[Thrombosis of the left auricle. Diagnostic usefulness of two-dimensional echocardiography]

The purpose of this study is to determine the sensitivity and specificity of two dimensional echocardiography in the diagnosis of thrombosis of the left atrial appendage. Sixty patients with mitral rheumatic heart disease were examined prospectively 24 to 72 hours prior to cardiac surgery. Two images were used to identify thrombosis in the appendage: parasternal short axis at the level of the aortic valve with a lateral and superior inclination of the transducer and a modified apical five chamber view with counter clockwise rotation of the transducer between the apical long axis and the five chamber view. Diagnosis was corroborated during surgery and by histopathological analysis. In all cases the presence and predominance of mitral lesion (stenosis or regurgitation) were established by clinical history, electrocardiogram, chest roentgenogram and two dimensional echocardiogram. In 58 patients the lesions were also confirmed by cardiac catheterization. Of the 60 patients (46 females and 14 males between 16 and 61 years of age), eleven cases (18.3%) of left atrial thrombosis were detected, of which seven had formed in the left atrial appendage. All were confirmed during surgical intervention and pathological analysis. One thrombus in the left atrial appendage not diagnosed by echocardiography was found during surgery (Sensitivity:90.9%). In this case pathology studies demonstrated recently formed thrombi. In all cases in which two dimensional echocardiography did not show signs suggesting thrombosis, surgery confirmed that atrial thrombosis did not exist (Specificity: 100%). This study demonstrates the utility of two dimensional echocardiography in the diagnosis of thrombosis of the left atrial appendage, thus making it possible to schedule corrective surgery and the use of anticoagulants.

[Echocardiographic and Doppler study of pulmonary atresia with an intact interventricular septum]

Pulmonary atresia with intact ventricular septum represents a congenital cardiac lesion for which the prognosis depends on the patency of the ductus arteriosus. Nine children with pulmonary atresia and intact ventricular septum underwent echocardiographic studies before cardiac catheterization trying to visualize the anatomy of the outflow tract of the right ventricle, the dimension of the ventricular cavity, the characteristics of the tricuspid valve and finally the size and integrity of the interventricular septum. Using Doppler ultrasound it was possible to evaluate the function of the tricuspid valve and the patency of the ductus arteriosus. The results obtained were correlated with the angiographic and anatomic studies. We concluded that noninvasive assessment of this malformation permits an excellent correlation with the angiographic and anatomic studies.

[Usefulness of 2-dimensional echocardiography in detecting intraventricular thrombi in patients with acute myocardial infarction]

The purpose of this study is to determine the importance of two-dimensional echocardiography performed soon after admission to the coronary care unit to provide useful information concerning wall-motion abnormalities, and to detect and characterize left ventricular thrombi. A major goal is to identify a subgroup of patients with acute myocardial infarction who are at risk for systemic embolization; in this subgroup the benefits of anticoagulation treatment would theoretically outweigh the associated risks. We studied 7 consecutive male patients, age range from 32 to 60 years, with acute myocardial infarction. Five patients had antero-septal infarction, 1 anterolateral and another had anterior wall infarction. We performed two-dimensional echocardiography within the first week after admission. All patients had severe apical-wall-motion abnormalities (akinesis or dyskinesis) and left ventricular thrombi. All patients received anticoagulation therapy. Two-dimensional echocardiography, performed one month after the first study, showed that the thrombi had decreased in size in 6 patients and could not be visualized in 1 patient. The noninvasive nature of echocardiography allows serial evaluations of patients with known left ventricular thrombi and permits assessment of the effect of therapy.

[Diagnosis of constrictive pericarditis and restrictive cardiomyopathy by pulsed Doppler echocardiography]

Characteristics of flow through atrioventricular valves were analyzed by pulsed Doppler echocardiography (PDE) in 7 patients with either constrictive pericarditis or restrictive cardiomyopathy and 10 controls to determine the value of this technique in their differentiation. All patients were admitted with systemic venous congestion and underwent right and left heart catheterization. PDE variables considered included peak flow velocity (PV), acceleration time, peak velocity of the atrial component (PVA), PVA/PV quotient, duration of early diastolic fillings, deceleration of early diastolic filling, duration of diastolic flow and mean temporal velocity. Ventricular filling differed between patients and controls in that the former group was characterized by higher PV's, lower PVA's, higher deceleration and lower PVA/PV quotient. When we compared both patient groups we found a significant tendency toward higher PV's, faster deceleration and lower PVA/PV quotient in constrictive pericarditis.

