Rihei Shimada

Noninvasive assessment of right ventricular systolic pressure in atrial septal defect: Analysis of the end-systolic configuration of the ventricular septum by two-dimensional echocardiography

This study was performed to determine if 2-dimensional echocardiography (2-D echo) can be used to predict right ventricular (RV) systolic pressure. Ninety-one patients with atrial septal defect were studied prospectively. Analysis of the end-systolic configuration of the ventricular septum (VS) in the short-axis 2-D echocardiogram allowed classification of patients into 4 groups: type A (67 patients)--the VS was more circular at end-systole than at end-diastole; type B (9 patients)--the VS curvature at end-systole was same as or further flattened compared with that at end-diastole; type C (9 patients)--the VS was straight at end-systole; type D (6 patients)--the VS curvature at end-systole was reversed so that it was convex toward the left ventricle. Between these types, the RV pressure was different. The RV systolic pressure ranged from 18 to 55 mm Hg (mean 34 +/- 1) in type A, 46 to 55 mm Hg (50 +/- 1) in type B, 60 to 76 mm Hg (66 +/- 2) in type C, and 72 to 118 mm Hg (93 +/- 7) in type D. The RV systolic pressure was statistically different between types except for types C and D. These data indicate that the end-systolic configuration of the VS in the short-axis 2-D echocardiogram may be useful for the semiquantitative assessment of the RV systolic pressure in patients with atrial septal defect.

Diagnosis of tricuspid stenosis by M-mode and two-dimensional echocardiography

A decreased diastolic slope (EF slope) of the tricuspid valve on the M-mode echocardiogram may not indicate the presence of tricuspid stenosis (TS). To explore diagnostic echocardiographic signs of TS, we examined an M-mode and 2-dimensional (2-D) echocardiogram in 9 patients with documented TS of rheumatic origin and in 14 patients with rheumatic heart disease who showed a decreased EF slope (less than 40 mm/s) but did not have TS. By M-mode echocardiography, the EF slope was not different between patients with TS (24.4 +/- 2.2 mm/s) and those without TS (27.4 +/- 2.0 mm/s). The early diastolic excursion (DE amplitude) of the tricuspid valve was significantly lower (p less than 0.001) in patients with TS (7.6 +/- 1.0 mm) than in patients without TS (13.9 +/- 0.6 mm). Two-dimensional echocardiograms of the tricuspid valve revealed diastolic doming in all patients with TS. Diastolic doming of the tricuspid valve was detected most often (all of 7 patients) in the apical 4-chamber view. In contrast, no patients without TS who had a decreased EF slope on the M-mode echocardiogram showed diastolic doming. These data suggest that a reduced DE amplitude of less than or equal to 10 mm associated with a decreased EF slope on the M-mode echocardiogram and diastolic doming of the tricuspid valve on the 2-D echocardiogram are useful echocardiographic signs in the diagnosis of TS.

Computer Analysis of Left Ventricular Pressure-Volume Relationships by Echocardiography

Programs were developed for the analysis of left ventricular pressure-volume relationships in clinical situations. Regression lines of end-systolic points on the pressure-volume plane were obtained from nine patients. Correlation coefficients between end-systolic pressure and volume were high. The indices calculated may be useful for diagnosis and research of left ventricular function.