Robin S Freedberg, M.D.

Isolated left atrial appendage ostial stenosis
Stern, Joshua D; Skolnick, Adam H; Freedberg, Robin S; Kronzon, Itzhak
2009 Jul;10(5):702-703, European journal of echocardiography
A patient with atrial tachycardia presented with dyspnoea on exertion. Transoesophageal echocardiography revealed idiopathic left atrial appendage stenosis. The mouth of the atrial appendage was narrowed, and there was a high velocity to and fro jet between the left atrial body and the left atrial appendage. The study, therefore, suggested isolated left atrial appendage orifice stenosis
— id: 100048, year: 2009, vol: 10, page: 702, stat: Journal Article,

Feasibility and cardiac safety of pegylated liposomal doxorubicin plus trastuzumab in heavily pretreated patients with recurrent HER2-overexpressing metastatic breast cancer
Andreopoulou, Eleni; Gaiotti, Darci; Kim, Eugene; Volm, Matthew; Oratz, Ruth; Freedberg, Robin; Downey, Andrea; Vogel, Charles L; Chia, Stephen; Muggia, Franco
2007 Aug;7(9):690-696, Clinical breast cancer
BACKGROUND: Few studies have evaluated concomitant pegylated liposomal doxorubicin (PLD) plus trastuzumab as therapy for HER2-overexpressing metastatic breast cancer (MBC). This open-label, prospective, phase II trial assessed the safety and efficacy of this regimen, with cardiac tolerance as the principal focus. PATIENTS AND METHODS: Women with HER2-overexpressing recurrent MBC, baseline left ventricular ejection fraction >or= 55%, and no history of serious cardiac illness were eligible; preexisting cardiac risk factors, including previous anthracyclines and previous trastuzumab for MBC, were allowed. Patients received weekly trastuzumab and every-3-week PLD until progression, prohibitive toxicity, or patient refusal. Left ventricular ejection fraction was assessed during and after therapy. Grade 3/4 congestive heart failure (CHF) was monitored for premature closure. RESULTS: The trial closed after 2.5 years for slow accrual. Twelve patients were enrolled: 7 had received adjuvant anthracyclines; 9 had received previous MBC treatment, of whom 7 had received trastuzumab in combination with chemotherapy. Patients received a mean of 4.8 cycles of PLD; 8 patients experienced stable disease; 4 patients experienced progression. Mean left ventricular ejection fraction levels did not change substantially: 60.4%, 57%, 60.3%, and 56.8% at baseline, after cycle 2, after cycle 4, and after completion of treatment, respectively. No patients experienced grade 4 CHF. One patient discontinued treatment after grade 3 CHF. Three patients experienced grade 2 left ventricular dysfunction, of whom 2 discontinued treatment. Cardiac function improved in all 4 patients after going off study. Other adverse events were generally mild (grade 1/2) and infrequent. CONCLUSION: Pegylated liposomal doxorubicin plus trastuzumab might be an option for heavily pretreated patients with recurrent HER2-overexpressing MBC
— id: 75388, year: 2007, vol: 7, page: 690, stat: Journal Article,

The risk of the development of aortic stenosis in patients with "benign" aortic valve thickening
Cosmi, John E; Kort, Smadar; Tunick, Paul A; Rosenzweig, Barry P; Freedberg, Robin S; Katz, Edward S; Applebaum, Robert M; Kronzon, Itzhak
2002 Nov 11;162(20):2345-2347, Archives of internal medicine
BACKGROUND: Aortic valve thickening (AVT) without aortic stenosis (AS) is common and was often considered benign. However, it has recently been found to be associated with increased morbidity and mortality. It is unknown whether patients with AVT are at risk for the development of AS. METHODS: Our echocardiography database from 1987 to 1993 was searched for cases of AVT with at least 1 year of echocardiographic follow-up. The risk of the development of AS was compared in patients with and without AVT. RESULTS: There were 2131 patients with AVT and at least 1 year of echocardiographic follow-up. Aortic stenosis developed in 338 patients (15.9%) (mild, 10.5%; moderate, 2.9%; and severe, 2.5%). Multivariate analysis, including age, left ventricular hypertrophy, and mitral annular calcification, revealed that only mitral annular calcification was independently and significantly associated with progression to AS. CONCLUSIONS: Aortic valve thickening without stenosis is common, and it may progress to significant AS. It is possible that this development of AS may be responsible for some of the increased morbidity and mortality in patients with AVT
— id: 39568, year: 2002, vol: 162, page: 2345, stat: Journal Article,

Paradoxically normal septal motion in Ebstein's anomaly
Reynolds, Harmony R; Tunick, Paul A; Freedberg, Robin S; Rutkowski, Monika; Kaplan, Kenneth C; Kronzon, Itzhak
2002 Aug;15(8):841-842, Journal of the American Society of Echocardiography
Paradoxical septal motion has been reported as characteristic of Ebstein's anomaly. The patient reported here has the characteristic apical displacement of the tricuspid value, but septal motion is uncharacteristically normal. Because there is only mild tricuspid regurgitation, it is likely that the absence of right ventricular volume overload accounts for the normal septal motion in this patient
— id: 32260, year: 2002, vol: 15, page: 841, stat: Journal Article,

Effect of treatment on the incidence of stroke and other emboli in 519 patients with severe thoracic aortic plaque
Tunick, Paul A; Nayar, Ambika C; Goodkin, Gregory M; Mirchandani, Sunil; Francescone, Steven; Rosenzweig, Barry P; Freedberg, Robin S; Katz, Edward S; Applebaum, Robert M; Kronzon, Itzhak
2002 Dec 15;90(12):1320-1325, American journal of cardiology
Severe aortic plaques seen on transesophageal echocardiography (TEE) are a high-risk cause of stroke and peripheral embolization. Evidence to guide therapy is lacking. Retrospective information was obtained regarding the occurrence of embolic events (stroke, transient ischemic attacks, or peripheral emboli) in 519 patients with severe thoracic aortic plaque seen on TEE since 1988. Treatment with statins, warfarin, or antiplatelet medications was noted. Treatment was not randomized. In a matched-paired analysis, each patient taking each class of therapy was matched for age, gender, previous embolic event, hypertension, diabetes, congestive failure, and atrial fibrillation to someone not taking that medication. Multivariate analysis was also performed. An embolic event occurred in 111 patients (21%). Multivariate analysis showed that statin use was independently protective against recurrent events (p = 0.0001). Matched analysis also showed a protective effect of statins (p = 0.0004; absolute risk reduction 17%, relative risk reduction 59%, number needed to treat [n = 6]). No protective effect was found for warfarin or antiplatelet drugs. The odds ratio for embolic events was 0.3 (95% confidence interval [CI] 0.2 to 0.6) for statin therapy, 0.7 (95% CI 0.4 to 1.2) for warfarin, and 1.4 (95% CI 0.8 to 2.4) for antiplatelet agents. Thus, there is a protective effect of statin therapy, and no significant benefit of warfarin or antiplatelet drugs on the incidence of stroke and other embolic events in patients with severe thoracic aortic plaque on TEE
— id: 36577, year: 2002, vol: 90, page: 1320, stat: Journal Article,

