Itzhak Kronzon, M.D.

Utility of combined two-dimensional and three-dimensional transesophageal imaging for catheter-based mitral valve clip repair of mitral regurgitation
Biner, Simon; Perk, Gila; Kar, Saibal; Rafique, Asim M; Slater, James; Shiota, Takahiro; Hussaini, Asma; Chou, Stanley; Kronzon, Itzhak; Siegel, Robert J
2011 Jun;24(6):611-617, Journal of the American Society of Echocardiography
BACKGROUND: Catheter-based mitral valve clip repair (CBMCR) is feasible for selected patients with mitral regurgitation (MR). Two-dimensional (2D) transesophageal echocardiography (TEE) is the standard modality for evaluating MR and procedural guidance. Recently, real-time three-dimensional TEE became available. The aim of this study was to evaluate the value of combined 2D and three-dimensional TEE for CBMCR. In evaluating MR for CBMCR, the confidence of interpretation of 2D TEE was compared with that of combined imaging for the localization of major valve pathology. In patients who underwent CBMCR, the outcomes and the duration of CBMCR were compared. METHODS: In this retrospective study, MR evaluation was performed by 2D TEE alone and by combined imaging in 80 and 57 patients, respectively. CBMCR was guided by 2D TEE alone in 20 patients and by combined imaging in 39 patients. RESULTS: Examination by combined imaging allowed en face visualization of mitral valve anatomy and MR jet origin. The confidence of interpretation by combined imaging was higher than for 2D TEE (1.1 +/- 0.3 vs 1.8 +/- 0.7, P < .001).The guidance of CBMCR by combined imaging facilitated alignment of the catheter trajectory, clip positioning, and orientation of clip arms. The procedural success and final MR grade were not different between the two study groups. However, the procedural time of CBMCR using combined imaging compared with that using 2D TEE guidance alone was shorter (241 +/- 58 vs 201 +/- 68 min, P = .035). CONCLUSIONS: The use of combined imaging compared with 2D TEE alone appears to enhance the confidence of interpretation concerning mitral pathology and catheter-clip system location and may also reduce CBMCR time
— id: 134181, year: 2011, vol: 24, page: 611, stat: Journal Article,

Bilateral left-sidedness heterotaxy syndrome
Danilov, Tatyana; Saric, Muhamed; Srichai, Monvadi B; Kronzon, Itzhak
2011 Jun 28;58(1):87-87, Journal of the American College of Cardiology
— id: 134728, year: 2011, vol: 58, page: 87, stat: Journal Article,

Inside and out: an epicardial lead gone astray
Hong, Susie N; Rosenzweig, Barry; Crooke, Gregory A; Kronzon, Itzhak; Srichai, Monvadi B
2011 ;38(2):204-205, Texas Heart Institute journal
— id: 133461, year: 2011, vol: 38, page: 204, stat: Journal Article,

Cholesterol embolization syndrome
Saric, Muhamed; Kronzon, Itzhak
2011 Nov;26(6):472-479, Current opinion in cardiology
PURPOSE OF REVIEW: To describe cholesterol embolization syndrome (CES) and its risk factors, pathophysiology, clinical presentation, diagnosis and treatment. RECENT FINDINGS: To date, no specific diagnostic test (other than biopsy) for CES has been developed. Effective treatments for CES are yet to be developed. SUMMARY: CES (also referred to as cholesterol crystal embolization, atheromatous embolization or atheroembolism) occurs when cholesterol crystals and other contents of an atherosclerotic plaque embolize from a large proximal artery to smaller distal arteries, causing ischemic end-organ damage. Clinical manifestations of CES include constitutional symptoms (fever, anorexia, weight loss, fatigue and myalgias), signs of systemic inflammation (anemia, thrombocytopenia leukocytosis, high erythrocyte sedimentation rate, elevated levels of C-reactive protein, hypocomplementemia), hypereosinophilia, eosinophiluria, acute onset of diffuse neurologic deficit, amaurosis fugax, acute renal failure, gut ischemia, livedo reticularis and blue-toe syndrome. CES may occur spontaneously or after an arterial procedure. There is no specific laboratory test for CES. Retinal exam demonstrating Hollenhorst plaques supports the diagnosis of CES. Biopsy of target organs (usually skin, skeletal muscles or kidneys) is the only means of confirming the diagnosis of CES. Treatment consists of supportive care and general management of atherosclerosis and arterial ischemia
— id: 139476, year: 2011, vol: 26, page: 472, stat: Journal Article,

A giant pericardial cyst
Thanneer, Latha; Saric, Muhamed; Perk, Gila; Mason, Derek; Kronzon, Itzhak
2011 Apr 26;57(17):1784-1784, Journal of the American College of Cardiology
— id: 131817, year: 2011, vol: 57, page: 1784, stat: Journal Article,

Three-dimensional echocardiography in the assessment of prosthetic valves
Tsang, Wendy; Weinert, Lynn; Kronzon, Itzhak; Lang, Roberto M
2011 Jan;64(1):1-7, Revista espanola de cardiologica
— id: 122117, year: 2011, vol: 64, page: 1, stat: Journal Article,

Carcinoid heart disease
Hong, Susie N; Saric, Muhamed; Kronzon, Itzhak
2010 May 4;55(18):1996-1996, Journal of the American College of Cardiology
— id: 109565, year: 2010, vol: 55, page: 1996, stat: Journal Article,

Uncommon Doppler echocardiographic findings of severe pulmonic insufficiency
Jhaveri, Rahul R; Saric, Muhamed; Kronzon, Itzhak
2010 Oct;23(10):1071-1075, Journal of the American Society of Echocardiography
BACKGROUND: Two-dimensional and Doppler echocardiography are standard methods to assess the severity of pulmonic insufficiency (PI). However, methods to define severity of
— id: 113656, year: 2010, vol: 23, page: 1071, stat: Journal Article,

Images and case reports in interventional cardiology. Left atrial hypertension as a result of occlusion of a patent foreman ovale
Kim, Eugene; Slater, James N; Kronzon, Itzhak
2010 Jun 1;3(3):e4-e5, Circulation: Cardiovascular Interventions
— id: 110106, year: 2010, vol: 3, page: e4, stat: Journal Article,

Diagnosing patent foramen ovale: too little or too much?
Kronzon, Itzhak; Ruiz, Carlos E
2010 Apr;3(4):349-351, JACC: Cardiovascular Imaging
— id: 122118, year: 2010, vol: 3, page: 349, stat: Journal Article,

Cholesterol embolization syndrome
Kronzon, Itzhak; Saric, Muhamed
2010 Aug 10;122(6):631-641, Circulation
— id: 111595, year: 2010, vol: 122, page: 631, stat: Journal Article,

Carney's complex
Pursnani, Amit K; Levy, Natalie K; Benito, Maryellen; Hong, Susie N; Srichai, Monvadi B; Yee, Herman; Kronzon, Itzhak
2010 Mar 30;55(13):1395-1395, Journal of the American College of Cardiology
— id: 114156, year: 2010, vol: 55, page: 1395, stat: Journal Article,

Acquired gerbode defect after aortic valve replacement
Pursnani, Amit K; Tabaksblat, Martin; Saric, Muhamed; Perk, Gila; Loulmet, Didier; Kronzon, Itzhak
2010 Jun 22;55(25):e145-e145, Journal of the American College of Cardiology
— id: 110667, year: 2010, vol: 55, page: e145, stat: Journal Article,

Normal intima-media thickness on carotid ultrasound reliably excludes an ischemic cause of cardiomyopathy
Reynolds, Harmony R; Steckman, David A; Tunick, Paul A; Kronzon, Itzhak; Lobach, Iryna; Rosenzweig, Barry P
2010 Jun;159(6):1059-1066, American heart journal
BACKGROUND: Coronary artery disease (CAD) is the most common cause of left ventricular systolic dysfunction (LVSD). Patients with ischemia as the cause of LVSD may warrant revascularization. Angiography is the most accurate method of CAD diagnosis but is invasive, expensive, and associated with some risk. Noninvasive imaging for CAD often involves expensive equipment, radiation exposure, medication, and/or contrast administration. Carotid ultrasound with measurement of intima-media thickness (IMT) is safe and inexpensive. Carotid IMT is well correlated with the presence of CAD. We assessed the accuracy of carotid ultrasound for identification of CAD as a potential etiology of LVSD. METHODS: Patients with LVSD (ejection fraction < or =40%) of uncertain etiology referred for angiography underwent carotid ultrasound. Patients with history of myocardial infarction were excluded. Two experienced cardiologists blinded to CAD status determined common carotid artery (CCA) IMT and plaque. Significant CAD was defined as > or =50% stenosis of any major artery. Ischemic LVSD was defined as (1) left main and/or proximal left anterior descending coronary artery > or =75% or (2) > or =2 major arteries with > or =75% stenosis. RESULTS: Mean ejection fraction was 27% +/- 10% in 150 patients. Significant CAD was found in 64 (42.7%) and ischemic LVSD in 40 (26.7%). Carotid plaque was seen in 95 (63.3%). Mean CCA IMT was > or =0.9 mm in 69 (46.0%). The combination of mean CCA IMT <0.9 mm and no plaque had negative predictive value for ischemic LVSD of 98%. CONCLUSIONS: Carotid ultrasound with IMT measurement is a valuable screening tool for excluding an ischemic etiology of LVSD when CAD is suspected
— id: 110089, year: 2010, vol: 159, page: 1059, stat: Journal Article,

Closure of prosthetic paravalvular leaks: a long way to go
Ruiz, Carlos E.; Cohen, Howard; Del Valle-Fernandez, Raquel; Gila Perk, Vladimir Jelnin; Kronzon, Itzhak
2010 SEP ;12(E):E52-E62, European heart journal supplements
— id: 113927, year: 2010, vol: 12, page: E52, stat: Journal Article,

Imaging atrial septal defects by real-time three-dimensional transesophageal echocardiography: step-by-step approach
Saric, Muhamed; Perk, Gila; Purgess, Jan R; Kronzon, Itzhak
2010 Nov;23(11):1128-1135, Journal of the American Society of Echocardiography
BACKGROUND: There are currently no standardized three-dimensional (3D) transesophageal echocardiographic (TEE) views of the interatrial septum and atrial septal defects (ASDs). Without a standardized approach, it is difficult to ascertain the important anatomic relationships (such as the location of the aortic rim of an ASD), to perform relevant measurements (such as the size of an ASD or the size of its rims), or to guide the deployment of catheters and devices during atrial septal closure. METHODS: Using a 3D TEE matrix-array transducer, 706 TEE studies were performed over a 14-month period. The purpose of the study was to develop a standardized protocol for anatomically correct orientation of 3D TEE images of the interatrial septum and ASDs. RESULTS: Among 706 TEE studies, there were 23 patients with ASDs, representing 3.3% of the study population. Eighteen patients had secundum ASDs, two had primum ASDs, and three had sinus venosus ASDs of the superior vena cava type. A protocol for properly orienting 3D TEE images of the interatrial septum and ASDs was developed. When the images are acquired at an angle of 0 degrees , the septum is properly oriented by the tilt-up-then-left maneuver. The initial 3D TEE image in first tilted up to reveal the right atrial side of the septum. Then the image is tilted 180 degrees around its vertical axis to reveal the left atrial side of the septum; the aortic rim is on the left, the superior vena cava on the top, and the right-sided pulmonary vein ostia on the right side of the screen. For acquisitions at a higher angle, the rotate-left-in-z-axis maneuver is used. The image is first tilted up to reveal the right atrial side of the septum, as in the tilt-up-then-left maneuver. The image is then rotated counterclockwise in the z axis until the superior vena cave is at 12 o'clock. Finally, the image is tilted 180 degrees around its vertical axis to reveal the left atrial side of the septum. CONCLUSIONS: The use of standardized tilt-up-then-left and rotate-left-in-z-axis maneuvers enhances the diagnosis of ASDs, ascertains the important anatomic relationships of ASDs to surrounding structures, and facilitates communication between echocardiographers obtaining 3D TEE images and interventional cardiologists or cardiac surgeons performing ASD closures
— id: 114045, year: 2010, vol: 23, page: 1128, stat: Journal Article,

Continuing medical education program in echocardiography
Fan P.; Skolnick A.; Vavas E.; Kronzon I.
2009 ;26(2):232-, Echocardiography
— id: 92204, year: 2009, vol: 26, page: 232, stat: Journal Article,

The Added Value of Real Time, Three Dimensional Transesophgeal Echocardiography in the Evaluation of Thoracic Aortic Atherosclerosis
Frankel, Z; Varkey, M; Perk, G; Kronzon, I
2009 NOV 3 ;120(18):S360-S360, Circulation
— id: 106969, year: 2009, vol: 120, page: S360, stat: Journal Article,

Percutaneous closure of a post-myocardial infarction ventricular septal defect guided by real-time three-dimensional echocardiography
Halpern, Dan G; Perk, Gila; Ruiz, Carlos; Marino, Nino; Kronzon, Itzhak
2009 Jun;10(4):569-571, European journal of echocardiography
We present an adult patient who had an acute myocardial infarction complicated by a ventricular septal defect and had it repaired percutaneously. Real-time three-dimensional echocardiography (RT3D) before and during the closure procedure were performed. RT3D provided anatomical and functional information of the defect as well as real-time guidance during the procedure. This case highlights the utility of three-dimensional echocardiography in guiding transcatheter procedures
— id: 95766, year: 2009, vol: 10, page: 569, stat: Journal Article,

Echocardiographic manifestations of complications of radiation therapy
Hamza, Anna; Tunick, Paul A; Kronzon, Itzhak
2009 Jul;26(6):724-728, Echocardiography
Radiation therapy may affect all of the layers of the heart (epicardial arteries, pericardium, valves, and myocardium). This is especially true after mediastinal or breast irradiation. Coronary artery disease, with resultant myocardial infarction, is the most common cause of death. We present a patient who developed typical constrictive pericarditis as well as valve lesions typical of radiation toxicity (the mitral valve leaflets were thickened at their bases, with the tips spared). The pericardial constriction was manifested by all of the typical echo Doppler findings, namely septal bounce, dilated inferior vena cava, significant respiratory drop in inspiratory mitral E velocity with a normal tissue Doppler e', and expiratory reversal of flow into the hepatic veins
— id: 100672, year: 2009, vol: 26, page: 724, stat: Journal Article,

The Incremental Value of Real-Time 3-Dimensional Transesophageal Echocardiography in the Evaluation of Intracardiac Wire Related Infective Endocarditis
Hong, SS; Lang, RM; Perk, G; Weinert, L; Sugeung, L; Kronzon, I
2009 NOV 3 ;120(18):S387-S387, Circulation
— id: 106970, year: 2009, vol: 120, page: S387, stat: Journal Article,

Evaluation of a posterior mitral valve leaflet aneurysm by real time three-dimensional transesophageal echocardiography
Hong, Susie N; Perk, Gila; Skolnick, Adam; Kronzon, Itzhak
2009 Oct;26(9):1089-1091, Echocardiography
Posterior mitral valve (MV) leaflet aneurysms are extremely rare complications of infective endocarditis (IE). When MV aneurysms occur, they usually involve the anterior leaflet. Real time three-dimensional transesophageal echocardiography (RT3D TEE) has been recently developed and provides views of unparalleled quality by optimizing visualization of spatial relationships. We present a rare case of a posterior MV leaflet aneurysm due to IE in a 64-year-old woman, best visualized by RT3D TEE
— id: 104732, year: 2009, vol: 26, page: 1089, stat: Journal Article,

PRO: Intraoperative Doppler tissue imaging is a valuable addition to cardiac anesthesiologists' armamentarium
Kronzon, Itzhak
2009 Jan;108(1):37-40, Anesthesia & analgesia
— id: 93516, year: 2009, vol: 108, page: 37, stat: Journal Article,

The many faces of strain
Kronzon, Itzhak
2009 Mar;26(3):297-298, Echocardiography
— id: 100051, year: 2009, vol: 26, page: 297, stat: Journal Article,

Real-time 3-dimensional transesophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence
Kronzon, Itzhak; Sugeng, Lissa; Perk, Gila; Hirsh, David; Weinert, Lynn; Garcia Fernandez, Miguel Angel; Lang, Roberto M
2009 Apr 28;53(17):1543-1547, Journal of the American College of Cardiology
OBJECTIVES: This study sought to assess the use of real-time (RT) 3-dimensional (3D) transthoracic and transesophageal echocardiography (TEE) in the evaluation of post-operative mitral valve dehiscence. BACKGROUND: Mitral valve replacement or repair may be complicated by post-operative dehiscence of the valve or annuloplasty ring resulting in clinically significant mitral regurgitation or hemolysis. Diagnosis is generally performed using 2-dimensional transthoracic echocardiography and TEE. Recently, an RT 3D TEE probe has been developed to produce high-quality real-time images. METHODS: We used RT 3D TEE to evaluate mitral regurgitation after mitral valve repair or replacement as a result of mitral ring dehiscence. We studied the additional information and diagnostic utility provided by RT 3D TEE. RESULTS: Eighteen patients were studied (8 patients after repair and 10 after replacement). Real-time 3D TEE allowed accurate evaluation of the pathology, including definition of the type of ring or prosthesis used; description of the site, size, shape, and area of the dehisced segment; and clear definition of the origin of the mitral regurgitation. CONCLUSIONS: In mitral valve dehiscence, RT 3D TEE provides additional information about the exact anatomic characteristics of the dehiscence that can be used to help in planning the most appropriate corrective intervention
— id: 99592, year: 2009, vol: 53, page: 1543, stat: Journal Article,

Pericardial and pleural effusions in congestive heart failure-anatomical, pathophysiologic, and clinical considerations
Natanzon, Alex; Kronzon, Itzhak
2009 Sep;338(3):211-216, American journal of the medical sciences
Transudative pleural and pericardial effusions are not uncommon in patients with congestive heart failure. Pericardial effusion forms only with elevation of the right-sided filling pressure in the heart. In patients with biventricular failure, there is no evidence that elevated left-sided pressure, in the absence of elevated right-sided pressure, can cause a pericardial effusion. Pleural effusion forms with acute elevation of the right-sided or the left-sided filling pressure in the heart. In patients with congestive heart failure, elevated right-sided filling pressures are less common than elevated left-sided filling pressures, thus, explaining a lower prevalence of pericardial than pleural effusions. Pleural effusions in patients with congestive heart failure are typically bilateral. However, a unilateral pleural effusion is more commonly seen on the right side. Although multiple theories attempt to explain the right-sided preponderance of pleural effusion, to date, no mechanism has been universally accepted or experimentally proven
— id: 102398, year: 2009, vol: 338, page: 211, stat: Journal Article,

Amounts of aortic atherosclerosis in patients with aortic stenosis as determined by transesophageal echocardiography
Osranek, Martin; Pilip, Adelbert; Patel, Paragh R; Molisse, Theresa; Tunick, Paul A; Kronzon, Itzhak
2009 Mar 1;103(5):713-717, American journal of cardiology
We quantified the graded amounts of aortic atherosclerosis (AA) in patients with aortic stenosis (AS) to better delineate the need for preprocedural risk stratification. Complex AA is strongly related to embolic events, especially during open heart surgery and catheterization. Despite the frequency of these procedures in patients with AS and the increased prevalence of atherosclerosis, current guidelines do not recommend screening for AA. Patients with concomitant transesophageal and transthoracic echocardiograms were retrospectively identified. AS and AA were graded by expert reviewers as mild, moderate, and severe according to established guidelines. Three hundred sixty patients (212 men, mean age 69 +/- 14 years) were identified, 186 (52%) without AS, 82 (23%) with mild AS, 55 (15%) with moderate AS, and 37 (10%) with severe AS. There was a strong graded positive association between AA and AS (p <0.00001). The prevalence of severe AA increased across grades of AS. Of all patients with severe AS, 54% had severe AA. Of patients with severe AS not referred for an embolic event, 57% had severe AA. The odds ratio for severe AA was 4.9 (95% confidence interval 2.3 to 10.3) in patients with severe AS compared with without AS. In conclusion, AS and AA are closely correlated. The majority of patients with severe AS have severe AA, even without previous thromboembolic events. This significant atherosclerotic burden may warrant preprocedural risk assessment with transesophageal echocardiography
— id: 95049, year: 2009, vol: 103, page: 713, stat: Journal Article,

Non-Doppler two dimensional strain imaging for evaluation of coronary artery disease
Perk, Gila; Kronzon, Itzhak
2009 Mar;26(3):299-306, Echocardiography
Over the recent years, strain echocardiography has emerged as a quantitative technique for the evaluation of global and segmental cardiac function. Strain is a measure of deformation, expressed as a percent change in a segment's length compared to its predeformation length. Strain rate (SR) is the local rate of deformation or strain per unit time. Recently non-Doppler two dimensional strain imaging has been developed. This technique is based on tracking ultrasonic speckles from the two dimensional echocardiographic images. These speckles are followed over a number of successive frames, and myocardial velocity is calculated by measuring frame-to-frame changes. This technique is independent of the Doppler angle of incidence and allows measurement of several vectors of strain within myocardial tissue. Non-Doppler strain is a powerful tool, enabling detection of subtle abnormalities in myocardial function. Current evidence shows that non-Doppler strain imaging may allow identification of the early changes that occur with ischemic insult to the myocardium. It may also provide a tool for identification of scarred, non-viable myocardium, with similar accuracy to that of cardiac MRI. Non-Doppler strain imaging is likely to become a standard tool in the evaluation of patients with ischemic heart disease
— id: 100050, year: 2009, vol: 26, page: 299, stat: Journal Article,

Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions
Perk, Gila; Lang, Roberto M; Garcia-Fernandez, Miguel Angel; Lodato, Joe; Sugeng, Lissa; Lopez, John; Knight, Brad P; Messika-Zeitoun, David; Shah, Sanjiv; Slater, James; Brochet, Eric; Varkey, Mathew; Hijazi, Ziyad; Marino, Nino; Ruiz, Carlos; Kronzon, Itzhak
2009 Aug;22(8):865-882, Journal of the American Society of Echocardiography
BACKGROUND: Real-time three-dimensional (RT3D) echocardiography is a recently developed technique that is being increasingly used in echocardiography laboratories. Over the past several years, improvements in transducer technologies have allowed development of a full matrix-array transducer that allows acquisition of pyramidal-shaped data sets. These data sets can be processed online and offline to allow accurate evaluation of cardiac structures, volumes, and mass. More recently, a transesophageal transducer with RT3D capabilities has been developed. This allows acquisition of high-quality RT3D images on transesophageal echocardiography (TEE). Percutaneous catheter-based procedures have gained growing acceptance in the cardiac procedural armamentarium. Advances in technology and technical skills allow increasingly complex procedures to be performed using a catheter-based approach, thus obviating the need for open-heart surgery. METHODS: The authors used RT3D TEE to guide 72 catheter-based cardiac interventions. The procedures included the occlusion of atrial septal defects or patent foramen ovales (n=25), percutaneous mitral valve repair (e-valve clipping; n=3), mitral balloon valvuloplasty for mitral stenosis (n=10), left atrial appendage obliteration (n=11), left atrial or pulmonary vein ablation for atrial fibrillation (n=5), percutaneous closures of prosthetic valve dehiscence (n=10), percutaneous aortic valve replacement (n=6), and percutaneous closures of ventricular septal defects (n=2). In this review, the authors describe their experience with this technique, the added value over multiplanar two-dimensional TEE, and the pitfalls that were encountered. RESULTS: The main advantages found for the use RT3D TEE during catheter-based interventions were (1) the ability to visualize the entire lengths of intracardiac catheters, including the tips of all catheters and the balloons or devices they carry, along with a clear depiction of their positions in relation to other cardiac structures, and (2) the ability to ability to demonstrate certain structures in an 'en face' view, which is not offered by any other currently available real-time imaging technique, enabling appreciation of the exact nature of the lesion that is undergoing intervention. CONCLUSION: RT3D TEE is a powerful new imaging tool that may become the technique of choice and the standard of care for guidance of selected percutaneous catheter-based procedures
— id: 101330, year: 2009, vol: 22, page: 865, stat: Journal Article,

The wishful thinking of indirect mitral annuloplasty: will it ever become a reality?
Ruiz, Carlos E; Kronzon, Itzhak
2009 Aug;2(4):271-272, Circulation: Cardiovascular Interventions
— id: 122119, year: 2009, vol: 2, page: 271, stat: Journal Article,

Transient apical ballooning syndrome precipitated by dobutamine stress testing
Skolnick, Adam H; Michelin, Krista; Nayar, Ambika; Fisher, Daniel; Kronzon, Itzhak
2009 Apr 7;150(7):501-502, Annals of internal medicine
— id: 100049, year: 2009, vol: 150, page: 501, stat: Journal Article,

Osteoporosis treatment and progression of aortic stenosis
Skolnick, Adam H; Osranek, Martin; Formica, Philip; Kronzon, Itzhak
2009 Jul 1;104(1):122-124, American journal of cardiology
A decrease in bone mineral density has been reported to be associated with increased progression of aortic stenosis (AS). We hypothesized that osteoporosis treatment (OT) is associated with decreased progression of AS. We performed an observational study of patients with AS from our echocardiographic database comparing 18 patients on OT (bisphosphonates, calcitonin, or estrogen receptor modulators) with 37 patients not on OT. All patients had serial echocardiograms. Patients with mitral stenosis, aortic valve replacement, renal failure, calcium disorders, or left ventricular ejection fraction <40% were excluded. Aortic valve area (AVA) was calculated using the continuity equation. There was no significant difference in age, gender, renal function, hypertension, statin use, diabetes, or calcium level between the 2 groups. Mean baseline AVA was 1.33 cm(2) and not significantly different between groups. After a mean of 2.4 +/- 1.0 years, mean annual changes in AVA were -0.22 +/- 0.22 cm(2) in those not on OT and -0.10 +/- 0.18 cm(2) in patients receiving OT (p = 0.025). There was a graded association between AS progression rate and OT. In a multivariable analysis including age, gender, and statin use, only OT was associated with a change in AVA. In conclusion, OT is strongly and independently associated with decreased progression of AS. This association warrants investigation in a larger, prospective study
— id: 100627, year: 2009, vol: 104, page: 122, stat: Journal Article,

Optimization of ASD assessment using real time three-dimensional transesophageal echocardiography
Skolnick, Adam; Vavas, Eleni; Kronzon, Itzhak
2009 Feb;26(2):233-235, Echocardiography
— id: 95767, year: 2009, vol: 26, page: 233, stat: Journal Article,

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,

Correlation between plasma osteopontin levels and aortic valve calcification: potential insights into the pathogenesis of aortic valve calcification and stenosis
Yu, Pey-Jen; Skolnick, Adam; Ferrari, Giovanni; Heretis, Katherine; Mignatti, Paolo; Pintucci, Giuseppe; Rosenzweig, Barry; Diaz-Cartelle, Juan; Kronzon, Itzhak; Perk, Gila; Pass, Harvey I; Galloway, Aubrey C; Grossi, Eugene A; Grau, Juan B
2009 Jul;138(1):196-199, Journal of thoracic & cardiovascular surgery
OBJECTIVE: The inflammatory process of aortic stenosis involves the differentiation of aortic valve myofibroblasts into osteoblasts. Osteopontin, a proinflammatory glycoprotein, both stimulates differentiation of myofibroblasts and regulates the deposition of calcium by osteoblasts. Osteopontin levels are increased in patients with such conditions as end-stage renal disease, ectopic calcification, and autoimmune disease. We hypothesized that increased plasma osteopontin levels might be associated with the presence of aortic valve calcification and stenosis. METHODS: Venous blood from volunteers older than 65 years undergoing routine echocardiographic analysis or aortic valve surgery for aortic stenosis was collected. Plasma osteopontin levels were measured by means of enzyme-linked immunosorbent assay. The presence of aortic stenosis was defined as an aortic valve area of less than 2.0 cm(2). Aortic valve calcification was assessed by using a validated echocardiographic grading system (1, none; 2, mild; 3, moderate; 4, severe). Comparisons were performed with nonpaired t tests. RESULTS: Aortic stenosis was present in 23 patients (mean age, 78 years) and was absent in 7 patients (mean age, 72 years). Aortic valve calcification scores were 3.5 +/- 0.6 and 1.3 +/- 0.5 in patients with and without aortic stenosis, respectively (P < .001). Patients with no or mild aortic valve calcification had lower osteopontin levels compared with patients with moderate or severe aortic valve calcification (406.1 +/- 165.8 vs 629.5 +/- 227.5 ng/mL, P = .01). Similarly, patients with aortic stenosis had higher osteopontin levels compared with patients without aortic stenosis (652.2 +/- 218.7 vs 379.7 +/- 159.9 ng/mL, P < .01). CONCLUSION: Increased levels of plasma osteopontin are associated with the presence of aortic valve calcification and stenosis. These findings suggest that osteopontin might play a functional role in the pathogenesis of calcific aortic stenosis
— id: 100629, year: 2009, vol: 138, page: 196, stat: Journal Article,

The 'A-dip' of diastolic mitral regurgitation: an unusual Doppler flow pattern in a patient with severe aortic insufficiency and complete heart block
Berger, Rachel Levine; Katz, Edward; Tunick, Paul; Kronzon, Itzhak
2008 Jan;9(1):69-71, European journal of echocardiography
This is an unusual case of diastolic mitral regurgitation (MR) with a high diastolic velocity jet and prolonged jet duration related to a combination of acute severe aortic insufficiency and high-degree atrioventricular block. This case illustrates an interesting hemodynamic phenomenon with multiple transient decreases in the pressure gradient between the left ventricle and left atrium during diastole related to a temporary increase in left atrial pressure associated with atrial contraction
— id: 79134, year: 2008, vol: 9, page: 69, stat: Journal Article,

The vanishing subaortic membrane
Berger, Rachel Levine; Kronzon, Itzhak
2008 Jul;9(4):569-571, European journal of echocardiography
A fixed subaortic membrane is a rare cause for left ventricular outflow tract obstruction. This case report describes an unusual echocardiographic presentation of a subaortic membrane in which the membrane, initially not seen, was identified only after a linear shadow posterior to the membrane was seen on a transesophageal echocardiogram. This represents an unusual demonstration of an ultrasound beam 'dropout' of a subaortic membrane
— id: 80818, year: 2008, vol: 9, page: 569, stat: Journal Article,

Left atrial appendage thrombus outside of a 'successful' ligation
Donnino, Robert; Tunick, Paul A; Kronzon, Itzhak
2008 May;9(3):397-398, European journal of echocardiography
A 79-year-old woman with severe aortic stenosis underwent aortic valve replacement surgery, and had ligation of the left atrial appendage (LAA) using an epicardial approach. On a post-operative echocardiographic evaluation, the distal portion of the LAA was excluded, leaving no communication with the left atrium. The proximal portion of the LAA, however, was in continuity with the circulation and a large thrombus was present within it. While previous reports of incomplete LAA ligation have involved disruption of the suture line, this present report describes a case of incomplete ligation due to persistence of the proximal portion of the appendage. Thus, thrombus formation occurred despite a 'successful' epicardial exclusion of the distal LAA
— id: 79405, year: 2008, vol: 9, page: 397, stat: Journal Article,

Three-dimensional transthoracic echocardiographic evaluation of cor triatriatum
Einav, Eldad; Perk, Gila; Kronzon, Itzhak
2008 Jan;9(1):110-112, European journal of echocardiography
We present an adult patient with cor triatriatum (CTT) due to a left atrial (LA) membrane. Two-dimensional and real-time three-dimensional transthoracic echocardiography (3DE) were performed as well as echocardiographic examination after exercise. These non-invasive modalities provided a comprehensive anatomic and hemodynamic evaluation of the anomaly
— id: 97573, year: 2008, vol: 9, page: 110, stat: Journal Article,

The effect of transvenous pacemaker and implantable cardioverter defibrillator lead placement on tricuspid valve function: an observational study
Kim, Juyong B; Spevack, Daniel M; Tunick, Paul A; Bullinga, John R; Kronzon, Itzhak; Chinitz, Larry A; Reynolds, Harmony R
2008 Mar;21(3):284-287, Journal of the American Society of Echocardiography
This study assessed the effect of transtricuspid placement of permanent pacemaker (PPM) and implantable cardioverter defibrillator (ICD) leads on tricuspid regurgitation (TR) in 248 patients with echocardiograms before and after placement. Some 21.2% of patients with baseline mild TR or less developed abnormal TR (3.4% mild-moderate, 12.8% moderate, 1.1% moderate-severe, 3.9% severe) after implant. TR worsened by 1 grade or more after implant in 24.2% (20.7% of PPMs vs. 32.4% of ICDs; P < .05). TR worsening was more common with ICDs than PPMs in patients with baseline mild TR or less. After lead implantation, abnormal TR developed in 21.2% and severe TR developed in 3.9% of patients with initially normal TR. TR worsened by at least 1 grade in 24.2%. Patients with ICDs had a higher rate of TR worsening compared with patients with PPMs (32.4% vs. 20.1%; P < .05)
— id: 76454, year: 2008, vol: 21, page: 284, stat: Journal Article,

Tricuspid prosthesis stenosis associated with endocarditis: a new M-mode finding
Logue, Michael A; Perk, Gila; Kronzon, Itzhak
2008 May;25(5):511-513, Echocardiography
A man with endocarditis was found to have prosthetic tricuspid valve (TV) stenosis without regurgitation. The large vegetation moved into the TV prosthesis orifice in diastole. A seldom-recognized echocardiographic finding was observed in which the interatrial septum bulged toward the left atrium in diastole
— id: 86541, year: 2008, vol: 25, page: 511, stat: Journal Article,

American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography
Mulvagh, Sharon L; Rakowski, Harry; Vannan, Mani A; Abdelmoneim, Sahar S; Becher, Harald; Bierig, S Michelle; Burns, Peter N; Castello, Ramon; Coon, Patrick D; Hagen, Mary E; Jollis, James G; Kimball, Thomas R; Kitzman, Dalane W; Kronzon, Itzhak; Labovitz, Arthur J; Lang, Roberto M; Mathew, Joseph; Moir, W Stuart; Nagueh, Sherif F; Pearlman, Alan S; Perez, Julio E; Porter, Thomas R; Rosenbloom, Judy; Strachan, G Monet; Thanigaraj, Srihari; Wei, Kevin; Woo, Anna; Yu, Eric H C; Zoghbi, William A
2008 Nov;21(11):1179-1201, Journal of the American Society of Echocardiography
ACCREDITATION STATEMENT: The American Society of Echocardiography (ASE) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASE designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit.trade mark Physicians should only claim credit commensurate with the extent of their participation in the activity. The American Registry of Diagnostic Medical Sonographers and Cardiovascular Credentialing International recognize the ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers. The ASE is committed to resolving all conflict-of-interest issues, and its mandate is to retain only those speakers with financial interests that can be reconciled with the goals and educational integrity of the educational program. Disclosure of faculty and commercial support sponsor relationships, if any, have been indicated. TARGET AUDIENCE: This activity is designed for all cardiovascular physicians, cardiac sonographers, and nurses with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, sonographers, and other medical professionals having a specific interest in contrast echocardiography may be included. OBJECTIVES: Upon completing this activity, participants will be able to: 1. Demonstrate an increased knowledge of the applications for contrast echocardiography and their impact on cardiac diagnosis. 2. Differentiate the available ultrasound contrast agents and ultrasound equipment imaging features to optimize their use. 3. Recognize the indications, benefits, and safety of ultrasound contrast agents, acknowledging the recent labeling changes by the US Food and Drug Administration (FDA) regarding contrast agent use and safety information. 4. Identify specific patient populations that represent potential candidates for the use of contrast agents, to enable cost-effective clinical diagnosis. 5. Incorporate effective teamwork strategies for the implementation of contrast agents in the echocardiography laboratory and establish guidelines for contrast use. 6. Use contrast enhancement for endocardial border delineation and left ventricular opacification in rest and stress echocardiography and unique patient care environments in which echocardiographic image acquisition is frequently challenging, including intensive care units (ICUs) and emergency departments. 7. Effectively use contrast echocardiography for the diagnosis of intracardiac and extracardiac abnormalities, including the identification of complications of acute myocardial infarction. 8. Assess the common pitfalls in contrast imaging and use stepwise, guideline-based contrast equipment setup and contrast agent administration techniques to optimize image acquisition
— id: 95768, year: 2008, vol: 21, page: 1179, stat: Journal Article,

A defibrillator wire vegetation: the contribution of 3D real time transesophageal echocardiography
Paley, Ari J; Kronzon, Itzhak
2008 Oct;25(9):1014-1015, Echocardiography
— id: 92171, year: 2008, vol: 25, page: 1014, stat: Journal Article,

Systolic anterior motion of a retained anterior mitral valve leaflet following mitral valve replacement
Rachofsky, Edward L; Tunick, Paul A; Kronzon, Itzhak
2008 Mar-Apr;17(2):128-129, American journal of geriatric cardiology
— id: 79380, year: 2008, vol: 17, page: 128, stat: Journal Article,

Carotid intima-media thickness measurement is an excellent screening tool for the detection of severe coronary artery disease associated with left ventricular systolic dysfunction
Reynolds, HB; Steckman, DA; Hynes, PJ; Sarswat, N; Tunick, PA; Vargas, BD; Khandwalla, RM; Kronzon, I; Rosenzweig, BP
2008 MAR 11 ;51(10):A225-A225, Journal of the American College of Cardiology
— id: 78386, year: 2008, vol: 51, page: A225, stat: Journal Article,

Fibrinous material in a pericardial effusion mimicking intraatrial thrombus
Skolnick, Adam H; Perk, Gila; Kronzon, Itzhak
2008 Jul;25(6):639-641, Echocardiography
A 74-year-old woman presented with an acute cerebrovascular infarct involving multiple vascular territories, suggestive of an embolic event. The initial transesophageal images create the impression of an echogenic mass in the left atrial appendage. A small pericardial effusion was also seen surrounding the left atrial appendage. After further views were obtained, the echogenic mass appeared to be in this fluid-filled space rather than in the appendage itself. To confirm this finding, echo contrast (Definity) was administered. After contrast injection, the left atrial appendage was opacified, while the effusion around the appendage and the echodensity within this space were not opacified. Our case highlights the utility of contrast-enhanced echocardiography in clearly delineating the boundaries of the endocardium in cases, when a pericardial effusion surrounds the left atrial appendage
— id: 86544, year: 2008, vol: 25, page: 639, stat: Journal Article,

Three-dimensional transthoracic echocardiographic evaluation of cor triatriatum
Einav E; Perk G; Kronzon I
2007 Mar 16;:?-?, European journal of echocardiography
We present an adult patient with cor triatriatum (CTT) due to a left atrial (LA) membrane. Two-dimensional and real-time-three-dimensional transthoracic echocardiography (3DE) were performed as well as echocardiographic examination after exercise. These non-invasive modalities provided a comprehensive anatomic and hemodynamic evaluation of the anomaly
— id: 73331, year: 2007, vol: , page: ?, stat: Journal Article,

Diplopia after topical pharyngeal anesthesia for transesophageal echocardiography
Einav, Eldad; Molisse, Theresa; Kronzon, Itzhak
2007 Oct;20(10):1219.e1-1219.e2, Journal of the American Society of Echocardiography
— id: 74403, year: 2007, vol: 20, page: 1219.e1, stat: Journal Article,

Masa' arokh el tokh ha-lev = Long day's journey into the heart
Kronzon, Itzhak
Tel Aviv : 'Am 'oved, 2007,
— id: 1537, year: 2007, vol: , page: , stat: ,

Evaluation of the abdominal aorta and the renal arteries with an intracardiac echocardiography probe placed in the inferior vena cava: a feasibility study
Kronzon, Itzhak; Chen, Carol; Chinitz, Larry A; Bernstein, Neil E; Slater, James N; Varkey, Mathew; Tunick, Paul A
2007 Feb;20(2):119-125, Journal of the American Society of Echocardiography
BACKGROUND: Ultrasound evaluation of the abdominal aorta and its branches is usually performed transabdominally. Not infrequently, the image quality is suboptimal. Recently, an intracardiac echocardiography probe has become commercially available. These probes are usually inserted intravenously and advanced to the right heart for diagnostic and monitoring purposes during procedures such as atrial septal defect closure and pulmonary vein isolation. Because of the close anatomic relation between the abdominal aorta and the inferior vena cava, we hypothesized that these probes would be useful in the evaluation of the abdominal aorta and the renal arteries. METHODS: Sixteen patients with normal renal function and no history of hypertension who were undergoing a pulmonary vein isolation procedure or atrial septal defect closure were studied. In each patient, the intracardiac echocardiography probe was inserted in the femoral vein and advanced to the right atrium for the evaluation of the left atrium and the pulmonary veins during the procedure. At the end of the therapeutic procedure, the probe was withdrawn into the inferior vena cava for the evaluation of the aorta and renal arteries. RESULTS: High-resolution images of the abdominal aorta from the diaphragm to its bifurcation were easily obtained in all patients. These images allowed for the evaluation of arterial size, shape, and blood flow. Both renal arteries were easily visualized in each patient. With the probe in the inferior vena cava, both renal arteries were parallel to the imaging plane and, therefore, accurate measurement of renal blood flow velocity and individual renal blood flow were measured
— id: 70878, year: 2007, vol: 20, page: 119, stat: Journal Article,

