Myocardial Perfusion by Coronary Computed Tomography in the Evaluation of Myocardial Ischemia: Simultaneous Stress Protocol with SPECT / Perfusão Miocárdica por Angiotomografia de Coronárias na Avaliação da Isquemia Miocárdica: Protocolo de Estresse Simultâneo com SPECT

Abstract Background: Functional assessment to rule out myocardial ischemia using coronary computed tomography angiography (CCTA) is extremely important and data on the Brazilian population are still limited. Objective: To assess the diagnostic performance of myocardial perfusion by CCTA in the detection of severe obstructive coronary artery disease (CAD) compared with single-photon emission computerized tomography (SPECT). To analyze the importance of anatomical knowledge to understand the presence of myocardial perfusion defects on SPECT imaging that is not identified on computed tomography (CT) scan. Method: A total of 35 patients were evaluated by a simultaneous pharmacologic stress protocol. Fisher's exact test was used to compare proportions. The patients were grouped according to the presence or absence of significant CAD. The area under the ROC curve was used to identify the diagnostic performance of CCTA and SPECT in perfusion assessment. P < 0.05 values were considered statistically significant. Results: For detection of obstructive CAD, CT myocardial perfusion analysis yielded an area under the ROC curve of 0.84 [a 95% confidence interval (CI95%): 0.67-0.94, p < 0.001]. SPECT myocardial perfusion imaging, on the other hand, showed an AUC of 0.58 (95% CI 0.40 - 0.74, p < 0.001). In this study, false-positive results with SPECT are described. Conclusion: Myocardial perfusion analysis by CTA displays satisfactory results compared to SPECT in the detection of obstructive CAD. CCTA can rule out false-positive results of SPECT.

Resumo Fundamento: A avaliação funcional para descartar a isquemia miocárdica utilizando a angiotomografia computadorizada (angio-TC) de coronárias é de extrema importância e dados na população brasileira ainda são escassos. Objetivo: Avaliar o desempenho diagnóstico da perfusão miocárdica pela angio-TC de coronárias na detecção de doença arterial coronariana (DAC) obstrutiva significativa em comparação com a tomografia computadorizada por emissão de fóton único (SPECT; do inglês, single photon emission computerized tomography). Analisar a importância do conhecimento anatômico para entender a presença de defeito de perfusão miocárdica pela SPECT que não é identificado pela tomografia computadorizada (TC). Método: Trinta e cinco pacientes foram avaliados por um protocolo de estresse farmacológico simultâneo. O teste exato de Fisher foi utilizado para comparação entre as proporções. Os pacientes foram agrupados de acordo com a presença ou não de DAC significativa. A área sob a curva foi utilizada para identificar o desempenho diagnóstico da avaliação da perfusão pela angio-TC de coronárias e pela SPECT. Os valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Para detecção de DAC obstrutiva a avaliação da perfusão miocárdica pela TC teve uma área sob a curva de 0,84 [intervalo de confiança de 95% (IC95%): 0,67 a 0,94, p < 0,001]. Já o estudo da perfusão miocárdica pela SPECT foi de 0,58 (IC95%: 0,40 a 0,74, p < 0,001). Neste estudo, foram descritos falso-positivos pela SPECT. Conclusão: A avaliação da perfusão miocárdica pela angio-TC apresenta resultados satisfatórios em comparação com os da SPECT na detecção de DAC obstrutiva. A angio-TC de coronárias tem capacidade de afastar falso-positivos da SPECT.

Clinical value of multi-slice spiral CT angiography in the diagnosis of abdominal tumors / 中国基层医药

Objective To study the clinical value of multi－slice spiral CT angiography in the diagnosis of abdominal tumors. Methods From January 2015 to December 2017,90 patients with abdominal neoplasms in the First People＇s Hospital of Yongkang were divided into two groups according to double－blind randomized method,with 45 patients in each group. The patients with conventional CT scan were included in the control group,and the patients with multislice spiral CT angiography were selected as the observation group. The scan results,invasion range and location of abdominal tumor, vascular display and perfusion parameters were compared between the two groups. Results The diagnostic accuracy of abdominal tumor and invasion range in the observation group ( 93. 33% , 80. 00% ) was higher than those of the control group(χ2=5. 414,5. 086,all P＜0. 05). The proportions of abnormal thickening of one supply artery(27 cases) and two blood supply arteries(8 cases) in patients with malignant and borderline venereal lesions with normal diameter were higher than those of patients with benign lesions(χ2=31. 765, 8. 372,all P＜0. 05). The contrast medium through time,blood flow,blood volume and capillary surface permeability in patients with benign lesions and normal average diameter were (10. 55 ± 3. 02) s,(21. 54 ± 5. 58) mL·min－1· 100 g－1,(4.04 ±0.76) mL/100 g,(10.16 ±2.73)mL·min－1·100 g－1,respectively,which were lower than those of patients with malignant and border venereal focal lesions (t =3. 016,5. 005,4. 982,6. 989,all P ＜0. 05). Conclusion Application of multislice spiral CT angiography in the clinical diagnosis of abdominal tumors has high accuracy and can better display the abnormal condition of blood vessels.

