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Permanent cardiac pacing is a widely applied procedure in invasive cardiology. The aim of our study was the analysis of the localisation of the tip of the pacemaker lead and its course in the right ventricle. Research was carried out on a group of 12 patients (5F, 7M), from 40 to 93 years of age (average 70±15 yrs) with permanent cardiac pacing or implantable cardioverter-defibrillator (ICD). Subsequent echocardiographic views were applied: an apical four chamber view, a subcostal one and a parasternal right ventricular inflow tract view. At the level of the tricuspid annulus the electrode was positioned: the anterior leaflet – 41.7% (5 pts), the anteroseptal commissure 25% (3 pts), the posterior leaflet 8.3% (1 pt) and the septal one – 8.3% (1 pt). In 16.7% (2 patients) the lead was positioned centrally in the right atrioventricular orifice. Regarding the further positioning of the electrode in the ventricle, in 41.7% (5 pts) the leads were placed along the interventricular septum, in 16.7% (2 pts) along the anterior wall of right ventricle and in 41.7% (5 pts) across the centre of the right ventricle. The tip of the lead was positioned in the apex of the right ventricle in 83.4% (10 pts). In the remaining 16.7% (2 pts) the position was not apical — in 1 patient the anterior wall of the right ventricle and in 1 patient the interventricular septum. In the VVI pacing mode the electrode did not lie on the interventricular septum. In contrast to this in 80% of patients (4 pts) having the DDD pacing mode the lead was situated on the interventricular septum on its course downwards to the ventricle. Conclusions: 1) On the level of the leaflets of the tricuspid valve the lead most often was positioned at the level of the anterior leaflet and the anteroseptal commissure. 2) Most patients had an apical localisation of the tip of the lead. 3) Differences between morphological and echocardiographic studies are related to the intravital and the two-dimensional character of echocardiography, and probably to the small population of the group examined.
One of the hypotheses put forward concerning the mechanism of vasovagal syncope is that the vagal afferent fibres are activated during vigorous contractions against a partly empty left ventricle. The aim of the study was to confirm this hypothesis by using 2D echocardiography during a head-up tilt test. The study was carried out on 39 patients (17 male, 22 female, age range 21–64 years), all with a history of recurrent syncope. The patients were examined using a 2D echo to measure the end-diastolic and end-systolic volume before the head-up tilt test after the Westminster protocol (45min/60 grade) and every five minutes after tilting. T patients during head-up tilt test had a positive response and 32 proved negative. A reduction of both the end-diastolic and end-systolic volumes of the left ventricle was noticed. There was no significant difference in the degree of ejection fraction reduction. The difference in ejection fraction reduction between the two groups was similarly non-significant. It was also noticed that the patients with a positive response had more vigorous contractions than those with a negative test. The decision was therefore taken to use a different parameter for the left ventricle contraction, namely the LV posterior wall slope. As this parameter is partly dependent on time, its use in confirming the extremely vigorous nature of the contractions was considered appropriate. Only 6 patients were tested using this parameter. A tendency towards greater left ventricle posterior wall slope values, both before and during tilting was noticed in the group of patients with vasovagal reaction. Our data shows that vigorous contraction is probably less responsible for vasovagal syncope release than left ventricle volume reduction.
Background: Congenital heart diseases (CHD) are the leading cause of birth defect-related deaths. Multidedector computed tomography (MDCT) plays an important role for imaging CHD in addition to echocardiography and provides a comprehensive evaluation of complex heart malformations for the referring cardiologist. The aim of the study was to evaluate the utility of MDCT in the assessment of CHD. Materials and methods: A 102 patients with CHD were investigated after initial assessment by echocardiography. The information obtained by MDCT and findings of echocardiography were reviewed together by paediatric cardiologists and cardiac radiologists. Perioperative anatomic descriptions, wherever available (n = 34) formed the gold standard for the comparison. Results: The clinical consensus diagnosis defined 154 cardiovascular lesions in the patients. The results were classified in groups. We present the appearance of various congenital cardiac lesions seen in clinical practice. Conclusions: MDCT provides important information about anatomic details of CHD for the referring cardiologist. The evaluation of different anatomic structures such as heart, great vessels, lungs and abdomen is possible in one acquisition with this technique. (Folia Morphol 2013; 72, 3: 188–196)
Rhythm and conductivity disturbances in heart muscle, change in autonomic system function and raised arterial blood pressure have been described in workers exposed to lead. They may be accompanied by changes in echocardiography test and accordingly we undertook this investigation. The study population included employees of zinc and lead steelworks in the south of Poland that were divided into 2 groups: exposed to lead compounds (n=88) and the reference group - administration workers (n=55) with normal levels of lead concentration in blood (PbB) and zinc protoporphyrin in blood. Left ventricular enddiastolic dimension (LVDd), interventricular septal and posterior wall thickness, right ventricular diastolic, left atrium diameter, aortic diameter and left ventricular ejection fraction (EF) in echocardiograms were performed. Left ventricular mass LVM (g) and left ventricular mass index LVMI (g/m2) was calculated. In the group exposed to lead, EF decreased by 3%, increased LVDd by 6%, and raised LVM by 11% and LVMI by 10%. There was a positive relation between PbB and LVDd (R=0.18) and between PbB and LVM (R=0.14). Decreased EF, enlargement of the left ventricle and raised left ventricle mass in research undertaken, may be a result of raised arterial blood tension.