Role of echocardiography in aortic atherosclerotic disease and stroke
Molisse, T; Tunick, P A; Kronzon, I
2007 Apr;55(2):267-274, Minerva cardioangiologica
Patients with severe aortic atherosclerosis are at high risk for stroke. The risk is highest for those with atherosclerotic plaque measuring = or >4 mm in thickness. There is currently no proven medical therapy to reduce embolic risk in patients with aortic plaque. Antiplatelet therapy, smoking cessation, and management of diabetes and hypertension are important. Retrospective data support the use of statins to prevent stroke in patients with severe aortic plaque. Embolism from aortic atherosclerosis may occur spontaneously, or less commonly, as a complication of invasive or surgical cardiovascular procedures. Transesophageal echocardiography (TEE) is the procedure of choice for the characterization of plaque and the detection of superimposed mobile thrombi. Therefore, TEE is a useful tool to identify patients at high risk for stroke. For patients who are being evaluated for coronary artery bypass graft (CABG) surgery or coronary angiography, the risks and benefits of these procedures must be carefully weighed and alternate approaches should be considered in patients with severe plaque. Options include off-pump CABG or coronary angiography via a brachial (rather than femoral) approach
— id: 73698, year: 2007, vol: 55, page: 267, stat: Journal Article,

Complications of aortic atherosclerosis: atheroemboli and thromboemboli
Molisse, Theresa A; Tunick, Paul A; Kronzon, Itzhak
2007 Apr;9(2):137-147, Current treatment options in cardiovascular medicine
Patients with severe aortic atherosclerosis are at high risk for stroke and other embolic complications. Therapy to prevent emboli from aortic plaque is not yet established. Therefore, patients with atherosclerosis or risk factors for embolic disease should be identified and treated aggressively. Aspirin, smoking cessation, and control of blood pressure and glucose are important. Retrospective data in patients with severe aortic plaque support the use of statins to prevent stroke. Iatrogenic embolization can occur as a result of aortic manipulation during invasive vascular procedures or cardiovascular surgery. The risks and benefits of these procedures must be carefully weighed, and alternate approaches should be considered for patients with severe aortic atherosclerosis. For those who require coronary artery bypass graft (CABG) surgery, off-pump CABG is an option. Prophylactic aortic arch atherectomy should not be routinely performed. Aortic filters or stenting have been introduced but have not yet been fully evaluated. For patients who require angiography and have severe descending aortic, aortic arch, or abdominal aortic plaque, it is possible that a brachial (rather than a femoral) approach may avoid embolic complications
— id: 95050, year: 2007, vol: 9, page: 137, stat: Journal Article,

Laptop-sized echocardiography machine versus full-sized top-of-the-line machine: a comparative study
Perk, Gila; Molisse, Theresa; Remolina, Athena; Choy-Shan, Alana; Tunick, Paul A; Kronzon, Itzhak
2007 Mar;20(3):281-284, Journal of the American Society of Echocardiography
— id: 71350, year: 2007, vol: 20, page: 281, stat: Journal Article,

Unusual intraventricular flow pattern after left ventricular aneurysmorrhaphy
Perk, Gila; Remolina, Athena; Tunick, Paul A; Kronzon, Itzhak
2007 Jun;20(6):771.e7-771.e8, Journal of the American Society of Echocardiography
— id: 72995, year: 2007, vol: 20, page: 771.e7, stat: Journal Article,

Non-Doppler two-dimensional strain imaging by echocardiography--from technical considerations to clinical applications
Perk, Gila; Tunick, Paul A; Kronzon, Itzhak
2007 Mar;20(3):234-243, Journal of the American Society of Echocardiography
During the past several years, strain and strain rate imaging have emerged as a quantitative technique to accurately estimate myocardial function and contractility. Non-Doppler, 2-dimensional (2D) strain imaging is a new echocardiographic technique for obtaining strain and strain rate measurements. It analyzes motion by tracking speckles in the ultrasonic image in two dimensions. Current available software allows spatial and temporal image processing with recognition and selection of such elements on ultrasound image. The geometric shift of each speckle represents local tissue movement. By tracking theses speckles, 2D tissue velocity, strain, and strain rate can be calculated. Non-Doppler 2D strain imaging is simple to perform. It requires only one cardiac cycle to be acquired; further processing and interpretation can be done after image data acquisition. Because it is not based on tissue Doppler measurements, it is angle independent. Data regarding accuracy, validity, and clinical application of non-Doppler 2D strain imaging are rapidly accumulating. This technique may prove to be of significant clinical value, enabling rapid and accurate assessment of global and segmental myocardial function
— id: 71349, year: 2007, vol: 20, page: 234, stat: Journal Article,

Systolic and diastolic pulsus alternans in severe heart failure
Perk, Gila; Tunick, Paul A; Kronzon, Itzhak
2007 Jul;20(7):905.e5-905.e7, Journal of the American Society of Echocardiography
Pulsus alternans is usually a systolic phenomenon. We present a case of a patient with severe heart failure, and systolic and diastolic pulsus alternans. This case may help clarify the mechanism of pulsus alternans
— id: 73330, year: 2007, vol: 20, page: 905.e5, stat: Journal Article,

Paradoxical septal motion after cardiac surgery: a review of 3,292 cases
Reynolds, Harmony R; Tunick, Paul A; Grossi, Eugene A; Dilmanian, Hajir; Colvin, Stephen B; Kronzon, Itzhak
2007 Dec;30(12):621-623, Clinical cardiology
BACKGROUND: Paradoxical septal motion (PSM) is the systolic movement of the interventricular septum toward the right ventricle despite normal thickening. The PSM is a frequent echocardiographic finding after cardiac surgery. Although it is universally recognized, there has been no large-scale study to correlate PSM with the type of surgical procedure. The cause of PSM is unknown; prevailing theories include: (1) operation on the heart alters the degree to which it is restrained by the pericardium and the chest wall and (2) transient ischemia alters septal motion. HYPOTHESIS: The PSM is related to type of surgery and surgical approach. METHODS: Between 1996 and 2002, 3,292 patients underwent a first cardiac operation and had a postoperative echocardiogram; 313 were excluded due to other explanations for PSM (severe tricuspid regurgitation [TR] cardiac pacing), leaving a study group of 2,979 patients. Univariate and multivariate analyses were performed to determine which surgical characteristics were correlated with postoperative PSM. Septal thickening was assessed in a subset. RESULTS: On multivariate analysis, aortic (p = 0.02) and mitral valve surgery (p < 0.001) and longer cardiopulmonary bypass time (p < 0.001) were independently associated with PSM. Coronary artery bypass grafting (CABG) was less likely to cause PSM than non-CABG surgery (p = 0.003) and off-pump coronary artery bypass (OPCAB) caused less PSM than did on-pump CABG. CONCLUSIONS: 1. Valve surgery is more likely to cause PSM than CABG. 2. Among patients with CABG, OPCAB causes less PSM. 3. Cardiopulmonary bypass time is associated with the development of PSM. 4. The cause of PSM is likely to be multifactorial
— id: 75772, year: 2007, vol: 30, page: 621, stat: Journal Article,

Quadricuspid aortic valve: Imaging findings on multidetector helical CT with echocardiographic correlation
Jacobs, Jill E; Srichai, Monvadi; Kim, Danny; Hecht, Elizabeth; Kronzon, Itzhak
2006 Jul-Aug;30(4):569-571, Journal of computer assisted tomography
Cardiac multidetector helical computed tomography angiogram (MDCTA) findings of a quadricuspid aortic valve are presented. MDCTA enabled evaluation of the aortic valve and its function, the coronary arteries, and left ventricular function. This case is, to our knowledge, the first description of the MDCTA imaging appearance of quadricuspid aortic valve
— id: 66760, year: 2006, vol: 30, page: 569, stat: Journal Article,

Patent foramen ovale: echocardiographic evaluation and clinical implications
Kronzon, Itzhak
2006 Nov;8(11):793-797, Israel Medical Association journal
— id: 69710, year: 2006, vol: 8, page: 793, stat: Journal Article,

Aortic atherosclerotic disease and stroke
Kronzon, Itzhak; Tunick, Paul A
2006 Jul 4;114(1):63-75, Circulation
— id: 66467, year: 2006, vol: 114, page: 63, stat: Journal Article,

Echocardiography as a tool in the evaluation of conditions with a high likelihood of cardiogenic embolism
Kronzon, Itzhak; Tunick, Paul A; Charney, Leon H
2006 Nov;8(11):768-772, Israel Medical Association journal
— id: 69709, year: 2006, vol: 8, page: 768, stat: Journal Article,

Ventricular pump function in heart failure with normal ejection fraction: insights from pressure-volume measurements
Maurer, Mathew S; Kronzon, Itzhak; Burkhoff, Daniel
2006 Nov-Dec;49(3):182-195, Progress in cardiovascular diseases
The syndrome of heart failure in the setting of normal ejection fraction (HFNEF) is manifest in a clinically heterogeneous group of patients with multiple and varied comorbid conditions. In this report, we review available data derived from pressure-volume (PV) analyses in patients with and in animal models of HFNEF. Pressure-volume analysis of ventricular function is challenging in the clinical setting but provides unique insights into the systolic, diastolic, and overall pumping characteristics of the heart. Results of such analyses have thus far been limited to small cohorts of patients but suggest that different cohorts of patients with HFNEF having PV relations that imply different pathophysiologic mechanisms exist. This emphasizes the need to take a view of this syndrome, which extends beyond diastolic dysfunction, particularly when it comes to proposing and investigating therapeutic targets. We therefore propose that progress can be made in advancing therapeutics for HFNEF if it is appreciated that different underlying pathophysiologic mechanisms may be important in different cohorts and if attention expands beyond diastolic dysfunction as the sole target. Similar to the success that was achieved in advancing therapeutics for systolic heart failure when attention shifted away from the heart to the neurohormonal and renal axes, our interpretation of data in human beings and in animal models suggests that addressing similar targets (perhaps not in exactly the same manner) may prove to be fruitful, at least for some patients with HFNEF as well
— id: 100052, year: 2006, vol: 49, page: 182, stat: Journal Article,

Hand-carried ultrasound--revolution or a hassle?
Perk, Gila; Kronzon, Itzhak
2006 Jul-Aug;58(4):304-307, Indian heart journal
— id: 92151, year: 2006, vol: 58, page: 304, stat: Journal Article,

Increase in circulating bone marrow progenitor cells after myocardial infarction
Spevack, Daniel M; Cavaleri, Salvatore; Zolotarev, Alexander; Liebes, Leonard; Inghirami, Giorgio; Tunick, Paul A; Kronzon, Itzhak
2006 May;17(4):345-349, Coronary artery disease
BACKGROUND: Most circulating blood cells expressing the marker CD34 are bone marrow progenitor cells. These cells differentiate into cardiomyocytes, endothelial and smooth muscle cells after myocardial infarction in vivo. Mobilization of bone marrow progenitor cells into the peripheral blood after myocardial infarction may supply these cells to the heart. Rise in CD34+ cell concentrations following myocardial infarction would support the existence of myocardial-initiated mobilization. METHODS: Serial measurements of circulating CD34+ cells were made in 42 consecutive patients presenting with first ST-elevation myocardial infarction. Measurement of serum concentrations of monocyte chemoattractant protein-1, stromal derived factor-1, hepatocyte growth factor, interleukin-17 and thrombopoietin was also performed. Samples were drawn on day 1 after myocardial infarction, and on days 4, 8 and 12. Levels of CD34+ cells and cytokines were also measured in 15 controls. RESULTS: By day 8, the mean concentration of CD34+ cells rose by 74% above mean control level of 2527 cells/ml, and 41% above day 1 mean (P=0.02). This rise was sustained on day 12 (P=0.05). On day 1, there was a 9.3-fold rise in hepatocyte growth factor above the control level of 589 pg/ml (P=0.002). Hepatocyte growth factor levels declined from the day 1 mean of 6061 to 1485 pg/ml on day 12 (P=0.002). No significant change in stromal derived factor-1, interleukin-17, monocyte chemoattractant protein-1 and thrombopoietin was observed. Elevations in CD34+ cells and hepatocyte growth factor were not related to infarction size as estimated on echocardiography. CONCLUSIONS: Elevation in the concentration of circulating CD34+ cells after myocardial infarction suggests that myocardial initiated bone marrow progenitor cell mobilization exists in humans. The cytokines studied in our protocol are not likely to play a direct role in bone marrow progenitor cell mobilization
— id: 69237, year: 2006, vol: 17, page: 345, stat: Journal Article,

Pulmonary vein compression by tumor: an unusual Doppler flow pattern
Chen, Carol L; Tunick, Paul A; Kronzon, Itzhak
2005 Oct;22(9):746-747, Echocardiography
Pulmonary venous compression caused by a large lung mass was diagnosed in a 50-year-old female with metastatic renal cell carcinoma. The pulmonary venous flow pattern on Doppler revealed high flow velocity as well as the unusual finding of continued antegrade flow throughout the cardiac cycle (without reversal during atrial contraction). Extracardiac tumors can compress pulmonary veins, mimicking pulmonary vein stenosis. This may cause dyspnea due to elevated pulmonary venous pressures. This report describes an unusual pulmonary vein blood flow pattern in a patient with lung metastases
— id: 58969, year: 2005, vol: 22, page: 746, stat: Journal Article,

Rare flow pattern in a patient with cor triatriatum
Ghalchi, Michael; Rosenzweig, Barry P; Colvin, Stephen B; Tunick, Paul A; Kronzon, Itzhak
2005 Sep;22(8):705-706, Echocardiography
Doppler echocardiography demonstrated a rare flow pattern due to cor triatriatum that is also present in subvalvular or supravalvular mitral stenosis: a forward gradient, in both systole and diastole
— id: 61260, year: 2005, vol: 22, page: 705, stat: Journal Article,

Challenging cases in echocardiography
Kronzon, Itzhak; Tunick, Paul A
Philadelphia PA : Lippincott Williams & Wilkins, 2005,
— id: 907, year: 2005, vol: , page: , stat: ,

Combined transesophageal echocardiography and transesophageal cardioversion probe: technical aspects
Kronzon, Itzhak; Tunick, Paul A; Scholten, Marcoen F; Kerber, Richard E; Roelandt, J R T C
2005 Mar;18(3):213-215, Journal of the American Society of Echocardiography
A probe assembly for simultaneous transesophageal echocardiography and transesophageal cardioversion has been developed. This probe allows cardioversion with the delivery of much lower energy than the standard external approach. Details of the probe construction and its use are described, as is the prospect for future practice. The use of a combined probe may be the technique of choice for patients who require both cardioversion and transesophageal echocardiography
— id: 51392, year: 2005, vol: 18, page: 213, stat: Journal Article,

Diastolic dysfunction and doppler echocardiography - Reply
Maurer, M; Spevack, D; Burkhoff, D; Kronzon, I
2005 JUN 21 ;45(12):2095-2095, Journal of the American College of Cardiology
— id: 56256, year: 2005, vol: 45, page: 2095, stat: Journal Article,

Cardiac cavernous hemangioma
Perk, Gila; Yim, Joon; Varkey, Mathew; Colvin, Stephen B; Tunick, Paul A; Kronzon, Itzhak
2005 Sep;18(9):979-979, Journal of the American Society of Echocardiography
— id: 63027, year: 2005, vol: 18, page: 979, stat: Journal Article,

Usefulness of myocardial perfusion echocardiography to identify obstructive coronary artery disease in patients with abnormal ventricular septal motion
Spevack, Daniel M; Shoyeb, Abu; Yoon, Andrew J; Gordon, Garet M; Matros, Todd; Reynolds, Harmony A; Shah, Alan; Tunick, Paul A; Kronzon, Itzhak
2005 Apr 1;95(7):852-855, American journal of cardiology
Twenty-three patients who had septal wall motion abnormalities and who underwent angiography within 2 weeks were evaluated by myocardial perfusion echocardiography. Mean perfusion score (plateau video intensity times the wash-in rate) was lower in segments that were supplied by obstructed coronary arteries in real time (7.5 vs 22.6 dB/s, p <0.005) and with end-systolic triggering (8.6 vs 20.9 dB/s, p <0.001). Lower mean septal perfusion scores (<12 dB/s) were seen in 14 of 16 patients who had obstructive septal coronary artery disease, and normal mean septal perfusion scores were seen in 6 of 7 patients who did not have obstructive septal coronary artery disease
— id: 58970, year: 2005, vol: 95, page: 852, stat: Journal Article,

Atherosclerosis of the aorta: a risk factor, risk marker, or an innocent bystander?
Tunick, Paul A; Kronzon, Itzhak
2005 Jun 7;45(11):1907-1907, Journal of the American College of Cardiology
— id: 58971, year: 2005, vol: 45, page: 1907, stat: Journal Article,

Saphenous vein graft aneurysm masquerading as a right atrial mass
Yatskar, Leonid; Rosenzweig, Barry P; Attubato, Michael; Axel, Leon; Tunick, Paul A; Kronzon, Itzhak
2005 Mar;22(3):263-265, Echocardiography
We report a case of a large saphenous vein graft (SVG) aneurysm masquerading as a right atrial mass on transesophageal echocardiogram. Cardiac magnetic resonance angiography reliably made a diagnosis of SVG aneurysm extrinsically compressing right atrium. This case illustrates the importance of using combined imaging modalities for the diagnosis and management of cardiac masses
— id: 55961, year: 2005, vol: 22, page: 263, stat: Journal Article,

The dynamic nature of aortic atherosclerosis
Cohen, A; McAleer, E; Blanchard, B; Amarenco, P; Lin, K; Bousser, MG; Tunick, PA; Kronzon, I
2004 OCT 26 ;110(17):472-472, Circulation
— id: 55946, year: 2004, vol: 110, page: 472, stat: Journal Article,

Mortality in patients with paravalvular abscess diagnosed by transesophageal echocardiography
Cosmi, John E; Tunick, Paul A; Kronzon, Itzhak
2004 Jul;17(7):766-768, Journal of the American Society of Echocardiography
BACKGROUND: Paravalvular abscess is a complication of endocarditis that may lead to persistent infection, conduction abnormalities, fistula formation, worsening congestive heart failure, and death. METHODS: Between 1991 and 2001, paravalvular abscess was identified on transesophageal echocardiography in 24 patients who subsequently underwent surgical treatment. Echocardiographic findings were reviewed for location of abscess, presence of a valvular prosthesis, valvular function, and presence of vegetations. Information gathered included the time interval between transesophageal echocardiography diagnosis and operation, inhospital mortality, and microbiologic data. RESULTS: Of 24 patients, 9 died, for a mortality of 38%. Of the patients who died, the average survival after operation was 43 days, with a range of 1 to 238 days. Of the 14 patients with significant valvular or paravalvular regurgitation, 8 died (57%). However, of the 10 patients with mild or no regurgitation, only 1 died (10%). This difference was statistically significant (P =.02). CONCLUSION: Patients without preserved valve function (those with moderate or severe regurgitation) have a significantly worse outcome (57% mortality) than do those with normal valvular function (10% mortality)
— id: 44660, year: 2004, vol: 17, page: 766, stat: Journal Article,

Intraoperative echocardiography in minimally invasive cardiac surgery and novel cardiovascular surgical techniques
Kronzon, Itzhak; Matros, Todd G
2004 Fall;2(4):198-204, American heart hospital journal
Minimally invasive cardiovascular surgery has been developed in an effort to decrease hospital length of stay and cost by decreasing pulmonary and neurologic complications, pain, chest trauma, and infection. The smaller incisions provide less direct cardiac visualization and exposure, which makes transesophageal echocardiography an essential and integral part of these innovative procedures. Transesophageal echocardiography does not obstruct the surgical field and can perform a full evaluation of the heart. This includes assessment of the aorta and great vessels, valve function, ventricular wall motion, placement of catheters and cannulae, hemodynamic monitoring, and immediate evaluation of surgical results and complications
— id: 47791, year: 2004, vol: 2, page: 198, stat: Journal Article,

Diastolic dysfunction: can it be diagnosed by Doppler echocardiography?
Maurer, Mathew S; Spevack, Daniel; Burkhoff, Daniel; Kronzon, Itzhak
2004 Oct 19;44(8):1543-1549, Journal of the American College of Cardiology
Heart failure with a normal ejection fraction (HFNEF) predominantly afflicts older, female individuals and is considered to be a consequence of diastolic dysfunction. Doppler echocardiography has become the standard method for identifying and characterizing diastolic function. However, the important distinction between Doppler measures of filling dynamics and true indexes of intrinsic ventricular diastolic chamber properties is not widely appreciated. Herein, we delineate physiologic measures of intrinsic ventricular diastolic function, as determined by pressure volume analysis, and compare and contrast these measures with those derived from Doppler echocardiography. Doppler-derived indexes of ventricular filling do not provide specific information on intrinsic passive diastolic properties, and thus, abnormal filling dynamics do not necessarily equate with intrinsic myocardial diastolic dysfunction. This raises a fundamental question as to whether delayed relaxation and/or stiffened passive properties are the unifying pathophysiologic mechanisms in all patients who present with HFNEF
— id: 47839, year: 2004, vol: 44, page: 1543, stat: Journal Article,

Comparison of image quality between a narrow caliber transesophageal echocardiographic probe and the standard size probe during intraoperative evaluation
Reynolds, Harmony R; Spevack, Daniel M; Shah, Alan; Applebaum, Robert M; Kanchuger, Mark; Tunick, Paul A; Kronzon, Itzhak
2004 Oct;17(10):1050-1052, Journal of the American Society of Echocardiography
BACKGROUND: Transesophageal echocardiography (TEE) has become an integral part of the evaluation and monitoring of patients during cardiac operation. Until recently, the smallest TEE probe with multiplane imaging measured 13 mm in diameter. This size is now standard for adult TEE probes. Recently, a new TEE probe has become available (MiniMulti TEE probe, Philips Medical Systems, Andover, Mass), which has a diameter of 8 mm. Although using a smaller probe is attractive, the quality of images it generates when used in adults has not yet been examined. OBJECTIVE: The purpose of this study was to compare TEE studies done with both probes. METHODS: After informed consent was obtained, full intraoperative TEE studies were performed in 20 patients with a small pediatric probe. The study was then repeated using a standard adult probe. The studies were read in random order by two experienced echocardiographers blinded to probe used. For each study, 18 anatomic cardiac structures and 5 Doppler patterns were subjectively graded as excellent (1), good (2), fair (3), or poor (4) in quality. The average score for each structure or Doppler profile was computed for each probe. RESULTS: The average score for all findings was lower (better) for the adult TEE probe (1.4 +/- 0.4 vs 1.7 +/- 0.4; P =.003). When each finding was compared separately, several cardiac structures (left ventricle [LV], pericardium, right ventricle [RV], interatrial septum, left atrium, left atrial appendage, mitral valve, aortic valve) had better scores with the adult probe, and the differences for the LV and RV were larger than those for the other findings (LV scores differed by 0.7, P =.0004; RV scores differed by 0.5, P =.01). There was no significant difference between probes when evaluating venous structures (coronary sinus, superior vena cava, pulmonary vein), the thoracic aorta, or the right atrium or tricuspid valve. In addition, Doppler patterns were not significantly different with the two probes. There were two findings that were missed with the small probe and seen with the adult probe (one aortic plaque and one left atrial appendage thrombus). CONCLUSIONS: In the adult, the larger probe provides better images, particularly of the RV and LV. In addition, important findings may be missed with the smaller probe. However, if the adult probe cannot be passed, the pediatric probe is a reasonable alternative
— id: 45390, year: 2004, vol: 17, page: 1050, stat: Journal Article,

Frequency of severe renal artery stenosis in patients with severe thoracic aortic plaque
Reynolds, Harmony R; Tunick, Paul A; Benenstein, Ricardo J; Nakra, Navin C; Shah, Alan; Spevack, Daniel M; Kronzon, Itzhak
2004 Sep 15;94(6):844-846, American journal of cardiology
Atherosclerotic renal artery stenosis (RAS) is an underdiagnosed disorder and a treatable etiology of hypertension and renal insufficiency. All patients were referred for a transesophageal echocardiogram for various indications. Abdominal ultrasound was performed in 69 patients, 43 with severe thoracic aortic plaque (> or =4 mm) and 26 controls with no or mild plaque (< or =2 mm). Severe RAS (> or =60%) was defined as flow velocity > or =1.8 m/s and a renal:aortic ratio of > or =3.5. There were 8 cases of RAS (all severe) in the 43 patients with severe aortic plaque (19% vs 0% of controls; p = 0.02). Severe plaque (p = 0.02) and hypertension (p = 0.03) were correlated with RAS. On multivariate analysis, severe plaque (p = 0.017) and hypertension (p = 0.002) remained independently correlated with RAS. In a paired analysis, matched for age and gender (McNemar), severe plaque was significantly associated with RAS (p = 0.008). Severe thoracic aortic plaque is strongly associated with RAS, which is found in 19% of patients with severe plaque. Patients found to have severe aortic plaque on transesophageal echocardiography should be screened for RAS
— id: 45391, year: 2004, vol: 94, page: 844, stat: Journal Article,

Severe renal artery stenosis is common in patients with severe thoracic aortic plaque
Reynolds, HR; Benenstein, RJ; Nakra, NC; Shah, A; Spevack, DM; Kronzon, I; Tunick, PA
2004 MAR 3 ;43(5):461A-461A, Journal of the American College of Cardiology
— id: 42454, year: 2004, vol: 43, page: 461A, stat: Journal Article,

Comparison of a small (pediatric) transesophageal echocardiography probe with a standard (adult) probe
Reynolds, HR; Spevack, DM; Shah, A; Applebaum, RM; Kanchuger, M; Tunick, PA; Kronzon, I
2004 MAR 3 ;43(5):350A-350A, Journal of the American College of Cardiology
— id: 42452, year: 2004, vol: 43, page: 350A, stat: Journal Article,

Usefulness of transesophageal echocardiography using a combined probe when converting atrial fibrillation to sinus rhythm
Scholten, Marcoen F; Thornton, Andrew S; Jordaens, Luc J; Roelandt, Jos R; Kerber, Richard E; Kronzon, Itzhak
2004 Aug 15;94(4):470-473, American journal of cardiology
We studied the feasibility and efficacy of transesophageal echocardiography (TEE) combined with transesophageal cardioversion (TEC). Secondary aims were to study left atrial flow velocities before and 1 and 5 minutes after TEC, biochemical markers of myocardial damage, and patient tolerability. TEC after a short period of anticoagulation and exclusion of a clot with TEE was safe. TEC was well tolerated and efficacious. The use of a combined probe for TEE and TEC therefore can save time and be more effective. A custom-made probe for combined TEE plus TEC was used. TEC was performed with a step-up protocol (20 J to between 30 and 50 J) and with biphasic shocks. Presence of spontaneous echo contrast was scored. Cumulative energy needed to achieve sinus rhythm was calculated. Discomfort was scored on a scale of 0 to 10. Twenty-six patients underwent combined TEE/TEC. Sinus rhythm was achieved in 24 of 26 patients (92%) with a mean cumulative energy of 42.3 J. Sixteen of 26 patients were cardioverted with a 20-J shock, and 6 of these patients had early recurrence of atrial fibrillation. All biochemical markers were unaffected, and TEE/TEC was well tolerated. Left atrial appendage velocity decreased significantly after TEC. Thus, the use of a TEE/TEC probe offers effective cardioversion with low energy levels, is well tolerated, and hemodynamics during and immediately after cardioversion can be monitored. Early cardioversion after exclusion of a clot with this combined probe is time saving and cost effective
— id: 100053, year: 2004, vol: 94, page: 470, stat: Journal Article,

Measurement of atrial function before and immediately after cardioversion for atrial fibrillation using a combined transesophageal probe for cardioversion and echocardiography
Scholten, MF; Jordaens, LJ; Roelandt, JR; Tunick, PA; Kronzon, I
2004 MAR 3 ;43(5):107A-107A, Journal of the American College of Cardiology
— id: 42448, year: 2004, vol: 43, page: 107A, stat: Journal Article,

Transoesophageal echocardiography and cardioversion using a combined probe
Scholten, MF; Thornton, AS; Jordaens, LJL; Roelandt, JR; Kerber, RE; Kronzon, I
2004 AUG-SEP ;25(3):493-493, European heart journal
— id: 49016, year: 2004, vol: 25, page: 493, stat: Journal Article,

Isolated subclavian artery aneurysm: evaluation by transesophageal echocardiography
Shah, Alan; Katz, Edward S; Stern, Alexandra; Tunick, Paul A; Kronzon, Itzhak
2004 Jan;21(1):73-76, Echocardiography
A 50-year-old man was evaluated following a motor vehicle accident. Chest X-ray showed a widened mediastinum. Transesophageal echocardiography was helpful in identifying the left subclavian artery and in demonstrating an isolated subclavian artery aneurysm. The TEE findings correlated well with the results of chest CT. Using TEE for the identification of the aortic branches in patients with chest trauma may be critical
— id: 43006, year: 2004, vol: 21, page: 73, stat: Journal Article,

Diastolic right-to-left shunting in a patient with atrial septal defect and pericardial tamponade
Shah, Alan; Tunick, Paul A; Kronzon, Itzhak
2004 May;17(5):461-463, Journal of the American Society of Echocardiography
We present the case of a patient with an atrial septal defect who presented with hypotension, hypoxia, and cyanosis as a result of pericardial tamponade. The classic findings of pulsus paradoxus and low measured right heart output were not present. Echocardiography demonstrated the atrial septal defect, pericardial effusion, and diastolic chamber collapse. Furthermore, Doppler study showed not only a large left-to-right shunt but also a diastolic right-to-left shunt, which explained the patient's hypoxia
— id: 43004, year: 2004, vol: 17, page: 461, stat: Journal Article,

Propensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease
Sharony, Ram; Grossi, Eugene A; Saunders, Paul C; Galloway, Aubrey C; Applebaum, Robert; Ribakove, Greg H; Culliford, Alfred T; Kanchuger, Marc; Kronzon, Itzhak; Colvin, Stephen B
2004 Feb;127(2):406-413, Journal of thoracic & cardiovascular surgery
OBJECTIVE: Atheromatous aortic disease is a risk factor for excessive mortality and stroke in patients undergoing coronary artery bypass grafting. Outcomes of off-pump coronary artery bypass grafting and coronary artery bypass grafting with cardiopulmonary bypass in patients with severe atheromatous aortic disease were compared by propensity case-match methods. METHODS: Routine intraoperative transesophageal echocardiography identified 985 patients undergoing isolated coronary artery bypass grafting with severe atheromatous disease in the aortic arch or ascending aorta. Off-pump coronary artery bypass grafting was performed in 281 patients (28.5%). Propensity matched-pairs analysis was used to match patients undergoing off-pump coronary artery bypass grafting (n = 245) with patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. RESULTS: Univariate analysis revealed decreased hospital mortality (16/245, 6.5% vs 28/245, 11.4%; P =.058) and stroke prevalence (4/245, 1.6% vs 14/245, 5.7%; P =.03) in off-pump coronary artery bypass grafting compared with coronary artery bypass grafting with cardiopulmonary bypass. Freedom from any postoperative complication was higher in off-pump coronary artery bypass grafting compared with coronary artery bypass grafting with cardiopulmonary bypass (226/245, 92.2% vs 196/245, 80.0%; P <.001). Multivariable analysis of preoperative risk factors showed that increased hospital mortality was associated with coronary artery bypass grafting with cardiopulmonary bypass (odds ratio = 2.7; P =.01), fewer grafts (P =.05), acute myocardial infarction (odds ratio = 11.5; P <.001), chronic obstructive pulmonary disease (odds ratio = 2.4; P =.03), previous cardiac surgery (odds ratio = 10.2, P =.05), and peripheral vascular disease (odds ratio = 2.1; P =.05). Cardiopulmonary bypass was the only independent risk factor for stroke (odds ratio = 3.6, P =.03). At 36 months' follow-up, comparable survival was observed in the off-pump coronary artery bypass grafting and coronary artery bypass grafting with cardiopulmonary bypass groups (74% vs 72%). Multivariable analysis revealed that renal disease (P <.001), advanced age (P <.001), previous myocardial infarction (P =.03), and lower number of grafts (P =.02) were independent risks for late mortality. CONCLUSIONS: Patients with severe atherosclerotic aortic disease who undergo off-pump coronary artery bypass grafting have a significantly lower prevalence of hospital mortality, perioperative stroke, and overall complications than matched patients who underwent coronary artery bypass grafting with cardiopulmonary bypass. Routine intraoperative transesophageal echocardiography identifies severe atheromatous aortic disease and directs the choice of surgical technique
— id: 42050, year: 2004, vol: 127, page: 406, stat: Journal Article,

Semirigid partial annuloplasty band allows dynamic mitral annular motion and minimizes valvular gradients: an echocardiographic study
Sharony, Ram; Saunders, Paul C; Nayar, Ambika; McAleer, Eileen; Galloway, Aubrey C; Delianides, Julie; Schwartz, Charles F; Applebaum, Robert M; Kronzon, Itzhak; Colvin, Stephen B; Grossi, Eugene A
2004 Feb;77(2):518-522, Annals of thoracic surgery
BACKGROUND: Traditional mitral annuloplasty devices include both rigid rings, which restrict annular motion, and soft rings and bands, which can locally deform. Conflicting data exist regarding their impact on annular dynamics. We studied mitral annuloplasty with a semirigid partial band and with a nearly complete rigid ring. METHODS: Intraoperative three-dimensional transesophageal echocardiograms (n = 14) and predischarge transthoracic echocardiograms were retrospectively analyzed in patients undergoing mitral valve repair for degenerative disease with either a rigid ring (n = 77) or a semirigid partial band (n = 38). Each transesophageal echocardiogram was analyzed with TomTec three-dimensional software to produce cardiac cycle frame planimetry and to measure device geometry. Actual device sizes provided reference dimensions. Blinded analysis of Doppler data from transthoracic echocardiograms was performed. RESULTS: Validation of the quantitative transesophageal echocardiogram methodology revealed a 1.3% +/- 0.3% (mean +/- standard error of the mean) underestimation of actual linear dimension. With the semirigid partial band, systolic valve orifice area and intertrigonal distance decreased from 6.14 +/- 0.37 to 5.55 +/- 0.24 cm(2) (-9.6%; p = 0.01) and from 2.69 +/- 0.08 to 2.55 +/- 0.13 cm (-5.2%; p = 0.03), respectively. Systolic anterior-posterior distance decreased from 2.1 +/- 0.10 to 1.95 +/- 0.06 cm (-7.1%; p = 0.01) compared with diastole. In contrast, rigid ring orifice area was unchanged (4.12 +/- 0.15 to 4.10 +/- 0.16 cm(2); -0.5%; p = 0.48) during the cardiac cycle. Transthoracic echocardiography revealed significantly lower mitral inflow gradients with semirigid partial band (mean gradients compared with rigid ring, 4.0 +/- 0.3 versus 5.0 +/- 0.3 mm Hg; p = 0.02; peak gradients, 8.9 +/- 0.5 versus 11.1 +/- 0.5 mm Hg; p = 0.01). CONCLUSIONS: Three-dimensional transesophageal echocardiographic measurements of annular dynamics are valid and reliable when discrete annuloplasty devices are present. In contrast to the rigid ring, the semirigid partial band permits more physiologic geometric changes and is associated with lower postoperative mitral valve gradients
— id: 42597, year: 2004, vol: 77, page: 518, stat: Journal Article,

Operative risk stratification and predictors for long-term outcome in low-gradient aortic stenosis
Tunick, Paul A; Kronzon, Itzhak
2004 Feb 10;109(5):e33-e33, Circulation
— id: 43005, year: 2004, vol: 109, page: e33, stat: Journal Article,

Doppler diagnosis of acute occlusion of the superior vena cava
Benenstein, Ricardo; Nayar, Ambika C; Rosen, Robert; Schlossberg, Peter; Katz, Edward S; Tunick, Paul A; Kronzon, Itzhak
2003 Jan;20(1):97-98, Echocardiography
— id: 39153, year: 2003, vol: 20, page: 97, stat: Journal Article,

Sokusensho handobukko : Cardiogenic embolism
Daniel, Werner G; Kronzon, Itzhak; Mugge, A; Furui, Eisuke
Niigata : Nishimura shoten, 2003,
— id: 1539, year: 2003, vol: , page: , stat: ,

Routine intraoperative transesophageal echocardiography identifies patients with atheromatous aortas: Impact on "off-pump" coronary artery bypass and perioperative stroke
Grossi, Eugene A; Bizekis, Costas S; Sharony, Ram; Saunders, Paul C; Galloway, Aubrey C; Lapietra, Angelo; Applebaum, Robert M; Esposito, Rick A; Ribakove, Greg H; Culliford, Alfred T; Kanchuger, Marc; Kronzon, Itzhak; Colvin, Stephen B
2003 Jul;16(7):751-755, Journal of the American Society of Echocardiography
BACKGROUND: Patients with severe atheromatous aortic disease (AAD) undergoing coronary artery bypass grafting (CABG) have increased operative risks. The 'off-pump' CABG (OPCAB) technique was evaluated in patients given the diagnosis of severe AAD by routine transesophageal echocardiography. METHODS: A total of 5737 patients underwent CABG, with 913 having transesophageal echocardiography findings of severe AAD. Of the patients with severe AAD, 678 (74.3%) had conventional CABG and 235 (25.7%) had OPCAB. RESULTS: Hospital mortality was 8.7% for conventional CABG and 5.1% for OPCAB (P =.08). Multivariate analysis revealed that increased mortality was significantly associated with acute myocardial infarction, conventional CABG, age, renal disease, history of stroke, and ejection fraction < 30%. Neurologic complications occurred in 6.3% of patients undergoing CABG and in 2.1% undergoing OPCAB (P =.01). Freedom from any complication was significantly greater with OPCAB. CONCLUSION: Routine intraoperative transesophageal echocardiography identifies patients with severe AAD. In these patients, OPCAB technique is associated with a lower risk of death, stroke, and all complications
— id: 36724, year: 2003, vol: 16, page: 751, stat: Journal Article,

Bilateral pulmonary artery compression and obstruction by tumor: diagnosis by unusual Doppler flow patterns
Katz, Edward S; Shah, Alan; Rosenzweig, Barry P; Tunick, Paul A; Kronzon, Itzhak
2003 Feb;16(2):185-187, Journal of the American Society of Echocardiography
Pulmonary artery obstruction may be caused by tumor within or external to the arteries. Presented here is a patient with life-threatening compromise in pulmonary flow that was caused by a pulmonary neoplasm. The Doppler echocardiogram showed subtotal narrowing of the right pulmonary artery and total occlusion of the left pulmonary artery. In addition, the beneficial effects of chemotherapy were documented by Doppler
— id: 36576, year: 2003, vol: 16, page: 185, stat: Journal Article,

The hand-carried ultrasound revolution
Kronzon, Itzhak
2003 Jul;20(5):453-454, Echocardiography
— id: 39152, year: 2003, vol: 20, page: 453, stat: Journal Article,

Avoiding the left internal mammary artery during anterior pericardiocentesis
Kronzon, Itzhak; Glassman, Lawrence R; Tunick, Paul A
2003 Aug;20(6):533-534, Echocardiography
In patients with pericardial effusions who require anterior pericardiocentesis, it is important to avoid trauma to the left internal mammary artery. Such trauma could result in severe bleeding or tamponade. This article describes how the left internal mammary artery may be identified by duplex ultrasound, and therefore avoided. It is also important to ensure that the needle stick is just lateral to the artery, to avoid hitting the left lung
— id: 42663, year: 2003, vol: 20, page: 533, stat: Journal Article,

Review: anticoagulants are not more effective than antiplatelet agents in acute ischemic stroke
Kronzon, Itzhak; Tunick, Paul A
2003 Jul-Aug;139(1):5-5, ACP journal club
— id: 39164, year: 2003, vol: 139, page: 5, stat: Journal Article,

Review: beta-blockers, sotalol, amiodarone, and biatrial pacing all reduce atrial fibrillation after heart surgery
Kronzon, Itzhak; Tunick, Paul A
2003 Mar-Apr;138(2):36-36, ACP journal club
— id: 39283, year: 2003, vol: 138, page: 36, stat: Journal Article,

