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Biomedical subjects

D J Sahn

Publications and source records attributed to D J Sahn.

At least 289 records · Page 16Linked to original sources
PubMed1977

The utility of contrast echocardiographic techniques in the care of critically ill infants with cardiac and pulmonary disease.

In order to assess the utility of contrast M-mode echocardiography in an intensive care nursery population of critically ill newborns with cardiac and pulmonary disease and to validate contrast echo methods, we performed 200 serial contrast echoes on 40 infants via umbilical arterial or venous catheters which had been placed into these infants for clinical indications. The resulting contrast echoes recorded from the precordium or the suprasternal notch allowed the delineation of intra- and extracardiac right-to-left and left-to-right shunting patterns. Patterns identified and validated by cardiac catheterization (in cardiac patients) were: right-to-left atrial shunts, right-to-left ventricular shunts, and left-to-right patent ductus arteriosus shunts. The studies were without complication. Serial application of these echocardiographic techniques was extremely important in assessing changing physiology in these neonates. Contrast echocardiography adds physiologic flow information to the anatomical information available from M-mode echoes and is quite important in the diagnosis and sometimes in the management of critically ill newborns.

Arteries↗
PubMed1976

Echocardiographic detection of large left to right shunts and cardiomyopathies in infants and children.

Diagnostic separation of infants with signs of cardiac failure (hypoglycemia, sepsis, myocarditis, hypoxemia) but no congenital cardiocirculatory malformation from those with a large left to right shunt is crucial in newborn management. Echocardiographic studies of 218 infants and children allowed group separation and distinction from normal by the assessment of mean velocity of circumferential fiber shortening (Vcf) and the ratio of left atrial to aortic root diameter at end-systole (LA/Ao). In normal premature and full-term infants, Vcf (1.51 +/- 0.04 [mean +/- standard error]) was significantly lower than in infants with a large shunt (2.12 +/- 0.08, P less than 0.01) and higher than in infants with nonstructural heart disease (1.18 +/- 0.06, P less than 0.001). LA/Ao ratios were comparable in the groups with a large shunt and nonstructural heart disease (1.14 +/- 0.1 and 1.26 +/- 0.2, respectively) and were significantly higher in both groups than in normal subjects (0.77 +/- 0.01, P less than 0.001). Similar echocardiographic distinctions could be made when 10 older children (aged 2 to 10 years) with cardiomyopathy were compared with 45 normal older children. Serial determination of these variables was of major assistance in patient management.

Cardiomyopathies↗
PubMed1976

Cross-sectional echocardiographic localization of sites of left ventricular outflow tract obstruction.

Real time two-dimensional echocardiographic studies of left ventricular outflow tract cross-sectional anatomy were obtained by the multicrystal echocardiographic method (Bom system) in 35 patients with various types of outflow obstruction as delineated by clinical, hemodynamic and angiographic studies. In each patient the noninvasive test allowed prediction of the site of obstruction. In valvular aortic stenosis, echocardiographic diagnostic findings included poststenotic dilatation of the ascending aorta, thickened aortic cusp tissue and increased superior-inferior cusp excursion (doming). The site of supravalvular aortic stenosis was readily observed although echocardiographic findings often underestimated the degree of obstruction recorded at cardiac catheterization. In patients with discrete subvalvular aortic stenosis, the major finding was a localized thickening of the septum and anterior mitral anulus producing a narrowing of the left ventricular outflow tract that was present in diastole and persisted throughout the cardiac cycle.

Adolescent↗
PubMed1976

The asymmetrically hypertrophied septum. Further differentiation of its causes.

Fifty-eight subjects with echocardiographic criteria for an abnormal septal to left ventricular posterior wall ratio were studied. Echocardiographic findings were related to clinical cardiac status. Abnormal ratios were found in normal children and in children with a variety of cardiac lesions, only one of which was obstructive or non-obstructive cardiomyopathy. In those without cardiomyopathy, the abnormal ratio usually resolved by one or two years of age. Persistence of abnormal ratio usually occurred in patients with increased right ventricular anterior wall thickness or idiopathic hypertrophic subaortic stenosis. The cause of abnormal ratio is multifactorial.

