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This book contains the manuscripts of the majority of the papers
given during the symposium 'Improvement of Myocardial Perfusion'
which was held from Sep tember 27-29,1984 in Mainz/Germany. It has
been the purpose of this meeting to focus the interest of
scientifically and clinically interested cardiologists on the new
developments in this field. We therefore chose the subtitle
'Medical-Mechanical -Surgical Approach'. The medical improvements
in myocardial perfusion have been brought about by the application
of streptokinase, urokinase and tissue-type plasminogen ac tivator
in the first hours after the onset of an acute myocardial
infarction. The different modes of application and the
possibilities to evaluate and eventually to quantify the results of
these treatments were addressed during the first part of the
meeting. The mechanical way to improve perfusion nowadays mainly
consists of the application of intracoronary balloon angioplasty.
Although since 1977 the treat ment has become a routine method,
several questions are still open such as the exact mode of action,
the reaction of the vessel wall, the optimal pressure and balloon
size as well as the long term results and the prevention of
restenosis.
This is the first book to present an overview of the exciting new
cardiac imaging technique of tissue Doppler echocardiography (TDE).
In order to understand the background of this technique, it is
necessary to compare the physical properties of blood, which
reflects ultrasound poorly but moves with high velocity (up to 150
cm/s) with those of the myocar dium, which reflects ultrasound
strongly but moves with low velocity (less than 10 cm/s). In tissue
Doppler imaging, existing Doppler technology has been modified to
bypass the high-pass filter and enhance calculation of low
velocities, thus enabling selective visualization of the myocardium
rather than of the blood. Because the color Doppler tissue images
are super imposed on the conventional two-dimensional ultrasound
images, this technique is known as TDE. Following a brief
introduction, the history of ultrasound and Doppler imaging is
presented. It is now about 150 years since the death of Christian
Doppler, who described the "Doppler" effect, and more than 100
years since Pierre Curie discovered the piezoelectric effects of
crystals. TDE was developed by Nobuo Yamazaki and Yoshitaka Mine at
the Medi cal Engineering Laboratory, Toshiba Corporation, Tochigi,
Japan. En gineers involved in the development of the technique have
provided important technical information, which the reader will
find an invaluable background to potential applications ofTDE."
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