Echocardiography in the identification of unusual surgical errors resulting from attempted closure of secundum atrial septal defects: Report of two cases
Kronzon, Itzhak; Tunick, Paul A; Rosenzweig, Barry P; Katz, Edward S; Colvin, Stephen B
2003 Jul;16(7):774-776, Journal of the American Society of Echocardiography
— id: 36723, year: 2003, vol: 16, page: 774, stat: Journal Article,

Iatrogenic Femoral Artery Pseudoaneurysm
Piedad BT; Kronzon I
2003 Apr;5(2):103-108, Current treatment options in cardiovascular medicine
A small (< 6 cm(3) in volume or 1.8 cm in diameter), uncomplicated iatrogenic femoral artery pseudoaneurysm in a reliable patient not requiring anticoagulation can be safely observed with weekly physical examinations and ultrasound evaluations until full thrombosis is documented. The patient should be informed that any symptoms or complications should be reported to a physician immediately. A pseudoaneurysm associated with limb ischemia, severe infection, neurologic deficit, skin necrosis, rapid expansion, or hemorrhage should be treated surgically. Also, surgery is recommended if less invasive treatment strategies have failed, or if a planned surgical procedure involving the groin is anticipated. Given its high success rate, low complication rate, and cost-effectiveness, ultrasound-guided thrombin injection should be considered as first-line treatment for uncomplicated iatrogenic femoral pseudoaneurysm. Ultrasound-guided compression repair is an effective alternative to thrombin injection, especially in institutions that have little or no experience with thrombin injection. Alternative treatment strategies, such as percutaneous endovascular stenting and perfusion ballooning, are generally not recommended as first-line treatment options, because they have not been studied as extensively as ultrasound-guided compression repair or thrombin injection. If no other options are available, however, these alternative approaches may be appropriate in certain clinical situations
— id: 39249, year: 2003, vol: 5, page: 103, stat: Journal Article,

Sensitivity of transthoracic versus transesophageal echocardiography for the detection of native valve vegetations in the modern era
Reynolds, Harmony R; Jagen, Michael A; Tunick, Paul A; Kronzon, Itzhak
2003 Jan;16(1):67-70, Journal of the American Society of Echocardiography
BACKGROUND: Thirteen years ago, transthoracic echocardiography (TTE) was found to be less sensitive than transesophageal echocardiography (TEE) for native valve vegetations. Since then, harmonic imaging and other advances have improved TTE. How this affects the sensitivity of TTE is unknown. METHODS: Fifty patients with echocardiography-diagnosed endocarditis had TTE and TEE examinations on high-end machines. These were matched for date of study with 50 patients who had TTE and TEE examinations that were negative for vegetations. RESULTS: A total of 51 vegetations were seen on TEE. The sensitivity of TTE for vegetations was only 55% (aortic 50% [12/24]; mitral 62% [16/26]; tricuspid 0% [0/1]). Anatomic valvular abnormalities did not alter the sensitivity of TTE (P =.42 for mitral; P =.97 for aortic valves). However, larger vegetations were more likely to be found by TTE. CONCLUSION: Despite advances in imaging during 12 years, TTE is still insensitive compared with TEE for the detection of native valve vegetations, and fails to demonstrate nearly half of them
— id: 39334, year: 2003, vol: 16, page: 67, stat: Journal Article,

Substernal epicardial echocardiography: review of a new technique
Reynolds, Harmony R; Nayar, Ambika C; McAleer, Eileen P; Schwartz, Jesse D; Tunick, Paul A; Applebaum, Robert M; Colvin, Stephen B; Culliford, Alfred T; Galloway, Aubrey C; Grossi, Eugene A; Ribakove, Gregory H; Kronzon, Itzhak
2003 Nov;16(11):1204-1210, Journal of the American Society of Echocardiography
BACKGROUND: Patients after cardiac operation pose a challenge to the treating physician-these patients may become critically ill and are among the most difficult to image using transthoracic echocardiography. Several factors contribute to this, including difficulties in positioning the patient, inability of the patient to cooperate with instructions, surgical dressings, and hyperinflated lungs. Transesophageal echocardiography may be performed when transthoracic echocardiography is not diagnostic; however, transesophageal echocardiography is semi-invasive and does not lend itself to prolonged or repeated monitoring. METHODS: Recently, a new approach to echocardiography for use in the patient after operation has been introduced with the modification of the standard mediastinal drainage tube to allow for substernal epicardial echocardiography (SEE). The SEE tube has 2 lumens. The first allows for routine mediastinal drainage and the second has a blind end that permits the insertion of a standard transesophageal echocardiographic probe for high-resolution imaging as often as is desired over the period during which the mediastinal tube is in place. CONCLUSION: This article reviews the technique of SEE including a description of the method of performance of SEE (with representative images), a review of the published literature on this new modality, examples of clinical use, and a discussion of the advantages, indications, and limitations of SEE with an eye toward future directions for research
— id: 42051, year: 2003, vol: 16, page: 1204, stat: Journal Article,

Role of transesophageal echocardiography in the evaluation of patients with stroke
Reynolds, Harmony R; Tunick, Paul A; Kronzon, Itzhak
2003 Sep;18(5):340-345, Current opinion in cardiology
This review article summarizes recent advances in the care of patients presenting with neurologic events, in which transesophageal echocardiography plays an important role in diagnosis, prognosis, and treatment. New research on the use of transesophageal echocardiography in patients with stroke and atrial fibrillation is discussed, including left atrial clot formation, maintenance of sinus rhythm after cardioversion, and techniques of left atrial appendage occlusion. A discussion of developments in the diagnosis and management of thoracic aortic plaque follows. The association of patent foramen ovale and atrial septal aneurysm with stroke is outlined, and possible reasons for this association are discussed. Recent literature on the use of percutaneous closure devices for patent foramen ovale is reviewed
— id: 39086, year: 2003, vol: 18, page: 340, stat: Journal Article,

Substernal epicardial echocardiography may be a critical diagnostic tool in the postoperative cardiac surgery patient
Reynolds, HR; Applebaum, RM; Spevack, DM; Shah, A; Mcaleer, EP; Nayar, AC; Tunick, PA; Lapietra, A; Patel, S; Bizekis, CS; Wood, MG; Grossi, EA; Ribakove, GH; Colvin, SB; Kronzon, I
2003 MAR 19 ;41(6):449A-449A, Journal of the American College of Cardiology
— id: 37102, year: 2003, vol: 41, page: 449A, stat: Journal Article,

Transesophageal cardioversion and transesophageal echocardiography using a combined probe: Feasibility and safety
Scholten, MF; Tunick, PA; Kerber, R; Jordaens, LJ; Roelandt, JR; Kronzon, I
2003 OCT 28 ;108(17):709-709, Circulation
— id: 42531, year: 2003, vol: 108, page: 709, stat: Journal Article,

The a-dip of aortic regurgitation
Sethi, Jesse S; Shah, Alan; Benenstein, Ricardo; Rosenzweig, Barry P; Tunick, Paul A; Kronzon, Itzhak
2003 Oct;16(10):1078-1079, Journal of the American Society of Echocardiography
Echocardiography has become the diagnostic technique of choice for delineating the intracardiac hemodynamics in a host of pathophysiologic states. Pressures and flows can be estimated or measured with enough accuracy to allow for clinical decision-making. We present a case with an unusual Doppler echocardiographic finding and discuss its derivation
— id: 39027, year: 2003, vol: 16, page: 1078, stat: Journal Article,

The enigma of occult mitral regurgitation in a patient with cardiogenic shock
Shah, Alan; Kronzon, Itzhak
2003 Oct;16(10):1080-1081, Journal of the American Society of Echocardiography
In patients with mitral regurgitation (MR), there is a high pressure gradient between the left ventricle (LV) and left atrium that Doppler echocardiography can easily detect. We present a case where transthoracic echocardiography (TTE) failed to provide an accurate evaluation of a patient who presented in cardiogenic shock. A transesophageal echocardiogram diagnosed MR because of a flail leaflet caused by a ruptured papillary muscle in the setting of normal ventricular function
— id: 39026, year: 2003, vol: 16, page: 1080, stat: Journal Article,

Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: a case control study
Sharony, Ram; Bizekis, Costas S; Kanchuger, Marc; Galloway, Aubrey C; Saunders, Paul C; Applebaum, Robert; Schwartz, Charles F; Ribakove, Greg H; Culliford, Alfred T; Baumann, F Gregory; Kronzon, Itzhak; Colvin, Stephen B; Grossi, Eugene A
2003 Sep 9;108 Suppl 1(19):II15-II20, Circulation
BACKGROUND: Patients with severe atheromatous aortic disease (AAD) who undergo coronary artery bypass (CABG) have an increased risk of death and stroke. We hypothesized that in these high risk patients, off-pump coronary artery bypass (OPCAB) technique is associated with lower morbidity and mortality. METHODS AND RESULTS: Between June 1993 and January 2002, 5737 patients undergoing CABG had routine intra-operative TEE with 913 (15.9%) found to have severe AAD in the aortic arch or ascending aorta. Of these, 211 patients who underwent OPCAB were matched with 211 on-pump CABG patients by age, ejection fraction, history of stroke, cerebrovascular disease, diabetes, renal disease, nonelective operation, and previous cardiac surgery. Hospital mortality was 11.4% (24/211) for on-pump CABG and 3.8% (8/211) for OPCAB (P=0.003). Multivariate analysis revealed that increased mortality was associated with on-pump CABG (P=0.001), acute MI (P=0.03), number of grafts (P=0.01), age (P=0.01), history of stroke or cerebrovascular disease (P=0.04), CHF (P=0.02), and peripheral vascular disease (P=0.03). Multivariate analysis showed that OPCAB technique was associated with decreased stroke (P=0.05). Freedom from any complication was 78.7% for on-pump CABG and 91.9% for OPCAB (P<0.001). At 36 month follow-up multivariate analysis revealed that increased mortality was associated with age (P=0.001), previous MI (P=0.03), and renal disease (P=0.04), whereas increased survival was associated with increased number of grafts (P=0.001) and OPCAB (P=0.01). CONCLUSIONS: OPCAB surgery in patients with severe AAD is associated with lower risk of death, stroke and complications and improved mid-term survival. Routine intra-operative TEE allows identification of these patients and directs choice of appropriate surgical technique
— id: 39076, year: 2003, vol: 108 Suppl 1, page: II15, stat: Journal Article,

Hand carried echocardiography in the critical care setting
Spevack, Daniel M; Spevack, Daniel M; Tunick, Paul A; Kronzon, Itzhak
2003 Jul;20(5):455-461, Echocardiography
Miniaturized echocardiography units known as hand carried ultrasound (HCU) now exist with features similar to those used for standard echocardiography. The small size and low cost of these units may lead to increased availability of echocardiography to be performed by all physicians taking care of critically ill patients. Use of HCU by critical care physicians may allow for improved bedside diagnosis with improved accuracy over physical examination. Studies comparing HCU with standard echocardiography in the critical care setting have reported that HCU is limited by decreased image quality and that it may miss important diagnoses even when used by experienced sonographers and echocardiographers. Despite its limitations, however, HCU can often answer important clinical questions in the critically ill. This review explores the current literature on the use of HCU in the critical care setting, discusses the limitations of HCU, and examines the costs of implementing this new technology
— id: 39151, year: 2003, vol: 20, page: 455, stat: Journal Article,

Unusual right ventricular flow pattern in a patient with inferior wall myocardial infarction
Spevack, Daniel M; Tunick, Paul A; Kronzon, Itzhak
2003 Jun;16(6):693-694, Journal of the American Society of Echocardiography
We describe a case of an unusual right ventricular flow pattern in a patient with inferior wall myocardial infarction associated with massive right ventricular infarction. Echocardiography was significant for nearly continuous antegrade flow through both the tricuspid and pulmonic valves demonstrated by color and pulsed wave Doppler. The tricuspid and pulmonic valves remained open throughout the cardiac cycle. These findings signify the nearly complete loss of right ventricular pumping function, and indicate that the right heart was serving as a passive conduit with a flow pattern similar to a vein
— id: 43007, year: 2003, vol: 16, page: 693, stat: Journal Article,

Prevalence and association of ventricular tachycardia and complex ventricular arrhythmias with new coronary events in older men and women with and without cardiovascular disease
Aronow, Wilbert S; Ahn, Chul; Mercando, Anthony D; Epstein, Stanley; Kronzon, Itzhak
2002 Mar;57(3):M178-M180, Journals of gerontology. Series A. Biological sciences & medical sciences
BACKGROUND: We report the prevalence of ventricular tachycardia (VT) and of complex ventricular arrhythmias (VA) and their association with new coronary events in older men and women. METHODS: The prevalence of VT and of complex VA detected by 24-hour ambulatory electrocardiograms and the incidence of new coronary events in older persons with coronary artery disease (CAD), with hypertension, valvular disease, or cardiomyopathy without CAD, and with no cardiovascular disease was investigated in 915 men (mean age 80 +/- 8 years) and in 1,874 women (mean age 81 +/- 8 years) in a long-term health care facility. Follow-up was 45 +/- 30 months in men and 47 +/- 30 months in women. RESULTS: The prevalence of VT was 16% in men and 15% in women with CAD, 9% in men and 8% in women with hypertension, valvular disease, or cardiomyopathy without CAD, and 3% in men and 2% in women with no cardiovascular disease. The prevalence of complex VA was 69% in men and 68% in women with CAD, 54% in men and 55% in women with hypertension, valvular disease, or cardiomyopathy without CAD, and 31% in men and 30% in women with no cardiovascular disease. In men and in women with CAD or with hypertension, valvular disease, or cardiomyopathy, VT and complex VA increased the incidence of new coronary events (p <.0001). Within each of the groups of patients, the incidences of new coronary events in men and in women with and without VT or complex VA were similar. CONCLUSIONS: The prevalence of VT and of complex VA were similar in older men and women. VT and complex VA were associated with a higher incidence of new coronary events in men and women with CAD or with hypertension, valvular disease, or cardiomyopathy without CAD, but not in men and women with no cardiovascular disease
— id: 100058, year: 2002, vol: 57, page: M178, stat: Journal Article,

Prevalence of and association between silent myocardial ischemia and new coronary events in older men and women with and without cardiovascular disease
Aronow, Wilbert S; Ahn, Chul; Mercando, Anthony D; Epstein, Stanley; Kronzon, Itzhak
2002 Jun;50(6):1075-1078, Journal of the American Geriatrics Society
OBJECTIVES: To investigate the prevalence of silent ischemia (SI) in older men and women detected by 24-hour ambulatory electrocardiograms (AECGs) and the association between SI and new coronary events.DESIGN: In a prospective study, the prevalence of SI detected by 24-hour AECGs and the incidence of new coronary events in 915 older men and 1,874 older women with coronary artery disease (CAD); with hypertension, valvular disease, or cardiomyopathy without CAD; and with no cardiovascular disease were investigated. SETTING: Large long-term healthcare facility. PARTICIPANTS: Nine hundred fifteen men, mean age 80, and 1,874 women, mean age 81. MEASUREMENTS: The prevalence of SI and the incidence of new coronary events in older men and women. RESULTS: SI was present in 34% of men and 33% of women with CAD; 15% of men and 14% of women with hypertension, valvular disease, or cardiomyopathy without CAD; and 6% of men and 5% of women with no cardiovascular disease. At 45-month follow-up in men and 47-month follow-up in women, SI significantly increased the incidence of new coronary events by 2.0 times in men and women with CAD (P <.001); by 1.8 times in men and 1.7 times in women with hypertension, valvular disease, or cardiomyopathy without CAD (P <.001); and by 6.3 times in men (P =.018) and 4.4 times in women (P =.008) with no cardiovascular disease. CONCLUSIONS: SI increases the incidence of new coronary events in older men and women with CAD, with hypertension, valvular disease, or cardiomyopathy without CAD, and with no cardiovascular disease
— id: 100055, year: 2002, vol: 50, page: 1075, stat: Journal Article,

Off pump CABG reduces mortality and neurologic complications in patients with atheromatous aortas: A case control study
Bizekis, CS; Grossi, EA; Sharony, R; Galloway, AC; Applebaum, R; Esposito, RA; Ribakove, GH; Culliford, AT; Kanchuger, M; Kronzon, I; Colvin, SB
2002 NOV 5 ;106(19):638-638, Circulation
— id: 37208, year: 2002, vol: 106, page: 638, stat: Journal Article,

Outcome of cardiac surgery in patients with paravalvular abscess detected by transesophageal echocardiography
Cosmi, JE; Tunick, PA; Grossi, EA; Baumann, FG; Kronzon, I
2002 Mar 6;39(5):430A-430A, Journal of the American College of Cardiology
— id: 27518, year: 2002, vol: 39, page: 430A, 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,

Proximal isovelocity surface area (PISA) in the evaluation of fixed membranous subaortic stenosis
Goodkin, Gregory M; Tunick, Paul A; Kronzon, Itzhak
2002 Feb;19(2):157-159, Echocardiography
The evaluation of the severity of subaortic stenosis is usually expressed by the magnitude of the subvalvular gradient. Calculation of the membrane orifice area noninvasively is difficult by the standard means. We present a patient in whom the area was calculated using the proximal isovelocity surface area (PISA) method. This method should have clinical applicability because it is not flow dependent and can be used in patients with normal, reduced, or increased stroke volume
— id: 32263, year: 2002, vol: 19, page: 157, stat: Journal Article,

Clopidogrel plus aspirin was effective but increased bleeding in acute coronary syndromes without ST-segment elevation
Kronzon, Ithak; Feit, Frederick
2002 Mar-Apr;136(2):45-45, ACP journal club
— id: 27279, year: 2002, vol: 136, page: 45, stat: Journal Article,

Protruding aortic plaque - a time to define a unique clinical entity
Kronzon, Itzhak
2002 Mar;3(1):1-2, European journal of echocardiography
— id: 100056, year: 2002, vol: 3, page: 1, stat: Journal Article,

Quantification of left-to-right shunt in patent ductus arteriosus with the PISA method
Kronzon, Itzhak; Tunick, Paul A; Rosenzweig, Barry P
2002 Apr;15(4):376-378, Journal of the American Society of Echocardiography
Direct Doppler echocardiographic calculation of shunt flow in patent ductus arteriosus (PDA) may be difficult because the orifice area is not well visualized. We used proximal isovelocity surface area (PISA) method to calculate the effective shunt orifice area and the shunt volume in a patient with PDA. The PISA calculation correlated well with shunt estimation by echocardiographic volumetric methods and by oximetry
— id: 32262, year: 2002, vol: 15, page: 376, stat: Journal Article,

Is it open or is it closed? Thrombosis of a St. Jude's tricuspid valve prosthesis
Mehra, Divya; Tunick, Paul A; Goodkin, Gregory M; Kahn, Martin L; Kronzon, Itzhak
2002 May;19(4):341-342, Echocardiography
A 49-year-old woman with mitral and tricuspid mechanical valve prostheses developed marked weight gain with increasing abdominal girth and facial plethora 4 weeks after anticoagulation was temporarily interrupted for abdominal surgery. Transthoracic and transesophageal echocardiography documented severe tricuspid stenosis and regurgitation. The two discs of the tricuspid prosthesis were immobilized, half open and half closed. The prosthesis was replaced and the patient did well
— id: 32129, year: 2002, vol: 19, page: 341, stat: Journal Article,

Effect of treatment on embolic events in patients with severe thoracic aortic atheromas: Interim data analysis from the NYU Atheroma Group
Nayar, AC; Goodkin, GM; Mirchandani, S; Tunick, PA; Kronzon, I
2002 Mar 6;39(5):242A-242A, Journal of the American College of Cardiology
— id: 27517, year: 2002, vol: 39, page: 242A, stat: Journal Article,

Benign metastasizing leiomyomatosis diagnosed by echocardiography
Nayar, Ambika C; McAleer, Eileen P; Tunick, Paul A; Applebaum, Robert M; Colvin, Stephen B; Kronzon, Itzhak
2002 Oct;19(7 Pt 1):571-572, Echocardiography
— id: 36727, year: 2002, vol: 19, page: 571, stat: Journal Article,

Cardiac contractility modulation by electric currents applied during the refractory period in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy
Pappone, Carlo; Rosanio, Salvatore; Burkhoff, Daniel; Mika, Yuval; Vicedomini, Gabriele; Augello, Giuseppe; Shemer, Itzhak; Prutchi, David; Haddad, Walid; Aviv, Ricardo; Snir, Yehuda; Kronzon, Itzhak; Alfieri, Ottavio; Ben-Haim, Shlomo A
2002 Dec 15;90(12):1307-1313, American journal of cardiology
We assessed the feasibility of cardiac contractility modulation (CCM) by electric currents applied during the refractory period in patients with heart failure (HF). Extracellular electric currents modulating action potential and calcium transients have been shown to potentiate myocardial contractility in vitro and in animal models of chronic HF. CCM signals were biphasic square-wave pulses with adjustable amplitude, duration, and time delay from sensing of local electric activity. Signals were applied to the left ventricle through an epicardial vein (in 12 patients) or to the right ventricular (RV) aspect of the septum endocardially (in 6 patients). Simultaneous left ventricular (LV) and aortic pressure measurements were performed using a Millar catheter (Millar Instruments, Houston, Texas). Hemodynamics during RV temporary dual-chamber pacing was regarded as the control condition. Both LV and RV CCM stimulation increased dP/dt(max) to a similar degree (9.1 +/- 4.5% and 7.1 +/- 0.8%, respectively; p <0.01 vs controls), with associated aortic pulse pressure changes of 10.3 +/- 7.2% and 10.8 +/- 1.1% (p <0.01 vs controls). Regional systolic wall motion assessed quantitatively by color kinesis echocardiography was markedly enhanced near the CCM electrode, and the area of increased contractility involved 4.6 +/- 1.2 segments per patient. In 6 patients with HF with left bundle branch block, CCM signals delivered during biventricular pacing (BVP) produced an additional 16.1 +/- 3.7% increase in dP/dt(max) and a 17.0 +/- 7.5% increase in pulse pressure compared with BVP alone (p <0.01). CCM stimulation in patients with HF enhanced regional and global measures of LV systolic function, regardless of the varied delivery chamber or whether modulation was performed during RV pacing or BVP
— id: 100054, year: 2002, vol: 90, page: 1307, 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,

Hand-carried cardiac ultrasound (HCU) device: recommendations regarding new technology. A report from the Echocardiography Task Force on New Technology of the Nomenclature and Standards Committee of the American Society of Echocardiography
Seward, James B; Douglas, Pamela S; Erbel, Raimund; Kerber, Richard E; Kronzon, Itzhak; Rakowski, Harry; Sahn, L David J; Sisk, Eric J; Tajik, A Jamil; Wann, Samuel
2002 Apr;15(4):369-373, Journal of the American Society of Echocardiography
The newest introduction to echocardiography is a hand-carried ultrasound (HCU) device. It is a small echocardiographic machine that typically weighs less than 6 lb and can obtain echocardiographic images and data. However, neither the device nor the context of the examination fulfills the criteria for a comprehensive or complete echocardiographic examination. The American Society of Echocardiography believes that HCU will extend the concept of the 'complete physical examination,' allowing more rapid assessment of cardiovascular anatomy, function, and physiology. However, appropriate user-specific training (Level 1 at a minimum) and assumption of responsibility are essential to ensure the most accurate acquisition, interpretation, and use of the data
— id: 100057, year: 2002, vol: 15, page: 369, 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,

Association of mitral annular calcium with symptomatic peripheral arterial disease in older persons
Aronow, W S; Ahn, C; Kronzon, I
2001 Aug 1;88(3):333-334, American journal of cardiology
— id: 100062, year: 2001, vol: 88, page: 333, stat: Journal Article,

Association of valvular aortic stenosis with symptomatic peripheral arterial disease in older persons
Aronow, W S; Ahn, C; Kronzon, I
2001 Nov 1;88(9):1046-1047, American journal of cardiology
— id: 100060, year: 2001, vol: 88, page: 1046, stat: Journal Article,

Comparison of echocardiographic abnormalities in African-American, Hispanic, and white men and women aged >60 years
Aronow, W S; Ahn, C; Kronzon, I
2001 May 1;87(9):1131-3, A10, American journal of cardiology
— id: 100063, year: 2001, vol: 87, page: 1131, stat: Journal Article,

Effect of beta blockers alone, of angiotensin-converting enzyme inhibitors alone, and of beta blockers plus angiotensin-converting enzyme inhibitors on new coronary events and on congestive heart failure in older persons with healed myocardial infarcts and asymptomatic left ventricular systolic dysfunction
Aronow, W S; Ahn, C; Kronzon, I
2001 Dec 1;88(11):1298-1300, American journal of cardiology
— id: 100059, year: 2001, vol: 88, page: 1298, stat: Journal Article,

Prognosis of congestive heart failure after prior myocardial infarction in older persons with atrial fibrillation versus sinus rhythm
Aronow, W S; Ahn, C; Kronzon, I
2001 Jan 15;87(2):224-5, A8, American journal of cardiology
In a prospective study of 651 older persons with congestive heart failure after prior myocardial infarction, persons with atrial fibrillation had a significantly higher mortality than those with sinus rhythm if they had an abnormal (p = 0.005) or normal (p = 0.0001) left ventricular ejection fraction. The Cox regression model showed that significant independent risk factors for total mortality were age (risk ratio 1.03 for an increment of 1 year of age), hypertension (risk ratio 1.2), diabetes mellitus (risk ratio 1.4), abnormal left ventricular ejection fraction (risk ratio 2.1), and atrial fibrillation (risk ratio 1.5)
— id: 100067, year: 2001, vol: 87, page: 224, stat: Journal Article,

Association of coronary risk factors and use of statins with progression of mild valvular aortic stenosis in older persons
Aronow, W S; Ahn, C; Kronzon, I; Goldman, M E
2001 Sep 15;88(6):693-695, American journal of cardiology
— id: 100061, year: 2001, vol: 88, page: 693, stat: Journal Article,

Association of mitral annular calcium with symptomatic peripheral arterial disease in older men and women
Aronow, WS; Ahn, C; Kronzon, I
2001 APR ;49(4):S121-S121, Journal of the American Geriatrics Society
— id: 55063, year: 2001, vol: 49, page: S121, 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,

How useful is hand-carried bedside echocardiography in critically ill patients?
Goodkin GM; Spevack DM; Tunick PA; Kronzon I
2001 Jun 15;37(8):2019-2022, Journal of the American College of Cardiology
OBJECTIVES: The study compared a hand-carried echocardiography (HC) device with standard echocardiography (SE) in critically ill patients. BACKGROUND: Recently, small HC devices have been introduced, and early reports showed a good correlation with SE. METHODS: We used HC (SonoSite, Bothell, Washington) echocardiography to evaluate critically ill patients, and we compared the results with SE obtained with state-of-the-art equipment (Sonos 5500, Hewlett-Packard, Andover, Massachusetts). Each of 80 critically ill patients was studied twice (HC and SE). The studies were done and interpreted separately in blinded fashion. RESULTS: The HC device missed a clinical finding related to the reason for referral in 31% of patients. In 19% of patients a clinically important finding separate from the indication for echocardiography was also missed. The total number of patients with one or more missed findings was 36 (45%). Findings were missed by HC for several reasons. First, HC does not contain spectral Doppler, electrocardiographic, or M-mode capabilities. Two-dimensional imaging is superior on SE, with improved image processing. In addition, although HC does contain color power Doppler, it does not have true color flow Doppler imaging. Therefore, HC often failed to detect or accurately quantify valvular regurgitation. CONCLUSIONS: Although the HC device was able to provide important anatomic information, the device falls far short of SE in the evaluation of critically ill patients
— id: 21171, year: 2001, vol: 37, page: 2019, stat: Journal Article,

Warfarin prevents embolization in patients with thoracic aortic atheromas on T
Goodkin, GM; Tunick, PA; Kronzon, I
2001 FEB ;37(2):277A-277A, Journal of the American College of Cardiology
— id: 55174, year: 2001, vol: 37, page: 277A, stat: Journal Article,

Minimally invasive versus sternotomy approaches for mitral reconstruction: comparison of intermediate-term results
Grossi EA; LaPietra A; Ribakove GH; Delianides J; Esposito R; Culliford AT; Derivaux CC; Applebaum RM; Kronzon I; Steinberg BM; Baumann FG; Galloway AC; Colvin SB
2001 Apr;121(4):708-713, Journal of thoracic & cardiovascular surgery
BACKGROUND: This study compares intermediate-term outcomes of mitral valve reconstruction after either the standard sternotomy approach or the new minimally invasive approach. Although minimally invasive mitral valve operations appear to offer certain advantages, such as reduced postoperative discomfort and decreased postoperative recovery time, the intermediate-term functional and echocardiographic efficacy has not yet been documented. METHODS: From May 1996 to February 1999, 100 consecutive patients underwent primary mitral reconstruction through a minimally invasive right anterior thoracotomy and peripheral cardiopulmonary bypass and Port-Access technology (Heartport, Inc, Redwood City, Calif). Outcomes were compared with those for our previous 100 patients undergoing primary mitral repair who were operated on with the standard sternotomy approach. RESULTS: Although patients were similar in age, the patients undergoing the minimally invasive approach had a lower preoperative New York Heart Association classification (2.1 +/- 0.5 vs 2.6 +/- 0.6, P <.001). There was one (1.0%) hospital mortality with the sternotomy approach and no such case with the minimally invasive approach. Follow-up revealed that residual mitral insufficiency was similar between the minimally invasive and sternotomy approaches (0.79 +/- 0.06 vs 0.77 +/- 0.06, P =.89, 0- to 3-point scale); likewise, the cumulative freedom from reoperation was not significantly different (94.4% vs 96.8%, P =.38). Follow-up New York Heart Association functional class was significantly better in the patients undergoing the minimally invasive approach (1.5 +/- 0.05 vs 1.2 +/- 0.05, P <.01). CONCLUSIONS: These findings demonstrate comparable 1-year follow-up results after minimally invasive mitral valve reconstruction. Both echocardiographic results and New York Heart Association functional improvements were compatible with results achieved with the standard sternotomy approach. The minimally invasive approach for mitral valve reconstruction provides equally durable results with marked advantages for the patient and should be more widely adopted
— id: 21220, year: 2001, vol: 121, page: 708, stat: Journal Article,

Decreased stroke with routine intraoperative transesophogeal echocardiography in coronary artery bypass grafting
Grossi, EA; Galloway, AC; Lapietra, A; Applebaum, RM; Esposito, RA; Bizekis, CS; Ribakove, GH; Culliford, AT; Kanchugar, M; Kronzon, I; Colvin, SB
2001 OCT 23 abstract #2091;104(17):441-441, Circulation
— id: 33419, year: 2001, vol: 104, page: 441, stat: Journal Article,

Minimally invasive aortic valve replacement: echocardiographic and clinical results
Kort S; Applebaum RM; Grossi EA; Baumann FG; Colvin SB; Galloway AC; Ribakove GH; Steinberg BM; Piedad B; Tunick PA; Kronzon I
2001 Sep;142(3):476-481, American heart journal
BACKGROUND: Port access has been described for mitral and bypass surgery. The purpose of this study was to review the clinical and echocardiographic outcomes of aortic valve replacement by use of port access. METHODS: Between 1996 and 1999, 153 port-access aortic valve replacements were performed at our institution. The mean age was 63 years (range 16-91 years); 58% were male. The New York Heart Association mean class was III; 18% were in class IV. Thirteen percent had diabetes, 42% hypertension, 7% prior transient ischemic episode or stroke, 7% lung disease, 3% renal failure, and 13% previous surgery. Echocardiograms were obtained after valve replacement in 125 patients (96 intraoperative transesophageal and 97 transthoracic echoes). RESULTS: Median length of stay was 8 days. There were no intraoperative deaths; 10 patients (6.5%) died in the postoperative period. Stroke occurred in 4 (2.6%), sepsis in 5 (3.3%), renal failure in 5 (3.3%), pneumonia in 3 (2%), and wound infection in 1 (0.7%). Tissue prosthesis was present in 83 and a mechanical prosthesis in 42. No or trace regurgitation was seen on 94 of 96 (98%) postbypass intraoperative echocardiograms and mild on 2. On follow-up echocardiograms, moderate regurgitation was seen in 4 of 97 (4.1%), mild-to-moderate in 2 (2.1%), mild in 18 (18.6%), and no or trace in 71 (73.2%). Of those who had aortic regurgitation on intraoperative or follow-up echocardiograms, it was paravalvular in 8. CONCLUSIONS: Minimally invasive aortic valve replacement with a port-access approach is feasible, even in high-risk patients. Small incisions, a low infection rate, and a short length of stay are attainable. However, the complications associated with traditional aortic valve replacement still occur. Echocardiography is valuable both for intraoperative monitoring and follow-up of this new procedure
— id: 26678, year: 2001, vol: 142, page: 476, stat: Journal Article,

Acquired aorta-pulmonary artery fistula: diagnosis by multiple imaging modalities
Kort S; Tunick PA; Applebaum RM; Hayes R; Krinsky GA; Sadler W; Culliford A; Grossi E; Ostrowski J; Kronzon I
2001 Aug;14(8):842-845, Journal of the American Society of Echocardiography
Acquired communication between the aorta and the pulmonary artery is a rare phenomenon. We describe two patients with a thoracic aortic aneurysm in whom the diagnosis of a communication with the pulmonary artery was first made on transthoracic echocardiography and then more completely elucidated by means of multiple imaging modalities: transesophageal echocardiography, epiaortic ultrasound, computed tomography, and magnetic resonance imaging. Representative images from these complementary studies are presented. A successful repair of the fistula was subsequently accomplished in both patients
— id: 26710, year: 2001, vol: 14, page: 842, stat: Journal Article,

Port-Access aortic valve replacement: Echocardiographic and clinical results
Kort, S; Applebaum, RM; Grossi, EA; Colvin, SB; Galloway, AC; Ribakove, GH; Baumann, FG; Piedad, B; Tunick, PA; Kronzon, I
2001 FEB ;37(2):422A-422A, Journal of the American College of Cardiology
— id: 33422, year: 2001, vol: 37, page: 422A, stat: Journal Article,

Transesophageal echocardiography in intimal flap fenestration
Kronzon I; Tunick PA; Riles T; Rosen R
2001 Sep;14(9):934-936, Journal of the American Society of Echocardiography
In selected patients with descending aortic dissection, percutaneous intimal flap fenestration is a less-invasive alternative to surgery. We describe a patient with decreased renal and mesenteric blood flow as a result of descending aortic dissection. Percutaneous balloon intimal fenestration was performed under guidance of transesophageal echocardiography. Transesophageal echocardiography provided crucial information about the intimal flap puncture site and true- and false-lumen blood flow. After the flap fenestration, false-lumen blood flow increased, and the patient improved clinically
— id: 26620, year: 2001, vol: 14, page: 934, stat: Journal Article,

Unusual echocardiographic views of bicuspid and tricuspid pulmonic valves
McAleer E; Kort S; Rosenzweig BP; Katz ES; Tunick PA; Phoon CK; Kronzon I
2001 Oct;14(10):1036-1038, Journal of the American Society of Echocardiography
The pulmonary artery is typically seen on transthoracic echocardiography in its longitudinal axis. Therefore, short axis views of the pulmonic valve leaflets are not generally obtained, and the distinction between tricuspid and bicuspid pulmonic valves is difficult or impossible. Bicuspid pulmonic valve is one cause of pulmonic stenosis, which is especially common in tetralogy of Fallot. Presented here are 2 patients in whom the orientation of the pulmonary artery was unusual, and the pulmonic valve was seen en face. The first patient had tetralogy of Fallot and a bicuspid pulmonic valve. The severe obstruction to right ventricular outflow was infundibular. The second patient had severe stenosis of a tricuspid pulmonic valve, which was treated with balloon valvuloplasty. These unusual views of the pulmonic valve leaflets were obtained because of anterior displacement of the pulmonary artery, and precise anatomic delineation of the problem in each case was possible with transthoracic echocardiography
— id: 26604, year: 2001, vol: 14, page: 1036, stat: Journal Article,

Electrical modulation of cardiac contractility: clinical aspects in congestive heart failure
Pappone, C; Vicedomini, G; Salvati, A; Meloni, C; Haddad, W; Aviv, R; Mika, Y; Darvish, N; Kimchy, Y; Shemer, I; Snir, Y; Pruchi, D; Ben-Haim, S A; Kronzon, I
2001 Jan;6(1):55-60, Heart Failure Reviews
Heart failure is a highly prevalent disease in western society. Drug therapies aimed at increasing myocardial contractility have been associated with decreased survival. Several short and mid term clinical studies have suggested adjuvant or alternative therapies to congestive heart failure using modified pacing techniques that were aimed to increase contractility (e.g. Paired pacing) or restore synchrony of contraction (biventricular pacing). While delivery of paired pacing was abandoned during the early 70's, biventricular pacing has recently emerged as an adjuvant treatment to limited group of congestive heart failure patients with aberrant left ventricular conduction. In this brief review, we describe our initial safety and efficacy experience in patients with heart failure using a novel non-stimulatory electrical approach to the delivery of positive inotropic therapy to the failing myocardium. The study suggests that unlike modified pacing techniques, delivery of the signal to the left ventricle during the refractory period resulted in a rapid increase in myocardial contractility and improved hemodynamic performance. The near instantaneous contractility improvement achieved by this type of stimulus was shown to be safe and effective independently of the primary cause of heart failure or the function of the conduction system. Unlike pharmacologic treatments, which have a relatively constant effect, use of electrical stimuli may prove useful as a new therapeutic modality in the treatment of heart failure with which contractility can be improved when and as needed
— id: 100064, year: 2001, vol: 6, page: 55, 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,

Thromboembolus from a ligated left atrial appendage
Rosenzweig BP; Katz E; Kort S; Schloss M; Kronzon I
2001 May;14(5):396-398, Journal of the American Society of Echocardiography
The left atrial appendage of patients with mitral valve disease is commonly a source of thromboembolus and is often ligated during mitral valve surgery to diminish this risk. However, ligation is often incomplete. We describe a patient with a stroke whose only source of embolus was an incompletely ligated left atrial appendage. Attempts to exclude the left atrial appendage from the arterial circulation by suture ligation may not decrease the risk of thromboemboli and instead may increase such risk
— id: 20686, year: 2001, vol: 14, page: 396, stat: Journal Article,

Echo contrast-enhanced diagnosis of atrial septal defect
Rosenzweig BP; Nayar AC; Varkey MP; Kronzon I
2001 Feb;14(2):155-157, Journal of the American Society of Echocardiography
Pulsed wave, continuous wave, and color flow Doppler imaging as well as intravenously administered agitated saline solution can detect intracardiac shunts during transthoracic echocardiography. Ultrasonographic contrast agents have greatly improved the visualization of left heart chambers and can enhance signals from blood flow within chambers and across valves, increasing the sensitivity of Doppler techniques. We describe a patient in whom the use of echo contrast media during transthoracic echocardiography allowed the detection of a previously unseen atrial septal defect. Combining such modalities may help to increase the sensitivity of transthoracic echocardiography and may eliminate the need for transesophageal echocardiography in selected patients
— id: 26795, year: 2001, vol: 14, page: 155, stat: Journal Article,

Pulmonary venous flow in large, uncomplicated atrial septal defect
Saric M; Applebaum RM; Phoon CK; Katz ES; Goldstein SA; Tunick PA; Kronzon I
2001 May;14(5):386-390, Journal of the American Society of Echocardiography
BACKGROUND: The pulmonary venous flow velocity pattern (PVFVP) in atrial septal defect (ASD) has not been previously studied in detail. Normally, PVFVP is primarily determined by the left heart performance. We hypothesized that the impact of left-sided heart dynamics on PVFVP is diminished in patients with ASD because of the presence of a left-to-right shunt into the low-resistance right side of the heart. METHODS AND RESULTS: Transesophageal echocardiography was performed in 19 adults and 3 children with a large, uncomplicated secundum ASD (maximum diameter 0.6 to 3.0 cm). All patients were in normal sinus rhythm with an average heart rate of 78 bpm in adults and 116 bpm in children. In 21 subjects the antegrade PVFVP lacked distinct systolic (S) and diastolic (D) waves. Instead, we observed a single continuous antegrade wave extending from the beginning of systole to the onset of atrial contraction. Furthermore, the amplitude of the atrial reversal (AR) wave was smaller than in historical controls. In 3 patients in whom ASD was surgically repaired, we observed an immediate return of distinct S and D waves postoperatively. This confirmed that PVFVP abnormality was indeed the result of the ASD. Also a large increase in the AR wave amplitude (46 + 15 cm/s) was noted postoperatively. CONCLUSIONS: This previously unrecognized PVFVP comprising a single continuous antegrade wave and a diminished AR wave sheds new light on the hemodynamics of ASDs. Its presence may also alert the echocardiographer to the possibility of an ASD when the septal defect cannot be visualized directly
— id: 20687, year: 2001, vol: 14, page: 386, stat: Journal Article,

