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Objective: To evaluate the comparative diagnostic value of harmonic imaging (HI) in the assessment of patients with suspected infective endocarditis (IE). Setting: Tertiary referral centre. Design: 139 consecutive patients were evaluated with three imaging modalities: transthoracic echocardiography with fundamental imaging (FI); HI; and transoesophageal echocardiography (TOE). Image quality was assessed for each modality by semiquantitative scoring (0, poor, to 3, excellent). Presence, dimension, and characteristics of vegetations were assessed separately for each imaging modality, as well as presence of abscesses. Results: 35 patients had definite IE. TOE was positive in 33 patients, HI in 28, and FI in 12 (p <0.001 for FI vHI and vTOE). Mean image quality was 1 .4 (0.7) for FI, 2.1 (0.6) for HI (p < 0.01 vFI), and 2.6(0.4) for TOE (p <0.001 v HI). The association between FI and TOE findings was φ = 0.35 (x² = 17.57, p = 0.0014) and between HI and TOE it was (F = 0.95 (x² = 125.72, p < 0.0001; p <0.0001 v FI). The global echo score of vegetations was 7.1(3.3) with FI, 8.5 (3.4) with HI, and 11.3 (3.9) with TOE (p <0.001 v HI). Compared with TOE, FI identified only one of seven abscesses (sensitivity 14%) and HI identified two of seven abscesses (sensitivity 28%). Conclusions: HI provides an accurate assessment of suspected IE. TOE achieves superior definition of IE related abnormalities. [ABSTRACT FROM AUTHOR]

Objective -- To investigate transthoracic Doppler echocardiography in the identification coronary artery bypass graft (CABG) flow for assessing graft patency. Design -- The initial study group comprised 45 consecutive patients with previous CABG undergoing elective cardiac catheterisation for recurrent ischaemia. The Doppler variables best correlated with angiographic graft patency were then tested prospectively in a further 84 patients (test group). Setting -- Three tertiary referral centres. Interventions -- Flow velocities in grafts were recorded at rest and during hyperaemia induced by dipyridamole (0.56 mg/kg/4 min), under the guidance of transthoracic colour Doppler flow mapping. Findings on transthoracic Doppler were compared with angiography. Main outcome measures -- Feasibility of identifying open grafts by Doppler and diagnostic accuracy for Doppler detection of significant (&ges; 70%) graft stenosis. Results -- In the test group the identification rate for mammary artery grafts was 100%, for saphenous vein grafts to left anterior descending coronary artery 91%, for vein grafts to right coronary artery 96%, and for vein grafts to circumflex artery 90%. Coronary flow reserve (the ratio between peak diastolic velocity under hyperaemia and at baseline) of < 1.9 (95% confidence interval 1.83 to 2.08) had 100% sensitivity, 98% specificity, 87.5% positive predictive value, and 100% negative predictive value for mammary artery graft stenosis. Coronary flow reserve of < 1.6 (95% CI 1.51 to 1.73) had 91% sensitivity, 87% specificity, 85.4% positive predictive value, and 92.3% negative predictive value for significant vein graft stenosis. Conclusions -- Transthoracic Doppler can provide non-invasive assessment of CABG patency. [ABSTRACT FROM AUTHOR]

Objective: To assess the diagnostic potential of transthoracic and transoesophageal echocardiography for the detection of traumatic cardiovascular injuries in patients suffering from severe blunt chest trauma.Design: Prospective study over a three year period.Setting: A regional cardiothoracic centre.Patients: 134 consecutive patients (94 M/40 F; mean age 38 (SD 14) years) suffering from severe blunt chest trauma (injury severity score 33.5 (18.2)). Most patients (89%) were victims of motor vehicle accidents.Evaluation: All patients underwent transthoracic and transoesophageal echocardiography within 8 h of admission. Aortography was performed in the first 20 patients and in a further five equivocal cases.Results: Transthoracic echocardiography provided suboptimal images in 83 patients, detecting three aortic ruptures, 28 pericardial effusions (one cardiac tamponade), 35 left pleural effusions, and 15 myocardial contusions. Transoesophageal echocardiography was feasible in 131 patients and detected 14 aortic ruptures (13 at the isthmus), 40 pericardial effusions, 51 left pleural effusions, 34 periaortic haematomas, 45 myocardial contusions, right atrial laceration in one patient with cardiac tamponade, one tricuspid valve rupture, and one severe mitral regurgitation caused by annular disruption. For the detection of aortic rupture transoesophageal echocardiography showed 93% sensitivity, 98% specificity, and 98% accuracy. Time to surgery was significantly shorter (30 (12) v 71 (21) min; P < 0.05) for patients operated on only on the basis of transoesophageal echocardiographic findings.Conclusions: Transthoracic echocardiography has low diagnostic yield in severe blunt chest trauma, while transoesophageal echocardiography provides accurate diagnosis in a short time at the bedside, is inexpensive, minimally invasive, and does not interfere with other diagnostic or therapeutic procedures. [ABSTRACT FROM AUTHOR]

The article presents a case of a 49-year-old man with a history of hypertension presented to the emergency department because of chest pain and syncope. The echocardiography has demonstrated a dilated ascending aorta and a mildly regurgitant bicuspidal aortic valve. The article highlights the results of the echocardiographic findings.

This article presents a study on a 45 year old man with a history of hypertrophic obstructive cardiomyopathy (HOCM). The diagnosis of HOCM had initially been made at cardiac catheterisation in 1975. He had been given I20mg propranolol daily and his subsequent clinical history was uneventful. Since 1981 he had been undergoing echocardiography every two years. Echocardiography revealed notably hypertrophied ventricles and severe obstruction to the left ventricular outflow. The gradient to the left ventricular outflow decreased over the years and in 1998 no gradient to both left and right ventricular outflow was detected. In March 2000 he had paroxysmal atrial flutter with syncope.