RESUMEN
UNLABELLED: The potential cardioembolic sources for ischemic stroke in patients younger than 40 years could be asymptomatic. The purpose of this study is to justify routine implementation of transesophageal echocardiography (TEE) in the study of young patients with ischemic stroke. MATERIAL AND METHODS: 34 patients younger than 40 years with ischemic stroke were studied with TEE complemented with contrast study, looking for potential cardioembolic sources or intracardiac shunts. RESULTS: 19 patients were male and 15 female with ages between 18-40 years (average 31 years). None had cardiac signs or symptoms. Eleven anomalies were detected in 20 patients (58.8%); of these, only 3 were considered as probably coursing with cardioembolic sources: patent foramen ovale (PFO), mitral valve prolapse, and ventricular enlargement, which were found in 12 patients (35.29%). In patients with cardiovascular anomalies, we found a hypercoagulable state, associated in eight patients with PFO (four patients), two with valvular thickening, and two with valvular nodules. CONCLUSIONS: In patients younger than 40 years with ischemic stroke, TEE is useful in detecting direct and indirect cardiac sources of embolism, even in those patients with unsuspected cardiac disease.
Asunto(s)
Ecocardiografía Transesofágica , Accidente Cerebrovascular/diagnóstico por imagen , Adolescente , Adulto , Factores de Edad , Femenino , Humanos , MasculinoRESUMEN
The recovery of the mechanical function of the myocardium is the best parameter of viability. Therefore, it is necessary that tissue perfusion and metabolic interchange at myocardiac fiber level be sufficient in both amount and quality, and also that the channels by which the nutrients arrive (microcirculation) are adequate, and the substratum (myocardium), still has the response capacity, meaning that it has its contractile reserve.
Asunto(s)
Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Humanos , UltrasonografíaRESUMEN
OBJECTIVE: Three-dimensional echocardiography represents a new era in the contemporary cardiology, because depicts the cardiac structures in their realistic forms. This information can not be obtained using a two-dimensional perspective. Although two-dimensional (2D) and M-mode echocardiography has greatly enhanced the ability to visualize the functioning heart for more than 30 years, 3D interpretative mental skills are necessary to compile the 2D slices of the complex 3D anatomy, particularly in congenital heart disease. CONCLUSIONS: At present, its additional morphological and functional information in surgical decision-making and the increasing number of clinical questions than can be answered justify the clinical use of this technique. In the future it will the study of "virtual" pathologic anatomy.
Asunto(s)
Ecocardiografía Tridimensional , Cardiopatías/diagnóstico por imagen , Ecocardiografía Tridimensional/métodos , HumanosRESUMEN
Kidney transplant (KT) resolves many of the cardiac abnormalities associated with chronic kidney failure (CKF). This study analyzed cardiac alterations of kidney failure and their modification with transplant. Thirteen patients in CKF underwent conventional echocardiograms, dobutamine stress echocardiograms, and injection of contrast to examine perfusion before KT and 3 months after transplant. Nine patients had evidence of left ventricular hypertrophy and six had evidence of diastolic dysfunction. Wall thickness, left ventricular mass, and mass index diminished after KT; only two patients continued to manifest hypertrophy. Left ventricular systolic diameters and volumes diminished at 3 months, and diastolic diameters after 4 months. Left ventricular fractional shortening and ejection fraction increased 3 months after transplant. At the end of the study, only two patients continued to show diastolic dysfunction. Dobutamine echocardiograms showed no segmental wall-movement abnormalities. Myocardial perfusion was normal before and after transplant. The results suggest that KT diminishes hypertrophy and improves left ventricular systolic and diastolic function. Echocardiography provides valuable information for detection and follow-up of cardiac abnormalities in patients with kidney disease. Evaluation of segmental wall movement and myocardial perfusion aid in demonstrating that our studied patients with CKF had no indirect signs of coronary artery disease.
