Diastolic function abnormalities in rheumatoid arthritis; an echocardiographic study

The aim of this study was to evaluate left ventricular-filling in patients with rheumatoid arthritis [RA], analyzing transmitral flow and pulmonary venous flow, with special regard to disease duration. Forty-five patients affected by RA according to ARA criteria were selected, without evidence of cardiac disease, and compared with matched control subjects. All patients and control group were submitted to M-mode, two- dimensional Doppler and color Doppler [continuous and pulsed wave] echocardiography. Transmitral flow [E/A ratio], pulmonary venous flow [S/D ratio], IVRT and DT. In RA patients, left ventricular filling abnormalities were found to be characterized by a reduced E/A ratio. It was concluded that RA patients, in the absence of clinical evidence of heart disease, show LV diastolic dysfunction characterized by impaired E/A and S/D ratio. The relation with the disease duration suggests a sub-clinical myocardial involvement

Ventricular septal defects color echo-doppler assessment versus intraoperative findings

This study included 30 patients with congenital ventricular septal defect [VSD]. Out of them, 23 had isolated VSD, one patient had associated patient ducts arteriosus and two had valvular pulmonary stenosis. All patients were assessed for the detection of type and size of the VSD. Twenty-six cases of the 30 VSDs were perimembranous and 20 were described as outlet and three as muscular VSD [one of them was classified as multiple type and the other two cases were single VSD]. The size of VSD ranged 0.3-1.6 cm with a mean of 0.78 + 0.39 cm. The size of VSD by 2D echo ranged between 0.2 and 1.7 cm with a mean of 0.73 + 0.40. There were good correlations between the size of VSDs assessed by 2D echo-Doppler and that measured during surgery

Role of transesophageal echocardiography in detecting cardiac source of cerebral emboli

To study the ability of transesophageal echocardiography in detecting cardiac source of emboli in patients with cerebral stroke [Transient Ischemic Attack [TIA] or infarction]. Transthoracic and Biplane Transesophageal echocardiographic studies were performed in 30 consecutive patients with cerebral infarction or TIA. Transesophageal echocardiography identified cardiac source of embolism in 15 patient [50%] of patients where transthoracic echocardiography identified cardiac source of emboli in only 2 patient [6.7%] P<0.0005, the group of patients with no cardiovascular disease clinically were 10 patients with normal transthoracic echocardiography but transesophageal echocardiography revealed mitral valve prolapse in one patient and aortic protruding atheroma in another patient as a source of emboli, in the group of patients with clinical evidence of cardiovascular disease 20 patients transesophageal echocardiography was detecting cardiac source of emboli in the form of left atrial thrombus in 3 patients, left atrial spontaneous echo contrast in 6 patients, prosthetic cardiac valve thrombus or vegetation in 5 patients and patent foramen oval in one patient, All patients thrombi not detected with transthoracic echocardiography. Transesophageal echocardiography is superior than transthoracic echocardiography in detecting the cardiac source of emboli in patients with embolic cerebral stroke or transient Ischemic attacks

study of spontaneous echo contrast in patients with rheumatic mitral stenosis and normal sinus rhythm

To study the incidence of spontaneous echocontrast in left atrium of patients having rheumatic mitral stenosis with normal sinus rhythm and to define its relations. Transthoracic and Biplane transesophageal echocardiographic studies were performed in 50 consecutive patients with rheumatic mitral stenosis who were in normal sinus rhythm. Spontaneous echo contrast in the left atrium was seen in 60% of patients on Biplane transoesophageal echocardiography and in only 4% on transthoracic. Echocardiographic results The mean mitral valve area was 1.07 + 0.33 cm2 and 1.32 +0.45 cm2 [P=0.004], mean left atrial size was 4.27 + 0.67 cm and 3.91 + 0.5 cm. [P=0.029], mean diastolic pressure gradient was 12.64 + 5.69] mm Hg and 10 + 5.5 mm Hg [P=0.049], and absence of mitral regurgitation was seen in 50% and 30% of patients respectively [P=0.1] among patients with spontaneous echo contrast, 30% had either left atrial/or appendage thrombus or history of embolism, versus 0% in patients without spontaneous echo contrast [P<0.0001]. There is a high incidence of spontaneous echo contrast in the left atrium in patient with rheumatic mitral stenosis in normal sinus rhythm on Biplane transesophageal echocardiography. These patients are likely to embolise or form thrombi in the left atrium