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A study of heart lesions has been conducted in 38 patients with systemic sclerosis using echocardiography, doppler and colour doppler. Abnormalities were found in 66% patients. Valvulopathies (mainly mitral regurgitation) were the most frequent lesions (45%). The presence of anti-SCL70 antibody was correlated to right cavities dilatation. Pulmonary hypertension was found in 6 patients.

Carcinoid cardiopathy involves the tricuspid valve and the right heart. In 3 observations we report the interest of modern echo-cardiographic techniques (transoesophagal echocardiography, doppler, colour doppler and contrast echocardiograpy). By using these techniques lesions of the left heart are found in 2 cases.

Precise non-invasive localisation of the site of a small ventricular septal defect was attempted using a new technique that simultaneously combines conventional cross sectional echocardiography with a Doppler system by superimposing the colour coded direction and velocity of blood flow directly on to real time ultrasound images. Twenty three patients with unoperated ventricular septal defects and a further eight after surgical closure were studied; 12 children with normal hearts served as controls. A colour coded blood flow jet entering the right ventricle during systole was identified in all 23 unoperated patients, in 11 of whom the defect was too small to be visualised by conventional cross sectional echocardiography. The colour Doppler technique precisely located 19 perimembranous and five trabecular defects (one patient had two defects). Five of the postoperative patients were without clinical evidence of a significant shunt but had pansystolic murmurs. In each of these five, trans-septal shunt blood flow as demonstrated by colour Doppler images whereas in only three of these patients was the residual defect large enough to be visualised by conventional cross sectional echocardiography. Three postoperative patients had no murmurs and showed no residual shunt on colour Doppler images. This was confirmed at cardiac catheterisation. There were no false positive results among the controls. This technique is useful for the more accurate diagnosis and location of ventricular septal defects and may help in assessing their natural or surgical closure.

Colour flow mapping was used to examine the pattern of regurgitant flow in 46 patients with mitral regurgitation due to mitral valve prolapse. Valve morphology was assessed from the real-time two-dimensional image and the presence of mitral regurgitation was determined from real time Doppler. On morphological criteria 11 (24%) patients had isolated or predominant anterior leaflet prolapse, 22 (48%) patients posterior and 13 (28%) patients bi-leaflet prolapse. A single regurgitant jet was detected in 43 patients (93%) and multiple jets in three (7%). The direction of the regurgitant jet was assessed in multiple views in two orthogonal planes (antero-posterior and medial-lateral) defined in relation to the mitral valve leaflets. The regurgitant jet was eccentric in the antero-posterior plane of the mitral leaflets in 40 of 45 (89%) cases and in the medial-lateral plane in 36 of 40 (90%) cases. Posterior leaflet prolapse was usually associated with antero-medially directed jets, anterior leaflet prolapse with postero-central or postero-lateral jets and bi-leaflet prolapse with predominantly postero-medial jets. In a subgroup of patients with significant mitral regurgitation and an eccentric regurgitant jet, a 'swirling' effect was produced with late systolic flow in the body of the left atrium toward the mitral valve. Colour flow mapping in patients with mitral regurgitation due to mitral valve prolapse demonstrated eccentric jets in most patients. The direction of regurgitant flow appeared to depend greatly on the dynamic anatomy of the mitral valve leaflets during systole. Although a single jet was detected in most patients, multiple jets did occur in a minority.

A linear array colour Doppler sonographic method was used experimentally on a vessel phantom in order to determine flow velocity, and the results were compared with DSA. Both the Doppler and the DSA method showed very good agreement with true velocities (r greater than 0.97). The Doppler method underestimated flow velocity. Early clinical results indicate that colour Doppler sonography is able, at the same time, to demonstrate morphology and function (direction flow and flow velocity) of significant vascular abnormalities by a non-invasive method.

