Paradoxical Interventricular Septal Motion Research Articles

28 CONSTRICTIVE PERICARDITIS: A ROOM FOR MULTI-MODALITY IMAGING

Abstract Introduction The diagnosis of constrictive pericarditis can be challenging through conventional imaging. Novel imaging techniques have been proposed to improve it. Clinical Case A 74-year-old man with a previous diagnosis of heart failure with preserved ejection fraction and permanent atrial fibrillation (AF) was admitted because of worsening dyspnea, peripheral edema, and ascites refractory to diuretics therapy. ECG revealed low QRS voltages and AF with normal heart rate and laboratory exams detected increased values of BNP and hepatic stasis indices; blood count and CRP were normal. Echocardiography revealed mildly reduced bi-ventricular pump function (left ventricular ejection fraction = 52%, right ventricular fractional area change = 25%) and slightly increased wall thickness. Atria were moderately dilated (left and right atrium 46 and 44 ml/mq, respectively) and mitral and tricuspid annuli were dilated too. There was inferior vena cava plethora, moderate atriogenic tricuspid regurgitation and mild-to-moderate atriogenic mitral regurgitation. A paradoxical interventricular septal motion and significant respiratory changes on trans-mitral (>25%) and trans-tricuspid (>30%) pulsed Doppler were noted; however, there was no "annulus reversus" (lateral and septal e’ 13 and 11 cm/sec, respectively) at TDI analysis. In contrast, 2D-speckle-tracking global longitudinal strain showed impaired deformation ​​of the lateral segments with relative sparing of the septal segments. The latter pattern has been recently described as "strain reversus" or "hot septum sign". The findings were suspected of constrictive pericarditis, but a chest Computed Tomography excluded pericardial calcifications. Cardiac magnetic resonance (CMR) was then performed revealing a "septal shift" at cine-real time sequences analysis. The pericardium was slightly thickened (4-5 mm) with widespread late gadolinium enhancement but without signs of acute inflammation at T2-weighted imaging. Tricuspid regurgitation was confirmed to be "moderate" after phase-contrast imaging. Cardiac catheterization finally revealed normal coronary arteries and confirmed the diagnosis of constrictive pericarditis (square root sign, equalization of bi-ventricular end-diastolic pressures). The patient underwent pericardiectomy and tricuspid and mitral valve repair and was asymptomatic at 6-months follow-up. Conclusions Constrictive pericarditis represents a potentially reversible cause of heart failure but can be easily missed through conventional imaging. In the present case, advanced echocardiography and CMR were essential to come up with an accurate diagnosis, guiding the patient's clinical management with excellent outcome.

Paradoxical Interventricular Septal Motion as a Major Determinant of Late Gadolinium Enhancement in Ventricular Insertion Points in Pulmonary Hypertension

BackgroundThis study investigated the major clinical determinants of late gadolinium enhancement (LGE) at ventricular insertion points (VIPs) commonly seen in patients with pulmonary hypertension (PH).MethodsForty-six consecutive PH patients (mean pulmonary artery pressure ≥25 mmHg at rest) and 21 matched controls were examined. Right ventricular (RV) morphology, function and LGE mass volume at VIPs were assessed by cardiac magnetic resonance (CMR). Radial motion of the left ventricular (LV) wall and interventricular septum (IVS) was assessed by speckle-tracking echocardiography. Paradoxical IVS motion index was then calculated. Univariate and multivariate regression analysis were conducted to characterize the relationship between LGE volume at VIPs and PH-related clinical indices, including the paradoxical IVS motion index.ResultsMean pulmonary arterial pressure (MPAP) of PH patients was 38±9 mmHg. LGE at VIPs was observed in 42 of 46 PH patients, and the LGE volume was 2.02 mL (0.47–2.99 mL). Significant correlations with LGE volume at VIPs were observed for MPAP (r = 0.50) and CMR-derived parameters [RV mass index (r = 0.53), RV end-diastolic volume index (r = 0.53), RV ejection fraction (r = −0.56), and paradoxical IVS motion index (r = 0.77)]. In multiple regression analysis, paradoxical IVS motion index alone significantly predicted LGE volume at VIPs (p<0.001).ConclusionsLGE at VIPs seen in patients with PH appears to reflect altered IVS motion rather than elevated RV pressure or remodeling. Long-term studies would be of benefit to characterize the clinical relevance of LGE at VIPs.

