association exists between AAA and ATHs and to assess the importance of screening patients with ATHs for AAA. METHODS: For the retrospective analysis, 109 patients with AAA and 109 matched controls were compared for the prevalence of ATHs on TEE and for historical variables. For the prospective analysis, screening for AAA on ultrasonography was performed in 364 patients at the time of TEE. RESULTS: Results of the retrospective analysis showed that ATHs were present in 52% of patients with AAA and in 25% of controls (odds ratio [OR] = 3.3; P =.00003). There was a significantly higher prevalence of hypertension, myocardial infarction, heart failure, smoking, and carotid or peripheral arterial disease in patients with AAA. However, only ATHs were independently associated with AAA on multivariate analysis (P =.001). Results of the prospective analysis showed that screening at the time of TEE in 364 patients revealed AAA in 13.9% of those with ATHs and in 1.4% of those without ATHs (P <.0001; OR = 11.4). CONCLUSIONS: (1) There is a strong, highly significant association between abdominal aneurysm and thoracic atheromas. (2) Patients with AAA may be at high risk for stroke because of the concomitance of thoracic aortic atheromas. (3) The high prevalence of abdominal aneurysm in patients with thoracic atheromas suggests that screening for abdominal aneurysm should be carried out in all patients with thoracic atheromas identified by TEE.
Assuntos
Aneurisma da Aorta Abdominal/complicações , Doenças da Aorta/complicações , Arteriosclerose/complicações , Idoso , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Arteriosclerose/diagnóstico por imagem , Estudos de Casos e Controles , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
The pulmonary artery is typically seen on transthoracic echocardiography in its longitudinal axis. Therefore, short axis views of the pulmonic valve leaflets are not generally obtained, and the distinction between tricuspid and bicuspid pulmonic valves is difficult or impossible. Bicuspid pulmonic valve is one cause of pulmonic stenosis, which is especially common in tetralogy of Fallot. Presented here are 2 patients in whom the orientation of the pulmonary artery was unusual, and the pulmonic valve was seen en face. The first patient had tetralogy of Fallot and a bicuspid pulmonic valve. The severe obstruction to right ventricular outflow was infundibular. The second patient had severe stenosis of a tricuspid pulmonic valve, which was treated with balloon valvuloplasty. These unusual views of the pulmonic valve leaflets were obtained because of anterior displacement of the pulmonary artery, and precise anatomic delineation of the problem in each case was possible with transthoracic echocardiography.
Assuntos
Artéria Pulmonar/anormalidades , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Tricúspide/diagnóstico por imagem , Adulto , Ecocardiografia , Feminino , Humanos , Recém-Nascido , Masculino , Estenose da Valva Pulmonar/cirurgia , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Estenose da Valva Tricúspide/cirurgiaRESUMO
The left atrial appendage of patients with mitral valve disease is commonly a source of thromboembolus and is often ligated during mitral valve surgery to diminish this risk. However, ligation is often incomplete. We describe a patient with a stroke whose only source of embolus was an incompletely ligated left atrial appendage. Attempts to exclude the left atrial appendage from the arterial circulation by suture ligation may not decrease the risk of thromboemboli and instead may increase such risk.
Assuntos
Apêndice Atrial , Cardiopatias/etiologia , Tromboembolia/etiologia , Idoso , Ecocardiografia Transesofagiana , Cardiopatias/diagnóstico por imagem , Humanos , Ligadura , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias , Acidente Vascular Cerebral/complicações , Tromboembolia/diagnóstico por imagemRESUMO
Pulsed wave, continuous wave, and color flow Doppler imaging as well as intravenously administered agitated saline solution can detect intracardiac shunts during transthoracic echocardiography. Ultrasonographic contrast agents have greatly improved the visualization of left heart chambers and can enhance signals from blood flow within chambers and across valves, increasing the sensitivity of Doppler techniques. We describe a patient in whom the use of echo contrast media during transthoracic echocardiography allowed the detection of a previously unseen atrial septal defect. Combining such modalities may help to increase the sensitivity of transthoracic echocardiography and may eliminate the need for transesophageal echocardiography in selected patients.
