True posttraumatic radial artery aneurysm / Aneurisma verdadeiro de arteria radial pos-traumatico

Radial artery aneurysms are rare and mostly secondary to traumatic events (posttraumatic pseudoaneurysms). Radial artery aneurysms should be treated due to the high risk of embolization, thrombosis, and compression of adjacent nerves. The authors describe a case of a 49-year-old patient complaining of a progressively growing tumor in the left wrist after a dog bite. The tumor proved to be a true posttraumatic aneurysm. Treatment consisted of removal of the aneurysm sac and ligation of the radial artery.

Os aneurismas de artéria radial são raros, sendo, na maioria das vezes, pseudoaneurismas pós-traumáticos. Os aneurismas de artéria radial devem ser tratados devido ao risco de embolização, trombose e compressão de estruturas nervosas adjacentes. Os autores relatam o caso de um paciente de 49 anos referindo tumoração de crescimento progressivo em punho esquerdo após mordedura canina, sendo diagnosticado aneurisma verdadeiro de artéria radial pós-traumático. Optou-se pela ressecção do saco aneurismático e ligadura da artéria radial.

Oclusión unilateral de la carótida interna con flujos reversos en ambas arterias oftálmicas: reporte de un caso / Unilateral internal carotid artery occlusion with bilateral ophthalmic arteries reverse flow: case report

El hallazgo de flujo reverso en una arteria oftálmica a través de la ventana transorbitaria en la evaluación de la oclusión carotidea, complementa el Doppler de vasos de cuello, demostrando la existencia de circulación colateral. En el siguiente caso, un paciente con oclusión carotidea derecha presenta flujo reverso en ambas arterias oftálmicas.

Comparação dos valores de débito cardíaco obtidos por termodiluição e dopplerfluxometria transesofágica / Comparison between two methods for hemodynamic measurement: thermodilution and oesophageal doppler

OBJETIVO: A termodiluição (TD) é padrão de monitorização hemodinâmica. Alguns parâmetros hemodinâmicos podem ser medidos através do Doppler Transesofágico (DTE). Método simples, menos invasivo. Com o objetivo de avaliar a acurácia do DTE foram comparados TD e DTE na determinação de medidas de débito cardíaco (DC). MÉTODOS: Foram determinadas 192 medidas simultâneas, em diferentes situações clínicas em dez pacientes com idade entre 21 85 anos (cinco do gênero masculino e cinco do feminino), oito internados sépticos em uso de drogas vasoativas e dois monitorizados para laringectomia e transplante hepático; todas avaliadas ao longo de quatro horas, em intervalos de 30 minutos. Foram utilizados dois tipos de doppler: o DeltexR, e o ArrowR, introduzidos entre 35 e 45 cm da fossa nasal e localizados no ponto de maior diâmetro da aorta descendente. Na TD, foi utilizado cateter de artéria pulmonar (Swan Ganz BaxterR) e monitor DX-2001R, confirmado o posicionamento radiologicamente e através das curvas pressóricas geradas. As medidas do DC realizadas através da TD foram obtidas com soro fisiológico gelado, sendo considerada a média de quatro medidas não diferentes de 5 por cento. Foi aplicado o método estatístico de Bland e Altman, com utilização de gráfico de regressão linear. RESULTADOS: Não houve diferença estatisticamente significante entre esses dois métodos de medida hemodinâmica, com coeficiente de correlação de 0,88 para o DC (Doppler DeltexR X Swan Ganz BaxterR) e coeficiente de correlação de 0,99 DC (Doppler Arrow rR X Swan Ganz BaxterR) respectivamente, observando-se correlação. CONCLUSÃO: A medida das variáveis hemodinâmicas ao DTE foi obtida com facilidade nos dez pacientes estudados e revelou ter este dispositivo acurácia compatível à TD.