323: Pulmonary embolism: the value of transthoracic echocardiography

Acute pulmonary embolism (PE) remains a life-threatening disease and one of three major disease entities with chest discomfort seen in the emergency room. Despite progress in imaging techniques and knowledge of this disease, its medical diagnosis is one of the most difficult to achieve. The clinical assessment of PE probability remains central to the diagnosis and evaluation. Presently, accepted diagnostic modalities for the confirmation of PE include V/Q scanning, chest CT, and standard angiography. All approaches have limitations. Because echocardiography is noninvasive, provides rapid bedside results. It is an attractive imaging modality to diagnose PE. The purpose of this study is to assess the contribution of transthoracic echocardiography (TTE) in the clinical setting of PE. Eighteen patients were included. There were 7 men and 11 women. The mean age was 57 years [28; 80]. TTE was performed in all patients within the first 24 to 72 hours of admission. The diagnosis of PE was confirmed by standard angiography in all cases. Tricuspid regurgitation was the most common TTE finding (16 of 18), followed by dilated right ventricle (15 of 18), pulmonary hypertension (11 of 18), paradoxical interventricular septal motion (7 of 18) and right ventricular hypokinesis (2 of 18). TTE revealed thrombi inside the right-sided heart cavities in 3 patients. The thrombus was detected at the apex of the right ventricle in the first case, at the right atria in the second case and many thrombi were objectified even at the right atria and ventricle, at the inferior vena cava and at the left pulmonary artery in the third case. Transthoracic echocardiography may reveal findings that strongly support hemodynamically significant PE. In the majority of cases TTE provides only indirect signs of PE. It could, though, far less frequently visualise thromboembolic material inside the right-sided heart cavities. Direct visualisation of the thrombus, although confirming PE, remains an exceptional finding. This may be useful for prompt decision making in patients with haemodynamic compromise considered for thrombolysis or embolectomy.

Ventricular Dyssynchrony and Function Improve following Catheter Ablation of Nonseptal Accessory Pathways in Children

Introduction. Paradoxical or hypokinetic interventricular septal motion has been described in patients with septal or paraseptal accessory pathways. Data regarding nonseptal pathways is limited. Methods and Results. We quantified left ventricular dyssynchrony and function in 16 consecutive children, 14.2 ± 3.7 years, weighing 53 ± 17 kg, prior to and following catheter ablation of bidirectional septal (N = 6) and nonseptal (N = 10) accessory pathways. Following ablation, the left ventricular ejection fraction increased by 4.9 ± 2.1% (P = 0.038) from a baseline value of 57.0% ± 7.8%. By tissue Doppler imaging, the interval between QRS onset and peak systolic velocity (Ts) decreased from a median of 33.0 ms to 18.0 ms (P = 0.013). The left ventricular ejection fraction increased to a greater extent following catheter ablation of nonseptal (5.9% ± 2.6%, P = 0.023) versus septal (2.5% ± 4.1%, P = 0.461) pathways. The four patients with an ejection fraction <50%, two of whom had left lateral pathways, improved to >50% after ablation. Similarly, the improvement in dyssynchrony was more marked in patients with nonseptal versus septal pathways (difference between septal and lateral wall motion delay before and after ablation 20.6 ± 7.1 ms (P = 0.015) versus 1.4 ± 11.4 ms (P = 0.655)). Conclusion. Left ventricular systolic function and dyssynchrony improve after ablation of antegrade-conducting accessory pathways in children, with more pronounced changes noted for nonseptal pathways.

Mid-Term Results of Balloon Pulmonary Valvuloplasty in Children at Queen Alia Heart Institute

Objective: To evaluate the mid-term results of balloon pulmonary valvuloplasty (BPV) in children. Design: Prospective study. Settings: Pediatric Cardiology Department of Queen Alia Heart (QAHI), Jordan. Methods: One hundred and thirty-two patients with a median age of 3 years (range 1 day to 16 years), underwent (BPV) between January 1999 and January 2006. We evaluated our patients with regard to peak pressure gradient across the right ventricular outflow tract before and after BPV. Thereafter we followed them at the Outpatient Clinic regarding the peak instantaneous gradient pressure, the pulmonary valve incompetence, right ventricular function based on echocardiographic findings, and the need for repeat BPV. Results: There was significant reduction in the peak to peak gradient from 93.5 ± 32.3 mmHg to 26.1 ± 9.6 mmHg (p &lt; 0.001). Echo-Doppler data showed that residual peak instantaneous gradient dropped from 26.1 ± 9. 6 to 19 ± 6 mmHg; (p &lt; 0.001) on follow-up for 6 years. Mild to moderarte pulmonary valve regurgitation was noticed in 34 patients (27.8%) at one year and in 43 patients (38%) at mid term follow-up, but non had right ventricular dilatation or paradoxical interventricular septal motion. Conclusions: The results of mid-term follow up after balloon dilatation of the pulmonary valve are encouraging. The degree of pulmonary regurgitation is increasing with time. Longer term follow-up studies should be undertaken to evaluate the significance of residual pulmonary regurgitation.

