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At least 1,369 records · Page 76Linked to original sources
PubMed1989

A quantitative comparison of transesophageal and epicardial color Doppler echocardiography in the intraoperative assessment of mitral regurgitation.

Epicardial and transesophageal color Doppler echocardiography are both widely used for the intraoperative assessment of mitral regurgitation (MR); however, it has not been established whether grading of regurgitation is comparable when evaluated by these 2 techniques. MR jet size was quantitatively compared in 29 hemodynamically and temporally matched open-chest epicardial and transesophageal color Doppler echocardiography studies from 22 patients (18 with native and 4 with porcine mitral valves) scheduled to undergo mitral valve repair or replacement. Jet area, jet length and left atrial area were analyzed. Comparison of jet area measurements as assessed by epicardial and transesophageal color flow mapping revealed an excellent correlation between the techniques (r = 0.95, p less than 0.001). Epicardial and transesophageal jet length measurements were also similar (r = 0.77, p less than 0.001). Left atrial area could not be measured in 18 transesophageal studies (62%) due to foreshortening, and in 5 epicardial studies (17%) due to poor image resolution. Acoustic interference with left atrial and color flow mapping signals was noted in all patients with mitral valve prostheses when imaged by epicardial echocardiography, but this did not occur with transesophageal imaging. Thus, in patients undergoing valve repair or replacement, transesophageal and epicardial color flow mapping provide similar quantitative assessment of MR jet size. Jet area to left atrial area ratios have limited applicability in transesophageal color flow mapping, due to foreshortening of the left atrial borders in transesophageal views. Transesophageal color flow mapping may be especially useful in assessing dysfunctional mitral prostheses due to the lack of left atrial acoustic interference.

Adult↗
PubMed2004

Casting alloys.

Although the role of dental casting alloys has changed in recent years with the development of improved all-ceramic materials and resin-based composites, alloys will likely continue to be critical assets in the treatment of missing and severely damaged teeth. Alloy shave physical, chemical, and biologic properties that exceed other classes of materials. The selection of the appropriate dental casting alloy is paramount to the long-term success of dental prostheses,and the selection process has become complex with the development of many new alloys. However, this selection process is manageable if the practitioner focuses on the appropriate physical and biologic properties, such as tensile strength, modulus of elasticity,corrosion, and biocompatibility, and avoids dwelling on the less important properties of alloy color and short-term cost. The appropriate selection of an alloy helps to ensure a longer-lasting restoration and better oral health for the patient.

Biocompatible Materials↗
PubMed1992

[Assessment of blood flow in hart and large vessels using Doppler color flow mapping].

Two-dimensional echocardiography allows the noninvasive assessment of the morphology and the movement of cardiac structures, including valves and ventricular walls. Color Doppler flow imaging presents a spatial visualization of blood flow, superimposed on two-dimensional echocardiographic images. The color indicates the direction of flow. Turbulent flow is readily identified by the 'mosaic pattern' of the color flow signal. The method facilitates the detection and localization of obstruction to flow, valvular regurgitation or a shunt.

Blood Flow Velocity↗
PubMedDate not supplied

Contrast-enhanced ultrasound in detection and follow-up of an infrarenal abdominal aortic aneurysm with aorto-caval fistula and endovascular treatment.

An aorto-caval fistula is a rare complication of a symptomatic or ruptured infrarenal aortic aneurysm having a frequency of 3-6%. Patients typically present with clinical signs of diffuse abdominal pain associated with increasing venous congestion and tachycardia, rapid cardiopulmonary decompensation with acute dyspnea, and an audible machinerylike bruit. Perioperative mortality is high, ranging from 20% to 60%. We report a case of an endovascular aortic repair in a patient with a symptomatic infrarenal aortic aneurysm and an aorto-caval fistula. Contrast-enhanced ultrasound seems to be a promising new diagnostic option for the diagnosis and preoperative treatment planning for patients with abdominal aortic aneurysms with rupture into the inferior vena cava. It is in addition to computed tomography angiography. It might allow a more rapid and noninvasive diagnosis, especially for patients in intensive care because of its bedside availability. Because the examination is dynamic, additional information about blood flow between the aorta and inferior cava vein can be evaluated.

