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Ajuares dotales e inventarios de prendas atestiguan una lenta evolución de los vestuarios castellanos populares, en pugna estética civilizatoria diferenciadora. Aunque aquel proceso no fue nada estático, el triunfo de las costumbres modernas arrinconaba los usos tradicionales (mudanzas aparentes o necesidades; «monos» frente a rústicos) al imponerse en el enfrentamiento entre los ámbitos culturales urbanos y rurales.Los cambios en las modas no eran exclusivos del mundo cortesano. No obstante, el concepto «vulgar» cada vez se asociaba menos al mantenimiento de lo imperecedero y más a lo arcaico tradicional y al freno a toda novedad, vestimentaria y mental.Al indagar en el estilo de vida cotidiano campesino al final del Antiguo Régimen se incide en sus resistencias culturales, primando el peso inmutable comunitario (trajes regionales), un minoritario espíritu innovador rural (en clave de jerarquías y conflictos de apariencia) y en la dualidad externa de rusticidad–casticismo como modelos estéticos vinculados al atraso local en pugna con una modernización cosmopolita.

Sin entrar aquí en los caminos del ciclo vital de la juventud de antiguo régimen en los que más se ha centrado la historiografía modernista hasta la fecha, esta propuesta bucea en todas las fuentes documentales posibles a la hora de plantearse preguntas y de tratar de dar las primeras respuestas a innumerables cuestiones capitales sobre el devenir del mundo socio-familiar juvenil en clave cultural y de civilización urbana. A la par que se abren nuevos focos de atención, documentales y de perspectiva, la cuestión se centra en la existencia o no de una cultura juvenil propia, tras el desarrollo de su progreso formativo, con la finalidad de fijar su avance como grupo de edad estratégico y cada vez mejor definido.

Objetives: The clinical and prognostic usefulness of tricuspid annular plane systolic excursion (TAPSE) is well established. However, the ability of TAPSE to assess right ventricular (RV) function in patients with previous tricuspid valve annulopasty is controversial. This study examined the TAPSE suitability in patients with previous tricuspid valve annuloplasty using right ventricular fractional area change (RVFAC) as reference method., Methods: We retrospectively analyzed 53 patients who underwent tricuspid valve annuloplasty at our hospital between 2013 and 2016. TAPSE and RVFAC were obtained in preoperative and postoperative periods using standard methodology., Results: Mean age was 68±12years and 34 patients (64.1%) were women. TAPSE decreased significantly after surgery in comparison with pre-surgical values (17±4.2 Vs 12.9±4.1mm, p<0.001). On the contrary, RVFAC did not change significantly after surgery (37±9.2 Vs 36.2.9, p=0.25). The correlation between RVFAC and TAPSE was better in the preoperative (r=0.63, p<0.0001) than in the postoperative period (r=0.38, P=0.005). Good intra- and interobserver agreement for TAPSE and RVFAC was obtained, with intraclass correlation coefficients of 0.97 and 0.92 for TAPSE; and 0.90 and 0.85 for RVFAC, respectively., Conclusions: These findings suggest that TAPSE is not suitable after tricuspid valve annuloplasty and it leads to an underestimation of RV systolic function. It seems to be appropriate to rely on echocardiographic parameters of global RV function such as RVFAC in this context., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

In this paper, the dosimetric characterization of an EMF exposure setup compatible with real-time impedance measurements of adherent biological cells is proposed. The EMF are directly delivered to the 16-well format plate used by the commercial xCELLigence apparatus. Experiments and numerical simulations were carried out for the dosimetric analysis. The reflection coefficient was less than -10 dB up to 180 MHz and this exposure system can be matched at higher frequencies up to 900 and 1800 MHz. The specific absorption rate (SAR) distribution within the wells containing the biological medium was calculated by numerical finite-difference time domain simulations and results were verified by temperature measurements at 13.56 MHz. Numerical SAR values were obtained at the microelectrode level where the biological cells were exposed to EMF including 13.56, 900, and 1800 MHz. At 13.56 MHz, the SAR values, within the cell layer and the 270-μL volume of medium, are 1.9e3 and 3.5 W/kg/incident mW, respectively.

Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur, including heart failure, thromboembolism, or tachyarrhythmias. We report the case of a 78-year-old male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded, and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm, causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

Certain chemotherapy drugs for breast cancer may induce cardiotoxicity and these patients should be echocardiographically monitored. The performance of a focused echocardiographic evaluation (echoscopy) at the patient's location by a non-cardiologist appears to be feasible. The aim of the present study was to assess the accuracy of echoscopy performed by medical oncologists in an outpatient clinic using hand-held echocardiography devices. The study cohort comprised consecutive unselected patients who attended an oncology outpatient clinic. Two medical oncologists attended a one-week training period, which included theoretical and practical teaching by an expert cardiologist. Every subject underwent two echo examinations. The first examination was performed by an oncologist using a hand-held echo device and the second was performed by a cardiologist using a 'premium' device. Out of the 101 enrolled patients, 32 were men (31.7%) and the mean age was 56.03±16.88 years. There was a good global agreement [intra-class correlation coefficient (ICC): 0.65 for left ventricular ejection fraction (LVEF)]. When the results were analyzed depending on the period of time when the echo studies were performed, a clear and short learning curve was observed: LVEF started at ICC=0.58 and increased to 0.66 and 0.77 in the second and third period, respectively. There were extremely few clinically significant differences and a learning curve was also evident. In conclusion, cardiac echoscopy performed by an oncologist with a hand-held device may lead to a similar clinical management as a study performed by an expert cardiologist with a 'premium' system in patients under chemotherapy following a short training period.

The use of cardiac imaging techniques as a diagnostic method in the understanding of physiopathology, as well as in cardiology research has been one of the most important revolutions in the management of cardiac patients, our understanding of physiopathology, and basic research in almost all heart diseases. This article analyzes the literature on echocardiography, cardiovascular magnetic resonance imaging, computed tomography, and nuclear medicine during the last 60 years and provides an overview of how these techniques have developed and how their introduction into daily practice has changed attitudes among cardiologists. The literature not only shows that the implementation of these techniques in daily practice requires an immense amount of research and effort by many working groups throughout the scientific world, but also that techniques that once seemed promising may finally be discarded., (Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Background: The two-dimensional (2D) proximal isovelocity surface area (PISA) method has important technical limitations for mitral valve orifice area (MVA) assessment in mitral stenosis (MS), mainly the geometric assumptions of PISA shape and the requirement of an angle correction factor. Single-beat real-time three-dimensional (3D) color Doppler imaging allows the direct measurement of PISA without geometric assumptions or the requirement of an angle correction factor. The aim of this study was to validate this method in patients with rheumatic MS., Methods: Sixty-three consecutive patients with rheumatic MS were included. MVA was assessed using the transthoracic 2D and 3D PISA methods. Planimetry of MVA (2D and 3D) and the pressure half-time method were used as reference methods., Results: The 3D PISA method had better correlations with the reference methods (with 2D planimetry, r = 0.85, P < .001; with 3D planimetry, r = 0.89, P < .001; and with pressure half-time, r = 0.85, P < .001) than the conventional 2D PISA method (with 2D planimetry, r = 0.63, P < .001; with 3D planimetry, r = 0.66, P < .001; and with pressure half-time, r = 0.68, P < .001). In addition, a consistent significant underestimation of MVA using the conventional 2D PISA method was observed. A high percentage (30%) of patients with nonsevere MS by 3D planimetry were misclassified by the 2D PISA method as having severe MS (effective regurgitant orifice area < 1 cm(2)). In contrast, the 3D PISA method had 94% agreement with 3D planimetry. Good intra- and interobserver agreement for 3D PISA measurements were observed, with intraclass correlation coefficients of 0.95 and 0.90, respectively., Conclusions: MVA assessment using PISA by single-beat real-time 3D color Doppler echocardiography is feasible in the clinical setting and more accurate than the conventional 2D PISA method., (Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.)

