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Biomedical subjects

Z Vered

Publications and source records attributed to Z Vered.

At least 91 records · Page 5Linked to original sources
PubMed1985

Mitral valve prolapse. Quantitative analysis and long-term follow-up.

Forty-two patients with systolic posterior motion of the mitral valve on M-mode echocardiogram were reevaluated after a mean clinical follow-up of 6.7 years and an echocardiographic follow-up of 5.1 years. A new method for quantitation of mitral valve prolapse (MVP) is presented. A straight line (A) was drawn connecting the site of posterior leaflet motion with the D point of the subsequent diastole. A vertical line (B), termed "the degree of MVP," was drawn from the site of maximal MVP to line A. The degree of MVP was then correlated with various clinical and ECG parameters and with the presence of complications. Measurements could be taken in 21 patients; the mean degree of MVP increased from 5.9 +/- 2.1 to 7.1 +/- 2.9 mm (P less than 0.01), and mean left atrial size increased from 3.0 +/- 0.5 to 3.5 +/- 0.8 cm (P less than 0.01). No correlation was found between the degree of MVP and symptoms, auscultatory findings or the presence of complications. There were no deaths and in none was life-threatening arrhythmia documented. The complications we encountered were endocarditis in five patients, transient ischemic attacks in two and cardiac arrest during surgery in one. We conclude that 1) the degree of MVP can be measured by M-mode echocardiography; 2) there seems to be no correlation between the degree of MVP and the patient's clinical state; 3) complications in MVP are rather frequent; and 4) left atrial size and degree of MVP tend to increase with time, which may indicate a progressive nature of the disease.

Adolescent↗
PubMed1984

Two-dimensional echocardiography in discrete subaortic stenosis.

Thirty-seven patients with discrete subaortic stenosis (DSS) underwent 2-dimensional echocardiography (2-D echo) and cardiac catheterization. The peak systolic pressure gradients ranged from 0 to 150 mm Hg. Thirty-two patients had membranous DSS and 5 had fibromuscular DSS. Of 37 patients with DSS, 2-D echo diagnosed the presence and type in 35; in 2, a membrane was demonstrated by angiography. Of the 35 patients accurately diagnosed by 2-D echo, angiography corroborated the diagnosis in 33, but failed to show the membrane in 2. Subsequent cardiac surgery confirmed the accuracy of the echocardiographic diagnosis in these 2 patients. In all patients with membranous DSS, the anterior insertion of the membrane was demonstrated. In 9 of them the posterior insertion was demonstrated by tilt of the transducer but the anterior insertion disappeared. In 4 patients both insertions were demonstrated simultaneously and in 3 patients the membrane was demonstrated as a continuous line. In 4 of the 5 patients with fibromuscular DSS, both insertions of the lesion were demonstrated simultaneously. However, 2-D echo was unsuccessful in assessing the severity of obstruction. In only 1 patient did demonstration of the whole subaortic membrane as a continuous line below the aortic valve correlate with severe obstruction. Thus, the presence and type of DSS, but not the degree and severity, can be accurately and reliably diagnosed by means of 2-D echo.

Adolescent↗
PubMed1984

Diagnosis of pulmonic regurgitation by contrast echocardiography.

In order to determine whether pulmonic regurgitation (PR) can be reliably diagnosed using contrast echocardiography, we studied 24 subjects using echocardiography during intravenous injections of 5% dextrose solution. Twelve were without PR, and twelve had PR (10 after intracardiac repair of tetralogy of Fallot, one after a Brock procedure for pulmonic stenosis, and one after insertion of a right ventricle-pulmonary artery conduit for pseudo truncus arteriosus). Two blinded independent observers correctly diagnosed PR in all patients when it was present, and correctly excluded it in 11 of 12 of the patients without PR. They disagreed in one patient who had an unusual contrast pattern during diastole. Four postoperative patients had PR by contrast echocardiography despite the absence of a cardiac murmur at the time of their study. We conclude that contrast echocardiography is a safe, simple, sensitive, and specific method for diagnosing PR. Some methodologic suggestions and limitations of the method are discussed.

Adolescent↗
PubMed1983

Diagnosing tricuspid regurgitation by direct imaging of the regurgitant flow in the right atrium using contrast echocardiography.

