Influence of Echocardiographic Guidance on Positioning of the Buttoned Occluder for Transcatheter Closure of Atrial Septal Defects

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73381/1/j.1540-8175.1996.tb00878.x.pd

Echocardiographic evaluation of atrioventricular orifice anatomy in children with atrioventricular septal defect

AbstractIn atrioventricular (AV) septal defect, the common AV valve can have a common orifice or can be divided by bridging leaflet tissue into two separate orifices. To determine the accuracy of a two-dimensional echocardiographic technique devised specifically for evaluation of the number of AV valve orifices, all 69 children undergoing surgical repair of AV septal defect from April 1987 to August 1999 were examined prospectively. The presence of bridging leaflet tissue and the number of AV valve orifices were determined with use of a subcostal imaging plane. From a standard subcostal four-chamber view, the plane of sound was rotated 30 ° to 45 ° clockwise until the AV valve was seen en face. The plane of sound was then tilted from a superior to an inferior direction so that cross-sectional views of the AV valve were examined from the inferior margin of the atrial septum to the superior margin of the ventricular septum.Of the 69 patients, 6 (9%) were excluded because the appropriate subcostal images were not obtained (in 3 because of obesity and in 3 as a result of operator failure). The remaining 63 children, ranging in age from 1 day to 13.5 years and in weight from 1 to 55 kg, constituted the study group. Echocardiographic results were compared with surgical observations in 62 patients and with autopsy findings in 1 patient.With the two-dimensional echocardiographic technique, 32 of 33 patients with a common orifice and 28 of 30 patients with two separate AV valve orifices were correctly identified. By chi-square analysis, the echocardiographic technique allowed correct identification of a common orifice valve with 94% sensitivity and 97% specificity. For correct identification of two separate orifices, the echocardiographic technique had 97% sensitivity and 94% specificity. The positive predictive value of the echocardiographic technique was 97% for a common orifices and 93% for two separate orifices. Thus, in patients with AV septal defect, the presence of bridging leaflet tissue and the number of AV valve orifices can be accurately determined with use of a subcostal two-dimensional imaging plane

Echocardiographic evaluation of atrioventricular orifice anatomy in children with atrioventricular septal defect

AbstractIn atrioventricular (AV) septal defect, the common AV valve can have a common orifice or can be divided by bridging leaflet tissue into two separate orifices. To determine the accuracy of a two-dimensional echocardiographic technique devised specifically for evaluation of the number of AV valve orifices, all 69 children undergoing surgical repair of AV septal defect from April 1987 to August 1999 were examined prospectively. The presence of bridging leaflet tissue and the number of AV valve orifices were determined with use of a subcostal imaging plane. From a standard subcostal four-chamber view, the plane of sound was rotated 30 ° to 45 ° clockwise until the AV valve was seen en face. The plane of sound was then tilted from a superior to an inferior direction so that cross-sectional views of the AV valve were examined from the inferior margin of the atrial septum to the superior margin of the ventricular septum.Of the 69 patients, 6 (9%) were excluded because the appropriate subcostal images were not obtained (in 3 because of obesity and in 3 as a result of operator failure). The remaining 63 children, ranging in age from 1 day to 13.5 years and in weight from 1 to 55 kg, constituted the study group. Echocardiographic results were compared with surgical observations in 62 patients and with autopsy findings in 1 patient.With the two-dimensional echocardiographic technique, 32 of 33 patients with a common orifice and 28 of 30 patients with two separate AV valve orifices were correctly identified. By chi-square analysis, the echocardiographic technique allowed correct identification of a common orifice valve with 94% sensitivity and 97% specificity. For correct identification of two separate orifices, the echocardiographic technique had 97% sensitivity and 94% specificity. The positive predictive value of the echocardiographic technique was 97% for a common orifices and 93% for two separate orifices. Thus, in patients with AV septal defect, the presence of bridging leaflet tissue and the number of AV valve orifices can be accurately determined with use of a subcostal two-dimensional imaging plane

Aortopulmonary Window with Interrupted Aortic Arch and Pulmonary Artery Sling: Diagnosis by Echocardiography and Magnetic Resonance Imaging: Case Report and Literature Review

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71570/1/j.1540-8175.1999.tb00796.x.pd

Transient atrioventricular block resulting from left ventricular angiography in infants with ventricular septal defect

