Mean Left Ventricular Dimension Research Articles

Transcatheter Versus Surgical Closure of Acute Ruptured Sinus of Valsalva Aneurysms with Associated Ventricular Septal Defects.

Transcatheter ruptured sinus of valsalva aneurysm (RSOVA) closure is an alternative to surgery. When a restrictive ventricular septal defect (rVSD) coexists, there are doubts about support for an occluder and persistent left ventricular (LV) dilatation. We compared the outcomes of patients from a single centre with rVSD and RSOVA after surgery or transcatheter intervention in the past 8years in this study. Location of rVSD did not alter the approach. Compliant balloon interrogation before transcatheter closure was occasionally used to assess significance of interventricular shunt or aortic regurgitation. Procedural success and LV dimensions before and after treatment were analyzed. Seventeen patients with a mean age of 36.64 ± 12.58years were analyzed. 12/13 catheter procedures (92%) were successful, of whom eight patients had an outlet VSD. rVSD was closed with device in one patient with perimembranous rVSD, but unaddressed in others. Four patients underwent balloon interrogation. Surgery included the single patient who failed intervention. Transcatheter group had more acute symptoms and advanced functional class than surgical group, though not significant. At a median follow-up of 4.5 (1-7.5) years, the mean LV dimensions (50.3 ± 10.1mm and 50.1 ± 3.1mm, p = 0.46) were not different in the transcatheter and surgical groups. Mean end-diastolic volumes (110.5 ± 42. 1ml and 98.5 ± 37.5ml, p = 0.91) were not significantly different either. Transcatheter RSOVA closure success was not altered by rVSD despite their location underneath the aneurysms, including outlet rVSD with defect in aortoventricular junction. Persistent LV dilatation was not observed after catheter intervention even when the VSD was not closed.

Low blood pressure in the very old, a consequence of imminent heart failure: the Leiden 85-plus Study

Low blood pressure in the very old has been associated with organ dysfunction and excess mortality but the underlying mechanism has yet to be elucidated. We hypothesized that cardiac dysfunction contributes to low blood pressure in the very old. We invited a convenience sample consisting of 82 participants all aged 90 years from a population-based cohort study in the very old. Blood pressure was measured twice, and all but one underwent echocardiography to assess cardiac dimensions and functional cardiac parameters. Some 47 participants were free from haemodynamically significant valvular disease and were included in the present analyses. There were low values for mean cardiac output (2.04 l(-1) min(-1) m(-2), s.e. 0.40) and mean stroke volume (31.4 ml m(-2), s.e. 7.7). For every 10-mm Hg decrease in systolic blood pressure, cardiac output was 0.09 l(-1) min(-1) m(-2) lower (s.e. 0.04, P=0.019), and stroke volume was 1.58 ml m(-2) lower (s.e. 0.68, P=0.024). Mean left ventricular ejection fraction was normal and 2.39% (s.e. 1.16, P=0.046) higher for each 10-mm Hg decrease in systolic blood pressure. Mean left ventricular dimensions were normal but the E/A ratio was reduced (0.68, s.d. 0.21), indicating diastolic dysfunction. In conclusion, among the oldest old, low systolic blood pressure correlates with low cardiac output. Systolic ventricular function is not impaired.

Aortic valve repair by cusp extension with the use of fresh autologous pericardium in children with rheumatic aortic insufficiency

Objectives: Our goal was to evaluate the midterm results of aortic valve repair by a more sophisticated tailoring of cusp extension—taking into account the dimensions of the native aortic cusps—with the use of fresh autologous pericardium. Patients and methods: Forty-one children who had severe rheumatic aortic insufficiency (mean age 11.5 ± 2.7 years) underwent aortic valve repair by means of this cusp extension technique over a 5-year period. Twenty-four of them underwent concomitant mitral valve repair for associated rheumatic mitral valve disease. All children were then followed up by transthoracic echocardiography before discharge, at 3 and 6 months after the operation, and at yearly intervals thereafter. Results: Follow-up was complete in all patients and ranged from 3 months to 5 years (median 3 years). No operative and no early postoperative deaths occurred. Only 1 patient died, 9 months after the operation, of septicemia and multiple organ failure. Actuarial survival was 97% at 1 year and has remained unchanged at 3 years. On discharge, the degree of aortic insufficiency was grade 0 for 27 children and grade I for 14. Exacerbation of aortic insufficiency from grade I to grade II was observed in only 1 patient, and none of the children required reoperation for aortic insufficiency during the follow-up period. Mean peak systolic aortic valve gradients at discharge were lower than preoperative values ( P = .04), and no significant increase in the peak systolic transvalvular gradient was detected thereafter during the follow-up period. Mean left ventricular dimensions were significantly reduced at discharge when compared with preoperative values ( P < .0001). Conclusions: Functional results of aortic valve repair with cusp extension using fresh pericardium have been satisfactory at medium term, particularly in children with a small aortic anulus at the time of initial repair, because the expansion potential of fresh autologous pericardium is equivalent to that of the growing sinotubular junction and aortic anulus diameters. (J Thorac Cardiovasc Surg 1999;118:225-36)

Relationship between cumulative anthracycline dose and late cardiotoxicity in childhood acute lymphoblastic leukemia.

