Systolic intra-cavitary gradients following aortic valve replacement: an echo-Doppler study.

Systolic left ventricular flow was studied by pulsed and continuous wave Doppler in 41 patients following aortic valve replacement for severe stenosis (mean valvular area: 0.58 cm2; range 0.3-0.75 cm2). Maximal left ventricular velocities by continuous wave Doppler study, were higher than 2.5 m.s-1 with a sharp peak at end-systole in five patients in basal condition and in four others after amyl nitrite inhalation. Pulsed Doppler study showed that the high velocities started from the apex or mitral papillary muscle level with a marked chamber narrowing at two-dimensional echography. Only one patient had a systolic anterior motion (SAM) of the anterior mitral leaflet with mitral-septal contact. The left ventricular dimensions, as measured by M-mode echography were compared in the various patient groups. High velocities seemed statistically associated with the smaller systolic and diastolic diameters of the left ventricle and outflow tract and the larger relative thickness of the posterior wall. The highest pressure gradients disappeared after correction of hypovolaemia (one patient), clearance of pericardial effusion (one patient), or beta-blocker treatment (three patients). The present study confirms that left intra-ventricular dynamic gradients can occur after clearance of fixed outflow obstruction, for which Doppler examination is a reliable and innocuous diagnostic means. Haemodynamically, this syndrome resembles hypertrophic obstructive cardiomyopathy, but the scarcity of the systolic anterior motion of the mitral leaflets is suggestive of a different mechanism that could be cavity obliteration or mid-ventricular obstruction.

Benefits and limits of selective right ventricular cineangiography in arrhythmogenic right ventricular dysplasia.

Cineangiographic data from patients with probable arrhythmogenic right ventricular dysplasia (ARVD) were compared with those from matched controls. Some changes previously thought to indicate ARVD did not do so in this study. The abnormalities specific for ARVD were free wall morphological and wall motion abnormalities, particularly bulges and mamillated akinetic areas.

Critical analysis of cineangiographic criteria for diagnosis of arrhythmogenic right ventricular dysplasia.

Biplane 30-degree RAO and 60-degree LAO RV selective cineangiography was performed in 21 patients with significant ventricular arrhythmias (ventricular tachycardia in 14, salvos in three, and complex PVCs in seven) and a high presumption of arrhythmogenic RV dysplasia (ARVD), and in a control group of 10 presumed normal individuals. Comparing the two series revealed the lack of specificity of some angiographic images usually reported as suggestive signs of ARVD, such as slow dye evacuation of RV during the levophase and deep fissuring in the anterior wall with a "pile of plates" image. Inversely, localized morphologic and contraction abnormalities in the RV free wall were more sensitive and specific signs for diagnosis of ARVD; these were localized akinetic or dyskinetic bulges sometimes giving a true image of aneurysm (90%), wide and deep fissuring of the apex or of the inferior wall (33%), and large areas of akinesia. By order of frequency, these abnormalities were found on the apex in 71%, on the inferior wall in 52%, on the anterior wall in 48%, in the subtricuspid area in 38%, and on the pulmonary infundibulum in 33%. These localized lesions can suffice for the diagnosis of RV dysplasia in the absence of associated pathologies, such as ischemic heart disease or congenital defects. Usually a global RV systolic dysfunction is associated in ARVD, as confirmed by greater RV volumes (134 +/- 26 vs 79 +/- 10 ml/m2 for RVEDV, p less than 0.001; 76 +/- 34 vs 32 +/- 6 ml/m2 for RVESV, p less than 0.001), and lower RV ejection fraction (58 +/- 18% vs 47 +/- 8%, p less than 0.001) in the ARVD group compared to controls. Nevertheless, normal RV volumes and ejection fraction can be observed in some localized forms with mono- or bisegmental lesions in which RV systolic dysfunction is absent or moderate, and extensive forms with multiple segmental lesions where RV systolic dysfunction is constant and often severe. Six out of 21 patients in the ARVD group exhibited obvious global or segmental LV dysfunction, indicating the possibility of biventricular forms, as previously reported in other publications.