Recent clinical studies have indicated echocardiographic observations

of gaseous emboli in the left ventricle (LV) and atrium (LA) during studies in

patients with mechanical heart valves (MHV) in the mitral position. These reports

have shown that the intensities of these gas bubbles in elderly patients are less

than those in younger patients. These facts may indicate a correlation between

formation of the gas bubbles and the LV functions. The goal was to utilize our

pulse duplication system to create the corresponding physiologic conditions

and to understand the impact of these parameters on SpE formation

Gharib, Mory

Levy, Denis J.

Milo, Simcha

Rambod, Edmond

Reisner, Shimon A.

Caltech Authors - Main

1-592 Supplement I Circulation Vo/92, No 8 October 15, 1995 
Val~e TEEt TEEZ 
N% length Widt~ N Length Width 
Mitral 16(731 8±3 1 0 ± 03 10 9 := 1 5' 08±02 
AOrtiC 12(551 7 ;: 2 1.0 ± 02 8 9:::4 09 ± 02 
· P < 0 02 as compared to length on TEE 1. LE length and Width are expressed 1n mm. 
LE were hyperrnobile and all but 2 were located at the leaflet coaptation 
point. All mitra l LE prolapsed 1nto the atrium during systole and the aortic LE 
prolapsed into the outflow tract during diastole. No LE were noted on the 
tricusp1d and pulmonic valves. No subject had a cardioembolic event during 
Jongterm lollow up. Conclusions: 1) LE are common (14%) in subjects with 
normal hearts. 2) LE are seen with equal frequency on the mitral and aortic 
valves; 3) LE persist unchar1ged over time; and more important 4) LE may not 
be a substrate for card•oembolism. 
2830 
Spontaneous Echocardiographic Contrast (SpE): An in-vitro 
Study of the Impact of Cardiac Output, Left Ventricular dP/dt and 
Temperature 
Edmond Rambod, Mory Gharib. Denis J Levy, Simcha Milot. Shimon 
A. Re1sner 1 California lnstirute of Technology, Pasadena, CA; 1 Rambam 
Medical Center and the Technron-School of Med1cme, Haifa, Israel; Oregon 
Hlth Sci Univ. Portland. OR 
Purpose: Recent clinical studies have indicated echocardiographic observations 
of g8seous emboli in the lett ventricle (LV) and atrium (LA) during studies rn 
patients with mechanical heart valves(MHV) In the mitral position. These reports 
have shown that the intensities of these gas bubbles in elderly patients are less 
than those tn younger pauents. These facts may indicate a correlation between 
formatton of the gas bubbles and the LV functions. The goal was to utilize our 
pulse duplication system to create the corresponding physiologic conditions 
and to understand the unpact of these parameters on SpE formation. 
Methods: Our system wtth a flex1ble LV model Simulated phys1ological condi-
tions. (LAP)peak = 8, (lVP)pea~ = 130. (dP/dt)LV = 1800-3000, (SP)mean = 100. 
HR = 60, CO= 3-5Vmin, SR = 35% . .0. 27 mm Edwards-Duromedics(ED)valve 
was used in the mitral position. The aortic valve was a 23 mm porc1ne Carpentter-
Edwards. For the experiments. the liquid was de-ionized, de-bubbled. The liq-
uid temperature was carefully monitored and gradually increased from the room 
temperature to 37"C. M-Mode Doppler and 2D-echoof long and short axis planes 
were performed using a Vingmed CFM750 machine. An Argon-ton laser beam 
was used for planar illumination and high-speed video flow imaging. 
Resufts. High-speed videography of the mitral valve depicted little bright 
bubbles formed in the immediate vicinity of mechanical prosthesis upon closure 
at CO = 31/min. As the CO was increased. we observed an increase in their 
intensities and a sign1ftcant difference 1n their nature. The effect ol dP/dT was 
