Background. Left Ventricular (LV) diastolic performance is impaired in patients with aortic regurgitation (AR). The objective of this study is to determine the effect of AR jet direction on left ventricular diastolic performance. Methods. 20 patients with significant AR [regurgitant fraction (RF) > 30%] were studied by 2-dimensional, color, pulsed and tissue Doppler echocardiography. Subjects were divided into two groups based on jet direction as observed on the parasternal long-axis color flow image. Ten patients had the jet directed onto the anterior mitral leaflet (AML, mitral group) and 10 had the jet directed to the center of the LV (central group). Patients with significant mitral regurgitation or pseudonormal LV hemodynamics were excluded. The isovolumic contraction and relaxation times (ICT and IRT) were measured by combined mitral inflow and LV outflow velocity waves. Mitral annulus velocity was measured at the lateral annulus on the apical 4-chamber view by pulsed Doppler tissue imaging. The RF was calculated by combined use of pulsed Doppler and 2-dimensional echocardiography. Results. The two groups were similar in age, AR grade, LV end-diastolic volume, LV ejection fraction, and ICT; where-as, significant differences existed in the mitral inflow E/A ratio (mitral group, 0.59±0.17 vs. central group, 1.15±0.46, p<0.01), IRT (mitral group, 104±24 msec vs. central group, 83±15 msec, p<0.01), and mitral annulus velocity during early diastole (mitral group, 5.8±2.0 cm/sec vs. central group, 10.0±2.0 cm/s, p<0.01). Conclusions. LV diastolic performance is altered when a regurgitant jet is directed onto the AML in patients with significant AR.
Background. Left ventricular (LV) remodeling is greater in patients with anterior myocardial infarction (MI) compared to those with inferior MI. Left atrial (LA) remodeling is expected to have influences from both LV remodeling and mitral valve dysfunction or mitral regurgitation (MR), which is more frequent in inferior MI. Therefore, LA remodeling may not necessarily be less in inferior MI compared to anterior MI. The purpose of the study is comparison of LV and LA remodeling in patients with anteroseptal and inferior MI with or without MR. Methods. In 61 consecutive patients with prior anterior MI, 33 with prior inferior MI, and 22 normal control subjects, LV and LA volumes were measured using biplane Simpson's method, and MR fraction was quantified by Doppler echocardiography. Results. Although patients with inferior MI had significantly less LV dilatation (LV end-diastolic volume: 91±11 vs. 125±45 vs. 106±19 ml, control vs. anterior vs. inferior, p<0.01) and reduction in LV ejection fraction (63±6 vs. 44±7 vs. 49±8 %, p<0.01), their LA dilatation was significantly greater compared to those with anterior MI (51±12 vs. 64±28 vs. 78±31 ml, p<0.01). Incidence of ischemic MR (fraction>20%) was significantly higher in patients with inferior MI compared to anterior MI (7/61 vs. 12/33, p<0.01). In selected patients without significant ischemic MR, LA dilatation was comparable between inferior and anterior MI (60±28 vs. 61±16 ml, n.s.). Conclusions. Compared to patients with anterior MI, LV remodeling is significantly less but LA remodeling is significantly greater in inferior MI, suggesting the important role of ischemic MR to induce LA remodeling.
Background. In a recently developed hand-carried echo device, portability is achieved at the expense of display size and by the choice of directional color power Doppler (DCPD) rather than pulsed or standard color Doppler imaging. Accuracy of a hand-carried echo device in measuring cardiac chamber size and in assessing valve regurgitation by a trained sonographer was tested by comparing the measurements between hand-carried and standard echo systems. Methods. We studied 56 patients on a consecutive basis using a hand-carried echo device for minutes and then using a standard echo machine. Left ventricular (LV) end-diastolic and end-systolic diameters and the septal and posterior wall thickness were determined in 2D images by the reference of the mitral and aortic valve closure. Valve regurgitation was assessed with DCPD imaging using a hand-carried device and with color Doppler imaging using a standard machine. Results. There was a good correspondence in LV end-diastolic and end-systolic diameters and wall thickness between the two echo systems (r=0.96, 0.93 and 0.95). When the color Doppler imaging was taken as a gold standard, sensitivity and specificity of detecting valve regurgitation was 98 and 99%, respectively. There was a good correlation in the width and length of the regurgitant signal between the two echo systems (r=0.96 and r=0.84). Conclusions. The hand-carried echo device provides an accurate assessment of LV function, chamber size, wall thickness and valve regurgitation when the data are obtained and analyzed by a trained sonographer. Small display size and use of directional color power Doppler does not appear to deteriorate the accuracy.
A fistula between the septal perforator of the left anterior descending artery and the right ventricle was detected by transthoracic echocardiography in a patient with eosinophilic myocarditis who underwent an endomyocardial biopsy. This was a new finding, confirmed by coronary angiography, since a prior angiography taken seven months earlier. To the best of our knowledge, this is the first report that a combination of transthoracic color Doppler echocardiography and a high-frequency transducer will result in the detection of the coronary artery to the right ventricle fistula as a complication of endomyocardial biopsy.
Although chaotic atrial tachycardia (CAT) is a rare arrhythmia in children, some cases of Noonan's syndrome have been reported to be related with CAT. We encountered an infant with CAT and Noonan's syndrome. The present case showed atrial wall thickening and pulmonary interstitial consolidation just prior to the onset of CAT, which may indicate a relation between CAT and Noonan's syndrome.
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