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Right ventricular endomyocardial biopsy: Clinicopathologic correlates in 100 consecutive patients
ABSTRACTS
DIAGNOSISOF VALVULARDISEASE WITH DOPPLERREAL-TIME SPECTRALANALYSIS Kent L. Richards, MD, FACC; Scott R. Cannon, PhD; Sherman G. Sorensen. MD, FACC: Michael H. Crawford MD, FACC, Audie Murphy Veterans Hospital, San Antonio,'TX To determine parameters which allow differentiation of normal from diseased valves, 35 patients (6 normals and 29 abnormals with 49 valve lesions proven at catheterization) were examined using a new 3MHz duplex pulsed Doppler echocardiograph (PDE) with real-time, grey-scale spectral display (RTS). (N)represents number of patients with satCatheterisfactory Doppler and cath,data for each site. ization was the standard for mean pressure gradient and severity of regurgitation. To detect valve stenosis, the sample volume (SV) was positioned just down from the aortic or mitral valve orifice; the area within the systolic RTS envelope for the aortic valve and the diastolic area for the mitral valve were measured in KHz X Seconds: RTS Area (KHZ X Set) Pressure Gradient N Aortic 14 0 .ll- .30 (21) : 17 3-103 (X) .72-1.72 (1.23) PC.01 Mitral
17 0 .13- .64 ( .33) 6 8-22 (n) .75-1.68 (1.01) PC.01 To detect aortic regurgitation, the SV was piaced’in left ventricular outflow tract and diastolic RTS area determined; the systolic RTS area in the left atrium was measured for mitral regurgitation: Severity Regurgitation RTS Area (KHZ X Set) N 0 .13- .49 (2) p<.Dl Aortic 13 .12-2.58 (1.43) 16 Trace - 3+ Mitral 17 0 .04- .34 (2) p<.Ul .63-2.07 (1.22) Trace - 4+ of the above parameters from ;;sc;b":&l~;it{ a placation _. non invasive PDE allows reliable detection of aortic and/or mitral valve disease in adults.
USE OF COMPUTED TOMOGRAPHY IN THE INITIAL DIAGNOSIS AND SUBSEQUENT FOLLOW-UP OF CARDIAC NEOPLASMS Jeffrey M. Isner, MD, FACC; Mark S. Bankoff, MD; Barbara L. Carter, MD, Tufts-New England Medical Center, Boston, Massachusetts. Accurate diagnosis of cardiac neoplasms remains a persistent problem for both pediatric and adult cardiology despite a plethora of available non-invasive and invasive procedures. We used computed tomography (CT) to establish the diagnosis of a primary or a secondary cardiac neoplasm in 6 patients (pts), including 2 infants and 4 adults. Of the 2 infants studied, 1 was thought to have a pericardial effusion by cardiac ultrasound; prior to planned pericardiocentesis, however, CT was performed and suggested a cardiac neoplasm, confirmed by thin-needle biopsy. In the second infant, CT diagnosed and allowed accurate anteriorposterior as well as crania-caudad definition of the extent of what proved to be a biopsy-proven rhabdomyoma of the left ventricle. Of the 3 adults studied, CT was used to diagnose a biopsy-proven undifferentiated spindle-cell caecinoms of the heart; subsequently, CT provided a sensitive and reliable non-invasive means to follow, first, regression of the tumor in response to mediastinal irradiation, and then subsequent recurrence of the tumor prior to death. In 2 other adult pts, CT was used to make the diagnosis of an interatrial lipoma, an entity previously diagnosed only at necropsy, and an atypically located pericardial cyst. Finally, chest CT identified a 1.5 x 2.5 cm. secondary neoplasm of the heart in a pt with an extracardiac primary and suspected pericardial heart disease. CT thus provides a new modality for the identification and quantification of cardiac neoplasms, and is particularly promising as a tool for the serial evaluation of the response of cardiac neoplasms to various forms of therapy.