Background: Left atrium (LA) size assessment is clinically relevant, but the accuracy of two-dimensional echocardiographic (2D-echo) methods is limited. Three-dimensional (3D) echocardiography is an excellent alternative but is far from being used in daily clinical practice. Three-dimensional-wall motion tracking (3D-WMT) allows us to obtain volumes in a very simple and rapid manner. The aims of this study were to evaluate the accuracy of 3D-WMT technology to assess LA volume using cardiac magnetic resonance (CMR) as a reference method, to evaluate its reproducibility, and to determine its added clinical value to classify the LA enlargement severity., Methods and Results: Seventy consecutive patients referred for a CMR study were prospectively enrolled. They underwent LA volume assessment by means of 2D-echo, 3D-WMT, and CMR. Inter-methods agreement was assessed. The mean age was 56 ± 18 years and 42 patients (60%) were males. Average maximal LA volume obtained by 2D-echo, 3D-WMT, and CMR were 63.33 ± 26.82, 79.80 ± 29.0, and 79.80 ± 28.99 mL, respectively. Univariate linear regression analysis showed a good correlation between 3D-WMT and CMR (r = 0.83; P < 0.001). The agreement analysis showed a similar result (ICC = 0.83; 95% CI = 0.74-0.89; P < 0.001). Furthermore, the LA enlargement degree was better evaluated with 3D-WMT than with 2D-echo., Conclusion: This study validates LA volume measurements obtained using the new and fast 3D-WMT technology, compared with CMR. This method is fast, accurate, and reproducible, and it allows a better classification of left LA enlargement severity compared with 2D-echo., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)

Background: The two-dimensional (2D) proximal isovelocity surface area (PISA) method has known technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective regurgitant orifice area (EROA). Recently developed single-beat real-time three-dimensional (3D) color Doppler imaging allows the direct measurement of PISA without geometric assumptions and has already been validated for mitral regurgitation assessment. The aim of this study was to apply this novel method in patients with chronic tricuspid regurgitation (TR)., Methods: Ninety patients with chronic TR were enrolled. EROA and regurgitant volume (Rvol) were assessed using transthoracic 2D and 3D PISA methods. Quantitative Doppler and 3D transthoracic planimetry of EROA were used as reference methods., Results: Both EROA and Rvol assessed using the 3D PISA method had better correlations with the reference methods than using conventional 2D PISA, particularly in the assessment of eccentric jets. On the basis of 3D planimetry-derived EROA, 35 patients had severe TR (EROA ≥ 0.4 cm(2)). Among these 35 patients, 25.7% (n = 9) were underestimated as having nonsevere TR (EROA ≤ 0.4 cm(2)) using the 2D PISA method. In contrast, the 3D PISA method had 94.3% agreement (33 of 35) with 3D planimetry in classifying severe TR. Good intraobserver and interobserver agreement for 3D PISA measurements was observed, with intraclass correlation coefficients of 0.92 and 0.88 respectively., Conclusions: TR quantification using PISA by single-beat real-time 3D color Doppler echocardiography is feasible in the clinical setting and more accurate than the conventional 2D PISA method., (Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.)

Background: Real-time three-dimensional (RT3D) echocardiography is a recently developed technique that is being increasingly used in echocardiography laboratories. Over the past several years, improvements in transducer technologies have allowed development of a full matrix-array transducer that allows acquisition of pyramidal-shaped data sets. These data sets can be processed online and offline to allow accurate evaluation of cardiac structures, volumes, and mass. More recently, a transesophageal transducer with RT3D capabilities has been developed. This allows acquisition of high-quality RT3D images on transesophageal echocardiography (TEE). Percutaneous catheter-based procedures have gained growing acceptance in the cardiac procedural armamentarium. Advances in technology and technical skills allow increasingly complex procedures to be performed using a catheter-based approach, thus obviating the need for open-heart surgery., Methods: The authors used RT3D TEE to guide 72 catheter-based cardiac interventions. The procedures included the occlusion of atrial septal defects or patent foramen ovales (n=25), percutaneous mitral valve repair (e-valve clipping; n=3), mitral balloon valvuloplasty for mitral stenosis (n=10), left atrial appendage obliteration (n=11), left atrial or pulmonary vein ablation for atrial fibrillation (n=5), percutaneous closures of prosthetic valve dehiscence (n=10), percutaneous aortic valve replacement (n=6), and percutaneous closures of ventricular septal defects (n=2). In this review, the authors describe their experience with this technique, the added value over multiplanar two-dimensional TEE, and the pitfalls that were encountered., Results: The main advantages found for the use RT3D TEE during catheter-based interventions were (1) the ability to visualize the entire lengths of intracardiac catheters, including the tips of all catheters and the balloons or devices they carry, along with a clear depiction of their positions in relation to other cardiac structures, and (2) the ability to ability to demonstrate certain structures in an "en face" view, which is not offered by any other currently available real-time imaging technique, enabling appreciation of the exact nature of the lesion that is undergoing intervention., Conclusion: RT3D TEE is a powerful new imaging tool that may become the technique of choice and the standard of care for guidance of selected percutaneous catheter-based procedures.

