Echocardiography in Patients with Complications Related to Pacemakers and Cardiac Defibrillators

The evolving indications and uses for implantable cardiac devices have led to a significant increase in the number of implanted devices each year. Implantation of endocardial leads for permanent pacemakers and cardiac defibrillators can cause many delayed complications. Complications may be mechanical and related to the interaction of the device leads with the valves and endomyocardium, e.g., perforation, infection, and thrombosis, or due to the electrical pacing of the myocardium and conduction abnormalities, e.g., left ventricular dyssynchrony. Tricuspid regurgitation, another delayed complication in these patients, may be secondary to both mechanical and pacing effects of the device leads. Echocardiography plays an important role in the diagnosis of these device‐related complications. Both two‐dimensional transthoracic echocardiography and transesophageal echocardiography provide useful diagnostic information. Real time three‐dimensional echocardiography is a novel technique that can further enhance the detection of lead‐related complications.     

The Usefulness of Doppler Echocardiography for the Evaluation of Hemodynamics in Tetralogy of Fallot: Comparison of the Patients with Pre- and Post-Corrective Surgery and Control Healthy Children

Twodimensional Doppler echocardiographic examinations were performed in 61 patients (39 boys and 22 girls) with tetralogy of Fallot (TOF). The patients were examined at the Department of Pediatrics, University of Tokyo, and at the Department of Pediatrics, Ohta General Hospital, in Koriyama city, Fukushima Prefecture. One hundred and eighteen healthy children (59 boys and 59 girls) were also examined at the Waseda housing complex in Misato city, Saitama Prefecture. By short axis view of aorta, samples were collected from both the right ventricular outflow tract below the pulmonary valve and in the main pulmonary artery. On the other hand, the apex four chamber view was used to collect samples at the right and left atrial outflows. Right ventricular systolic time intervals were measured both at the main pulmonary artery (PA) and at the outflow tract below the pulmonary valve (RVO). The right ventricular systolic pre-ejection period (PAPEP) and acceleration time (PAACT), measured at the supra-valvular site, were shorter before surgery as compared to after surgery and normals. The ratio of right ventricular pre-ejection period to ejection time (PAPEP/ET) and the ratio of acceleration time to ejection time (PAACT/ET) were both significantly lower before surgery compared to after surgery and controls. The mean main pulmonary artery peak velocity before surgery was 369 cm/sec and the peak pressure gradient calculated with the modified Bernoulli formula was 55 mmHg. Before surgery, peak velocity of right ventricular rapid filling (R-wave) was low, while peak velocity of atrial contraction (A-wave) was high. After surgery, however, R-wave increased and A-wave decreased in velocity. The peak velocity of left ventricular filling R-wave was also low before surgery and increased after surgery, while peak velocity of left atrial contraction A-wave was increased before surgery and decreased to almost normal values after surgery. The left ventricular A/R ratio before surgery was also high as a result of low R-wave velocity. The measured time interval between aortic valve closing sound and left ventricular rapid filling wave (IIA-R time), and the measured time interval between pulmo nary valve closing sound and ventricular filling wave (IIP-R time) were both longer before surgery than those after surgery and controls. Consequently, the measured time intervals between rapid ventricular filling flow wave and atrial contraction wave (R-A time) for both right and left atrial were shorter before surgery than after surgery and controls. A new method for estimation of pulmonary-to-systemic blood flow ratio (Qp/Qs) was successfully applied to TOF, and a good correlation was obtained between Qp/Qs determined by this method and that by the Fick method.     

Echocardiogram‐gated multislice spiral CT in functionally univentricular heart following long‐lasting Waterston–Cooley anastomosis

Waterston–Cooley anastomosis may be carried out in patients with tricuspid atresia to provide pulmonary perfusion. It is associated with several complications, including preferential blood flow to the right lung, hypoplasia of the left pulmonary artery, obstruction of the anatomosis or rupture of pulmonary aneurysms. We study a patient with thrombosis in the pulmonary arteries following surgical construction of a Waterston shunt in childhood. Imaging findings and clinical symptoms are discussed with emphasis on echocardiogram‐gated multislice spiral CT.     