OBJECTIVE This prospective study was undertaken to evaluate the role of colour Doppler sonography in the assessment of prostate carcinoma. METHODS Forty consecutive patients who were suspected of having prostate carcinoma with either raised prostate specific antigen or abnormal digital rectal examination were included in the study. Transrectal greyscale and colour Doppler sonography of the prostate was performed using a 5–9 MHz intracavitary probe. Needle biopsies were taken from areas that showed increased flow on colour Doppler. The results were correlated with the final diagnosis established on histopathological examination. RESULTS Comparison of greyscale and colour Doppler sonography showed that the latter is more sensitive and specific in predicting the malignancy. The statistical parameters of colour Doppler versus greyscale sonography were: sensitivity 88.23 vs. 73.52, specificity 66.66 vs. 33.33, positive predictive value 93.75 vs. 85.18, and negative predictive value 50 vs. 22.22, respectively. CONCLUSION Colour Doppler and greyscale sonography should be routinely performed to improve detection of prostate carcinoma and to target the lesion.

Objectives to evaluate the distribution of superficial and deep venous reflux in patients with chronic leg ulcers. Materials retrospective study of 186 patients with chronic leg ulcers (212 lower limbs). Results in 127 legs without arterial disease and a history of deep venous thrombosis (DVT), 62 (49%) had superficial, 45 (35%) had superficial and deep, and 14 (11%) had isolated deep venous reflux. In legs with a previous DVT, isolated deep venous reflux was more common (21/55, 38%) but superficial reflux, often in combination with deep reflux, still predominated (56%). Conclusions a large part of the venous insufficiency causing venous leg ulcers is superficial and suitable for varicose vein surgery. In patients with chronic leg ulcers most reflux affects the superficial system and is potentially suitable for surgical correction.

Objective: to determine the clinical significance of continuous flow in the long saphenous vein in limbs with venous ulceration. Design: retrospective review. Patients and methods: review of 1608 consecutive limbs undergoing colour duplex scanning for venous disease over a 43 month period. Results: continuous flow in the long saphenous vein is seen in 8% of limbs with venous ulceration and in 37% of limbs with deep venous obstruction. Sixty-six per cent of ulcerated limbs with continuous flow in the long saphenous vein had deep venous obstruction, 27% had deep venous reflux with cellulitis and 7% had lymphoedema in addition to venous ulceration. Conclusion: continuous flow in the long saphenous vein in patients with venous ulceration should alert the clinician to the possibility of deep venous obstruction. Such limbs should be treated by compression bandaging with extreme caution.

T, an eight years old girl was diagnosed as a case of perimembranous Ventricular Septal Defect (VSD) since 6 months of her age. She had recurrent chest infection since early infancy. Her Echocardiography with colour Doppler showed a 4.5 mm perimembranous VSD which was 5 mm away from the aortic valve. As pulmonary artery pressure was normal, she was kept under follow up and device closure was planned. At last she was taken into the catheterization laboratory of combined military Hospital, Dhaka on 1st July 2008 and VSD was closed with an 8 mm Amplatzer perimembranous VSD device. Whole procedure was done under deep sedation with Ketamine and transthoracic echocardiography (TTE) and fluroscopy guide. It is the first ever case of VSD device closure where procedure was done under sedation and TTE guide which lead to the writing of this report.Keywords: VSD; Transthoracic Echo; Amplatzer Device. DOI: 10.3329/cardio.v3i1.6432Cardiovasc. j. 2010; 3(1): 89-91

Colour Doppler flow mapping (CD) has proved to be a very sensitive and specific means of diagnosing valvular regurgitation and obtaining a rapid semiquantitative estimation of the severity of regurgitation itself. We tried to compare a semiquantitative evaluation of aortic and mitral regurgitation, without time-consuming calculations of regurgitant jet areas, with the conventional visual semiquantitative angiographic estimation. We have also evaluated in detail the interobserver variability of this type of semiquantitation. Two independent observers (OB) have reviewed CD studies of a selected group of 47 consecutive patients who underwent both cineventriculography and aortography for aortic regurgitalion (AR) and/or mitral regurgitation (MR), then graded as mild, moderate or severe. AtCD, AR and MR were classified as present or absent and graded as mild, moderate or severe. The following interobserver percentage agreements were noted for AR presence or absence, AR grade, MR presence or absence, MR grade, respectively: 96%, 83%, 96%, 83%. Likewise, the respective echo-angio agreements were 90%, 58%, 80%, 70%. Agreement was significant (P

