The cardiocirculatory changes during pregnancy and delivery are marked. In some diseases and conditions, the maternal and fetal risks are high. Echocardiography plays a very important role to diagnose and to follow up in pregnant women with heart diseases, because it is noninvasive and does not expose the patients to radiation. We reviewed the value of echocardiography to determine the conditions under which women with heart disease can tolerate pregnancy, and the fetomaternal prognosis for major heart diseases.
Background. Transthoracic real-time 3-dimensional echocardiography (3DE) is useful for understanding anatomical structure in planning surgical procedures for treatment of congenital heart disease, but the image resolution has not reached a level that is sufficient to show the detailed anatomy required by surgeons, due to limitations in the width of the acoustic window and ultrasonic penetration. To improve the image quality, we applied the transpericardial approach to obtain the 3DE images and compared these images to those of the surgical findings. Methods. The study included 22 consecutive patients with congenital heart disease who underwent various surgical procedures and were imaged with transpericardial 3DE just before surgery, using a Philips iE33 system with an X3-1 probe (10 cases) or an X7-2 probe (12 cases)(Philips Medical Systems Inc. Andover, MA, USA). The 3D anatomical echocardiographic images were acquired by a pericardial approach and reconstructed using an off-line computer system (QLAB, Philips Med. Inc. Andover, MA, USA). Then these reconstructed 3DE images were compared to the intraoperative findings and the pictures taken during the operation. Results. Moving 3D images in a cardiac cycle were successfully reconstructed in all cases within 10 minutes. All intracardiac anatomy identified in each 3DE image corresponded to those seen in direct observation of the intracardiac structure. In one case with a double outlet right ventricle with subpulmonary ventricular septal defect (VSD), precise delineation of the spatial relationship between the great arteries and a VSD enabled simulation of the surgical procedure for placement of a patch to close the VSD. Conclusions. Transpericardial 3DE is a powerful diagnostic method to yield high quality real-time images equivalent enough to the surgical findings.
Background. The present study was conducted to examine left atrial (LA) dyssynchrony, determined by echocardiographic myocardial strain imaging, in patients with hypertrophic cardiomyopathy (HCM). Methods. We studied 26 patients with HCM (20 men and 6 women, age, 66±7 years) and 25 normal subjects (controls). Tissue Doppler-based strain images were recorded in the apical 2-, 4-chamber, and long-axis views. The LA strain curve was obtained with the region of interest placed at the 5 LA segments, namely, the atrial septum, lateral wall, inferior wall, anterior wall, and posterior wall. We measured standard deviation (SD) of the time-periods between aortic valve opening and maximal strain (reservoir dyssynchrony index) and SD of the time-periods between mitral valve opening and minimal strain (emptying dyssynchrony index). Results. Compared with controls, patients with HCM had greater indexes of reservoir (40±23 ms vs. 23±8 ms, p=0.001) and emptying (37±17 ms vs. 28±11 ms, p=0.02) dyssynchrony. Reservoir dyssynchrony (index >39 ms) was detectable in 11 patients, and emptying dyssynchrony (index >50 ms) was detectable in 5 patients. Patients with reservoir dyssynchrony had a greater LV mass index than those without (182±45 g/m2 vs. 142±32 g/m2, p=0.01), whereas patients with emptying dyssynchrony had greater LA minimal volume (39±12 ml/m2 vs. 26±10 ml/m2 p=0.02) and lower LA emptying fraction than those without (27±3% vs. 39±11%, p=0.02). Conclusions. LA dyssynchrony can be present throughout the cardiac cycle in patients with HCM. LA dyssynchrony is more common in the reservoir phase and may be attributed to significant myocardial involvement.
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