BACKGROUND: Prosthetic valve thrombosis is an uncommon but serious complication. Thrombolytic therapy has recently been proposed as an alternative to surgical methods in treating this condition and is used increasingly. However, the indications for thrombolytic treatment in prosthetic valve thrombosis have not been well defined and differential diagnosis of thrombosis is still difficult. METHODS: Four symptomatic patients with prosthetic valve thrombosis underwent 9 thrombolytic sessions for 7 distinct episodes. Transthoracic or transesophageal echocardiography and cinefluoroscopy were performed and repeated after each thrombolytic session. Urokinase or rt-PA (recombinant tissue-type plasminogen activator) was used and repeated dose was given if necessary. Recurrent thrombosis was treated also either with urokinase or rt-PA. RESULTS: All patients were female and mean age was 38.5 years old. Two valves were in mitral position and the other two were in tricuspid position. The anticoagulation status was inadequate in three patients. The initial success after first dose was 43% (3/7), which increased to 54% (4/7) after repeated thrombolytic therapy. Thrombolytic therapy was failed in three episodes; two thromboses and one ingrowths of pannus. Operations were needed in these cases. No complication was seen. CONCLUSION: Thrombolytic treatment can be used as an alternative to surgical therapy with a low risk of complications. But guideline of thrombolytic therapy for the recurrent thrombosis and education for the patients about the adequate anticoagulation were needed.
Diagnosis, Differential ; Echocardiography, Transesophageal ; Education ; Female ; Humans ; Plasminogen ; Thrombolytic Therapy ; Thrombosis* ; Urokinase-Type Plasminogen Activator

BACKGROUND AND OBJECTIVES: Neurohormonal compensation plays an important role on the pathophysiologic aspects of congestive heart failure (CHF). There is recent clinical evidence that beta blocker is beneficial in selected patients. However, there is little information regarding the effect of beta blocker on elderly patients. MATERIALS AND METHODS: 26 patients of CHF under stable condition by conventional management were selected and were divided into two age subgroup. Group 1 were more than 65 years (n=12) and group 2 were less than 65 years (n=14). From 12.5 to 25 mg/day of carvedilol was given according to the clinical condition. The left ventricular end diastolic dimension (LVEDD), left ventricular end systolic dimension (LVESD), left ventricular volume index (LVVI), ejection fraction (LVEF), E/A ratio and E wave deceleration time (EwDT) of mitral inflow doppler velocity were measured by echocardiographic examination before and 3 months after carvedilol trial. Six-minute walk distance were also measured. RESULTS: Between before and after carvedilol treatment, there were significant decrease of LVVI and sign-ificant increase of EF in group I and group II. The EwDT and 6 minute walk distance of both group were also increased significantly after carvedilol trial. The delta EF of group I is smaller than group II (4.1+/-5.7 vs 9.7+/-10.0, p<0.05). CONCLUSION: When compared to younger patients with CHF, the efficacy of carvedilol on LV function in aged patients was evident. Improved clinical conditions would be expected by using carvedilol in elderly patients with CHF.
Aged* ; Compensation and Redress ; Deceleration ; Echocardiography ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Ventricular Function, Left*

BACKGROUND: Tei index is a Doppler-derived index of combined systolic and diastolic myocardial performance proposed to be a promising noninvasive measurement of overall cardiac function, calculated as the sum of isovolumic contraction (ICT) and isovolumic relaxation times (IRT) divided by ejection time (ET). This study aimed to investigate the effect of changes in preload on Tei index. SUBJECTS AND METHOD: The study population was 10 patients with chronic renal failure who are on regular hemodialysis (HD). They were 3 men and 7 women with a mean age of 45.3+/-12.4 years old. The complete 2-dimensional and Doppler echocardiography including recordings of mitral inflow and left ventricular outflow were performed using HP SONOS 1500 equipment before and after HD. Body weight was measured using electric scale before and after HD. Blood pressure and pulse rate were measured by an automated cuff measurement every 1 hour throughout HD. Hematocrit was monitored noninvasively and continuously using the Crit-Line instrument (In-Line Diagnostics, Riverdale, UT, USA) during HD. RESULTS: There were no significant changes in systolic and diastolic blood pressure, RR interval, left ventricular end-diastolic and end-systolic dimension, left atrial dimension, and left ventricular ejection fraction during HD. The mean body weight loss during HD was 2.1+/-0.65 kg. The percentage of reduction of body weight was 4.1+/-1.56%. Changes in total blood volume at the end of HD were compared with that of baseline -11.79+/-5.51%. The percent change in total blood volume during the HD correlated significantly with the amount of change in body weight (r=0.678, p<0.05) and percent change in body weight (r=0.835, p<0.01), respectively. ICT before HD and at the end of HD were 39+/-13.0, 42+/-24.1 msec (p=NS). IRT before HD and at the end of HD were 76+/-29.1, 95+/-28.5 msec (p<0.01) and , ET before HD and at the end of HD were 317+/-18.1, 289+/-9.0 msec (p<0.01), respectively. Tei index before HD was 0.36+/-0.10, and the index at the end of HD were 0.47+/-0.13 (p<0.001). CONCLUSION: When there is a change in preload during a short period, it seems that the effect of change in preload should be considered when using Tei index to assess ventricular function.
Blood Pressure ; Blood Volume ; Body Weight ; Echocardiography, Doppler ; Female ; Heart Rate ; Hematocrit ; Humans ; Kidney Failure, Chronic ; Male ; Relaxation ; Renal Dialysis ; Stroke Volume ; Ventricular Function

