Effect of Calcium Hydroxide and Antioxidant Agents Filling the Pulp Chamber after Internal Bleaching.

To evaluate the effect of calcium hydroxide (CH), sodium ascorbate (SA) and sodium thiosulfate (ST) filling the pulp chamber on color stability and longevity of teeth after internal bleaching. Crowns of bovine incisors were submitted to internal bleaching and divided into groups according the material used in the pulp chamber: Control, CH, SA, ST. Each group was divided into two subgroups according to the time to perform restorative procedures (7 or 15 days). Color measurement was performed with a spectrophotometer at nine periods. The darkening (ΔE) values were calculated. The Mann-Whitney test was used to statistically analyze the data (p ⟨ 0.05). After bleaching, ΔE values were higher than 3.5, showing that the procedure was effective. After 24 hours, no difference was observed between groups. After 7 days, SA showed higher ΔE than the control group (p ⟨ 0.05). CH and TS did not differ from the control group. In restorations performed after 7/15 days, SA group showed higher values of darkening after 1 and 4 months than the control group (p ⟨ 0.05). SA induced perceptible darkening after bleaching and should not be used to fill the pulp chamber. ST and CH show color stability and longevity after 12 months.

Mid-pregnancy poly(I:C) viral mimic disrupts placental ABC transporter expression and leads to long-term offspring motor and cognitive dysfunction.

Limited information is available about the effect of mid-pregnancy viral infections on the placental expression of efflux transporters and offspring behavior. We hypothesized that maternal exposure to polyinosinic-polycytidylic acid [poly(I:C)], a synthetic double-stranded RNA viral mimic, would impair placental cell turnover, the expression of selected ABC transporters and adult offspring behavior. C57BL/6 mice were administered poly(I:C) (10 mg/Kg;ip) or vehicle at gestational day (GD) 13.5 (mid-pregnancy). Dams were euthanized for blood collection 4 h after injection, fetal and placental collection at GD18.5 or allowed to deliver spontaneously at term. At GD 13.5, poly(I:C) induced an acute pro-inflammatory response characterized by an increase in maternal plasma levels of IL-6, CXCL-1 and CCL-2/MCP-1. At GD 18.5, poly(I:C) decreased cell proliferation/death in the labyrinthine and increased cell death in the junctional zones, characterizing a disruption of placental cell turnover. Abca1 and Abcg1 immunolabelling was decreased in the labyrinthine zone, whereas Abca1, Abcg1 and breast cancer resistance transporter (Bcrp) expression increased in the junctional zone. Moreover, adult offspring showed motor and cognitive impairments in the Rotarod and T-water maze tests. These results indicate that viral infection during mid-pregnancy may disrupt relevant placental efflux transporters, as well as placental cell turnover and offspring behavior in adult life.

Influence of ultraconservative access cavities on instrumentation efficacy with XP-endo Shaper and Reciproc, filling ability and load capacity of mandibular molars subjected to thermomechanical cycling.

AIM: To evaluate the influence of ultraconservative access cavities (UltraAC) on canal shaping and filling ability and load capacity of mandibular molars after root canal preparation with XP-endo Shaper (XP) or Reciproc (RC), under simulated clinical conditions. Traditional access cavities (TradAC) were used for comparison. METHODOLOGY: Forty extracted mandibular molars were scanned by micro-computed tomographic and, based on similar anatomical features, were divided into four groups (n = 10), according to the type of access cavity and canal instrumentation protocol: TradAC/RC, TradAC/XP, UltraAC/RC and UltraAC/XP. All root canal procedures were performed with the teeth placed in a dental mannequin. Teeth were scanned after root canal instrumentation and filling. Unprepared canal area, dentine removed, accumulated hard tissue debris (AHTD), canal transportation, presence of voids and filling material remnants within the pulp chamber were analysed. After restorative procedures, the teeth were subjected to thermomechanical cycling and to a load capacity test. Statistical analyses were performed using two-way anova test, considering the randomized blocks design (P < 0.05). RESULTS: The percentage of unprepared canal area was significantly lower in TradAC groups when compared to UltraAC groups (P < 0.05), regardless of the instrument used. The UltraAC/XP group had significantly lower percentage of root dentine removed when compared to other groups (P < 0.05). UltraAC/XP and TradAC/XP groups had significantly lower percentages of AHTD than UltraAC/RC and TradAC/RC groups (P < 0.05). Regarding canal transportation, in the MB root canals, the TradAC/XP group had significantly lower values than other groups (P < 0.05). In general, in ML and distal root canals, TradAC/XP and UltraAC/XP groups had significantly lower values of canal transportation when compared to other groups (P < 0.05). Moreover, the UltraAC/RC had the greatest canal transportation values in MB and distal canals. The UltraAC groups had significantly greater percentages of voids and volume of remaining root filling material within the pulp chamber after cleaning procedures than TradAC groups (P < 0.05). There was no difference in the load capacity amongst groups (P < 0.05). CONCLUSION: The UltraAC/XP and UltraAC/RC groups had significantly greater areas of unprepared canal walls, significantly more voids and volume of root filling material remnants within the pulp chamber after canal filling. UltraAC/XP was associated with significantly less root dentine removal and significantly more AHTD whilst TradAC/XP had overall significantly less canal transportation. No differences were observed in the load capacity amongst groups.

