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Biomedical subjects

A F Parisi

Publications and source records attributed to A F Parisi.

At least 109 records · Page 6Linked to original sources
PubMed1980

Echocardiography in acute and remote myocardial infarction.

Two dimensional echocardiography is just beginning to be used to characterize cardiac damage in patients with acute myocardial infarction. The two dimensional approach allows for a more comprehensive evaluation of cardiac anatomy and is able to detect with high sensitivity changes in regional wall motion that previously were sometimes missed or only found with difficulty using M mode echocardiography. Two dimensional echocardiography appears to offer a basis for quantifying the extent of myocardial damage in acute myocardial infarction and thus may permit objective assessment of therapeutic modalities and prognosis. In addition, the technique facilitates recognition of specific complications in acute myocardial infarction. In particular, the technique offers te ability to distinguish true from false ventricular aneurysm, postinfarction ventricular septal defect from papillary muscle dysfunction and rupture, and right ventricular infarction from cardiac tamponade.

Animals↗
PubMed1980

Intracardiac masses. Tumors, vegetations, thrombi, and foreign bodies.

Echocardiography has enhanced our diagnostic capability in the detection of cardiac myxomas and, to some degree, metastatic tumor. It has assisted in the evaluation and treatment of certain patients with infective endocarditis and now appears to be providing insight into the recognition and course of some cases of intracardiac thrombosis. However, the limitations in the latter conditions are still significant and careful interpretation and clinical correlation should be the rule.

Adolescent↗
PubMed1980

Echocardiographic evaluation of left ventricular function.

The ability of echocardiography to assess left ventricular function is entering an era of transition. Most existing data have been derived from M-mode measurements made along a single echo beam axis and, as such, were based on the assumption that the performance of the sampled segment represented that of the whole ventricle. The recent availability of two dimenensional echocardiography lessens the need to rely on this assumption.

Echocardiography↗
PubMed1980

Noninvasive tests to evaluate the severity of aortic stenosis. Limitations and reliability.

Fifty patients were examined with phonocardiograms, carotid pulse tracings, and M-mode echocardiograms to evaluate the ability of noninvasive tests to identify the severity of aortic valvular disease as determined at cardiac catheterization. Linear and multivariate analysis showed these noninvasive approaches to have only fair correlation with the severity of the disease. A binary division of the population under study into severe and nonsevere subgroups based on aortic valvular area (less than or equal to 0.8 sq cm in severe group [n = 25]; greater than 0.8 sq cm in nonsevere group [n = 25]) allowed sensitivity, specificity, and likelihood ratios to be determined. The likelihood ratio increased fourfold as the interval from the ECG Q wave to the murmur's peak (Q-MP) prolonged to 320 msec and increased sevenfold when the rate-corrected left ventricular ejection time (delta LVET) was more than 40 msec beyond values predicted from standard regression equations. Echocardiographic measurements were less helpful. Prolonged values of Q-MP and delta LVET proved to be the best discriminators of severe aortic valvular disease in this population where the prevalence of severe and nonsevere disease was equal.

Adult↗
PubMed1980

Echocardiographic features of an unruptured aneurysm of the right sinus of Valsalva.

A 2-cm aneurysm of the right sinus of Valsalva was documented in a patient with a prosthetic aortic valve. The M-mode findings differed from prior reports and mimicked those of aortic root dissection or a catheter placed in the right ventricular outflow tract. Two-dimensional echocardiograms readily distinguished the aneurysm of the right sinus of Valsalva from the alternative possibilities.

Adult↗
PubMed1979

Approaches to determination of left ventricular volume and ejection fraction by real-time two-dimensional echocardiography.

