Clinical, electrocardiographic, phonocardiographic, and echocardiographic examinations were performed in 100 presumably healthy young females. Treadmill testing and ambulatory electrocardiographic monitoring were performed in a selected group of these subjects. Phonocardiograms, recorded with the subjects supine at rest, after inhalation of amyl nitrite, and in the upright position, revealed a 17% incidence of nonejection clicks and/or late or mid- to late systolic murmurs (PHONO-MSCLSM). Echocardiographic studies were performed in the second, third, fourth, and fifth intercostal space with emphasis on the importance of transducer angulation on the chest. Studies obtained with the transducer perpendicular to the chest in the sagittal plane, or pointing cephalad at a time when both mitral leaflets and left atrium are recorded, are optimal to study the mitral valve systolic motion. With the transducer in this position, 21 subjects were found to have pansystolic or late systolic prolapse, as previously defined on the echocardiogram. The presence of these echocardiographic findings was statistically related to the presence of PHONO-MSCLSM. Other echocardiographic patterns were identified and their relation to PHONO-MSCLSM and transducer position is discussed. Ten subjects with both echocardiographic evidence of mitral valve prolapse and PHONO-MSCLSM were identified (group EP), while 18 other subjects had either echocardiographic or phonocardiographic findings suggestive of mitral valve abnormality (group EorP). Seventy-two subjects had no abnormality (group noEP). The incidence of various clinical, electrocardiographic, and echocardiographic findings in these three groups was determined. Some findings said to be common in patients with proven mitral valve prolapse were seen more frequently in group EP subjects. Echocardiographic and phonocardiographic findings suggesting mitral valve abnormalities were found more commonly than expected in a population of presumably healthy young females.

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An asymptomatic adult population of 196 men and women was studied with the echocardiogram to derive age- and sex-specific "normal" values for a number of clinically used echocardiograhic variables. The results are in general agreement with previously published normal values. Body position during the examination, age and sex influence the echocardiographic results; body surface area correction normalized most of these effects. The prevalence of occult abnormalities determined by the echocardiogram is 7%; the most common finding was mitral valve prolapse. Inter- and intraobserver variability was assessed. The interobserver differences found on analysis are statistically, but not clinically , significant. The echocardiogram appears to be a suitable tool to use in epidemiologic studies to detect selected cardiac abnormalities, but is limited for this purpose because some subjects in such a population cannot be adequately examined.

SUMMARY Twenty patients with coronary artery disease were studied with two-dimensional echocardiography the day before saphenous vein bypass graft surgery. Serial studies were obtained 7.4 2.5 (±+ SD) and 43.4 + 13.1 days postoperatively to qualitatively assess the effect of bypass surgery on regional wall motion. Changes in segmental wall motion were assessed semiquantitatively by assigning a segmental wall motion score to each of nine echocardiographically defined segments. Preoperatively, 18% of the segments moved abnormally. The mean overall segmental wall motion score did not change significantly, as shown by comparing the postoperative studies with the preoperative study. However, there was a significant worsening in septal motion (apical and basal) and a significant improvement in posterior wall motion (apical and basal) after bypass surgery. Anterior and lateral wall motion were not significantly changed. Nonseptal segments that were normal preoperatively usually remained normal; abnormal nonseptal segments usually improved or were unchanged by surgery. The motion of septal segments, however, generally worsened postoperatively whether they were normal or abnormal preoperatively. We conclude that segmental wall motion assessed by two-dimensional echocardiography may improve after revascularization surgery, but the interventricular septum shows impaired motion. This effect of coronary artery bypass surgery on wall motion is better demonstrated relatively late after operation than early in the postoperative course, as has been done in some previous studies.STUDIES on the effect of coronary artery bypass graft surgery on left ventricular wall motion have yielded conflicting results. Some investigators have noted postoperative improvement in overall ventricular function, regional wall motion, or ejection fraction after surgery,'-5 but others have detected no change or a deterioration in these variables in significant numbers of patients.6°Two-dimensional echocardiography permits assessment of segmental left ventricular wall motion serially and without risk to the patients, although it currently provides less quantitative information than other techniques.As part of our ongoing evaluation of patients with coronary artery disease using two-dimensional echocardiography, we assessed segmental left ventricular wall motion in patients immediately before and twice after coronary artery bypass graft surgery. Our goals were to use multiple two-dimensional echocardiograms to analyze segmental motion over the entire ventricle; to observe the overall results of revascularization by comparing the effects of surgery on both normal and abnormal (preoperative) segments; and to assess changes in regional wall motion occurring 1-6 weeks postoperatively. Methods Patient PopulationTwenty patients admitted to the University Cardio-

SUMMARY We reviewed M-mode and two-dimensional echocardiographic findings in 11 patients with abacteremic endocarditis to study the application of echocardiography in this setting. All patients had negative blood cultures but underwent surgery that confirmed the presence of active infective endocarditis. The infection involved native valves in five patients and prosthetic valves in six patients. Valvular masses were identified in eight patients. The other three patients, who had prosthetic aortic valves, had diastolic mitral valve vibration characteristic of aortic regurgitation. One of these three also showed dehiscence of the prosthesis.Three patients had poorly defined clinical illnesses and echocardiography was a prime element in the diagnosis because valvular masses were identified. The operation was facilitated by knowledge of the mass indicated by echocardiography in these eight cases. Also, the surgical approach was affected by knowledge of dehiscence and perivalvular abscess formation in two cases each.