Nils-Rune Lundström

Dimensions of cardiac chambers and great vessels by cross-sectional echocardiography in infants and children.

SummaryA total of 120 healthy infants, children, and teenagers were examined by cross-sectional echocardiography. Right and left atrial and ventricular dimensions and areas were measured in the parasternal, apical, and subcostal views. Dimensions of the inferior caval vein, the pulmonary artery and the aorta were obtained in the parasternal, suprasternal, and subcostal views. Reproducibility was studied in separate material consisting of 19 children with various forms of congenital heart disease examined consecutively by two different observers. Interobserver reproducibility was expressed as the 95% tolerance limit for the difference between two measurements.Good correlation with body surface area was demonstrated for all measurements, and the regression equations for the normal values of the parameters studied are given. Interobserver reproducibility was fairly good for measurements in the parasternal views, but moderate or low for measurements in the apical and the subcostal four-chamber views.Measurements in cross-sectional echocardiography are clinically useful, especially in the study of the right-sided cardiac structures that are difficult to evaluate with M-mode echocardiography, but the problems of reproducibility have to be taken into account.

Echocardiography in the Diagnosis of Ebstein's Anomaly of the Tricuspid Valve

Nineteen patients aged between 4 days and 40 years with Ebsteins anomaly of the tricuspid valve have been examined with echocardiography. The diagnosis was verified with angiocardiography in all but one patient. The results at echocardiography are compared with those found in some other patients where an echo from the anterior tricuspid leaflet could be obtained (atrial septal defect, total anomalous pulmonary venous return, pulmonary hypertension, and one patient with congenital tricuspid stenosis).An echo from the anterior tricuspid leaflet could be obtained in all patients with Ebsteins anomaly. This echo had an abnormal pattern of movement with an abnormally anterior position during the entire diastole. A late tricuspid opening was found in most patients. A late tricuspid closure compared with the time of mitral closure was a constant finding. It is suggested that this late tricuspid closure is mainly caused by mechanical factors related to the abnormal, large anterior tricuspid leaflet. The abnormal pattern of movement of the echo from the anterior tricuspid leaflet with a late tricuspid closure has not been found in any other patient examined.

Ultrasoundcardiographic Studies of the Mitral Valve Region in Young Infants with Mitral Atresia, Mitral Stenosis, Hypoplasia of the Left Ventricle, and Cor Triatriatum

Reflected ultrasound has been used for investigation of the mitral valve region in early infancy. The material consists of two patients with mitral atresia, three patients with mitral stenosis and aortic valvular atresia, five patients with mitral and aortic valvular stenosis, one patient with cor triatriatum, and one patient with severe degree of aortic valvular stenosis with a normal mitral valve. The results are compared with ultrasoundcardiographic findings in ten infants without heart disease. A specific abnormal echo was obtained in cases with mitral atresia and cor triatriatum. The patients with a combination of mitral and aortic valvular lesions could be separated into two groups by means of ultrasoundcardiography. This separation reflected the functional state of the left ventricle based on the degree of mitral stenosis and hypoplasia of the left ventricle.This noninvasive technic has been found useful as a complementary method for the investigation of the mitral valve region. It can even be performed in seriously ill infants.

Cross-sectional echocardiographic measurements of right ventricular size and growth in patients with pulmonary atresia and intact ventricular septum

SummaryFifteen patients with pulmonary atresia or critical pulmonary stenosis and intact ventricular septum were studied. All were operated on in the neonatal period, with valvotomy or a systemic to pulmonary arterial shunt, or both. In 12 patients, right ventricular to pulmonary arterial communication was established in the neonatal period. In three patients, only systemic to pulmonary arterial shunts were constructed. Six patients died. The median follow-up period for the surviving patients was 65 months (range, 12–87 months).Right and left atrial and ventricular dimensions and areas, the tricuspid annular diameter, and the cross-sectional area of the aortic root were measured in cross-sectional echocardiograms from the neonatal period, at the age of 1 year, and at the latest clinical follow-up. A classification of right ventricular morphology was made, based on identification of the inlet, the trabecular, and the outlet parts.Most of the patients had hypoplastic right ventricles at birth but at the latest follow-up, seven of nine surviving patients had right ventricles in the normal range. Right ventricular growth was better in patients who were given a right ventricular to pulmonary arterial communication in the neonatal period and those with complete right ventricular anatomy. The patients who died had severely hypoplastic right ventricles and small tricuspid valves.