Assuntos
Albuminas , Meios de Contraste , Ecocardiografia , Fluorocarbonos , Comunicação Interatrial/diagnóstico por imagem , Microesferas , Idoso , Humanos , Aumento da Imagem , MasculinoRESUMO
BACKGROUND: The outcome of aortic valve replacement for severe aortic stenosis is worse in patients with impaired left ventricular function. Such dysfunction in aortic stenosis may be reversible if caused by afterload mismatch, but not if it is caused by superimposed myocardial infarction. METHODS: From our echocardiography database, 55 patients with severe aortic stenosis (valve area < or =0.75 cm2) and ejection fractions of 30% or lower who subsequently underwent aortic valve replacement were included. The operative mortality and clinical follow-up were detailed. RESULTS: There were 10 perioperative deaths (operative mortality, 18%). Twenty (36%) of the 55 patients had a prior myocardial infarction. In the 35 patients without prior myocardial infarction, there was only 1 death (3%). In contrast, 9 of 20 patients with prior myocardial infarction died (mortality rate, 45%; P< or =.001). The factors significantly associated with perioperative death on univariate analysis (functional class, mean aortic gradient, and prior myocardial infarction) were entered into a model for stepwise logistic regression. This multivariate analysis showed that only prior myocardial infarction was independently associated with perioperative death (odds ratio, 14.9; 95% confidence interval, 2.4-92.1; P = .004). CONCLUSIONS: The risk of aortic valve replacement in patients with severe aortic stenosis and severely reduced left ventricular systolic function is extremely high if the patients have had a prior myocardial infarction. This information should be factored into the risk-benefit analysis that is done preoperatively for these patients, and it may preclude operation for some.
Assuntos
Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Disfunção Ventricular Esquerda/complicações , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The eustachian valve directs oxygen-rich blood from the inferior vena cava toward the foramen ovale and away from the tricuspid valve during fetal development. Ordinarily, it does not prevent reflux of right atrial blood back into the inferior vena cava because it does not function as a true valve. Here we describe an unusual adult patient with severe tricuspid valve regurgitation in whom the eustachian valve did function as a true, albeit regurgitant, valve.
Assuntos
Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Veia Cava Inferior/fisiopatologia , Idoso , Feminino , Humanos , UltrassonografiaRESUMO
OBJECTIVES: The study examined the value of contrast echocardiography in the assessment of left ventricular (LV) wall motion in intensive care unit (ICU) patients. BACKGROUND: Echocardiograms done in the ICU are often suboptimal. The most common indication is the evaluation of LV wall motion and ejection fraction (EF). METHODS: Transthoracic echocardiograms were done in 70 unselected ICU patients. Wall motion was evaluated on standard echocardiography (SE), harmonic echocardiography (HE), and after intravenous (IV) contrast echocardiography (CE) using a score for each of 16 segments. A confidence score was also given for each segment with each technique (unable to judge; not sure; sure). The EF was estimated visually for each technique, and a confidence score was applied to the EF. RESULTS: Uninterpretable wall motion was present in 5.4 segments/patient on SE, 4.4 on HE (p = 0.2), and 1.1 on CE (p < 0.0001). An average of 7.8 segments were read with surety on SE, 9.2 on HE (p = 0.1), and 13.7 on CE (p < 0.0001). Ejection fraction was uninterpretable in 23% on SE, 13% on HE (p = 0.14), and 0% on CE (p = 0.002 vs. HE; p < 0.0001 vs. SE). The EF was read with surety in 56% of patients on SE, 62% on HE (p = 0.47), and 91% on CE (p < 0.0001). Thus, wall motion was seen with more confidence on CE. More importantly, the actual readings of segmental wall motion and EF significantly differed using CE. CONCLUSIONS: CE should be used in all ICU patients with suboptimal transthoracic echocardiograms.
Assuntos
Albuminas , Meios de Contraste , Ecocardiografia/métodos , Fluorocarbonos , Ventrículos do Coração/diagnóstico por imagem , Unidades de Terapia Intensiva , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Albuminas/administração & dosagem , Estado Terminal , Feminino , Fluorocarbonos/administração & dosagem , Ventrículos do Coração/fisiopatologia , Humanos , Injeções Intravenosas , Masculino , Microesferas , Pessoa de Meia-Idade , Contração Miocárdica , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
Twenty patients with right atrial thrombi were identified through the use of transthoracic and transesophageal echocardiography. Transesophageal echocardiography identified right atrial thrombi in all 20 cases. Transthoracic echocardiography showed definite thrombi in only 6 (30%) cases and suggested thrombus in another 2 (10%) patients. Thus transthoracic echocardiography results were false-negative for right atrial thrombus in 60% of cases. All 3 thrombi found within the right atrial appendage and 2 of 3 thrombi on pacemaker wires were missed by transthoracic echocardiography. There was no significant difference in the mean size between those thrombi seen (1.37 +/- 0.6 cm) and those missed (1.5 +/- 0.9 cm) by transthoracic echocardiography. Transesophageal echocardiography also significantly affected treatment. Anticoagulation was initiated or amplified in 13 patients. In 8 of these 13, thrombi were seen only by transesophageal echocardiography. Surgery was performed to remove thrombi in 7 cases, and in 3 (43%) cases it was because of thrombi seen only by transesophageal echocardiography. This study suggests that transesophageal echocardiography should be performed whenever right atrial thrombi are suspected. Transesophageal echocardiography has a significant effect on the diagnosis and management of patients with right atrial thrombi.
