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J Kisslo

Publications and source records attributed to J Kisslo.

At least 55 records · Page 3Linked to original sources
PubMed1990

In vitro analysis of jets by Doppler colour flow imaging: the importance of time to maximum jet area.

Regurgitant jets were simulated in vitro and analysed using Doppler colour flow imaging. The regurgitant volumes were estimated using total jet area (JA), variance area (VA), and the maximum area of variance x time to maximum area of variance (MAVT). Both flow rate and injected volume were significantly correlated to area of variance (r = 0.89 and r = 0.98, respectively) for a given orifice size. When MAVT was analysed, it correlated better to injected volume (r = 0.97) at a fixed flow rate, than varying flow rate (r = 0.69) at a fixed injected volume. The relationship between MAVT and injected volume was also examined with varying flow rate. There was a highly significant correlation between MAVT and injected volume under these circumstances (r = 0.99). A similar relationship between MAVT and injected volume was found when the orifice size was altered. Using multivariate regression analysis the injected volume was best defined by MAVT (R2 = 0.88). The addition of orifice size only improved the fit to the model marginally (R2 = 0.90). These data document the importance of analysing the time to maximum area of variance when applying Doppler colour flow imaging to regurgitant jets. MAVT is a better predictor of regurgitant volumes in vitro compared with jet sizes alone and may have potential use in man to quantify the severity of regurgitant valve lesions.

Aortic Valve Insufficiency↗
PubMed1990

Use of Doppler echocardiography and amyl nitrite inhalation to characterize left ventricular outflow obstruction in hypertrophic cardiomyopathy.

The presence of left ventricular outflow tract obstruction (LVOTO) of either a resting or dynamic nature may have important therapeutic and prognostic implications in patients with hypertrophic cardiomyopathy (HCM). Doppler echocardiograms combined with amyl nitrite (Amyl) inhalation were performed in 333 consecutive patients referred for suspected HCM to diagnose and categorize the nature and severity of LVOTO. Hypertrophic cardiomyopathy was present by 2-D and M-mode criteria in 145/333 (44 percent) patients. Normal limits of resting and post-Amyl continuous wave Doppler peak left ventricular outflow tract velocities were established in 15 subjects with completely normal 2-D and Doppler echocardiograms. Based on these criteria, of the 145 patients with HCM, 63 (43 percent) were classified as having resting LVOTO, peak velocity 4.2 +/- 1.3 m/s. Among 82 patients with HCM without resting LVOTO, 47 (57 percent) received Amyl. Latent LVOTO was provoked in 25/47 (53 percent), peak post-Amyl velocity 4.5 +/- 1.2 m/s. The remaining 22 (47 percent) had nonobstructive HCM, as indicated by no significant increase in post-Amyl velocity. Among a total 62 subjects receiving Amyl, none experienced serious morbidity or mortality. Doppler echocardiography, in conjunction with Amyl inhalation in selected patients, is a useful noninvasive method to diagnose and categorize patients with HCM according to the nature and severity of LVOTO.

Aged↗
PubMed1990

Intraoperative perfusion contrast echocardiography. Initial experience during coronary artery bypass grafting.

Intraoperative evaluation of the effectiveness of myocardial revascularization has been limited by an inability to assess regional myocardial perfusion. Microbubbles of sonicated diatrizoate sodium and diatrizoate meglumine (Renografin) have been an effective echocardiographic contrast agent and have been employed clinically during cardiac catheterization. This recent development in contrast-enhanced two-dimensional echocardiography permits real-time imaging of transmural myocardial blood flow but has not been evaluated in the operating room. This study represents the initial surgical application of this directed technique and was designed to evaluate the safety and efficacy of intraoperative perfusion contrast echocardiography in assessing the results of coronary artery bypass grafting. Twenty men with significant coronary artery disease ranging in age from 49 to 73 years were studied. Direct contrast agent injection into completed saphenous vein bypass grafts caused the myocardium supplied by each graft to be well delineated and provided a tomographic view of contrast distribution. The enhanced region was well correlated with the size and distribution of the native vessel. Rapid contrast washout (less than 20 seconds) indicated satisfactory regional perfusion. Contrast echocardiography prolonged the operation less than 10 minutes and did not result in any perioperative complications.

Aged↗
PubMed1989

Doppler left ventricular diastolic filling abnormalities in aortic stenosis and their relation to hemodynamic parameters.

