ABSTRACT
BACKGROUND: Relaxation of the esophagogastric junction (EGJ) is now evaluated calculating 4-second integrated relaxation pressure (4-s IRP) by high resolution manometry (HREPT). Solid-state catheters have been used to define abnormal values. Our aim was to evaluate 4-s IRP in esophageal achalasia using HREPT with perfused catheters. METHODS: From June 2009 to June 2013, 936 HREPT studies have been performed in our unit. Of these, 194 patients having treated achalasia were excluded. Control group was constituted by 695 patients without achalasia, and 47 patients with untreated achalasia constituted the study group. HREPT was performed with water-perfused catheters. To establish the cut-off value for 4-s IRP that better discriminate patients with achalasia from all other patients, a receiver operating characteristic (ROC) analysis was performed. KEY RESULTS: Twenty three of 47 achalasia patients (49%) showed a 4-s IRP under 15 mmHg; and seven (15%) had a value under modified Chicago criteria. A cut-off value for 4-s IRP of 6.5 mmHg, calculated by ROC analysis, highly discriminates achalasia from the rest of the patients and especially from scleroderma patients (area under the curve: 0.997, 95% CI: 0.995-1.000; p < 0.001). CONCLUSIONS & INFERENCES: Cut-off values for 4-s IRP defined using HREPT with solid-state catheters are not adequate for diagnosing esophageal achalasia with water-perfused systems. A lower value, i.e., 6.5 mmHg, is suggested for this equipment. The diagnostic criteria of esophageal achalasia should be modified for HREPT performed with water-perfused systems.
Subject(s)
Esophageal Achalasia/diagnosis , Esophagogastric Junction/physiopathology , Manometry/methods , Adolescent , Adult , Aged , Aged, 80 and over , Area Under Curve , Catheters , Female , Humans , Male , Manometry/instrumentation , Middle Aged , Muscle Relaxation/physiology , Muscle, Smooth/physiopathology , Pressure , ROC Curve , Reference Values , Water , Young AdultSubject(s)
Critical Care , Echocardiography/methods , Aorta, Thoracic/pathology , Aortic Diseases/diagnosis , Color , Embolism/diagnosis , Esophagus , Heart Valve Diseases/diagnosis , Heart Valve Prosthesis , Humans , Myocardial Infarction/diagnosis , Postoperative Complications/diagnosis , Prosthesis FailureABSTRACT
The diagnosis of a left circumflex coronary artery--coronary sinus fistula draining into the right atrium was confirmed by echocardiographic analysis. Two-dimensional echocardiography revealed a dilatation of the left main coronary artery, the left circumflex artery, the coronary sinus and a fistulous communication. Pulsed Doppler echocardiographic study showed a turbulent, continuous flow within the dilated coronary artery, in the coronary sinus and at the site of its drainage into the right atrium. There was a diastolic flow-reversal in the descending aorta in absence of aortic insufficiency. Color Doppler echocardiography enhanced the finding of the correct diagnosis by simultaneously displaying blood flow within various parts of the heart and the coronary vessels. This technique aided in establishing the exact location of the fistula by demonstrating a turbulent blood flow, even in narrow cardiac structures. The echocardiographic diagnosis was confirmed by coronary angiography.
Subject(s)
Arteriovenous Fistula/diagnosis , Coronary Disease/diagnosis , Echocardiography, Doppler/methods , Aged , Blood Flow Velocity , Cardiac Catheterization , Coronary Angiography , Female , Hemodynamics , HumansABSTRACT
Five patients (four males and one female, aged 29 to 75 years) with subaortic stenoses were examined by transthoracal and transoesophageal echocardiography, including two-dimensional Doppler echocardiography. In only one patient could the obstruction of the left ventricular outflow tract be definitively evaluated by transthoracal echocardiography, whereas by transoesophageal echocardiography the presence of a subaortic membrane could be demonstrated in all patients. The latter method thus proved to be reliable in evaluating the extent of obstruction.
