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TELECONFRENCES
2004
The Changing Left Ventricle

2003
Aortic Valve Disease: New Dimensions in Evaluation and Management

2002
Heart Failure: Echo's Role in and Emerging Health Crisis

2001
Chest Pain in Children & Adults: The Role of Echo

2000
Mitral Regurgitation: New Concept

1998
The Falling Left Ventricle: Diastolic & Systolic Function

1997
Changing the Outcome of Coronary Artery Disease
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Chest Pain in Children and Adults

Mitral Regurgitation: New Concepts

Diastolic and Systolic Function

Changing the Outcome of CAD

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2000 MV
2001 Chest Pain
2002 Heart Failure



Complications Of Myocardial Infarction
Left Ventricular Aneurysm and Thrombus
Fig. 56

Following extensive infarction, the affected myocardium may become thin and fibrotic resulting in outward bulging of the ventricular wall during systole. Aneurysms may occasionally have mural thrombus within the aneurysmal segment (Fig. 56).

The presence of an aneurysm can sometimes be inferred from a slow M-mode sweep from the base of the heart toward the apex, in which the ventricular cavity size is seen to increase markedly toward the apex.

Fig. 57

However, two-dimensional echocardiography has largely supplanted the M-mode approach. Aneurysms are most commonly found in the septal, apical, and lateral regions, and thus are best visualized using the parasternal or apical long-axis and four-chamber approaches. As well as the Presence of a region where the wall is thin and dyskinetic, the best criterion for diagnosis of a true aneurysm is the presence of a "hinge", where there is a transition from normal to akinetic or paradoxical wall motion. (Fig. 57) shows an apical four-chamber view with the heart normal in diameter at the base and a massive left ventricular aneurysm involving the distal two-thirds of the chamber.

Fig. 58

Echoes suggestive of clot are frequently seen in the apical region, or attached to the septum, in patients with ischemic disease and poor left ventricular function.
(Fig. 58) shows a layered mural thrombus at the apex while (Fig. 59) shows a multilobulated thrombus or thrombi at the apex.

Fig. 59

It has been shown that the multilobulated presentation of a mural thrombus, particularly one with rapidly moving intracavitary components, has a higher incidence of peripheral embolization. Data is still inconclusive as to the need for, or benefit of, anticoagulation in patients with mural thrombi in the setting of myocardial infarction.

Fig. 60

Another presentation of mural thrombus is when the morphology of the thrombus is "web-like". Such a thrombus is seen filling most of the left ventricular cavity in a patient with severe ischemic cardiomyopathy in (Fig. 60). Such thrombi are, however, more commonly restricted to the area of the ventricular apex.

Mural thrombi are almost invariably associated with an underlying wall-motion abnormality. Occasionally, chest wall reverberations make adequate interrogation of the left ventricular apex quite difficult, and the diagnosis of apical mural thrombus is best left to experienced observers.

While the sensitivity and specificity of the echocardiographic diagnosis of ventricular thrombus are not known precisely, there is a growing abundance of data that this approach is the most clinically reliable method currently available.

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BASIC ECHO: 2D Echo | Heart Valves | Heart Muscle | Congenital Disease
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