Perfil de pacientes internados com diagnóstico de síndrome coronariana aguda / Profile of patients admitted to hospital with diagnosis of acute coronary syndrome

OBJETIVO: Descrever o perfil de pacientes internados com diagnóstico de síndrome coronariana aguda. MÉTODOS: Estudo analítico, observacional e transversal, com dados obtidos da análise dos prontuários de cem pacientes internados em um hospital, de fevereiro de 2014 a janeiro de 2015, os quais tiveram diagnóstico de síndrome coronariana aguda e foram regulados para a realização da cineangiocoronariografia. Foi traçado o perfil epidemiológico e fisiopatológico desta população. RESULTADOS: Em nossa amostra, 49 (55,7%) pacientes eram do sexo masculino, com média de idade de 63,88±13,3 anos, sendo 60,2% acima de 60 anos. O quadro clínico mais prevalente foi angina instável (41%). Constatou-se maior prevalência de portadores de hipertensão arterial (88,7%), além de associação positiva entre os pacientes com idade avançada e doença multiarterial. Também foi encontrada obstrução coronariana significativa em cerca de 90% dos pacientes diabéticos. Cineangiocoronariografia sem lesão significativa foi duas vezes mais identificada, em comparação com dados da American College of Cardiology. CONCLUSÃO: Fatores de risco modificáveis devem ser controlados, visando à redução do número de casos de doenças cardiovasculares agudas e daqueles com desfechos desfavoráveis. Sugere-se que a divulgação dos sintomas de infarto seja ampliada, para que os pacientes cheguem à emergência em tempo hábil de receber o tratamento.(AU)

OBJECTIVE: To describe the profile of patients admitted to Hospital with a diagnosis of acute coronary syndrome METHODS: This is an analytical, observational and crosssectional study with data obtained from the analyses of the medical records of 100 patients admitted to a hospital from February/2014 to January / 2015), who were diagnosed with acute coronary syndrome, and were regulated for undergoing coronary angiography. The epidemiological and pathophysiological profile of this population was described. RESULTS: In our sample, there were 49 (55.7 %) male patients with a mean age of 63.88±13.3 years, with 60.2 % being over 60 years. The most prevalent clinical condition was unstable angina (41%). A higher prevalence of patients with hypertension (88.7 %) was found, as well as a positive association of patients with advanced age and multivessel disease. We also find significant coronary obstruction in about 90 % of diabetic patients. Coronary angiographywith no significant lesion was twice as identified if compared with the American College of Cardiology data. CONCLUSION: The modifiable risk factors should be monitored, in order to reduce the number of cases of acute cardiovascular disease and those with unfavorable outcomes. The dissemination of information about infarction should be enhanced for the patients to search for emergent care in a timely manner.(AU)

Syntax Score and Major Adverse Cardiac Events in Patients with Suspected Coronary Artery Disease: Results from a Cohort Study in a University-Affiliated Hospital in Southern Brazil / Syntax Escore e Eventos Cardíacos Adversos Maiores em Pacientes com Suspeita de Doença Arterial Coronariana: Resultados de um Estudo de Coorte em Hospital Universitário no Sul do Brasil