Pulmonary arterial hypertension: the key role of echocardiography

Given the nonspecific nature of its early symptoms and signs, pulmonary arterial hypertension (PAH) is often diagnosed in its advanced stages. Although clinical assessment is essential when initially evaluating patients with suspected PAH, echocardiography is a key screening tool in the diagnostic algorithm. It not only provides an estimate of pulmonary pressure at rest and during exercise, but it may also help to exclude any secondary causes of pulmonary hypertension, predict the prognosis, monitor the efficacy of specific therapeutic interventions, and detect the preclinical stage of the disease.     

Tricuspid stenosis secondary to entanglement of ventriculoatrial catheter in the valve leaflets

Tricuspid stenosis secondary to entanglement of ventriculoatrial shunt catheter was discovered in a patient at autopsy. A brief review of the pertinent literature is included.     

Carcinoid heart disease: A Doppler echocardiographic report

This paper describes the two-dimensional echocardiographic andpulsed Doppler findings in a 25-year-old man with tricuspidinsufficiency due to carcinoid heart involvement. A hypothesisexplaining the time sequence of the carcinoid valve involvementis suggested.     

多普勒超声心动图评价经皮球囊二尖瓣扩张术成功对相关的三尖瓣返流严重程度的影响

二尖瓣狭窄常伴有不同程度的三尖瓣返流,尽管成功的经皮球囊二尖辩扩张术（PBMV）表明能降低肺动脉压力和阻力,但是否肯定改善三尖瓣返流尚有争议．本研究对65例风湿性二尖瓣狭窄伴三尖瓣返流的病人应用多普勒超声心动图,彩色血流显像评价经皮球囊二尖辩扩张术成功对三尖瓣返流严重程度的影响．经皮二尖瓣扩张术成功的定义为：二尖辩面积>1．5cm2和二尖瓣返流面积<2 。根据三尖瓣返流面积与右心房面积的比例确定三尖瓣返流严重程度,分级为轻度、中度、重度,PBMV术前,术后24h及6个月观察右房面积（RAA）,右室收缩压（RVSP）、右室内径（RVID）、三尖瓣坏内径（TAD）、二尖瓣返流束面积（TRA）,其结果表现术后有不同程度的改善,提示PBMV是一种安全有效的技术,可选择性应用于二尖瓣狭窄伴三尖瓣返流的病人．     

Balloon valvuloplasty for fungal endocarditis induced stenosis of a bioprosthetic tricuspid valve

Palliative treatment was provided without complications by double balloon valvuloplasty of a stenotic porcine tricuspid valve in a patient with fungal endocarditis. With two 15 mm diameter valvulotomy balloons the peak tricuspid gradient decreased from 21 to 7 mm Hg and valve area increased from 0.3 to 1.2 cm². After the procedure the patient clinically improved; however, valve replacement was not performed as planned because the patient developed an intracranial hemorrhage. She subsequently died of complications of fungemia. The present report demonstrates the possible use of valvuloplasty as a palliative procedure in selected patients with valvular stenosis involved with endocarditis.     

Carcinoid Heart Disease in Association with a Primary Ovarian Carcinoid Tumor: Diagnostic Role of Echocardiography

We describe a patient with carcinoid heart disease secondary to a primary ovarian carcinoid tumor who initially presented with unexplained right-sided heart failure. The patient did not exhibit any of the typical clinical manifestations of the carcinoid syndrome. Echocardiography demonstrated typical features of carcinoid heart disease and played an important role in the detection and management of a condition that was previously unrecognized.     

The Mechanisms and Importance of Tricuspid Regurgitation and Hepatic Pulsations in Dilated Cardiomyopathy: A Review

Secondary tricuspid regurgitation is a common finding in dilated cardiomyopathy, being present in up to 90% of patients studied with Doppler echocardiography. It appears to be primarily due to annular dilatation and loss of the sphincter-like action of the tricuspid annulus during systole. Apical displacement of the papillary muscle and increased chordal tension may also contribute to mal-coaptation of the tricuspid leaflets in systole. Hepatic pulsations generally occur late in dilated cardiomyopathy, indicating hepatic congestion due to progressive biventricular failure. These are thought to result from secondary tricuspid regurgitation and transmission of the regurgitant v wave to the liver. Careful pulsed-Doppler studies of the timing of hepatic pulsations in dilated cardiomyopathy often show them to be presystolic, rather than systolic, suggesting that a mechanism other than tricuspid regurgitation may be responsible. (ECHOCARDIOGRAPHY, Volume 8, March 1991)