Fragment reconstruction of coronary arteries using transesophageal echocardiography for coronary diagnostics.

AIMS: Ultrasound differs procedurally from the established methods for non-invasive coronary visualization and is therefore an interesting alternative for non-invasive diagnostics. In this study, fragment reconstruction of coronary arteries by transesophageal echocardiography (FRC-TEE) was investigated for the first time in a patient population being evaluated for coronary angiography. METHODS AND RESULTS: Ultrasonic and angiographic findings were compared visually and using quantitative measurements in 50 patients. One hundred and seventy-one vessels were examined by FRC-TEE. The total lengths visualized were 9.6 +/- 1.7 cm for the right coronary artery, 7.0 +/- 1.1 cm for left circumflex, 3.9 +/- 1.2 cm for left anterior descending (LAD), and 1.5 +/- 0.8 cm for the left main coronary artery. There was high concordance between results of both procedures. Sixty-three stenoses were detected using FRC-TEE. The mean difference in degree of stenosis between techniques was 0.2 +/- 5.1%. Stents could be visualized in 19 segments. FRC-TEE detected distal stenoses of the coronary arteries to only a limited extent: 14 stenoses and 2 stents, predominantly in the LAD artery (n = 13), were not identified. CONCLUSIONS: FRC-TEE is a potential method for diagnosing coronary artery disease. FRC-TEE and angiography yield comparable findings during the evaluation of coronary lesions. Further investigations are needed to verify the encouraging findings and define FRC-TEE's applications.

Fragment reconstruction of coronary arteries by transesophageal echocardiography: a method for visualizing coronary arteries with ultrasound.

BACKGROUND: If transesophageal echocardiography (TEE) is to play a role in coronary diagnostics, satisfactory image documentation of the coronary status is indispensable so that the requirements for validity and quality assurance of a medical examination can be met. Our goal was to develop a suitable and valid procedure for imaging coronary arteries with 2D TEE. METHODS AND RESULTS: After pilot trials and formulation of requirements, a new method of imaging coronary arteries was designed, supported by theoretical and mathematical principles: FRC-TEE, or fragment reconstruction of coronary arteries by means of 2D TEE. The method generates images of successive vessel fragments so that reconstruction in a summation picture is possible. The procedure orients itself to the vessel and ensures proof of identity by permanently following it on the screen. FRC-TEE was evaluated in 12 consecutive patients with an indication for TEE. One hundred percent visualization in proximal, middle, and distal segments was achieved. The total lengths visualized were 10.74+/-2.56 cm for the right and 8.67+/-1.12 cm for the left coronary artery. Stents and stenoses within the vessels were identified convincingly. Because of a technical problem, investigation of the left anterior descending artery was initially avoided. In a pilot trial series (n=12), 6.65+/-0.92 cm of this vessel was imaged. CONCLUSIONS: FRC-TEE is a newly developed method of visualizing coronary arteries by means of ultrasound, which permits good pictorial documentation. Initial studies have achieved promising results. Representation of the length of coronary arteries with ultrasound was considerably improved with this technique.

Pre-procedural expression of Mac-1 and LFA-1 on leukocytes for prediction of late restenosis and their possible correlation with advanced coronary artery disease.

BACKGROUND: The activation status of the inflammatory system has been suggested to play an important role in predicting restenosis. Activation of leukocyte adhesion molecules occur after coronary intervention and the level of activation correlates to restenosis. However, little is known about the specific role of adhesion molecules before intervention. The purpose of this study concerned the search for differences in the expression level of selected adhesion molecules to identify suitable tools for the pre-procedural identification of restenosis patients prior to angioplasty. METHODS: Blood samples of 31 patients undergoing elective coronary angiography were obtained just before intervention. Seven healthy volunteers were also enrolled. Surface expression of leukocyte adhesion molecules Mac-1 (CD11b/CD18), LFA-1 (CD11a/CD18), L-Selectin (CD62L), ICAM-1 (CD54), and MHC-II (HLA-DR) were assessed by flow cytometry. Patients with a successful angioplasty received a follow-up angiography after six months. RESULTS: According to the clinical and angiographic data, patients were divided into four groups: control (N = 14), no restenosis (N = 11), restenosis (N = 4), and advanced coronary artery disease (CAD, N = 9). The restenosis group and the advanced CAD group showed higher expression of Mac-1 and LFA-1 on monocytes and neutrophils compared to the other groups. Using the pre-procedural expression levels, patients with restenosis could be predicted by discriminant analysis with CD11a, CD11b, and CD18 (average recognition index = 95.5%). CONCLUSIONS: The data of this pilot study indicate that pre-procedural activation status of CD11a and CD11b may play a role in the subsequent development of restenosis. Moreover, CD11a, CD11b, and CD18 may be helpful as indicators for the progression of CAD.

Free-hand four-dimensional echocardiography: a diagnostic tool in coronary artery disease.

Direct echocardiographic visualization of coronary arteries has been difficult due to the inherent problems involved in obtaining ultrasound access. We used freehand four-dimensional echocardiography in a 79-year-old patient with a trifurcational stenosis. We were able to identify a 6 x 11 mm possibly subintimal atheromathous plaque and to measure the diameters of the left descending coronary artery before, in, and behind the stenosis. There was good agreement with the angiographic measurements. This successful approach may be an argument to motivate further research in this area.

Atypical Bland-White-Garland syndrome: a 58-year-old woman with stenosis of the pulmonary origin of the left coronary artery.

UNLABELLED: The anomalous origin of the left coronary artery from the main pulmonary trunk (also known as Bland-White-Garland syndrome) is a rare congenital malformation that occurs in 0.4% of patients with cardiac anomalies. We present an adult case (a 58-year-old woman) of atypical Bland-White-Garland syndrome. The patient displayed a stenosis at the ostium of the anomalous origin of the left coronary artery and an aortopulmonary fistula. Using conventional angiography, it was not possible to differentiate between an anomalous origin of the pulmonary coronary artery and total stenosis of the left main coronary artery in combination with a pulmonary fistula. However, transesophageal echocardiography (TEE) succeeded in making this differential diagnosis. CONCLUSION: If there is subtotal or total occlusion, TEE can be used for detection of coronary vessel morphology, particularly in cases of coronary anomalies.