PubMed · 1166845
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G G Gensini. 1975. Letter: Sequential studies of left ventricular function.. https://doi.org/10.1016/0002-9149(75)90498-1
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Left ventricular (LV) and left atrial (LA) chamber sizes are frequently used to assist in assessing the severity of mitral regurgitation (MR). To study the reliability of these measurements in the clinical setting 2-dimensional echocardiographic measurements of the left ventricle and left atrium were obtained in 92 consecutive patients with MR present on both angiography and Doppler echocardiographic examinations performed within 2.8 +/- 2.5 days of each other. The accuracy of chamber dimensions in identifying severe MR (angiographic grade 3 to 4+) was determined in the total population and the following patient subgroups: (1) isolated chronic MR with preserved LV function inclusive of all rhythms; (2) isolated chronic MR, preserved LV function and sinus rhythm; (3) isolated chronic MR with LV dysfunction; (4) chronic MR associated with other valvular disease; and (5) acute MR. Only in subgroup 2 were chamber sizes reliable in identifying severe MR. Atrial dimensions provided the most accurate assessment with an LA volume greater than 58 ml, anteroposterior dimension greater than 45 mm and superoinferior dimension greater than 55 mm, with sensitivities of 75, 75 and 88%, specificities of 83, 100 and 83%, positive predictive values of 92, 100, and 93% and negative predictive values of 56, 60, and 71%, respectively. LV dimensions had excellent positive predictive values but lower sensitivities. Normalizing for body surface area did not improve the accuracy of uncorrected dimensions. Although increased LA and LV dimensions can identify severe MR, smaller dimensions do not exclude this diagnosis. With acute MR, atrial fibrillation, LV dysfunction or associated valvular disease, these dimensions are not reliable.
After palliative procedure a 2 years old girl with congenital heart disease was corrected with aortic homograft. Truncus arteriosus is a rare congenital heart disease and this is the first successfully corrected case in our country. Using homograft in this age group improves the early and late result of this type of corrective surgery.
An infant with scimitar syndrome, absent right pulmonary artery, and systemic blood supply to the right lung presented in severe cardiac failure. Cardiac catheterization revealed suprasystemic pressure of the left pulmonary artery and a high pulmonary vascular resistance. Right-sided pneumonectomy abolished cardiac failure and normalized both pulmonary artery pressure and resistance. Pure volume load affecting one lung--as in this case through absence of the right pulmonary artery plus additional left-to-right shunt from a systemic collateral--can lead to pulmonary hypertension. Early operative intervention can reverse this process and prevent pulmonary vascular disease.