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Objectives: We sought to determine the predictors of short-term morbidity and mortality (

We describe our experience in using transesophageal echocardiography to identify both right and left posterior intercostal arteries and assessing them for stenosis.

In the present study, we report our experience of using live three-dimensional transthoracic echocardiography in the assessment of aortic dissection in ten adult patients. To our knowledge, this has not been reported previously.

Apical ballooning syndrome is classically described as transient left ventricular (LV) dysfunction, marked LV akinesia, and normal or near-normal coronary arteries. The etiology is unclear and there is limited information based on case reports and small case series. We describe a 35-year-old woman who underwent surgical hepatectomy and developed apical ballooning syndrome in the postoperative period. The novel use of myocardial contrast echocardiography (MCE) in this setting demonstrated intact microvascular perfusion and lack of coronary flow-limiting abnormalities despite apical akinesis. In select patients with similar clinical presentations, performing MCE is safe and may be pursued as an alternative to invasive coronary angiography.

We sought to determine the predictors of short-term morbidity and mortality (30 days) after noncardiac surgery in patients with pulmonary hypertension (PH).Pulmonary hypertension is considered to be a significant preoperative risk factor.The PH and surgical data bases were matched from 1991 to 2003. Patients were excluded if PH was secondary to left heart disease, not present before surgery, or the procedure involved cardiopulmonary bypass. Univariate and multivariate logistic regression analyses were used to identify variables associated with short-term morbidity and mortality.Of 1,276 patients in the PH database, 145 patients (73% female) met all study criteria. The mean age (+/-SD) was 60.1 +/- 16.0 years. Right ventricular systolic pressure (RVSP) (mean +/- SD) on the two-dimensional echocardiogram was 68 +/- 21 mm Hg. There were 60 patients (42%) who experienced one or more short-term morbid event(s) (1.8 events/patient experiencing any event). A history of pulmonary embolism (p = 0.01), New York Heart Association functional classor = II (p = 0.02), intermediate- to high-risk surgery (p = 0.04), and duration of anesthesia3 h (p = 0.04) were independent predictors of short-term morbidity. There were 10 early deaths (7%). A history of pulmonary embolism (p = 0.04), right-axis deviation (p = 0.02), right ventricular (RV) hypertrophy (p = 0.04), RV index of myocardial performanceor = 0.75 (p = 0.03), RVSP/systolic blood pressureor = 0.66 (p = 0.01), intraoperative use of vasopressors (p0.01), and anesthesia when nitrous oxide was not used (p0.01) were each associated with postoperative mortality.In patients with PH undergoing noncardiac surgery with general anesthesia, specific clinical, diagnostic, and intraoperative factors may predict worse outcomes.

We describe two patients in whom mitral valve prosthetic inflow mimicked severe aortic regurgitation. Repeat transthoracic echocardiography using multiple transducer angulations and a narrow color Doppler sector angle in one patient and a color Doppler M-Mode study in the second patient proved useful in excluding the presence of severe aortic regurgitation. (ECHOCARDIOGRAPHY, Volume 21, January 2004)