[Diagnosis by two-dimensional and Doppler echocardiography of coronary aneurysm in a Mexican boy with Kawasaki disease]

The mucocutaneous lymph node syndrome or Kawasaki's disease, is a clinical entity consisting of high fever, mucocutaneous involvement and cervical lymphadenopathy that affects infants and young children. Although syndrome is predominantly found in Japan, it has become increasingly recognized in other countries. This disease appears to be benign and self-limited in most instances. However, extensive cardiac involvement may cause sudden death due to myocardial infarction from occlusive coronary artery disease, rupture of a coronary aneurysm or conduction abnormalities. As a result, it has become important to establish a noninvasive diagnostic method for assessing cardiac involvement in this disease. The purpose of this study is to describe the echocardiographic recognition of a left coronary artery aneurysm in a 3 years old mexican boy with Kawasaki's disease.

[Echocardiographic diagnosis of pulmonary valve calcification]

Calcification of the pulmonary valve is a uncommon condition. Non invasive diagnostic methods such as M-mode and two dimensional echocardiography have facilitated the identification of vegetations and calcifications on the pulmonary valve. Very few cases of isolated calcification on the pulmonary valve have been reported; a previous lesion of the valve almost always exists. The purpose of this communication is to report two cases with calcification of pulmonary valves without underlying pathology and to highlight the great utility of echocardiography in diagnosis and follow-up of such cases.

[Usefulness of M-mode echocardiography, two-dimensional and Doppler, in the study of pericardial diseases]

The objective of this communication is to determine utility of echocardiography M mode, two-dimensional and Doppler, in the diagnosis and follow-up of patients with pericardial disease. This procedure was used initially to the diagnosis of pericardial effusion, actually it has a lot of new applications. It's noninvasive and low cost, and would give us important information about our patients.

[Left ventricular hypertrophy simulating an intracavitary tumor. Echocardiographic diagnosis]

We report a case of a 14 month old infant with severe stenosis of the pulmonary valve in whom the angiographic image suggested the presence of a right ventricular (RV) tumor mass. The patient was admitted because of clinical manifestations of heart failure. Right heart catheterization demonstrated a transvalvular pulmonary gradient and filling defects in the infundibulum compatible with an intracavitary mass. Two dimensional and Doppler echocardiography confirmed pulmonary stenosis and showed that the mass corresponded to hypertrophy of the anterior RV wall. The combination of two dimensional and Doppler echocardiography are the indicated techniques in differential diagnosis of RV tumor masses and RV hypertrophy secondary to severe pulmonary valve stenosis.

[Malposition of the great arteries. Is this term a valid one?]

We present four cases of a congenital heart malformation classically known as malposition of the great arteries. This term means there are concordant ventriculo-arterial connections with abnormal spatial relations of the aortic and the pulmonary arteries, in which the former is anterior relative to the latter, and either to the right or to the left, according to the position of the corresponding ventricle. This anomaly can be found in any type of atrial situs, notwithstanding the type or mode of atrioventricular connection, as in the cases we studied. If we consider that this anomaly depends on the associated lesions in order to produce physiological heart alterations, we think that the term of malposition of the great arteries is not valid, since in the anatomic diagnosis of congenital heart disease it is important to consider the connections between atria, ventricles and arteries, the spatial relations between them being of second importance.

[Quantification of pulmonary arterial hypertension by phonocardiography and M-mode echocardiography in children with congenital cardiopathies]

We studied 20 children with congenital heart disease using Echo-Phonocardiographic techniques to determine the presence and magnitude of pulmonary arterial hypertension. The results were compared with those obtained by catheterization. There was a significant correlation between the pulmonary arterial systolic pressure (PSP) estimated from the right ventricular isovolumetric relaxation period and the PSP from the catheterization (r = 0.92). The ratio preejection period /right ventricular ejection time (PEP/RVET) identified the patients (PEP/RVET greater than or equal to 0.30) with a PSP mean value = 64.5 mmHg (p less than 0.01). The presence of a systolic notch on the pulmonary valve echogram distinguished the group with a PSP mean value = 60 mmHg (p less than 0.005). There was a poor correlation between the depth of the "a" wave and the E-F slope of the pulmonary valve echogram and the catheterization PSP (r = -0.50 and r = -0.40, respectively). The interval PR from the electrocardiogram minus the distance AC from the tricuspid valve echogram had a poor correlation with the right ventricular end diastolic pressure (r = 0.57). We conclude that there are some Echo-Phonocardiographic signs which are very useful in the diagnosis and measurement of pulmonary arterial hypertension in children with congenital heart disease.