Left atrial and left atrial appendage function in paroxysmal atrial fibrillation.

PURPOSE: In patients with paroxysmal atrial fibrillation (PAF) little information is available about left atrial (LA)function, and there is less information about LA appendage (LAA) function, and about their relations. METHODS AND RESULTS: 46 patients were selected for catheter ablation (CA) because of nonvalvular PAF.Transthoracic, tissue Doppler and transoesophageal echocardiography was performed before CA. LA volumes and volume index (LAVI) were calculated. LA function was assessed by LA filling fraction (LAFF), LA emptying fraction (LAEF), systolic fraction of pulmonary venous flow (PVSF) and late diastolic velocities of mitral annulus(Aa,, A5at) LAA function was assessed by peak LAA emptying flow velocity (PLAAEFV). Diastolic dysfunction(DD) was also assessed. Dilated LAVI in 32, LA dysfunction in 20, DD with elevated LV filling pressure in 19 patients was found. Aa,at and Aa,p correlated with LAFF (r:0.53; p<0.001 and r:0.43; p<0.05), LAEF (r:0.51;p<0.001 and r:0.63; p<0.001), PVSF (r:0.49; p<0.001 and r:0.46; p<0.005) and PLAAEFV (r:0.58; p<0.001 and r:0.45; p<0.01). CONCLUSIONS: In PAF patients Aa velocity is useful to assess LA function and correlates positively with other TTE derived LA functional parameters and LAA function by TEE derived PLAAEFV.

Echocardiographic evaluation of patients with undocumented arrhythmias occurring in adults late after repair of tetralogy of Fallot.

AIMS: Arrhythmias occurring late after repair of tetralogy of Fallot (ToF) are common. Due to the risk of sudden cardiac death, attention is focused towards ventricular tachycardias (VT). The aims of this study were to determine the clinical profile of patients with known benign and malignant arrhythmias and to assess patients with palpitations without documented arrhythmias. METHODS AND RESULTS: Fifty-two patients with prior ToF repair were included in this study (mean follow-up: 18+/-7.3 years). Echocardiographic measurements such as left ventricular ejection fraction, left and right atrial (LA and RA) diameters, left and right ventricular diameters (LVEDD and RVEDD), pulmonary and tricuspid regurgitation (TI and PI) and electrocardiographic parameters such as QRS duration, P-wave duration, P-wave dispersion were obtained and compared in patients with and without a history of palpitations. The same comparisons were performed between patients with documented supraventricular tachycardias (SVT) and VT. Twenty-seven of 52 patients had a clinical history of palpitations. The remaining 25 patients served as controls. Eleven patients had documented SVT and 6 patients had documented VT. In patients with documented SVT, the RA size and the QRS durations were significantly higher than in the controls (RA: 55.3+/-5.6 vs. 47.4+/-4.8 mm, P=0.03, QRS: 160.0+/-25.9 vs. 131.8+/-26.1 ms, P=0.01). In patients with VT, the LVEDD, LA, and QRS durations showed significantly higher values compared with the control patients (LVEDD: 53.5+/-4.7 vs. 45.6+/-6.8 mm; LA: 56.0+/-3.4 vs. 48.5+/-4.8 mm, P=0.01; QRS: 169.5+/-29.7 ms vs. 131.8+/-26.1 ms; P=0.001). The only significant differences between patients with and without palpitations were the RA size (58.2+/-3.9 vs. 50.5+/-5.2 mm, P=0.02) and the P-wave dispersion (26.8+/-15.2 vs. 16.6+/-4.3 ms, P=0.04). CONCLUSION: Our present data suggest that undocumented arrhythmias are most likely SVTs and are associated with increased RA size.

[Evaluation of myocardial perfusion using intravenous contrast echocardiography]. / Myocardialis perfúzió értékelése intravénás kontraszt-echokardiográfia segítségével.