960
March 1982
The American Journal of CARDIDLDGY
RIGHT VENTRICULAR ENDOMYOCARDIAL BIOPSY: CLINICOPATHOLOGIC CORRELATES IN 100 CONSECUTIVE PATIENTS Todd B. Nippoldt, B.Mech.E.; William D. Edwards, MD, FACC; David R. Holmes, Jr., MD, FACC; Guy S. Reeder, MD; Geoffrey 0. Hartzler, MD, FACC; Hugh C. Smith, MD, FACC, Mayo Clinic, Rochester, MN. The first 100 consecutive patients (pts) to undergo right ventricular endomyocardial biopsy (RVEMB) at the Mayo Clinic were studied to determine its utility in various clinical settings. The pts were divided retrospectively into five groups depending on prebiopsy clinical diagnosis, and the biopsies were reviewed histologically in a single-blind format. Group I, 34 pts, had a diagnosis of unexplained congestive heart failure (CHF) with a dilated heart; of these, 4 (1%) had active myocarditis by biopsy. Group II, 6 pts, had a clinical diagnosis of active myocarditis; of these, 1 (17%) had biopsy evidence of active myocarditis and 2 (33%) had changes which were consistent with cardiomyopathy (CM). Group III, 27 pts, had a primary dysrhythmia, syncope or cardiac arrest without CHF; of these, 4 (15%) had active myocarditis by biopsy and 8 (30%) had changes consistent with CM. Group IV, 19 pts, had a diagnosis of unexplained CHF with a non-dilated heart; of these, 4 (21%) had cardiac amyloid on biopsy. Group V was a diverse group of 14 pts with possible cardiac involvement by a known systemic disease; myocardial disease was documented by biopsy in 7 (50%). In the clinical setting of dilated CM, RVEMB is indicated to evaluate the tissue for an underlying myocarditis. In pts with dysrhythmias or clinical myocarditis, RVEMB may disclose myocarditis or changes consistent with CM. The rationale for AVEMB in pts with hypertrophic or restrictive CM is to analyze the tissue for amyloid. Transient complications occurred in 4.4% of biopsy procedures. With these goals in mind, RVEMB is a safe and diagnostically useful clinical tool.
PERICARDIOSCOPY: A NEW DIAGNOSTIC TECHNIQUE FOR PERICARDIAL DISEASE. Jorge Le6n-Galindo, M.D.; Carlos Uribe-Velez, M.D. Javeriana Medical school.San Ignacio Hospital, Bogota Colombia. This is a new diagnostic technique for ericardial disease(PD).We used a Dyonics needlescope(NS !2.2 mn of diameter and a Wolf arthroscope 4 mn of diameter.We studied B patients(pts.) (ages 12-72 years; 6 females, 2 males). All had large pericardial effusion shown by M-Mode echocardiography.The procedure was done as a regular pericar dial tap through the subxiphoid area and having the pts. connected to the electrocardiogram.In 7 pts. the procedu re was performed as a diagnostic test.In one pt. as a tFie rapeutic tap because of a cardiac tamponade resulting - from anticoagulation in a post-operatory cardiac surgery. In 2 pts. a tuberculous bacillus was found.In one pt. se veral metastatic lesions were seen in the parietal and viceral pericardium.In all pts. a No 5 or N" 7 Cordis s1 de hole catheter was passed through the NS cannula and under fluoroscopy it was possible to orient the catheter to the anterior, posterior and lateral pericardial space to withdraw the pericardial effusi0n.A washout with normal saline was done.In all pts. we had a direct view ena bling us to reach the pericardial space without touching the heart.It was important to see in the pts.the patholo gic changes in the pericardium(fibrine, metastatic lesions, blood clots).It is hoped that with an improved flexible scope desing it will be possible to take a perL cardial biopsy and to reach the lateral and posterior pericardial spaces.We feel this preliminary report indica tes this procedure might be safer than the usual blind pericardial puncture and may increase our diagnostic capabilities.
