Renal transplantation and cardiac function in pediatric patients.

Nine pediatric patients underwent echocardiographic evaluation prior to and after renal transplantation. Prior to transplantation parameters of cardiac contractility such as mean velocity of circumferential fiber shortening, ejection time, ejection fraction and shortening fraction were within the normal ranges for the age group. Post transplantation there was a significant decrease in heart rate and cardiac index. In addition a dramatic increase in hemoglobin levels was observed. The improvement in circulating hemoglobin levels rather than the removal of uremia appears to be the dominant beneficial result in improving cardiovasuclar hemodynamics.

[Prognostic value at 12 months of two-dimensional echocardiography performed during the acute phase of myocardial infarction. A prospective study of 140 patients]. / Valeur pronostique à 12 mois d'une échocardiographie bidimensionnelle réalisée en phase aiguë d'un infarctus du myocarde. Etude prospective de 140 patients.

A two-dimensional echocardiography was performed in the acute phase of myocardial infarction in 140 consecutive patients admitted to hospital for transmural infarction 12 +/- 3 days on average after necrosis was formed. The examination consisted of 4 ventricular sections, including 2 through the apex: 8 ventricular segments were individualized, to be interpreted only when 50 p. 100 of the endocardium was visualized. An echocardiographic score was devised for the kinetics of each ventricular segment, i.e.: -1:dyskinetic, 0:akinetic, +1:hypokinetic, +2: normal, +3:hyperkinetic. The maximum score corresponding to normal contraction of all segments was 16. The hospital results were a mean score of 6.52 +/- 2.90 for 73 anterior and/or lateral infarctions and a mean score of 12.5 +/- 2.38 for 67 inferior infarctions (p less than 0.001). Correlations between echographic scores and angiographic ejection fractions were studied in 99 of the 140 patients. Good correlation between the two examinations was found in 91 cases, with a less than or equal to 6/16 score corresponding to a less than or equal to 40 p. 100 ejection fraction, and a greater than or equal to 7/16 score to a less than or equal to 40 p. 100 ejection fraction. This showed that echocardiography can be relied upon to detect abnormalities of left ventricular kinetics in myocardial infarction. 137 patients were followed up for a mean period of 16.4 months (range: 12 to 25 months). The follow-up was clinical and included angina, recurrent or extended infarction, heart failure, aorto-coronary bypass and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prognostic indices of the normalization of left ventricular function in chronic aortic insufficiency following valve replacement]. / Indices prédictifs de normalisation de la fonction ventriculaire gauche dans les insuffisances aortiques chroniques après remplacement valvulaire.

The aim of this study of 31 patients was to identify M mode echocardiographic parameters predictive of normalisation of left ventricular function after valvular replacement for chronic aortic incompetence in order to determine the optimal time for surgery. Only patients with chronic, pure aortic incompetence (ventriculo-aortic pressure gradient less than or equal to 30 mmHG) were considered. At the time of investigation 4 patients were in functional Class I, 6 in Class II, 10 in Class III and 11 in Class IV (NYHA). M mode echocardiography was performed on an Echovideorex or an Irex System II echocardiograph. The following measurements were made and corrected for body surface area according to the recommendations of the American Society of Echocardiography; end systolic and end diastolic dimensions (mm), fractional shortening (%), end systolic and end diastolic wall thickness (mm), diastolic radius to wall thickness ratio, short axis myocardial surface area (cme), wall stress, end systolic stress (mmHg). The study comprised pre and postoperative studies with an interval of 22.7 +/- 12.5 months (range 5 to 46 months); the data obtained was compared with a control group of 10 normal subjects. The results showed that preoperative fractional shortening less than 28% was associated with an increased risk of persistent postoperative left ventricular dysfunction.

[Study of left ventricular diastolic function using pulsed Doppler in myocardial infarct in hypertensive subjects]. / Etude de la fonction ventriculaire gauche diastolique par doppler pulsé dans l'infarctus du myocarde chez l'hypertendu.

To determine if impairment of left ventricular filling is influenced by acute myocardial infarction in patients with arterial hypertension, left ventricular diastolic function was assessed by pulsed doppler echocardiography in 46 patients (pts) subdivided into four groups (Gr): G.1 (n = 12 pts) with acute myocardial infarction and hypertensive heart disease. G.2 (n = 12 pts) acute myocardial infarction without arterial hypertension. G.3 (n = 10 pts) arterial hypertension without history of coronary artery disease. G.4 (n = 12 pts) healthy subjects. Coronary angiography and left ventricular cineangiogram was performed in 24 pts (G.1 + G.2). Peak mitral flow velocity (cm/s) in early diastole (E), atrial systole (A), A/E and int A/int E ratios were measured by pulsed doppler. Age and heart rate were statistically similar in all groups. No difference was found among G.1 and G.2 in ejection fraction, and left ventricular segmental kinetic. (tables; see text) Conclusion left ventricular filling is impaired in pts with arterial hypertension and in pts with acute myocardial infarction; acute myocardial infarction increase the impairment of left ventricular diastolic function in pts with hypertensive heart disease.