OBJECTIVES: Thermodilution (TD) is the "gold standard method" for hemodynamic monitoring. Some parameters can be measured by Oesophageal Doppler (OD), which is simpler and less invasive. To evaluate the accuracy of OD, we compared this method with TD in measurement of cardiac output (CO). METHODS: One hundred and ninety two simultaneous measurements were made in 10 patients (5 male and 5 female) with different clinical situations, 8 with sepsis using vasoactive drugs and 2 monitored for laryngectomy and liver transplantation. Measurements were taken during 4 hours at 30 minute intervals. The two oesophageal dopplers used DeltexR and ArrowR, were introduced between 35 and 45 cm from the nose and located at the point of largest diameter of the descending aorta. In TD, we used the pulmonary artery catheter (Swan Ganz BaxterR) and the DX- 2001 monitorR positioning was confirmed with support of radiology and of pressures curves. Measurements of CO carried out by means of TD were achieved using an iced saline solution considering the mean of four measurements with less than a 5 percent difference. The statistical method used was the Bland-Altman scatter plot and dispersion graphic. RESULTS: No statistically significant difference was found between the two methods for hemodyamic measurement with a correlation coefficient of 0.8 for CO (Deltex DopplerR and Baxter Swan GanzR) and a correlation coefficient of 0.99 for CO (Arrow DopplerR and Baxter Swan GanzR). CONCLUSION: Homodynamic measurements with OD have the same accuracy as those with TD and were easily obtained in the 10 patients.

Ressincronização cardíaca total com marcapasso tetracâmara na insuficiência cardíaca refratária / Total cardiac resynchronization with four chamber pacemaker for refractory heart failure

A ressincronização cardíaca total, ou seja, interventricular, interatrial e atrioventricular, com intervalo atrioventricular ótimo, pode ser imperiosa nos casos de pacientes com indicação formal de ressincronização cardíaca com marcapasso biventricular para tratamento da insuficiência cardíaca refratária ao tratamento medicamentoso e que também apresentam evidências de distúrbios de condução interatrial. Neste artigo, apresentamos dois casos de pacientes portadores de miocardiopatia dilatada com dissincronia em todos os níveis(interatrial, interventricular e atrioventricular) que necessitaram de implante de marcapasso tetracâmara para obter os benefícios da terapia de ressincronização cardíaca

Experimental study of assessment on ventricular activation origin and contraction sequence by Doppler tissue imaging / 华中科技大学学报（医学）（英德文版）

To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mode, M-mode, and spectrum mode DTI. Our results showed that: (1) Acceleration mode DTI could show the origin of activation and conduction sequence on line; (2) M-mode DTI revealed that the activation in mid-interventricular septum was earlier than that in mid-left ventricular posterior wall at sinus activation; (3) Spectrum DTI showed the ventricular endocardium was activated earlier than the ventricular epicardium in all segments at sinus rhythm. The earliest site of activation of the normal ventricular wall was at middle interventricular septum; the latest site was at basal-posterior wall; the contraction sequence was different at the different walls; (4) During abnormal ventricular activation, mid-left ventricular posterior wall was activated earliest in accordance with the pacing sites. Abnormal ventricular activation was slower than sinus activation, and the contraction sequence varied at different sites of ventricular wall. It is concluded that DTI can be used to localize the origin of normal or abnormal myocardial activation and to assess the contraction sequence conveniently, accurately and non-invasively.

Digitized M-mode computer assisted analysis of diastolic left ventricular function in comparison with doppler echocardiography

