Two dimensional and Doppler echocardiographic diagnosis of bicuspid pulmonary valve.

The diagnosis of bicuspid pulmonary valve is usually established postmortem, occurring in 7% of patients with pulmonary stenosis and is usually associated to tetralogy of Fallot or ventricular septal defect. The authors report the case of a 14-year-old girl with patent ductus arteriosus in whom 2-D echocardiography disclosed a pulmonary valve formed of two slightly thickened leaflets that opened with the shape of a dome in systole, and moved under the valve ring plane during diastole. A Doppler examination showed a 21 mmHg transvalvar gradient. These characteristic features suggest that 2-D and Doppler echocardiography are the techniques of choice in the diagnosis of bicuspid pulmonary valve.

[Doppler color transesophageal echocardiography. Report of the first 110 studies carried out at the Ignacio Chávez National Institute of Cardiology]. / Ecocardiografía transesofágica con Doppler color. Informe de los primeros 110 estudios efectuados en el Instituto Nacional de Cardiología Ignacio Chávez.

Transesophageal echocardiography allows views of the posterior structures of the heart. This approach provides additional and complementary information to the transthoracic study, it is also an alternative in those patients with technical limitations for optimal precordial imaging. This study analysis the first 110 cases studied with transesophageal echocardiography in the National Institute of Cardiology Ignacio Chávez. They correspond to patients with valvular heart disease, prosthesis, acute and chronic ischemic heart disease, dissecting aortic aneurysm, cardiomyopathies, thrombus, tumors and masses. As well as paediatric and adult with complex congenital heart disease. The advantages of the transesophageal technique compared with the precordial approach are described.

[Transesophageal echocardiography. General principles and applications]. / Ecocardiografia transesofagica. Principios generales y aplicaciones.

A new echocardiographic technique is described, which allows cardiovascular ultrasonic exploration by means of a transducer mounted on the distal tip of a gastroscope. The transducer is moved along the esophagus and from time to time into the stomach, which permits real-time visualization of the different cardiac segments and the great arteries. This technique is of special utility in the exploration of posterior structures as are the left atrium and its appendage, the pulmonary veins, etc. The most important views in the transverse plane are described, as well as the technical aspects, the limitations and the possible complications.

[Echocardiographic study of valvular prosthesis]. / Estudio ecocardiográfico de las prótesis valvulares.

Eighty-six patients with valvular prosthesis (PV) were included in this study, 52 females and 34 males, from 9 to 55 years of age. The functional state of the PV was corroborated with catheterization, surgery or necropsy. The results of 92 PV were analyzed, of which 72 were in mitral position, including 49 dura mater valves (DMPV). In aortic position were 18, including 12 mechanical Bjork-Shilley (BS) and 2 in tricuspid position. The prostheses were classified in three groups: I. with regurgitation, II. with obstruction and III. without dysfunction. Of the 49 DMPV in mitral position 11 were in group I and 7 in group II. The echocardiogram revealed a diminished opening velocity in group II (255 +/- 41.2 mm/sec., P less than 0.001) as well as a diminished opening excursion (10.9 +/- 3.4 mm, P less than 0.02) and increased thickness of the leaflets (4.7 +/- 3.6 mm, P less than 0.05). Paradoxical interventricular septal movement was less frequent in group I (27.2%, P less than 0.05). Seventeen BS valves were in mitral position; of these 2 were classified in group I and the rest in group III, the opening velocity was increased (1200 mm/sec) in those of group I. None of the BS valves in aortic position were dysfunctional. No patients from group III died; mortality in groups I and II was 35%. In 5.1% of group III and 20% of groups I and II either no improvement or greater clinical deterioration was observed.