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The hallmark of an atrioventricular septal defect (AVSD) is a common atrioventricular junction, giving rise to a trileaflet left atrioventricular valve. AVSDs have the potential for interatrial shunting alone, interventricular shunting alone, or both. AVSDs without interatrial or interventricular communications have been identified at postmortem examination, but there are no reports of AVSDs with intact septal structures diagnosed in life. Six patients are described with AVSD and intact atrial and ventricular septa diagnosed echocardiographically. This report shows that AVSDs can exist without interatrial or interventricular communications and that the characteristic feature of this condition, the common atrioventricular junction with a trileaflet left atrioventricular valve, can be diagnosed in life by using cross sectional echocardiography. AVSDs with intact septal structures may be more common than previously described.

Ten hearts were cut in planes to simulate echocardiographic cuts which may be taken to visualise the anatomy of the cardiac chambers and great arteries. The various myocardial wall segments were named from these sections by referring to their position in the reconstituted heart. The sections were studied in their correct anatomical position. In this way they provide a reference for appropriate orientation of echocardiographic images.

Imaging algorithms in congenital heart disease, as in the patient with acquired heart diseases continue to evolve, with more and more information gleaned noninvasively. The emphasis will be on the newer aspects of imaging, not cross sectional echocardiography with color Doppler.

Objectives To design a new echocardiographic method of screening for hypertrophic cardiomyopathy applicable to children and adults, with a low false positive rate in athletes. Setting Regional centre of cardiology, Oxford, UK. Methods Forty one patients with hypertrophic cardiomyopathy, 66 first degree relatives from families with familial hypertrophic cardiomyopathy, 262 normal subjects, and 32 athletes were studied by long axis M mode and cross sectional echocardiography to determine the frequency distribution of diastolic and systolic ratios of cardiac wall thickness to cavity diameter. Results The best screening measure for hypertrophic cardiomyopathy is diastolic septum to cavity ratio, where a value of > 0.26 yielded a 100% disease detection rate at all ages with 0% false positives in the ordinary population. In comparison, the conventional screening tool of diastolic septum to posterior left ventricular wall ratio of > 1.5 yielded a detection rate of only 75%, for a false positive rate of 2%. In first degree relatives, a septum to cavity ratio > 0.26 yielded a 100% detection rate for an abnormal phenotype suggestive of carriage of a mutation for hypertrophic cardiomyopathy with no obvious false positives. Conventional screening showed a detection rate of only 44%. Athletes with physiological cardiac hypertrophy showed only a 6% false positive rate with diastolic septum to cavity ratio, and could be differentiated from subjects with hypertrophic cardiomyopathy by the absence of hypercontractility shown by a normal systolic left ventricular wall to cavity ratio (cut off < 0.63; 0% false positives). Conclusions M mode echocardiographic measurement of the septum to cavity ratio provides a good screening test for hypertrophic cardiomyopathy at all ages. Combining this measurement with systolic left ventricular wall to cavity ratio improves the accuracy further.

OBJECTIVE: To evaluate the accuracy of quantitative three dimensional echocardiography in patients with deformed left ventricles. DESIGN: Three dimensional and cross sectional echocardiographic estimates of left ventricular volume and ejection fraction were prospectively compared to those obtained from magnetic resonance imaging. SETTING: Echocardiography laboratory of a university hospital. PATIENTS: 26 patients (9 months to 42 years, median age 11 years) with pulmonary hypertension and fixed reversal of normal interventricular septal curvature. MAIN OUTCOME MEASURES: Left ventricular end diastolic and end systolic volumes and ejection fraction. RESULTS: Three dimensional echocardiographic comparison to magnetic resonance imaging (MRI) yielded r values of 0.94 and 0.87 with a bias of -6.9 (SD 6.9) ml and -16 (11.2) ml for systolic and diastolic volumes respectively. Inter-observer variability was minimal (8.3% and 7.6% respectively). Cross sectional echocardiography gave correlation coefficients of 0.62 and 0.80 and bias of 3.1 (14.1) ml and 16.3 (18.3) ml for systolic and diastolic volumes respectively. Ejection fraction by three dimensional echocardiography also had closer agreement with MRI (bias = 1.1 (7.7)%) than cross sectional echocardiography (bias = 4.4 (13.9)%). CONCLUSIONS: Three dimensional echocardiography provides reliable estimates of left ventricular volumes and ejection fraction, comparable to magnetic resonance imaging in pulmonary hypertension patients with compressed ventricular geometry. Because it eliminates the need for geometric assumptions it shows closer agreement with magnetic resonance imaging in that setting than cross sectional echocardiography.