Doppler mitral flow indexes and their relation to invasively measured hemodynamic diastolic indexes were assessed in 13 patients with isolated aortic stenosis (AS), and compared to Doppler indexes in 10 normal subjects matched for age, heart rate, left ventricular (LV) ejection fraction and LV load. Patients with AS showed no difference in Doppler early filling (E) indexes, but demonstrated greater Doppler atrial filling (A) indexes in comparison to normal subjects: atrial velocity (89 +/- 31 vs 56 +/- 7 cm/s), atrial integral (11.4 +/- 4.8 vs 5.7 +/- 1.6 cm), A/E velocity (1.69 +/- 0.89 vs 1.06 +/- 0.26) and A/E integral (3.53 +/- 6.64 vs 0.81 +/- 0.27) (all p less than 0.05). Doppler indexes in patients with AS did not correlate with hemodynamic indexes of LV relaxation or chamber stiffness. Significant correlations were observed between Doppler and angiographic peak filling rates (r = 0.70) and between Doppler atrial filling velocity and LV end-diastolic volume (r = -0.66), LV end-diastolic pressure (r = -0.48) and LV ejection fraction (r = 0.53) (all p less than 0.05). These data indicate that, compared to matched normal subjects, most patients with AS have an increased atrial contribution to LV filling. However, in patients with decreased LV function, atrial function may also be depressed, as indicated by a decreased atrial contribution to LV filling, resulting in "normalization" of the Doppler mitral flow pattern.

Aged↗
PubMed1989

Utility of Doppler color flow imaging for identification of femoral arterial complications of cardiac catheterization.

Doppler color flow and two-dimensional ultrasonographic images of the femoral region were obtained in 25 patients referred for suspected vascular complications of cardiac catheterization. Five patients had normal findings, while 23 abnormalities were noted in 20 patients, including seven femoral arteriovenous fistulae, 12 femoral pseudoaneurysms, and two patients with both femoral arteriovenous fistulas and pseudoaneurysms. Operation confirmed the abnormalities diagnosed by color flow examination in 15 of 20 patients. Three patients refused operation and one was not felt to be a surgical candidate due to high anesthetic risk. One patient died preoperatively and postmortem examination confirmed the color flow diagnosis. Etiologies of the arterial complications included percutaneous aortic valvuloplasty (6), coronary angioplasty (4), and arterial or both arterial and venous catheterization (10). Doppler color flow imaging is a reliable technique for identification of vascular complications following catheterization procedures.

Aged↗
PubMed1989

Analysis of the early rise in aortic transvalvular gradient after aortic valvuloplasty.

The relationship between dynamic changes in aortic valve gradient and left ventricular ejection performance in the early period after successful percutaneous aortic valvuloplasty has not been described in detail. Accordingly 20 adult patients with severe symptomatic calcific aortic stenosis underwent first-pass radionuclide angiography and Doppler echocardiography before, immediately after, and 2 to 4 days after the valvuloplasty procedure. A significant (p less than 0.001) reduction in peak-to-peak (72 +/- 24 mm Hg to 36 +/- 11 mmHg) and mean (60 +/- 20 mm Hg to 34 +/- 9 mm Hg) transaortic gradient and an increase in aortic valve area (0.5 +/- 0.2 cm2 to 0.8 +/- 0.2 cm2) were measured by high-fidelity micromanometer catheters immediately after aortic valvuloplasty. Results of Doppler echocardiography showed a significant (p less than 0.001) immediate decrease in peak instantaneous (81 +/- 22 mm Hg to 53 +/- 15 mm Hg) and mean (48 +/- 14 mm Hg to 31 +/- 9 mm Hg) aortic gradients. However, 2 to 4 days later a significant (p less than 0.001) return of peak (56 +/- 15 mm Hg to 65 +/- 20 mm Hg) and mean (31 +/- 9 mm Hg to 39 +/- 12 mm Hg) transvalvular gradient occurred. Aortic valve area as determined by the continuity equation also increased from 0.4 +/- 0.2 cm2 to 0.6 +/- 0.2 cm2 immediately after the procedure (p less than 0.001), then partially returned to baseline (0.5 +/- 0.2 cm2; p less than 0.005) at 2 to 4 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Two-dimensional echocardiography in arrhythmogenic right ventricular dysplasia.

