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PubMed1989

[A case of successful surgery for atrial septal defect accompanied with angina pectoris].

A 59-year-old patient with atrial septal defect (ASD) and angina pectoris due to 99% stenosis of the anterior descending coronary artery (LAD) was successfully treated by closure of ASD and coronary artery bypass grafting (CABG) to the LAD #7 with a saphenous vein graft. Preoperatively, the right ventricle was overloaded with high pulmonary arterial pressure (52 mmHg) and anterior segmental wall motion of the left ventricle was reduced probably due to myocardial ischemia. Combined operation, ASD closure and CABG, made these impairments normal and resulted in disappearance of the chest pain and reinstatement to his former job.

Angina Pectoris↗
PubMed1989

[An operative case of partial anomalous pulmonary venous connection with patent ductus arteriosus and atrial septal defect].

The patient was a 28-year-old female who had underwent the operation of the closure of ASD on 7 years old. She administered due to palpitation. Cardiac catheterization revealed PDA, residual ASD, and PAPVC that blood flow from right superior pulmonary vein returned to the high level of SVC (juxsta-inominate vein). Successful repair was performed by intraluminal direct closure for PDA and placing a long patch for ASD and PAPVC.

Adult↗
PubMed1989

[A case of successful surgery of atrial septal defect combined with coronary artery bypass grafting].

A 66-year-old man, who had atrial septal defect (ASD) associated with severe coronary artery disease, underwent closure of ASD and concomitant coronary artery bypass grafting (LIMA-LAD & SVG-RCA). Response to surgery was excellent, with improvement of cardiac function and returning to NYHA functional class I, while, preoperatively, the patient had been limited due to symptoms related both to large left to right shunt flows (Qp/Qs 3.04) and to left ventricular dysfunction because of severe myocardial ischemia as well as previous inferior myocardial infarction. SAD is the most common form of congenital heart disease requiring surgery in adults, accordingly it should be remembered that some of the elderly patients with ASD might have obvious or occult coronary artery disease at the time of diagnosis and operative intervention.

Aged↗
PubMed1989

[Non-invasive diagnosis of atrial septal defects and anomalous pulmonary venous return using magnetic resonance tomography].

The present study was to evaluate the diagnostic information that may be obtained in patients with atrial septal defect (ASD) and/or with anomalous pulmonary venous return using spin echo and gradient echo magnetic resonance imaging (MRI). The interatrial septum and pulmonary veins were studied in 31 patients and in 16 healthy volunteers. In all patients cardiac anatomy and dilatation due to right-sided volume overload was well depicted. In 87% of the patients examined by spin echo technique and in 100% of the patients examined by gradient echo technique the defect was reliably documented. All cases of anomalous pulmonary venous return were shown. MRI diagnosis of ASD was improved by combined use of spin echo and gradient echo techniques. The new MRI sequence was particularly helpful in patients with small ASDs and anomalous pulmonary venous return.

Adolescent↗
PubMed1986

[Diagnosis of atrial septal defects by contrast echocardiography with sensitivity increased by coughing].

The aim of this study was to assess the sensitivity of contrast echocardiography in the diagnosis of permanent (atrial septal defects, ASD) and transient (patent foramen ovale, PFO) interatrial communications under basal conditions, after Valsalva manoeuvres and coughing. Sixty-four patients suspected of having defects of the interatrial septum were studied. The results of echocardiography were compared with those of cardiac catheterisation, the classical method of reference. The sensitivity of contrast echocardiography was significantly improved in the diagnosis of PFO by the cough test (100%) compared with contrast echocardiography during spontaneous respiration (55%). Similarly, the cough test increased the sensitivity of contrast echocardiography in the diagnosis of ASD (96% compared to 83%). The specificity was good in both cases, about 90%. The cough test was a better method (98%) than Valsalva manoeuvres (59%) for the potentiation of interatrial right-to-left shunts. The results of echocardiography and catheterisation explain the mechanism of the right-to-left shunt during spontaneous respiration, Valsalva manoeuvres and coughing. The passage of the microbubbles from the right to the left atrium occurs during early systole when the atrioventricular valves are closed. The right-to-left shunt is potentiated by provocative manoeuvres. The demonstration of a right-to-left shunt by contrast echocardiography therefore indicates the presence of an interatrial communication; our results show that this non-invasive technique is a reliable method of diagnosing ASD and PFO.