Raised anticardiolipin antibodies (ACA) have been related to recurrent abortions, thrombosis, thrombocytopenia and cerebral involvement in systemic lupus erythematosus (SLE). To evaluate its possible association with cardiac involvement in this condition, we studied 28 consecutive SLE patients mean age= 31 (17-58) using 2-D echocardiography and colour Doppler (echo) and correlated these findings with ACA titres. Echo was normal in 15 and abnormal in 13 of the 28. Abnormalities recorded were: pericardial effusion =3, myocardial dysfunction (localized or global)=6, and valvular abnormalities (valvular thickening = 3, valvular vegetations = 4, valvular insufficiency without structural abnormalities = 2). Some patients had more than one abnormality. ACA were raised (>9 Hammersmith units) in 9 of 13 patients with abnormal echo and in only 1 of 15 of the normal echo. This patient had recurrent venous thrombosis. 4/4 patients with vegetations, 2/3 with valvular thickening and 6/6 with myocardial dysfunction had raised ACA. We postulate a strong association between myocardial and valvular involvement in SLE and raised ACA titres.

Round ligament varicosity (RLV) is rare and almost all cases are pregnant women. RLV appears as a unilateral or bilateral groin swelling. Pain and tenderness may present. Clinical evaluation is inadequate for exact diagnosis because inguinal hernia has similar findings. Ultrasonography (US) is essential when a groin swelling is detected in a pregnant woman. We present gray scale US and colour Doppler US findings of a 32-week pregnant woman with bilateral RLVs at the inguinal canal, parauterine area and in the myometrium.

The use of Doppler ultrasound in rheumatology has grown in recent years. This is partly due to the increasing number of rheumatologists who perform US in their daily clinical practise and also to the technological advances of US systems. Both colour Doppler and power Doppler are used to evaluate the degree of intra- and peri-articular soft tissue inflammation. Moreover, Doppler US has been found to be of help in the assessment of vascular pathologies such as the vasculitides. In this review we provide an update of the data regarding the use of colour Doppler and power Doppler in rheumatology.

The aims of this prospective study were to investigate the accuracy of B-mode transvaginal ultrasonography alone, using the typical finding of the presence of an elongated shaped mass with incomplete septa, in the screening of hydrosalpinx in women undergoing surgery for gynaecological diseases, and to determine the predictive value of this method combined with colour Doppler energy (CDE) imaging evaluation and CA125 concentrations in differentiating hydrosalpinx from other adnexal masses. In the first part of the study, 378 consecutive pre-menopausal non-pregnant women were submitted to transvaginal ultrasonography alone before surgery. In the second part of the study, 256 adnexal masses underwent transvaginal ultrasonography combined with CDE imaging evaluation associated with spectral Doppler analysis and plasma concentrations of CA125. Sensitivity and specificity for the ultrasonographic screening were 84.6 and 99.7% respectively, calculated for each adnexum (n = 756) and 93.3 and 99.6% respectively, calculated for each mass, for differentiating hydrosalpinx from other adnexal masses. The CDE imaging and the evaluation of CA125 plasma concentrations do not seem to increase the accuracy of B-mode transvaginal ultrasonography. Inter- and intra-observer agreement, expressed in terms of k-values, was high (0.87 and 0.93 respectively). In conclusion, transvaginal ultrasonography alone is a useful method of detection of hydrosalpinx.

