Color Doppler echocardiographic assessment of atrial septal defect size: correlation with surgical measurements.

In patients with atrial septal defect (ASD), color flow Doppler echocardiography provides visualization of the transseptal jet, the maximal dimension of which can be assumed to correspond to the maximal dimension of the true orifice. To test whether color flow Doppler echocardiography can provide an alternative method for measurement of ASD size, we studied 63 consecutive patients with echocardiographic evidence of ASD. In 48 patients the maximal dimension of the jet was measured in the parasternal, apical, or subcostal four-chamber view or in the parasternal short-axis view. In the remaining 15 patients transesophageal echocardiography was performed because of transthoracic views were inadequate. The transesophageal studies also measured, from two-dimensional images, the maximal transverse discontinuity in the atrial septum. All patients underwent surgical repair, during which the surgeon directly measured the maximal dimension of ASD. Linear regression equations were performed to compare transthoracic and transesophageal dimensions to those measured at operation. Correlation coefficients were as follows for transthoracic versus surgical measurements: r = 0.745, standard error = 4.35, p less than 0.001. Transesophageal measurements derived from both two-dimensional images and echocardiographic jet width showed similar excellent correlation with surgical measurements (n = 0.91, standard error = 4.33, p less than 0.001; and r = 0.919, standard error = 4.42, p less than 0.001, respectively). We conclude that ASD size derived from color flow Doppler echocardiography shows a good correlation with the anatomic maximal dimension observed at operation. Both transesophageal color flow Doppler echocardiography of jet width and direct surgical measurement of the defect provide an accurate estimation of ASD size.

[Effects of acute intravenous administration of propafenone on left ventricular function in patients with acute myocardial infarction]. / Effetti della somministrazione acuta endovena di propafenone sulla funzione ventricolare sinistra in pazienti con infarto miocardico acuto.

UNLABELLED: In order to evaluate the effects of propafenone (an antiarrhythmic class 1 c agent) acutely administered intravenously on left ventricular function, 10 patients with acute myocardial infarction (AMI), affected by arrhythmias (greater than or equal to Lown class III), belonging to Killip class I and II, and with normal serum electrolyte levels, were studied 2-4 days after an acute episode. No patients had previously been treated with antiarrhythmic drugs, or, if treated, the agent was withdrawn since at least 4 half-lives. In no case were inotropic substances or other pharmacological treatments, capable affecting L.V. function administered. Intravenous nitroderivative (Venitrin) infusion was continued when indicated. Each patient was administered a propafenone bolus (1 mg pro Kg in 4 minutes). Two dimensional and Doppler echocardiography were performed under basal conditions i.e. before propafenone infusion, during the infusion and after 1, 2, 3 and 4 hours, deriving following parameters: L.V. end diastolic and end systolic dimensions and volumes, ejection fraction (area-length method), II motion abnormalities, and transmitral flow velocity profile (E/A ratio). Statistical data were obtained using two way analysis of variance. RESULTS: In no case was the treatment interrupted, on the basis of our protocol criteria (reactions of hypersensitivity, proarrhythmic effects, acute hemodynamic deterioration that requires immediate positive inotropic and chronotropic agents administration, worsening of previous arrhythmic class). Heart rate and systemic arterial blood pressure did not change significatively during or after infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Antiapolipoprotein B cryoglobulinemia associated with normal plasma lipids and severe atherosclerosis.

A middle-aged female presented with diffuse planar xanthomas, associated with normal plasma lipids and a severe crescendo angina. Hematological testing disclosed the presence of a cryoglobulin binding to apolipoprotein B. The patient died after a short and dramatic clinical course. At autopsy, a markedly thickened aorta with diffuse atheromatous lesions of the major peripheral arteries were observed. Intracytoplasmic filaments (50-100 A), comparable to those described in amyloid deposits, were also detected. Endothelial cells were filled with lipid-containing vacuoles without extracellular lipid deposits. The reported case indicates that benign gammopathies against 'atherogenic' lipoprotein components, without clinical myeloma, may result in the development of severe arterial lesions.

[Role of M-mode and 2-dimensional (sector-scan) echocardiography in studying postinfarct ventricular kinetic changes]. / Ruolo dell'ecocardiografia unidimensionale e bidimensionale (sector-scan) nello studio delle cinesi ventricolare post-infartuale.

