3-D echocardiographic imaging of double aortic arch.

Delineation of arch abnormalities is difficult by conventional 2-D echocardiography and MRI has been the investigation of choice. 3-D echocardiography is increasingly used in congenital heart disease for both functional anatomy and morphology. This case report demonstrates that 3-D echocardiography can be used in delineating arch anomalies, which can avoid further imaging that needs a general anaesthetic.     

Transthoracic and transesophageal echocardiographic study of pulmonary autograft valve in aortic position

Eleven patients who underwent pulmonary valve autograft to aortic position with placement of bovine pericardial prosthesis in pulmonary position were studied with echocardiography. The etiology of aortic valvuloplasty as determined by anatomopathological examination was rheumatic in five, degenerative in four, and congenital in two. Important mitral stenosis coexisted in two patients, and during the same operation as the Ross surgery, a mitral valvuloplasty with Carpentier ring was practiced on one and an open mitral commissurotomy on the other. Transthoracic echocardiography, which helped to confirm the viability of the surgery by determining the diameters of the semilunar valve rings and quantifying the severity of the aortic valve lesions, was performed on all patients before surgery and repeated 3 months later. Transesophageal echocardiograms were practiced on nine patients during the surgical procedure and repeated after 6 months on seven. The latter technique aided in immediate postoperative evaluation, and repetition at 6 months served to explore the ventricular infundibuli and evaluate pulmonary valve performance in aortic position. In conclusion, transthoracic and transesophageal echocardiography provide a practical and valuable means of investigating the pre-, trans-, and postoperative conditions of patients undergoing Ross surgery.     

Live three-dimensional transthoracic echocardiographic assessment of aortic dissection

In the present study, we report our experience of using live three-dimensional transthoracic echocardiography in the assessment of aortic dissection in ten adult patients. To our knowledge, this has not been reported previously.     

Live/real time three-dimensional transthoracic echocardiographic identification of quadricuspid aortic valve

We describe an adult in whom live/real time three-dimensional echocardiography was able to make a definite diagnosis of a quadricuspid aortic valve which was misdiagnosed as bicuspid by live two-dimensional transthoracic echocardiography (2DTTE).     

主动脉弓粥样硬化斑块与卒中

主动脉弓粥样硬化斑块是栓塞性卒中的原因之一.随着对主动脉弓斑块研究的深入.其与卒中的关系也越来越清楚,尤其是主动脉弓斑块厚度≥4 mm与原因不明性卒中、卒中复发以及其他血管事件有关.虽然对主动脉弓斑块与卒中的临床特点有了进一步的了解,但仍然存在许多疑问.     

Aortic Dissection in Progress Diagnosed by Transthoracic Echocardiography

This report describes a patient who presented with vague chest pain, syncope, and seizures. The diagnosis of dissection of the ascending aorta was clearly established by transthoracic echocardiography. The dissection was initially limited to the ascending aorta. Using the suprasternal window, it was possible to monitor the progression of the dissection almost beat by beat as it extended from the ascending aorta and across the aortic arch to the descending thoracic aorta. Surgical intervention was carried out immediately with successful results. Although transesophageal echocardiography is the procedure of choice in aortic dissection, definitive information can be obtained quickly and safely using the transthoracic approach. The suprasternal window in this case showed the dramatic progression of the disease process.     

A case of complete double aortic arch visualized by transthoracic echocardiography

A case of double aortic arch that was well visualized using transthoracic echocardiography is reported. A 38‐year‐old man underwent transthoracic echocardiography for the evaluation of dyspnea. A suprasternal view of transthoracic echocardiography showed the ascending aorta bifurcate to left and right aortic arches, with blood flow from the ascending aorta to bilateral aortic arches. The diagnosis of right side–dominant double aortic arch was made, and the patient's symptom was conceivably related to compression of the trachea due to a vascular ring. This report indicates the potential usefulness of transthoracic echocardiography for noninvasive detection of double aortic arch in adults.     

Feasibility and utility of three-dimensional color flow echocardiography of the aortic arch: The "echocardiographic angiogram"

Two-dimensional transthoracic echocardiography (2DE) is the most commonly used diagnostic modality to evaluate congenital and acquired abnormalities of the aortic arch. However, 2DE is frequently limited in this ability due to the three-dimensional character of the arch and its interrelationships with other vascular structures. Recently, three-dimensional echocardiography (3DE) with 3D color flow Doppler became commercially available. We examined the feasibility and utility of 3DE with 3D color Doppler in the evaluation of patients with congenital (native and postoperative) abnormalities of the aortic arch. We found that 3DE color flow provides important diagnostic information in patients with aortic arch anomalies, in a manner that is quick and user-friendly. In addition, 17 of the 26 patients had their 3DE findings confirmed by additional modalities, providing reasonably significant validation for our findings with 3DE.     

