Outflow Tract Diameter Research Articles

Right ventricular end-systolic area as a simple first-line marker predicting right ventricular enlargement and decreased systolic function in children referred for cardiac magnetic resonance imaging

To assess the accuracy of simple cardiovascular magnetic resonance imaging (CMR) parameters for first-line analysis of right ventricle (RV) dysfunction in children to identify those who require in-depth analysis and those in whom simple assessment is sufficient. Sixty paediatric CMR studies were analysed. The following CMR parameters were measured: RV end-diastolic and end-systolic area (4CH EDA and 4CH ESA), fractional area change (FAC), RV diameter in end-diastole (RVD1), tricuspid annular plane systolic excursion (TAPSE), and RV outflow tract diameter in end-diastole (RVOT prox). They were correlated with RV end-diastolic volume (RVEDVI) and RV ejection fraction (RVEF). RVEDVI correlated best with 4CH ESA (r=0.85, <0.001) and EDA (r=0.82, <0.001). For RVEF only a moderate reverse correlation was found for 4CH ESA (-0.56, <0.001), 4CH EDA (-0.49, 0.001) and positive correlation for FAC (0.49, <0.001). There was no correlation between TAPSE and RVEF and only weak between RVD1 and RVEDVI. A 4CH ESA cut-off value of 8.5cm2/m2 had a very high diagnostic accuracy for predicting an enlarged RV (AUC=0.912, p<0.001, sensitivity 92.3%, specificity 79%) and a cut-off value of 10.5cm2/m2 was also a good predictor of depressed RV systolic function (AUC=0.873, p<0.001, sensitivity 83%, specificity 89%). For routine screening in clinical practice, 4CH ESA seems a reliable and easy method to identify patients with RV dysfunction.

Can Three-Dimensional Echocardiography Shed Light on the Optimal Left Ventricular Outflow Tract Diameter Measurement for Assessment of Aortic Valve Area in Bicuspid Aortic Valves: The Where, How, and Why?

Can Three-Dimensional Echocardiography Shed Light on the Optimal Left Ventricular Outflow Tract Diameter Measurement for Assessment of Aortic Valve Area in Bicuspid Aortic Valves: The Where, How, and Why?

Prosthesis-Patient mismatch after aortic valve replacement: A single-center experience

Background: The impact of prosthesis-patient mismatch (PPM) on early and late outcomes after aortic valve replacement (AVR) remains controversial. In this study, we aimed to investigate the patient and surgery-related factors leading to various severities of PPM following AVR. Methods: Ninety-six patients who had undergone AVR with a prosthetic valve between 2001 and 2013 and later found to have PPM were enrolled. PPM was defined as the indexed effective orifice area (iEOA) of the aortic prosthesis to be ≤0.8 cm2/m2. PPM was considered to be of moderate or severe degrees if the iEOA was between 0.66 and 0.85 cm2/m2 or ≤0.65 cm2/m2, respectively. Results: The mean age of patients was 26 ± 15 years, and 51% of patients were female. Sixteen patients (15.2%) had mild PPM, 40 patients (38.1%) had moderate PPM, and 40 patients (38.1%) had severe PPM. The majority of our patients had surgery due to congenital causes. Prosthetic valve size and preoperative left ventricular outflow tract diameter were factors statistically related to PPM in the three groups (P

Estimation of Left Ventricular Outflow Tract Diameter by Nomogram From Body Surface Area: Providing a Safeguard for Cases with Difficult Echocardiographic Images

Estimation of Left Ventricular Outflow Tract Diameter by Nomogram From Body Surface Area: Providing a Safeguard for Cases with Difficult Echocardiographic Images

Effect of age on cardiac output after coronary angioplasty in patients of acute myocardial infarction