Unusually located left atrial papillary fibroelastoma with probable embolization to the spinal cord
Friedman GR; Pappas TW; Colangelo R; Tunick PA; Freedberg RS; Scholes JV; Kronzon I
2001 Aug;18(6):523-526, Echocardiography
This report presents a patient with flaccid paraplegia, most probably secondary to embolization from a left atrial papillary fibroelastoma. The unique location of the tumor, attached to the ridge in the left atrium between the left atrial appendage and pulmonary vein, was well documented on transesophageal echocardiography, and the diagnosis was confirmed by histopathology. Although benign, these tumors may develop in all four cardiac chambers and result in pulmonary or systemic embolization. Paraplegia is a rare embolic complication
— id: 26614, year: 2001, vol: 18, page: 523, stat: Journal Article,

Innominate artery atheroma: a lesion seen with gadolinium-enhanced MR angiography and often missed by transesophageal echocardiography
Krinsky GA; Freedberg R; Lee VS; Rockman C; Tunick PA
2001 Jul-Aug;25(4):251-257, Clinical imaging
Transesophageal echocardiography (TEE) is the procedure of choice for identifying aortic atheromas, which may result in stroke, transient ischemic attack and peripheral embolization. However, because of anatomic constraints, the innominate artery may not be visualized. We investigated gadolinium-enhanced MR angiography (MRA) as an alternative technique for evaluation of suspected atheromas of the innominate artery. From a retrospective review of 520 examinations, we identified five patients who had innominate artery atheromas diagnosed prospectively with gadolinium-enhanced MRA who also underwent TEE within 1 month. A total of 10 innominate artery atheromas were demonstrated on MRA; none of these were visualized on TEE. One patient had three atheromas, two patients had two atheromas and three patients had one atheroma. They ranged in size from 3 mm to 1.5 cm (mean 6.5 mm). One atheroma was flat, two were filiform, and seven were protruding. Gadolinium-enhanced MRA is superior to TEE for the diagnosis of atheromas of the innominate artery. In the setting of right cerebral or right arm embolization, when no source is seen in the arch on TEE, gadolinium-enhanced MRA should be considered
— id: 26656, year: 2001, vol: 25, page: 251, stat: Journal Article,

Abdominal aortic aneurysms and thoracic aortic atheromas
Reynolds HR; Tunick PA; Kort S; Rosenzweig BP; Freedberg RS; Katz ES; Applebaum RM; Portnay EL; Adelman MA; Attubato MJ; Kronzon I
2001 Nov;14(11):1127-1131, Journal of the American Society of Echocardiography
BACKGROUND: Abdominal aortic aneurysm (AAA) is associated with atherosclerosis elsewhere. Thoracic aortic atheromas (ATHs) seen on transesophageal echocardiography (TEE) are an important cause of stroke and peripheral embolization. The purposes of this study were to determine whether an association exists between AAA and ATHs and to assess the importance of screening patients with ATHs for AAA. METHODS: For the retrospective analysis, 109 patients with AAA and 109 matched controls were compared for the prevalence of ATHs on TEE and for historical variables. For the prospective analysis, screening for AAA on ultrasonography was performed in 364 patients at the time of TEE. RESULTS: Results of the retrospective analysis showed that ATHs were present in 52% of patients with AAA and in 25% of controls (odds ratio [OR] = 3.3; P =.00003). There was a significantly higher prevalence of hypertension, myocardial infarction, heart failure, smoking, and carotid or peripheral arterial disease in patients with AAA. However, only ATHs were independently associated with AAA on multivariate analysis (P =.001). Results of the prospective analysis showed that screening at the time of TEE in 364 patients revealed AAA in 13.9% of those with ATHs and in 1.4% of those without ATHs (P <.0001; OR = 11.4). CONCLUSIONS: (1) There is a strong, highly significant association between abdominal aneurysm and thoracic atheromas. (2) Patients with AAA may be at high risk for stroke because of the concomitance of thoracic aortic atheromas. (3) The high prevalence of abdominal aneurysm in patients with thoracic atheromas suggests that screening for abdominal aneurysm should be carried out in all patients with thoracic atheromas identified by TEE
— id: 26574, year: 2001, vol: 14, page: 1127, stat: Journal Article,

Aortic valve replacement in patients with aortic stenosis and severe left ventricular dysfunction
Powell DE; Tunick PA; Rosenzweig BP; Freedberg RS; Katz ES; Applebaum RM; Perez JL; Kronzon I
2000 May 8;160(9):1337-1341, Archives of internal medicine
BACKGROUND: The outcome of aortic valve replacement for severe aortic stenosis is worse in patients with impaired left ventricular function. Such dysfunction in aortic stenosis may be reversible if caused by afterload mismatch, but not if it is caused by superimposed myocardial infarction. METHODS: From our echocardiography database, 55 patients with severe aortic stenosis (valve area < or =0.75 cm2) and ejection fractions of 30% or lower who subsequently underwent aortic valve replacement were included. The operative mortality and clinical follow-up were detailed. RESULTS: There were 10 perioperative deaths (operative mortality, 18%). Twenty (36%) of the 55 patients had a prior myocardial infarction. In the 35 patients without prior myocardial infarction, there was only 1 death (3%). In contrast, 9 of 20 patients with prior myocardial infarction died (mortality rate, 45%; P< or =.001). The factors significantly associated with perioperative death on univariate analysis (functional class, mean aortic gradient, and prior myocardial infarction) were entered into a model for stepwise logistic regression. This multivariate analysis showed that only prior myocardial infarction was independently associated with perioperative death (odds ratio, 14.9; 95% confidence interval, 2.4-92.1; P = .004). CONCLUSIONS: The risk of aortic valve replacement in patients with severe aortic stenosis and severely reduced left ventricular systolic function is extremely high if the patients have had a prior myocardial infarction. This information should be factored into the risk-benefit analysis that is done preoperatively for these patients, and it may preclude operation for some
— id: 11701, year: 2000, vol: 160, page: 1337, stat: Journal Article,