Angioplasty↗
PubMed1999

Eversion endarterectomy versus open thromboendarterectomy and patch plasty for the treatment of internal carotid artery stenosis.

OBJECTIVE: in 1996 we changed our treatment for stenosis of the internal carotid artery (ICA) from open thromboendarterectomy and PTFE-patch plasty (TEA) to eversion endarterectomy (EEA). DESIGN: retrospective study. METHODS: a total of 475 EEAs of the ICA were performed between 2/96 and 11/96. These results were compared to the results of TEA carried out between 2/94 and 11/94 (n=388). RESULTS: clamping and operation time were significantly shorter for EEA. Neurological complications included transient ischaemic attacks in 1. 0% in the EEA group versus 1.3% after TEA (p=0.72), minor strokes (0. 6% vs. 1.8%, p=0.10) and major strokes in 1.5% versus 1.1% (p=0.59). The rate of restenosis >50% was 2.5% after EEA and 10.2% after TEA. The only detectable difference of statistical significance in complication rates was in the lesions of the hypoglossal nerve (5.3% vs. 2.6%, p=0.04). CONCLUSIONS: EEA of the ICA is a safe procedure for carotid reconstruction with the additional advantages of short clamping time, possibility of simultaneous shortening of an elongated ICA, and no requirement for patching.

Adult↗
PubMedDate not supplied

[Aneurysms of the visceral arteries: report of 5 cases].

Visceral artery aneurysms are uncommon and usually result from atherosclerosis, periarteritis nodosa and fibromuscular dysplasia. Hepatic artery aneurysms were detected in two patient, splenic artery aneurysms in three. In four patients rupture occurred. In the two patients with hepatic artery aneurysm hemobilia from arterial rupture into the common bile duct and intraperitoneal bleeding in lesser sac was assessed. Ruptured aneurysms of the splenic artery with free intraperitoneal bleeding occurred in two patients, one patient had an asymptomatic splenic artery aneurysm. In four patients the diagnosis was made by contrast-TC and/or celiac and mesenteric angiography. In four patients excision of the aneurysm was successfully performed. One patient with ruptured hepatic artery aneurysm and in which resection and revascularization was made died.

Adult↗
PubMed2003

[Portable echocardiographs: useful or futile?].

Echocardiographic systems which are the size of a laptop computer are currently available. These hand-held ultrasound units are very easy to use at patient bedside in various clinical settings. According to the miniaturized devices, spectral Doppler may not be available and power Doppler may replace true color Doppler. Validation studies of hand-held echocardiography have been conducted in critically ill patients, in patients hospitalized in ward, but also in outpatients and as a screening tool for the detection of cardiac abnormalities in the community. Hand-held echocardiography appears to have important limitations in specific clinical settings, such as shock, pulmonary hypertension, assessment of valvulopathy or valvular prosthesis, dynamic left outflow tract obstruction, left ventricular restriction or construction. The miniaturized system with spectral Doppler capability has not yet been properly validated in these indications. At its present stage of development, hand-carried ultrasound units do not allow to perform a comprehensive examination which relies on the use of a full-feature system, especially when a precise hemodynamic evaluation is required. Diagnostic ability of hand-held echocardiography is similar to that of upper-end platforms for diagnoses based on two-dimensional imaging: left ventricular systolic function, detection of wall motion abnormalities, size of cardiac chambers, identification of pericardial or pleural effusions. Hand-carried ultrasound devices may be considered as a "visual stethoscope" which provides an extension of the physical examination, but not as a potential alternative to standard transthoracic echocardiography. Its large potential clinical field of use raises the concern of taylored training programs to intensivists which could be focused on goal-directed echocardiographic examinations.

Clinical Trials as Topic↗
PubMed2006

Safety and efficacy of carotid angioplasty and stenting in high-risk patients.