In a 4-year-old boy with severe mitral regurgitation, cross sectional echocardiography combined with Doppler interrogation confirmed the presence of isolated perforation of the aortic leaflet of the mitral valve. The perforation was closed with a patch of fresh autologous pericardium. Serial echocardiograms taken postoperatively showed no regurgitation across the mitral valve.

SummaryBecause left ventricular mass may be important in judging feasibility of Fontan type of palliation in tricuspid atresia, this study was undertaken to generate data on left ventricular mass, volume and mass to volume ratio in newborns and infants with tricuspid atresia, native pulmonary stenosis and concordant ventriculoarterial connections prior to any surgical palliation to obtain values for “normal” left ventricular dimensions in tricuspid atresia. The left ventricle was evaluated in the apical two and four chamber view. From these two perpendicular imaging planes, we calculated mass as difference between epicardial and endocardial volume x 1.05 (specific gravity of heart muscle). Mass divided by volume at end-diastole yields the index: mass to volume. Data from 23 newborns and infants with tricuspid atresia were compared to data from 30 age-matched controls with normal hearts. In both patient and control groups, growth of the left ventricle was not linear but related to the 1.4 (volume) or 1.25 (mass) power of body surface area. The equation best describing relation between left ventricular volume and body surface area in normals is volume = 60.7(body surface area)1.4−0.2 ml; in patients with tricuspid atresia volume calculates as 96.7(body surface area)1.4+0.9 ml. In relation to normal infants, infants with tricuspid atresia had a left ventricular volume of 167 (135–206)% of normal and a left ventricular mass of 163 (132–201)% of normal. Left ventricular mass assessed in normals calculates as mass = 59.9(body surface area)1.25+1.3 grams; in patients with tricuspid atresia it calculates as mass= 117.5 (body surface area)1.25−0.9 grams. The index of left ventricular mass to volume in patients with tricuspid atresia measured 1.32, not significantly different from controls, in whom this index calculates as 1.34.

To date there has been little discussion about image orientation for three-dimensional (3D) echocardiography when applied to congenital heart lesions. Anatomic relations cannot be assumed in congenital heart disease and image cropping during post processing may by necessity remove external or even internal anatomic references. We present an approach to consistent anatomic orientation which is both intuitive and consistent with regard to superior-inferior, anterior-posterior and left-right axes. Such anatomic orientation is also concordant with other common 3D imaging modes such as cardiac magnetic resonance imaging and computed tomography. Views derived from standard cross sectional echocardiography have such universal familiarity that analogous 3D projections of these views may be retained but novel hitherto unavailable views such as en face views of the cardiac septums or atrioventricular valves may be projected using anatomic orientation.

Cardiac structures have been measured in normal fetuses by cross-sectional echocardiography to establish a range of normal values. Gestational ages varied from 16 weeks to term. The cardiac structures measured were left and right ventricular width (n = 337), aortic root diameter (n = 296), pulmonary artery diameter (n = 312), mitral valve orifice (n = 159), and tricuspid valve orifice (n = 161). The lengths of the left and right ventricles were measured in 100 fetuses. Normal ranges were constructed using real-time ultrasound images which can be readily used in routine practice. Measurement of cardiac structures is an aid to the study of cardiac abnormalities and the availability of normal ranges of measurements of fetal cardiac structures may help to confirm and define suspected cardiac malformation during routine screening.

SummaryCross-sectional echocardiography is an essential tool in the evaluation ofchildren with Kawasaki disease, both in the acute and chronic stages. In the acute phase of the illness, it is valuable for diagnosis and management of pancarditis and for the long-term monitoring of pericardial effusions, left ventricular function, and the rare cases of chronic valvar dysfunction. When coronary arterial abnormalities are detected, echocardiography can serially evaluate long-term treatment with drugs which prevent the aggregation of platelets and monitor the resolution of coronary aneurysms. The value of cross-sectional echocardiography, nonetheless, is very limited in the detection of coronary arterial stenosis. Coronary arteriography is still important for the diagnosis of obstructive lesions in the coronary arteries and should be used in conjunction with cross-sectional echocardiography for the appropriate long- term management of children with Kawasaki disease at high risk of developing coronary arterial stenosis. Perhaps, in the future, high resolution transesophageal echocardiography will allow clear delineation of coronary arterial anatomy and specifically stenosis, but its role in the evaluation and management of children with Kawasaki disease remains to be explored.

