Ehlers-Danlos syndrome and pregnancy: a case of uterine rupture.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
Y Hada
Publications and source records attributed to Y Hada.
Mitral valve prolapse in five members of a family including the identical twins.
A family in which the five members including the identical twins had a mitral valve prolapse was described. None of these members had any known stigmata of Marfan syndrome and their auscultatory findings were different each other. M-mode echocardiograms disclosed a midsystolic buckling of the mitral valve in the identical twins, their parents and the mother's brother, but all were asymptomatic. Electrocardiograms revealed a wandering pacemaker in two members. The index case was a 13-year-old girl whose apical late systolic murmur was detected incidentally by the mass screening examination for cardiac diseases. Both the inhalation of amyl nitrite and injection of methoxamine induced the augmentation of this murmur and made it holosystolic. The identical twin of the index case had multiple apical non-ejection clicks. However, a mitral regurgitant murmur was not induced by pharmacological provocations. Two-dimensional echocardiograms revealed prolapse of both the anterior and posterior mitral valve leaflets in both of them. Their mother had a late systolic click and the mother's brother had a cardiopulmonary murmur. The abnormal auscultatory findings were not observed in their father. This familial study suggested the genetic background and the various clinical manifestations of mitral valve prolapse.
Adolescent↗
[Detection of coronary sinus by parasternal two-dimensional echocardiography and the clinical significance].
To investigate the potential of a new method for detecting coronary sinus (CS), two-dimensional (2-D) echocardiography was satisfactorily performed on 80 consecutive cases, of which the coronary sinus was detected in 74 by adopting parasternal three-chamber approach. These 74 cases were classified into four groups; 25 normal individuals, 7 patients with atrial septal defect (ASD) but without tricuspid insufficiency (TI), 13 with TI and 29 with other cardiac diseases. We measured diastolic maximum diameter of CS on 2-D echocardiograms. The mean diameter of the CS was significantly increased in ASD (9.0 mm) and TI (12.4 mm) comparing with normal control (6.7 mm). The enlargement of CS seemed to correlate with right-sided volume overload. Although there were three exceptional cases, we could observe the CS during the whole cardiac cycle only in patients with TI. We conclude that CS is excellently detected in over 90% of cases by a new parasternal approach and that the diameter of CS would be a new screening index of right-sided volume overload.
Adolescent↗
[Generalized lentigo in a case of hypertrophic cardiomyopathy with right ventricular outflow tract obstruction].
A case was reported in which generalized lentigo was associated with hypertrophic cardiomyopathy and right ventricular outflow tract obstruction. A 34-year-old man was admitted to our hospital for cardiac evaluation. He had been noted to have a heart murmur since his childhood and had had a diagnosis of pulmonary stenosis in his high school age. Physical examination revealed precordial murmurs and numerous lentigines over his whole body surface including palms and soles. Two-dimensional and M-mode echocardiography disclosed asymmetric septal hypertrophy, systolic anterior motion of the mitral valve (SAM) and systolic semiclosure of both semilunar valves. A systolic turbulent flow was recorded at the outflow tracts of both ventricles by pulsed Doppler technique. Cardiac catheterization demonstrated a pressure gradient of 13 mmHg across the right ventricular outflow tract. We considered that the present case was an atypical LEOPARD syndrome with predominant right ventricular outflow tract obstruction which was precisely evaluated by noninvasive techniques.
Adult↗
Pulsus alternans determined by biventricular simultaneous systolic time intervals.
This investigation was performed to determine the presence of unilateral or bilateral pulsus alternans in the systemic and pulmonary circulations in heart failure and to estimate the prevalence of pulsus alternans in congestive cardiomyopathy. The subjects were 36 adult patients in heart failure due to a variety of cardiopulmonary diseases. We measured left- and right-sided systolic time intervals from simultaneous dual echocardiograms of both semilunar valves. The alternans was left-sided in seven patients, right-sided in one patient and bilateral in six patients. Pulsus alternans was induced by ventricular premature complexes (VPCs), except in one patient with bilateral and persistent alternans. For a VPC to precipitate alternans, the early beat itself must be associated with an abbreviated ejection time. Echophonocardiographic records of 100 patients with congestive cardiomyopathy were reviewed for evidence of pulsus alternans. We found persistent alternans in 10 patients and VPC-induced alternans in seven patients. We could not measure any difference in severity of disease in patients with pulsus alternans compared with those without.
Adult↗
Detection of tricuspid regurgitation by contrast echocardiography.