This work aims to examine the correlation between digitized system computer-assisted analysis of the simultaneously recorded phono-M-mode echocardiogram with the diastolic function estimated by Doppler echocardiography. A total of 100 subjects were included in this study. They were divided into 3 groups, group I [control] consisted of 25 normal subjects [mean age = 41 +/- 4.7 years] group II [hypertensive] consisted of 55 hypertensive patients [mean age = 43 +/- 6 years], and group III [ischemic group], consisted of 20 patients with evidence of ischemic heart disease, [mean age = 42 +/- 5.4 years]. They all underwent [1] M-mode echocardiographic examination from which the data were processed by the computer and analyzed with the help of a video-screen and a keyboard, [2] pulsed Doppler examination of LV inflow tract and obtaining different diastolic filling parameters. The study demonstrated that hypertensive patients have marked changes in LV filling. By Doppler there were reversal of E/A ratio, prolonged velocity half, time, decreased EF slope, reduced early filling fraction and increased late filling fraction. By digitized M-mode there were reduction of peak filling rate, increased isovolumic relaxation period, delay in mitral valve opening, marked increase in LV dimension during isovolumic relaxation, reduction of the rapid filling period and increased atrial systolic period. On the other hand patients with ischemic heart disease showed abnormalities in diastolic function measured by digitized M-mode. There were a decrease in the early peak rate of dimension increase, prolonged time from minimum dimension to mitral valve opening and prolonged duration of LV filling due to atrial contraction. While Doppler indices of diastolic function showed no significant changes compared to control. When correlation between the two methods was performed for each group separately, the results were less significant, non-significant and sometimes incorrectly significant-However, when correlation between the two methods was performed for the combined groups the results are conventional. The alsolute solute and to lesser extent the relative rapid filling periods and the dimensional changes before mitral valve opening could b e considered the only diastolic measures by the digitized M-mode that were related to most of the Doppler measures of diastolic function in the combined groups of patients. Doppler and M-mode echocadiograms measure different aspects of LV diastolic function, so they are slightly correlated to each other. Therefore both techniques can be regarded as complementary rather than exclusive or interchangeable, and their combined use, especially with non-invasive methods, is likely to be much more productive than that of either alone

Evidence of valve regurgitation by Doppler echocardiography in patients with rheumatic fever without clinical carditis

Because of the observation that patients with acute rheumatic fever without clinical carditis develop later rheumatic heart disease, and the postulation that such patients may have a subclinical [silent] carditis in the initial attack, we studied the heart in a group of such patients using Doppler echocardiography. Twenty five patients with recent isolated rheumatic arthritis and 25 patients with recent isolated rheumatic chorea in their initial attack were the subject of the study. They all had no past history of rheumatic fever or rheumatic heart disease. Doppler studies were done one to 28 days from the onset of symptoms. It was found that 50% of the patients had Doppler evidence of valve regurgitation, most commonly of the mitral and aortic valves. The severity of regurgitation was mild in most cases [75%] and moderate in the rest. 28% of the sample had two valves affected simultaneously. The results explain the finding of rheumatic heart disease in patients initially free of carditis several years after the first attack. They demonstrate that the use of Doppler echocardiography in the diagnosis of carditis in initial rheumatic fever attacks is essential They also demonstrate the importance of more prolonged bed rest, treatment with corticosteroids, and possibly life time prophylaxis in rheumatic fever patients who have Doppler evidence of valve regurgitation in the absence of acardiac murmur

Dimensión de ecocardiografía modo M bidimensional y Doppler en la enfermedad pulmonar obstructiva crónica