Objectives: This study sought to assess the use of real-time (RT) 3-dimensional (3D) transthoracic and transesophageal echocardiography (TEE) in the evaluation of post-operative mitral valve dehiscence., Background: Mitral valve replacement or repair may be complicated by post-operative dehiscence of the valve or annuloplasty ring resulting in clinically significant mitral regurgitation or hemolysis. Diagnosis is generally performed using 2-dimensional transthoracic echocardiography and TEE. Recently, an RT 3D TEE probe has been developed to produce high-quality real-time images., Methods: We used RT 3D TEE to evaluate mitral regurgitation after mitral valve repair or replacement as a result of mitral ring dehiscence. We studied the additional information and diagnostic utility provided by RT 3D TEE., Results: Eighteen patients were studied (8 patients after repair and 10 after replacement). Real-time 3D TEE allowed accurate evaluation of the pathology, including definition of the type of ring or prosthesis used; description of the site, size, shape, and area of the dehisced segment; and clear definition of the origin of the mitral regurgitation., Conclusions: In mitral valve dehiscence, RT 3D TEE provides additional information about the exact anatomic characteristics of the dehiscence that can be used to help in planning the most appropriate corrective intervention.

Acute ventricular septal rupture is a high-risk complication of myocardial infarction. Although early surgical treatment improves the prognosis of this condition, hospital mortality after emergency surgery ranges from 10% to 60%. Transcatheter closure is an established method of treating selected congenital septal defects; less experience exists regarding its usefulness for postmyocardial infarction ventricular septal defect. We report a case of successful transcatheter closure of a postmyocardial infarction ventricular septal defect with a septal occluder in a 71-year-old patient rejected for surgery.

Isolated noncompaction of the ventricular myocardium is frequently mistaken for other cardiomyopathies. We report a case of a 49-year-old woman admitted to hospital for heart failure and initially given the diagnosis of apical hypertrophic cardiomyopathy. In this case, myocardial contrast echocardiography and magnetic resonance imaging played a pivotal role in establishing the diagnosis of isolated noncompaction of the ventricular myocardium.

Objectives: QRS complex width is not an accurate marker of cardiac asynchrony. Our aims were to determine the prevalence of cardiac asynchrony by Doppler echocardiography for patients with left ventricular (LV) dysfunction and to evaluate whether QRS width is a reliable method for detecting asynchrony., Methods: In all, 316 consecutive patients with a LV ejection fraction less than 40% from 13 hospitals comprised the study group. Interventricular asynchrony was defined by the interventricular mechanical delay. Intraventricular asynchrony was evaluated using the calculation of the septal-to-posterior wall motion delay, the difference between time from Q wave to LV ejection end, and time from Q wave to the end of the systolic wave of the most delayed basal segment by Doppler tissue imaging, the SD of the time from the Q wave to the end of the systolic wave of 4 basal segments, and the maximum difference in the time from the Q wave to the end of the systolic wave of all 4 basal segments., Results: Mean age was 62.14 +/- 13.5 years (234 men; 74.1%). Interventricular asynchrony was present in 50 (26.2%) patients in the narrow QRS group and in 57 (55.3%) patients in the prolonged QRS group (P < .001). Intraventricular asynchrony was present in 40 (20.8%) to 136 (72.8%) patients in the narrow QRS group and in 27 (26.2%) to 82 (79.6%) in the prolonged QRS group, depending on the method used., Conclusions: Cardiac asynchrony is highly prevalent for patients with LV dysfunction but there is a very poor agreement among the different methods used to detect it. Interventricular asynchrony is more prevalent for patients with prolonged QRS but intraventricular asynchrony is irrespective of the QRS duration. Further studies are needed to evaluate which method is the best to detect cardiac resynchronization therapy responders.

