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Biomedical subjects

L E Jacobs

Publications and source records attributed to L E Jacobs.

At least 55 records · Page 3Linked to original sources
PubMed1991

Dilated cardiomyopathy with mitral regurgitation: decreased survival despite a low frequency of left ventricular thrombus.

Ninety-one patients with dilated cardiomyopathy were studied by two-dimensional, pulsed, and color Doppler echocardiography (1) to detect and quantify mitral regurgitation (MR), (2) to record apical flow velocities in systole and diastole, and (3) to detect the presence of left ventricular thrombi. MR was detected in 57% of the patients and thrombi were present in 40%, but the occurrence of both MR and thrombus was rare (8%). Apical flow velocity was significantly higher throughout the cardiac cycle in the group with MR (diastole 15 +/- 7 vs 9 +/- 7 cm/sec; systole 29 +/- 12 vs 16 +/- 13 cm/sec; p less than 0.001 for both), accounting for the rarity of thrombi in this group. Follow-up data on 89% of the patients showed markedly decreased survival in the group with MR (22% vs 60% at 32 +/- 6 months, p less than 0.005), and this was evident even in patients with mild MR. Thus although MR is a noninvasively obtainable marker of a large subgroup of patients with dilated cardiomyopathy "protected" from left ventricular thrombus formation, it is a sensitive marker of decreased survival.

Aged↗
PubMed1991

Coronary vasospasm secondary to labetalol in a patient with aortic dissection.

A 66-year-old hypertensive woman presented with epigastric and scapular pain on the basis of type 3 aortic dissection. Appropriate therapy with a combined alpha-adrenergic and beta-adrenergic antagonist agent prevented further ongoing dissection and amelioration of symptoms. On day 5, an episode of coronary vasospasm occurred presumably due to beta-blockade with unopposed alpha-adrenergic activity.

Aged↗
PubMed1990

Right atrial compression in postoperative cardiac patients: detection by transesophageal echocardiography.

Four patients developed hypotension after heart surgery. Hemodynamic measurements revealed elevated right atrial pressure with normal pulmonary capillary wedge pressure. Conventional transthoracic two-dimensional echocardiography was technically suboptimal for detection of pericardial effusion. In each patient transesophageal echocardiography demonstrated significant compression of the right atrium by a localized mass. At reoperation atrial compression by an organized hematoma was found and in each instance successfully drained. Thus, transesophageal echocardiography is superior to transthoracic echocardiography in evaluating critically ill postoperative hypotensive patients and can differentiate isolated right atrial tamponade from other causes of hemodynamic deterioration such as prosthetic valve dysfunction or left ventricular systolic dysfunction, or both.

Aged↗
PubMed1988

Pulsed, continuous, and color flow Doppler echocardiographic assessment of normal and abnormal Ionescu-Shiley pericardial valves.

We studied the value of pulsed, continuous, and color flow Doppler echocardiography for identifying normal and abnormal function in 51 Ionescu-Shiley bovine pericardial valves. In 15 patients with clinically normal functioning mitral valves, the peak and mean pressure gradients as calculated by the modified Bernoulli equation were 8.5 +/- 4.9 mmHg (mean +/- SD) and 2.6 +/- 2.9 mmHg, respectively. The mitral valve area as calculated by the pressure half-time method was 2.2 +/- 0.6 cm2. In 18 patients with normally functioning aortic valves, the peak and mean pressure gradients were 22.9 +/- 9.0 mmHg and 11.1 +/- 5.0 mmHg, respectively. In five patients with suspected mitral prosthetic dysfunction, two-dimensional and Doppler echocardiography showed: two had mitral stenosis with a mean gradient of 14.2 mmHg and mean mitral valve area of 1.0 cm2, two had severe mitral regurgitation, and one was thickened but nonstenotic. In 13 patients with suspected aortic prosthetic dysfunction, two-dimensional and Doppler echocardiography showed: two patients had markedly thickened leaflets and mean aortic gradient of 41.5 mmHg, two patients had mild aortic regurgitation, four patients had severe aortic regurgitation, and five patients had systolic murmurs secondary to pathology unrelated to the prosthetic aortic valve. Of the three patients with severe aortic regurgitation who had color Doppler, the site and direction of the regurgitant jet was correctly identified in all compared to intraoperative assessment. Pulsed, continuous, and color flow Doppler are useful as noninvasive techniques in assessing Ionescu-Shiley valve hemodynamics and function.

Academic Medical Centers↗
PubMedDate not supplied

Cardiac sarcoidosis masquerading as a metastatic tumor: the role of transthoracic and transesophageal echocardiography.

We present an unusual case of biopsy-proven myocardial sarcoidosis in which the transthoracic and transesophageal echocardiographic findings suggested metastatic tumor involvement of the myocardium and pericardium. The pathologic, clinical, and echocardiographic features of cardiac sarcoidosis are reviewed, with emphasis on the role of echocardiography.

Adult↗
PubMedDate not supplied

The utility of transesophageal echocardiography in the management of renal cell carcinoma with intracardiac extension.

The accurate assessment of the distal extent of vena caval invasion of renal cell carcinoma into the hepatic veins, inferior vena cava, and right atrium is critical before surgical resection. We present two cases of renal carcinoma with vena caval extension in which preoperative transesophageal echocardiography accurately assessed tumor extent and guided surgical therapy. The role of transesophageal echocardiography in comparison to other diagnostic modalities is discussed.