Conduction disturbances often occur with manipulation of catheters within the atria or ventricles during cardiac catheterization.1,2 Catheter movement may induce transient right or left bundle branch block, or complete heart block in patients with or without preexistent bundle branch block.3-6 To our knowledge, however, there have been no previous reports of complete heart block resulting from an intramyocardial stain in the region of the atrioventricular (AV) conduction system. This report describes 2 infants who developed transient complete heart block following injection of contrast medium in the left ventricle. In each, complete heart block resulted from the intra-myocardial injection of contrast medium in the region of the AV conduction system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27865/1/0000278.pd

Left ventricular ejection fraction measured with Doppler color flow mapping techniques

To determine if left ventricular (LV) ejection fraction (EF) can be accurately measured from the color Doppler examination, 11 patients (aged 0.4 to 22 years) underwent 2-dimensional and color Doppler examinations within 24 hours of cardiac catheterization. With use of a biplane Simpson's rule, LV end-diastolic volume, endsystolic volume and EF were measured from cineangiograms, 2-dimensional echocardiograms and color Doppler examinations. The 2-dimensional echocardiographic and color Doppler measurements were obtained from apical 4-chamber and long-axis views. The color Doppler examinations were performed by placing the color sector over the left ventricle only. The velocity scale was set at the lowest possible Nyquist limit (<0.17 m/s), and the highest possible carrier frequency was used to obtain this limit. With these settings, all flow signals in the LV chamber were aliased so that the entire chamber was filled with mosaic color Doppler signals. Motion of the surrounding LV walls gave rise to nonaliased (pure red-blue) signals. With use of an off-line analysis system equipped with a color frame grabber, the border of the mosaic color flow area was traced to obtain volumes and EF. End-diastolic and endsystolic volumes measured with color Doppler correlated well with those measured from 2-dimensional echocardiography (r = 0.99, standard error of the estimate [SEE] = 11.9 ml; R = 0.99, SEE = 4.4 ml, respectively) and cineangiography (r = 0.92, SEE = 16.8 ml; R = 0.90, SEE = 9.9 ml, respectively). Similarly, EF derived from color Doppler correlated extremely well with that measured from 2-dimensional echocardiography (r = 0.99, SEE = 1.6%) and cineangiography (r = 0.96, SEE = 3.4%). Thus, EF can be accurately measured from the color Doppler examination. With the addition of automatic edge-detecting algorithms, this technique has the potential for providing a quick and automatic on-line calculation of EF.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29166/1/0000211.pd

Doppler assessment of pulmonary artery flow patterns and ventricular function after the Fontan operation

To assess the relation between ventricular systolic and diastolic function and pulmonary artery (PA) flow patterns after the Fontan operation, 15 postoperative patients were prospectively evaluated with echocardiography. Blood flow velocities in the PA were recorded with pulsed Doppler echocardiography. Ejection fraction was measured by 2-dimensional echocardiography using Simpson's rule. Indexes of diastolic function were measured from the systemic atrioventricular valve inflow Doppler and included peak E and A velocities, peak filling rate normalized for stroke volume, the fractions of filling in early and late diastole (E and A area fractions), and the E/A velocity and area ratios. Compared with 15 age-matched control subjects, the 15 patients who had undergone the Fontan procedure had decreased peak E velocity (0.65 +/- 0.20 vs 0.87 +/- 0.10 m/s), decreased E/A velocity ratio (1.29 +/- 0.23 vs 1.98 +/- 0.46), decreased normalized peak filling rate (6.09 +/- 0.90 vs 6.81 +/- 0.83 s-1), decreased E area fraction (0.63 +/- 0.09 vs 0.72 +/- 0.07), increased A area fraction (0.37 +/- 0.07 vs 0.24 +/- 0.06), and decreased E/A area ratio (1.77 +/- 0.45 vs 3.33 +/- 1.15) (p < 0.05). These diastolic filling abnormalities are consistent with impaired ventricular relaxation and decreased early diastolic transvalvular pressure gradient. PA Doppler recordings showed 2 distinct patterns of flow. Pattern I, observed in 9 patients, showed biphasic forward flow with peak velocities in mid to late systole and middiastole. Pattern II, observed in the remaining 6 patients, showed decreased systolic forward flow, a late systolic to early diastolic flow reversal, and delayed onset of diastolic forward flow. Compared with pattern I patients, pattern II patients had no significant differences in any of the Doppler indexes of diastolic function; however, pattern II patients had a significantly tower ejection fraction (43 +/- 9 vs 57 +/- 5%). Thus, many patients undergoing the Fontan procedure have impaired ventricular relaxation, but, in the presence of a normal ejection fraction, biphasic forward PA flow is maintained. With the development of decreased ejection fraction, atrial systolic filling pressures are likely increased, the ventricular suction effect is decreased, and PA flow is diminished or absent in systole and early diastole.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29071/1/0000106.pd