Preserving dentine in minimally invasive access cavities does not strength fracture resistance of restored mandibular molars.

AIM: To evaluate the correlation between the volume of dental hard tissues removed and the fracture resistance of mandibular molar teeth with ultraconservative (UltraAC) or traditional (TradAC) access cavity preparations. METHODOLOGY: Sixty recently extracted and intact mandibular first molars were scanned in a microcomputed tomographic (micro-CT) device, anatomically matched and assigned at random to 2 groups (n = 30), according to the access cavity type: UltraAC or TradAC. After access preparation, mesial and distal canals were prepared using Reciproc instruments and a new scan was taken. The volumes of pulp chamber and dental hard tissues in each specimen were measured before and after the experimental procedures, and the percentage volume reduction of hard tissues calculated for the entire tooth and for the crown separately. Teeth were then root filled, restored and subjected to fracture resistance tests in an universal testing machine. The force required to fracture was recorded in Newtons (N). The adherence of the variables to a Gaussian curve was verified using a Shapiro-Wilk test. Skewed data were analysed with nonparametric Wilcoxon signed rank or Spearman correlation tests, whilst the normally distributed data were analysed with a dependent samples Student t-test. Level of significance was set at 5%. RESULTS: Pre-operatively, no difference was observed between groups regarding the volume of pulp canal space or dental hard tissues (P > 0.05). After access preparation, volumes of the removed hard tissues from the entire tooth and from the crown were significantly greater in teeth prepared with TradAC than with UltraAC (P < 0.05). No significant difference was observed in the fracture resistance values between TradAC (902.9 ± 347.8 N) and UltraAC (948.7 ± 405.7 N) groups (P = 0.975). The Spearman test was unable to identify a correlation between fracture resistance and percentage volume of removed dental hard tissues in the entire root (P = 0.525, r = -0.084) or only in the crown (P = 0.152, r = -0.187). CONCLUSION: The volume of hard dental tissues removed, although greater in teeth with TradAC compared to UltraAC, did not correlate with the fracture resistance results, indicating that a minimally invasive access cavity did not increase the resistance of restored mandibular first molars to fracture.

The influence of endodontic access cavity design on the efficacy of canal instrumentation, microbial reduction, root canal filling and fracture resistance in mandibular molars.

