Background: Tissue Doppler imaging (TDI) is a well developed technique for the quantification of the myocardial contraction and relaxation in the left ventricle, but it may be useful for directly assessing the contractile function of the left atrium (LA) as well. Atrial fibrillation (AF), even if paroxysmal, may affect the LA size and function. However, little is known about the changes in the LA contractile function in AF patients. Methods: TDI was performed in 92 AF patients (paroxysmal [PAF]-59, chronic [CAF]-33) and 114 control subjects. In the apical long-axis view, the region of the interest (ROI) was employed at the LA roof. While moving the ROI within the LA roof, the maximum velocity (LAWV) was determined during late-diastole (atrial contraction period). Results: The LAWV was 3.1±0.8 cm/s, and was not age-dependent in the control subjects. The LAWV was smaller in the PAF patients (2.3±1.3 cm/s) than in the control (p<0.001). One day after the LA ablation for PAF, the LAWV decreased to 1.5±1.1 cm/s (p=0.003 vs. before ablation), but recovered to 2.1±1.2 cm/s 1 month after the ablation. In the CAF patients, the LAWV was 0.6±0.6 cm/s 1 day after the cardioversion. However, it increased to 1.9±1.2 cm/s 1 month after the cardioversion (p<0.001 vs. 1 day after the cardioversion). Conclusions: The LAWV is a useful and sensitive measurement of the LA contractile function, and it is not affected by age.

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This paper illustrates the importance of the three vessels and trachea (3VT) view in fetal heart screening by describing three cases of vascular ring.
Fetal heart screening is one of the most integral parts of the routine obstetric ultrasound examination. There are four check points: the cross sectional abdominal view, four chamber view, right and left outflow tract views and the aortic arch view. The latter is the most difficult to screen but is made easier by the 3VT view.
We report three cases of vascular ring: two cases of right aortic arch with aberrant left subclavian artery (RAA with ALSA) and one case of double aortic arch (DAA). These cases were detected in low risk pregnancies by the 3VT view. Without this additional screening, these anomalies which were not associated with intra-cardiac anomalies would have been missed.
Vascular ring is an aortic arch anomaly. The trachea and esophagus are entrapped by the abnormal aortic arch vessels. Symptoms are breathing and swallowing difficulties. The severity of symptoms depends on the tightness of the ring. There are two major types of vascular ring:DAA and RAA with ALSA. It is common to have more severe symptoms in DAA than in RAA with ALSA. It is extremely difficult to diagnose in the postnatal period because of non-specific symptoms. On the other hand, in the fetal period it is easier to check for aortic arch anomaly by use of the 3VT view.
Therefore, it can be seen that great improvement in fetal heart screening is achieved by use of the 3VT view.

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