Asunto(s)
Corazón/fisiología , Trasplante de Riñón , Adulto , Angina de Pecho/diagnóstico , Dobutamina , Ecocardiografía , Electrocardiografía , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Glomerulonefritis/complicaciones , Humanos , Hipertensión/complicaciones , Hipertrofia Ventricular Izquierda/complicaciones , Fallo Renal Crónico/etiología , Fallo Renal Crónico/terapia , Trasplante de Riñón/diagnóstico por imagen , Masculino , México , Persona de Mediana Edad , Contracción Miocárdica/fisiología , Estudios Prospectivos , Diálisis Renal , Factores de Tiempo , Función Ventricular/fisiologíaRESUMEN
BACKGROUND: Infective endocarditis (IE) occurs with significant frequency in patients with congenital heart disease. The complications leading to increased morbidity and mortality may be detected by echocardiographic examination. This study was undertaken in order to identify echocardiographic findings that influence the outcome of patients with congenital heart disease and IE. METHODS: Twenty-five patients with an average age of 28 years were selected and divided into two groups according to evolution. Group I included patients who survived the infectious process, while Group II included patients who died during hospitalization or after release. RESULTS: Aortic valve disease was the most frequent anomaly. The clinical finding of most relevance for evolution during hospitalization was heart failure. Acute kidney failure and multiple organ failure from sepsis were the most common complications in patients who died. Echocardiograms established the diagnosis in all cases. Transesophageal studies revealed all periaortic abscesses. CONCLUSIONS: Echocardiography makes it possible to identify and evaluate complications associated with elevated morbidity and mortality in patients with congenital heart disease and IE.
Asunto(s)
Ecocardiografía , Endocarditis Bacteriana/diagnóstico por imagen , Cardiopatías Congénitas/diagnóstico por imagen , Infecciones Estreptocócicas , Adolescente , Adulto , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Endocarditis Bacteriana/complicaciones , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/complicaciones , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We evaluated the hemodynamic response of patients with chronic aortic regurgitation and decreased ejection fraction (EF), mean value +/- SD (37 +/- 9), to dobutamine stress echocardiography (DSE). Eleven patients were studied with DSE. Nine patients were in New York Heart Association (NYHA) Class II and two in NYHA Class III. Ten patients received medical treatment in the only other periodic evaluation. With DSE in nine patients, a significant decrease in left ventricular end-diastolic and end-systolic diameters (LVEDD and LVESD) as well as LV end-diastolic and end-systolic volumes (LVEDV and LVESV) was documented in comparison to resting values. EF and fractional shortening (FS) improved significantly with DSE. Systolic wall stress (SWS) and pulmonary arterial systolic pressure (PASP) did not change. Average follow-up was 6.7 months. Three patients underwent valve replacement with mechanical prostheses. Two of them are in NYHA Class I and the other died of LV failure 3 days after surgery. One patient deteriorated beyond surgical treatment and was in NYHA Class II. The other seven patients remain in NYHA Class II and await valve replacement. In patients with chronic aortic regurgitation and depressed EF, the variables relevant to myocardial reserve appear to be EF, FS, LVEDD, LVESD, LVEDV, and LVESV.
Asunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico , Dobutamina , Prueba de Esfuerzo , Adulto , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Enfermedad Crónica , Ecocardiografía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico/efectos de los fármacos , Volumen Sistólico/fisiología , Función Ventricular Izquierda/efectos de los fármacos , Función Ventricular Izquierda/fisiologíaRESUMEN
The adequate study of the left atrial appendage is an echocardiographic challenge. The purpose of this study was to assess the ability of 3-dimensional echocardiography in reconstructing this potentially complex structure.
Asunto(s)
Apéndice Atrial/anatomía & histología , Apéndice Atrial/diagnóstico por imagen , Ecocardiografía Tridimensional , Procesamiento de Imagen Asistido por Computador , Ecocardiografía , Ecocardiografía Tridimensional/métodos , HumanosRESUMEN
We present the 2-dimensional findings and 3-dimensional reconstruction of images from an 18-year-old patient with unroofed coronary sinus, persistent left superior vena cava, a common atrium with levoisomerism, ventricular septal defect, and double-outlet right ventricle. The left superior vena cava showed continuity with the floor of the coronary sinus. Diagnosis of the constellation of anomalies established by transesophageal reconstruction clarified the continuity of the coronary sinus with left superior vena cava and atrial wall.
