Hemodynamics in Childhood Hypertension

Children with elevated systolic blood pressure have a wide range of cardiac output. We investigated the mechanisms regulating resting and exercise blood pressure in 264 children who were selected from the low, middle, and upper quintile of the distribution of blood pressure of an entire school population. We identified patterns of response to exercise that correlated both with resting cardiac output and resting blood pressure. During isometric exercise, systolic blood pressure adjusted for age and body size increased in all groups. The low group mean pressure remained significantly lower than the high group's pressures throughout the entire exercise period. Body size adjusted group systolic and diastolic blood pressure level differences existed during dynamic exercise. The product of the systolic blood pressure times the heart rate in the high blood pressure group was significantly higher throughout dynamic exercise than in the other two groups. Elevated resting resistance was correlated with elevated resistance during isometric exercise and elevated diastolic blood pressure during dynamic exercise. Cardiac index had a significant negative correlation to age (r=-0.58) at all levels of blood pressure. This observation, in children, lends some support to the concept of evolution from a hyperkinetic circulation in early childhood to a circulation with lower cardiac output and more elevated systemic vascular resistance at an older age.     

Chagas心脏病研究现状

<正>Chagas病即查加斯病,是一个古老的热带寄生虫病。该病由克氏锥虫感染引起,可累及皮肤、心脏和消化道等全身多个系统,因其广泛流行于墨西哥及拉丁美洲国家的贫穷地区也被称为美洲锥虫病(American trypanosomiasis)。但1909     

3D-echo in preoperative assessment of aortic cusps effective height

Effective height,which represents the height difference between the central free margins and the aortic insertion lines can be easily determined by 2-D echocardiography and allows for identification of prolapse in the native cusps and assessment of prolapse correction after valve repair.Nonetheless,it allows to see only two of three aortic valve(AV)coaptation planes and this may lead to misunderstanding of the underlying pathophysiological mechanism for aortic regurgitation and hence in unsuccessful repair.In contrast,3D transoesophageal echocardiography and multiple plane reconstruction lets visualize all the three coaptation planes between the AV cusps and it represents an invaluable tool in the assessment of aortic valve geometry.It is highly recommendable before AV repair to accurately study the complex three dimensional cusps anatomy and their geometric interrelation with aortic root.     

A serial echocardiographic study of myocardial abscess in a patient surviving staphylococcal septicemia

2D echocardiography was performed on a 4-year-old child suffering from right thigh abscess due to MRSA infection following diagnosis of pericardial effusion by USG abdomen. It revealed myocardial abscess and pericardial effusion. This child underwent series of 2D echocardiographic studies which showed image appearance of myocardial abscess with its time course of healing.     

Prevalence of diastolic dysfunction as a possible cause of dyspnea in the elderly

PURPOSE: Symptoms in patients with heart failure and preserved left ventricular ejection fraction may be caused by isolated diastolic dysfunction. The purpose of this study was to assess the prevalence of diastolic dysfunction as a potential cause of dyspnea in a sample of elderly subjects, as well as of isolated diastolic dysfunction as a potential cause of dyspnea in a subgroup with a preserved left ventricular ejection fraction and normal lung function. METHODS: A total of 152 subjects with dyspnea underwent echocardiography, electrocardiography, and lung function testing. Subjects with normal lung function test results (n = 60) underwent cardiac magnetic resonance imaging, chest radiography, bicycle exercise tests, and blood tests. Left ventricular diastolic function was assessed by a variety of echocardiographic/Doppler techniques. RESULTS: Of 129 subjects with dyspnea, 81 (63%) had signs of lung disease or 'obvious' cardiac disease. In the remaining 48 subjects, 32 (67%) had a potential cardiac/noncardiac cause of dyspnea. In all subjects with dyspnea, 1% to 11% had diastolic dysfunction, and in the 48 remaining subjects, 0% to 10% had isolated diastolic dysfunction, depending on the definition used. CONCLUSION: The frequency of diastolic dysfunction was low in the sample of elderly subjects with dyspnea as well as in the subgroup of persons with no signs of lung disease, left ventricular systolic dysfunction, atrial fibrillation, or valvular heart disease. Diastolic dysfunction was infrequent as a possible cause of dyspnea, and coexisting potential causes of dyspnea were often present.     

