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CAO 103 Intracardiac echocardiography: Observations in normal and diseased heart
CA0101
CA0102
CONTRAST ENHANCED ECHOCARDIOGRAPHY USING ECHOGEN” VERSUS MRI Michael Main University of Texas, Dallas, Texas, USA The efficacy of EchoGen* contrast enhanced echocardiography was compared with magnetic resonance imaging (MRI) for the determination of left ventricular (LV) volumes (LVV), ejection fraction (EF) and wall motion abnormalities in an open-label study. A total of 35 evaluable patients undergoing echocardiography received a single injection of EchoGene (0.05 mL/kg iv). The LW and EF for baseline and contrast-enhanced were compared to the corresponding MRl values as a reference standard. Both linear regressions and Bland-Altman analyses showed that EchoGene enhanced echocardiography can measure end diastolic volume (EDV), end systolic volume (ESV) and EF more closely to MRI measurements than can non-contrast echocardiography. The r of the regressions improved from 0.843 to 0.879, from 0.891 to 0.941 and from 0.707 to 0.864 for EDV, ESV and EF, respectively. The Bland-Altman limits of agreement narrowed from spans of 97 mL to 85 mL, from 81 to 59 mL and from 0.37 to 0.25 for EDV, ESV and EF, respectively. In addition, EchoGen’ also significantly improved diagnosis of LV impairment (correctly classified patients: EchoGen*-enhanced, 9 l%, vs unenhanced, 7 1%) and improved the ability to evaluate regional wall motion (correctly evaluated segments: EchoGe@enhanced, 77%, vs unenhanced, 65%). EchoGen@was well tolerated; only transient paresthesia (n=l) and headache (n=l) were experienced. In conclusion, EchoGen@ improved the accuracy of assessmentof LW, EF, and regional wall motion in patients undergoing echocardiography.
ON-LINE TRANSESOPHAGBAL ECHOCARBIOGRAPI-IY IN BALLOON MITRAL COMMISSUROTOMY Chene-Wen Chian~,, Yu-Shien Ko, Po-Hsien Chu, Chi-Jen Chang, Long-An Hsu, GmHong Lin The First Cardiovascular Division, Chang Gung Memorial Hospital. Taipei, Taiwan, ROC
Background and Objectives:Balloon mitral connqissurotomy(BMC) has been widely applied in treating mitral stenosis. In most centers& is guided by fluoroscopy. In view of the better visuahzation of the interatrial septum and the mitral apparatus by tramesophageal echocardiography (TEE),we employed on-line multiplane TEE to supplement fluoroscopy for BMC.
Patients and Methods: Consecutive 150 patients wth mitral valve area cl.5 cm’ , no thrombus in the lefi atnal cavity. and nutral regurgitation less than grade 3. were enrolled in the study. Seventy (47%) wte
of them had thrombus in the left atrial appendage inspite of anticoagulation before BMC. We used Inoue balloon catheter and stepwise dilatation with on-line TEE gmdance.
Results: Immediately after BMC, the mitral orifice area increased from 1.0 f0.3 to 1.8f0.6cm2 @X1.000), the mean pressure gradient dropped from 10.9f4.6 to 5.lf2.5mmHg (p=O.OOO), and the left a&ml endsystolic diameter decreased from 48klO to 43+9mm (p=O.OOO).
There was no procedure-related mortality, stroke, or emergency valvular operation. Septal puncture became easy and safe.On-line assessmentbecame very effectiveand radiation hazards were greatly reduced. Conclusion:
On-line TEE appears to be vety helpful in wchng
BMC
CA0103 INTRACARDIAC ECHOCARDIOGRAPHY: OBSERVATIONS IN NORMAL AND DISEASED HEART Morean Fu, J&Sung Hung’ Section of Cardiology, Chang Gung Memorial Hospital, Kaohsiung; China Medical College Hospital*, Taichung, Taiwan, ROC In order to test the feasibility of a newly developed 8 F 10 MHz ultrasound catheter and usefulness of intracardiac echocardiography (ICE) in clinical practice, we conducted this study. From August 1991,90 patients (pts) (M:38; F:2) received ICE examination. Their ages ranged from 18 to 76 years old (Mean:47). Five pts who had chest pain with normal coronary angiograms were as a control group. 30 pts were severe mitral stenosis. 2 pts had aortic stenosis. 24 pts had congenital heart disease including Ebstein’s anomaly 1, pulmonary stenosis 1, atria1 septal defect 7, ventricular septal defect 6, patent ductus arteriosus 4, unroofing coronary sinus 1, coronary artery-vein fistula 1, and coarctation of aorta 1.15 pts had coronary artery disease, 2 pts had aortic dissection, 4 pts had pericardial disease, 2 pts had cardiac tumor and 2 pts had cardiomyopathy. Others had pulmonary embolism, Budd-Chiari syndrome and one had aortic valve replacement. The transducer catheter used was 8 F 10 MHz non-over-the wire catheter. The imaging system used was Cardiovascular Imaging System. From our primitive study, we have the following conclusions: 10 MHz transducer catheter is feasible and useful in defining the cardiac structure especially in some rare or special conditions. As a diagnostic modalities, ICE has limited clinical applications in usual diseases. In rare cases such as connection between SVC and right upper vein or unroofing coronary sinus, ICE plays an important and unexpected role in diagnosis. The most useful indications of ICE is in guiding or monitoring invasive interventional procedures. The limited condition is the frequency of the available transducer being too high for whole heart imaging. Development of lower frequency transducer catheter is desirable for better depth penetration. s3
