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Biomedical subjects

J Kisslo

Publications and source records attributed to J Kisslo.

At least 73 records · Page 4Linked to original sources
PubMed1985

Subvalvular left ventricular pseudoaneurysm after mitral valve replacement: two-dimensional echocardiographic findings.

Disruption of the posterior mitral anulus is a rare complication of mitral valve replacement that may result in subvalvular left ventricular pseudoaneurysm formation. Such pseudoaneurysm formation was easily recognized by two-dimensional echocardiography in a 54 year old man 3 years after his second mitral valve replacement. The finding was confirmed by cineangiography and direct surgical inspection. Recognition of this rare complication of mitral valve replacement has therapeutic importance because surgical correction is necessary.

Cineangiography↗
PubMed1984

The safety of contrast echocardiography: report of the Committee on Contrast Echocardiography for the American Society of Echocardiography.

The results of a survey of 363 physicians performing echocardiography were evaluated to assess the relative safety of contrast echocardiography. Fifteen physicians reported a variety of transient side effects, including neurologic and respiratory symptoms. Although contrast echocardiography appeared to carry some risk for side effects, that risk was low (0.062%) and no residual side effects or complications were observed. In view of the significant benefits reported for contrast echocardiography, it appears to remain a valuable technique that is safer than currently available alternative diagnostic modalities. However, during contrast echocardiography, precautions should be taken to prevent the injection of visible amounts of air, especially in patients with a right to left shunt or arterial catheters.

Contrast Media↗
PubMed1983

Echocardiography in infective endocarditis.

Echocardiography may detect the presence of vegetative lesions in between 55 and 80% of patients with the clinical syndrome of bacterial endocarditis. While the mere presence of vegetations does not alone warrant surgical intervention in patients with this disorder those patients with echocardiographically documented large left sided lesions are more prone to embolic events and patients with multiple valve involvement do have a tendency for progressive valvular deterioration. Serial echocardiography is of help in identifying patients with certain complications such as leaflet disruption, abscess or fistula formation and ventricular compromise. Vegetative lesions do not regress in size with antibiotic treatment and may remain for years. Major criteria for surgical intervention continued to be clinical presence of refractory congestive heart failure, repeated embolic events or persistent septicemia. When surgical intervention is decided on clinical grounds, cardiac catheterization is rarely required in patients with adequate echocardiographic studies.

Echocardiography↗
PubMed1983

The cardiac diagnostic unit. A new approach to patient care.

The Cardiac Diagnostic Unit at Duke University Hospital brings together multiple diagnostic services for evaluation of patients with cardiovascular disease. This Unit is a combined effort of the departments of Medicine, Radiology, Surgery, Bioengineering, and Computer Sciences. The reasons for the establishment of the Unit are discussed, along with some illustrative case studies.

Aged↗
PubMed1980

Evaluation of the left ventricle with two dimensional echocardiography.

Two dimensional echocardiography, because of its wide field of view, has been shown to be superior to the M mode approach for ultrasonic evaluation of the left ventricle. The use of this technique for determination of ventricular volume estimates and detection of asynergy has been promising but is limited by compromised image quality found in many patients with ischemic heart disease. Because it supplies cross-sectional information about the ventricular chamber and wall thickness simultaneously, this new technique lends itself to the anatomic localization of changes in regional performance that accompany ischemic heart disease. It allows simultaneous study of regional dynamic changes in chamber circumference, wall thickness and motion characteristics that give practical information on coronary artery disease and acute myocardial infarction.

Animals↗
PubMed1978

The prognostic spectrum of left main stenosis.

Three-year survival for 163 consecutive medically treated patients with 50% or greater left main stenosis was 50%. Survival was significantly higher for patients with 50 to 70% left main stenosis (one and three-year survivals of 91% and 66%) than for patients with 70% or greater left main stenosis (one and three-year survivals of 72% and 41%). In fact, left main lesions of less than 70% were not associated with the increased risk usually attributed to patients with left main stenosis. A number of noninvasive and catheterization characteristics were significant predictors of survival for patients with 70% or greater left main stenosis. Noninvasive descriptors defined a low risk subgroup (one and three-year survivals of 97% and 74%) and a high risk subgroup (one- and three-year survivals of 59% and 25%). These observations have important implications both in assessing therapeutic interventions and in managing individual patients.

Cardiac Catheterization↗
PubMed1978

Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements.

