Possibilities of ultrasound methods in the diagnosis of decompression sickness

Aim of the work: to conduct a comparative analysis of methods of ultrasound examination of the right heart with audio and visual indication of intravascular decompression gas formation in divers after diving.Materials and methods. An examination of the right heart in divers after 152 man-descents was carried out. Intravascular decompression gas production was assessed by ultrasound using sound location based on the Doppler effect and transthoracic two-dimensional echocardiography.Results and discussion. Both methods make it possible to determine intravascular decompression gas formation after a diving descent, correlate with the clinical picture of acute decompression sickness and should be used in the medical support of diving descents. At the same time, the method of ultrasound examination based on transthoracic two-dimensional echocardiography turned out to be more sensitive in determining gas bubbles in the right heart as compared to auditory location with the Doppler effect.

Comparative assessment of aortic valve stenosis using two-dimensional, three-dimensional transesophageal echocardiography, computed tomography and cardiac catheterization

Aim. To compare effectiveness of ultrasound, radiological and invasive methods for assessing aortic valve (AV) stenosis.Material and methods. This study included 33 patients with AV stenosis. The mean age of the patients was 71,8±6,8 years. All patients underwent standard and three-dimensional echocardiography, computed tomography, and cardiac catheterization.Results. According to two-dimensional echocardiography, the AV area averaged 0,58±0,21 mm2, according to cardiac catheterization — 0,61±0,17 mm2, according to three-dimensional transesophageal echocardiography — 1,13±0,42 mm2, and according to multislice computed tomography 0,88±0,48 mm2. The difference between the values was significant (p<0,05).Conclusion. For routine diagnosis of AV stenosis, two-dimensional echocardiography is the optimal research method. With indications for radical treatment methods, three-dimensional echocardiography or multislice computed tomography should be performed.

366 The use of dedicated long-axis views focused on the left atrium improves the accuracy of left atrial volumes and function measured by cardiovascular magnetic resonance

Aims The use of apical views focused on the left atrium (LA) has improved the accuracy of LA volume evaluation by two-dimensional echocardiography. However, routine cardiac magnetic resonance (CMR) evaluation of LA volumes still uses standard 2- and 4-chamber cine images focused on the left ventricle. To investigate the potential of LA-focused CMR cine images, we compared LA maximal (LAVmax) and minimal (LAVmin) volumes, and emptying fraction (LA-EF) calculated on both standard and LA-focused long-axis cine images with LA volumes obtained by short-axis cine stacks covering the LA. Methods and results LA volumes and LA-EF were obtained from 108 consecutive patients by applying the biplane area-length algorithm to both standard and LA-focused 2- and 4-chamber cine images. Manual segmentation of a short-axis cine stack covering the LA was used as the reference method. Compared to the reference method, the standard approach significantly underestimated LA volumes (LAVmax: bias −13 ml; LOA = +11 ml, −37 ml; LAVmin; bias −10 ml, LOA: +9 ml, −28ml), and overestimated LA-EF (bias= 5%, LOA: +23%, −14%). Conversely, LA volumes (LAVmax bias −0.03 ml; LOA: +10 ml, −10 ml. LAVmin bias = −1.5 ml; LOA: +7 ml, −10 ml), and LA-EF (bias 2%, LOA: +11%, −7%) by LA-focused cine images were similar to those measured using the reference method. Moreover, LA volumes by LA-focused images were obtained faster than using the reference method (1.2 vs. 4.5 min, P &lt; 0.001). Conclusions LA volumes and LA-EF measured using dedicated LA-focused long-axis cine imaging are more accurate than using standard (LV-focused) cine images.

Magnetic Resonance Assessment of Ejection Fraction Versus Echocardiography for Cardioverter-Defibrillator Implantation Eligibility

Background: The aim of this study was to investigate the potential impact of performing two-dimensional echocardiography (2DE) compared to cardiovascular magnetic resonance (CMR) for left ventricular ejection fraction (LVEF) on implantable cardioverter defibrillator (ICD) eligibility. Methods: A prospective cohort of 166 consecutive patients with nonischemic cardiomyopathy (NICM) was designed to compare transthoracic 2DE and CMR imaging. Results: Echocardiography measurements have important differences and large limits of agreement compared to CMR, especially when assessing ventricle volumes, and smaller but relevant differences when assessing LVEF. The agreement between CMR and 2DE regarding the identification of subjects with EF <= 35, respectively <= 30, and thus eligible for an ICD measured by Cohen’s Kappa was 0.78 (95% CI: 0.68–0.88), p < 0.001, respectively 0.65 (95% CI: 0.52–0.78), p < 0.001. The disagreement represented 7.9%/11.3% of the subjects who had EF < 35%/< 30% as observed by CMR, who would have been classified as eligible for an ICD, resulting in an additional need to use an ICD. Moreover, 2.6%/3.3% would have been deemed eligible by echocardiography for an ICD. Conclusions: These measurement problems result in incorrect assignments of eligibility that may have serious implications on the quality of life and the prevention of death events for patients assessed for eligibility of an ICD.