The aim of the study was to assess the accuracy of rest myocardial contrast echocardiography (MCE) in detecting perfusion abnormalities after intravenous contrast administration in chronic coronary artery disease. In 21 patients (mean age 49 years) contrast agent was injected intravenously. ATL HDI 5000 ultrasound machine was used. Triggering every fifth cardiac cycle in end-systole apical 2-chamber, 3-chamber and 4-chamber views were used. All patients underwent thallium scintigraphy on the same day and coronary angiography was performed within 24 hours. Second harmonic imaging and power Doppler were used in assessing presence or absence of perfusion, localization and extent of perfusion defects, and their relation with wall motion. In the first group all the 13 patients after myocardial infarction had akinetic segments on echocardiography in accordance with the coronary occlusion detected by coronary angiography. In the second group none of the 8 patients without previous myocardial infarction had wall motion abnormality. Group I: dividing the left ventricle into 16 segments out of 208 segments 44 were akinetic. Perfusion defect was detected by MCE in 29 segments. In 12 segments with wall motion abnormality the normal myocardial perfusion was consistent with viable myocardium, 2 inferior akinetic segments could not be evaluated due to contrast attenuation and in one inferior segment MCE in contrast to the thallium scintigraphy showed no perfusion defect. Group II: good contrast effect was detected in all 128 segments except one inferior segment in which there was a fixed perfusion defect also by thallium scintigraphy and coronary angiography revealed occluded right coronary artery. In conclusion MCE and second harmonic triggered imaging is comparable with thallium scintigraphy in detecting fixed perfusion abnormalities. MCE may contribute to the detection of viable myocardium.

[Comparative study of the analgesic effect of Apranax and Cataflam after oral surgical procedures]. / Az Apranax és a Cataflam fájdalomcsillapító hatásának összehasonlító vizsgálata szájsebészeti beavatkozást követóen.

After oral- and maxillo-facial surgical interventions both Apranax and Cataflam proved to be satisfying against pain. Though there is no difference in the kinetics of the effect, we found Apranax more effective to relieve postoperative pain. Besides the fast elimination of pain the medicine significantly mitigate the symptoms of inflammation.

Characterization of normal leakage flow of monostrut tilting disk prosthetic mitral valves by multiplane transesophageal echocardiography.

To assess normal prosthetic mitral valve function, multiplane transesophageal Doppler echocardiographic studies were performed on 22 patients with Monostrut tilting disk valves. Mean follow-up after implantation was 63 +/- 12 months. Two holosystolic red low-velocity regurgitant jets were detected in all but one case. The length of these jets ranged from 0.8 to 6.9 cm and the area ranged from 0.5 to 10.1 cm2 in various planes. The origin of the jets was inside the rings of the prosthetic valves and started with a mosaic spot of 2 mm maximum diameter. In this mosaic spot, jet velocity by the high pulse-repetition frequency mode measured greater than 4 m/sec. Thin, high-velocity regurgitant jets originating outside the sewing ring were present in three cases. In one case we found a high-velocity turbulent jet originating outside the ring corresponding to a paravalvular regurgitation of moderate degree. The low-velocity jets were obscured in the patient with moderate paravalvular leak but not in patients with trivial paravalvular leaks.

[Changes in the left ventricular diastolic function in acute myocardial infarction]. / A bal kamra diastolés functiójának változása acut myocardialis infarctusban.

Changes of left ventricular systolic function in acute myocardial infarction are well known. However, diastolic function may also have a role for patients' symptoms and prognosis. The purpose of this study was to evaluate changes of diastolic function non-invazively and to delineate the relation between systolic and diastolic function. 52 patients with acute myocardial infarction were examined by Doppler echocardiography within the first 48 hours and one week later. Systolic function was defined by left ventricular outflow velocity measurements, diastolic function was characterized by mitral inflow parameters and patterns. Four types of mitral inflow were determined: normal pattern, patterns suggesting prolonged relaxation, pattern suggesting elevated filling pressure and "normalized" pattern. In the last situation the influence of prolonged relaxation and elevated filling pressure equalized each others effect producing a "normalized" inflow pattern. Diastolic function improved in 18 cases and impaired in 9 pts, systolic function improved only in 11 cases and decreased in 28 pts by the time of the second examination. Worsening of diastolic function was always accompanied by worsening of systolic function. Despite improving diastolic function, worsening in systolic function could be observed in 8 cases. Monitoring of patients with acute myocardial infarction by Doppler echocardiography offers a possibility to select high risk patients with worsening left ventricular function for further closer follow-up.

