Echocardiographic measurements of cardiac dimensions correlate better with body length than with body weight or body surface area.

Looking after children means caring for very small infants up to adult-sized adolescents, with weights ranging from 500 g to more than 100 kg and heights ranging from 25 to more than 200 cm. The available echocardiographic reference data were drawn from a small sample, which did not include preterm infants. Most authors have used body weight or body surface area to predict left ventricular dimensions. The current authors had the impression that body length would be a better surrogate parameter than body weight or body surface area. They analyzed their echocardiographic database retrospectively. The analysis included all available echocardiographic data from 6 June 2001 to 15 December 2011 from their echocardiographic database. The authors included 12,086 of 26,325 subjects documented as patients with normal hearts in their analysis by the examining the pediatric cardiologist. For their analysis, they selected body weight, length, age, and aortic and pulmonary valve diameter in two-dimensional echocardiography and left ventricular dimension in M-mode. They found good correlation between echocardiographic dimensions and body surface area, body weight, and body length. The analysis showed a complex relationship between echocardiographic measurements and body weight and body surface area, whereas body length showed a linear relationship. This makes prediction of echo parameters more reliable. According to this retrospective analysis, body length is a better parameter for evaluating echocardiographic measurements than body weight or body surface area and should therefore be used in daily practice.

[Gallop in the Routineergometrie: Only Chore or Diagnostic Challenge?] / Extrasystolie in der Routineergometrie: lästige Pflicht oder diagnostische Kür?

ANAMNESIS: A 47-year-old recreational sportsman showed in a routine ergometry polymorphic ventricular extrasystoles with good physical performance. INVESTIGATIONS: In resting ECG impressed ventricular extrasystoles (VES) predominantly right-hand-block-like with superior axis, a long-term ECG yielded up to 100 VES per hour. Echocardiographically imposing 4 - 5 trabeculae, feathered, reticular structures apically in the left and lower in the right ventricle. The cardio-MRT revealed a wall dilation laterally and apically with increased trabecularization, no late enhancement. DIAGNOSIS: mild form of NCCM, currently asymptomatic THERAPY: Cardiac insufficiency treatment is based on the guidelines, including ICD-CRT therapy. We recommended ramipril and decided against transvenous ICD implantation. At the time of the presentation, subcutaneous ICD systems were not available. Family screening and genotyping of affected persons are recommended. CONCLUSION: Most patients have cardiac insufficiency, rhythmic symptoms, or thrombi formation in the noncompact portions of the left ventricular wall. Ventricular tachycardias are frequent and sudden cardiac death is the leading cause of death. Arrythmias are accessible to medication or ablation treatment. Endurance sports lead to favorable adaptations of the cardiovascular system in spite of increased risk of sudden cardiac death. The example shows that asymptomatic boundary findings also exist. Whether a sporting activity has a protective influence must be further investigated.

[Pulsatile tumor on the left side of the thorax after heart surgery]. / Pulsierender Tumor auf der linken Thoraxseite nach Herzoperation.

HISTORY AND ADMISSION FINDINGS: In a 67-year-old woman a large haematoma developed on the left side of the chest after two sternotomies because of an aortic valve and aorta ascendens replacement for aortic type A dissection. After a few weeks, a pulsating mass remained over the 6th left parasternal intercostal space. A consultant general surgeon punctured the lesion and aspirated bright red blood. The patient was transferred for further diagnostic procedures to the cardiology department. INVESTIGATIONS: Ultrasound examination of the pulsating mass showed a 35 mm echo-free cavity with turbulent flow in the color Doppler. To clarify the inflow into this perfused cavity magnetic resonance imaging (MRI) with angiography of the thorax vessels was performed. The cavity was found to be a perfused pseudoaneurysm originating from the native left mammary artery. The aneurysm had a 6 mm long neck and a diameter of 35 mm. An interventional closure was planned. TREATMENT AND COURSE: With access via the right groin a 6 French LIMA guiding catheter was inserted into the origin of the left internal mammary artery. With a 0.014 inch Balance Middleweight coronary guide wire it was possible to engage the pseudoaneurysm. Over the wire, a tracker 18 infusion catheter was pushed down and placed in the pseudoaneurysm. The closure was performed by insertion of a 0.018 inch 3 cm/4 mm Hilal Microcoil into the aneurysm neck. The mammary artery was anatomically and functionally unaffected. After the deposit of a coil, the inflow was stopped. An ultrasound showed a blood coagulation in the pseudoaneurysm, which decreased in size over time. CONCLUSION: After sternotomy a pseudoaneurysm of the left internal mammary artery had developed. As a noninvasive imaging modalitiy the magnetic resonance angiography showed well the exact flow into the aneurysm and allowed the planning of the intervention. The closure was achieved with a microcoil with preservation of the native internal mammary artery.