[Atrial septal defect calibration: comparison of methods using balloons and 3D-transesophageal echocardiography]. / Calibrage des communications interauriculaires: comparaison des méthodes du ballon et de l'échocardiographie transoesophagienne 3D.

The atrial septal defects (ASDs) occlusion by cardiac catheterization is an alternative to the surgical technique. The use of stretching by balloon is considered as the gold-standard for the ASDs calibration. Three dimensional transesophageral echocardiography (3D-TEE) brings an imaging of the ASD surface and allows the measurement of its maximal diameter. With the goal of a percutaneous ASD occlusion, seventy patients had a simultaneous calibration of the ASDs by 3D-TEE and the balloon method. The mean maximal diameter measured by 3D-TEE was at 20 + 15 mm (range 10-28 mm) compared to the mean balloon-stretched diameter at 22 + 5 mm (range 9-31 mm). The correlation between both methods is good (y = 3.15 + 0.77x, r = 0.8, p < 0.0001). The mean difference between the diameters measured by both methods was 1.85 + 3.17 mm. The ASD visualized by 3D-TEE was single in 54 cases and multiple in 16 cases. The correlation between both methods was excellent in those with a single ASD (y = 1.74 + 0.84x; r = 0.85. p < 0.0001) but it was poor in those with multiple ASD (y = 12.4 + 0.4x; r = 0.45). The calibration by the balloon method which tests the septum resistance is an additive method to 3D-TEE which measures the anatomic diameter of ASD.

[Systemic fibrinolytic treatment in the acute phase of myocardial infarction. Effects on coronary repermeation and left ventricular function]. / Traitement fibrinolytique par voie générale à la phase aiguë de l'infarctus du myocarde. Effets sur la reperméabilisation coronaire et sur la fonction ventriculaire gauche.

Coronary angiography and 2D echocardiography were performed at the 24th hour and 21st day of acute myocardial infarction in 18 patients to study the effects of peripheral fibrinolytic therapy on coronary repermeabilisation and left ventricular function. The treatment was the same for all patients included in the study. The left ventricular ejection fraction and sequential left ventricular contractility were analysed. The first coronary angiographic control study (24th hour) showed coronary repermeabilisation in 18 cases, occurring in significantly stenosed vessels in 15 cases and in angiographically normal vessels in 3 cases, demonstrating appearances of thrombosis. Transluminal coronary angioplasty was performed in 8 cases. Coronary angiography at the 21st day showed 4 secondary occlusions in patients who had not undergone angioplasty. The comparative study of left ventricular function did not show a statistically significant difference between the 24th hour and the 21st day studies. Biochemical studies showed on early massive elevation of the specific myocardial enzyme CPK MB and a rapid fall in the fibrinolytic activity of all patients. The treatment was well tolerated and mortality was nil.

[3D-transthoracic echocardiography: a selection method prior to percutaneous closure of atrial septal defects]. / Echocardiographie transthoracique 3D: une méthode de sélection avant fermeture percutanée des communications interauriculaires.

Prior to putting in place a percutaneous device, the assessment of the atrial septal defect anatomy is mandatory. The 3D transthoracic echocardiography is a non-invasive method bringing an imaging of the septal defect surface and its borders. Fifty-two patients ageing from 3 to 16 years old had a rotational 3D transthoracic echocardiography. Thirty-six (69%) were selected for a percutaneous closure (borders > 7 mm and a septal surface/atrial septal defect ratio > 2). Thirty-two of these selected patients (89%) benefited from the Amplatz prosthesis implantation with success. The maximal 3D diameter of the septal defect was 20 + 4 mm (14-30) compared to the mean size of prosthesis at 22 mm (18-30). Four of the 36 patients (aneurismal septum or a borderline septal surface/atrial septal defect ratio) were secondarily oriented to surgeons. Sixteen patients (31%) were selected directly to a surgical closure. The lack of borders or septal surface were confirmed by the surgical view. The 3D transthoracic echocardiography allows to define new criteria for the selection of patients prior to a percutaneous closure of atrial septal defects. This prospective study demonstrates that 9 out of 10 patients who had the 3D criteria had a percutaneous closure of the septal defect.

[Percutaneous closure of an interatrial communication via the internal jugular route using an Amplatzer prosthesis]. / Fermeture percutanée d'une communication interauriculaire par voie jugulaire interne par une prothèse d'Amplatzer.