Diagnosis of esophageal carcinoma because of findings on transesophageal echocardiography
Shah A; Tunick PA; Greaney E; Pfeffer RD; Kronzon I
2001 Nov;14(11):1134-1136, Journal of the American Society of Echocardiography
A patient in whom transesophageal echocardiography was performed to evaluate a possible source of cerebral embolization. The fact that the probe could not be passed easily beyond 35 cm from the incisors suggested esophageal obstruction or compression. A mass was seen posterior to the left atrium that was heterogenous and contained blood vessels, suggesting a malignancy. There were no complications of the procedure. Esophageal adenocarcinoma was confirmed on biopsy. Transesophageal echocardiography may be diagnostic of paracardiac mediastinal masses, both benign and malignant. Great care must be taken if passage of the probe through the esophagus is met with resistance, to avoid serious complications
— id: 26573, year: 2001, vol: 14, page: 1134, stat: Journal Article,

Embolism from the Aorta: Atheroemboli and Thromboemboli
Tunick PA; Kronzon I
2001 Jun;3(3):181-186, Current treatment options in cardiovascular medicine
To date, there are no evidence-based data to support specific drug therapy for a patient with atheroembolism. It makes sense to use HMG CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors (statins) in any patient with atherosclerosis, as these drugs have been shown to reduce the risk of myocardial infarction and stroke, and have a theoretical benefit on plaque stabilization. Surgical treatment should be considered for patients with abdominal aortic or popliteal artery aneurysms and downstream atheroembolism. There are case reports of atheroemboli in patients worsening after given warfarin or heparin. For this reason, some institutions are reluctant to prescribe these drugs for patients with atheroemboli or thromboemboli from aortic plaque. However, the incidence of this complication is quite low. Anticoagulation probably should be stopped if a patient develops atheroembolism. Similarly, the current state of knowledge does not allow for selecting specific pharmacologic intervention in patients with thromboemboli from aortic plaque. Statin therapy does make sense, as these drugs theoretically stabilize plaques and prevent plaque hemorrhage, thrombosis, and subsequent embolization. Unstable aortic plaques may develop superimposed thrombi (red thrombi on pathologic examination), easily seen as mobile elements on transesophageal echocardiography. Therefore, it is possible that anticoagulation with warfarin might prevent embolic events in these patients. For this reason, we are often in the position of recommending warfarin therapy for patients with emboli and severe atheromas seen on transesophageal echocardiography, especially when superimposed mobile thrombi are seen. There are small series in the literature that indicate the potential benefit of warfarin. However, until a large multicenter randomized clinical trial is done, the use of warfarin can not be definitively recommended. Antiplatelet agents, although safer than warfarin (less risk of hemorrhage), have not been proven beneficial in patients with thromboembolism from the aorta. Surgery (endarterectomy) of the aortic arch is a very risky procedure that should not be performed routinely, but may be used in highly selected patients
— id: 20682, year: 2001, vol: 3, page: 181, stat: Journal Article,

Homograft pulmonic stenosis after the Ross procedure: evaluation of the stenotic valve area by proximal isovelocity surface area (PISA)
Tunick PA; Kronzon I
2001 Jan;14(1):67-69, Journal of the American Society of Echocardiography
The proximal isovelocity surface area (PISA) technique has been used to evaluate valvular regurgitant flow, regurgitant orifice area, and stenotic valve area. This report shows the usefulness of this Doppler technique in quantifying the stenotic valve area of a pulmonic valve homograft prosthesis after the Ross procedure. The patient was a 35-year-old man who had a Ross procedure 3 years earlier for aortic stenosis, which included replacement of the pulmonic valve with a cryopreserved homograft pulmonic valve. With an aliasing velocity set at 40 cm/s and a PISA radius of 1.1 cm, the pulmonic valve area was calculated as follows: Pulmonic valve peak flow rate = 2 x3.14 x1.12 x40 = 304 mL/s; Pulmonic valve area = Peak flow rate / Peak velocity = 284/350 = 0.87 cm2
— id: 26807, year: 2001, vol: 14, page: 67, stat: Journal Article,

Implications of stroke risk criteria on the anticoagulation decision in nonvalvular atrial fibrillation
Tunick PA; Kronzon I
2001 Apr 10;103(14):E79-E79, Circulation
— id: 63029, year: 2001, vol: 103, page: E79, stat: Journal Article,

Primary prevention of ischemic stroke
Tunick PA; Kronzon I
2001 Sep 11;104(11):E59-E59, Circulation
— id: 63028, year: 2001, vol: 104, page: E59, stat: Journal Article,

Association of mitral annular calcium with prior thromboembolic stroke in older White, African-American, and Hispanic men and women
Aronow WS; Ahn C; Kronzon I; Gutstein H
2000 Mar 1;85(5):672-3, A11, American journal of cardiology
Prior thromboembolic stroke was present in 57 of 188 white men (30%) with mitral annular calcium (MAC) and in 62 of 303 white men (20%) without MAC, in 42 of 65 African-American men (65%) with MAC and in 50 of 123 African-American men (41%) without MAC, and in 13 of 27 Hispanic men (48%) with MAC and in 21 of 58 Hispanic (36%) without MAC. Prior thromboembolic stroke was present in 164 of 614 white women (27%) with MAC and in 85 of 516 white women (16%) without MAC, in 111 of 193 African-American women (58%) with MAC and in 77 of 225 African-American women (34%) without MAC, and in 36 of 69 Hispanic women (52%) with MAC, and in 17 of 58 Hispanic women (29%) without MAC
— id: 27849, year: 2000, vol: 85, page: 672, stat: Journal Article,

Prognosis of congestive heart failure after prior myocardial infarction in older men and women with abnormal versus normal left ventricular ejection fraction
Aronow, W S; Ahn, C; Kronzon, I
2000 Jun 1;85(11):1382-1384, American journal of cardiology
— id: 100070, year: 2000, vol: 85, page: 1382, stat: Journal Article,

Effect of warfarin versus aspirin on the incidence of new thromboembolic stroke in older persons with chronic atrial fibrillation and abnormal and normal left ventricular ejection fraction
Aronow, W S; Ahn, C; Kronzon, I; Gutstein, H
2000 Apr 15;85(8):1033-1035, American journal of cardiology
— id: 100071, year: 2000, vol: 85, page: 1033, stat: Journal Article,

Prognosis of heart failure after myocardial infarction in men and women with abnormal versus normal ejection fraction
Aronow, W; Ahn, C; Kronzon, I
2000 AUG ;48(8):S51-S51, Journal of the American Geriatrics Society
— id: 54475, year: 2000, vol: 48, page: S51, stat: Journal Article,

Effect of warfarin versus aspirin on stroke incidence in atrial fibrillation with normal and abnormal ejection fraction
Aronow, W; Kronzon, I; Gutstein, H
2000 AUG ;48(8):S21-S21, Journal of the American Geriatrics Society
— id: 54473, year: 2000, vol: 48, page: S21, stat: Journal Article,

Increased mortality of heart failure after myocardial infarction in older persons with atrial fibrillation
Aronow, WS; Ahn, C; Kronzon, I
2000 SEP ;48(5):275A-275A, Journal of investigative medicine
— id: 54477, year: 2000, vol: 48, page: 275A, stat: Journal Article,

Prognosis of heart failure after myocardial infarction in men and women with abnormal versus normal Left Ventricular Ejection Fraction
Aronow, WS; Ahn, C; Kronzon, I
2000 JAN ;48(1):177A-177A, Journal of investigative medicine
— id: 54652, year: 2000, vol: 48, page: 177A, stat: Journal Article,

Effect of warfarin versus aspirin on stroke incidence in atrial fibrillation with normal and abnormal left ventricular ejection fraction
Aronow, WS; Ahn, C; Kronzon, I; Gutstein, H
2000 JAN ;48(1):177A-177A, Journal of investigative medicine
— id: 54651, year: 2000, vol: 48, page: 177A, stat: Journal Article,

Infiltrative nonamyloidotic monoclonal immunoglobulin light chain cardiomyopathy: an underappreciated manifestation of plasma cell dyscrasias
Buxbaum JN; Genega EM; Lazowski P; Kumar A; Tunick PA; Kronzon I; Gallo GR
2000 ;93(4):220-228, Cardiology
BACKGROUND: Infiltrative cardiomyopathies are characterized by diastolic dysfunction. In monoclonal plasma cell dyscrasias, organ compromise may be produced by tissue deposition of monoclonal immunoglobulins or their constituent peptides independently of the effects of unbridled plasma cell proliferation. The deposits may be fibrillar, as in light chain amyloid (AL) or nonfibrillar, as in light chain deposition disease (LCDD). AL disease of the heart is a restrictive cardiomyopathy. We hypothesized that, despite differences in physical properties, nonamyloidotic light chain deposition in the myocardium could produce similar clinical and physiological abnormalities. METHODS: Cardiac tissue from five patients with LCDD and cardiac dysfunction was examined by immunohistochemical and electron microscopic techniques. Hospital charts, electrocardiograms, echocardiograms and cardiac catheterization results were reviewed. In two cases, the original echocardiograms were reanalyzed. RESULTS: The five patients with nonamyloidotic light chain deposits in the myocardium had either mechanical or electrocardiographic abnormalities. In four with adequate clinical documentation, the diastolic dysfunction and conduction abnormalities were similar or identical to that described in cardiac AL disease. CONCLUSIONS: Although nonamyloidotic immunoglobulin light chain deposits in the myocardium differ in distribution and ultrastructural organization from the fibrillar deposits of AL disease, an analogous pattern of diastolic dysfunction and conduction disturbances results. The diagnosis should be considered in patients with a plasmacytic dyscrasia and restrictive cardiomyopathy in whom Congo red staining of endomyocardial biopsy tissue is negative. The diagnosis can be established by using the appropriate immunohistochemical and ultrastructural tissue examinations
— id: 39543, year: 2000, vol: 93, page: 220, stat: Journal Article,

Surgical left atrial appendage ligation is frequently incomplete: A transesophageal echocardiographic study
Katz ES; Tsiamtsiouris T; Applebaum RM; Schwartzbard A; Kronzon I
2000 Aug;36(2):468-471, Journal of the American College of Cardiology
OBJECTIVES: This study sought to determine the incidence of incomplete ligation of the left atrial appendage (LAA) during mitral valve surgery. BACKGROUND: Ligation of the LAA to prevent future thromboembolic events is commonly performed during mitral surgery. However, success in completely exduding the appendage from the circulation has never been systematically assessed. METHODS: Using transesophageal Doppler echocardiography, we studied 50 patients who underwent mitral valve surgery and ligation of the LAA. Thirty patients were studied immediately postoperative, and 20 patients were studied 6 days to 13 years after surgery. Incomplete ligation was detected by demonstrating a color jet traversing the separation between the left atrial body and appendage. RESULTS: Transesophageal echocardiography detected incomplete LAA ligation in 18 of 50 (36%) patients. The incidence of incomplete ligation was not significantly different between patients studied immediately postoperative and patients studied at various times after surgery. Type of mitral surgery (repair vs. replacement), operative approach (sternotomy vs. port access), left atrial size or degree of mitral regurgias unrelated to type of surgery, surgical approach, left atrial size or degree of mitral regurgitation. Residual communication between the incompletely ligated appendage and the left atrial body may produce a milieu of stagnant blood flow within the appendage and be a potential mechanism for embolic events
— id: 8152, year: 2000, vol: 36, page: 468, stat: Journal Article,

Electrical Alternans in Cardiac Tamponade
Kosta E; Kronzon I
2000 Aug;17(6 Pt 1):575-576, Echocardiography
— id: 11492, year: 2000, vol: 17, page: 575, stat: Journal Article,

Protruding aortic atheroma: is there a need for a new imaging modality?
Kronzon, I
2000 Jan;2(1):54-55, Israel Medical Association journal
— id: 100069, year: 2000, vol: 2, page: 54, stat: Journal Article,

The department of card tricks and close magic
Kronzon, I
2000 Dec 19;133(12):1005-1007, Annals of internal medicine
— id: 100068, year: 2000, vol: 133, page: 1005, 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,

Contrast echocardiography clarifies uninterpretable wall motion in intensive care unit patients [see comments]
Reilly JP; Tunick PA; Timmermans RJ; Stein B; Rosenzweig BP; Kronzon I
2000 Feb;35(2):485-490, Journal of the American College of Cardiology
OBJECTIVES: The study examined the value of contrast echocardiography in the assessment of left ventricular (LV) wall motion in intensive care unit (ICU) patients. BACKGROUND: Echocardiograms done in the ICU are often suboptimal. The most common indication is the evaluation of LV wall motion and ejection fraction (EF). METHODS: Transthoracic echocardiograms were done in 70 unselected ICU patients. Wall motion was evaluated on standard echocardiography (SE), harmonic echocardiography (HE), and after intravenous (IV) contrast echocardiography (CE) using a score for each of 16 segments. A confidence score was also given for each segment with each technique (unable to judge; not sure; sure). The EF was estimated visually for each technique, and a confidence score was applied to the EF. RESULTS: Uninterpretable wall motion was present in 5.4 segments/patient on SE, 4.4 on HE (p = 0.2), and 1.1 on CE (p < 0.0001). An average of 7.8 segments were read with surety on SE, 9.2 on HE (p = 0.1), and 13.7 on CE (p < 0.0001). Ejection fraction was uninterpretable in 23% on SE, 13% on HE (p = 0.14), and 0% on CE (p = 0.002 vs. HE; p < 0.0001 vs. SE). The EF was read with surety in 56% of patients on SE, 62% on HE (p = 0.47), and 91% on CE (p < 0.0001). Thus, wall motion was seen with more confidence on CE. More importantly, the actual readings of segmental wall motion and EF significantly differed using CE. CONCLUSIONS: CE should be used in all ICU patients with suboptimal transthoracic echocardiograms
— id: 8556, year: 2000, vol: 35, page: 485, stat: Journal Article,

Unusual myocardial hypertrophy in a young woman [In Process Citation]
Rosenzweig BP; Strouse D; Kronzon I
2000 Jul;17(5):451-451, Echocardiography
— id: 11508, year: 2000, vol: 17, page: 451, stat: Journal Article,

Unusual eustachian valve function
Saric M; Rosenzweig BP; Kronzon I
2000 Apr;13(4):316-318, Journal of the American Society of Echocardiography
The eustachian valve directs oxygen-rich blood from the inferior vena cava toward the foramen ovale and away from the tricuspid valve during fetal development. Ordinarily, it does not prevent reflux of right atrial blood back into the inferior vena cava because it does not function as a true valve. Here we describe an unusual adult patient with severe tricuspid valve regurgitation in whom the eustachian valve did function as a true, albeit regurgitant, valve
— id: 11764, year: 2000, vol: 13, page: 316, 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,

Diagnosis of a giant coronary aneurysm with multiple imaging modalities
Strouse D; Katz ES; Tunick PA; Winer HE; Krinsky GA; Galloway AC; Kronzon I
2000 Feb;17(2):173-176, Echocardiography
Echocardiography demonstrated an 8-cm mass adjacent to the right side of the heart in a 79-year-old man with a history of hypertension and a repaired abdominal aortic aneurysm. The results of Doppler echocardiography and magnetic resonance imaging suggested the diagnosis of an unusually large coronary artery aneurysm, and this was confirmed with coronary angiography. At surgery, the 8- to 10-cm coronary aneurysm was resected, and the patient made an uneventful recovery
— id: 27877, year: 2000, vol: 17, page: 173, 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,

Diagnostic imaging of thoracic aortic atherosclerosis
Tunick PA; Krinsky GA; Lee VS; Kronzon I
2000 Apr;174(4):1119-1125, American journal of roentgenology
— id: 11777, year: 2000, vol: 174, page: 1119, stat: Journal Article,

Atheromas of the thoracic aorta: clinical and therapeutic update
Tunick PA; Kronzon I
2000 Mar 1;35(3):545-554, Journal of the American College of Cardiology
Atherosclerotic lesions of the thoracic aorta have recently been recognized as an important cause of stroke and peripheral embolization, which may result in severe neurologic damage as well as multiorgan failure and death. Their prevalence is approximately 27% in patients with previous embolic events. Transesophageal echocardiography is the modality of choice for the diagnosis of these atheromas, although computed tomography, magnetic resonance imaging and intraoperative epiaortic ultrasound are complementary. Two clinical syndromes account for the embolic phenomena, atheroemboli and, more commonly, thromboemboli. In addition to such superimposed thrombi, plaque thickness (especially > or =4 mm) also correlates with embolic risk. This risk is high, with 12% of patients having a recurrent stroke within approximately one year, and up to 33% of patients having a stroke or peripheral embolus. In addition, aortic atheromas (as seen with intraoperative transesophageal echocardiography and intraoperative epiaortic ultrasound) are an important cause of stroke during heart surgery requiring cardiopulmonary bypass. Such strokes occur during approximately 12% of cardiac operations employing cardiopulmonary bypass when aortic arch atheromas are seen with transesophageal echocardiography (six times the general intraoperative stroke rate). Although anticoagulant strategies have been reported with encouraging results in nonrandomized studies, prospective, randomized data must be developed before an effective and safe treatment strategy can be determined. This review details the current state of knowledge in this area, including the clinical and pathologic evidence that thoracic aortic atherosclerosis is an important embolic source, data which guide current therapy and future directions for clinical investigation
— id: 8331, year: 2000, vol: 35, page: 545, stat: Journal Article,

Stroke in patients with asymptomatic internal-carotid-artery stenosis
Tunick PA; Kronzon I
2000 Nov 9;343(19):1421-1421, New England journal of medicine
— id: 63030, year: 2000, vol: 343, page: 1421, stat: Journal Article,

The Role of Transesophageal Echocardiography During Port-Access Minimally Invasive Cardiac Surgery: A New Challenge for the Echocardiographer
Applebaum RM; Colvin SB; Galloway AC; Ribakove GH; Grossi EA; Tunick PA; Kronzon I I
1999 Aug;16(6):595-602, Echocardiography
The recent development of endovascular catheters that are placed via the femoral artery and vein has enabled patients to be placed on cardiopulmonary bypass without the need for direct visualization of the heart or great vessels via sternotomy. This has allowed cardiac surgery to be performed through smaller, thoracotomy incisions. Placement of these catheters initially was performed under fluoroscopic guidance, which has major imaging limitations. Now, transesophageal echocardiography (TEE) has replaced fluoroscopy as the primary imaging technique to assist in the placement of endovascular catheters during minimally invasive, port-access cardiac surgery. In our institution, 449 port-access procedures have been performed from May 1996 through July 1998. We found that TEE is able to adequately visualize the cardiac structures and assist in the placement of the endovascular catheters in all patients. Fluoroscopy is helpful only as an aid to the use of TEE for placement of the coronary sinus catheter
— id: 33337, year: 1999, vol: 16, page: 595, stat: Journal Article,

Incidence of new thromboembolic stroke in persons 62 years and older with chronic atrial fibrillation treated with warfarin versus aspirin
Aronow WS; Ahn C; Kronzon I; Gutstein H
1999 Mar;47(3):366-368, Journal of the American Geriatrics Society
OBJECTIVE: To investigate the incidence of new thromboembolic (TE) stroke in older persons with chronic atrial fibrillation treated with oral warfarin versus aspirin. DESIGN: In an observational study of 312 older persons with chronic atrial fibrillation, long-term aspirin 325 mg daily was administered to 187 persons, and oral warfarin, in a dose adjusted to maintain the international normalized ratio (INR) between 2.0 and 3.0, was administered to 115 persons. The incidence of new TE stroke was analyzed in persons treated with warfarin versus aspirin at 36 +/- 17 months (1 to 99 months) follow-up. SETTING: A large, long-term healthcare facility. PATIENTS: The patients included 208 women and 104 men, mean age 84 +/- 7 years (range 62 to 101 years). MEASUREMENTS AND MAIN RESULTS: Four of 125 persons (3%) on warfarin stopped taking warfarin compared with four of 187 persons (2%) on aspirin who stopped taking aspirin because of adverse effects (P not significant). In persons with prior stroke, the incidence of new TE stroke was 40% (27 of 67) in persons treated with warfarin versus 81% (56 of 69) in persons treated with aspirin (P < .001). In persons with no prior stroke, the incidence of new TE stroke was 22% (13 of 58) in persons treated with warfarin versus 56% (66 of 118) in persons treated with aspirin (P < .001). The incidence of new TE stroke in all subjects was 32% (40 of 125) in persons treated with warfarin versus 65% (122 of 187) in persons treated with aspirin (P < .001). Cox regression analysis showed that persons taking warfarin had a 76% less chance of developing a new TE stroke than those taking aspirin after controlling the confounding effects of other risk factors. CONCLUSION: In an observational study of older persons with chronic atrial fibrillation, persons treated with oral warfarin to maintain an INR between 2.0 and 3.0 had a significantly lower incidence of new TE stroke than persons treated with oral aspirin 325 mg daily
— id: 57019, year: 1999, vol: 47, page: 366, stat: Journal Article,

Comparison of frequency of new coronary events in older subjects with and without valvular aortic sclerosis
Aronow WS; Ahn C; Shirani J; Kronzon I
1999 Feb 15;83(4):599-600, A8, American journal of cardiology
In a prospective study of 1,980 subjects (mean age 81 +/- 8 years) without valvular aortic stenosis, 981 (50%) had valvular aortic sclerosis diagnosed by 2-dimensional and continuous-wave Doppler echocardiography. Independent risk factors for new coronary events were prior coronary artery disease (p = 0.0001, risk ratio 2.8), male gender (p = 0.002, risk ratio 1.3), and valvular aortic sclerosis (p = 0.0001, risk ratio 1.8)
— id: 57020, year: 1999, vol: 83, page: 599, stat: Journal Article,

Association of mitral annular calcium and of aortic cuspal calcium with coronary artery disease in older patients
Aronow, W S; Ahn, C; Kronzon, I
1999 Nov 1;84(9):1084-5, A9, American journal of cardiology
In a prospective study, mitral annular calcium (MAC) was present in 274 of 752 men (36%), mean age 80 years, and in 869 of 1,663 women (52%), mean age 82 years (p <0.0001); aortic cuspal calcium was present in 295 of 752 men (39%) and in 672 of 1,663 women (40%) without aortic cuspal calcium (p = NS). Coronary artery disease was present in 150 of 274 men (55%) with versus 192 of 478 men (40%) without MAC (p = 0.0001) and in 446 of 869 women (51%) with versus 276 of 794 women (35%) without MAC (p <0.0001); coronary artery disease was present in 167 of 295 men (57%) with versus 175 of 457 men (38%) without aortic cuspal calcium (p <0.0001), and in 360 of 672 women (54%) with versus 362 of 991 women (37%) without aortic cuspal calcium (p <0.0001)
— id: 100072, year: 1999, vol: 84, page: 1084, stat: Journal Article,

Comparison of incidences of congestive heart failure in older African-Americans, Hispanics, and whites
Aronow, W S; Ahn, C; Kronzon, I
1999 Sep 1;84(5):611-2, A9, American journal of cardiology
In a prospective study of 2,893 African-Americans, Hispanics, and whites, mean age 81 years, at 43-month follow-up, congestive heart failure (CHF) developed in 194 of 686 African-Americans (28%), in 67 of 257 Hispanics (26%), and in 533 of 1,950 whites (27%) (p = NS). The Cox regression model showed that significant independent risk factors for CHF were male gender (risk ratio = 1.4, p = 0.0001); hypertension (risk ratio = 2.5, p = 0.0001); coronary artery disease (risk ratio = 4.0, p = 0.0001); diabetes mellitus (risk ratio = 1.6, p = 0.0001); and age (risk ratio = 1.05, p = 0.0001)
— id: 100073, year: 1999, vol: 84, page: 611, stat: Journal Article,

Association of left ventricular hypertrophy and chronic atrial fibrillation with the incidence of new thromboembolic stroke in 2,384 older persons
Aronow, W S; Ahn, C; Kronzon, I; Gutstein, H
1999 Aug 15;84(4):468-9, A9, American journal of cardiology
In a prospective study of 2,384 persons, mean age 81 years, at 44-month follow-up, new thromboembolic stroke developed in 510 of 2,384 persons (21%). The Cox regression model showed that significant independent risk factors for new thromboembolic stroke were atrial fibrillation (risk ratio 3.2), left ventricular hypertrophy (risk ratio 2.8), prior stroke (risk ratio 2.2), and male gender (risk ratio 1.2)
— id: 100074, year: 1999, vol: 84, page: 468, stat: Journal Article,

Association of mitral annular calcium with coronary artery disease
Aronow, WS; Ahn, C; Kronzon, I
1999 AUG ;47(7):254A-254A, Journal of investigative medicine
— id: 53924, year: 1999, vol: 47, page: 254A, stat: Journal Article,

Association of mitral annular calcium with prior stroke
Aronow, WS; Ahn, C; Kronzon, I
1999 AUG ;47(7):246A-246A, Journal of investigative medicine
— id: 53922, year: 1999, vol: 47, page: 246A, stat: Journal Article,

Incidence of congestive heart failure in older African-Americans, Hispanics, and whites
Aronow, WS; Ahn, C; Kronzon, I
1999 SEP ;47(9):S93-S93, Journal of the American Geriatrics Society
— id: 53900, year: 1999, vol: 47, page: S93, stat: Journal Article,

Incidence of stroke in older persons with and without left ventricular hypertrophy and with and without atrial fibrillation
Aronow, WS; Ahn, C; Kronzon, I; Gutstein, H
1999 SEP ;47(9):S69-S69, Journal of the American Geriatrics Society
— id: 53898, year: 1999, vol: 47, page: S69, stat: Journal Article,

Echocardiography in Minimally Invasive Direct Coronary Artery Bypass
Kasliwal R; Mittal S; Shrivastava S; Mishra Y; Malhotra R; Kanojia A; Trehan N; Kronzon I I
1999 Aug;16(6):603-610, Echocardiography
Minimally invasive direct coronary artery bypass (MIDCAB) is a recently developed, less-invasive alternative to standard bypass surgery. MIDCAB is performed through a small incision (2-3 inches) on the beating heart without the use of cardiopulmonary bypass or cardioplegia. It is associated with less trauma and a shorter hospital stay than conventional surgery. Transesophageal echocardiography helps in patient selection by detecting protruding aortic atheromas (PATHs), which are associated with a high risk of stroke during typical cardiopulmonary bypass. MIDCAB may be the technique of choice in patients with PATHs. Intraoperative echocardiography can detect wall motion abnormalities and helps in determining intraoperative myocardial ischemia and the postoperative prognosis. Duplex study of the internal mammary arteries is helpful in evaluating coronary anastomosis patency. Characteristically, a patent coronary anastomosis demonstrates a high diastolic flow fraction, with a ratio between peak diastolic and peak systolic flow velocity of > 1
— id: 100065, year: 1999, vol: 16, page: 603, stat: Journal Article,

Less Is More: Echocardiography in the Evaluation of Newer, Less-Invasive Cardiovascular Procedures
Kronzon I I
1999 Aug;16(6):593-593, Echocardiography
— id: 100066, year: 1999, vol: 16, page: 593, stat: Journal Article,

Transcatheter, Endovascular Repair of Abdominal Aortic Aneurysm: Feasibility, Noninvasive Diagnosis, Problems, and Follow-Up
Kronzon I I; Varkey M; Tunick PA; Riles T; Rosen R
1999 Aug;16(6):617-623, Echocardiography
Until recently, the repair of an abdominal aortic aneurysm (AAA) required major surgery. Recently, the transcatheter technique has allowed minimally invasive endovascular stenting of infrarenal AAAs. This procedure is less traumatic and is associated with a shorter hospital stay than conservative surgery. With the stent placement, the effective aortic lumen diameter decreases and the aneurysmal space is excluded from the circulation. Ultrasonographic studies have allowed imaging of the abdominal aorta, its main branches, and the endovascular stent. The aortic blood flow after the repair is ideally limited to the stent lumen. Follow-up studies have permitted reevaluation of the aorta and the stent, with special emphasis on the aortic expansion and blood flow within the excluded space. These studies have correlated well with other imaging techniques such as intravascular ultrasound, computed tomography scanning, and aortography
— id: 39446, year: 1999, vol: 16, page: 617, stat: Journal Article,

Atheromas of the thoracic aorta: A comparison of transesophageal echocardiography and breath-hold gadolinium-enhanced 3-dimensional magnetic resonance angiography
Kutz SM; Lee VS; Tunick PA; Krinsky GA; Kronzon I
1999 Oct;12(10):853-858, Journal of the American Society of Echocardiography
Transesophageal echocardiography (TEE) has been the procedure of choice for identifying thoracic aortic atheromas. All patients over a 2-year period who underwent both TEE and magnetic resonance angiography of the thoracic aorta within 1 month were identified. The largest plaque in 3 aortic segments (ascending, arch, and descending) was measured. Thirty patients (16 men; 66.8 +/- 12.9 years) were studied. The mean size of the atheromas in the arch was larger as measured by TEE compared with magnetic resonance angiography (3.4 vs 1.4 mm, P =.01). However, the mean atheroma size was similar in the ascending aorta (1.9 vs 1.3 mm, P =.5) and descending aorta (3.9 vs 3.5 mm, P =.66). Of 24 aortic segments with plaques measuring >/=5 mm (with high embolic risk), 22 (92%) were seen on TEE and only 13 (54%) on magnetic resonance angiography (P =. 003). In conclusion, although both techniques are complementary, TEE does identify more high-risk plaques
— id: 6258, year: 1999, vol: 12, page: 853, stat: Journal Article,

Atheromas of the thoracic aorta: Comparison of TEE and MRA
Kutz, Stephen M; Lee, Vivian S; Tunick, Paul A; Krinsky, Glenn A; Kronzon, Itzhak
1999 Mar 7-10;33(2 SUPPL. A):414A-415A, Journal of the American College of Cardiology
— id: 15893, year: 1999, vol: 33, page: 414A, stat: Journal Article,

Abdominal aortic aneurysms are strongly associated with thoracic aortic atheromas seen on TEE
Reynolds, HR; Tunick, PA; Adelman, MA; Attubato, MJ; Kronzon, I
1999 NOV 2 ;100(18):168-169, Circulation
— id: 53788, year: 1999, vol: 100, page: 168, stat: Journal Article,

Massive Atrial Septal Lipomatous Hypertrophy
Saric M; Applebaum RM; Culliford AT; Huang J; Scholes JV; Kronzon I I
1999 Nov;16(8):833-834, Echocardiography
— id: 28919, year: 1999, vol: 16, page: 833, stat: Journal Article,

Pulmonary venous flow in large uncomplicated atrial septal defects
Saric, M; Applebaum, RM; Phoon, CK; Goldstein, SA; Tunick, PA; Kronzon, I
1999 NOV 2 ;100(18):213-213, Circulation
— id: 53789, year: 1999, vol: 100, page: 213, stat: Journal Article,

The role of transesophageal echocardiography in the diagnosis and treatment of right atrial thrombi
Schwartzbard AZ; Tunick PA; Rosenzweig BP; Kronzon I
1999 Jan;12(1):64-69, Journal of the American Society of Echocardiography
Twenty patients with right atrial thrombi were identified through the use of transthoracic and transesophageal echocardiography. Transesophageal echocardiography identified right atrial thrombi in all 20 cases. Transthoracic echocardiography showed definite thrombi in only 6 (30%) cases and suggested thrombus in another 2 (10%) patients. Thus transthoracic echocardiography results were false-negative for right atrial thrombus in 60% of cases. All 3 thrombi found within the right atrial appendage and 2 of 3 thrombi on pacemaker wires were missed by transthoracic echocardiography. There was no significant difference in the mean size between those thrombi seen (1.37 +/- 0.6 cm) and those missed (1.5 +/- 0.9 cm) by transthoracic echocardiography. Transesophageal echocardiography also significantly affected treatment. Anticoagulation was initiated or amplified in 13 patients. In 8 of these 13, thrombi were seen only by transesophageal echocardiography. Surgery was performed to remove thrombi in 7 cases, and in 3 (43%) cases it was because of thrombi seen only by transesophageal echocardiography. This study suggests that transesophageal echocardiography should be performed whenever right atrial thrombi are suspected. Transesophageal echocardiography has a significant effect on the diagnosis and management of patients with right atrial thrombi
— id: 7443, year: 1999, vol: 12, page: 64, stat: Journal Article,

Protruding aortic arch atheromas: risk of stroke during heart surgery with and without aortic arch endarterectomy [see comments]
Stern A; Tunick PA; Culliford AT; Lachmann J; Baumann FG; Kanchuger MS; Marschall K; Shah A; Grossi E; Kronzon I
1999 Oct;138(4 Pt 1):746-752, American heart journal
BACKGROUND: Stroke occurs in 1% to 7% of heart surgery. Aortic arch atherosclerosis is a risk factor for intraoperative stroke, and endarterectomy has been proposed to prevent stroke during heart surgery in patients with arch atheromas. METHODS AND RESULTS: Intraoperative transesophageal echocardiography was performed in 3404 patients undergoing heart surgery between 1990 and 1996. Use of transesophageal echocardiography was unselected and based on equipment availability. Aortic arch atheromas (>/=5 mm, or mobile) were seen in 268 (8%) patients. They were evaluated for intraoperative stroke (confirmed by a neurologist and cerebral infarction on computed tomography or magnetic resonance imaging). Arch endarterectomy was performed in 43 patients as an adjunct to their cardiac procedure in an attempt to prevent intraoperative stroke. The intraoperative stroke rate in all 268 patients with atheromas was high (15.3%). On univariate analysis, age, previous stroke, and arch endarterectomy were significantly associated with intraoperative stroke. On multivariate analysis, age (odds ratio 3.9, P =.01) and arch endarterectomy (odds ratio 3.6, P =.001) were independently predictive of intraoperative stroke. Mortality rate in all 268 patients was high (14.9%). These patients with atheromas also had a long recovery room, intensive care unit, and total hospital length of stay (48 days). CONCLUSIONS: Patients with protruding aortic arch atheromas are at high risk for intraoperative stroke, significant and multiple morbidity, prolonged hospital stay, and death resulting from heart surgery. Aortic arch endarterectomy is strongly associated with intraoperative stroke; its use should be carefully considered in light of these results
— id: 6213, year: 1999, vol: 138, page: 746, stat: Journal Article,

Echocardiography in emergency medicine: a policy statement by the American Society of Echocardiography and the American College of Cardiology. Task Force on Echocardiography in Emergency Medicine of the American Society of Echocardiography and the Echocardiography and Technology and Practice Executive Committees of the American College of Cardiology
Stewart, W J; Douglas, P S; Sagar, K; Seward, J B; Armstrong, W F; Zoghbi, W; Kronzon, I; Mays, J M; Pearlman, A S; Schnittger, I; St Vrain, J A; Kerber, R E
1999 Feb;33(2):586-588, Journal of the American College of Cardiology
— id: 100075, year: 1999, vol: 33, page: 586, stat: Journal Article,

Echocardiography in emergency medicine: a policy statement by the American Society of Echocardiography and the American College of Cardiology. The Task Force on Echocardiography in Emergency Medicine of the American Society of Echocardiography and the Echocardiography TPEC Committees of the American College of Cardiology
Stewart, W J; Douglas, P S; Sagar, K; Seward, J B; Armstrong, W F; Zoghbi, W; Kronzon, I; Mays, J M; Pearlman, A S; Schnittger, I; St Vrain, J A; Kerber, R E
1999 Jan;12(1):82-84, Journal of the American Society of Echocardiography
— id: 100076, year: 1999, vol: 12, page: 82, stat: Journal Article,

Utility of transesophageal echocardiography during port-access minimally invasive cardiac surgery
Applebaum RM; Cutler WM; Bhardwaj N; Colvin SB; Galloway AC; Ribakove GH; Grossi EA; Schwartz DS; Anderson RV; Tunick PA; Kronzon I
1998 Jul 15;82(2):183-188, American journal of cardiology
In this study, we sought to determine the use of transesophageal echocardiography (TEE) as the primary imaging technique to assist in the placement of endovascular catheters during minimally invasive, port-access cardiac surgery. The recent development of endovascular catheters that are placed via the femoral artery and vein has enabled patients to be placed on cardiopulmonary bypass without the need for direct visualization of the heart or great vessels via sternotomy. This has allowed cardiac surgery to be performed through smaller thoracotomy incisions. Placement of these catheters has previously been performed with fluoroscopic guidance, which has major imaging limitations. Thirty-six patients underwent port-access cardiac surgery at our institution during the study period. All patients underwent intraoperative TEE. We used TEE to visualize the coronary sinus os, right atrium and superior vena cava, and thoracic aorta to assist with placement of the coronary sinus catheter, venous cannula, and endoaortic clamp. Twenty patients underwent mitral valve surgery, 14 patients coronary artery bypass grafting, 1 patient aortic valve replacement, and 1 patient repair of an atrial septal defect by the port-access approach. TEE was able to adequately visualize the cardiac structures and assist in the placement of the endovascular catheters in all patients. Fluoroscopy was only helpful as an aid to TEE for placement of the coronary sinus catheter. TEE is an excellent imaging modality for the proper placement of these new endovascular catheters, obviating the need for fluoroscopy, except to be on standby and for placement of the coronary sinus catheter
— id: 12089, year: 1998, vol: 82, page: 183, stat: Journal Article,

Utility of three-dimensional echocardiography during balloon mitral valvuloplasty
Applebaum RM; Kasliwal RR; Kanojia A; Seth A; Bhandari S; Trehan N; Winer HE; Tunick PA; Kronzon I
1998 Nov;32(5):1405-1409, Journal of the American College of Cardiology
OBJECTIVES: We investigated the role of three-dimensional echocardiography in assessing mitral valve anatomy in greater detail in patients immediately before and after balloon mitral valvuloplasty (BMV). BACKGROUND: Three-dimensional echocardiography is a recently developed, evolving imaging technique that allows visualization of intracardiac structures from any perspective. METHODS: We studied 19 patients undergoing BMV using transesophageal echocardiography (TEE) (Chicago, Illinois) to image the mitral valve. The TEE was interfaced to a TomTec three-dimensional workstation that allows electrocardiographic and respiratory cycle gated image acquisition. The acquired images are digitized, and after postprocessing a three-dimensional image is reconstructed. The mitral valve was viewed 'en-face' as if looking up from the left ventricle. RESULTS: The mean mitral valve area (by pressure half-time from the Doppler of the two-dimensional echocardiogram) increased after BMV from 0.86+/-0.06 cm2 to 2.07+/-0.10 cm2, p < 0.0001. This was similar to the mitral valve areas obtained by planimetry from the three-dimensional images. The three-dimensional reconstructions showed a complete commissural split in 10 patients and partial splitting in 9 patients. In three of the eight patients who had an increase in the amount of mitral regurgitation secondary to BMV, the three-dimensional reconstructions were able to detect tears within the valve leaflet. One leaflet tear actually extended up to the mitral valve annulus and was associated with the only case of severe mitral regurgitation. CONCLUSIONS: The three-dimensional echocardiographic reconstruction enabled visualization of the mitral valve so that commissural splitting and leaflet tears not seen on the two-dimensional echocardiogram became visible
— id: 7487, year: 1998, vol: 32, page: 1405, stat: Journal Article,

Effects of intraaortic balloon counterpulsation on carotid artery blood flow
Applebaum RM; Wun HH; Katz ES; Tunick PA; Kronzon I
1998 May;135(5 Pt 1):850-854, American heart journal
BACKGROUND: The intraaortic balloon pump has been shown to improve cardiac output and diastolic coronary flow. Animal studies with balloon counterpulsation have shown variable effects on carotid and cerebral blood flow. We investigated the effects of counterpulsation with the intraaortic balloon pump on blood flow in the common carotid artery in human beings. METHODS AND RESULTS: We studied 14 patients who had an intraaortic balloon pump placed for clinical indications; 9 were hypotensive (4 in the setting of an acute myocardial infarction and 5 immediately after cardiac surgery). Five patients required counterpulsation after undergoing complicated coronary angioplasty. Common carotid artery blood flow was assessed with carotid Duplex scanning both with and without 1:1 balloon augmentation. We found no net increase in the total blood flow in the common carotid artery with intraaortic balloon counterpulsation. This result occurred despite a significant mean increase in both the peak flow velocity and flow velocity integral of the augmented diastolic flows by 160% and 78%, respectively. Total flow did not change because an early systolic reversal of blood flow was seen only with balloon augmentation, which negated the augmented diastolic flow. CONCLUSION: Despite a significant augmentation in diastolic blood flow with balloon counterpulsation, no increase occurred in total carotid artery blood flow. This appeared to be caused by improper timing of balloon deflation. This could result in no improvement in cerebral blood flow with intraaortic balloon pump counterpulsation in critically ill patients
— id: 7485, year: 1998, vol: 135, page: 850, stat: Journal Article,

