[Isolated right ventricular myxoma: report of a clinical case]. / Mixoma isolado do ventrículo direito: A propósito de um caso clínico.

A clinical case of a 14 years old white female with asthenia and easy fatigue of two months duration is presented. The two-dimensional echocardiography study has identified a tumorous and homogeneous mass filling completely the right ventricle. During the cardiac surgery and with the help of extemporaneous biopsy the real nature of the tumor was confirmed-cardiac myxoma. In this report the authors discuss the incidence of cardiac tumors and particularly cardiac myxomas and point out the rarity of isolated myxomas in the right ventricle.

[Echocardiographic evaluation of pulmonary valve stenosis for valvuloplasty in children and adults]. / Avaliação ecocardiográfica da estenose valvular pulmonar para valvuloplastia na criança e no adulto.

OBJECTIVES: 1--To determine the accuracy of the echocardiographic selection and characterization of the pulmonary stenosis (PS) for balloon valvuloplasty; 2--To analyze the differences between children and adults in obtaining the echocardiographic parameters used for pulmonary stenosis characterization. MATERIAL AND METHODS: We studied 53 consecutive patients with PS and a peak Doppler gradient > or = 40 mmHg, submitted to cardiac catheterization to perform balloon valvuloplasty if the right ventricle to pulmonary artery peak-to-peak systolic pressure gradient was > or = 40 mmHg. The patients were divided into 3 groups on the basis of age: < or = 5 years (group 1; n = 18), 6-16 years (group 2; n = 17) and > 16 years (group 3; n = 18). A complete echocardiographic study was performed including identification of valvular morphology (commissural fusion, dysplasia or mixed), determination of right ventricle to pulmonary artery peak Doppler gradient and the transducer position that yielded the highest transvalvular flow velocity (V), evaluation of the right ventricular outflow tract morphology and measurement of the valvular annulus diameter. RESULTS: Technically adequate recordings were obtained in all patients. Fifty patients (94%) were submitted to pulmonary valvuloplasty. The echo-Doppler recording of V was obtained from the parasternal position in 27 patients (51%), suprasternal in 14 (26%), subcostal in 10 (19%) and apical in 2. In group 1, the V was obtained from the suprasternal position in 8 patients (44%), subcostal in 5 (28%), parasternal in 4 (22%) and apical in 1. In group 2, it was the parasternal position in 8 patients (47%), suprasternal in 6 (35%), subcostal in 2 (12%) and apical in 1. In group 3, it was the parasternal position in 15 patients (83%) and subcostal in 3. The peak Doppler gradient ranged from 40 to 215 mmHg (mean +/- SD = 78 +/- 37) and the peak-to-peak gradient at cardiac catheterization from 32 to 220 mmHg (mean +/- SD = 81 +/- 41). The correlation between eco-Doppler peak gradient and peak-to-peak gradient at cardiac catheterization was r = 0.95 (SEE = 12 mmHg) being, for group 1, r = 0.89 (SEE = 14 mmHg), for group 2, r = 0.97 (SEE = 8 mmHg) and, for group 3, r = 0.98 (SEE = 10 mmHg). The right ventricular outflow tract shows dynamic reaction 48 patients. Two patients had an infundibular gradient > 25 mmHg, significantly underestimated by echo-Doppler in one. All 5 patients (9%) but one with angiographic criteria for valvular dysplasia, were identified by echocardiography. One patient had a mixed form. The remaining 47 patients had valvular commissural fusion. The annulus size measured by echocardiography ranged from 10 to 28 mm (mean +/- SD = 17.7 +/- 4.3) and by angiography from 10 to 28 mm (mean +/- SD = 17.6 +/- 4.4). Close correlations were found between echocardiographic and angiographic measurements: r = 0.97 (SEE = 1.1 mm) being, for group 1, r = 0.90 (SEE = 1.1 mm), for group 2, r = 0.94 (SEE = 0.8 mm) and, for group 3, r = 0.87 (SEE = 1.3 mm). CONCLUSION: The echocardiographic examination allows an accurate selection and characterization of the PS for balloon valvuloplasty. The most significant difference in the study of PS in children and adults, was the lack in the ability of the eco-Doppler to record the V from the suprasternal position in adults. 2D echocardiography can reliably measure the annulus diameter in children and adults, providing precise information for balloon diameter selection before valvuloplasty.

[Echocardiographic assessment of interventricular septal defect corrected during the first year of life]. / Avaliação ecocardiográfica da comunicação interventricular corrigida no primeiro ano de vida.