Right‐sided aortic arch and Kommerell diverticulum with aberrant left subclavian artery: Preliminarily diagnosed by echocardiography

Kommerell diverticulum (KD) with aberrant left subclavian artery (ALSA) is a rare congenital variation of vascular structure. We reported a case of 3‐year‐old boy with KD and ALSA, which was preliminarily diagnosed by transthoracic echocardiography and verified by computed tomography angiography (CTA). The patient was treated successfully with KD resection and anastomosed the left subclavian artery directly to the left carotid artery under cardiopulmonary bypass. Our case illustrates that echocardiography and CTA should be used to comprehensively assess all the internal and external cardiac structures in order to determine the appropriate surgical plan.     

Prosthetic mitral inflow mimicking severe aortic regurgitation (revisited). An echocardiographic challenge

Assessing aortic regurgitation (AR) severity in patients with mitral valve prosthesis may pose an echocardiographic challenge. We present a case of mild AR in whom difficulty occurred in judging its severity due to eccentric mitral prosthetic inflow signals filling practically completely the proximal left ventricular outflow tract in diastole mimicking severe AR. Frame‐by‐frame analysis of two‐dimensional transthoracic echocardiographic images using a small sector depth and width was helpful in clarifying the true severity of AR.     

Definitive diagnosis of descending thoracic aortic dissection by real time/live three-dimensional transthoracic echocardiography

We describe a patient with descending thoracic aortic dissection in whom three- dimensional transthoracic echocardiography was able to clearly visualize the dissection flap en face as a sheet of tissue, as well as demonstrate a large communication between the true and false lumen in three dimensions, enabling a definitive diagnosis of dissection.     

A larger aortic annulus causes aortic regurgitation and a smaller aortic annulus causes aortic stenosis in bicuspid aortic valve

A bicuspid aortic valve (BAV) often causes aortic stenosis (AS) or regurgitation (AR). In 54 patients with a BAV (48 +/- 16 years), transthoracic and transesophageal echo were performed to measure aortic annulus diameter (AAD), to evaluate the severity of aortic valve disease (AVD) and to calculate the area eccentricity index (AEI) of a BAV defined as a ratio of the larger aortic cusp area to a smaller aortic cusp area. By multiple linear regression analysis, the severity of AR correlated significantly with the AAD (r = 0.38) and AEI (r = 0.35) (P < 0.05) and that of AS correlated significantly with the AAD (r =-0.40) and AEI (r = 0.34) (P < 0.05). Thirty-six patients showed anteroposteriorly (A-P) located BAVs and 18 patients showed right-left (R-L) located BAVs. The AAD was larger in A-P type than in R-L type (15 +/- 3 vs 13 +/- 2 mm/BSA, P < 0.05) and there was no difference in the age and AEI between the two groups. AR was more severe in A-P type than in R-L type while AS was more severe in R-L type than in A-P type (P < 0.05). Twenty-nine patients showed raphes. The AEI was larger in raphe (+) type than in raphe (-) type (1.83 +/- 0.53 vs 1.51 +/- 0.47, P < 0.05) and there was no difference in the AAD and severity of AVD between the two groups. In conclusion, a BAV with larger aortic annulus or A-P located will tend to cause AR while a BAV with smaller aortic annulus or R-L located will tend to cause AS.     

Reproducibility of transesophageal echocardiography in evaluating aortic atheroma in stroke patients

Although transesophageal echocardiography (TEE) is a well-established tool in delineating the cardiac and aortic sources of emboli in stroke patients, its reproducibility in detecting aortic atherosclerosis (AA) that may lead to stroke is not well documented. The aim of this study is to demonstrate the inter- and intra-observer agreement in diagnosing AA based on the TEE study. During the study period, 2 echocardiographers read 32 TEE studies performed on a group of stroke patients. The AA was estimated by measuring the largest atheroma thickness in millimeters (mm). The intra-observers and intraclass correlation coefficients (ICC) were 0.97 and 0.85, respectively, for the 2 TEE observers. The inter-rater ICC coefficient between TEE readers was 0.91. In conclusion, TEE detected AA and defined high proportions of the morphological characteristics of atheroma with good reproducibility among inter and intra-observers.     