Adolescent↗
PubMed1988

[Atrial septal defect diagnosed and quantitatively-evaluated by transesophageal two-dimensional Doppler echocardiography].

Transesophageal two-dimensional (2-D) echocardiography (TEE: horizontal sector scan) combined with the pulsed Doppler method was performed to determine the size of atrial septal defect (ASD) and to measure directly shunt flow signals through the defects in six ASD patients (32 +/- 16 yrs) confirmed by cardiac catheterization. The size of the defect in the horizontal dimension was measured by TEE; the vertical dimension of the defect was determined from the distance of the transesophageal probe positions of the rostral and caudal margins of the defect. The size of defect determined by TEE was compared with that observed at surgery. Shunt flow signals were recorded by the pulsed Doppler technique by setting the sample volume at the center of the defect. Left-to-right shunt flow was determined as follows: shunt flow volume (ml/min) = mean velocity (cm/s) x the area of a defect (cm2) x 60. The shunt flow was compared with that obtained by the Fick's method. In all patients, TEE accomplished unequivocal visualization of a defect. The defect sizes by TEE correlated well with measurements obtained at surgery (r = 0.66). A clear laminar shunt flow with its peak in late systole and atrial systole was observed. Significant correlations were obtained between shunt volumes by TEE and those by the Fick's method (r = 0.91, p less than 0.05). Thus, TEE proved a useful method for diagnosing ASD and for evaluating shunt flow volumes.

Adolescent↗
PubMed1988

[Diastolic right ventricular hemodynamics in right ventricular overloads assessed by pulsed Doppler echocardiography].

To assess right ventricular (RV) filling dynamics, RV inflow velocity patterns of pulsed Doppler echocardiograms and jugular pulse tracings were analyzed in 59 patients with various types of RV overloads and in 20 normal subjects. The patients were classified as (1) RV volume overload group (RVVO) consisting of 25 patients with atrial septal defect (ASD) without pulmonary hypertension (PH), (2) RV pressure overload group consisting of 26 patients including 12 with primary pulmonary hypertension (PPH), eight with mitral stenosis, three with pulmonary stenosis and three with cor pulmonale, and (3) RV volume and pressure overload group consisting of eight patients with ASD and PH. The acceleration time (AT), deceleration time (DT) and the A/D ratio were measured from the RV inflow velocity patterns, and v-y interval and the y/H ratio were measured from jugular pulse tracings. The results were as follows: 1. AT was significantly prolonged in groups with pressure overload as well as pressure and volume overload compared with that of the normal controls. 2. DT was significantly prolonged in all overload groups compared with that of the normal controls except for PPH, and was particularly prolonged in the group with pressure overload. 3. The A/D ratio was significantly increased in all overload groups, particularly in the groups with pressure overload. 4. In patients with volume overloads, the v-y interval was longer and the y/H ratio was higher than in the normal controls. RVVO shifted to the right and superiorly. The reverse was true in the pressure overload group, and the high ratios were observed in the remainder. 5. In 12 patients with ASD evaluated pre- and postoperatively, AT, DT and the A/D ratio were restored to normal after surgery. These findings suggest that RV volume overload was characterized not only by increased inflow velocity during the rapid filling period, but prolongation of this period and compensatory increase of atrial inflow velocity. However, the pressure overload group had disturbed rapid filling and a decrease in end-diastolic RV compliance. The group with both pressure and volume overloads was between the two. In conclusion, the mode of RV filling in patients with RV overload showed various patterns depending on the type of overload. The RV inflow velocity pattern recorded by pulsed Doppler echocardiography is of use in discriminating these varieties.

Adult↗
PubMed1986

[Functional significance of left ventricular distortion in patients with right ventricular volume or pressure overloading].