Abstract Background: The importance of coronary anatomy in predicting cardiovascular events is well known. The use of traditional anatomical scores in routine angiography, however, has not been incorporated to clinical practice. SYNTAX score (SXscore) is a scoring system that estimates the anatomical extent of coronary artery disease (CAD). Its ability to predict outcomes based on a baseline diagnostic angiography has not been tested to date. Objective: To evaluate the performance of the SXscore in predicting major adverse cardiac events (MACE) in patients referred for diagnostic angiography. Methods: Prospective cohort of 895 patients with suspected CAD referred for elective diagnostic coronary angiography from 2008 to 2011, at a university-affiliated hospital in Brazil. They had their SXscores calculated and were stratified in three categories: no significant CAD (n = 495), SXscoreLOW-INTERMEDIATE: < 23 (n = 346), and SXscoreHIGH: ≥ 23 (n = 54). Primary outcome was a composite of cardiac death, myocardial infarction, and late revascularization. Secondary endpoints were the components of MACE and death from any cause. Results: On average, patients were followed up for 1.8 ± 1.4 years. The primary outcome occurred in 2.2%, 15.3%, and 20.4% in groups with no significant CAD, SXscoreLOW-INTERMEDIATE, and SXscoreHIGH, respectively (p < 0.001). All-cause death was significantly higher in the SXscoreHIGH compared with the 'no significant CAD' group, 16.7% and 3.8% (p < 0.001), respectively. After adjustment for confounding factors, all outcomes remained associated with the SXscore. Conclusions: SXscore independently predicts MACE in patients submitted to diagnostic coronary angiography. Its routine use in this setting could identify patients with worse prognosis.

Resumo Fundamento: A importância da anatomia coronariana na predição de eventos cardiovasculares é bem conhecida. O uso de escores anatômicos tradicionais na cineangiocoronariografia de rotina, entretanto, não foi incorporado à prática clínica. O SYNTAX escore (SXescore) é um sistema de escore que estima a extensão anatômica da doença arterial coronariana (DAC). Sua capacidade para predizer desfechos com base na cineangiocoronariografia diagnóstica de base ainda não foi testada. Objetivo: Avaliar o desempenho do SXescore para predizer eventos cardíacos adversos maiores (MACE) em pacientes encaminhados para cineangiocoronariografia diagnóstica. Métodos: Coorte prospectiva de 895 pacientes com suspeita de DAC encaminhados para cineangiocoronariografia diagnóstica eletiva de 2008 a 2011, em hospital universitário no Brasil. Os pacientes tiveram seus SXescores calculados e foram estratificados em três categorias: 'sem DAC significativa' (n = 495); SXescoreBAIXO-INTERMEDIÁRIO: < 23 (n = 346); e SXescoreALTO: ≥ 23 (n = 54). O desfecho primário foi composto de morte cardíaca, infarto do miocárdio e revascularização tardia. Os desfechos secundários foram MACE e morte por todas as causas. Resultados: Em média, os pacientes foram acompanhados por 1,8 ± 1,4 anos. Desfecho primário ocorreu em 2,2%, 15,3% e 20,4% nos grupos 'sem DAC significativa', SXescoreBAIXO-INTERMEDIÁRIO e SXescoreALTO, respectivamente (p < 0,001). Morte por todas as causas foi significativamente mais frequente no grupo de SXescoreALTO comparado ao grupo 'sem DAC significativa', 16,7% e 3,8% (p < 0,001), respectivamente. Após ajuste para fatores de confusão, todos os desfechos permaneceram associados com o SXescore. Conclusão: O SXescore prediz independentemente MACE em pacientes submetidos a cineangiocoronariografia diagnóstica. Seu uso rotineiro nesse contexto poderia identificar pacientes de pior prognóstico.

Radiation Exposure in Coronary Angiography: A Comparison of Cineangiography and Fluorography

BACKGROUND AND OBJECTIVES: Coronary angiography (CAG) is the gold standard for diagnosing coronary artery disease. However, exposure to ionizing radiation delivered during CAG has various negative biological effects on humans. In this study, there was an evaluation of whether fluorography resulted in decreased radiation exposure, as compared with cineangiography. SUBJECTS AND METHODS: Fifty-five patients were prospectively enrolled and divided into two CAG groups, in accordance with the operator's professional discretion: a conventional cineangiography group versus a fluorography group. Fluorography refers to the photography of fluoroscopic images that are retrospectively stored, e.g., using the "Store fluoro" function of the Siemens cardiac angiography system. The primary outcomes included the air kinetic energy released per unit mass {air kerma (AK) mGy} and the dose (kerma)-area product (DAP; microGy . m2), both measured using built-in software in the Siemens system. The secondary outcomes included the total procedure time and amount of contrast agent used with each CAG method. RESULTS: The total AK and DAP were significantly lower in the fluorography group (159.3+/-64.9 mGy and 1337.9+/-629.6 microGy . m2, respectively) than in the cineangiography group (326.9+/-107.5 mGy and 2341.1+/-849.9 microGy . m2, respectively; p=0.000 for both). The total procedure time (cineangiography vs. fluorography, 12.8+/-4.7 vs. 12.5+/-2.9 min; p=0.779) and contrast agent amount (136.1+/-28.3 vs. 126.3+/-25.7, p=0.214) were comparable between the two groups. CONCLUSION: Fluorography is a useful method to decrease the radiation exposure in selected patients requiring CAG.