AIM: To assess the impact of conservative endodontic access cavities (CEC) and truss access cavities (TAC) during root canal treatment performed on mandibular molars in terms of: ability to shape and fill root canals, microbial reduction in canals, and cleaning of the pulp chamber. In addition, the fracture resistance of the teeth after coronal restoration was assessed. Traditional endodontic cavities (TEC) were used as a reference technique for comparison. METHODOLOGY: Thirty extracted intact mandibular molars were scanned in a microcomputed tomography device (micro-CT), matched based on similar anatomical features and assigned to TEC, CEC or TAC groups (n = 10). The specimens were accessed accordingly, and root canals were contaminated with bacterial suspensions of Enterococcus faecalis (21 days). Subsequently, the first microbial sample was collected from root canals (S1). The canals were initially prepared with Reciproc Blue R25 instrument followed by a second instrumentation using Reciproc Blue R40. Eight mL of 0.5% NaOCl were used as an irrigant for each instrument. A final irrigation protocol was performed with 2 mL of 0.5% NaOCl, 2 mL of 17% EDTA and another 2 mL of 0.5% NaOCl. Microbial samples were collected from root canals after R25 (S2), R40 (S3) and final irrigation (S4). The teeth were rescanned after S4. Then, root canals were filled, rescanned, restored and the teeth subjected to fracture resistance tests. The statistical analysis was performed with type I negative binomial and beta 0-1 inflation regression models for microbiological analysis. Instrumentation, filling and resistance to fracture results were subjected to anova and Tukey tests (P < 0.05). RESULTS: S4 revealed no significant variations in microbial reduction amongst the groups (P > 0.05). TEC had a significantly lower percentage of unprepared surface area than CEC (P < 0.05). No differences were found regarding the percentage of dentine removed, transportation, centring ability and filling voids amongst the groups (P > 0.05). The TEC group had a significantly lower volume of remaining root filling material within the pulp chamber than CEC and TAC groups (P < 0.05). There was no difference regarding fracture resistance amongst the groups (P > 0.05). CONCLUSION: Conservative access cavities did not offer any advantage in comparison with the traditional endodontic cavities in any of the parameters considered. Furthermore, conservative methods were associated with larger percentages of unprepared canal surface area and larger volumes of remaining root filling material within the pulp chamber.

The impact of minimally invasive root canal preparation strategies on the ability to shape root canals of mandibular molars.

AIM: To evaluate the use of a reduced taper endodontic instrument system (Bassi Logic™ .03 taper) and expandable heat-treated system (XP-endo Shaper) on the ability to shape canals in mandibular molars, by means of microcomputed tomography (micro-CT) analysis. The Reciproc system was used as the reference for comparison. METHODOLOGY: Twenty-four mandibular molars were scanned in a micro-CT, matched based on similar anatomical features and sorted into three groups (n = 8 per group), according to root canal preparation system: Bassi Logic™ .03, XP-endo Shaper and Reciproc. The teeth were mounted onto a mannequin and the pulp chambers were accessed with traditional access cavities. In Bassi Logic™ .03 and Reciproc groups, mesial canals were prepared with size 25, .03 taper or R25 (size 25, .08v taper) instruments and the distal root canal with size 25, .03 taper and size 40, .03 taper or R25 and R40 (size 40, .06v taper), respectively. In XP-endo Shaper groups, all root canals were prepared with XP-endo Shaper (size 30, .04v taper). After root canal preparation, the teeth were rescanned. The percentage of untouched canal areas and the percentage of removed dentine were evaluated separately for mesial and distal root canals. The data were analysed using one-way anova and Tukey tests (P < 0.05). RESULTS: The Bassi Logic™ .03 group was associated with a greater percentage of untouched canal areas when compared to XP-endo Shaper and Reciproc groups for mesial and distal root canals (P < 0.05), but no differences were found between XP-endo Shaper and Reciproc groups (P > 0.05). No significant difference was observed in the percentage of dentine removed amongst the groups for mesial and distal root canals (P > 0.05). CONCLUSION: The use of a reduced taper system (Bassi Logic™ .03) during root canal preparation resulted in a greater percentage of untouched canal areas when compared to XP-endo Shaper and Reciproc instruments. No differences were observed amongst the systems regarding the percentage of dentine removed.

Influence of minimally invasive endodontic access cavities on root canal shaping and filling ability, pulp chamber cleaning and fracture resistance of extracted human mandibular incisors.

AIM: To evaluate the influence of the location and design of endodontic access cavities on root canal shaping and filling ability, pulp chamber cleaning and fracture resistance of extracted human mandibular incisors. METHODOLOGY: After pre-selection using periapical radiographs, forty extracted intact human mandibular incisors were scanned in a micro-computed tomographic device. The teeth were matched based on similar anatomical features of the canals and assigned to four experimental groups (n = 10) according to the endodontic access cavity and root canal preparation protocol: traditional/TRUShape (T/TRU); traditional/MTwo (T/MT); minimally invasive/TRUShape (MI/TRU); and minimally invasive/MTwo (MI/MT). The samples were scanned after root canal instrumentation and filling procedures. The parameters evaluated were as follows: volume and area of the root canal, noninstrumented canal areas, canal transportation and centring ratio, accumulated hard tissue debris, voids in root canal fillings and remnants of root canal filling materials in the pulp chamber. After root canal filling and cavity restoration procedures, the samples were submitted to a fracture resistance test. Data were statistically analysed using Shapiro-Wilk, one-way anova and Bonferroni tests with a significance level of 5% (α = 0.05). RESULTS: There was no difference regarding all parameters evaluated before and after root canal preparation (volume and area of the root canal, noninstrumented canal areas, canal transportation and centring ratio, and accumulated hard tissue debris) amongst the groups (P > 0.05). MI/TRU and MI/MT groups were associated with significantly more voids in root canal fillings when compared to the T/TRU and T/MT groups (P < 0.05). Percentage of root canal filling material remnants in the pulp chamber after cleaning procedures and mean fracture resistance values were not significantly different amongst the four experimental groups (P > 0.05). CONCLUSIONS: The location and design of the endodontic access cavity did not impact on root canal preparation nor resistance to fracture of extracted mandibular incisors, regardless of the instrument used. Minimally invasive access cavities were associated with significantly more voids in root canal fillings.