Contrast echocardiography with simultaneous M-mode echocardiography was performed in 77 cases of tricuspid regurgitation (TR) and 168 cases having no TR (non-TR). The echocardiographical characteristics of TR were as follows: 1) By the subxiphoid approach, a contrast appeared in the inferior vena cava during systole. In some cases of non-TR, a similar appearance was noted but limited to the atriosystolic or late systolic-to-early diastolic phases. Such confusing cases should be excluded by the simultaneous observation of the M-mode contrast echogram. 2) By apical four-chamber view, a negative contrast echo above the tricuspid valve and subsequent back and forth movements of the contrast across the valve were useful. This movement, however, may be misleading on two-dimensional echo and the M-mode echocardiogram was also necessary to obtain the exact timing and the direction of regurgitant flow. 3) Presence of the dilated inferior vena cava. The sensitivity of this method was extremely high, and the specificity was also excellent for TR.
Adult↗
Pacing echocardiography: regional wall motion, left ventricular dimension and R wave amplitude in patients with angina pectoris.
In view of the fact that stable echocardiograms are easily obtained during atrial pacing, pacing echocardiography was performed to evaluate the usefulness for detecting regional wall motion abnormalities during pacing-induced ischemia and to investigate the relationship between changes in the R wave and left ventricular dimension. The patients were 12 cases of angina pectoris (10 of coronary artery disease; CAD, and 2 of coronary patent aortic valvular disease; AVD) and 6 control cases. Simultaneous recording of two-dimensional and M-mode echocardiograms and electrocardiograms was done before, during and after the atrial pacing at increasing heart rate until angina appeared or the heart rate of at least 140/min was reached. In 12 angina cases, angina and ST depression were induced in 10 and 11, respectively. Excursion of the interventricular septum (IVS) decreased during pacing-induced ischemia in 6 of 7 CAD cases, in which the left anterior descending coronary artery was significantly stenosed (more than 75%). Excursion of the left ventricular posterior wall (LVPW) decreased during pacing-induced ischemia in 4 of 7 CAD cases, in which the vessels giving rise to posterior descending coronary artery were significantly stenosed (more than 75%). In 2 AVD cases, excursion of both IVS and LVPW decreased during ischemia. Left ventricular end-diastolic dimension (LVEDD) increased in only 2 angina cases, although R wave amplitude increased in 6 angina cases.
Adult↗
[Echocardiographic manifestations of the heart in the Hunter syndrome: report of a case].
Cardiac involvement of mucopolysaccharidosis has not been well characterized by echocardiography. In this paper, we reported a case of Hunter syndrome with special reference to the noninvasive diagnosis of cardiac anomalies. A 21-year-old male of Hunter syndrome was referred to our noninvasive laboratory for the evaluation of his heart murmurs. He was strikingly dwarfed, 115 cm in height and 28 kg in weight, and had apparently Gargoyle-like facial appearance. Physical examination disclosed a mild funnel chest and a loud systolic murmur. Blood pressure was 98/56 mmHg and regular pulse rate was 100/min. The chest X-ray film revealed a shift of the heart to the left with a prominent pulmonary artery segment. There were no signs of pulmonary congestion. The electrocardiogram demonstrated right axis deviation, clockwise rotation and left atrial overload. In phonocardiograms, a basal ejection and an apical scratchy systolic murmurs were recorded. The latter was associated with a presystolic murmur and a loud first heart sound. A loud pulmonary second heart sound was also present. Outstanding findings were observed in the two-dimensional and M-mode echocardiograms, which showed remarkable thickening of both mitral valve leaflets with reduced opening. There was also generalized thickening of tricuspid and aortic valves, and endocardium of the free ventricular wall. Two leaflets of the tricuspid valve were visualized to prolapse, but the aortic valve motion appeared intact. In addition, echocardiograms revealed the dilatation of right-sided cardiac chambers and pulmonary artery, but the size of the left ventricle was rather small. Pulsed Doppler echocardiography demonstrated systolic turbulence in the right atrium in the vicinity of the tricuspid valve orifice. Stenotic turbulence was also recorded in the inflow tract of the left ventricle during diastole. Thus, the final diagnosis of predominant mitral stenosis associated with tricuspid valve prolapse and pulmonary hypertension was obtained. In conclusion, cardiac involvements in Hunter syndrome were precisely evaluated by noninvasive methods. Hunter syndrome may be considered as one of the etiologies producing mitral stenosis.
Adult↗
[Noninvasive evaluation of cardiac involvements and left ventricular function in schoolchildren with the history of mucocutaneous lymph node syndrome].