Background: Although most of the acute coronary syndrome (ACS) patients are elderly, less data available on the effect of age on outcome after percutaneous coronary interventions (PCI) and major adverse cardiovascular events. In this study, we evaluated the effect of age on clinical outcomes in patients with ACS undergoing PCI because it is a well-known fact that the ages of patients influence clinical outcomes in ACS. Aims and Objectives: The aim of the study was to find out the effect of age on outcome of angioplasty in acute myocardial infarction (AMI) patients. Materials and Methods: It is a cross-sectional, self-control, interventional study. In this study, cardiac output (CO) of 52 patients of AMI was measured by echocardiography before and after angioplasty. CO is calculated with the help of end diastolic volume, end systolic volume, and left ventricular outflow tract diameter. Statistical software IBM SPSS version 16 was used for analysis of data. Results: A negative and statistically significant coefficient of correlation (r = −0.384 and P = 0.005) was found between age of patients and the value of CO after coronary angioplasty. Linear regression analysis was also done taking CO after coronary angioplasty as dependent variable and age of the patient as the independent variable. It can be hypothesized that as the age advances, CO after angioplasty deteriorates. Conclusion: Advancing age is associated with deterioration in outcome after coronary angioplasty in AMI patients.

Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis.

Aortic prosthesis area (EOA) is computed by continuity equation from left ventricular (LV) stroke volume (SV) derived from LV outflow tract diameter (LVOTD ) or, when unmeasurable, from LV volumes (SVV ). There is evidence to suggest LVOT ellipticity and recommend 3D LVOT area (LVOTCSA ) adoption in aortic stenosis. We sought to evaluate if the same concept applies to supra-annular aortic prosthesis comparing SV and EOA derived from LVOTD (EOAD ) and from LVOTCSA (EOACSA ). EOA computed from SVV (EAOV ) accuracy was evaluated in this setting. Patient-prosthesis mismatch (PPM) was compared among different EOA computations. A consecutive series of 202 patients (aged 81±4years, 43% males) underwent St.Jude Trifecta aortic valve replacement (AVR) and were followed up with echocardiography at one-year (335±31days). All measurements followed the EACVI or ASE guidelines, 3D X-plane modality was used to compute SVv and measure LVOTCSA ; SV was calculated from LVOTD (SVD ) and LVOTCSA (SVCSA ). PPM was indexed EOA <0.65cm²/m². LVOT showed a significant ellipticity index (1.17±.27), independent of prosthesis size. EOAD (1.70±0.55cm²) was less than EOACSA (1.95±0.62cm²) (P<.0001). SVV was significantly lower than SVD and SVCSA . Bland-Altman analysis showed a significant correlation between SVV and SVD or SVCSA although with large bias and imprecision. The correlations improved reducing bias and imprecision when LVOT time-velocity integral was <20cm. PPM incidence was higher in EOAV (15.6%) compared to EOAD (P=.04) or EOACSA (P<.001). In supra-annular AVR, LVOT retains its elliptical shape and LVOTCSA yielded larger prosthesis EOA with lower PPM incidence. PPM may be overestimated by EOAV .

Annulus-Sparing Tetralogy of Fallot Repair: Low Risk and Benefits to Right Ventricular Geometry

Annulus-sparing repair of tetralogy of Fallot (TOF) carries a potential increased risk of reoperation for restenosis and unproven benefits on right ventricular (RV) geometry. Primary TOF repairs (n= 434) between 2000 and 2012 were studied using risk-adjusted parametric techniques. Progression of cardiac dimensions was analyzed using repeated measures regression using reports of all 2,103 echocardiograms undertaken throughout the study period, to a maximum follow-up of 13.7 years. Repair was at a mean age of 180 days: AS approach in 296 (68%) patients; and transannular patch in 138 (32%). Intraoperative revisions (for residual stenosis) were required in 135 patients (29%). There have been 4 deaths (survival 99%). Surgical reoperation for recurrent right ventricular outflow tract stenosis was occasionally required in both groups at comparable rates (transannular patch, 5 of 136 [4%]; annulus-sparing repair, 14 of 296 [5%]; p= 0.83). Larger increases in RV end-diastolic dimensions were evident in transannular patch patients versus annulus-sparing repair patients (p < 0.0001). Other risks for RV dilation included worse grade of postoperative pulmonary regurgitation, larger right ventricular end-diastolic dimension at the time of diagnosis, and higher operative weight (all p < 0.0001). Factors associated with successful annulus-sparing repair included (1) pulmonary annulus greater than 7 mm, right ventricular end-diastolic dimension greater than 1.2 cm, and tricuspid annulus greater than 1.4 cm (all preoperatively); and (2) right ventricular outflow tract diameter greater than 10 mm and right ventricular systolic pressure less than 50 mm Hg (both intraoperatively after repair). Pursuit of annulus-sparing repair strategies can lower the use of transannular patch to approximately 30% with low risk of reoperation for the patient. Annulus-sparing repair is associated with significantly reduced long-term RV dilation. Pulmonary valve enlargement to approximately 10 mm and right ventricular systolic pressure less than 50 mm Hg during annulus-sparing repair are associated with low risk of recurrent stenosis.

