Role of left ventricular geometry in the alteration of initial QRS vectors due to concentric ventricular hypertrophy.

The relation between serial magnitudes of instantaneous spatial vectors, obtained throughout ventricular depolarization, and echocardiographically estimated left ventricular (LV) mass was investigated in 64 patients with congenital aortic stenosis and in 16 patients with coarctation of the aorta. While the correlation was positive between LV mass and vector magnitudes at 50 and 60 ms after QRS onset (r = .530 and .557, P < .01), it was found to be negative with regard to the magnitude of the initial 10 and 20 ms vectors (r = -.285 and -.355, P < .01). Computer simulation of activation propagation in different models of LV enlargement has shown that the decrease of the spatial magnitude of initial vectors, as well as a marked decrease of the area of the anterior portion of the horizontal plane QRS loop and of the Q amplitude of the orthogonal z lead, are characteristic of concentric LV hypertrophy with decreased diastolic volume and were not observed with unchanged or dilated chamber size. Repeated assessment of the magnitude of initial QRS vectors may indicate changes of LV remodeling in patients with LV pressure overload.

[Echocardiography in the diagnosis and prevention of congenital heart defects of a primarily genetic etiology]. / Prínos echokardiografie v diagnostike a prevencii vrodených vývojových chýb srdca primárne genetickej etiológie.

Over the period from January 1982 to June 1989 the authors examined 1723 children and adolescents with congenital heart diseases (CHD), hospitalized in the Institute of Cardiovascular Diseases in Bratislava. Of these patients, 96 (5.6%) had CHD of primarily genetic etiology: monogenic diseases 51 (3%), chromosomal anomalies 45 (2.6%) patients. In indicated cases (polystigmatization, positive family history) the relatives were examined. Echocardiographic examination of 203 relatives of patients with genetically determined CHD yielded positive echocardiographic findings in 32 subjects (15.5%). In relatives of patients with CHD of primarily genetic etiology, even structural changes which hemodynamically are not severe may be of value for individuals who are carriers of pathologic genetic information. Echocardiography is a contribution not only to diagnosis but also to prevention of CHD in association with adequate genetic counselling. (Tab. 4, Ref. 7.)

[Vectorcardiographic features of right ventricular dilatation]. / Vektorokardiografický obraz dilatácie pravej komory.

Axial McFee-Parungao lead system vectorcardiograms were obtained in 55 patients with type atrial septal defect, aged 3-24 years, prior to and in average 3 years after surgical repair of the defect. Changes of the QRS loop observed after intervention led to the conclusion that the vectorcardiographic signs of right ventricular dilatation consist of a rightward shift of the posteriorly orientated horizontal plane vectors at 50-70 ms of QRS, decrease of the magnitude of vectors around the 40th ms, no changes in the magnitude and orientation of the initial (10-30 ms) QRS vectors as well abnormal departures of the spatial VCG loop from its preferential plane even in the absence of other signs of right ventricular conduction impairment. The above abnormalities vanished after normalization of hemodynamics.

[The hypereosinophilic syndrome in a child with endomyocardial fibrosis treated surgically]. / Hypereozinofilný syndróm dietata s endomyokardiálnou fibrózou riesený operacne.

The authors describe the case-history of a 12-year-old patient with hypereosinophil syndrome, endomyocardial fibrosis of the left ventricle and dominating mitral valve insufficiency. By correction of the insufficiency, using a Carpentier ring, the authors achieved substantial improvement of the haemodynamics. One year after operation the patient is cardially compensated.

[Anomalies of venous drainage of the left lung]. / Anomálna venózna drenáz l'avých pl'úc.

The authors present their experiences with diagnosis and surgical treatment of anomalous venous drainage of the left lung into the left innominate vein. The anomaly was found only in four out of 704 patients operated on for atrial septal defect. In three patients in whom leftsided anomalous pulmonary venous drainage was associated with atrial septal defect, the derangement was corrected by using extracorporeal circulation. The patient who had no atrial defect was operated on without extracorporeal circulation on applying leftsided thoracotomy. The mean age of the patients was 26.25 years. After correcting the defect, drainage of the left lung into the left atrium was found satisfactory in all operated patients. Exact assessment of the possibility of an associated intracardiac defect is being emphasized, as it is crucial for selecting the appropriate surgical approach.