Biopsy of a Right Atrial Mass Under Transesophageal Echocardiographic Guidance

Transesophageal echocardiography was utilized to accurately define a right atrial mass and safely guide transvenous biopsy, resulting in accurate diagnosis and appropriate treatment. Although transthoracic echocardiography was utilized to detect the mass, transesophageal echocardiography provided detail that allowed safe localization and biopsy of the mass.     

Acute Myocardial Infarction During Transesophageal Echocardiography

We describe the occurrence of acute myocardial infarction during transesophageal echocardiography (TEE) in a patient with atrial fibrillation and underestimated angina. Such a case has not been previously reported in the literature. This case illustrates one of the possible complications of TEE, leading us to suggest systematic sedation in patients with angina in whom TEE is envisaged.     

Right Atrial and Ventricular Infarction

In order to compare the results of transesophageal echocardiography (TEE) in diagnosis of right atrial (RA) and right ventricular (RV) infarction with those of transthoracic echocardiography (TTE), 11 patients admitted to the coronary care unit with the diagnosis of posteroinferior left ventricular (LV) acute myocardial infarction (MI) and electrocardiographic suspicion of extension to RV were studied. In two of the 11 patients, RA infarction was identified on the basis of akinesis of the RA free wall, dilatation of the atrial cavity, spontaneous echo contrast, mural thrombosis, and poor atrial contribution to RV filling. In all 11 patients, RV infarction was determined by akinesis of one or more segmental regions, dilatation of the cavity in four patients, and tricuspid regurgitation in seven. Only six cases of RV infarction were diagnosed with TTE. The findings indicate that TEE provides additional information to TTE for determining RA and RV infarction during the early stages of MI.     

Transesophageal Color Doppler Echocardiographic Diagnosis of Cardiac Rupture Following Acute Myocardial Infarction

This report describes a case of cardiac rupture following acute myocardial infarction accurately diagnosed by transesophageal color Doppler echocardiography, which showed a very narrow transmural tract from the left ventricle into the pseudoaneurysm cavity. Such a small, slitlike rupture would most likely have been missed by an otherwise routine transesophageal examination, and we stress the importance of color Doppler interrogation in its accurate diagnosis.     

Left Ventricular Apical Thrombus and Myocardial Viability: A Dobutamine Stress Echocardiographic Study

The objective of this article was to determine whether the presence of left ventricular apical thrombus is a marker of nonviable myocardium. Reduced coronary blood flow secondary to atherosclerosis may result in chronic reversible left ventricular wall-motion abnormalities. Severe regional abnormalities also predispose to formation of left ventricular thrombus. The relationship between left ventricular apical thrombus and myocardial viability has not been previously described. Eighty patients with coronary artery disease and chronic left ventricular dysfunction were studied by dobutamine stress echocardiography. Left ventricular apical thrombus was identified using echocardiographic criteria. Wall-motion analysis was performed using a standard 16-segment model and ejection fraction was calculated. As a result, 48 patients (60%) had definite or highly suspicious findings for left ventricular thrombus (group 1), and 32 patients (40%) had no thrombus (group 2). Group 1 had significantly higher composite (  54.0 ± 5.8 vs 43.3 ± 6.4  ) and apical (  6.0 ± 2.7 vs 12.4 ± 3.4  ) wall-motion scores compared to those in group 2 (  P = 0.01  ). Thirty-two patients (67%) in group 1 demonstrated no contractile reserve in the apical segments, consistent with lack of viability, versus eight patients (25%) in group 2 (  P = 0.0003  ). The number of viable apical segments per patient was significantly less in group 1 (  0.7 ± 1.2  ) versus group 2 (  1.8 ± 1.3  ) (  P = 0.01  ). Left ventricular apical thrombus is more likely to be present when there is absence of myocardial viability in the corresponding segments.     

Transesophageal Echocardiographic Evidence for Acute Right Atrial Dysfunction

We describe the clinical course and echocardiographic findings of a 64-year-old man who was hospitalized with an infarction of the inferior myocardial wall of 5 days' evolution and extension to the right ventricle. Transesophageal echocardiography showed biventricular inferior dyssynergia and akinesis of the right atrial wall. One thrombus was visible in the right atrial appendage, and another crossed the foramen ovale and reached the mitral valve. After the patient received anticoagulant agents, transesophageal studies showed the disappearance of atrial thrombi, as well as recuperation of right atrial movement and active participation of atrial contraction in right ventricular filling. The findings of these serial echocardiograms support the existence of ischemic right atrial stunning manifested by wall akinesis that favored slow atrial flow and the formation of thrombi.     

Diagnosis of Myocardial Abscess After Acute Myocardial Infarction by Transesophageal Echocardiography: Case Report and Short Review of Published Data

A 56-year-old man received thrombolysis for an anterior myocardial infarction after chest pain for 18 hours. Ten days later he was readmitted with fever and hemodynamic deterioration. Transesophageal echocardiography demonstrated a thin-walled cavity at the apex of the left ventricle. At operation he was found to have a myocardial abscess, and after excision and antibiotics his subsequent clinical course was uneventful. We review the echocardiographic diagnosis and clinical features of myocardial abscess complicating acute infarction. Presumed etiologic factors in our patient included late thrombolysis, mural thrombus, and poor dental hygiene leading to septicaemia.     