To evaluate the effects of left ventricular (LV) distortion on its pump function, the LV cavity shape was analyzed by two-dimensional echocardiography in normal subjects and in patients with right ventricular (RV) volume or pressure overload. The functional significance of LV distortion in the short-axis sections was evaluated by an index of the efficiency of ejection (E) of endocardial circumferential fiber length (ECL) shortening in reducing LV cavity area during systole; E = measured systolic area reduction/ideal systolic area reduction X 100 (%), where an ideal area at end-diastole or end-systole was computed for the measured ECL, assuming its shape to be perfectly circular (ideal area = ECL2/4 pi), and then an ideal systolic area reduction was determined. E at the chordal level was termed Ech. In patients with atrial septal defect (ASD), the LV cavity was distorted at end-diastole and became more circular at end-systole. Since this characteristic change during systole diminished the E, and the values of E at the chordal level (Ech) were significantly lower in ASD than those in normal subjects (89.4 +/- 4.4% vs 98.3 +/- 0.8%, p less than 0.001), strongly suggesting impairment of the efficiency of LV pump function in ASD. In patients with pulmonary hypertension, the LV cavity was more distorted at systole, and a decrease in cavity area at end-systole with the distorted LV contributed to increased systolic area reduction. Thus, the values of Ech in this group exceeded 100% in five of nine patients (103.8 +/- 12.3%). In other words, when marked RV systolic overload exists, an increase in LV systolic area reduction due to progressive LV compression will occur against LV systolic pressure. This phenomenon suggests the existence of "cardiac massage on the LV by the RV with elevated pressure". In conclusion, it was strongly suggested that the efficiency of LV pump function is modulated by RV overload through dynamic changes in the LV shape.

Adolescent↗
PubMed1986

Future Air Force systems.

Planning for the future is under way in earnest at the Aeronautical Systems Division (ASD) at Wright-Patterson Air Force Base. It has been statistically established that it takes from 14-16 years from the generation of a new system idea to enter into engineering development. With this unpleasing, but realistic, schedule in mind, ASD has, during the last 3 years, been initiating long-term planning projects that are pre-starts for new system ideas. They are generated from throughout the Air Force and are locally managed and funded. Through this process, which spans from 12-14 months, specific and revolutionary new ideas for the systems of the future are generated. This article addresses more than a dozen specific new ideas in work at ASD today. These ideas range from a need to replace the C-130 type aircraft after the year 2000 to planning a follow-on to the B-18 well into the 21st century. Among other specific projects are investigation into an immortal fighter intended to be free of reliability and maintenance demands for an especially long period of operation, a new training system and advanced trainer to replace the T-38, a transatmospheric vehicle that could operate in the 100,000-500,000 foot flight region (30,480-152,400 m), and a new means of defending against hostile cruise missile launchers and cruise missiles. Other ideas are also addressed. The article concludes with emphasis on systems that can operate hypersonically in and out of the known atmosphere and greater use of airbreathing propulsion systems operating between Mach 3 and Mach 6.

Aircraft↗
PubMed1985

[Coronary sinus type atrial septal defect diagnosed by two-dimensional color Doppler echocardiography: a case report].

This is a case report of coronary sinus type atrial septal defect (ASD) diagnosed preoperatively by two-dimensional color Doppler echocardiography. A 22-year-old asymptomatic woman was admitted for preoperative cardiac evaluation. A cardiac murmur and cardiomegaly had been noted at a routine examination which included electrocardiography and chest radiography, and M-mode echocardiography suggested the presence of a secundum type ASD. Color Doppler echocardiography revealed a left to right atrial shunt flow through the coronary sinus ostium into the right atrium. By peripheral contrast echocardiography, a negative contrast echo from the coronary sinus ostium was observed within the right atrium and persistent left superior vena cava was excluded. At operation, a 2 X 3 cm defect was demonstrated at the interatrial septum in the vicinity of the coronary sinus ostium. This is the first reported case of a coronary sinus type ASD diagnosed preoperatively by color Doppler echocardiography.

Adult↗
PubMed1985

[Familial forms of interauricular communication of the ostium secundum type].