Late anthrocycline cardiotoxicity after treatment for childhood cancer is common and often progressive. A safe anthracycline dose that will not result in late cardiac abnormalities has not been established due to the limited dose ranges used in existing studies. To determine the relationship between cumulative anthracycline dose and late cardiotoxicity, we performed echocardiograms on 189 survivors of childhood acute lymphoblastic leukemia a median of 8.1 years (range, 2.0 to 23.4) after completion of anthracycline therapy. Patients were treated according to protocols that used widely varying cumulative anthracycline doses, but comparable nonanthracycline chemotherapy. Patients were divided into four groups based on the city of treatment and cumulative anthracycline dose: Copenhagen, 0 to 23 mg/m2 (n = 32); Boston, 45 mg/m2 (n = 17); Copenhagen, 73 to 301 mg/m2 (n = 53); and Boston, 244 to 550 mg/m2 (n = 87). Left ventricular dimension and fractional shortening were adjusted for sex and age or body-surface area through use of a control population (n = 296), and then compared among the four groups. Mean left ventricular dimension was significantly increased in the high-dose Boston group (observed:predicted value, 4.57 cm:4.45 cm; P = .002) and significantly higher than in the two Copenhagen groups. In the three lower-dose groups, there was no significant increase in mean left ventricular dimension, and the groups were not significantly different from each other. Similarly, the mean left ventricular fractional shortening was significantly depressed in the high-dose Boston group (observed:predicted value, 29.0%:33.8%; P = .0001) and significantly lower than in the three lower-dose groups. Depressed left ventricular fractional shortening and left ventricular dilatation were uncommon years after treatment of childhood leukemia when cumulative anthracycline doses were < or = 300 mg/m2.

Bedside diagnosis of preserved versus impaired left ventricular systolic function in heart failure

The importance of recognizing symptomatic heart failure with preserved left ventricular (LV) systolic function has only recently been apprecated. To determine its frequency and identify clinical features that make the bedside diagnosis likely, 82 patients admitted for decompensated heart failure were classified into 2 groups based on their LV systolic performance, as defined by fractional shortening (FS): group I (n = 59), with impaired systolic function (fractional shortening <24%), and group II (n = 23) with preserved systolic function (fractional shortening ≥24%). Mean fractional shortening was 15 ± 5% and 39 ± 1% for groups I and II, respectively. Female gender (p < 0.05), obesity (p < 0.01) and diastolic blood pressure ≥105 mm Hg (p < 0.05) predominated in group II. Jugular venous distention was identified more frequently in group I (p < 0.05). No statistically significant difference between the 2 groups was noted among various demographic variables (age, duration of symptoms, history of hypertension, ischemic heart disease and heavy alcohol drinking) or physical findings (S 3 gallop, edema, cardiomegaly, pulmonary congestion and pulmonary edema). Echocardiographic mean left ventricular dimension measured 6.6 ± 1 versus 5.0 ± 1 cm (p < 0.01) and mean posterior wall thickness 1.1 ± 0.3 versus 1.4 ± 0.4 cm (p < 0.01) in group I and II, respectively. The combination of diastolic blood pressure ≥105 mm Hg and an absence of jugular venous distention had a high specificity and positive predictive value (100%) for identifying group II patients. It is concluded that, of 82 consecutive patients with symptomatic heart failure admitted to a city hospital, a sizeable portion (28%) have preserved systolic function. The combination of diastolic blood pressure ≥105 mm Hg and the absence of jugular venous distention has high specificity and positive predictive value in identifying heart failure with preserved systolic performance.

Estimation of right and left ventricular size by ultrasound: A study of the echoes from the interventricular septum

A technic utilizing pulsed reflected ultrasound has been developed for estimating the size of both the right and left ventricles. The key to this technic is the recording of echoes from the interventricular septum. These echoes have been recognized previously but never have been described in any detail. With the septal echoes it is possible to obtain a right ventricular dimension between the echo originating from the anterior epicardial surface of the right ventricle to the right side of the interventricular septum. A left ventricular internal dimension is also obtainable between the left side of the septum and the echoes stemming from the endocardial surface of the posterior left ventricular wall. These ultrasound measurements were obtained during end-diastole in 26 normal subjects, 23 patients with atrial septal defects and large left to right shunts proved by cardiac catheterization and 12 patients with angiographically proved marked aortic or mitral regurgitation and dilated left ventricle. In the normal group the mean right ventricular dimension was 1.5 ± 0.4 cm. (range 0.5 to 2.1). The mean left ventricular dimension was 4.5 ± 0.5 cm. (range 3.5 to 5.3). The patients with the atrial septal defects had an increased mean right ventricular dimension of 3.7 ± 1.1 cm. (range 2.2 to 6.3), which differed significantly from the normal ( p < 0.001). The group with the dilated left ventricles had a normal right ventricular dimension but the mean left ventricular internal dimension was 6.9 ± 0.9 cm. (range 5.5 to 9.0). This measurement was significantly higher than in the normal group ( p < 0.001). These results are very promising and suggest that a qualitative and possibly quantitative estimate of right and left ventricular size is feasible using this technic. Besides facilitating measurements of the right and left ventricles, recognition of the interventricular septal echoes represents an important contribution to echocardiography because these echoes can be a source of confusion when examining for pericardial effusion or mitral stenosis. In addition, the location and motion of the interventricular septum introduces a new area of investigative and diagnostic possibilities for this increasingly popular technic.