Aged↗
PubMedDate not supplied

Long-term follow-up of mitral paraprosthetic regurgitation by transesophageal echocardiography.

Paravalvular regurgitation (PVR) is an uncommon complication of mitral valve replacement (MVR). Although severe PVR is almost always repaired immediately when recognized during surgery, there are little data available on the management of patients with mild and moderate PVR. This study includes eight patients with mild (n = 6) and moderate (n = 2) PVR identified by transesophageal echocardiography at the time of MVR who were treated conservatively. Clinical and echocardiographic follow-up was obtained at a mean of 16.3 months. Two of six patients with mild PVR at the time of MVR and two of two patients with moderate PVR at the time of MVR deteriorated clinically and echocardiographically over time. We suggest that moderate PVR should be corrected at the time of valve-replacement surgery, if this can be performed without high operative risk. Mild PVR should probably also be repaired, if this can be performed at low risk, because some will progress. Patients left with mild PVR after surgery, or patients in whom PVR is recognized only after surgery, should be followed up carefully with serial clinical and echocardiographic examinations.

Echocardiography, Transesophageal↗
PubMedDate not supplied

Flow patterns in dilated cardiomyopathy: a pulsed-wave and color flow Doppler study.

In 48 patients with dilated cardiomyopathy, pulsed-wave and color Doppler examination were performed. In addition, 14 normal patients served as control subjects. Peak inflow velocity at the level of the mitral valve, middle left ventricle, and apex and outflow velocity at the level of the apex, middle left ventricle, and subaortic area were measured. In normal patients there was brisk propagation of inflow velocity to the apex. Patients with dilated cardiomyopathy demonstrated delayed propagation and prolongation of the duration of inflow compared with control subjects (p less than 0.04). Continuous apical flow was visualized in 25% of dilated cardiomyopathies and in no normal patients. Apical velocities were significantly increased in cardiomyopathies with significant mitral regurgitation. Outflow velocities were decreased in dilated cardiomyopathy. In patients with dilated cardiomyopathy and apical dyskinesis, flow directed toward the base was measured in the middle left ventricle during isovolumic relaxation secondary to dyskinetic rebound. Patterns of abnormal flow in dilated cardiomyopathies are readily apparent by color M-mode and two-dimensional color Doppler.

Adult↗
PubMedDate not supplied

Patent foramen ovale: a nonfunctional embryological remnant or a potential cause of significant pathology?

A patent foramen ovale (PFO) is an embryological remnant found in 27% of adults. It is a potential right-to-left intracardiac shunt. Shunting may be the result of reversal in the interatrial pressure gradient or abnormal streaming of blood in the right atrium. The pathologic consequences of right-to-left shunting include hypoxemia and paradoxical embolism. PFO may exacerbate preexisting hypoxemia or be its primary cause. Paradoxical embolism through a PFO is well documented. Its role in cryptogenic stroke remains controversial. A PFO may be detected by both invasive and noninvasive techniques. Contrast transesophageal echocardiography with provocative maneuvers is the diagnostic method of choice allowing visualization of the shunt. Patients with cryptogenic stroke should be screened for a PFO. If detected, noninvasive studies for deep vein thrombosis are recommended. Treatment must be tailored to the presentation. Surgical or transcatheter closure is recommended for hypoxemia. Prevention of venous embolism (air or thrombus) with or without closure of the PFO is recommended for paradoxical embolism.

Heart Septal Defects, Atrial↗
PubMedDate not supplied

Significant mitral regurgitation is protective against left atrial spontaneous echo contrast and thrombus as assessed by transesophageal echocardiography.

This retrospective study examines whether a relationship exists between the severity of mitral regurgitation (MR) and the presence of left atrial spontaneous echo contrast and/or thrombus (SEC/THR) as assessed by transesophageal echocardiography in 427 consecutive patients. Clinical data were evaluated in 316 of these patients. Nine percent of patients with MR < or = 2+ versus < 1% of those with MR > or = 3+ had SEC/THR (p < 0.03). Atrial fibrillation, left ventricular dysfunction, mitral stenosis, and mitral valve prosthesis were demonstrated to be independent positive predictors of left atrial SEC/THR, whereas MR > or = 3+ was an independent negative predictor of SEC/THR. SEC/THR was less common in patients with MR > or = 3+ than in patients with MR < or = 2+ for any given number of independent positive predictors of SEC/THR. This relationship did not hold true in patients with a mechanical mitral prosthetic valve. Clinical data revealed a trend towards a lower prevalence of stroke or transient ischemic attacks in patients with MR > or = 3+. Stroke and transient ischemic attacks were significantly more common in patients with SEC/THR (p < 0.001). We suggest that significant MR may be protective against the formation of left atrial SEC/THR.

Echocardiography↗
PubMedDate not supplied

Superior vena caval thrombosis detected by transesophageal echocardiography.

Three patients with clinical suspicion of bacterial endocarditis, induced by either pacemaker or indwelling catheter, underwent transesophageal echocardiography. High short-axis cuts through the great vessels, however, revealed the presence of superior vena caval thrombus in all three patients. Transesophageal echocardiography is more sensitive in establishing the diagnosis of superior vena caval thrombus than surface echocardiography. Comparison of transesophageal echocardiography with other diagnostic modalities is needed in assessing its overall sensitivity and specificity.

Adult↗