Performance of carotid endarterectomy (CEA) may be associated with an increased risk in patients with significant comorbid medical conditions, neck irradiation, or previous CEA. This study compared the results of CEA with carotid angioplasty and stenting (CAS) in high-risk patients treated for carotid stenosis. Five hundred forty-five patients who underwent CEA and 148 patients who underwent CAS were evaluated. For patients undergoing CEA, general anesthesia was used in 91 per cent, electroencephalographic monitoring was used in 63 per cent, and shunting was performed in 19.8 per cent. Cerebral protection devices were used in 145/148 of CAS cases, and self-expanding stents were used in all cases. Evaluated end points included major cardiovascular events, and a composite of death, stroke, or myocardial infarction for the duration of the follow-up. Mean follow-up was 18 months for CAS and 23 months for CEA. Significant differences were present in patient age (CAS, 75 +/- 11.0 years vs CEA, 71 +/- 9 years, P = 0.012), however, there were no significant differences (P = NS) in gender or smoking history. The mean modified Goldman Score was significantly higher for CAS (21.1 +/- 14.8 [95% confidence interval = 18, 24]) than for CEA (6.3 +/- 6.8 [95% confidence interval = 5.7, 6.9]; P = 0.0001) patients. The incidence of periprocedural complications did not vary significantly between patients treated with CAS (CVA, 1.4%; myocardial infarction [MI], 1.4%; death, 0.7%; CVA/MI/death, 3.4%) compared with CEA (CVA, 1.8%; MI, 1.1%; death, 0.4%; CVA/MI/death, 4.0%). CAS is equivalent to CEA in safety and efficacy, even when performed in patients who may be at increased surgical risk.

Age Factors↗
PubMed1994

Flow reversal in the descending aorta: a guide to intraoperative assessment of aortic regurgitation with transesophageal echocardiography.

This study assessed the value of biplane transesophageal echocardiographic assessment of diastolic flow reversal in the descending aorta as an alternative to Doppler color flow imaging in determining severity of aortic regurgitation. In 45 patients undergoing cardiac operations, the severity of aortic regurgitation was assessed by semiquantitative grading of the width of the Doppler color flow regurgitant jet relative to the left ventricular outflow tract, and the presence of diastolic flow reversal was assessed with pulsed-wave Doppler measurements at three sites in the descending aorta. In four patients, the diastolic flow reversal method was the only available form of assessment because of inadequate visualization of the left ventricular outflow tract beneath a mitral valve prosthesis. Diastolic flow reversal in the descending aorta was not observed in patients without aortic regurgitation and was always present in patients with severe aortic regurgitation. Aortic valve replacement successfully eliminated descending aortic flow reversal in all 19 patients in whom it was present before valve replacement. Identification of diastolic flow reversal at multiple sites in the descending aorta with biplane transesophageal echocardiography helps to confirm the presence of severe aortic regurgitation and can serve as an alternative method of assessment when visualization of the left ventricular outflow tract is impaired.

Aged↗
PubMed1993

Bioprosthesis replacement with mechanical valve implantation on the bioprosthetic ring. Surgical and 2D echo considerations.

Removal of a failing bioprosthesis can be a delicate operation and extensive damage can be caused. Eighteen patients with failing bioprostheses underwent excision of the leaflets, then the "new" mechanical valve was sewn onto the "old" bioprosthetic ring. At follow-up, clinical and 2D color-flow echo-Doppler evaluations showed good hemodynamic performance of the mechanical valves.

Adult↗
PubMedDate not supplied

Regurgitant flow in apparently normal valve prostheses: improved detection and semiquantitative analysis by transesophageal two-dimensional color-coded Doppler echocardiography.