Herein we report a case of a cardiac echinococcal cyst located in the interventricular septum and producing a mild obstruction of the left ventricular outflow tract. The cyst was detected by cross-sectional echocardiography and thoracic computed tomography and treated successfully with mebendazole.

The cross-sectional and colour flow mapping echocardiographic appearances of extension of ductal tissue within the pulmonary artery in three infants referred for echocardiographic assessment of a cardiac murmur are reported. The ductal plaques described may be common but are not necessarily of clinical significance.

Ninety-one patients with Kawasaki disease were examined by cross sectional echocardiography between 1980 and 1988. In the 75 patients evaluated during the acute phase of the illness (the first month), the first echocardiographic examination was carried out at a mean time of 16 days (range 5-30) and coronary arterial lesions were seen in 21 (28%). Two patients with medium sized aneurysms had myocardial infarctions, and one died. Coronary arterial lesions persisted in 17 (23%) patients, most often in younger children. The remaining 16 patients were examined from one month to four years after their acute illnesses, and this group did not have coronary arterial abnormalities. Seven patients with coronary artery lesions have reached school age and require regular echocardiographic examination and exercise electrocardiography. Selective coronary arteriography may be indicated in some patients to identify coronary artery stenosis, which the Japanese experience has shown may progress for several years after the acute illness.

Between 1983–1988 cross-sectional echocardiography was performed in 63 patients having an atrioventricular septal defect with common atrioventricular orifice. We excluded from this study all those patients with separate right and left orifices ("ostium primum" defects), those with isomerism of the right and left atrial appendages, those with univentricular atrioventricular connexions and those with discordant atrioventricular and ventriculo-arterial connexions. Parasternal long- and short-axis views, apical 4-chamber views and subcostal long-axis views were employed in all patients. In the last 26 cases, we also obtained the subcostal short-axis view. Nineteen patients showed ventricular dominance, with the right ventricle being dominant in 15. Ten patients had an associated defect in the oval fossa, while the atrial septum was partially or completely absent in the other 53. A ventricular septal defect was observed in all, but it was small in 10 and multiple in 2. Attachments of the superior and inferior bridging leaflets to the crest or the right side of the ventricular septum were seen in 32 cases. The inferior leaflet was hypoplastic in 19 patients. There was narrowing of the left ventricular outflow tract in 8 patients, and obstruction of the right ventricular outflow tract in 3. Abnormal attachment of the right portion of the common valvar orifice was present in 2 cases. A solitary papillary muscle supporting the left ventricular component of the common valve was seen in 6 cases producing a parachute-like arrangement. Our study shows that cross-sectional echocardiography is an excellent technique for the analysis of this anomaly.

A 20-month-old patient with a previously diagnosed atrial septal defect presented with acute heart failure. The clinical and echocardiographic features at admission to hospital were of a congenitally partitioned left atrium. At surgery a medially displaced and infolded left atrial appendage together with infolded left atrial wall was found, which gave a false appearance of a left atrial ‘membrane'. This unusual arrangement was subsequently correctly identified by transoesophageal echocardiography. It is speculated that the abnormal orientation of the appendage may have produced a physiologic and haemodynamic situation akin to anomalous drainage of the pulmonary veins, which would account for the clinical features in this patient.

Accurate evaluation of an atrioventricular septal defect is readily achieved by echocardiography. A sound understanding of the basic morphology and associated lesions is key to this approach. This article first details the features that are common to all hearts with an atrioventricular septal defect, irrespective of the presence or absence of an interatrial or interventricular communication. These common features are: (1) inlet outlet disproportion; (2) absence of the atrioventricular muscular septum; (3) abnormal position of the left ventricular papillary muscles; (4) abnormal configuration of the atrioventricular valves and, (5) cleft in the left atrioventricular valve. These are all predicated by a sprung atrioventricular junction. Second, is a detailed outline of the associated risk factors that must be identified by the echocardiographer prior to presenting the patient for surgical management, with the most important ones being abnormalities of the left atrioventricular valve and left ventricular outflow tract obstruction. Indeed, in this current era it is rarely necessary to perform other investigations prior to surgical repair.

