Faculty Bibliography

Twenty-nine patients were studied by pulsed, continuous wave, and color Doppler before and after percutaneous transseptal valvuloplasty. New atrial septal defects were detected in 14 patients, and the patients were monitored for up to 320 days after the procedure. The diameter of the defect, best evaluated by the transesophageal approach, was 3 to 15 mm. A narrow, high velocity (1.4 to 3.1 meters per second) left-to-right shunt jet was detected in 13 of 14 patients. The shunt jet was continuous in nine of 14 patients, late systolic-holodiastolic in four patients, and bidirectional in one patient. Cardiac catheterization in nine patients confirmed the Doppler findings and demonstrated a peak pressure gradient of 10 to 32 mm Hg between the left and right atria. Oximetry revealed a calculated pulmonary to systemic flow ratio ranging from 2.3:1 in the patient with the largest atrial septal defect by echocardiography to 1:1 (no oxygen saturation step-up) in the patient with the smallest atrial septal defect. In the three patients who underwent cardiac surgery, the operative findings confirmed those of echocardiography. We concluded that atrial septal defects are common after transseptal valvuloplasty. Usually, their relatively small size and the underlying valvular disease that produces high left atrial pressure are responsible for the high pressure gradient between the left and right atria. This results in the high velocity and continuous shunt jet detected by Doppler echocardiography

Although the effects of aging on the heart have been reviewed, these reviews are primarily based on autopsy findings. We report the echocardiographic and Doppler findings in 58 patients over the age of 90. Half of the patients had enlarged left atria, but the large majority had normal-sized ventricles and aortic roots. Left ventricular wall motion was normal or increased in 71% and 52% had left ventricular hypertrophy. Aortic stenosis (all grades) was present in 31%. Other valve lesions are reviewed. None of our patients had a completely normal echocardiogram, even when mild valvular regurgitation is considered normal

Echocardiography is a valuable modality for imaging thrombi and vegetations. Although patients with systemic lupus erythematosus may develop Libman-Sacks endocarditis, in which punctate verrucous plaques are found histologically on valvular endocardial tissue, these lesions are ordinarily too small for ultrasonic imaging. We describe a patient with systemic lupus erythematosus complicated by systemic embolization, who had a large mobile aortic valve thrombus, which was discovered with the aid of echocardiography and was confirmed by surgical resection

MAgnetic resonance (MR) imaging was performed in 14 patients with intracavitary cardiac tumors diagnosed by echocardiography. Except in the patients whose echocardiograms were diagnostic of atrial myxomas, this modality contributed important additional anatomic information regarding the tumor's relationship to the normal intracardiac structures and/or its extension to the adjacent vascular and mediastinal structures. The MR findings correlated extremely well with the findings in all 12 patients who underwent surgical exploration or postmortem examination, and in the other two patients, MR guided the decision to obtain transvenous biopsy samples of their right heart masses