The occurrence of several cases of ASD in the same family is rare. Familial forms of ASD are characterised by the high incidence of associated cardiac lesions in affected patients or in the family, by the frequency of atrioventricular block with prolongation of the PR interval and by the presence of a large defect in the interatrial septum. The condition is thought to be transmitted in an autosomal dominant manner. The authors report the case of a family in which 7 cases of ASD were found, 6 of which were repaired surgically. There were no associated cardiac or extracardiac malformations; AV conduction was normal in 4 of the 6 operated cases--the defects were all large. The study of the genealogical tree with examination of most members of the family suggests autosomal dominant transmission of the condition.

Adolescent↗
PubMed1972

Humoral antibody responses of swine infected experimentally with group E streptococcus. II. Antistreptokinase and antistreptodornase responses.

Swine infected experimentally with group E Streptococcus (GES) produced significant antibody titers against streptokinase (streptococcal fibrinolysin, SK) and streptodornase (streptococcal deoxyribonuclease, SD). The antibodies directed against SK (antistreptokinase, ASK) appeared two to nine weeks postexposure and persisted for the duration of the experiment (nearly six months). The ASK inhibited SK produced by GES antigenic types III, IV, and V, by GES devoid of type specific antigen, and by a group P Streptococcus. Selected strains of GES serotypes I and II and group U Streptococcus did not produce detectable SK. The antibodies directed against SD (antistreptodornase, ASD) appeared two to three weeks postexposure, reached a peak about six weeks postexposure, and persisted at high levels for nearly six months (the duration of the experiment). The ASD inhibited SD produced by all known antigenic types of GES, by GES devoid of type specific antigen, and by strains of groups P and U Streptococcus. The antibodies failed to inhibit SD produced by group C Streptococcus. The potential utilization of ASK and ASD titers as serological means of identifying swine infected with GES (carrier swine) is discussed.

Animals↗
PubMed1984

[Detection of a shunt flow through a defect in secundum atrial septal defect by right parasternal approach using pulsed Doppler echocardiography].

Pulsed Doppler echocardiography combined with two-dimensional echocardiographic (2-DE) system was performed to detect a shunt flow through a defect in the interatrial septum (IAS) in patients with secundum atrial septal defect (ASD) utilizing right parasternal approach (RPA). RPA is a method which provides an accurate evaluation of a defect in the IAS on a 2-DE image by placing a transducer on the right of the sternum because the ultrasonic beam passes in a plane almost perpendicular to the IAS. The subjects consisted of 20 patients with ASD (25 +/- 22 yrs) diagnosed by cardiac catheterization or 2-DE with peripheral contrast material injection, and 10 cases of healthy subjects (34 +/- 18 yrs). Defects in the IAS were clearly visible in 19 patients with ASD on 2-DE images by RPA. By placing the sample volume in the center of the defect, Doppler flows could be obtained in 17 of them. In 13 with sinus rhythm, except a case of Eisenmenger syndrome, Doppler signals showed mainly a laminar flow toward the transducer (positive flow), but a transient flow of low velocity away from the transducer (negative flow) was also observed. The positive flow had its peaks in late systole and atrial systole and occasionally in mid-systole, early diastole and mid-diastole. The negative flow occurred in early systole, mid-diastole and late diastole. In a patient with Eisenmenger syndrome and tricuspid regurgitation (TR), a negative turbulent flow was observed from early systole to mid-diastole. In three patients with atrial fibrillation, Doppler signals were variable. The Doppler echogram of a patient with atrial fibrillation but no complication showed a laminar positive flow with its peaks in late systole and mid-diastole, and a negative flow in early systole. One patient with atrial fibrillation and TR had a systolic negative turbulent flow and a mid-diastolic laminar positive flow. In a patient with TR and mitral regurgitation, the Doppler echocardiogram showed a laminar positive flow throughout the entire cardiac cycle with its peaks in early diastole and mid-diastole. Doppler signals from the left atrium (LA) to the right atrium (RA) through a defect coincided in timing with the appearance of negative contrast echo from the defect to the RA on 2-DE image and signals from the RA to the LA coincided with the appearance of the contrast echo into the LA from the RA through the defect. Doppler signals disappeared after the closure of the defect in all six patients examined.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

[Abnormalities in the ventricular configuration and movement of the interventricular septum].