BACKGROUND: Coronary flow reserve (CFR) was defined as the ability to increase coronary blood flow maximally in response to demand. The presence of viable myocardium in an infarcted zone indicates the presence of an intact microvasculature. We hypothesized that coronary flow reserve, which assesses the microcirculation, might be associated with the presence of viable myocardium. METHODS: Thirty seven patients with acute anterior myocardial infarction (mean age 55+/-10, 25 males) were enrolled and abnormal 127 segments were analyzed. Dobutamine stress echocard-iography (5 to 20 g/kg/min) was performed before coronary angiography (6+/-3 days after acute myocardial infarction (AMI)). Coronary flow reserve in infarct-related artery was measured at distal site to lesion immediately after successful angioplasty (7+/-2 days after AMI, with residual stenosis less than 20%) by using intracoronary Doppler flow wire. And follow-up 2-dimentional transthoracic echocardiography was performed in 26 patients during 333+/-161 (range of 109-780) days after acute myocardial infarction. Improvement of wall motion at least one segment by one more grade in dobutamine stress echocardiography was defined as contractile reserve. Viable myocardium was defined as the improvement of wall motion in transthoracic echocardiography during follow-up periods. RESULTS: In 26 patients, viable myocardium was detected in 19 patients (73%) and their mean CFR was 1.74+/-0.42, which was significantly increased than 1.16+/-0.14 of CFR of patients without viable myocardium (p<0.001). The agreement of CFR score and presence of viable myocardium in AMI was excellent when CFR was above 1.3 (Area under the curve was 0.906 in receiver operating characteristic (ROC) curve). Sensitivity and specificity to detect viable myocardium in CFR more than 1.3 were 84% & 85% respectively. CONCLUSION: CFR was increased in patients with viable myocardium, and the cut-off value of CFR more than 1.3 was agreed excellently to detect viable myocardium.
Angioplasty ; Arteries ; Constriction, Pathologic ; Coronary Angiography ; Dobutamine ; Echocardiography ; Echocardiography, Stress ; Follow-Up Studies ; Humans ; Microcirculation ; Microvessels ; Myocardial Infarction* ; Myocardium* ; ROC Curve ; Sensitivity and Specificity

BACKGROUND: Unlike 99mTc-Sestamibi, microbubbles used during myocardial contrast echocardiography (MCE) exist only in the vascular space. Therefore, there may be a difference in the pattern of myocardial perfusion between MCE and 99mTc-Sestamibi Single-Photon Emission Computed Tomography (SPECT) in acute myocardial infarction (AMI). OBJECTIVES: The purpose of this study was to assess myocardial perfusion using MCE with intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin microbubbles (IV MCE), and to compare it with SPECT and MCE with intracoronary injection of sonicated Hexabrix (IC MCE). METHODS: Seventeen patients with AMI (male 13, age 59.5+/-8.8 years, anterior MI 10) underwent IV MCE at 8.1+/-3.7 days after onset. SPECT and IC MCE were also performed at 1.2+/-1.0 days and 2.0+/-1.5 days from IV MCE respectively. Any revascularization procedures were not performed between three studies. Perfusion defect by three methods was scored semiquantitatively as 1 : normal perfusion, 0.5 : moderate defect, and 0 : severe defect at 16 segments of the left ventricle. RESULTS: 1) Perfusion defect in infarction territory was detected in 15 patients with SPECT, 12 patients with IV MCE and 11 patients with IC MCE. 2) Concordance of perfusion score at each segment was 93% between IV MCE and IC MCE, 65% between IV MCE and SPECT, and 64% between IC MCE and SPECT. 3) With IV MCE, perfusion defect was observed in all 32 segments which were considered as having defect (score 0 and 0.5) by IC MCE. However, defect by IV MCE was found only in 31 out of 108 segments considered as having defect by SPECT. CONCLUSION: In the assessment of myocardial perfusion in pts with AMI, IV MCE and IC MCE showed similar results. However, there was some discrepancy in the extent of perfusion defect between MCE studies and SPECT.
Echocardiography ; Glucose ; Heart Ventricles ; Humans ; Infarction ; Infusions, Intravenous ; Ioxaglic Acid ; Microbubbles ; Myocardial Infarction* ; Perfusion* ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