In this study, show-jumping horses (n = 80) and Arabian race horses (n = 80) from different work groups were examined, with the guidance of 2-D, by M-Mode echocardiography, to establish the reference values and to determine the differences in the cardiac structural measurements. Measurements were performed in four different planes by obtaining M-Mode cross-sections from M. papillaris, C. tendinei, mitral valves and aorta root levels, with the guidance of 2-D in the 4th intercostal space. Left ventricle, right ventricle, left atrium, aorta root, interventriculer septum, left ventricle posterior wall and heart wall movements were observed and end-systolic and end-diastolic diameters with left ventricle function evaluations were performed. Subsequently, all of these values were compared between the two groups. The results indicated statistical significance of P < 0.001 in end-diastolic volume (EDV) and ejection fraction (EF), and P < 0.005 in diastolic left ventricle internal diameter (LVIDd), diastolic interventricular septum thickness (IVSd), diastolic right ventricle internal diameter (RVd), diastolic aorta internal diameter (Aod), fractional shortening (FS) and cardiac output (CO). It has been concluded that Arabian race horses are more advantageous with their powerful left ventricle functions, while show-jumping horses have the benefit of possessing wider left ventricles, indicating the probability that exercise improves the left ventricle functions in horses.
In this research, LV systolic functions of the 14 mature dogs with idiopathic pericardial effusion (IHPE) and cardiac neoplaesia (CN) were examined. The dogs were between 1-16 years old, generally large breed and male. Signs of cardiomegaly were observed in the chest radiography and low amplitude QRS complexes in electrocardiograms. Pericardial effusion, cardiac masses and paradoxical motion were detected by 2D echocardiography. Left ventricle (LV) systolic functions were detected with M mode echocardiographic examinations. A statistical significance (p<0.001) was found between echo-free pericardial Space (EPS) and fractional shortening (FS%), ejection fraction (EF%), velocity of circumferential fiber shortening (VcF), in the dogs with IHPE. A distinction was also found between EPS and EF in the dogs with CN (p < 0.001). FS, EF and VcF were significantly decreased in the dogs with IHPE in contrast to the dogs with CN. It was detected that the systolic function of the left ventricle could be considerably disturbed by the excessive volume of the pericardial effusion, even if no cardiac tamponade occurred.
The present study was performed on 128 spontaneously aborted human foetuses aged 15–34 weeks in order to establish normal values for thoracic aorta dimensions at various gestational ages. Using anatomical dissection, digital-image analysis (the Leica QWin Pro 16 system) and statistical analysis (ANOVA, regression analysis) the growth of the length, the original and terminal external diameters and the volume of the thoracic aorta during gestation was examined. No significant gender differences were found (p > 0.05). The growth curves were generated of the best fit for the plot for each morphometric feature against gestational age. Both the length and external diameters of the thoracic aorta increased in proportion to the advance in foetal age. The length ranged from 12.49 ± 1.85 mm to 48.82 ± 6.31 mm according to the linear function y = –19.654 + 2.0512 x ± 3.5168. The original external diameter ranged from 1.25 ± 0.28 mm to 5.65 ± 0.48 mm according to the linear fashion y = –2.3834 + 0.2367 x ± 0.3850. The terminal external diameter ranged from 1.15 ± 0.26 mm to 5.18 ± 0.45 mm, in agreement with the linear model y = –2.1438 + 0.2156 x ± 0.3555 (r = 0.96, p < 0.001 for each feature). The volume of the thoracic aorta ranged from 15.75 ± 8.06 mm³ to 1158.01 ± 301.85 mm³ according to the quadratic function y = 1376.2 – 154.42 x + 4.419 x² ± 125.6 (R² = 0.90). The growth curves generated from my data may be useful as a reference for foetal echocardiographers, who must distinguish abnormal from normal foetal development.
Echocardiography is a valuable tool for the evaluation of systolic and diastolic cardiac function. A high correlation between measurements of diastolic mitral inflow parameters analyzed with Doppler echocardiography and invasive methods makes the former valuable. The aim of this study was to ascertain if significant differences occur in diastolic myocardial parameters between dogs with no heart disease and dogs with subclinical or clinical dilated cardiomyopathy. Furthermore the aim of the study was to determine whether heart failure in dilated cardiomypathy is a result of systolic dysfunction alone or both systolic and diastolic dysfunction. Eleven parameters were analyzed: E wave, E-AT, E-DT, E time, A wave, A-AT, A-DT, A time, E+A time, E/A ratio, and IVRT. The study confirmed the value of noninvasive echocardiographic assessment of diastolic function in dogs with dilated cardiomyopathy. Significant differences were found in E wave, E-AT, E time, E/A ratio and IVRT between healthy dogs and dogs with dilated cardiomyopathy. All are characterized by a significant decrease compared to healthy dogs after taking into account age and body weight except for the E/A ratio, which significantly increased in value. There were no significant changes in any of the Doppler parameters for diastolic evaluation in subclinical cases of DCM. Advanced heart failure in dilated cardiomyopathy entails systolic and diastolic dysfunction.
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