Prognostic assessment of uncomplicated first myocardial infarction by exercise echocardiography and Tc-99m tetrofosmin gated SPECT.

BACKGROUND: We evaluate the prognostic value of stress echo and gated single photon emission computed tomography (SPECT) after a first uncomplicated acute myocardial infarction. METHODS AND RESULTS: We used predischarge maximal subjective exercise echocardiography and gated SPECT with technetium 99m tetrofosmin to prospectively study 103 patients younger than 70 years with a first acute myocardial infarction. During a 12-month follow-up period, 2 patients died, 9 had heart failure, and 29 had ischemic complications (4 reinfarction and 25 angina). Predictive variables for heart failure in multivariate analysis were ejection fraction evaluated by echocardiography (odds ratio [OR] 8.5, P =.016) or by gated SPECT (OR 10.7, P =.009). Predictive variables for ischemic complications in multivariate analysis were less than 5 metabolic equivalents (METS) in exercise test (OR 5.2, P =.007) and greater than 15% ischemic extent in the polar map (OR 3.6, P =.04) of SPECT. CONCLUSIONS: Exercise echocardiography and Tc-99m tetrofosmin gated SPECT were predictive for heart failure, but exercise SPECT was the only test with predictive power for ischemic complications.

[Morphologic classification of hypertrophic cardiomyopathy with myocardial single photon emission tomography. Comparison with echocardiographic classification]. / Clasificación morfológica de la miocardiopatía hipertrófica mediante tomogammagrafía miocárdica. Comparación con la clasificación ecocardiográfica.

INTRODUCTION AND OBJECTIVES: The aim of this study was to compare different morphologic types of hypertrophic cardiomyopathy obtained by single photon emission tomography to those obtained by echocardiogram. MATERIALS AND METHODS: In 76 (64%) out of 119 patients with hypertrophic cardiomyopathy the echocardiogram permitted an optimal visualization of all left ventricular segments in the short axis view and consequent classification to one of the six morphological types: type I (septal anterior hypertrophy), type II (septal anterior and septal posterior hypertrophy), type III (septal and antero-lateral hypertrophy), type IV (antero-lateral and/or septal posterior hypertrophy), type V (concentric hypertrophy) and type VI (apical hypertrophy). Without knowledge of echo data, two experienced observers included the short axis of single photon emission tomography images at rest (99mTc-tetrofosmin) to one of those types. RESULTS: Global concordance between echocardiogram and single photon emission tomography was 75%. Type III was the most frequent both in echo (76%) and in single photon emission tomography (74%) and type III produced the majority of discrepancies. SPET identified 4 patients with a predominant septal and inferior hypertrophy, that did not correspond to any of the 6 types of echocardiographic classification and had been previously classified as type III by echo in 3 cases and as type V in 1 case. CONCLUSIONS: There was agreement between echo and single photon emission tomography in the morphological classification of most of the patients (75%) with hypertrophic cardiomyopathy. Nevertheless, some discrepancies were observed for the type III echocardiogram.

[Quantification of left-to-right shunt in atrial septal defect using oximetry, isotopes, and Doppler echocardiography. Is there a method of reference?]. / Cuantificación del cortocircuito de la comunicación interauricular mediante oximetría, isótopos y ecocardiografía Doppler. Existe un método de referencia?

