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Berlin Brandenburg

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  • Kronzon, Itzhak  (15)
  • 1
    Language: English
    In: Journal of the American Society of Echocardiography, 2001, Vol.14(10), pp.1036-1038
    Description: The pulmonary artery is typically seen on transthoracic echocardiography in its longitudinal axis. Therefore, short axis views of the pulmonic valve leaflets are not generally obtained, and the distinction between tricuspid and bicuspid pulmonic valves is difficult or impossible. Bicuspid pulmonic valve is one cause of pulmonic stenosis, which is especially common in tetralogy of Fallot. Presented here are 2 patients in whom the orientation of the pulmonary artery was unusual, and the pulmonic valve was seen en face. The first patient had tetralogy of Fallot and a bicuspid pulmonic valve. The severe obstruction to right ventricular outflow was infundibular. The second patient had severe stenosis of a tricuspid pulmonic valve, which was treated with balloon valvuloplasty. These unusual views of the pulmonic valve leaflets were obtained because of anterior displacement of the pulmonary artery, and precise anatomic delineation of the problem in each case was possible with transthoracic echocardiography.
    Keywords: Medicine
    ISSN: 0894-7317
    E-ISSN: 1097-6795
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  • 2
    Language: English
    In: American Heart Journal, 1996, Vol.132(4), pp.893-894
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
    E-ISSN: 10975330
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  • 3
    In: Archives of Internal Medicine, May 8, 2000, Vol.160(9), p.1337
    Description: Background: The outcome of aortic valve replacement for severe aortic stenosis is worse in patients with impaired left ventricular function. Such dysfunction in aortic stenosis may be reversible if caused by afterload mismatch, but not if it is caused by superimposed myocardial infarction. Methods: From our echocardiography database, 55 patients with severe aortic stenosis (valve area [is less than or equal to] 0.75 [cm.sup.2]) and ejection fractions of 30% or lower who subsequently underwent aortic valve replacement were included. The operative mortality and clinical follow-up were detailed. Results: There were 10 perioperative deaths (operative mortality, 18%). Twenty (36%) of the 55 patients had a prior myocardial infarction. In the 35 patients without prior myocardial infarction, there was only 1 death (3%). In contrast, 9 of 20 patients with prior myocardial infarction died (mortality rate, 45%; P [is less than or equal to] .001). The factors significantly associated with perioperative death on univariate analysis (functional class, mean aortic gradient, and prior myocardial infarction) were entered into a model for stepwise logistic regression. This multivariate analysis showed that only prior myocardial infarction was independently associated with perioperative death (odds ratio, 14.9; 95% confidence interval, 2.4-92.1; P = .004). Conclusions: The risk of aortic valve replacement in patients with severe aortic stenosis and severely reduced left ventricular systolic function is extremely high if the patients have had a prior myocardial infarction. This information should be factored into the risk-benefit analysis that is done preoperatively for these patients, and it may preclude operation for some. Arch Intern Med. 2000;160:1337-1341
    Keywords: Heart Valve Replacement -- Usage ; Aortic Valve Stenosis ; Surgery
    ISSN: 0003-9926
    E-ISSN: 15383679
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  • 4
    Language: English
    In: Journal of the American College of Cardiology, April 1994, Vol.23(5), pp.1085-1090
    Description: . The purpose of this study was to prospectively evaluate the risk of vascular events in patients with protruding aortic atheromas. . Protruding atheromas of the thoracic aorta have been shown to be associated with embolic disease in previous retrospective studies. . During a 1-year period, 521 patients had transesophageal echocardiography. Of these, 42 patients had protruding atheromas and no other source of emboli. They were followed up for up to 2 years (mean follow-up 14 months) and compared with a control group without atheromas, matched for age, gender and hypertension. . Of 42 patients with atheromas, 14 (33%) had 19 vascular events during follow-up (5 brain, 2 eye, 4 kidney, 1 bowel, 7 lower extremity). Of 42 control patients, 3 (7%) had vascular events (2 brain, 1 eye). Univariate analysis identified only protruding atheromas as significantly correlating with events (p = 0.003). There was no positive correlation of events with age, gender, hypertension, smoking, family history, atrial fibrillation, valve replacement, antithrombotic drug use, diabetes or coronary disease. Multivariate analysis showed that only protruding atheromas independently predicted events (p = 0.005, odds ratio 4.3, 95% confidence interval 1.2 to 15.0). Nine patients died in the atheroma group versus six in the control group, but this was not statistically significant (p = 0.39). . Protruding atheromas seen on transesophageal echocardiography predict future vascular events.
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
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  • 5
    Language: English
    In: The American Journal of Cardiology, 1992, Vol.69(17), pp.1495-1497
    Description: Perforation of a mitral valve leaflet is uncommon. Most perforations are the result of bacterial endocarditis. Although mitral regurgitation is readily diagnosed by Doppler echocardiography, identification of leaflet perforation by conventional transthoracic echocardiography (TTE) may be difficult. Limitations in resolution, reverberatory echoes and signal dropout may contribute to this problem. 1 Improved visualization of mitral valve pathology by transesophageal echocardiography (TEE) has been well documented in patients with bacterial endocarditis. 2–4 In this study of 10 patients with mitral valve perforation we compared the diagnostic sensitivity of TTE with that of TEE for the demonstration of mitral valve perforation, valvular vegetation and mitral valve aneurysm. We also report an association of aortic regurgitation with mitral valve perforation.
