Sanjay Rajdev

Quantification of tricuspid regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area.

We evaluated tricuspid regurgitation (TR) by multiple echocardiographic techniques in 93 consecutive patients who underwent standard two‐dimensional (2D) and live three‐dimensional (3D) transthoracic echocardiography (TTE). TR vena contracta (VC) area was obtained by 3D TTE by systematic and sequential cropping of the acquired 3D TTE dataset. Assessment of VC area by 3D TTE was compared to 2D TTE measurements of the ratio of TR regurgitant jet area to right atrial area (RJA/RAA), RJA alone, VC width, and calculated VC area. VC area from 3D TTE closely correlated with RJA/RAA and RJA alone as determined from 2D TTE measurements. Live 3D TTE color Doppler measurements of VC area can be used for quantitative assessment of TR and offer incremental value for quantification of particularly severe regurgitant lesions.

Live/real time three-dimensional transthoracic echocardiographic assessment of Ebstein's anomaly

We describe our experience in using live/real time three‐dimensional transthoracic echocardiography (3D TTE) in the assessment of five adult patients with Ebsteins anomaly. The technique was found useful in assessing the distribution and extent of tethering of each of the three leaflets of the tricuspid valve (TV) to the underlying right ventricular walls and the ventricular septum. The characteristic bubble‐like appearance resulting from bulging of the non‐tethered areas of the TV leaflets was also well visualized in three dimensions and their size measured. Thus, an estimate of the nontethered or free segments of all three leaflets of the TV could be obtained using this technique. This has important implications when considering these patients for surgical repair of the TV. Visualization of all three leaflets of the TV and their extent of tethering by 3D TTE also made it easier to identify the boundaries of the functioning right ventricular chamber potentially providing a more reliable assessment of its volumes and ejection fraction. Cropping of color Doppler 3D TTE data sets provided en face viewing of the TV regurgitation vena contracta permitting accurate assessment of its shape and size. This has the potential to provide a more accurate quantitative estimation of TV regurgitation severity as compared to two‐dimensional color Doppler. In conclusion, live/real time 3D TTE appears useful in supplementing two‐dimensional echocardiography in more comprehensively assessing the morphologic features of Ebsteins anomaly. (ECHOCARDIOGRAPHY, Volume 22, November 2005)

Usefulness of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in the Identification of Individual Segment/Scallop Prolapse of the Mitral Valve

In this report, we present 34 patients in whom surgical intervention was undertaken for severe mitral insufficiency due to mitral valve prolapse (MVP). Location and severity of MVP and regurgitation were assessed preoperatively by live/real time three‐dimensional transthoracic echocardiography and closely agreed with the surgical findings.

Papillary Fibroelastoma of the Pulmonary Valve: Assessment by Live/Real Time Three‐Dimensional Transthoracic Echocardiography

The differential diagnosis of a cardiac valve mass includes fibroelastoma, myxoma, lipoma, Lambls excrescences, thrombus, and vegetation. Fibroelastomas are extremely rare primary cardiac tumors. Their incidence is 0.00017–0.033% in autopsy series and 0.019% in clinical series identified on echocardiography. Although rare, fibroelastomas are the most common tumors affecting the cardiac valves with aortic, mitral, tricuspid, and pulmonary valves being involved in this order. In the current report we describe a case of pulmonary valve mass in which a confident prospective diagnosis of fibroelastoma could be made utilizing the technique of three‐dimensional transthoracic echocardiography.

Tissue Doppler Assessment of Longitudinal Right and Left Ventricular Strain and Strain Rate in Pulmonary Artery Hypertension

Tissue Doppler imaging (TDI) in 38 adult patients with pulmonary artery hypertension of varied etiology and normal left ventricular systolic function by two‐dimensional transthoracic echocardiography showed significantly reduced peak systolic strain (SS) in all three segments of left ventricular free wall and ventricular septum and two of three segments of right ventricular free wall when compared to 29 adults with no clinical or echocardiographic evidence of heart disease and normal left and right ventricular systolic function. A similar reduction in peak diastolic strain (DS) was also noted in all three segments of left ventricular free wall and ventricular septum and one of three segments of right ventricular free wall. This reduction in strain indices in patients with pulmonary hypertension was noted irrespective of whether right ventricular systolic function was normal or reduced as assessed by two‐dimensional transthoracic echocardiography. SS and DS rates also showed reductions in patients with pulmonary artery hypertension. Our study shows the potential value of TDI indices in identifying reduced regional left ventricular systolic and diastolic longitudinal function in patients with pulmonary artery hypertension and normal left ventricular systolic function by two‐dimensional transthoracic echocardiography. This reduction in left ventricular function was noted in patients with both normal and reduced right ventricular systolic functions by two‐dimensional echocardiography.

