650 Better detection of left ventricular spontaneous contrast on transthoracic echocardiography using fusion harmonic and high frequency transducers

1999 ◽  
Vol 1 ◽  
pp. S110-S110
Author(s):  
E ROMBAUT ◽  
L DUCROT ◽  
J JAMART ◽  
C SCAVEE ◽  
J DEOLIVAL ◽  
...  
Keyword(s):  
Transthoracic Echocardiography ◽  
High Frequency ◽  
Left Ventricular

Left Ventricular Endocardial and Epicardial Border Length Delineation with Perflutren Contrast during Transthoracic Echocardiography

2011 ◽  
Vol 28 (7) ◽  
pp. 761-766 ◽  
Author(s):  
Vincent L. Sorrell ◽  
William D. Ross ◽  
Sachin Kumar ◽  
Nishant Kalra
Keyword(s):  
Transthoracic Echocardiography ◽  
Left Ventricular

Rate-dependent shortening of action potential duration increases ventricular vulnerability in failing rabbit heart

2011 ◽  
Vol 300 (2) ◽  
pp. H565-H573 ◽  
Author(s):  
Masahide Harada ◽  
Yukiomi Tsuji ◽  
Yuko S. Ishiguro ◽  
Hiroki Takanari ◽  
Yusuke Okuno ◽  
...  
Keyword(s):  
Action Potential ◽  
High Frequency ◽  
Rabbit Heart ◽  
Left Ventricular ◽  
High Frequency Stimulation ◽  
Electrophysiological Properties ◽  
Rate Dependent ◽  
Frequency Stimulation ◽  
And Control

Congestive heart failure (CHF) predisposes to ventricular fibrillation (VF) in association with electrical remodeling of the ventricle. However, much remains unknown about the rate-dependent electrophysiological properties in a failing heart. Action potential properties in the left ventricular subepicardial muscles during dynamic pacing were examined with optical mapping in pacing-induced CHF ( n = 18) and control ( n = 17) rabbit hearts perfused in vitro. Action potential durations (APDs) in CHF were significantly longer than those observed for controls at basic cycle lengths (BCLs) >1,000 ms but significantly shorter at BCLs <400 ms. Spatial APD dispersions were significantly increased in CHF versus control (by 17–81%), and conduction velocity was significantly decreased in CHF (by 6–20%). In both groups, high-frequency stimulation (BCLs <150 ms) always caused spatial APD alternans; spatially concordant alternans and spatially discordant alternans (SDA) were induced at 60% and 40% in control, respectively, whereas 18% and 82% in CHF. SDA in CHF caused wavebreaks followed by reentrant excitations, giving rise to VF. Incidence of ventricular tachycardia/VFs elicited by high-frequency dynamic pacing (BCLs <150 ms) was significantly higher in CHF versus control (93% vs. 20%). In CHF, left ventricular subepicardial muscles show significant APD shortenings at short BCLs favoring reentry formations following wavebreaks in association with SDA. High-frequency excitation itself may increase the vulnerability to VF in CHF.

Hemodynamic Effects of Synchronized High-frequency Jet Ventilation Compared with Low-frequency Intermittent Positive-pressure Ventilation after Myocardial Revascularization

2000 ◽  
Vol 92 (1) ◽  
pp. 24-24 ◽  
Author(s):  
Jacques-Andre Romand ◽  
Miriam M. Treggiari-Venzi ◽  
Thierry Bichel ◽  
Peter M. Suter ◽  
Michael R. Pinsky
Keyword(s):  
Mechanical Ventilation ◽  
High Frequency ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Left Ventricular ◽  
Artery Bypass Graft ◽  
Jet Ventilation ◽  
High Frequency Jet Ventilation ◽  
Venous Oxygen Saturation ◽  
Controlled Mechanical Ventilation

Background The purpose of this prospective study was to examine the effect on cardiac performance of selective increases in airway pressure at specific points of the cardiac cycle using synchronized high-frequency jet ventilation (sync-HFJV) delivered concomitantly with each single heart beat compared with controlled mechanical ventilation in 20 hemodynamically stable, deeply sedated patients immediately after coronary artery bypass graft. Methods Five 30-min sequential ventilation periods were used interspersing controlled mechanical ventilation with sync-HFJV twice to control for time and sequencing effects. Sync-HFJV was applied using a driving pressure, which generated a tidal volume resulting in gas exchanges close to those obtained on controlled mechanical ventilation and associated with the maximal mixed venous oxygen saturation. Hemodynamic variables including cardiac output, mixed venous oxygen saturation and vascular pressures were recorded at the end of each ventilation period. Results The authors found that in 20 patients, hemodynamic changes induced by controlled mechanical ventilation and by sync-HFJV were similar. Cardiac index did not change (mean +/- SD for controlled mechanical ventilation: 2.6 +/- 0.7 l x min(-1) x m(-2); for sync-HFJV: 2.7 +/- 0.7 l x min(-1) x m(-2); P value not significant). This observation persisted after stratification according to baseline left-ventricular contractility, as estimated by ejection fraction. Conclusions The authors conclude that after coronary artery bypass graft, if gas-exchange values are maintained within normal range, sync-HFJV does not result in more favorable hemodynamic support than controlled mechanical ventilation. These findings contrast with the beneficial effects of sync-HFJV, resulting in marked hypocapnia, on cardiac performance observed in patients with terminal left-ventricular failure.