The value of repeat transesophageal echocardiography in the evaluation of embolism from the aorta
Schwartzbard A; Freedberg RS; Kronzon I
2000 Dec;13(12):1124-1126, Journal of the American Society of Echocardiography
Transesophageal echocardiography (TEE) is now widely used in the evaluation of patients with unexplained stroke or transient ischemic attack, in part to exclude the presence of protruding aortic arch atheromas. We report two cases in which repeated TEE revealed an aortic clot not seen on the earlier transesophageal echocardiogram performed immediately after embolization. These cases illustrate the dynamic nature of aortic thrombus and the role of TEE in its diagnosis
— id: 39502, year: 2000, vol: 13, page: 1124, stat: Journal Article,

Coronary stent In situ [In Process Citation]
Timmermans RJ; Freedberg RS; Kronzon I
2000 Apr;17(3):267-267, Echocardiography
— id: 11509, year: 2000, vol: 17, page: 267, stat: Journal Article,

Emboli in transit: the missing link
Freedberg RS; Tunick PA; Kronzon I
1998 Aug;11(8):826-828, Journal of the American Society of Echocardiography
Since they were first described in 1990, there has been great interest in protruding atheromas in the aortic arch and descending thoracic aorta as an important source of stroke and other embolic phenomena. This report describes a patient with severe protruding aortic atheromas who died of documented embolic phenomena, in whom actual emboli in transit were seen for the first time during transesophageal echocardiography of the aorta
— id: 7567, year: 1998, vol: 11, page: 826, stat: Journal Article,

Correlation between plasma homocyst(e)ine and aortic atherosclerosis
Konecky N; Malinow MR; Tunick PA; Freedberg RS; Rosenzweig BP; Katz ES; Hess DL; Upson B; Leung B; Perez J; Kronzon I
1997 May;133(5):534-540, American heart journal
Plasma homocyst(e)ine [H(e)] levels correlate with the prevalence of arterial occlusive diseases. Recently, transesophageal echocardiography (TEE) has been used to evaluate patients with atherosclerotic plaques in the thoracic aorta. The purpose of this study was to determine whether H(e) levels correlate with the degree of atherosclerotic plaque in the thoracic aorta (ATH) as seen on TEE. Maximum plaque areas for three locations in the thoracic aorta (arch, proximal descending, and distal descending) were measured with TEE in 156 patients. Maximum plaque areas for these locations were added to yield an estimate of ATH. ATH and H(e) levels, and levels of folic acid, vitamin B12, and pyridoxal 5'-phosphate were measured in a double-blind manner. Univariate analysis demonstrated a significant correlation of H(e) with ATH (r = 0.3, p< 0.001). On multivariate analysis, H(e) was independently predictive of ATH (r for the model including H(e) was 0.63, p < 0.0001). Plasma H(e) levels are therefore significantly and independently correlated with the degree of atherosclerosis in the thoracic aorta
— id: 12323, year: 1997, vol: 133, page: 534, stat: Journal Article,

Visualization and identification of the left common carotid and left subclavian arteries: a transesophageal echocardiographic approach [see comments]
Katz ES; Konecky N; Tunick PA; Rosenzweig BP; Freedberg RS; Kronzon I
1996 Jan-Feb;9(1):58-61, Journal of the American Society of Echocardiography
— id: 7008, year: 1996, vol: 9, page: 58, stat: Journal Article,

Valve strands are strongly associated with systemic embolization: a transesophageal echocardiographic study
Freedberg RS; Goodkin GM; Perez JL; Tunick PA; Kronzon I
1995 Dec;26(7):1709-1712, Journal of the American College of Cardiology
OBJECTIVES. We attempted to determine the prevalence of strands on native and prosthetic valves, as detected by transesophageal echocardiography, and to assess the relative risk for systemic emboli associated with these strands. BACKGROUND. Fine threadlike strands, seen on native and prosthetic valves by transesophageal echocardiography, have been implicated in systemic embolization. METHODS. During a 2-year period, 1,559 patients underwent transesophageal echocardiography at our center. Of these, 41 patients had strands and no other identifiable source of systemic emboli. They were matched for age, gender, history of hypertension and history of smoking with a control group of 41 patients without strands who also had no identifiable source of emboli. The risk of embolization in the two groups was compared. RESULTS. Of 1,559 patients studied by transesophageal echocardiography, 86 (5.5%) had strands. Strands were far more common on mitral valves than on aortic valves. Of the patients with strands, 38% had had an event consistent with a systemic embolus, whereas 62% had not. Of 597 patients with an embolic event, 63 (10.6%) had strands, whereas only 23 (2.3%) of 962 patients without emboli had strands. In the case-control study, 33 (83%) of the 41 patients with strands without another source of embolism had emboli compared with only 12 (29%) of the 41 control patients without another source (odds ratio 10.0, 95% confidence interval 3.6 to 27.8, p = 0.00001). CONCLUSIONS. Valvular strands visualized by transesophageal echocardiography are associated with systemic embolization
— id: 6910, year: 1995, vol: 26, page: 1709, stat: Journal Article,

Absent right and persistent left superior vena cava without other congenital anomaly: a rare combination diagnosed by transesophageal echocardiography
Konecky N; Freedberg RS; McCauley D; Kronzon I
1995 Sep-Oct;8(5 Pt 1):761-766, Journal of the American Society of Echocardiography
A 70-year old man with a history of anorexia, weight loss, and progressive shortness of breath was studied by transesophageal echocardiography. In addition to a mass occupying the right ventricular outflow tract, a rare congenital heart anomaly was discovered serendipitously: persistent left superior vena cava, absent right superior vena cava, and no other congenital abnormality. The echocardiographic findings were confirmed by computed tomographic scanning and later during heart surgery performed to resect the malignant tumor
— id: 12187, year: 1995, vol: 8, page: 761, stat: Journal Article,