Mucocutaneous lymph node syndrome (MCLS) in the young has been known to have coronary aneurysms, and then it has been recently suspected as a cause of premature atherosclerosis and cardiomyopathy. Thirty-three schoolchildren who suffered from MCLS were studied to evaluate cardiac involvements and left ventricular function using two-dimensional (2-D) echocardiograms and submaximal stress test. Fifteen normal schoolchildren were studied as normal control. All these MCLS children were asymptomatic and had no significant findings in routine chest X-ray and electrocardiographic examinations. According to submaximal stress test, 8 cases showed a J type ST depression of only 0.5--1.0 mm, and there were no positive cases. Using 2-D echocardiograms, the left coronary artery was detected in 85% and the right coronary in 27%. One case showed an aneurysm of the left coronary artery. However, none of them showed abnormal left ventricular wall motion or the wall motion abnormality compatible with cardiomyopathy. There were no significant differences between MCLS and normal control in ejection fraction, mean VCF, diastolic descent rate of the anterior mitral valve, D/S ratio of the left ventricular wall, and Weissler's index (PEP/ET). These findings suggested that 1) most of MCLS schoolchildren do not have obvious cardiac involvement and their left ventricular function is within normal limits, 2) because of its low sensitivity, submaximal stress test is not so useful in screening coronary lesions, and 3) the 2-D echocardiogram works not only in detecting coronary aneurysms but also in evaluating left ventricular function.
Adolescent↗
[Echocardiographic determinants of the operative intervention in patients with aortic regurgitation].
Explore the source record for details and available documents.
Adult↗
[Recurrent multiple cardiac myxomas: report of a case].
A case of recurrent multiple cardiac myxomas was presented. The patient was a 27-year-old housewife. Four years ago, she underwent urgent resection of a left atrial myxoma and replacement of the interatrial septum with a patch graft by right atrial approach. The tumor was very friable and a part of the tumor dropped into cardiac chambers during the operation, and immediately saline lavage and aspiration were performed. The recovery was uneventful. On March, 1981, she was readmitted to our hospital because of increasing dry cough. Two-dimensional echocardiography demonstrated abnormal masses in the right atrium, right ventricle, and left atrium. Open heart surgery revealed three independent tumors, which were successfully removed. All tumors were benign myxomas histologically. The patient returned to full-time housework again. A case of recurrent multiple myxomas has not been previously reported. The recurrence of the myxoma in our case is thought to be caused by implantation of tumor cells during the initial operative procedure. Our case will suggest the malignant potentiality of cardiac myxoma. The necessity of radical excision and gentle handling of the tumor during the operation are reemphasized. Postoperative follow-up study is also mandatory for early detection of the recurrence of this potentially malignant neoplasm.
Adult↗
[Phonoechocardiographic study on the genesis of the initial low-frequency component of the first heart sound].
The high-frequency vibrations of the first heart sound (S1) have been reported to be associated with the closure of atrioventricular valves. However, the genesis of the low-frequency component (LFC) preceding S1 remains controversial. In order to investigate the genesis of the production of this LFC, we recorded phonocardiograms simultaneously with M-mode echocardiograms in 10 healthy subjects and 26 patients with various diseases including mitral valve replacement. The apical phonocardiograms were recorded using a 100 Hz/12 dB high-pass filter and a commercially available acceleration microphone. Patients with rheumatic mitral valve disease and bundle branch block were excluded from this study. The electrocardiograms demonstrated sinus rhythm in 23, atrial fibrillation in nine, complete atrioventricular block in two and atrial flutter in two. The P-R interval in sinus rhythm ranged from 130 to 200 msec. The LFC occurred an average of 24 msec after the QRS complex, but 38 msec before the first high-frequency component of S1. The final fast closing movement of the mitral valve echogram started following the onset of LFC in sinus rhythm or the arrhythmias. Coaptation of the mitral valve leaflets was coincident with the first high-frequency S1. In 23 cases with the visible tricuspid valve, the valve closure occurred 28 msec after that of the mitral valve. The onset of the LFC was almost synchronous in timing with, or very close (10 msec or less) to the initial upstroke of apex cardiograms simultaneously recorded in 10 cases. The amplitude of the LFC was constantly smaller than that of S1 in all cases, but it was variable in atrial fibrillation or complete atrioventricular block. The LFC became loudest after a short RR interval and then ventricular systole was coincided in time with the rapid filling of the left ventricle, or when atrial systole was very close in time to an expected time of ventricular systole. It is certain that antegrade mitral blood flow was decelerated at that time, though the mitral valve was in the rapidly closing process. We conclude that the LFC is produced by the vibration of cardiohemic system, or the acceleration of the left ventricular mass plus the deceleration of blood flow, and that atrial activity and atrioventricular valve tension are not prerequisite to the production of this soft apical vibration preceding S1.