A laboratory study of the impact of ultraconservative access cavities and minimal root canal tapers on the ability to shape canals in extracted mandibular molars and their fracture resistance.

AIM: To evaluate the influence of ultraconservative endodontic access cavities (UEC) and the use of instruments with various tapers (.03 or .05) and tip diameters (25 or 40) on the ability to shape canals in mandibular molars and their fracture resistance in comparison with traditional endodontic access cavities (TEC). METHODOLOGY: Thirty-two intact extracted mandibular molars were scanned in a micro-computed tomography device, matched based on similar anatomical features and assigned to UEC or TEC groups and to subgroups according to mechanical canal preparation with Bassi Logic™ rotary NiTi instruments with .03 or .05 taper (n = 8 per group). The teeth were mounted onto a mannequin head, and the pulp chambers were accessed and the root canals subjected to instrumentation. In the first stage, size 25 endodontic instruments were used, with .03 or .05 tapers. The teeth were re-scanned. Subsequently, a second canal instrumentation was performed with the size 40 instruments with .03 or .05 tapers and scanned again. The root canals were filled and then the teeth restored before being subjected to fracture resistance tests. The data on untouched canal areas, canal transportation, centring ability, the percentage of removed dentine and maximum load at fracture were analysed. One-way anova and Tukey's tests were performed for inter-group analysis. The paired-samples t-test was performed on the results between size 25 and size 40 apical preparations for each individual specimen (P < 0.05). RESULTS: No significant difference was observed for the percentage of untouched canal area when comparing UEC and TEC groups or between the .03 and .05 tapers with the same instrument tip size (P > 0.05). There was a significantly lower percentage of untouched canal area after instrumentation with size 40 instruments when compared to size 25 (P < 0.05). No significant difference in the percentage of dentine removed was observed between the access cavities or the different tapers (P > 0.05). Size 40 apical preparations removed significantly more dentine than size 25 preparations (P < 0.05). No significant differences were observed in canal transportation, centring ability and fracture resistance in any of the tested groups (P > 0.05). CONCLUSIONS: Ultraconservative endodontic access cavities did not offer any advantages in comparison with traditional endodontic access cavities on the ability to shape canals, nor the fracture resistance of mandibular molars. No differences were observed in shaping ability and fracture resistance between .03 and .05 taper canal preparations. Apical preparation with larger instruments resulted in significantly less untouched canal area in all groups.

Effects of alcohol and nicotine consumption on the development of apical periodontitis in rats: a correlative micro-computed tomographic, histological and immunohistochemical study.

AIM: To evaluate the effects of alcohol and nicotine, when used alone or simultaneously, in the development of apical periodontitis induced in rats, using a correlative analytic approach with micro-CT, histological and immunohistochemical analysis. METHODOLOGY: Twenty-eight male Wistar rats were arranged into four groups: Control, Nicotine, Alcohol and Alcohol + Nicotine. The alcohol groups were exposed to self-administration of a 25% alcohol solution, whilst the other groups drunk only filtered water. The nicotine groups received daily intraperitoneal injections of a solution with 0.19 µL of nicotine per mL, whilst the other groups received saline solution. The pulps of the left mandibular first molars were exposed for 28 days to induce periapical lesions. Throughout the experiment, drug administration was maintained, and the animals had their weight and solid and liquid consumption measured. After euthanasia, the mandibles were removed and the area, volume and major diameter of the periapical lesions were measured using micro-computed tomography images. The samples were submitted to histopathological evaluation and immunohistochemistry for RANKL and PTHrP. Statistical analysis was undertaken with a significance level of 5%. Nonparametric data were analysed using the Kruskal-Wallis test followed by Dunn's test, whilst one-way anova followed by Tukey's test was performed for parametric data. RESULTS: The alcohol groups had lower solid and liquid consumption and gained less weight when compared to the nonalcohol groups (P < 0.05). The Alcohol + Nicotine group had lesions with significantly larger volume and area when compared to the other groups (P < 0.05), whilst the Alcohol or Nicotine groups had significantly larger lesions than the control group (P < 0.05). There was no significant difference in the largest diameter of the lesions amongst groups (P > 0.05). The experimental groups had greater inflammatory response scores than the control group (P < 0.05), and the representative samples had more pronounced immunoreaction against RANKL and PTHrP antibodies. CONCLUSIONS: Alcohol and nicotine consumption exacerbated the inflammatory response and the development of periradicular lesions in rats. The association of both substances enhanced their harmful effects.

