PubMed · 13655935
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A GENECIN. 1959. Oxygen therapy.. https://pubmed.ncbi.nlm.nih.gov/13655935/
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Pulmonary hypertension is associated with worse perinatal outcomes in infants with respiratory disorders. In these infants, right ventricular dysfunction may result in poor pulmonary blood flow. The objective of this study was to follow changes in right ventricular volumes during the first 2 days of life in infants with respiratory distress syndrome. Serial echocardiographic examinations were performed on days 0-2 on infants ventilated for respiratory distress syndrome. Two-dimensional echocardiography with the ellipsoid approximation was used to calculate systolic and diastolic volumes. In 17 ventilated preterm infants, right ventricular volumes were significantly lower on day 2 compared with day 0 and decreased from a median (interquartile range) end systolic volume of 0.80 ml/kg (0.66-0.91 ml/kg) to 0.45 ml/kg (0.39-0.54 ml/kg) ( p < 0.001). End diastolic volume decreased from a median (interquartile range) of 1.54 ml/kg (1.44-1.65 ml/kg) to 1.30 ml/kg (1.22-1.60 ml/kg) ( p = 0.039). Right ventricular ejection fraction increased from a median (interquartile range) of 0.48 ml/kg (0.44-0.56 ml/kg) to 0.62 ml/kg (0.58-0.71 ml/kg) during the same period ( p < 0.001), as did right ventricular output from a median (interquartile range) 120 ml/kg/min (96-125 ml/kg/min) to 140 ml/kg/min (113-168 ml/kg/min) ( p = 0.044). Right ventricular volume decreases during the first 2 days of life in ventilated preterm infants. However, right ventricular performance is maintained.
BACKGROUND: Postsystolic thickening (PST) of ischemic myocardial segments has been reported to account for the characteristic heterogeneity or regional asynchrony of myocardial wall motion during acute ischemia. HYPOTHESIS: Postsystolic thickening detected by Doppler myocardial imaging (DMI) could be a useful clinical index of myocardial viability or peri-infarction viability in patients with myocardial infarction (MI). METHODS: Doppler myocardial imaging was recorded at each stage of a standard dobutamine stress echocardiogram (DSE) in 20 patients (16 male, 60 +/- 13 years) with an MI in the territory of the left anterior descending artery. Myocardial velocity data were measured in the interventricular septum and apical inferior segment of the MI territory. Postsystolic thickening was identified if the absolute velocity of PST was higher than peak systolic velocity in the presence of either a resting PST > 2.0 cm/s or if PST doubled at low-dose dobutamine infusion. RESULTS: Doppler myocardial imaging data could be analyzed in 38 ischemic segments (95%), and PST was observed in 21 segments (55%), including 3 segments showing PST only at low-dose dobutamine infusion. There was no significant difference of baseline wall motion score index (2.1 +/- 0.3 vs. 2.1 +/- 0.6, p = 0.77) or peak systolic velocity (1.1 +/- 1.1 vs. 1.9 +/- 2.0 cm/s, p = 0.05) between segments with and without PST. Peri-infarction ischemia or viability during DSE was more frequently observed in segments with PST than in those without (86 vs. 24%, p < 0.05). The sensitivity and specificity of PST for prediction of peri-infarction viability or ischemia was 82 and 81%, respectively. CONCLUSIONS: Postsystolic thickening in the infarct territory detected by DMI is closely related with peri-infarction ischemia or viability at DSE.
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