The assessment of regional left ventricular (LV) function has been an important yet unresolved problem since the introduction of echocardiography as a diagnostic tool. Abnormal regional LV wall motion is an early finding in multiple cardiac pathologies and its diagnosis is of critical importance. In the last few years diagnostic procedures based on combined use of existing echocardiographic technologies were geared toward improving the accuracy of detection of baseline and/or induced regional wall motion abnormalities. One of the assumptions is that the combination of reduced LV wall thickening and reduced myocardial velocities can be used to accurately diagnose regional myocardial dysfunction. In this article we will discuss several new techniques for the quantification of regional LV function using Doppler echocardiography.

Pulsed-wave Doppler tissue imaging (DTI) allows the examination of regional wall motion at a very high temporal resolution and therefore constitutes an excellent technique for assessing diastolic motion of left ventricular walls. Regional relaxation has been well characterized in normal subjects using this technique, and physiological time intervals and motion wave profiles are described. In an experimental model of acute ischemia, local relaxation impairment was observed showing highly characteristic local diastolic abnormalities. Interestingly, these findings took place before any decrease in systolic motion was recordable. In a prospective clinical study, noninvasive regional DTI parameters were compared with coronary angiography to assess the feasibility and clinical value of the technique; the diagnostic accuracy is discussed in detail. Also, the association between regional diastolic parameters and global regional function as assessed by Doppler analysis of transmitral left ventricular filling flow was studied, stressing the impact of regional diastolic function on overall ventricular performance. Finally, the diagnostic role of pulsed-wave DTI on stress testing, identification of myocardial viability, and microvascular angina is reviewed.

Objective: To present the experience of transesophageal echocardiography with a multiplane probe, its methodology, the advantages, disadvantages and diagnostic improvements of this type of probe., Setting: Laboratory of Echocardiography of the General Hospital Gregorio Marañon., Material and Methods: Analysis of the first 1000 examinations performed on hospitalized patients and outpatients, in most cases to study either native valvular heart disease and valvular prosthesis or to search for embolic sources. We evaluate the advantages, disadvantages, initial difficulties and complications of this type of probe., Results: Multiplane probe provides continuous imaging from 0 degree to 180 degrees without need of intraesophagic movements. This type of probe increases the diagnostic capability of transesophagic echocardiography because it performs as a scanning of anatomy and pathological features of cardiac chambers and great vessels. Pulmonary artery and its branches, right heart chambers and tricuspid valve, inferior and superior vena cava, outflow tract of both ventricles, aortic root, pulmonary veins and segmental views of both ventricles are well analyzed. Also in native and prosthetic regurgitants jets, cardiac tumors and other masses, diagnosis and complications of endocarditis, aortic dissection and in anomalous return of pulmonary veins, multiplane probe proves to be more informative. There was no difficulties in the intubation despite the bigger size of the transducer. No severe complications occurred. The higher price and the initial more difficult understanding of the images are the only disadvantages we have found., Conclusions: Multiplane probe contributes to increase diagnostic capability of transesophageal echocardiography without significant risk and it is an important and promising refinement of the transesophageal technique.

We report a clinical case of a 60 year old male patient with a orthotopic cardiac transplant, submitted to a transesophageal echocardiographic study. This semi-invasive study showed a mobile multi-lobulated mass of the left atria, related with the hyperplastic process of the surgical suture area and directly associated with the cardiac transplant procedure. We discuss the rarity of this benign case, the different forms of two-dimensional echocardiographic presentation of this type of lesions, the problems of non invasive diagnostic techniques, the risk and the prognostic value of these structures. We conclude that a longitudinal study in a larger number of cardiac transplant patients will be needed, in order to define better the clinical implications of these echocardiographic findings.

