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M mode echocardiogram of the coronary artery
ABSTRACTS
COMPARISON OF FOUR TWO-DIMENSIONAL ECHOCARDIOGRAPHIC VIEWS FOR MEASURING LEFT ATRIAL SIZE S.E Sohabelman, MD; N.B. Sohiller, MD, FACC: R.A. Anschuetz, MD; N.H. Silverman, MD, FACC; S.A. Glantz,PhD, University of California, San Francisco, Ca. The left atria of 60 patients were examined by M-mode and by wide angle two-dimensional echographic techniques to establish normal values for 7 end-systolic axes obtained from 4 tomographic projections and to compare these measurements with M-mode (DM). Nineteen patients were normal (NL), 21 had cardiomyopathy (CM), and 20 had mitral valve disease (MVD) diagnosed clinically, echocardiograpb ically and, in 14, hemodynamically. The projections were the long and short axes, via precordial win&w and the right anterior oblique and hemiaxial equivalents (RAO-E & REM-E) from the apex. The left atria1 diameters are shown below. The maaaurements in mm were: Dl D2 D3 D4 DS D6 D7 IX4 NL(meanfSD) 25?4 34f4 3624 26f4 33f5 33f6 35k.627f4 CM 32*8 43f9 41t6 34i5 40f9 39f7 43t8 38f5 MVD 39i9 SO*9 55f9 4329 45f8 49i8 53*9 5Oi9 All dimensions correlated significantly with each other; in particular, the correlations with M-mode ware between We mnclude that linear measurements .82 and .86(pCOOl). of left atria1 size from four project5ons were closely correlated with M-mode through a range of atria1 size and with each other. These findings suggest that the left atrium enlarges in all ares and that it can be adequately umplop evaluated with any obtainable proiec$&!.
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M MODE ECHOCARDIOGRAMOF THE CORONARY ARTERY Kiyoshi lnoue MD; Kaiichi Kuwaki MD; Keiko Ueda MD; Tetsuro Shirai MD; Toshinori Utsunomiya MS, Cardiovascular Center, Tokyo Metropolitan Police Hospital, Tokyo, Japan. The clinical applicability of a new method for recording M mode display of the origin of left main coronary artery (LMCA), developed in our laboratory, was evaluated with verifing its identity by visualizing catheter and contrast media and with observing changes in the diameter of LMCA follwoing sublingual nitroglycerin (NTG) administration in 21 patients having coronary artery disease undergoing coronary angiography. Using Toshiba model SSL-53H real time cross sectional linear scanner and placing the probe of 85 mm in length along cardiac long axis, simultaneous cross sectional picture of out flow tracts of two ventricles, pulmonic valve (PV), aortic valve (AV) and sinus of valsalva (SV) was obtained. BY turninq the probe toward short axial direction holding.SV as the center of the probe, LMCA was observed for the length from 5 to 20 mm. The M mode of LMCA was obtained by selecting beam on the line of LMCA. The two walls of LMCA were seen as two parallel echoes in the M mode display and the picture was much clearer than cross sectional. The catheter inserted and the dye injected into LMCA was visualized. NTG administration changed the diameter of LMCA for 1.5 to 3 times as wide of control. Using standared echocardiography and probe, the recordings of M mode display were repeatedat the bed side in all patients. By appling standared probe at 2nd left interspace, projecting it to the PV direction, and shifting slightly to AV, clear parallel echoes of two walls of LMCA were obtained in all cases. NTG administration changed the diameter of LHCA from 1.1 to 3.8 time as wide. M mode display of the LMCA are easy to record and the picture are clearer than those of cross sectional.
BIPLANE MEASUREMENTS OF LEFT AND RIGHT VENTRICULARVOLUMES USING WIDE ANGLE CROSS-SECTIONAL ECHOCARDIOGRAPHY. Khalid R. Chaudry, ND, Satoshi Ogawa, MD, Ferrel J. Pauletto,MD, FACC, Francis E. Hubbard, MD, Leonard 5. Dreifus, MD, FACC, Lankenau Hospital, Philadelphia, Pa. Forty-seven patients (pts) undergoing left ventricular (LV) single-plane cineangiography were studied with a phased array 84' sector scanner. LV and right ventricular (RV) volumes (V) were measured from biplane images of cross-sectional echocardiography (Echo). (1) A major LV axis (L) was obtained with an apex Echo view (an image equivalent to an angiographic right anterior oblique view) and two minor axes (antero-posterior, Dl, and lateral D2) were obtained on a short axis view of LV at the level of the mitral valve tip. The LV-V was calculated at end-dias tale (EDV) and end-systole (ESV) by: V=4/3n(L/2) (Dl/2) (D2/2). (2) The RV-V was given by the formula for a pyramid with a triangular base: V=A x H/3, where A=an area of a triangular base; Heheight of a pyramid. "A" was determined by planimetry on a hemiaxial view obtained by an apex Echo. "H" was measured on a sagittal cross-section view of RV. Results: Technically satisEactory images for LV and RV measurements were obtained in 30 pts including 20 pts with coronary artery disease. Echo-EDV, ESV, stroke volume (SV) and ejection fraction (EF) of LV were correlated significantly with angiographic (Angie) data (r=0.86. 0.91, 0.74 and 0.73) in pts with normal-sized LV as well as large spherical LV. Correlation was shown between Echo RV-SV and Angie LV-SV only when Angio LV-EDV was less than 170 ml (r=0.86 N=9). Echo RV-SV underestimated Angie LV-SV b 16-86 ml. The mean values for RV-SV sr and RV-EF were 41.6-12.7 ml (+SD) and 55.4+11.2%. It is concluded that 1) Echo provided a reliable technique for the biplane determination of LV-V, especially in pts with dilated hearts, and 2) RV measurements were of limited value in evaluating RV performance.
