Echocardiographic assessment of left ventricular outflow tract in d-transposition of the great arteries

Aziz, Kalim U.; Paul, Milton H.; Muster, Alexander J.

doi:10.1016/0002-9149(78)90013-9

Cited by 29 publications

(13 citation statements)

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“…'3' 14, [16][17][18][19][20] Their occurrence in patients with excellent surgical results indicates a lack of correlation with the hemodynamic abnormalities of semilunar valve insufficiency or pulmonic stenosis with which they are associated in normal patients. Rather, these features appear to be related to the presence of the altered anatomic structures and turbulence resulting from altered flow patterns, as suggested by previous workers.'…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic features of patients with and without residual defects after Mustard's procedure for transposition of the great vessels.

Thompson¹,

Serwer²

1981

Circulation

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SUMMARY The usefulness of echocardiography in evaluating patients who have undergone Mustard's procedure for d-transposition of the great vessels was investigated by examining the M-mode studies and cardiac catheterization data of 20 patients at least 1 year after operation. The patients were separated into two groups using the findings at cardiac catheterization. The 12 patients in group 1 were asymptomatic, were not taking cardiac medications and were free of significant residual hemodynamic defects. Echocardiographically, left ventricular diastolic dimension (LVDD) and posterior wall size (PW) were smaller than normal in these children, whereas right ventricular diastolic dimension (RVDD) and anterior wall thickness (AW) were greater than normal. The percent fractional shortening of the left ventricle (%FS) was elevated. Systemic venous atrial-to-pulmonary venous atrial dimension ratios (SVA/PVA) fell into a narrow range regardless of patient size (mean 1.00 ± 0.06) (SD). All patients in group 1 had diastolic flutter of both atrioventricular valves and abnormal septal motion.. Two patients had systolic flutter of the pulmonary valve and nine had systolic anterior motion of the mitral valve. The eight patients in group 2 had significant residuai defects. In all five patients with baffle obstruction of systemic venous return and in the patient with baffle obstruction of pulmonary venous return, SVA/PVA was well outside group 1 limits..RVDD was above group 1 limits in one patient with RV dysfunction andAtwo with tricuspid insufficiency. Pulmonary artery diameter, LVDD, and PW were above the respective group 1 ranges in two patients with elevated pulmonary artery pressure, while pulmonary artery diameter was below. group 1 limits in the patient with pulmonic stenosis. All group 2 patients were easily distinguishable from group 1 patients by at least one variable. Thus, while marked echocardiographic differences exist between group 1 and normal patients, patients with residual defects after the Mustard procedure can be readily identified, indicating a useful role for echocardiography in the postoperative management of patients with transposition of the great vessels.

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Section: Discussionmentioning

confidence: 99%

Echocardiographic features of patients with and without residual defects after Mustard's procedure for transposition of the great vessels.

Thompson¹,

Serwer²

1981

Circulation

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“…Repeated scan sweeps from the pulmonary artery to the left ventricle were obtained. Care was exercised in keeping an approximate parallel alignment between the pulmonary artery and the interventricular septum, so that quantification of the left ventricular outflow tract could be obtained [3]. Ventricular end-diastolic dimension and wall thickness were obtained at the time of the ECG R-wave peak, where maximum amplitude of the mitral valve was present [6].…”

Section: Methodsmentioning

confidence: 99%

“…In patients with surgically induced complete right bundle-branch block, the dimensions were obtained at a point just proximal to the isovolumetric systolic notch on the posterior left ventricular wall tracing. The left ventricular dimensions were measured from the anterior edge of the ventricular free wall endocardium to the posterior edge of the ventricular septal endocardium [3].…”

Section: Methodsmentioning

confidence: 99%

“…Right and left ventricular dimensions were obtained at the same site. The left ventricular posterior wall was measured from the anterior edge of the pericardium to the anterior edge of the endocardium, and the septal thickness was measured between the right and left ventricular endocardial edges [3]. We have used our own [3] and previously published normal values for the various echocardiographic parameters obtained as described above and have not followed the recommendations of the Committee on Echocardiography.…”

Section: Methodsmentioning

confidence: 99%

“…The M-mode echocardiographic diagnostic criteria are the demonstration of (1) an anterior aorta, identified by opening of the anterior semilunar valve after the posterior semilunar valve, and (2) tion of the aortic root relative to the pulmonary artery root. Associated lesions such as left ventricular outflow tract stenosis can be qualitatively and quantitatively evaluated [3,12]. Echocardiographic assessments of pulmonary artery 110, 11] and left ventricular pressure [13] have also been reported, but the clinical reliability of these criteria is yet to be tested.…”

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M-mode echocardiographic assessment of d-transposition of the great arteries and associated defects

et al. 1982

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SUMMARY. M-mode echocardiographic, hemodynamic, and angiographic correlations are presented for 97 patients with d-transposition of the great arteries. Forty-one patients were Studied before and 73 patients after the Mustard operation; 17 patients were studied sequentially before and after the Mustard operation. The echocardiographic diagnosis of d-transposition Could be made with high accuracy by using two criteria: (1) opening of the posterior semilunar Valve earlier than the anterior semilunar valve, and (2) location of the anterior semilunar valve to the right of the posterior semilunar valve with transducer angulation toward the right shoulder. In the pre-Mustard group the presence of associated lesions such as patent ductus arteriosus and Ventricular septal defect was suggested by an elevated left ventricular end-diastolic/right ventricular end-diastolic dimension ratio (> 1.2). In the post-Mustard group, after correction of shunting lesions, this ratio was similar to that in patients with intact ventricular septum. In preMustard patients the anatomically fixed type of left ventricular outflow tract stenosis was SUggested by a left ventricular outflow tract/pulmonary artery ratio of less than 0.5. This ratio Was 0.52 • 0.1 in those in whom resection of the anatomic stenosis and Mustard operation were Performed. Right ventricular function could be assessed by the pre-ejection period/right ventricular ejection time ratio; a ratio of greater than 0.5 was associated with angiographically determined ejection fraction of 0.5 or less.It is suggested that M-mode echocardiography provides a reliable means for the diagnosis of dtransposition of the great arteries as well as the quantitative and qualitative assessment of associated lesions.KEy WORDS: Echocardiography in transposition m Dynamic stenosis in transposition Echocardiographic diagnosis of transposition M-mode echocardiography has proved to be a reliable means for the diagnosis of d-transposition of the great arteries [8,5]. The M-mode echocardiographic diagnostic criteria are the demonstration of (1) an anterior aorta, identified by opening of the anterior semilunar valve after the posterior semilunar valve, and (2) tion of the aortic root relative to the pulmonary artery root. Associated lesions such as left ventricular outflow tract stenosis can be qualitatively and quantitatively evaluated [3,12]. Echocardiographic assessments of pulmonary artery 110, 11] and left ventricular pressure [13] have also been reported, but the clinical reliability of these criteria is yet to be tested. The purpose of this study was to evaluate the diagnostic usefulness of various echocardiographic parameters and to present their hemodynamic correlates, both before and after the Mustard operation and correction of associated lesions.

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2003

The Natural and Modifed History of Congenital Heart Disease

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Echocardiographic assessment of left ventricular outflow tract in d-transposition of the great arteries

Cited by 29 publications

References 10 publications

Echocardiographic features of patients with and without residual defects after Mustard's procedure for transposition of the great vessels.

Echocardiographic features of patients with and without residual defects after Mustard's procedure for transposition of the great vessels.

M-mode echocardiographic assessment of d-transposition of the great arteries and associated defects

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