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Publications and source records attributed to G Satomi.
In a 48-year-old woman, the diagnosis of a right coronary arteriovenous fistula communicating with the coronary sinus was made noninvasively using two-dimensional, pulsed and color Doppler echocardiography. These noninvasive techniques were superior to angiography in delineating the cardiac chamber into which the fistula emptied.
We analyzed hemodynamic variables in patients with transposition of the great arteries with intact ventricular septum (simple transposition) after pulmonary artery banding and Blalock-Taussig anastomosis to establish the criteria for two-staged arterial switch operation. The study included 35 patients who underwent the switch operation after banding and anastomosis; two died shortly after surgery, and one died of tachycardia 31 days after the operation. The left-to-right ventricular pressure ratio was above 0.83 in all surviving patients, 0.68 and 0.63 in the two operative deaths, and 0.84 in the other death. In the 32 surviving patients, angiographically determined left ventricular (LV) end-diastolic volume and ejection fraction averaged 147 +/- 46(SD)% of normal and 0.64 +/- 0.12, respectively. We also measured LV mass using angiographic LV semiaxes and end-diastolic LV posterior wall thickness obtained from an echocardiogram. These variables of the patients who died were not different from those of the surviving patients. The wall thickness was greater than 4 mm in the surviving patients, while it was 3.5 mm in the two patients who died early and 5 mm in the patient who died later. From the semiaxes, the wall thickness, and aortic diastolic pressure, all of which were obtained before the anatomic repair, we calculated the predictive LV wall stress. This wall stress would indicate the LV wall stress at the time of aortic valve opening immediately after the arterial switch operation. Predictive wall stress was less than 120 x 10(3) dynes/cm2 in all but one of the surviving patients, whereas it was 151, 153, and 186 x 10(3) dynes/cm2 in the three patients who died.(ABSTRACT TRUNCATED AT 250 WORDS)
Echocardiographic left ventricular (LV) dimensions in patients with complete transposition of the great arteries (TGA's) were measured before and after the Jatene procedure and/or pulmonary artery banding (PAB). The LV posterior wall thickness at end-diastole (LVPWTD) increased from 3.5 +/- 0.4 to 4.9 +/- 0.9 mm (mean +/- 1SD) (p less than 0.01) after PAB, but it did not show a significant change following the Jatene procedure (from 4.5 +/- 1.0 to 5.3 +/- 0.8 mm). The LV end-diastolic internal dimension (LVIDD) increased from 17.7 +/- 4.0 to 22.6 +/- 6.5 mm after PAB (p less than 0.01), but remained unchanged after the Jatene procedure (from 24.5 +/- 5.0 to 25.0 +/- 3.0 mm). The LV shortening fraction (LVSF) decreased from 0.62 +/- 0.10 to 0.47 +/- 0.14 after PAB (p less than 0.01), but remained unchanged after the Jatene procedure (0.40 +/- 0.10 to 0.37 +/- 0.10). the a/b ratio at end-systole: (a/b)s, which indicates the flatness of the LV configuration, increased from 0.27 +/- 0.14 to 0.60 +/- 0.21 after PAB (p less than 0.01) and from 0.61 +/- 0.13 to 0.74 +/- 0.17 after the Jatene procedure (p less than 0.01). The data obtained became stable 1 month after operation. One patient died of low cardiac output with no evidence of myocardial infarction after the Jatene procedure. In this patient, LVPWTD was 5.7 mm, LVIDD was 26 mm, LVSF was 0.71 and the (a/b)s ratio was 0.55.(ABSTRACT TRUNCATED AT 250 WORDS)
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Identification of the azygos or hemiazygos connection is important in the diagnosis of congenital heart disease, especially in cases of the polysplenia syndrome. Although two-dimensional echocardiographic observation of this anomaly has been reported, the direct visualization of drainage sites is still rather difficult. A method for visualizing the azygos or hemiazygos connection by a combined use of two-dimensional and pulsed and color Doppler echocardiography was reported here. Subjects consisted of 10 patients with the polysplenia syndrome, each of whom had been confirmed as having the azygos or hemiazygos connection; five each of the azygos and hemiazygos types. The transducer was placed over the second intercostal space on the right side for the azygos, and on the left side for hemiazygos connection. The two-dimensional echocardiographic plane was adjusted to visualize the long-axis view of the superior vena cava; the right superior vena cava for the azygos and the left superior vena cava for the hemiazygos connection. The mode of the equipment was changed to color Doppler, and an orange-colored blood flow toward the transducer, draining into the superior vena cava was carefully sought. Finally the pulsed Doppler mode was selected and the sampling volume was set in the orange-colored area. The wave form of the pulsed Doppler echocardiogram of the azygos or hemiazygos vein potentially had two peaks per cardiac cycle, and was modified by respiration. We found azygos or hemiazygos veins coursing from the posterior aspect of the right pulmonary artery in seven of 10 cases by two-dimensional echocardiography alone, while we observed all veins by the additional use of color and pulsed Doppler echocardiography.