[Intraoperative evaluation of the function of the saphenous vein as coronary graft, visualized by myocardial contrast echocardiography]. / Vena saphena koronária graft ellátási területének mérése miokardiális kontraszt echokardiográfia segítségével mütét alatt.

UNLABELLED: The assessment of area at risk of saphenous vein graft occlusion is an unsolved problem. We studied myocardial perfusion with contrast echocardiography in 13 patients undergoing coronary surgery. The left ventricle was imaged in the transgastric short axis view at midpapillary muscle level. The myocardial distribution area of 21 saphenous vein grafts was measured by injecting 0.2-0.5 cc of sonicated 5% albumin microspheres directly in the graft, early after weaning from cardiopulmonary bypass. Percent left ventricular area opacification was calculated for each graft injection: right coronary (N = 8) 21 +/- 7%, marginal branch (N = 10) 17 +/- 5%, left anterior descending and diagonal branch (N = 3) 41 +/- 4%. Myocardial systolic wall thickening was not effected by contrast injection (preinjection 45 +/- 12% vs postinjection 46 +/- 7%, p = NS). No local or systemic side effects were encountered. IN CONCLUSION: myocardial contrast echocardiography is a safe and useful method to measure the area at risk for saphenous vein graft occlusion.

[Clinical use of biplane transesophageal echocardiography]. / A biplan transoesophagealis echocardiographia klinikai alkalmazása.

The clinical value of biplane transesophageal echocardiography (TEE) was assessed on basis of the experience of the first 100 cases. All studies were performed in awake patients, there was no complication or failure. There wee 43 males and 57 females, aged between 13 and 82 years. The indication of TEE was infective endocarditis in 33, congenital heart disease in 25, suspected tumor or thrombus in 18, search for source of embolism in 9, thoracic aortic pathology in 9, prosthetic valve dysfunction in 3 and other problems in 3 cases. Biplane technique provided additional information as compared to single plane TEE in the diagnosis of infective endocarditis (by the visualization of small vegetations and of mitral valve fenestration, and by the differentiation of mitral vegetation from prolapse or aneurysm), in the identification of source of embolism (by easier visualization of patent foramen ovale and of the left atrial appendage thrombus), in the imaging of ascending aorta, of right ventricular outflow tract and of the left ventricular endocardium. Biplane technique enhanced therapeutic decision making particularly in the indications of anticoagulant treatment and in planning certain cardiac operations. Biplane TEE is an easily acquired technique and it will replace single plane TEE in a number of indications.

[The role of transesophageal echocardiography in atrial septal defect detected in adults]. / A transoesophagealis módszerrel kiegészített echocardiographia szerepe a felnöttkorban észlelt pitvari septum defectus diagnosztikájában.

UNLABELLED: To assess the value of combined transesophageal echocardiography (TE) and transthoracic echocardiography (TTE) in the preoperative evaluation of atrial septal defect (ASD) 59 consecutive patients (aged 15-62, mean 38 yrs) with clinically or echocardiographically suspected ASD underwent TE and complete noninvasive hemodynamic study by TTE. ASD was found by TE in 48: fossa ovalis (FO) type in 36, sinus venosus (SV) type in 11 and primum type in 1. For FO and SV defect the sensitivity of clinical judgement was 83 and 0%, the specificity 39 and 100% resp., the sensitivity of TTE was 78 and 9%, the specificity 78 and 100%. The most frequently associated anomaly by TE was mitral valve prolapse (25%). SV defect was always associated with anomalous right upper pulmonary venous drainage, and left superior vena cava was found in 27% of SV defects. There was significant correlation between Qp/Qs measured by TTE and by catheterization (r = 0.64), but the Qp/Qs was not related to defect size. An excellent correlation was found between pulmonary artery systolic pressure measured by CW Doppler and catheterization (r = 0.98). IN CONCLUSION: 1) TTE combined with TE is reliable in the preoperative assessment of ASD in adults, 2) TE is not necessary if there are unequivocal clinical and TTE signs of an FO defect with significant left-to-right shunt, 3) TE is indicated in patients with signs of right ventricular overload or pulmonary hypertension if an ASD cannot be ruled out by TTE, 4) catheterization is necessary if all 4 pulmonary veins cannot be visualized by TE.