Feasibility of Various Aortic Valve Area Calculations Using 3D Transoesophageal Echocardiography and 2D Transthoracic Echocardiography in Patients with Aortic Stenosis

Background: Left ventricular outflow tract diameter has been shown to be one of the greatest source of error measurements when calculating aortic valve area (AVA) due its eccentricity nature and potential magnification of erroneous measurements whenever an inaccurate LVOT diameter is applied to a continuity equation. 3D transesophageal echocardiography (3D TEE) has allowed a multidimensional visualization of the LVOT similar to computed tomography but minus the radiation.

Sleep: A Window Into Autonomic Control in Children Born Preterm and Growth Restricted.

Preterm birth and fetal growth restriction (FGR) are both associated with risk of hypertension in adulthood. Mechanisms leading to this pathology are unclear. In children aged 5-12 years, who were born preterm and FGR, we used sleep as a tool to assess autonomic control with assessment of cardiovascular structure and function. Eighteen children born preterm and FGR, 15 children born preterm with appropriate birth weights for gestational age (AGA), and 20 AGA term-born children were studied. Children underwent overnight polysomnography with the addition of continuous noninvasive blood pressure (Finometer™). Spectral measures of heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity were assessed and overnight urinary catecholamine levels measured. Echocardiographic studies (Vivid7, GE Healthcare) were performed and vascular compliance assessed (Miller Instruments™). Statistical comparisons were adjusted for age and body size. Compared to term children, preterm AGA children had increased high frequency HRV (p < .05) and BPV (p < .05) during sleep, reflecting increased parasympathetic activation and blood pressure changes related to respiration. Preterm FGR children had smaller left ventricular lengths, ascending aorta, and left ventricular outflow tract diameter (p < .05 for all) and vascular compliance was positively correlated with gestational age (r2 = 0.93, p < .05). FGR combined with preterm birth did not alter autonomic control but altered heart structure in children. In contrast, preterm birth alone altered autonomic control but had no change in heart structure. These changes in children born preterm and FGR may contribute, in part, to increased risk of cardiovascular disease later in life but by different mechanisms.

Ocena układu sercowo-naczyniowego u dzieci po korekcji tetralogii Fallota

The aim of the study was to assess residual sequels in children after tetralogy of Fallot surgical repair (rTOF). Patients and MethodsThe study group (SG) consisted of 52 patients, mean age 13.7±3.4 years, and the control group (CG) comprised 34 healthy volunteers, mean age 13.7±3.0 years. Durations of QRS complexes and arrhythmia were assessed in ECG, Holter ECG and treadmill test. Right ventricular size was analysed by two-dimensional echocardiography. ResultsVentricular arrhythmia (VE) was detected in 18 (34%) patients. The QRS duration was longer in rTOF in whom VE was seen (151±14ms) than in those in whom no VE was found (123±19ms), p<0.05. Right ventricular dimensions were higher in SG than in CG respectively, with proximal transverse diameter: 38.8±7.9mm vs. 34.1±5,6mm (p<0.05), outflow tract in parasternal long axis view: 26.4±8.6mm vs. 18.9±7.3mm (p<0.05) and outflow tract in parasternal short axis view: 30.0±7.7mm vs. 25.4±5.1. The outflow tract diameter indexed up to body surface was statistically significantly wider (p<0.05) in patients with VE than in patients without VE 23.8±6.3mm/m2vs. 14.5±4.3mm/m2. ConclusionsThe results of tetralogy of Fallot surgical repair are good; however, after cardiosurgery some residual sequels are universally observed indicating the need of regular follow-up in this group of patients. Pulmonary valve regurgitation resulting from tetralogy of Fallot correction drives towards gradual right ventricular enlargement. Various types of arrhythmia may be observed in patients after the tetralogy of Fallot surgical repair; therefore, diagnostic procedures during follow-up should be focused on arrhythmic events detection.

