SUMMARY A new and simplified method to determine left ventricular (LV) volumes with two-dimensional echocardiography (2-D echo) was developed using the parasternal long-axis and apical four-and twochamber views. An end-diastolic area (EDA) was derived using the longest minor axis (Dmax) from either of the three views and the major long axis (Lmax) gle-plane LV angiography were performed within 24 hours of each other. Five patients were excluded, three because of poor-quality 2-D echoes and two because of poor-quality LV angiograms. Among the remaining 25 patients (17 males and eight females, mean age 54 years, range 29-77 years), 18 had coronary artery disease (CAD), 16 with regional dyssynergy and two with normal wall motion; two patients had aortic insufficiency, one patient had mitral regurgitation, one patient had congestive cardiomyopathy, and three patients had normal heart evaluations. Echocardiographic Measurement of VolumesWide-angle, 2-D echoes were recorded using a mechanical sector scanner (Advanced Technology Laboratories Mark V) or a phased-array sector scanner (Varian V-3400). All studies were videotaped on 3/4-inch Umatic videocasette recorders equipped with a back-spacer search module, which allows frame-byframe bidirectional playback. The video frame rate of the system is approximately 60 frames/sec.All patients were studied in the left lateral recumbent position using multiple views through the left parasternal and apical windows. Three views were selected for measurements: parasternal long-axis, apical four-chamber and apical two-chamber. Several minoraxis LV dimensions at the upper, middle and lower third of the LV cavity were measured at end-systole and end-diastole, as previously described8 ( fig. 1)

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To study left ventricular diastolic function in Chagas's disease, simultaneous echocardiograms, phonocardiograms, and apexcardiograms were recorded in 20 asymptomatic patients with positive Chagas's serology and no signs of heart disease (group 1), 12 with Chagas's heart disease and symptoms of ventricular arrhythmia but no heart failure (group 2), 20 normal subjects (group 3), and 12 patients with left ventricular hypertrophy (group 4). The recordings were digitised to determine left ventricular isovolumic relaxation time and the rate and duration of left ventricular cavity dimension increase and wall thinning. In groups 1 and 2 (a) aortic valve closure (A2) and mitral valve opening were significantly delayed relative to minimum dimension and were associated with prolonged isovolumic relaxation, (b) left ventricular cavity size was abnormally increased during isovolumic relaxation and abnormally reduced during isovolumic contraction, and (c) peak rate of posterior wall thinning and dimension increase were significantly reduced and duration of posterior wall thinning was significantly prolonged; both of these abnormalities occurred at the onset of diastolic filling. These abnormalities were more pronounced in group 2 and were accompanied by an increase in the height of the apexcardiogram "a" wave, an indication of pronounced atrial systole secondary to end diastolic filling impairment due to reduced left ventricular distensibility. Group 4, which had an established pattern of diastolic abnormalities, showed changes similar to those in group 2; however, the delay in aortic valve closure (A2) and in mitral valve opening and the degree of dimension change were greater in the latter group. Thus early isovolumic relaxation and left ventricular abnormalities were pronounced in the patients with Chagas's heart disease and may precede systolic compromise, which may become apparent in later stages of the disease. The digitised method is valuable in the early detection of myocardial damage.

We describe a newborn with acute respiratory distress syndrome, subjected to mechanical ventilatory assistance with high level of peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP), who developed cardiac tamponade due to pneumopericardium. Tension pneumopericardium produces the same physiological derangement as cardiac tamponade secondary to accumulated blood or other fluids. This life-threatening complication demands immediate diagnosis and treatment.

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