RESEARCH FROM THE UNIVERSITY OF ALABAMA AT BIRMINGHAM: Live/Real Time Three‐Dimensional Transthoracic Echocardiographic Assessment of Ebstein's Anomaly

We describe our experience in using live/real time three‐dimensional transthoracic echocardiography (3D TTE) in the assessment of five adult patients with Ebsteins anomaly. The technique was found useful in assessing the distribution and extent of tethering of each of the three leaflets of the tricuspid valve (TV) to the underlying right ventricular walls and the ventricular septum. The characteristic bubble‐like appearance resulting from bulging of the non‐tethered areas of the TV leaflets was also well visualized in three dimensions and their size measured. Thus, an estimate of the nontethered or free segments of all three leaflets of the TV could be obtained using this technique. This has important implications when considering these patients for surgical repair of the TV. Visualization of all three leaflets of the TV and their extent of tethering by 3D TTE also made it easier to identify the boundaries of the functioning right ventricular chamber potentially providing a more reliable assessment of its volumes and ejection fraction. Cropping of color Doppler 3D TTE data sets provided en face viewing of the TV regurgitation vena contracta permitting accurate assessment of its shape and size. This has the potential to provide a more accurate quantitative estimation of TV regurgitation severity as compared to two‐dimensional color Doppler. In conclusion, live/real time 3D TTE appears useful in supplementing two‐dimensional echocardiography in more comprehensively assessing the morphologic features of Ebsteins anomaly. (ECHOCARDIOGRAPHY, Volume 22, November 2005)

Live/Real Time Three-Dimensional Echocardiographic Demonstration of Left Ventricular Noncompaction and Thrombi

We describe two adult patients with left ventricular noncompaction in whom live/real time three‐dimensional transthoracic echocardiography (3DTTE) supplemented two‐dimensional transthoracic echocardiography in making a definitive diagnosis of clots coexisting with trabeculations in the left ventricle. Mobility of clots and the presence of central echolucencies consistent with clot lysis were best demonstrated by 3DTTE and served to confidently differentiate clots from adjacent trabeculations.

Real Time/Three-Dimensional Transthoracic Echocardiographic Visualization of the Valve of Foramen Ovale

We describe an adult patient in whom the valve of foramen ovale and its opening and closing movements were well visualized by live/real time three‐dimensional transthoracic echocardiography.

Live/real time three-dimensional transthoracic echocardiographic assessment of mycotic pseudoaneurysm involving the descending thoracic aorta.

We describe a patient in whom a mycotic aneurysm involving the distal descending thoracic aorta could be definitively diagnosed by live/real time three‐dimensional transthoracic echocardiography.

RESEARCH FROM THE UNIVERSITY OF ALABAMA AT BIRMINGHAM: Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of Ebstein's Anomaly: 3D ECHO IN EBSTEIN'S ANOMALY

We describe our experience in using live/real time three‐dimensional transthoracic echocardiography (3D TTE) in the assessment of five adult patients with Ebsteins anomaly. The technique was found useful in assessing the distribution and extent of tethering of each of the three leaflets of the tricuspid valve (TV) to the underlying right ventricular walls and the ventricular septum. The characteristic bubble‐like appearance resulting from bulging of the non‐tethered areas of the TV leaflets was also well visualized in three dimensions and their size measured. Thus, an estimate of the nontethered or free segments of all three leaflets of the TV could be obtained using this technique. This has important implications when considering these patients for surgical repair of the TV. Visualization of all three leaflets of the TV and their extent of tethering by 3D TTE also made it easier to identify the boundaries of the functioning right ventricular chamber potentially providing a more reliable assessment of its volumes and ejection fraction. Cropping of color Doppler 3D TTE data sets provided en face viewing of the TV regurgitation vena contracta permitting accurate assessment of its shape and size. This has the potential to provide a more accurate quantitative estimation of TV regurgitation severity as compared to two‐dimensional color Doppler. In conclusion, live/real time 3D TTE appears useful in supplementing two‐dimensional echocardiography in more comprehensively assessing the morphologic features of Ebsteins anomaly. (ECHOCARDIOGRAPHY, Volume 22, November 2005)