By W. Fadi. University of Texas at Tyler.
Non invasive cerebral oximeter as a surrogate for mixed venous saturation in children generic 2.5mg lozol. Changes in cerebral and somatic oxygenation during stage I palliation of hypoplastic left heart syndrome using continuous regional cerebral perfusion discount generic lozol uk. Correlation of abdominal site near infrared spectroscopy with gastric tonometry in infants following surgery for congenital heart disease order lozol online. Low renal oximetry correlates with acute kidney injury after infant cardiac surgery cheap 1.5 mg lozol with amex. Percutaneous pulmonary artery catheterization in pediatric cardiovascular anesthesia: insertion techniques and use. Pulmonary artery catheter placement under transoesophageal echocardiography guidance. Prospective, randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma. Estimation of cardiac index by means of the arterial and the mixed venous oxygen content and pulmonary oxygen uptake determination in the early post-operative period following surgery of congenital heart disease. Cardiac output measured by lithium dilution and transpulmonary thermodilution in patients in a paediatric intensive care unit. Cardiac output determination in children; equivalence of the transpulmonary thermodilution method to the direct Fick principle. Cardiac index monitoring by pulse contour analysis and thermodilution after pediatric cardiac surgery. Arterial pulse wave analysis: an accurate means of determining cardiac output in children. Hemodynamic monitoring by transpulmonary thermodilution and pulse contour analysis in critically ill children. Prediction of fluid responsiveness in infants and neonates undergoing congenital heart surgery. Web-based survey of current trends in hemodynamic monitoring after congenital heart surgery. The Pediatric Cardiac Intensive Care Society evidence-based review and consensus statement on monitoring of hemodynamics and oxygen transport balance. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Duration and magnitude of vasopressor support predicts poor outcome after infant cardiac operations. Peripheral vascular effects of noradrenaline, isopropylnoradrenaline and dopamine. Reactivity of renal systemic circulation to vasoconstrictor agents in normotensive and hypertensive subjects. Mechanism by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs. International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendation. Systemic and coronary effects of intravenous milrinone and dobutamine in congestive heart failure. Acute hemodynamic effects of dobutamine and isoproterenol in patients with low output cardiac failure. Milrinone in the treatment of low cardiac output states following cardiac surgery. Pharmacokinetics and side effects of Milrinone in infants and children after open heart surgery. Milrinone: Systemic and pulmonary hemodynamic effects in neonates after cardiac surgery. Safety and clinical utility of long term intravenous milrinone in advanced heart failure. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Population pharmacokinetics of milrinone in neonates with hypoplastic left heart syndrome undergoing stage I reconstruction. Relation between ionized calcium concentration and ventricular pump performance in the dog under hemodynamically controlled conditions. Normal parathyroid hormone responses to hypocalcemia during cardiopulmonary bypass. Perioperative hemodynamic effects of an intravenous infusion of calcium chloride in children following cardiac surgery. A prospective, randomized, double-blind comparison of calcium chloride and calcium gluconate therapies for hypocalcemia in critically ill children. Increased calcium supplementation is associated with morbidity and mortality in the infant postoperative cardiac patient. Dilator responses to isoproterenol in cutaneous and skeletal muscle vascular beds of adrenergic blocking drugs. Comparison of the effects of ouabain and isoproterenol on ischemic myocardium of conscious dogs. Epinephrine plasma metabolic clearance rates and physiologic thresholds for metabolic and hemodynamic actions in man. Noradrenaline for management of septic shock refractory to fluid loading and dopamine or dobutamine in full-term newborn infants. Correlation between arterial blood pressure and oxygenation in Tetralogy of Fallot. Intraoperative Doppler echocardiography in hypertrophic cardiomyopathy: correlations with the obstructive gradient. Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Vasopressin reversal of phenoxybenzamine-induced hypotension after the Norwood procedure. Terlipressin as a rescue therapy for catecholamine-resistant septic shock in children. Clinical response to arginine vasopressin therapy after paediatric cardiac surgery. Hyponatremia during arginine vasopressin therapy in children following cardiac surgery. Ventricular function and coronary hemodynamics after intravenous nitroglycerin in coronary artery disease. Hemodynamic effects of intravenous nitroglycerin in pediatric patients after heart surgery. The impact of afterload reduction on the early postoperative course after the Norwood operation - a 12-year single-centre experience. Evaluation of sodium nitroprusside toxicity in pediatric cardiac surgical patients. The safety, efficacy, and pharmacokinetics of esmolol for blood pressure control immediately after repair of coarctation of the aorta in infants and children: a multicenter, double-blind, randomized trial. Effects of prostaglandin E1 infusion in the pre-operative management of critical congenital heart disease. Prostaglandin E1: A new therapy for refractory right heart failure and pulmonary hypertension after mitral valve replacement. Comparison of effects of Prostaglandin E1 and Nitroprusside on pulmonary vascular resistance in children after open-heart surgery. Prostaglandin E1: An effective treatment of right heart failure after orthotopic heart transplantation. Comparison between prostaglandin E1 and epoprostenol in infants after heart surgery. Aerosolized prostacyclin for preoperative evaluation and post-cardiosurgical treatment of patients with pulmonary hypertension. Inhaled prostacyclin for the treatment of pulmonary hypertension after cardiac surgery or heart transplantation: a pharmacodynamic study. Use of inhaled iloprost in a case of pulmonary hypertension during pediatric congenital heart surgery. Intravenous sildenafil lowers pulmonary vascular resistance in a model of neonatal pulmonary hypertension. Effects of escalating doses of sildenafil on hemodynamics and gas exchange in children with pulmonary hypertension and congenital cardiac defects.
The tumour is blocking the left eustachian tube and fuid is accumulating in the mastoid (*) purchase lozol us. There is also hypertrophy and oedema of the fat behind the eye which adds to the exophthalmos buy genuine lozol. When severe buy lozol 1.5 mg on-line, these changes can lead to compression of the optic nerve in the apex of the orbit buy lozol 1.5mg without prescription. The break in the orbital foor allows herniation of orbital contents into the antrum, which Orbital foor fractures also occur with trauma to the may result in diplopia. A fracture result in a fuid level or complete opacifcation of the of the orbital foor may also be visible. Salivary glands disorders, including masses, diffuse A sialogogue may be used to stimulate secretion of saliva enlargement or symptoms of dry mouth, are all frst inves- to improve visualization. The commonest salivary be performed by injecting contrast into the ducts of the gland tumour of the parotid gland is a benign pleomorphic salivary glands. It confrms the pres- Sialography ence of the mass and differentiates solid from cystic lesions. Note the long duct of even calibre and the fne branching of the ducts within the gland. Direct inspection by laryn- C goscopy reveals a great deal of information about the larynx, particularly in regard to the vocal cords. However, imaging can provide additional information regarding the extent of the tumour and its spread outside the larynx (Fig. The thyroid gland, which is the investigation of abnormal thyroid function and in situated on either side of the trachea, normally enhances patients with known thyroid carcinoma. It is important to note eating the extent of most tumours in the neck because of that iodinated contrast should be avoided in those patients the superior soft tissue contrast. Ultrasound deter- too small to palpate or are in sites not amenable to clinical mines whether a nodule is cystic or solid or a mixture of examination. Ultrasound may Ultrasound is more able to accurately predict the underly- show that the nodule is part of a multinodular goitre by 464 Chapter 16 M (a) (b) Fig. The two lobes of the tumour (T) in the larynx that has destroyed the vocal cords and thyroid (arrows) lie on either side of the trachea (T). The enlarged thyroid almost surrounds the trachea (T) and enhances avidly after intravenous contrast showing many nodules of varying size. Scintigraphy (with 123I or 131I) for metastatic spread at presentation is usually to no avail as the metastases do not take up suffcient radionuclide. Any metastases, recurrent tumour or residual thyroid tissue may subsequently be treated with a therapeutic dose of 131I. Parathyroid imaging Localization of a parathyroid adenoma prior to surgery for hyperparathyroidism is important because about 10% of (b) adenomas are multiple or occur in an ectopic position. Scintigraphy complex malignant thyroid nodule with cystic areas (*) and bright foci that indicate punctate calcifcation (arrow), which is allows functional localization of abnormal parathyroid associated with papillary and medullary thyroid cancer. Normal parathyroid glands are too small to be visu- Ultrasound showing several hyperplastic nodules in the right alized, but even a small adenoma can be detected. This image was acquired during a therapeutic dose of 131I and shows residual uptake in the thyroid bed (*) as well as multiple bone metastases (one