Yoichi Fukui

Real-time observation of cardiac movement and structures in congenital and acquired heart diseases employing high-speed ultrasonocardiotomography

Echocardiography has proved useful for cardiac diagnosis during the past several years; however, the conventional one-dimensional ultrasound pulse echo method cannot easily visualize the anatomical relationships of the various cardiac structures. To overcome the limitation, the authors attempted a real-time observation of cardiac structures and introduced high-speed ultrasonocardiotomography with a Sonolayergraph Model SSL-51H (Toshiba) having a logarithmic amplifier. Thirty sector images are produced per second by a mechanically operated, single flat or 75 mm. focus transducer measuring 10 mm. in diameter. The angle of a sector image composed of about 120 scanning lines is arbitrarily changeable from null to 65 degrees. The fast succession of images produced enables clear observation of the movement of cardiac structures in real time. Study of 230 patients by means of the proposed system suggests that it is advantageous as a quick method to provide two-dimensional echocardiograms for cardiac diagnosis and assessment, especially in noninvasive diagnosis.

Apex and subxiphoid approaches to Ebstein's anomaly using cross-sectional echocardiography

Abstract Apex and subxiphoid cross-sectional echocardiography was performed with an electronic sector scan on 11 patients having Ebsteins anomaly, isolated or associated with other cardiac diseases. For control study, 10 normal subjects and 10 ASD patients were similarly examined. In the apical four-chamber view, the displacement of the STL was measured in end-diastole using 8 mm. cinematography. It ranged from 1.4 to 3.2 cm., with an average of 2.1 ± 0.5 cm. in eight out of the 11 patients, whereas in control subjects, there was no displacement of the STL. From the apical three-chamber view of the right side of the heart, the downward displacement of the STL into the right ventricular cavity was also clearly visualized, as well as the tricuspid valve ring. Thus, the right-sided heart was seen to be divided into the functional and atrialized right ventricles and the right atrium by the displacement of the STL. In addition, the CT inserting into the ATL was observed in five cases from the three-chamber view and in four instances from the four-chamber view. The interpretable subxiphoid cross-sectional images were obtained in nine of the 11 patients. The right and left sides of the heart were widely visualized and the elongated ATL was fully observed from the tip to the thickened root. Moreover, the CT inserting into the ATL was visualized in six out of the nine patients.

Clinical study on the right-sided Austin Flint murmur using intracardiac phonocardiography.

Right heart catheterization was carried out on 14 patients with pulmonic regurgitation using intracardiac phonocardiography. All the patients showed pulmonic regurgitant murmur in the right ventricular outflow tract. In addition, seven out of the 14 patients showed mid-diastolic and presystolic murmurs maximally in the outflow tract of the right ventricle. Furthermore, inspiration increased the loudness of these diastolic murmurs in four patients. These findings were compatible with those of right-sided Austin Flint murmur due to functional tricuspid stenosis in pulmonic incompetence. Ten out of the 14 patients had pulmonary hypertension and all the subjects with a rightsided Austin Flint murmur showed elevated pulmonary arterial pressure. Thus, pulmonic regurgitation with pulmonary hypertension is thought to be closely related to the right-sided Austin Flint murmur and the turbulence resulting from antegrade flow across a closing tricuspid valve may be responsible for the genesis of the murmur.

Origin of the basal systolic murmurs in mitral stenosis. A study with intracardiac phonocardiography

In order to study the origin of the basal systolic murmurs in mitral stenosis, left and right heart catheterization was performed in 18 patients with mitral stenosis using intracardiac phonocardiography. Our data revealed that the basal systolic murmurs originated in the aorta, the pulmonary artery, and the outflow tract of the right ventricle. In 14 cases, we noted the maximal ejection systolic murmur in the aorta near the aortic valve. However, in two cases, there was a loud systolic murmur in the pulmonary artery. These murmurs occurred in early to mild-systole and were crescendo-decrescendo in configuration. The pitch of the murmur ranged from low to medium frequency in the majority of cases. They are produced by the turbulence of blood flow in the aorta and the pulmonary artery. A late systolic murmur was also recorded in the outflow tract of the right ventricle in two patients. This is thought to occur due to functional or relative infundibular stenosis of the right ventricle. It differs in location and timing from those in the aorta and the pulmonary artery. The outflow tract of the right ventricle is regarded as the third origin of the basal systolic murmur in mitral stenosis.