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Biomedical subjects

L E Jacobs

Publications and source records attributed to L E Jacobs.

At least 37 records · Page 2Linked to original sources
PubMed1994

Penetrating atherosclerotic aortic ulcers.

Penetrating atherosclerotic aortic ulceration is a unique disease with distinct management and prognostic implications. It is an important clinical entity that must be distinguished from classic aortic dissection and rapid expansion or contained rupture of a thoracic aortic aneurysm. Although symptoms of penetrating aortic ulceration may mimic dissection, the characteristic signs of dissection are absent. New imaging modalities have made it possible to establish the diagnosis of penetrating aortic ulceration with a high degree of accuracy and to tailor management according to the presence of complications. Physicians should be aware of the possibility of atherosclerotic aortic ulceration, particularly in elderly patients with systemic atherosclerosis and hypertension who have sudden onset of chest or back pain.

Aged↗
PubMed1994

Intravascular ultrasound for angiographically indeterminant left main coronary artery disease.

The precise diagnosis of the presence of significant left main coronary artery disease has profound prognostic and therapeutic implications. Coronary cineangiography has shown to be imprecise and inaccurate to determine the percent stenosis of the left main coronary artery. We report a case with significant left main coronary artery disease in whom coronary cineangiography was in discordance with the clinical data and intravascular ultrasonography. Based on the intravascular ultrasound findings, the patient underwent coronary artery bypass graft surgery. Therefore, the intravascular ultrasonography may be the procedure of choice for assessing indeterminant left main coronary artery lesions by coronary angiography.

Coronary Angiography↗
PubMed1993

Pitfalls in the echo-Doppler diagnosis of hypertrophic cardiomyopathy.

While Doppler echocardiography has become the gold standard for the diagnosis of hypertrophic cardiomyopathy, there are many pitfalls in its use. Some of these pitfalls are technical in nature resulting from inadequate image quality, incorrect transducer angulation, and improper equipment settings. Other pitfalls relate to the diversity and heterogeneity in defining hypertrophic cardiomyopathy and to the host of disorders that may mimic it by echocardiography. The pattern and extent of ventricular hypertrophy, systolic anterior motion of the mitral valve, and Doppler determination of left ventricular outflow tract obstruction, diastolic dysfunction, and mitral regurgitation are discussed, as are wall-motion abnormalities and myocardial echo reflectivity. While these echocardiographic features of hypertrophic cardiomyopathy are nonspecific when seen in isolation, their combined presence in the appropriate clinical setting makes the diagnosis likely.

Cardiomyopathy, Hypertrophic↗
PubMed1993

Assessment of aortic regurgitation by transesophageal echocardiography: correlation with angiographic determination.

Transthoracic echocardiographic studies have shown that color Doppler mapping of the aortic regurgitation (AR) jet correlated well with the severity of regurgitation as assessed by contrast aortography. The present study was performed to assess whether these parameters could be similarly applied to measurements determined by transesophageal echocardiography (TEE). In order to determine and validate criteria for the assessment of AR severity, 39 clinically stable patients with a TEE color Doppler study and contrast aortography within a 2-week period were identified. The ratio of the jet area (JA) to left ventricular diastolic area (LVDA) had the best correlation to AR severity as determined by contrast aortography (r = 0.89). Jet length, JA, the ratio of jet width to the width of the left ventricular outflow tract and jet width had r values of 0.88, 0.88, 0.83, and 0.84, respectively. The best sensitivity and specificity for the assessment of AR by TEE were obtained as follows: JA/LVDA ratio of 0%-7% predicts 0-1 + AR; 8%-20% 2-3 + AR, and greater than 20% 4 + AR. Of the three patients miscategorized, none was misgraded by more than one angiographic grade of AR. Jets that measure more than 6 cm in length or have an area of greater than 10 cm 2 have a 100% sensitivity and specificity for diagnosing 4 + AR. In the present study the ratio of JA to LVDA area correlates best with AR severity as determined by angiography.

