The Development of Color Doppler Echocardiography: Innovation and Collaboration.

Conception, development, innovation, introduction, and validation are some of the steps in the introduction of new technologies and their clinical applications. More than 50 years ago, Doppler techniques and applications were introduced into echocardiography. An important further addition was the introduction of color as a medium for the display of Doppler information. The amplitude of the returning ultrasound signal has been used to generate a black and white image of structure. The phase shift between the transmitted and returning Doppler signal has been used to display Doppler shift information in color. This review focuses on some of the resources critical to this new development, the challenges imposed by the introduction of a new color display, and some of the early clinical validation and applications of color Doppler echocardiography.

Ultrasound assisted evaluation of chest pain in the emergency department.

Chest pain is a commonly encountered emergency department complaint, with a broad differential including several life-threatening possible conditions. Ultrasound-assisted evaluation can potentially be used to rapidly and accurately arrive at the correct diagnosis. We propose an organized, ultrasound assisted evaluation of the patient with chest pain using a combination of ultrasound, echocardiography and clinical parameters. Basic echo techniques which can be mastered by residents in a short time are used plus standardized clinical questions and examination. Information is kept on a checklist. We hypothesize that this will result in a quicker, more accurate evaluation of chest pain in the ED leading to timely treatment and disposition of the patient, less provider anxiety, a reduction in the number of diagnostic errors, and the removal of false assumptions from the diagnostic process.

Perioperative transoesophageal echocardiography: current status and future directions.

Transoesophageal echocardiography (TOE) is used in the perioperative arena to monitor patients during life-threatening emergencies, cardiac and high-risk non-cardiac surgeries. It provides qualitative and quantitative information on valvular and ventricular functions, and dynamic cardiac anatomy can be displayed with a physiological perspective. This technology has evolved from two-dimensional (2D) to the ready availability of real-time three-dimensional (RT-3D) imaging in the operating rooms. Enhanced spatial and temporal resolutions with 3D imaging have most significantly impacted the quality of intraoperative surgical valve repair and replacement decisions. Additionally, 3D imaging has facilitated the advent of minimally invasive and percutaneous interventions for structural heart disease. Information derived from TEE is routinely used to evaluate a patient's suitability for an intervention, provide guidance during the intervention and eventually comment on the quality and success of the procedure. Expertise in perioperative TEE is an integral component of a cardiac anaesthesiologist's skill sets. With structural heart disease interventions becoming more minimally invasive, the intraoperative guidance provided by TEE will continue to be a critical component of these procedures. With improving computational and processing power, the expectations from TEE will continue to be incremental in the perioperative arena.

The glorious years leading Doppler flow to the heart, the odyssey of the pioneers!

This review pays tribute to those pioneers in Doppler flow during an early and exciting period ranging from the end of the 1960s to the 1990s. Three major 'approaches' contributed to what is nowadays built into every patient's investigation. The source was Daniel Kalmanson, who developed flow directionality, assigning a physiological meaning to the recordings. This was the first time Doppler flow was used on the heart, providing new insights in cardiac pathophysiology. The second approach relied on the Norwegian group who applied the laws of physics to fluid dynamics. Simplification of the formula provided a new non-invasive approach enabling quantification of valvular lesions and haemodynamic measurements. This new tool pushed back previous routine catheterisation. To crown it all, the introduction of colour Doppler flow, mainly relying on the Japanese groups, overcame the long-lasting scepticism of the scientific community: cardiologists started to "believe" in the Doppler technique. Other innovative pioneers around the world joined the three groups to develop this new field of cardiology. At the turning of the new millennium, the Doppler technique is mature, through a strong methodology. Convergence of the three original approaches for mutual benefit, constant update of examination modalities according to improved technology, and new insights into cardiac dynamics, are the three cornerstones supporting this methodology. They should contribute to keep it alive and efficient, independently of the imaging modality of the future.

Three-dimensional echocardiography of colour Doppler flow.

Three-dimensional echocardiography of colour Doppler flow developed quickly with the advent of three-dimensional echocardiography. An increasing amount of research has shown that three-dimensional echocardiography of colour Doppler flow is feasible and facilitates measurement of stroke volume and cardiac output, and assessment of heart valve and congenital heart diseases. Although the technique still has some drawbacks that hamper its widespread use, as the technology continues to improve, three-dimensional echocardiography of colour Doppler flow has the potential to serve as a powerful noninvasive clinical tool, aiding physicians in the serial assessment of heart disease and response to intervention. We review the developmental history and the most recent clinical information related to three-dimensional echocardiography of colour Doppler flow.

The bright minds beyond our machines: Henry Coanda and his ideas.

Most cardiologists rarely remember that new ideas dedicated initially to completely different areas, are the technological background of most medical devices. Also, they almost ignore the bright minds beyond these ideas. The Coanda effect, vital in the color-Doppler assessment of valvular regurgitations with eccentric jets--bears the name of a Romanian inventor whose life (1886-1972) was mostly dedicated to aeronautics and who is considered the 'father' of jet engines. His fluid dynamics discovery was patented in 1934, but its importance for medical applications was recognized much later.