Asunto(s)
Anomalías de los Vasos Coronarios/diagnóstico por imagen , Atrios Cardíacos/anomalías , Adolescente , Ecocardiografía/métodos , Femenino , Atrios Cardíacos/diagnóstico por imagen , Humanos , Vena Cava Superior/anomalías , Vena Cava Superior/diagnóstico por imagenRESUMEN
UNLABELLED: Pulmonary circulation time (PCT) varies under different clinical conditions. To evaluate the PCT, the persistence of contrast in both ventricles and the digital arterial saturation of oxygen with peripheral intravenous injection of microbubbles, were examined 14 patients. Groups: I normals, II left ventricular hypertrophy (EF > 50%), III with mitral stenosis and IV in congestive heart failure. In seven patients, isosorbide S/L was administered after the first injection. The transpulmonary transit in beats was 7.3 in normals, and larger in the others. The persistence of echo contrast in right chambers was 31 beats in group I, and larger in the other groups. In left chambers it was 20.6 beats in group I, and larger in others. There were no alterations with regards to peripheral arterial saturation of oxygen. AII patients with isosorbide presented shorter PCT and persistence of contrast in right chambers. CONCLUSIONS: There are differences in PCT among normals, patients with mitral stenosis and those with congestive heart failure. Prolonged persistence contrast in right chambers indicates abnormally slow transpulmonary transit. Patients with congestive heart failure and ventricular damage, have longer persistence of echo contrast. PCT studied with contrast is an easy means of evaluating some aspects of pulmonary circulation.
Asunto(s)
Medios de Contraste , Ecocardiografía Doppler/métodos , Insuficiencia Cardíaca/diagnóstico por imagen , Hipertensión Pulmonar/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Estenosis de la Válvula Mitral/diagnóstico por imagen , Polisacáridos , Arteria Pulmonar/diagnóstico por imagen , Circulación Pulmonar , Insuficiencia Cardíaca/fisiopatología , Frecuencia Cardíaca , Humanos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Hipertrofia Ventricular Izquierda/complicaciones , Hipertrofia Ventricular Izquierda/fisiopatología , Isosorbida/farmacología , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/fisiopatología , Oxígeno/sangre , Presión Parcial , Factores de TiempoRESUMEN
UNLABELLED: This study was performed to determine the safety and efficacy of intravenous dodecafluoropentane emulsion (Echo Gen), to determine the efficacy and duration of contrast agent in left cavities by transthoracic echocardiography and to evaluate the clinical impact of Echogen. Fifteen patients were studied, by transthoracic echocardiography. Duration of contrast intensity of left ventricular cavity opacification and endocardial border definition were studied. The adverse effects were assessed immediately, 24 hours and 7 days after Echogen. Both the vital signs and electrocardiogram did not show any significant changes. Minimal changes in hepatic function in one patient and in renal function in other one were observed. The mean duration of left ventricular opacification was 4 minutes 47 seconds and full or intermediate opacification was more frequently observed after Echogen. Endocardial border delineation was poor in one patient, intermediate in five and excellent in nine. In 86.7% the diagnostic information obtained was sufficiently and allowed other studies. CONCLUSIONS: This study demonstrates that Echogen is effective for Left ventricular cavity opacification, endocardial border definition and assessment of left ventricular volume and ejection fraction 2) The obtained information with the use of Echogen allowed other studies. 3) The intravenous administration of Echogen is safe in doses of 0.05 ml/Kg.
Asunto(s)
Medios de Contraste , Ecocardiografía , Fluorocarburos , Adulto , Anciano , Medios de Contraste/administración & dosificación , Medios de Contraste/efectos adversos , Medios de Contraste/farmacología , Electrocardiografía/efectos de los fármacos , Femenino , Fluorocarburos/administración & dosificación , Fluorocarburos/efectos adversos , Fluorocarburos/farmacología , Cardiopatías/diagnóstico por imagen , Cardiopatías/tratamiento farmacológico , Cardiopatías/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Seguridad , Volumen Sistólico , Función Ventricular IzquierdaRESUMEN
Cor triatriatum dexter is an unusual cardiac abnormality with division between the sinus and primitive atrial portions of the right atrium. Three-dimensional echocardiography is a novel technique that defines this entity.