The understanding, diagnosis and treatment of congenital malformations of the heart has been revolutionized over the past few decades, reflecting not only a greater appreciation of the morphological variability to be found within the malformed hearts, but also huge advances in the design and construction of machines available for diagnosis, treatment and life support. Nowadays, despite the anatomical complexity, accurate diagnosis is to be expected in all cases, with the greater majority of patients expected to survive treatment, which is being undertaken progressively earlier in life. Keywords: sequential segmental analysis; cross-sectional echocardiography; catheterization; angiography; interventional catheterization; open heart surgery

A patient with malignant thymoma is described in whom the initial manifestation was pericardial metastasis and effusion which were identified by cross-sectional echocardiography.

Congenital aneurysms of the interventricular septum were found in a 29 year old man and his four year old son. Both were symptom free. In both, M mode and cross sectional echocardiography showed an aneurysm in the mid-muscular trabecular portion of the ventricular septum with considerable paradoxical motion of the aneurysmal segment. Otherwise the chamber dimensions, intracardiac structures, and cardiac function were normal for age. Congenital aneurysm of the interventricular septum is rare and these familial cases may be unique.

We present a patient with a left atrial myxoma in whom the intraoperative use of transesophageal cross-sectional echocardiography proved helpful in selecting the most appropriate surgical approach, thus allowing expeditious and complete excision of the tumor. This technique, which permits continuous monitoring of cardiac function throughout open heart procedures, appears particularly valuable in patients with intracardiac masses.

A 30 year old female admitted for evaluation of left chest pain was suspected to have multiple cardiac hydatid cysts. The diagnosis was established by cross sectional echocardiography and computed tomography, supported by enzyme linked immunosorbent assay (ELISA) for echinococcosis. Medical therapy altered the echopattern of the cysts but failed to reduce cystic masses. Surgery was advocated but refused by the patient.

Whereas abnormalities of the morphological tricuspid valve are common in the setting of discordant atrioventricular connections, there are only a few postmortem reports of abnormalities of the mitral valve in this condition. This report describes two patients with discordant atrioventricular connections, in whom important abnormalities of the mitral valve were found during life by cross sectional echocardiography.

Although left ventricular (LV) mass may be important to judge effects of left-sided cardiac obstruction or hypertension, reproducible noninvasively determined normal data in the pediatric age group are scarce. To validate cross-sectional echocardiographic LV mass determination, our data were compared with LV mass assessed by magnetic resonance imaging (MRI). MRI was considered to be a good reference method because there is usually no problem in defining endo- and epicardial borders with MRI. LV mass was assessed in 14 children aged 5.3 years (10 days to 14.7 years) with a mean body surface area of 0.78 m2 (range 0.25 to 1.61). With cross-sectional echocardiography the epicardial and endocardial volumes were calculated using a Simpsons rule algorithm in the apical 2- and 4-chamber view. The difference between epi- and endocardial volumes was multiplied by 1.05 to yield the mass. Mass was assessed with MRI using a multislice technique; the area of each myocardial slice was calculated and multiplied with the slice thickness, and the resultant slice volumes were added to obtain the myocardial volume. On cross-sectional echocardiography, the mass was 55 g (range 12 to 126) or 64 g/m2 (range 46 to 79); on MRI it was 60 g (range 33 to 87) or 69 g/m2 (range 46 to 89). Regression analysis yielded an r value of 0.98 with a standard error of the estimate of 5.7 g or a 10% difference. In older children, LV mass determined by MRI was bigger than the one derived by echocardiography. It is concluded that cross-sectional echocardiography can reliably assess LV myocardial mass in pediatric patients.

A rare case of Ebstein9s anomaly of the mitral valve was diagnosed by cross sectional echocardiography and angiography.