We discussed the left ventricular deformity in atrial septal defect (ASD) using two-dimensional echocardiography and elucidated the mechanism responsible for the production of mitral valve prolapse (MVP) associated with ASD. Two-dimensional echocardiography was performed for 78 cases with ASD, ranging in age from three to 64 years. The diagnosis was made by cardiac catheterization in all patients and was verified by surgical intervention in 66 cases. Two-dimensional images were obtained using an electronic sector scanning system of Toshiba (SSH-11A). The recording was made with 8 mm cinematography and an ordinary 35 mm camera. The major diameter/the minor diameter of the short-axis cross-section of the left ventricle was defined as the left ventricular distortion ratio (LVDR). The LVDR in early diastole was significantly larger than those in end-diastole and end-systole (p less than 0.001, n = 33). Furthermore, in end-diastole, the left ventricle showed a greater distortion ratio than that in end-systole (p less than 0.001, n = 33). The left ventricular short-axis area (LVSAA) corrected for the body surface area (BSA) was significantly greater both in early diastole and end-diastole than that in end-systole (p less than 0.001, n = 33). In early diastole, there was a poor correlation between the LVDR and the pulmonic to systemic flow ratio (Qp/Qs) (r = 0.44, p less than 0.05, n = 33). Similarly, the LVDR was poorly related with the right ventricular dimension (RVD) in early diastole (r = 0.43, p less than 0.05, n = 30).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Ventricular interdependence reflected in interventricular septal motion: with special reference to right ventricular pressure overload].

The dynamic features of the interventricular septum were studied with two-dimensional echocardiography with special reference to the influence of right ventricular (RV) pressure overload. The subjects were 52 patients, including 30 with atrial septal defect (ASD), 14 with rheumatic mitral valvular disease and 8 with pulmonary hypertension (PH) due to cor pulmonale, pulmonary embolism, or primary PH. To assess septal motion, the configuration of the left ventricle (LV) in the short-axis view was quantified as the deformity index, and characterized as the distortion from right circle. As an accurate short axis was required to assess the deformity of the cavity, the transducer was attached to the guide arm, providing comparable positions and directions. The deformity index was highest at the chordal level among other levels in the same cardiac phase. In ASD without PH, the deformity was minimal in end systole and maximal in early diastole. The index curve showed two peaks in early diastole and these times coincided with those of the minute backward notches on the ventricular septal echogram. In ASD with PH, the deformity was minimal in early systole and became greater during systole. The maximum deformity was shown in early diastole, corresponding to the momentary retracting motion of the septum by M-mode echocardiography. At that moment, the septum became convex to the LV. In patients with RV pressure overload, the systolic peak of the RV pressure was delayed and the decrease in pressure became sluggish, resulting in the RV pressure exceeding that of the LV transiently in early diastole. This was the reason for the septum becoming convex to the LV in this phase. Among the patients, the bi-ventricular systolic pressure ratio correlated not only with the index in end systole but also with that in early diastole. Good correlation between systolic pressure ratio and early diastolic deformity index seemed to be attributable to the fact that the higher the RV systolic pressure, the larger the reversed pressure gradient between both ventricles in early diastole.(ABSTRACT TRUNCATED AT 400 WORDS)

Diastole↗
PubMed1984

Detection of atrial and ventricular septum defects by transoesophageal two-dimensional echocardiography with a mechanical sectorscanner.

Two-dimensional (transthoracic) echocardiography (2DE) and two-dimensional endoscopic (transoesophageal) echocardiography ( 2DEE ) were performed in 19 consecutive patients with atrial septum defect (ASD), and in 17 controls, 3 with ventricular septum defect (VSD) and 14 with various diseases. In detection of ASD the sensitivity was 61% (11/18) and the specificity 88% (2/17) with 2DE whereas 2DEE revealed a sensitivity of 95% (18/19) and a specificity of 100% (0/17). 2DEE enabled to visualize the VSD in all 3 patients (2DE in 1/3). With 2DEE the site and size of the atrial septum defects could be estimated well as confirmed in 14 patients who underwent cardiac surgery. The lateral resolution of the 7.5 MHz transoesophageal probe was about 0.5 cm. Further studies are required to clarify if cardiac catheterization prior to surgery of an ASD may be replaced by 2DEE .

