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Radioangioscintigraphy and Doppler echocardiography in the quantification of left-to-right shunt.

The magnitude of left-to-right shunt in 55 children with isolated congenital heart disease [atrial septal defect (ASD) or ventricular septal defect (VSD) (muscular and perimembranous)] was estimated by two methods: radionuclide quantification and Doppler echocardiography [flow (L/min) = mean velocity x area x ejection time x heart rate]. We found little difference between the magnitude of left-to-right shunt obtained with Doppler echocardiography and that with radioangioscintigraphy for a whole group of patients (N = 55, -11.42% to 12.04%) and for subgroups of ASD (n = 24, -12.49% to 12.19%) and VSD (n = 31, -10.69% to 12.23%). These results indicate that Doppler echocardiography, in comparison with radioangioscintigraphy, is sufficiently accurate for clinical estimation of the Q(p)/Q(s) ratio in isolated congenital heart disease with left-to-right shunt.

Adolescent↗
PubMed1975

Interatrial septum in B-mode and conventional echocardiograms - a clue for the diagnosis of congenital heart diseases.

The interatrial septum was studied with B-mode echocardiography to determine whether there were specific ultrasonic features characteristic of such congenital heart diseases as atrial septal defect and endocardial cushion defect. In transverse tomograms in the third and fourth intercostal space the interatrial septum is detected almost parallel to the anterior chest wall. The septum continues leftward to the echo of the anterior mitral leaflet. When the interatrial septum extends beyond the left sternal border, it can also be recorded near the left sternal border in the sagittal tomogram. The interatrial septum can also be recorded by conventional echocardiography. The pattern is wavy and synchronous with the heart beat with an amplitude of about 10 mm. It is seen near the chest wall in patients with left atrial enlargement and far from the chest wall in patients with right atrial enlargement. The defect in the interatrial septum was visualized by B-mode and conventional echocardiogram in patients with ostium secundum atrial septal defect. The defects were no longer observed after surgery.

Adolescent↗
PubMed1958

ATRIAL septal defect.

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Heart Defects, Congenital↗
PubMed1999

Analysis of ventricular septal motion by doppler tissue imaging in atrial septal defect and normal heart.

The aortic root and the upper part of the ventricular septum moves anteriorly in early systole, while the lower part moves posteriorly. The hinge of the counterpart motion of the ventricular septum is called pivot point. Using Doppler tissue imaging (DTI), we attempted to clarify the location of the pivot point of the ventricular septum in children with normal heart and with atrial septal defect (ASD), and to investigate the relation between the degree of the downward shift of the pivot point and that of volume overload of the right ventricle in patients with ASD. Study subjects consisted of 20 healthy children and 36 patients with ASD, aged from 1 to 15 years (mean 5.7+/-3.4) in the normal group and 6 months to 12 years (mean 4.4+/-3.2) in the ASD group, respectively. The pivot point was designated as a border of the color signal of DTI of the ventricular septum in early systole. Measurements were then obtained on cross-sectional echocardiography and DTI: septal length in the parasternal long-axis view, distance from aortic valve to pivot point in early systole, diastolic left ventricular internal dimension, and diastolic right ventricular internal dimension. In the normal group, the ratio of distance from aortic valve to pivot point/septal length was 0.13+/-0.049, whereas it was 0.26+/-0.168 in the group with ASD (p <0.001). In the ASD group, the distance from aortic valve to pivot point normalized by body surface area (mm/m2) correlated with the ratio of diastolic right/left ventricular internal dimension and with the ratio of pulmonary to systemic flow (Qp/Qs) (r = 0.63 and 0.50, respectively). The ratio of the distance from aortic valve to pivot point/septal length correlated with the ratio of diastolic right/left ventricular internal dimension and Qp/Qs (r = 0.56 and 0.44, respectively). By DTI, the pivot point was located at the upper 13+/-5% of the total length of the ventricular septum in normal children, and was located at 26+/-17% in patients with ASD (p < 0.001). The degree of this displacement in ASD correlated with that of volume overload of the right ventricle. The paradoxic motion of the ventricular septum shown in the ASD could be explained by this downward shift of the pivot point.

