DOCSLIB.ORG

Contrast Echocardiography: Evidence-Based Recommendations by European Association of Echocardiography

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Contrast Echocardiography: Evidence-Based Recommendations by European Association of Echocardiography European Journal of Echocardiography (2009) 10, 194–212 doi:10.1093/ejechocard/jep005 EAE RECOMMENDATIONS Contrast echocardiography: evidence-based recommendations by European Association of Echocardiography Roxy Senior1*, Harald Becher2, Mark Monaghan3, Luciano Agati4, Jose Zamorano5, Jean Louis Vanoverschelde6, and Petros Nihoyannopoulos7 1Department of Cardiology, Northwick Park Hospital, Imperial College, London, Harrow HA1 3UJ, UK; 2John Radcliffe Hospital, Oxford, UK; 3King’s College Hospital, London, UK; 4La Sapienza University, Rome, Italy; 5Hospital Clı´nico San Carlos, Madrid, Spain; 6Cliniques Universitaires St-Luc, Universite´ Catholique de Louvain, Brussels, Belgium; and 7Hammersmith Hospital, Imperial College, London, UK Received 30 December 2008; accepted 11 January 2009 KEYWORDS This paper examines the evidence for contrast echocardiography, both for improving assessment of left Contrast echocardiography; ventricular structure and function compared with unenhanced echocardiography and for the identifi- Recommendations cation of myocardial perfusion. Based on the evidence, recommendations are proposed for the clinical use of contrast echocardiography. Introduction (which has relatively lower myocardial blood volume). With the advancement in ultrasound techniques and In a significant proportion of patients, echocardiography improved microbubble technology, it is now possible also fails to produce diagnostically useful images despite tissue to assess myocardial microcirculation and hence perfusion. harmonic imaging.1 The main impediments appear to be 2 This paper examines the clinical efficacy and safety of obesity and lung disease. The problem is even greater in ultrasound contrast agents and proposes evidence-based patients referred for stress echocardiography as images 3 recommendations and protocols for the use of contrast are suboptimal in as many as 33% of the patients. This echocardiography in various clinical scenarios. results in inaccurate assessment of left ventricular (LV) func- tion, and suboptimal reproducibility especially in the sub- group of patients with poor images, resulting in Contrast agent subsequent referrals for other tests because of uninterpre- Echogenicity and ultrasound properties are determined by table images. the size, shell, and encapsulated gas characterizing the These concerns prompted the facilitation of contrast microbubbles within the various contrast agents. Micro- ultrasound imaging that utilizes contrast agents. The bubble ultrasound scatter is proportional to the sixth present generation of ultrasound contrast agents consist of power of the radius, so the largest bubble capable of microbubbles of encapsulated high-molecular-weight gas. passing through the pulmonary microcirculation will have Since the ultrasound characteristics of microbubbles are dis- the best acoustic profile.4 The harmonic properties of micro- tinctly different from those of the surrounding blood cells bubbles are a function of their non-linear oscillation, which and cardiac tissue, the backscatter that they produce means that they reflect sound not only at the fundamental result in intense echocardiographic signals, which are pro- frequency of the ultrasound source but also at higher harmo- portional to the blood volume. Thus, the LV cavity is nics.5 A microbubble’s ultrasonic characteristics also depend enhanced compared with the surrounding heart muscle on its size, the composition of the outer shell of the bubble, and the encapsulated gas.5 In general, the more elastic the shell, the more easily it will be compressed in an ultrasonic * Corresponding author. Tel: þ44 20 8869 2547/2548; fax: þ44 20 8864 0075. field and the better it will resonate. Conversely, stiffer E-mail address: [email protected] shells may rupture when subjected to ultrasound. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2009. For permissions please email: [email protected]. Evidence-based recommendations by EAE on contrast echocardiography 195 Table 1 Characteristic of currently available contrast agents in UK and Europe SonoVue6 Optison7 Luminity8 Gas Sulphur hexafluoride Perfluoropropane Perfluoropropane Bubble size 2–8 mm 3.0–4.5 mm 1.1–2.5 mm Surface coating Surfactant/powder Human albumin Naturally occurring lipids Contraindications and precautions Patients experiencing side effects 11 17 8 in clinical trials (%) Most frequent side effects in Headache (2.1%), nausea (1.3%), Headache (5.4%), nausea and/ Headache (2.0%), flushing (1.0%), clinical trials chest pain (1.3%), taste or vomiting (4.3%), warm back pain (0.9%). rash/ perversion (0.9%), sensation or flushing (3.6%), urticaria, wheezing/,allergic/ hyperglycaemia (0.6%), injection dizziness (2.5%). anaphylaxis site reaction 0.6%), paresthesia (0.6%), vasodilation (0.6%), injection site pain (0.5%). Manufacturer Bracco Diagnostics GE Healthcare Lantheus Medical Imaging (formerly Bristol-Myers Squibb) The microbubbles must be stable enough to resist destruc- Pulse 1 are subtracted from that derived from Pulse 2, and tion at normal ultrasound power outputs and so maintain a the difference represents the contrast signal since the sufficient concentration in the heart to give a satisfactory tissue signal cancels out. Newer high power techniques image. This is largely a factor of solubility of the gas in also utilize ultraharmonic properties of the microbubble, blood with high-molecular-weight bubbles being less which improves the detection of the ‘signal’ of the micro- soluble and so more stable.5 Characteristics of the three- bubble, from the ‘noise’ of the background tissue, since marketed second-generation contrast agents that use tissue produces very little ultraharmonic signal.10 high-molecular-weight gases are listed in Table 1.6–8 In order to use real-time imaging of contrast within the LV cavity and/or myocardium, it is necessary to reduce signifi- Contrast imaging modalities cantly the transmitted ultrasound power (low MI imaging) and this has required more sophisticated, contrast-specific As previously mentioned, harmonic imaging utilizes the non- imaging modalities.11 These modalities have unique fea- linear scattering properties of ultrasound contrast agents to tures, and have been named according to the developing facilitate their detection within the heart. However, tissue ultrasound system manufacturer: power pulse inversion, also generates a harmonic signal as ultrasound is propagated power modulation, and cadence (or coherent) contrast through it and a high-quality contrast-enhanced image is one imaging. They essentially work by transmitting multiple where the distribution of contrast (within the LV cavity and/ pulses down each scan line. Alternate pulses are 1808 out or myocardium) is clearly seen without the presence of con- of phase with other or vary in magnitude of amplitude by founding myocardial tissue signals. The mechanical index a fixed ratio, or are a combination of both strategies. All (MI) is a measure of the power generated by an ultrasound these types of modalities rely on the fact that tissue is transducer within an acoustic field. Harmonic imaging essentially a linear and relatively predictable ultrasound requires relatively high ultrasound power (high MI) that scatterer, especially at low ultrasound energy levels, very quickly destroys (bursts) most commercially available whereas contrast microbubbles are not, and are therefore ultrasound contrast agents and therefore is not a suitable described as being ‘non-linear’. When alternate backscat- imaging modality for continuous, or ‘real-time’ contrast tered signals are received, which are perfectly out of imaging. High MI contrast imaging modalities have been suc- phase or proportionally altered in amplitude, they are pro- cessfully utilized for the detection of myocardial contrast cessed by the imaging software as being derived from using intermittent or triggered imaging modes where one tissue and therefore are filtered out and suppressed. All imaging frame is created every one, two, three, or up to remaining ‘non-linear’ signals are considered to be derived six cardiac cycles. The most common form of high MI from contrast microbubbles and are displayed. When using imaging modality used in this way is harmonic power this kind of imaging modality, the image will normally be Doppler, which works best when utilized with a fragile con- totally dark prior to contrast administration, confirming trast agent which is quickly destroyed and contains a soluble effective suppression of tissue data. This type of imaging gas (air or nitrogen).9 This typically involves a dual-pulse is very effective for LV endocardial border enhancement, technique where the difference in backscattered signal as it demonstrates a sharp demarcation between the from two high MI pulses transmitted down each scan line is contrast-enhanced cavity and the myocardium. With minor examined. If contrast micro-bubbles are encountered by modification and increased contrast concentration, it can the first pulse, they will generate a backscattered signal also effectively detect and display contrast within the myo- and also be destroyed. In addition, any tissue targets will cardium, facilitating the evaluation of myocardial perfusion also generate a signal. The second pulse will only generate as described later.11 It is common to combine this form of a signal from tissue because all contrast will have been low MI contrast imaging with a burst of a few frames of destroyed
Load more

Recommended publications
  • Cardiac CT - Quantitative Evaluation of Coronary Calcification
