Isometric contraction and relaxation times of right and left ventricles in normal subjects and in patients with right ventricular overloading measured with bidirectional echocardiography

M-mode echocardiographic findings in children with idiopathic restrictive cardiomyopathy

The M-mode echocardiographic findings in five pediatric patients, ages 4-15 years, with primary idiopathic restrictive cardiomyopathy, diagnosed by cardiac catheterization, and of 12 normal children (control group) are presented. The M-mode echocardiographic findings in patients with restrictive cardiomyopathy were (1) normal left and right ventricular end-diastolic dimension, (2) normal left ventricular posterior wall and interventricular septal thickness (three patients) or mild concentric hypertrophy (two patients), (3) normal opening and closing velocity of the mitral valve, (4) consistently enlarged left atrium (more than 40 mm) in all, and (5) right ventricular systolic time intervals compatible with pulmonary artery hypertension. The left ventricular ejection phase parameters (systolic time intervals, shortening fraction, and mean velocity of circumferential fiber shortening) were normal. Left ventricular relaxation phase parameters (diastolic function) were abnormal. The isovolumic relaxation time index was prolonged, 68 +/- 40 ms (+/- SD), in the study group as compared with 11 +/- 6 ms (+/- SD) in the control group (P less than 0.001). Percent relaxation of left ventricular posterior wall endocardium at 50% of diastole was decreased, 58 +/- 4% (+/- SD), in the study group as compared with 85 +/- 6% (+/- SD) in the control group (P less than 0.005). We conclude that M-mode echocardiography provides a relatively useful and specific noninvasive method for the diagnosis of primary restrictive cardiomyopathy in pediatric patients.

Echocardiographic abnormalities of tricuspid valve motion in pulmonary embolism

Echocardiographic findings in five patients with pulmonary embolism were studied. Tricuspid echocardiograms showed abnormalities in valve motion, that is a monophasic triangular wave during diastole in all the patients as well as an increased dimension of the right ventricle. An "a' dip of the pulmonary valve echocardiogram was also recognised in all five. Later tricuspid echocardiograms regained the normal M-shaped configuration. The monophasic triangular pattern of the tricuspid valve during diastole may be related to the shorter duration of tricuspid valve opening compared with that of the mitral valve. Tachycardia cannot explain this difference between tricuspid and mitral valve motion, which seems to be caused by a prolonged isovolumic relaxation time of the right ventricle resulting in a delayed opening of the tricuspid valve. These results were obtained by comparing these data with those of control subjects and patients with chronic right ventricular overloading resulting from atrial septal defect.

Relation between isovolumic relaxation period of left ventricle and pulmonary artery pressure in d-transposition of the great arteries

The study aimed to identify the best echocardiographic time interval (systolic or diastolic) for assessing pulmonary artery pressure in children with d-transposition of the great arteries. Echocardiograms were performed in 21 children with d-transposition of the great arteries within 48 hours of cardiac catheterisation. None of the children had had a Mustard procedure. Twenty-four recordings were obtained, three patients having been catheterised twice. Highest correlations were found for the ratio of the isovolumic relaxation time over the ejection time of the left ventricle (IRT/LVET) to the systolic pressure in the pulmonary artery and also between IRT/LVET and the difference between mean pulmonary artery pressure and mean left atrial pressure. All patients with a negative IRT/LVET ratio had a pulmonary systolic pressure lower than 35 mmHg and a mean pulmonary pressure lower than 25 mmHg. In patients with d-transposition, a negative IRT/LVET ratio appears to be a reliable indication of normal pressure in the pulmonary circulation. Serial echocardiographic studies for the follow-up of patients with d-transposition should include measurement of the time of relaxation of the left ventricle.