La ecocardiografía de modo M y bidimensional proporciona información anatómica y funcional del corazón derecho. Asociada a Eco-Doppler permite cuantificar de manera muy aproximada la presión del ventriculo derecho, además de informar sobre los intervalos sistólicos. Resultados : Se hizo una investigación descriptiva, observacional, análitica de casos y controles. Se estudiaron 32 casos de nuestro trabajo de EPOC y leña. Dichos pacientes fueron manejados desde el punto de vista clínico, radiológico, electrocardiográfico, espirométrico y ecocardiográfico. El grupo control estuvo constituido, para los intervalos sistólicos, espesor y diámetro de las cavidades normales, por los estudios ecocardiográficos normales, realizados en el Servicio de Ecocardiografía de la Unidad de Cardiología del Hospital San Juan de Dios de Santafé de Bogotá, en número de 51, y para las presiones pulmonares, por los estudios de cateterismo derecho practicados en el Servicio de Hemodinamia de la Unidad de Cardiología, en número de 66, en pacientes con cardiopatías congénitas o adquiridas. En casos de EPOC, los signos electrocardiográficos más frecuentes fueron el crecimiento auricular derecho (64.51 por ciento) y el crecimiento ventricular derecho (58.06 por ciento). Los Rayos X de otra parte mostraron los siguientes signos de hipertensión pulmonar : prominencia del tronco de la arteria pulmonar (78.51 por ciento) crecimiento auricular y ventricular derechos (64.28 por ciento) y aumento de la rama inferior derecha de la arteria pulmonar (60.71 por ciento). En cambio la ecocardiografía muestra aumento del espesor del ventrículo derecho (93.75 por ciento), aumento de su diámetro diastólico final (62.50 por ciento) y valores superiores a 35 mm de Hg de presión del ventrículo derecho en 65.62 por ciento. Son igualmente significativos el tiempo de aceleración del ventrículo derecho que disminuye, el PPE.V.D. que aumenta, y la relación PPE.V.D/TE.V.D aumentado. Conclusión : La ecocardiografía de modo M y bidimensional y la Eco Doppler, proporcionan información valiosa no invasiva, confiable y fácilmente repetible en casos de EPOC.

Constrictive pericarditis-a diagnostic challenge

Constrictive pericarditis presents with protean manifestation and may masquerade as pleural effusion or as abdominal discomfort or ascites of unknown aetiology. Three cases who presented with atypical manifestations to Salmaniya Medical Centre are reported to emphasise the difficult diagnostic challenge the disease poses. The importance of eliciting subtle physical signs such as jugular venous pulsations, precordial movements and heart sounds and the common investigations to clinch the diagnosis are discussed. Timely diagnosis and prompt surgical resection of the pericardium result in gratifying results and the condition is potentially curable with good prognosis in the long term

Quantitative assessment of mitral regurgitation by doppler echocardiography: value of multifactorial approach

This study was undertaken to assess the value of Doppler echocardiographic parameters taken singly and in association for the quantification of mitral regurgitation. Fifty-eight patient, with angiographically mild [Group I,n=21], moderate [Group II, n=9] or severe [Group III, n=28] mitral regurgitation, underwent Doppler echocardiographic examination. The following parameters were chosen for the study; maximum color Doppler regurgitant jet area, ratio of maximum regurgitant jet area to left t atrial area, width of the reguritantjet at its origin, maximum regurgitant jet length, peak early velocity of mitral inflow, and intensity of regurgitant signal on continuous wave Doppler [CW] graded 1 to 3. univariate statistical analysis showed that maximum regurgitation jet area >8.1 cm° predicted the presence of severe regurgitation with a sensitivity of 50% and a specificity of 100. peak early velocities of mitral inflow over 1.7 m/s identified Group III patients with sensitivity of 54% and a specificity of 100%.finally, Grade 3 CW signal intensity predicted severe regurgitation with a sensitivity of 86%and a specificity of 97%. A score was elaborated from multivariate analysis based on maximum regurgitant jet area and continuous wave signal intensity. All patients with scores over 3.5 [n=14] had severe regurgitation and patients with a score of0 or less [n=23] had mild to moderate mitral regurgitation. Left ventriculography was required to differentiate patients with intermediate scores [n=21]. Non-invasive Doppler echocardiographic quantification of mitral regurgitation remains difficult even when a multifactorial approach is used. However, severe regurgitation can be reliably diagnosed or excluded in more than 60% of cases by this method

Neonatal pulmonary flow pattern--a pulsed Doppler echo study.

The pulmonary flow pattern was analysed by pulsed Doppler in 77 normal neonates, at < 48 hours (36 subjects), 49 to 96 hours (25 subjects) and 97 to 148 hours (16 subjects). From the flow velocity spectrum, using an built in computer system, the acceleration time and the ejection time were measured, and the ratio was calculated. This ratio was 0.24 +/- 0.08 in the subjects within 48 hours whereas this ratio was 0.53 +/- 0.11 in the subjects above 97 hours; thus the ratio increased with age. We noticed that the ratio obtained from the pulsed Doppler is useful in assessing the pulmonary vascular status, even in neonates.