Percutaneous catheterization of the femoral vessels in children II. Thrombotic occlusion of the catheterized artery: Frequency and causes

The frequency of, and the conditions which contribute to a reduction of the arterial peak flow to the calves after percutaneous catheterization of the femoral artery were studied by strain gauge plethysmography in 98 catheterizations of children aged 2–16 years.Marked, rapidly disappearing flow reduction, considered to be caused by intense spasm in the femoral artery, occurred in about 5 per cent of cases. Flow reduction under these conditions was generally less marked than at thrombotic occlusion.Thrombotic occlusion of the femoral artery appeared in about 5 per cent of cases, mainly in the younger children and principally in those exposed to catheterizations involving increased risk of intimal trauma. This led to the conclusion that intimal damage is the primary cause of thrombotic occlusion of the femoral artery after catheterization. However, an increased haematocrit value may possibly also promote thrombosis.The arterial blood flow at rest was not abnormally decreased in cases with thrombotic occlusion of the femoral artery.The length of the stay of the catheter in the artery does not seem to be of importance for thrombotic complications.The results indicate that the best way to avoid thromboric occlusion of the artery at catheterization is to take measures to reduce intimal damage.

ULTRASOUNDCARDIOGRAPHY IN INFANTS AND CHILDREN

Ultrasoundcardiography (UCG) studies have been performed in about three hundred children. The age of the children varied between 1 day and 16 years. Most of the studies have been performed without premedication and all without discomfort.

Myocardial scintigraphy with 201thallium in pediatric cardiology: A review of 52 cases

SummaryWe report our experience of myocardial scintigraphy with201thallium (201Tl) in 52 children, aged 4 days to 18 years, in which 80 studies were made primarily to demonstrate or exclude impaired myocardial perfusion. For analysis, the patients were divided into the following eight groups: group I, coronary artery malformations (five patients); group II, Kawasakis syndrome (six patients); group III, arterial switch operation (seven patients); group IV, dilated cardiomyopathy (18 patients); group V, hypertrophic cardiomyopathy (four patients); group VI, myocardial dysfunction after surgery for congenital heart disease (five patients); group VII, pulmonary atresia (three patients); and group VIII, miscellaneous (four patients).Myocardial scintigraphy was performed with a planar or tomographic technique at rest or after exercise (four patients). Isotope-uptake defects, indicating impaired myocardial perfusion, were present in 14 patients, including small infants. Defects were seen in all groups except those with hypertrophic cardiomyopathy and pulmonary atresia. The absence of such defects in several of the patients with Kawasakis syndrome was particularly valuable as it made coronary angiography unnecessary. In the other groups of patients myocardial scintigraphy was a valuable adjunct to other investigations.

Echocardiography in the Diagnosis of Congenital Mitral Stenosis and in Evaluation of the Results of Mitral Valvotomy

Seven patients with congenital mitral stenosis have been investigated with echocardiography using reflected ultrasound. In all cases the mitral stenosis was combined with other cardiovascular malformations. The results are compared with those obtained at clinical investigation, cardiac catheterization, and operation and/or autopsy. It is concluded that the method is of definite value in diagnosing congenital mitral stenosis, even when this is combined with other cardiovascular malformations. The method is also found to be of value in assessing the severity of mitral stenosis.Three patients have been investigated after mitral valvotomy. It is concluded that the findings at echocardiographic examination agree quite well with the clinical findings and with the results of postoperative cardiac catheterization in the evaluation of the result of mitral valvotomy.

Hypoxic-ischaemic encephalopathy is associated with regional changes in cerebral blood flow velocity and alterations in cardiovascular function

Doppler-derived indices of cerebral blood flow velocity (CBFV) and echocardiographic parameters of left ventricular function were measured in 18 patients with hypoxic-ischaemic encephalopathy HIE (group I) and in 28 normal controls (group II). Group-I infants had a subnormal distribution of CBFV values increasing over the first 85 h postnatally. CBFV values were constantly higher in the internal carotid than in the anterior cerebral artery. During the first 24 h postnatally, pulsatility and resistance indices of cerebral blood flow were significantly higher in group-I patients. From 30 to 85 h after birth, resistance indices were lower in group-I infants with severe HIE. Depressed left ventricular function and/or hypotension was documented in 50% of group-I patients.

Cardiac function in healthy infants and children: Doppler echocardiographic evaluation

SummaryTo establish normal values for Doppler-derived parameters of cardiac function, pulsed-wave Doppler recordings from the ascending aorta were obtained in 80 healthy infants and children. Stroke and minute distance, peak velocity, mean acceleration, acceleration and ejection time intervals, and the acceleration/ejection time ratios were measured or calculated from the Doppler recordings. The relations between the Doppler parameters and heart rate, age, and body surface area were analyzed separately for the children below and above 6 months of age. The normal values for the two groups are given as the median and range and as the mean and standard deviations, respectively. For the older age group, strong negative correlations with heart rate were found for stroke distance and ejection time, suggesting that these parameters should be evaluated in relation to heart rate. Intraobserver and interobserver reproducibility were studied in 10 children. Good reproducibility was found for stroke and minute distance, peak velocity, and left ventricular ejection time. For measurements related to acceleration, the reproducibility was less good.