Oclusão da artéria central da retina secundária a cineangiocoronariografia via artéria braquial: relato de caso / Central retinal artery occlusion secondary to brachial cineangiocoronography: case report

Os autores relatam o caso de um paciente com insuficiência coronariana que desenvolveu quadro de oclusão de artéria central da retina após ser submetido a cateterização cardíaca por via braquial e realização de cineangiocoronariografia. Este procedimento pode desencadear fenômenos embólicos oculares consistentes com o quadro descrito.

The authors report a case of a patient with coronary insufficiency who developed central retinal artery occlusion following cardiac catheterism through the brachial artery and cineangiocoronography. This procedure can lead to embolic phenomena like that which was reported.

An Analysis on Size-limitation of Swine Myocardial Infarction with A Reference to Effects of Saiko-ka-ryukotsu-borei-to / 日本東洋医学雑誌

We studied the effect of Kampo for the size-limitation of myocardial infarct with morphometrical analysis, utilizing total of 19 male swine. A hand made metal-coil (2×1mm) was inserted in the left anterior descending coronary artery (LAD) of swine with catheterization, in order to induce acute myocardial infarction (AMI). After occurrence of AMI, the swine were divided into two groups, experimental group: Saiko-ka-ryukotsu-borei-to (n=10) and control (n=9). This Kampo formula (0.66/kg/day) was administered via stomach tubes for 4 weeks. The control group received basal rations alone. After serial cross sections of heart, total infarct areas were weighed.<br>An infarct weight to heart weight of the experimental group (2.9±1.6%, n=10) was significantly decreased than that of the control group (8.2±4.8%, n=9). The infarct weight to left ventricular weight of the experimental group (4.9±2.6%) was significantly decreased than that of the control group (13.4±8.0%). Thus the infarct size of the experimental group was significantly smaller than that of the control. The histological character of the infarct in the control was numerous inflammatory cell infiltration and foci of fresh coagulate necrosis in the border zone, while the infarct of the experimental group was apparent in the border zone with marked fibrosis and few inflammatory cells. Angiogenesis in both the infarct and border zone was marked in the experimental group than in the control. We summarize that this Kampo formula inhibits size development of AMI in animal model.

Coronary Artery Calcification Its Incidence and Significance in Patients Detected by Cineangiography

BACKGROUND: The clacification of the wall and narrowing of the lumen of the coronary artery is closely related to the process of atherosclerosis and its severity. Thus, the present study of calcified coronary artery lesions by analysis of cineangiography is attempt to define the incidence and factors to affect the coronary artery calcification. METHODS: Our report concerns a consecutive series of 513 patients who underwent coronary angiography between January 1, 1991 and September 30, 1993. We determined the relationship between the coronary artery calcification and sex, age, risk factors, serum calcium, BUN, creatinine, lesional lumen stenosis and severity of coronary artery disease. RESULTS: Among patients with significant coronary artery disease, 22%(62/282 cases) had the coronary artery calcification by cineangiography. Patients with calcification were older(62+/-8 years) than those without calcification(56+/-10 years)(p=0.0001). The distribution of calcified coronary artery was 35 lesions in LAD, 17 in LCX, 16 in RCA and 4 in LM. The calcification rate was 38%(40/104 cases) for patients with multi-vessel disease, compared to 12%(22/178 case) for those with single vessel disease(p=0.0001). Patients with calcification significantly had the long lesion(22.4+/-13.4mm), compared to those without calcification(18.0+/-11.3mm)(=0.012). Coronary artery calcification was correlated with smoking habits. CONCLUSION: Coronary artery calcification was seen in 22 percent and strongly correlated with age, smoking habits, the severity of disease and length of lesion.