20 patients with previous myocardial infarction clinically suspected to have large impairment of ventricular wall kinesis were studied to evaluate the contribution of M-mode and two-dimensional echocardiography compared with the cineangiographic study in detecting left ventricular asynergy. Two-dimensional cross-sectional echocardiography yielded a satisfactory overlapping of results with ventriculography as far as left ventricular internal dimension and apical and posterior wall kinesis were concerned. The two-dimensional study proved to be an useful technique to observe the interventricular septum, in all its extension and the lateral wall as well. The M-mode technique, on the other hand, provided a reliable method, by means of the mitral valve echo, to determine the presence of elevated left-ventricular end-diastolic pressure; this was indicated by the occurrence of a B point, on the AC slope. A late opening of the mitral valve compared with the onset of left ventricular posterior wall relaxation phase, and other anomalies observed on the CD slope (SAM or pseudo-SAM), indicated pathological left ventricular kinesis. The failure of the left ventricular posterior wall to reach the septum moving the transducer from the aorta to the cardiac apex was considered indicative of apical dilatation, even if limited by a great number of false negatives. M-mode echocardiography provided also a quantitative evaluation of septal and postero-basal wall movement (particularly important from a prognostic point of view) and left ventricular end-diastolic dimension which, if corrected by body surface, resulted similar to those obtained by the two-dimensional technique. M-mode and Two-dimensional cross sectional echocardiography appeared to be complementary techniques which allow an adequate evaluation and diagnosis of left ventricular asynergy. They seem to be particularly useful to follow prospectively patients affected by myocardial infarction.

[Specificity and sensitivity of pulmonary valve motion in echocardiographic examination as an index of pulmonary hypertension]. / Specificita' e sensibilita' del movimento della valvola polmonare all'esame ecocardiografico come indice di ipertensione polmonare.

Many investigation have been made to establish the role of echocardiography in the diagnosis of pulmonary hypertension based on some parameters derived from the pulmonic valve leaflet echo motion. By observing 160 echo tracings of pulmonary valve motion, the authors calculated the specificity, sensibility and predictive value of these parameters as predictor of pulmonary hypertension, comparing echo data with corresponding haemodynamic determination of pulmonary artery systolic, diastolic and mean pressure and the degree of pulmonary vascular resistances. By means of the statistical analysis of variance correlation between "a" wave depth and severity of pulmonary hypertension was made. "A" wave depth and RPEP/RVET ratio resulted quite sensitive and highly specific indices of pulmonary hypertension, in particular "a" wave depth proved to correlate very well with the level of pulmonary artery systolic, diastolic and mean pressure and with the degree of pulmonary vascular resistances. Highly specific, but not always detectable, was the presence of a midsystolic notch. In conclusion, pulmonary valve echo motion detected by M-mode technique provides useful index of pulmonary hypertension, chiefly by the measurement of "a" wave depth which can also predict its severity.

[M-mode and two-dimensional echocardiography in subjects with suspected infective endocarditis. Report of 4 cases (author's transl)]. / L'esame ecocardiografico uni bidimensionale in pazienti con sospetta endocardite batterica. Studio di quattro casi.

4 hospitalized patients with valvular disease or prosthetic valves clinically suspected for infective endocarditis, were studied. The diagnostic contributions of echocardiography are reported. In fact this technique allows evidencing valvular vegetations with the possibility to clearly define their locations and dimensions, providing important data on the function of the affected structures. In particular the value of renal time cross sectional echocardiography is stressed. In fact this technique provided more detailed and specific images when compared with the M-mode tracings. All the echocardiographic results were compared with the surgical and/or autoptic data. In conclusion the importance of the echocardiographic approach in the study of valvular diseases is referred, stressing the utility of real time cross-sectional technique.

[Uni- and cross-sectional bidimensional echocardiography in coronary care unit. Study on 117 patients (author's transl)]. / Impiego dell'ecocardiografia uni e bidimensionale in unita' coronarica. Studio di 117 casi.

The Authors present the results of an unidimensional and cross-sectional bidimensional echocardiographic study carried out on 117 patients taken into the Coronary Care Unit of the Divisione Rizzi in the Milano-Niguarda Hospital. The purpose of this work was to reconsider the usefulness of this diagnostic methodology in situations of cardiologic emergency, with particular reference to acute coronaropaties. The echocardiographic examination was recorded within 24-48 hours since the admission in CCU of patients taken in for acute myocardial infarction, cardiogenic shock, serious dysrhythmias and unstable angina. In particular, 17 cases of acute myocardial infarction have been followed with cross-sectional bidimensional echocardiography, holding the exams at the time of admission and in II, III, V and XV day of illness. Moreover, such examinations were held in emergency situations as occurred in CCU. All the patients were also investigated from the clinical, electrocardiograhic, radiological and laboratorial point of view. The obtained results were the following: 1) In contrast with unidimensional echocardiography, cross-sectional bidimensional echocardiography has turned out to be technically feasible in all cases; moreover, it has permitted a view of the zones of the left ventricul that couldn't be explored by unidimensional technique. 2) A good correlation has been demonstrated between electrocardiographical location of acute myocardial infarction and dyskinetic zones as seen on the echocadiogram; indeed, in some cases, echocardiography has been able to point out an impairment of wall motion greater than expected only on the basis of electrocardiographic evaluation. 3) Systematic use of the echocardiography in CCU has often been able to point out pathological findings whose diagnosis was not feasible only on the basis of the usual clinical or instrumental data. In conclusion, the Authors confirm the diagnostic and prognostic usefulness of unidimensional echocardiographic study in CCU and underline that the event of cross-sectional bidimensional echocadiography opens new opportunities for the employment of the ultrasonographic methodology, although it is not yet in the position to completely substitute unidimensional echocardiography.