Comparison of valve performance of the mechanically expanding Lotus and the balloon-expanded SAPIEN3 transcatheter heart valves: an observational study with independent core laboratory analysis.

The Lotus and SAPIEN3 are second-generation transcatheter heart valves, which are designed to minimize paravalvular aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR). We sought to compare both devices for valve performance and with emphasis on PAR by independent core laboratory analysis. A total of 162 (79 Lotus and 83 SAPIEN3) consecutive patients (51% female, 80 ± 8 years, Logistic EuroSCORE 14.8 ± 9.4%) who underwent TAVR because of aortic stenosis were included. Patients with aortic valve-in-valve treatment were excluded. Pre-discharge echocardiograms were analysed by an independent core laboratory using the Valve Academic Research Consortium 2 criteria. There were no differences in baseline and procedural characteristics, except for a larger aortic annulus and sizing indices in SAPIEN3-treated patients and frequency of post-dilatation (0% in Lotus and 13.1% in SAPIEN3). Both valves have similar mean residual gradient, indexed effective orifice area and Doppler velocity index when adjusted to valve size. The frequency of mild (13.9% vs. 31.3%) and at least moderate (1.3% vs. 3.6%) PAR was less after Lotus than after SAPIEN3 implantation (P = 0.02). Multi-slice computed tomography-based annulus and left ventricular outflow tract diameters, calcification and percentage of oversizing were not different between those with or without mild or more PAR. On multivariate analysis, the use of Lotus valve was associated with less (odds ratio OR, 0.41, P = 0.03) occurrence of PAR. Overall, haemodynamic performance was comparable between the Lotus and SAPIEN3 valves. Lotus valve required less oversizing and was associated with less PAR than SAPIEN3.

Evaluate Energy Loss Changes within Left Ventricle in 4 Patients with Obstructive Hypertrophic Cardiomyopathy after Modified Morrow Procedure Using Vector Flow Mapping

To evaluate the changes of left ventricle energy loss (EL) in patients with obstructive hypertrophic cardiomypoathy (HOCM) after modified morrow procedure using vector flow mapping (VFM), and to explore its clinical value in evaluating the operation effect. Retrospectively analyzed the data from four patients with HOCM treated by modified morrow procedure. Measure the echocardiographic parameters before and after surgery, respectively, and EL of LV was analyzed frame by frame using color Doppler images of a standard apical three-chamber dynamic view on an offline VFM workstation. The average EL of LV isovolumetric contraction phase, ejection phase, isovolumetric relaxation phase and filling phase were calculated. Compared with preoperative condition, 1). echocardiographic parameters: the left ventricular outflow tract (LVOT) diameter and left ventricular end-systolic volume were obviously increased, the LVOT gradient and the thickness of ventricular septum were significantly decreased, the differences were obviously significant (P < 0.05). Systolic anterior motion (SAM) disappeared in all cases. 2). EL value changes: During isovolumetric contraction phase and filling phase, averaged EL values were markedly increased in patient 1 and patient 2 and markedly decreased in patient 4, in patient 3 it was increased a little. During isovolumetric relaxation phase and ejection phase, averaged EL values were markedly increased in patient 1 and patient 2 and markedly decreased in patient 3 and patient 4. As a whole the variation trend was that the EL values in patient 1 and patient 2 increased greatly, but decreased greatly in patient 3 and patient 4. After modified Morrow procedure, even the normal conditions and echocardiographic parameters were significantly improved in HOCM patients, an increased energy loss may lead to worse outcomes, EL might be an new index for precise and quantitative assessment of intracardiac flow dynamics under different pathophysiology conditions.

