Assessment of congenital coronary artery fistulas by transesophageal color Doppler echocardiography

PURPOSE: Coronary angiography is the gold standard for imaging the coronary tree, but the relation of coronary artery fistulas to other structures, and their origin and course, may not be apparent. We evaluated the ability of multiplane color Doppler transesophageal echocardiography to identify coronary fistulas. PATIENTS AND METHODS: Twenty-one patients with angiographically confirmed coronary artery fistulas were investigated by transesophageal echocardiography in four Italian hospitals between January 1997 and May 2001. RESULTS: Transesophageal echocardiography correctly diagnosed fistulous connection in all 21 patients. This included 6 patients with connections from the left circumflex artery (into the right chambers of the heart in 5 patients, and into the left ventricle in 1 patient), 10 patients with a fistula arising from the left anterior descending artery or left main coronary artery (with drainage into the right ventricle or main pulmonary artery), and 5 patients with a fistula from the right coronary artery (with drainage sites in the lateral aspect of the right ventricle, the low posterior right atrium, or the superior vena cava). In 4 of the 21 patients, angiography did not identify the precise site of a fistula into the coronary sinus or right ventricle. CONCLUSION: Color Doppler transesophageal echocardiography is useful in the diagnosis and in the precise localization of coronary artery fistulas.     

经食道超声心图评价成人先天性房间隔缺损

目的：探讨经食道超声心动图评价成人先天性心脏病的价值。方法：我们用经食道超声心动图（TEE）诊断成人先天性心脏病173例,156例经心导管和／或手术证实。结果：在131例经手术和／或心导管证实的房间隔缺损（ASD）的病例,经胸超声心动图（TTE）显示ADS109例,TEE显示ASD128例,TTE诊断房间隔缺损的敏感性为83％,TEE诊断房间隔缺损的敏感性为98％,值得注意的是,10例静脉窦型ASD,TTE仅能显示3例,而TEE能观察到所有的10例,且所有的TEE检查的病例,能清晰地观察到与静脉窦型ASD相关的部分肺静脉异位引流,3例冠状静脉窦部位的小ASD,TTE显示2例,但TEE未能显示,结论：TEE探查ADS明显优于TTE,尤其是静脉窦型ASD,但靠近冠状静脉窦部位的小ASD,TEE并不比TTE检查优越,同时TEE对其他先天性心脏病异常结构的观察也提供大量的附加信息。     

食道超声引导下经胸外科封堵治疗先天性心脏病的疗效

目的 探讨食管超声引导下经胸外科封堵术治疗先天性心脏病的疗效和预后。方法 选取2016年1月至2018年12月在我院行食管超声引导下经胸外科封堵治疗的先天性心脏病患者52例为研究组,同期行体外循环下修补治疗患者53例为对照组,记录并比较两组患者手术时间、术中出血量、输血量、呼吸机辅助时间、ICU停留时间、血管活性药物使用情况及术后住院时间、并发症发生率等指标,术前及出院前均采用经胸超声心动图对患者心脏结构功能进行评价,术后随访12个月观察预后情况。结果 两组患者全部手术成功,均无死亡和危及生命的严重并发症。研究组手术时间（72.69±6.14）min、术中出血量（29.96±5.99）ml、输血比例（1.92%）、呼吸机辅助时间（132.70±13.21）min、ICU停留时间（11.85±1.43）h、住院时间（6.83±0.49）d均明显少于对照组的（130.50±3.53）min、（112.80±11.93）ml、（28.30%）、（217.20±19.02）min、（20.60±0.71）h、（8.34±0.39）d,P<0.01。血管活性药物使用比例（32.69%）也明显低于对照组（90.57%）,两组总并发症发生的差异也有统计学意义。术后3、6、12个月随访超声心动图检查示,52例患者封堵器均位置良好,未见残余分流及血栓形成,心电图也未见严重心律失常。结论 食管超声引导下经胸外科封堵治疗先天性心脏病是一种安全有效的方法,具有创伤小、易操作、恢复快等优点。     

