Dynamic Right Ventricular Outflow Obstruction After Single-Lung Transplantation
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Ventricular outflow tract
This article reports on the technical aspects of an online real‐time biplane transesophageal echocardiographic imaging system and of a single‐matrix, phased‐array transducer capable of transverse and longitudinal scanning.
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BACKGROUND Assessment of left ventricular outflow tract (LVOT) area is a key component of quantification of aortic stenosis and stroke volume. Current international guidelines recommend measurement of the LVOT diameter with two-dimensional (2D) echocardiography and assume a circle. This may lead to erroneous measures of aortic valve area and adversely affect peri-operative decision making. Multiplane orthogonal (biplane) and three-dimensional (3D) echocardiography imaging may allow more accurate calculation of LVOT, aortic valve area and stroke volume. OBJECTIVE To evaluate the shape and area of the LVOT with conventional 2D diameter, short axis cross-sectional planimetry with biplane imaging and 3D multiplane reconstruction in patients undergoing cardiac surgery with transoesophageal echocardiography (TOE). DESIGN A retrospective observational study. SETTING A single centre university hospital. PATIENTS 119 patients undergoing cardiac surgery with TOE. INTERVENTIONS None. MAIN OUTCOME MEASURES Measurements of the shape and area of the LVOT with standard 2D TOE, short axis biplane imaging and 3D TOE. RESULTS The LVOT shape is elliptical in 70% of patients. The (mean ± SD, [range]) LVOT cross-sectional area with 2D TOE was 4.29 cm 2 ± 0.98, [2.46 to 6.70], with biplane was 4.68 cm 2 ± 1.03, [2.92 to 7.30] and with 3D was 4.59 cm 2 ± 0.99, [2.78 to 7.10]. There was a statistically significant difference ( P < 0.001) in the three pairwise comparisons. 2D LVOT area had large bias (7 to 9%) and wider limits of agreement (LOA) with both biplane and 3D LVOT area (−17 to 36%). Biplane and 3D LVOT areas had small bias (1.8%) with relatively narrow LOA (−8 to 11%). CONCLUSIONS 2D diameter measures of the LVOT assuming a circle underestimate LVOT area, underestimate aortic valve area and increase the apparent severity of aortic stenosis. This may lead to inappropriate aortic valve intervention. In a busy operating room environment, we suggest that for the calculation of stroke volume and aortic valve area, LVOT area is measured with biplane imaging. TRIAL REGISTRATION Observational study with no interventions so trial not registered.
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Objective To evaluate the BiPlane for the quantification of mitral valve area(MVA) in patients with mitral stenosis(MS).Methods Thirty patients with MS were investigated in this study.MVA was calculated by BiPlane in operative.Results MVA in patients with MS measured by BiPlane correlated well with MVA by the(r=0.954),).MVA by BiPlane was slightly greater than the measurement within intraoperative(1.23 cm2 vs 1.20 cm2).Conclusions The BiPlane can easily and accurately acquire the optimal plane of smallest MVA.
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To determine whether left ventricular volumes and ejection fractions calculated from single plane two-dimensional echocardiograms using the algorithm (0·85A2L) correlate with those calculated using the biplane Simpson's method, and whether small changes in volumes and ejection fraction occurring post-infarction could be detected from single-plane as well as from biplane two-dimensional echocardiograms.
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This study evaluates the feasibility of the combined use of an adult matrix probe with a real‐time biplane imaging system, and also describes the performance of a newly developed pediatric matrix probe. (ECHOCARDIOGRAPHY, Volume 8, November 1991)
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Image acquisition time and wall-motion score of conventional 2-dimensional (2D) dobutamine stress echocardiography (DSE) were compared with those of biplane and 3-dimensional (3D) DSE in 50 patients (age 67 +/- 13 years) with regular rhythms during clinically indicated DSE. Commercially available systems were used for the study. We used a conventional transducer for 2D and a matrix-array transducer (x4 or x3-1) for two biplane (60- and 120-degree) images and one 3D full-volume image. Image quality was scored as 1 = good; 2 = adequate; and 3 = inadequate. Segmental wall-motion scores for each method were analyzed in blinded fashion. Acquisition times of biplane (9.3 +/- 2.8 seconds) and biplane-guided 3D (additional 2.6 +/- 1.0 seconds) echocardiography were significantly shorter than those of conventional 2D DSE (60.0 +/- 26.7 seconds) (P < .001). Image quality was adequate or good in 94% for biplane and 96% for 3D echocardiography. Agreement of segmental wall-motion score was present in 87.6% of segments for 2D versus biplane and 85.9% for 2D versus 3D at baseline and in 88.0% for 2D versus biplane and 87.4% for 2D versus 3D at peak stress. Acquisition of biplane or biplane-guided 3D volumetric data during DSE with use of a new matrix-array transducer was feasible and shortened image acquisition time without affecting the diagnostic yield compared with conventional 2D imaging.
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