of which is shown with an arrow). Orbits, Head and Neck 469 sestamibi) and one that visualizes the parathyroid glands only (123I or 99mTc pertechnetate). The two sets of images are digitally subtracted from one another and residual radio- activity on the subtraction image represents a hyperfunc- tioning parathyroid tissue (Fig. A few minutes compressing the puncture site peutic interventions that involve the arterial and venous with the fngers is enough to stop the bleeding in most system. The advantages of the Seldinger technique are ology in which minimally invasive procedures are carried that it is easy and quick to perform, that the hole in the out under image guidance. Diagnostic vascular angiography Prior to undertaking any intervention, it is important to Magnetic resonance angiography have an accurate assessment of the extent and distribution of disease whether in the venous or, more commonly, the Magnetic resonance angiography is a very useful non- arterial system. In the past this could be obtained with invasive technique, which can demonstrate both arteries a diagnostic angiogram, though increasingly non-invasive and veins. Magnetic resonance angiography is particularly useful Arteriography for showing the aorta and its branches (Fig. Aneurysms and vas- but occasionally carbon dioxide) is injected through the cular malformations can also be detected in the intracranial catheter, which opacifes the target vessel. At the end of the procedure, the catheter injection of contrast, many thin sections can be obtained so Diagnostic Imaging, Seventh Edition. On the subtracted image (a) the bones and soft tissues are barely visible compared to the unsubtracted image (b). The angiogram shows a patent popliteal artery (thin arrow) with a short segment occlusion proximal to the trifurcation (curved arrow). Computed tomography angiography is particularly useful for visualizing the aorta and its branches for sus- pected aneurysms (Fig. Ultrasound of the arterial system Ultrasound has an important role to play in diagnosing Fig. A normal internal vessels, and is commonly the primary imaging modality carotid artery is seen on the left (arrowhead). The common, internal and external carotid arteries can be readily visualized in the neck. The location or size of any atheromatous plaques and the sever- Ultrasound venography ity of any luminal narrowing can be determined. With colour Doppler imaging, a stenosis in the artery can be Duplex ultrasound has now largely replaced contrast visualized and an occlusion will show as an absence of venography for the detection of venous thrombosis. Because a stenosis disrupts the normal fow pattern, a venous thrombosis, intraluminal echogenic material is analysis of the fow–velocity waveform can give further visible and the veins lose their normal compressibility; information regarding the degree of stenosis. Imaging of thrombus-free veins should be compressible by direct pres- the iliac vessels may be diffcult due to overlying bowel sure using the ultrasound transducer. Colour Doppler gas, but evaluation of the abdominal aorta is invariably scanning shows that there is a lack of spontaneous fow successful and can easily be performed during an outpa- in the affected veins. In practice, this is often not clinically signifcant as of contrast medium is injected into a vein on the arm or calf vein (i. The contrast is forced into the deep venous system of the upper limb by means of a tourniquet. Thrombi may be seen as flling defects in the opacifed veins, and Contrast venography any stenosis or occlusion in the central veins is well Contrast venography is routinely used for the evaluation demonstrated. Vascular and Interventional Radiology 475 under local anaesthesia, causing only relatively minor dis- comfort to the patient, allowing many procedures to be performed as ‘day cases’. Only the basic principles of the interventional techniques in widespread use will be described here. Angioplasty and stents Arterial stenoses and even occlusions may be traversed with a guidewire. A balloon catheter can be passed through the abnormal site, which has been previously determined by arteriography (Fig. This percuta- neous technique, which usually uses the femoral artery as an access route, has been widely employed in peripheral vascular disease and gives results as good as bypass surgery, particularly for iliac and superfcial femoral artery disease. Stents are balloon expandable or self-expanding metal cylinders that can be embedded in plastic and collapsed to enable them to be inserted through an artery or vein (Fig. As they ‘reinforce’ the vessel at the site of angioplasty, they have a more durable result. Stents are commonly used in the treatment of arterial stenosis and occlusion in coro- nary disease, in peripheral vascular disease, and in patients with mesenteric ischaemia secondary to atherosclerotic stenoses in the mesenteric arteries. Their role in the man- agement of renal artery stenosis is debatable following Fig. Reconstruction from