Role of Transesophageal Echocardiography in the Diagnosis of Paradoxical Low Flow, Low Gradient Severe Aortic Stenosis.

Background and ObjectivesPrior studies indicate that up to 35% of cases of severe aortic stenosis (AS) have paradoxical low flow, low gradient despite preserved left ventricular ejection fraction (LVEF). However, error in left ventricular outflow tract (LVOT) diameter may lead to misclassification. Herein, we determined whether measurement of LVOT diameter by transesophageal echocardiography (TEE) results in reclassification of cases to non-severe AS.Subjects and MethodsPatients with severe AS with aortic valve area (AVA) <1 cm2 by transthoracic echocardiography (TTE) within 6 months were studied. Paradoxical low flow, low gradient was defined as mean Doppler gradient (MG) <40 mm Hg and stroke volume index (SVI) ≤35 mL/m2. Preserved LVEF was defined as ≥0.50.ResultsAmong 108 patients, 12 (15%) had paradoxical low flow, low gradient severe AS despite preserved LVEF based on TTE measurement. When LVOT diameter by TEE in 2D was used, only 5 (6.3%) patients had low flow, low gradient severe AS (p<0.001). Coefficients of variability for intraobserver and interobserver measurement of LVOT were <10%. However, the limits of agreement between TTE and TEE measurement of LVOT ranged from 0.43 cm (95% confidence interval [CI]: 0.36 to 0.5) to -0.31 cm (95% CI: -0.38 to -0.23).ConclusionTEE measured LVOT diameter may result in reclassification to moderate AS in some patients due to low prevalence of true paradoxical low flow, low gradient (PLFLG) severe AS.

Combination of ECG and Echocardiography for Identification of Arrhythmic Events in Early ARVC

ObjectivesThe aim of this study was to investigate early markers of arrhythmic events (AEs) and improve risk stratification in early arrhythmogenic right ventricular cardiomyopathy (ARVC). BackgroundAEs are frequent in patients with ARVC, but risk stratification in subjects with early ARVC is challenging. MethodsEarly ARVC disease was defined as possible or borderline ARVC diagnosis according to the ARVC Task Force Criteria 2010. We performed resting and signal averaged electrocardiogram (ECG). Using echocardiography, we assessed right ventricular (RV) outflow tract diameter and right ventricular basal diameter (RV diameter). Global longitudinal strain and mechanical dispersion (MD) from strain echocardiography were assessed in both the right and left ventricle. AEs were defined as documented ventricular tachycardia, cardiac syncope, or aborted cardiac arrest. ResultsOf 162 included subjects with ARVC (41 ± 16 years of age, 47% female), 73 had early ARVC, including mutation positive family members not fulfilling definite ARVC diagnosis. AEs occurred in 15 (21%) subjects with early ARVC. Those with AEs in early disease had larger RV diameter (40 ± 4 mm vs. 37 ± 5 mm), more pronounced RVMD (39 ± 15 ms vs. 26 ± 11 ms), and more pathological signal averaged ECGs compared with those without AEs (all p ≤ 0.05). Adding measurements of RV diameter and RVMD to electrical parameters improved identification of subjects with AEs compared with electrical parameters alone (p = 0.05). ConclusionsECG parameters, RV diameter, and RVMD were markers of previous arrhythmic events in patients with early ARVC. A combination of electrical and echocardiographic parameters improved identification of subjects with AEs in early ARVC disease.

