RESUMO
The aim of this study was to assess the comparative diagnostic value of transesophageal echocardiography (TEE) and retrograde aortography for morphologic evaluation and anatomic mapping of aortic dissection. Seventy patients (aged 18 to 79 years) were prospectively evaluated with both techniques for suspected aortic dissection. In 64 patients, findings on aortography and TEE could be validated against intraoperative (n = 53) and postmortem (n = 11) findings. Examination time was significantly shorter for TEE (9 +/- 6 vs 48 +/- 25 minutes; p < 0.001). For the detection of aortic dissection, aortography showed lower sensitivity (87.5% vs 97.5%) and negative predictive value (85.3% vs 96.7%; both trends did not reach statistical significance) due mostly to the inability to identify noncommunicating dissection (dissection without intimal tears). For the epiphenomena of aortic dissection, aortography was significantly more accurate (97.2% vs 78%; p < 0.05) in assessing the site of entry, and TEE was more accurate in identifying thrombus formation (90% vs 65%; p < 0.05). There was no significant difference between aortography and TEE with regard to assessing secondary tears, aortic regurgitation, coronary dissection, and extension of the dissection. Thus, both TEE and aortography offer detailed anatomic mapping for guided surgical interventions. In elective patients, integration of both techniques seems the best approach; in unstable patients, TEE may be preferential because it is less invasive, requires no contrast injection, and provides accurate diagnosis in a short time at the bedside.
Assuntos
Aneurisma da Aorta Torácica/diagnóstico , Dissecção Aórtica/diagnóstico , Aortografia , Ecocardiografia Transesofagiana , Adulto , Idoso , Dissecção Aórtica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To assess the diagnostic potential of transthoracic and transoesophageal echocardiography for the detection of traumatic cardiovascular injuries in patients suffering from severe blunt chest trauma. DESIGN: Prospective study over a three year period. SETTING: A regional cardiothoracic centre. PATIENTS: 134 consecutive patients (94 M/40 F; mean age 38 (SD 14) years) suffering from severe blunt chest trauma (injury severity score 33.5 (18.2)). Most patients (89%) were victims of motor vehicle accidents. EVALUATION: All patients underwent transthoracic and transoesophageal echocardiography within 8 h of admission. Aortography was performed in the first 20 patients and in a further five equivocal cases. RESULTS: Transthoracic echocardiography provided suboptimal images in 83 patients, detecting three aortic ruptures, 28 pericardial effusions (one cardiac tamponade), 35 left pleural effusions, and 15 myocardial contusions. Transoesophageal echocardiography was feasible in 131 patients and detected 14 aortic ruptures (13 at the isthmus), 40 pericardial effusions, 51 left pleural effusions, 34 periaortic haematomas, 45 myocardial contusions, right atrial laceration in one patient with cardiac tamponade, one tricuspid valve rupture, and one severe mitral regurgitation caused by annular disruption. For the detection of aortic rupture transoesophageal echocardiography showed 93% sensitivity, 98% specificity, and 98% accuracy. Time to surgery was significantly shorter (30 (12) v 71 (21) min; P < 0.05) for patients operated on only on the basis of transoesophageal echocardiographic findings. CONCLUSIONS: Transthoracic echocardiography has low diagnostic yield in severe blunt chest trauma, while transoesophageal echocardiography provides accurate diagnosis in a short time at the bedside, is inexpensive, minimally invasive, and does not interfere with other diagnostic or therapeutic procedures.
Assuntos
Sistema Cardiovascular/lesões , Ecocardiografia Transesofagiana , Ecocardiografia , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Torácicos/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Acidentes de Trânsito , Adolescente , Adulto , Idoso , Ruptura Aórtica/diagnóstico por imagem , Aortografia , Sistema Cardiovascular/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
A 25-yr-old female who had undergone surgery for common atrium and atrioventricular septal defect at the age of 9, was found to have residual shunting at the level of the atrioventricular junction. Precordial echocardiography failed to assess the direction of the shunt. Transesophageal echocardiography showed dehiscence of the atrial patch at the level of the atrioventricular junction. Through this defect left-atrium-to right ventricle shunting occurred in diastole, whereas in systole the defect was closed by the juxtaposition of the anterior tricuspid valve leaflet.