Assuntos
Ecocardiografia Transesofagiana , Cardiopatias/diagnóstico por imagem , Trombose/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Ecocardiografia , Reações Falso-Negativas , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/efeitos dos fármacos , Átrios do Coração/cirurgia , Cardiopatias/tratamento farmacológico , Cardiopatias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , Estudos Retrospectivos , Sensibilidade e Especificidade , Taxa de Sobrevida , Trombectomia , Trombose/tratamento farmacológico , Trombose/cirurgia , Varfarina/uso terapêuticoRESUMO
Cardiac compression is a potentially life-threatening complication of heart surgery. This syndrome often has atypical manifestations, challenging our ability to make a rapid diagnosis and to institute emergent, life-saving treatment. We recently evaluated one such patient who showed cardiac compression caused by an unusual paracardiac mass. The addition of transesophageal echocardiography to the usual transthoracic study may have played more than just a diagnostic role in this case.
Assuntos
Tamponamento Cardíaco/diagnóstico por imagem , Ecocardiografia Transesofagiana , Derrame Pericárdico/diagnóstico por imagem , Idoso , Tamponamento Cardíaco/terapia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Valva Mitral , Derrame Pericárdico/terapia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , RadiografiaRESUMO
Plasma homocyst(e)ine [H(e)] levels correlate with the prevalence of arterial occlusive diseases. Recently, transesophageal echocardiography (TEE) has been used to evaluate patients with atherosclerotic plaques in the thoracic aorta. The purpose of this study was to determine whether H(e) levels correlate with the degree of atherosclerotic plaque in the thoracic aorta (ATH) as seen on TEE. Maximum plaque areas for three locations in the thoracic aorta (arch, proximal descending, and distal descending) were measured with TEE in 156 patients. Maximum plaque areas for these locations were added to yield an estimate of ATH. ATH and H(e) levels, and levels of folic acid, vitamin B12, and pyridoxal 5'-phosphate were measured in a double-blind manner. Univariate analysis demonstrated a significant correlation of H(e) with ATH (r = 0.3, p< 0.001). On multivariate analysis, H(e) was independently predictive of ATH (r for the model including H(e) was 0.63, p < 0.0001). Plasma H(e) levels are therefore significantly and independently correlated with the degree of atherosclerosis in the thoracic aorta.
Assuntos
Doenças da Aorta/sangue , Arteriosclerose/sangue , Homocisteína/sangue , Idoso , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/epidemiologia , Arteriosclerose/diagnóstico por imagem , Arteriosclerose/epidemiologia , Ecocardiografia Transesofagiana , Feminino , Ácido Fólico/sangue , Humanos , Masculino , Análise Multivariada , Variações Dependentes do Observador , Fosfato de Piridoxal/sangue , Piridoxina/sangue , Fatores de Risco , Vitamina B 12/sangueAssuntos
Cateterismo/efeitos adversos , Cardiopatias/etiologia , Estenose da Valva Mitral/terapia , Trombose/etiologia , Adulto , Cateterismo Cardíaco , Ecocardiografia Transesofagiana , Feminino , Átrios do Coração , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Humanos , Embolia Pulmonar/etiologia , Trombose/complicações , Trombose/diagnóstico por imagemRESUMO
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.
Assuntos
Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Ventrículos do Coração/patologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Aorta Torácica , Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Corpos Estranhos/etiologia , Tampões de Gaze Cirúrgicos/efeitos adversos , Aorta Torácica/diagnóstico por imagem , Ecocardiografia Transesofagiana , Corpos Estranhos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-OperatóriasAssuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Ecocardiografia Transesofagiana , Artéria Subclávia/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Ecocardiografia Doppler de Pulso , Ecocardiografia Transesofagiana/instrumentação , Ecocardiografia Transesofagiana/métodos , Estudos de Viabilidade , Humanos , Reprodutibilidade dos Testes , Transdutores , Resistência VascularRESUMO
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.