Closure of interatrial communications by interventional catheterisation is recommended and effective. The usual approach is via the femoral vein. However, difficulty in positioning the probe and the guide in a stable fashion across the septal defect occurred during closure of the interatrial communication by the percutaneous route in a 71 year old female with severe scoliosis. This deformity most certainly contributed to the failure of the femoral approach. The decision for closure by the internal jugular route was taken and allowed closure of the interatrial communication to be achieved. The internal jugular route can be an alternative for closure of interatrial communications with difficult access.

[Respiratory variations in the right ventricular diameter: an echocardiographic element in the diagnosis of partial isolated pulmonary venous return anomaly]. / Variations respiratoires du diamètre ventriculaire droit: un élément échocardiographique du diagnostic de l'anomalie partielle du retour veineux pulmonaire isolée.

Isolated partial anomalous pulmonary venous drainage (PAPVD), in contrast to atrial septal defect (ASD), does not cancel out the effects of respiration on blood flow in the right ventricle. The aim of this study was to see whether this difference could contribute to the diagnosis of PAPVD without ASD on M mode echocardiography. The diastolic dimensions of the right ventricle on expiration and inspiration were compared in 4 groups of patients aged 2 to 17 years. Group 1 comprised 6 children with PAPVD without ASD; Group 2: 10 children with PAPVD and ASD; Group 3: 11 children with isolated non-restrictive ASD, and Group 4: 10 normal children. Groups 1 and 4 were comparable with a respiratory variation of RV dimension of 10 to 29%. On the other hand, in Groups 2 and 3 the percentage variation was less than 6%. The finding of isolated RV dilatation with normal respiratory variation of its internal dimension should therefore alert the operator to the possible diagnosis of PAPVD without ASD.

[Echocardiographic evaluation of intravenous streptokinase in myocardial infarction in the acute phase]. / Evaluation échocardiographique de la streptokinase intraveineuse dans l'infarctus du myocarde en phase aiguë.

The effects of intravenous fibrinolysis on left ventricular function in acute myocardial infarction were investigated by two-dimensional echocardiography in patients aged less than 70 for whom fibrinolysis was not contra-indicated and who were admitted less than 6 hours after the onset of a first myocardial infarction without heart failure. The 12 patients thus recruited were male; their mean age was 55 years and the infarct was anterior in 6 cases and posterior in 6 cases. Streptokinase was administered first by bolus intravenous injection (250,000 IU over 20 min), then by intravenous infusion (100,000 IU over 12 hours); this was followed by heparin. No other medication was given, except for intravenous lidocaine and oral nifedipine. Two-dimensional echocardiography was performed after 24 hours and on the 21st day, using the apical, two-cavities projection. The ejection fraction and the percentage of shortening in 16 ventricular segments (8 in the anterior and 8 in the inferior territories) were evaluated from systolic and diastolic ventricular contours. Ventricular angiography and coronary arteriography were performed concomitantly with echocardiography. No significant improvement in ejection fraction was observed. On both day 1 and day 21, the kinetics of the lower segments was improved and that of the anterior segments was distinctly reduced in inferior infarcts. The kinetics of all segments, irrespective of their territory, was significantly improved in anterior infarcts.

Improvement in left ventricular hypertrophy and left ventricular diastolic function following verapamil therapy in mild to moderate hypertension.

We evaluated the effect of verapamil therapy on left ventricular hypertrophy and left ventricular diastolic function in 13 patients with mild to moderate hypertension. Left ventricular hypertrophy was determined by M-mode echocardiographic measurements of interventricular septal thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI) both before (T0) and after 3 months (T3) of verapamil therapy. Left ventricular diastolic transmitral flow was measured by pulsed Doppler indices of early (E) and atrial (A) velocity, E/A ratio, total area (Ta), A area (Aa), Aa/Ta ratio, E-pressure half-time (E-PHT). A-pressure half-time (A-PHT) and E-PHT/A-PHT ratio both before and after 3 months of verapamil therapy. No significant changes occurred in mean heart rate, systolic function or body weight. We conclude that 3 months' therapy with verapamil resulted in an improvement in left ventricular hypertrophy and left ventricular diastolic function and a normalization of blood pressure, without a corresponding deterioration in left ventricular systolic function.

Hang-out time of pulmonary valve in d-transposition of great arteries.

Recently it has been shown that in patients with transposition of the great arteries the isometric relaxation time of the left ventricle could be negative in the presence of normal pulmonary artery pressure. In order to find an explanation for this apparently paradoxical situation, it was decided to evaluate the importance of the delay of closure of the pulmonary valve in 15 patients with transposition of the great arteries. This delay is called the hang-out time. The hang-out time was found to correlate inversely with the isometric relaxation time as well as with the pulmonary artery systolic (r = -0 . 70) and mean pressures. A weaker correlation was found between the isometric relaxation time and the time of mitral valve opening. These results show that in transposition of the great arteries with normal pulmonary artery pressure, the pulmonary valve has a prolonged hang-out time, to the extent that it frequently closes after the opening of the mitral valve, explaining the negative isometric relaxation time found in these cases. This finding may help in the non-invasive assessment of the pulmonary vascular resistance of patients with transposition of the great arteries.

