Kenneth L. Wanderman

Left ventricular performance in patients with atrial septal defect: evaluation with noninvasive methods.

Eighteen patients with an atrial septal defect (Group I) and 45 patients whose defect had been repaired (Group II) were studied with echocardiography and systolic time Intervals. All patients In Group I had an increased right ventricular diameter (mean 24.5 mm/m2) that showed a direct linear relation to the size of the shunt (Qp/Qs ratio). In Group II the right ventricular diameter was significantly smaller (mean 15.6 mm/m2) (P < 0.001). The left ventricular diameter measured less than the mean normal value in 13 of the 18 patients in Group I (mean 23.2 mm/m2) and was significantly larger in the 45 in Group II (mean 27.7 mm/m2) (P < 0.001). n nComparison of systolic time intervals in Groups I and II showed that patients in the former group had shorter mean left ventricular ejection time index (LVETI) (407.9 versus 420.8 msec, P < 0.05), a longer mean preejection period index (PEPI) (140.9 versus 126.7 msec, P < 0.001) and a higher mean ratio of preejection period to ejection time (PEP/LVET) (0.39 versus 0.33, P < 0.001). A direct linear relation existed between both the preejection period index and the PEP/LVET ratio and the size of the shunt (Qp/Qs) in Group I. In three patients the abnormal systolic time intervals were consistent with mildly diminished left ventricular performance preoperatively but promptly returned to normal postoperatively. However, echocardiographic assessment revealed that left ventricular wall contractility was normal or hyperdynamic in all cases. n nThe mildly diminished overall left ventricular performance as shown by systolic time intervals appears to be related to the volume overload of the right ventricle and to the concomitantly diminished volume of the left ventricle rather than to any impairment of myocardial contractility. After closure of the defect the size of the ventricle and its performance return to normal.

Spontaneous Closure of a Traumatic Ventricular Septal Defect after Blunt Trauma Documented by Serial Echocardiography

A ventricular septal defect (caused by blunt chest trauma) that closed spontaneously over a period of 5 years was documented by serial echo-Doppler examinations. The shunt was relatively small and the patient was without symptoms from the time the lesion was discovered until its closure. In the absence of cardiac decompensation or pulmonary hypertension, a conservative approach, including serial echo-Doppler examinations, can be justified.

Viral myocarditis simulating dilated cardiomyopathy in early childhood: evaluation by serial echocardiography.

Left ventricular dimensions and function were assessed by serial M mode and cross sectional echocardiography in ten infants and young children with heart muscle disease characterised by left ventricular dilatation and impaired systolic function presenting in congestive heart failure, severe respiratory distress, or both. The patients were followed for 8-60 months after their initial admission. The aetiology was probably viral in all cases. One patient died three weeks after diagnosis. Left ventricular size and function returned to normal in only one child; however, various degrees of improvement were found in seven others who were symptom free at follow up. This study demonstrates that serial echocardiography adequately defines this disease in infants and young children and that invasive evaluation is seldom required. Furthermore, it emphasises the fact that even in symptom free children an echocardiographic picture that is indistinguishable from dilated cardiomyopathy may persist; such patients required continued follow up.

A Common Color Flow Doppler Finding in the Mitral Regurgitation of Acute Rheumatic Fever

Between October 1986 and May 1991, 19 patients with acute rheumatic fever who were hospitalized in the Department of Pediatrics at Soroka Medical Center underwent echocardiographic color flow Doppler examination. Five patients had an echocardiographic picture of mitral valve prolapse, with or without leaflet thickening, and one had a flail anterior leaflet. Six had mitral valve thickening without prolapse, and seven patients had an echocardiographically normal appearing mitral valve. All 19 patients had a posterolaterally directed jet of mitral regurgitation demonstrated on color flow Doppler. All patients had echocardiographically normal aortic valves. However, mild aortic regurgitation was noted in eight of them. The posterolateral jet of mitral insufficiency in acute rheumatic fever may be the most common echo‐Doppler finding in this condition. (ECHOCARDIOGRAPHY, Volume 8, November 1991)

Severe rheumatic mitral valve disease in children. Evaluation by echocardiography.

SummarySevere rheumatic mitral stenosis with or without mitral insufficiency is virtually unseen in children in the affluent countries of the western world, but is not uncommon in developing countries. Fifteen cases of rapidly progressive rheumatic mitral valve disease in children are presented to illustrate the value of echocardiography in the diagnosis and evaluation of this lesion. Cardiac catheterization was performed in nine and simply confirmed the diagnosis made noninvasively. Our experience demonstrates that thorough echocardiographic examination in these cases frequently enables the examiner to assess the need for surgical intervention without cardiac catheterization.