[Echocardiography methods in the diagnosis of cardiomyopathies in children]. / Echokardiographische Methoden in der Diagnostik von Kardiomyopathien bei Kindern.

We investigated 59 children with cardiomyopathy (CMP) by echocardiographic methods (ECHO). 29 children with dilated CMP showed typical enlargement of the left ventricle 159 +/- 31%, xxx; (% of normal value +/- SD) and of the left atrium (143 +/- 27%, xxx). Systolic and diastolic function of the left ventricle were decreased, systolic change in size of the left ventricle % delta D = 16 +/- 7%; xxx; systolic change in area of the left ventricle % delta A = 20 +/- 8%; xxx; maximum filling rate of the left ventricle in the phase of quick filling E max = 0.37 +/- 0.09 m. sec-1, xxx; the percentage of filling in the first third of diastole 0.33 DA = 37 +/- 9%, xx. Mitral insufficiency was found by us in 81% of children. In 25 children with hypertrophic CMP the size of left ventricle was decreased (81 +/- 13%, xxx). Asymmetric septal hypertrophy was found by us in 69% of children, symmetric hypertrophy in 27%, local hypertrophy of the apex in 4%. Systolic function of the left ventricle was increased (% delta D = 47 +/- 10%, xxx; % delta A = 70 +/- 10%, xxx). Diastolic dysfunction manifested itself by reduced E max (0.71 +/- 0.19 m.sec-1, xx) and 0.33 DA (45 +/- 12%, x). Mitral insufficiency was found in 54% of the children. In the case of the 5 children with restrictive CMP an extreme enlargement of left atrium (195 +/- 41%, xxx) was typical, as well as diastolic dysfunction of the left ventricle (0.33 DA = 67 +/- 6%, x).(ABSTRACT TRUNCATED AT 250 WORDS)

[Can atrial septal defects be reliably diagnosed by echocardiography?]. / Lze echokardiografií spolehlive diagnostikovat defekt sínového septa?

The diagnostic reliability of echocardiography (ECHO) was analyzed in a group of 179 children operated on account of an atrial septal defect (ASD) and partial anomalous pulmonary venous drainage (PAPVD). A total of 223 individual types of ASD and PAPVD and their mutual combinations were proved on operation. In all patients indirect signs of a left-to-right shunt at the atrial level was proved. The sensitivity and specificity of ECHO examinations in the ASD type fossa ovalis was 0.97 and 0.80 resp., in ASD type sinus venosus it was 0.47 and 0.98, in PAPVD 0.38 and 0.99. In both types of ASD type sinus coronarius assessed on operation the ECHO diagnosis was correct. The application of colour Doppler technique increased the reliability of the ECHO examination. The accuracy of ECHO in ASD and PAPVD depends indirectly on age, body weight and body surface. No relationship was proved between reliability of ECHO diagnosis of the defect and the magnitude of the left-to-right shunt assessed by radiocirculography and the size of the defect assessed during operation. In no instance the diagnostic inaccuracy affected the surgical approach and the result of the operation. Despite certain diagnostic pitfalls, it is therefore possible to operate, using the comprehensive non-invasive examination procedure, children with these anomalies in our department without previous cardiac catheterization and angiography.

[Prenatal diagnosis of malformation of the heart using echocardiography]. / Malformace srdce diagnostikované prenatálne pomocí echokardiografie.

Fetal echocardiographic findings were compared with autoptic ones in 11 from 22 fetuses and neonates with prenatal diagnosis of a congenital heart malformation. Pregnancy was interrupted on mother's desire in 7 from these 11 cases and completed by delivery in 4 cases. Diagnosed heart anomalies included ectopia (2), double outlet right ventricle with other malformations (2), tetralogy of Fallot (1), complete atrioventricular canal (1), syndrome of visceral symmetry (levoisomerism) with aortic atresia and common atrium as well as ventricle (1) and pulmonary atresia with a dysplastic tricuspid valve (1). Autoptic verification of a broad spectrum of heart malformations diagnosed in utero showed a developing potential of fetal echocardiography. A prenatal diagnosis of malformation enables to interrupt pregnancy in indicated cases. A complete morphological examination has particular demands on pathologist's attitude and training.

[Normal values of 2-dimensional echocardiographic parameters in children]. / Normální hodnoty dvourozmerných echokardiografických parametru u detí.

