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Calcified right ventricular fibroma causing outflow obstruction. Report of a case with successful excision.

A 5-year-old boy with clinical findings of pulmonic stenosis was found to have a large calcified mass in the right ventricular outflow region and a gradient of 120 mm Hg between the right ventricle and the pulmonary artery. At surgery, an ovalshaped tumor attached to the interventricular septum and obstructing the right ventricular outflow tract was removed. The child survived and is doing well. Histologically, the tumor had the characteristics of fibroma. A hemodynamic study three months after surgery showed almost complete abolishment of the gradient. To our knowledge this is the fifth reported case of calcified right ventricular fibroma with successful operation. In childhood intracardiac calcifications, together with obstruction, are highly suggestive of this lesion.

Angiocardiography↗

Echocardiography in cystic fibrosis.

Echocardiograms were obtained for 25 patients with cystic fibrosis (CF) and 20 controls to evaluate this technique as a means of assessment of right ventricular changes in patients with CF. Right ventricular anterior wall thickness per square meter of body surface (RVAW/sq m) and right ventricular internal dimension per square meter of body surface (RVID/sq m) were compared with other techniques for detection of cor pulmonale. Significant correlations existed between both RVAW/sq m and RVID/sq m and the forced vital capacity, forced expiratory volume in one second, midmaximal expiratory flow rate, clinical score of severity of disease, and roentgenographic score of pulmonary involvement. The RVAW/sq m was slightly more sensitive than RVID/sq m; RVAW/sq m thickness on echocardiogram in vivo compared well with actual measurements at autopsy in five patients. No correlations were found between echocardiography and electrocardiograms, vectorcardiograms, thoracic index, or cardiothoracic ratio.

Adolescent↗

Performance of QRS detection for cardiac magnetic resonance imaging with a novel vectorcardiographic triggering method.

In many cardiac patients, image quality and/or scan efficiency is reduced due to imprecise R-wave ability to trigger the scan due to noise on the electrocardiogram (ECG) caused by the magnetic resonance (MR) environment. We developed a triggering system that uses the spatial information of the vectorcardiogram (VCG) to minimize the effects of MR-related noise on triggering. Fifteen volunteers underwent standard cardiovascular MR exams, and a total of 52,474 R-waves were evaluated with the algorithm, giving a performance index of 99.91%. The mean propagation delay of the system was -10.64 +/- 3.19 msec, which falls within the real-time definition for cardiac MRI triggering. Five patients had arrhythmias consisting of premature ventricular depolarizations (PVDs) and supraventricular extra systoles. For those patients with PVDs, all arrhythmic beats were rejected unless they passed through the algorithm's reference point. The performance index for the arrhythmic patients approached 100%. VCG-based triggering has been demonstrated to provide near 100% triggering performance during cardiac MR examinations.

Adult↗

Comprehensive analysis of exertional ECG changes before and after oral propranolol.

In 12 patients with symptomatic coronary heart disease and three normal persons, comprehensive analyses of the electrocardiographic changes associated with symptom-limited upright exercise are made by computer analysis of the electrocardiogram recorded using a Frank XYZ lead system. This analysis provided a display of the 12 lead ECG, vectorcardiogram, polarcardiogram, and spatial cardiogram and measurements of spatial magnitudes of heart vectors. The effect of 40 mg of oral propranolol was assessed by repeating the exercise protocol 60--90 min later. There is evidence that propranolol reduces the electrocardiographic features of myocardial ischemia. This reduction in myocardial ischemia correlates with reductions in pressure rate product and heart rate. The presence of infarct criteria with exercise is variable and not apparently influenced by propranolol.

Adult↗

A computerized approach to evaluating rest and exercise-induced ECG/VCG changes after cardiac rehabilitation.

A computerized method of acquiring and analyzing rest and exercise test 12-lead electrocardiographic and three-dimensional lead vectorcardiographic data before and after cardiac rehabilitations is described. Fourteen coronary heart disease patients were exercise tested before and after a mean of five months of aerobic exercise training, The only significant ST-segment improvements were found in three-dimensional space. Spatial measurements should be considered in the assessment of electrocardiographic changes secondary to exercise training.

Adult↗

Reassessment of electrovectorcardiographic signs of left atrial enlargement.

Echocardiographic left atrial size was correlated with 27 electrovectorcardiographic parameters in 93 subjects. In 20 of them hemodynamic studies, including calculation of the left atrial volume, were performed. Subjects were divided into four groups as follows: Group I, 21 healthy subjects; group II, 45 patients with heart disease but no left atrial enlargement; group III, 15 patients with heart disease and left atrial size from 4.1 to 5 cm; and group IV, 12 patients with heart disease and a left atrial size exceeding 5 cm. A good correlation was found between left atrial size and the following parameters: Duration of P wave in standard lead II, voltage of both terminal forces of P wave in lead V1 and its maximal vector in the frontal and sagittal planes. A new index (duration/voltage of P wave in lead II) was postulated, which showed an excellent correlation with left atrial size (p less than 0.001). In all cases the superposition between groups was excessive. These findings indicate the limitations of the classical patterns and raise interest in new parameters concerning the electrocardiographic diagnosis of left atrial enlargement.

Adolescent↗

Cardiogoniometry: a new noninvasive method for detection of ischemic heart disease.

Cardiogoniometry is a new vectorcardiographic method. The vector-loops are constructed from three orthogonal ECG leads and registered on-line by a microprocessor. The angle between the maximal QRS and T vectors, as well as the spatial orientation of these vectors are very constant in healthy individuals. Deviations of these vectors and angles are sensitive indicators for changes in repolarization occurring, for instance, during coronary insufficiency. The changes in these variables were evaluated in 50 patients with suspected coronary artery disease and correlated with angiographic findings. Cardiogoniometry showed a sensitivity of 79% and a specificity of 82%, which is comparable to exercise testing. In contrast to the latter cardiogoniometry can be performed at rest, is free of risk, and therefore also suitable for elderly patients.

Computers↗