Assuntos
Ecocardiografia , Cardiopatias Congênitas/cirurgia , Comunicação Interatrial/cirurgia , Comunicação Interventricular/cirurgia , Hemodinâmica/fisiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Deiscência da Ferida Operatória/diagnóstico por imagem , Adulto , Velocidade do Fluxo Sanguíneo , Ecocardiografia Doppler , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interventricular/diagnóstico por imagem , Humanos , Pericárdio/transplante , Técnicas de SuturaRESUMO
In order to widen the diagnostic capability of single-plane transesophageal echocardiography, which has been so far confined to transverse imaging planes, we obtained four transgastric longitudinal echocardiographic views which have not been previously described. These views can image structures such as superior and inferior vena cava, the right ventricular inflow and outflow tract, the mitral apparatus and the ascending aorta, which are poorly visualized by transesophageal transverse single-plane echocardiography. Among 400 consecutive patients these scans gave relevant additional diagnostic information in 62 cases (15.5%) and provided the correct diagnosis in 37 (9.2%). There were no complications related to the longer gastric manipulation of the probe and the quality of the images was high. We conclude that longitudinal echotomographic scanning of the heart is not exclusively confined to the use of biplane or omniplane probes, but longitudinal views can be consistently obtained with a single-plane instrument.
Assuntos
Ecocardiografia/métodos , Aorta/diagnóstico por imagem , Feminino , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Estômago , Veias Cavas/diagnóstico por imagemRESUMO
BACKGROUND AND AIMS OF THE STUDY: Pericardial xenografts were introduced for clinical use following evidence of their good hemodynamic characteristics in laboratory tests; however, their efficiency in comparison with porcine valves has not been fully assessed. Pericarbon, a new type of pericardial bioprosthesis, has been recently developed in order to provide better hemodynamic performances and longer durability than such bioprostheses currently in use. METHODS: Fifteen patients operated on for aortic valve replacement with a 23 mm Pericarbon and a sex- and age-matched group operated on with a 23 mm Hancock II bioprosthesis were submitted to echocardiographic and Doppler examinations in order to compare the hemodynamic performance of the two devices. RESULTS: Peak transvalvular gradients for Pericarbon and Hancock II bioprostheses (38.9 +/- 13.0 vs. 33.9 +/- 13.0 mmHg; p = 0.294) and mean transvalvular gradients (24.7 +/- 7.6 vs. 20.8 +/- 9.9 mmHg, p = 0.24) showed no significant difference. However, the indexed effective prosthetic dynamic area was significantly larger for the Hancock II device (0.73 +/- 0.14 vs. 0.62 +/- 0.13 cm2; p < 0.05). CONCLUSIONS: When installed as 23 mm pericardial bioprostheses, the Pericarbon device appears not to demonstrate superior hemodynamic performance to that of the Hancock II; however, additional studies are needed to provide a definitive conclusion.