Transcatheter closure of secundum atrial septal defects using the amplatzer septal occluder: initial experience in taiwan

We assessed the safety and efficacy of closure of secundum-type atrial septal defects (ASDs) using the Amplatzer septal occluder (ASO) in a sample of Taiwanese patients. Between June 2000 and April 2002, 25 patients underwent transcatheter closure of their secundum-type atrial septal defect/s using the ASO device. The procedures were performed under general anesthesia with access through the femoral vein using guidance provided by transoesophageal echocardiography (TEE) and fluoroscopy. Twenty-two patients had larger defects with right cardiac dilatation and paradoxical interventricular septal motion, while family concerns were the primary indications for closure for the other three. Twenty-five ASO devices were successfully implanted in 24 patients, with a lone individual referred for surgery due to implantation failure. The mean age of the patients was 12.5 years. The male-female ratio was 12:13. The mean pulmonary-systemic blood flow ratio (Qp:Qs) was 2.5:1. The ASD size (mean 20.2 mm; range 8–28.5) was measured using transoesophageal echocardiography, with a balloon-stretched diameter of 8–29.5 mm (mean 20.5). The size of the implanted devices ranged from 9–36 mm (mean 23.1). Fluoroscopy duration ranged from 9.7–41.2 minutes (mean 23.5). A residual shunt, assessed not significant from transoesophageal echocardiography, was detected in one patient who had received two ASO devices for multiple ASDs. Follow-up intervals ranged from 0.1–2 years (median 1.0), with no late complications determined for any patient. Transcatheter closure of secundum ASDs using the Amplatzer septal occluder is a safe and effective alternative to the surgical analog. With careful selection of patients, secundum ASDs can be successfully closed, with minimal procedural morbidity and excellent early results. Long-term follow up is necessary for evaluation, however, if this procedure is to be as effective as surgery.

Understanding Late Gadolinium Enhancement in Pulmonary Hypertension

A 68-year-old woman with a 3-year history of breathlessness (World Health Organization functional class III) was diagnosed with idiopathic pulmonary arterial hypertension. Investigations included a 12-lead ECG, chest radiograph, and computed tomography scan of the thorax (Figure 1, A-C). At cardiac catheterization, mean pulmonary arterial pressure and pulmonary vascular resistance were elevated (73 mm Hg and 1545 dyne · s · cm−5, respectively), and cardiac index was reduced (1.9 L/min/m2). A solitary 60% left circumflex coronary artery stenosis was present. Cardiovascular magnetic resonance identified right ventricular (RV) hypertrophy (indexed mass of 64 g/m2; normal=16 to 36 g/m2), right ventricular systolic dysfunction (RV ejection fraction 31%; normal >57%), and paradoxical interventricular septal (IVS) motion. Late gadolinium-enhanced (LGE) images taken 10 minutes after injection of 0.1 mmol/kg gadolinium–diethylenetriamine pentaacetic acid showed enhancement of both insertion regions (Figure 2A, 2B, and 2D). Figure 1. A, Twelve-lead ECG: …

Quantitative Analysis of Paradoxical Interventricular Septal Motion Following Corrective Surgery of Tetralogy of Fallot

This study aimed to quantify paradoxical interventricular septal motion (PSM) among 20 patients following tetralogy of Fallot (TOF) repair without severe pulmonary regurgitation and 20 age-matched normal subjects. PSM was quantified using the echocardiography-derived paradox index. Tissue Doppler-derived strain rate was used to assess the longitudinal and radial systolic function of the interventricular septum (IVS). The tissue Doppler-derived Tei index was used to assess the global left ventricular function. Compared to the control group, the paradox index in patients after repair of TOF was significantly higher (p = 0.001), whereas the regional IVS longitudinal (p = 0.02) and radial (p = 0.001) systolic strain rate peaks were significantly reduced. The paradox index in the patient group correlated inversely with the IVS radial peak systolic strain rate (r = -0.64, p = 0.004) and positively with QRS duration (r = 0.50, p = 0.02). The left ventricular (LV) Tei-index correlated significantly with the paradox index (r = 0.71, p = 0.001) and with the septal radial systolic strain rate peak (r = 0.59, p = 0.004). We conclude that electrical delay and reduced regional septal systolic function were the main causes for paradoxical septal motion among patients following TOF repair without significant pulmonary regurgitation. The reduced LV systolic function among this group of patients is mainly secondary to diminished septal systolic function and the paradoxical septal motion.

