Grading Aortic Valve Stenosis With Dimensionless Index During Pre-cardiopulmonary Bypass Transesophageal Echocardiography: A Comparison With Transthoracic Echocardiography.

OBJECTIVE: The authors hypothesized that grading valvular aortic stenosis (AS) with dimensionless index (DI) during intraoperative pre-cardiopulmonary bypass (pre-CPB) transesophageal echocardiography (TEE) would match the grade of AS during preoperative transthoracic echocardiography (TTE) for the same patients more often than when using peak velocity (Vp), mean pressure gradient (PGm), or aortic valve area (AVA). DESIGN: Retrospective, observational. SETTING: Single university hospital. PARTICIPANTS: The participants in this study included 123 cardiac surgical patients with any degree of AS, who underwent open cardiac surgery between 2010 and 2016 at the Medical University of South Carolina and had Vp, PGm, AVA, and DI values available from reporting databases or archived imaging. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: When using DI, pre-CPB TEE grading of AS severity was 1 grade higher 21.1% of the time and 1 grade lower 13.0% of the time compared with TTE, for an overall disagreement rate of 34.1%. The overall disagreement rates between pre-CPB TEE and TTE for Vp, PGm, and AVA were 39.8%, 33.3%, and 33.3%, respectively. CONCLUSIONS: The authors could not demonstrate that DI was better than Vp, PGm, or AVA at matching AS grades between intraoperative pre-CPB TEE and preoperative TTE. When DI was used, pre-CPB TEE was more likely to overestimate than underestimate the severity of AS compared with TTE. However, when Vp or PGm was used, pre-CPB TEE was more likely to underestimate the severity of AS compared with TTE. A comprehensive approach without overemphasis on 1 parameter should be used for AS assessment by intraoperative TEE.

Multiple focal nodular hyperplasia syndrome: diagnosis with dynamic, gadolinium-enhanced MRI.

We present a rare case of multiple focal nodular hyperplasia (FNH) with greater than 20 FNH lesions and coexistent liver hemangiomata. Particular attention is paid to the MRI characteristics of this disease process and the features of "multiple FNH syndrome" are discussed.

Diffuse abdominal angiomatosis.

We present a rare case of diffuse abdominal angiomatosis occurring in a 19-year-old male; particular attention is paid to the MR imaging features of this disease process.

Echocardiography in the intensive care unit.

As ultrasound technology improves and ultrasound availability increases, echocardiography utilization is growing within intensive care units. Although not replacing the often-needed comprehensive echocardiographic evaluation, limited bedside echocardiography promises to provide intensivists with enhanced diagnostic ability and improved hemodynamic understanding of individual patients. Routine and emergency echocardiography within the intensive care unit focuses on identifying and optimizing medically treatable conditions in a timely manner. Methods for such goal-directed assessments are presented.

Prophylactic beta-blocker use to prevent perioperative morbidity and mortality.

Cardiovascular disease continues to be a major health concern and leads to significant perioperative morbidity and mortality. Evidence for prophylactic use of beta-blockade to decrease these complications continues to grow. Not all patients benefit from perioperative beta-blockade, thus a thorough preoperative cardiac assessment should be performed with every patient undergoing surgery. Although physicians may have doubts with this new strategy, the literature overwhelmingly supports prophylactic beta-blockade use as a safe, efficacious, and cost effective new therapy in patients at risk for cardiac complications.