Transesophageal echocardiography as the guiding imaging technique during port access minimally invasive cardiac surgery
Applebaum, RM; Cutler, WM; Bhardwaj, N; Colvin, SB; Galloway, AC; Ribakove, GH; Grossi, EA; Schwartz, DS; Anderson, RV; Tunick, PA; Kronzon, I
1998 FEB ;31(2):87A-87A, Journal of the American College of Cardiology
— id: 33432, year: 1998, vol: 31, page: 87A, stat: Journal Article,

Normal left ventricular ejection fraction in older persons with congestive heart failure
Aronow, W S; Ahn, C; Kronzon, I
1998 Apr;113(4):867-869, Chest
STUDY OBJECTIVES: To investigate in older patients with congestive heart failure (CHF) associated with prior myocardial infarction or hypertension the relationship between normal left ventricular (LV) ejection fraction and age, gender, hypertension, prior myocardial infarction, and atrial fibrillation. DESIGN: A prospective study was performed in 572 older patients (age >60 years) with CHF associated with prior myocardial infarction or hypertension and technically adequate two-dimensional echocardiograms for measuring LV ejection fraction. SETTING: A long-term health-care facility. PATIENTS: One hundred seventy-seven men and 395 women, mean age 82+/-8 years, with CHF associated with prior myocardial infarction or hypertension. MEASUREMENTS AND RESULTS: Normal LV ejection fraction (> or = 50%) occurred in 66 of 177 men (37%) and in 221 of 395 women (56%) (p<0.0001). Multiple logistic regression analysis showed that independent risk factors for normal LV ejection fraction in patients with CHF were no prior myocardial infarction (p=0.0001; odds ratio=3.048), female gender (p=0.0004; odds ratio=1.978), and age (p=0.016; odds ratio=1.029). CONCLUSIONS: Normal LV ejection fraction occurred in 50% of 572 older patients with CHF associated with prior myocardial infarction or hypertension. Independent risk factors for normal LV ejection fraction in patients with CHF were no prior myocardial infarction, female gender, and age
— id: 100078, year: 1998, vol: 113, page: 867, stat: Journal Article,

Association of mitral annular calcium with new thromboembolic stroke at 44-month follow-up of 2,148 persons, mean age 81 years
Aronow, W S; Ahn, C; Kronzon, I; Gutstein, H
1998 Jan 1;81(1):105-106, American journal of cardiology
We investigated in a prospective study of 2,148 persons (mean age 81 years), the association between mitral annular calcium and new thromboembolic stroke at 44-month follow-up. Independent risk factors for new thromboembolic stroke were prior stroke (risk ratio 2.4), mitral annular calcium (risk ratio 2.6), atrial fibrillation (risk ratio 3.0), and male gender (risk ratio 1.6)
— id: 100080, year: 1998, vol: 81, page: 105, stat: Journal Article,

Risk factors for new thromboembolic stroke in patients > or = 62 years of age with chronic atrial fibrillation
Aronow, W S; Ahn, C; Kronzon, I; Gutstein, H
1998 Jul 1;82(1):119-121, American journal of cardiology
In a prospective study of 312 older patients with chronic atrial fibrillation, at 36-month follow-up evaluation, new thromboembolic stroke developed in 162 of 312 patients (52%). Significant independent risk factors for new thromboembolic stroke were prior stroke (risk ratio = 1.6), rheumatic mitral stenosis (risk ratio = 2.0), left ventricular (LV) hypertrophy (risk ratio = 2.8), abnormal LV ejection fraction (risk ratio = 1.8), serum total cholesterol (risk ratio = 1.005), and serum high-density lipoprotein cholesterol (risk ratio = 0.96)
— id: 100077, year: 1998, vol: 82, page: 119, stat: Journal Article,

Comparison of frequency of new coronary events in older persons with mild, moderate, and severe valvular aortic stenosis with those without aortic stenosis
Aronow, W S; Ahn, C; Shirani, J; Kronzon, I
1998 Mar 1;81(5):647-649, American journal of cardiology
Independent risk factors for new coronary events were prior myocardial infarction, valvular aortic stenosis, male gender, and increasing age in patients with aortic stenosis. In older persons with moderate or severe valvular aortic stenosis, congestive heart failure, syncope, or angina pectoris was present in 101 of 114 persons (89%) with new coronary events and in 1 of 22 persons (5%) without new coronary events (p <0.0001)
— id: 100079, year: 1998, vol: 81, page: 647, stat: Journal Article,

Non-amyloid infiltrative cardiomyopathy in plasma cell dyscrasias
Buxbaum, J; Genega, E; Kronzon, I; Tunick, PA; Gallo, G
1998 FEB ;31(2):67A-67A, Journal of the American College of Cardiology
— id: 53547, year: 1998, vol: 31, page: 67A, stat: Journal Article,

Images in cardiovascular medicine: quadricuspid aortic valve
Feliciano E; Steinberg E; Kronzon I
1998 Jan 6-13;97(1):113-113, Circulation
— id: 57146, year: 1998, vol: 97, page: 113, stat: Journal Article,

Large gradient across a partially ligated left atrial appendage
Fisher DC; Tunick PA; Kronzon I
1998 Dec;11(12):1163-1165, Journal of the American Society of Echocardiography
The left atrial appendage is frequently ligated during mitral valve surgery to decrease the future risk of embolic events. The postoperative detection of a partially occluded left atrial appendage has previously been reported with the use of transesophageal echocardiography. We describe an unusual case in which Doppler echocardiography demonstrated a remarkably high-velocity jet emanating from a partially ligated left atrial appendage
— id: 7563, year: 1998, vol: 11, page: 1163, 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,

Initial echocardiogram after mitral valve reconstruction predicts durability of repair
Grossi, EA; Applebaum, RM; Galloway, AC; Spencer, FC; Kronzon, I; Colvin, SB
1998 FEB ;31(2):399A-399A, Journal of the American College of Cardiology
— id: 33434, year: 1998, vol: 31, page: 399A, stat: Journal Article,

Surgical left atrial appendage ligation is frequently incomplete: A transesophageal echocardiographic study
Katz, ES; Tsiamtsiouris, T; Applebaum, RM; Schwartzbard, A; Kronzon, I
1998 OCT 27 ;98(17):501-501, Circulation
— id: 53667, year: 1998, vol: 98, page: 501, stat: Journal Article,

Extraordinary QRS voltage in apical hypertrophic cardiomyopathy
Kronzon I; Tunick PA
1998 Jul;21(7):1489-1489, Pacing & clinical electrophysiology
— id: 7640, year: 1998, vol: 21, page: 1489, stat: Journal Article,

Ultrasound evaluation of endovascular repair of abdominal aortic aneurysms
Kronzon I; Tunick PA; Rosen R; Riles T
1998 Apr;11(4):377-380, Journal of the American Society of Echocardiography
Endovascular repair of an abdominal aortic aneurysm (AAA) offers a minimally invasive alternative to an open surgical procedure in selected patients. The purpose of this study was to examine the usefulness of ultrasonography for evaluating the results of endovascular repair. METHODS: We studied 17 patients who underwent endovascular repair. In 10 patients a bifurcated prosthesis was positioned below the renal arteries with the bifurcated branches in the iliac arteries. The other 7 patients had a nonbifurcated infrarenal prosthesis. RESULTS: In each patient the AAA and the entire prosthesis, including its bifurcated branches, were visualized. The mean AAA diameter was 5.0 +/- 0.6 cm. The mean prosthesis body diameter was 2.2 +/- 0.3 cm, and the diameters of the bifurcated limbs were 1.0 to 1.2 cm. Color Doppler studies revealed blood flow limited to the prosthetic lumen and its bifurcation in 16 patients; the space between the prosthesis and the AAA wall was clotted in these patients. In 1 patient a communication was seen between the prosthesis and the AAA lumen through a dehiscence in the distal attachment. CONCLUSION: Ultrasonography is a simple, noninvasive tool for the evaluation of the results of endovascular repair of AAA and can detect complications of this procedure
— id: 7639, year: 1998, vol: 11, page: 377, stat: Journal Article,

Ultrasound evaluation after endovascular repair of abdominal aortic aneurysm
Kronzon, I; Tunick, PA; Riles, TS; Rosen, R
1998 FEB ;31(2):217A-217A, Journal of the American College of Cardiology
— id: 53549, year: 1998, vol: 31, page: 217A, stat: Journal Article,

Contrast echo clarifies uninterpretable wall motion in ICU patients
Reilly, JP; Tunick, PA; Rosenzweig, BP; Kronzon, I
1998 OCT 27 ;98(17):501-502, Circulation
— id: 53668, year: 1998, vol: 98, page: 501, stat: Journal Article,

Transesophageal echocardiography in a case of cardiac compression: was it therapeutic?
Rosenzweig BP; Stern A; Kronzon I
1998 May;11(5):494-496, Journal of the American Society of Echocardiography
Cardiac compression is a potentially life-threatening complication of heart surgery. This syndrome often has atypical manifestations, challenging our ability to make a rapid diagnosis and to institute emergent, life-saving treatment. We recently evaluated one such patient who showed cardiac compression caused by an unusual paracardiac mass. The addition of transesophageal echocardiography to the usual transthoracic study may have played more than just a diagnostic role in this case
— id: 12113, year: 1998, vol: 11, page: 494, stat: Journal Article,

Images in cardiovascular medicine. Aorta-to-left atrium fistula: a complication of endocarditis
Schwartzbard A; Tunick PA; Kronzon I
1998 Aug 11;98(6):604-604, Circulation
— id: 7785, year: 1998, vol: 98, page: 604, stat: Journal Article,

Transesophageal echocardiography in high-risk patients with atrial fibrillation
Tunick PA; Kronzon I
1998 Nov 1;129(9):748-748, Annals of internal medicine
— id: 7832, year: 1998, vol: 129, page: 748, stat: Journal Article,

Transesophageal echocardiographic identification of a retrograde dissection of the ascending aorta caused by inadvertent cannulation of the common carotid artery
Applebaum RM; Adelman MA; Kanschuger MS; Jacobowitz G; Kronzon I
1997 Sep;10(7):749-751, Journal of the American Society of Echocardiography
Retrograde aortic dissections can be a complication of vascular procedures. We describe a case of an inadvertent cannulation of the right common carotid artery during an attempt at inserting a pulmonary artery catheter. This resulted in dissection of the right common carotid, subclavian, and innominate arteries. Transesophageal echocardiography was able to visualize a retrograde dissection extending back into the ascending aorta
— id: 12268, year: 1997, vol: 10, page: 749, stat: Journal Article,

Sequential external counterpulsation increases cerebral and renal blood flow
Applebaum RM; Kasliwal R; Tunick PA; Konecky N; Katz ES; Trehan N; Kronzon I
1997 Jun;133(6):611-615, American heart journal
The purpose of this study was to evaluate the effect of sequential external counterpulsation (SECP) on cerebral and renal blood flow. The effect of SECP on carotid and renal artery blood flow was studied in 35 and 18 patients, respectively. With a portable unit, cuffs were applied to the calves and thighs, sequentially inflated with air at the onset of diastole, and deflated at the onset of systole. Carotid and renal artery Duplex studies were performed during intermittent SECP. Flow velocity and flow velocity integral were measured at baseline and during SECP. Diastolic augmentation of carotid and renal artery flow velocity was observed in all patients. The mean carotid flow velocity integral increased by 22% from 27.7 +/- 1.8 cm to 33.1 +/- 2.3 cm (P = 0.001). The mean renal artery flow velocity integral increased by 19% from 21 +/- 1 cm to 25 +/- 1 cm (P = 0.0001). With SECP, a new diastolic Doppler flow velocity wave was observed, with an average peak carotid diastolic flow velocity of 56 +/- 4 cm/sec and an average peak renal artery diastolic flow velocity of 40 +/- 2.5 cm/sec. This diastolic wave was 75% (carotid) and 68% (renal) as high as the systolic wave during SECP. In addition, with SECP the systolic wave increased by 6% and 8% in the carotid and renal artery, respectively (P = 0.02 and 0.006, respectively). In conclusion, SECP significantly increases carotid and renal blood flow. This noninvasive, harmless treatment may be useful to support patients with decreased cerebral and renal perfusion
— id: 7103, year: 1997, vol: 133, page: 611, stat: Journal Article,

Three dimensional ultrasonic imaging of femoral arterial pseudoaneurysms
Applebaum, RM; Kronzon, I; Attubato, MJ; Feit, F
1997 FEB ;29(2):9450-9450, Journal of the American College of Cardiology
— id: 53294, year: 1997, vol: 29, page: 9450, stat: Journal Article,

Intra-aortic balloon pumping does not improve carotid artery blood flow
Applebaum, RM; Wun, HH; Katz, ES; Tunick, PA; Kronzon, I
1997 FEB ;29(2):8043-8043, Journal of the American College of Cardiology
— id: 53291, year: 1997, vol: 29, page: 8043, stat: Journal Article,

Effect of propranolol versus no propranolol on total mortality plus nonfatal myocardial infarction in older patients with prior myocardial infarction, congestive heart failure, and left ventricular ejection fraction > or = 40% treated with diuretics plus angiotensin-converting enzyme inhibitors
Aronow, W S; Ahn, C; Kronzon, I
1997 Jul 15;80(2):207-209, American journal of cardiology
At 32-month follow-up of older patients with prior myocardial infarction, congestive heart failure, and a left ventricular ejection fraction > or = 40% treated with diuretics plus angiotensin-converting enzyme inhibitors, and also with digoxin if atrial fibrillation was present, propranolol caused a 35% significant reduction in total mortality and a 37% significant decrease in total mortality plus nonfatal myocardial infarction compared with no propranolol. At 1-year follow-up, propranolol caused a significantly greater increase in left ventricular ejection fraction (6%) and a significantly greater reduction in left ventricular mass (34 g) than did no propranolol (2% and 20 g, respectively)
— id: 100081, year: 1997, vol: 80, page: 207, stat: Journal Article,

Prevalence of echocardiographic findings in 554 men and in 1,243 women aged > 60 years in a long-term health care facility
Aronow, W S; Ahn, C; Kronzon, I
1997 Feb 1;79(3):379-380, American journal of cardiology
The prevalence of mitral regurgitation, valvular aortic stenosis, aortic regurgitation, hypertrophic cardiomyopathy, idiopathic dilated cardiomyopathy, and of left ventricular hypertrophy was not significantly different in older men and women. Older women had a significantly higher prevalence of rheumatic mitral stenosis, mitral annular calcium, and left atrial enlargement than older men, and older men had a significantly higher prevalence of abnormal left ventricular ejection fraction than older women
— id: 100084, year: 1997, vol: 79, page: 379, stat: Journal Article,

Association of plasma renin activity and echocardiographic left ventricular hypertrophy with frequency of new coronary events and new atherothrombotic brain infarction in older persons with systemic hypertension
Aronow, W S; Ahn, C; Kronzon, I; Gutstein, H
1997 Jun 1;79(11):1543-1545, American journal of cardiology
In older hypertensive persons, male gender, prior coronary artery disease, prior atherothrombotic brain infarction (ABI), and echocardiographic left ventricular (LV) hypertrophy are independent risk factors for new coronary events; age, prior ABI, and echocardiographic LV hypertrophy are independent risk factors for new ABI. The data suggest that high plasma renin activity in hypertensive older persons is associated with a high risk of new coronary events and of new ABI through its association with echocardiographic LV hypertrophy
— id: 100082, year: 1997, vol: 79, page: 1543, stat: Journal Article,

Association of extracranial carotid arterial disease, prior atherothrombotic brain infarction, systemic hypertension, and left ventricular hypertrophy with the incidence of new atherothrombotic brain infarction at 45-month follow-up in 1,482 older patients
Aronow, W S; Ahn, C; Kronzon, I; Gutstein, H; Schoenfeld, M R
1997 Apr 1;79(7):991-993, American journal of cardiology
Comparison of 239 older patients with 40% to 100% extracranial carotid arterial disease (ECAD) with 1,243 older patients with no significant ECAD showed a higher prevalence of systemic hypertension, left ventricular (LV) hypertrophy, and prior atherothrombotic brain infarction (ABI) and a higher incidence of new ABI in patients with ECAD than in patients without ECAD. A multivariate Cox regression model showed that independent predictors of new ABI were ECAD (risk ratio = 2.5), systemic hypertension (risk ratio = 2.3), prior ABI (risk ratio = 2.3), LV hypertrophy (risk ratio = 2.3), and male sex (risk ratio = 1.3)
— id: 100083, year: 1997, vol: 79, page: 991, stat: Journal Article,

Effect of propranolol on mortality in patients with prior myocardial infarction, congestive heart failure, and left ventricular ejection fraction >=40%
Aronow, WS; Ahn, C; Kronzon, I
1997 FEB ;29(2):63176-63176, Journal of the American College of Cardiology
— id: 53292, year: 1997, vol: 29, page: 63176, stat: Journal Article,

Increase in renal blood flow with external counterpulsation
Kasliwal, R; Trehan, N; Tunick, PA; Konecky, N; Applebaum, RM; Katz, ES; Kronzon, I
1997 FEB ;29(2):14157-14157, Journal of the American College of Cardiology
— id: 53290, year: 1997, vol: 29, page: 14157, stat: Journal Article,

Tortuosity of the descending thoracic aorta simulating dissection on transesophageal echocardiography
Katz ES; Applebaum RM; Earls JP; Krinsky G; Weinreb J; Kronzon I
1997 Jan-Feb;10(1):83-87, Journal of the American Society of Echocardiography
In an 80-year-old patient with syncope, a markedly tortuous descending thoracic aorta produced images on transesophageal echocardiography which were suggestive of an intimal flap caused by dissection. A magnetic resonance aortogram clearly showed that the trans-esophageal echocardiogram was a false positive. In addition, multiplanar reconstructed images of the magnetic resonance aortogram through the tortuous descending thoracic aorta could reproduce images similar to that seen by transesophageal echocardiography. Because transesophageal echocardiography has become a popular imaging modality for the detection of aortic dissection, it is essential for echocardiographers to be aware of possible pitfalls which may create false positive findings
— id: 12417, year: 1997, vol: 10, page: 83, 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,

Diagnosis and treatment of iatrogenic femoral artery pseudoaneurysm: a review [published erratum appears in J Am Soc Echocardiogr 1997 Jun;10(5):30A-31A]
Kronzon I
1997 Apr;10(3):236-245, Journal of the American Society of Echocardiography
A pseudoaneurysm is a pulsatile hematoma that communicates with an artery through a disruption in the arterial wall. Femoral pseudoaneurysm is a common complication of invasive procedures. It occurs in 0.1% to 0.2% of diagnostic angiograms and 3.5% to 5.5% of interventional procedures. Longer procedures, large-bore catheters, anticoagulation, and a faulty lower site of puncture are associated with a higher incidence of femoral pseudoaneurysm. Pseudoaneurysms are associated with the characteristic findings of a pulsatile mass, a palpable thrill, and an audible to-and-fro murmur. The diagnosis is confirmed by imaging of the pseudoaneurysm. A femoral arterial duplex study is the diagnostic imaging modality of choice. It can show the pseudoaneurysm, the degree of clotting, the communication with the femoral artery, and the blood flow velocity pattern within the artery, the communication, and the pseudoaneurysm. Small (less than 2 cm) femoral pseudoaneurysms clot spontaneously and usually require no treatment. Larger femoral pseudoaneurysms may lead to complications including rupture and compression of the adjacent femoral vein (with resulting venous thrombosis) or of the femoral nerve. Treatment may be surgical. However, recently it has been shown that direct, noninvasive compression of the pseudoaneurysm stops the blood flow in the communication and leads to pseudoaneurysm clotting and obliteration
— id: 12339, year: 1997, vol: 10, page: 236, stat: Journal Article,

Atheromatous disease of the thoracic aorta: pathologic and clinical implications
Kronzon I; Tunick PA
1997 Apr 15;126(8):629-637, Annals of internal medicine
PURPOSE: To review recent developments in the diagnosis, clinical epidemiology, pathology, and management of atherosclerosis of the thoracic aorta, especially atherosclerosis of the thoracic aorta as a source of embolization. DATA SOURCES: MEDLINE searches, bibliographies of published papers, and consultation with experts in the field. STUDY SELECTION: English-language publications on atherosclerosis of the thoracic aorta were selected. DATA SYNTHESIS: During the last 6 years, the increasing use of transesophageal echocardiography has shown that atherosclerotic plaque in the thoracic aorta is a source of otherwise unexplained embolic events, including stroke, transient ischemic attack, and peripheral emboli. Retrospective studies have documented a strong independent association between larger lesions (4 mm to 5 mm) and previous embolic disease, and prospective studies have shown that patients with these lesions have a high risk for future events (in one study, the risk for stroke was 12%; in another, the risk for cerebral or peripheral events was 33% in a follow-up period of just 14 months). These lesions also pose a serious risk for embolization caused by manipulation of the aorta during catheterization, intra-aortic balloon-pump placement, and cannulation of the aorta for heart surgery. Pathologic examination has shown atherosclerotic plaque, often with superimposed thrombi that account for the mobile components seen on transesophageal echocardiography. The management of patients who have atherosclerotic lesions in the thoracic aorta has not been determined prospectively. However, anticoagulation may help prevent emboli, as it does for patients who have thrombi in other locations, such as the left atrium and the left ventricle. CONCLUSIONS: Protruding atherosclerotic lesions in the thoracic aorta, often with superimposed mobile thrombi, are an important cause of embolic disease. Transesophageal echocardiography should be considered in the work-up of patients who have unexplained embolic events
— id: 12326, year: 1997, vol: 126, page: 629, stat: Journal Article,

Ethanol and hypertrophic cardiomyopathy - Reply
Paz, R; Tunick, PA; Kronzon, I
1997 MAR 20 ;336(12):878-878, New England journal of medicine
— id: 53239, year: 1997, vol: 336, page: 878, stat: Journal Article,

Minimally invasive mitral valve replacement: port-access technique, feasibility, and myocardial functional preservation
Schwartz DS; Ribakove GH; Grossi EA; Buttenheim PM; Schwartz JD; Applebaum RM; Kronzon I; Baumann FG; Colvin SB; Galloway AC
1997 Jun;113(6):1022-1030, Journal of thoracic & cardiovascular surgery
OBJECTIVE: This experiment examined the feasibility of minimally invasive port-access mitral valve replacement via a 2.5 cm incision. METHODS: The study evaluated valvular performance and myocardial functional recovery in six mongrel dogs after port-access mitral valve replacement with a St. Jude Medical prosthesis (St. Jude Medical, Inc., St. Paul, Minn.). Femoro-femoral cardiopulmonary bypass and a balloon catheter system for myocardial protection with cardioplegic arrest (Heartport, Inc., Redwood City, Calif.) were used. The mitral valve was replaced through a 2.5 cm port in the left side of the chest, and the animals were weaned from bypass. Cardiac function was measured before and at 30 and 60 minutes after bypass. Left ventricular pressure and electrical conductance volume were used to calculate changes in load-independent indexes of ventricular function. RESULTS: Each procedure was successfully completed. Recovery of left ventricular function was excellent at 30 and 60 minutes after bypass compared with the prebypass values for elastance (30 minutes = 4.04 +/- 0.97 and 60 minutes = 4.27 +/- 0.57 vs prebypass = 4.45 +/- 0.96; p = 0.51) and for preload recruitable stroke work (30 minutes = 76.23 +/- 4.80 and 60 minutes = 71.21 +/- 2.99 vs prebypass = 71.23 +/- 3.75; p = 0.45). Preload recruitable work area remained at 96% and 85% of baseline at 30 and 60 minutes (p = not significant). In addition, transesophageal echocardiography demonstrated normal prosthetic valve function, as well as normal regional and global ventricular wall motion. Autopsy revealed secure annular-sewing apposition and normal leaflet motion. CONCLUSIONS: These results suggest that minimally invasive mitral valve replacement using percutaneous cardiopulmonary bypass with cardioplegic arrest is technically reproducible, achieves normal valve placement, and results in complete cardiac functional recovery. Minimally invasive mitral valve replacement is now feasible, and clinical trials are indicated
— id: 7256, year: 1997, vol: 113, page: 1022, stat: Journal Article,

Long-term prognostic significance of dobutamine echocardiography in patients with suspected coronary artery disease: results of a 5-year follow-up study
Steinberg EH; Madmon L; Patel CP; Sedlis SP; Kronzon I; Cohen JL
1997 Apr;29(5):969-973, Journal of the American College of Cardiology
OBJECTIVES:This study sought to assess the long-term prognostic utility of dobutamine stress echocardiography in predicting fatal and nonfatal cardiac events. BACKGROUND: Although dobutamine stress echocardiography has improved sensitivity and specificity for detection of coronary artery disease, little is known of its predictive value for long-term cardiac events. Therefore, we followed up 120 consecutive patients who underwent dobutamine echocardiography for suspected coronary disease from March 1989 to August 1991. METHODS: All patients presenting for coronary angiography for chest pain were eligible for recruitment. Follow-up was 100% complete at 5 years (range 3.0 to 6.1). Cardiac events were defined as cardiac death or nonfatal myocardial infarction or the need for coronary revascularization (coronary angioplasty or bypass surgery). RESULTS: Positive (n = 78) and negative (n = 42) dobutamine test groups differed in their rates of coronary artery bypass graft surgery (37.2% vs. 9.5%, p < 0.001, respectively) and mortality. Of 26 total deaths, 22 occurred in the group with positive dobutamine test results (28% vs. 9.5%, p < 0.018); all 7 cardiac deaths occurred in this group as well (9% vs. 0%, p < 0.045). By multivariate regression analysis, positive results on dobutamine echocardiography remained independently predictive of future cardiac death after left ventricular ejection fraction and other clinical variables were accounted for. CONCLUSIONS: A positive finding on dobutamine echocardiography is an independent predictor of long-term cardiac mortality, whereas a negative finding confers a significantly reduced likelihood of cardiac death as much as 5 years from initial testing. We conclude that dobutamine stress echocardiography can be used to predict which patients with suspected coronary artery disease are at low risk for cardiac death and do not require concurrent nuclear or invasive testing
— id: 12336, year: 1997, vol: 29, page: 969, stat: Journal Article,

Prognostic significance of spontaneous echo contrast in the thoracic aorta: relation with accelerated clinical progression of coronary artery disease
Steinberg EH; Madmon L; Wesolowsky H; Feliciano EA; Sanfilipo MP; Sedlis SP; Gindea AJ; Marcus AJ; Kronzon I
1997 Jul;30(1):71-75, Journal of the American College of Cardiology
OBJECTIVES: The purposes of this study were to identify the incidence of aortic smoke in an unselected cohort of patients and to determine the utility of this measurement as a clinical marker for future coronary events and long-term cardiac prognosis. BACKGROUND: Although spontaneous echo contrast detected within the cardiac chambers has been associated with an increased risk of thromboembolism, less is known about 'smoke' within the thoracic aorta and its relation to progression of coronary artery disease. METHODS: We prospectively assessed 118 unselected, consecutive male patients (mean age 67 years, range 29 to 86) who underwent transesophageal echocardiography (TEE). The presence of aortic smoke was identified by swirling echodense shadows distinct from high gain artifact. A positive result required confirmation by two of three independent observers. RESULTS: Aortic smoke without dissection was found in 25 of the patients (21%). Indications for TEE, coronary risk factors, the incidence of reduced left ventricular ejection fraction and mitral insufficiency and known coronary artery disease severity collectively did not differ significantly at baseline between the groups with and without smoke. Follow-up averaged 20.4 months (range 18 to 24) and was 100% complete for mortality and 98% complete for morbidity. The presence of aortic smoke was an independent predictor of myocardial infarction (16.0% vs. 2.2%, p < 0.005) and cardiac death (20.0% vs. 1.1%, p < 0.0001). These statistics remained significant after covarying for age, ejection fraction < 50%, hypertension, diabetes, aortic dimension, the presence of an atheromatous plaque and smoke in the left atrium. CONCLUSIONS: Spontaneous echo contrast detected within the thoracic aorta by transesophageal echocardiography is a common and important clinical marker that is strongly associated with an increased risk for future myocardial infarction and cardiac mortality. Future studies will attempt to define the pathophysiology of this relation and assess whether aggressive revascularization strategies and antithrombotic therapy may aid in the reduction of this risk
— id: 12309, year: 1997, vol: 30, page: 71, stat: Journal Article,

High risk of stroke and death during heart surgery in patients with protruding aortic arch atheromas
Stem, A; Tunick, PA; Culliford, AT; Lachmann, J; Baumann, FG; Kanchuger, MS; Marschall, K; Shah, A; Grossi, EA; Kronzon, I
1997 OCT 21 ;96(8):571-571, Circulation
— id: 33436, year: 1997, vol: 96, page: 571, stat: Journal Article,

Aortic arch endarterectomy increases the risk of stroke during heart surgery in patients with protruding aortic arch atheromas
Stern, A; Tunick, PA; Culliford, AT; Lachmann, J; Baumann, FG; Kanchuger, MS; Marschall, K; Shah, A; Grossi, EA; Kronzon, I
1997 OCT 21 ;96(8):1024-1024, Circulation
— id: 33437, year: 1997, vol: 96, page: 1024, stat: Journal Article,

Pseudoatrial flutter: artifact simulating atrial flutter caused by a transcutaneous electrical nerve stimulator (TENS)
Weitz SH; Tunick PA; McElhinney L; Mitchell T; Kronzon I
1997 Dec;20(12 Pt 1):3010-3011, Pacing & clinical electrophysiology
A patient with previous actual atrial flutter had what appeared to be atrial flutter seen on Holter monitoring during treatment with a transcutaneous electrical nerve stimulation (TENS) unit. This proved to be artifact caused by the unit rather than a true arrhythmia. The artifact was reproduced in a normal volunteer by application of a TENS unit
— id: 7847, year: 1997, vol: 20, page: 3010, stat: Journal Article,

Evaluation and management of cholesterol embolization and the blue toe syndrome
Applebaum RM; Kronzon I
1996 Sep;11(5):533-542, Current opinion in cardiology
The blue toe syndrome is characterized by tissue ischemia secondary to cholesterol crystal or atherothrombotic embolization leading to occlusion of small vessels. Embolization occurs typically from an ulcerated atherosclerotic plaque located in the aorto-iliac-femoral arterial system. Clinical presentation can range from a cyanotic toe to a diffuse multiorgan systemic disease that can mimic other systemic illness. Mortality can be higher than 70% depending on the scope of the illness. Embolization can occur spontaneously or from a variety of insults such as invasive vascular procedures, anticoagulation, or thrombolytic therapy. Angiography, duplex ultrasonography, computerized tomographic scanning, and magnetic resonance imaging have been used to image the offending lesions, with angiography considered the 'gold standard' despite its inherent risks. Recently, transesophageal echocardiography has been shown to be a helpful tool in imaging the thoracic aorta and delineating in great detail the anatomy of the aortic atheroma. At present, surgery remains the most viable treatment option. However, we look to the future for large randomized trials to help predict embolization and thus the proper medical therapy
— id: 12549, year: 1996, vol: 11, page: 533, stat: Journal Article,

Prevalence of echocardiographic abnormalities in 1797 older persons
Aronow, WS; Ahn, C; Kronzon, I
1996 SEP ;44(7):A411-A411, Journal of investigative medicine
— id: 52822, year: 1996, vol: 44, page: A411, stat: Journal Article,

Carotid disease, hypertension, left ventricular hypertrophy, and stroke
Aronow, WS; Ahn, C; Kronzon, I; Gutstein, H; Schoenfeld, MR
1996 SEP ;44(7):A405-A405, Journal of investigative medicine
— id: 52821, year: 1996, vol: 44, page: A405, stat: Journal Article,

Rapid growth rate of an apical left ventricular myxoma
Artel B; Colvin SB; Kronzon I
1996 Apr;131(4):820-822, American heart journal
— id: 12631, year: 1996, vol: 131, page: 820, stat: Journal Article,

Cardiogenic embolism
Daniel, Werner G; Kronzon, Itzhak; Mugge, Andreas
Baltimore : Williams & Wilkins, 1996,
— id: 1534, year: 1996, vol: , page: , stat: ,

Early results of posterior leaflet folding plasty: A new technique for mitral valve reconstruction
Grossi, EA; Galloway, AC; Delianides, J; Schwartz, DS; Kronzon, I; Colvin, SB
1996 OCT 15 ;94(8):3119-3119, Circulation
— id: 33443, year: 1996, vol: 94, page: 3119, stat: Journal Article,

Sequential external counterpulsation: an adjunctive therapy for patients with chronic coronary artery disease and left ventricular dysfunction
Kasliwal, R R; Mittal, S; Kanojia, A; Bhatia, M L; Kronzon, I; Trehan, N
1996 Mar-Apr;48(2):150-154, Indian heart journal
We assessed the clinical and haemodynamic improvement with 3 weeks of sequential external counterpulsation (SECP) therapy in 23 patients with chronic coronary artery disease (CAD) and left ventricular (LV) dysfunction who were refractory to maximal tolerated doses of medical therapy and in whom intervention or surgery was not contemplated. All patients were subjected to one-hour duration of SECP for 3 weeks. SECP is a new noninvasive tool which increases coronary artery filling utilizing external pressure in a sequential manner from calf to thigh. A detailed clinical and echocardiographic evaluation was done before and after the completion of therapy to assess the utility of SECP. There were 18 males and 5 females with a mean age of 53 years. On coronary angiography, 39 percent patients had single, 8.7 percent had double and 48 percent had triple vessel disease. Four patients had coronary artery bypass graft (CABG) surgery in the past. Out of all patients, 48 percent had diffuse or distal coronary artery disease which was considered not suitable for CABG, 22 percent were not willing for intervention and 30 percent had other systemic diseases making them unfit for surgery. After 3 weeks of SECP, the anginal frequency reduced from 9 episodes/week to 1 episode/week. Before SECP, 74 percent patients were in NYHA class III, whereas only 8.7 percent were class III symptomatic after SECP. All patients claimed symptomatic improvement of a mean of 6.8 +/- 1.4 on a visual analog scale of 1-10. After SECP, the LV diastolic dimensions reduced from 54.6 +/- 7 to 51 +/- 7 mm, systolic dimensions reduced from 40 +/- 8 to 36 +/- 8 mm and LVEF increased from 32.7 +/- 9 to 37.4 +/- 8.5 percent. In conclusion, 3 weeks of therapy with SECP produces significant improvement in symptomatic status and cardiac function in patients with chronic CAD and LV dysfunction, refractory to medical therapy
— id: 100087, year: 1996, vol: 48, page: 150, stat: Journal Article,

Utility of three dimensional echocardiography during balloon mitral valvuloplasty
Kasliwal, RR; Kanojia, A; Applebaum, RM; Seth, A; Bhandari, S; Trehan, N; Winer, HE; Kronzon, I
1996 OCT 15 ;94(8):419-419, Circulation
— id: 52741, year: 1996, vol: 94, page: 419, stat: Journal Article,

Incomplete occlusion of left ventricular aneurysms after endoventricular aneurysmorrhaphy: diagnosis by echocardiography and ventriculography
Katz ES; Applebaum RM; Pierson C; Chinitz L; Colvin SB; Kronzon I
1996 May;38(1):96-99, Catheterization & cardiovascular diagnosis
Surgical treatment of left ventricular aneurysms have recently focused on maintaining normal left ventricular geometry by using a circular patch repair to exclude the aneurysmal cavity (endoaneurysmorrhaphy). We describe two patients who underwent this procedure and were subsequently found by echocardiography and angiography to have a residual communication between the left ventricular cavity and the aneurysm which contained thrombus. This finding may have implications regarding the optimal hemodynamic result of the surgery and the risk of thromboembolism
— id: 12616, year: 1996, vol: 38, page: 96, 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,

Right atrial thrombus complicating mitral valvuloplasty
Konecky N; Rosenzweig BP; Katz ES; Kronzon I
1996 Oct;132(4):893-894, American heart journal
— id: 7077, year: 1996, vol: 132, page: 893, stat: Journal Article,

Pushing Echocardiography Past the Aortic Root
Kronzon I
1996 Mar;13(2):165-166, Echocardiography
— id: 100086, year: 1996, vol: 13, page: 165, stat: Journal Article,

A 58-year-old man with shortness of breath, ascites, and leg edema [clinical conference]
Kronzon I; Fedor M; Schwartz D; Gallo G; Jacobson DR
1996 Sep 15;94(6):1483-1488, Circulation
— id: 12539, year: 1996, vol: 94, page: 1483, stat: Journal Article,

Transesophageal Echocardiography in Thoracic Aortic Atherosclerosis
Kronzon I; Tunick PA
1996 Mar;13(2):233-246, Echocardiography
Transesophageal echocardiography opened a new window to the thoracic aorta and for the first time permitted in vivo imaging of aortic atherosclerotic disease. The technique is useful in assessing the extent of the disorder, its complications, and possible treatment modalities. It will also be useful in the assessment of the progression as well as the possible regression of the disorder with appropriate (dietary or chemical) therapy. (ECHOCARDIOGRAPHY, Volume 13, March 1996)
— id: 63034, year: 1996, vol: 13, page: 233, stat: Journal Article,

Tsintur ha-lev
Kronzon, Itzhak
Rosh ha-'Ayin : Prolog, 1996,
— id: 1538, year: 1996, vol: , page: , stat: ,

Intracardiac shunts
Nacht A; Kronzon I
1996 Apr;12(2):295-319, Critical care clinics
Unsuspected intracardiac shunts can be a cause of acute deterioration in critically ill patients. Shunts can be acquired or congenital conditions that become symptomatic only with changed physiologic conditions. Transesophageal echocardiography is an excellent tool for the diagnosis of intracardiac shunts
— id: 12621, year: 1996, vol: 12, page: 295, stat: Journal Article,

The effect of the ingestion of ethanol on obstruction of the left ventricular outflow tract in hypertrophic cardiomyopathy
Paz R; Jortner R; Tunick PA; Sclarovsky S; Eilat B; Perez JL; Kronzon I
1996 Sep 26;335(13):938-941, New England journal of medicine
BACKGROUND: Ethanol causes vasodilation, which might have an adverse effect, due to increased obstruction of the left ventricular outflow tract, in patients with hypertrophic obstructive cardiomyopathy. We assessed the hemodynamic effects of the ingestion of ethanol, in an amount commonly consumed socially, in patients with hypertrophic cardiomyopathy. METHODS: We performed echocardiography in 36 patients before and several times after the ingestion of either 50 ml of 40 percent ethanol or an isocaloric placebo with the aroma of rum. Each patient received both ethanol and placebo, on different days. The patients, but not the physicians, were blinded to the content of the drink. We measured the sizes of the left atrium and left ventricle, the left-ventricular-wall thickness, blood pressure, heart rate, the degree of systolic anterior motion of the mitral valve, and the pressure gradient across the left ventricular outflow tract. RESULTS: The ingestion of ethanol regulated in a significant drop in the mean (+/- SD) systolic blood pressure (from 130.5 +/- 18.6 to 122.5 +/- 20.3 mm Hg, P<0.001), a significant increase in systolic anterior motion of the mitral valve (from a grade of 2.1 to a grade of 2.5, P<0.001), and a 63 percent increase in the mean gradient across the left ventricular outflow tract (from 38.1 +/- 26.5 to 62.2 +/- 42.4 mm Hg, P<0.001). These changes, which were not associated with symptoms, did not occur after the ingestion of placebo. CONCLUSION: The ingestion of a small amount of ethanol caused an increase in the gradient across the left ventricular outflow tract in patients with hypertrophic obstructive cardiomyopathy, which could have and adverse clinical effect
— id: 63033, year: 1996, vol: 335, page: 938, stat: Journal Article,

Intraaortic mass after repair of an aortic dissection
Rosenzweig BP; Colvin SB; Leitman BS; Kronzon I
1996 Jan-Feb;9(1):100-103, Journal of the American Society of Echocardiography
After graft repair of an ascending aortic aneurysm, a patient was seen by us with a chest x-ray film indicating a retained foreign body. Mediastinal exploration had been unrevealing. Transesophageal echocardiography demonstrated the nature and exact location of the foreign body and therefore was instrumental in directing its retrieval
— id: 12694, year: 1996, vol: 9, page: 100, stat: Journal Article,