CLINICAL UTILITY OF IDENTIFICATION OF THE RIGHT VENTRICULAR OUTFLOW TRACT, PULMONARY ARTERY AND ITS BIFURCATION BY CONTRAST TWO-DIMENSIONAL ECHOCARDIOGRAPHY Martin Klicpera, MD; Theodore D. Fraker, Jr., MO; Joseph Kisslo., MD:, Duke Universitv Medical Center. Durham. NC. of
Two-dimensional echocardiographic (2DE) examinations the right ventricular outflow tract (RVOT), pulmonary
artery (PA) and its bifurcation (BIF) were obtained using a focused phased-array imaging system in 75 consecutive adult patients (PTS) in order to assess the utility of
this approach for the identification of potential cardiac disorders involving these structures. The ultrasonic technique was combined with several rapid injections of 10 ml. of normal saline into an antecubital vein to intraduce
microcavitations
into
the
right-sided
cardiac
chambers and vessels. Adequate images of the RVOT, PA and BIF along with microcavitations were seen in 58 PTS ,-._",. Pulmonary insufficiency was detected in 2'PTS, compression of the right main stem PA due to tumor was found in 1 PT, dilatation of the PA due to .large left to right shunt was found in 4 PTS, negative contrast enteriq the PA due to a high ventricular septal defect was found in 1 PT. In addition, an abscess involving the area between the right coronary sinus of valsalva and the proximal pulmonary artery due to bacterial endocarditis could be identified. These data indicate that: (1) adequate images of the RVOT, PA and BIF could be obtained using contrast 2DE, (2) useful clinical information concerning several types of cardiac disorders involving these structures can be obtained using this method and (3) further studies are indicated to investigate the specific applicability of this approach for evaluation of intrinsic or extrinsic abnormalities of the RVOT, PA and its branches.
February 1978
The American Journal of CARDIOLOGY
Volume 41
391
COMPARISON OF FOUR TWO-DIMENSIONAL ECHOCARDIOGRAPHIC VIEWS FOR MEASURING LEFT ATRIAL SIZE S.E Sohabelman, MD; N.B. Sohiller, MD, FACC: R.A. Anschuetz, MD; N.H. Silverman, MD, FACC; S.A. Glantz,PhD, University of California, San Francisco, Ca. The left atria of 60 patients were examined by M-mode and by wide angle two-dimensional echographic techniques to establish normal values for 7 end-systolic axes obtained from 4 tomographic projections and to compare these measurements with M-mode (DM). Nineteen patients were normal (NL), 21 had cardiomyopathy (CM), and 20 had mitral valve disease (MVD) diagnosed clinically, echocardiograpb ically and, in 14, hemodynamically. The projections were the long and short axes, via precordial win&w and the right anterior oblique and hemiaxial equivalents (RAO-E & REM-E) from the apex. The left atria1 diameters are shown below. The maaaurements in mm were: Dl D2 D3 D4 DS D6 D7 IX4 NL(meanfSD) 25?4 34f4 3624 26f4 33f5 33f6 35k.627f4 CM 32*8 43f9 41t6 34i5 40f9 39f7 43t8 38f5 MVD 39i9 SO*9 55f9 4329 45f8 49i8 53*9 5Oi9 All dimensions correlated significantly with each other; in particular, the correlations with M-mode ware between We mnclude that linear measurements .82 and .86(pCOOl). of left atria1 size from four project5ons were closely correlated with M-mode through a range of atria1 size and with each other. These findings suggest that the left atrium enlarges in all ares and that it can be adequately umplop evaluated with any obtainable proiec$&!.
