In order to assess M-mode echocardiographic recordings in a normal Norwegian population, 190 apparently healthy subjects (95 women and 95 men) aged 21-69 years were examined with an Irex Meridian system. Measurements were performed according to criteria recommended by the American Society of Echocardiography. Absolute values for all parameters except for left ventricular (LV) shortening fraction (SF) were greater in men (P less than 0.001). When corrected for body surface area (BSA), the differences between the two genders were far less pronounced. Women had greater left atrium (LA) (P less than 0.01) and LV end-diastolic diameter (EDD) (P less than 0.001), whereas the interventricular septum in end-diastole (IVS-ED) (P less than 0.05) and LV posterior wall (PW) in ED (P less than 0.001) were thicker in men. Only weak correlations between age and the various echocardiographic parameters with r-values less than or equal to 0.30 were observed. It is recommended that BSA corrected values should be preferred since the differences between men and women are negligible. When absolute values are used, different normal ranges for both sexes should be applied.

We report our initial experience in three children with percutaneous transvenous closure of significant atrial septal defects. A newly developed one-piece nitinol device is delivered through a long venous sheath of 7 French calibre under fluoroscopic and transoesophageal echocardiographic monitoring. Complete closure of all defects was verified by echocardiography on the morning after the procedure. No complication occurred. In the first two patients, the device slipped sideways into the defect. This was easily discovered and corrected. Our experience shows that the Amplatzer® device is reliable, easy to implant, and presents very clearly on transoesophageal echocardiography and fluoroscopy. This makes implantation a controlled procedure. Until release, the device can easily be retracted into the sheath at any time and removed. The results suggest that closure of an atrial septal defect with this device is feasible, rapid, and safe.

An isolated ventricular septal defect (VSD) was diagnosed in 70 patients (39 men and 31 women, mean age 29 years, range 10-64 years). Surgery was judged unnecessary. The follow-up period was at least 10 years, or until death or 31 December 1988, comprising a mean duration of 21 (range 6-29) years. The mortality was 11/69 (one lost to follow-up), and was not significantly higher than in a matched 'normal' group. Six deaths were cardiac, four of which could probably be related to the VSD. The follow-up study revealed that: (1) 14 (22%) subjects had major, VSD-related complications, and cardiac surgery was indicated in eight patients; (2) six (10%) had minor complications. By the end of 1988, 24% of subjects had significant dyspnoea, 22% had chest pain and 19% used cardioactive drugs. Only 33% were receiving regular cardiac control in a hospital. Thus unoperated adults with a small VSD should be monitored closely, since this condition is far from benign.

The reproducibility of physical capacity expressed as cumulative work (CW) and work pulse (WP) as well as haemodynamic response to maximal exercise was evaluated by two different principles for increasing work load during a maximal bicycle ergometer exercise test: (i) stepwise increment (SI) of 50 Watts (W) every fourth minute; (ii) continuous increment (CI) of 10 W at the end of every minute, both with a starting load of 50 W. Forty apparently healthy men aged 29-69 (mean 47) years performed two tests with a mean interval of 17 (3-43) days. Group A: 10 men who did SI twice; group B: 10 who repeated CI; group C: 10 men who performed SI and CI alternatively; group D: 10 men who did SI in the morning vs afternoon. Error % (percentage of the absolute difference of the mean of two values) was 3.9 for CW in group A vs 7.8 in group B (p less than 0.05). The error % of heart rates at submaximal work levels were lower with SI than CI. Mean CW in group C was 182.3 +/- 65.1 kJ for CI and 154.8 +/- 48.8 kJ for SI (p less than 0.01), whereas the mean exercise time was 1206 +/- 297 s and 1089 +/- 197 s respectively (p less than 0.01). Group D subjects achieved 142.7 +/- 49.4 kJ in the morning and 134.4 +/- 48.8 kJ in the afternoon (p less than 0.05). No significant differences were noted for WP in groups A-D. A better reproducibility for CW was found for SI, whereas both tests had similar reproducibility for heart rate and blood pressure response during maximal exercise.