Right aortic arch with mirror image branching accompanied by absent pulmonary valve syndrome and tricuspid stenosis: Prenatal echocardiographic diagnosis of an unusual congenital heart defect

Right aortic arch (RAA) with mirror image branching (RAMI) accompanied by absent pulmonary valve syndrome (APVS), tricuspid stenosis, and hypoplastic right ventricle is an extremely rare combination of congenital heart anomalies. This combination might result in severe cardiac failure and respiratory compromise, indicating a poor prognosis. Here, we describe a detailed prenatal echocardiographic diagnosis of RAMI accompanied by APVS and tricuspid stenosis. These anomalies were further confirmed by autopsy. This case could be helpful in improving our understanding of this abnormal combination and the development of an early therapeutic strategy.     

Transthoracic Doppler echocardiographic measurement of left atrial appendage blood flow velocity: comparison with transoesophageal measurement.

AIM: We validated transthoracic echocardiographic measurements of left atrial appendage flow velocity by comparing them with transoesophageal echocardiographic measurements. METHODS AND RESULTS: Eighty-four consecutive patients (mean age, 64.6 years) with various cardiac diseases, who underwent both transthoracic echocardiography and transoesophageal echocardiography were studied. Thirty-two patients were in sinus rhythm, and the remaining 52 patients were in atrial fibrillation. On transthoracic echocardiography, the transducer was placed somewhat superior and outside from the position viewing the conventional parasternal short-axis image of the aortic valve, so that the angle between left atrial appendage midline and Doppler beam could be narrowed. The left atrial appendage flow velocity pattern was recorded by pulsed Doppler mode with a sampling volume placed at the left atrial appendage orifice on both transthoracic echocardiography and transoesophageal echocardiography. In both approaches, the peak emptying velocity (LAA-E) and the peak filling velocity (LAA-F) of the left atrial appendage were measured. In sinus rhythm, the LAA-E was detectable in 25 of the 32 patients (78.1%) and the LAA-F in 20 of the 32 patients (62.5%). Both LAA-E and LAA-F were detectable in 46 of the 52 patients (88.5%) in atrial fibrillation. Good correlations of LAA-E and LAA-F were observed between transthoracic echocardiography and transoesophageal echocardiography measurements in sinus rhythm (r=0.94, r=0.95, respectively; both, P<0.0001) and in atrial fibrillation (r=0.89, r=0.95, respectively; both, P<0.0001). CONCLUSIONS: The left atrial appendage flow velocities could be sufficiently recorded and assessed by transthoracic echocardiography in 84 Japanese unselected consecutive patients with sinus rhythm or atrial fibrillation.     

Two-dimensional and pulsed Doppler echocardiographic diagnosis of an acquired aortic right ventricular fistula

A patient with an asymptomatic aortic right ventricular fistula acquired after aortic valve and mitral valve replacement is presented. This was diagnosed by two-dimensional and pulsed Doppler echocardiography, and confirmed at cardiac catheterization.     

Transoesophageal echocardiographic follow-up of patients with surgically treated aortic aneurysms

In the present study, biplane transoesophageal echocardiography(TEE) was scheduled as part of an aneurysm surveillance programmeduring routine ambulatory follow-up of 37 patients followingaortic aneurysm surgery. Time from surgery ranged from 3–72months. Twenty-two patients had had aortic dissection and 15non-dissecting aneurysms. Nineteen patients received an interpositiongraft of the ascending aorta, 12 valved conduit and six an interpositiongraft of the descending thoracic aorta. TEE showed enlargementof the sinus of Valsalva >45 mm in seven patients. Dilatation>45 mm of one or more aortic segments was found in four patients.An intimal flap was present in all patients, with primary aorticdissection if the initial dissection extended beyond the replacedsegment. This was the case in 17 of 22 patients with aorticdissection. One to four intimal tears were identified in 15of these patients. In all patients with intimal tears, flowwas detected by colour flow Doppler in the false lumen. Thrombusformation was nil or minimal in the false lumen in 12 patients. TEE significantly influenced further management in 14 of 37patients (38%). More frequent follow-up was scheduled in eightpatients. Aortic surgery was performed electively for the secondor third time in six patients based on TEE findings. We conclude tliat after surgical repair of aortic aneurysm,the incidence of pathological findings by TEE is high. Thesemay have significant influence on further patient managementand emphasize the need for careful follow-up.