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Echo Research and Practice

Victoria Pettemerides, Thomas Jake Turner, Conor Steele, Anita Macnab
INTRODUCTION: The 2016 NICE clinical guideline 95 (CG95) demoted functional imaging to a second line test following computed tomography coronary angiography (CTCA). Many cardiac CT services in the UK require substantial investment and growth to implement this. Chest pain services like ours are likely to continue to use stress testing for the foreseeable future. We share service evaluation data from our department to show that a negative stress echocardiogram can continue to be used for chest pain assessment...
March 1, 2019: Echo Research and Practice
Jack Parnell, Mehak Tahir, Benoy Nalin Shah
A 62-year-old man admitted with palpitations had a 12-lead ECG that revealed atrial flutter with 2:1 AV block (rate 150bpm). Transthoracic echocardiography (TTE) revealed normal left ventricular size with impaired systolic function and severe MR. No MV prolapse was seen. The admitting doctor informed the patient that mitral valve surgery was the likely outcome. However, after senior review, the patient was commenced on rate-control, diuretic and anticoagulant medications. He was discharged and returned six weeks later for direct current cardioversion, which successfully restored sinus rhythm...
March 1, 2019: Echo Research and Practice
Karthik Seetharam, Nobuyuki Kagiyama, Partho P Sengupta
The intersection of global broadband technology and miniaturized high capability computing devices has led to a revolution in the delivery of healthcare and the birth of telemedicine and mobile health (mHealth). Rapid advances in handheld imaging devices with other mHealth devices such as smartphone apps and wearable devices, are making great strides in the field of cardiovascular imaging like never before. Although these technologies offer a bright promise in cardiovascular imaging, it is far from straightforward...
February 1, 2019: Echo Research and Practice
Bushra Rana, Shaun Robinson, Rajeevan Francis, Mark Toshner, Martin J Swaans, Sharad Agarwal, Ravi De Silva, Amer A Rana, Petros Nihoyannopoulos
Tricuspid regurgitation natural history and treatment remain poorly understood. Right ventricular function is a key factor in determining prognosis, timing for intervention and longer-term outcome. The right ventricle is a thin-walled chamber with a predominance of longitudinal fibres and a shared ventricular septum. In health, the low-pressure pulmonary circulation results in a highly compliant RV well equipped to respond to changes in preload but sensitive to even small alterations in afterload. In the first of two articles, discussion focuses on key principles of ventricular function assessment and the importance of right ventricular chamber size, volumes and ejection fraction, particularly in risk stratification in tricuspid regurgitation...
February 1, 2019: Echo Research and Practice
John Chambers, Madalina Garbi, Norman Briffa, Vishal Sharma, Rick Steeds
Echocardiography plays a vital role in the follow up of patients with replacement heart valves. However, there is considerable variation in international guidelines regarding the recommended time points after implantation at which routine echocardiography should be performed. The purpose of routine echocardiography is to detect early structural valve deterioration in biological valves to improve the timing of redo interventions. However the risk of valve deterioration depends on many valve-related factors (valve design, patient prosthesis mismatch) and patient-related factors (age, diabetes, systemic hypertension, renal dysfunction and smoking)...
February 1, 2019: Echo Research and Practice
Hannah Chaouki Sinclair, Paul Russhard, Chris Howell Critoph, Christopher D Steadman
A 70-year-old female with exertional dyspnoea was found to have basal septal hypertrophy, or a 'basal septal bulge', with evidence of mild left ventricular outflow tract obstruction (LVOT) at rest on her initial echocardiogram. She was usually fit and well and had no significant past medical history. She had no history of hypertension. There was no family history of hypertrophic cardiomyopathy (HCM). A cardiac MRI did not demonstrate any typical features of HCM. ECG showed sinus tachycardia but was otherwise unremarkable, Appendix 1...
January 1, 2019: Echo Research and Practice
Richard P Steeds, Craig E Stiles, Vishal Sharma, John B Chambers, Guy Lloyd, William Drake
This is a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology on the role of echocardiography in monitoring patients receiving dopamine agonist (DA) therapy for hyperprolactinaemia. (1) Evidence that DA pharmacotherapy causes abnormal valve morphology and dysfunction at doses used in the management of hyperprolactinaemia is extremely limited. Evidence of clinically significant valve pathology is absent, except for isolated case reports around which questions remain...