食管超声引导下经胸外科封堵治疗先天性心脏病的疗效

目的 探讨食管超声引导下经胸外科封堵术治疗先天性心脏病的疗效和预后.方法 选取2016年1月至2018年12月在我院行食管超声引导下经胸外科封堵治疗的先天性心脏病患者52例为研究组,同期行体外循环下修补治疗患者53例为对照组,记录并比较两组患者手术时间、术中出血量、输血量、呼吸机辅助时间、ICU停留时间、血管活性药物使用情况及术后住院时间、并发症发生率等指标,术前及出院前均采用经胸超声心动图对患者心脏结构功能进行评价,术后随访12个月观察预后情况.结果 两组患者全部手术成功,均无死亡和危及生命的严重并发症.研究组手术时间(72.69±6.14)min、术中出血量(29.96±5.99)ml、输血比例(1.92%)、呼吸机辅助时间(132.70±13.21)min、ICU停留时间(11.85±1.43)h、住院时间(6.83±0.49)d均明显少于对照组的(130.50±3.53)min、(112.80±11.93)ml、(28.30%)、(217.20±19.02)min、(20.60±0.71)h、(8.34±0.39)d(P<0.01).血管活性药物使用比例(32.69%)也明显低于对照组(90.57%),两组总并发症发生的差异也有统计学意义.术后3、6、12个月随访超声心动图检查示,52例患者封堵器均位置良好,未见残余分流及血栓形成,心电图也未见严重心律失常.结论 食管超声引导下经胸外科封堵治疗先天性心脏病是一种安全有效的方法,具有创伤小、易操作、恢复快等优点.     

Comparison of transthoracic echocardiography using second harmonic imaging, transcranial Doppler and transesophageal echocardiography for the detection of patent foramen ovale in stroke patients.

AIMS: The comparison of three imaging methods to determine which is the most accurate and reliable for the detection of right-to-left shunt. METHODS AND RESULTS: One hundred and seven patients who were hospitalized for stroke underwent: a transthoracic echocardiography (TTE) using second harmonic, a transcranial Doppler (TCD) and a transesophageal echocardiography (TEE) from August 2003 to April 2004. All studies were recorded on a videotape and were studied by a physician blinded to the study. With TTE and TEE, we found 44 (41%) patent foramen ovales. All contrast tests were positive with TCD for these 44 patients. For two patients, the contrast test was positive only with TTE and TCD. We found four false negative contrast tests with TTE. Among the 63 patients who had a negative contrast test with TEE and TTE, the results were the same with TCD for 59 of them; we were not able to determine a cause for the four positive tests. CONCLUSION: This study confirms that transesophageal echocardiography has limitations in the diagnosis of patent foramen ovale. In this study, the negative predictive value of transcranial Doppler was excellent. Therefore, this examination is able to exclude a patent foramen ovale with a high level of confidence.     

Clinical usefulness of biplane transesophageal echocardiography

The clinical usefulness of biplane color Doppler transesophageal echocardiography is illustrated by the results obtained in 300 successive examinations. The additional contribution of the newer longitudinal plane was judged significant or major in 64% of the cases. The method was useful mainly for intraoperative examinations, assessment of native valvular disease, prosthetic valve evaluation, search for tumors, and assessment of endocarditis, congenital heart disease, and aortic disease. In contrast, the longitudinal plane option was not contributory in 68% of the cases of thromboembolism. Typically, the technique aided in the evaluation of mitral valve insufficiency and the detection of paraprosthetic leaks. Lesions located at the level of the ascending aorta, the left and right ventricular outflow tracts, and the interatrial septum were also visualized best. The limitations of the method were negligible and the duration of the examination was not significantly increased in comparison to the monoplane method. When available, biplane transesophageal echocardiography seems to be preferred in most clinical settings.     

彩色超声心动图诊断冠心病的临床价值

目的探讨和分析彩色超声心动图诊断冠心病的临床价值。方法选取我院经初步诊断为冠心病的患者160例,对所有患者进行彩色超声心动图及冠状动脉造影检查,将患者检查结果进行对比分析,并以冠状动脉造影检查的诊断结果作为评价标准,对彩色超声心动图诊断冠心病的临床价值进行评价。结果 160例初诊冠心病均采用彩色超声心动图检查,结果显示153例有不同程度的冠状动脉主干狭窄,再经冠状动脉造影检查后,确诊冠心病的患者有131例。结论对所有患者采用彩色超声心动图和冠状动脉造影检查后,将两种检查方法的诊断结果对比,充分证明彩色超声心动图诊断冠心病具有十分满意的效果且临床价值较高,值得临床推广及应用。     