INTRODUCTION: Determination of pulmonary to systemic blood flow ratio (QP/QS) is considered to be important for the management of patients with atrial septal defect. The QP/QS provides information on shunt severity and is usually determined by three methods: oximetry, first-pass radionuclide angiocardiography and Doppler echocardiography. The aim of the present study was to assess the accuracy and concordance level of these three methods in QP/QS quantification in atrial septal defects. PATIENTS AND METHODS: Sixty-four adult atrial septal defects patients in whom QP/QS was determined by these three methods with a 6 month interval were studied. Nuclear and echocardiographic post-surgical studies were repeated in 36 patients. RESULTS: QP/QS values determined by the three techniques had a low correlation between them: oximetry (r = 0.52; SEE = 0.74); radionuclide angiocardiography (r = 0.40; SEE = 0.79) and Doppler echocardiography (r = 0.72; SEE = 0.57). Radionuclide angiocardiography underestimated QP/QS > 3 (-0.61 +/- 1.21; p < 0.01). Only in 33% of studies there concordance (differences < 0.5) among the three methods and in 58% between two methods. Right ventricular dilatation and tricuspid regurgitation influenced radionuclide accuracy. Nevertheless, the correlation between this technique and echocardiography was satisfactory when the 36 post-surgical were included (r = 0.75); both techniques agreed in the diagnosis of the two cases with residual post-surgical shunt. CONCLUSIONS: Inter-method disparity in QP/QS quantification is high and no method can be used as a gold standard; clinical decisions therefore based on QP/QS quantification by one technique alone are ill-advised.

[Prognostic value of pre-discharge exertion echocardiography after acute myocardial infarct]. / Valor pronóstico de la ecocardiografía de esfuerzo postinfarto agudo de miocardio antes del alta hospitalaria.

OBJECTIVE: The aim of the present work was to ascertain the usefulness of exercise echocardiography performed prior to discharge following acute non-complicated myocardial infarction in the prognosis and detection of multi-vessel disease. PATIENTS AND METHODS: Sixty-five consecutive patients with primary episode of acute non-complicated myocardial infarction, with normal or slightly depressed ventricular function, were studied. Submaximal exercise test including echocardiogram pre- and immediately post-exercise were performed 7 to 10 days after infarction. Mean follow-up was 15 +/- 8 months; 15 patients presented angina, 9 revascularization and 1 died. RESULTS: Electrocardiographic ischaemia had low sensitivity and negative predictive value regarding complications (44% and 73% respectively); however, its specificity and positive predictive values were high (97% and 92%). In contrast, echocardiography-detected ischaemia showed much better sensitivity and negative predictive values (72% and 83%), with a slight decrease in specificity and positive predictive values (87% and 78%). Both remote ischaemia and the increase in global score > 0.25 during exercise were of high prognostic value (p < 0.001). Remote echocardiographic ischaemia yielded the diagnosis of multi-vessel disease with greater sensitivity than electrocardiographic ischaemia (84% vs 41%). CONCLUSIONS: Exercise echocardiography is highly useful in the prognostic assessment of patients prior to discharge following acute non-complicated myocardial infarction. The ischaemia detected on sub-maximal exercise and assessed by echocardiography was much more sensitive than that detected by electrocardiography in the prediction of new coronary events and multi-vessel disease.

[The use of transesophageal echocardiography in the diagnosis of aortic hematoma after an aortic recoarctation angioplasty]. / Utilidad de la ecocardiografía transesofágica en el diagnóstico de un hematoma aórtico tras la angioplastia de una recoartación aórtica.

Transesophageal echocardiography is a very useful technique in studying thoracic aorta diseases, particularly aortic dissection and aortic intramural hematoma. In this report, we describe a case of aortic intramural hematoma after balloon angioplasty of a recoarctation. This case illustrates the importance of transesophageal echocardiography in the diagnosis and subsequent management of possible complications following this technique.

[Thrombus in the thoracic aorta as cause of peripheral embolism diagnosed using transesophageal echocardiography]. / Trombo en aorta torácica como causa de embolismo periférico diagnosticado por ecocardiografía transesofágica.

The authors report the cases of two patients, with no risk factors for thromboembolism, in whom a mobile thrombus of the thoracic aorta was diagnosed by transesophageal echocardiography, after an episode of systemic embolism. The outcomes of the two cases were very different. In one patient the thrombus was no longer present after anticoagulant treatment with no recurrent embolic event. The other patient had a new embolic event and the thrombus persisted while having anticoagulant therapy. This patient underwent surgery, and the thrombus was removed. These cases illustrate the value of transesophageal echocardiography in the detection of embolic source.