many thin axial several recent trials, but is still indicated to treat patients sections following an intravenous injection of contrast with deteriorating renal function, fash pulmonary oedema demonstrating an aortic aneurysm (arrow). Due to the size of the Radiologists carry out various percutaneous techniques deployment system of these large stent grafts, they are under imaging control, including dilating stenoses, occlud- normally introduced through a femoral arteriotomy. Stents ing vessels, draining abscesses and other fuid collections, can also be introduced through the femoral vein and placed and obtaining biopsy samples. These procedures greatly across a stricture in the superior vena cava to overcome the assist and may modify surgery, or even replace it alto- distressing symptoms of superior vena caval obstruction, gether. They are carried out with the help of a variety which is usually caused by a malignant tumour in the of imaging modalities, notably fuoroscopy, angiography, mediastinum. Interventional radiology is usually performed vessel) in peripheral vessels of the lower limb can also be 476 Chapter 17 (a) (b) Fig. The covered stent (short arrows), acting as an endoskeleton, has excluded the aneurysm from the circulation by creating a seal proximally below the renal arteries (long arrows) and distally in the iliacs.
These adaptive changes are usually well tolerated by women without heart disease order lozol pills in toronto; however generic lozol 2.5 mg visa, in some women with heart disease such changes result in cardiac decompensation generic 2.5 mg lozol visa. As well cheap lozol 1.5mg otc, pre-existing heart disease may first be revealed during pregnancy when the heart is challenged by an increased hemodynamic burden. Red cell mass increases during pregnancy to as much as 40% above prepregnancy levels (6,9). A “physiologic anemia of pregnancy” is seen because the increase in plasma volume is proportionately greater than the increase in red blood cell mass. In addition, there are increased levels of clotting factors and decreased fibrinolytic activity (10), both acting to promote the hypercoagulability that underlies the increased risk for thromboembolism during pregnancy. This mediates a decrease in systemic arterial pressure that begins in the first trimester and reaches its nadir in mid pregnancy, after which blood pressure stabilizes (11,12). After the 32nd week of gestation, the systemic vascular resistance slowly increases until term, accompanied by recovery of systemic arterial pressure, which ultimately reaches or exceeds prepregnancy levels. Renal blood flow also increases, accompanied by a 50% increase in glomerular filtration rate (13). Increased blood flow to the hands and feet, nasal passages, and breasts results in warm erythematous extremities, nasal congestion, and breast engorgement, respectively. Cardiac output increases during pregnancy as a result of increases in both heart rate and stroke volume. Most of the early increase in cardiac output is a result of progressive increase in stroke volume, whereas later in pregnancy the heart rate effect becomes more important because the stroke volume stabilizes while the heart rate continues to rise (11,14). The mean heart rate increases to approximately 10 to 20 beats above prepregnancy levels by term. Increase in cardiac output begins as early as the 5th week of gestation, reaches its zenith near the end of the second trimester, typically after the 24th week of gestation and then plateaus until term at 30% to 50% above prepregnancy levels (11,15,16,17). Pregnant women with underlying cardiac disease have been shown to have lower cardiac output than pregnant women with normal cardiac function (18). Cardiac output can fall acutely if the inferior vena cava is compressed by the gravid uterus in the supine position, a phenomenon that can be reversed by assuming the left lateral decubitus position. Although increases in left ventricular ejection fraction during pregnancy have been reported by some (11,16), other studies have not demonstrated this finding (17,19,20). During labor and delivery pain, anxiety and uterine contractions result in tachycardia, hypertension, and further increases in cardiac output, sometimes provoking cardiac decompensation in women with heart disease. During labor, there is a 10% increase in cardiac output beyond the pre-labor level, mediated by increases in the heart rate and stroke volume, augmented by yet a further increase of 7% to 15% in response to each uterine contraction, with maximal augmentation noted during the second stage of labor (21). Immediately following delivery, cardiac output may transiently increase to as much as 80% above pre-labor values due to relief of inferior vena cava compression and autotransfusion from the placenta, but output returns to pre-labor levels by approximately 1 hour postpartum. Thereafter, the hemodynamic changes that developed during pregnancy return toward baseline values; most of the changes resolve early after