Images in cardiovascular medicine. Impending paradoxical embolus
Rosenzweig BP; Glassman L; Kronzon I
1996 Jan 15;93(2):387-387, Circulation
— id: 12655, year: 1996, vol: 93, page: 387, stat: Journal Article,

Aortic dissection with flap prolapse into the left ventricle
Rosenzweig BP; Goldstein S; Sherrid M; Kronzon I
1996 Jan 15;77(2):214-216, American journal of cardiology
Transesophageal echocardiography provided an accurate diagnosis of intimal flap prolapse into the left ventricle in all 6 of our patients. This complication of AD is a newly recognized and uncommonly discerned cause of severe AR
— id: 6956, year: 1996, vol: 77, page: 214, stat: Journal Article,

Spontaneous echocardiographic contrast within an unruptured sinus of Valsalva aneurysm: a potential embolic source diagnosed by transesophageal echocardiography
Steinberg E; Wun H; Bosco J; Kronzon I
1996 Nov-Dec;9(6):880-881, Journal of the American Society of Echocardiography
A 75-year-old male patient had an unexplained transient ischemic attack. Transesophageal echocardiography revealed a large, unruptured Sinus of Valsalva aneurysm which contained spontaneous echo contrast. This finding represents a potential source of embolism
— id: 12491, year: 1996, vol: 9, page: 880, stat: Journal Article,

Images in cardiovascular medicine. Giant left ventricular pseudoaneurysm
Yucel, G; Steinberg, E; O'Reilly, M; Kronzon, I
1996 Aug 15;94(4):848-848, Circulation
— id: 100085, year: 1996, vol: 94, page: 848, stat: Journal Article,

Echocardiographic findings associated with atrial fibrillation in 1,699 patients aged > 60 years
Aronow, W S; Ahn, C; Kronzon, I
1995 Dec 1;76(16):1191-1192, American journal of cardiology
— id: 100088, year: 1995, vol: 76, page: 1191, stat: Journal Article,

Left ventricular hypertrophy is more prevalent in patients with systemic hypertension with extracranial carotid arterial disease than in patients with systemic hypertension without extracranial carotid arterial disease
Aronow, W S; Kronzon, I; Schoenfeld, M R
1995 Jul 15;76(3):192-193, American journal of cardiology
The mechanism of the association between LV hypertrophy and ECAD is unknown and needs to be investigated. Whether LV hypertrophy in patients with systemic hypertension is a marker for ECAD or contributes to ECAD needs to be investigated. The association between LV hypertrophy and significant ECAD was independent of the level of blood pressure in our patients. Coronary atherosclerosis in our patients with signifciant ECAD may have contributed to the increased prevalence of LV hypertrophy. The association between LV hypertrophy and significant ECAD may contribute to the high incidence of stroke in patients with LV hypertrophy. This is currently under investigation by our group
— id: 100089, year: 1995, vol: 76, page: 192, stat: Journal Article,

Prevalence of extracranial carotid arterial disease and of valvular aortic stenosis and their association in the elderly
Aronow, W S; Kronzon, I; Schoenfeld, M R
1995 Feb 1;75(4):304-305, American journal of cardiology
— id: 100091, year: 1995, vol: 75, page: 304, stat: Journal Article,

EXTRACRANIAL CAROTID ARTERIAL-DISEASE, HYPERTENSION, AND LEFT-VENTRICULAR HYPERTROPHY
ARONOW, WS; KRONZON, I; SCHOENFELD, MR
1995 SEP ;43(9):SA20-SA20, Journal of the American Geriatrics Society
— id: 86757, year: 1995, vol: 43, page: SA20, stat: Journal Article,

Transesophageal echocardiographic diagnosis of right atrial thrombi associated with the antiphospholipid syndrome
Day SM; Rosenzweig BP; Kronzon I
1995 Nov-Dec;8(6):937-940, Journal of the American Society of Echocardiography
Thromboembolic disorders are a hallmark of the antiphospholipid antibody syndrome. We describe a patient with IgM antiphospholipid antibodies associated with pulmonary emboli and in situ thrombosis within an otherwise normal right atrium. Echocardiography, particularly the transesophageal study, proved invaluable in providing a diagnosis and guiding our patient's evaluation and treatment
— id: 11475, year: 1995, vol: 8, page: 937, stat: Journal Article,

Protruding atheromas of the aortic arch in symptomatic patients with carotid artery disease
Demopoulos LA; Tunick PA; Bernstein NE; Perez JL; Kronzon I
1995 Jan;129(1):40-44, American heart journal
Protruding aortic arch atheromas are associated with otherwise unexplained strokes and transient ischemic attacks. Therefore aortic atheromas also may be important in patients with carotid artery disease. Forty-five patients with > or = 50% carotid stenosis and stroke or transient ischemic attack within 6 weeks underwent transesophageal echocardiographic examination (TEE). They were matched for age, sex, and hypertension with 45 control subjects who had also had a recent cerebral event but in whom significant carotid stenosis was absent. Protruding aortic arch atheromas were present in 17 (38%) of 45 patients with carotid disease and only 7 (16%) of 45 of control subjects (p = 0.02). Mobile atheromas (with the greatest embolic potential) were present almost exclusively in case patients, 6 (13%) of 45, versus 1 (2%) of 45 control subjects (p = 0.05). Case patients with mobile atheromas had the most severe carotid stenosis ( > or = 80%). Cerebral symptoms were discordant with the side of the carotid stenosis in 10 case patients, and 4 had atheromas. In conclusion, protruding atheromas of the aortic arch are present in significant numbers of symptomatic patients with carotid artery disease. These atheromas may represent an additional cause of symptoms in patients with carotid stenosis. TEE to look for protruding aortic atheromas may be considered in patients with neurologic events despite the presence of significant carotid stenosis, especially if the symptoms are discordant with the side of carotid stenosis
— id: 6603, year: 1995, vol: 129, page: 40, 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,

Endoventricular remodeling of left ventricular aneurysm. Functional, clinical, and electrophysiological results
Grossi EA; Chinitz LA; Galloway AC; Delianides J; Schwartz DS; McLoughlin DE; Keller N; Kronzon I; Spencer FC; Colvin SB
1995 Nov 1;92(9 Suppl):II98-I100, Circulation
BACKGROUND: Recent advances in surgical techniques for the repair of left ventricular aneurysms (LVAs) include the use of an endoventricular patch to exclude the aneurysm cavity. This technique has replaced conventional linear plication of the aneurysm. The endoventricular patch technique remodels the left ventricular cavity to a more physiological geometry that improves function. METHODS AND RESULTS: From December 1989 through November 1993, 45 patients underwent an LVA repair with an endoventricular patch. This procedure was performed in association with coronary artery bypass grafting in 40 patients. Twenty-eight patients (62.2%) also had nonguided encircling subendocardial incisions. Operative procedures included 7 emergency operations, 3 concomitant valve procedures, and a mean of 2.2 bypass grafts per patient. Eight patients had previous cardiac operations. Hospital mortality was 15.6% (7/45) for all patients and 9.1% (3/33) for nonemergent revascularization and LVA repairs. Ejection fraction improved from a mean of 25.8% preoperatively to 37.8% postoperatively; the mean New York Heart Association classification improved from 3.5 to 1.5. Of patients known to have preoperative arrhythmias (inducible or sudden death), 69% were not inducible postoperatively without antiarrhythmic medication. Survival from late cardiac death (including death of unknown origin) was 86.5% at 2 years. Freedom from documented ventricular arrhythmias was 94.3% at 2 years. CONCLUSIONS: These results indicate that the patch endoaneurysmorrhaphy technique can provide an excellent functional and physiological outcome in patients with LVAs and severely impaired ventricular function
— id: 56759, year: 1995, vol: 92, page: II98, 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,

Systolic aortic regurgitation: a hemodynamic challenge for the clinician
Kronzon I; Konecky N; Tunick PA
1995 Nov-Dec;8(6):941-943, Journal of the American Society of Echocardiography
Aortic regurgitation is considered a diastolic phenomenon. We describe a case in which premature beats resulted in a left ventricular systolic pressure that was lower than the aortic pressure, and thus aortic regurgitation continued throughout the systole of the premature beat. This sequence of events was clearly demonstrated by Doppler echocardiography
— id: 11474, year: 1995, vol: 8, page: 941, 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,

DIASTOLIC LEFT-TO-RIGHT SHUNTING IN UNCOMPLICATED VENTRICULAR SEPTAL-DEFECT
KRONZON, I; CZINER, DG; ROSENZWEIG, BP; TUNICK, PA
1995 SEP ;12(5):457-463, Echocardiography
The systolic left-to-right shunt in patients with uncomplicated ventricular septal defect is associated with a classic loud murmur, and is well described. The additional diastolic left-to-right shunt, always silent, is less well recognized. Left-to-right diastolic shunt flow is directly related to the defect size, to the diastolic pressure gradient between. the left and right ventricle, and to the duration of diastole. The purpose of this study was to evaluate by Doppler echocardiography the duration, magnitude, and flow velocity characteristics of the diastolic left-to-right shunt. There were 30 adult patients with uncomplicated ventricular septal defects studied by color, pulsed, and continuous wave Doppler echocardiography. In each patient, the uncomplicated ventricular septal defect was visualized by two-dimensional echocardiography and/or Doppler echocardiography, and the systolic and diastolic left-to-right shunt flow was identified by Doppler echocardiography. Accurate Doppler flow velocity peas twice, in beginning and again. at end diastole. The mean diastolic flow velocity was 0.5-1.5 msec (average 0.83 +/- 22 msec). This flow velocity was markedly lower than the mean systolic shunt flow velocity (2.4-5.3 msec, average 3.8 +/- .7 msec). The Doppler flow velocity integral was 0.17-0.64 m (average 0.36 +/- 0.14), markedly smaller than the systolic flow velocity integral (0.8-1.8 m, average 1.3 +/- 0.3). The diastolic left-to-right shunt flow teas 12-41% (average 21 +/- 8) of total (systolic and diastolic) shunt flow. In conclusion: Diastolic left-to-right shunts can be identified in all patients with uncomplicated ventricular septal defects, and analyzed in the majority of patients. A significant degree of the left to right shunting in. uncomplicated ventricular septal defects occur during diastole
— id: 86730, year: 1995, vol: 12, page: 457, 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,

Cardiologic evaluation
Levin RI; Kronzon I
Emergency diagnostic testing St. Louis MO : Mosby, 1995,
— id: 4552, year: 1995, vol: , page: 169, stat: Chapter,

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,

ETHANOL INGESTION INCREASES OUTFLOW OBSTRUCTION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY
PAZ, R; JORTNER, R; TUNICK, PA; SKLAROVSKY, S; EILAT, B; KRONZON, I
1995 OCT 15 ;92(8):3237-3237, Circulation
— id: 86676, year: 1995, vol: 92, page: 3237, stat: Journal Article,

Prognosis of patients with heart failure and unoperated severe aortic valvular regurgitation and relation to ejection fraction
Aronow, W S; Ahn, C; Kronzon, I; Nanna, M
1994 Aug 1;74(3):286-288, American journal of cardiology
— id: 100093, year: 1994, vol: 74, page: 286, stat: Journal Article,

Decrease in mortality by propranolol in patients with heart disease and complex ventricular arrhythmias is more an anti-ischemic than an antiarrhythmic effect
Aronow, W S; Ahn, C; Mercando, A D; Epstein, S; Kronzon, I
1994 Sep 15;74(6):613-615, American journal of cardiology
— id: 100092, year: 1994, vol: 74, page: 613, stat: Journal Article,

Effect of propranolol versus no antiarrhythmic drug on sudden cardiac death, total cardiac death, and total death in patients > or = 62 years of age with heart disease, complex ventricular arrhythmias, and left ventricular ejection fraction > or = 40%
Aronow, W S; Ahn, C; Mercando, A D; Epstein, S; Kronzon, I
1994 Aug 1;74(3):267-270, American journal of cardiology
— id: 100094, year: 1994, vol: 74, page: 267, stat: Journal Article,

Venous changes occurring during the Valsalva maneuver: evaluation by intravascular ultrasound
Attubato MJ; Katz ES; Feit F; Bernstein N; Schwartzman D; Kronzon I
1994 Aug 15;74(4):408-410, American journal of cardiology
— id: 12917, year: 1994, vol: 74, page: 408, stat: Journal Article,

Correlates of spontaneous echo contrast in patients with mitral stenosis and normal sinus rhythm
Bernstein NE; Demopoulos LA; Tunick PA; Rosenzweig BP; Kronzon I
1994 Aug;128(2):287-292, American heart journal
The purpose of this study was to evaluate the correlates of spontaneous echo contrast in mitral stenosis and normal sinus rhythm. Spontaneous echo contrast is associated with clot formation and embolic phenomena. It has been noted in conditions involving blood stasis, especially mitral stenosis and atrial fibrillation, but the correlates of spontaneous echo contrast in patients with mitral stenosis and normal sinus rhythm have not been extensively evaluated. The transthoracic and transesophageal echocardiograms and clinical findings of 47 patients with mitral stenosis and normal sinus rhythm were reviewed. Left atrial size, mean transmitral gradient, and valve area were measured, and the presence or absence of spontaneous echo contrast in the left atrium was noted. Spontaneous echo contrast was found in the echocardiograms of 21 (45%, group 1) of 47 patients. There was no contrast in those of the other 26 patients (group 2). Mean transmitral gradient was significantly higher in group 1 (13.6 +/- 5.2 mm Hg) than in group 2 (10.5 +/- 4.9 mm Hg) (p < 0.05). Mitral valve area was significantly smaller in group 1 than in group 2 (1.0 +/- 0.5 vs 1.4 +/- 0.5 cm2; p < 0.02). There was a trend toward a higher prevalence of significant mitral regurgitation in group 2. There was no significant difference with respect to age, left atrial size, history of embolism, or warfarin therapy. We conclude that spontaneous echo contrast in the left atrium of patients with mitral stenosis and normal sinus rhythm is common and is associated with a significantly smaller mitral valve area and higher mitral gradient.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 12931, year: 1994, vol: 128, page: 287, 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,

Thrombosis of a Starr-Edwards tricuspid prosthesis: diagnosis by Doppler echocardiography and treatment with thrombolysis
Glotzer TV; Tunick PA; Kloth H; Galloway AC; Kronzon I
1994 Mar;127(3):705-708, American heart journal
— id: 6385, year: 1994, vol: 127, page: 705, stat: Journal Article,

ENDOVENTRICULAR REMODELING FOR LV ANEURYSM - FUNCTIONAL AND ELECTROPHYSIOLOGICAL RESULTS
GROSSI, EA; CHINITZ, LA; GALLOWAY, AC; DELIANIDES, J; KRONZON, I; SPENCER, FC; COLVIN, SB
1994 OCT ;90(4):640-640, Circulation
— id: 33449, year: 1994, vol: 90, page: 640, stat: Journal Article,

HORIZONTAL PLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY MAY BE FALSE-NEGATIVE FOR LARGE TRICUSPID VEGETATIONS
GUARNERI, E; TUNICK, PA; KENNEDY, JT; KRONZON, I
1994 JAN ;11(1):35-37, Echocardiography
A 37-year-old man was admitted to the hospital with fever. Because of a history of intravenous drug abuse, and a picture consistent with septic pulmonary emboli, right-sided endocarditis was suspected. However, transthoracic echocardiography did not reveal any vegetations. Transesophageal echocardiography was therefore done, and excellent visualization of the tricuspid valve with the horizontal plane view showed what appeared to be a normal tricuspid valve. However, the vertical plane image clearly showed a Large tricuspid vegetation. This case illustrates the advantage of the biplane transesophageal transducer, as the diagnosis would have been missed with a standard single plane probe
— id: 52589, year: 1994, vol: 11, page: 35, stat: Journal Article,

Transesophageal echocardiography in the diagnosis of Q-fever endocarditis
Jortner R; Demopoulos LA; Bernstein NE; Tunick PA; Shapira Y; Shaked Y; Kronzon I
1994 Oct;128(4):827-831, American heart journal
— id: 63035, year: 1994, vol: 128, page: 827, stat: Journal Article,

Echocardiographic evaluation of the five-chamber heart: a rare congenital coronary anomaly
Jortner RT; Daniel WG; Ayzenberg O; Saad A; Tunick PA; Kronzon I
1994 Jan-Feb;7(1):61-66, Journal of the American Society of Echocardiography
Coronary artery fistulas are rare congenital anomalies that usually drain into one of the cardiac chambers or veins. The current patient was found to have a distinctly unusual anatomic picture, with a fifth cardiac chamber appearing at the cardiac apex. This proved to be the drainage site for a large coronary artery fistula originating in the left anterior descending coronary artery. The anatomic relations and blood flow patterns were demonstrated with transthoracic and transesophageal echocardiography
— id: 63037, year: 1994, vol: 7, page: 61, stat: Journal Article,

Pulsus alternans as a sign of prosthetic valve dysfunction
Jortner RT; Rafaelof B; Tunick PA; Kronzon I
1994 Jan;127(1):221-224, American heart journal
— id: 63036, year: 1994, vol: 127, page: 221, 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,

COMPLICATIONS OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN 3,003 PATIENTS - THE VALUE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY STUDY
KRONZON, I; TUNICK, P; GOLDSTEIN, S; BARZILAI, B; DAVIDOFF, R; DITTRICH, H; HOMMA, S; MOTRO, M; ROSEN, S; VERED, Z; BUDD, J; VORCHHEIMER, D; BARUCH, L; DAVID, O; VOULGARIS, K; FISHER, E; GOLDMAN, M
1994 OCT ;90(4):20-20, Circulation
— id: 52309, year: 1994, vol: 90, page: 20, 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,

Transesophageal echocardiographic diagnosis of the superior vena cava syndrome resulting from aortic dissection: a multiplane study
Rosenzweig BP; Kronzon I
1994 Jul-Aug;7(4):414-418, Journal of the American Society of Echocardiography
The case of an 82-year-old patient with signs and symptoms of superior vena cava syndrome is described. A multiplane transesophageal echocardiogram demonstrated anatomic and Doppler flow evidence of superior vena caval obstruction due to compression by a dissected, aneurysmal ascending aorta. Multiplane transesophageal echocardiography is particularly useful in the diagnosis of superior vena cava syndrome when it is a sequela of thoracic aortic disease
— id: 6732, year: 1994, vol: 7, page: 414, 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,

Fistulous tract within a left atrial thrombus: an unusual route for prosthetic mitral regurgitation demonstrated by transesophageal echocardiography
Tunick PA; Schulman IC; Kronzon I
1994 Mar;127(3):716-719, American heart journal
— id: 6543, year: 1994, vol: 127, page: 716, stat: Journal Article,

Prognosis of congestive heart failure in patients aged > or = 62 years with unoperated severe valvular aortic stenosis
Aronow, W S; Ahn, C; Kronzon, I; Nanna, M
1993 Oct 1;72(11):846-848, American journal of cardiology
— id: 100095, year: 1993, vol: 72, page: 846, stat: Journal Article,

Effect of enalapril on congestive heart failure treated with diuretics in elderly patients with prior myocardial infarction and normal left ventricular ejection fraction
Aronow, W S; Kronzon, I
1993 Mar 1;71(7):602-604, American journal of cardiology
— id: 100096, year: 1993, vol: 71, page: 602, stat: Journal Article,

PROGNOSIS OF CONGESTIVE-HEART-FAILURE DUE TO SEVERE AORTIC-STENOSIS
ARONOW, WS; AHN, C; KRONZON, I; NANNA, M
1993 APR ;41(2):A334-A334, Clinical research
— id: 54283, year: 1993, vol: 41, page: A334, 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,

ECHOCARDIOGRAPHIC CORRELATES OF SPONTANEOUS ECHO CONTRAST IN PATIENTS WITH MITRAL-STENOSIS AND NORMAL SINUS RHYTHM
BERNSTEIN, NE; ROSENZWEIG, BP; DEMOPOULOS, LA; TUNICK, PA; KRONZON, I
1993 OCT ;88(4):206-206, Circulation
— id: 52203, year: 1993, vol: 88, page: 206, 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,

TRANSESOPHAGEAL ECHOCARDIOGRAPHY OF THE THORACIC AORTA
CZINER, DG; TUNICK, PA; BLUM, LF; KRONZON, I
1993 JUN ;11(1):29-43, Journal of cardiovascular ultrasonography
— id: 54127, year: 1993, vol: 11, page: 29, 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,

Aortic dissection complicating cardiac surgery: diagnosis by intraoperative biplane transesophageal echocardiography
Katz ES; Tunick PA; Colvin SB; Culliford AT; Kronzon I
1993 Mar-Apr;6(2):217-222, Journal of the American Society of Echocardiography
Aortic dissection is a rare but devastating complication of cardiopulmonary bypass. Intraoperative transesophageal echocardiography can be a useful technique to define the anatomy of the dissection, to evaluate its extension and progression, and to detect the presence of aortic insufficiency. We describe two cases in which transesophageal echocardiography helped in making a rapid diagnosis of aortic dissection during cardiac surgery and demonstrate how it may play a role in therapeutic decision making
— id: 13221, year: 1993, vol: 6, page: 217, stat: Journal Article,

Transesophageal echocardiography as a tool in the evaluation of patients with embolic disorders
Kronzon I; Tunick PA
1993 Jul-Aug;36(1):39-60, Progress in cardiovascular diseases
TEE has become one of the most powerful tools for evaluating patients with unexplained stroke, TIA, and peripheral and pulmonary embolization. This is especially encouraging in view of the previously disappointing results of TTE in these patients. In addition to the dramatic results in terms of clot visualization and the other intracardiac sources of embolization described previously, a new extracardiac source has been identified, namely protruding atheromas in the thoracic aorta. These atheromas have been seen for the first time because of the new diagnostic window that has been opened by the development of TEE. Their recognition and follow-up may lead to information that will change the approach to a significant number of patients with embolic ischemic episodes
— id: 6430, year: 1993, vol: 36, page: 39, stat: Journal Article,

Relation between pulmonary artery pressure and mitral stenosis severity in patients undergoing balloon mitral commissurotomy
Otto CM; Davis KB; Reid CL; Slater JN; Kronzon I; Kisslo KB; Bashore TM
1993 Apr 1;71(10):874-878, American journal of cardiology
— id: 38026, year: 1993, vol: 71, page: 874, stat: Journal Article,

Echocardiographic manifestations in a patient with pseudoxanthoma elasticum
Rosenzweig BP; Guarneri E; Kronzon I
1993 Sep 15;119(6):487-490, Annals of internal medicine
— id: 13071, year: 1993, vol: 119, page: 487, stat: Journal Article,

Protruding atheromas in the thoracic aorta: a newly recognized source of cerebral and systemic embolization
Tunick PA; Kronzon I
1993 Jul;10(4):419-428, Echocardiography
Up to 40% of stroke patients do not have an obvious etiology for their illness. Because transthoracic echocardiography is often negative in these patients, there has been increasing enthusiasm for transesophageal echocardiography (TEE) as a newer tool for evaluating patients with embolic disease. In a study of patients referred because of unexplained stroke or transient ischemic attacks, the most common finding was protruding atheroma in the aortic arch. In a case control study, protruding aortic atheromas were found in 33 of the 122 patients with emboli (27%). Mobile components to the atheromas were found in 11 case patients, and there were no mobile components found in any control patients. It is also possible that protruding aortic atheromas may play a role in patients with other sources of emboli (e.g., carotid disease). Atheromas may also cause emboli during catheterization, balloon pump placement, and cardiopulmonary bypass. The pathological composition of the lesions seen on TEE has been atheroma with superimposed thrombus. The correct treatment for patients with embolization due to protruding aortic atheromas has not yet been determined, although anticoagulation may play a role, since the mobile components to these lesions appear to be thrombus. We have recommended surgery for several patients. However, the operation is a major one with major potential complications, including aortic dissection. TEE should be done in patients with unexplained emboli, and it may also play a role in patients with other sources of embolization. TEE should be considered in elderly patients or those with extensive vascular disease before cardiac catheterization or heart surgery. In addition, cannulation techniques during bypass can be modified to avoid atheromas. The ideal medical and/or surgical approaches to patients with protruding atheromas remain to be clarified
— id: 13133, year: 1993, vol: 10, page: 419, stat: Journal Article,

Electrocardiographic changes during cesarean section: a cause for concern?
Zakowski MI; Ramanathan S; Baratta JB; Cziner D; Goldstein MJ; Kronzon I; Turndorf H
1993 Jan;76(1):162-167, Anesthesia & analgesia
A Holter monitor was used to record ST segment changes during cesarean section in 170 consecutive healthy parturients starting 2 h before and ending 3 h after surgery. Lumbar epidural anesthesia (LEA, n = 120) or subarachnoid anesthesia (SA, n = 50) was used. Transthoracic 2-D echocardiograms were obtained in 30 patients from the LEA group. ST depression or elevation occurred 160 times in 44 patients from both groups. Ninety-eight percent of these changes occurred between induction of anesthesia and the end of surgery, with 78% of the episodes registering -1 mV. In the LEA group, the number of episodes tended to increase after delivery, but in the SA group, the frequency remained constant. ST segment depression was recorded in 38% and 14% of patients in the LEA and SA groups, respectively (P < 0.05, x2 analysis). No wall motion abnormality was noted in the echocardiogram during ST segment depression. Neither the 12-lead electrocardiogram nor plasma myocardial specific creatine kinase suggested myocardial damage. The operative events, alone or in combination, including hypertension, tachycardia, hypotension, bradycardia, air embolism (precordial Doppler) were neither specific nor sensitive as predictors of ST segment change (stepwise logistic regression). Tachycardia was associated with ST segment changes in 10% of time epochs (5 min) (P = 0.05, x2 analysis). Thus, ST segment changes during cesarean section are not caused by myocardial ischemia and are not of any clinical consequence
— id: 56609, year: 1993, vol: 76, page: 162, stat: Journal Article,

VENOUS CHANGES OCCURRING DURING THE VALSALVA MANEUVER - AN INTRAVASCULAR ULTRASOUND STUDY
ATTUBATO, MJ; KATZ, ES; FEIT, F; BERNSTEIN, N; SCHWARTZMAN, D; KRONZON, I
1992 OCT ;86(4):871-871, Circulation
— id: 51837, year: 1992, vol: 86, page: 871, stat: Journal Article,

Echocardiographic changes during cesarean section
Baratta J; Cziner D; Zakowski M; Kronzon I; Ramanathan S; Turndorf H
1992 ;77:A1043-A1043, Anesthesiology
— id: 47345, year: 1992, vol: 77, page: A1043, stat: Journal Article,

Transesophageal versus transthoracic echocardiography for diagnosing mitral valve perforation
Cziner DG; Rosenzweig BP; Katz ES; Keller AM; Daniel WG; Kronzon I
1992 Jun 1;69(17):1495-1497, American journal of cardiology
— id: 13577, year: 1992, vol: 69, page: 1495, stat: Journal Article,

Pseudoaneurysm of the thoracic aorta due to cardiopulmonary resuscitation: diagnosis by transesophageal echocardiography
Dorsa FB; Tunick PA; Culliford A; Kronzon I
1992 May;123(5):1398-1400, American heart journal
— id: 13613, year: 1992, vol: 123, page: 1398, stat: Journal Article,

Experience with twenty-eight cases of systolic anterior motion after mitral valve reconstruction by the Carpentier technique
Grossi EA; Galloway AC; Parish MA; Asai T; Gindea AJ; Harty S; Kronzon I; Spencer FC; Colvin SB
1992 Mar;103(3):466-470, Journal of thoracic & cardiovascular surgery
Systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction after Carpentier-type mitral reconstruction with ring annuloplasty has led some surgeons to abandon an otherwise successful repair or to avoid use of a rigid ring. To assess the long-term significance of such motion, we studied 439 patients undergoing Carpenter mitral reconstruction at our institution between March 1981 and June 1990. The hospital mortality rate was 4.8% (21/439) overall and 3.7% (9/243) for isolated mitral reconstruction. Systolic anterior motion was found in 6.4% (28/438) after the operation, and 2.3% (10/438) had a coexisting left ventricular outflow tract gradient (mean 53 mm Hg). Of the 28 patients with systolic anterior motion, 27 (96.4%) had leaflet prolapse, 17 (60.7%) had undergone more than a 3 cm resection of the posterior leaflet, and two (7.1%) had preexisting idiopathic hypertrophic subaortic stenosis. All patients were treated medically, 14 with negative inotropic agents. Follow-up echocardiograms at a mean of 32 months demonstrated the disappearance of systolic anterior motion in 13 of 28 patients (46.4%) and resolution of the outflow tract gradient in 10 of 10 (100%). At follow-up only one patient was in New York Heart Association class III or IV and required reoperation for rheumatic mitral insufficiency. These data demonstrate that systolic anterior motion after Carpentier mitral reconstruction with ring annuloplasty is not prevalent and should be managed medically in most cases. Associated left ventricular outflow tract obstruction resolves with medical treatment
— id: 13676, year: 1992, vol: 103, page: 466, stat: Journal Article,

Diagnosis of tumor embolus to the pulmonary artery by transesophageal echocardiography
Katz ES; Rosenzweig BP; Rorman D; Kronzon I
1992 Jul-Aug;5(4):439-443, Journal of the American Society of Echocardiography
This article describes a patient with renal cell carcinoma and massive tumor extension into the inferior vena cava who experienced sudden tachypnea and subsequent cardiopulmonary arrest. Transesophageal echocardiography was used to diagnose a massive tumor embolus to the pulmonary artery that was subsequently confirmed at autopsy. Transesophageal echocardiography provided a rapid bedside diagnosis of this unusual entity in an acutely ill patient. This technique may prove more widely applicable in the evaluation of patients with suspected pulmonary embolus, whether neoplastic or thromboembolic
— id: 13538, year: 1992, vol: 5, page: 439, stat: Journal Article,

Observations of coronary flow augmentation and balloon function during intraaortic balloon counterpulsation using transesophageal echocardiography
Katz ES; Tunick PA; Kronzon I
1992 Jun 15;69(19):1635-1639, American journal of cardiology
The intraaortic balloon pump has been shown to decrease myocardial oxygen demand by afterload reduction, while increasing myocardial oxygen supply by diastolic augmentation of coronary blood flow. This diastolic augmentation of coronary flow has been demonstrated experimentally with invasive methods. Noninvasively, transesophageal echocardiography has demonstrated efficacy in enabling visualization of the proximal left coronary artery and in recording coronary blood flow velocity. To assess the potential of this technique in demonstrating quantitatively the increase in coronary flow during counterpulsation, 6 patients were studied during intermittent balloon pumping. Peak diastolic coronary blood flow velocity increased by a mean of 117% (range 62 to 287) during balloon inflation (p = 0.002). Furthermore, coronary flow velocity integral increased by a mean of 87% (range 43 to 176; p = 0.003). Problems associated with intraaortic balloon pumping were discovered by transesophageal echocardiography in 4 patients (incorrect balloon placement, damage to the aortic wall [2 patients], and premature balloon deflation time). Transesophageal echocardiography can be used in evaluating intraaortic balloon positioning within the aorta and in monitoring coronary artery flow augmentation during counterpulsation. This relatively noninvasive technique adds another dimension to the evaluation of balloon function and may help in optimizing the benefits of counterpulsation
— id: 13560, year: 1992, vol: 69, page: 1635, stat: Journal Article,

Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography
Katz ES; Tunick PA; Rusinek H; Ribakove G; Spencer FC; Kronzon I
1992 Jul;20(1):70-77, Journal of the American College of Cardiology
Protruding atheromas of the aortic arch identified by transesophageal echocardiography have been implicated as a cause of stroke in elderly patients. One hundred thirty patients greater than or equal to 65 years of age were studied with intraoperative transesophageal echocardiography to detect aortic arch protruding atheromas and determine if these patients were at higher risk for perioperative stroke. Protruding atheromas were identified in 23 (18%) of 130 patients. In 19 (83%) of these 23 patients, palpation of the aortic arch at operation did not identify significant abnormalities. Five patients (4%) had perioperative stroke. Logistic regression identified aortic arch atheroma as the only historical or procedural variable that was predictive of stroke (odds ratio 5.8, 95% confidence interval 1.2 to 27.9, p less than 0.03). A history of peripheral or cerebrovascular disease, presence of aortic calcification, cardiac risk factors, age and duration of cardiopulmonary bypass did not predict stroke. In contrast, patients with protruding atheromas with mobile components were at highest risk. There were 3 (25%) of 12 patients with a mobile atheroma who had a stroke versus 2 (2%) of 118 patients without a mobile atheroma (chi-square = 10.3, p = 0.001). Displacement and detachment of the frail, protruding atherosclerotic material by aortic arch cannulation or by the high pressure jet emanating from the cannula tip may play an important role in the creation of embolization and stroke
— id: 13531, year: 1992, vol: 20, page: 70, 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,

INCOMPLETE LIGATION OF THE LEFT ATRIAL APPENDAGE - DIAGNOSIS BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY
KATZ, ES; KRONZON, I
1992 JUL-AUG ;6(4):262-263, American journal of noninvasive cardiology
Ligation of the left atrial appendage during mitral valve surgery is routinely performed to decrease the incidence of future thromboembolic events. Complete obliteration of the appendage cavity is the surgical aim, but this has been difficult to verify by objective means. In this paper, we report 2 cases of incomplete left atrial appendage ligation detected incidentally by transesophageal echocardiography and speculate on the clinical relevance of this finding
— id: 51911, year: 1992, vol: 6, page: 262, 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,

Surgical implications of transesophageal echocardiography to grade the atheromatous aortic arch
Ribakove GH; Katz ES; Galloway AC; Grossi EA; Esposito RA; Baumann FG; Kronzon I; Spencer FC
1992 May;53(5):758-761, Annals of thoracic surgery
Stroke is an especially serious complication of cardiopulmonary bypass with an incidence of 2% to 5%. This prospective study used transesophageal echocardiography (TEE) in 97 patients more than 65 years of age (mean age, 73 years) to identify those at high risk for aortic atheroemboli. The atheromatous disease of the aorta was graded by TEE: grade I = minimal intimal thickening (n = 29); II = extensive intimal thickening (n = 33); III = sessile atheroma (n = 15); IV = protruding atheroma (n = 10); V = mobile atheroma (n = 10). Clinical evaluation was also performed by intraoperative aortic palpation. Four patients who were graded as having normal aortas by palpation had intraoperative strokes. In contrast, 3 of these 4 patients were in grade V on TEE. The relationship of TEE to incidence of stroke was statistically significant (p less than 0.006), whereas there was no significant correlation between clinical grade and stroke incidence. Four of 10 TEE grade V patients were treated with hypothermic circulatory arrest and aortic arch debridement, and none suffered strokes. The other 6 patients were treated with standard techniques, and 3 had strokes. These results suggest that patients with mobile atheromatous disease are at high risk for embolic strokes that are not predicted by routine clinical evaluation. Selective use of circulatory arrest in the presence of TEE-detected mobile arch atheromas may reduce the risk of intraoperative stroke
— id: 13614, year: 1992, vol: 53, page: 758, stat: Journal Article,

Silent maladie de Roger
Rosenzweig BP; Rey MJ; Williams LB; Kronzon I
1992 Jul;102(1):320-322, Chest
A patient with no cardiac murmur was found to have a ventricular septal defect by Doppler echocardiography yet no evidence of pulmonary or right ventricular hypertension. This array of findings is distinctly unusual and appears to be at odds with the clinical teachings concerning small ventricular septal defects
— id: 13525, year: 1992, vol: 102, page: 320, stat: Journal Article,

Association between residual mitral regurgitation and left ventricular outflow obstruction after Carpentier ring mitral annuloplasty
Tunick PA; Cziner DG; Katz ES; Perez JL; Kronzon I
1992 Sep 1;70(6):689-691, American journal of cardiology
— id: 13449, year: 1992, vol: 70, page: 689, 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,

Limitations of transoesophageal echocardiography in patients with focal cerebral ischaemic events
Tunick PA; Kronzon I
1992 Dec;68(6):634-634, British heart journal
— id: 63038, year: 1992, vol: 68, page: 634, stat: Journal Article,

The improved yield of transesophageal echocardiography over transthoracic echocardiography in patients with neurological events is largely due to the detection of aortic protruding atheromas
Tunick PA; Kronzon I
1992 Sep;9(5):491-495, Echocardiography
It is important to determine what, if any, the added contribution of transesophageal echocardiography is to the evaluation of patients with unexplained strokes and transient ischemic attacks. Transesophageal echocardiography was performed in 283 consecutive patients over an 8-month period. The reason for referral in 63 of these patients was unexplained stroke or transient ischemic attack. These 63 studies were evaluated for the presence of lesions that could be etiologic in these patients, including protruding aortic atheromas, spontaneous echo contrast, atrial septal aneurysms, and atrial clots. The transesophageal and transthoracic techniques were compared. The main finding was that there were 23 abnormal findings that might have been responsible for stroke or transient ischemic attacks seen on transesophageal echocardiography, which were not visualized on transthoracic echocardiography. Transthoracic echocardiography was false negative in 19 (30%) of 63 patients. None of the protruding aortic arch atheromas seen on transesophageal echocardiography were diagnosed with transthoracic echocardiography. Transesophageal echocardiography is indicated in the evaluation of patients with unexplained strokes and transient ischemic attacks, and the added yield of this technique is largely due to the finding of protruding aortic arch atheromas
— id: 13481, year: 1992, vol: 9, page: 491, stat: Journal Article,

Multiple emboli from a large aortic arch thrombus in a patient with thrombotic diathesis
Tunick PA; Lackner H; Katz ES; Culliford AT; Giangola G; Kronzon I
1992 Jul;124(1):239-241, American heart journal
— id: 13529, year: 1992, vol: 124, page: 239, stat: Journal Article,

The alternation between atrial flutter and atrial fibrillation [see comments]
Tunick PA; McElhinney L; Mitchell T; Kronzon I
1992 Jan;101(1):34-36, Chest
Atrial fibrillation and atrial flutter share a common reentrant mechanism. However, the relationship between these arrhythmias has not been systemically studied to date. To evaluate the degree to which these arrhythmias may alternate, consecutive Holter monitor recordings which showed fibrillation or flutter in 96 patients were reviewed. One half of the patients were studied after open-heart surgery and the other half for varying indications. One quarter of the patients had atrial flutter in addition to fibrillation, and this alternation with flutter was significantly associated with the use of a type 1A antiarrhythmic drug (p = 0.007), but not with the use of digoxin or beta blockers (p = NS for both). Furthermore, this alternation with flutter was more common in the postoperative group (p = 0.01). A history of embolization was less common in patients who were in the postoperative group (p = 0.003) and patients who had flutter in addition to fibrillation (p = 0.05)
— id: 13727, year: 1992, vol: 101, page: 34, stat: Journal Article,

TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR AORTIC-ANEURYSM - REPLY
TUNICK, PA; KRONZON, I
1992 JAN 15 ;116(2):170-170, Annals of internal medicine
— id: 52116, year: 1992, vol: 116, page: 170, stat: Journal Article,

Congestive heart failure, coronary events and atherothrombotic brain infarction in elderly blacks and whites with systemic hypertension and with and without echocardiographic and electrocardiographic evidence of left ventricular hypertrophy
Aronow, W S; Ahn, C; Kronzon, I; Koenigsberg, M
1991 Feb 1;67(4):295-299, American journal of cardiology
Hypertension was present in 50% of 196 blacks and in 36% of 382 whites (p less than 0.001). A prospective study of 84 elderly blacks (70% women) and 326 elderly whites (73% women) with hypertension correlated echocardiographic and electrocardiographic left ventricular (LV) hypertrophy with incidences of congestive heart failure (CHF), coronary events and atherothrombotic brain infarction (ABI). Echocardiographic LV hypertrophy (p less than 0.02) and concentric LV hypertrophy (p less than 0.001) were more prevalent in hypertensive blacks than in hypertensive whites. Hypertensive blacks were younger (78 +/- 9 years) than hypertensive whites (82 +/- 7 years) (p less than 0.001). Other coronary risk factors were similar, except for higher serum triglycerides in whites than in blacks (p less than 0.02). Follow-up was 37 +/- 18 months in blacks and 43 +/- 18 months in whites (p less than 0.01). Incidences of CHF and coronary events were not significantly different in blacks and whites. ABI incidence was 38% in blacks and 21% in whites (p less than 0.005). Multiple logistic regression analysis showed that prior CHF (p = 0.000), concentric LV hypertrophy (p = 0.018) and echocardiographic LV hypertrophy (p = 0.022) were independent risk factors for CHF. Echocardiographic LV hypertrophy (p = 0.001), serum total cholesterol (p = 0.002), concentric LV hypertrophy (p = 0.005) and prior coronary artery disease (p = 0.042) were independent risk factors for coronary events. Prior ABI (p = 0.001), echocardiographic LV hypertrophy (p = 0.001) and electrocardiographic LV hypertrophy (p = 0.034) were independent risk factors for ABI
— id: 100099, year: 1991, vol: 67, page: 295, stat: Journal Article,

