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R A Foale

Publications and source records attributed to R A Foale.

69 records · Page 4Linked to original sources
PubMed1984

Pseudoaneurysm of the pulmonary artery after the banding procedure: two-dimensional echocardiographic description.

This report describes an infant with double-outlet right ventricle who underwent pulmonary artery banding as palliation for excessive left to right shunting through a ventricular septal defect. Three weeks after this procedure, there was abrupt clinical deterioration, and two-dimensional echocardiography clearly defined a large pseudoaneurysm arising from a breach in the posterior pulmonary artery wall, just proximal to the band. The diagnosis was confirmed at surgery, during which total correction was performed with successful outcome. The two-dimensional echocardiographic features of a pseudoaneurysm of the pulmonary artery are shown and the role of this noninvasive technique in the evaluation of pulmonary artery bands is discussed.

Aneurysm↗
PubMed1984

Clinical significance of incomplete tricuspid valve closure seen on two-dimensional echocardiography.

Incomplete closure of the tricuspid valve without apparent cusp disease was noted on two-dimensional echocardiography in 31 patients. This abnormality was defined as a failure of the tricuspid valve leaflet tips to reach the plane of the tricuspid valve anulus by at least 1 cm in the standard apical four chamber view at the point of maximal systolic closure. This resulted in a final systolic leaflet position deeper within the right ventricular cavity than is normally seen. The finding was present in the following diagnostic subgroups: Group A, pulmonary hypertension (11 patients); Group B, rheumatic heart disease (4 patients); Group C, dilated cardiomyopathy (9 patients) and Group D, previous myocardial infarction (7 patients). Right atrial, right ventricular and tricuspid anulus measurements were made and compared with those from a group of 67 normal subjects. The results were as follows: right atrial endsystolic area = 27.2 +/- 8.6 cm2 (normal = 13.4 +/- 2.0); right ventricular end-systolic area = 25.6 +/- 8.7 cm2 (normal = 10.9 +/- 2.9); right ventricular end-diastolic area = 31.5 +/- 9.1 cm2 (normal = 20.1 +/- 4.9) and tricuspid valve anular end-systolic dimension = 4.0 +/- 0.6 cm (normal = 2.2 +/- 0.3). The differences from the normal data were all statistically significant (p less than 0.001). Incomplete closure of the tricuspid valve, although a nonspecific diagnostic finding, is primarily associated with right-sided chamber enlargement. Tricuspid regurgitation may be present. The mechanism could be related to geometric changes in valve apparatus dynamics secondary to right-sided cardiac enlargement and tricuspid valve anular dilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Comparison of the echocardiographic and hemodynamic diagnosis of rheumatic tricuspid stenosis.

Two-dimensional echocardiography has proved to be reliable in the diagnosis of mitral, aortic and pulmonary stenosis. Its role in the diagnosis of rheumatic tricuspid stenosis is still being defined; therefore, the tricuspid valve echograms of 147 patients with rheumatic heart disease were examined. Thirty-eight of these patients also underwent hemodynamic evaluation. Tricuspid stenosis was defined echocardiographically as diastolic anterior leaflet doming, thickening and restricted excursion of the other two tricuspid leaflets and decreased separation of the leaflet tips. Using these criteria, the sensitivity and specificity of the echocardiogram in detecting tricuspid stenosis were 69 and 96%, respectively, in the group of 38 patients who had both echocardiographic and hemodynamic evaluations. However, when the smaller group of 17 patients who had simultaneous right atrial and right ventricular pressure recordings were considered separately, there was complete agreement between the echocardiographic and hemodynamic data. Thus, the two-dimensional echocardiogram is a sensitive and specific test for diagnosing rheumatic tricuspid stenosis. In addition, these data provided an opportunity to determine the prevalence of tricuspid stenosis in this group of patients with chronic rheumatic valvular disease. Tricuspid stenosis was present in 14 (9.5%) of the total group of 147 patients who had two-dimensional echocardiograms, and in 10 (26.3%) of the 38 who had both echocardiographic and hemodynamic studies. In patients with rheumatic heart disease about to undergo cardiac catheterization, an echocardiographic study should prove useful in making the diagnosis of tricuspid stenosis.

Adult↗
PubMed1984

Ventricular tachycardia of left bundle branch block configuration in patients with isolated right ventricular dilatation. Clinical and electrophysiological features.

Electrophysiological studies showed ventricular tachycardia in five patients (four male, one female) with isolated right ventricular dilatation. All had been asymptomatic before the onset of palpitation which had developed in adolescence or early adult life. Tachycardia had been associated with syncope in four patients, and three had been resuscitated from ventricular fibrillation before investigation. The electrocardiogram during ventricular tachycardia showed a left bundle branch block pattern, and endocardial mapping at electrophysiological study confirmed the right ventricular origin. The presenting tachycardia could be induced in all patients by programmed stimulation, and in three patients ventricular tachycardia of differing configuration could be induced, but the right ventricular origin and left bundle branch block pattern were maintained. In two patients ventricular tachycardia degenerated into ventricular fibrillation. Cineangiography, cross sectional echocardiography, and multigated radionuclide angiography confirmed the dilated abnormal right ventricle while indicating that left ventricular function was normal. On resting electrocardiograms T wave inversion over the right precordial leads was the sole abnormality. There were no signs of right heart failure and exercise tolerance was normal. Four patients have received maintenance treatment with antiarrhythmic drugs, and one had undergone operative mapping and ablative surgery. Thus ventricular tachycardia complicating right ventricular dilatation may be associated with serious symptoms and ventricular electrical instability; and in adults it may be suspected on clinical grounds by inverted T waves in the right precordial leads.