even more substantial. At dP/dt = 3000. we observed a major increase In the 
size of these bubbles and in their fife-span. Increasing temperature from 22•c 
to 37"C caused an immediate 10crease in the bubbles mtensities and s1ze. 
Conclusions: CO. dP/dt. and Temperature have major impact on SpE forma-
tion in MHV. 
2831 
Is the Patent Foramen Ovale Functionally Closed In Patients with 
Elevated Left Atrial Pressure? 
Birke Schneider, Thomas Hofmann, Rudolf Bauer. Allgemeines Kr8nkenhaus 
St Georg, Hamburg, Germany 
It 1s assumed thai a patent foramen ovale (PFO) due to its valvefike structure 
allows only right-to-left (R·to-L) shunting but is functionally closed with elevated 
left atrial pressure. whereas an atrial septal defect (ASD) allows bidirectional 
shunting. To assess the prevalence of a PFO. we studied 245 consecutive 
patients (P}. 59 with and 186 without significant left heart disease (LHD). by 
transesophageaf contrast (C-TE) and color Doppler echo-cardiography (D-TE). 
A PFO was diagnosed tf ~1 microbubble appeared tn the left atrium within 3 
heart cycles after opacification of the right atrtum or if a color jet across the 
atrial septum was identified and no obvious ASD was seen. A PFO with R·to·L 
shunt by C-TE tncluding provocative maneuvers was present 1n 4159 P {7%} with 
LHD vs 49/186 P (26%) withoiJt LHD (p < 0.005). A PFO w ith L·to-R shunttng 
by D-TE was identified in 15 P with LHD The shunt was intermittent in 4 P 
with and continuous m 11 P without a R·to-L shunt by C-TE. In 711 1 P with 
continuous L-to·R shunt on D-TE. a typical PFO with valvelike morphology was 
subsequently confirmed at surgery (n = 5) or autopsy (n = 2). Combining C-TE 
and D-TE results. a PFO was present in 15/59 P (25%) with LHD vs 49/186 P 
(26%) without LHD (p = ns). In 2 P with LHD and a follow-up study. preoperative 
diagnosis of a PFO could be achieved only by 1).. TE showing a continuous L-to-R 
shunt. After valve surgery with normalization of intracardiac pressures, however. 
a R·to-L shunt across the PFO was demonstrated by C-TE. Conclusion: Despite 
its valvelike structure. a PFO may allow bidirectional shunting. In P with LHD. 
D-TE IS supenor to C-TE for diagnosis of a PFO. 
2832 
A Normal Transthoracic Echocardlogram Obviates the Need f 1 , 
Transesophageat Echocardiography in Suspected Endocardit~: 
Waleed N. lrano. Paul A Grayburn. M. Elizabeth Brickner. lmran Afridi. UT 
Southwestern 8nd VA Medical Centers. Dallas, TX 
It has been demonstrated that transesophageal echocardiography (TEEt 
superior to transthoracic echocardiography (TIE} for detection of valvular v IS 
lations The lower sens_itivit.y of TIE is la.rge~y ~ue to shado~ing from prost~~­
valves or a poor acoustiC w1ndow resultmg tn tnadequate v•sualtzation Wheth c 
TEE improves the diagnostic yield in patients with suspected nat1ve valve enrt 
carditis after a technically adequate TIE is uncertain. Accordingly, we rev1ew~ 
the records of 181 patients, without prosthetic valves. referred for evaluatlo 
of suspected endocardttis Of these. 25% had a techntcally difficult TTE an: 
were excluded from analysis. Of the 135 remaining patients. 87 were men and 
48 were women (mean age 45 ± 14 yrs). All patients underwent TIE followet.l 
by TEE withtn 72 hours Patients were classified 1nto 3 groups based on the 
results of the TIE: definite endocarditis. if a vegetation was seen; suspicious 
if there was valvular thiCkening or regurgitation, and normal. TEE studies wer~ 
revtewed separately and the presence or absence of a vegetation was noted 
All patients with a positive TIE (42/42) had endocarditis by TEE whereas 96% 