Objective: Transesophageal echocardiographic analysis of color Doppler characteristics of mitral valvular regurgitation jets., Design: Transesophageal echocardiographic prospective study., Setting: Ambulatory patients referred to Echocardiographic Laboratory of Gregorio Marañon General Hospital, Madrid, Spain., Material and Methods: We studied a group of 100 consecutive patients with mitral regurgitation diagnosis. In each patient we calculated the degree of severity, percentage of wall intersection, maximal traced area, axis direction, atrial depth, maximal transversal diameter, perimeter and angle of the mitral regurgitation jet. We divided the entire population in three different groups according to the jet direction in central (CJ), eccentric (EJ) and wall jets (WJ)., Main Results: The direction of the mitral regurgitation jet was central in 49%, eccentric in 33% and impinging the left atrial wall in 18%. The mitral regurgitation jet angle was in the CJ 80 +/- 11 degrees, EJ 33 +/- 10 degrees and WJ 6 +/- 7 degrees. Maximal mitral regurgitant traced area in CJ was 732 +/- 104 mm2, EJ was 593 +/- 110 mm2 and WJ was 267 +/- 80 mm2. Maximal regurgitant jet depth in CJ was 36 +/- 17 mm, EJ 30 +/- 15 mm and WJ 49 +/- 14 mm. The perimeter of the mitral regurgitation jet in the CJ was 87 +/- 22 mm, EJ was 68 +/- 22 mm and WJ was 92 +/- 30 mm., Conclusions: Color Doppler quantification criteria are not useful in all patients with mitral regurgitation jets. The presence of atrial walls close to the mitral regurgitation jet area is an important factor in the mitral regurgitation color Doppler evaluation.

It has recently been reported the rare existence of intraventricular diastolic gradients in patients with hypertrophic cardiomyopathy. This proves the great disturbance of diastolic function that exists in these patients. We report the case of a patient with this disease, in whom a significant diastolic intraventricular gradient was detected with color Doppler echocardiography. In the end we make a summing up of its most probable physiopathology.

Objective: Transthoracic and transesophageal comparative analysis of functional and morphological abnormalities associated to idiopathic mitral valve prolapse (MVP)., Design: Prospective study., Setting: Outpatients with MVP diagnosis referred to echocardiographic laboratory of Cardiology Institute in Madrid, Spain., Material and Methods: In each case we analyzed by TTE and TEE, anterior, posterior and double localization of MVP, number of prolapsed mitral leaflets/patient, total area of MVP to mitral valve plane, mitral annulus diameter, total area and spatial distribution of mitral regurgitation., Results: TEE diagnosed a greater number of prolapsed mitral leaflets and a greater percentage of double (80%) MVP. MPV area by TEE (50 +/- 31 mm2) was considerably larger (96 +/- 30 mm2) than TTE MVP area (50 +/- 31 mm3. Associated mitral valve regurgitation area calculated through TEE was larger (558 +/- 502 mm2) than the same parameter evaluated by TTE (450 +/- 515 mm2)., Conclusions: TEE is an efficient technique in MVP non invasive diagnosis and particularly sensitive to posterior MVP. Our data could be helpful in MVP cases scheduled for mitral valve repairment.

Objective: The aim of this study was to analyze, through transesophageal echocardiography, different factors related to left atrial spontaneous echocardiographic formation., Design: Transthoracic and transesophageal comparative study of left atrial thrombotic phenomena., Setting: Ambulatory and in hospital patients referred to Gregorio Marañon General Hospital Echocardiographic Laboratory., Patients: 120 consecutive patients with mitral valve disease or prosthesis were included in this transesophageal echocardiographic prospective study. All patients were divided in two groups, according with left atrial spontaneous contrast. In each patient we measured total left atrial area, rhythm abnormalities, mitral valve area, left atrial cavity thrombus and maximal mitral regurgitation area., Measurements and Results: Transthoracic echocardiography did not detect any patient with left atrial spontaneous contrast, compared to 57.5% diagnosed through the transesophageal technique. Transesophageal echocardiography diagnosed left atrial thrombosis in 19% (n = 23) of patients compared to 1% (n = 2) through the transthoracic technique. In the group with left atrial contrast, 59% of patients had mitral regurgitation less than 600 mm2, 64% were in atrial fibrillation and left atrial total area was 28 +/- 10.8 mm2., Conclusions: Transesophageal echocardiography is the technique of choice to diagnose, with greater security, left atrial cavity thrombosis, and establish the relationship of echocardiographic variables and left atrial thrombotic phenomena. Among these echocardiographic factors, left atrial dynamic spontaneous echocontrast is fundamental.