Cateterismo cardíaco ambulatorial: análise da experiência acumulada em 10 meses / Outpatient Cardiac Catheterization. Analysis of a 10 Month Experience

Objetivo - Identificar pacientes que se prestem à estratégia do cateterismo cardíaco ambulatorial, com base nos aspectos sociais, riscos e complicações, por um período de 24 h. Métodos - Dos 2.126 casos submetidos a ca-teterismo cardíaco, no Instituto Dante Pazzanese de Cardiologia, no período de setembro de 1990 a junho de 1991, excluíramse: a) aqueles com idade superior a 75 anos; b) os com síndromes isquêmicas agudas; c) os com descompensação cardíaca classe IV (NYHA); d) os estudados pela técnica femoral com sistemas introdutores de alto perfil; e) os submetidos à anestesia geral, estudos eletrofisiológicos ou biópsias endomiocárdicas. Após a realização do exame, seguia-se período de observação de 3 h e, na ausência de complicacões, os pacientes re-cebiam alta com orientação de retorno obrigatório no dia seguinte, para reavaliação clínica. As eventuais complicacões deste período foram anotadas. Resultados - Dos 719pacientes elegíveis, 68% eram do sexo masculino, e a idade média era de 55,3 anos. Sessenta e um por cento estavam em classefuncional I da NYHA e a maioria (80,8%) foi estudada pela via braquial. Em 83% dos casos realizou-se a coronariografia, dos quais, 52%exibiam aterosclerose coronária. Quatrocentos e quatorze casos não receberam alta, pela seguintes razões: 217 por término do exame após as 18 h, 111 por razões sócio-econômicas, 23 por recusa do médico assistente, 8 devido à lesão do tronco da coronária esquerda e 55 por complicacões diversas. Todos os 305 pacientes que receberam alta ambulatorial não mostraram qualquer complicação na avaliação clínica do dia seguinte. Conclusão - O cateterismo ambulatorial demonstrou ser seguro em pacientes selecionados, viabilizando grande número de exames, com relativa economia de leitos e outros recursos hospitalares

Purpose - To identify patients suitable for out-patient cardiac catheterization strategy, based on social aspects, risks and complications, for a 24 hour period. Methods - In a series of 2.126 cases submitted to cardiac catheterization at the Instituto Dante Pazzanese de Cardiologia, between September 1990 and June 1991, were excluded: a) those over 75 years of age; b) the acute ischemic syndroms; c) those in NYHA functional class IV; d) patients who used 7 or 8 French femoral angiographtc catheters; e) patients who had undergone general anesthesia, electrophysiological study or endomyocardial biopsy. After the procedure, the patients were observed for a 3 hour period and in the absence of any complication, they were discharged from the hospital, returning the next day for clinical evaluation. If any complication occurred it was registered. Results - In a cohort of 719 eligible patients, 68% were male, with a mean age of 55,3 years. Sixty one per cent were in NYHA functional class I and most of them (80,8%) were studied by the brachial approach. Eigthy-three per cent of the patients were submitted to coronary angiography, with 52% of them having coronary artery disease. Four hundred and fourteen patients were not discharged on the same day: 217 did not have their procedures finish after 6p.m., 111forsocial-economical reasons, 23 because of theirphysician's refuse, 8 because of left main coronary disease, 55 because of any kind of complication. All the 305 patients who were discharged on the same day, did not have shown any complication in the next day evaluation. Conclusion - Outpatient cardiac catheterization is a safe technique in selected patients, making possible the accomplishment of a greater number of procedures improving bed utilization and decreasing hospitalar costs

A clinical study on cardiovascular disease of children taken cardiac catheterization and cineangiography

No abstract available.

Complicaçöes atuais do cateterismo cardíaco: análise de 1000 pacientes / Current complications of heart catheterization: analysis of 1000 cases

Avaliar o imnpacto das novas técnicas de cateterismo cardíaco sobre a incidência de complicaçöes. Mil pacientes consecutivos submetidos a cateterismo cardíaco no período de agosto a dezembro de 1989 (739 cateterismos diagnósticos e 261 terapêuticos) acompanhados até a alta hospitalar. As complicaçöes foram classificadas segundo o tipo e a gravidade e correlacionadas à técnica do procedimento e à fraçäo de ejeçäo do ventrículo esquerdo (FEVE). Em 77,7% dos pacientes näo houve complicaçöes. Nos restantes (22,3%) as complicaçöes foramÑ leves (11,2%), moderadas (7,3%) e severas (3,8%). Entre as últimas, ocorreram ,5% de intercorrências vasculares graves, 0,1% de perfuraçäo cardíaca necessitando de cirurgia de emergência, 1,4% de arritmias severas, 0,4% de infarto agudo do miocárdio, 0,3% de edema agudo de pulmäo e 0,5% de mortalidade. Os estudos hemodinâmicos permanecem com índice relativamente baixo de complicaçöes, apesar do crescente número de procedimentos intervencionistas e da maior gravidade dos pacientes estudados