Prevalence and severity of valvular aortic stenosis determined by Doppler echocardiography and its association with echocardiographic and electrocardiographic left ventricular hypertrophy and physical signs of aortic stenosis in elderly patients
Aronow, W S; Kronzon, I
1991 Apr 1;67(8):776-777, American journal of cardiology
— id: 100098, year: 1991, vol: 67, page: 776, stat: Journal Article,

Prevalence of coronary risk factors in elderly blacks and whites
Aronow, W S; Kronzon, I
1991 Jun;39(6):567-570, Journal of the American Geriatrics Society
Coronary risk factors were determined in a prospective study of 1,414 elderly persons (999 women and 415 men), mean age 82 +/- 8 years. Of 1,414 persons, 215 (15%) were black and 1,140 (81%) were white. The prevalences of cigarette smoking, hypercholesterolemia, low serum high-density lipoprotein cholesterol, and increased serum total cholesterol/high-density lipoprotein cholesterol ratio were not significantly different in elderly blacks and whites. Elderly blacks had a higher prevalence of hypertension (50% versus 36%, P less than 0.001), diabetes mellitus (27% versus 19%, P less than 0.01), and obesity (11% versus 5%, P less than 0.005) and a lower prevalence of hypertriglyceridemia (9% versus 15%, P less than 0.05) than elderly whites. In elderly persons with hypertension, electrocardiographic left ventricular hypertrophy occurred in 19% of blacks and 14% of whites (P not significant), echocardiographic left ventricular hypertrophy occurred in 72% of blacks and 56% of whites (P less than 0.01), and concentric left ventricular hypertrophy occurred in 60% of blacks and 39% of whites (P less than 0.001)
— id: 100097, year: 1991, vol: 39, page: 567, stat: Journal Article,

VALVULAR AORTIC-STENOSIS IN ELDERLY PATIENTS
ARONOW, WS; KRONZON, I
1991 AUG ;39(8):A25-A25, Journal of the American Geriatrics Society
— id: 51563, year: 1991, vol: 39, page: A25, stat: Journal Article,

Multifaceted echocardiographic approach to the diagnosis of a ruptured sinus of Valsalva aneurysm
Katz ES; Cziner DG; Rosenzweig BP; Attubato M; Feit F; Kronzon I
1991 Sep-Oct;4(5):494-498, Journal of the American Society of Echocardiography
— id: 13927, year: 1991, vol: 4, page: 494, stat: Journal Article,

To-and-fro left ventricular-to-right atrial shunting after valve replacement shown by transesophageal echocardiography
Katz ES; Tunick PA; Kronzon I
1991 Jan;121(1 Pt 1):211-214, American heart journal
— id: 14176, year: 1991, vol: 121, page: 211, 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,

Fingerlike mass in the left atrium
Kronzon I; Tunick PA; Schrem SS; Yarmush L
1991 Jan-Feb;4(1):75-75, Journal of the American Society of Echocardiography
— id: 14169, year: 1991, vol: 4, page: 75, stat: Journal Article,

Mi mekabel et Belgiyah? : sipurim = Who will get Belgium?
Kronzon, Itzhak
Tel Aviv : 'Am 'oved, 1991,
— id: 1536, year: 1991, vol: , page: , stat: ,

Left ventricle-to-ascending aorta communication complicating composite graft repair undetected by aortography: diagnosis by transesophageal echocardiography
Rosenzweig BP; Donahue T; Attubato M; Feit F; Kronzon I
1991 Nov-Dec;4(6):639-644, Journal of the American Society of Echocardiography
A 57-year-old man underwent composite ascending aortic conduit and prosthetic aortic valve repair of a sinus of Valsalva aneurysm. The patient's course was complicated by recurrent aneurysm formation caused by a communication between the left ventricular outflow tract and the ascending aorta outside the conduit. Transesophageal echocardiography documented the anatomic and functional characteristics of this complication, whereas aortography failed to demonstrate them. Findings at surgery confirmed the transesophageal echocardiogram results of a left ventricular outflow tract to aorta communication, a normal prosthetic aortic valve, and an intact distal anastomosis of the conduit with the aorta. Transesophageal echocardiography is a useful modality for the evaluation of composite graft repairs of the aortic valve and ascending aorta
— id: 13856, year: 1991, vol: 4, page: 639, stat: Journal Article,

Atheromatosis of the aortic arch as an occult source of multiple systemic emboli [see comments]
Tunick PA; Culliford AT; Lamparello PJ; Kronzon I
1991 Mar 1;114(5):391-392, Annals of internal medicine
— id: 14120, year: 1991, vol: 114, page: 391, stat: Journal Article,

Protruding atheromas in the thoracic aorta and systemic embolization [see comments]
Tunick PA; Perez JL; Kronzon I
1991 Sep 15;115(6):423-427, Annals of internal medicine
OBJECTIVE: To determine whether protruding atheromas in the thoracic aorta are a risk factor for systemic embolization. DESIGN: Case-control study. SETTING: A referral hospital. PATIENTS: A total of 122 patients with a history of stroke, transient ischemic attack, or peripheral emboli and an equal number of age- and sex-matched control patients. MEASUREMENTS: Evaluation using transesophageal echocardiography was done in case patients to detect protruding atheromas in the thoracic aorta and in control patients for cardiac indications other than emboli. MAIN RESULTS: Matched logistic regression showed that the presence of protruding atheromas was strongly related to the occurrence of embolic symptoms (odds ratio, 3.2; 95% Cl, 1.6 to 6.5; P less than 0.001). Furthermore, atheromas with mobile components were present only in case patients. When known risk factors for stroke (hypertension and diabetes) were added to the model, the presence of protruding atheromas remained an independent risk factor for embolic symptoms (odds ratio, 3.8). Hypertension was also independently associated with embolic symptoms (odds ratio, 2.7), but diabetes was not (odds ratio, 1.0). CONCLUSION: Protruding atheromas in the thoracic aorta can be detected by transesophageal echocardiography and should be considered as a cause of strokes, transient ischemic attacks, and peripheral emboli
— id: 13900, year: 1991, vol: 115, page: 423, stat: Journal Article,

Echocardiographic diagnosis of secondary coarctation complicating the repair of a traumatic pseudoaneurysm of the aorta
Weitz SH; Gindea AJ; Katz ES; Kronzon I
1991 Jul-Aug;4(4):393-396, Journal of the American Society of Echocardiography
An 18-year-old patient underwent repair of traumatic aortic pseudoaneurysm. Postoperatively, the physical examination showed hypertension with 30 mm Hg gradient between the upper and lower extremities. Doppler echocardiographic evaluation demonstrated a new (secondary) aortic coarctation at the site of the repair. Transesophageal echocardiography revealed the detailed anatomy and the cross-sectional area of the coarctation
— id: 13977, year: 1991, vol: 4, page: 393, stat: Journal Article,

Prognosis of congestive heart failure in elderly patients with normal versus abnormal left ventricular systolic function associated with coronary artery disease
Aronow, W S; Ahn, C; Kronzon, I
1990 Nov 15;66(17):1257-1259, American journal of cardiology
— id: 100100, year: 1990, vol: 66, page: 1257, stat: Journal Article,

Association of mitral anular calcium with new thromboembolic stroke and cardiac events at 39-month follow-up in elderly patients
Aronow, W S; Koenigsberg, M; Kronzon, I; Gutstein, H
1990 Jun 15;65(22):1511-1512, American journal of cardiology
— id: 100102, year: 1990, vol: 65, page: 1511, stat: Journal Article,

Effect of quinidine or procainamide versus no antiarrhythmic drug on sudden cardiac death, total cardiac death, and total death in elderly patients with heart disease and complex ventricular arrhythmias
Aronow, W S; Mercando, A D; Epstein, S; Kronzon, I
1990 Aug 15;66(4):423-428, American journal of cardiology
A prospective study correlated the effect of quinidine or procainamide versus no antiarrhythmic drug on sudden cardiac death, total cardiac death and total death in 406 elderly patients with heart disease and asymptomatic complex ventricular arrhythmias detected by 24-hour ambulatory electrocardiograms. Of 397 patients treated with quinidine, 184 (46%) developed adverse effects during the first 2 weeks of therapy and were given no further antiarrhythmic therapy. Of 9 patients treated with procainamide, 2 (22%) developed adverse effects during the first 2 weeks of therapy and were given no further antiarrhythmic therapy. Adverse effects developed during long-term therapy in 6 patients (2%) receiving quinidine and in 3 patients (33%) receiving procainamide. Mean follow-up was 24 +/- 15 months in both groups. Sudden cardiac death, total cardiac death and total death occurred in 21, 43 and 65% of patients receiving quinidine or procainamide, respectively, and in 23, 44 and 63% of patients receiving no antiarrhythmic drug, respectively (difference not significant). Survival by Kaplan-Meier analysis showed no significant difference between the 2 groups for sudden cardiac death, total cardiac death or total death through 4 years. Patients with abnormal left ventricular ejection fraction had a 3.4 times higher incidence of sudden cardiac death, a 2.4 times higher incidence of total cardiac death and a 1.4 times higher incidence of total death than patients with normal left ventricular ejection fraction. These data showed no significant difference in sudden cardiac death, total cardiac death or total death between patients treated with quinidine or procainamide or with no antiarrhythmic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 100101, year: 1990, vol: 66, page: 423, stat: Journal Article,

PROGNOSIS OF CONGESTIVE HEART-FAILURE IN ELDERLY PATIENTS
Aronow, WS; Ahn, C; Kronzon, I
1990 Oct;38(3):A780-A780, Clinical research
— id: 32042, year: 1990, vol: 38, page: A780, stat: Journal Article,

CORRELATION OF LEVELS OF ECHOCARDIOGRAPHIC LEFT-VENTRICULAR EJECTION FRACTION WITH NEW CORONARY EVENTS IN 914 PATIENTS OVER 62 YEARS OF AGE
Aronow, WS; Koenigsberg, M; Kronzon, I
1990 Jul-Aug;1(4):491-493, Coronary artery disease
— id: 32054, year: 1990, vol: 1, page: 491, stat: Journal Article,

CORRELATION OF MITRAL ANULAR CALCIUM WITH NEW THROMBOEMBOLIC STROKE AND CARDIAC EVENTS AT 35-MONTH FOLLOW-UP IN ELDERLY PATIENTS
ARONOW, WS; KOENIGSBERG, M; KRONZON, I; GUTSTEIN, H
1990 AUG ;38(8):A29-A29, Journal of the American Geriatrics Society
— id: 51474, year: 1990, vol: 38, page: A29, stat: Journal Article,

EFFECT OF QUINIDINE OR PROCAINAMIDE ON MORTALITY IN ELDERLY PATIENTS WITH COMPLEX VENTRICULAR ARRHYTHMIAS AND HEART-DISEASE
Aronow, WS; Mercando, AD; Epstein, S; Kronzon, I
1990 Apr;38(2):A377-A377, Clinical research
— id: 32066, year: 1990, vol: 38, page: A377, 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,

Doppler echocardiographic flow velocity measurements in the superior vena cava during the Valsalva maneuver in normal subjects
Gindea, A J; Slater, J; Kronzon, I
1990 Jun 1;65(20):1387-1391, American journal of cardiology
The hemodynamic manifestations of the Valsalva maneuver are in part the result of changes in the venous return accompanying changes in intrathoracic pressure. Doppler echocardiography was performed during Valsalva maneuver in 13 normal subjects. Superior vena cava flow velocities and flow velocity integrals were measured in all 13 subjects. In the 5 subjects in whom the superior vena cava was clearly visualized throughout the maneuver, vena cava diameter was also analyzed. The superior vena cava flow velocity integral at rest was 17 +/- 2 cm. It diminished significantly, disappeared or reversed (-13 +/- 6 cm, p less than 0.001) with phase I of the maneuver. During the maintenance phase (phase II), the flow velocity integral increased significantly (31 +/- 2 cm, p = 0.05 vs baseline and phase I) and was associated with a decrease in superior vena cava lumen diameter at the time of Valsalva and continuing throughout the strain. With release of the maneuver (phase III), there was a sudden significant increase in flow velocity integral (61 +/- 2 cm, p = 0.005 vs phase II) and superior vena cava lumen diameter. Subsequently, superior vena cava flow velocity integral returned to baseline values. This study suggests that one of the ways in which the Valsalva maneuver leads to decreased venous return may be by direct external compression of the superior vena cava
— id: 100104, year: 1990, vol: 65, page: 1387, 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,

TRANSESOPHAGEAL ECHOCARDIOGRAPHY IMPROVES THE DIAGNOSTIC- ACCURACY OF OSTIAL STENOSIS OF THE LEFT MAIN CORONARY-ARTERY
Kronzon, I; Schrem, SS; Tunick, PA; Slater, J
1990 Oct;82(4):625-625, Circulation
— id: 31912, year: 1990, vol: 82, page: 625, stat: Journal Article,

Metastatic cardiac liposarcoma: diagnosis by transesophageal echocardiography and magnetic resonance imaging
Schrem SS; Colvin SB; Weinreb JC; Glassman E; Kronzon I
1990 Mar-Apr;3(2):149-153, Journal of the American Society of Echocardiography
The most superior portion of the right atrium is not well visualized by transthoracic echocardiography. This limits the ability of the technique to detect intracardiac disease in this area. We describe a 41-year-old man with a history of liposarcoma in whom transthoracic echocardiography was unable to elucidate a right atrial metastasis. Transesophageal echocardiography demonstrated the morphology and extent of the large right atrial mass. These findings were well correlated with both magnetic resonance imaging and surgery
— id: 36730, year: 1990, vol: 3, page: 149, 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,

Transesophageal echocardiography in the diagnosis of ostial left coronary artery stenosis
Schrem SS; Tunick PA; Slater J; Kronzon I
1990 Sep-Oct;3(5):367-373, Journal of the American Society of Echocardiography
The diagnosis of ostial stenosis of the left main coronary artery is usually made by use of coronary angiography. However, positioning of the catheter across the obstruction may obscure this diagnosis during contrast injection. Although a damping of arterial pressure when the catheter enters the left coronary artery may suggest ostial stenosis, it may not be possible to make this diagnosis with certainty during cardiac catheterization. We report a series of four patients in whom the left coronary ostium and proximal left coronary arteries were visualized by means of transesophageal echocardiography. Both ostial narrowing by plaque and abnormally fast flow velocities were seen. In each case the echocardiographic findings contributed to the subsequent management of the patients
— id: 63040, year: 1990, vol: 3, page: 367, stat: Journal Article,

Clinical evaluation of high-frequency (ultrasonic) mechanical debridement in the surgical treatment of calcific aortic stenosis
Schwinger ME; Colvin S; Harty S; Feiner H; Opitz L; Kronzon I
1990 Dec;120(6 Pt 1):1320-1325, American heart journal
Repair of aortic valve stenosis due to calcific degeneration may lead to hemodynamic and clinical improvement without the problems inherent with prosthetic valves. We have evaluated the use of a device capable of debriding calcium, the Cavitron ultrasonic aspirator (CUSA), as an adjunct to mechanical debridement in the repair of calcific aortic stenosis. Ten patients (five women), ages 63 to 83 years, were studied by M-mode, two-dimensional, and Doppler echocardiography before and an average of 26 (range 3 to 124) days after this procedure. The degree of calcification of the valve cusps was clearly reduced. The maximal cusp excursion increased from 0.7 +/- 0.1 cm preoperatively to 1.5 +/- 0.4 cm postoperatively (p = 0.006). The peak aortic gradient fell from 80 +/- 36 mm Hg to 28 +/- 10 mm Hg (p = 0.0007). The mean aortic gradient fell from 53 +/- 20 mm Hg to 16 +/- 5 mm Hg (p less than 0.0001). Aortic valve area calculated by the continuity equation increased from 0.6 + 0.2 cm2 to 1.6 +/- 0.6 cm2 (p = 0.0009). No patient had more than mild aortic insufficiency preoperatively. Postoperatively, color Doppler flow mapping revealed severe aortic insufficiency in two patients. Seven patients had further echocardiographic evaluation 99 (range 33 to 196) days after the procedure. These studies revealed the development of severe aortic insufficiency in an additional four patients. Four patients with severe symptomatic aortic insufficiency eventually underwent aortic valve replacement. Pathology revealed scarring and retraction of the aortic cusps. Widening of the commissures was responsible for the severe aortic insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 14255, year: 1990, vol: 120, page: 1320, 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,

Diagnosis of unexpected atrial septal defect by inspired hydrogen appearance time in adult patients referred for cardiac catheterization
Schwinger ME; Tunick PA; Glassman E; Kronzon I
1990 Jun;20(2):84-87, Catheterization & cardiovascular diagnosis
Atrial septal defects may have clinical consequences regardless of their size. We evaluated the incidence of clinically unsuspected atrial septal defects in 4,411 consecutive adult patients referred for cardiac catheterization by the previously validated method of inspired hydrogen appearance time. Oximetry was performed only when an abnormally short inspired hydrogen appearance time was measured. Seventy-five patients (1.7%) were discovered to have a left-to-right shunt by this method. The shunting was at the atrial level in 65 patients. Thirty-five of these patients (0.8% of all catheterizations) were not suspected of having any form of congenital heart disease by history, physical examination, chest X-ray, EKG, or echocardiogram. In 19 cases there was no significant oxygen step-up and the diagnosis would have been missed by oximetry. The atrial septum was explored during open heart surgery in 7 patients. Atrial septal defects were detected and closed in all. Four patients had the finding confirmed by echocardiography after the catheterization. Small atrial septal defects are frequently not detected by clinical evaluation, noninvasive testing, or oximetry and are easily detected by the rapid, safe, and accurate method of inspired hydrogen appearance time
— id: 63042, year: 1990, vol: 20, page: 84, 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,

The echocardiographic recognition of an atrial myxoma vegetation
Tunick PA; Fox AC; Culliford A; Levy R; Kronzon I
1990 Mar;119(3 Pt 1):679-680, American heart journal
— id: 32335, year: 1990, vol: 119, page: 679, 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,

Effect of aortic valve replacement for aortic stenosis on severity of mitral regurgitation
Tunick PA; Gindea A; Kronzon I
1990 May 15;65(18):1219-1221, American journal of cardiology
The severity of mitral regurgitation (MR) was determined by color Doppler echocardiography in 44 adult patients with severe symptomatic aortic stenosis before and after isolated aortic valve replacement. Preoperative MR was absent in 17, mild in 14, moderate in 11 and severe in 2 patients. Three to 388 (mean 58) days after surgery, 14 patients continued to have no MR. In the other 30 patients, MR decreased in 18 (60%), remained unchanged in 8 (27%) and increased in only 4 (13%). Furthermore, in 13 patients with significant (moderate or severe) MR, the severity decreased in 12 (92%). Thus, the severity of MR often decreases after aortic valve replacement for aortic stenosis
— id: 63043, year: 1990, vol: 65, page: 1219, stat: Journal Article,

Protruding atherosclerotic plaque in the aortic arch of patients with systemic embolization: a new finding seen by transesophageal echocardiography
Tunick PA; Kronzon I
1990 Sep;120(3):658-660, American heart journal
Patients with unexplained stroke or other embolic phenomena are often referred for echocardiography. The aortic arch is not usually visualized in detail during routine echocardiography; however, with the introduction of transesophageal echocardiography, this area may be seen with great resolution. We recently studied three patients who had embolic events, and transesophageal echocardiography showed a new and unexpected finding; large, protrusive plaques in the aortic arch and descending aorta, which have mobile projections that move freely with the blood flow. These lesions could be responsible for embolic syndromes, especially after catheter manipulation in the aorta
— id: 8330, year: 1990, vol: 120, page: 658, stat: Journal Article,

Effect of mitral regurgitation on the left ventricular outflow pressure gradient in obstructive hypertrophic cardiomyopathy
Tunick PA; Lampert R; Perez JL; Kronzon I
1990 Nov 15;66(17):1271-1273, American journal of cardiology
— id: 14275, year: 1990, vol: 66, page: 1271, stat: Journal Article,

Reversal of echocardiographic signs of pericardial tamponade by transfusion
Tunick PA; Nachamie M; Kronzon I
1990 Jan;119(1):199-201, American heart journal
— id: 63047, year: 1990, vol: 119, page: 199, stat: Journal Article,

Discrete atherosclerotic coronary artery aneurysms: a study of 20 patients
Tunick PA; Slater J; Kronzon I; Glassman E
1990 Feb;15(2):279-282, Journal of the American College of Cardiology
The incidence, angiographic features and natural history of discrete atherosclerotic coronary aneurysms were evaluated in 20 patients with 22 aneurysms (0.2% of 8,422 patients referred for coronary angiography). Fifteen aneurysms (68%) were in the left anterior descending, four (18%) in the circumflex, two (9%) in the right and one (5%) in the left main coronary artery. Aneurysm diameter ranged from 4 to 35 mm (mean 8); 95% of aneurysms were adjacent to a severe obstruction. Seventy-five percent of patients had severe triple vessel disease that included severe left main disease in 15%. Total obstruction of one or two arteries was present in 75%. In patients with wall motion abnormalities, 78% of the abnormalities were in the distribution of the aneurysm. Follow-up (range 1 to 90 months [mean 30]) was obtained in all 20 patients. There were two cardiac and two noncardiac deaths; 12 patients had coronary bypass surgery and of 16 survivors, 13 were angina-free. In conclusion, discrete coronary aneurysms are much less common than diffuse ectasia. Unlike ectasia, they are never found in arteries without severe stenosis, and are most common in the left anterior descending coronary artery. Associated coronary artery disease is more severe in patients with discrete aneurysms than in those with diffuse ectasia. Discrete coronary aneurysms do not appear to rupture, and their resection is not warranted
— id: 63045, year: 1990, vol: 15, page: 279, stat: Journal Article,

Correlation of prevalence and severity of aortic regurgitation detected by pulsed Doppler echocardiography with the murmur of aortic regurgitation in elderly patients in a long-term health care facility
Aronow, W S; Kronzon, I
1989 Jan 1;63(1):128-129, American journal of cardiology
— id: 100108, year: 1989, vol: 63, page: 128, stat: Journal Article,

ECHOCARDIOGRAPHIC LEFT-VENTRICULAR EJECTION FRACTION CORRELATED WITH NEW CARDIAC EVENTS IN 914 ELDERLY PATIENTS
Aronow, WS; Koenigsberg, M; Kronzon, I
1989 Sep;37(3):A835-A835, Clinical research
— id: 31786, year: 1989, vol: 37, page: A835, 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,

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,

Cardiac lymphoma in the acquired immunodeficiency syndrome
Goldfarb A; King CL; Rosenzweig BP; Feit F; Kamat BR; Rumancik WM; Kronzon I
1989 Dec;118(6):1340-1344, American heart journal
— id: 10405, year: 1989, vol: 118, page: 1340, stat: Journal Article,

A patient with right and left atrial membranes: the role of transesophageal echocardiography and magnetic resonance imaging in diagnosis
Goldfarb A; Weinreb J; Daniel WG; Kronzon I
1989 Sep-Oct;2(5):350-353, Journal of the American Society of Echocardiography
A patient who had right and left atrial membranes was examined. The diagnosis and the hemodynamic significance of both membranes were detailed by transesophageal echocardiography and were confirmed by magnetic resonance imaging. Transesophageal imaging was found to be superior to routine echocardiography in visualization of these atrial structures
— id: 10511, year: 1989, vol: 2, page: 350, stat: Journal Article,

Transesophageal echocardiography during percutaneous mitral valvuloplasty
Kronzon I; Tunick PA; Schwinger ME; Slater J; Glassman E
1989 Nov-Dec;2(6):380-385, Journal of the American Society of Echocardiography
Transesophageal echocardiography was performed during mitral balloon valvuloplasty. It provided valuable information about the position of the transseptal needle, wires, and balloon catheter throughout the procedure, and it helped in the immediate evaluation of its results. Transesophageal echocardiography was well tolerated and there were no complications
— id: 10442, year: 1989, vol: 2, page: 380, stat: Journal Article,

[Transesophageal echocardiography]
Kronzon, I; Daniel, W; Laniado, S
1989 Jul;117(1-2):20-25, Harefuah: journal of the Israeli Medical Association
— id: 100107, year: 1989, vol: 117, page: 20, stat: Journal Article,

Mirror-image dextrocardia with failure of apical pivoting ("levocardia") and situs inversus
Rosenzweig BP; Gindea AJ; Lubat E; Danilowicz D; Weinreb J; Kronzon I
1989 Oct;118(4):845-848, American heart journal
— id: 10477, year: 1989, vol: 118, page: 845, stat: Journal Article,

Right atrial papillary fibroelastoma: diagnosis by transthoracic and transesophageal echocardiography and percutaneous transvenous biopsy
Schwinger ME; Katz E; Rotterdam H; Slater J; Weiss EC; Kronzon I
1989 Nov;118(5 Pt 1):1047-1050, American heart journal
— id: 10431, year: 1989, vol: 118, page: 1047, stat: Journal Article,

Improved evaluation of left ventricular outflow tract obstruction by transesophageal echocardiography
Schwinger ME; Kronzon I
1989 May-Jun;2(3):191-194, Journal of the American Society of Echocardiography
— id: 10658, year: 1989, vol: 2, page: 191, stat: Journal Article,

Aorta to right atrium fistula caused by endocarditis: diagnosis by color Doppler echocardiography
Tunick PA; Lefkow P; Kronzon I
1989 Jan-Feb;2(1):53-55, Journal of the American Society of Echocardiography
— id: 10809, year: 1989, vol: 2, page: 53, stat: Journal Article,

Diagnosis of unsuspected atrial septal defect in the adult by color Doppler echocardiography
Tunick PA; Schwinger ME; Kronzon I
1989 Mar-Apr;2(2):151-153, Journal of the American Society of Echocardiography
— id: 10711, year: 1989, vol: 2, page: 151, stat: Journal Article,

Coronary artery aneurysms: a transesophageal echocardiographic study
Tunick PA; Slater J; Pasternack P; Kronzon I
1989 Jul;118(1):176-179, American heart journal
— id: 10554, year: 1989, vol: 118, page: 176, stat: Journal Article,

The hemodynamics of left ventricular pseudoaneurysm: color Doppler echocardiographic study
Tunick PA; Slater W; Kronzon I
1989 May;117(5):1161-1165, American heart journal
— id: 10638, year: 1989, vol: 117, page: 1161, stat: Journal Article,

Prevalence of hypertrophic cardiomyopathy and its association with mitral anular calcium in elderly patients
Aronow, W S; Kronzon, I
1988 Dec;94(6):1295-1296, Chest
We investigated the prevalence of hypertrophic cardiomyopathy (HC) and its association with mitral anular calcium (MAC) detected by Doppler echocardiography in 379 unselected elderly patients in a long-term health care facility. HC was present in 17 of 379 patients (4 percent). Of 17 patients with HC, ten (59 percent) had asymmetric septal hypertrophy, and seven (41 percent) had idiopathic hypertrophic subaortic stenosis with resting gradients of 20 to 110 mm Hg across the left ventricular outflow tract. The mean age of patients with HC was 85 +/- 7 years compared with 82 +/- 8 years in patients without HC (difference not significant). MAC was present in 13 of 17 patients (76 percent) with HC and in 176 of 362 (49 percent) without HC (p less than 0.025)
— id: 100109, year: 1988, vol: 94, page: 1295, stat: Journal Article,

PREVALENCE OF HYPERTROPHIC CARDIOMYOPATHY AND ITS ASSOCIATION WITH MITRAL ANULAR CALCIUM IN ELDERLY PATIENTS
ARONOW, WS; KRONZON, I
1988 APR ;36(3):A258-A258, Clinical research
— id: 41784, year: 1988, vol: 36, page: A258, 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,

Long-term results of mitral valve reconstruction with Carpentier techniques in 148 patients with mitral insufficiency
Galloway AC; Colvin SB; Baumann FG; Esposito R; Vohra R; Harty S; Freeberg R; Kronzon I; Spencer FC
1988 Sep;78(3 Pt 2):I97-105, Circulation
There have been few relatively complete follow-up studies of long-term mitral valve function after Carpentier-type surgical reconstruction. Between January 1980 and May 1986, 148 patients underwent Carpentier reconstruction for mitral valve disease (43% degenerative and 30% rheumatic). Operative mortality was 5.4% overall (1.2% for isolated mitral reconstruction), and follow-up (mean, 26 months) was completed for all survivors. Five-year survival from late cardiac death was 90.0%, as was 5-year freedom from postreconstruction mitral valve replacement. Postreconstruction mitral replacement was needed in eight patients, in only five for failure of repair. Follow-up echocardiographic studies on 83.2% (104 of 125) of eligible patients showed 92.3% were free of significant (3+ or 4+) mitral regurgitation. Freedom from mitral valve replacement or recurrent severe (4+) insufficiency was 84.4% at 5 years overall, but was lower for the rheumatic type of mitral disease than for the degenerative type (71.6% vs. 88.3%). At 5 years, 95.2% of patients were free from thromboembolism without the necessity for long-term warfarin (Coumadin) therapy. At follow-up, 95.3% of survivors had improved to New York Heart Association Class I or II. The functional durability of mitral reconstruction and consistently high level of freedom from late endocarditis and thromboembolic and anticoagulant complications support the value of the Carpentier method of mitral reconstruction for mitral insufficiency, especially insufficiency due to degenerative disease
— id: 10965, year: 1988, vol: 78, page: I97, 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,

High flow velocity across a complicated atrial septal defect: Doppler findings and hemodynamic correlations
Goldfarb A; Chinitz LA; Kronzon I
1988 Sep-Oct;1(5):348-350, Journal of the American Society of Echocardiography
An unusually high atrial shunt flow velocity pattern was recorded in a patient whose atrial septal defect was created iatrogenically during a transatrial septal approach to aortic valvuloplasty. The flow velocity pattern measured by Doppler echocardiography was predictive of the high transatrial pressure gradient noted later at catheterization
— id: 10967, year: 1988, vol: 1, page: 348, stat: Journal Article,

Massive aneurysmal dilatation of saphenous vein grafts used for systemic-pulmonary artery shunts: a role for magnetic resonance imaging in diagnosis
Goldfarb A; Danilowicz D; Friedman DM; Gluck R; Rumancik WM; Kronzon I
1988 Sep;116(3):870-873, American heart journal
— id: 10964, year: 1988, vol: 116, page: 870, 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,

Systolic antegrade tricuspid blood flow--a sign of severe prosthetic valve stenosis
Rosenzweig BP; Kronzon I; Feit F; Stecy PJ; Nachamie MS; Politzer F
1988 Mar;115(3):693-696, American heart journal
— id: 11161, year: 1988, vol: 115, page: 693, 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,

Echocardiographic diagnosis of atrioventricular septal perforation caused by an aortic valve vegetation
Trehan N; Goldfarb A; Gindea AJ; Kronzon I
1988 Mar-Apr;1(2):150-151, Journal of the American Society of Echocardiography
A case of aortic valve endocarditis is presented in which a vegetation eroded through the atrioventricular septum and extended into the right atrium. This was diagnosed by echocardiography and confirmed at surgery
— id: 11173, year: 1988, vol: 1, page: 150, stat: Journal Article,

Paradoxical (right-to-left) shunting across an iatrogenic atrial septal defect during Valsalva's maneuver: a transesophageal Doppler echocardiographic study
Tunick PA; Daniel W; Goldfarb A; Kronzon I
1988 Nov-Dec;1(6):455-457, Journal of the American Society of Echocardiography
— id: 10887, year: 1988, vol: 1, page: 455, stat: Journal Article,

Diagnosis of patent ductus arteriosus by serendipity in the adult
Tunick PA; Kronzon I
1988 Nov-Dec;1(6):446-449, Journal of the American Society of Echocardiography
Seven patients with patent ductus arteriosus (PDA) were seen in our adult echocardiography laboratory. In five of seven patients the diagnosis was made on color Doppler when it was not suspected clinically. The diagnosis became apparent because of a turbulent retrograde jet seen on color Doppler in the main pulmonary artery. One of the patients had known congenital heart disease and heart surgery in the past, and the diagnosis of PDA was missed both on catheterization and in the operating room. PDA may be unsuspected in adult patients and may be missed by techniques other than color Doppler echocardiography. The striking findings on color Doppler may help to make this important diagnosis in such patients
— id: 10888, year: 1988, vol: 1, page: 446, stat: Journal Article,

Correlation of prevalence and severity of mitral regurgitation and mitral stenosis determined by Doppler echocardiography with physical signs of mitral regurgitation and mitral stenosis in 100 patients aged 62 to 100 years with mitral anular calcium
Aronow, W S; Kronzon, I
1987 Nov 15;60(14):1189-1190, American journal of cardiology
— id: 100111, year: 1987, vol: 60, page: 1189, stat: Journal Article,

Correlation of prevalence and severity of valvular aortic stenosis determined by continuous-wave Doppler echocardiography with physical signs of aortic stenosis in patients aged 62 to 100 years with aortic systolic ejection murmurs
Aronow, W S; Kronzon, I
1987 Aug 1;60(4):399-401, American journal of cardiology
— id: 100113, year: 1987, vol: 60, page: 399, stat: Journal Article,

CORRELATION OF AORTIC-STENOSIS BY DOPPLER ECHOCARDIOGRAPHY WITH PHYSICAL SIGNS OF AORTIC-STENOSIS IN ELDERLY PATIENTS WITH AORTIC SYSTOLIC EJECTION MURMURS
Aronow, WS; Kronzon, I
1987 Apr;35(3):A258-A258, Clinical research
— id: 31362, year: 1987, vol: 35, page: A258, stat: Journal Article,

Complementary use of two-dimensional echocardiography and magnetic resonance imaging in the diagnosis of ventricular myxoma
Camesas, A M; Lichtstein, E; Kramer, J; Liebeskind, D; Kronzon, I; Tyras, D; Bodenheimer, M
1987 Aug;114(2):440-442, American heart journal
— id: 100112, year: 1987, vol: 114, page: 440, stat: Journal Article,

SUPERIOR VENA-CAVA FLOW VELOCITY IN EXPERIMENTAL CARDIAC- TAMPONADE
Cohen, M; Kronzon, I; Axelrod, H
1987 Oct;76(4):410-410, Circulation
— id: 31116, year: 1987, vol: 76, page: 410, 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,

Biventricular cavity obliteration by metastatic malignant melanoma: role of magnetic resonance imaging in the diagnosis
Gindea AJ; Steele P; Rumancik WM; Culubret M; Feiner H; Sanger JJ; Kronzon I
1987 Nov;114(5):1249-1253, American heart journal
— id: 11324, year: 1987, vol: 114, page: 1249, stat: Journal Article,

Total occlusion of the abdominal aorta in a patient with Takayasu's arteritis: the importance of lower rib notching in the differential diagnosis
Chinitz, L A; Kronzon, I; Trehan, N; Kang, J G
1986 ;12(6):405-408, Catheterization & cardiovascular diagnosis
— id: 100119, year: 1986, vol: 12, page: 405, stat: Journal Article,

Superior vena caval blood flow velocities in adults: a Doppler echocardiographic study
Cohen, M L; Cohen, B S; Kronzon, I; Lighty, G W; Winer, H E
1986 Jul;61(1):215-219, Journal of applied physiology (Bethesda)
Superior vena caval blood flow velocity was measured in 30 normal adults (age 20-65, mean 36 yr). The flow velocities were measured by pulsed Doppler echocardiography, using a Duplex system with the transducer at the right supraclavicular fossa, approximating a 0 degrees Doppler angle. Four distinct flow waveforms were found during each cardiac cycle: A, a small retrograde flow during right atrial contraction (peak flow velocity 12.4 +/- 2.2 cm/s); B, a small antegrade flow during right atrial relaxation (15.7 +/- 5.0 cm/s); S, a large antegrade flow during ventricular systole (35.2 +/- 7.3 cm/s); and D, a large antegrade flow during ventricular diastole (23.2 +/- 3.1 cm/s). The wave duration was inversely related to heart rate. The peak flow velocities of the S and D waves were inversely related to the patients' ages. This study provides recognition of the pattern and range of normality essential to extension of this noninvasive technique to the diagnosis of pathological conditions
— id: 100116, year: 1986, vol: 61, page: 215, stat: Journal Article,

Candida albicans-infected transvenous pacemaker wire: detection by two-dimensional echocardiography
Cole, W J; Slater, J; Kronzon, I; Galler, M; Trehan, N; Cohen, M; Gargiulo, A
1986 Feb;111(2):417-418, American heart journal
— id: 100118, year: 1986, vol: 111, page: 417, stat: Journal Article,

Long-term follow-up after mitral valve reconstruction: incidence of postoperative left ventricular outflow obstruction
Galler, M; Kronzon, I; Slater, J; Lighty, G W Jr; Politzer, F; Colvin, S; Spencer, F
1986 Sep;74(3 Pt 2):I99-103, Circulation
Reconstructive surgery of the mitral valve has been an alternative to mitral valve replacement in patients with mitral regurgitation. Previously, we reported on postoperative left ventricular outflow tract obstruction associated with systolic anterior motion of the anterior mitral leaflet. The current study was designed to evaluate the incidence of this complication and the long-term results of mitral valve reconstructive surgery. Sixty-five patients, aged 19 to 78 years, had mitral valve reconstructive surgery. Two patients died perioperatively, and three died late after surgery. The 60 surviving patients were studied by M mode, two-dimensional, and Doppler echocardiography 1 to 55 months postoperatively (mean 21). Fifty patients had no evidence of postoperative mitral regurgitation, two patients had moderate mitral regurgitation, three patients had mild mitral regurgitation, and five patients had trace mitral regurgitation. No significant mitral stenosis was detected in any patient postoperatively. After surgery, the diameter of the left ventricular outflow tract was significantly smaller than that before surgery. The echocardiograms of six patients showed abnormal systolic anterior motion of the anterior mitral leaflet that was not observed preoperatively. Doppler echocardiography demonstrated pressure gradients across the left ventricular outflow tract between 10 and 64 mm Hg. Inhalation of amyl nitrite increased these gradients. An additional patient who had systolic anterior motion but no gradient developed a 36 mm Hg gradient after inhalation of amyl nitrite. The remaining patients had no gradient induced by amyl nitrite. Abnormal systolic anterior motion of the anterior mitral leaflet may be surgically induced by changes in left ventricular geometry and the size of the left ventricular outflow tract during systole.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 100115, year: 1986, vol: 74, page: I99, stat: Journal Article,

SUPERIOR VENA-CAVAL BLOOD-FLOW VELOCITIES IN PATIENTS WITH TRICUSPID REGURGITATION
KRONZON, I; COHEN, ML; COHEN, B; LIGHTY, GW; POLITZER, F
1986 JUN ;89(6):S527-S527, Chest
— id: 41385, year: 1986, vol: 89, page: S527, stat: Journal Article,

[Magnetic resonance imaging of the heart and the great vessels]
Kronzon, I; Laniado, S
1986 Jun 15;110(12):618-624, Harefuah: journal of the Israeli Medical Association
— id: 100117, year: 1986, vol: 110, page: 618, stat: Journal Article,

Comparison of multiple views for the evaluation of pulmonary arterial blood flow by Doppler echocardiography
Lighty, G W Jr; Gargiulo, A; Kronzon, I; Politzer, F
1986 Nov;74(5):1002-1006, Circulation
Forty adult patients underwent Doppler and two-dimensional echocardiographic examination of the pulmonary artery from multiple views to determine the variability in the magnitude of Doppler-determined flow velocity and pulmonary arterial diameter from various echocardiographic windows. Flows were recorded from two or more views in 32 patients (80%). Twelve of these patients (38%) had flow velocities recorded from two or more views that were within 6% of each other. Twenty of these patients (62%) had view-dependent differences in measured flow velocity ranging from 7% to 48%. The commonly used parasternal short-axis view yielded the highest pulmonary arterial flow velocity in only 35% of the patients studied. Determinations of pulmonary arterial blood flow can vary markedly when measured from different sites, and this is presumably due to varying ability to approximate a zero-degree Doppler angle from different views. Measurement of pulmonary arterial flow velocity should be attempted from multiple views, and the highest flow velocity should be selected as that obtained with the best zero-degree Doppler angle approximation
— id: 100114, year: 1986, vol: 74, page: 1002, stat: Journal Article,

NORMAL LEFT-VENTRICULAR ECHOCARDIOGRAMS IN PATIENTS WITH AORTIC-STENOSIS
Lipton, M; Slater, J; Kramer, P; Schwartz, W; Winer, H; Kronzon, I; Glassman, E
1986 FEB ;7(2):A30-A30, Journal of the American College of Cardiology
— id: 51208, year: 1986, vol: 7, page: A30, stat: Journal Article,

