One hundred and one consecutive patients with infectious endocarditis were examined by transthoracic (TTE) and transoesophageal echocardiography (TEE). There were 71 cases of endocarditis on native valves (N) and 30 cases of endocarditis on prosthetic valves (P). The detection of vegetations was significantly greater by TEE (93%), than by TEE (73%) on native valves but the rate of detection of endocarditis on prosthetic valves was low and identical with bothy methods.Out of a total of 18 abscesses, only 6 were detected by TEE compared with 15 by TEE. There ware 3 false negative results by TEE : small anterior abscesses marked by the prosthesis or aortic calcifications.In addition, TEE demonstrated 3 perforations and 2 mycotic aneurysms of the mitral valve. The lesions were confirmed anatomically in 48 cases. The sensitivity of TEE was 94% and the specificity was 84.5%; the negative predictive value was 87.5%.These results show that TEE is significantly superior in the detection and morphological analysis of vegetations. It is the method of choice for the diagnosis of abscesses, especially in prosthetic valve endocarditis.

Spontaneous echo contrast in the left atrium in patients with sinus rhythm is unusual. The aim of this study was to assess the mechanism of this phenomenon and any clinical implications. We studied 90 consecutive patients using transesophageal echocardiography. Spontaneous echo contrast was seen within the left atrium in 29 patients, 11 of whom were in sinus rhythm. In patients with spontaneous contrast and sinus rhythm, the underlying diseases were: mitral insufficiency (5), mitral stenosis (1), mitral prostheses (2), congestive cardiomyopathy (1), hypertrophic cardiomyopathy (1), and heart transplantation (1). Spontaneous echo contrast tended to be faint in this group (10/11). The left atrium was enlarged in all, with subjective poor atrial contraction. Furthermore, reduced mitral A wave suggested an impairment of left atrial contractility. Holter monitoring demonstrated paroxysmal atrial fibrillation in five subjects. Two patients had a history of transient ischemic attacks. No atrial thrombus was observed in any patient. The demonstration of spontaneous echo contrast with transesophageal echocardiography does not seem uncommon even in patients in sinus rhythm. This may indicate an increased risk of thromboembolism.

We report a case of mitochondrial myopathy (MM), assessed by histological and biochemical studies. This illness was diagnosed in a 69-year-old patient with myocardiopathy revealed by ventricular arrhythmias. The originality of this case lies in the patient's age, the mode of onset and the biochemical features (i.e. normal mitochondrial enzymatic complexes but very low respiration when using glutamate as a substrate).

The mechanisms of the motion of the intimal flap and of thrombus formation in acute or chronic aortic dissection are not definitively elucidated. Transesophageal echocardiography seems to be a technique of choice to analyze the flow in the true and false lumina. Twenty‐one consecutive patients were studied in order to define the mobility of the intimal flap, the color Doppler flow patterns, the presence of spontaneous echocardiographic contrast, and thrombus formation at different levels of the aorta. The results suggest that clotted false lumen is more often seen in chronic aortic dissection at the level of the descending thoracic aorta. However, thrombosed false lumen in the aortic arch is suggestive of a retrograde aortic dissection. In cases of complete obliteration of the false lumen, the differentiation between aortic dissection and aortic ectasia with mural thrombus may be extremely difficult.

One hundred and one consecutive patients with infectious endocarditis were examined by transthoracic (TTE) and transoesophageal echocardiography (TEE). There were 71 cases of endocarditis on native valves (N) and 30 cases of endocarditis on prosthetic valves (P). The detection of vegetations was significantly greater by TEE (93%), than by TEE (73%) on native valves but the rate of detection of endocarditis on prosthetic valves was low and identical with both methods. Out of a total of 18 abscesses, only 6 were detected by TEE compared with 15 by TEE. There were 3 false negative results by TEE: small anterior abscesses marked by the prosthesis or aortic calcifications. In addition, TEE demonstrated 3 perforations and 2 mycotic aneurysms of the mitral valve. The lesions were confirmed anatomically in 48 cases. The sensitivity of TEE was 94% and the specificity was 84.5%; the negative predictive value was 87.5%. These results show that TEE is significantly superior in the detection and morphological analysis of vegetations. It is the method of choice for the diagnosis of abscesses, especially in prosthetic valve endocarditis.