Asunto(s)
Corazón Triatrial/diagnóstico por imagen , Ecocardiografía Transesofágica , Procesamiento de Imagen Asistido por Computador/métodos , Adulto , Ecocardiografía Doppler , Humanos , MasculinoRESUMEN
The echocardiographic findings of an intramyocardial dissecting hematoma that formed after an extensive acute myocardial infarction of the anterior wall of a 42-year- old man are described. Serial transesophageal studies were used to construct 3-dimensional images that clarified the participation of various myocardial layers that surrounded the dissecting hematoma. The patient was successfully treated with intra-aortic balloon counterpulsation and subsequently coronary artery bypass grafting. Intramyocardial dissecting hematoma is a rare complication of acute infarction; differential diagnosis must be made with pseudoaneurysm by establishing integrity of epicardium and with intracavitary thrombosis by identifying the endomyocardial layer surrounding the neoformation and associated wall movement.
Asunto(s)
Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Cardiopatías/diagnóstico por imagen , Hematoma/diagnóstico por imagen , Adulto , Trombosis Coronaria/diagnóstico por imagen , Diagnóstico Diferencial , Cardiopatías/etiología , Hematoma/etiología , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Masculino , Infarto del Miocardio/complicacionesRESUMEN
In order to determine the effect of right atrial dysfunction on clinical outcome, six patients with inferior myocardial infarction with extension to right ventricle and right atrium involving only obstructions of the right coronary artery were examined with transesophageal echocardiography (TEE) at the time of the event. Five of the patients were reexamined 15 to 55 months later. Two patients underwent thrombolysis and maintained ratios of right-to-left ventricular diameters of less than 1, as well as normal convexity of the interatrial septum. One patient had spontaneous reperfusion of the right coronary artery, reduction in right ventricular diameter, and normalization of interatrial septum. Another patient underwent delayed angioplasty and manifested a diminished wall movement score (WMS) in the follow-up echocardiogram. One patient died during his first hospitalization with significant right ventricular dilatation, inverted convexity of the interatrial septum, and right atrial thrombosis. The last patient died during follow-up with right ventricular dilatation, increased WMS, right atrial akinesis, and inverted interatrial convexity. Serial TEE examination of patients with infarction of the left ventricular inferior wall is a safe technique for determining the degree of the extension of the ischemic process to the right chambers.
Asunto(s)
Fibrilación Atrial/diagnóstico por imagen , Aleteo Atrial/diagnóstico por imagen , Ecocardiografía Transesofágica/métodos , Infarto del Miocardio/diagnóstico por imagen , Disfunción Ventricular Derecha/diagnóstico por imagen , Adulto , Anciano , Fibrilación Atrial/complicaciones , Fibrilación Atrial/mortalidad , Aleteo Atrial/complicaciones , Aleteo Atrial/mortalidad , Angiografía Coronaria , Femenino , Estudios de Seguimiento , Atrios Cardíacos/diagnóstico por imagen , Pruebas de Función Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/mortalidad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Factores de Tiempo , Disfunción Ventricular Derecha/complicaciones , Disfunción Ventricular Derecha/mortalidadRESUMEN
Fifty-four percent of left atrial appendages have two lobes. The number ranges from one to four lobes. We describe three patients with accessory lobes of the left atrial appendage studied with multiplanar transesophageal echocardiography (TEE). In one patient there was evidence of thrombi in the accessory lobe.
Asunto(s)
Apéndice Atrial , Ecocardiografía Transesofágica , Cardiopatías/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Anciano , Apéndice Atrial/anomalías , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We present the case of a 63-year-old man who developed a subaortic gradient of 182 mmHg during an echocardiographic pharmacological stress study with dobutamine.