Echocardiographic evaluation of the coronary sinus
Kronzon I; Tunick PA; Jortner R; Drenger B; Katz ES; Bernstein N; Chinitz LA; Freedberg RS
1995 Jul-Aug;8(4):518-526, Journal of the American Society of Echocardiography
The purpose of this study was to compare transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in the evaluation of the coronary sinus and its blood flow. Forty patients were studied by TTE and TEE. The distal coronary sinus and its right atrial communication could be identified in 21 of 40 by TTE, and in all patients by TEE. Coronary sinus diameter measurement at the right atrial communication was possible by TTE in 16 of 40, and in all patients by TEE (maximal diameter 6 to 14 mm, mean 9 +/- 2). Flow velocity measurement by pulsed Doppler was possible in 25 of 40 patients (63%) by TEE, and in none by TTE. The flow velocity pattern was similar to central vein flow velocity, with systolic and diastolic antegrade waves, and a small retrograde end diastolic wave. The coronary sinus cross-sectional area was measured in 5 patients by intravascular ultrasound. It varied in size and shape during the cardiac cycle, reaching a maximum (0.3 to 1.5 cm2) at end diastole, and decreasing by 40% to 70% at end systole. TEE is superior to TTE in the evaluation of the coronary sinus and its blood flow velocity. However, because of the variability in cross-sectional area size and shape, measurement of coronary sinus blood flow may be inaccurate
— id: 6924, year: 1995, vol: 8, page: 518, stat: Journal Article,

Transesophageal versus transthoracic echocardiography in the evaluation of right atrial tumors
Leibowitz G; Keller NM; Daniel WG; Freedberg RS; Tunick PA; Stottmeister C; Kronzon I
1995 Dec;130(6):1224-1227, American heart journal
The purpose of this study was to define the contribution of transesophageal echocardiography to the diagnosis of right atrial tumors in a large series of patients with this rare finding. Transesophageal echocardiography (TEE) has been found to be valuable in evaluating patients with intracardiac masses and has been shown to be superior to transthoracic echocardiography (TTE) in evaluating left heart masses. Between 1989 and 1993, 23 patients with either known tumors elsewhere or right atrial masses that were detected on TTE were evaluated with TEE. TEE studies were performed in the noninvasive cardiology laboratory. All patients were studied with 5 MHz biplane or omniplane transducers. The right atrium was evaluated for the presence, characteristics, extent, and attachment of any masses and for extension of these masses into the great vessels or other cardiac chambers. No complications occurred. Six patients had primary right atrial tumors. In 10 patients the tumors reached the right atrium via the inferior vena cava. Seven patients had malignant secondary tumors. TEE demonstrated three tumors not detected by TTE. Furthermore TEE provided 16 additional findings not seen on TTE. In conclusion, TEE is superior to TTE in the evaluation of right atrial tumors. TEE should be considered in patients with right atrial tumors even when these tumors have been demonstrated with TTE
— id: 6928, year: 1995, vol: 130, page: 1224, stat: Journal Article,

Atrial septal aneurysm in adult patients. A multicenter study using transthoracic and transesophageal echocardiography
Mugge, A; Daniel, W G; Angermann, C; Spes, C; Khandheria, B K; Kronzon, I; Freedberg, R S; Keren, A; Denning, K; Engberding, R
1995 Jun 1;91(11):2785-2792, Circulation
BACKGROUND: An atrial septal aneurysm (ASA) is a well-recognized abnormality of uncertain clinical relevance. We reevaluated the clinical significance of ASA in a large series of patients. The aims of the study were to define morphological characteristics of ASA by transesophageal echocardiography (TEE), to define the incidence of ASA-associated abnormalities, and to investigate whether certain morphological characteristics of ASA are different in patients with and without previous events compatible with cardiogenic embolism. METHODS AND RESULTS: Patients with ASA were enrolled from 11 centers between May 1989 and October 1993. All patients had to undergo transthoracic and transesophageal echocardiography within 24 hours of each other; ASA was defined as a protrusion of the aneurysm > 10 mm beyond the plane of the atrial septum as measured by TEE. Patients with mitral stenosis or prosthesis or after cardiothoracic surgery involving the atrial septum were excluded. Based on these criteria, 195 patients 54.6 +/- 16.0 years old (mean +/- SD) were included in this study. Whereas TEE could visualize the region of the atrial septum and therefore diagnose ASA in all patients, ASA defined by TEE was missed by transthoracic echocardiography in 92 patients (47%). As judged from TEE, ASA involved the entire septum in 100 patients (51%) and was limited to the fossa ovalis in 95 (49%). ASA was an isolated structural defect in 62 patients (32%). In 106 patients (54%), ASA was associated with interatrial shunting (atrial septal defect, n = 38; patent foramen ovale, n = 65; sinus venosus defect, n = 3). In only 2 patients (1%), thrombi attached to the region of the ASA were noted. Prior clinical events compatible with cardiogenic embolism were associated with 87 patients (44%) with ASA; in 21 patients (24%) with prior presumed cardiogenic embolism, no other potential cardiac sources of embolism were present. Length of ASA, extent of bulging, and incidence of spontaneous oscillations were similar in patients with and without previous cardiogenic embolism; however, associated abnormalities such as atrial shunts were significantly more frequent in patients with possible embolism. CONCLUSIONS: As shown previously, TEE is superior to the transthoracic approach in the diagnosis of ASA. The most common abnormalities associated with ASA are interatrial shunts, in particular patent foramen ovale. In this retrospective study, patients with ASA (especially with shunts) showed a high frequency of previous clinical events compatible with cardiogenic embolism; in a significant subgroup of patients, ASA appears to be the only source of embolism, as judged by TEE. Our data are consistent with the view that ASA is a risk factor for cardiogenic embolism, but thrombi attached to ASA as detected by TEE are apparently rare
— id: 100090, year: 1995, vol: 91, page: 2785, stat: Journal Article,

Presumed single-leaflet mitral valve: recognition by transthoracic and transesophageal echocardiography
Bernstein NE; Tunick PA; Freedberg RS; Adler M; Kronzon I
1994 Jan;127(1):216-219, American heart journal
— id: 6322, year: 1994, vol: 127, page: 216, stat: Journal Article,