We report a case of mitochondrial myopathy (MM), assessed by histological and biochemical studies. This illness was diagnosed in a 69-year-old patient with myocardiopathy revealed by ventricular arrhythmias. The originality of this case lies in the patient's age, the mode of onset and the biochemical features (i.e. normal mitochondrial enzymatic complexes but very low respiration when using glutamate as a substrate).

The incidence of bacteraemia during transoesophageal echocardiography (TEE) was evaluated in a prospective study of 82 consecutive patients. Three series of blood cultures were carried out for each patient: from group 1 (n = 44), prior to the examination, at the end of the examination and 15 min afterwards. For group 2 (n = 38), blood cultures were performed prior to the examination, 10 min after the start and immediately after the end. A single positive blood culture was detected in two patients. For the first patient, blood culture at the end of the examination demonstrated Corynebacteria, and for the second, Staphylococcus epidermidis was identified on cultures taken during the examination. During the first 24 h, a transient subfebrile temperature was recorded in 15% of the patients, including the patient with the Corynebacteria-positive blood culture. By mid-term (6 months) no patient had developed endocarditis. Our findings suggest that antibiotic prophylaxis during TEE is not warranted.

Left ventricular hypertrophy (LVH), defined as an abnormal increase in left ventricular mass (LVM), is detected by echocardiography in 16-19% of a general population. Its prevalence is strongly associated with age, systolic blood pressure and obesity. In addition to the assessment of LVM, echocardiography allows different forms of left ventricular remodelling in hypertension to be described: eccentric or concentric, and symmetric or asymmetric LVH. The significance of the different forms, however, is not yet well defined. Increased LVM is now recognized as a powerful, independent risk factor for all cardiovascular diseases. This observation is at variance with the general concept that LVH is a useful adaptation of the left ventricle to chronic overload. To explain this paradox, three hypotheses are proposed: LVH serves as a marker, a limited adaptative process, or a pathological process. Each hypothesis implies different therapeutic approaches; thus it is necessary to clarify the reasons why LVH is such an important risk factor.

We have reviewed ten prospective studies of bacteremia with transesophageal echocardiography (TEE) in 720 patients. The incidence of TEE related positive culture is low, and general recommendation for antibiotic prophylaxis during TEE is not warranted.

The increasingly frequent use of arteriography in the investigation of hypertension and of obliterative arterial disease of the lower limbs has led to recognition of the actual incidence of renal artery aneurysms. The importance of this type of lesion is due to the fact that the natural history of renal artery aneurysms remains unknown, their relationship with hypertension is still controversial and the risk of complications, and rupture in particular, has led to the suggested possible need for their routine surgical excision. The current trend is to limit indications for surgery to certain specific cases since a number of recent series have shown that the risk of rupture of a small saccular aneurysm was very small.