Atherosclerotic aortic plaques detected by transesophageal echocardiography

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二尖瓣位机械瓣梗阻的彩色多普勒评价

目的评价彩色多普勒超声在诊断二尖瓣位机械瓣(单叶碟瓣)梗阻的价值。方法对比二尖瓣位机械瓣梗阻12例的彩色多普勒超声结果与手术所见。结果左心长轴切面和心尖四腔切面可较清晰地显示二尖瓣位机械瓣梗阻患者的瓣叶活动显著受限,瓣叶开放角度平均10°(0°-25°),彩色血流束呈单束或双束狭窄的边缘血流束,无瓣周漏及中度以上的瓣关闭不全,最大跨瓣血流速度及压差无显著改变:术中见12例瓣叶均被“卡”在近关闭状态位,开放角度小于300°,瓣周纤维肉芽组织增生伴血栓形成,瓣口狭小(0-0．5mm),其中4例瓣口及瓣周完全被血栓块“封堵”。结论彩色多普勒超声心动图显示机械瓣梗阻特征为瓣叶开放角度和幅度显著减小,瓣口呈边缘性狭窄血流束,与手术所见一致,但瓣口血流速度及压差指数等特异改变在彩色多普勒超声心动图不明显;虽然彩色多普勒超声心动图对异常增生组织和血栓的显示不清晰,但仍不失为诊断二尖瓣位机械瓣梗阻的简便有效的手段。     

Stress Doppler echocardiography in the evaluation of ischemic heart disease

Doppler echocardiography enables convenient, noninvasive evaluation of global, systolic performance at rest and during exercise. Early studies suggested that Doppler parameters of systolic function were sensitive to exercise-induced myocardial ischemia and could identify patients with severe coronary artery disease. Subsequent investigation, however, has identified several factors in addition to myocardial ischemia that can significantly influence exercise Doppler study results. Thus, in order to obtain reliable information, the many factors that can influence Doppler measurements of aortic flow velocity and acceleration must be accounted for. Further work in this area is likely to produce results that encourage greater application of this technique in experimental and clinical research. At present, the role of stress Doppler echocardiography in the evaluation of ischemic heart disease remains uncertain.     

单纯经食道超声心动图引导下经皮房间隔缺损封堵术的疗效分析

分析单纯经食管超声心动图引导下经皮行房间隔缺损封堵术的临床资料,评价方法的安全性和有效性。 方法：回顾性分析2017年6月至2018年6月采用经食道超声心动图引导经皮房间隔缺损封堵术患者共16例,操作均在普通手术室进行,单纯采用经食道超声心动图引导,在全身麻醉下,经股静脉穿刺封堵房间隔缺损。食道超声全程监测封堵全过程并评估手术效果。所有患者均在术后1个月、6个月接受经胸超声心动图复查。结果 共14例患者封堵成功,1例患者术中封堵器释放后超声心动图提示封堵器靠近下腔边缘存在大量分流,封堵器收入鞘管再次释放后仍存在残余分流,调整为经右胸小切口成功释放封堵伞,另一例术后7日出院前复查超声心动图提示封堵器脱落位于右心室内,再次行房间隔缺损修补术。随访过程中均未见明显并发症。结论 经食道超声心动图引导下可以完成大多数房间隔缺损经皮封堵术,避免放射线可能引起伤害,取得良好的临床应用效果。     

Doppler color flow echocardiography: indispensable application to congenital heart disease

Doppler color flow imaging has become indispensable in the diagnosis and management of patients with congenital heart disease. Certain defects may not be possible, or may be very difficult to diagnose by two-dimensional echocardiography alone. Such examples include multiple ventricular septal defects, anomalous pulmonary venous connection, coronary artery malformations, and the hypertensive patent ductus arteriosus. Additionally, color flow Doppler echocardiography significantly provides additional information, and reduces the time for fetal and transesophageal echocardiographic studies. Doppler color flow imaging has become an essential part of the echocardiographic examination. Experience has broadened the use of this important technological advance, with anticipation of an ever expanding future for its clinical application.     

CDFI在新生儿先天性心脏病筛查中的应用

目的探讨基层医院彩色多普勒超声（color doppler flow imaging,CDFI）对新生儿先天性心脏病（先心病）筛查和诊断效果。方法回顾性分析2006年3月至2010年8月492例新生儿CDFI检查的结果,统计出现的先心病类型及各类型先心病的发病构成比。结果本组资料共检出先心病患者215例,先心病总检出率为43.7%（215/492）,占出生总数的11.0‰（215/19480）,构成比位居前三位的先心病类型分别为房间隔缺损71例（33.0%）,室间隔缺损67例（31.2%）,动脉导管未闭54例（25.1%）。结论房间隔缺损、室间隔缺损、动脉导管未闭是最常见的新生儿先心病病种,CDFI仍是基层医院首选的先心病筛查方法。     

Fatal ventricular arrhythmia as a complication of transesophageal echocardiography.