March 1, 2019: Echo Research and Practice
R Bedair, X Iriart
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect, affecting 3 in 10,000 live births. Surgical correction in early childhood is associated with good outcomes, but lifelong follow-up is necessary to identify the long-term sequelae that may occur. This article will cover the diagnosis of TOF in childhood, the objectives of surveillance through adulthood and the value of multi-modality imaging in identifying and guiding timely surgical and percutaneous interventions.
March 1, 2019: Echo Research and Practice
Philip McCall, Alvin Soosay, John Kinsella, Piotr Sonecki, Ben Shelley
Right ventricular (RV) dysfunction occurs following lung resection and is associated with post-operative complications and long-term functional morbidity. Accurate peri-operative assessment of RV function would have utility in this population. The difficulties of trans thoracic echocardiographic (TTE) assessment of RV function may be compounded following lung resection surgery and no parameters have been validated in this patient group. This study compares conventional TTE methods for assessing RV systolic function to a reference method in a lung resection population...
December 1, 2018: Echo Research and Practice
Michael Roshen, Sophia John, Selda Ahmet, Rajiv Amersey, Sandy Gupta, George Collins
The British Society of Echocardiography (BSE) highlights the importance of patient questionnaires as part of the quality improvement process, To this end, we implemented a novel system whereby paired surveys were completed by patients and physiologists for transthoracic echocardiography scans, allowing for parallel comparison of the experiences of service providers and end users. Anonymised questionnaires were completed for each scan by the patient and physiologist for outpatient echocardiographic scans in a teaching hospital...
December 1, 2018: Echo Research and Practice
Mohammed Andaleeb Chowdhury, Jered M Cook, George V Moukarbel, Sana Ashtiani, Thomas A Schwann, Mark R Bonnell, Christopher J Cooper, Samer J Khouri
Background This analysis aims to assess the prognostic value of pre-operative right ventricular echocardiographic parameters in predicting short-term adverse outcomes and long-term mortality after coronary artery bypass graft (CABG). Methods Study design: Observational retrospective cohort. Pre-operative echocardiographic data, perioperative adverse outcomes (POAO) and long-term mortality were retrospectively analyzed in 491 patients who underwent isolated CABG at a single academic center between 2006 and 2014...
December 1, 2018: Echo Research and Practice
A E Velcea, S Mihaila Baldea, D Muraru, L P Badano, D Vinereanu
Neck venous malformations and their potentially life-threatening complications are rarely reported in the available literature. Cases of aneurysmal or hypo-plastic jugular vein thrombosis associated with systemic embolization have not been frequently reported. We present the case of a 60-year-old male, without any known risk factors for thromboembolic disease, admitted for sudden onset dyspnea. The physical examination was remarkable for a right lateral cervical mass, expanding with Valsalva maneuver. Thoracic CT with contrast established the diagnosis of bilateral pulmonary embolism and raised the suspicion of superior vena cava and right atrial thrombosis...
December 1, 2018: Echo Research and Practice
Thomas E Ingram, Steph Baker, Jane Allen, Sarah Ritzmann, Nina Bual, Laura Duffy, Chris Ellis, Karina Bunting, Noel Black, Marcus Peck, Sandeep S Hothi, Vishal Sharma, Keith Pearce, Richard P Steeds, Navroz Masani
Background Quality assurance (QA) of echocardiographic studies is vital to ensure that clinicians can act on findings of high quality to deliver excellent patient care. To date, there is a paucity of published guidance on how to perform this QA. The British Society of Echocardiography (BSE) has previously produced an Echocardiography Quality Framework (EQF) to assist departments with their QA processes. This article expands on the EQF with a structured yet versatile approach on how to analyse echocardiographic departments to ensure high-quality standards are met...
December 1, 2018: Echo Research and Practice
P Luke, C Eggett, I Spyridopoulos, T Irvine
At present there are two recognised guidelines for the echocardiographic assessment of left ventricular diastolic function provided by the British Society of Echocardiography and American Society of Echocardiography/European Association of Cardiovascular Imaging. However, no direct comparison of these guidelines has been performed to establish whether they provide similar diastolic grading. One hundred and eighty-nine consecutive patients in sinus rhythm who underwent transthoracic echocardiography for a primary indication of either heart failure assessment or assessment of left ventricular systolic function were extracted from our database (McKesson Cardiology)...