Comprehensive noninvasive assessment of cardiac involvement in limited systemic sclerosis.

OBJECTIVE: To assess cardiovascular abnormalities in patients with limited systemic sclerosis (SSc), using noninvasive cardiac techniques. METHODS: Sixty-three patients with limited SSc were prospectively evaluated with Doppler echocardiography and thallium-201 perfusion scintigraphy after a cold-stress test and radionuclide ventriculography. RESULTS: In the patients with limited SSc, there was a significantly high prevalence of abnormal left- and right-diastolic function parameters (P = 0.001 and P = 0.0002, respectively), thickening of papillary muscles (46%; P = 0.003), and mild mitral regurgitation (49%; P < 0.0001), compared with controls. Systolic pulmonary arterial hypertension was detected in 9 patients (14%), and pericardial effusion in 11 patients (18%). In 64% of patients with limited SSc, an ischemic response was detected on the thallium cold-stress scan; similarly, an ischemic response was detected in 57% of patients with primary Raynaud's phenomenon (P < 0.0001 versus controls). CONCLUSION: Although the frequency of cardiovascular symptoms was low in patients with limited SSc, a significant rate of cardiovascular abnormalities was found by noninvasive cardiac techniques.

[Normal values of valvular flow velocities determined by Doppler echocardiography: relations with heart rate and age]. / Valores normales de las velocidades de los flujos valvulares determinadas por ecocardiografía-Doppler: relación con la frecuencia cardíaca y la edad.

INTRODUCTION AND OBJECTIVES: The velocity-time integral (VTI) and the mean velocity of valvular flow are widely-used variables in Doppler-echocardiography. The aim of the present work was to determine normal VTI and mean velocity values of valvular flow and their relation to age, sex, heart rate and body surface area. METHODS: One hundred and fifty-six patients (84 men, 72 women; age range: 6-86 y; mean: 37 +/- 20) without cardiovascular disease were studied by Doppler echocardiography. VTI and the mean velocity of left and right ventricular outflow tract, and mitral and tricuspid valvular flow were determined by pulsed-wave Doppler. Aortic and pulmonary valvular flow were assessed by continuous wave Doppler. RESULTS: Mean value of aortic valvular flow VTI (22 +/- 4 cm) was slightly higher than that of pulmonary valvular flow (20 +/- 4 cm). Mean VTI values of left and right ventricular outflow tract and mitral valvular flow were similar (16 +/- 3, 15 +/- 3 and 15 +/- 3 cm, respectively) with an acceptable correlation (r = 0.76-0.83). VTI of tricuspid valvular flow was clearly lower than the rest (10 +/- 3 cm; p < 0.001). Linear regression analysis showed the VTI to be inversely related to heart rate and age, and mean velocity positively related to heart rate and inversely to age. While VTI remained relatively stable up to the age of 60 and decreased sharply thereafter, mean velocity decreased progressively with age. VTI values were identical for both sexes; however, mean velocity was higher in women up to the age of 60. CONCLUSIONS: VTI is a Doppler parameter independent of body surface area, inversely related to heart rate, not sex-related and remains stable up to the age of 60. Normal mean velocity values should be defined in relation to heart rate and age. Normal values of these Doppler parameters should be borne in mind for non-invasive assessment of cardiovascular function.

Diagnosis of ascending aortic dissection by transesophageal echocardiography: utility of M-mode in recognizing artifacts.