Comparison of two-dimensional echocardiography and right ventricular angiographic findings was carried out in patients with arrhythmogenic right ventricular dysplasia. Diagnosis was based on ECG and angiographic criteria in all cases. Echo and angiographic findings corresponded closely when diffuse enlargement and hypokinesis of the right ventricle were present. Echo evidence of localized disease, manifest by bulges or sacculations of the right ventricle, predicted the presence of similar lesions by angiography, but agreement as to specific lesion location was poor. In a review of over 9000 consecutive echocardiograms, right ventricular abnormalities were detected in 18% with only two patients having documented right ventricular dysplasia. In the patient with suspected arrhythmogenic right ventricular dysplasia, two-dimensional echo evidence of diffuse right ventricular enlargement, which is otherwise unexplained, strongly supports the diagnosis and angiography may be avoided. Local changes seen by echo should increase suspicion of right ventricular dysplasia in patients with relevant clinical findings. The detection of any right ventricular abnormality, without coexisting clinical findings is not enough to assign the diagnosis of right ventricular dysplasia since there are so many other disorders that alter right ventricular morphology.

Adolescent↗
PubMed1989

Intraoperative echocardiography in congenital heart disease surgery: preliminary report on a current study.

CLINICAL PERSPECTIVE: The first prospective trial in which both echocardiography and Doppler color flow imaging (echo-DCFI) are used routinely during surgery for congenital heart lesions has been undertaken at Duke Medical Center. Precardiopulmonary bypass (CPB) echo-DCFI examinations have revealed previously unsuspected cardiac findings in several of the patients. These examinations have influenced the surgical course in some way in many of the cases. Post-CPB ultrasound evaluation of the quality of the surgical repairs alone has resulted in immediate additional corrective surgery in several patients, most of whom then left the operating room with an optimum repair.

Adolescent↗
PubMed1987

In vitro color flow, pulsed and continuous wave Doppler ultrasound masking of flow by prosthetic valves.

On the hypothesis that Doppler ultrasound fails to penetrate prosthetic valves, an in vitro flow simulation system was constructed in a large water tank. Conventional pulsed, continuous wave and Doppler color flow systems were used to detect flow in tubing placed diagonally within the water and maintained by a continuous pump. After control periods of flow detection within the tubing, six different prosthetic valves were interposed on a stage between the transducer and the tubing. In comparison with control measurements, detection of flow within the tubing was impossible when the Doppler beam traversed the central occluding ball of the Starr-Edwards Silastic prosthesis by any modality. Marked reduction in the detection of the Doppler signal was noted for the Starr-Edwards stellite prosthesis with only slight improvement in the ability to detect the flow signals through the central occluding discs of the Björk-Shiley, Hall-Kastor and St. Jude valves. In distinction to the other valves, the ability of Doppler ultrasound to detect flow behind the cusps of the Carpentier-Edwards heterograft was similar to that during the control period. An understanding of flow masking should improve the clinical utility of Doppler methods for investigating prosthetic valve dysfunction.

Color↗
PubMed1986

Interatrial shunting in atrial septal aneurysm.

Adequate contrast 2-dimensional (2-D) echocardiograms were recorded in 13 to 16 patients with typical 2-D findings of atrial septal aneurysm. Five patients were referred for detection of intracardiac source of emboli after embolic stroke and 11 were evaluated for suspicion of valvular or other forms of heart disease. Contrary to findings of previous clinical studies, all 13 patients had 2-D evidence of right-to-left atrial level shunting. These findings represent the first clinical evidence of a high prevalence of atrial shunting in patients with atrial septal aneurysm.

Adult↗
PubMed1986

Real-time orthogonal mode scanning of the heart. I. System design.

A necessary percursor to real-time three-dimensional echocardiographic imaging is the ability to obtain multiple planes of acoustic data simultaneously. A new ultrasound imaging technique facilitates the display of two real-time orthogonal B-mode images (O-mode). The O-mode technique uses a novel two-dimensional transducer and system processor to interrogate the two perpendicular planes simultaneously, yielding sector arcs that share one origin. It permits simultaneous display of two sector arcs on a single monitor either side by side or in a two-dimensional projection designed to convey the three-dimensional nature of the acoustic data. Clinical results from the first 50 patients undergoing O-mode evaluation indicate that image quality in the two simultaneously obtained planes is equal to that of a single plane when the system is operating in its conventional format. These data confirm the feasibility of real-time multiplane imaging. The system design offers the potential for the future addition of more simultaneous planes and, thus, the possibility of real-time three-dimensional ultrasound imaging.