December 1, 2018: Echo Research and Practice
Kai Neoh, Jamal N Khan, Khaled Albouaini, Adrian Chenzbraun
A 42-year-old intravenous drug user presented with seizures and septicaemia. CT and MRI were suggestive of multiple brain and systemic emboli, and blood and CSF cultures were positive for Staphylococcus aureus. Initial transthoracic echocardiogram did not show any abnormalities but subsequent transoesophageal echocardiography showed two masses in the left and the right ventricle. The LV mass was large, irregular, non-mobile and attached to the basal anterolateral LV segment abutting but not involving the mitral valve...
December 1, 2018: Echo Research and Practice
Sergio Barros-Gomes, Abdallah El Sabbagh, Mackram F Eleid, Sunil V Mankrad
Non-atherosclerotic myocardial infarction (MI) is an important but often misdiagnosed cause of acute MI. Furthermore, non-atherosclerotic MI with concomitant acute stroke and pulmonary embolism due to in-transit thrombus across a patent foramen ovale (PFO) is a rare but potentially fatal combination (1, 2, 3). Early detection of this clinical entity can facilitate delivery of targeted therapies and avoid poor outcome (1, 2). Here, we describe a 68-year-old female with hypertension, tobacco abuse and chronic obstructive pulmonary disease presenting with facial droop, right arm weakness and aphasia...
December 1, 2018: Echo Research and Practice
Sadie Bennett, Duwarakan Satchithananda, Gareth Law
Summary: A 42-year-old male was admitted with shortness of breath secondary to suspected heart failure and chest infection. An echocardiogram revealed a dilated and impaired left ventricle; ejection fraction 29%, with a large, mobile thrombus within the left ventricular apex. Due to the presence of liver dysfunction, vitamin K antagonists were deemed inappropriate; thus, the decision was taken to use the novel anticoagulation agent Apixaban. After 6 days of receiving Apixaban, a cardiac magnetic resonance scan was preformed, which showed complete resolution of the LV apical thrombus...
December 1, 2018: Echo Research and Practice
Victor Galusko, Owen Bodger, Adrian Ionescu
Introduction: Hand-held imaging devices are widely used in clinical practice and are a useful tool. There is no published review examining the diagnostic parameters achieved with these devices in clinical practice. Methods: We searched three online medical literature databases (PubMed, EMBASE and MEDLINE) for all literature published up until January 2018. We selected studies that (1) were conducted in the adult population; (2) used a truly hand-held device; (3) featured sensitivities and/or specificities on the use of the hand-held scanner...
December 1, 2018: Echo Research and Practice
C Bleakley, M Eskandari, O Aldalati, K Moschonas, M Huang, A Whittaker, M J Monaghan
Background: The mitral valve orifice area (MVOA) is difficult to assess accurately by 2D echocardiography because of geometric assumptions; therefore, 3D planimetry may offer advantages. We studied the differences in MVOA measurements between the most frequently used methods, to determine if 3D planimetry would result in the re-grading of severity in any cases, and whether it was a more accurate predictor of clinical outcomes. Methods: This was a head-to-head comparison of the three most commonly used techniques to grade mitral stenosis (MS) by orifice area and to assess their impact on clinical outcomes...
December 1, 2018: Echo Research and Practice
Neil David Hauser, Justiaan Swanevelder
Transoesophageal echocardiography (TOE) has, in certain clinical situations, become an almost universal monitor and diagnostic tool. In the perioperative environment, TOE is frequently used to guide anaesthetic management and assist with surgical decision making for, but not limited to, cardiothoracic, major vascular and transplant operations. The use of TOE is not limited to the theatre environment being frequently used in outpatient clinics, emergency departments and intensive care settings. Two case reports, one of oesophageal perforation and another of TOE utilization in a patient having previously undergone an oesophagectomy, introduce the need for care while using TOE and highlight the need for vigilance...
December 1, 2018: Echo Research and Practice
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