(44/46) wfth a normal TIE had no evidence of endocarditis by TEE 
TEE Endoeard1t1s 
Normal 
TIE 
definite 
42 
0 
suspicious 
17 
30 
normal 
2 
44 
We conclude that in patients without prosthetic valves who have a normal 
TIE. TEE is unlikely to be of incremental benefit in diagnosing endocarditis 
2833 
Geometry and Volume of Right Ventricles - A Quantitative Echo 
CT Study 
Ernst Wellnhofer. Jost Stalke. Michael Grafe. Pia Skarabis, Michael Schartl. 
Dept. of Int. Medicine/Cardiology. DHZB; Virchow, HU Berlin, DE 
The function of the right ventricle (RV) may be limiting in patients with pul-
monary or heart disease. Echocardiographic evaluation of ventrtcufar volumes. 
and geometry is often diffiCUlt and usually semi- quantitative. Thus our objec-
tive was to characterize different pathologic abnomnallties of RV by quantifying 
volume and geometry. 
The study was done with 3·D reconstructed RV from mult1plane transoe-
sophageal echocardiograms (TEE) in 4 groups of patients (controls (C) n = 4, I ' 
coronary heart disease (CHD) n = 7. mitral stenosis IMS) n = 6. RV volume load 
(VOL) n = 4). Volume (V) was calculated by summing up manually traced slices 
in diastole and systole from echotomographic picture files. Geometry (G) was I ' 
assessed by circumference (C) to area (.0.) ratios in 2 orthogonal views (A 1: A2) 1 1 
G is an easily calculated parameter. which is maxtmally 2 in a circular section 
(S) and depends on shape and size in other sections. 
Inter-individual reproducibility of V (r = 0.94, mean diff. (D) 1.7 ml), A (r 
= 0.99. D 1 cm2) and C (r = 0.95, D 0 .5 em) is good and agreement with 
angiographic volumes (r = 0.84. D 12 ml) is fair. V and G (mean values and SO} 
are listed below: 
V diastole lml} V systole (ml) G diastole Gsystole 
c 110 ± 35 48± t5 0.8A1/0.8A2 0 75 A1/0.7A2 
CHD 106± 16 47 ±9 0.73A111 .2A2 0 55A 1/0.92A2 
MS 99 ± 24 42 ± 14 0.9A111.2A2 0.7A 1/0.9A2 
VOL 300 ±42 136±38 13A1/t .2A2 1 2A1/1 1A2 
Discriminant analysis allowed a I 00 percent correct classification of disease 
groups by V and G. By variance analysis significant intergroup differences 
in v and G were found. ConclusiOfl: Ouantttative analysis of RV volume and 
geometry from Echo CT is reproducible and fairly accurate. Different pathologic ~ 
conditions affecting the right ventricle are reflected by quantitative analysis and 
geometry of the nght ventricle 
2834 
Index of Myocardial Performance: A Simple and Reproducible 
Measurement of 'Global' Right Ventricular Myocardial Function 
Chuwa Tei. James B. Seward. A Jamil Tajik. Shinichi Minagoe 1. 
Yoshihumi Toyama 1 . Mayo Clioic, Rochester, MN; t Nanpuh Hosptl81. 
Kagoshim8, Japan 
Assessment of right ventncular (RV) function remains cumbersome and chal· 
lenging. Thus. there is a clinical need for a simple measure of RV function. We 
have recently developed new Doppler index (TEl index) of combined systolie 
and dtastolic myocardial performance for assessment of pnmarily left myocaP 
dial dysfunction. In this study, we determmed whether the index is useful to 
assess RV function. We studied 49 normal subjects {Mean Age: 55 :l: 18 yearsl 


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Spontaneous Echocardiographic Contrast (SPE) – An In-Vitro Study of the Impact of Cardiac-Output, Left-Ventricular DP/DT and Temperature

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Spontaneous Echocardiographic Contrast (SPE) – An In-Vitro Study of the Impact of Cardiac-Output, Left-Ventricular DP/DT and Temperature

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