novel method for quantification of left ventricular noncompaction using two-dimensional echocardiography in children

Although there are several echocardiographic criteria, there is not yet a general consensus about the diagnosis of left ventricular noncompaction. The current criteria are mostly based on the areas with maximal noncompaction in the heart The echocardiographer may miss this maximal point leading to a misdiagnosis. Accordingly, we suggested a new method to measure the percentage of myocardial noncompaction using two-dimensional echocardiography. In this study, the new method was examined on 4 noncompaction and 26 dilated cardiomyopathies, and 25 normal subjects. The percentage of noncompaction was measured at 3 levels [apical, papillary muscle and mitral valve] and averaged. The mean percentages of myocardial noncompaction were 3.59 +/- 2.27, 8.86 +/- 5.52 and 34.7 +/- 26.1 in the control, dilated cardiomyopathy and noncompaction groups, respectively. A value of 17% or greater could distinguish left ventricular noncompaction from dilated cardiomyopathy with 92% specificity and 100% sensitivity and from normal subjects with 100% specificity and sensitivity. This percentage had a statistically significant association with noncompacted to compacted myocardial thickness ratio [P<0.001]. This method showed good correlations with the existing echocardiographic and magnetic resonance criteria. However, it is not dependent on finding the area of maximal involvement Being comparable to magnetic resonance imaging in accuracy, it is easier to perform and more available

Right ventricular myocardial tissue velocities, myocardial performance index, and tricuspid annular plane systolic excursion in totally corrected tetralogy of Fallot patients

Longer survival after the total repair of the Tetralogy of Fallot increases the importance of late complications such as right ventricular dysfunction. This is a prospective study of the right ventricular function in totally corrected Tetralogy of Fallot patients versus healthy children. Thirty-two healthy children were prospectively compared with 30 totally corrected Tetralogy of Fallot patients. Right ventricular myocardial tissue velocities, right ventricular myocardial performance index, and tricuspid annular plane systolic excursion were investigated as well as the presence and severity of pulmonary regurgitation. The two groups were age-and sex-matched. Mean systolic peak velocity [Sa] and tricuspid annular plane systolic excursion were significantly decreased, while myocardial performance index and early to late diastolic velocity [Ea/Aa] were significantly increased in the Tetralogy of Fallot patients. Early diastolic velocity [Ea] showed no significant difference between the two groups. Sa correlated significantly with tricuspid annular plane systolic excursion in both the normal children and totally corrected Tetralogy of Fallot patients. Myocardial performance index was significantly higher in the patients with moderate to severe pulmonary regurgitation than in those with mild regurgitation. However, there was no significant correlation between this index and right ventricular myocardial tissue velocities. In this study, systolic right ventricular function indices [Sa and tricuspid annular plane systolic excursion] were impaired in the totally corrected Tetralogy of Fallot patients. Myocardial performance index was affected by the severity of pulmonary regurgitation

Assessment of left atrial ejection force in mildly asphyxiated newborns

Asphyxia-induced cardiac insult is one of the major causes of mortality and morbidity in the course of perinatal asphyxia. Nowadays, a remarkable trend of interest is sensed introducing a plausible modality for early detection of cardiac insults at the beginning stages of asphyxia. In this study we aimed to evaluate diagnostic utility of transmitral Doppler-derived parameters as well as left atrial ejection force index as a marker of left atrial contractile function in these patients. In a prospective study selected cases of 26 asphyxiated newborns with preserved systolic function underwent conventional transmitral Doppler flow echocardiographic assessment. Left atrial ejection force index was further calculated for all patients. Data was compared with normal ranges of healthy newborns in order to clarify the diagnostic utility of these parameters for determining minor cardiac insults in this age group. We found that mildly asphyxiated newborns showed an increase in the values of left atrial ejection force index [5.44 +/- 2.12 kilodyne vs. 6.66 +/- 2.17 kilodyne, P= 0.02] and left atrial filling fraction [39% +/- 10% vs. 45% +/- 8%, P= 0.01]. Furthermore, the acceleration and deceleration rate of early filling flow peak velocity were decreased in this group of asphyxiated newborns. Assessment of left atrial ejection force in mildly asphyxiated newborns reveals that newborns with even mild asphyxia, although could not be categorized in conventional grading system, suffer to some extent from a ventricular filling abnormality. This type of latent ventricular filling abnormality could simply be unmasked by calculation of atrial ejection force index

