No abstract

SUMMARY Sixty-two subjects underwent M-mode and two-dimensional echocardiographic studies that included imaging of the inferior vena cava (IVC) during upper extremity contrast injections. Group 1 consisted of 10 patients with clinical tricuspid regurgitation (TR). Group 2 consisted of 40 patients without definite clinical signs of TR but with conditions known to be commonly associated with TR (e.g., mitral valve disease, pulmonary hypertension, former tricuspid valve surgery). Group 3 consisted of 12 normal subjects. The IVC could be imaged by two-dimensional echocardiography followed by M-mode in all subjects. M-mode IVC measurements in the absence of contrast were not sufficient to reliably separate TR patients from non-TR patients. IVC contrast was imaged, frequently during deep inspiration, in all 10 group 1 patients, 36 of 40 group 2 patients and three of 12 group 3 normal subjects. Three patterns of contrast appearance in the IVC were observed: "v-wave synchronous" patterns in all but two patients with TR and "a-wave synchronous" or "random" patterns in patients without TR. The presence of TR was independently assessed during angiography or surgery in 26 patients. There were two false-negative echo studies, as judged by lntraoperative palpation of a thrill on the right atrium. There were no false-positive v-wave synchronous studies. M-mode echocardiography was superior to two-dimensional echocardiography in detection of the appearance of contrast in the IVC and ease of pattern interpretation. Recognition of false-positive (a-wave synchronous or random) and false-negative patterns (insufficient central contrast, excessively inferior transducer position) improves the diagnostic accuracy of contrast IVC echocardiography, which is a sensitive and specific method for diagnosing TR. LIEPPE et al.' recently suggested that two-dimensional echocardiography is a sensitive and specific means for diagnosing tricuspid regurgitation (TR). They used ultrasound contrast from an antecubital vein injection of saline or indocyanine green, and monitored the inferior vena cava (IVC) for appearance of contrast from the subcostal transducer position. We noted appearance of contrast in the IVC with this technique in several patients without TR, and undertook a study to examine the sensitivity and specificity of contrast echocardiography for the diagnosis of TR. We also examined the relative usefulness of Mmode and two-dimensional echocardiography in diagnosing TR. Methods PatientsSixty-two patients underwent M-mode and twodimensional echocardiography with peripheral contrast injections. Each patient was examined by a car-

No abstract

The aim of the study was to determine the safety and efficacy of the second-generation ACS Multi-Link Duet coronary stent system for the treatment of single, symptomatic, de novo, native coronary artery lesions. Between February and June 1998, 427 patients (69.3% male, 51.5% class 3 or 4 angina, 20.1% diabetic, 43.6% hyperlipidemia) were included at 38 centers in this prospective observational study. All patients received ticlopidine 500 mg/day for 1 month and aspirin > or =100 mg/day. The Duet stent was available in 8, 18, and 28 mm length and 3.0, 3.5, and 4.0 mm diameter. After adequate predilatation, stents were successfully implanted, at up to 16 atm, in 99.3% of patients. Mean vessel diameter by core laboratory quantitative coronary angiography was 3.0 +/- 0.53 mm and postprocedural minimum luminal diameter was 2.79 +/- 0.43 mm (12% +/- 9.3% diameter stenosis). At 30 days, 96.7% of patients were event-free and at 6 months 88.1% remained free of major adverse cardiac events. The restenosis rate was 18.1%. The ACS Duet stent was safely implanted in >99% of target lesions by a diverse group of international investigators. With late outcomes at least comparable to the best published results, this stent platform provides safe and effective percutaneous treatment of obstructive coronary artery disease. Cathet Cardiovasc Intervent 2001;54:25-33.