Marlene A. Enderlein

Two-dimensional echocardiographic determination of aortic and pulmonary artery sizes from infancy to adulthood in normal subjects.

The aorta, right pulmonary artery and pulmonary trunk were measured from the 2-dimensional echocardiogram (2-D echo) of 110 normal subjects aged 1 day to 18 years. The vessel diameters were measured from the parasternal short-axis view, the suprasternal long-axis view and the suprasternal short-axis view. Measurements were made at end-systole and at end-diastole and in both an axial and lateral direction where possible. When analyzed with respect to body surface area (BSA), the echocardiographic measurements were linearly related to the square root of the BSA, and there was inequality of variance around the relation. To establish a range of normal values for each vessel dimension, a weighted regression analysis was used to produce estimates of the regression line and a set of tolerance intervals. The systolic vessel dimension was larger than the diastolic vessel dimension and the measurement of a vessel in an axial direction was larger than the measurement of the same vessel in a lateral direction. In general, when a vessel was measured in several views, the largest diameter was obtained using the view that imaged the vessel in cross section. These data on normal values for the echocardiographic measurement of the aorta and pulmonary arteries at different BSAs should be useful for identifying patients with abnormalities in arterial size and for the serial assessment of arterial size in children who have undergone surgical or medical therapy.

Isolated ventricular inversion: two-dimensional echocardiographic findings and a review of the literature.

SummaryIn a cyanotic newborn infant, the diagnosis of isolated ventricular inversion in situs solitus was made from the two-dimensional echocardiographic examination and later confirmed at cardiac catheterization and surgery. The four-chamber views were especially useful for identifying the normal atrial situs and discordant atrioventricular connections in this infant. The normal relationships of the great arteries to each other (aortic valve rightward, posterior, and inferior to the pulmonary valve; great arteries coiled around each other) and to the ventricles (mitral-aortic fibrous continuity, well-developed subpulmonic conus) were well defined in the subcostal views. A review of the medical literature revealed a total of 12 cases of isolated ventricular inversion, most of which were diagnosed only at postmortem examination. The two-dimensional echocardiogram provides a rapid, safe technique for prompt diagnosis in these very sick cyanotic infants.

Comparison of M-mode echocardiographic measurement of right ventricular wall thickness obtained by the subcostal and parasternal approach in children

Right ventricular (RV) wall thickness was measured from M-mode echocardiograms at end-diastole from both the parasternal and subcostal approaches in 50 children of various body surface areas (0.24 to 1.68 m2). The measurements were obtained from M-mode recordings generated from sector scans to ensure precise location and position. Twenty-three children had normal hearts, and 27 had various congenital heart defects that may be associated with RV hypertrophy. Corresponding measurements of the RV wall thickness at end-diastole from the 2 approaches were similar. Subcostal echocardiographic measurement of RV wall thickness was found to be a reliable alternative to parasternal measurement in children with normal hearts and in those with congenital heart disease and RV hypertrophy.

Contrast Echocardiography in Congenital Heart Disease: An Underutilized Technique

Contrast echocardiography (CE) is a sensitive and safe technique for the definition of congenital cardiac anomalies. We have used CE in 283 patients since 1980. To stabilize the microcavitations, 1–2-ml saline boluses were withdrawn from a bottle of normal saline—to which had been added approximately 0.1–0.5 ml of the patient’s blood obtained on the initial venoclysis using a 3-ml syringe. This contrast medium was then rapidly injected into an arm or scalp vein, a radial artery, or via a catheter into a central vein, artery, or cardiac chamber. There was no recognizable complication from CE in any of the patients studied via this technique.

The Uses of Pulsed Doppler Ultrasound in the Human Fetus

High-quality images of the fetal heart obtained in the second and third trimesters of pregnancy can be supplemented by pulsed Doppler ultrasound on the human fetus [1–7]. We present our experience with 205 fetuses between 18 weeks gestation and term who underwent combined ultrasonography.

Usefulness of Doppler echocardiography for determining hemodynamic improvement with intravenous verapamil in hypertrophic cardiomyopathy

Abstract Verapamil is effective in the treatment of hypertrophic cardiomyopathy (HC). 1–4 Continuous-wave Doppler ultrasound is useful in the noninvasive assessment of high-velocity intracardiac blood flow. 5 We evaluated the hemodynamic response in a child with HC through intravenously administered verapamil during cardiac catheterization with simultaneous continuous-wave Doppler flow study for the noninvasive evaluation of changes in left ventricular (LV) outflow obstruction.

ATRIOVENTRICULAR VALVE INSUFFICIENCY ASSOCIATED WITH CONGENITAL HEART DISEASE DETECTED IN UTERO USING COMBINED 2D ECHO/DOPPLER ULTRASOUND

Little is known about the effects of atrioventricular valve insufficiency (AVVI) in utero in association with congenital heart disease. Using an ATL ultrasound system with a 3 MHz range-gated pulsed Doppler (PD) transducer we found 3 of 114 fetuses had AVVI. The atria were insonated using the 2D echocardiographic image as a guide for position. The mother of one fetus, gestational age (GA) of 20 weeks, had received high dosage lithium during early pregnancy. Tricuspid insufficiency was associated with Ebsteins anomaly of the tricuspid valve. Serial studies showed nonimmune fetal hydrops (NIH) developed at 34 weeks GA. Labor was induced but the fetus died from low cardiac output and blood pressure after delivery. At postmortem the diagnosis was confirmed. A second fetus, 36 weeks GA, was referred for examination because of bradycardia. The 2D echocardiogram showed an atrioventricular canal defect. NIH was present. PD showed insufficiency of the common atrioventricular valve. Following induction of labor and delivery, low cardiac output and blood pressure persisted despite medication and the infant died. In a 23 week twin pregnancy, one fetus had NIH. 2D echo showed this fetus to have pulmonary atresia with a normally developed right ventricle. Tricuspid insufficiency was found by PD. The pregnancy terminated spontaneously. AVVI in the presence of congenital heart disease has a poor prognosis. Associated NIH may make the prognosis even worse and reflect in utero cardiac failure.