Adolescent↗
PubMed1995

The first heart sound in atrial septal defect with reference to atrioventricular valve motion and hemodynamics.

To clarify the characteristics of the first heart sound in atrial septal defect (ASD) and its pathophysiological basis, 17 patients with ASD associated with incomplete right bundle branch block (IRBBB) and 7 with isolated IRBBB were studied using phonoechocardiography and Doppler echocardiography. Fifteen of the 17 ASD patients also were studied following surgical closure of the defect. Indices were compared among the preoperative ASD, postoperative ASD, and IRBBB groups including: P-Q intervals, loudness of the mitral and tricuspid component of the first heart sound (IM, IT), end-diastolic closing excursions of the mitral and tricuspid valves (Mx, Tx), and mitral and tricuspid inflow velocities during early diastole and atrial contraction. There were no significant differences in the P-Q intervals among these 3 groups. IM was attenuated, and IT was accentuated in ASD compared with IRBBB. Postoperatively, IM was augmented in all but 1 patient and IT was attenuated in all patients. Mx was significantly smaller, and Tx was significantly larger in ASD than in IRBBB. Postoperatively, Mx was significantly increased and Tx was significantly reduced; the maximal mitral inflow velocity during atrial contraction was increased while the maximal tricuspid inflow velocity was significantly reduced. Thus, the first heart sound in ASD is characterized by an attenuated mitral component and an accentuated tricuspid component. Hemodynamic alterations and consequent changes in closing energies of the atrioventricular valves probably account for these features.

Adolescent↗
PubMed1990

[Characteristic difference of functional tricuspid regurgitation between acquired valvular heart disease and atrial septal defect].

The characteristic difference in functional tricuspid regurgitation (TR) was studied between acquired valvular heart disease (VHD) and adult atrial septal defect (ASD). Fifty patients of VHD and 20 patients of ASD were subjected to this study. In all patients, the TR volume per beat (VTR) was calculated with our original method using 2-dimensional color Doppler (2-DD) and continuous-wave Doppler (CW) echocardiographies. VTR is obtained by the product of the cross-sectional areas (S) of the base of regurgitant jet in 2-DD and the regurgitant volume of one unit area (Vu) in CW (VTR = 1/3.S.Vu). The preoperative evaluation of TR according to VTR showed a good relationship with the operative findings, and the patients with preoperative VTR greater than or equal to 10 cc were candidates for tricuspid valve repair. In all patients with preoperative VTR less than 10 cc (18 patients of VHD and 10 patients of ASD), VTR decreased postoperatively without any tricuspid valve repair. In patients with VTR = 10-20 cc (19 patients of VHD and 5 of ASD), VTR showed a decrease to below 10 cc after tricuspid annuloplasty (TAP) by Kay's method in 18 patients of VHD and 5 of ASD, and with no tricuspid valve repair in one patient of VHD. In patients with VTR greater than or equal to 20 cc (13 patients of VHD and 5 of ASD), the postoperative VTR diminished to below 10 cc after Kay's TAP in 8 patients of VHD and 5 of ASD, and VTR disappeared after valve replacement (TVR) in 2 patients of VHD.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Mental health and psychosocial functioning in adolescents with congenital heart disease. A comparison between adolescents born with severe heart defect and atrial septal defect.

Twenty-six adolescents, aged 13-18 years, with severe congenital heart disease were matched for sex, age and living area with 26 adolescents with repaired atrial septal defect and regarded as physically fit. These two groups were compared according to somatic condition, psychopathology, psychosocial functioning and chronic family difficulties. A higher rate of psychiatric problems in the complex group, an association between psychosocial functioning and physical capacity, as well as an association between psychosocial functioning and chronic family difficulties were observed. These findings suggest that physical capacity is of crucial importance for mental health and functioning of adolescents with congenital heart disease. The association with chronic family difficulties also suggests that a comprehensive biopsychosocial approach is necessary in the treatment and rehabilitation of these patients.

Adolescent↗