Aged↗
PubMed1993

Discrete subaortic valvular stenosis: the clinical utility and limitations of transesophageal echocardiography.

Transesophageal echocardiography (TEE) is a useful technique in the diagnosis and intraoperative assessment of discrete subaortic stenosis (DSS). It allows clear visualization of the subaortic membrane, which may be missed by transthoracic echocardiography, differentiates DSS from other causes of left ventricular outflow tract obstruction, and accurately detects the presence of associated aortic regurgitation and bacterial endocarditis. Limitations in its use include inadequate visualization of the left ventricular outflow tract by TEE in the presence of a prosthetic mitral valve or mitral annular calcification, and improper alignment of the Doppler cursor across the outflow tract.

Adult↗
PubMed1993

Echo-Doppler in valvular heart disease.

Although Doppler echocardiography plays an important role in evaluating patients with suspected valvular heart disease, it should not replace a careful history, a meticulous physical examination, an electrocardiogram, and well-performed posteroanterior and lateral chest x-rays. Two-dimensional echocardiography can reliably evaluate anatomic valvular lesions, estimate left and right ventricular function, and exclude associated pericardial disease. Doppler echocardiography provides accurate hemodynamic parameters of the severity of aortic and mitral stenosis and the degree of pulmonary hypertension. In addition, color-flow Doppler is helpful in providing semiquantitative information with regard to the degree of MR, AR, or TR. Doppler echocardiography is very useful in evaluating patients before and after valvuloplasty but may be inaccurate when compared with cardiac catheterization immediately following mitral balloon valvuloplasty. However, in the long-term followup, after valvuloplasty, Doppler echocardiography is ideally suited to predict restenosis. A properly performed echo-Doppler study may allow the clinician to send a young patient for surgery when warranted by the clinical symptoms. However, in older patients, especially those with suspected coronary artery disease, and in multivalvular disease, cardiac catheterization may still be required.

Catheterization↗
PubMed1992

Quantification of mitral regurgitation: a comparison of transesophageal echocardiography and contrast ventriculography.

Transesophageal echocardiography (TEE) allows an unobscured view of the left atrium for the assessment of mitral regurgitation (MR). However, criteria for assessing MR by TEE have not been carefully validated. In order to determine and validate criteria for the assessment of MR severity, 65 clinically stable patients with a TEE color Doppler study and contrast ventriculography within a 2-week period were identified. Maximal or peak mitral regurgitation jet area to left atrial area ratio (MR/LA) derived solely from TEE imaging had the best correlation to MR severity by contrast ventriculography (r = 0.89). Utilizing MR jet area without correction for LA size resulted in r = 0.72 to 0.75. Utilizing LA area data from transthoracic echocardiograms in a subset of 29 patients resulted in r = 0.77. Best sensitivity and specificity for the assessment of MR by TEE were obtained using the following criteria: Peak MR/LA of 0%-9% predicts 0 + MR; 10%-28% 1 + MR; 29%-54% 2 + to 3 + MR; and greater than 55% 4 + MR. Best sensitivity and specificity occurs for assessment of 0 + and 4 + MR. Considerable overlap in data occurs in the 1 + and 3 + MR range utilizing the above stated criteria. Peak MR/LA ratio derived from a single TEE view in which the MR jet is maximally imaged is the best determinant of MR severity.

Aged↗
PubMed1992

Utility of transesophageal echocardiography in the conservative management of prosthetic valve endocarditis.

Prosthetic valve endocarditis is a formidable complication following cardiac valve replacement. Surgical intervention has resulted in a significant reduction in mortality when certain complications prevail. We report two such cases of prosthetic valve endocarditis in which the use of transesophageal echocardiography permitted close surveillance during medical therapy and thus avoided the need for surgical intervention. Therefore, with the improved ability to monitor disease progression with transesophageal echocardiography, nonsurgical management of prosthetic valve endocarditis remains an option.

Adult↗