Catheter-induced mitral regurgitation during transseptal left heart catheterization: relationship to valve morphology
Caracciolo EA; Kronzon I; Schwartzman DS; Cziner DG; Glassman E; Freedberg RS
1994 Jul;32(3):238-241, Catheterization & cardiovascular diagnosis
— id: 12958, year: 1994, vol: 32, page: 238, stat: Journal Article,

Right atrial and right ventricular obstruction by recurrent stromomyoma
Kronzon I; Goodkin GM; Culliford A; Scholes JV; Boctor F; Freedberg RS; Tunick PA
1994 Sep-Oct;7(5):528-533, Journal of the American Society of Echocardiography
A 30-year-old woman had a history of a uterine fibroid 6 years before admission. She had resection of a right atrial mass diagnosed as a leiomyoma 2 years ago and a second cardiac procedure for recurrent tumor 1 year ago. Pathologic examination at that time indicated that the tumor was a low-grade endometrial stromal sarcoma (stromatosis) with features of benign leiomyoma (intravenous leiomyomatosis). This time she was admitted with facial and lower extremity swelling as well as ascites. Transthoracic and transesophageal echocardiography revealed a large tumor entering the heart from the inferior vena cava and filling the right atrium and ventricle. Lower extremity ischemia from bilateral compartment syndrome due to severe edema developed, and she underwent successful surgical resection of the tumor that filled the right side of the heart, inferior vena cava, and mesenteric and renal veins
— id: 12905, year: 1994, vol: 7, page: 528, stat: Journal Article,

Transesophageal echocardiography in pericardial disease and tamponade
Kronzon I; Tunick PA; Freedberg RS
1994 Sep;11(5):493-505, Echocardiography
While most pericardial disorders can be imaged by transthoracic echocardiography, transesophageal echocardiography may be required in those cases where pericardial pathology is clinically suspected, but cannot be imaged adequately with transthoracic echocardiography. Transesophageal echocardiography is especially helpful in patients after heart or chest surgery, with cardiac compression by a loculated pericardial hematoma, in patients with dissection, endocarditis, or interatrial shunting associated with pericardial effusion, in patients with pericardial tumors, and in the differential diagnosis between constrictive pericarditis and restrictive cardiomyopathy
— id: 12921, year: 1994, vol: 11, page: 493, stat: Journal Article,

Pulmonary embolectomy for intravenous uterine leiomyomatosis
Marcus SG; Krauss T; Freedberg RS; Culliford AT; Weinreich DJ; Kronzon I
1994 Jun;127(6):1642-1645, American heart journal
— id: 6445, year: 1994, vol: 127, page: 1642, stat: Journal Article,

High risk for vascular events in patients with protruding aortic atheromas: a prospective study
Tunick PA; Rosenzweig BP; Katz ES; Freedberg RS; Perez JL; Kronzon I
1994 Apr;23(5):1085-1090, Journal of the American College of Cardiology
OBJECTIVES. The purpose of this study was to prospectively evaluate the risk of vascular events in patients with protruding aortic atheromas. BACKGROUND. Protruding atheromas of the thoracic aorta have been shown to be associated with embolic disease in previous retrospective studies. METHODS. During a 1-year period, 521 patients had transesophageal echocardiography. Of these, 42 patients had protruding atheromas and no other source of emboli. They were followed up for up to 2 years (mean follow-up 14 months) and compared with a control group without atheromas, matched for age, gender and hypertension. RESULTS. Of 42 patients with atheromas, 14 (33%) had 19 vascular events during follow-up (5 brain, 2 eye, 4 kidney, 1 bowel, 7 lower extremity). Of 42 control patients, 3 (7%) had vascular events (2 brain, 1 eye). Univariate analysis identified only protruding atheromas as significantly correlating with events (p = 0.003). There was no positive correlation of events with age, gender, hypertension, smoking, family history, atrial fibrillation, valve replacement, antithrombotic drug use, diabetes or coronary disease. Multivariate analysis showed that only protruding atheromas independently predicted events (p = 0.005, odds ratio 4.3, 95% confidence interval 1.2 to 15.0). Nine patients died in the atheroma group versus six in the control group, but this was not statistically significant (p = 0.39). CONCLUSIONS. Protruding atheromas seen on transesophageal echocardiography predict future vascular events
— id: 6542, year: 1994, vol: 23, page: 1085, stat: Journal Article,

Four-valve endocarditis resulting from Staphylococcus aureus diagnosed by biplane transesophageal echocardiography
Bernstein NE; Freedberg RS; O'Brien FJ; Kronzon I
1993 Jul;126(1):251-254, American heart journal
— id: 13123, year: 1993, vol: 126, page: 251, stat: Journal Article,

Transesophageal echocardiographic diagnosis of a primary intraaortic tumor
Cziner DG; Freedberg RS; Tunick PA; Friedman G; Culliford AT; Rizk C; Kronzon I
1993 Apr;125(4):1189-1192, American heart journal
— id: 13206, year: 1993, vol: 125, page: 1189, stat: Journal Article,

Disappearance of a large intraaortic mass in a patient with prior systemic embolization
Freedberg RS; Tunick PA; Culliford AT; Tatelbaum RJ; Kronzon I
1993 May;125(5 Pt 1):1445-1447, American heart journal
— id: 13176, year: 1993, vol: 125, page: 1445, stat: Journal Article,

IDENTIFICATION OF AN UNUSUAL RIGHT ATRIAL MASS AS A CHIARI NETWORK BY BIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY
KATZ, ES; FREEDBERG, RS; RUTKOVSKY, L; MARTIN, JC; KRONZON, I
1992 MAY ;9(3):273-275, Echocardiography
An unusual right atrial mass was visualized on the transthoracic and single planar transesophageal echocardiograms of a young female patient. Biplane transesophageal echocardiography, however, clearly demonstrated this structure to be a prominent Chiari network. Large eustachian valves and Chiari networks may mimic tumor or thrombus formation when conventional noninvasive diagnostic techniques are used. Multiplanar imaging can be essential in defining anatomical relationships of normal variant structures, eliminating concern for pathological entities and the need for further invasive work-up
— id: 51961, year: 1992, vol: 9, page: 273, stat: Journal Article,

Buckling of the tip of the transesophageal echocardiography probe: a potentially dangerous technical malfunction
Kronzon I; Cziner DG; Katz ES; Gargiulo A; Tunick PA; Freedberg RS; Daniel WG
1992 Mar-Apr;5(2):176-177, Journal of the American Society of Echocardiography
— id: 13669, year: 1992, vol: 5, page: 176, stat: Journal Article,