OBJECTIVES: This study sought to assess the reliability of biplanar transesophageal echocardiography in the diagnosis of ascending aortic dissection and to test the utility of M-mode information in the differential diagnosis of ascending aortic ultrasound artifacts and intimal flap images. BACKGROUND: Transesophageal echocardiography is a useful technique in the diagnosis of aortic dissection. However, ultrasound artifacts in the ascending aorta are an important limitation. METHODS: Transesophageal echocardiography was performed in 132 consecutive patients with clinically suspected aortic dissection. Two-dimensional and M-mode echocardiography and color Doppler were used to diagnose intimal flap and artifact images. Diagnoses were validated either anatomically or with reference techniques. RESULTS: The sensitivity and specificity of transesophageal echocardiography in the diagnosis of ascending aortic dissection were 96.8% and 100%, respectively. Ninety-three artifacts were observed in 56 (55%) of 101 patients without ascending aortic dissection. Two-dimensional echocardiography easily identified 74 artifacts (80%). Color Doppler showed no ascending flow abnormalities in 71% of artifact images. M-mode echocardiography showed three location and mobility artifact patterns related to the posterior wall of the aorta or the right pulmonary artery. In contrast, intimal flap movement showed no relation to the aortic wall movement in 25 cases (83%). Blind analysis of transesophageal echocardiographic study tapes underlined the utility of M-mode in the differential diagnosis. Ranges of sensitivity, specificity and positive predictive value (established by including doubtful results as either positive or negative) improved from 87.1-93.5% to 93.5-96.8%, from 85.1-94.1% to 99-100% and from 65.9-81.8% to 96.8-100%, respectively, with the inclusion of M-mode data. CONCLUSIONS: Biplanar transesophageal echocardiography permits reliable diagnosis of ascending aortic dissection. Ultrasound artifacts are common, but assessment of the location and mobility of intraluminal images by M-mode echocardiography definitely improves diagnostic accuracy.

Clinical outcome of severe asymptomatic chronic aortic regurgitation: a long-term prospective follow-up study.

One hundred one patients with asymptomatic chronic severe aortic regurgitation and normal ejection fraction were monitored for up to 10 years (mean 55.4 +/- 33.5 months). Predefined surgical indications were the development of cardiac symptoms or the documentation of impaired basal left ventricular function. During the follow-up period there were no cardiac deaths; 14 patients needed surgery, 8 because of development of symptoms and 6 because of left ventricular impairment. The risk of surgery was 12% at 5 years and 24% at 10 years. Baseline end-systolic diameter > 50 mm and radionuclide ejection fraction < 60% were independent predictors or either cardiac symptoms or left ventricular dysfunction. In patients needing surgery, a pattern of progressive left ventricular dilatation was demonstrated. There were no deaths during surgery, and echocardiographic and radionuclide parameters normalized in the first year of follow-up. Our data confirm that the prognosis of severe aortic regurgitation in patients with no symptoms is good and that the occurrence of asymptomatic left ventricular dysfunction is an uncommon event. Surgery can be safely postponed until the appearance of cardiac symptoms or the documentation of left ventricular dysfunction at rest.

Cardiac index quantification by Doppler ultrasound in patients without left ventricular outflow tract abnormalities.

OBJECTIVES: We attempted to ascertain whether cardiac index can be directly estimated from Doppler mean velocity. BACKGROUND: Although diverse Doppler echocardiographic methods have been described for cardiac output quantification, they are not widely used in clinical practice. Cross-sectional area measurement has been identified as the main source of error in flow volume quantification. METHODS: A three-phase study by Doppler echocardiography was conducted in 306 patients. In phase I, the normal mean velocity ratio of the left and right ventricular outflow tracts was established in 170 normal subjects. In phase II, cardiac index, calculated as the product of aortic annular area index by mean velocity (conventional method), and mean velocity determined in the left ventricular outflow tract and ascending aorta by pulsed and continuous wave Doppler, respectively, were correlated with thermodilution cardiac index in 66 patients. In phase III, the accuracy of the regression equations obtained was prospectively assessed in an additional 70 patients. RESULTS: The normal left/right ventricular outflow tract mean velocity ratio by pulsed wave Doppler was 1.1 +/- 0.1. Cardiac index (CI) calculated by the conventional method and thermodilution (TD) showed acceptable correlation (r = 0.90, CITD = 1.20 CIPWD + 357; r = 0.86, CITD = 0.90 CICWD + 262) for pulsed (PWD) and continuous wave (CWD) Doppler, respectively, but with systematic underestimation (-28 +/- 13%, p < 0.01) by pulsed wave Doppler. Mean velocity (MV) showed excellent correlation with the thermodilution cardiac index (r = 0.97, CITD = 172 MVPWD - 172; r = 0.93, CITD = 129 MVCWD - 255). When these regression equations were prospectively applied, better agreement with the thermodilution cardiac index was obtained by pulsed wave Doppler directly from mean velocity (SD 240 ml/min per m2) than when aortic annular area was considered in the calculation (SD 428 ml/min per m2). Similar results were obtained by continuous wave Doppler (SD 433 vs. 599 ml/min per m2) but with less accuracy. CONCLUSIONS: Left ventricular outflow tract mean velocity determined by pulsed wave Doppler permits easy, accurate cardiac index quantification in the absence of left ventricular outflow abnormalities. The simplicity of this method enhances its clinical applicability in noninvasive monitoring of cardiac index.

