Echocardiographic determination of left atrial volumes in children with congenital heart disease.

Yabek, Steven M.; Isabel-Jones, Josephine; Bhatt, D R; Nakazawa, Makoto; Marks, R A; Jarmakani, Jay M.

doi:10.1161/01.cir.53.2.268

Cited by 38 publications

(18 citation statements)

References 18 publications

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“…In a clinical study, identical correlations were shown to exist between angiographicalry determined left atrial anteroposterior minor axes and the left atrial volume in both the normal and volume overloaded left atrium with a wide variety of lesions. 23 All these data verify the postulation that any left atrial dimension should be sufficient to evaluate the chamber size, particularly when sequential changes are to be assessed serially in a single animal. The similarity of the phasic pattern of atrial diameter to directly measured flow across the mitral valve 24 also lends support to the idea that such measurements can serve as an indicator of global performance of the left atrium.…”

supporting

confidence: 59%

Role of the left atrium in adaptation of the heart to chronic mitral regurgitation in conscious dogs.

Kihara

Sasayama

Miyazaki

et al. 1988

Circulation Research

112

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The manner in which the left atrium adapts to chronic mitral regurgitation and the role of the adapted left atrium as a modulator of excessive central blood volume were analyzed in seven conscious dogs, instrumented with high-fidelity pressure transducers and ultrasonic dimension gauges for measurement of left atrial and left ventricular pressure and cavity size. After obtaining data in a control situation, mitral regurgitation was produced by transventricular chordal sectioning. Heart rate was matched by right atrial pacing. In the "early" stage (7-14 days), left ventricular end-diastolic and mean left atrial pressures increased from 6 to 16 mm Hg and from 4 to 12 mm Hg, respectively. Both left ventricular end-diastolic segment length and left atrial diameter prior to atrial contraction increased by 7%. In the "late" stage (20-35 days), despite significant decreases in left ventricular filling pressure (11 mm Hg) and left atrial pressure (8 mm Hg), there was a continuous increase in left ventricular end-diastolic dimension (10%) and atrial end-diastolic diameter (10%). After the onset of mitral regurgitation, the left atrium performed greater work with a more enlarged cavity. Left atrial chamber stiffness was progressively decreased. These changes were associated with progressive increase in the left atrial diameter at zero stress, and there was a significant increase in the diameter of the left atrial myocyte. These results indicate that during chronic mitral regurgitation, the left atrium enlarges in size and mass, with a more potent booster action. The left atrial chamber becomes more compliant. Thus, the enlarged left atrium appears to exert an important compensatory mechanism in the case of T he left atrium, a muscular contractile chamber located in the inflow path to the left ventricle, functions both as a pump and as a reservoir for blood.1 During mitral regurgitation, the left ventricle decompresses into the left atrium as the mitral orifice, in parallel with the aortic valve, acts as a pressuredependent outlet for the ventricle. The physiological consequences to the left atrium are characterized by increases in left atrial size and pressure; however, the magnitude of these changes depends chiefly on the rapidity and severity with which the regurgitation develops. In animal experiments, we observed that the atrial diameter suddenly increased following the onset of acute mitral regurgitation. Hence, atrial shortening was initially augmented, in accord with the FrankStarling mechanism in atrial muscle. However, progressive increase in regurgitation was associated with further increases in atrial size but diminished atrial stroke; hence, the atrial chamber was rendered less compliant.2 These changes in left atrial compliance were postulated as follows: the atrium subjected to From the Third Division, Department of Internal Medicine, Faculty of Medicine, Kyoto University, Kyoto, Japan, and the Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan.Presented in pa...

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supporting

confidence: 59%

Role of the left atrium in adaptation of the heart to chronic mitral regurgitation in conscious dogs.