The cross-sectional echocardiographic findings were analysed retrospectively in 26 patients with Ebstein's malformation in the light of studies of autopsied specimens from different patients showing this lesion. The salient anatomical feature in diagnosis is the finding of the hinge point of the septal and mural leaflets of the valve within the inlet component of the right ventricle rather than at the atrioventricular junction. The other important feature is the nature of the distal attachment of the leaflets, particularly the anterosuperior one, which can either be in focal or linear fashion. The hinge point of the septal leaflet was noted echocardiographically to be displaced in 19 patients but, significantly, the leaflet was absent in the other seven. Also significant was that the hinge point of the mural leaflet at the crux had been visualized in only 15 of the patients. The anterosuperior leaflet had a distal linear attachment in 20 of the patients, with the anteroseptal commissure becoming a keyhole in six of these through which blood passed to the functional right ventricle. The valve remained a competent structure, even though closing at the junction of atrialized and functional components of the right ventricle rather than at the atrioventricular junction. Cross-sectional echocardiography is the technique of choice with which to display the salient morphological features of Ebstein's malformation.

Changes in left ventricular muscle mass may be an important diagnostic or prognostic finding in children with congenital heart defects, but there are no data on normal mass as determined by cross-sectional echocardiography (CSE) in children. Fourteen newborns, 12 infants, and 69 children (1.5–17 years old) with a structurally normal heart were studied. Enddiastolic and end-systolic volume and mass were calculated from biplane-paired echocardiographic imaging planes—apical two-chamber and apical four-chamber views—using both an area/length and a Simpson's rule geometric method. Data were compared with M-mode measurements. There was a good correlation between area/length and Simpson's rule method [r=0.94, standard error (SE) 4 g/m2]. To validate the measurements, interobserver data were gathered and end-diastolic and endsystolic mass measurements were compared. Interobserver variability for the measurements on the echocardiographic recordings was low at 4.8%; for end-diastolic mass the correlation between two observers wasr=0.99 (SE 3.3 g/m2) and for end-systolic massr=0.97 (SE 7.6 g/m2). Correlation between end-systolic and end-diastolic mass was acceptable (r=0.88, SE 5.9 g/m2) for the CSE mass determination, but poor for the M-mode measurements (r=0.51, SE 20.2 g/m2). Similarly, correlation between M-mode mass and mass estimated by CSE was poor, atr=0.58 for end-diastolic andr=0.094 for end-systolic mass. In newborns and infants the ratio of end-diastolic mass to end-diastolic volume was higher than in the older children, mainly because of a smaller ventricular volume in relation to body surface area in this age group. In the 26 newborns and infants, left ventricular mass was 48.7±10 g/m2 and volume was 34.6±7 ml/m2, yielding a mas to volume ratio of 1.41±0.03. For the 69 children (mean age 7.4±3.8 years), left ventricular mass was 63±10 g/m2 and volume 59±10 ml/m2 with a mass to volume ratio of 1.07±0.2. Left ventricular end-diastolic mass and volume strongly correlated with age (r=0.9) and body surface area (r=0.98 and 0.97, respectively). As CSE is easy to perform and repeatable, these normal values should provide a valuable database for further longitudinal studies of the development of left ventricular mass in patients with various cardiac abnormalities.

Pseudoaneurysms of the ascending aorta is a rare postoperative complication which, once identified, needs urgent attention. This report describes 5 consecutive patients with this complication who presented 2-15 months following open heart surgery. The role of cross-sectional echocardiography in diagnosis of this condition is highlighted.

The first echocardiographic descriptions of the aortopulmonary window (APW) were case reports.1,2 These observations were extended by Smallhorn et al,3 who described appearances of an isolated APW in 4 infants and compared these with appearances in 14 patients with a common arterial trunk and in 6 with a single pulmonary artery originating at the ascending aorta. In these reports,1-3 diagnosis was also established by invasive investigation and did not include any patient who had APW with associated cardiac abnormalities. The publication of case reports as late as 1988 suggests that the echocardiographic diagnosis of even an isolated APW is not always straightforward,4 perhaps because the lesion may be confused with other structural abnormalities.5 There have been no reports of the accuracy of cross-sectional echocardiography for the prospective diagnosis of APW. We reviewed our experience since the cases previously described3 to determine the implications for clinical practice.

An unusual case of self-inserted needle in the heart is reported, in which cross-sectional echocardiography helped in diagnosis and accurate preoperative localization.