delivery, although complete resolution of all measureable pregnancy-associated effects may take as long as 6 months (22). Cardiac Findings in Normal Pregnancy Fatigue, dyspnea, light-headedness, and palpitations are symptoms associated with normal pregnancy but overlap with symptoms of cardiac decompensation. The hemodynamic changes of pregnancy are responsible for corresponding changes in the physical examination P. They include displacement of the apical impulse, prominence of the jugular venous pulsation, wide splitting of the first and second heart sounds, soft systolic flow murmurs and continuous murmurs. Sinus tachycardia and premature atrial or ventricular ectopic beats may also increase in frequency during normal pregnancy and do not necessarily reflect cardiac decompensation or any cardiac disease. This overlap of signs and symptoms may make diagnosis of cardiac decompensation during pregnancy challenging; brain natriuretic peptide can be a useful test to adjudicate the basis for symptoms and signs when a benign basis is not certain (23). Echocardiographic studies during normal pregnancy reveal that dimensions of all four cardiac chambers increase and there is an increase in left ventricular wall thickness and mass (16,22,24,25). Mitral, tricuspid, and pulmonic annular diameters increase and may result in increasing degrees of mitral, tricuspid, and pulmonic regurgitation, respectively (26). Assessment of Pregnancy Risk in Women with Congenital Heart Disease: General Concepts and Global Evaluation Women with cardiac disease are at increased risk of developing adverse maternal cardiac events during pregnancy (27). Maternal cardiac risk can usually be estimated after a complete cardiovascular history and physical examination, a 12-lead electrocardiogram, a transthoracic echocardiogram, and arterial oxygen saturation when indicated. Prepregnancy exercise testing, specifically focusing on measures of heart rate responsiveness to exercise, may aid risk stratification (28). Prepregnancy stress testing to assess functional capacity and blood pressure response to exercise can help with risk stratification in women with severe aortic stenosis. Stress echocardiography can be used to assess ischemia in women with coronary anomalies. Additional risk factors identified from subsequent studies on pregnancy risk (33,34). Early studies showed that poor maternal functional class and cyanosis are associated with adverse maternal cardiac events (30,31). Based on these predictors, women can be classified into low- (0 predictor), intermediate- (1 predictor), or high- (>1 predictor) risk categories. The study showed that women in low-, intermediate-, and high-risk categories have, respectively, a 5%, 25%, or >75% chances of developing an adverse cardiac event during pregnancy (Table 69. In a single-center retrospective study examining outcomes in 1,741 women, the largest to date, the maternal cardiac event rate was 9. For example, women with Marfan syndrome and dilated aortic root, Eisenmenger syndrome, or those with a Fontan circulation were underrepresented in the derivation sets and therefore their known pregnancy- associated risks will not be reliably predicted by the global risk scores. The various risk indices are helpful in placing patients into risk groups, but clinical judgment and expertise are required to fine tune risk stratification. Furthermore, the prediction rules reported discriminative (differentiate between those that will vs. At our center, we use global risk scores to place patients into low-, intermediate-, and high-risk groups, avoiding quantifying risk numerically in view of the previous-mentioned limitations. If pregnancy is decided upon, intensive specialist cardiac and obstetric monitoring needed throughout pregnancy, childbirth and the puerperium. Additional described factors that increase pregnancy risk include the presence of a prosthetic valve or conduit (especially if associated with abnormal prosthetic valve function), occurrence of an obstetric complication such as preeclampsia, and use of anticoagulants or teratogenic drugs. Some of these matters are elaborated further in sections below on prosthetic heart valves, management of anticoagulation and preconception issues. In comprehensive assessment of maternal risk it is helpful to integrate a global risk index with contemporary lesion-specific and other markers of risk, as well as expert opinion. When there is discordance between the global and the lesion- specific estimates of risk, the higher risk estimate should drive the care plan to avoid false reassurance. High-risk obstetric characteristics include smoking, use of anticoagulation, multiple gestations, and maternal age. Heart disease group with neither left heart obstruction nor poor functional class/cyanosis is represented by gray bars. Heart disease group with left heart obstruction or poor functional class/cyanosis is represented by black bars. Adverse neonatal and cardiac outcomes are more common in pregnant women with cardiac