OBJECTIVE: To evaluate the medium term results of surgical closure of ventricular septal defect (VSD) performed during the first year of life, using echocardiography (echo). MATERIAL AND METHODS: We studied prospectively 29 patients aged from 17 to 68 months (mean = 37) who underwent surgical closure of perimembranous VSD during the first year of life. The postoperative follow-up time ranged from 6 to 60 months (mean = 26). Fifteen age-matched normal children were used as a control group in evaluating the left ventricular (LV) systolic function. The echo study included: 1) the assessment of LV systolic function using the shortening fraction, ejection fraction, pre-ejection to ejection time ratio (PET/ET), aortic flow acceleration time, acceleration to ejection time ratio, mean aortic flow acceleration; 2) detection and quantification of residual VSD as well as tricuspid and or aortic regurgitation; 3) determination of right ventricular systolic pressure (RVSP). The RVSP was evaluated from the maximum flow velocity from a residual VSD or tricuspid regurgitation, using the simplified Bernoulli equation. RESULTS: The LV systolic function parameters from patients versus (vs) normals showed a significantly different shortening fraction (34 +/- 5 vs 39 +/- 4; p = 0.005) and PET/ET ratio (0.34 +/- 0.04 vs 0.31 +/- 0.03; p = 0.02). None of the other studied parameters was significantly different from normal. Five (17%) patients had a small residual VSD. Two (7%) patients had mild aortic regurgitation. Tricuspid regurgitation was detected in 23 (79%) patients being trivial in 20 and mild to moderate in 3. The RVSP was quantified in 22 (76%) patients, ranging from 30 to 45 mmHg (mean +/- SD = 36 +/- 4). None of the remaining 7 patients showed changes in the end-systolic interventricular septal configuration. CONCLUSIONS: Our study shows that surgical closure of perimembranous VSD performed during the first year of life was possible without significant mobility. Furthermore, the echo allowed a complete and noninvasive cardiac evaluation of the anatomic, functional and hemodynamic status of this group of patients, thus limiting the need for postoperative control cardiac catheterization.

[Value of ventricular geometry in the evaluation of direct ventricular pressure]. / Interesse da geometria ventricular na avaliação da pressão ventricular direita.

OBJECTIVE: To determine the echocardiographic end-systolic ventricular geometry value in evaluating right ventricular systolic pressure (RVSP). MATERIAL AND METHODS: We studied prospectively 68 patients (mean age = 6.0 +/- 5.0 years), submitted to cardiac catheterization for cardiac disorders not involving left ventricular (LV) outflow tract obstruction, within 24 hours after two-dimensional echocardiographic (2D echo) examination. 2D echo evaluation of RVSP was performed using end-systolic LV transverse orthogonal diameters (TDR). The LV transverse orthogonal diameters (antero-posterior and supero-inferior) were measured on a parasternal short-axis image, at the tips of papillary muscles. 2D echo semi-quantitative evaluation of RVSP was tested correlating TDR with hemodynamic RVSP/LV systolic pressure (LVSP) ratio--group 1. We also used regression equation derived from the first 35 patients to quantify RVSP in the last 33 patients--group 2. In these cases, systolic systemic arterial pressure measured by sphygmomanometry was taken as LVSP. RESULTS: The TDR ranged from 1.0 to 2.1 (mean = 1.5 +/- 0.3) and the RVSP/LVSP ratio from 0.3 to 1.7 (mean = 0.7 +/- 0.4). All patients with RVSP/LVSP greater than or equal to 65% have TDR greater than or equal to 1.3 and when RVSP less than or equal to 35 mmHg we always obtained TDR less than or equal to 1.2. The correlation between 2D echo estimated and catheter measured RVSP shows, for group 1, r = 0.88 and y = 1.1X-0.88 and, for group 2'. r = 0.88. CONCLUSION: In the absence of LV systolic obstruction, TDR is a reliable non invasive method in evaluating the RVSP.

[Fistula of the right coronary artery near the right ventricle. An echocardiographic study]. / Fístula de la arteria coronaria derecha hacia el ventrículo derecho. Estudio ecocardiográfico.

A case of a 42-year-old woman with a right coronary artery fistula into the right ventricle is reported; she was asymptomatic and a continuous precordial murmur was found on physical examination. We discuss the usefulness and limitation of the Echo 2-D/Doppler findings, concerning this diagnosis, which was only definitively established by angiocardiography.

