Background. This study aimed to assess the serial changes of right ventricular (RV) function in patients with congestive heart failure (CHF) from the acute to the convalescent stage using the Doppler derived total cardiac performance index (TEI index).
Methods. Sixteen patients (11 men; mean age, 67 years) with acute left heart failure and sinus rhythm were studied by two-dimensional and Doppler echocardiography during the acute and convalescent stages of CHF. The ratio of early to late diastolic filling velocity (E/A) of both ventricles and the volume and ejection fraction of the left ventricle (LV) were measured. The isovolumic contraction (RVICT), relaxation times (RVIRT), and the ejection time (RVET) were measured from the recordings of the RV inflow or outflow velocities and the electrocardiogram. The RV TEI index was calculated as (RVICT + RVIRT) / RVET.
Results. During the acute stage, the RVICT and RVIRT were prolonged, the RVET was shortened, and subsequently the RV TEI index was increased. As the condition improved, the RVICT and RVIRT were shortened, the RVET was prolonged, and the RV TEI index was significantly decreased along with a decrease in the LV volume and an increase in the LV ejection fraction.
Conclusions. The RV TEI index seems to be useful for evaluating global RV function in patients with congestive left heart failure.

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Background. An exact determination of aortic invasion by lung cancer is necessary for planning surgical intervention. We assessed whether or not the aortic wall is invaded by the tumor by transesophageal echocardiography (TEE).
Methods. We studied 6 patients (mean age, 68.5 years) who had lung tumors located in the left upper lobe, and invasion to the aorta was strongly suspected but inconclusive. With the use of TEE, aortic invasion is represented by the disappearance of the outer hyperechoic layer of the aorta and the lack of synchronous movement of consolidation during respiration.
Results. By TEE, 5 patients showed signs of invasion to the aorta. One of the patients underwent left upper lobectomy as well as replacement of the descending aorta, and aortic invasion was histologically proven.
Conclusions. In lung cancer, the diagnostic procedure should be complemented by TEE if therapeutic management depends on whether or not the aortic wall is invaded by the tumor.

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Background. There have only been a few studies that visualized the human coronary tree continuously from coronary arteries to capillaries in the clinical setting. The purpose of this study was to visualize the human coronary tree non-invasively with myocardial contrast echocardiography (MCE) by changing frame rates.
Methods. MCE was performed intravenously using ^TMLevovist. Study population consisted of 20 patients with ischemic heart disease. We performed 3 kinds of MCE: intermittent, semi-real, and real-time harmonic imaging.
Results. 1. Myocardial blood flow velocity and volume were obtained from the time-intensity replenishment curve with intermittent imaging. Curve fitting was possible in 75% of the targeted region of interest. 2. Semi-real-time perfusion image was obtained with a frame rate of 5/sec. We observed a cyclic variation of echo-intensity in one cardiac cycle in only viable region (Peak subtracted signal intensity: 53±29 in end-diastole and 33±27 in end-systole, p<0.05). This phenomenon may result from the compression of arterioles according to cardiac beat. 3. Real-time perfusion image was obtained at a rate of 26 frames/sec. We observed line-form small artery flows in 80 % of the viable area.
Conclusions. Thus, coronary tree following major epicardial coronary arteries was visualized non-invasively from the small artery to the capillary bed with 3-staged intravenous-MCE in the clinical setting.

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Objectives. Conventional echocardiography was used to clarify left ventricular (LV) geometrical characterization in patients with preserved LV systolic function (diastolic heart failure, DHF).
Background. Despite a growing awareness of the importance of DHF, LV geometry has not been characterized in patients with DHF so far.
Methods. LV mass index (LVMI) and relative wall thickness (RWTh) were determined in 147 consecutive patients who fulfilled the following inclusion criteria: (1) presence of symptoms of HF, (2) pulmonary arterial systolic pressure that was estimated from continuous-wave Doppler tricuspid regurgitant velocity by applying simplified Bernoulli equation of 35mmHg or greater, and (3) preserved LV ejection fraction (>=0.50).
Results. LV geometry showed normal geometry (RWTh<0.41, LVMI<120 g/m²) in 49 patients (33%), concentric remodeling (RWTh>=0.41, LVMI<120 g/m²) in 39 patients (27%), concentric hypertrophy (RWTh>=0.41, LVMI>=120 g/m²) in 35 patients (24%), and eccentric hypertrophy (RWTh<0.41, LVMI>=120 g/m²) in 24 patients (16%). LV concentric geometry was more frequently observed in females than in males (55 vs. 46%). If those of 85 years or older were analyzed, the incidence of concentric remodeling increased to 47% while incidence of eccentric hypertrophy decreased to 6%.
Conclusions. Not only LV hypertrophy, but concentric geometry is an important contributor to the occurrence of DHF. Concentric geometry was particularly important in aged patients.

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Background. Three-dimensional (3D) quantitative assessment of mitral apparatus geometry has been required to evaluate its unique and complicated morphology. Recently, we have developed a novel software, REAL VIEW^®, which allows us 3D visualization and quantitation of mitral leaflets and annulus geometry by using transthoracic real-time 3D echocardiography. In the present study, we sought to investigate the accuracy of 3D measurement using REAL VIEW.
Methods. Our in vitro study was carried out with annuloplasty rings (Carpentier-Edwards Physio ring^®) and a phantom rubber model with a conical shape in a water bath. By using real-time 3D echocardiographic data, 3D images of the phantom models were reconstructed by utilizing REAL VIEW. Ring diameters, circumferences and volume of the model were calculated from the 3D datasets.
Results. Ring diameters and circumferences measured by REAL VIEW showed good agreements with known size of the annuloplasty rings (y=0.97x+1.21, r=0.99, y=1.01x+0.55, r=0.98). Volume of the phantom model measured by REAL VIEW showed good agreement with the actual volume of the conic balloon (y=1.00x-0.16, r=0.99).
Conclusions. We could measure the annuloplasty ring size and phantom model volume precisely by using REAL VIEW. This software should be useful in various investigations of mitral valve diseases.

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