Adult↗
PubMed1984

Coronary artery aneurysms and Kawasaki's disease in an adult.

A 28 year old man had an acute myocardial infarction and was found to have coronary artery aneurysms. These may have been caused by a previous episode of Kawasaki's disease, an entity that should be considered in adults presenting with proximal discrete coronary artery aneurysms.

Adult↗
PubMed1984

Importance of temporal heterogeneity in assessing the contraction abnormalities associated with acute myocardial ischemia.

A number of recent two-dimensional echocardiographic studies have attempted to relate quantitative changes in short-axis left ventricular radial wall motion to underlying myocardial ischemia/infarction. The significance of temporal variation in the contraction sequence within these ischemic regions in the overall evaluation of segmental left ventricular dysfunction, however, remains undefined. To assess this, we examined the motion of 192 individual radii that intersected known ischemic segments at 16.7 msec intervals from end-diastole to end-systole. The studies were performed in 13 dogs 1 hr after acute coronary ligation (six of the left anterior descending and seven of the circumflex coronary artery). Zones of infarction were confirmed by triphenyltetrazolium chloride staining at the termination of the experiment and by a corresponding decrease of more than 75% in myocardial perfusion at the 1 hr sampling period. Dyskinesis (defined for each radius as negative or outward excursion relative to the end-diastolic reference on two consecutive fields) was noted along 168 of 192 radii (88%) at some point in the contraction sequence. The maximal outward or dyskinetic motion occurred most commonly in the fourth decile of the normalized contraction sequence. In 147 of the 168 dyskinetic radii (88%) the maximal outward motion occurred during the first half of systole while in only two radii in one animal was the maximal outward motion noted at end-systole. The total number of radii showing dyskinetic motion at any given point in the contraction sequence likewise varied with time. Although again the greatest number of radii showed abnormal motion during the fourth decile of the normalized contraction sequence, only 66 of 168 or 39% remained dyskinetic to end-systole. No relationship was observed between the point of maximal dyskinesis (time-weighted average of all dyskinetic radii for a given animal) and (1) the total number of radii showing dyskinesis, (2) the total number of radii within the infarct zone, or (3) the infarct area expressed as a percent of the slice area. The major factor determining persistence of dyskinesis to end-systole for any radius was the maximal outward motion of the endocardial segment at the point of maximal dyskinesis. Therefore, simple measurement of endocardial excursion from end-diastole to end-systole may fail to detect important wall motion abnormalities and, in some cases, may miss dyskinetic segments completely.

Acute Disease↗
PubMed1984

A comparison of quantitative echocardiographic methods for delineating infarct-induced abnormal wall motion.

Current echocardiographic methods for quantitating abnormal regional left ventricular wall motion rely primarily on changes in endocardial excusion from end-diastole to end-systole. Recent studies demonstrating important spatial and temporal heterogeneity in wall motion within ischemic regions, however, raise questions about the validity of this approach. To determine the optimal method for defining abnormal left ventricular wall motion, we used a canine preparation of acute experimental infarction to examine four quantitative methods of wall motion analysis. The circumferential extent of abnormal wall motion assessed by each method was compared with the circumferential extent of infarction (defined by triphenyltetrazolium chloride staining) and the circumferential extent of reduced transmural blood flow (determined by radiolabeled microsphere techniques) 6 hr after acute coronary occlusion. The following methods of quantitating abnormal wall motion were examined: (1) determination of end-diastolic to end-systolic endocardial excursion (less than 0.20 end-diastolic radius), (2) determination of the extent of maximal dyskinesis (systolic bulging), and (3) and (4) two derived correlation methods that consider the entire course of systolic radial motion by correlating the observed echocardiographic field-by-field (every 16.7 msec) motion of each of 36 evenly spaced endocardial targets with the course of normal motion established from pooled normal data. Results obtained with the correlation methods showed a better correlation with the triphenyltetrazolium chloride-defined circumferential extent of infarction (r = .87 and r = .78) than did determinations of reduced end-diastolic to end-systolic endocardial excursion (r = .35) or the extent of maximal dyskinesis (r = .37). Similarly, the best correlation with the extent of reduced flow was obtained with one of the correlation methods (r = .80). We conclude that correlation methods that "integrate" endocardial motion over the entire systolic contraction sequence provide better definition of ischemic left ventricular dysfunction than do methods that consider motion at only single points in time.

Acute Disease↗
PubMed1983

Detection of aortic porcine valve dysfunction by maximum entropy spectral analysis.