Papillary fibroelastoma in the left ventricular outflow tract

Summary We report a case of a papillary fibroelastoma originating from the left ventricular endocardium in the outflow tract which was discovered by echocardiography in an asymptomatic patient. Two echocardiographic features were observed: (1) the tumor surface was smooth, and characteristic papillary formation was not detected; and (2) the outline of the mass was clearly defined as a dense echo, with the central, radiolucent, portion surrounded by a highly refractive linear echo at the level of the maximum diameter of the mass. The excised tumor was covered with a gelatinous substance that masked multiple papillae on the surface, but its echolucent center could not be explained by the pathology of the tumor which was solid centrally. Our case indicates that a papillary fibroelastoma may sometimes show echocardiographic findings similar to those of a myxoma, although other investigators have not noted the smooth surface and the echolucent center makes it indistinguishable from a myxoma. Thus, in some cases, it is difficult to distinguish papillary fibroelastoma from myxoma by echocardiography.     

Role of real-time three-dimensional transesophageal echocardiograpny in mitral valve repair

Background and objective Pre-operative assessment of mitral valve(MV)anatomy is essential to surgical design in patientsundergoing MV repair.Although 2-dimensional(2D)echocardiography provides precise information regarding MV anatomy,RT-3DTEE could increase the understanding of MV apparatus and individual scallop identification.We aimed to investigate the value of RT-3DTEE in MV repair. Methods RT-3DTEE was performed in six patients with mitral valve prolapse(MVP) by using Philips IE33with X7-2t probe.Preoperative RT-3DTEE studies were compared with surgical findings in patients undergoing surgical mitral valverepair,and quantitative evaluation was performed by QLab 6.0 software before and after surgicalmitralvalve repair.Results RT-3DTEE could display dynamic morphology of MV,the location of prolapse,and spatial relation to the surrounding tissue.It couldprovide surgical views of the valves and the valvular apparatus.These resuIts were consistent with surgical findings.The quantitativeevahuation before and after surgical MV repair indicated that anterolateral to posteromedial diameter of annalus.anterior to posteriordiameter of annulus,perimeter of annullus.,and area of annalus in projectionplane were significantlv smaller after operation comparedwith those before operation(P＜0.05).The length of posterior leaflet,,the area of anterior and posterior leaflet,the maximal prolapseheight,the volume of leaflet prolapse and the length of coaptation in projection planewere significantly reduced after operation(P＜0.05).Conclusion RT-3DTEE is a unique new medality for rapid and accurate evaluation of mitral valve prolapse and miwal valverepair.     

非杓型高血压对左心室肥厚的影响及其临床意义

目的：以杓型高血压患者为对照，探讨非杓型高血压在左心室肥厚发生和发展中的作用。方法：应用２４小时动态血压和超声心动图检测２３０例高血压患者，选择年龄、病程、昼间血压基本相同的杓型、非杓型高血压患者１５０例，其中男性各４５例，女性各３０例。结果：非杓型高血压患者舒张末期左心房内径显著大于杓型高血压患者，男性分别为３５．８±２．９ｍｍ与３１．２±２．７ｍｍ（Ｐ＜０．０１）；女性分别为３２．４±２．５ｍｍ与２９．４±１．８ｍｍ（Ｐ＜０．０５）。女性杓型、非杓型高血压患者间舒张末期左心室内径的差异（４９．５±３．２ｍｍ与５４．８±３．７ｍｍ，Ｐ＜０．０１）比男性（５３．８±４．６ｍｍ与５７．４±４．５ｍｍ，Ｐ＜０．０５）更为显著。非杓型高血压患者左心室重量指数显著大于杓型高血压患者，男性分别为１５８．０±７．９ｇ／ｍ２与１３０．０±６．７ｇ／ｍ２（Ｐ＜０．０１）；女性分别为１３８．０±５．６ｇ／ｍ２与１１５．０±４．７ｇ／ｍ２（Ｐ＜０．０１）。结论：非杓型高血压患者左心室肥厚的检出率比杓型高血压患者为高。