Adult↗
PubMed1983

[Studies on the mechanisms of the third and fourth heart sounds: with special reference to the phase analysis of mitral flow velocity pattern].

To investigate the genesis of the third ( IIIs ) and fourth heart sounds (IVs), apical phonocardiograms were recorded simultaneously with pulsed Doppler signals of the mitral flow and interventricular septal (IVS) and left ventricular posterior wall (PW) echoes by M-mode echocardiography in 26 cases with the IIIs and 11 cases with the IVs. The following results were obtained: Cases with the IIIs were classified into the following three groups according to the time relationship between the IIIs and a rapid filling wave (D wave) of the mitral flow velocity pattern. IIIs -peak group: The IIIs occurred coincidently with the peak of the D wave in five healthy adolescents and in 12 cases with absolute left ventricular volume overload including mitral regurgitation (MR: eight cases), postoperative atrial septal defect (ASD: three cases) and ventricular septal defect (one case). IIIs -delay group: The IIIs occurred about 38 msec after the peak of the D wave in eight cases with relative left ventricular volume overload including congestive cardiomyopathy (CCM: three cases) and ischemic heart disease (IHD: five cases). IIIs -early phase group: The IIIs occurred about 35 msec before the peak of the D wave in a case with acute MR due to chordal rupture. In the IIIs -peak group, the IIIs coincided in time with the points of inflection (check points) of both the IVS and PW during rapid filling phase in three cases with MR of mild to moderate degree and one case of postoperative ASD. In the IIIs -delay group, the IIIs occurred simultaneously with either the check point of the IVS or PW in two cases with CCM and one case with IHD, and it occurred before the check points of both the IVS and PW in two cases with severe MR of IIIs -peak group and in a case with acute MR due to chordal rupture of IIIs -early phase group. Cases with the IVs were classified into following 2 groups according to the time relationship between the IVs and the atrial contraction wave (A wave) of the mitral flow velocity pattern. IVs-peak group: The IVs occurred coincidentally with the peak of the A wave in six cases with left ventricular hypertrophy including hypertrophic cardiomyopathy (five cases) and hypertension (one case). IVs-delay group: The IVs occurred about 33 msec after the peak of the A wave in five cases with left ventricular dilatation or dysfunction including old myocardial infarction (two cases), CCM (one case), postoperative ASD (one case) and aortic regurgitation (one case). There were two types of IVs in time relationship between the IVs and the check points of the left ventricular wall during atrial contraction phase.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1982

[Congenital cardiopathies in adults. 179 cases].

Congenital heart disease in the adult represents less than 25 p. 100 of all congenital heart diseases; 179 out of 800 cases in the authors' experience. Atrial septal defect (ASD) is by far the most common (44 cases) especially in adults over 40 years of age. Practically all large ASD develop complications and systematic repair is recommended in all age groups except in forms with severe pulmonary hypertension and high pulmonary arteriolar resistance. Ventricular septal defect (VSD) is almost as common. They are usually small and only rarely present after 40 years of age, suggesting that spontaneous closure may occur even after 20 years of age. Coarctation of the aorta should be operated on before adulthood as persistant hypertension becomes more common in patients operated later. Eisenmenger's syndrome, the inevitable conclusion of VSD with severe hypertension not operated during childhood, or of some large ASDs in adults is often well tolerated and may survive until an advanced age. Survival of Fallot's tetralogy is very rare after 20 years without surgery; complete repair should therefore be performed early despite its drawbacks. Thus, unoperated congenital heart diseases should no longer be observed in adults excepting minor forms which do not justify the operative risks, and complicated forms for which no surgical cure is yet available.

Adult↗