The influence of the addition of surfactants to sodium hypochlorite on the removal of hard tissue debris.

AIM: To evaluate the effect of the addition of surfactants to sodium hypochlorite (NaOCl) on the removal of accumulated hard tissue debris (AHTD), before and after final irrigation with 17% EDTA, from mesial canals of mandibular molars through microcomputed tomographic (micro-CT) analysis. METHODOLOGY: Thirty moderately curved mandibular mesial roots with Vertucci type II canal configuration were selected and scanned in a micro-CT device at an isotropic resolution of 22.9 µm. The specimens were assigned to three groups (n = 10) with respect to the root length, degree of curvature of the mesial root, volume and 3D anatomy of the root canals according to the irrigating solution used during root canal preparation: 2.5% NaOCl and 0.1% Benzalkonium Chloride, 2.5% NaOCl and 0.1% Tween 80 and 2.5% NaOCl without additives. The root canals were instrumented up to Reciproc R25 instrument. Then, the specimens were scanned again after canal preparation and after final irrigation with 17% EDTA, and the registered data sets were examined to evaluate the percentage of AHTD. For comparison between the different groups before and after using 17% EDTA, the Kruskal-Wallis test was used with a significance level of 5%. For comparison between the same groups before and after using 17% EDTA, the Wilcoxon test was used with a significance level of 5%. RESULTS: None of the irrigant solutions tested was able to completely eliminate hard tissue debris from mesial canals of mandibular molars. There were no significant differences in the percentage of AHTD amongst the different irrigation solutions (P > 0.05). Final irrigation with 17% EDTA significantly reduced the percentage of AHTD (P < 0.05), without differences amongst the groups (P > 0.05). CONCLUSIONS: The addition of surfactants to NaOCl did not affect the removal of AHTD from mesial canals of extracted mandibular molars. Final irrigation with 17% EDTA significantly improved AHTD removal.

Influence of heat treatment on torsional resistance and surface roughness of nickel-titanium instruments.

AIM: To evaluate the influence of controlled memory (CM) thermal treatment on the torsional resistance and surface roughness of nickel-titanium instruments with identical geometric and dimensional characteristics. The influence of environmental temperature on torsional resistance was also evaluated. METHODOLOGY: A sample of 25 conventional NiTi alloy and 25 CM thermal-treated NiTi instruments, with an identical geometric design and a nominal size of 0.25 mm at D0 and a nominal taper of .06 mm mm-1 were selected. The torsional strength and the angle of rotation of the instruments were tested following ISO 3630-1 at two temperatures: 21 and 35 °C. The fracture surfaces of all tested instruments were verified with a scanning electron microscope. The surface roughness of the blades of conventional NiTi alloy and CM wire files was evaluated by using a New View 7100 Profilometer. Statistical analysis was performed using Student's t-test and paired t-test to analyse the torsional resistance and surface roughness at a significance level of P < 0.05. RESULTS: The torsional strength of thermally-treated instruments was significantly lower than nontreated instruments (P < 0.05). However, thermally-treated instruments had significantly greater angular rotation to fracture than nontreated instruments (P < 0.05). Temperature did not influence the torsional strength (P > 0.05) and the angular rotation (P > 0.05) of the instruments. Regarding the roughness measurements, groove depth was lower at the surface of thermally-treated instruments when compared to nontreated instruments (P < 0.05). CONCLUSION: Thermal treatment influenced the torsional resistance and surface roughness of NiTi instruments with identical geometric and dimensional characteristics. Temperature did not affect torsional behaviour.

