RECENT DEVELOPMENTS IN CLINICAL ECHOCARDIOGRAPHY

In clinical echocardiography, several recent developments appear of importance: Progress in methods mainly involves transesophageal echocardiography (TEE) and Doppler methods. In TEE large scale investigations have proved a low incidence of complications (lethal < 1, non-lethal < 17/10 000 examinations; endocarditis due to bacteremia absent or negligible). Transducers with more than one plane of sector scanning offer further improvement in anatomical orientation. Doppler methods alone seem to be sufficient for preoperative diagnosis in 80% of mitral and 95% of aortic valve patients. Left ventricular contrast media improve results in mitral incompetence up to the level of TEE and enhance correct quantification of aortic stenosis, while imaging of myocardial perfusion is not yet clinically reliable. The analysis of pathophysiology in mitral valve flow yielded new clinically useful information. In regurgitation the resulting jets tend to decrease in extension with increasing size of the receiving chamber and show predictable distortion of shape in the vicinity of heart walls. Quantification may improve with use of the ''PISA'' method in color flow imaging. Diastolic filling is shown to depend on many variables, thus precluding simple statements about diastolic function. Systolic left ventricular function has been shown to improve with upright posture by Doppler criteria. It was found to be constant for years after HTP by use of afterload stress. Studies on normal and transplanted hearts confirmed a vagal reflex vasodilatation with systolic pressure overload.