Adolescent↗
[Detection of pulmonary regurgitation by contrast echocardiography].
Explore the source record for details and available documents.
Adult↗
[Echocardiographic study of left ventricular motion in cases with acute left ventricular diastolic volume overload(author's transl)].
M-mode and two-dimensional echocardiography were performed to investigate the motion of the interventricular septum (IVS) and posterior wall (PW) in cases with pure mitral (MI) or aortic (AI) insufficiency. Subjects were classified into four groups; 15 cases with chorda rupture or floppy mitral valve (acute MI), four with AI of acute onset (acute AI), 17 with chronic MI including rheumatic MI, mitral valve prolapse syndrome, and 11 with chronic AI. There wee no differences of left ventricular dimension (LVDI), stroke volume (SV), ejection fraction (EF) and cardiac output (CI) between acute and chronic MI, and between acute and chronic AI, although LVDI and CI were increased in all groups. The ratio of the amplitude of IVS to PW excursion was significantly increased in cases with LV dilation due to acute MI or AI, compared with that in chronic MI or AI. This ratio had a linear relationship with LVDI in acute volume overload, but in chronic volume overload, it was constantly 1.0 or less. The mechanism of the increased septal motion in acute MI or AI is still unknown, but it appears to reflect the intact and contractile septum which adapts to volume overload more readily than the posterior wall. It is probably because the posterior wall is prevented from distension by the pericardium. On the other hand, in chronic MI or AI, vigorous septal motion would not be observed because of the occasional presence of relative tricuspid insufficiency, the effects of the long standing burden on the septal myocardium, and compensatory distension of the posterior wall and pericardium.
Adolescent↗
[Electrocardiographic voltage change in pericardial effusion (author's transl)].
Explore the source record for details and available documents.
Adolescent↗
[Echocardiographic study of mitral and tricuspid valve openings in normal subjects (author's transl)].
The purpose of the present echocardiographic study is to determine the timing and order of both mitral and tricuspid valve openings in normal subjects and to provide the basic data for evaluating diastolic hemodynamics in cardiac patients. The subjects consisted of three groups: (i) 30 normal young cases in which the opening of both valves was recorded, (ii) 8 cases with idiopathic atrial fibrillation in which the relationship between preceding R-R and early diastolic intervals was determined, and (iii) 10 cases in which the effect of the direction of the ultrasonic beam on mitral valve echograms was evaluated. By applying dual echocardiography or phonoechocardiography, the interval from the aortic component of the second heart sound (IIA) to the point of maximal anterior opening (E), the isovolumic relaxation period from IIA to the onset of opening (D') and opening slope of the anterior leaflet were measured in each valve echogram. Careful recording was mandatory for measurements because even slight angulation of the transducer toward the mitral ring induced the timing of D' point and opening slope to vary. Respiratory variation was observed on the movements of both valves. During inspiration mitral valve opening occurred further from IIA or did not change in timing, but the tricuspid valve opened prematurely. During expiratory phase, the mitral valve opened nearly simultaneously with the tricuspid valve. The measurements were: IIA-E interval = 99.8 +/- 13.1 (mean +/- SD), 104.5 +/0 20.6 msec; IIA-D' interval = 47.2 +/- 9.9, 48.3 +/- 13.1 msec; opening slope = 301 +/- 76, 264 +/- 59 mm/sec, in mitral and tricuspid valve echograms, respectively. In cases with atrial fibrillation, these measurements were nearly constant regardless of varied preceding R-R intervals in 8 mitral and in one tricuspid valve echograms. It was expected from observing the effect of R-R intervals on valve opening in a case of valvular disease that diastolic hemodynamics could be evaluated by analysing the timing and order of both valvular openings, especially in relation to the preceding R-R intervals in atrial fibrillation.
Adolescent↗
Right ventricular myxoma. Case report and review of phonocardiographic and auscultatory manifestations.
Tumors in the right ventricle are extremely rare. This report concerns the pathogenesis of physical signs resulting from a right ventricular myxoma. In systole a loud midsystolic murmur representing outflow obstruction was present. In diastole a prominent vibration was heard and recorded. By echophonocardiography this noise could be ascribed to sudden halting of the retrograde excursion of the mass into the right ventricle--a mechanism analogus to the tumor "plop" associated with the halting of antegrade movement of a left atrial myxoma in the left ventricle in early diastole.
Adolescent↗
Echocardiography of the semilunar valves.
Explore the source record for details and available documents.
Animals↗