Clinical Diagnostic Value of Two-Dimensional and Four-Dimensional Echocardiography in Fetal Cardiac Tumor

This paper aims to investigate the clinical diagnostic value of two-dimensional and four-dimensional echocardiography in fetal cardiac tumor. Material and Methods: A total of 24 pregnant women whose fetus had suspected cardiac tumor in The No.4 Hospital 1946 Jinan Shandong from February 2011 to April 2018 were selected as objects of study, including 18 cases whose fetus was pathologically diagnosed with fetal cardiac tumor (+) and 6 cases whose fetus was diagnosed with fetal cardiac tumor (−). Results:These patients were retrospectively analyzed. The tumor site, size, activity and fetal edema predicted using two-dimensional and four-dimensional ultrasound images were compared with pathological examination results, and the diagnostic value of the two kinds of echocardiography in fetal cardiac tumor was analyzed. The echocardiographic results revealed that there were no statistically significant differences in the four-dimensional ultrasonic diagnosis and two-dimensional ultrasonic diagnosis results compared with pathological diagnosis results (p>0.05). In terms of the diagnostic value, the sensitivity, specificity and diagnostic accordance rate in the clinical diagnosis of fetal cardiac tumor were 66.67%, 50.00% and 62.5%, respectively, in two-dimensional echocardiography, and 94.44%, 83.33% and 91.67%, respectively, in four-dimensional echocardiography. Conclusions: Echocardiography can determine the activity, shape, site, size, etc., of primary cardiac tumor. Two-dimensional and four-dimensional ultrasonic diagnosis can be used to observe the fetal cardiac tumor, thus making an early diagnosis. The sensitivity, specificity and diagnostic accordance rate of four-dimensional echocardiography in the clinical diagnosis of fetal cardiac tumor are significantly higher than those of two-dimensional echocardiography, so four-dimensional echocardiography has higher diagnostic value in fetal cardiac tumor.

A case report of mass and pressure: the utility of contrast echocardiography

Background Diagnostic dilemmas in an unwell neonate can require the use of enhanced imaging modalities, especially in post-operative cardiac disease. Case summary A neonate presented a diagnostic challenge following the repair of complex transposition of the great arteries, when an echogenic mass was noted in the region of the left atrial appendage on two-dimensional echocardiography, in the context of a monitoring line (left atrial line) inserted directly through this area. Although the pressure monitoring on this line suggested elevated left atrial pressure, the neonate was clinically and haemodynamically stable. Contrast echocardiography was used to investigate this further and found the mass to be extracardiac. Conclusion Contrast echocardiography is a simple and readily available tool for further echocardiographic delineation of structures, although needs to be performed carefully and the results interpreted logically.

Echocardiographic Diagnostics of Heart Tumors

The article focuses on ultrasound diagnosis of cardiac tumors (CT). In recent time, the frequency of detecting cardiac neoplasm has been growing. Correct diagnosis at an early stage of the process would allow timely treatment. Before the introduction of two-dimensional echocardiography (EchoCG), life-time diagnosis of CT was very rare. This article describes major echocardiographic criteria for most common benign, malignant, and metastatic CTs. The article is illustrated with original echocardiographic images.

Incidence of cardiac arrhythmias and left ventricular hypertrophy in recreational scuba divers

Introduction: The aims of this study were to investigate the potential impact of age, sex and body mass index (BMI) upon the incidence of arrhythmias pre- and post- diving, and to identify the prevalence of left ventricular hypertrophy (LVH) in older recreational divers. Methods: Divers aged ≥ 40 years participating in group dive trips had ECG rhythm and echocardiograph recordings before and after diving. Arrhythmias were confirmed by an experienced human reader. LVH was identified by two-dimensional echocardiography. Weighted (0.5 fractional) values were used to account for participation by seven divers in 14 trips. Results: Seventy-seven divers undertook 84 dive trips and recorded 677 dives. Among divers with no pre-trip arrhythmias (n = 55), we observed that 6.5 (12%) recorded post-trip arrhythmias and the median increase was 1.0 arrhythmia. In divers with pre-trip arrhythmias, 14.5 had a median of 1.0 fewer post-trip arrhythmias, 2.0 had no change and 5.5 had a median of 16.0 greater. Age, but neither sex nor BMI, was associated with change in the number of arrhythmias before and after dive trips (P = 0.02). The relative risk for experiencing a change in the frequency of arrhythmias after a diver trip, was 2.1 for each additional 10 years of age (95% CI 1.1, 4.0). Of the 60 divers with imaging of their heart, five had left ventricular hypertrophy. Conclusions: We observed a higher than expected prevalence of arrhythmias. Divers with pre-trip arrhythmias tended to be older than divers without pre-trip arrhythmias (P = 0.02). The prevalence of LVH in our cohort was one quarter of that found post-mortem in scuba fatalities.