Walter Paulsen

Doppler echocardiographic evaluation of Hancock and Björk-Shiley prosthetic valves

Doppler echocardiographic characteristics of normally functioning Hancock and Björk-Shiley prostheses in the mitral and aortic positions were studied in 50 patients whose valvular function was considered normal by clinical evaluation. Doppler studies were also performed in 46 patients with suspected malfunction of Hancock and Björk-Shiley valves and who subsequently underwent cardiac catheterization. Mean gradients were estimated for both mitral and aortic valve prostheses and valve area was calculated for the mitral prostheses. Doppler prosthetic mitral valve gradient and valve area showed good correlation with values obtained with cardiac catheterization (r = 0.93 and 0.97, respectively) for both types of prosthetic valves. The correlation coefficient (r = 0.93) for mean prosthetic aortic valve gradient was also good, although Doppler echocardiography overestimated the mean gradient at lower degrees of obstruction. Regurgitation of Hancock and Björk-Shiley prostheses in the mitral and aortic positions was correctly diagnosed. These results suggest that Doppler echocardiography is a reliable method for the characterization of normal and abnormal prosthetic valve function.

Electrocardiographic criteria for diagnosis of left ventricular hypertrophy in the presence of complete right bundle branch block

The usual electrocardiographic criteria recommended for left ventricular (LV) hypertrophy may be unreliable in the presence of complete right bundle branch block (BBB). Thirty-six standard electrocardiographic criteria for LV hypertrophy were evaluated in 100 patients (mean age +/- standard deviation 67 +/- 11 years) with right BBB and technically satisfactory echocardiograms. Eight additional electrocardiographic criteria derived from this study also were evaluated. LV mass index was determined from the echocardiogram using the Penn method. LV hypertrophy defined as LV mass index greater than 132 g/m2 in men and 109 g/m2 in women was present in 56 of the 100 patients. Electrocardiographic criteria with the highest sensitivity were SIII + (R + S) maximal precordial lead greater than or equal to 30 mm (sensitivity 68%), specificity 66%), left axis deviation of -30 degrees to -90 degrees (sensitivity 59%, specificity 71%) and combination of left axis deviation and SIII + (R + S) maximal precordial lead greater than or equal to 30 mm (sensitivity 52%, specificity 84%). The electrocardiographic criteria with the highest sensitivity and specificity greater than 90% were left axis deviation of -30 degrees to -90 degrees and SV1 greater than 2 mm (sensitivity 34%), point-score system, RaVL greater than 12 mm and RI + SIII greater than 25 mm (each with a sensitivity of 27%). In general, limb lead voltage criteria such as RaVL greater than 11 mm (sensitivity 29%, specificity 86%) had higher sensitivities than criteria using right precordial lead S-wave voltage criteria such as SV1 + RV5, V6 greater than 35 mm (sensitivity 2%, specificity 100%).(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiographic evaluation of patients with a left ventricular device.

Limited donor heart availability is primarily responsible for the renewal of interest in mechanical left ventricular assist devices (LVADs) as a bridge to transplantation. Donor availability is unlikely to increase significantly in the near future. Experience to date has shown that many patients can be maintained long enough to undergo transplantation, and LVADs may be acceptable as alternate therapy in some who may not be candidates for transplantation. However, criteria for noninvasive evaluation of patients on LVADs have not been developed. In a prospective study using serial echocardiography, we found that aortic valve opening, aortic forward flow, nonlaminar flow in the left ventricle, and mismatch of Doppler derived cardiac output at the pulmonic valve and device output are associated with device malfunction. Echocardiography was diagnostic in five of six patients with clinical instability unrelated to the device. These findings suggest that echocardiography is helpful in the routine evaluation of patients on LVADs.

Improved identification of posterior left ventricular pseudoaneurysms by transesophageal echocardiography

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