    Keywords: Medicine
    ISSN: 0002-9149
    E-ISSN: 1879-1913
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  • 6
    Language: English
    In: American Heart Journal, 1997, Vol.133(5), pp.534-540
    Description: Plasma homocyst(e)ine [H(e)] levels correlate with the prevalence of arterial occlusive diseases. Recently, transesophageal echocardiography (TEE) has been used to evaluate patients with atherosclerotic plaques in the thoracic aorta. The purpose of this study was to determine whether H(e) levels correlate with the degree of atherosclerotic plaque in the thoracic aorta (ATH) as seen on TEE. Maximum plaque areas for three locations in the thoracic aorta (arch, proximal descending, and distal descending) were measured with TEE in 156 patients. Maximum plaque areas for these locations were added to yield an estimate of ATH. ATH and H(e) levels, and levels of folic acid, vitamin B , and pyridoxal 5`-phosphate were measured in a double-blind manner. Univariate analysis demonstrated a significant correlation of H(e) with ATH ( = 0.3, 〈 0.001). On multivariate analysis, H(e) was independently predictive of ATH ( for the model including H(e) was 0.63, 〈 0.0001). Plasma H(e) levels are therefore significantly and independently correlated with the degree of atherosclerosis in the thoracic aorta. (Am Heart J 1997;133:534-40.)
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
    E-ISSN: 10975330
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  • 7
    Language: English
    In: Journal of the American Society of Echocardiography, 2003, Vol.16(7), pp.774-776
    Keywords: Medicine
    ISSN: 0894-7317
    E-ISSN: 1097-6795
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  • 8
    Language: English
    In: Journal of the American Society of Echocardiography, May 2001, Vol.14(5), pp.396-398
    Description: The left atrial appendage of patients with mitral valve disease is commonly a source of thromboembolus and is often ligated during mitral valve surgery to diminish this risk. However, ligation is often incomplete. We describe a patient with a stroke whose only source of embolus was an incompletely ligated left atrial appendage. Attempts to exclude the left atrial appendage from the arterial circulation by suture ligation may not decrease the risk of thromboemboli and instead may increase such risk.
    Keywords: Medicine
    ISSN: 0894-7317
    E-ISSN: 1097-6795
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  • 9
    Language: English
    In: Archives of internal medicine, 11 November 2002, Vol.162(20), pp.2345-7
    Description: Aortic valve thickening (AVT) without aortic stenosis (AS) is common and was often considered benign. However, it has recently been found to be associated with increased morbidity and mortality. It is unknown whether patients with AVT are at risk for the development of AS. Our echocardiography database from 1987 to 1993 was searched for cases of AVT with at least 1 year of echocardiographic follow-up. The risk of the development of AS was compared in patients with and without AVT. There were 2131 patients with AVT and at least 1 year of echocardiographic follow-up. Aortic stenosis developed in 338 patients (15.9%) (mild, 10.5%; moderate, 2.9%; and severe, 2.5%). Multivariate analysis, including age, left ventricular hypertrophy, and mitral annular calcification, revealed that only mitral annular calcification was independently and significantly associated with progression to AS. Aortic valve thickening without stenosis is common, and it may progress to significant AS. It is possible that this development of AS may be responsible for some of the increased morbidity and mortality in patients with AVT.
    Keywords: Aortic Valve -- Diagnostic Imaging ; Aortic Valve Stenosis -- Diagnostic Imaging ; Cardiomegaly -- Complications
    ISSN: 0003-9926
    E-ISSN: 15383679
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  • 10
    Language: English
    In: The American Journal of Cardiology, 2002, Vol.90(12), pp.1320-1325
    Description: Severe aortic plaques seen on transesophageal echocardiography (TEE) are a high-risk cause of stroke and peripheral embolization. Evidence to guide therapy is lacking. Retrospective information was obtained regarding the occurrence of embolic events (stroke, transient ischemic attacks, or peripheral emboli) in 519 patients with severe thoracic aortic plaque seen on TEE since 1988. Treatment with statins, warfarin, or antiplatelet medications was noted. Treatment was not randomized. In a matched-paired analysis, each patient taking each class of therapy was matched for age, gender, previous embolic event, hypertension, diabetes, congestive failure, and atrial fibrillation to someone not taking that medication. Multivariate analysis was also performed. An embolic event occurred in 111 patients (21%). Multivariate analysis showed that statin use was independently protective against recurrent events (p = 0.0001). Matched analysis also showed a protective effect of statins (p = 0.0004; absolute risk reduction 17%, relative risk reduction 59%, number needed to treat [n = 6]). No protective effect was found for warfarin or antiplatelet drugs. The odds ratio for embolic events was 0.3 (95% confidence interval [CI] 0.2 to 0.6) for statin therapy, 0.7 (95% CI 0.4 to 1.2) for warfarin, and 1.4 (95% CI 0.8 to 2.4) for antiplatelet agents. Thus, there is a protective effect of statin therapy, and no significant benefit of warfarin or antiplatelet drugs on the incidence of stroke and other embolic events in patients with severe thoracic aortic plaque on TEE.
    Keywords: Medicine
    ISSN: 0002-9149
    E-ISSN: 1879-1913
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