Assuntos
Síndrome Antifosfolipídica/complicações , Ecocardiografia Transesofagiana , Cardiopatias/diagnóstico por imagem , Trombose/diagnóstico por imagem , Adulto , Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/imunologia , Feminino , Átrios do Coração , Cardiopatias/etiologia , Humanos , Imunoglobulina M/sangue , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Trombose/etiologiaRESUMO
The purpose of this study was to evaluate the correlates of spontaneous echo contrast in mitral stenosis and normal sinus rhythm. Spontaneous echo contrast is associated with clot formation and embolic phenomena. It has been noted in conditions involving blood stasis, especially mitral stenosis and atrial fibrillation, but the correlates of spontaneous echo contrast in patients with mitral stenosis and normal sinus rhythm have not been extensively evaluated. The transthoracic and transesophageal echocardiograms and clinical findings of 47 patients with mitral stenosis and normal sinus rhythm were reviewed. Left atrial size, mean transmitral gradient, and valve area were measured, and the presence or absence of spontaneous echo contrast in the left atrium was noted. Spontaneous echo contrast was found in the echocardiograms of 21 (45%, group 1) of 47 patients. There was no contrast in those of the other 26 patients (group 2). Mean transmitral gradient was significantly higher in group 1 (13.6 +/- 5.2 mm Hg) than in group 2 (10.5 +/- 4.9 mm Hg) (p < 0.05). Mitral valve area was significantly smaller in group 1 than in group 2 (1.0 +/- 0.5 vs 1.4 +/- 0.5 cm2; p < 0.02). There was a trend toward a higher prevalence of significant mitral regurgitation in group 2. There was no significant difference with respect to age, left atrial size, history of embolism, or warfarin therapy. We conclude that spontaneous echo contrast in the left atrium of patients with mitral stenosis and normal sinus rhythm is common and is associated with a significantly smaller mitral valve area and higher mitral gradient.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Ecocardiografia Transesofagiana , Átrios do Coração/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico por imagem , Adulto , Feminino , Átrios do Coração/anatomia & histologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/anatomia & histologia , Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/patologia , Estenose da Valva Mitral/fisiopatologia , Estudos RetrospectivosRESUMO
The case of an 82-year-old patient with signs and symptoms of superior vena cava syndrome is described. A multiplane transesophageal echocardiogram demonstrated anatomic and Doppler flow evidence of superior vena caval obstruction due to compression by a dissected, aneurysmal ascending aorta. Multiplane transesophageal echocardiography is particularly useful in the diagnosis of superior vena cava syndrome when it is a sequela of thoracic aortic disease.
Assuntos
Aneurisma Aórtico/complicações , Dissecção Aórtica/complicações , Ecocardiografia Transesofagiana , Síndrome da Veia Cava Superior/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Ecocardiografia Doppler , Feminino , Humanos , Síndrome da Veia Cava Superior/etiologiaRESUMO
OBJECTIVES: The purpose of this study was to prospectively evaluate the risk of vascular events in patients with protruding aortic atheromas. BACKGROUND: Protruding atheromas of the thoracic aorta have been shown to be associated with embolic disease in previous retrospective studies. METHODS: During a 1-year period, 521 patients had transesophageal echocardiography. Of these, 42 patients had protruding atheromas and no other source of emboli. They were followed up for up to 2 years (mean follow-up 14 months) and compared with a control group without atheromas, matched for age, gender and hypertension. RESULTS: Of 42 patients with atheromas, 14 (33%) had 19 vascular events during follow-up (5 brain, 2 eye, 4 kidney, 1 bowel, 7 lower extremity). Of 42 control patients, 3 (7%) had vascular events (2 brain, 1 eye). Univariate analysis identified only protruding atheromas as significantly correlating with events (p = 0.003). There was no positive correlation of events with age, gender, hypertension, smoking, family history, atrial fibrillation, valve replacement, antithrombotic drug use, diabetes or coronary disease. Multivariate analysis showed that only protruding atheromas independently predicted events (p = 0.005, odds ratio 4.3, 95% confidence interval 1.2 to 15.0). Nine patients died in the atheroma group versus six in the control group, but this was not statistically significant (p = 0.39). CONCLUSIONS: Protruding atheromas seen on transesophageal echocardiography predict future vascular events.