[The usefulness of transesophageal echocardiography in the diagnosis of infectious endocarditis and its complications]. / Utilidad de la ecocardiografía transesofágica en el diagnóstico de la endocarditis infecciosa y sus complicaciones.

INTRODUCTION AND AIMS: Transthoracic echocardiography is a technique with high specificity but low sensitivity in the diagnosis of valvular vegetations and infectious endocarditis complications. Recent reports have shown the transesophageal technique to be more sensitive. The aim of this study was to assess the comparative diagnostic roles of transthoracic and transesophageal echocardiography in infectious endocarditis. METHODS: Eighty-eight patients with infectious endocarditis (native valve in 71 and prosthesis in 17) were studied. All underwent transthoracic echocardiogram followed by transesophageal study to detect vegetations and possible complications, particularly paravalvular abscesses. RESULTS: Transthoracic echocardiogram diagnosed vegetations in 33 (46%) of the 71 native valve endocarditis, whereas these were detected by transesophageal study in 67 (94%). In 23 patients vegetations were surgically confirmed. Transthoracic echocardiography failed to diagnose vegetations in any of the prosthetic endocarditis, whereas they were detected by transesophageal study in 11 of the 17 cases (65%). Of the 9 patients who underwent surgery in the acute phase, 5 presented vegetations on transesophageal study which were confirmed at surgery. Transesophageal echocardiography diagnosed 14 abscesses: 11 aortic peri-annular and 3 in the interfibrous. Echocardiography only detected 1 of the peri-annular aortic abscesses. All patients with peri-annular abscess underwent surgery. Transesophageal echocardiography was also more effective than transthoracic in the diagnosis of other complications: 15 vs 4 chordae tendineae mitral valve rupture and 18 vs 13 aortic valve disruption. CONCLUSIONS: Transesophageal echocardiography is more effective than transthoracic echocardiography in the diagnosis of infectious endocarditis and its complications and would therefore be indicated in all cases of absence of vegetations on transthoracic echocardiography and clinical suspicion of endocarditis. Transesophageal echocardiography could be indicated in all cases of clinically suspected aortic endocarditis to rule out peri-annular abscesses.

[Treatment of hypertrophic obstructive cardiomyopathy with dual chamber pacing. Use of isoproterenol in determining the optimal AV interval]. / Tratamiento de la miocardiopatía hipertrófica obstructiva mediante marcapasos bicameral. Empleo del isoproterenol para determinar el intervalo AV óptimo.

Dual chamber pacing may be used as an alternative in the treatment of selected patients who are refractory to conventional medical treatment of hypertrophic obstructive cardiomyopathy. When programming the pacemaker it is essential to know the value of the atrio-ventricular interval which is able to cause the greatest reduction in the left ventricle outflow tract pressure gradient. We have used isoproterenol to calculate the parameter mentioned above. This allowed us to know the optimum value, not only in non-active conditions, but also reproducing the changes in the pressure gradient in different physiological situations.