    Clinical Appropriateness Guidelines: Advanced Imaging Appropriate Use Criteria: Imaging of the Heart Effective Date: January 1, 2018 Proprietary Date of Origin: 03/30/2005 Last revised: 11/14/2017 Last reviewed: 11/14/2017 8600 W Bryn Mawr Avenue South Tower - Suite 800 Chicago, IL 60631 P. 773.864.4600 Copyright © 2018. AIM Specialty Health. All Rights Reserved www.aimspecialtyhealth.com Table of Contents Description and Application of the Guidelines ........................................................................3 Administrative Guidelines ........................................................................................................4 Ordering of Multiple Studies ...................................................................................................................................4 Pre-test Requirements ...........................................................................................................................................5 Cardiac Imaging ........................................................................................................................6 Myocardial Perfusion Imaging ................................................................................................................................6 Cardiac Blood Pool Imaging .................................................................................................................................12 Infarct Imaging .....................................................................................................................................................15
    [Show full text]
  • Comparison of Echocardiography and Angiography in Determining the Cause of Severe Aortic Regurgitation
    Br Heart J: first published as 10.1136/hrt.51.1.36 on 1 January 1984. Downloaded from Br Heart J 1984; 51: 36-45 Comparison of echocardiography and angiography in determining the cause of severe aortic regurgitation NICHOLAS L DEPACE, PASQUALE F NESTICO, MORRIS N KOTLER, GARY S MINTZ, DEMETRIOS KIMBIRIS, INDER P GOEL, E ELAINE GLAZIER-LASKEY, JOHN ROSS From the LikoffCardiovascular Institute, Hahnemann University, Philadelphia, Pennsylvania, USA SUMMARY To assess the accuracy of echocardiography in determining the cause of aortic regurgita- tion M mode and cross sectional echocardiography were compared with angiography in 43 patients with predominant aortic regurgitation. Each patient had all three investigations performed during the same admission to hospital. In each instance, the cause of aortic regurgitation was confirmed at surgery or necropsy. Seventeen patients had rheumatic aortic valve disease, 13 bacterial endocarditis with a perforated or partially destroyed cusp, five a biscuspid aortic valve (four with a history of endocarditis), and eight aortic regurgitation secondary to aortic root dilatation or aneurysm. Overall sensitivity of echocardiography and aortography was 84% in determining the cause of aortic regurgi- tation. Thus, rheumatic valve disease and endocarditis appear to be the most common causes of severe aortic regurgitation in this hospital based population. Furthermore, echocardiography is a sensitive non-invasive technique for determining the cause of aortic regurgitation and allows differentiation of valvular from root causes of aortic regurgitation. Aortic regurgitation may be caused by valvular dis- ment for predominant aortic regurgitation were http://heart.bmj.com/ ease, aortic root disease, or a combination of both. reviewed.
    [Show full text]
  • Thoracic Aorta
    GUIDELINES AND STANDARDS Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging Endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance Steven A. Goldstein, MD, Co-Chair, Arturo Evangelista, MD, FESC, Co-Chair, Suhny Abbara, MD, Andrew Arai, MD, Federico M. Asch, MD, FASE, Luigi P. Badano, MD, PhD, FESC, Michael A. Bolen, MD, Heidi M. Connolly, MD, Hug Cuellar-Calabria, MD, Martin Czerny, MD, Richard B. Devereux, MD, Raimund A. Erbel, MD, FASE, FESC, Rossella Fattori, MD, Eric M. Isselbacher, MD, Joseph M. Lindsay, MD, Marti McCulloch, MBA, RDCS, FASE, Hector I. Michelena, MD, FASE, Christoph A. Nienaber, MD, FESC, Jae K. Oh, MD, FASE, Mauro Pepi, MD, FESC, Allen J. Taylor, MD, Jonathan W. Weinsaft, MD, Jose Luis Zamorano, MD, FESC, FASE, Contributing Editors: Harry Dietz, MD, Kim Eagle, MD, John Elefteriades, MD, Guillaume Jondeau, MD, PhD, FESC, Herve Rousseau, MD, PhD, and Marc Schepens, MD, Washington, District of Columbia; Barcelona and Madrid, Spain; Dallas and Houston, Texas; Bethesda and Baltimore, Maryland; Padua, Pesaro, and Milan, Italy; Cleveland, Ohio; Rochester, Minnesota; Zurich, Switzerland; New York, New York; Essen and Rostock, Germany; Boston, Massachusetts; Ann Arbor, Michigan; New Haven, Connecticut; Paris and Toulouse, France; and Brugge, Belgium (J Am Soc Echocardiogr 2015;28:119-82.) TABLE OF CONTENTS Preamble 121 B. How to Measure the Aorta 124 I. Anatomy and Physiology of the Aorta 121 1. Interface, Definitions, and Timing of Aortic Measure- A. The Normal Aorta and Reference Values 121 ments 124 1.