Objective: Transesophageal (TEE) and Transthoracic (TTE) comparative echocardiographic analysis of patients with mitral valve prosthesis., Design: Prospective study., Setting: In hospital and out patients with mitral prosthesis in a follow-up study by the Cardiology Department and referred to the echocardiographic laboratory of Gregorio Marañon General Hospital, Madrid., Patients: We studied 90 consecutive patients with mitral prosthesis diagnosis., Interventions: Comparative and prospective echocardiographic study of transthoracic and transesophageal techniques in mitral prosthesis pathology., Results: TTE diagnosed 18% of dysfunctioning mitral prosthesis patients compared to 56% of cases identified by TEE. TTE observed 1% of mitral prosthesis vegetation compared to 8.8% by TEE. TEE diagnosed left atrial thrombosis in 2.2% and TEE in 10%. Left atrial spontaneous dynamic contrast was identified exclusively by TEE in 55% of all cases. Paravalvular mitral prosthesis leak was correctly identified exclusively by TEE in 20% of cases., Conclusions: TEE has a greater diagnostic capacity compared to TTE in mitral prosthesis patients. This technique can give a greater security in evaluating mitral prosthesis thrombi, vegetations and leak, establishing a more precise diagnosis of mitral prosthesis dysfunction. The authors concluded that TEE is the technique of choice in noninvasive evaluation of patients admitted with the suspicion of mitral prosthesis dysfunction.

Study Objective: To analyze the regurgitant jets of mitral valve prostheses studied by transesophageal echocardiography., Design: Prospective study of patients with mitral prostheses with or without suspicion of dysfunction., Setting: Patients referred to the Echocardiology Department of the Instituto de Cardiologia in Madrid, some as outpatients., Patients and Interventions: Twenty five patients with mitral valve prostheses (5 biological, 7 St Jude, 12 Bjork Shiley and 1 Hall Kaster). Ten male patients and fifteen female, mean age 50 years. Five also had aortic valve prostheses. In only 5 there was a suspicion of dysfunction. The transthoracic echos were done with phased array transducers and the transthoracic with 2.5 (18 patients) or 5 MHz (7 patients) transducers coupled to a commercial echocardiographer. The presence of regurgitant jets was looked for, as well as their origin, maximal area and length, their type and degree of turbulence., Main Results: Only 3 mitral regurgitations were noticed by transthoracic echocardiography. All the mechanical prostheses and 80% of the biological ones had regurgitant jets by transesophageal echocardiography. The tilting disc prostheses had two physiological jets, the St. Jude 2, 3, or exceptionally only one central jet. The biological prostheses had one central regurgitant jet, that was smaller than those from the mechanical prostheses (p less than 0.05). There were ten malfunctioning prostheses (5 Bjork Shiley, 3 St Jude and 2 biological). The diagnosis of dysfunction was based on the abnormal origin of the jet (9 cases) or just simply on the characteristics of the regurgitation (turbulence). Four patients were submitted to surgery, all with dysfunctioning prostheses., Conclusions: Transthoracic echocardiography has a low sensitivity for detecting the regurgitant jets of mitral prostheses. All mechanical prostheses and 80% of biological ones have regurgitation by transesophageal echocardiography. The area and length of the jets are not so different between normal and malfunctioning prostheses in order to separate them. The abnormal jets are recognised because of their abnormal origin and/or their characteristics, with formation of mosaic in color coded Doppler echocardiography.

Transesophageal echocardiography is one of the most important innovations that have lately turned up for the evaluation of the cardiac patient. This technical approach consists not only of the study of the two dimensional image but of the cardiac flows obtained with pulsed and color Doppler as well, using a gastroscopic probe to which an ultrasonic transducer has been adapted. In this paper we make a revision of the methodology used in our laboratory. We discuss the utility of this technical approach not only for the study of the ambulatory patient but also for the critically ill patient.