No abstract available.
Echocardiography*

No abstract available.
Aneurysm, False* ; Inferior Wall Myocardial Infarction*

Primary cardiac malignancy is very rare. Angiosarcoma is the most frequent malignant cardiac tumor and associated with a very unfavourable outcome. We report the case of an cardiac angiosarcoma complicated with cardiac tamponade revealed by echocardiography with pericardiocentesis and confirmed histopathologically in a 25 years old man.
Adult ; Cardiac Tamponade* ; Echocardiography ; Heart Neoplasms ; Hemangiosarcoma* ; Humans ; Pericardiocentesis

Primary aortic malignant tumors are extremely rare. When symptomatic, aortic intimal sarcomas give clinical findings secondary to embolic phenomena;they can produce mesenteric ischemia, hypertension, skin necrosis, absence of peripheral pulses. The diagnosis can be suspected radiologically Fibrosarcoma is the most common primary aortic malignancy, but angiosarcoma and leiomyosarcoma may also occur. We experienced a case of intraaortic mass, that was suspected as angiosarcoma, that diagnosed by chest CT, transesophageal echocardiography, aortography, and biopsy.
Aorta ; Aortography ; Biopsy ; Diagnosis ; Echocardiography, Transesophageal ; Fibrosarcoma ; Hemangiosarcoma ; Hypertension ; Ischemia ; Leiomyosarcoma ; Necrosis ; Sarcoma ; Skin ; Tomography, X-Ray Computed

BACKGROUND: Myocardial Doppler imaging has allowed the quantification of regional myocardial motion. The aim of this study was to characterize regional left ventricular systolic and diastolic function by myocardial Doppler imaging (velocity and deformation) in patients with normal, concentric hypertrophy due to hypertension and hypertrophic cardiomyopathy (HCM). METHOD: In forty-five patients (normal 15, concentric hypertrophy 15, HCM 15), we assessed the time velocity integral (systolic, early and late diastolic), systolic strain and strain rate (SR) (systolic, early and late diastolic) at apical 4 chamber view (basal septum, mid-septum, apical setum, apex, apico-lateral, mid-lateral, and basal lateral wall). RESULT: The mean interventricular septal dimensions of normal, concentric hypertrophy and HCM were 0.96 cm, 1.31 cm and 1.73 cm, respectively (p<001). Patients with HCM reduced peak systolic strain, systolic SR, early diastolic SR and late diastolic SR at mid-septum (-0.58%, -0.92/sec, 0.37/sec, 1.06/sec, respectively) compared with that in normal and concentric hypertrophy (-20.27%, -1.71/sec, 1.58/sec, 1.94/sec, p<0.01and -14.37%, -1.01/sec, 1.31/sec, 1.73/ sec, p<0.01). In the patients with HCM, peak systolic strain in mid-septum (-0.58%) was significantly less than that in the basal, and apical septum and apical, mid, and basal lateral wall (-14.21%, -18.47%, -8.81%, -9.00%, -8.58%, respectively, p<0.05). In the concentric hypertrophy group, the average peak systolic strain of septal and lateral wall (-16.88%, -5.82%) were reduced compared with that in normal group (-2119%, -14.40%, respectively, p<0.05). The interventricular septal dimension was significant correlation between mid-septal systolic strain, systolic SR, early diastolic SR, and late diastolic SR (r=0.707 p<0.01, r=0689 p< 0.01, r=-0.687 p<0.01, r=-0.554 p<0.01) in all 45 patients. CONCLUSION: Hypertrophied myocardium had abnormality of myocardium deformation related to the degree of hypertrophy. Myocardial Doppler imaging offer a approach to quantify regional systolic and diastolic dysfunction.
Cardiomyopathies ; Cardiomyopathy, Hypertrophic ; Humans ; Hypertension ; Hypertrophy* ; Myocardium