Volume 49
DIAGNOSISOF VALVULARDISEASE WITH DOPPLERREAL-TIME SPECTRALANALYSIS Kent L. Richards, MD, FACC; Scott R. Cannon, PhD; Sherman G. Sorensen. MD, FACC: Michael H. Crawford MD, FACC, Audie Murphy Veterans Hospital, San Antonio,'TX To determine parameters which allow differentiation of normal from diseased valves, 35 patients (6 normals and 29 abnormals with 49 valve lesions proven at catheterization) were examined using a new 3MHz duplex pulsed Doppler echocardiograph (PDE) with real-time, grey-scale spectral display (RTS). (N)represents number of patients with satCatheterisfactory Doppler and cath,data for each site. ization was the standard for mean pressure gradient and severity of regurgitation. To detect valve stenosis, the sample volume (SV) was positioned just down from the aortic or mitral valve orifice; the area within the systolic RTS envelope for the aortic valve and the diastolic area for the mitral valve were measured in KHz X Seconds: RTS Area (KHZ X Set) Pressure Gradient N Aortic 14 0 .ll- .30 (21) : 17 3-103 (X) .72-1.72 (1.23) PC.01 Mitral
17 0 .13- .64 ( .33) 6 8-22 (n) .75-1.68 (1.01) PC.01 To detect aortic regurgitation, the SV was piaced’in left ventricular outflow tract and diastolic RTS area determined; the systolic RTS area in the left atrium was measured for mitral regurgitation: Severity Regurgitation RTS Area (KHZ X Set) N 0 .13- .49 (2) p<.Dl Aortic 13 .12-2.58 (1.43) 16 Trace - 3+ Mitral 17 0 .04- .34 (2) p<.Ul .63-2.07 (1.22) Trace - 4+ of the above parameters from ;;sc;b":&l~;it{ a placation _. non invasive PDE allows reliable detection of aortic and/or mitral valve disease in adults.
USE OF COMPUTED TOMOGRAPHY IN THE INITIAL DIAGNOSIS AND SUBSEQUENT FOLLOW-UP OF CARDIAC NEOPLASMS Jeffrey M. Isner, MD, FACC; Mark S. Bankoff, MD; Barbara L. Carter, MD, Tufts-New England Medical Center, Boston, Massachusetts. Accurate diagnosis of cardiac neoplasms remains a persistent problem for both pediatric and adult cardiology despite a plethora of available non-invasive and invasive procedures. We used computed tomography (CT) to establish the diagnosis of a primary or a secondary cardiac neoplasm in 6 patients (pts), including 2 infants and 4 adults. Of the 2 infants studied, 1 was thought to have a pericardial effusion by cardiac ultrasound; prior to planned pericardiocentesis, however, CT was performed and suggested a cardiac neoplasm, confirmed by thin-needle biopsy. In the second infant, CT diagnosed and allowed accurate anteriorposterior as well as crania-caudad definition of the extent of what proved to be a biopsy-proven rhabdomyoma of the left ventricle. Of the 3 adults studied, CT was used to diagnose a biopsy-proven undifferentiated spindle-cell caecinoms of the heart; subsequently, CT provided a sensitive and reliable non-invasive means to follow, first, regression of the tumor in response to mediastinal irradiation, and then subsequent recurrence of the tumor prior to death. In 2 other adult pts, CT was used to make the diagnosis of an interatrial lipoma, an entity previously diagnosed only at necropsy, and an atypically located pericardial cyst. Finally, chest CT identified a 1.5 x 2.5 cm. secondary neoplasm of the heart in a pt with an extracardiac primary and suspected pericardial heart disease. CT thus provides a new modality for the identification and quantification of cardiac neoplasms, and is particularly promising as a tool for the serial evaluation of the response of cardiac neoplasms to various forms of therapy.
