A. D. Hagan

Ultrasound Evaluation of Systolic Anterior Septal Motion in Patients With and Without Right Ventricular Volume Overload

Little information is available concerning the normal systolic pattern of movement of the interventricular septum in man. Accordingly, we studied 242 patients without clinical or catheterization evidence of right ventricular volume overload (RVVO) employing the ultrasound continuous recording technique. In the plane of the mitral valve, systolic anterior septal motion (SASM) was present in 111 patients; in 38 patients the septum did not move during systole while in 74 patients, septal motion was variably anterior and posterior during the same recording. Normal posterior septal motion occurred in only 19 patients. However, at or below the level of the chordae tendineae, 226 of the 242 patients (93%) had normal posterior septal motion. The other 16 patients had severely impaired left ventricular function.In 56 patients with RVVO, 34 had abnormal septal motion at the level of the chordae tendineae (24 with SASM, 7 with variable motion and 3 with no movement).To evaluate septal motion further, 100 normal subjects were studied using a phased multicrystal ultrasound system designed by Bom which provided a sagittal plane image of the cardiac structures. In all 100 subjects the superior septum moved anteriorly in systole with the aortic root, and the upper one-third of the septum acted as a “hinge’ for the lower two-thirds which moved posteriorly. In 8 of 21 patients with RVVO studied by the multicrystal method, the entire septum moved anteriorly during systole; variable patterns occurred in 7 patients, while normal septal motion was present in 6 patients.We conclude that 1) normal septal motion consists of anterior movement of the superior segment of the septum during systole; 2) below a pivot point, the inferior two-thirds of the septum moves posteriorly during systole; 3) the normal pivot point of the septum frequently results in SASM when recordings are made in the plane of the mitral valve in patients with and without RVVO; and 4) paradoxical septal motion is not always present in patients with RVVO even when echocardiographic recordings are obtained at or below the level of the chordae tendineae.

Echocardiographie Criteria for Normal Newborn Infants

Echocardiograms were obtained from 200 normal newborn infants ranging from 6 to 10 pounds in weight and from 10 to 72 hours in age. A continuous recording technique is described employing a 5 MHz transducer. Criteria have been established for a normal echocardiographic profile in the full-term neonate. This profile consists of obtaining quantitative measurements of mitral valve excursion and velocity, tricuspid valve excursion and velocity, pulmonary artery diameter, aortic root diameter, left atrial diameter, and interventricular septal thicknesses. In addition, qualitative assessment is made of the septal contour, position of the aortic root to pulmonary artery, continuity of mitral valve with posterior aortic root, and continuity of tricuspid valve with anterior aortic root. No correlation was found between the magnitude of any one parameter and either body surface area or weight. The establishment of normal echocardiographic criteria for the newborn may be expected to significantly facilitate application of this noninvasive technique to infants born with congenital heart disease.

An echocardiographic study of interventricular septal motion in the Wolff-Parkinson-White syndrome.

SUMMARY Echocardiographic studies of interventricular septal motion were performed in 26 consecutive patients with the Wolff- Parkinson-White (WPW) syndrome and in ten normal subjects. All patients with types A or B pre-excitation were subclassified into groups I to IV on the basis of their electrocardiogram utilizing the method of Boineau and associates. In all 14 patients with type A (Group III or IV) pre-excitation, the motion of the interventricular septum and posterior left ventricular wall motion were normal. However, in 11 patients with type B (Group 1) WPW an abnormal septal movement was noted. This was characterized in ten patients by an early systolic posterior motion, a subsequent anterior movement in mid systole, and the usual posterior septal motion beginning in late systole. In eight patients, including the one without early systolic posterior movement of the septum, the late systolic posterior movement was interrupted by a prominent septal notch. One patient with type B (Group II) WPW was studied and exhibited normal septal and posterior wall motion. In one patient with a spontaneous change in the QRS complex from normal to a type B (Group I) WPW pattern, the septal motion was initially normal and abruptly changed following the first WPW beat. The onset of abnormal interventricular septal motion with type B pre-excitation QRS complexes strongly suggests that abnormal septal movement may be related to an altered sequence of ventricular depolarization during right ventricular pre-excitation.

Assessment of left ventricular function in severe aortic regurgitation

SUMMARY Echocardiographic (echo) measurements of left ventricular ejection phase indices — ejection fraction, percent shortening of the minor diameter (%ΔD), and velocity of circumferential fiber shortening (Vcf) — are said to be accurate reflections of their angiographic (angio) counterparts. Most studies correlating echo and angio left ventricular function parameters have induded relatively few patients with aortic regurgitation. Echo and angio measurements of left ventricular ejection phase indices thus might not correlate in these patients in whom left ventricular geometry may have been altered due to the volume overload. To test this hypothesis, left ventricular ejection phase indices were determined by angiography and echocardiography and compared in 20 patients with isolated, symptomatic, severe aortic regurgitation. Ejection fraction, %ΔD, and Vcf by LAO cineangiograms and echo were uniformly higher than corresponding meaurements from RAO angio, and were often normal in the presence of other indicators of significant left ventricular dysfunction. We conclude that the usual, linear echocardiographic measurement of left ventricular wall motion may not reflect sigpificant myocardial dysfunction in patients with severe aortic regurgitation.

Nitroglycerin ointment: a review.

construed as official or as necessarily reflecting the views of the Medical Department of the Navy or the Naval Service at large. Nitroglycerin is the most widely used drug in the treatment of angina pectoris. In addition to alleviating angina pectoris, it reduces left ventricular end-diastolic and end-systolic volume1,2 which may contribute to improved left ventricular performance in the setting of congestive heart failure. It decreases peak systolic and end-diastolic tension,3 and thereby decreases myocardial oxygen consumption and possibly increases diastolic coronary blood flow by diminishing extravascular resistance to flow.3 In patients with previous myocardial infarction, nitroglycerin enhances performance in areas of resting or exercise-induced left ventricular dyssynergy, decreases left heart size, and increases the velocity and extent of shortening in adjacent normal left ventricular segments.’ Nitroglycerin has been found to decrease the frequency of spontaneous ventricular fibrillation and to enhance ventricular electrical stability after ischemic injury in both man and experimental animals,5-’ and it raises the ventricular fibrillation threshold in nonishchemic canine myocardium as well.’ Data also suggest that nitroglycerin can improve conduction through the AV node.’