Unusual "Polycystic" Appearance of a Right Atrial Angiosarcoma Described by Transesophageal Echocardiography

Angiosarcoma is the most common primary sarcoma of the heart and the most frequent location of the tumor is the right atrium. In the few published cases of right atrial angiosarcoma studied by transesophageal echocardiogaphy, the features described greatly differ from one to another. We describe the transesophageal images of a prolapsing mass type angiosarcoma with polycystic appearance previously misinterpreted as a right atrial myxoma in two consecutives transthoracic echocar-diograms.     

Clinical-Echocardiographic Correlation of Myocardial Infarction with Extension to Right Chambers

In order to determine the transesophageal echocardiographic characteristics in patients with acute myocardial infarction of right ventricle and establish the relationship between these findings, the clinical condition, and their prognostic value, 38 patients consecutively admitted to the Instituto Nacional de Cardiología with a diagnosis of acute left ventricular myocardial infarction with extension to right ventricle and/or atrium were retrospectively studied. Of the left ventricular infarctions, 37 were posteroinferior and one anterior. Significant elevations of CPK and DHL were found in 35. In 30 patients (78%) electrocardiographic evidence of extension of infarction to the right ventricle was found, and in 3, evidence of right atrial infarction. Twenty-one patients presented clinical data compatible with right ventricular infarction. In 19, cardiac rhythm and atrioventricular conduction disturbances were documented. Coronary angiograms practiced on 34 patients demonstrated single-vessel (right coronary) disease in 12, affection of two vessels in 14, and lesions in three or more in 6. Coronary arteries presented no significant lesions in two cases. With TEE, alterations of right ventricular segmental mobility were demonstrated in all patients, and in 6, alterations of right atrial mobility as well. As respects the ventricular wall movement index, 68.5% had total scores (RV + LV) of <5. The other 31.5% had scores >/= 5. In 26%, the right ventricular wall movement index was >/=4. The RVDD/LVDD ratio was 1 or less in 30 patients (78%) and >1 in only 8 (22%). The conclusions from these findings are that: (1) TEE is an excellent diagnostic means of identifying right ventricular and/or atrial infarction; and (2) a relationship exists between the magnitude of right ventricular damage and a wall movement index of 5 or more or an RV/LV diastolic diameter ratio > 1:postinfarction hemodynamic deterioration is significantly greater and the incidence of intrahospitalary complications higher.     

Echocardiographic Diagnosis of Biventricular Thrombi in a Cocaine-Induced Myocardial Infarction

We present the case of a patient with a biventricular myocardial infarction induced by cocaine and a large left and a smaller right ventricular apical thrombus. Serial multiplane transesophageal echocardiography was used to document the morphological course of the thrombi during anticoagulation therapy over a period of 6 weeks.     

Transesophageal Echocardiographic Diagnosis of Left Atrial Wall Dehiscene

Six months following Carbomedics mitral and aortic valve replacement, multiplane transesophageal echocardiography performed (TEE) in a 49-year-old black gentleman showed a prominent 1.0-cm linear echo protruding into the left atrium at the mid-interatrial septal level distal to the sewing ring. Plane angulations at 105 and 111 degrees demonstrated the linear echo to be related to left atrial wall dehiscence indicated by the presence of a cavitary defect at the same level. At the time of surgery, a 1.0 cm-paravalvular defect and dehiscence of the left atrial wall distal to the sewing ring 2.0 centimeters anterior to the posteromedial commisure were found.     

急性心肌梗塞后应用多巴酚丁胺负荷超声心动图对心肌存活性的研究

本文目的应用多巴酚丁胺负荷超声心动图研究急性心肌梗塞后梗塞区域心肌存活性。选择36例急性心肌梗塞患者，用5μg／kg·min多巴酚丁胺静脉滴注，体表超声心动图于用药前后对比观察梗塞区域心肌室壁运动和收缩期增厚率（T％），识别心肌存活性。36例患者分为576段心肌，基础状态下94段心肌运动消失，T％为0。静注5μg/kg·min多巴酚丁胺后，94段心肌中30段心肌恢复或部分恢复运动，T％增加121～60．0％。结果提示94段运动消失的心肌中30段（31．9％）具有存活性。表明多巴酚丁胺负荷超声心动图对急性心肌梗塞后存活心肌的识别是安全、可靠的，具有十分重要的临床意义。     

Echocardiographic Features of Ventricular Septal Rupture with Right Ventricular Aneurysm After Acute Myocardial Infarction

Postinfarction ventricular septal defect is a life-threatening disorder that may be adequately treated if the diagnosis is obtained promptly. Two-dimensional color Doppler echocardiography is a reliable tool for this diagnosis and gives additional information regarding its location, size, and shape. The authors emphasize the feasibility of this method to depict a particular form of postinfarction interventricular septal rupture, which developed an aneurysm inside the right ventricular cavity. Its characteristics were completely defined by color Doppler echocardiography and confirmed at surgery.     