Cardiomyopathy, Hypertrophic↗
PubMed1976

Mitral valve prolapse in children: a problem defined by real-time cross-sectional echocardiography.

The cross-sectional echocardiographic features of mitral valve prolapse were defined in 26 children (ages 2-18 years) using a real-time, multiple-crystal ultrasound scanner. In each patient the physical findings of the mitral valve click-murmur syndrome were present and mitral valve prolapse had been diagnosed previously by conventional single crystal echocardiography. Mitral prolapse occurred in a familial setting in eight patients and was associated with the Marfan syndrome in five. Real-time two-dimensional echocardiography uniformly disclosed maximum mitral arching and the superior-posterior prolapse. These visual observations were confirmed by M-mode recordings derived from single elements within the array of 20 crystals. The method allowed a complete M-mode description of the phasic motion of the entire mitral apparatus and observations of the spectrum of prolapse from discrete late systolic prolapse to "hammock-like" holosystolic prolapse. Further, the recording of multiple systolic M-mode lines occurred when the ultrasound beam intersected the arched leaflets more than once. Pseudosystolic anterior motion was observed often and resulted clearly from a superimposition of echoes from the mitral annulus and from the posterior-superiorly arched prolapsed leaflets. A major finding in 22 patients was the association with prolapse of biconvex enlargement of the aortic sinuses of Valsalva and a significant increase in the diameter of the aortic root. Aortic root dilatation was most marked in, but not confined to, patients with the Marfan syndrome and was a prominent finding in six patients with minor musculoskeletal abnormalities. The presence of aortic root dilatation in children with normal body habitus raises important questions concerning the generalized nature of an abnormality of cardiac connective tissue in patients with mitral prolapse. The cross-sectional approach significantly enhances the noninvasive evaluation of mitral valve prolapse and provides an explanation for many of the single crystal observations reported previously.

Adolescent↗
PubMed1975

Echocardiographic recognition of ventricular septal aneurysm--a case report.

The noninvasive detection of an aneurysm of the interventricular septum may be predictive of spontaneous closure of a ventricular septal defect. Moreover, in patients with audible systolic clicks the distinction must be made between septal aneurysm and mitral valve prolapse. The current report describes the echocardiographic visualization and pattern of motion of an aneurysm of the membranous ventricular septum. The diagnosis was made by both single crystal and real-time cross-sectional, multiple crystal ultrasound techniques prior to catheterization. These findings from the basis of the present study.

Angiocardiography↗
PubMed1975

Pediatric echocardiography: a review of its clinical utility.

Echocardiography is a new noninvasive tool which provides real-time motion visualization of intracardiac structures for the evaluation of anatomy and physiology in patients with congenital heart disease. This paper is presented to acquaint the pediatrician with the utilization and potential of this technique as practiced by pediatric cardiologists. A discussion of principles of physics and instrumentation in echocardiography is followed by a description of normal echocardiographic anatomy. Specific malformations which can be diagnosed reliably by this technique include: hypoplastic left heart syndrome, transposition of the great vessels, tetralogy of Fallot, idiopathic hypertrophic subaortic stenosis, mitral valve prolapse, and pericardial effusion. In addition, the evaluation of patients with atrial septal defects and patent ductus arteriosus is discussed. New advances in instrumentation and their potential impact in pediatric cardiology are reviewed.

Aorta↗
PubMed1975

Catheter positions in congenital cardiac malformations.

Biplane cineangiocardiograms were examined from a population of patients with diverse forms of congenital heart disease and examples were selected to illustrate catheter positions which may help define and elucidate the anatomy of simple and complex cardiac lesions. Familiarity with the appearance of these typical and atypical catheter positions may be of considerable aid in the course of hemodynamic study and in the evaluation of cineangiocardiograms. The editors suggest that each figure be evaluated as an unknown before reading the caption.

Angiocardiography↗