Assessment of muscular ventricular septal defect closure by transcatheter or surgical approach: a three-dimensional echocardiographic study.

AIMS: Previous classification of muscular ventricular septal defects (VSDs) visualized on two-dimensional echocardiography relied on artificial divisions of the septum. New visualization of the ventricular septum integrating the third dimension would facilitate communication between cardiologists and surgeons. The objectives of this study were (1) to assess in patients with muscular ventricular septal defects the accuracy of left ventricular three-dimensional echocardiographic reconstructions in demonstrating the position, the size and the tissue rims of the defects; (2) to compare findings by three-dimensional echocardiography with those obtained by surgical and transcatheter approaches. METHODS AND RESULTS: Twenty-six patients, aged from one month to 40 years, with muscular ventricular septal defects underwent three-dimensional echocardiographic study. From the left ventricular three-dimensional echocardiographic reconstructions, the localization, the maximal diameter and the tissue rim of the defect were analysed and compared with surgical or transcatheter findings. Optimal three-dimensional echocardiographic reconstructions were obtained in 22 patients. Nineteen had a single muscular ventricular septal defect and three had multiple muscular ventricular septal defects. The muscular ventricular septal defect localizations were the inlet septum in three, the outlet septum in three, the mid-muscular septum in 14 and the apex in eighth. In 10 patients who underwent surgical closure, the correlation between three-dimensional echocardiography and surgery for muscular ventricular septal defect maximal diameter was y=0 x 95 x +0.13 (r=0.98; P<0.001). The agreement between three-dimensional echocardiographic and intraoperative findings on muscular ventricular septal defect localization were complete. In five patients who underwent transcatheter closure, the mean difference between three-dimensional echocardiographic maximal diameter and stretched diameter was 1 x 8+/-0 x 5 mm. CONCLUSION: The three-dimensional echocardiographic left ventricular views provide a new and easily communicated visualization of various muscular ventricular septal defects. Such new imaging should contribute to the surgical and transcatheter treatments of muscular ventricular septal defects.

Value of respiratory variations of right ventricular dimension in the identification of small atrial septal defects (secundum type) not requiring surgery: an echocardiographic study.

In search of reliable criteria that could help differentiate insignificant atrial septal defects (ASDs) from those with a large shunt, M-mode echocardiograms of three groups of patients were studied retrospectively: group I = 10 normal children (mean age 5.7 years); group II = 10 patients (mean age 7 years) with small ASD in whom the decision was taken not to proceed to surgical closure, based on hemodynamic and angiographic criteria; and group III = 15 patients (mean age 7 years) with an "operable" shunt, who underwent corrective surgery. The results showed that right ventricular end-diastolic dimensions during expiration (RVDDE) were increased in all patients in group III but were normal in only 3 of the 10 patients in group II. A normal septal movement was found in all patients in groups I and II but also in five patients in group III. The variation in right ventricular diastolic dimension with respiration (RVDVR) was always normal in group II. However, in group III all patients but one had a small RVDVR (less than 6%). It was concluded that a normal RVDDE is very specific (100%) but not sensitive (30%), a normal septal movement is very sensitive (100%) and moderately specific (70.6%), and a normal RVDVR is both very sensitive (100%) and specific (94.4%) as a criterion for identification of small ASDs not requiring surgery.

Influence of age on wall thickness, cavity dimensions and myocardial contractility of the left ventricle in simple transposition of the great arteries.

This study was carried out to establish a reference table of echocardiographic values for the left ventricle of simple d-transposition of the great arteries (d-TGA) and to determine at what age left ventricular dimensions in these patients become different from those of a normal population. Fifty-three patients with d-TGA and normal pulmonary pressure and 395 normal children ages 1 day to 10 years were studied by M-mode echocardiography. Results show that in d-TGA, left ventricular systolic and diastolic internal diameters are normal at birth. After 1 month, however, both diameters were below normal and despite a progressive increase with age, the mean values were always below normal. The mean posterior wall thickness of patients with d-TGA was also normal at birth but did not increase with age (2.3 mm in diastole and 4.3 mm in systole) and became significantly thinner than normal at 10 months of age in diastole and 7 months in systole. Septal thickness of patients with d-TGA did not differ from that of the control group. The shortening fraction and mean velocity of circumferential fiber shortening were significantly greater in d-TGA at all ages. Left ventricular measurements related to age are presented and should be of help in interpreting M-mode echocardiograms of patients with d-TGA.