Ruptured mitral chordae tendineae may be a frequent and insignificant complication in the mitral valve prolapse syndrome.

In this study, we performed 512 echocardiographic studies on 264 consecutive unselected patients with the idiopathic mitral valve prolapse syndrome. Twenty-eight patients (10.6%) had evidence of ruptured chordae tendineae of the mitral valve on M-mode examination and in 24 the diagnosis was confirmed by two-dimensional echocardiography. Mild to severe mitral insufficiency was proven in all of them by left ventriculography during cardiac catheterization. Eight patients underwent surgery to relieve symptomatic severe mitral regurgitation. At operation all had myxomatous degeneration of the mitral valve, two patients were found to have rupture of anterior mitral chordae, and six had rupture of posterior mitral chordae. Twenty (71%) patients with chordal rupture had either mild symptoms or were completely asymptomatic. It is concluded that chordal rupture in patients with the mitral valve prolapse syndrome may be present in asymptomatic patients and go undetected clinically in a substantial number of patients unless a high index of suspicion is maintained. Serial M-mode and two-dimensional echocardiographic studies are of importance in identifying the progression of prolapse findings and may reveal the natural history of this pathologic condition in asymptomatic patients.

Left ventricular wall motion abnormalities in Kawasaki's disease.

Two-dimensional (2DE) and M-mode echocardiographic examinations were reviewed for 21 patients with Kawasaki's disease. Cardiac catheterization including coronary angiography was performed in 14 patients. 2DE detected regional myocardial contraction deficits in four patients later proven to have coronary disease. Coronary aneurysms were detected by echocardiography in two of four patients with proven coronary lesions. Although a minor pericardial effusion was detected in two patients and an increased left ventricular (LV) cavity dimension was found in one patient, M-mode function studies were not helpful for detection of cardiac involvement. ECG and chest x-ray examination were also noncontributory. We conclude that 2DE detection of LV wall contraction abnormalities may be a sensitive method for detecting cardiac contraction abnormalities may be a sensitive method for detecting cardiac involvement in Kawasaki's disease. 2DE may be better for assessing LV contraction than for imaging aneurysms in Kawasaki patients.

Two-dimensional echocardiography for evaluation of metastatic cardiac tumors in pediatric patients.

We have studied five patients with metastatic cancer in whom two-dimensional echocardiography (2DE) demonstrated cardiac or pericardial involvement. Echo studies may guide the clinician in instituting and/or modifying cardiac and cancer therapy in such patients.

Prediction of the severity of left ventricular outflow tract obstruction by quantitative two-dimensional echocardiographic Doppler studies.

In this study we explored the use of continuous wave Doppler echocardiography guided by simultaneous two-dimensional echocardiographic imaging as a method for noninvasively estimating pressure gradients in patients with discrete forms of left ventricular outflow tract obstruction. We studied 16 children, ages 6 months to 17 years, with valvular aortic stenosis (n = 12) or with discrete subaortic stenosis (n = 4) and compared maximal Doppler velocities in the aorta with pressure gradients obtained at cardiac catheterization. Examinations could be performed from the suprasternal notch view or from the apical left ventricular outflow tract view with equal accuracy for the study of flow in the left ventricular outflow tract, and results were comparable in both views. With a simplified Bernoulli relationship (gradient = 4 X [maximal velocity]2), results suggested that Doppler echocardiography could be used to predict the severity of obstruction in our patients with a correlation coefficient of r = .94 (SEE +/- 7.5 mm Hg) between Doppler-estimated gradients and gradients obtained at catheterization. The method appears promising for initial evaluation and for serial management of patients with discrete forms of left ventricular outflow tract obstruction.

Noninvasive prediction of transvalvular pressure gradient in patients with pulmonary stenosis by quantitative two-dimensional echocardiographic Doppler studies.

Recent studies suggest that maximal Doppler velocities measured within the jets that form downstream from stenotic valves can be used to predict aortic valve gradients. To test whether the Doppler method would be useful for evaluation and management of pediatric patients with right ventricular outflow obstruction, we evaluated pulmonary artery flow before catheterization in 16 children with pulmonary valve stenosis. We used a 3.5-MHz, quantitative, range-gated, two-dimensional, pulsed, echocardiographic Doppler scanner with fast Fourier transform spectral output and a 2.5-MHz phased array with pulsed or continuous-mode Doppler. Peak systolic pulmonary artery flow velocities in the jet were recorded distal to the domed pulmonary valve leaflets in short-axis parasternal echocardiographic views. The pulsed Doppler scanner, because of its limitations for resolving high velocities, could quantify only the mildest stenoses; but, especially with the continuous Doppler technique, a close correlation was found between maximal velocity recorded in the jet and transpulmonary gradients between 11 and 180 mm Hg. A simplified Bernoulli equation (transvalvular gradient = 4 x [maximal velocity]2) proposed by Hatle and Angelsen could be used to predict the gradients found at catheterization with a high degree of accuracy (r = 0.98, SEE = +/- 7 mm Hg). Our study shows that recording of maximal Doppler jet velocities appears to provide a reliable measure of the severity of valvular pulmonic stenosis.