Critical Review of Current Approaches for Echocardiographic Reproducibility and Reliability Assessment in Clinical Research

There is no broadly accepted standard method for assessing the quality of echocardiographic measurements in clinical research reports, despite the recognized importance of this information in assessing the quality of study results. Twenty unique clinical studies were identified reporting echocardiographic data quality for determinations of left ventricular (LV) volumes (n=13), ejection fraction (n=12), mass (n=9), outflow tract diameter (n=3), and mitral Doppler peak early velocity (n=4). To better understand the range of possible estimates of data quality and to compare their utility, reported reproducibility measures were tabulated, and de novo estimates were then calculated for missing measures, including intraclass correlation coefficient (ICC), 95% limits of agreement, coefficient of variation (CV), coverage probability, and total deviation index, for each variable for each study. The studies varied in approaches to reproducibility testing, sample size, and metrics assessed and values reported. Reported metrics included mean difference and its SD (n=7 studies), ICC (n=5), CV (n=4), and Bland-Altman limits of agreement (n=4). Once de novo estimates of all missing indices were determined, reasonable reproducibility targets for each were identified as those achieved by the majority of studies. These included, for LV end-diastolic volume, ICC>0.95, CV<7%, and coverage probability>0.93 within 30mL; for LV ejection fraction, ICC>0.85, CV<8%, and coverage probability>0.85 within 10%; and for LV mass, ICC>0.85, CV<10%, and coverage probability>0.60 within 20g. Assessment of data quality in echocardiographic clinical research is infrequent, and methods vary substantially. A first step to standardizing echocardiographic quality reporting is to standardize assessments and reporting metrics. Potential benefits include clearer communication of data quality and the identification of achievable targets to benchmark quality improvement initiatives.

RECLASSIFICATION OF PARADOXICAL LOW-FLOW, LOW-GRADIENT SEVERE AORTIC STENOSIS BASED ON BIPLANE-DERIVED STROKE VOLUME

Incumbent to the diagnosis of paradoxical low-flow, low-gradient severe aortic stenosis (LFLG AS) is a low indexed stroke volume (SVi) being < 35 mL/m2. This crucial value, with purported prognostic significance, is now embedded in the valve guidelines from the European Society of Cardiology and the ACC/AHA. However, measuring the LV outflow tract (LVOT) diameter necessary to derive SVi is fraught with error and poor reproducibility. In addition, the LVOT is not circular but rather elliptical, adding to the discrepancies in estimating SVi. As the SVi is typically calculated from Doppler as part of the continuity equation for calculating the aortic valve area (AVA), we postulate that calculating SVi from 2D volumes (thereby eliminating the LVOT measurement) may reclassify some of these patients.

Paravalvular leak after transcatheter aortic valve implantation: is it anatomically predictable or procedurally determined? MDCT study

To investigate the determinants of paravalvular leak (PVL) occurring after transcatheter aortic valve implantation (TAVI). One hundred and eight patients with severe symptomatic aortic stenosis (mean age 75.5±11.8 years, 72.2% male) underwent contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) then successful TAVI. The following parameters were determined in the late systolic phase: annular and left ventricular outflow tract (LVOT) diameters, annular perimeter, ellipticity index, annular area, indexed annular area, LVOT perimeter, annulus/LVOT perimeter difference ratio, the LVOT to ascending aorta angle (< LVOT-AO). In the diastolic phase, the extent of calcification of the aortic valve (AVC) was assessed visually and graded semi-quantitatively as grade I, II, and III at the annulus, LVOT, and aortic cusps levels. Pre-discharge transthoracic echocardiography (TTE) was performed, and the PVL was graded as grade I, II, and III. The area-dependent device-annulus sizing ratio was calculated. Absence of PVL was observed in 44.44% of the patients, 30.56% had grade I PVL, 25% of the patients had grade II or above, and any PVL was observed in 55.56%. There was no statistically significant association between the degree of PVL and the extent or the distribution of AVC, aortic annulus diameters, ellipticity index, annulus/LVOT perimeter difference ratio or < LVOT-AO. The frequency of PVL was not significantly different with the use of balloon-expandable or self-expandable valves. A larger transcatheter heart valve (THV)/annulus sizing ratio was associated with a lower incidence and degree of PVL (p<0.001); there was no detectable PVL with a mean sizing ratio of 14.89±7.29, and grade I PVL occurred with a mean sizing ratio 12.43±0.84, while PVL of grade II or above occurred using the mean sizing ratio -0.42±5.57. The procedure-related THV/annulus sizing ratio was an important determinant of the degree of PVL after TAVI, whereas the MDCT-derived anatomical measurements of the aortic root and AVC were not predictors of PVL.

