[Two-dimensional echocardiographic diagnosis of aortic arch by suprasternal approach (author's transl)]

Two-dimensional echocardiographic studies of the aortic arch and proximal descending aorta were performed in 6 cases with coarctation of the aorta, 40 normal subjects and 9 cases of coarctectomy approached by the suprasternal notch. In cases with the normal aortic arch and proximal descending aorta, the ascending aorta, aortic arch, descending aorta and right pulmonary artery were visualized clearly. The diameter of the aortic lumen is consistent throughout the plane of the scan. The origins of the left carotid artery and the left subclavian artery were seen clearly. In 3 of 7 normal newborns a localized area of a slightly aortic narrowing (diameter of aortic narrowing area / diameter of proximal descending aorta greater than 0.75) was visualized. In 5 of 6 cases with coarctation of the aorta a localized area of an aortic narrowing distal to the origin of the left subclavian artery is visualized which corresponded to the angiographic appearance of the coarctation. In 1 of 6 cases with coarctation of the aorta a more diffuse area of aortic obstruction beginning from distal portion of the left carotid artery to distal portion of the left subclavian artery was visualized. In this case, aortic valve stenosis, ventricular septal defect, patent ductus arteriosus, and hypertrophy of the interventricular septum and left ventricular posterior wall were associated. In 9 coarctectomy cases a localized area of an aortic narrowing distal to the origin of the subclavian artery was enlarged after operation. Two-dimensional echocardiogram approached by the suprasternal notch may offer a useful noninvasive method for direct visualization of the aortic arch and proximal descending aorta.

[Application of two dimensional echocardiography for the intracardiac manipulation: the evaluation of atrial septal movement before and after balloon atrial septostomy (author's transl)]

Two-dimensional echocardiography was applied to intracardiac catheter manipulation (especially balloon atrial septostomy: BAS) in 6 babies with complete transposition of the great arteries and 2 with total anomalous pulmonary venous drainage. Under the usual roentgenoscopic investigation, intracardiac catheter manipulation was observed by two-dimensional echocardiography directly representing the right atrium, left atrium, atrial septum, right ventricle, left ventricle and interventricular septum by the subcostal approach. Also, formation and movement of the atrial septum and intra-atrial shunt before and after BAS was evaluated by contrast echocardiography. 1. It was confirmed that the catheter tip was inserted into the left atrium from the right atrium. 2. It was clearly demonstrated that the balloon was expanding in the left atrium. 3. When the balloon was pulled out to the right atrium from the left atrium, the movement of the atrial septum and the balloon was observed. 4. The formation and movement of atrial septal defect by BAS was demonstrated and the shunt of this site was estimated by using contrast echocardiography. The relation between the catheter tip and the intracardiac structures can be judged more correctly by two-dimensional echocardiography than roentgenoscopic investigation. Also the structural and hemodynamic changes by BAS can be clearly estimated by the observation of the atrial septum by two-dimensional echography.