We evaluated 147 patients with adequate color Doppler and angiographic studies for mitral regurgitation. Sixty-five patients had no mitral regurgitation by both color Doppler and angiography and 82 patients had mitral regurgitation by both techniques. Thus the sensitivity and specificity of color Doppler for the detection of mitral regurgitation was 100%. Materials and methodsThe original study consisted of 160 patients. However, 13 were excluded, eight because of poor acoustic window and inadequate echocardiographic images of the left atrium and five because of the presence of multiple premature ventricular contractions at the time of angiography, making the quantitation of mitral regurgitation impossible. Thus a total of 147 patients who had adequate color Doppler and angiographic examinations form the basis of this study. There were 79 men and 68 women, ranging in age from 17 to 84 years (mean 56). Eighty-two patients had mitral regurgitation by angiography, and the remaining 65 demonstrated normal mitral valvular function. The etiology of mitral regurgitation was ischemic heart disease in 34 rheumatic heart disease in 24, congestive cardiomyopathy in 13, and mitral valve prolapse in 11. Thirty-one of the 82 patients with mitral regurgitation were in atrial fibrillation and the remaining were in normal sinus rhythm. None of the patients without mitral regurgitation were in atrial fibrillation.
The color Doppler echocardiographic studies and aortic angiograms of all patients who had these procedures performed within 2 weeks of each other between October 1984 and August 1985 were reviewed to determine whether any parameters of the regurgitant jet visualized by color Doppler study predicted the severity of aortic insufficiency as assessed by angiographic grading. Patients with an aortic valve prosthesis were excluded. Twenty-nine patients had aortic insufficiency and had adequate color Doppler studies for analysis. The mean time between color Doppler examination and angiography was 2.3 days (range 0 to 12). The maximal length and area of the regurgitant jet were poorly predictive of the angiographic grade of aortic insufficiency. The short-axis area of the regurgitant jet from the parasternal short-axis view at the level of the high left ventricular outflow tract relative to the short-axis area of the left ventricular outflow tract at the same location best predicted angiographic grade, correctly classifying 23 of 24 patients. However, the jet could be seen from this view in only 24 of the 29 patients. The height of the regurgitant jet relative to left ventricular outflow tract height measured from the parasternal long-axis view just beneath the aortic valve correctly classified 23 of the 29 patients. Mitral stenosis or valve prosthesis, which was present in 10 patients, did not interfere with the diagnosis or quantitation of aortic insufficiency by these methods.(ABSTRACT TRUNCATED AT 250 WORDS)
London, UK summARY A classification with clinical significance is proposed for ventricular septal defect based on the study of 220 hearts with defects of the ventricular septum. All had atrioventricular and ventriculoarterial concordance with normal relations of cardiac structure. For the purpose of classification, the ventricular septum was considered as possessing muscular and membranous portions, the muscular septum itselfbeing divided into inlet, trabecular, and outlet (or infundibular) components. Defects were observed in the area of the membranous septum, termed perimembranous defects; within the muscular septum, termed muscular defects; or in the area of septum subjacent to the arterial valves, termed subarterial infundibular defects. Perimembranous defects were found extending either into the inlet, trabecular, or infundibular septa. Muscular defects were found in or between the inlet septum, trabecular septum, or infundibular septum. Review of the angiograms showed that the classification was easy to use in the catheterisation laboratory, and our observations suggest that the precision thus obtained has considerable surgical significance.In this report, we present a simplified concept for the classification of ventricular septal defects based on the study of over 200 pathological specimens with atrioventricular concordance, ventriculoarterial concordance, and usual relations of intracardiac structures. We have shown it to be useful for angiographic diagnosis and we believe it to have considerable surgical relevance. Subjects and methodsThe hearts studied were taken from the cardiopathological collections of the Cardiothoracic Institute, Brompton Hospital, London; the Royal
Anatomically corrected malposition of the great arteries is a congenital cardiac malformation in which the atria and ventricles are in concordant relation, as are the ventricles and great arteries, but the aorta is to the left of the pulmonary artery (1-position). The reported cases and our two patients have had situs solitus of viscera and atria. The aortic and pulmonary circulations are in series. We report successful surgical repair in 2 patients with associated large ventricular septal defects and pulmonary stenosis. In one the defect was posterior and in relation to the pulmonary artery which slightly overrode it. In the other the defect was anterior and the aorta overrode it. The developmental basis of these two examples of the same entity is probably different. An appropriate terminology and categorization that is useful surgically is presented.
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