THE INFLUENCE OF CORONARY-ARTERY DISEASE ON THE HEMODYNAMIC PROFILE OF PATIENTS WITH ANGINA AND AORTIC-STENOSIS
Lipton, M; Slater, J; Kramer, P; Schwartz, W; Winer, H; Kronzon, I; Glassman, E
1986 FEB ;7(2):A171-A171, Journal of the American College of Cardiology
— id: 51209, year: 1986, vol: 7, page: A171, stat: Journal Article,

DOPPLER ECHOCARDIOGRAPHIC EVALUATION OF SUPERIOR VENA-CAVAL BLOOD-FLOW IN NORMAL ADULTS
Cohen, ML; Lighty, GW; Kronzon, I
1985 ;33(2):A176-A176, Clinical research
— id: 30917, year: 1985, vol: 33, page: A176, stat: Journal Article,

Echocardiographic findings after tricuspid valvectomy
Friedman, G; Kronzon, I; Nobile, J; Cohen, M L; Winer, H E
1985 May;87(5):668-670, Chest
Resection of the tricuspid valve without prosthetic replacement has successfully been performed in patients with tricuspid valvular endocarditis. Using M-mode, two-dimensional, and Doppler echocardiograms, we studied four patients who underwent tricuspid valvectomy. All patients had previous history of intravenous drug abuse and staphylococcal endocarditis with tricuspid valvular involvement. In all patients, M-mode and two-dimensional echocardiograms showed that the tricuspid valve was absent. The right ventricle was dilated, and the interventricular septum had paradoxical motion in each patient. In each patient the right atrium was dilated, and with each ventricular systole, it expanded and its short axis increased by 20 to 33 percent. This caused shift of the interatrial septum toward the left atrium, with compression of its cavity. Doppler echocardiographic studies showed retrograde flow during systole in the right atrium, inferior vena cava, and hepatic vein. Echocardiographic findings in patients with tricuspid valvectomy correlate with the pathophysiologic findings of this condition
— id: 100120, year: 1985, vol: 87, page: 668, stat: Journal Article,

LONG-TERM FOLLOW UP AFTER MITRAL-VALVE RECONSTRUCTION - INCIDENCE OF POSTOPERATIVE LEFT-VENTRICULAR OUTFLOW OBSTRUCTION
Galler, M; Kronzon, I; Lighty, GW; Colvin, S; Spencer, FC
1985 ;72(4):210-210, Circulation
— id: 30840, year: 1985, vol: 72, page: 210, stat: Journal Article,

Ima, shemesh u-moledet sipurim = Mother, sunshine, homeland
Kronzon, Itzhak
Tel Aviv : Sheva, 1985,
— id: 1535, year: 1985, vol: , page: , stat: ,

COMPARISON OF MULTIPLE PARASTERNAL AND SUBCOSTAL VIEWS FOR THE EVALUATION OF PULMONARY-ARTERY BLOOD-FLOW BY DOPPLER ECHOCARDIOGRAPHY
Lighty, GW; Gargiulo, A; Kronzon, I
1985 ;5(2):499-499, Journal of the American College of Cardiology
— id: 30992, year: 1985, vol: 5, page: 499, stat: Journal Article,

NON-INVASIVE SUPERIOR VENA-CAVA FLOWMETRY BY ECHO-DOPPLER--PRELIMINARY OBSERVATIONS
COHEN, ML; KRONZON, I; LIGHTY, GW
1984 ;86(2):333-333, Chest
— id: 40922, year: 1984, vol: 86, page: 333, stat: Journal Article,

Left ventricular outflow obstruction: a complication of mitral valvuloplasty
Kronzon I; Cohen ML; Winer HE; Colvin SB
1984 Oct;4(4):825-828, Journal of the American College of Cardiology
Thirty-two patients with severe mitral regurgitation underwent Carpentier mitral valvuloplasty. Postoperatively, three of these patients developed clinical and echocardiographic evidence of left ventricular outflow tract obstruction. None of these patients had asymmetric septal hypertrophy or preoperative echocardiographic demonstration of systolic anterior motion of the mitral valve. Outflow obstruction postoperatively was caused by systolic anterior motion of the mitral valve. Because this potential complication of Carpentier mitral valvuloplasty produced significant hemodynamic effects in two patients, echocardiography should be routinely performed after this operation
— id: 36734, year: 1984, vol: 4, page: 825, stat: Journal Article,

Use of two-dimensional echocardiography during transseptal cardiac catheterization
Kronzon, I; Glassman, E; Cohen, M; Winer, H
1984 Aug;4(2):425-428, Journal of the American College of Cardiology
Inadvertent puncture of the intrapericardial aorta is a serious complication of transseptal catheterization. Two-dimensional echocardiography allows delineation and spatial resolution of the aorta and interatrial septum. Thirteen patients underwent transseptal catheterization with simultaneous monitoring of needle and catheter position using fluoroscopy and two-dimensional echocardiography. The interatrial septum was demonstrated in the short-axis and four chamber views, and clearly separated from the ascending aorta. The transseptal needle and catheter were visualized by echocardiography while the needle tip was manipulated into the fossa ovalis avoiding puncture of the aortic root. In some cases, under pressure from the needle tip just before puncture, the interatrial septum appears to bulge toward the left atrium. Saline solution contrast echocardiography helped to confirm the needle position in the right atrium, and in the left atrium after puncture. These data suggest that two-dimensional echocardiography is a useful adjunct to fluoroscopy during transseptal catheterization that may improve its safety and prevent complications
— id: 100123, year: 1984, vol: 4, page: 425, stat: Journal Article,

THE USE OF 2 DIMENSIONAL ECHOCARDIOGRAPHY DURING TRANS-SEPTAL CARDIAC-CATHETERIZATION
KRONZON, I; GLASSMAN, E; COHEN, ML; WINER, HE; WEISINGER, B
1984 ;3(2):564-564, Journal of the American College of Cardiology
— id: 41026, year: 1984, vol: 3, page: 564, stat: Journal Article,

Intracardiac leiomyomatosis: diagnosis and treatment
Politzer, F; Kronzon, I; Wieczorek, R; Feiner, H; De Marco, L E; Weintraub, P R; Schlossman, R E; Hisler, S
1984 Sep;4(3):629-634, Journal of the American College of Cardiology
Intracardiac leiomyomatosis is the presence of a benign smooth muscle tumor within a cardiac chamber reaching the heart by direct intravenous extension from an extracardiac source. After a case report and a review of the 13 previously reported cases, the clinical features, diagnostic considerations, differential diagnosis and treatment modalities of intracardiac leiomyomatosis are discussed
— id: 100122, year: 1984, vol: 4, page: 629, stat: Journal Article,

LEFT-VENTRICULAR OUTFLOW TRACT ANATOMY IN PATIENTS WITH MITRAL ANNULAR CALCIFICATION
SLATER, J; KRONZON, I; COHEN, ML
1984 ;86(2):315-315, Chest
— id: 40921, year: 1984, vol: 86, page: 315, stat: Journal Article,

Doppler echocardiography and computed tomography in diagnosis of left coronary arteriovenous fistula
Slater, J; Lighty, G W Jr; Winer, H E; Kahn, M L; Kronzon, I; Isom, O W
1984 Dec;4(6):1290-1293, Journal of the American College of Cardiology
A 37 year old man with recurrent episodes of endocarditis was found to have a large left coronary arteriovenous fistula communicating with the right atrium. The origin and termination of the fistula were identified using computed tomography and two-dimensional Doppler echocardiography. Coronary angiography confirmed the diagnosis and the patient underwent a successful operation
— id: 100121, year: 1984, vol: 4, page: 1290, stat: Journal Article,

The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study
Weitzman, L B; Tinker, W P; Kronzon, I; Cohen, M L; Glassman, E; Spencer, F C
1984 Mar;69(3):506-511, Circulation
One hundred twenty-two consecutive patients (104 men; 18 women) were studied to determine the incidence and natural history of pericardial effusion occurring 2, 5, 10, and 20 to 50 days after cardiac surgery. Three patients had pericardial effusions before and 103 patients (91 men; three women) had effusions after surgery. Effusions were first recorded on the second postoperative day in 72 patients, on the fifth postoperative day in 29 patients, and on the tenth postoperative day in two patients. In 96 of these patients, effusions reached their maximum size by postoperative day 10. Of the 103 patients with effusions, 66 (64%) were followed to complete resolution. A specific pattern was observed in most resolving effusions. The echo-free space diagnostic of pericardial effusion became progressively more echo-dense as the effusion diminished in size. As the effusion became echo-dense, the posterior pericardium, which had been motionless, resumed its normal systolic anterior motion. One patient developed cardiac tamponade on postoperative day 3. We conclude that pericardial effusion occurs frequently after cardiac surgery, but that associated complications are rare
— id: 100124, year: 1984, vol: 69, page: 506, stat: Journal Article,

INCIDENCE AND NATURAL-HISTORY OF PERICARDIAL-EFFUSION AFTER CARDIAC-SURGERY
WEITZMAN, L; TINKER, P; KRONZON, I; GLASSMAN, E; SPENCER, FC
1984 ;3(2):488-488, Journal of the American College of Cardiology
— id: 41024, year: 1984, vol: 3, page: 488, stat: Journal Article,

Coronary artery spasm: analysis of seventy-one patients
Gelfand, M L; Kronzon, I; DeCarolis, P
1983 May;59(4):345-357, Bulletin of the New York Academy of Medicine
— id: 100129, year: 1983, vol: 59, page: 345, stat: Journal Article,

Cardiac tamponade by loculated pericardial hematoma: limitations of M-mode echocardiography
Kronzon, I; Cohen, M L; Winer, H E
1983 Mar;1(3):913-915, Journal of the American College of Cardiology
Three patients developed cardiac tamponade after heart surgery. Pericardial effusion was not identified by M-mode echocardiography. Two patients underwent two-dimensional echocardiography which showed compression of the right atrium by a localized mass. At reoperation, atrial compression by a loculated effusion or hematoma was found and successfully relieved. When cardiac tamponade is suggested by the clinical setting, but not supported by M-mode echocardiography, the presence of a loculated effusion should be considered and evaluated by a two-dimensional echocardiographic study
— id: 100132, year: 1983, vol: 1, page: 913, stat: Journal Article,

Contribution of echocardiography to the understanding of the pathophysiology of cardiac tamponade
Kronzon, I; Cohen, M L; Winer, H E
1983 Apr;1(4):1180-1182, Journal of the American College of Cardiology
— id: 100131, year: 1983, vol: 1, page: 1180, stat: Journal Article,

Diastolic atrial compression: a sensitive echocardiographic sign of cardiac tamponade
Kronzon, I; Cohen, M L; Winer, H E
1983 Oct;2(4):770-775, Journal of the American College of Cardiology
Nine patients with clinical and hemodynamic evidence of cardiac tamponade underwent M-mode and two-dimensional echocardiography. Pericardial effusion was documented in each patient. Four patients demonstrated respiratory variation in ventricular volumes in association with paradoxical pulse. Right ventricular compression was present in seven. In five patients, echocardiography demonstrated diastolic left atrial compression. In all nine patients, the apical four chamber view revealed diastolic right atrial compression. Drainage of 450 to 1,800 cc of pericardial fluid relieved the cardiac tamponade and eliminated the echocardiographic findings associated with this disorder. These observations suggest that the echocardiographic findings of atrial compression is a sensitive sign of cardiac tamponade
— id: 100125, year: 1983, vol: 2, page: 770, stat: Journal Article,

NON-INVASIVE EVALUATION OF MITRAL RECONSTRUCTION
KRONZON, I; MERCURIO, P; COLVIN, S
1983 ;1(2):626-626, Journal of the American College of Cardiology
— id: 40719, year: 1983, vol: 1, page: 626, stat: Journal Article,

Echocardiographic evaluation of Carpentier mitral valvuloplasty
Kronzon, I; Mercurio, P; Winer, H E; Colvin, S
1983 Aug;106(2):362-368, American heart journal
Carpentier's technique for reconstructive mitral valve surgery is an alternative to mitral valve replacement in patients with mitral regurgitation. The procedure involves reconstruction of the mitral valve and insertion of a ring into the mitral anulus. To study the results of this operation, pre- and postoperative M-mode, two-dimensional (2DE), and Doppler echocardiography were performed on 13 patients with severe, symptomatic mitral regurgitation, who underwent reconstructive mitral surgery. A significant clinical improvement was noted in all patients. This correlated with the hemodynamic and angiographic improvement in six of the patients who underwent postoperative cardiac catheterization. Postoperative echocardiography showed that the mitral valve E-F slope decreased from 129 +/- 30 mm/sec preoperatively to 53 +/- 13 mm/sec postoperatively (p less than 0.001). The mitral valve excursion decreased from 28 +/- 6 mm preoperatively to 19 +/- 2 mm postoperatively. The left ventricular minor axis shortening decreased from 32 +/- 9% to 28 +/- 6%. In seven patients the mitral valve area decreased from 4.5 +/- 0.9 cm2 to 2.8 +/- 0.5 cm2 (p less than 0.005). In each patient a new echocardiographic finding was observed: two parallel dense linear echoes from the prosthetic ring were noted on M-mode echocardiography near the base of the mitral valve. 2DE visualized the entire ring. Doppler echocardiography suggested moderate or severe mitral regurgitation in eight of eight patients studied preoperatively. Postoperatively 10 of 11 patients had no Doppler echocardiography finding of mitral regurgitation
— id: 100127, year: 1983, vol: 106, page: 362, stat: Journal Article,

Sterile, caseous mitral anular abscess
Kronzon, I; Winer, H E; Cohen, M L
1983 Jul;2(1):186-190, Journal of the American College of Cardiology
Echocardiography identified three patients with a mitral anular mass. Fluoroscopy demonstrated a faint, homogeneous intracardiac calcific density in each patient. Cardiac catheterization and angiography were performed and showed no left ventricular inflow or outflow obstruction. One patient died suddenly and two patients had cardiac surgery (one for mitral regurgitation and another for constrictive pericarditis). Examination demonstrated that each mass was nonencapsulated, sterile and acellular and contained cholesterol, calcium and fatty acids. The clinical significance and cause of these masses are unclear at present
— id: 100128, year: 1983, vol: 2, page: 186, stat: Journal Article,

Severe hemolytic anemia in patients with a porcine aortic valve prosthesis
Lader, E; Kronzon, I; Trehan, N; Colvin, S; Newman, W; Roseff, I
1983 Apr;1(4):1174-1176, Journal of the American College of Cardiology
— id: 100130, year: 1983, vol: 1, page: 1174, stat: Journal Article,

Unusual clinical and echocardiographic features of severe isolated pulmonic insufficiency
Roistacher, N; Kronzon, I; Winer, H E
1983 Aug;84(2):227-229, Chest
A 57-year-old psoriatic man had severe, isolated pulmonic regurgitation, with intractable right sided failure. Echocardiography showed flail pulmonic leaflet and premature opening of the valve. Cardiac catheterization documented severe pulmonic regurgitation. The right ventricular end-diastolic pressure was elevated above the pulmonary artery diastolic pressure, thus explaining the echocardiographic finding. The patient was treated successfully by pulmonic valve replacement
— id: 100126, year: 1983, vol: 84, page: 227, stat: Journal Article,

THE INCIDENCE OF PERIOPERATIVE ARRHYTHMIAS IN PATIENTS WITH MITRAL-VALVE PROLAPSE
ROTH, S; TUNICK, P; THOMAS, S; KRONZON, I
1983 ;84(3):361-361, Chest
— id: 40634, year: 1983, vol: 84, page: 361, stat: Journal Article,

Cardiac surgery for total rupture of the anterolateral papillary muscle
Cohen, B E; Snively, S; Kronzon, I; Colvin, S; Deutsch, P
1982 Feb;81(2):259-261, Chest
— id: 100141, year: 1982, vol: 81, page: 259, stat: Journal Article,

Reversible doxorubicin-induced congestive heart failure
Cohen, M; Kronzon, I; Lebowitz, A
1982 Aug;142(8):1570-1571, Archives of internal medicine
Doxorubicin hydrochloride is a chemotherapeutic agent highly effective against a wide range of neoplasms. A prime limiting factor to the administration of this drug is cardiotoxicity, which frequently develops when the cumulative dose exceeds 500 mg/sq m. Late cardiomyopathy, which may develop up to a year after therapy has been discontinued, was thought to be rapidly progressive and unresponsive to standard cardiac therapy. An adult who received 475 mg/sq m of doxorubicin hydrochloride experienced a cardiotoxic reaction one year after the completion of therapy. The patient responded to standard cardiac therapy. Resolution of left ventricular dysfunction was verified by echocardiography and radionuclide angiocardiography
— id: 100134, year: 1982, vol: 142, page: 1570, stat: Journal Article,

Microbubble formation: in vitro and in vivo observation
Kort, A; Kronzon, I
1982 Mar;10(3):117-120, Journal of clinical ultrasound
Injection of liquid through a catheter into the circulation is known to produce clouds of signals detected by sonography. Blood forced through a stenotic conduit produced sonographic clouding, and bubbles of 10-100 microns were observed were observed by light microscopy. The microbubbles persisted up to three and a half minutes. Microbubbles were observed in the microcirculation of the rat by placing the catheter tip into the descending aorta of 15 animals, viewing the mesentery at 400X magnification, and recording the results on videotape. Following injection of the rats' own blood, numerous microbubbles lodged promptly at the arteriolar level and obstructed blood flow for up to 200 sec before shrinking sufficiently to pass downstream and allow restitution of flow
— id: 100140, year: 1982, vol: 10, page: 117, stat: Journal Article,

Adverse effect of hydralazine in patients with primary pulmonary hypertension
Kronzon, I; Cohen, M; Winer, H E
1982 Jun 11;247(22):3112-3114, JAMA
— id: 100135, year: 1982, vol: 247, page: 3112, stat: Journal Article,

Diagnosis of a large left atrial myxoma: the role of two-dimensional echocardiography
Kronzon, I; Rosenzweig, B; Dack, S
1982 Jan;10(1):39-41, Journal of clinical ultrasound
— id: 100142, year: 1982, vol: 10, page: 39, stat: Journal Article,

Noninvasive diagnosis of left coronary arteriovenous fistula communicating with the right ventricle
Kronzon, I; Winer, H E; Cohen, M
1982 May;49(7):1811-1813, American journal of cardiology
— id: 100136, year: 1982, vol: 49, page: 1811, stat: Journal Article,

Ice-water-induced arrhythmias in a patient with ischemic heart disease
Lader, E W; Kronzon, I
1982 May;96(5):614-615, Annals of internal medicine
— id: 100137, year: 1982, vol: 96, page: 614, stat: Journal Article,

SPASM OF A NORMAL CORONARY-ARTERY WITH FIXED STENOSES OF THE REMAINING VESSELS
Mercurio, P; Kronzon, I
1982 ;49(4):965-965, American journal of cardiology
— id: 30451, year: 1982, vol: 49, page: 965, stat: Journal Article,

Spasm of a normal or minimally narrowed coronary artery in the presence of severe fixed stenoses of the remaining vessels: clinical and angiographic observations
Mercurio, P; Kronzon, I; Winer, H
1982 Apr;65(4):825-830, Circulation
Four patients with medically refractory unstable angina are presented. Each patient had ST-segment abnormalities during some episode of pain. Three patients had at least one episode of documented ST-segment elevation with their spontaneously occurring chest pain. One had recurrent ventricular tachycardia. Two patients had prior myocardial infarction. Angiography demonstrated localized left ventricular akinesis and a severe fixed stenosis in the coronary artery supplying the abnormal segment. There were severe, fixed lesions in two coronary arteries in two patients and in one vessel in two patients. After i.v. ergonovine maleate, coronary artery spasm was documented in a normal or minimally diseased coronary artery in each patient. In two patients, ergonovine-induced spasm not only occluded the vessel, but also markedly decreased retrograde filling of a vessel with severe, fixed narrowing. Each patient's characteristic symptoms appeared with the ergonovine-induced spasm. Thus, ergonovine maleate can provoke spasm of a normal coronary artery, even in the presence of severe fixed stenoses of the remaining vessels. This observation may have an important role in the diagnosis and clinical management of patients with chest pain
— id: 100138, year: 1982, vol: 65, page: 825, stat: Journal Article,

M-mode echocardiography in dehiscence of porcine xenograft in mitral position
Miceli, C; Kronzon, I; Winer, H E
1982 Mar;82(3):366-367, New York state journal of medicine
— id: 100139, year: 1982, vol: 82, page: 366, stat: Journal Article,

Echocardiographic diagnosis of papillary muscle calcification
Rosenzweig, B; Kronzon, I; Newman, P; Gargiulo, A
1982 Sep;10(7):342-344, Journal of clinical ultrasound
— id: 100133, year: 1982, vol: 10, page: 342, stat: Journal Article,

Adverse hemodynamic effects of phentolamine in primary pulmonary hypertension
Cohen, M L; Kronzon, I
1981 Nov;95(5):591-592, Annals of internal medicine
— id: 100143, year: 1981, vol: 95, page: 591, stat: Journal Article,

Giant right atrium in Ebstein's anomaly
Desimone, A R; Kronzon, I
1981 Jan;79(1):80-82, Chest
— id: 100147, year: 1981, vol: 79, page: 80, stat: Journal Article,

Mitral-valve prolapse in a patient with translocation of chromosomes 14 and 18
Gelfand, M L; Hirschorn, R; Wolman, R; Kronzon, I
1981 Oct 29;305(18):1094-1094, New England journal of medicine
— id: 100145, year: 1981, vol: 305, page: 1094, stat: Journal Article,

CORONARY-ARTERY SPASM-ANALYSIS OF 40 PATIENTS
GELFAND, ML; KRONZON, I; MERCURIO, P; DECAROLIS, PJ
1981 ;29(2):A194-A194, Clinical research
— id: 40218, year: 1981, vol: 29, page: A194, stat: Journal Article,

Transvenous intracardiac echocardiography
Glassman, E; Kronzon, I
1981 Jun;47(6):1255-1259, American journal of cardiology
A specially designed ultrasonic transducer, 0.2 mm in length and 0.75 mm in diameter, operating at 7.5 megahertz and mounted on a thin flexible coaxial cable was advanced to the distal tip of a right heart or transseptal catheter in 20 patients during cardiac catheterization. Left atrial, aortic root and right atrial cavity size, pulmonary arterial diameter at various sites, right ventricular wall thickness and the width of a pericardial effusion were demonstrated. Tricuspid, pulmonary, and aortic valves were seen and their motion displayed. With the transducer positioned at the tip of a transseptal needle it could be recognized when it made contact with the interatrial septum. Puncture into the left atrium, avoiding such structures as the aorta, was facilitated in this fashion. No complications were encountered in any patient. Intracardiac echocardiography appears to be a safe, valuable adjunct to both conventional echocardiography and cardiac catheterization. Furthermore, recordings of structures that may be difficult or impossible to obtain with routine external echocardiography may be made possible
— id: 100146, year: 1981, vol: 47, page: 1255, stat: Journal Article,

ECHOCARDIOGRAPHY IN PARADOXIC PULSE
KRONZON, I; WINER, H; WEISS, E; BERGER, A
1981 ;80(3):376-376, Chest
— id: 40194, year: 1981, vol: 80, page: 376, stat: Journal Article,

Mitral valve prolapse - risk of dysrhythmia in the perioperative period
Roth SL; Thomas SJ; Tunick P; Kronzon I
1981 ;55:A57-A57, Anesthesiology
— id: 47434, year: 1981, vol: 55, page: A57, stat: Journal Article,

Case report: echocardiographic observations in patients with Friedreich's ataxia
Weiss, E; Kronzon, I; Winer, H E; Berger, A R
1981 Nov-Dec;282(3):136-140, American journal of the medical sciences
Echocardiography was performed on 11 patients with Friedreich's Ataxia. Eight of 11 had asymmetric septal hypertrophy and systolic anterior motion of the anterior leaflet of the mitral valve at rest or after inhalation of amyl nitrite. Two patients had concentric left ventricular hypertrophy. In view of this high incidence of hypertrophic cardiomyopathy, echocardiography is suggested as part of the routine evaluation of the patient with Friedreich's Ataxia
— id: 100144, year: 1981, vol: 282, page: 136, stat: Journal Article,

Single channel dual echocardiography
Arditti, A; Rosenzweig, B; Kronzon, I; Sharaz, J; Laniado, S
1980 Aug;46(2):277-280, American journal of cardiology
An inexpensive method for obtaining simultaneous echograms from two or more cardiac areas is described. The measurement of systolic and diastolic time intervals, the identification of various auscultatory findings and the diagnosis of some valvular lesions are among the uses of such a technique
— id: 100149, year: 1980, vol: 46, page: 277, stat: Journal Article,

Echocardiographic patterns after mitral annuloplasty
Danilowicz D; Kronzon I; Doyle EF; Reed G
1980 ;65(3):129-135, Cardiology
18 adolescents and children who underwent mitral annuloplasty for severe mitral regurgitation were evaluated by echocardiography. In 7 patients studied preoperatively, mitral valve excursion ranged from 25 to 56 mm with E-F slopes from 92 to 160 mm/sec. 5 of the 7 patients showed mitral valve prolapse. The left ventricle was dilated in 6 and the left atrium was dilated in 4 patients. Postoperatively, the mitral valve excursion decreased ( range 15-26 mm; p less than 0.01) as did the E-F slope (range 44-100 mm/sec; 0.10 greater than p greater than 0.05). The prolapse pattern disappeared and the left heart chambers decreased in size. In these 7 patients and in 11 others studied postoperatively only, a common echocardiographic pattern was that of early anterior motion of the posterior mitral valve leaflet, which was not present preoperatively and was, therefore, tentatively ascribed to the technique of annuloplasty repair. No calciferation and no definite mitral steosis has occurred in the follow-up of these patients to date. Persistent left atrial/left ventricular dilatation appeared related to residual mitral regurgitation with or without atrial fibrillation
— id: 18071, year: 1980, vol: 65, page: 129, stat: Journal Article,

Mitral valve systolic click syndrome
Gelfand, M L; Kronzon, I; Decarolis, P; Winer, H E
1980 May;21(5):135-141, American family physician
Mitral valve prolapse, although usually a benign condition, can cause incapacitating chest pain or refractory arrhythmias. Among patients undergoing cardiac catheterization for evaluation of chest pain, 50 who were found to have mitral valve prolapse were analyzed. Three patients had neither a click nor a murmur. Echocardiography was diagnostic in 46 patients; two patients had no evidence of prolapse, and two patients had tests that were technically inadequate. Only 15 of the patients demonstrated a normal electrocardiogram
— id: 100150, year: 1980, vol: 21, page: 135, stat: Journal Article,

Two-dimensional echocardiography in mitral annulus calcification
Kronzon, I; Mitchell, J; Shapiro, J; Winer, H E; Newman, P
1980 Feb;134(2):355-358, American journal of roentgenology
Mitral annular calcification, established by fluoroscopy, was studied by M-mode and two-dimensional echocardiography in 18 patients. M-mode echocardiography revealed the typical dense, linear echo of mitral annular calcification, but not its extent. Two-dimenstional echocardiography demonstrated a dense, elipsoidal echo at the junction of the left atrium and ventricle in the long axis view, and an area of calcification below the mitral valve in the short axis view. These patterns were not seen in 20 control patients without mitral annular calcification by fluoroscopy. Two-dimensional echocardiography establishes the site and extent of mitral annular calcification, minimizes the potential for diagnostic error associated with M-mode echocardiography, and is superior to M-mode echocardiography for the recognition of mitral annular calcification
— id: 100152, year: 1980, vol: 134, page: 355, stat: Journal Article,

Echocardiographic observations of paradoxic pulse without pericardial disease
Kronzon, I; Winer, H E; Weiss, E C; Berger, A R
1980 Sep;78(3):474-479, Chest
Echocardiograms were obtained in 10 normal patients and in 11 patients with respiratory insufficiency due to chronic obstructive lung disease (8) and to thoracic poliomyelitis (3). Only the eight patients with obstructive lung disease had paradoxic pulse. No patient had pericardial disease. The left ventricular internal dimension, stroke volume, and the mitral valve E-F slope and D-E excursion were measured. The inspiratory to expiratory ratio of each measurement was significantly lower in patients with obstructive lung disease than in normal subjects. The patients with thoracic poliomyelitis demonstrated almost no respiratory change in these measurements. The magnitude of the change in the measured factors probably relates to the degree of negativity of intrathoracic pressure during respiration. The inspiratory reduction of mitral valve motion and left ventricular internal dimension is not specific to tamponade but may be seen in patients who exhibit paradoxic pulse due to other conditions
— id: 100148, year: 1980, vol: 78, page: 474, stat: Journal Article,

Propranolol: an unrecognized cause of central nervous system dysfunction in patients undergoing cardiopulmonary bypass
Lieberman, A; Kronzon, I; Colvin, S; Lowenstein, J; Lieberman, I
1980 Apr;29(4):378-380, Annals of thoracic surgery
An organic mental syndrome developed in a patient soon after he underwent repair of a dissecting thoracic aortic aneurysm. The operation was accomplished with cardiopulmonary bypass. Initially, the mental changes were thought to be related to the operation. However, they subsequently were shown to be associated with propranolol. The potential role of propranolol in inducing central nervous system disturbances is emphasized, and the literature on the subject is reviewed
— id: 100151, year: 1980, vol: 29, page: 378, stat: Journal Article,

Echocardiographic findings in patients with left superior vena cava and dilated coronary sinus
Cohen, B E; Winer, H E; Kronzon, I
1979 Jul;44(1):158-161, American journal of cardiology
Three patients with a left superior vena cava draining into a dilated coronary sinus were studied with cardiac catheterization and echocardiography. The diagnosis was confirmed at operation in two patients. A posterior echo-free space was filled with echoes during injection of contrast medium into the left but not the right arm. This echo-free space was localized to the left atrioventricular groove. This technique established the presence of a left superior vena cava communicating with the coronary sinus and excluded pericardial effusion as the source of the posterior echo-free space
— id: 100154, year: 1979, vol: 44, page: 158, stat: Journal Article,

Use of contrast echocardiography in the diagnosis of partial anomalous pulmonary venous connection
Danilowicz D; Kronzon I
1979 Feb;43(2):248-252, American journal of cardiology
Contrast echocardiography is useful in diagnosing the presence of partial anomalous pulmonary venous connection, particularly when it occurs in association with an atrial septal defect. Injections of saline solution, Cardiogreen or the patient's own blood were made in the inferior vena cava, left atrium and pulmonary veins of 27 patients. In all patients, the inferior vena caval injections showed only right heart clouding with no evidence of a right to left shunt. In 21 patients, the left atrial and pulmonary venous injections showed clouding of both the right and left heart structures, indicating a left to right atrial shunt and normal pulmonary venous connection. In six patients, the left artrial injections showed right and left heart clouding, but the right pulmonary venous injections showed only right heart structures, indicating a left to right atrial shunt with partial anomalous pulmonary venous connection. Contrast echocardiography proved to be a sensitive method of diagnosing the anomalous venous connection without the use of dye curves. The method is not useful when a right to left atrial shunt is present and may show false positive results for partial anomalous pulmonary venous connection it left atrial visualization is not adequate during injection into the pulmonary vein
— id: 18072, year: 1979, vol: 43, page: 248, stat: Journal Article,

TRANSVENOUS INTRA-CARDIAC ECHOCARDIOGRAPHY
Glassman, E; Kronzon, I
1979 ;60(4):203-203, Circulation
— id: 30074, year: 1979, vol: 60, page: 203, stat: Journal Article,

MICRO BUBBLE PRODUCTION AND EMBOLIZATION - POSSIBLE MECHANISM OF TRANSIENT ISCHEMIA
KORT, AA; KRONZON, I; WINER, HE
1979 ;27(2):A438-A438, Clinical research
— id: 50236, year: 1979, vol: 27, page: A438, stat: Journal Article,

MITRAL ANULAR CALCIFICATION AND IDIOPATHIC HYPERTROPHIC SUB-AORTIC STENOSIS - REPLY
KRONZON, I; GLASSMAN, E
1979 ;44(3):579-580, American journal of cardiology
— id: 50190, year: 1979, vol: 44, page: 579, stat: Journal Article,

Diagnosis of left atrial tumors by coronary angiography and left ventriculography
Shapiro, J B; Kronzon, I; Winer, H E
1979 ;5(1):41-49, Catheterization & cardiovascular diagnosis
The left ventriculograms and pulmonary and coronary angiograms of eight patients with left atrial (LA) tumors were reviewed. The patients' ages ranged from 52 to 65 years. In each case the tumor was outlined during left ventriculography. Coronary arteriography allowed visualization of tumor vessels in six cases (six of seven myxomas). Two of the patients had significant coronary obstructions. It is concluded that a left ventriculogram is a sensitive diagnostic test for the presence of LA tumors. Coronary arteriography is indicated in patients with LA tumors in this age group and is likely to provide independent evidence of the presence of an LA tumor
— id: 100155, year: 1979, vol: 5, page: 41, stat: Journal Article,

CHANGES IN LEFT-VENTRICULAR DIMENSION DURING POSITIVE PRESSURE RESPIRATION
Weiss, E; Kronzon, I; Winer, HE; Berger, A
1979 ;27(2):A494-A494, Clinical research
— id: 30127, year: 1979, vol: 27, page: A494, stat: Journal Article,

Absence of paradoxical pulse in patients with cardiac tamponade and atrial septal defects
Winer, H E; Kronzon, I
1979 Aug;44(2):378-380, American journal of cardiology
Five patients with atrial septal defect and proved cardiac tamponade had neither paradoxical pulse nor the inspiratory reduction of left ventricular internal dimension associated with this sign. It is assumed that equilibration of flow across the atrial septal defect prevented paradoxical pulse. Patients with a large atrial septal defect and tamponade do not manifest a paradoxical pulse
— id: 100153, year: 1979, vol: 44, page: 378, stat: Journal Article,

CONTRAST ECHOCARDIOGRAPHY IN PARTIAL ANOMALOUS PULMONARY VENOUS RETURN
Danilowicz, D; Kronzon, I
1978 ;41(2):393-393, American journal of cardiology
— id: 29857, year: 1978, vol: 41, page: 393, stat: Journal Article,

Digital range-gated echocardiographic tracking
Donnerstein, R; Emerson, R; Kronzon, I; Schloss, M; Glassman, E
1978 May-Jun;12(3):184-188, Medical instrumentation
Many applications of standard echocardiography require velocity computation which is usually determined by manually measuring slopes on an echocardiogram. However, manual techniques are limited by the inaccuracy with which slopes may be drawn and measured, the large amount of time required for detailed analysis, and the lack of real time information. A system is described which automatically provides real time and continuous and essentially instantaneous position and velocity measurements on selected heart structures. The system is designed with digital electronics wherever possible to facilitate data processing and the transfer of information to a computer. The system has advantages over continuous wave ultrasonic Doppler techniques and a range-gated ultrasonic Doppler system because dynamic, range-gated digital tracking allows target isolation and identification. Also, because range gate size may be kept small, noise susceptibility is minimized
— id: 100157, year: 1978, vol: 12, page: 184, stat: Journal Article,

CLINICAL AND ECHOCARDIOGRAPHIC CORRELATION IN PATIENTS WITH MITRAL-VALVE PROLAPSE SYNDROME
Gelfand, ML; Kronzon, I
1978 ;26(3):A233-A233, Clinical research
— id: 29811, year: 1978, vol: 26, page: A233, stat: Journal Article,

Mitral ring calcification in idiopathic hypertrophic subaortic stenosis
Kronzon, I; Glassman, E
1978 Jul;42(1):60-66, American journal of cardiology
— id: 100156, year: 1978, vol: 42, page: 60, stat: Journal Article,

Isolated diagonal artery disease
Kronzon, I; Winer, H; Glassman, E
1978 Mar-Apr;275(2):187-191, American journal of the medical sciences
The clinical, electrocardiographic, angiographic, and hemodynamic features of seven patients with isolated, severe (greater than 75% of diameter) narrowing of a diagonal branch of the left anterior descending artery are presented. The incidence of this entity was 0.5% among patients with arteriosclerotic heart disease undergoing coronary angiography. Angina was severe in two patients, moderate in four, and mild in one. One patient had unstable angina. Stress tests were abnormal in two of three patients. Six patients had normal left ventricular angiograms, and one had a mildly decreased ejection fraction. All patients survived a mean follow-up of 18 months (range 6 to 32). No patient suffered a myocardial infarction. Five became asymptomatic on medical therapy; one patient with mild and another with moderate angina were unimproved. This rare anatomic subset of patients with coronary artery disease has a favorable short-term prognosis
— id: 100158, year: 1978, vol: 275, page: 187, stat: Journal Article,

ABSENCE OF PARADOXICAL PULSE IN PATIENTS WITH ATRIAL SE
Kronzon, I; Winer, HW
1978 ;41(2):446-446, American journal of cardiology
— id: 29858, year: 1978, vol: 41, page: 446, stat: Journal Article,

Maximal instantaneous mitral valve velocities measured with a digital echocardiographic tracking system
Emerson, R; Donnerstein, R; Kronzon, I; Schloss, M; Glassman, E
1977 Jan;24(1):71-73, IEEE transactions on biomedical engineering
— id: 100163, year: 1977, vol: 24, page: 71, stat: Journal Article,

Prolapse of the mitral valve: clinical spectrum and coronary arterial distribution
Glassman, E; Kronzon, I
1977 ;62(4-6):347-354, Cardiology
Coronary angiograms were reviewed in 31 patients with idiopathic prolapse of the posterior mitral leaflet. There were 19 males and 12 females, ranging in age from 33 to 69. The coronary artery which supplied the posterior descending branch was designated as dominant. There were 27 dominant right coronary arteries and 4 dominant left coronary arteries. Attention was paid to whether the origin of the vessel which courses in the posterior atrioventricular groove branch was from the right coronary artery or the left circumflex. In the dominant right coronary artery group, the arterioventricular groove branch arose from the right coronary artery alone in 6 and from the left circumflex alone in 1 patient, and in 20 patients, from both. In the dominant left coronary artery group, the atrioventricular groove branch arose from the left coronary artery in all 4 patients. The frequency of dominant right coronary artery and left coronary and the origin of the atrioventricular groove branch did not differ in the patients with prolapse of the mitral valve from a control group of 30 patients similarly analyzed. In all instances, the atrioventricular groove branch arose from either the right coronary artery ro the left circumflex, or both. In no case was the arterioventricular groove branch totally absent. The results of this investigation do not support the thesis, previously advanced by others, that prolapse of the mitral valve is related to absence of the left circumflex coronary artery, but indicate a normal range of variation in coronary arterial distribution
— id: 100164, year: 1977, vol: 62, page: 347, stat: Journal Article,

Displacement of the heart by a giant mediastinal cyst
Koch, P C; Kronzon, I; Winer, H E; Adams, P; Trubek, M
1977 Sep;40(3):445-448, American journal of cardiology
A giant mediastinal cyst caused marked cardiac displacement, factitious cardiomegaly and clinical and hemodynamic findings suggestive of constrictive pericarditis. The correct diagnosis was established with echocardiography and confirmed with angiography and surgery
— id: 100161, year: 1977, vol: 40, page: 445, stat: Journal Article,

[Mechanical left ventricular assist devices]
Kronzon, I
1977 Aug;93(3-4):105-107, Harefuah: journal of the Israeli Medical Association
— id: 100162, year: 1977, vol: 93, page: 105, stat: Journal Article,

Left internal mammary--left ventricular fistula after Vineberg operation
Kronzon, I; Schloss, M; Glassman, E
1977 ;3(3):279-282, Catheterization & cardiovascular diagnosis
This communication presents an unusual complication in a patient who underwent the Vineberg procedure with the formation of an internal mammary to left-ventricular fistula, which caused a new apical diastolic murmur. This represents a previously unreported etiology for the appearance of an apical blowing diastolic murmur
— id: 100165, year: 1977, vol: 3, page: 279, stat: Journal Article,

ECHOCARDIOGRAPHY IN PARADOXICAL PULSE WITHOUT PERICARDIAL-EFFUSION
KRONZON, I; WEISS, E; WINER, HE; BERGER, A
1977 ;56(4):67-67, Circulation
— id: 39933, year: 1977, vol: 56, page: 67, stat: Journal Article,

Combined tricuspid and pulmonic stenosis. Clinical, echocardiographic, hemodynamic, surgical, and pathological features
Mehl SJ; Kaltman AJ; Kronzon I; Dworkin L; Adams P; Spencer FC
1977 Jul;74(1):55-60, Journal of thorac