Continuous wave (CW) Doppler ultrasound has facilitated accurate estimates of pressure gradient (PG) across a stenotic valve. However, the severity of stenosis cannot be assessed using PG alone because it is dependent on actual flow across the valve. In this study, Doppler techniques were used to predict PG and aortic valve areas (AVA) in adults with aortic stenosis (AS). Fifty-four adult patients undergoing cardiac catheterization for suspected AS were prospectively evaluated. There were 28 men and 26 women, who ranged in age from 25 to 68 years with a mean of 56 years. These Doppler ultrasound studies were performed using a 2 MHz transducer and an Aloka SSD-730. With CW Doppler ultrasound, the highest velocities of the aortic jet were recorded from an apical approach. Left ventricular outflow flows were recorded about 1.0-1.5 cm below the aortic annulus using high PRF. Doppler waveforms were analyzed for the AT/ET (AT: acceleration time, ET: ejection time), and Doppler PG was calculated from the maximum velocity (V) of the aortic jet based on a modified Bernoulli equation (PG = 4V2), and aortic valve area was obtained using the continuity equation-(AVA = left ventricular outflow tract stroke volume divided by AS jet velocity integral). These data were compared with hemodynamic data obtained from cardiac catheterization. The following results were obtained: 1. In eight patients with substantial aortic regurgitation, whose maximum catheter PG were from 20 to 45 mmHg, the AT/ET was less than 0.30. The ratio of AT/ET correlated with the peak velocity of the aortic jet (r = 0.88) and the maximum PG (r = 0.87) obtained from cardiac catheterization. 2. In 46 patients with AS, the maximum PG by CW Doppler showed an excellent correlation with maximum catheterization PG (r = 0.97, SEE 6 mmHg), and the mean PG as calculated by the two techniques also disclosed a good correlation (r = 0.97, SEE 5.4 mmHg).(ABSTRACT TRUNCATED AT 400 WORDS)
The clinical characteristics and prognosis of 16 cases of mitral regurgitation (MR) secondary to Kawasaki disease (KD) were studied, and its pathogenesis was discussed. The observation period ranged from 3 years and 17 months to 15 years. Six of the 16 patients died, and 10 are alive. MR has disappeared spontaneously in 2 of these survivors. Thirteen of the 16 patients were male and 3 were female, there being a predominance in male, which is a striking contrast to rheumatic mitral regurgitation which is predominant in females. The age at the time of diagnosis ranged from 3 months to 7 years. The appearance time of MR showed two different patterns, one with early onset within a few weeks to one month after affliction with KD and the other with MR developing months or years later during the course of the follow-up. The cardiothoracic ratio was greater in those who had a progressively downhill course, and whose sigma RV1-6 decreased with time course. This was considered to be due to the decrease of the remaining functioning myocardial mass. The outcome of the patients with a severe degree of coronary arterial stenosis and occlusion observed on the coronary angiogram was poor. The prognosis of the patients with severe left coronary arterial stenosis was especially poor. MR due to KD is regarded as a new clinical entity, and its pathogenesis is thought to be due to ischemia, papillary muscle dysfunction, coronary angitis, myocardial failure and valvulitis. Incidence of MR will increase when examined by Doppler echocardiography especially in the acute stage. Our experience as well as that of others indicates the presence of valvulitis, myocarditis or left ventricular dilatation leading to MR in the acute stage.