Assessment of left ventricular diastolic function in young diabetics--a two dimensional echo Doppler study.

Left ventricular diastolic function was assessed in 21 young diabetic subjects (less than 35 years) by Doppler transmitral flow velocity examination and compared with an equal number of matched controls. Diabetic subjects had higher heart rates (89 +/- 2 vs 79 +/- 4 beats/minute, p less than 0.015), peak late diastolic (A) velocity and a velocity time integral (56.6 +/- 13.4 vs 45.3 +/- 11.4 cm/sec. p less than 0.005 and 7.3 +/- 5.2 vs 6.5 +/- 2.5 cm p less than 0.03 respectively) and total transmitral flow velocity integral (25.8 +/- 5 vs 22 +/- 3.2 cm, p less than 0.05). Peak E velocities, E velocity time integrals, E/A ratio, and peak filling rates were similar in two groups (p = not significant). These data suggests that young patients with diabetes mellitus have normal left ventricular diastolic function. The minor transmitral flow abnormalities are possibly due to autonomic dysfunction, e.g. increased sympathetic activity resulting in increased heart rate and cardiac output.

Effect of different atrioventricular delays in patients with dual chamber pacing on left ventricular function at rest: echo-doppler study

In presence of normal SA node function, VDD mode, is often the most efficient means to pace the heart in a truly physiological pattern. In this study, Doppler echocardiography has been used to assess at rest both cardiac systolic and diastolic functions during VDD mode of pacing at different atrioventricular delays [AVD] and VVI mode at the same rate. In conclusion, this study confirms the hemodynamic benefit gained by patients with complete A-V block from the dual chamber mode of pacing, and demonstrates the simplicity, reliability and reproducibility of the echo-Doppler study in assessment of myocardial performance and the necessity of atrial systole. The study also stressed the importance of a properly timed atrial contraction, and that there is an optimal AV delay at which myocardial function is at its maximum. Finally, the interindividual variability of the optimal AV delay has been confirmed

Parameters of heart failure in the pediatric age group

This is a comprehensive study about heart failure [HF] in pediatric age group. Ninety-two patients [51 males and 41 females] with HF were submitted to clinical and electrocardiographic examinations, chest X- ray, arterial pH and blood gases estimation. Echocardiography was performed to all patients with special emphasis on left ventricular systolic function. According to age, patients were segregated in 2 groups: Group I included 35 infants and group II included 57 children. Rheumatic heart disease was the commonest entity causing HF in 70% of patients of group II, followed by congenital heart diseases in 38% of all patients and dilated cardiomyopathy found in 18.4% of all patients. Left ventricular systolic function was found to be the lowest in dilated cardiomyopathy. It is recommended to expand the surgical repair of valvular rheumatic heart lesions and to assess left ventricular function by echocardiography in all patients with HF. It is crucial to establish a center for cardiac transplantation to manage those patients who have no available other alternative

Role of doppler echocardiography in diagnosis of mitral valve diseases

Doppler echocardiography has been established as an indispensable, noninvasive technique in the evaluation of mitral valve diseases. This study included 2 groups, a group of 30 patients having mitral valve lesions and a control group of 10 normal subjects. A meticulous Doppler echocardiographic examination was performed for each subject. The normal diastolic mitral valve flow pattern was demonstrated and the mean values of the maximum velocity of blood flow [Max. V], the maximum transvalvular pressure gradient [Max. PG], and the maximum pressure half time [Pt 1/2] were recorded. Patients of the first group were diagnosed and classified according to the type of lesion, whether isolated mitral stenosis [10 cases], isolated regurgitation [18 cases] or combined stenosis and regurgitation [2 cases]. Max. V, Max. PG and Max. Pt 1/2 were calculated in each case and the characteristic Doppler flow pattern across the valve was demonstrated in each lesion. Doppler echocardiography showed high sensitivity and specificity in the diagnosis of mitral valve diseases and in assessment of its severity