Four hundred M-mode echocardiographic surveys were distributed to determine interobserver variability in M-mode echocardiographic measurements. This was done with a view toward examining the need and determining the criteria for standardization of measurement. Each survey consisted of five M-mode echocardiograms with a calibration marker, measured by the survey participants anonymously. The echoes were judged of adequate quality for measurement of structures. Seventy-six of the 400 (19%) were returned, allowing comparison of interobserver variability as well as examination of the measurement criteria which were used. Mean measurements and percent uncertainty were derived for each structure for each criterion of measurement. For example, for the aorta, 33% of examiners measured the aorta as an outer/inner or leading edge dimension, and 20% measured it as an outer/outer dimension. The percent uncertainty for the measurement (1.97 SD divided by the mean) showed a mean of 13.8% for the 25 packets of five echoes measured using the former criteria and 24.2% using the latter criteria. For ventricular chamber and cavity measurements, almost one-half of the examiners used the peak of the QRS and one-half of the examiners used the onset of the QRS for determining end-diastole. Estimates of the percent of measurement uncertainty for the septum, posterior wall and left ventricular cavity dimension in this study were 10--25%. They were much higher (40--70%) for the right ventricular cavity and right ventricular anterior wall. The survey shows significant interobserver and interlaboratory variation in measurement when examining the same echoes and indicates a need for ongoing education, quality control and standardization of measurement criteria. Recommendations for new criteria for measurement of M-mode echocardiograms are offered.

Aorta↗
PubMed1976

Echocardiographic evaluation of tricuspid valve endocarditis: an M mode and two dimensional study.

Standard M mode echocardiography and a new real time two dimensional echocardiographic imaging system were utilized to follow the progressive anatomic destruction of the tricuspid valve in a patient with bacterial endocarditis. The initial two dimensional echocardiographic study revealed large vegetative masses attached to severely prolapsing tricuspid leaflets. Serial studies demonstrated eventual disruption of the chordal attachments of the anterior tricuspid leaflet resulting in frank leaflet flail. This technique was seen to complement both M mode echocardiography and cardiac angiography by providing spatial information concerning serial changes in the disordered tricuspid valve. Such findings call attention to the relative roles of various diagnostic measures, including M mode and two dimensional echocardiography, in assessing the specific anatomic and functional performance of a diseased tricuspid valve.

Adult↗
PubMed1976

Cardiac imaging using a phased array ultrasound system. II. Clinical technique and application.

A new two-dimensional ultrasound imaging system capable of producing high resolution tomographic images of the heart in real time has been developed. This system relies on phased array principles to rapidly steer the ultrasound beam through the structures under investigation. A hand-held linear array of 16 ultrasound transducers with overall dimensions of 14 mm at the site of contanct may be readily manipulated to image various cardiac structures. The resulting images are displayed in a circular sector format, 60 degrees in azimuth and typically 15 cm in range. At his maximum range, image frames consisting of 256 lines are generated at the rate of 20 frames/second. High azimuthal resolution throughout the field of view is assured by a focused transmit beam and by sweeping the focus of the receiver is synchrony with the range of returning echoes. Azimuthal resolution varies from 2 to 5 mm throughout the field of view while range resolution is 1.5 mm. This imaging system has proven particularly useful for the delineation of left ventricular spatial geometry by the identification of endocardium, myocardium, papillary muscles and interventricular septum. High quality images of anterior and posterior mitral leaflets, aortic root and aortic leaflets as well as left atrium and other cardiac structures have been obtained.

Echocardiography↗
PubMedDate not supplied

Three-dimensional flow images by reconstruction from two-dimensional vector velocity maps.

A method for constructing three-dimensional images of flow is described. The technique involves the acquisition of numerous closely spaced planes, each comprised of a map of the two-dimensional velocities measured in that plane. Each such vector velocity map is formed by tracking the motion of small regions of ultrasonic speckle between two ultrasonic acquisitions separated by a short time interval. In contrast to current Doppler velocity methods, this technique measures both the axial and lateral components of flow and is not subject to aliasing. The resulting series of two-dimensional vector velocity maps is then combined into a three-dimensional data set, which can be manipulated with appropriate software to yield quantitative three-dimensional displays of the flow within the interrogated volume. In this article we present such images obtained from measurements of in vitro laminar flow in a vessel, as well as a free jet phantom. The results allow comprehensive visualization of the three-dimensional flow characteristics, indicating promise for more complete and quantitative clinical assessment of blood flow.

Blood Flow Velocity↗
PubMedDate not supplied

Reporting of preliminary data: time to take our sonographers "off the hook".

The article by McDonald et al. points out the widespread demand for preliminary reporting of echocardiographic data by sonographers, at least in the setting of physicians in training. Such preliminary reporting is illegal in most states because it constitutes the unauthorized practice of medicine. In most states it is also illegal for physicians to authorize sonographers to do such preliminary reporting because it aids and abets the unauthorized practice of medicine. Such practices also likely violate federal Medicare statutes. Lastly, the practice is simply not fair to patients who are deserving of final diagnostic information. Now that we know the practice is widespread among physicians in training, we can conjecture that the demand for improper reporting of diagnostic data by sonographers is likely widespread among physicians in practice also. Now is the time to check your local statutes, change the way your practice works, and adopt a clear policy for reporting of diagnostic echocardiographic and Doppler data.

Allied Health Personnel↗