Transcatheter closure of secundum atrial septal defects using the amplatzer septal occluder: initial experience in taiwan

We assessed the safety and efficacy of closure of secundum-type atrial septal defects (ASDs) using the Amplatzer septal occluder (ASO) in a sample of Taiwanese patients. Between June 2000 and April 2002, 25 patients underwent transcatheter closure of their secundum-type atrial septal defect/s using the ASO device. The procedures were performed under general anesthesia with access through the femoral vein using guidance provided by transoesophageal echocardiography (TEE) and fluoroscopy. Twenty-two patients had larger defects with right cardiac dilatation and paradoxical interventricular septal motion, while family concerns were the primary indications for closure for the other three. Twenty-five ASO devices were successfully implanted in 24 patients, with a lone individual referred for surgery due to implantation failure. The mean age of the patients was 12.5 years. The male-female ratio was 12:13. The mean pulmonary-systemic blood flow ratio (Qp:Qs) was 2.5:1. The ASD size (mean 20.2 mm; range 8–28.5) was measured using transoesophageal echocardiography, with a balloon-stretched diameter of 8–29.5 mm (mean 20.5). The size of the implanted devices ranged from 9–36 mm (mean 23.1). Fluoroscopy duration ranged from 9.7–41.2 minutes (mean 23.5). A residual shunt, assessed not significant from transoesophageal echocardiography, was detected in one patient who had received two ASO devices for multiple ASDs. Follow-up intervals ranged from 0.1–2 years (median 1.0), with no late complications determined for any patient. Transcatheter closure of secundum ASDs using the Amplatzer septal occluder is a safe and effective alternative to the surgical analog. With careful selection of patients, secundum ASDs can be successfully closed, with minimal procedural morbidity and excellent early results. Long-term follow up is necessary for evaluation, however, if this procedure is to be as effective as surgery.

Evaluation of paradoxical interventricular septal motion after cardiac surgery assessment by strain rate combined with tissue doppler imaging

Evaluation of paradoxical interventricular septal motion after cardiac surgery assessment by strain rate combined with tissue doppler imaging

Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients.

Floating right heart thrombi (FRHTS) are a rare phenomenon, encountered almost exclusively in patients with suspected or proven pulmonary embolism and diagnosed by transthoracic echocardiography. Their management remains controversial. We report on a series of 38 consecutive patients encountered over the past 12 years. Thirty-two patients were in NYHA class IV, 20 in cardiogenic shock. Echocardiography usually demonstrated signs of cor pulmonale: right ventricular overload (91.7% of the population), paradoxical interventricular septal motion (75%), and pulmonary hypertension (86. 1%). The thrombus was typically wormlike (36 of 38 patients). It extended from the left atrium through a patent foramen ovale in 4 patients. Pulmonary embolism was confirmed in all but 1. Mortality was high (17 of 38 patients) irrespective of the therapeutic option chosen: surgery (8 of 17), thrombolytics (2 of 9), heparin (5 of 8), or interventional percutaneous techniques (2 of 4). The in-hospital mortality rate was significantly linked with the occurrence of cardiac arrest. Conversely, the outcome after discharge was usually good, because 18 of 21 patients were still alive 47.2 months later (range, 1 to 70 months). Severe pulmonary embolism was the rule in our series of FRHTS (mortality rate, 44.7%). The choice of therapy had no effect on mortality. Emergency surgery is usually advocated. However, thrombolysis is a faster, readily available treatment and seems promising either as the only treatment or as a bridge to surgery. In patients with contraindications to surgery or lytic therapy, interventional techniques may be proposed.

Results of three to 10 year follow up of balloon dilatation of the pulmonary valve

BackgroundThe results of immediate and short term follow up of balloon dilatation of the pulmonary valve have been well documented, but there is limited information on long term follow up.ObjectiveTo...