Left ventricular volumes and ejection fraction were derived from real time two-dimensional echocardiographic images (2 DE) and single plane (RAO) left ventricular cineangiograms in a series of 50 patients. Prospective application of a series of 6 alternate algorithms showed that a modified Simpson's rule approach using mitral and papillary muscle cross sections and an apical four chamber view provided the best 2 DE - angiographic correlations: for end-diastolic volume r = 0.82, SEE = 39 ml; for end-systolic volume r = 0.90, SEE = 29 ml and for ejection fraction r = 0.80, SEE = 0.09. The large SEE for volume determination indicates that further refinements are necessary to predict left ventricular volumes adequately; however, ejection fraction can be derived with an accuracy which allows practical clinical decisions in patients with satisfactory 2 DE images.

Cardiac Output↗
PubMed1979

Coronary calcification in the diagnosis of coronary artery disease.

Clinical, postmortem and angiographic studies of coronary calcification are reviewed to define the value of fluoroscopy in the diagnosis and management of coronary artery disease. Autopsy studies consistently show a unique association between calcification of the coronary arteries and atherosclerosis. The relation of coronary calcification to the presence of major stenosis is more variable but is strong enough to be of clinical value, particularly in the younger subject. The diagnostic value of fluoroscopy can be improved by attention to the detailed features of calcification observed with the technique. Combined use of fluoroscopy and exercise testing appears to be a valid and as yet unexploited approach to the noninvasive diagnosis of coronary stenosis. Fluoroscopy has been a neglected method of noninvasive diagnosis and is sufficiently promising to warrant greater clinical use.

Calcinosis↗
PubMed1979

Cardiac effects of increased lung volume and decreased pleural pressure in man.

The cardiac effects of increased lung volume and/or decreased intrathoracic pressure were assessed by radionuclide angiography in normal male subjects. Increased lung volume alone produced no change in left ventricular (LV) or right ventricular (RV) end-diastolic size. Decreasing intrathoracic pressure to -30 Torr with a Mueller maneuver led to increases in LV end-diastolic and end-systolic volumes, and to increases in RV diastolic area. LV ejection fraction did not change significantly but RV ejection fraction decreased with the Mueller maneuver. Increases in transmural central venous pressure were also noted with the Mueller maneuver. The effects of combining increased lung volume with the Mueller maneuver were similar to those with the Mueller maneuver alone. These effects are consistent with the hypothesis that producing large negative pleural pressures acts to impede left ventricular outflow (i.e., afterloading) and raises the possibility of similar changes during acute attacks of bronchospasm.

Adolescent↗
PubMed1979

Assessment of left ventricular ejection fraction and volumes by real-time, two-dimensional echocardiography. A comparison of cineangiographic and radionuclide techniques.

Five different algorithms for determining left ventricular (LV) ejection fraction (EF) and volumes from two-dimensional echocardiographic examination (TDE) were compared with standard methods for obtaining EF and volume from x-ray cineangiography (cine) and EF from radionuclide ventriculography (RVG) in 35 patients. Although all methods correlated positively, the degree of correlation varied with the algorithm used. For EF determination, TDE algorithms (especially those using multiple planes of section) were superior to unidimensional algorithms commonly used with M-mode echocardiography. The best algorithm (modified Simpson's rule) correlated well enough with cine EF (r = 0.78; SEE 0.097) and RVG EF (r = 0.75; SEE 0.087) to make clinically useful estimates. TDE volumes also correlated meaningfully with cine end-diastolic and end-systole volumes (r = 084; n = 70) but were associated with a large standard error of the estimate (43 ml) and offered less advantage over unidimensional volume estimates. Quantitative application of TDE appears to be a useful noninvasive method of evaluating LVEF, but is not as useful for estimating LV volumes.

Cineangiography↗
PubMed1979

Assessment of severity of mitral stenosis by echocardiographic leaflet separation.

Mitral valve area (MVA) determined at cardiac catheterization was compared with M mode echocardiographic measurements in 44 patients with mitral stenosis and no substantial mitral regurgitation. Despite statistically significant correlations, measurements of anterior leaflet motion, including rate of diastolic closure (EF slope) were not useful in predicting severity of stenosis. In contrast, maximal diastolic separation of anterior and posterior leaflets (SEP) was more closely correlated with MVA and appears to have some predictive value. Narrow separation was associated with severe mitral stenosis. Wide separation was associated with relatively mild stenosis. Intermediate values in 16 of 44 patients (36%) were not of predictive value. Recognizing this limitation, measurement of maximal diastolic mitral leaflet separation from M mode echocardiograms is proposed as a simple and useful method for assessing severity of mitral stenosis.