Acute ischaemia limited to the free wall of the right ventricle was produced by right coronary arterial ligation (RCAL) in 20 dogs. Contrast M-mode and cross-sectional echocardiography was performed in 7 cases to investigate the presence of tricuspid insufficiency. The haemodynamic findings obtained with an open pericardium at 15 to 30 min showed increases in right (1.2 +/- 0.5 to 2.7 +/- 0.7 mmHg, P less than 0.01) and left (5.0 +/- 0.8 to 6.6 +/- 0.9 mmHg, P less than 0.05) ventricular end-diastolic pressures, and decreases in heart rate (139 +/- 4.9 to 119 +/- 5.1 bpm, P less than 0.01), cardiac index (106 +/- 6.6 to 81 +/- 7.3 ml min-1 kg-1, P less than 0.01), stroke index (79 +/- 6 to 72 +/- 8 ml X 100 beat-1 kg-1, P less than 0.02), right (23.8 +/- 1.5 to 19.4 +/- 1.5 mmHg, P less than 0.01) and left (109 +/- 7.2 to 95 +/- 8.2 mmHg, P less than 0.05) ventricular systolic pressures and right ventricular stroke work index (18.3 +/- 2.4 to 11.4 +/- 1.8 g m kg-1, P less than 0.01). In 6 of 15 cases the 'y' descent became deeper than the 'x' descent in right atrial pressure (RAP). Tricuspid insufficiency grade I-II/IV was present in 3 of 7 cases, 2 of them with a 'y' greater than 'x' in RAP. Right ventricular mechanical alternans, probably secondary to a decrease in contractility, appeared in 10 of 20 cases after RCAL.(ABSTRACT TRUNCATED AT 250 WORDS)

Right ventricular (RV) segmental contraction was studied in 63 patients with acute myocardial infarction (MI), using 2-dimensional (2-D) echocardiography. Group A included 32 patients with ischemic RV dysfunction: 19 had a disproportionate increase in right atrial pressure at the time of the examination (Group AI) and in 13 patients, right atrial pressure was normal when the echocardiogram was obtained (Group AII). Group B included 31 patients without ischemic RV dysfunction. Alkinesia or dyskinesia of the RV wall was found in 30 patients: 19 from Group AI, 8 from Group AII, and 3 from Group B. Asynergy could be identified in all segments of the RV wall including the outflow tract, RV apex, and anterior wall, but was more frequently found in the posterior wall (29 patients), best seen in the transversal subcostal short-axis view. A significant difference was found either in the frequency of wall motion abnormalities or in the number of segments with asynergy among the 3 groups (p less than 0.001). However, asynergy of the RV wall may be present in some patients with normal right heart hemodynamic function, suggesting that asynergy may be more sensitive than hemodynamic function in the diagnosis of acute RV infarction. Paradoxical septal motion was found in 8 patients, all in Group AI, and all had a right atrial pressure equal to or greater than pulmonary capillary pressure.

The echocardiographic characteristics of hemopericardium with and without thrombus formation were investigated in 10 dogs and compared with that of saline solution injected into the pericardial cavity. Injection of 80 to 120 ml of saline solution produced an echolucent space between both pericardial layers and was considered as the control image in each dog for comparison with hemopericardium. Injection of heparinized blood filled the pericardial cavity with irregular echoes of variable acoustical impedence. High-density echoes of irregular distribution were observed in 3 dogs, in 5 dogs the echoes were of low acoustical density and in 2 dogs blood echoes were present but scarcely visible. Injection of clotted blood in 9 dogs (adding 20 mg of protamin sulphate and 8 mg of aminocaproic acid) produced echoes of high acoustical density easily identified in the 2-dimensional echocardiographic images. In 4 dogs attenuation and damping controls were increased to the point where myocardial echoes disappeared, while intrapericardial echoes were still visible. Thus, hemopericardium with or without thrombus formation may be identified by 2-dimensional echocardiography and differentiated from other types of pericardial effusion of lower acoustical density. Echogenicity of fluid blood in the pericardial cavity may be related to blood stasis.