[Clinical use of transesophageal echocardiography]. / A transoesophagealis echocardiographia klinikai alkalmazása.

Transoesophageal echocardiography (TE) presents a new window in echocardiography. Experience obtained in the first 70 TE studies performed in 66 patients is reported. The patients' age ranged between 15 and 75 years, there were 36 females and 30 males. Sixty studies were done in awake patients and 10 studies in anesthetized or intubated patients. TE indications included suspected mitral prosthetic valve dysfunction: 20, tumor or thrombus: 11, search for source of embolism: 10, infective endocarditis: 5, congenital heart disease: 8, intraoperative decision-making: 7, acute postoperative hypotension: 3, suspected aortic dissection: 3 and others. There was no unsuccessful intubation or complication. The most important results: the differentiation of left atrial tumor and thrombus by the presence or absence of spontaneous echocontrast, the role of TE in the intraoperative and early postoperative decision making and the diagnosis in rare clinical situations (multiplex myxoma; tricuspid prosthetic valvular regurgitation caused by pacemaker electrode dislocation). It is concluded that TE is a unique diagnostic technique which provides invaluable clinical informations and facilitates therapeutic decision making. It is a safe procedure both in awake and anesthetized patients therefore in certain indications it should supplement standard echocardiographic technique in routine clinical practice.

[Diagnosis of femoral pseudoaneurysm using 2-dimensional and Doppler echography]. / A femoralis álaneurysma diagnózisa 2-dimenziós és Doppler echographiával.

Femoral artery pseudoaneurysm was found by combined 2D, pulsed and continuous wave Doppler echography in 10 out of 16 patients with hematoma formation following cardiac catheterization. The typical features included an echofree area communicating with the femoral artery through a narrow neck. There was a low velocity systolic flow in the pseudoaneurysm and a high velocity systolic and reverse diastolic flow in the neck.

[Measurement of aortic flow indices by Doppler echocardiography for the determination of systolic function in infants and children]. / Aorta áramlás indexek mérése Doppler echocardiographiával csecsemökben és gyermekekben a systolés functio megítélésére.

Aortic blood flow velocity indexes measured by Doppler echocardiography to assess systolic function in infants and children. The obtained M-mode parameters were correlated with Doppler findings. We found the closest correlation between lin. EF and peak flow velocity integral (r = 0.83 p less than 0.001) Echocardiography completed by Doppler studies proved to be a safe noninvasive method not only estimating left ventricle dysfunction but in assessment the changes in the follow up too.

Indications and effects of captopril therapy in childhood.

Chronic effects of captopril were studied in 29 patients (age, 4 months to 16 years; mean, 6.9 years) suffering from digitalis and diuretic resistant congestive heart failure (CHF) or hypertension of different etiology. Twenty two patients with CHF (13 dilated, 4 restrictive cardiomyopathy, 5 congenital heart defects) and 7 cases with hypertension were treated for 1 to 31 months (mean, 9 months). The dose of captopril varied from 1 to 3 mg/kg/day (mean, 2.2 mg) in CHF and from 1.1 to 6.8 mg/kg/day (mean, 3.7 mg) in hypertension. In CHF digoxin therapy was maintained while the dose of diuretics could be reduced or discontinued. In 4 severely hypertensive patients the addition of a diuretic or beta blockers was necessary. In CHF clinical improvement was observed in 13 patients (59%), while there was no response in 4 and 5 patients died. The survivors exhibited a significant decrease of the cardiothoracic index (p less than 0.05), the PEP/LVET ratio (p less than 0.05) and an increase of the echocardiographic linear ejection fraction (p less than 0.001). If hypertension was present, blood pressure decreased in all patients (p less than 0.05). Captopril was well tolerated by all patients except one who developed anaemia. This side effect disappeared after having discontinued the drug. These findings suggest that captopril is of benefit in controlling chronic CHF. Captopril alone or in combination with other drugs is effective in the management of severe hypertension.