Echocardiographic Predictors of Left Ventricular Outflow Tract Obstruction following Repair of Atrioventricular Septal Defect.

Left ventricular outflow tract obstruction (LVOTO) is a common complication following surgical repair of atrioventricular septal defect (AVSD). We sought to determine predictors of LVOTO based on echocardiograms performed prior to initial repair of AVSD. Of the 415 children that had repair of AVSD from 2003 to 2012, 17 children were identified with LVOTO that required surgical intervention. Thirty-four patients with repaired AVSD and no LVOTO served as controls. Patient demographics, cardiac surgery type, and echocardiogram results at last follow-up were collected. Off-line analysis of the echocardiogram prior to AVSD repair was done to obtain: left ventricular outflow tract (LVOT) and interventricular septal diameter, chordae across LVOT, aortoseptal angle, left ventricular (LV) inflow/outflow length ratio, inferior displacement of the atrioventricular (AV) valve, atrioventricular valve index (AVVI) and presence of coarctation of the aorta. The LVOTO group had significantly smaller indexed LVOT diameters (P < .001), increased likelihood of chordae crossing the LVOT (P = .010), decreased LV inflow/outflow length ratio (P < .001), decreased AVVI (P = .014) and increased presence of coarctation of the aorta (P = .003) compared to control patients. A multiple logistic regression model including presence of chordae in the LVOT [OR 5.32, 95% CI: (1.24-22.78, P = .024] and an indexed LVOT diameter ≤2.5 cm/m2 [OR 5.41, 95% CI: (1.15-25.39) P = .032] demonstrated each to be independently associated with the development of LVOT obstruction (area under the receiving operating curve = 0.77). Chordae across the LVOT and an indexed LVOT diameter of ≤2.5 cm/m2 are associated with a higher risk of development of LVOTO following repair of AVSD. Identification of these risk factors on echocardiogram prior to initial AVSD repair can be useful in evaluating for future risk of LVOTO and the need for closer clinical follow-up.

Assessment of right heart function in preeclampsia by echocardiography.

Preeclampsia (PE) is a multisystemic disorder characterized by hypertension and proteinuria that is specific to pregnancy and associated with maternal and fetal morbidity-mortality. To assess right heart structure and function in PE by echocardiography using conventional and tissue Doppler techniques. In total, 67 women with untreated PE and 46 matched healthy pregnant women were included. PE was defined according to the ACOG (2002) criteria. Right and left heart functions were evaluated using transthoracic two-dimensional (2D) echocardiography with color Doppler and tissue Doppler imaging techniques. Right ventricular basal and outflow tract diameters and free wall thickness, right atrial end-systolic maximum diameter, and area were significantly higher in the PE group than the control group (p<0.05). Tricuspid annular plane systolic excursion, isovolumic acceleration time, tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), right ventricle fractional area change, and myocardial performance index (Tei) were significantly lower in the PE group than the controls (p<0.05). PE does not only affect the left side of the heart but also the right side. This finding may open new scenarios, because right ventricular dysfunction may also be responsible for PE-related morbidity.

SUBSTITUTION OF LEFT VENTRICULAR OUTFLOW TRACT DIAMETER WITH BODY SURFACE AREA

Measurement of the left ventricular outflow tract (LVOT) diameter is a key parameter in the calculation of stroke volume, aortic valve area and mitral valve area on transthoracic echocardiography (TTE). We had observed that the numeric value for body surface area (BSA) reported in m2 frequently