Implante de marcapasso ventricular esquerdo no tratamento da miocardiopatia dilatada e bloqueio de ramo esquerdo associado a discinesia de contração septal

Left branch bundle block may present as an isolated entity, even in normal hearts, in which apparently it does not impair the left ventricular function importantly. Studies in LBBB created by the implant of a right ventricular pacemeker, have shown deleterious effects on left ventricle systolic and diastolic functions associated sometimes with presence of mitral valve regurgitation. Paradoxical interventricular septal motion that follows the LBBB cause an additional impairment of left ventricular function and is in general present in patients with cardiomyopathy and congestive heart failure, with poor prognosis. In 1994 studying patients with cardiomyopathy Cazeau demonstrated that the use of four chamber pacing can increase cardiac output and decrease pulmonary capillary wedge pressures. Stimulated by this work, we decided to investigate the possibility of stimulation of the left ventricle apex alone, after sensing the P wave by the use of a dual-chamber pacemaker in patients with LBBB and paradoxical septal movement, aiming at the synchronization of interventricular septal contraction. This procedure was done in three patients and before hospital discharge they were submitted to echocardiographic studies with the pacemaker turned on and scintigraphy off to analyze the ejection fraction and the septal movement. In the first case the EF increased from 17 to 25%; in the second from 13 to 30% and in the third from 13 to 27%. The paradoxical movement disappeared in two cases and was classified as mild (+/+4+) in the first case. The functional class and mitral regurgitation were not included in this study because all three patients had combined procedures which could induce a false-positive improvement. Although this is a small number of cases, we believe that the procedure is promising for the treatment of patients with congestive heart failure, cardiomyopathy, left bundle branch block and paradoxical septal movement and it might be a future indication for the treatment of LBBB, before the deterioration of the left ventricle happens changing the quality of life and survival of these patients.

Mechanisms of the development and resolution of paradoxical interventricular septal motion after uncomplicated cardiac surgery

Of 16 patients with normal preoperative left ventricular (LV) function studied by simultaneous two-dimensional and M-mode echocardiography before and after uncomplicated cardiac surgery, M-mode interventricular septal motion remained normal in seven (group I) and was paradoxical in nine (group II) 7 to 13 days postoperatively, but was normal in all 12 patients (7 group II) studied 3 to 18 months later. An abnormal systolic increase in normalized septal curvature, the essential feature of truly paradoxical septal motion, was not observed in either group during any study period (mean = 0.92 ± 0.08), nor were significant differences found in septal thickening, LV fractional shortening, or fractional area change. In contrast, systolic anterior motion of the LV center increased from −0.1 ± 1.6 mm preoperatively to 4.8 ± 2.5 mm postoperatively in group II ( p < 0.001), and the LV posterior wall motion: thickening ratio increased from 1.10 ± 0.33 to 2.16 ± 0.45 ( p < 0.01), but both parameters had returned to preoperative levels at the follow-up study. Both parameters remained stable in group I during all study periods. In addition, direct intraoperative M-mode recordings (n = 14) demonstrated normal septal motion in both groups before chest closure, but esophageal echocardiograms (n = 10) demonstrated exaggerated anterior systolic LV motion within 2 hours of surgery in those from group II. Thus, early after uncomplicated cardiac surgery, apparently paradoxical septal motion relative to a fixed reference point is an artifact due to exaggerated cardiac mobility that resolves with the progressive restraining effect of postoperative adhesions.

Timing of abnormal interventricular septal motion after cardiopulmonary bypass operations: Lack of injury proved by preoperative, intraoperative, and postoperative echocardiography

Abnormal interventricular septal motion after cardiopulmonary bypass is a widely known occurrence. The cause and exact timing of this phenomenon remain unclear. We have studied 21 patients prospectively with preoperative, intraoperative, and postoperative two-dimensional and M-mode echocardiograms. Intraoperative studies were obtained with the pericardium closed and open and after completion of procedures performed with cardiopulmonary bypass. Fourteen patients had coronary artery bypass graft operations alone. Six patients had valve replacement with or without coronary bypass, and one patient had removal of a left atrial myxoma. All patients had normal interventricular septal motion before the operation, and none had abnormal septal motion intraoperatively. Four to eight days postoperatively, the septum still thickened normally in all patients, with five patients having normal, nine patients abnormal, and seven patients paradoxical interventricular septal motion. Studies in 11 patients 1 to 4 months postoperatively showed no change from the early postoperative study. The pericardium was left open postoperatively in all patients. Six patients were studied a few hours after sternal closure and all had abnormal interventricular septal motion. We conclude that abnormal interventricular septal motion after cardiac operations is not due to injury of the septum, adhesion formation, or loss of pericardial constraint. Closure of the chest wall itself, with the pericardium left open, is associated with this abnormality.