Assuntos
Bioprótese , Próteses Valvulares Cardíacas , Hemodinâmica/fisiologia , Idoso , Aorta , Ecocardiografia , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Infarto do Miocárdio/complicações , Idoso , Ecocardiografia , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Feminino , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/etiologia , Ruptura Cardíaca Pós-Infarto/etiologia , Septos Cardíacos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Valor Preditivo dos TestesAssuntos
Bioprótese/efeitos adversos , Endocardite Bacteriana/diagnóstico por imagem , Infecções por Bactérias Gram-Negativas/diagnóstico por imagem , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Veillonella , Ecocardiografia , Endocardite Bacteriana/etiologia , Infecções por Bactérias Gram-Negativas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Infecções Relacionadas à Prótese/etiologiaAssuntos
Acidentes por Quedas , Ecocardiografia Transesofagiana , Traumatismos Cardíacos/complicações , Hipóxia/etiologia , Ferimentos não Penetrantes/complicações , Traumatismos Cardíacos/diagnóstico por imagem , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/lesões , Humanos , Hipóxia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/lesões , Ferimentos não Penetrantes/diagnóstico por imagemAssuntos
Ecocardiografia , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Idoso , Feminino , Átrios do Coração , HumanosRESUMO
OBJECTIVE: To evaluate the comparative diagnostic value of harmonic imaging (HI) in the assessment of patients with suspected infective endocarditis (IE). SETTING: Tertiary referral centre. DESIGN: 139 consecutive patients were evaluated with three imaging modalities: transthoracic echocardiography with fundamental imaging (FI); HI; and transoesophageal echocardiography (TOE). Image quality was assessed for each modality by semiquantitative scoring (0, poor, to 3, excellent). Presence, dimension, and characteristics of vegetations were assessed separately for each imaging modality, as well as presence of abscesses. RESULTS: 35 patients had definite IE. TOE was positive in 33 patients, HI in 28, and FI in 12 (p < 0.001 for FI v HI and v TOE). Mean image quality was 1.4 (0.7) for FI, 2.1 (0.6) for HI (p < 0.01 v FI), and 2.6 (0.4) for TOE (p < 0.001 v HI). The association between FI and TOE findings was Phi = 0.35 (chi2 = 17.57, p = 0.0014) and between HI and TOE it was Phi = 0.95 (chi2 = 125.72, p < 0.0001; p < 0.0001 v FI). The global echo score of vegetations was 7.1 (3.3) with FI, 8.5 (3.4) with HI, and 11.3 (3.9) with TOE (p < 0.001 v HI). Compared with TOE, FI identified only one of seven abscesses (sensitivity 14%) and HI identified two of seven abscesses (sensitivity 28%). CONCLUSIONS: HI provides an accurate assessment of suspected IE. TOE achieves superior definition of IE related abnormalities.
Assuntos
Ecocardiografia/métodos , Endocardite Bacteriana/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Feminino , Febre de Causa Desconhecida/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
Papillary muscle rupture occurred in two patients with recent inferior myocardial infarction. In one case with partial rupture transesophageal echocardiography in the standard four-chamber view did not visualize the rupture and in the second case with complete rupture it provided incomplete diagnostic information. A not previously described transgastric longitudinal scanning of the left ventricle provided complete delineation of the lesion and it was of great value in the diagnosis and management of this potentially lethal complication. Both patients were operated upon and had a favourable outcome.
Assuntos
Ecocardiografia/métodos , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Músculos Papilares/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The echocardiographic characteristics of vegetation used by precordial echocardiography (PE) have been transferred unchanged to transesophageal echocardiography (TEE), which has different image definition and structural resolution. Twelve diagnostic criteria of vegetation were tested for their accuracy in 52 patients evaluated by PE and TEE for suspected endocarditis (36 men, 16 women; mean age, 62 +/- 18 years; 42 with proven endocarditis). Results of PE and TEE were validated against gross anatomic and histologic findings. Significant differences (P < .05) included the fact that TEE disclosed more vegetations not prolapsing in the subvalvular region and in absence of valvular regurgitation. At TEE vegetations presented motion distinct from the endocardial surface, irregular conformation, and uneven margins. Only chaotic motion was significantly associated with vegetations at PE; size < 0.5 cm and increased echogenicity characterized pseudovegetations at PE. Other features such as shaggy echoes or location out of the annular zone (previously indicated as typical of vegetations) were not significantly associated with infective lesions. Discriminant analysis of TEE characteristics of vegetations disclosed that chaotic motion was the variable most significantly (P = .008) associated with vegetation. Coexistence of this sign with size < 0.5 cm and uneven margins was associated with 93.3% sensitivity and 83.7% specificity. In conclusion, the echocardiographic aspect of vegetations is rather different when examined from the precordial and the transesophageal approach. Learning about pitfalls and normal variants should improve TEE specificity in the assessment of infective lesions.