    [Show full text]
  • “Cardiac Solution” Program Tip Sheet
    “Cardiac Solution” Program Tip Sheet MYOCARDIAL PERFUSION IMAGING (MPI) vs. STRESS ECHOCARDIOGRAPHY (SE) Main Points about the Two Tests: Both tests have equal diagnostic accuracy for coronary artery disease, with MPI showing greater sensitivity and SE showing greater specificity. MPI is based upon the expectation of relatively reduced blood flow in a myocardial segment during exercise or pharmacologic coronary microvessel dilation, while SE is based upon development of wall motion abnormality provoked by myocardial ischemia during treadmill exercise or similar stress. In order to perform a SE, one would prefer to have a patient who could perform treadmill exercise well, along with a good acoustic imaging window, while MPI can be performed with either exercise or the pharmacologic option. Exercise can also provide the additional information from the EKG, when the baseline EKG does not already have substantial abnormality (e.g. a 1 mm ST segment depression at baseline, left bundle branch block, ventricular pacing, PVCs, or pre-excitation). Even with MPI, an exercise modality is preferred over pharmacologic vasodilation due to the additional functional and EKG information inherent in exercise testing. However, in some patients, such as those with a pre-existing wall motion abnormality, left bundle branch block, ventricular paced rhythms, frequent PVCs, or pre-excitation (WPW), the related cardiac contraction pattern during exercise could obscure the effects of ischemia, making a pharmacologic approach more helpful. The radiation exposure of SE is zero, while MPI incurs a radiation Radiation Exposure dose of 7-24 mSv (the equivalent of about 117-400 PA & lateral chest X-rays), with an increase in lifetime radiation exposure and its MPI: 7 - 24 mSv associated cancer risk.
    [Show full text]
  • DIAGNOSTIC SERVICES Diagnostic Imaging
    DIAGNOSTIC SERVICES Diagnostic Imaging Diagnostic services are a critical Day Kimball Healthcare provides high quality, convenient diagnostic component in the continuum of care. imaging services at four locations across northeast Connecticut. Our state-of-the-art facilities use the latest technologies. Our associated That’s why our diagnostic imaging and board-certified radiologists from Jefferson Radiology are experts in laboratory services utilize the latest the fields of diagnostic imaging and interventional radiology. And, technologies to provide you with the our integrated Electronic Medical Records (EMR) system means your highest quality testing and most efficient care team will have access to your imaging results as soon as they’re results reporting possible. available, providing you with a shorter wait time to receive results and Multiple locations across northeast helping you to avoid redundant testing so you can better control your Connecticut offer convenient access to a healthcare costs. full range of the most advanced testing Our services include: possible, while our electronic medical • CT (Computerized Tomography) Scans - Head and body scans, CT records system ensures that your results angiography, and CT-guided biopsies and surgical procedures. are instantly shared with your care team • DEXA (Bone Density/Bone Densiometry) Testing - We offer dual as soon as they’re available. energy bone density imaging for the detection of osteoporosis and Our certified and dedicated diagnostics high definition instant vertebral assessment for detection of spine professionals, accredited facilities, and fractures with rapid, low dose, single energy images in seconds. integrated network ensure that you’ll • Interventional Radiology - Image guided interventional services receive the highest quality, most efficient include a wide range of procedures, biopsies and pain management and reliable testing available, in a treatment.