Echocardiography in pulmonary embolism.

Echocardiography was performed on 10 patients with suspected acute pulmonary embolism. In 3 patients with normal echocardiograms, the diagnosis was excluded by pulmonary angiography. Two with small emboli on angiography had a pulmonary arterial pressure less than or equal to 35 mmHg and normal echocardiograms. Five had an increased right ventricular end-diastolic dimension (RV-EDD) and 4 had a left ventricular end-diastolic dimension (LV-EDD) below normal or in low normal levels. The RVEDD/LVEDD ratio was increased in 4 patients, 3 of whom had paradoxical interventricular septal motion. The mitral valve E-F slope and left atrial dimension changed variably. The posterior aortic wall O-V excursion (PAW-OV-Ex) decreased in 5 and was correlated with LVEDD (r = +0.92, p less than 0.01) and the RVEDD/LVEDD ratio (r = -0.87, p less than 0.025). Follow-up echocardiography in 3 cases after recovery showed a decreased RVEDD/LVEDD ratio, normal septal motion and improved LVEDD and PAW-OV-Ex. The PAW-OV-Ex seems to mirror the abnormalities in volume changes of the left side of the heart resulting from pulmonary embolism. An entirely normal echocardiogram would be unlikely in the presence of a hemodynamically significant pulmonary embolism.

Echocardiography of the human fetal heart: Estimation of growth and function in utero

SummaryM-mode echocardiographic studies on 110 human fetuses at 18 to 40 weeks of pregnancy were carried out on Japanese women with a regular menstrual cycle and no complications of pregnancy, in order to evaluate the growth and function of the fetal heart. High correlations of fetal cardiac transverse diameter with the gestational age (r = 0˙93, P < 0˙001), and also with the biparietal diameter(r = 0˙93, p < 0˙001) were noted. Left ventricular diastolic dimension correlated well with the gestational age (r = 0˙69, P < 0˙001), as did left ventricular systolic dimension (r = 0˙64, p < 0˙001). A negative correlation between the left ventricular ejection fraction and gestational age was evident (r = 0˙31, 0˙01 <p <0˙02). The regression curve derived from the data for left ventricular stroke volume (y) and the gestational age (x) was log10y/(2025-y) = 0˙19(x-30˙7). A paradoxical interventricular septal motion was noted in many cases (62 per cent). Prenatal diagnosis of congenital heart anomalies is feasible u...

Range-gated pulsed Doppler echocardiographic diagnosis of supracardiac total anomalous pulmonary venous drainage.

Three patients with total anomalous pulmonary venous drainage (TAPVD) into the innominate vein were studied by using M-mode and pulsed Doppler echocardiography. An abnormal continuous flow towards the transducer in a suprasternal notch position detected by pulsed Doppler echocardiography in the left hemithorax leftward of the aortic echo is a sign of blood flow through the left vertical vein into the innominate vein. This finding is highly specific for TAPVD. High-velocity flow across the tricuspid valve, disturbed flow in the right pulmonary artery and abnormal flow in the left atrium are additional important pulsed Doppler echocardiographic findings in TAPVD. Right ventricular enlargement and paradoxical interventricular septal motion by M-mode echocardiography were not specific enough to distinguish TAPVD from other right ventricular volume overload lesions. An echo-free space posterior to the left atrium was not recorded.

Echocardiographic differentiation of partial and complete atrioventricular canal.

Retrospective examination of echocardiograms was performed in 34 patients with persistent atrioventricular (A-V) canal who had undergone cardiac catheterization. Characteristic findings in 16 patients with partial A-V canal were lack of continuity of mitral and tricuspid valves, paradoxical interventricular septal motion, definite E and A waves of the mitral valve anterior leaflet (MVAL) echoes and late systolic anterior motion of the mitral valve. Eighteen patients with persistent A-V canal had an interventricular communication and were classified as having the complete form. They characteristically had continuous mitral and tricuspid valves, normal interventricular septal motion, disorganized MVAL echoes, and normal systolic mitral valve motion. Combining these findings allowed differentiation of 31 of the 34 patients (91%) as having partial or complete A-V canal. Determining the presence of a VSD from loss of interventricular septal echoes was unsatisfactory. The severity of mitral insufficiency could not be estimated from echocardiograms of our patients with partial A-V canal.