Effects of chelating agent and acids on Biodentine.

BACKGROUND: To evaluate the effect of distilled water, ethylenediaminetetraacetic acid (EDTA), phosphoric acid and maleic acid on Biodentine regarding surface topography, microhardness and push-out bond strength (POBS). METHODS: Fifty-two cylindrical shaped Biodentine specimens were divided into groups: control (distilled water); EDTA (17% EDTA); PA (37% phosphoric acid); and MA (7% maleic acid). Surfaces were evaluated by topographic analysis and Vickers microhardness test. Topographic changes were evaluated qualitatively and microhardness was statistically analyzed by Kruskal-Wallis test. Forty mandibular molars were used to simulate clinical conditions. The crowns were removed and a perforation was created at the furcal floor. The Biodentine was packed into the root perforations and the roots were divided into four groups (DW, EDTA, PA, MA). Samples were stored and subjected to interfacial analysis. POBS data were analyzed by Kruskal-Wallis and Dunn tests. RESULTS: Ethylenediaminetetraacetic acid, MA and PA changed the morphology of the Biodentine surface. PA showed microhardness similar to distilled water (P > 0.05), while MA and EDTA demonstrated reduced values when compared with PA (P < 0.05). PA improved the POBS of Biodentine in comparison with the control. CONCLUSIONS: Changes in the topography, microhardness and POBS of Biodentine are associated with irrigant agent used.

Resistance to vertical root fracture of root filled teeth using different conceptual approaches to canal preparation.

AIM: To evaluate the resistance to vertical root fracture of root filled teeth using different root canal preparation concepts: apical stop and continuously tapering preparation, with different foraminal enlargement. In addition, the effect of filling associated with these different concepts was assessed. METHODOLOGY: Ninety single-rooted premolars were used. The crowns were removed to standardize the root length at 11 mm. Ten roots were not instrumented and not filled (control group). The other roots were divided into four groups (n = 20): apical stop to finishing file size 25, 0.08 taper; apical stop to finishing file size 45, 0.02 taper; continuously tapering preparation to finishing file size 25, 0.08 taper; and continuously tapering preparation to finishing file size 45, 0.02 taper. Afterwards, 10 roots of each group were root filled using Gutta-percha and AH Plus. A continuous wave of condensation was used as the filling technique. The roots were evaluated as regards resistance to vertical fracture using a universal testing machine. The data were evaluated using the Kruskal-Wallis and Mann-Whitney tests. RESULTS: No significant difference in performance was observed between continuously tapering preparation size 25, 0.08 taper and apical stop size 45, 0.02 taper groups. Lower resistance values were found in continuously tapering preparation size 45, 0.02 taper group and the highest in apical stop size 25, 0.08 taper group. After filling, a significant increase in resistance values was observed in all groups. In addition, the continuously tapering preparation size 45, 0.02 taper group had values comparable with those of the control. CONCLUSION: The different canal preparation techniques reduced resistance to fracture when compared with the control group; however, after root filling, there was a significant increase in resistance.

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.

Clinical utility of two-dimensional doppler echocardiographic techniques for estimating pulmonary to systemic blood flow ratios in children with left to right shunting atrial septal defect, ventricular septal defect or patent ductus arteriosus.

Range gated two-dimensional Doppler echocardiographic methods were evaluated for quantifying pulmonary (QP) to systemic (QS) blood flow ratios. Twenty-one patients were studied, 4 with patent ductus arteriosus, 6 with atrial septal defect and 11 with ventricular septal defect. The Doppler pulmonary to systemic flow (QP:QS) estimation method involved calculating volume flow (liters/min) at a variety of intracardiac sites by using imaging information for flow area and Doppler outputs to calculate mean flow velocity as a function of time. Area volume flows were combined to yield QP:QS ratios. The sites sampled were main pulmonary artery, ascending aorta, mitral valve orifice and subpulmonary right ventricular outflow tract. The overall correlation between Doppler QP:QS estimates and those obtained at cardiac catheterization (n = 18) or radionuclide angiography (n = 3) was r = 0.85 (standard error of the estimate = 0.48:1). These preliminary results suggest that clinical application of this Doppler echocardiographic method should allow noninvasive estimation of the magnitude of cardiac shunts.