    [Show full text]
  • Measurement of Peak Rates of Left Ventricular Wall Movement in Man Comparison of Echocardiography with Angiography
    British HeartJournal, I975, 37, 677-683. Br Heart J: first published as 10.1136/hrt.37.7.677 on 1 July 1975. Downloaded from Measurement of peak rates of left ventricular wall movement in man Comparison of echocardiography with angiography D. G. Gibson and D. J. Brown From the Cardiac Department, Brompton Hospital, London, and the Medical Computer Centre, Westminster Hospital, London Estimates ofpeak systolic and diastolic rates of left ventricular wall movement were made in 23 patients by echocardiography and angiocardiography. Echocardiographic measurements were calculated as the rate of change of the transverse left ventricular dimension, derived continuously throughout the cardiac cycle. These were compared with similar plots of transverse left ventricular diameter, in the same patients, derived from digitized cineangiograms taken within IO minutes of echocardiograms. The results indicate close correlation between the two methods, and suggest that either can be used to measure peak rates of left ventricular wall movements in patients with heart disease. Identification of echoes arising from the interven- Echocardiograms tricular septum and posterior wall of the left In order to reduce the time interval between the two ventricle has proved to be a significant advance in investigations, echocardiograms were performed at the study of cardiac function by allowing the trans- cardiac catheterization using techniques that have pre- verse diameter of the left ventricle to be measured viously been described (Gibson, 1973). Clear, con- http://heart.bmj.com/ at end-systole and end-diastole (Chapelle and tinuous echoes were obtained from the posterior surface Mensch, I969; Feigenbaum et al., I969). More of the septum and the endocardium ofthe posterior wall recently, it has been possible to derive this dimension of the left ventricle, which were distinguished from those originating from the mitral valve apparatus.
    [Show full text]
  • American College of Radiology – Practice Parameter for Cardiac CT
    The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice parameters and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice parameter and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review and approval. The practice parameters and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Revised 2021 (Resolution 45)* ACR–NASCI–SPR PRACTICE PARAMETER FOR THE PERFORMANCE AND INTERPRETATION OF CARDIAC COMPUTED TOMOGRAPHY (CT) PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care1.
    [Show full text]
  • Assessment of Myocardial Perfusion by Contrast Echocardiography - Ready for Clinical Practice?
    Journal of Clinical and Basic Cardiology An Independent International Scientific Journal Journal of Clinical and Basic Cardiology 2002; 5 (2), 145-148 Assessment of Myocardial Perfusion by Contrast Echocardiography - Ready for Clinical Practice? Kuntz-Hehner St, Becher H, Luederitz B, Omran H Schlosser Th, Tiemann K Homepage: www.kup.at/jcbc Online Data Base Search for Authors and Keywords Indexed in Chemical Abstracts EMBASE/Excerpta Medica Krause & Pachernegg GmbH · VERLAG für MEDIZIN und WIRTSCHAFT · A-3003 Gablitz/Austria FOCUS ON NEW DEVELOPMENTS IN ECHOCARDIOGRAPHY Contrast Echocardiographic Myocardial Perfusion Assessment J Clin Basic Cardiol 2002; 5: 145 Assessment of Myocardial Perfusion by Contrast Echocardiography – Ready for Clinical Practice? St. Kuntz-Hehner1, K. Tiemann1, Th. Schlosser1, H. Omran1, B. Luederitz1, H. Becher2 Increasing interest has been focused on myocardial contrast echocardiography (MCE) since latest ultrasound-specific imaging modalities allow the detection of ultrasound contrast agents within the myocardium after intravenous injection. Due to significant improvements in imaging technology MCE has become a valuable add-on tool for the diagnosis of coronary artery disease. This review summarizes and estimates the clinical value of recent developments in myocardial contrast echocardiography, particularly with regard to the new real-time perfusion imaging, which allows simultaneous assessment of perfusion and wall- motion. J Clin Basic Cardiol 2002; 5: 145–8. Key words: echocardiography, coronary artery disease, ultrasound contrast agent, myocardial contrast echocardiography, myocardial perfusion he assessment of myocardial perfusion following intra- nals in a process known as stimulated acoustic emission [12– T venous injection of ultrasound contrast agents (USCAs) 15]. has been a major objective of research in the last two decades.
    [Show full text]
  • Dual Imaging Stress Echocardiography Versus Computed
    Ciampi et al. Cardiovascular Ultrasound (2015) 13:21 DOI 10.1186/s12947-015-0013-8 CARDIOVASCULAR ULTRASOUND RESEARCH Open Access Dual imaging stress echocardiography versus computed tomography coronary angiography for risk stratification of patients with chest pain of unknown origin Quirino Ciampi1,2*, Fausto Rigo3, Elisabetta Grolla3, Eugenio Picano2 and Lauro Cortigiani4 Abstract Background: Dual imaging stress echocardiography, combining the evaluation of wall motion and coronary flow reserve (CFR) on the left anterior descending artery (LAD), and computed tomography coronary angiography (CTCA) are established techniques for assessing prognosis in chest pain patients. In this study we compared the prognostic value of the two methods in a cohort of patients with chest pain having suspected coronary artery disease (CAD). Methods: A total of 131 patients (76 men; age 68 ± 9 years) with chest pain of unknown origin underwent dipyridamole (up to 0.84 mg/kg over 6 min) stress echo with CFR assessment of LAD by Doppler and CTCA. A CFR ≤ 1.9 was considered abnormal, while > 50% lumen diameter reduction was the criterion for significant CAD at CTCA. Results: Of 131 patients, 34 (26%) had ischemia at stress echo (new wall motion abnormalities), and 56 (43%) had reduced CFR on LAD. Significant coronary stenosis at CTCA was found in 69 (53%) patients. Forty-six patients (84%) with abnormal CFR on LAD showed significant CAD at CTCA (p < 0.001). Calcium score was higher in patients with reduced than in those with normal CFR (265 ± 404 vs 131 ± 336, p = 0.04). During a median follow-up of 7 months (1st to 3rd quartile: 5–13 months), there were 45 major cardiac events (4 deaths, 11 nonfatal myocardial infarctions, and 30 late [≥6 months] coronary revascularizations).