disease. Maternal risk factors for adverse fetal and neonatal outcomes have been identified (see Table 69. The risk of neonatal complications is further increased if there are concomitant maternal noncardiac (obstetrical and other) risk factors (see Table 69. Finally, there is cardiac-lesion- specific variation in the risk for adverse obstetric outcomes during pregnancy (see Fig. Women with an intermediate to high risk of adverse maternal cardiac events during pregnancy or those at increased risk for fetal and neonatal complications should be considered for enhanced multidisciplinary surveillance in specialized high-risk cardiac and obstetric programs (29). As well, the impact of maternal heart disease on the probability of adverse obstetric outcomes should be considered when evaluating the need for enhanced intensity of obstetric oversight of pregnancy. The relationship between maternal cardiac status and fetal outcomes may be manifested by changes in uterine and umbilical Doppler flow patterns (40). Hemodynamic and hormonal changes of pregnancy may continue to impact maternal outcomes late after pregnancy (41,42,43,44,45). For example, adverse cardiac events late after pregnancy occurred more often in women who had adverse cardiac events during pregnancy (Fig. Pregnancy has been associated with an increased likelihood of requiring valve intervention late after pregnancy in women with moderate or severe aortic stenosis (45). At this time, the full extent and mechanisms of the late effects of pregnancy on the heart are poorly understood.
Normal values for Doppler flow velocities at rest in the left coronary artery have been published in a cohort of over 300 children (204) discount lozol 2.5 mg with visa, and have been studied in the branch coronary arteries (205) effective 1.5mg lozol. Velocities cheap lozol 2.5 mg with visa, which ranged up to 60 cm/s in young children cheap 2.5 mg lozol otc, decreased with age and increased with heart rate. Coronary flow reserve reflects the increase in coronary flow in response to stimuli such as pharmacologic agents (e. It is calculated as the ratio of the peak (or mean) diastolic velocity after hyperemic stimulation to the baseline peak (or mean) diastolic velocity and reflects the resistance of the coronary bed, its ability to maintain constant flow when myocardial perfusion pressure changes (autoregulation), and the ability to augment blood flow in response to stress (206). Coronary flow reserve is affected not only by stenosis or compression of the proximal coronary arteries, such as in Kawasaki disease (203,207) or hypertrophic cardiomyopathy (208), but also by abnormalities in the distal coronary microvasculature such as in dilated cardiomyopathy, where decreased coronary flow reserve by Doppler echo has been linked to worse outcome (209,210). More reassuringly, normal coronary flow reserve has been found in a small study of children after arterial switch operation for transposition of the great arteries, although a number of children with left coronary anomalies demonstrated abnormal coronary flow reserve by cardiac positron emission tomographic imaging in response to adenosine (211). These normal findings in most children after the arterial switch operation mirror an invasive study using a Doppler guide wire and (212) may predict lower risk for atherosclerosis in the following decade (213). On the other hand, past publications have found that while coronary artery anatomy is not a determinant of outcome after the arterial switch operation, a portion of children may have silent ischemia without echocardiographic abnormalities at rest (214). Whether these children will demonstrate abnormal coronary flow reserve is unknown. Echo Doppler assessment of coronary flow reserve in the right coronary artery has also been shown to be feasible in an adult population, using a coronary Doppler flow wire as a reference (211). Given the important limitations of echocardiography in detecting coronary anomalies, especially those related to coronary stenosis and perfusion abnormalities, there should be a low threshold to proceed to other imaging modalities when there is a clinical suspicion of coronary stenosis or a perfusion abnormality. Coronary Perfusion One of the major uses of stress echocardiography is in the assessment of coronary perfusion (202). On the echocardiogram, ischemia is manifested by a new or worsening regional wall motion abnormality. In children, stress echocardiography for coronary assessment can be useful for a variety of indications including Kawasaki disease, detection of coronary artery vasculopathy in the transplanted heart (213,214), and after the arterial switch operation. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Theoretical and empirical derivation of cardiovascular allometric relationships in children. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. Relationship of the dimension of cardiac structures to body size: an echocardiographic study in normal infants and children. Variability of M-mode versus two-dimensional echocardiography measurements in children with dilated cardiomyopathy. Comparison of two- and three-dimensional echocardiography with sequential magnetic resonance imaging for evaluating left ventricular volume and ejection fraction over time in patients with healed myocardial infarction. Rapid online quantification of left ventricular volume from real-time three-dimensional echocardiographic data. Three-dimensional echocardiographic evaluation of the heart chambers: size, function, and mass. Validation of a novel automated border-detection algorithm for rapid and accurate quantitation of left ventricular volumes based on three-dimensional echocardiography. How accurately, reproducibly, and efficiently can we measure left ventricular indices using M-mode, 2-dimensional, and 3-dimensional echocardiography in children? A novel method of expressing left ventricular mass relative to body size in children. Improved quantification of left ventricular mass based on endocardial and epicardial surface detection with real time three dimensional echocardiography. Echocardiography for assessment of right ventricular volumes revisited: a cardiac magnetic resonance comparison study in adults with repaired tetralogy of Fallot. Three-dimensional echocardiographic assessment of right ventricular volume and function in adult patients with congenital heart disease: comparison with magnetic resonance imaging. Assessments of right ventricular volume and function using three-dimensional echocardiography in older children and adults with congenital heart disease: comparison with cardiac magnetic resonance imaging. Clinical value of real-time three-dimensional echocardiography for right ventricular quantification in congenital heart disease: validation with cardiac magnetic resonance imaging. Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the Pediatric Heart Network Fontan Cross-Sectional Study). Matrix-array 3-dimensional echocardiographic assessment of volumes, mass, and ejection fraction in young pediatric patients with a functional single ventricle: a comparison study with cardiac magnetic resonance. American Society of Echocardiography recommendations for quality echocardiography laboratory operations. Developmental modulation of myocardial mechanics: age- and growth-related alterations in afterload and contractility. Noninvasive assessment of myocardial contractility, preload, and afterload in healthy newborn infants. Left ventricular end-systolic wall stress-velocity of fiber shortening relation: a load-independent index of myocardial contractility. Age-related variation in contractility estimate in patients less than or equal to 20 years of age. Wall stress misrepresents afterload in children and young adults with abnormal left ventricular geometry. Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood. Chronic progressive cardiac dysfunction years after doxorubicin therapy for childhood acute lymphoblastic leukemia. Doppler echocardiographic index for assessment of global right ventricular function. Prognostic value of a Doppler index combining systolic and diastolic performance in idiopathic-dilated cardiomyopathy. Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis. Myocardial tissue Doppler velocity imaging in children: comparative study between two ultrasound systems. Noninvasive assessment of left ventricular force-frequency relationships using tissue Doppler-derived isovolumic acceleration: validation in an animal model. Isovolumic acceleration at rest and during exercise in children normal values for the left ventricle and first noninvasive demonstration of exercise-induced force-frequency relationships. Comparison between different speckle tracking and color tissue Doppler techniques to measure global and regional myocardial deformation in children. Reference values for myocardial two- dimensional strain echocardiography in a healthy pediatric and young adult cohort. Global longitudinal strain as a major predictor of cardiac events in patients with depressed left ventricular function: a multicenter study. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Contraction pattern of the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. Physiological consequences of percutaneous pulmonary valve implantation: the different behaviour of volume- and pressure-overloaded ventricles. Acute pulmonary hypertension causes depression of left ventricular contractility and relaxation. Effects of inhaled iloprost on right ventricular contractility, right ventriculo-vascular coupling and ventricular interdependence: a randomized placebo- controlled trial in an experimental model of acute pulmonary hypertension. Ventricular interdependence: significant left ventricular contributions to right ventricular systolic function. Significant left ventricular contributions to right ventricular systolic function. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Nomograms for aortic root diameters in children using two- dimensional echocardiography.