Exercise Doppler echocardiography as an aid to clinical decision making in mitral valve disease
Tunick PA; Freedberg RS; Gargiulo A; Kronzon I
1992 May-Jun;5(3):225-230, Journal of the American Society of Echocardiography
The timing of valve replacement in patients with mitral valve disease, severe resting pulmonary hypertension, and severe symptoms is usually straightforward. However, this may not be true for patients with mild to moderate resting pulmonary pressures and symptoms that are difficult to evaluate. The measurement of hemodynamic parameters with exercise has been useful during cardiac catheterization. The purpose of this study was to evaluate the hemodynamic significance of dyspnea provoked by exercise in patients with mitral valve disease using exercise Doppler echocardiography. Nineteen tests were done in 17 patients (two patients had repeat studies 1 year after the first test). Dyspnea developed in patients during exercise in 11 tests, and the others were limited by fatigue (and angina in one patient). There was a significantly greater increment in pulmonary artery systolic pressure during exercise in the patients who developed dyspnea (24 mm Hg) than in those who did not (15 mm Hg, p = 0.04). The two groups exercised to approximately the same heart rate and blood pressure, but the dyspneic patients had a significantly shorter exercise capacity (p = 0.04). Furthermore, clinical decision making was affected by the test results in 84% (only three tests did not affect patient management) and included a decision to proceed to invasive testing and surgery in seven patients, and a decision to treat the patient medically in nine. In conclusion, exercise Doppler echocardiography is a useful adjunct in the diagnosis and treatment of patients with mitral valve disease and an aid to clinical decision making
— id: 13602, year: 1992, vol: 5, page: 225, stat: Journal Article,

Transesophageal echocardiography is superior to transthoracic echocardiography in the diagnosis of sinus venosus atrial septal defect
Kronzon I; Tunick PA; Freedberg RS; Trehan N; Rosenzweig BP; Schwinger ME
1991 Feb;17(2):537-542, Journal of the American College of Cardiology
The purpose of this study was to compare transthoracic and transesophageal echocardiography in the diagnosis of various types of atrial septal defects. Forty-one adult patients with the clinical diagnosis of atrial septal defect were studied by transthoracic and transesophageal echocardiography (30 women, 11 men; 18 to 81 years of age). Transthoracic echocardiography demonstrated the atrial septal defect in 33 patients (secundum type in 28, primum type in 3 and sinus venosus type in 2). Transesophageal echocardiography demonstrated the defect in all 41 patients. Thus, in 8 (20%) of 41 patients the atrial septal defect was demonstrated by transesophageal and not by transthoracic echocardiography. Six of the eight had a sinus venosus type atrial septal defect; the other two patients had a secundum atrial septal defect (one of these two had a technically poor transthoracic echocardiogram and the other had a small atrial septal defect). Transthoracic echocardiography, therefore, failed to demonstrate the sinus venosus defect in six (75%) of eight patients. An anomalous venous connection associated with the sinus venosus defect was visualized by transesophageal echocardiography in seven of the eight patients but was not seen on transthoracic echocardiography in any patient. Sinus venosus type atrial septal defects are frequently not visualized in adults by conventional transthoracic echocardiography. Transesophageal echocardiography is recommended when an atrial septal defect is clinically suspected but cannot be visualized by transthoracic echocardiography
— id: 14141, year: 1991, vol: 17, page: 537, stat: Journal Article,

Comparison of cardiac catheterization and Doppler echocardiography in the decision to operate in aortic and mitral valve disease [see comments]
Slater J; Gindea AJ; Freedberg RS; Chinitz LA; Tunick PA; Rosenzweig BP; Winer HE; Goldfarb A; Perez JL; Glassman E; et al
1991 Apr;17(5):1026-1036, Journal of the American College of Cardiology
Clinical decisions utilizing either Doppler echocardiographic or cardiac catheterization data were compared in adult patients with isolated or combined aortic and mitral valve disease. A clinical decision to operate, not operate or remain uncertain was made by experienced cardiologists given either Doppler echocardiographic or cardiac catheterization data. A prospective evaluation was performed on 189 consecutive patients (mean age 67 years) with valvular heart disease who were being considered for surgical treatment on the basis of clinical information. All patients underwent cardiac catheterization and detailed Doppler echocardiographic examination. Three sets of two cardiologist decision makers who did not know patient identity were given clinical information in combination with either Doppler echocardiographic or cardiac catheterization data. The combination of Doppler echocardiographic and clinical data was considered inadequate for clinical decision making in 21% of patients with aortic and 5% of patients with mitral valve disease. The combination of cardiac catheterization and clinical data was considered inadequate in 2% of patients with aortic and 2% of patients with mitral valve disease. Among the remaining patients, the cardiologists using echocardiographic or angiographic data were in agreement on the decision to operate or not operate in 113 (76% overall). When the data were analyzed by specific valve lesion, decisions based on Doppler echocardiography or catheterization were in agreement in 92%, 90%, 83% and 69%, respectively, of patients with aortic regurgitation, mitral stenosis, aortic stenosis and mitral regurgitation. Differences in cardiac output determination, estimation of valvular regurgitation and information concerning coronary anatomy were the main reasons for different clinical management decisions. These results suggest that for most adult patients with aortic or mitral valve disease, alone or in combination, Doppler echocardiographic data enable the clinician to make the same decision reached with catheterization data
— id: 14079, year: 1991, vol: 17, page: 1026, stat: Journal Article,

Constrictive pericarditis masquerading as extracardiac tumor
Freedberg RS; Schulman IC; Naidich D; Weinreb J; Culliford A; Kronzon I
1990 Aug;120(1):227-229, American heart journal
— id: 45690, year: 1990, vol: 120, page: 227, stat: Journal Article,

Pitfalls in the diagnosis of thoracic aortic aneurysm by transesophageal echocardiography
Kronzon I; Demopoulos L; Schrem SS; Pasternack P; McCauley D; Freedberg RS
1990 Mar-Apr;3(2):145-148, Journal of the American Society of Echocardiography
A 74-year-old man underwent transesophageal echocardiography to evaluate the possibility of dissection of the descending aorta. The study demonstrated a round lumen that contained an echogenic mass mimicking aortic aneurysm with thrombus. However, computerized tomographic scanning identified the lumen as the pleural cavity containing a collapsed lung. The esophagus was on the right side of the spine, and the transesophageal technique could not visualize the descending aorta
— id: 64557, year: 1990, vol: 3, page: 145, stat: Journal Article,