AIM: To report a case of serious ventricular arrhythmia during transesophageal echocardiography. METHODS AND RESULTS: A 58-year-old woman with previous mitral and tricuspid valve replacement and permanent pacemaker implantation suffered from recurrent fever and Staphylococcus aureus bacteremia. Transesophageal echocardiography was performed as part of the assessment for infective endocarditis. During this procedure the patient developed sustained ventricular tachycardia and subsequently ventricular flutter. She was successfully resuscitated. Subsequently the procedure was undertaken under general anesthesia with no complications. CONCLUSION: The increasing use of TEE in a wider spectrum of patients, many of whom are seriously ill, may result in serious side-effects.     

Shu 508 A (Levovist)-enhanced Doppler echocardiography improves the assessment of valvular heart disease

OBJECTIVE: To investigate whether intravenous injection of SHU 508 A improves the diagnostic accuracy of Doppler echocardiography in the assessment of valvular pathologies. METHODS AND RESULTS: One hundred and twenty-five consecutive patients with valvular pathology (aortic stenosis, n = 48; aortic regurgitation, n = 20; mitral stenosis, n = 21; and mitral regurgitation, n = 36) and diagnostically insufficient Doppler signal were enrolled in this multicenter study. The severity of valvular pathology was graded on a four-point scale using unenhanced and contrast-enhanced Doppler echocardiography as well as cardiac catheterization. Agreement with cardiac catheterization findings increased from 63% using the unenhanced examination to 73% using the contrast-enhanced Doppler examination. Grading was possible in all patients using SHU 508 A, whereas the unenhanced Doppler examination remained inconclusive in six patients. The weighted kappa coefficient between contrast-enhanced Doppler and cardiac catheterization for all diagnoses was 0.76 as compared to 0.68 between unenhanced Doppler and cardiac catheterization. Agreement was especially improved in aortic stenosis (kappa 0.69 unenhanced vs 0.81 contrast-enhanced) and in aortic regurgitation (kappa 0.45 unenhanced vs 0.75 contrast-enhanced). Patients with mitral stenosis and mitral regurgitation experienced less improvement. CONCLUSIONS: In case of an inconclusive unenhanced Doppler echo study, the administration of a left heart contrast agent should be considered. SHU 508 A is especially useful in improving the severity grading of aortic stenosis and aortic regurgitation, while grading of mitral stenosis and mitral regurgitation is less improved.     

Simultaneous transesophageal cardioversion and echocardiography: Feasibility and safety

BACKGROUND: Transesophageal echocardiography (TEE) is routinely used to exclude atrial thrombus prior to cardioversion of atrial fibrillation (AF). Because the TEE probe lies adjacent to the atria, cardioversion using an electrode attached to the TEE probe should allow for immediate low-energy transesophageal cardioversion. OBJECTIVE: The purpose of this study was to evaluate a cardioversion electrode sheath that can be affixed to conventional TEE probes for simultaneous thrombus exclusion and cardioversion of AF. METHODS: A thin electrode was integrated into a latex or polyurethane sheath covering a conventional TEE probe. TEE thrombus exclusion and biphasic transesophageal cardioversion using a step-up protocol were performed during deep sedation. Esophagoscopy was performed immediately after cardioversion and after 1 week. RESULTS: TEE was performed in 27 patients. One patient showed left atrial thrombi. Transesophageal cardioversion was successful in 25 of the remaining 26 patients. Mean atrial cardioversion threshold was 63 +/- 48 J. Transesophageal cardioversion restored sinus rhythm in two patients with unsuccessful transthoracic cardioversion. Transesophageal cardioversion in deep sedation was well tolerated. Esophagoscopy revealed slight mucosal damage in three patients at the site of shock application; two of these patients showed signs of gastroesophageal reflux disease. Mucosal damage unrelated to the site of shock delivery was noted in three patients. CONCLUSION: Atrial thrombus exclusion and transesophageal cardioversion of AF via a disposable cardioversion sheath offers the opportunity to perform transesophageal cardioversion and TEE thrombus exclusion during one sedation. It may not be suitable for use in patients with gastroesophageal reflux disease. Transesophageal cardioversion may establish sinus rhythm in selected patients refractory to transthoracic cardioversion.     