M mode and cross sectional echocardiography showed a highly mobile globular pedunculated mass(3.0 cm long with a maximum diameter of i.5 cm) attached to the eustachian valve in a heroin addict with staphylococcal endocarditis.

​ProfessorProfessor of paediatric cardiology University of Amsterdam (b 1940, q Cambridge 1967), died from Parkinson's disease on 29 November 2005. Figure 1 Fergus Macartney began his practice in Leeds as a consultant aged 29. His tenure of the newly created chair of paediatric cardiology at Great Ormond Street in London in 1975 established the road map for diagnosing congenital cardiac malformations using cross sectional echocardiography, as well as the system for classification and coding now used globally. He was also one of the first to use computers in clinical practice for decision making. He forsook clinical medicine to be an ordained minister, but he returned in 1991 as professor in the Academisch Medisch Centrum of the University of Amsterdam. He leaves a wife, Jackie, and three daughters.

A case of a previously unreported anomaly is presented in which absence of the aortic valve cusps, mitral atresia, a normal left ventricle, and an intact ventricular septum were diagnosed by cross sectional echocardiography. The development of a normal left ventricle, rather than the hypoplastic ventricle usually associated with mitral atresia, is explained by filling of the ventricular cavity via the regurgitant aortic valve.

Congenital diverticulosis of the left ventricle is an extremely rare maldevelopment. We report a 9 year old girl with probable isolated left ventricular diverticulum in whom the diagnosis was made by cross sectional echocardiography and by angiography.

Cross-sectional echocardiography utilizing the apical and longitudinal right ventricular inflow tract views was used to investigate the tricuspid valve in 64 patients with mitral valve prolapse and 16 controls who had no angiographic or echocardiographic evidence of mitral valve prolapse. The tricuspid valve leaflets and their coaptation point in systole were found to be below (towards the right ventricular apex) the level of the tricuspid valve ring in systole in all controls. Tricuspid valve prolapse, defined as the leaflet(s) of the tricuspid valve lying above the tricuspid valve ring level within the right atrium, was seen in 31/64(48 percent) of patients with mitral valve prolapse. The right ventricular inflow tract view demonstrated tricuspid valve prolapse most readily compared to the apical view, and 29 of the 31 patients with tricuspid valve prolapse had prolapse of at least two leaflets of the tricuspid valve. The 31 patients with both mitral and tricuspid valve prolapse, when compared to the 33 patients with mitral valve prolapse alone, had more symptomatology and abnormal physical findings.

Real-time cross-sectional echocardiographic studies of the left ventricle were performed in 31 consecutive patients with angiographically proven left ventricular aneurysms (group I). In each of these patients the presence and location of the aneurysm was visualized by the cross-sectional echocardiography. In four patients discrepancy in the extent of the aneurysm was noted due either to failure of the cross-sectional technique to visualize the entire anterior wall of the ventricle (3) or failure of the single plane angiogram to adequately define the lateral extent of the aneurysm (1). Ventricular shape and contraction sequence in patients with aneurysms were compared with similar patterns in 20 patients with normal left ventricles (group II), and 20 patients with ischemic heart disease and localized ventricular dysfunction without aneurysm formation (group III). Other noninvasive methods for detecting aneurysms (including physical examination, chest roentgenography, electrocardiography, and M-mode echocardiography) were also evaluated in the aneurysm group. This report suggests that cross-sectional echocardiography is a useful method for detecting ventricular aneurysms noninvasively.

Cross-sectional echocardiography was performed on two patients with mitral regurgitation in whom M-mode echocardiographic findings were not specific for the etiology of mitral regurgitation. In one patient, flail motion of the free edge of the anterior mitral leaflet into the left atrium was demonstrated only by cross-sectional echocardiograms. In the second patient, the flail posterior mitral leaflet was suggested to be a result of bacterial endocarditis. Cross-sectional echocardiograms clearly identified a flail motion of a mass of vegetation attached to the posterior mitral leaflet. Thus, cross-sectional echocardiography can provide critical information in recognizing patients with a flail mitral leaflet.

We describe the second reported case of congenital aortic atresia with normal left ventricle and intact ventricular septum. We believe this to be the first case diagnosed by cross-sectional echocardiography.