Regional Diastolic and Systolic Function by Strain Rate Imaging for the Detection of Intramural Viability during Dobutamine Stress Echocardiography in a Porcine Model of Myocardial Infarction

The aim of this study was to evaluate diastolic and systolic strain rate measurements for differentiation of transmural/nontransmural infarction during dobutamine stress echocardiography (DSE). An ameroid constrictor was placed around the circumflex artery in 23 pigs inducing chronic vessel occlusion. Five pigs without constrictor served as controls. During high‐dose DSE systolic strain rates (SR_sys), systolic and postsystolic strain values (?_sys, ?_ps) and early and late diastolic strain rates (SR_E and SR_A) were determined. At week 6, animals were evaluated regarding myocardial fibrosis. Histology revealed nontransmural in 14 and transmural infarction in 9 animals. In controls, dobutamine induced a linear increase of SR_sys to 12.3 ± 0.4 s^?1 at 40 μg/kg per minute (P = 0.001) and a linear decrease of SR_E to ?6.6 ± 0.3 s^?1 (P = 0.001). In the nontransmural group, SR_sys, ?_sys, ?_ps at rest, and during DSE were higher and SR_E was lower than in the transmural infarction group (P = 0.01). Best predictors for viability were SR_sys (ROC 0.96, P = 0.0003), SR_E at 10 μg/kg per minute dobutamine stimulation (ROC 0.94, P = 0.001) and positive SR values during isovolumetric relaxation at 40 μg/kg per minute dobutamine (ROC 0.86, P = 0.004). The extension of fibrosis correlated with SR_sys at rest, ?_sys at rest, and SR_E at rest (P < 0.001). For the detection of viability similar diagnostic accuracies of SR_E and SRsys were seen (sensitivity 93%/93%, specificity 96%/94%, respectively). Diastolic SR analysis seems to be equipotent for the identification of viable myocardium in comparison to systolic SR parameters and allows the differentiation of nontransmural from transmural myocardial infarction with high diagnostic accuracy. (Echocardiography 2010;27:552‐562)     

Transesophageal Echocardiographic Diagnosis of Aortic Graft Dehiscense at Coronary Anastomoses and Pseudonaneurysm Rupture into Right Atrium

We describe a case of aortic graft dehiscence at coronary anastomoses with rupture into the right atrium of the pseudoaneurysm complicating aortic graft replacement. These were diagnosed by intraoperative transesophageal echocardiography.     

Three Different Coexisting Mechanical Complications of Myocardial Infarction Detected by Transthoracic and Transesophageal Echocardiography

An aneurysm, pseudoaneurysm, and interventricular septal rupture were detected by transthoracic and transesophageal echocardiography (TEE) in a 61-year-old man with anterior myocardial infarction. This case illustrates the value of these techniques in the assessment of mechanical complications associated with myocardial infarction.     

Transesophageal Echocardiographic Identification of Atrial Septal Aneurysm

This case illustrates the usefulness of biplane transesophageal echocardiography in the diagnosis of an atrial septal aneurysm, which in some views, mimicked a mass lesion in the left atrium. (ECHOCARDIOGRAPHY, Volume 8, July 1991)     

Assessment of Myocardial Viability in Patients With Postischemic Left Ventricular Dysfunction: Role of Myocardial Contrast Echocardiography

The distinction between viable and nonviable dysfunctional left ventricular (LV) segments after acute myocardial infarction is very important, because revascularization increases survival only in patients with viable myocardial tissue. Recent studies have highlighted a mismatch between two highly specific investigations for viability assessment: dobutamine echocardiography, which measures inotropic reserve, and myocardial contrast echocardiography (MCE), which measures microvascular perfusion. Viability and functional reserve are not synonymous. Maintenance of microvascular perfusion, independently of functional reserve, attenuates left ventricular remodelling, reduces the risk of major cardiac events, and increases survival. MCE provides similar perfusion information as myocardial blush, but image quality is much higher. Quantitative analysis of digital data provides more accurate diagnostic MCE information than qualitative analysis of video signal intensity. In a recent study relating MCE findings to histologic data, MCE-derived quantitative data were closely correlated with microvascular density and capillary area, and inversely correlated with collagen content. One of the contrast agents routinely used for MCE is SonoVue, a second generation microbubble contrast agent, which is characterized by high response to ultrasound energy, ease of destruction at high energy, and strong harmonic signal at low energy. Recommendations for the assessment of postischemic LV dysfunction: routine use of MCE, followed by dobutamine echocardiography if perfusion is documented. If MCE is negative, revascularization is not indicated; if both tests are positive, revascularization is strongly recommended; if they are discordant, useful information can be obtained by assessing the extent of ²⁰¹T1 viability. (ECHOCARDIOGRAPHY, Volume 20, Supplement 1, 2003)