This study verified the usefulness of two-dimensional (2-D) and pulsed Doppler echocardiography (PDE) in the diagnosis of tricuspid stenosis (TS), and estimated the diastolic pressure gradient (PG) across the tricuspid valve (TV). Fifty-two patients with rheumatic mitral stenosis showing a decreased EF slope of the TV less than 40 mm/sec were studied. All patients underwent cardiac catheterization, and the mean diastolic pressure gradients (PG) across the TV were calculated with simultaneous recordings of right atrial and ventricular pressures. Based on surgical findings, all patients were categorized as the TS group consisting of 10 patients with TS (mean PG less than or equal to 5.0 mmHg; seven patients, greater than 5.0 mmHg; three patients), and the non-TS group consisting of 42 patients without TS. In three patients with PG exceeding 5 mmHg, the TV disclosed typical commissural fusions between the leaflets. 1. 2-D echocardiography The diagnosis of TS was made by recording diastolic doming and thickening of the TV in the parasternal long-axis and apical 4-chamber views. Among the 52 patients, 2-DE detected stenosis in all 10 patients with TS, for a sensitivity of 100%, while excluding TS in 40 of 42 patients without TS for a specificity of 95%. 2. Pulsed Doppler echocardiography The transtricuspid flow velocity in diastole was recorded from the apical window.(ABSTRACT TRUNCATED AT 250 WORDS)
We observed the blood flow profile in the right ventricular inflow tract through the tricuspid valve using the newly-developed equipment which images by instantaneous B-mode and multi-channel Doppler echocardiography. The Doppler system had 64 sampling gates in an ultrasonic beam within a depth of 13 cm. A cursor line was set at an angle of 45 degrees to the tricuspid annulus on two-dimensional echocardiography in a parasternal long-axis view of the right atrium and right ventricle. The blood flow velocity was displayed on the vertical line on the left-side of the CRT image. All Doppler-shifted frequencies of the 64 channels were analyzed using a fast Fourier transform formula by a built-in processor. The Doppler-shifted frequency was displayed at 30 frames per sec. The study subjects consisted of 20 children without cardiac anomalies. Their ages ranged from 2 to 18 years. A typical blood velocity profile at the tricuspid valve ring during the rapid filling phase had an "M" shape, i.e., the velocity was greater at both margins than in the central portion, followed by a flat profile. A small retrograde flow was observed behind the posterior tricuspid leaflet at this time. The flow velocity decreased in mid-diastole, then increased again during the atrial contraction period, with either flat or parabolic profile. During inspiration, the velocity was greater and the shape of the flow profile throughout diastole tended to be flat. In systole, a slow antegrade flow was observed in the tricuspid valve ring area, and its flow profile was parabolic.(ABSTRACT TRUNCATED AT 250 WORDS)
A new method of defining regional mechanical work done by a unit volume of myocardium of the ventricular wall and evaluating regional cardiac function is proposed. This method uses the relationship between mean wall stress (sigma) and the natural logarithm of the reciprocal of wall thickness (ln(1/H)). 1/H at a point on the epicardial surface is proportional to the regional area (A) of the ventricular wall containing that point. The value for regional work obtained from the relationship between the sigma and ln A or sigma and ln(1/H) has a true dimension of work, i.e., [J/m3]. The sigma-ln(1/H) relationship was studied in ten anesthetized dogs. Wall thickness and internal diameter of the left ventricle were measured with ultrasonic dimension gauges. Regional work per unit volume of myocardium multiplied by the total myocardial volume of the left ventricle correlated well with the total mechanical work of the entire left ventricle calculated from the pressure-volume relationship during pressure loading, contractility change, and volume loading. During pressure loading, the end-systolic sigma-ln(1/H) relationship showed linearity. After bolus injection of isoproterenol the sigma-ln(1/H) loop shifted to the left. We concluded that the sigma-ln(1/H) relationship provides a method of characterizing regional function normalized to the unit volume of myocardium. In addition, our methods have a potential for echocardiographic application.
We observed instantaneous blood flow velocity profiles at the right and left ventricular outflow tracts, the ascending aorta, and the lower thoracic aorta in human subjects using a newly devised method of real-time multichannel Doppler echocardiography. In 20 apparently healthy subjects, the blood flow velocity profile was successfully obtained in all cases at the right and left ventricular outflow tracts--in 13 cases at the ascending aorta, in 12 cases at the aortic arch, and in ten cases at the lower thoracic aorta. The configuration of the profile was almost flat during systole at the left ventricular outflow tract, the ascending aorta, and the descending aorta. The profile was triangular at the right ventricular outflow tract, where the velocity was faster at the ventricular septal side than at the free wall side, and it was also triangular at the aortic arch, where the velocity was faster at the inner side of the arch than at the outer side. These observations were very similar to those reported by others in previous experimental studies. Thus, the present study demonstrates that it is possible to record noninvasively the instantaneous blood flow velocity profile in humans using this new Doppler echocardiographic instrument.