A case is presented where the distinction between rheumatic fever and systemic lupus as a cause of mitral valvar disease was made by cross-sectional echocardiography. This showed an unusual appearance, consistent with descriptions of Libman-Sachs endocarditis from the presteroid era.

Two-dimensional echocardiography was performed on 18 unanesthetized, normal dogs (4.5 to 30 kg). Measurements of wall thickness, intracavitary dimensions, and cross-sectional area of the left atrium, left ventricle, and aorta were made. Satisfactory data were obtained from 17 dogs, and were used to determine normal values. Normal data were tested for significant correlation to body weight (kg) by linear regression. Repeatability was studied in six dogs examined, on three separate occasions, during a 5-day period. Differences between values obtained on different days were evaluated by analysis of variance. Satisfactory qualitative echocardiograms were repeatedly obtained by using consistent sites of transducer placement and by identifying internal cardiac structures. These tomographic planes were highly reproducible, with only ventricular length, and some views of the ventricular septum, showing statistically significant (P < 0.05) differences. Almost all linear and area measurements were significantly correlated to body size, while most indices of left ventricular function were independent of body weight. Dimensions obtained from the left and right parasternal position were nearly identical. Cross-sectional echocardiography allows repeatable assessment of cardiac anatomy, and it should prove useful for identification and quantitation of heart disease in the dog.

A case report is presented of a patient with subacute bacterial endocarditis affecting the pulmonary valve. There was no past history of valvular heart disease or narcotic addiction and no other valve was involved. Serial echocardiograms demonstrated the vegetations, but only cross-sectional echocardiography showed the flail movement of the leaflet and the size and shape of the vegetations.

In a patient with patent ductus arteriosus, a pulmonary regurgitant murmur developed after the treatment of endocarditis. M-mode echocardiograms showed abnormal echo mass, characterized by fine diastolic fluttering, in the right ventricular outflow tract during diastole which were continuous with anterior pulmonary leaflet and thick pedunculated lesions attached to the anterior pulmonary leaflet were seen to be moving freely by cross-sectional echocardiography. At autopsy the destruction of the pulmonary valve was confirmed.This study suggests that diagnosis of flail pulmonary valve is feasible by M-mode and cross-sectional echocardiography.

Aortic root abscess is frequently a lethal complication of infective endocarditis. Early diagnosis of this complication is of paramount importance because antibiotic therapy is often ineffective and early surgery is probably the treatment of choice. We have compared the diagnostic accuracy of cross-sectional echocardiography with operative findings in the diagnosis of aortic root abscess. Aortic root abscess was diagnosed in nine of 129 patients with infective endocarditis at the National Heart Hospital between 1983 and 1985. Cross-sectional echocardiography demonstrated the presence and location of the aortic root abscess in eight cases; in the ninth case a small abscess was missed. In two other cases, a large abscess was visualised, but abscesses of between 2 mm and 4 mm were missed; the extent and size of large aortic abscesses tended to be underestimated. Echocardiography should be an integral part of the investigation of patients with aortic valve infective endocarditis.

We studied prospectively 140 consecutive symptomatic neonates with suspected congenital heart disease by combined cross-sectional and pulsed Doppler echocardiography. Using the sequential segmental approach, the anatomy at all cardiovascular junctions was clearly defined in 89 (64%) babies. Based on the non-invasive investigations, 47 went to surgery while 42 babies were treated medically. The other 51 babies underwent further cardiac catheterisation. Of these, only 23 (16%) required diagnostic catheterisation prior to their management decision. The remaining 28 babies were catheterised for (1) angiographic measurement of anatomical structures (n = 12), (2) haemodynamic measurement (n = 1), and (3) balloon atrial septostomy (n = 15). One hundred and two babies had ultimate verification of their echocardiographic diagnoses. A total of 612 cardiovascular segments were identified. There were 33 (5%) echocardiographic errors, 23 of missed or uncertain diagnosis and 10 wrong interpretations. The diagnostic sensitivity and specificity for the combined non-invasive technique were thus 96 and 98%, respectively. Only one death was attributed directly to an echocardiographic error. Hence when the clinical outcome was taken into consideration, 88 of the 89 neonates without an initial catheterisation were judged to be appropriately managed for their presentation.