Candace Keirns

The effect of kidney transplant on cardiac function: an echocardiographic perspective.

Kidney transplant (KT) resolves many of the cardiac abnormalities associated with chronic kidney failure (CKF). This study analyzed cardiac alterations of kidney failure and their modification with transplant. Thirteen patients in CKF underwent conventional echocardiograms, dobutamine stress echocardiograms, and injection of contrast to examine perfusion before KT and 3 months after transplant. Nine patients had evidence of left ventricular hypertrophy and six had evidence of diastolic dysfunction. Wall thickness, left ventricular mass, and mass index diminished after KT; only two patients continued to manifest hypertrophy. Left ventricular systolic diameters and volumes diminished at 3 months, and diastolic diameters after 4 months. Left ventricular fractional shortening and ejection fraction increased 3 months after transplant. At the end of the study, only two patients continued to show diastolic dysfunction. Dobutamine echocardiograms showed no segmental wall‐movement abnormalities. Myocardial perfusion was normal before and after transplant. The results suggest that KT diminishes hypertrophy and improves left ventricular systolic and diastolic function. Echocardiography provides valuable information for detection and follow‐up of cardiac abnormalities in patients with kidney disease. Evaluation of segmental wall movement and myocardial perfusion aid in demonstrating that our studied patients with CKF had no indirect signs of coronary artery disease.

Severe dynamic obstruction of the left ventricular outflow tract induced by dobutamine.

We present the case of a 63‐year‐old man who developed a subaortic gradient of 182 mmHg during an echocardiographic pharmacological stress study with dobutamine. (ECHOCARDIOGRAPHY, Volume 17, January 2000)

Recurrent myxoma implanted in the left atrial appendage.

We present the case of a young woman who developed myxomas in multiple cardiac chambers for the third time. One of the tumors was found in the left atrial appendage with the use of transesophageal echocardiography, indicating that this technique is the method of choice for the follow‐up of multiple myxomas.

Echocardiographic Study of Patients with Congenital Heart Disease and Infective Endocarditis

Background: Infective endocarditis (IE) occurs with significant frequency in patients with congenital heart disease. The complications leading to increased morbidity and mortality may be detected by echocardiographic examination. This study was undertaken in order to identify echocardiographic findings that influence the outcome of patients with congenital heart disease and IE. Methods: Twenty‐five patients with an average age of 28 years were selected and divided into two groups according to evolution. Group I included patients who survived the infectious process, while Group II included patients who died during hospitalization or after release. Results: Aortic valve disease was the most frequent anomaly. The clinical finding of most relevance for evolution during hospitalization was heart failure. Acute kidney failure and multiple organ failure from sepsis were the most common complications in patients who died. Echocardiograms established the diagnosis in all cases. Transesophageal studies revealed all periaortic abscesses. Conclusions: Echocardiography makes it possible to identify and evaluate complications associated with elevated morbidity and mortality in patients with congenital heart disease and IE.

Coronary Reserve in Takayasu's Arteritis: Transesophageal Echocardiographic Analysis

Background: The incidence of coronary arteries lesion in Takayasus arteritis varies from 9% to 10% and is usually discovered at autopsy. Recent studies have demonstrated the value of echocardiography in noninvasive detection of significant coronary stenosis. Aim: The aim of our study was to evaluate coronary reserve in 15 patients with Takayasus arteritis using contrast transesophageal echocardiography (Optison). Methods: Transesophageal echocardiogram under basal conditions and in the hyperemic phase with dipyridamole challenge, myocardial perfusion studies and coronary angiography were performed on all patients. Seventy‐three percent of them had histories of systemic hypertension, and the most frequent cardiovascular symptoms were shortness of breath (80%), headache (46%), angina (40%), and dizziness (33%). Results: The transthoracic echocardiogram showed left ventricular systolic dysfunction in 6% and diastolic dysfunction in 53%. Aortic regurgitation was found in 67% of the patients, and 60% had mitral and/or tricuspid regurgitation. Coronary reserve was diminished in 3 patients with significant coronary lesions and in 2 patients with coronary dilation (33%). In the 3 patients with obstructive lesions and diminished coronary reserve, reversible perfusion defects were found with thallium‐201 single‐photon emission computed tomography. One patient with coronary dilation had normal perfusion, while the other demonstrated reversible and irreversible perfusion defects. One patient without coronary lesions and with normal coronary reserve had an irreversible fibrotic changes and the other reversible defects due to abnormal microcirculation. Conclusions: Transesophageal echocardiography is a feasible and promising technique for assessing coronary reserve in patients with Takayasus arteritis.

Echocardiographic Diagnosis of Biventricular Thrombi in a Cocaine-Induced Myocardial Infarction

We present the case of a patient with a biventricular myocardial infarction induced by cocaine and a large left and a smaller right ventricular apical thrombus. Serial multiplane transesophageal echocardiography was used to document the morphological course of the thrombi during anticoagulation therapy over a period of 6 weeks.

Left Atrial Thrombosis After Percutaneous Mitral Valvuloplasty: Resolution with Conservative Management

We report the detection of a thrombus 72 hours after mitral valvuloplasty through the use of the technique of Inoue. Images obtained by transesophageal echocardiography revealed its localization on the interatrial septum at the level of the transseptal puncture. Although the patient subsequently underwent surgery for the placement of a prosthetic valve in mitral position due to failure of the valvuloplasty, the thrombus resolved with conservative management. (ECHOCARDIOGRAPHY, Volume 17, January 2000)

Transesophageal Echocardiographic Diagnosis of Thrombus in Accessory Lobes of the Left Atrial Appendage

Fifty‐four percent of left atrial appendages have two lobes. The number ranges from one to four lobes. We describe three patients with accessory lobes of the left atrial appendage studied with multiplanar transesophageal echocardiography (TEE). In one patient there was evidence of thrombi in the accessory lobe.

Echocardiographic correlates of severe pulmonary hypertension in adult patients with ostium secundum atrial septal defect

To identify echocardiographic factors that correlate with pulmonary hypertension (PH) in adults with ostium secundum atrial septal defect (ASD).

Three‐Dimensional Reconstruction of Heart Defects Associated with Williams‐Beurer Syndrome

Williams‐Beurer syndrome is an unusual genetic alteration associated with congenital heart defects. We present the capabilities of three‐dimensional echocardiography in the study of the cardiopathy associated with this syndrome.