Transcatheter atrial septal defect closure under transthorasic echocardiography in children

Atrial septal defect [ASD] device closure is routinely done under the guide of transesophageal or intracardiac echocardiography which are expensive techniques and not easily affordable in developing countries. Using metallic devices, we attempted 32 ASD device closures under transthoracic echocardiography. Of those, 30 procedures were successful [94%]. In two patients with relatively large ASD we encountered difficulty in positioning the device. These patients were referred for surgical closure. ASD device closure can be carried out successfully in most patients under transthoracic echocardiography in situations where transesophageal or intravenous echocardiographies are not available or affordable

relationship between coronary artery aneurysm and QT interval dispersion in acute phase of Kawasaki disease

QT dispersion [QTd] has been proposed as a marker of ventricular repolarization inhomogeneity and several investigations have proved the relationship between it and cardiac ischemia, ventricular arrhythmia and sudden cardiac death. The aim of this study was to assess the relation between coronary artery involvement and QTd, and QTc dispersion [QTcd] in the acute phase of Kawasaki disease [KD]. We studied 65 patients with acute KD. Patients were divided into 3 groups. Group one consisted of 48 patients without coronary artery involvement. Group two comprised 13 patients with small to medium size aneurysm. In Group three there were 4 patients with giant aneurysm or multiple small to medium size aneurysms or thrombosis in coronary arteries. For each patient 12 lead ECG was obtained, and QT, QTc, QTd, QTcd, and RR interval were calculated. There were 40 males and 25 females with a mean age of 41.4 +/- 31.1 months. There was no significant difference in QT, QTc, RR measurements between 3 groups. QTd was greater in group 3 versus group 1 and 2, but the difference was not statistically significant [P=0.06]. QTcd was significantly greater in group 3 than in groups 1 and 2 [75.02 +/- 11.53 ms versus 46.82 +/- 15.39 ms and 48.88 +/- 10. 55 ms respectively [P = 0.04]]. The sensitivity of QTcd >/=60 ms to detect the patients with severe coronary arteries involvement was 100%, the specificity was 93.4%, positive predictive value was 50%, negative predictive value was 100%, and accuracy was 93.8%. QTcd can be used as a predictive factor for diagnosis of severe coronary arteries involvement in the acute phase of KD

Kawasaki disease in 159 Iranian children

Kawasaki disease [KD] is an intense life-threatening vasculitis. The diagnosis of Kawasaki disease is made by clinical criteria. This disease is a common rheomatologic disease in Iran. The aim of this stody was describe the demographics and clinical features of KD in Iranian patients. A review was conducted for all cases of KD treated at Pediatric rheumatology department in Children's Medical Center between January 1994 and July 2004. The diagnostic criteria for typical Kawasaki were based on the criteria of the Japan Kawasaki Disease Research Committee. Atypical or incomplete KD has been described in which patients not strictly meeting the diagnostic criteria but have coronary artery changes. Color doppler echocardiograms were done at the time of diagnosis, 14 to 21 days, 60 days, and 1 year after treatment. One hundred fifty nine patients were identified. One hundred twenty five children [78.6%] fulfilled criteria for typical KD. Echocardiographic abnormalities were found in 30 cases [18.9%], including 9.6% with typical and 46.1% with atypical Kawasaki. The incidence of atypical Kawasaki in our study was about 22%. Coronary arteries aneurysms found in 66.7% and 33.3% was other abnormalities. Male to female ratio was more in patients with cardiac complication [2.3:1]. Kawasaki disease should be considered in any infants or child [especially less than 2 years old] with a prolonged febrile illness. Demographic features of our patients were similar to reports from other country. The incidence of atypical Kawasaki in our study about 22%