Head to head comparison of transesophageal and transthoracic contrast-enhanced echocardiography during dobutamine administration for the detection of coronary artery disease

Dobutamine stress echocardiography (DSE) has been shown to be a very useful non-invasive technique for the detection of coronary artery disease. However, inadequate transthoracic images preclude the use of DSE in a significant proportion of patients. Transesophageal (TEE) or transthoracic contrast echocardiography (CE) can however overcome this limitation. The comparison between the two techniques has never been investigated during a stress test. Therefore, we designed a prospective study to compare DSE-CE and DSE-TEE for the detection of coronary artery disease in patients with poor echo image quality. We studied 42 patients scheduled for quantitative coronary angiography. Prospective DSE-CE and DSE-TEE with maximum one day interval were performed in a random order. Significant coronary artery disease was detected in 30 patients, nine with single vessel disease and 21 with multivessel disease. Sensitivity of DSE was higher with CE than with TEE (90% vs 87%, p = NS). There was no significant difference with respect to specificity in both groups (100% vs 92%, p = NS). The diagnostic accuracy was similar in both groups (93% vs 88%, NS). The κ value for identical interpretation of a stress echocardiography study was nearly identical with both modalities 0.75 to 0.78. In poorly echogenic patients, DSE-CE is a valuable alternative for the detection of myocardial ischemia in comparison with DSE-TEE. Because DSE-CE is more comfortable than TEE, it should be used in patients with suboptimal transthoracic echocardiograms for the evaluation of coronary artery disease during DSE.     

Diagnosis of mitral valve myxoma by transesophageal echocardiography

Mitral valve myxomas are rare. We report a patient with a mitralmyxoma arising from the posterior mitral leaflet in whom transthoracicechocardiography revealed equivocal findings. However, transoesophagealechocardiography provided accurate relevant anatomical informationincluding the size, morphological characteristics, and tumourattachment point.     

Impact of transesophageal color flow Doppler echocardiography in current cardiology practice

Of 3,480 patients who were referred for cardiac ultrasound evaluation, 230 patients (6.6%) underwent transesophageal echocardiography because the transthoracic study was not feasible, technically inadequate, or provided insufficient diagnostic information for optimal patient management. There were 149 inpatients and 81 outpatients. The majority (182 patients, 79%) had aortic or mitral disorders. In 166 patients (72%), transesophageal echocardiography played a significant role in patient management. Transesophageal echocardiography was most useful in evaluating diseases of the aorta (dissection, root abscess, or aneurysm), mitral prosthesis, complications of endocarditis, left atrial appendage thrombi, and in determining the cause of mitral insufficiency. Transesophageal echocardiography was useful in the evaluation of critically ill patients and those with severe lung disease.     

Doppler echocardiography during transesophageal atrial pacing in the detection of coronary artery disease Stress Doppler echocardiography in the detection of coronary artery disease

The aim of this study was to assess the applicability of the Doppler echocardiogram (EchoKG) during transesophageal atrial pacing (TAP) with respect to the detection of coronary artery disease (CAD). Aortic flow peak velocity (PV), mean acceleration (MA), stroke distance (SD), minute distance (MD) and time to PV were measured using pulsed Doppler EchoKG during sinus rhythm and at pacing rates of 120 and 140 bpm in 11 patients, taken as subjects, with CAD defined by coronary arteriography and 15 patients without CAD (the control group). Similar changes of PV, SD, MD and time to PV during TAP were observed in subjects with and without CAD. Only changes of MA were different between subjects with and without CAD:MA during TAP remained unchanged in the control group and decreased from 1055.2±49.7 cm/s² (baseline) to 829.0±55.9 cm/s² at a pacing rate 140 bpm (p<0.05) in subjects with CAD. On the basis of these data we suggest a new criterion for the detection of hemodynamically significant CAD: decrease of MA at a pacing rate of 140 bpm>15% of initial value. Its specificity and sensitivity in the detection of CAD were respectively 87% and 82%.We conclude that the Doppler EchoKG during TAP is a relatively simple and reliable method for the diagnosis of CAD, and that the response of the Doppler EchoKG parameter of MA to TAP is a sensitive and specific index, useful for the detection of significant coronary artery stenosis.