Transesophageal echocardiography to detect atrial clots in candidates for percutaneous transseptal mitral balloon valvuloplasty
Kronzon I; Tunick PA; Glassman E; Slater J; Schwinger M; Freedberg RS
1990 Nov;16(5):1320-1322, Journal of the American College of Cardiology
Left atrial thrombi are common in patients with mitral stenosis. When percutaneous balloon mitral valvuloplasty is performed on such patients, there is a potential risk of thrombus dislodgment and embolization. In this study conventional transthoracic echocardiography and transesophageal echocardiography were performed for percutaneous balloon mitral valvuloplasty on 19 consecutive candidates (6 men, 13 women, 23 to 81 years old). In five patients (26%), transesophageal echocardiography revealed a left atrial thrombus; in only one of these was there a suspicion of left atrial thrombus on transthoracic echocardiography. Balloon mitral valvuloplasty was canceled in four of the five patients. Three underwent mitral valve surgery that confirmed the echocardiographic findings. Transesophageal echocardiography is better than conventional transthoracic echocardiography in detecting left atrial clots in candidates for balloon mitral valvuloplasty. Because of the potential risk of embolization, transesophageal echocardiography is recommended in all candidates for balloon mitral valvuloplasty
— id: 14292, year: 1990, vol: 16, page: 1320, stat: Journal Article,

Echocardiographic and hemodynamic characteristics of atrial septal defects created by percutaneous valvuloplasty
Kronzon I; Tunick PA; Goldfarb A; Freedberg RS; Chinitz L; Slater J; Schwinger ME; Gindea AJ; Glassman E; Daniel WG
1990 Jan-Feb;3(1):64-71, Journal of the American Society of Echocardiography
Twenty-nine patients were studied by pulsed, continuous wave, and color Doppler before and after percutaneous transseptal valvuloplasty. New atrial septal defects were detected in 14 patients, and the patients were monitored for up to 320 days after the procedure. The diameter of the defect, best evaluated by the transesophageal approach, was 3 to 15 mm. A narrow, high velocity (1.4 to 3.1 meters per second) left-to-right shunt jet was detected in 13 of 14 patients. The shunt jet was continuous in nine of 14 patients, late systolic-holodiastolic in four patients, and bidirectional in one patient. Cardiac catheterization in nine patients confirmed the Doppler findings and demonstrated a peak pressure gradient of 10 to 32 mm Hg between the left and right atria. Oximetry revealed a calculated pulmonary to systemic flow ratio ranging from 2.3:1 in the patient with the largest atrial septal defect by echocardiography to 1:1 (no oxygen saturation step-up) in the patient with the smallest atrial septal defect. In the three patients who underwent cardiac surgery, the operative findings confirmed those of echocardiography. We concluded that atrial septal defects are common after transseptal valvuloplasty. Usually, their relatively small size and the underlying valvular disease that produces high left atrial pressure are responsible for the high pressure gradient between the left and right atria. This results in the high velocity and continuous shunt jet detected by Doppler echocardiography
— id: 63046, year: 1990, vol: 3, page: 64, stat: Journal Article,

The association between unusually large eustachian valves and atrioventricular valvular prolapse
Schrem SS; Freedberg RS; Gindea AJ; Kronzon I
1990 Jul;120(1):204-206, American heart journal
— id: 64556, year: 1990, vol: 120, page: 204, stat: Journal Article,

Vegetations on endocardial surfaces struck by regurgitant jets: diagnosis by transesophageal echocardiography
Schwinger ME; Tunick PA; Freedberg RS; Kronzon I
1990 May;119(5):1212-1215, American heart journal
— id: 63044, year: 1990, vol: 119, page: 1212, stat: Journal Article,

The anatomy of the interatrial septum: a transesophageal echocardiographic study
Schwinger, M E; Gindea, A J; Freedberg, R S; Kronzon, I
1990 Jun;119(6):1401-1405, American heart journal
Transesophageal echocardiography provides a unique view of the IAS. We reviewed results of 119 transesophageal studies (1) to study the detailed anatomy of the IAS, and (2) to determine the thickness of the IAS at different times during the cardiac cycle, (3) the effect of age, and (4) the thickness of the IAS in relation to various disease states. From the transesophageal view the IAS extends from the right posteriorly toward the left and anteriorly. The more inferior aspect of the septum courses in a more direct posteroanterior direction and is more difficult to accurately visualize. The IAS is thickest peripherally and gradually narrows toward the more centrally located fossa ovalis. A region of constant thickness is frequently present between the most peripheral aspect of the IAS and the fossa ovalis. We standardized the measurement of the thickness of the septum by measuring it only at this region of constant thickness in the plane that visualized the fossa ovalis. The mean thickness at this point was 6 +/- 2 mm. The thickness correlated weakly with the age of the patient. These results agree with previously published autopsy findings. Thickness was not affected by the presence of significant disease of the atrioventricular valves, atrial fibrillation, or an atrial septal defect. However, the thickness increased to 7 +/- 2 mm with atrial contraction during sinus rhythm (p less than 0.0001). The mean thickness of the septum primum covering the fossa ovalis was 1.8 +/- 0.7 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 100103, year: 1990, vol: 119, page: 1401, stat: Journal Article,

Dynamic left ventricular outflow obstruction after aortic valve replacement: a Doppler echocardiographic study
Schwinger, M E; O'Brien, F; Freedberg, R S; Kronzon, I
1990 May-Jun;3(3):205-208, Journal of the American Society of Echocardiography
An 81-year-old woman with severe symptomatic aortic stenosis underwent aortic valve replacement. The postoperative course was complicated by new subvalvular left ventricular outflow tract obstruction created by systolic anterior motion of the anterior mitral leaflet. The condition was recognized by echocardiography and was successfully treated medically
— id: 100105, year: 1990, vol: 3, page: 205, stat: Journal Article,

TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN AWAKE PATIENTS - A REVIEW OF 100 CONSECUTIVE CASES
Schwinger, ME; Tunick, PA; Goldfarb, A; Freedberg, RS; Kronzon, I
1990 Nov-Dec;4(6):321-330, American journal of noninvasive cardiology
— id: 31907, year: 1990, vol: 4, page: 321, stat: Journal Article,