Ten patients with total and one with partial anomalous pulmonary venous connection were studied by two-dimensional Doppler color flow-mapping echocardiography. In cases of anomalous pulmonary venous drainage into the innominate vein through the vertical vein, flow away from the transducer was detected in the echo space behind the atria in the subxiphoid four-chamber approach. In the suprasternal approach, flow toward the transducer was detected at the junction of the vertical and innominate veins. In the case of an anomalous pulmonary vein connecting directly into the superior vena cava, an area of flow toward the transducer, which was triangular in shape, was detected in the dilated superior vena cava. In the two cases in which the pulmonary vein drained into the coronary sinus, the flow toward the transducer was observed at the ostium of the coronary sinus in the subxiphoid four-chamber view, and it appeared as if the blood flow was emerging from this point. In a case of the paracardiac type of total anomalous pulmonary venous connection with drainage into the posterior wall of the right atrium, the flow toward the transducer occurred higher in the right atrium than in the cases with drainage into the coronary sinus. In a case with the infradiaphragmatic type of total anomalous pulmonary venous connection, continuous flow toward the transducer, which passed through the diaphragm in an anomalous vessel, was detected from the subxiphoid area. The downward flow in the anomalous vessel changed to an upward flow at the site of drainage into the hepatic vein.(ABSTRACT TRUNCATED AT 250 WORDS)
The morphology of the central pulmonary artery was studied by selective angiography in 21 previously unoperated patients (aged 11 days-21 years, median 4 years) with pulmonary atresia associated with various types of congenital heart disease. Angiographic findings were confirmed at operation in 10 patients. There was juxtaductal obstruction of the left pulmonary artery in two thirds of the patients with complete atresia in a quarter. Six of seven patients without juxtaductal obstruction had pulmonary valve atresia, but all nine patients with juxtaductal stenosis had truncal atresia. No patient had stenosis of the right pulmonary artery.
We analyzed blood flow pattern in the interatrial communication in 24 patients with complete transposition of the great arteries (TGA). Eight had TGA with atrial shunt (group 1), nine had TGA with patent ductus arteriosus or ventricular septal defect (group 2), and seven had pulmonary arterial banding and Blalock-Taussig shunt (group 3). The flow pattern was determined at the site of atrial septal defect by Doppler echo beam directed as perpendicular to the septum as possible. The flow pattern was composed of a left-to-right (L-R) flow and right-to-left (R-L) flow. The turning point (T1) from the R-L to L-R flow occurred immediately after the initiation of the QRS on the electrocardiogram and was common in all groups. The other turning point (T2) from L-R to R-L occurred after the second heart sound (S2). The S2-T2 interval decreased on inspiration, indicating prolongation of the period of R-L flow. The minimum S2-T2 interval ranged from 20 to 70 (mean +/- SD 50 +/- 18) msec in group 1, from 70 to 130 (114 +/- 25) msec in group 2, and from 50 to 138 (75 +/- 29) msec in group 3. The maximum S2-T2 interval ranged from 48 to 110 (88 +/- 21) msec in group 1, from 140 to 235 (175 +/- 36) msec in group 2, and from 80 to 170 (111 +/- 30) msec in group 3.(ABSTRACT TRUNCATED AT 250 WORDS)
Seventy patients with bioprosthetic mitral valve were examined to study the applicability of the Doppler techniques including pulsed, continuous wave and color Doppler echocardiography in diagnosing and evaluating the severity of prosthetic valve dysfunction. The study population consisted of 70 patients who underwent mitral valve replacement (45 patients with Hancock valve, 13 with Angell-Shiley valve, 10 with Carpentier-Edwards valve). The dysfunctions were transvalvular regurgitation in 20 instances and paravalvular regurgitation in three, all of which were confirmed at surgery. A control group of 47 patients with the normally functioning porcine prosthetic mitral valve were also studied. Diastolic transmitral flow patterns were recorded from parasternal and apical approaches using color Doppler echocardiography, and the direction of the flow was definitely identified on the flow image. Transmitral flow signals spread from the mitral orifice to the mid-portion of the interventricular septum, and its direction was perpendicular toward the mitral ring in all cases. Flow velocity patterns in the left ventricle and atrium were recorded in the apical long-axis view of the left ventricle or apical four-chamber view using pulsed (high pulse repetition frequency) and continuous wave Doppler techniques. Two dynamic alterations in patients with the porcine mitral valve were evaluated from 1) the peak velocity and pressure half time (PHT) of transmitral flow in early diastole, and 2) the regurgitant jet in the left atrium indicating transvalvular or paravalvular regurgitation. The results were as follows: 1. Normally functioning porcine mitral valves were characterized by peak velocities (PV) less than or equal to 1.82 (mean +/- SD 1.44 +/- 0.27) m/sec and PHT less than or equal to 180 (mean +/- SD: 135 +/- 30) msec. In 23 patients with prosthetic valve dysfunction documented at surgery, peak velocity (mean +/- SD 2.23 +/- 0.19 m/sec) was significantly greater (p less than .001) than that of patients in the normally functioning prosthetic valves, and PHT ranged from 135 to 340 msec (mean +/- SD: 226 +/- 81 msec). 