Kihara

Sasayama

Miyazaki

et al. 1988

Circulation Research

112

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“…Echocardiography has proved itself as a noninvasive method for determination of left atrial size with a high degree of accuracy. Measurements correlate closely with those obtained by angiography (Hirata et al, 1969;Lundstrom and Mortensson, 1974;Ten Cate et al, 1974;Yabek et al, 1976). The larger the left-to-right shunt, the greater the volume of blood delivered to the left atrium.…”

supporting

confidence: 73%

“…The left atrial dimension is affected by other factors apart from the volume of blood reaching it. Decreased left ventricular compliance will result in an increase in left atrial dimension, as will lesions of the mitral valve (Hawley et al, 1966;Yabek et al, 1976). One patient (not in this series) had a ventricular septal defect and coarctation of the aorta, and was in left ventricular failure; he had a larger left atrial dimension than expected from the size of the shunt.…”

Section: Resultsmentioning

confidence: 83%

“…This dimension is closely correlated with the volume of the left atrium in a variety of conditions (Hirata et al, 1969;Ten Cate et al, 1974). Though in a recent analysis Yabek et al (1976), stated that 'pancaking' of the left atrium was not seen with volume overload, it is possible that distortion of this axis of the left atrium might occasionally occur.…”

Section: Resultsmentioning

confidence: 97%

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Echocardiographic evaluation of left-to-right shunt in ventricular septal defect and persistent ductus arteriosus.

Bloom¹,

Rodrigues²,

Swan³

1977

Heart

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Forty-five patients with either a ventricular septal defect or a persistent ductus arteriosus were assessed by echocardiography and cardiac catheterisation. Left atrial dimension was expressed either as a function of the body surface area (LAD cm per m2 BSA), or as a multiple of the aortic root dimension (LAD/AR), and was compared with the shunt size as determined by oximetry. A highly significant (P<0.001) regression relation was found for the group as a whole. A significant relation also existed for each individual group: ventricular septal defect, ventricular septal defect with pulmonary hypertension, and persistent ductus arteriosus. Regression equations were derivedfor the whole group. The value of echocardiography is in separating largefrom small shunts and in adding a dimension to thefollow-up of the individual patient.

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“…Two-dimensionally guided M-mode echocardiography allows for the measurement of left atrial dimension in the parasternal long-axis orientation. M-mode-derived left atrial size has been shown to correlate well with angiographically derived left atrial areas and volumes 7 and has been used to monitor changes in left atrial size in AF. 8 -10 Left atrial enlargement is common among patients with AF.…”

Section: Role Of Transthoracic (Surface) Echocardiographymentioning

confidence: 99%

Role of Echocardiography in Patients Undergoing Elective Cardioversion of Atrial Fibrillation

Silverman

Manning

1998

Circulation

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Abstract-Echocardiography has emerged as a fundamental tool in the evaluation of patients with atrial fibrillation (AF).Transthoracic echocardiography remains a primary tool for the evaluation and management of many patients presenting with their first episode of AF, but it is not adequate for exclusion of atrial thrombi. TEE offers excellent visualization of the atria and accurate identification or exclusion of thrombi. In concert with therapeutic anticoagulation, a TEE-guided approach to early cardioversion appears to have a safety profile similar to that of conventional therapy (1 month of precardioversion warfarin). The TEE-guided approach offers the advantages of simplified anticoagulation management and shorter duration of sustained AF, thereby allowing for a more rapid recovery of atrial mechanical function. Warfarin should be continued for 1 month after cardioversion to allow for more complete recovery of atrial function and for prophylaxis should the patient revert to AF. Cost-effectiveness models demonstrate that TEE-guided cardioversion represents a cost-effective strategy, but only if the transthoracic echocardiogram is omitted. For patients with a thrombus on the initial TEE, follow-up TEE (to document thrombus resolution) is recommended before cardioversion. (Circulation. 1998;98:479-486.)

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Echocardiographic determination of left atrial volumes in children with congenital heart disease.

Cited by 38 publications

References 18 publications

Role of the left atrium in adaptation of the heart to chronic mitral regurgitation in conscious dogs.

Role of the left atrium in adaptation of the heart to chronic mitral regurgitation in conscious dogs.

Echocardiographic evaluation of left-to-right shunt in ventricular septal defect and persistent ductus arteriosus.

Role of Echocardiography in Patients Undergoing Elective Cardioversion of Atrial Fibrillation

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