@5-&
E2-L;
:(/$$$_(J&
ldylr-
$$$
UC-I
Pld
M MODE ECHOCARDIOGRAMOF THE CORONARY ARTERY Kiyoshi lnoue MD; Kaiichi Kuwaki MD; Keiko Ueda MD; Tetsuro Shirai MD; Toshinori Utsunomiya MS, Cardiovascular Center, Tokyo Metropolitan Police Hospital, Tokyo, Japan. The clinical applicability of a new method for recording M mode display of the origin of left main coronary artery (LMCA), developed in our laboratory, was evaluated with verifing its identity by visualizing catheter and contrast media and with observing changes in the diameter of LMCA follwoing sublingual nitroglycerin (NTG) administration in 21 patients having coronary artery disease undergoing coronary angiography. Using Toshiba model SSL-53H real time cross sectional linear scanner and placing the probe of 85 mm in length along cardiac long axis, simultaneous cross sectional picture of out flow tracts of two ventricles, pulmonic valve (PV), aortic valve (AV) and sinus of valsalva (SV) was obtained. BY turninq the probe toward short axial direction holding.SV as the center of the probe, LMCA was observed for the length from 5 to 20 mm. The M mode of LMCA was obtained by selecting beam on the line of LMCA. The two walls of LMCA were seen as two parallel echoes in the M mode display and the picture was much clearer than cross sectional. The catheter inserted and the dye injected into LMCA was visualized. NTG administration changed the diameter of LMCA for 1.5 to 3 times as wide of control. Using standared echocardiography and probe, the recordings of M mode display were repeatedat the bed side in all patients. By appling standared probe at 2nd left interspace, projecting it to the PV direction, and shifting slightly to AV, clear parallel echoes of two walls of LMCA were obtained in all cases. NTG administration changed the diameter of LHCA from 1.1 to 3.8 time as wide. M mode display of the LMCA are easy to record and the picture are clearer than those of cross sectional.
BIPLANE MEASUREMENTS OF LEFT AND RIGHT VENTRICULARVOLUMES USING WIDE ANGLE CROSS-SECTIONAL ECHOCARDIOGRAPHY. Khalid R. Chaudry, ND, Satoshi Ogawa, MD, Ferrel J. Pauletto,MD, FACC, Francis E. Hubbard, MD, Leonard 5. Dreifus, MD, FACC, Lankenau Hospital, Philadelphia, Pa. Forty-seven patients (pts) undergoing left ventricular (LV) single-plane cineangiography were studied with a phased array 84' sector scanner. LV and right ventricular (RV) volumes (V) were measured from biplane images of cross-sectional echocardiography (Echo). (1) A major LV axis (L) was obtained with an apex Echo view (an image equivalent to an angiographic right anterior oblique view) and two minor axes (antero-posterior, Dl, and lateral D2) were obtained on a short axis view of LV at the level of the mitral valve tip. The LV-V was calculated at end-dias tale (EDV) and end-systole (ESV) by: V=4/3n(L/2) (Dl/2) (D2/2). (2) The RV-V was given by the formula for a pyramid with a triangular base: V=A x H/3, where A=an area of a triangular base; Heheight of a pyramid. "A" was determined by planimetry on a hemiaxial view obtained by an apex Echo. "H" was measured on a sagittal cross-section view of RV. Results: Technically satisEactory images for LV and RV measurements were obtained in 30 pts including 20 pts with coronary artery disease. Echo-EDV, ESV, stroke volume (SV) and ejection fraction (EF) of LV were correlated significantly with angiographic (Angie) data (r=0.86. 0.91, 0.74 and 0.73) in pts with normal-sized LV as well as large spherical LV. Correlation was shown between Echo RV-SV and Angie LV-SV only when Angio LV-EDV was less than 170 ml (r=0.86 N=9). Echo RV-SV underestimated Angie LV-SV b 16-86 ml. The mean values for RV-SV sr and RV-EF were 41.6-12.7 ml (+SD) and 55.4+11.2%. It is concluded that 1) Echo provided a reliable technique for the biplane determination of LV-V, especially in pts with dilated hearts, and 2) RV measurements were of limited value in evaluating RV performance.
CLINICAL UTILITY OF IDENTIFICATION OF THE RIGHT VENTRICULAR OUTFLOW TRACT, PULMONARY ARTERY AND ITS BIFURCATION BY CONTRAST TWO-DIMENSIONAL ECHOCARDIOGRAPHY Martin Klicpera, MD; Theodore D. Fraker, Jr., MO; Joseph Kisslo., MD:, Duke Universitv Medical Center. Durham. NC. of
Two-dimensional echocardiographic (2DE) examinations the right ventricular outflow tract (RVOT), pulmonary
artery (PA) and its bifurcation (BIF) were obtained using a focused phased-array imaging system in 75 consecutive adult patients (PTS) in order to assess the utility of
this approach for the identification of potential cardiac disorders involving these structures. The ultrasonic technique was combined with several rapid injections of 10 ml. of normal saline into an antecubital vein to intraduce
microcavitations
into
the
right-sided
cardiac
chambers and vessels. Adequate images of the RVOT, PA and BIF along with microcavitations were seen in 58 PTS ,-._",. Pulmonary insufficiency was detected in 2'PTS, compression of the right main stem PA due to tumor was found in 1 PT, dilatation of the PA due to .large left to right shunt was found in 4 PTS, negative contrast enteriq the PA due to a high ventricular septal defect was found in 1 PT. In addition, an abscess involving the area between the right coronary sinus of valsalva and the proximal pulmonary artery due to bacterial endocarditis could be identified. These data indicate that: (1) adequate images of the RVOT, PA and BIF could be obtained using contrast 2DE, (2) useful clinical information concerning several types of cardiac disorders involving these structures can be obtained using this method and (3) further studies are indicated to investigate the specific applicability of this approach for evaluation of intrinsic or extrinsic abnormalities of the RVOT, PA and its branches.
February 1978
The American Journal of CARDIOLOGY
Volume 41
391