[Extrinsic compression of the pulmonary artery by a mediastinal lymphoma. Diagnosis by Doppler echocardiography]. / Compresión extrínseca de la arteria pulmonar por un linfoma mediastínico. Diagnóstico por ecocardiografía-Doppler.

A patient with an anterior mediastinal tumor and cardiomegaly observed by plain chest roentgenogram is presented. The echocardiographic-Doppler examination showed massive pericardial efussion with hemodynamic compromise, and external compression of the right atrium and pulmonary artery. A pericardiocentesis was performed, and a mediastinoscopy with biopsy was diagnostic of lymphoblastic lymphoma.

Recurring free-floating thrombus in the left atrium in a patient with mitral prosthesis.

A case of recurrent left atrial free-floating thrombus in a patient with mitral prosthesis and multiple emboli is described. Transthoracic echocardiography failed to show the first ball thrombus, whereas transesophageal echocardiography proved highly useful both in diagnosis and in indicating the left atrial appendage as the source of the thrombi.

[Transesophageal echocardiography in the diagnosis of aortic dissection]. / Ecocardiografía transesofágica en el diagnóstico de la disección aórtica.

INTRODUCTION AND OBJECTIVE: Eighty-two patients with suspected aortic dissection were studied to assess the usefulness of transesophageal echocardiography in the diagnosis of this entity. METHODS: All patients underwent transesophageal echocardiogram. The diagnosis of aortic dissection was established in 46 patients by other diagnostic procedures including angiography and computed tomography, surgery and necropsy. RESULTS: The sensitivity and specificity of transesophageal echocardiography were 98% and 97%, respectively. By computed tomography, sensitivity was 92% and specificity 88%. By angiography, sensitivity and specificity were 97% and 93%, respectively. In the diagnosis of the dissection type, transesophageal echocardiography classified correctly in 98%, computed tomography in 89% and angiography 97% of cases. Transesophageal echocardiography visualized the tear in 82% of cases, and angiography in 53%. CONCLUSIONS: Transesophageal echocardiography provides rapid, accurate diagnosis of aortic dissection and permits the initiation of appropriate treatment. Angiography is indicated in non-conclusive cases or those which supra-aortic involvement clinically suspected.

[The usefulness of transesophageal echocardiography in assessing mechanical mitral prostheses. A comparison with transthoracic echocardiography]. / Utilidad de la ecocardiografía transesofágica en la valoración de las prótesis mitrales mecánicas. Comparación con la ecocardiografía transtorácica.

One hundred and sixty mechanical mitral prostheses were studied by transoesophageal echocardiography to ascertain the role of this technique in their functional assessment. All patients underwent transoesophageal echocardiogram, and, in 83, transthoracic Doppler-echocardiogram had already been performed immediately prior to transoesophageal echocardiogram. Prostheses presenting structural anomaly on bidimensional image and/or areas of regurgitation with predominantly turbulent flow on colour Doppler were considered to be dysfunctional. Of the 160 prostheses, 115 were considered normofunctional, and regurgitation was detected in 85 (94%) by transoesophageal echocardiogram and 10 (9%) by transthoracic echocardiogram; haemodynamic and/or surgical confirmation was obtained in 6 of these prostheses and all proved to be functioning normally. Of the 45 remaining prostheses considered to be dysfunctional, haemodynamic and/or surgical confirmation was obtained in 21 (the non-confirmed 24 were excluded from the study). Seventeen of the dysfunctional prostheses presented with areas of regurgitation of 3.9-24 cm2 (mean: 9.21 + 5.36); in one case, the degree of regurgitation with respect haemodynamic study was over-assessed; transthoracic echocardiogram detected only periprosthetic leaks in 38% of cases, with areas of regurgitation of 1.8-6.3 cm2 (mean: 1.87 + 2.02). The other 4 dysfunctional prostheses presented dysfunction due to thrombosis; all 4 were diagnosed by both transthoracic and transoesophageal echocardiogram. Transoesophageal echocardiogram detected 12 structural anomalies (1 vegetations, 4 thromboses and 7 dehiscencies), whereas transthoracic echocardiogram only detected these anomalies in five of the cases (1 vegetations and 4 thromboses). Transoesophageal echocardiography surpasses transthoracic echocardiography in the assessment of mechanical mitral prostheses and dysfunction diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[The usefulness of Doppler echocardiography in the preoperative assessment of valvulopathies. A comparison with the hemodynamic and surgical findings]. / Utilidad de la ecocardiografía-Doppler en la evaluación prequirúrgica de las valvulopatías. Comparación con los hallazgos hemodinámicos y quirúrgicos.