To determine whether tricuspid regurgitation (TR) can be diagnosed by direct imaging of regurgitant flow in the right atrium (RA) using contrast echocardiography, echocardiography was performed in 35 patients using peripheral intravenous injections of 5% dextrose solution. Fifteen patients had TR judged by v-wave synchronous contrast appearance on the inferior vena cava echogram (a previously validated method for diagnosing TR), 5 of whom had clinically obvious TR. Twenty patients had no TR on inferior vena cava contrast echocardiography, 9 of whom were normal volunteers. On subsequent blind review, 13 of the 15 patients with TR were correctly identified on the basis of the regurgitant contrast flow just posterior to the tricuspid valve in the RA. Of the 20 without TR, 19 were correctly identified and there was 1 false-positive result. Using different criteria for the diagnosis (insisting on imaging of flow across the tricuspid valve in systole), another blinded observer correctly diagnosed only 8 of the 15 patients as having TR, but had no false-positive results. To avoid false-positive results, it is important to realize that there are 2 regions where retrograde flow can normally be seen in the RA: (1) briefly at the onset of systole coincident with tricuspid valve closure, and (2) in the posterior RA, as distinct from the anterior RA area just behind the tricuspid valve where TR is diagnosed in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Systematic analysis of contrast echocardiograms.

Contrast echocardiography was first described in 1968. Since then, many reports have described clinical and experimental uses for the technique. Contrast echocardiography is performed at least occasionally in most echocardiography laboratories, but most physicians use this technique merely to determine the presence of a shunt or, more rarely, for structure identification. Contrast echocardiography can provide much more information. Some different types of information available from contrast echocardiographic records are discussed, including timing of contrast appearance within the cardiac cycle, relative timing of appearance in different cardiac structures, relative intensity of contrast opacification, cyclical changes in contrast opacification, negative contrast effect, slope of contrast trajectories on M-mode contrast echocardiography, and clearance times.

Contrast Media↗
PubMed1983

Correlation between echocardiography and cardiac catheterization in assessing the severity of aortic stenosis.

The severity of aortic stenosis was assessed by echocardiography in 81 consecutive adult patients, 40 of whom underwent cardiac catheterization. The patients' mean age was 54 +/- 16.4 years. A good correlation was found between the severity of aortic stenosis assessed by cross-sectional echocardiography and cardiac catheterization. Aortic valve separation of 7 mm or less occurred only in severe aortic stenosis whereas a separation of 12 mm ruled out any significant aortic stenosis. A separation of 8-11 mm constituted a 'grey' area between mild and severe aortic stenosis. Cross-sectional echocardiography provides a reliable method for crude evaluation of aortic stenosis.

Adolescent↗
PubMed1979

Steady-state serum quinidine concentration: role in prophylactic therapy following acute myocardial infarction.

Steady-state serum quinidine concentrations were monitored in 24 patients with acute myocardial infarction who were on a 1,300-mg daily dosing regimen. Mean serum concentrations spanned the therapeutic range, from 2 to 6 microgram/ml in 21 patients. In no patient was the level of 7 microgram/ml exceeded. Mean levels were similar in patients with congestive heart failure [3.6 +/- 1.5 (SD) microgram/ml] as in those free of failure (3.2 +/- 1.3 microgram/ml), and did not vary with impairment of renal function. There was a significant correlation between mean individual serum quinidine concentrations and the rate-normalized QT interval prolongation (r = 0.54, P less than 0.01); however, variability of the response was high. Variability of the mean serum quinidine levels among individuals was 41%. Variability within individual patients was only 18%. In the individual patient receiving prophylactic oral quinidine therapy, monitoring serum quinidine levels appears to be an accurate, reproducible and pharmacologically significant guideline to therapy.

Adult↗
PubMedDate not supplied

Ruptured interventricular septum after blunt chest trauma: ultrasonographic diagnosis.

A 6-year-old child was found under a heavy bookcase that compressed her chest. On admission to the emergency room she was found to be dyspneic with a systolic murmur and complete atrioventricular (A-V) block. Her condition deteriorated rapidly, leading to cardiogenic shock and loss of consciousness. Echocardiographic Doppler evaluation demonstrated a large ventricular septal defect and tricuspid insufficiency. A pericardial patch was put over the tear in the septum, and torn chordae tendinae were reimplanted to the papillary muscles. A pacemaker was inserted. Her situation improved, but on the third day cardiogenic shock and right ventricular dysfunction ensued and the patient expired. A review of the previous 13 cases from the pediatric literature is presented.

Child↗
PubMedDate not supplied

Failure of transesophageal echocardiography to visualize a large mitral prosthesis vegetation detected solely by transthoracic echocardiography.

Transesophageal echocardiography yields a highly accurate diagnosis in the detection of valvular vegetations. We describe a case in which omniplane transesophageal echocardiography failed to demonstrate a large vegetation protruding from a Starr-Edwards mitral prosthesis, toward the left ventricular outflow tract. The vegetation could be detected solely by transthoracic echocardiography.

Echocardiography↗