Gopal Agrawal

Morphological Assessment of Left Ventricular Thrombus by Live Three‐Dimensional Transthoracic Echocardiography

We report the usefulness of live three‐dimensional transthoracic echocardiography (3DTTE) in the morphological assessment of a left ventricular thrombus. Using live 3DTTE, the thrombus could be easily viewed end‐on and from the sides. In addition, by cropping the 3D images sequentially in transverse (horizontal or short axis), longitudinal (vertical or long axis), frontal, and oblique planes, the degree and extent of lysis within the thrombus, which represents an integral part of the clot‐resolution process, could be comprehensively assessed. The site of attachment of the thrombus in the left ventricular apex and its morphology could also be fully evaluated in three dimensions by live 3DTTE.

Live Three‐Dimensional Transthoracic Echocardiographic Identification of Discrete Subaortic Membranous Stenosis

We describe an adult patient in whom live three‐dimensional transthoracic echocardiography illustrated the exact site and full extent of the subaortic membrane as well as the narrow opening within the membrane, indicative of severe stenosis. To our knowledge this has not been reported previously. (ECHOCARDIOGRAPHY, Volume 20, October 2003)

Live Three‐Dimensional Echocardiographic Assessment of Mitral Stenosis

In the present study, we describe our experience in using live three‐dimensional transthoracic echocardiography in the assessment of mitral stenosis. (ECHOCARDIOGRAPHY, Volume 20, November 2003)

Live three-dimensional transthoracic echocardiographic assessment of coronary arteries.

In the present study, we are illustrating some of the adult patients in whom live three‐dimensional transthoracic echocardiography was found useful in assessing proximal and mid‐coronary arteries. (ECHOCARDIOGRAPHY, Volume 20, November 2003)

Transesophageal Three-Dimensional Echocardiographic Assessment of Normal and Stenosed Coronary Arteries

We describe our preliminary experience in assessing normal and stenosed coronary arteries using transesophageal three‐dimensional echocardiography (3‐D echo) in 27 adult patients. Multiplane transesophageal two‐dimensional images of the coronary arteries (20 left, 3 right, 3 both left and right, and 1 posterior descending) were first acquired in the TomTec computer in 3° sequential increments, from 0° to 180°, and then 3‐D reconstruction was performed. The entire left main (LMC, measuring 0.5 to 1.7 cm, mean 1.0 cm) as well as variable lengths of proximal or both proximal and middle segments of the left anterior descending (LAD, measuring 0.2 to 2.5 cm, mean 0.8 cm) and circumflex (LCX, measuring 0.2 to 2.8 cm, mean 0.9 cm) coronary arteries together with some of their branches could be visualized in 3‐D in 22 of 23 patients. In the remaining patient, the LMC was absent, and both LAD and LCX could be visualized in 3‐D as having separate but adjacent origins from the left sinus of Valsalva (proven by angiography). In two patients, long segments of interventricular and great cardiac veins were also visualized accompanying the LAD and LCX, respectively. The right coronary artery (RCA, measuring 0.7 to 3.0 cm, mean 1.9 cm) was also successfully delineated in 3‐D in all six patients in whom an attempt was made to visualize it during echo examination. Using the transgastric approach, a long (1.8 cm) segment of the posterior descending branch (PDA) of RCA was imaged in one patient. In addition, nine significantly stenotic lesions (> 50% lumen diameter) were identified by 3‐D in eight patients involving LMC (1), proximal LAD (1), mid LAD (1), proximal LCX (2), proximal RCA(3), and mid PDA (1). Eight of these 9 lesions were confirmed by coronary angiography. The remaining lesion (mid PDA) could not be confirmed since the patient did not undergo angiography. Our preliminary study demonstrates the usefulness of transesophageal 3‐D echo not only in delineating normal coronary arteries but also diagnosing significant atherosclerotic stenosis in these vessels.

Hemodynamic evaluation of normally functioning sulzer carbomedics prosthetic valves

The Sulzer Carbomedics prosthetic heart valve (CP) is a commonly used mechanical valve in clinical practice. In the present study, we used conventional and color Doppler echocardiography to assess the hemodynamics of normally functioning CP in the aortic (n = 73) and mitral (n = 127) positions. Our findings demonstrate no significant correlation of Doppler-measured peak and mean pressure gradients and effective orifice area with implanted valve size and actual orifice areas, measured directly by the manufacturer for CPs in both the mitral and aortic positions. However, it is still useful to measure effective orifice area by Doppler because a value in the normal or nonstenotic range points to an unobstructed prosthesis in the aortic or mitral position, in the absence of poor left ventricular ejection fraction. A value in the stenotic range could mean a normally functioning or obstructed prosthesis and, therefore, may need further investigation, such as assessment of valve leaflet motion by transthoracic or transesophageal echocardiography or fluoroscopy. Valve regurgitation as evaluated by color Doppler flow mapping was mild in practically all CPs in the aortic position, and in the majority of CPs in the mitral position.

Live three-dimensional transthoracic echocardiographic assessment of aortic dissection.

In the present study, we report our experience of using live three‐dimensional transthoracic echocardiography in the assessment of aortic dissection in ten adult patients. To our knowledge, this has not been reported previously. (ECHOCARDIOGRAPHY, Volume 20, August 2003)

Color Doppler Visualization of Intramyocardial Coronary Arteries Using a New Echo System: Effect of Contrast Enhancement and Vasodilation.

Utilizing a new echocardiographic system, intramyocardial coronary arteries could be demonstrated by color Doppler in a small number of open chest animals. Both intravenous and intracoronary injections of a contrast agent (Levovist) resulted in significant enhancement of color flow signals with an increase in the length, width, and the number of these vessels. Similar results were obtained with intravenous infusion and direct intracoronary injections of a vasodilator (adenosine).

Transesophageal Echocardiographic Identification of Neck Veins: Value of Contrast Echocardiography.

We describe the technique for identification of innominate veins, azygos vein, and left subclavian and internal jugular veins during transesophageal echocardiography. Validation was provided with contrast echocardiography.

Transesophageal Echocardiographic Identification of Normal and Stenosed Posterior Intercostal Arteries

We describe our experience in using transesophageal echocardiography to identify both right and left posterior intercostal arteries and assessing them for stenosis. (ECHOCARDIOGRAPHY, Volume 20, October 2003)