2. Among the 23 patients with porcine valve dysfunction, a harmonic striped pattern were recorded at the mitral valve levels in eight patients. All these patients had a musical murmur, and their peak velocity was more than 2.0 m/sec, but the PHT was less than 180 msec in seven patients. In these patients, valvular tears without calcification were confirmed at surgery.(ABSTRACT TRUNCATED AT 400 WORDS)
Two-dimensional echocardiographic examinations were performed for 86 patients with the hypoplastic right heart syndrome (55 cases of tricuspid atresia, 9 of pure pulmonary stenosis and 22 of pure pulmonary atresia). Prolapse of the anterior mitral leaflet was detected in 14 patients (16.3%). Four of these 14 patients had mitral regurgitation. Among the patients with mitral valve prolapse, ruptured chordae tendineae of the mitral valve were detected in two, and elongation of the chordae in one. There were no significant relationships between the incidence of mitral valve prolapse and sex, age, type of tricuspid atresia, previous palliative surgery, or PaO2. However, one patient with pure pulmonary stenosis, who had had mitral valve prolapse without mitral regurgitation, developed mitral regurgitation several months after undergoing a Blalock-Taussig shunt operation. The mechanism responsible for mitral valve prolapse in the hypoplastic right heart syndrome is not clear. Multiple factors, such as long-standing left ventricular volume overload, hypoxic myocardial damage, and anatomical chordal abnormalities may cause mitral valve prolapse. The presence of a mitral valve abnormality has an important bearing on the natural history as well as the surgical procedure of choice. The need for careful echocardiographic examinations to detect mitral valve abnormalities in the hypoplastic right heart syndrome is thus underscored.
Membranous tricuspid atresia with right ventricular dysplasia and absent pulmonary valve is a very rare complex, and a unique type of tricuspid atresia. Three cases with this condition were presented with the echocardiographic evaluation. Two-dimensional echocardiography was performed in all patients, pulsed Doppler echocardiography in two, and contrast echocardiography in two patients. The echocardiographic findings characteristic of this complex were as follows: In the four chamber view, the interatrial and interventricular septa were aligned, and tricuspid valve atresia was of the membranous type. In the four-chamber view, the right ventricular wall was thin, irregular in shape, and it protruded aneurysmally into the left ventricular outflow tract. With systemic venous contrast echocardiography, the right ventricular cavity was opacified with contrast, four to five cardiac cycles after the appearance of contrast in the left ventricle. With pulsed Doppler echocardiography at the main pulmonary artery, antegrade flow was observed in ventricular systole, and retrograde flow in diastole. We conclude that these echocardiographic findings are useful in recognizing the morphology and hemodynamics of this complex.
A two-dimensional echocardiographic (2-DE) method of segmental approach for diagnosis of congenital heart disease is presented. Firstly, the visceroatrial situs is determined, i.e., whether it is solitus, inversus, or ambiguous, by identifying the inferior vena cava to right atrium junction. Secondly, it is ascertained whether the ventricular loop is D-loop or L-loop. The ventricular loop is determined by identifying the internal structure of the right and left ventricles by 2-DE. Thirdly, the spatial relationships of the great arteries are determined by identifying the pulmonary artery and aorta. The pulmonary artery is identified by its branches, and the other artery is the aorta. Fourthly, the atrioventricular connection is determined as follows: (1) usual alignment, (2) criss-crossing, (3) straddling, (4) double inlet, and (5) unilateral atrioventricular valve atresia, by using an apical four-chamber echo view. Finally, the ventriculo-great arterial relationship is determined from the apical four-chamber echo view with a tilting maneuver or by echocardiographic recognition of the existence of the fibrous continuities. Following this echocardiographic "five-step approach," hemodynamic considerations should be included, and by integrating all the information the diagnosis of congenital heart disease is completed.