The Doppler echocardiography and cardiac catheterization studies of all patients who underwent valvular surgery in a three-year period were reviewed to assess the correlation between the estimated severity of valvular disease by both methods. Two-hundred and thirty-five patients (group I: 140 male, age 58 +/- 12; 95 female, age 60 +/- 13) underwent both studies within 6 months. There was agreement on estimation of severity of valve lesions in 140 of 162 patients with aortic valve disease (93% of stenosis, 82% of regurgitations and 79% of mixed lesions), in 58 of 80 patients with mitral valve disease (83% of stenosis, 76% of regurgitations and 33% of mixed lesions) and in 10 of 16 patients with prosthetic valve disfunction. The correlation between both methods was significantly lower in mixed mitral lesions than in the remaining native valve lesions (p < 0.05). Significant disagreement occurred in 4 cases of aortic valve disease, four of mitral valve disease and five of prosthetic disfunction. When disagreement was present, Doppler often underestimated the severity of the disease. Disagreement was more frequent in patients with combined aortic and mitral disease. According to the surgical conclusions cardiac catheterization provided a diagnostic profit in the assessment of the disease severity in 8, 11 and 22% of cases of aortic and mitral valve disease and prosthetic valve disfunction, respectively. Coronary artery disease was present in 19% of patients who underwent coronary arteriography. One-hundred and two patients (group II: 44 m, 48 +/- 15; 58 f, 53 +/- 11) underwent surgery without previous cardiac catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)

[The diagnosis of ventricular pseudoaneurysms. The complementary role of echocardiography, isotopic ventriculography and contrast ventriculography]. / Diagnóstico de los seudoaneurismas ventriculares. Papel complementario de la ecocardiografía, la ventriculografía isotópica y la ventriculografía de contraste.

The diagnostic yield of echocardiography, radionuclide ventriculography (first pass and multiple gated) and contrast ventriculography was evaluated in 11 patients in whom a diagnosis of left ventricular pseudoaneurysm had been made during the last ten years. The diagnosis was made by two dimensional echocardiography (associated with Doppler in the last 5 patients) in 8 of 11 patients (sensitivity: 73%). The major limitation of the technique, in addition to the impossibility of an adequate recording due to a suboptimal acoustic window, is the poor definition of the neck of the pseudoaneurysm, particularly in the inferior localization. By contrast, echocardiography is the only technique which permits the direct visualization of thrombi within the pseudoaneurysm. Multiple gated radionuclide ventriculography was diagnostic in 7 of 10 patients (sensitivity: 70%). Its major limitations are the poorer spatial resolution to visualize the pseudoaneurysm neck and the thrombi within the cavity. First pass radionuclide ventriculography was diagnostic in 4 of 6 patients (sensitivity: 67%). In one of them it improved on the diagnostic yield of the multiple gated technique. Contrast ventriculography was diagnostic in 5 of 7 patients (sensitivity: 71%). The diagnosis was missed due to technical problems in one patient and to significant thrombosis within the pseudoaneurysm in another. Thus, none of the imaging studies has optimal sensitivity. Therefore, all play a complementary role in the diagnosis of ventricular pseudoaneurysm.