The authors examined by two-dimensional echocardiography a group of 186 healthy children from birth to the age of 18 years. From the assembled records they measured the following: the inner diameter of the inferior vena cava, the diameter of the abdominal aorta, the area of the right and left atrium at the end of systole, the width of the ring of the tricuspid and mitral valve at the end of diastole, the area of the right and left ventricle at the end of systole and its circumference, the width of the annulus of the pulmonary artery, the diameter of the aortic arch, the diameter of the right and left branch of the pulmonary artery. The systolic function of the left ventricle and the curvature of the ventricular septum during systole was calculated from the assessed parameters of the left ventricle. By means of a computer the regression equations of the relation of assessed echocardiographic parameters and body weight and body surface were calculated as well as their mean values +/- 2 standard deviations for the given body weight and body surface which are considered normal for the child population.

[Echocardiographic diagnosis of aortic coarctation in neonates and infants]. / Echokardiografická diagnostika koarktace aorty v novorozeneckém a kojeneckém veku.

Based on experience with the examination of 78 children under one year with coarctation of the aorta the authors present an account of basic echocardiographic examination procedures and findings in this defect. Two-dimensional echocardiography revealed in 98.8% of the patients a reduced pulsation of the abdominal aorta, as compared with the pulsation of the ascending aorta. In all instances it proved possible to visualize the coarctation. Pulsed Doppler echocardiography proved an abnormal flow in the abdominal aorta in 89.7% children; at the site of coarctation in 96.1% a typical saw-like flow with an acceleration typical for the flow in a stenotic vessel. Hypoplasia of the aortal arch was recorded in 51.3%, a patent ductus arteriosus in 73.2% of the children. An anomaly of the aortal valve was found in 57.7%, obstruction of the left ventricular, outflow tract in 35.9% children. An anomaly of the mitral valve was present in 23.2% children. M-mode echocardiographic findings proved enlargement of the right ventricle and hypertrophy of its wall. The size of the left ventricle and thickness of its wall differed less from normal values. The width of the aortal root was smaller than in a group of normal patients, the left atrium was enlarged. A combination of echocardiographic methods makes reliable non-invasive diagnosis of coarctation of the aorta in neonates and infants possible, as well as the evaluation of associated defects and indication for operation without the application of invasive methods.

[Echocardiographic diagnosis of interrupted aortic arch in a group of 13 patients (children)]. / Echokardiografická diagnostika interrupce aortálního oblouku, soubor 13 pacientu (detí).

Based on experience with the examination of 13 children with interruption of the aortal arch (IAA) the authors present an account of the basic echocardiographic (ECHO) diagnostic signs and procedures in IAA. Two-dimensional ECHO makes it possible, when a suprasternal approach is used, to assess the type of IAA. Examination from a subcostal and parasternal approach helps to detect associated heart diseases. ECHO findings correlated with angiocardiographic, surgical and necrotic findings. ECHO makes it possible to select further suitable examination methods and therapeutic procedures in this rare critical congenital heart disease.

[Pneumococcal infectious endocarditis in an infant (case report)]. / Pneumokoková infekcní endokarditida u kojence (kasuistika).

In a 10-month-old infant with purulent pneumococcal meningitis without structural heart disease acute infectious endocarditis developed. Echocardiographic examination revealed vegetations on both cusps of the mitral valve. With regard to the age and critical condition of the infant, in the acute stage surgical removal of the vegetations, was not indicated. During long-term intravenous antibiotic therapy the vegetations on the mitral valve and clinical and laboratory manifestations of endocarditis disappeared. The valve was, however, devastated and the child developed severe mitral insufficiency. Because of progressive cardiac failure which could not be controlled by drugs, at the age of 19 months a plastic operation of the mitral valve had to be performed after which the haemodynamics and clinical condition improved markedly.

[Echocardiographic diagnosis of total anomalous pulmonary venous return]. / Echokardiografická diagnostika totálního anomálního návratu plicních zil.

Based on experience with the examination of 33 children with total anomalous pulmonary venous return (TAPVD), the authors submit on account of basic echocardiographic (ECHO) findings and the examination procedure in TAPVD. The findings of two-dimensional ECHO reveal a typical enlargement of the right atrium and ventricle; in the four-chamber projection the pulmonary veins do not enter the left atrium but they join behind the left atrium. The site of the orifice of TAPVD in supracardial TAPVDS is found from a suprasternal approach, in intracardial TAPVD in the four-chamber projection, in infradiaphragmatic TAPVD from a subcostal approach. Doppler echocardiography reveals an impaired venous flow in the confluent on the pulmonary veins and in structures into which the pulmonary veins lead. ECHO makes it possible to assess the diagnosis of TAPVD by a non-invasive approach, to find the site of the orifice and indicate operation without the use of invasive examination methods.