Evaluation of Systolic Pattern of Left Ventricular Movements in Ventricular Septal D e fect

Various cardiac functional index which evaluates the cardiac function has been presented up to this time. Angiocardiographic study can be also considered as a method to determine the cardiac function in which the cardiac pump function and cardiac contractility as well as other methods are included. This time, using cineangiocardiograms, the author employed the classification of left ventricular movements to estimate whether the change of movements and configurations of the left ventricle appears or not when functional depression occures in the left heart. And by comparing the classified systolic patterns and other indices of cardiac function, the author estimated how much these classified systolic patterns and degree of disease are correlated.The subjects of this study were 20 cases of ventricular septal defect (VSD ) without complicated cardiac disease and 4 cases of functional murmur used as contrast group. These cases were limited as follows: the patients were in good condition that control of physical exercise in their daily life was not necessary, the right and left cardiac catheterizations and angiocardiographic examination were performed in order to decide the necessity of surgery, during the cine-contrast examination premature beats and respiratory movements were not seen, hemodynamic rotation was not seen, and left ventricle was well opacified.The age range of the cases was from 11 months to 6 years 5 months (average age 3years 3 months). Fourteen were males, and 10 were females.The author set the 8 points in the margin of left ventricle in cineangiocardiograms and the distance of their movements from end-diastole to end-systole were measured into percentage. By using these results, the author reconstructed the ventricular movements into circular graphs and classified the graphs into 4 systolic patterns. The author compared these 4 systolic patterns with age, CTR, HR, LVESP, PAESP, EF, shunt %, VSD area, LVEDV/BSA, SV/BSA, Cardiac index, mean VCF and ECG findings.Conclusion1) The author classified the systolic movements of left ventricular wall in cases with VSD (except severe patients) into 4 groups according to measurement of left lateral cine left ventriculogram.Type I: pre d ominant contraction of anterior wallType II: predominant contraction of posterior wallType III: equivalent contraction of both anterior and posterior wallType IV: concentric circular contraction of surrounding wall2) The systolic patterns which were classified by the aut hor well manifested both anatomical and physiological changes of LV, RV, PA and these were correlated with synthetic diagnosis of degree of disease obtained from indices of cardiac function, measuring the score of left ventricle and ECG finding.3) The degree of disease concerning 4 syst olic patterns of left ventricle becomes severe in the order I, II,11, IV and this classification revealed the severity of VSD, that is an enlargement of left ventricle, decrease of cardiac output and decrease of left ventricular contractility.4) The author can simply estimate the condition of both anatomical and cardiac functional changes in VSD by using the classified systolic patterns obtained by measuring the movements of left ventricular septal wall (anterior wall), left ventricular free posterior wall and left ventricular axes.