Adult↗
PubMed1978

Snare retrieval of a catheter fragment with inaccessible ends from the pulmonary artery.

Frequent use of central venous lines has led to an increasing problem with embolized catheter fragments which have become lodged in the right heart and pulmonary vasculature. Removal of catheter fragments is justified because of a high complication rate when they are left in situ. Using a snare retrieval apparatus catheter fragments may be quickly and easily removed. In the past year we have seen 3 patients with embolized catheter fragments. One case was unusual in that its transverse position in the pulmonary vasculature required initial dislodgement with a pigtail catheter before it could be successfully snared. The literature and our experience suggest that most, if not all, catheter fragments in the right heart and pulmonary circulation can be successfully retrieved without resorting to thoracotomy.

Catheterization↗
PubMed1978

Value of the QRS complex in assessing left ventricular ejection fraction.

The relation between electrocardiographic findings and the angiographic left ventricular ejection fraction and the augmented ejection fraction after a premature ventricular contraction was investigated in 73 patients with documented chronic coronary artery disease. The patients were separated into four groups according to the presence or absence of abnormal Q waves. Twenty-four patients had diaphragmatic myocardial infarction, 21 had anterior myocardial infarction, 15 had both and 13 had no myocardial infarction. There was no statistically significant differences in cardiac index, left ventricular end-diastolic pressure or number of coronary vessels showing critical narrowing in the four groups. The sum of R waves (in mv) in leads aVL, aVF and V1 to V6 (sigmaR) was correlated with the ejection fraction (EF) and the augmented ejection fraction (EFa). EF in percent = 6.6 sigmaR mv + 9.4 (no. =73, r = 0.61); and EFa in percent = 8.6 sigmaR mv + 11.0 (no. = 73, r = 0.77). Among patients with sigmaR of less than 4.0 mv, augmented ejection fraction was less than 0.45 in 73 percent; among patients with sigmaR of 4.0 mv or more the augmented ejection fraction was greater than 0.45 in 93 percent (P less than 0.001). Thus, the sigmaR, calculated from six precordial and two augmented leads in patients with chronic coronary artery disease, correlated with both ejection fraction and augmented ejection fraction. The electrocardiogram in patients with coronary artery disease may prove useful as a simple, readily available and noninvasive guide in the assessment of left ventricular function in patients with coronary artery disease.

Blood Pressure↗
PubMed1978

Echocardiography as an index of cardiac performance.

Ultrasound imaging of the heart provides a noninvasive technique for assessing cardiac performance and diagnosing a wide range of disorders. Recent improvements in two-dimensional, planar instrumentation promise to make echocardiography even more versatile, permitting more comprehensive views of left ventricular function, valve orifice areas, and the spatial relationships of the great vessels and ventricular chambers.

Cardiac Tamponade↗
PubMed1978

Echocardiographic features of constrictive pericarditis.

The most characteristic echocardiographic features of 12 patients with constrictive pericarditis were compared with the findings in 10 normal volunteers. Left ventricular posterior wall (LVPW) "flatness" was quantified by measuring the diastolic change in distance from the crystal artifact to the LVPW endocardium. In 11 of 12 patients the net diastolic LVPW endocardial movement was less than 1 mm. In 10 normal volunteers LVPW endocardium moved posteriorly in diastole from 1.5 to 4 mm (mean 2.2 +/- 0.8). Abnormal septal motion was present in five of 12 patients with constriction. Pericardial thickness measured using standard damping techniques for both cnstriction and normal population did not distinguish the two groups. The "flattening" of the left ventricular endocardium as quantified above verifies earlier qualitative observations and was the most consistent finding in this series of patients with constrictive pericarditis.

Aged↗