960
March 1982
The American Journal of CARDIDLDGY
RIGHT VENTRICULAR ENDOMYOCARDIAL BIOPSY: CLINICOPATHOLOGIC CORRELATES IN 100 CONSECUTIVE PATIENTS Todd B. Nippoldt, B.Mech.E.; William D. Edwards, MD, FACC; David R. Holmes, Jr., MD, FACC; Guy S. Reeder, MD; Geoffrey 0. Hartzler, MD, FACC; Hugh C. Smith, MD, FACC, Mayo Clinic, Rochester, MN. The first 100 consecutive patients (pts) to undergo right ventricular endomyocardial biopsy (RVEMB) at the Mayo Clinic were studied to determine its utility in various clinical settings. The pts were divided retrospectively into five groups depending on prebiopsy clinical diagnosis, and the biopsies were reviewed histologically in a single-blind format. Group I, 34 pts, had a diagnosis of unexplained congestive heart failure (CHF) with a dilated heart; of these, 4 (1%) had active myocarditis by biopsy. Group II, 6 pts, had a clinical diagnosis of active myocarditis; of these, 1 (17%) had biopsy evidence of active myocarditis and 2 (33%) had changes which were consistent with cardiomyopathy (CM). Group III, 27 pts, had a primary dysrhythmia, syncope or cardiac arrest without CHF; of these, 4 (15%) had active myocarditis by biopsy and 8 (30%) had changes consistent with CM. Group IV, 19 pts, had a diagnosis of unexplained CHF with a non-dilated heart; of these, 4 (21%) had cardiac amyloid on biopsy. Group V was a diverse group of 14 pts with possible cardiac involvement by a known systemic disease; myocardial disease was documented by biopsy in 7 (50%). In the clinical setting of dilated CM, RVEMB is indicated to evaluate the tissue for an underlying myocarditis. In pts with dysrhythmias or clinical myocarditis, RVEMB may disclose myocarditis or changes consistent with CM. The rationale for AVEMB in pts with hypertrophic or restrictive CM is to analyze the tissue for amyloid. Transient complications occurred in 4.4% of biopsy procedures. With these goals in mind, RVEMB is a safe and diagnostically useful clinical tool.
PERICARDIOSCOPY: A NEW DIAGNOSTIC TECHNIQUE FOR PERICARDIAL DISEASE. Jorge Le6n-Galindo, M.D.; Carlos Uribe-Velez, M.D. Javeriana Medical school.San Ignacio Hospital, Bogota Colombia. This is a new diagnostic technique for ericardial disease(PD).We used a Dyonics needlescope(NS !2.2 mn of diameter and a Wolf arthroscope 4 mn of diameter.We studied B patients(pts.) (ages 12-72 years; 6 females, 2 males). All had large pericardial effusion shown by M-Mode echocardiography.The procedure was done as a regular pericar dial tap through the subxiphoid area and having the pts. connected to the electrocardiogram.In 7 pts. the procedu re was performed as a diagnostic test.In one pt. as a tFie rapeutic tap because of a cardiac tamponade resulting - from anticoagulation in a post-operatory cardiac surgery. In 2 pts. a tuberculous bacillus was found.In one pt. se veral metastatic lesions were seen in the parietal and viceral pericardium.In all pts. a No 5 or N" 7 Cordis s1 de hole catheter was passed through the NS cannula and under fluoroscopy it was possible to orient the catheter to the anterior, posterior and lateral pericardial space to withdraw the pericardial effusi0n.A washout with normal saline was done.In all pts. we had a direct view ena bling us to reach the pericardial space without touching the heart.It was important to see in the pts.the patholo gic changes in the pericardium(fibrine, metastatic lesions, blood clots).It is hoped that with an improved flexible scope desing it will be possible to take a perL cardial biopsy and to reach the lateral and posterior pericardial spaces.We feel this preliminary report indica tes this procedure might be safer than the usual blind pericardial puncture and may increase our diagnostic capabilities.
Volume 49