Abhash C. Thakur

Lambl's Excrescences (Valvular Strands)

We review the literature on Lambls excrescences (valvular strands). With the widespread use of cardiac imaging modalities, most importantly, with transesophageal echocardiography, abnormal valvular structures are frequently identified on both native and prosthetic heart valves. However, there is no consensus in the literature on the correct terminology of these structures. The relationship between valvular strands (the so‐called Lambls excrescences) and papillary fibroelastomas has not been well established. In this review, we attempt to summarize the available echocardiographic descriptors and the gross macroscopic and histological features of Lambls excrescences (valvular strands). In addition, we review the etiology, pathogenesis, and clinical implications of these cardiac excrescences. Also, we describe features that help to distinguish between Lambls excrescences and papillary fibroelastomas. Because valvular strands (Lambls excrescences) have been implicated in systemic thromboembolism, we also review the available management principles for patients with valvular strands; unfortunately, no specific therapeutic guidelines can be proposed at the present time.

Transesophageal Echocardiographic Examination of Left Subclavian Artery Branches

This preliminary study demonstrates the feasibility of examining the proximal segments of the branches of the left subclavian artery during probe withdrawal toward the end of a routine transesophageal echocardiographic study. The branches identified most commonly were the vertebral and the internal mammary arteries.

Harmonic Power Doppler Contrast Echocardiography: Preliminary Experimental Results

This preliminary experimental study demonstrates the potential usefulness of harmonic power Doppler imaging in producing left ventricular myocardial opacification and demonstrating intra‐myocardial coronary vessels during contrast echocardiography using Levovist, a saccharide‐based contrast agent. The contrast effect was most dramatic when a vasodilator such as dipyridamole or nitroglycerin was used in conjunction with contrast injections of Levovist. No significant myocardial opacification was noted with B‐mode harmonic imaging alone.

Lambl's Excrescences Involving the Pulmonary Valve Detected by Transesophageal Echocardiography

We report the first case of echocardiographically detected Lambls excrescences on the pulmonary valve in a 72‐year‐old man who was referred for transesophageal echocardiography as a part of an evaluation for ischemic stroke. A total of four excrescences were noted on the arterial aspect of the pulmonary valve; two of them were on the anterior cusp, one was on the left cusp, and one was on the right cusp. The excrescence on the left cusp was the largest, measuring 5 mm in length. These valvular strands (Lambls excrescences) represented an incidental finding and were not associated with any disease process.

Three‐Dimensional Echocardiographic Reconstruction of Atrial Membranes

Three‐dimensional echocardiographic findings in cor triatriatum sinister (sinistrum), cor triatriatum dexter, mitral supravalvular membrane, and atrial baffle are presented.

Examination of Left External and Internal Carotid Arteries During Transesophageal Echocardiography.

The present study demonstrates the feasibility of delineating the carotid bulb and the proximal portions of the left external and left internal carotid arteries during transesophageal examination. This was accomplished by slowly and carefully withdrawing the probe from the esophagus into the pharynx.

Transesophageal Echocardiographic Diagnosis of Proximal Coronary Artery Stenosis in Patients with Ischemic Stroke

Atherosclerosis is the leading cause of death worldwide. It encompasses several clinical entities, including coronary artery disease and cerebrovascular disease. Because the underlying pathophysiological mechanism is the same, coronary artery disease and cerebrovascular disease frequently coexist. Transesophageal echocardiography (TEE) is routinely done in patients with ischemic stroke to exclude possible cardiac sources of cerebral embolism. Since the introduction of multiplane transesophageal transducers, it has become easier to visualize the proximal coronary arteries during transesophageal examinations. We report three cases in which routine TEE for ischemic stroke revealed significant coronary artery disease that was not previously suspected. In one patient, the stroke was so severe that further evaluation of the coronary artery disease was not deemed useful. The other two patients underwent coronary angiography based on the echocardiographic findings, confirming the lesions noted on the echocardiogram. Subsequently, both patients were successfully revascularized: one by percutaneous transluminal coronary angioplasty and the other by coronary artery bypass graft surgery. We conclude that the examination of coronary arteries during routine TEE for ischemic stroke may become a useful screening tool for the detection of coexisting, asymptomatic, significant proximal coronary artery disease.

Transpharyngeal Echocardiographic Diagnosis of Carotid Bulb and Left Internal Carotid Artery Stenosis.

We report a patient in whom we were able to make an accurate diagnosis of left carotid bulb and left internal carotid artery stenosis by carefully and slowly withdrawing the probe from the esophagus into the pharynx.

Transesophageal Echocardiographic Diagnosis of Coronary Stenosis in a Stroke Patient

This study represents another example of the usefulness of transesophageal echocardiography in the assessment of stenosis involving the proximal, mid, and distal coronary arteries in stroke patients referred for exclusion of a cardiac source of embolism.

Transesophageal Echocardiographic Diagnosis of Right‐Sided Aortic Arch

We present the transesophageal echocardiographic findings in two adult patients with right‐sided aortic arch: one without dissection and the other with traumatic aortic injury (dissection). In both patients, the branching pattern was the left common carotid artery and then the right common carotid artery, followed by the right and left subclavian arteries. The technique for the diagnosis of this anomaly and the identification of adjacent vascular structures using contrast echocardiography is described. Three‐dimensional reconstruction of the aortic arch also was performed in both patients.