A high-resolution method of spectral analysis, of the class generally called "maximum entropy method," was used in a study of aortic porcine valve closing sounds in 37 patients (ages 19 to 76). Spectra from 27 normal xenografts, implanted from 2 weeks to 61 months previously, were characterized by a dominant frequency peak, F1, at 89 +/- 15 Hz (mean +/- SD), with a lower amplitude peak, F2, at 154 +/- 25 Hz. Eight of nine patients with aortic porcine valve dysfunction were proved surgically to have leaflet degeneration or infection and had either F1 (139 +/- 54 Hz) and/or F2 (195 +/- 74 Hz) significantly higher than normal (p less than .001). In two patients with paravalvar leak but no leaflet abnormality, F1 and F2 were in the normal range. Estimation of F1 and F2 was highly reproducible and was unaffected by duration of implant up to 5 years. Spectral analysis of aortic porcine valve closing sounds by the maximum entropy method may be useful for detection of intrinsic xenograft dysfunction.

Adult↗
PubMed1982

Congenital aneurysms of the left atrium: recognition by cross-sectional echocardiography.

The two-dimensional echocardiographic features of three patients with congenital aneurysms of the left atrium are described. The aneurysm arose from the left atrial appendage in two patients and from the posterior left atrial wall in one. The aneurysms were characterized by their origin from an otherwise normal left atrium, a well-defined neck, their position within the pericardial space, and distortion of the left ventricular free wall by the aneurysmal body. The differentiation of these structures from other abnormalities of the left atrium are also discussed. Two-dimensional echocardiography is a safe and reliable method for diagnosing congenital aneurysm of the left atrium, and such studies should be considered in any patient with an otherwise unexplained abnormality on the chest radiograph.

Adult↗
PubMed1980

Salbutamol in treatment of heart failure.

The haemodynamic effects of oral and intravenous salbutamol were investigated in 22 patients with chronic heart failure. Intravenous salbutamol (13 micrograms/min) increased cardiac index by 53 per cent from 1.5 +/- 0.13 1/min per m2 to 2.3 +/- 0.23 1/min per m2 and decreased systemic vascular resistance by 28 per cent from 29.4 +/- 3.9 units to 21.2 +/- 2.5 units. Heart rate rose by 10 per cent from 101 +/- 3.5 beats per minute to 111 +/- 3.2 beats per minute and pulmonary artery end-diastolic pressure fell by 13 per cent from 26.3 +/- 1.8 mmHg to 22.8 +/- 2.1 mmHg. Similar results were obtained after oral salbutamol (8 mg). Cardiac index rose by 40 per cent and systemic vascular resistance fell by 30 per cent. There was a small rise in heart rate and a variable and not significant change in pulmonary artery end-diastolic pressure. Experiments on isolated rabbit papillary muscle showed that salbutamol, at the concentration which exists in patients, had no detectable positive inotropic effect. It is probable that the increase in cardiac output in patients is primarily the result of reduced afterload caused by vasodilatation. Salbutamol is a useful drug in the treatment of chronic heart failure.

Administration, Oral↗
PubMed1980

Identification of atrial septal defects by cross-sectional contrast echocardiography.

Cross-sectional echocardiography, combined with injections of contrast into peripheral arm veins, has been used to study 15 patients with atrial septal defects and 10 patients with an intact interatrial septum. Of 11 patients with ostium secundum or sinus venosus atrial septal defects and left-to-right shunts a defect could be visualised in all, and in eight some degree of transfer of contrast from right atrium to left atrium was seen. In three of four patients with a dominant right-to-left shunt a defect was seen and in all there was free transfer of contrast from right atrium to left atrium. Though there may be variable loss of echoes in the septal image in patients with an intact interatrial septum, in general no fixed defect is seen an there is no transfer of contrast from right atrium to left atrium. This is a potentially valuable technique in the assessment of patients in whom an atrial septal defect is suspected.

Adolescent↗
PubMed1980

Persistent left superior vena cava with coronary sinus and left atrial connections.

A 65-yr-old woman presented with severe congestive cardiac failure and physical signs of an atrial septal defect. Investigation by cardiac catheterisation and cross-sectional echocardiography showed a persistent left superior vena cava draining through an enlarged coronary sinus into the right atrium. In addition, the left atrium was connected to the coronary sinus by two defects in its lateral wall. The atrial septum was intact. The physiological result of this rare anatomical abnormality was a large left-to-right shunt with a small right-to-left component. The defects were closed surgically.

Coronary Vessel Anomalies↗
PubMed1979

Isolated congenital absence of coronary sinus.

A case is reported in which contrast angiography showed complete absence of the coronary sinus, the cardiac veins draining separately into left and right atria. Normal systemic venous drainage was demonstrated by contrast cross-sectional echocardiographic methods and later confirmed by conventional angiographic injections. In addition, angiography showed a stenosis in the anomalous cardiac vein draining into left atrium accounting for the presence of a continuous murmur for which the patient was initially referred.

Angiocardiography↗