Long-term assessment of right ventricular diastolic filling in patients with pulmonic valve stenosis successfully treated in childhood

Patients with severe pulmonic stenosis (PS) have right ventricular (RV) diastolic filling abnormalities detectable by tricuspid valve pulsed Doppler examination. To determine if these abnormalities persist long term after successful therapy of PS, 19 patients were examined 8 +/- 3 years after PS therapy. At the time of follow-up Doppler examination, the PS gradient was 15 +/- 8 mm Hg. From the tricuspid valve inflow Doppler study, the following measurements were obtained at peak inspiration: peak velocities at rapid filling (peak E) and during atrial contraction (peak A), ratio of peak E to peak A velocities, RV peak filling rate normalized for stroke volume, deceleration time, the fraction of filling in the first 0.33 of diastole as well as under the E and A waves, and the ratio of E to A area. Data from PS follow-up patients were compared with our previously reported data from 12 age-related control subjects and 14 untreated patients with PS. Patients with PS who were followed up had higher peak E velocity (0.75 +/- 0.14 vs 0.59 +/- 0.21 m/s), lower peak A velocity (0.47 +/- 0.09 vs 0.64 +/- 0.28 m/s), higher E/A velocity ratio (1.65 +/- 0.33 vs 1.11 +/- 0.52), higher 0.33 area fraction (0.52 +/- 0.08 vs 0.34 +/- 0.14), lower A area fraction (0.29 +/- 0.06 vs 0.45 +/- 0.21) and higher E/A area ratio (2.48 +/- 0.82 vs 1.73 +/- 1.05) than PS patients without treatment (p < 0.03). All Doppler indexes of the patients with PS who were followed up were the same as those of the control subjects except for the peak E velocity that was slightly higher (0.75 +/- 0.14 vs 0.63 +/- 0.11 m/s), the peak A velocity that was slightly higher (0.47 +/- 0.09 vs 0.38 +/- 0.09 m/s) and the E/A area ratio that was slightly lower (2.48 +/- 0.82 vs 3.50 +/- 1.25) (p < 0.03). Thus, at long-term follow-up, all RV diastolic filling indexes in successfully treated patients with PS improved compared with the untreated patients and approached values found in normal subjects. These data suggest that RV diastolic filling abnormalities in patients with PS are reversible over the long term and are therefore probably related to hypertrophy rather than fibrosis and scarring.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29164/1/0000209.pd

The Abnormal Contralateral Atrioventricular Valve in Mitral and Tricuspid Atresia in Neonates: An Echocardiographic Study

Abnormalities of the mitral valve (MV) or the tricuspid valve (TV) morphology and/or function in patients with functional single ventricle may result in early morbidity and death. The purpose of this study was to determine the incidence of contralateral atrioventricular valve (AVV) pathologies in mitral valve atresia (MA) and tricuspid valve atresia (TA). We retrospectively reviewed the echocardiographic data of 50 neonates with MV and 20 with TA. Appearance of the papillary muscles, chordae tendinae, and valve leaflets was assessed. AVV regurgitation was semiquantitated by color-flow Doppler and the AVV annulus diameter was measured and indexed to body surface area. MV abnormalities were found in 9 of 20 (45%) of patients with TA. The MV was myxomatous in 9 patients, the leaflets were redundant in 5 patients, and prolapsing occurred in 4 patients. Mild regurgitation was found in 2 patients. In 18 of 20 (90%) patients MV annulus size was larger than 95% of predicted normal values. TV abnormalities were found in 12 of 50 (24%) patients with MA. The TV was myxomatous in 4 patients, prolapsing in 2, and redundant in 3, and moderate TV regurgitation was found in 3 patients. In 29 of 50 (58%) patients TV annulus size was larger than 95% of predicted normal values. Contralateral AVV abnormalities in tricuspid and mitral valve atresia are common and should be assessed carefully before surgical procedures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42381/1/246-20-3-200_20n3p200.pd