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • Blood Flow Hemodynamics, Cardiac Mechanics, and Doppler Echocardiography
    79351_CH04_Bulwer.qxd 12/1/09 7:46 AM Page 45 CHAPTER 4 Blood Flow Hemodynamics, Cardiac Mechanics, and Doppler Echocardiography THE CARDIAC CYCLE Figure 4.1 The cardiac cycle showing superimposed hemody- namic and echocardio- graphic parameters. A4C: apical 4-chamber view; A5C: apical 5-chamber view; AC: aortic valve clo- sure; AO: aortic valve opening; E- and A-waves: spectral Doppler depiction of early and late diastolic filling of the left ventricle; MC: mitral valve closure; MO: mitral valve opening; LA: left atrium; LV: left ven- tricle; left atrial “a” and “e” waves reflecting atrial pressures; EDV: end dias- tolic LV volume; ESV: end- systolic LV volume. © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 79351_CH04_Bulwer.qxd 12/1/09 7:46 AM Page 46 46 CHAPTER 4 BLOOD FLOW HEMODYNAMICS Figure 4.2 Flow velocity profiles in normal pulsatile blood flow. Normal blood flow through the heart and blood vessels, at any instant in time, is not uniform. There is a range or spectrum of velocities at each instant during the cardiac cycle. This spectrum, at each instant during the cardiac cycle, can be differentiated and displayed using Doppler echocardiography (see Figures 4.3–4.22). © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 79351_CH04_Bulwer.qxd 12/1/09 7:46 AM Page 47 Blood Flow Velocity Profiles 47 BLOOD FLOW VELOCITY PROFILES Doppler echocardiography can assess blood flow velocity, direction and flow patterns/profiles (e.g., plug), and laminar, parabolic, and turbulent flow Figures 4.3–4.19 . Crucial to understanding Doppler echocardiography is the need to understand certain basic characteristics of blood flow.
    [Show full text]
  • A Forensic Study of Unnatural Deaths in Kuwait: Epidemiological, Virtual Autopsy and DNA Investigations
    A Forensic Study of Unnatural Deaths in Kuwait: Epidemiological, Virtual Autopsy and DNA Investigations by Nadiah Mohammad Al-Kandari A thesis submitted in partial fulfilment for the requirements for the degree of Doctor of Philosophy at the University of Central Lancashire September 2012 Declaration I declare that while registered as a candidate for the degree for which this submission is made that I have not been a registered candidate for another award by any other awarding body. No material contained in this thesis has been used in any other submission for an academic ward. Signature……………………………………………… Type of Award: (PhD) School: School of Forensic and Investigative Sciences Nadiah AL-Kandari ii Abstract Forensic science is growing rapidly in the world today. During the past decade, medico-legal investigations have been highly expanded to include all areas of forensic science. The present study investigated three important aspects of forensic biology. First, this present project investigated, a total number of 5,703 reported medico-legal cases diagnosed as un-natural deaths by The Forensic Department in Kuwait, during the year 2003-2009. The results show that accidental, homicidal and suicidal deaths accounted for 86%, 8% and 6%, respectively. The results showed that most people who died of unnatural deaths were more predominant in the age group 20-29 years (third decade). Road Traffic Accidents accounted for 65% of accidental deaths, and 4% out of them were related to alcohol consumption. The results also illustrated that the highest rate of homicide in Kuwait was due to stab wound injuries (38%) compared to the lower rate of homicidal pattern for infanticides (3%).
    [Show full text]