Evaluation of left ventricular function after acute myocardial infarction. Two-dimensional echocardiography versus radionuclide angiography. Study of 50 patients.

Two-dimensional echocardiography and gated blood radionuclide angiography was performed in 50 patients (mean age 51.3 years; 48 men and 2 women) after acute myocardial infarction, before discharge from the hospital. The aim of this study was to compare the wall motion score, determined by two-dimensional echocardiography (2DE), with the ejection fraction obtained by radionuclide angiography (RNA). The correlation between the results obtained by 2DE and RNA was good (r = 0.75; p less than 0.0001). We conclude that 2DE is a powerful diagnostic tool for the evaluation of left ventricular function.

[Significance of Doppler echocardiography in the diagnosis and management of children with heart disease]. / Valor da ecocardiografia-Döppler no diagnóstico e orientação da criança com doença cardíaca.

OBJECTIVE: To assess the accuracy of Doppler-echocardiography in the diagnosis and management of the child with heart disease. MATERIAL AND METHODS: Prospective echocardiographic study of 132 consecutive patients aged 1 day to 16 years old with heart disease confirmed by cardiac catheterization (n = 109) or anatomic examination (surgical = 21, necropsy = 2). RESULTS: Of the 258 cardiovascular anomalies diagnosed by cardiac catheterization and anatomical examination, 247 were correctly identified by echocardiography (sensitivity = 96%). There were 11 missed and 4 false positive diagnosis (specificity = 98%), all of them were vascular anomalies. Intracardiac anatomy and segmentary alignment were always correctly identified. The 21 cardiovascular anomalies operated without cardiac catheterization were correctly diagnosed. In 16 patients (12%) a management plan could not be established only on clinical echocardiographic grounds and, in another patient, the plan was incomplete. In the remaining 115 patients (87%) the management plan was correct and complete. CONCLUSIONS: The clinical-echocardiographic study allows: 1) an excellent anatomo-functional evaluation of the heart and great vessels, 2) surgical repair of some selected cardiovascular anomalies without previous cardiac catheterization.

[Echocardiographic evaluation of simple transposition of great vessels subjected to physiologic correction]. / Avaliação ecocardiográfica da transposição simples dos grandes vasos sujeita a correcção fisiológica.

The aim of the present study was to evaluate the cardiovascular morphology after Senning's operation for transposition of the great vessels (TGV) using Döppler-echocardiography. The study included 25 patients (pts) aged 17 to 127 months (mean = 60 +/- 27) who were evaluated 6 to 112 months (mean = 42 +/- 27) after surgery. The following parameters were analysed: right (RV) and left ventricular (LV) morphology and function; tricuspid regurgitation and its severity; caval and pulmonary venous pathways and the presence of pulmonary stenosis, its type and severity. All the 25 pts had an abnormal end-systolic interventricular septal (IVS) configuration, with left convexity in 22 (88%) and a flat septum present in 3 (12%). The LV fractional shortening (FS) ranged from 25 to 60% (mean = 41 +/- 10) and the preejection/ejection time ratio (PET/ET) from 0.18 to 0.33 (mean = 0.24 +/- 0.04). The RV mean FS ranged from 23.0 to 32.5% (mean = 26.9 +/- 3.0) and PET/ET from 0.27 to 0.46 (mean = 0.38). The RV wall motion study revealed that the IVS was hypokinetic in 3 pts (12%), akinetic in 19 (76%) and dyskinetic in 3 (12%). Three pts also had an hypokinetic antero-apical segment. TR was detected in 22 (88%) pts being trivial in 16 (64%), mild in 4 (16%) and moderate in 2 (8%). It was always possible to visualise the neo left and right atria as well as the caval-right atrial junctions. No systemic or pulmonary venous obstruction was detected. In 3 pts there was a mild subpulmonic dynamic stenosis related with septal buldging and mitral valve apposition. In conclusion, Döppler-echocardiography can provide accurate information for the follow-up of patients with TGV submitted to physiological correction and it can reduce the number and frequency of late postoperative cardiac catheterization.

Proceedings: Echocardiology.

Any technique which allows "a look inside the body" without being invasive, affords major diagnostic possibilities. The application of ultrasound offers this possibility now. The purpose of this paper is to review the current status of this relatively new diagnostic method for the detection and quantification of many cardiac disorders and to outline its usefulness. It may be said that echocardiology offers "the ideal diagnostic method" of the future, particularly when one considers the low cost-benefit ratio in comparison with other diagnostic methods such as angiocardiography.