Abstract 9634: As Compared With Cardiac Magnetic Resonance Imaging, Transthoracic Echocardiography Has an Excellent Accuracy in Diagnosing a Left Ventricular Thrombus After an Anterior Myocardial Infarction Complicated With Left Ventricular Dysfunction: Results of a Prospective Multicentric Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Philippe Meurin ◽  
Virginie Brandao Carreira ◽  
Raphaelle D Dumaine ◽  
Alain Shqueir ◽  
Olivier Milleron ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Magnetic Resonance Imaging ◽  
Antiplatelet Therapy ◽  
Transthoracic Echocardiography ◽  
Dual Antiplatelet Therapy ◽  
Left Ventricular ◽  
Resonance Imaging

Introduction: The generalization of reperfusion techniques to treat acute myocardial infarction (MI) has allowed for markedly reduced incidence in left ventricular (LV) thrombi because of the reduced myocardial damage. LV thrombi are estimated to complicate 5% to 10% of unselected anterior-wall MI (Ant-MI). However, the incidence and evolution of LV thrombi in high-risk patients with Ant-MI complicated by LV systolic dysfunction is not well known. Cardiac magnetic resonance imaging with contrast delayed enhancement (CMR-DE) is the gold standard in assessing LV thrombus, but comparisons of transthoracic echocardiography (TTE) and CMR-DE are scarce. Hypothesis: We assessed whether LV thrombi are still frequent after major Ant-MI, despite systematic dual antiplatelet therapy, and whether focused TTE has a good accuracy for detection as compared with CMR-DE. Methods: From 2011 to 2013, from 7 centers, we prospectively included patients with LV ejection fraction (LVEF) < 45% at a first TTE performed < 7 days after Ant-MI. A second evaluation including TTE and CMR-DE (analyzed by blinded examiners) was performed at 30 days. A third TTE and assessment of clinical status and adverse events were performed between months 6 and 12. Results: We included 100 consecutive patients (71% males; mean age 59.1 ± 12.1 years; LVEF 33.5 ± 6.0%) at a mean of 4.8 ± 1.9 days after Ant-MI; 88% had undergone primary coronary angioplasty. In total, 26 patients had LV thrombi detected at a mean of 23.2 ± 34.8 days after MI (6 during the first week after the MI, 16 from days 8 to 30, 4 after day 30). As compared with CMR-DE, TTE sensitivity and specificity were 94.7% and 98.5%, respectively. For 24 patients (92.3%), the LV thrombi disappeared with triple antithrombotic therapy including dual antiplatelet therapy and a vitamin K antagonist. One patient died from a recurrent subdural haematoma and another had a peripheral embolism. Conclusions: In this prospective multicenter study, LV thrombus occurred in 26% of patients after Ant-MI complicated by LV dysfunction. Focused TTE has a high accuracy for detection. CMR-DE should be performed only when the apex is not clearly seen.

scholarly journals P260 Left ventricular pseudoaneurysm manifesting as syncope

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J A Da Conceicao Pedro Pais ◽  
B Picarra ◽  
K Congo ◽  
M Carrington ◽  
A R Santos ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Pericardial Effusion ◽  
Coronary Disease ◽  
Transthoracic Echocardiography ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Cardiac Revascularization ◽  
Revascularization Surgery

Abstract Introduction Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. LV pseudoaneurysm is one of the mechanical complications of myocardial infarctions (MI), particularly inferior wall MI. Although LV pseudoaneurysms are not common, the diagnosis is difficult and they are prone to rupture. Transthoracic echocardiography is commonly used in clinical practice and is usually sufficient to make the diagnosis of LV pseudoaneurysm. Regardless of treatment, patients with LV pseudoaneurysms had a high mortality rate, especially those who did not undergo surgery. Description of the clinical case 74 years-old woman, with previous history of hypertension, dyslipidaemia and type 2 diabetes and stable coronary disease. In June 2018 the patient underwent coronary angiography that revealed left main and 3 vessels coronary disease, Cardiac revascularization surgery was proposed that the patient refused. The patient was stable during 6 months. Four days before presenting to emergency department the patient mentioned intermittent pre-cordial pain associated with exertion. At admission day she felt intense pre-cordial pain, accompanied by sudoresis and nausea, relieving with sublingual nitrate. The patient was hemodynamically stable at admission. Electrocardiogram showed sinus rhythm 65 bpm with 2mm ST-elevation of inferior leads. Troponin I was positive 30 ng/dL. Echocardiogram revealed marked hypokinesia of inferior and lateral wall with moderate depression of global systolic function ans presence of slight circumferential pericardial effusion (6mm in diastole on lateral wall) Emergent coronariography was performed and revealed progression of coronary disease of the right coronary artery with sub-occlusion of the mid segment. Cardiac revascularization surgery was proposed and the patient accepted this time. Echocardiogram was repeated during hospitalization revealed a stable pericardial effusion with reduced dimension comparing to admission. After 3 weeks, while waiting surgery in the ward, the patient was a syncope that resulted in fracture of the distal peroneum. Ecocardiogram was performed and revealed a LV posterior wall pseudoaneurysm through a narrow neck in parasternal long axis view and the presence of large pericardial effusion (Fig 1). The patient was submitted to definitive reparative cardiac surgery with pericardium patch and coronary artery bypass graft from left internal mammary to anterior descending coronary artery. The patient recovered well from the cardiac surgery and at 2 months follow up is alive and without signs of heart failure. This case illustrates the complexity in the management of patients with LV pseudoaneurysm. These patients require substantial critical care, imaging and surgical expertise. A high clinical index of suspicion is needed to avoid missing the diagnosis LV pseudoaneurysm and transthoracic echocardiography is essential to establish the diagnosis. Abstract P260 Figure. Fig 1 - LV pseudoaneurysm

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