Hemodynamic Effects of Innominate Artery Occlusive Disease on Anterior Cerebral Artery

Stenoses of the innominate artery (IA) may affect flow conditions in the carotid arteries. However, alternating flow in ipsilateral anterior cerebral artery (ACA) due to IA stenosis is extremely rare. A 49-year-old woman who was evaluated for symptomatic cerebrovascular disease presented with right latent subclavian and right carotid system steal. Transcranial Doppler examination displayed systolic deceleration wave-forms in the right terminal internal carotid artery and alternating flow in the right ACA. Magnetic resonance angiography demonstrated tight stenosis of the right IA. For a thorough study of the hemodynamic effects of IA stenosis, a combination of duplex and transcranial Doppler examination is required.     

Three-Dimensional Echocardiography in Adult Patients: Comparison Between Transthoracic and Transesophageal Reconstructions

BACKGROUND: Three-dimensional (3D) echocardiography is a relatively new technique typically implemented with transesophageal imaging with multiplane transducers. OBJECTIVES: The goals of this study were (1) to test the feasibility of 3D reconstruction with a new transthoracic multiplane transducer in adult subjects with excellent quality of 2-dimensional images and (2) to compare these reconstructions with those obtained in the same patients with the transesophageal approach. METHODS: Transthoracic multiplane image acquisition was performed in 37 patients who were selected on the basis of the quality of their 2-dimensional images. In addition, transesophageal acquisition was also performed in 19 of 37 patients. Three-dimensional reconstruction of mitral and aortic valves was performed. Three-dimensional images were reviewed, and the visualization of various anatomic features was graded. RESULTS: The reconstruction of 25 mitral valves and 16 aortic valves, normal and pathologic, was feasible and resulted in visualization of anatomic detail. Score indexes of all valvular characteristics studied were not significantly different when transthoracic and transesophageal reconstructions were compared. CONCLUSIONS: Transthoracic 3D echocardiography with a multiplane transducer in adult patients with good acoustic windows is feasible. This technique will allow easy noninvasive serial assessment of valvular pathophysiologic characteristics.     

Coronary Arteriovenous Fistula with a Giant Aneurysm: Role of Transesophageal Echocardiography

Congenital coronary arteriovenous fistulas are rare anomalies. Patients may present with congestive heart failure, ischemic chest pain, or endocarditis. In this case, transesophageal echocardiography provided valuable additional information to that obtained from cardiac catheterization, which was essential for the diagnosis and planning of surgical correction.     

Prenatal 3‐Dimensional Imaging Techniques in the Sonographic Evaluation of an Oral Mass

Historically, published reports of 3‐dimensional (3D) sonographic evaluation of fetal oral masses have been limited to the surface‐rendering mode. This report demonstrates the clinical potential of various 3D imaging techniques in the evaluation of fetal epignathus. A comparison is made among the images generated from 3D data sets, postnatal magnetic resonance imaging and computed tomographic scans, and the excised surgical specimen. The diagnostic value and limitations of several 3D imaging techniques in the evaluation of an oral mass are explored.