In 128 patients with apparently normally functioning prosthetic valves (n = 136) in the aortic position (n = 79) and the mitral position (n = 57), the prevalence of transprosthetic regurgitant flow was studied by use of transthoracic and transesophageal two-dimensional color-coded Doppler echocardiography. With the transthoracic approach, regurgitant flow was detected in early systole or diastole for 28% of the mitral prostheses and for 29% of the aortic prostheses. With transesophageal color-coded Doppler echocardiography, regurgitant jets were visualized for 95% of the mitral prostheses and for 44% of the aortic prostheses. In 40% of the Björk-Shiley prostheses and 88% of the St. Jude Medical prostheses in the mitral position, more than one jet with an eccentric origin was detected, whereas in bioprostheses only one centrally localized regurgitant jet was noted. The regurgitant jet length was 22 +/- 2 mm in mitral prostheses and 12 +/- 2 mm in aortic prostheses. The jet area was 154 +/- 31 mm2 in mitral prostheses and 61 +/- 26 mm2 in aortic prostheses. Jets of this size and frequency have to be considered a normal finding and the equivalent of regurgitant flow known from in vitro studies. We conclude that only transesophageal color-coded Doppler echocardiography seems to be a reliable method for following up mitral valve prostheses to detect and differentiate regurgitant jets. For aortic valve prostheses the advantage of transesophageal color-coded Doppler echocardiography does not seem to be as obvious as the advantage for mitral prostheses.

Adolescent↗
PubMed1990

Impact of transesophageal color flow Doppler echocardiography in current cardiology practice.

Of 3,480 patients who were referred for cardiac ultrasound evaluation, 230 patients (6.6%) underwent transesophageal echocardiography because the transthoracic study was not feasible, technically inadequate, or provided insufficient diagnostic information for optimal patient management. There were 149 inpatients and 81 outpatients. The majority (182 patients, 79%) had aortic or mitral disorders. In 166 patients (72%), transesophageal echocardiography played a significant role in patient management. Transesophageal echocardiography was most useful in evaluating diseases of the aorta (dissection, root abscess, or aneurysm), mitral prosthesis, complications of endocarditis, left atrial appendage thrombi, and in determining the cause of mitral insufficiency. Transesophageal echocardiography was useful in the evaluation of critically ill patients and those with severe lung disease.

Adolescent↗
PubMed1999

[Two years clinical observation of a kind of castable ceramic--IPS Empress].

UNLABELLED: We used this material in clinic since 1995. OBJECTIVE: Discussion on the prosthetic effects of the above-mentioned material to spreat it clinically. METHODS: Through half to two years clinical observations to evaluate the effect of IPS Empress crowns in anterior teeth and inlays in posteriors. RESULTS: and CONCLUSION: Prosthesis made of this kind of material IPS Empress is one kind of excellent all-ceramic prosthetic material. IPS Empress also could be used in post crowns and the clinical effect was satisfactory.

Adult↗
PubMed1995

Porcine stentless aortic valve in re-replacements and acute aortic valve endocarditis.

Between June 1990 and June 1993, 135 patients received a porcine stentless aortic valve (PSAV) at our institution. In this group, there were 33 patients in whom the stentless valve was used to replace a previously inserted malfunctioning aortic valve prosthesis (n = 19) or to treat acute aortic valve endocarditis (n = 14, five native, nine prosthetic endocarditis). There was one hospital death caused by multiple organ failure in a patient with endocarditis and preoperative cerebral stroke. Two patients died after hospital discharge; one suffered sudden death following a pacemaker failure four month after surgery and the other died due to Candida albicans sepsis after a prolonged antibiotic treatment. There were two reoperations; one to correct a dehiscence of the proximal suture line and the other to replace a degenerated valve 3.5 years after implantation in a 14 year old boy. All operative survivors were followed clinically with serial color Doppler echocardiography. No recurrence of endocarditis was detected. Aortic root reconstruction was achieved even in the presence of multiple abscesses. All but one patients showed a normally functioning valve with none or minimal aortic insufficiency. In our opinion the PSAV is an excellent aortic valve substitute for patients with damaged aortic annulus, because it promotes aortic root remodeling, decreases the incidence of postoperative paravalvular leaks and helps to prevent endocarditis recurrence.

Acute Disease↗
PubMed1991

Transcatheter occlusion of the persistently patent ductus arteriosus. Forty-month follow-up and prevalence of residual shunting.