Asunto(s)
Cardiotónicos/efectos adversos , Dobutamina/efectos adversos , Ecocardiografía Doppler/métodos , Obstrucción del Flujo Ventricular Externo/inducido químicamente , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Velocidad del Flujo Sanguíneo/fisiología , Presión Sanguínea/efectos de los fármacos , Cardiotónicos/administración & dosificación , Diagnóstico Diferencial , Dobutamina/administración & dosificación , Electrocardiografía , Prueba de Esfuerzo/efectos adversos , Humanos , Hipertensión/complicaciones , Hipertrofia Ventricular Izquierda/diagnóstico , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Contracción Miocárdica/efectos de los fármacos , Isquemia Miocárdica/diagnóstico , Índice de Severidad de la Enfermedad , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/fisiopatologíaRESUMEN
We report the detection of a thrombus 72 hours after mitral valvuloplasty through the use of the technique of Inoue. Images obtained by transesophageal echocardiography revealed its localization on the interatrial septum at the level of the transseptal puncture. Although the patient subsequently underwent surgery for the placement of a prosthetic valve in mitral position due to failure of the valvuloplasty, the thrombus resolved with conservative management.
Asunto(s)
Cateterismo/efectos adversos , Atrios Cardíacos , Cardiopatías/etiología , Trombosis/etiología , Enfermedad Aguda , Ecocardiografía Doppler/métodos , Ecocardiografía Transesofágica , Femenino , Fibrinolíticos/uso terapéutico , Atrios Cardíacos/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Cardiopatías/tratamiento farmacológico , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/terapia , Terapia Trombolítica , Trombosis/diagnóstico por imagen , Trombosis/tratamiento farmacológicoRESUMEN
We present the case of a young woman who developed myxomas in multiple cardiac chambers for the third time. One of the tumors was found in the left atrial appendage with the use of transesophageal echocardiography, indicating that this technique is the method of choice for the follow-up of multiple myxomas.
Asunto(s)
Neoplasias Cardíacas/diagnóstico por imagen , Mixoma/diagnóstico por imagen , Complicaciones Neoplásicas del Embarazo , Adulto , Diagnóstico Diferencial , Ecocardiografía Transesofágica , Femenino , Atrios Cardíacos/diagnóstico por imagen , Humanos , Recurrencia Local de Neoplasia , Embarazo , Complicaciones Neoplásicas del Embarazo/diagnóstico por imagenRESUMEN
Aortic intramural hematoma or atypical aortic dissection is an aortic dissection without intimal tear nor flow communication and it may be the first step of a typical dissection. We describe five cases, in which transesophageal echocardiography detected intramural hematoma of the aorta. Transesophageal echocardiography is a safe, accurate and specific method that allows bedside diagnosis as well as follow-up of patients with hematoma of the aorta.
Asunto(s)
Aneurisma de la Aorta/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Ecocardiografía Transesofágica , Hematoma/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Echocardiographic studies have demonstrated a high prevalence of valvular disease in patients with primary antiphospholipid syndrome (PAPS). However, there are no studies assessing changes over time in valvular abnormalities. We conducted a study to determine whether there are changes over time in valvular lesions as detected by serial transesophageal echocardiography (TEE). Twelve patients with a first TEE had a second evaluation after a mean period of 13.5 months. There were 10 women and two men with a mean age of 38 years. Two patients had normal TEE on both initial and follow-up studies. Ten patients (83%) had valvular abnormalities, predominantly of the mitral and aortic valves in both studies. Abnormalities consisted of thickening, nodules, regurgitation, regurgitation and stenosis, and calcification. The type and frequency of lesions changed over time. As an example, one mitral valve nodule disappeared on follow up but three new aortic nodules developed even though all patients were receiving anticoagulant therapy. Two patients with mitral and aortic nodules presented cerebral ischemia. Mitral valvuloplasty was performed in one case. These results show that valvular abnormalities in patients with PAPS resolve, appear, or persist irrespective of anticoagulant therapy. Regurgitation is often mild or moderate, but stenosis may appear.
Asunto(s)
Síndrome Antifosfolípido/complicaciones , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/etiología , Adulto , Anciano , Ecocardiografía Transesofágica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
We report a 36-year-old woman with hypertrophic cardiomyopathy with asymmetric septal hypertrophy without outflow tract obstruction associated with an ostium secundum-type atrial septal defect with significant hemodynamic repercussion. Diagnosis was established with transesophageal echocardiography. This is the second case of this rare association reported in the literature and the first evaluated by transesophageal echocardiography.