Hemodynamics and Left Ventricular Cineangiographic Findings in Idiopathic Dilated Cardiomyopathy

The authors analyzed data from 15 patients with idiopathic dilated cardiomyopathy to evaluate the hemodynamic changes and left ventricular cineangiogram as compared with normal control. Mean right atrial pressure, right ventricular systolic pressure, mean pulmonary artery pressure and mean pulmonary wedge pressure were signigicantly elevated in patients with dilated cardiomyopathy. Left ventricular enddiastolic volume was increased in idiopathic dilated cardiomyopathy(139.9+/-58.73 ml/m2). Cardiac index, left ventricular ejection fraction and circumferential fiber shortening were significantly reduced in patients with dilated cardiomyopathy as compared with normal control(p<0.001). Hypokinetic, diffuse wall motion abnormalities of left ventricle were common in idiopathic dilated cardiomyopathy. A few cases of akinetic or dyskinetic segmental wall motion abnormalities were present. Left ventricular configurations in patients with idiopathic dilated cardiomyopathy were globe shape(53.4%) as compared with pear core shape(90%) of normal control. Associated mitral regurgitations in patients with idiopathic dilated cardiomyopathy confirmed by left ventricular cineangiogram were 53.3 percent. Mild to moderate mitral regurgitations were often present(46.6%).

GROWTH OF THE VETRICULAR VOLUMES AND THE CHANGES OF INDICES OF CARDIAC PERFORMANCE / 体力科学

The purpose of this clinical investigation is to analyse the growth of the ventricular volumes and the changes of indices of cardiac performance during infancy and childhood. The materials were composed of 129 healthy infants and children (4 months to 13 years of age), who had a history of Kawasaki disease and without any evidence of coronary artery lesion. All the cases underwent cardiac catheterization and cineangiography under sedation. Volumes of the left and right ventricles were calculated by integration methods in tow frames for end-diastole and end-systole from biplane cineangiograms. Left ventricular mass was calculated in 120 infants and children by Rackley's method.<BR>All the volumes and masses were deviled by body surface area in order to normalize the crude values for infants and children of different size. The mean values of left ventricular end-diastolic volume index (LVEDVI), right ventricular end-diastolic volume index (RVEDVI) and stroke index (SI) for each age were less in the younger children than those in the older children, and abrupt stepwise increase was observed at 1 year, 6 years and 10-11 years of age in the values of LVEDVI, RVEDVI and SI.<BR>The infants and chidren were divided into four groups according to age (under 1 year, 1 to 5 years, 6 to 10 years and more than 11 years) . The values of LVEDVI, RVEDVI, SI and LVmass index were less in the younger age groups than those in the older age groups, and the difference of each age groups was statistically significant. The value of left ventricular ejection fraction (LVEF) was less in the youngest group (under 1 year) than those in the another groups (p<0.01) . The value for right ventricular ejection fraction (RVEF) was not significantly different in the age groups. End-systolic pressure-volume ratio was normalized with left ventricular mass (LVESP/ (LVESV/LVmass) ) . This normalized ratio was the lowest in the youngest group (under 1 year) and the highest in the oldest group (more than 11 years) .<BR>As mentioned before, abrupt stepwise increase was observed in the“normal”values of LVEDVI, RVEDVI and SI in infancts and children. The explanation of this fact may be difficult at present. By the evidence of the normalized end-systolic pressure-volume ratio, it can be said that the contractility of the left ventricle in“healthy”infants and children was increased according to age. The reason why the value of LVEF was less in the youngest group than those in the another groups can be attributed to the lower contrac-tility in the youngest group. A possible factor that the value of RVEF was not significantly different between the youngest group and the another groups is; because the right ventricle works under higher pressure during fetal and neonatal period, then the right ventricular performance developed already in infancy.