BACKGROUND: Percutaneous closure of the persistently patent ductus arteriosus with the Rashkind prosthesis is an established effective therapeutic modality, although some patients are left with residual shunting. To evaluate this, a retrospective study of the prevalence of persistent shunting over a 40-month period in the first 190 patients was undertaken. METHODS AND RESULTS: All patients (male 45, female 145; mean age, 3.9 +/- 3.6 years; range, 5 months to 20 years) had serial clinical and color-flow echocardiographic follow-up at 6-12-month intervals (range, 6-40 months). Four patients required surgical removal of an embolized device, leaving a cohort of 186 patients in whom 196 procedures were performed, resulting in successful placement of 195 devices (43 17-mm [22%] and 152 12-mm [78%]). Complications occurred in seven of 195 procedures (3.6%). Nine of 10 attempted reocclusions (all with 12-mm devices) were successful. The prevalence of residual shunting was 38% at 1 year, 18% at 2 years, and 8% at 40 months. Patients with ductus measuring less than 4 mm had a higher success of initial occlusion. Thirty-four patients were left with residual shunting determined by color-flow Doppler study, but no anatomic or echocardiographic features were found predictive for residual shunting. All remain asymptomatic with 26 (76%) having no detectable murmur, two (6%) a continuous murmur, and six (18%) a systolic murmur. CONCLUSIONS: Catheter occlusion will obviate the need for surgery in the majority of patients presenting with persistently patent ductus arteriosus. Reocclusion has been found feasible in those with continuous murmurs (nine of nine) and should be offered early because it is unlikely for spontaneous closure to occur in this group. It appears prudent to follow those with small residual shunting because further spontaneous closure can occur.

Adolescent↗
PubMed1990

[Augmentation mammoplasty and an improved method of silastic gel breast prosthesis implantation through an areolar incision].

"Flat chest" of a woman due to under development of the breast is not a rare deformity. This deformity is best treated with augmentation mammoplasty. Currently, silastic gel breast prosthesis implantation is the most commonly used operation. There are three methods to carry out this operation, Viz the inframammary incision method, the axillary incision method and the areolar incision method. The last method is not often used because it has many drawbacks. Nevertheless, it has one unique advantage that is the incision scar is not vivid and can be camouflaged by the dark color of the areolar skin and the roughness of the Montgomery's glands. The improved method of this paper can avoid the various drawbacks and retain the advantage.

Breast↗
PubMedDate not supplied

Transesophageal echocardiography: detection of an acquired left ventricular-right atrial shunt.

Communication between the left ventricle and right atrium has a reported prevalence of less than 1%. Acquired left ventricular--right atrial shunt is caused by chest trauma or valvular surgery. A case of acquired left ventricular--right atrial shunt after aortic valve surgery is reported. The detection was possible by use of echo-Doppler, color flow imaging, and transesophageal echocardiography. Combined use of these modalities and multiple transducer positions when transthoracic echocardiography is used are recommended to make the diagnosis.

Aortic Valve↗
PubMed2001

Treatment behavior and complete-mouth rehabilitation using AGC crowns: a case report.

This case report covers the combined functional and perioprosthetic complete-mouth rehabilitation of a 67-year-old patient with severe temporomandibular joint pain caused by a prognathic forced incorrect centric relation and severe overclosure. Once bite guard treatment had been concluded and the pain had subsided completely, AGC electroformed crown and bridgework was fabricated. Electroformed crown-and-bridge copings exhibit extremely high precision of fit and, from the clinical point of view, perfect esthetics. As the coping material is pure gold and there are no bonding oxides in the gold-porcelain bonding layer, AGC restorations are readily integrated into the biologic structures around the crown margins. Perfectly healthy, noninflamed soft tissues, a lack of bluish-livid colored gingival margins, and visible gingival reattachment around the crown margins are considerable benefits from the perioprosthetic point of view. This leads to foreseeable clinical success and promises further use of electroformed porcelain restorations.

Aged↗