No abstract

M-mode, cross-sectional and color flow Doppler echocardiography were performed in 28 patients with acute rheumatic fever. The patients were grouped according to the presence or absence of carditis and congestive heart failure. Abnormal echocardiographic findings were found in 25 patients (89%), including five with no carditis. M mode echocardiography showed significant cardiac enlargement in all patients with carditis, and in two patients with no carditis. The myocardial contractility, as based on ejection fraction and fractional shortening, was normal in all patients except one. Prolapse of the leaflets of the mitral valve (57%) and increased echogenicity of the leaflets of the mitral valve (36%) were the most common findings seen on cross-sectional echocardiography. Pericardial effusion was seen in six patients (21%), all with heart failure. Color flow and Doppler echocardiography showed that mitral regurgitation, which was seen in 24 patients (86%), was the most common finding. Aortic regurgitation was found in 17 patients (60%). The presence of congestive heart failure in patients with carditis was related to the severity of the valvar regurgitation and the number of valves involved. Echocardiographic evidence of rheumatic involvement of the heart may be observed even in the absence of clinical signs of carditis.

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Right pulmonary artery (rPA) diameter was measured during the first hour of life, then during the next 23 hours, at 72 hours and at 120 hours in 62 normal term and 14 normal preterm neonates by M-mode echocardiography via the suprasternal notch. Left atrium (LA) and aortic (Ao) diameters were likewise determined from the standard parasternal view. Comparison was also made with rPA values of 34 patients with patent ductus arteriosus (26), persistent fetal circulation (6) and cyanotic congenital heart disease (2).In normal term babies, the mean rPA size changed significantly during the 4 periods of examination with diameters of 4.6 mm, 5.5 mm, 5.2 mm and 4.7 mm respectively. Among preterm babies, mean rPA diameter at 24 hours was 3.8 mm, at 72 hours, 3.8 mm, and at 120 hours, 3.3 mm. Unlike those in term babies, the changes in preterm babies were not significant. LA dimensions and LA/Ao ratio were more variable. Furthermore, rPA measurements reliably differentiated clinical conditions with increased or decreased pulmonary blood flow. Thus, our data confirm the significance of rPA measurement as it closely correlates with the hemodynamic changes in the early neonatal period in normal and abnormal term and preterm babies.

A modified echocardiographic method (peripheral arterial contrast echocardiography, PACE) using suprasternal notch (SSN) echocardiography and rapid hand injection of 5% glucose solution through peripheral arteries is introduced. This method was used to determine the presence of a left-to-right shunting via patent ductus arteriosus (PDA) in 50 patients with various congenital heart disease among neonates, infants, and young children. Echocardiographic findings were compared with cardiac catheterization/angiography, surgery, and/or autopsy. Diagnosis of PDA made by PACE was sensitive in 98.5% and specific in 100% of cases. Thus, the PACE examination is a reliable bed-side technique to detect qualitatively the presence or absence of a left-to-right shunting PDA accompanied with acyanotic or cyanotic heart disease.