Summary Reasons for performing study: Although valvular regurgitation is diagnosed frequently by colour Doppler echocardiography in racehorses at rest, there is currently no information about the effect of exercise on valvular regurgitation. Objectives: To investigate the effect of light exercise on valvular regurgitation in a population of trotters. Methods: Standardbred trotters (n = 73) were examined by resting auscultation and echocardiography, of which 50 fullfilled the criteria of the study. Of these, 4 had reduced performance according to the trainers and were not included in the statistical analyses. Horses that showed valvular regurgitations diagnosed by colour Doppler echocardiography at rest, were light exercised and the regurgitant valves were then re-examined by colour Doppler echocardiography. Results: Of the 46 horses, 41 (89%) had one or more valvular regurgitations at rest with tricuspid regurgitation present in 83% of horses, mitral regurgitation 46%, pulmonary regurgitation 37% and aortic regurgitation 57%. After exercise, one or more valvular regurgitation persisted for 23 of the 41 horses (56%). The regurgitation decreased significantly for mitral, pulmonary and aortic valves; the mitral regurgitation persisted for 21% of the horses, pulmonary regurgitation persisted for 6% and aortic regurgitation persisted after exercise for 23% with regurgitation diagnosed at rest. Half of those with tricuspid regurgitation at rest still had tricuspid regurgitation after exercise. Conclusions: The results of this study showed that the majority of small valvular regurgitations disappear after light exercise. However, the severity of tricuspid regurgitation increased in 4 horses. Furthermore, these horses were not performing satisfactorily according to the trainers. Potential relevance: Studies in man have shown that severity after exercise suggests pathological regurgitation. The present study indicates that echocardiographic examination of valvular regurgitation after exercise might be a relevant examination in horses. However, more studies are needed to evaluate the effect of strenuous exercise on valvular regurgitation in horses.

Objectives To assess the urethral vascularity in continent women using colour doppler high frequency endovaginal ultrasonography (EVUS). Methods We recruited 61 continent women attending gynaecology clinics between July and October 2009. Exclusion criteria included symptoms of urinary incontinence, voiding dysfunction, pelvic organ prolapse or urinary tract infection. The participants underwent EVUS using high frequency (9-12 MHz) biplane transducer (type 8848 BK Medical), according to a standardised protocol. Colour Doppler US was performed in sagittal plane and in transverse plane at the level of the mid-urethra. Ten seconds video files were recorded and following vascular parameters: flow velocity (Vmix), area of the vessels (Amix), intensity of vascularity (Imix), pulsatility index (PImix) and resistance index (RImix) was evaluated. Results There were 30 nulliparous (49.2%) women and 31 multiparous women (50.8%) with a mean (±SD) age of 32 (±4) and 46 (±6) years respectively. Significant impairment of vascularity was observed in multiparous patients as compared to nulliparous and was reflected by increased values of RImix (p mix (p mix (p mix (p mix (p mix- from 0.02 ± 0.02 in nulliparous to 0.005 ± 0.01 in multiparous was observed. Cronbach alpha, used to assess vascular correlations and parity demonstrated a reduction when expressed only for vascular parameters, indicating that number of deliveries is an important factor while assessing urethral vascularity. Conclusions Compared to continent nulliparous women, continent multiparous women demonstrated a significant reduction in the vascularity parameters in all measured variables when parity was accounted for. Advances in knowledge This study provides the basis for further research in assessing urethral vascularity in women.

BackgroundLeft ventricular (LV) early diastolic filling is related to an active process of LV relaxation, caused by its rapid untwisting. The untwisting rate (UR) has been reported to be a robust marker of diastolic function but is technically hard to assess in practice. The untwisting phenomenon generates a diastolic intraventricular pressure gradient (IVPGd), which can be assessed by colour Doppler M-Mode. Previous studies showed a close temporal relation between the UR and the IVPGd peaks, but the relation between their magnitudes as well as their load dependency remain unclear.MethodWe developed our own Matlab software for IVPGd assessment by colour Doppler M-Mode based on Bernoulli equation.From our research database, we retrieved all echocardiograms where ejection fraction was normal, the colour M-Mode tracing was available and UR was measurable using speckle tracking. Passive leg raising was used in 19 healthy volunteers to study the impact of preload on the IVPGd measurement.ResultsWe included 104 echocardiograms (83% males, median age 23y [19-69]). The median peak IVPGd was 3.1mmHg [1.6-7.8] and correlated to the peak UR (r=0.57, P