Cardiac findings in the very elderly: analysis of echocardiography in fifty-eight nonagenarians
Tunick PA; Freedberg RS; Kronzon I
1990 ;36(4):206-211, Gerontology
Although the effects of aging on the heart have been reviewed, these reviews are primarily based on autopsy findings. We report the echocardiographic and Doppler findings in 58 patients over the age of 90. Half of the patients had enlarged left atria, but the large majority had normal-sized ventricles and aortic roots. Left ventricular wall motion was normal or increased in 71% and 52% had left ventricular hypertrophy. Aortic stenosis (all grades) was present in 31%. Other valve lesions are reviewed. None of our patients had a completely normal echocardiogram, even when mild valvular regurgitation is considered normal
— id: 63048, year: 1990, vol: 36, page: 206, stat: Journal Article,

Unusual mitral annular vegetation diagnosed by transesophageal echocardiography
Tunick PA; Freedberg RS; Schrem SS; Kronzon I
1990 Aug;120(2):444-446, American heart journal
— id: 63041, year: 1990, vol: 120, page: 444, stat: Journal Article,

Paraesophageal hernia may prevent cardiac imaging by transesophageal echocardiography
Freedberg RS; Weinreb J; Gluck M; Kronzon I
1989 May-Jun;2(3):202-203, Journal of the American Society of Echocardiography
— id: 10657, year: 1989, vol: 2, page: 202, stat: Journal Article,

Left ventricular outflow tract obstruction
Freedberg, R S; Kronzon, I
1989 Oct;18(2):129-129, Catheterization & cardiovascular diagnosis
— id: 100106, year: 1989, vol: 18, page: 129, stat: Journal Article,

Pulmonic valve replacement for pulmonic insufficiency one year after mitral valve replacement
Gindea AJ; Freedberg RS; Culliford A; Tunick PA
1989 Aug;89(7):422-423, New York state journal of medicine
— id: 45691, year: 1989, vol: 89, page: 422, stat: Journal Article,

Dehiscence of a Carpentier mitral ring: diagnosis by transesophageal echocardiography
Gindea AJ; Schwinger M; Freedberg RS; Colvin SB; Kronzon I
1989 Oct;118(4):841-843, American heart journal
— id: 10463, year: 1989, vol: 118, page: 841, stat: Journal Article,

The contribution of magnetic resonance imaging to the evaluation of intracardiac tumors diagnosed by echocardiography
Freedberg RS; Kronzon I; Rumancik WM; Liebeskind D
1988 Jan;77(1):96-103, Circulation
MAgnetic resonance (MR) imaging was performed in 14 patients with intracavitary cardiac tumors diagnosed by echocardiography. Except in the patients whose echocardiograms were diagnostic of atrial myxomas, this modality contributed important additional anatomic information regarding the tumor's relationship to the normal intracardiac structures and/or its extension to the adjacent vascular and mediastinal structures. The MR findings correlated extremely well with the findings in all 12 patients who underwent surgical exploration or postmortem examination, and in the other two patients, MR guided the decision to obtain transvenous biopsy samples of their right heart masses
— id: 11226, year: 1988, vol: 77, page: 96, stat: Journal Article,

Unusual cardiac metastasis in hypernephroma: the complementary role of echocardiography and magnetic resonance imaging
Gindea AJ; Gentin B; Naidich DP; Freedberg RS; McCauley D; Kronzon I
1988 Nov;116(5 Pt 1):1359-1361, American heart journal
— id: 10902, year: 1988, vol: 116, page: 1359, stat: Journal Article,

The usefulness of echocardiography in a long term health care facility
Kronzon, I; Freedberg, R S; Khan, B; Cohen, M L; Berger, A; Weiss, E C
1988 Jul;88(7):357-359, New York state journal of medicine
— id: 100110, year: 1988, vol: 88, page: 357, stat: Journal Article,

Echocardiographic diagnosis of bland thrombus on an aortic valve
Schrem S; Freedberg RS; Culliford AJ; Kronzon I
1988 Jul-Aug;1(4):271-272, Journal of the American Society of Echocardiography
Echocardiography is a valuable modality for imaging thrombi and vegetations. Although patients with systemic lupus erythematosus may develop Libman-Sacks endocarditis, in which punctate verrucous plaques are found histologically on valvular endocardial tissue, these lesions are ordinarily too small for ultrasonic imaging. We describe a patient with systemic lupus erythematosus complicated by systemic embolization, who had a large mobile aortic valve thrombus, which was discovered with the aid of echocardiography and was confirmed by surgical resection
— id: 11040, year: 1988, vol: 1, page: 271, stat: Journal Article,

Cardiogenic shock due to antihistamine overdose. Reversal with intra-aortic balloon counterpulsation
Freedberg RS; Friedman GR; Palu RN; Feit F
1987 Feb 6;257(5):660-661, JAMA
— id: 35864, year: 1987, vol: 257, page: 660, stat: Journal Article,

Herpes simplex pericarditis in AIDS
Freedberg RS; Gindea AJ; Dieterich DT; Greene JB
1987 May;87(5):304-306, New York state journal of medicine
— id: 14727, year: 1987, vol: 87, page: 304, stat: Journal Article,

Noninvasive diagnosis of left ventricular outflow tract obstruction caused by a porcine mitral prosthesis
Freedberg RS; Kronzon I; Gindea AJ; Culliford AT; Tunick PA
1987 Mar;9(3):698-700, Journal of the American College of Cardiology
A patient developed shortness of breath 8 years after mitral valve replacement with a porcine prosthesis. Doppler echocardiography revealed left ventricular outflow tract obstruction created by a protruding prosthesis
— id: 28924, year: 1987, vol: 9, page: 698, stat: Journal Article,

LATE RESULTS OF CARPENTIER TECHNIQUE FOR MITRAL-VALVE RECONSTRUCTION IN 148 PATIENTS WITH MITRAL-INSUFFICIENCY
Galloway, AC; Colvin, SB; Baumann, FG; Esposito, R; Vohra, R; Harty, S; Freedberg, R; Kronzon, I; Spencer, FC
1987 Oct;76(4):445-445, Circulation
— id: 31117, year: 1987, vol: 76, page: 445, stat: Journal Article,