Adult↗
PubMed1986

Utility of echocardiography in the management of patients with penetrating missile wounds of the heart.

Nine consecutive patients with penetrating missile wounds of the heart were evaluated by M-mode and two-dimensional echocardiography for localization of retained missile fragments noted to be moving in synchrony with the heart by fluoroscopy. Echocardiography precisely located all 12 moving fragments: 2 in the pericardium, 5 in the anterior right ventricular wall, 3 in the free left ventricular wall, 1 in the interventricular septum and 1 in the right posterior atrioventricular groove. Five patients had echocardiographic evidence of pericardial effusion and only one manifested a wall motion abnormality, indicating that direct myocardial perforation does not always result in detectable intrapericardial bleeding or asynergy. Localization of the missile fragments to be in danger of endocardial perforation, in danger of eroding the right coronary artery and creating a clinically unsuspected membranous ventricular septal defect led directly to surgical intervention in three different patients. In all three, intraoperative echocardiography quickly localized the missile fragments and significantly reduced patient cardiopulmonary bypass time. In the remaining six patients, localization of missile fragments well within the myocardium with no danger of erosion led to decisions against surgical removal.

Adolescent↗
PubMed1985

Comparison of two-dimensional echocardiographic and angiographic findings in arrhythmogenic right ventricular dysplasia.

Comparison of 2-dimensional (2-D) echocardiographic and right ventricular (RV) angiographic findings was performed in 10 patients with arrhythmogenic RV dysplasia. Diagnosis was based on accepted electrocardiographic and angiographic criteria. Nine patients underwent invasive electrophysiologic study, which confirmed RV source of ventricular tachycardia (VT) in 7. Biopsy findings of RV dysplasia were available in 3 patients. Two-dimensional echocardiography and angiography corresponded closely when diffuse RV enlargement and hypokinesia were present. Such diffuse findings were not invariably present. Localized abnormalities consisting of bulging or sacculation of the RV wall were noted by both techniques, even in the absence of diffuse changes. Echocardiographic evidence of localized disease predicted the presence of similar lesions at angiography, but agreement as to specific location was poor. Subjectivity in interpreting subtle RV abnormalities by either technique and the inherent differences in information provided by the 2 methods probably account for the inconsistencies. In the patient with suspected arrhythmogenic RV dysplasia, 2-D echocardiographic evidence of diffuse RV enlargement, otherwise unexplained, strongly supports the diagnosis and angiography may be avoided. Isolated local changes seen by echocardiography should increase suspicion of RV dysplasia, but complementary angiographic study is warranted.

Adolescent↗
PubMed1985

A reconsideration of Doppler assessed gradients in suspected aortic stenosis.

To further define the clinical role of continuous wave Doppler echocardiography for determining aortic valve gradient, we studied 60 consecutive adult patients (age range 22 to 81 years, mean age 63) with suspected aortic stenosis within 24 hours of catheterization. Blind comparisons of Doppler peak and mean gradients by the simplified Bernoulli equation were made with catheterization peak-to-peak (r = 0.84), peak (r = 0.87) and mean (r = 0.84) gradients in a double-blind fashion. Despite these favorable correlations, Doppler peak gradient generally overestimated catheterization peak-to-peak gradient (1 to 53 mm Hg), making it impractical for clinical use. Doppler-catheterization correlations of peak and mean gradients were more favorable, with the least scatter noticed for mean gradient. The results of analysis of pooled data indicated that mean gradient may also be most specific for differentiating severe from less severe aortic stenosis. In this consecutive series where a full range of catheterization gradients was encountered, seven patients with predicted Doppler gradients were found to have none, which is best explained by the use of the simplified Bernoulli equation in patients with aortic insufficiency. These data indicate that prudence should be maintained when Doppler gradients alone are used for the assessment of aortic stenosis.

Adult↗
PubMed1985

Ultrasound diagnosis of pseudoaneurysm and contiguous ventricular septal defect complicating inferior myocardial infarction.

Two patients with recent inferior myocardial infarction were found by two-dimensional and Doppler echocardiography to have both an inferior wall pseudoaneurysm and a contiguous rupture of the posterior ventricular septum. The pseudoaneurysm was not suspected clinically in either patient. In one patient, a complex or dissecting septal rupture was visualized in detail. To our knowledge, the combined defect has not previously been diagnosed during life by noninvasive methods.

Aged↗