The effects of 6 months treatment with nifedipine 20 mg SR (N) or verapamil 240 mg SR (V) on rest and exercise BP and left ventricular mass (LVM) and function were evaluated m 31 essential hypertensive patients (mean age : 54, 19 males, 12 females), never treated with calcium antagonist. After a 15 days placebo run in, BP was measured at rest and during a maximal bicycle exercise test (stages : 30 watts, 3 min). 2D guided M mode echocardiography and pulsed Doppler allowed assessment of left ventricular mass (Devereux's formula) and function (fractional shortening FS, peak early (E) and late (A) velocities of LV filling). Patients were randomised to N (n = 18) or V (n = 13) and reassessed 6 months later. All echo-Doppler recordings were read blindly by 2 observers.Results : rest BP was similary reduced in both groups (V 148 +/- 12/88 +/- 5 vs 162 +/- 10/101 +/- 7 ; N : 148 +/- 15/90 +/- 7 vs 170 +/- 14/101 +/- 8), as well as exercise maximal BP (V : 224 +/- 32/93 +/- 11 vs 243 +/- 21/104 +/- 11 ; N : 206 +/- 27/90 +/- 10 vs 231 +/- 17/97 +/- 8). The duration of exercise was significantly increased with V (I 5 +/- 5 min vs 12 +/- 4, p < 0,05) and unsignificantly decreased with N (11 +/- 2 vs 12 +/- 3). Left ventricular mass was higher in V group at entry and was significantly more reduced with V (250 g +/- 74 vs 302 g +/- 92, p < 0.01) than with N (225 g +/- 54 vs 234 g +/- 69). FS and E/A ratio were unchanged in both groups.So V and N allowed a similar reduction of rest and exercise maximal BP. Exercise duration was increased with V. V induced a significant left ventricular mass regression.

Echo-duplex exploration of heart and inferior limbs arteries is performed in 76 patients less than 60 years old, with angiographically established coronary heart disease. Peripheral vascular lesions are found in 15 cases (20%), they are more frequent in patients with tritrunkular coronary disease (35%) than in those with one (16%) or two-vessel lesions (10%). Mean encephalic circulatory resistance index is higher in patients with tritrunkular lesions (p less than 0.03). Vascular echo-duplex should be performed in case of coronary disease in order to avoid catheterism complications and to purpose combined surgical procedure (coronary bypass and carotid endarterectomy).

Doppler echocardiography is being used increasingly in the follow-up of patients with valvular heart prostheses because it provides unique hemodynamic information about flow through prosthetic valves. A baseline checkup about 3 months after implantation is now recommended. We therefore now supply each patient with an identity and follow-up card for each particular prosthesis.

The aim of this study was to evaluate the results of transesophageal echocardiography in the diagnosis of abnormal intraatrial echoes detected by transthoratic echocardiography. Patients with active endocarditis, mitral stenosis, and valve prostheses were excluded. The 47 patients (28 women and 19 men) were classified into 4 groups according to the results of transesophageal echocardiography.- Group I: normal (7 cases), "phantom echos"; - Group II: anatomical variants (9 cases), Chiari apparatus, muscular spur; - Group III: pseudo-tumours (7 cases); retroatrial haematoma, mitral valve prolapse, interatrial septal aneurysm; - Group IV: cardiac masses (24 cases). This group comprises: . typical myxomas (10 cases), . typical thrombi (2 cases), . localised atypical masses, relatively immobile and nonprolapsing: 5 myxomas, 1 metastasis, 2 thrombi.The results of this study suggest that transesophageal echocardiography is very useful in diagnosing suspected abnormal intraatrial echos observed on conventional transthoracic examination. However, the nature of the mass may remain obscure.

The aim of this study was to evaluate the results of transesophageal echocardiography in the diagnosis of abnormal intraatrial echoes detected by transthoracic echocardiography. Patients with active endocarditis, mitral stenosis, and valve prostheses were excluded. The 47 patients (28 women and 19 men) were classified into 4 groups according to the results of transesophageal echocardiography. Group I: normal (7 cases), "phantom echos"; Group II: anatomical variants (9 cases), Chiari apparatus, muscular spur; Group III: pseudo-tumours (7 cases); retro-atrial haematoma, mitral valve prolapse, interatrial septal aneurysm; Group IV: cardiac masses (24 cases). This group comprises: typical myxomas (10 cases), typical thrombi (2 cases), localised atypical masses, relatively immobile and non-prolapsing: 5 myxomas, 1 metastasis, 2 thrombi. The results of this study suggest that transesophageal echocardiography is very useful in diagnosing suspected abnormal intraatrial echos observed on conventional transthoracic examination. However, the nature of the mass may remain obscure.