CA0102
CONTRAST ENHANCED ECHOCARDIOGRAPHY USING ECHOGEN” VERSUS MRI Michael Main University of Texas, Dallas, Texas, USA The efficacy of EchoGen* contrast enhanced echocardiography was compared with magnetic resonance imaging (MRI) for the determination of left ventricular (LV) volumes (LVV), ejection fraction (EF) and wall motion abnormalities in an open-label study. A total of 35 evaluable patients undergoing echocardiography received a single injection of EchoGene (0.05 mL/kg iv). The LW and EF for baseline and contrast-enhanced were compared to the corresponding MRl values as a reference standard. Both linear regressions and Bland-Altman analyses showed that EchoGene enhanced echocardiography can measure end diastolic volume (EDV), end systolic volume (ESV) and EF more closely to MRI measurements than can non-contrast echocardiography. The r of the regressions improved from 0.843 to 0.879, from 0.891 to 0.941 and from 0.707 to 0.864 for EDV, ESV and EF, respectively. The Bland-Altman limits of agreement narrowed from spans of 97 mL to 85 mL, from 81 to 59 mL and from 0.37 to 0.25 for EDV, ESV and EF, respectively. In addition, EchoGen’ also significantly improved diagnosis of LV impairment (correctly classified patients: EchoGen*-enhanced, 9 l%, vs unenhanced, 7 1%) and improved the ability to evaluate regional wall motion (correctly evaluated segments: EchoGe@enhanced, 77%, vs unenhanced, 65%). EchoGen@was well tolerated; only transient paresthesia (n=l) and headache (n=l) were experienced. In conclusion, EchoGen@ improved the accuracy of assessmentof LW, EF, and regional wall motion in patients undergoing echocardiography.
ON-LINE TRANSESOPHAGBAL ECHOCARBIOGRAPI-IY IN BALLOON MITRAL COMMISSUROTOMY Chene-Wen Chian~,, Yu-Shien Ko, Po-Hsien Chu, Chi-Jen Chang, Long-An Hsu, GmHong Lin The First Cardiovascular Division, Chang Gung Memorial Hospital. Taipei, Taiwan, ROC
Background and Objectives:Balloon mitral connqissurotomy(BMC) has been widely applied in treating mitral stenosis. In most centers& is guided by fluoroscopy. In view of the better visuahzation of the interatrial septum and the mitral apparatus by tramesophageal echocardiography (TEE),we employed on-line multiplane TEE to supplement fluoroscopy for BMC.
Patients and Methods: Consecutive 150 patients wth mitral valve area cl.5 cm’ , no thrombus in the lefi atnal cavity. and nutral regurgitation less than grade 3. were enrolled in the study. Seventy (47%) wte
of them had thrombus in the left atrial appendage inspite of anticoagulation before BMC. We used Inoue balloon catheter and stepwise dilatation with on-line TEE gmdance.
Results: Immediately after BMC, the mitral orifice area increased from 1.0 f0.3 to 1.8f0.6cm2 @X1.000), the mean pressure gradient dropped from 10.9f4.6 to 5.lf2.5mmHg (p=O.OOO), and the left a&ml endsystolic diameter decreased from 48klO to 43+9mm (p=O.OOO).
There was no procedure-related mortality, stroke, or emergency valvular operation. Septal puncture became easy and safe.On-line assessmentbecame very effectiveand radiation hazards were greatly reduced. Conclusion:
On-line TEE appears to be vety helpful in wchng
BMC
CA0103 INTRACARDIAC ECHOCARDIOGRAPHY: OBSERVATIONS IN NORMAL AND DISEASED HEART Morean Fu, J&Sung Hung’ Section of Cardiology, Chang Gung Memorial Hospital, Kaohsiung; China Medical College Hospital*, Taichung, Taiwan, ROC In order to test the feasibility of a newly developed 8 F 10 MHz ultrasound catheter and usefulness of intracardiac echocardiography (ICE) in clinical practice, we conducted this study. From August 1991,90 patients (pts) (M:38; F:2) received ICE examination. Their ages ranged from 18 to 76 years old (Mean:47). Five pts who had chest pain with normal coronary angiograms were as a control group. 30 pts were severe mitral stenosis. 2 pts had aortic stenosis. 24 pts had congenital heart disease including Ebstein’s anomaly 1, pulmonary stenosis 1, atria1 septal defect 7, ventricular septal defect 6, patent ductus arteriosus 4, unroofing coronary sinus 1, coronary artery-vein fistula 1, and coarctation of aorta 1.15 pts had coronary artery disease, 2 pts had aortic dissection, 4 pts had pericardial disease, 2 pts had cardiac tumor and 2 pts had cardiomyopathy. Others had pulmonary embolism, Budd-Chiari syndrome and one had aortic valve replacement. The transducer catheter used was 8 F 10 MHz non-over-the wire catheter. The imaging system used was Cardiovascular Imaging System. From our primitive study, we have the following conclusions: 10 MHz transducer catheter is feasible and useful in defining the cardiac structure especially in some rare or special conditions. As a diagnostic modalities, ICE has limited clinical applications in usual diseases. In rare cases such as connection between SVC and right upper vein or unroofing coronary sinus, ICE plays an important and unexpected role in diagnosis. The most useful indications of ICE is in guiding or monitoring invasive interventional procedures. The limited condition is the frequency of the available transducer being too high for whole heart imaging. Development of lower frequency transducer catheter is desirable for better depth penetration. s3