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Contour plot spectral phonocardiography
Volume 69
Number 5
part 2
Abstracts
patients. Biplane cineangiocardiography was used to evaluate the timing of shunts throughout the cardiac cycle. The pressures of the two ventricles were recorded on magnetic tape and processed with a digital computer which produced in graphic form the quantitative values of the pressure gradient and simultaneous right and left ventricular pressure derivatives (rate of pressure change). Patients with large left-to-right shunts and slightly elevated right ventricuiar pressures showed almost continuous L-R shunting across the ventricular defect during periods of isovolumic contraction and relaxation. The shunt occurred into the pulmonary artery during systole and into the body of the right ventricle during diastole. Patients with moderately elevated right ventricular pressures demonstrated art isovolumic relaxation right-to-left shunt across the defect with no rightto-left shunt present on arterial dye curves. With equal systemic-pulmonary pressures and large leftto-right shunts, left-to-right shunting across the defect occurred during isovolumic contraction and right-to-left shunting during isovolumic relaxation with additional right-to-left shunting occurring into the aorta during ventricular systole. With pulmonary-systemic resistance ratios greater than 0.75, pressure-flow relationships were similar to tetralogy of Fallot.
35. Contour plot spectral phonocardiography Lowell
W.
Perry, ~ David
E.
Winer, ~
Lewis P. Scott, ~ and Cesar A. Caceres, ~ Heart Disease Control Program, United States Public Health Service, Children's Hospital of The District of Columbia, and George Washington University, Washington, D. C. Introduced by Robert H. Parrott, M . D . One-hundred-two recordings of heart sounds of normal children and of children with heart disease were displayed utilizing a spectral contour plotter (Signatec 701) for the purpose of determining the physical characteristics of these sounds. With the contour plot spectrogram (CPS) the three physical parameters of sound (frequency, intensity, and time) are displayed, frequency on the ordinate and time on the abscissa. Intensity is displayed quantitatively as contour lines which give the CPS the appearance of a topographical map and which allow for the display of a dynamic range of 42 db. The CPS of normal heart sounds consists of regular patterns of sound intensity over distinct frequency ranges. Considerable variation in sound pattern is a Conspicuous feature, not only from beat to beat, but als0 when the same patient is analyzed 'at different times. Heart sounds have an earlier appearance and longer duration when a
965
CPS is compared with other types of phonocardiography. Mitral and aortic valve lesions often are associated with an irregular pattern of the first and second heart sound, respectively. The frequencyintensity characteristics of the murmur of pulmonic stenosis vary with the pressure gradient. The configuration, of the murmur of ventricular septal defect can be related to the magnitude of the left-to-right shunt.
36. Normal standards /or cardiovascular hemodynamics L. Jerome Krovetz, M. B. Mitchell, and G. L. Schiebler, University of Florida College of Medicine, Gainesville, Fla. Over the past 4 years we have studied 35 apparently normal children from one day to 20 years of age. Means, standard deviations, and standard errors were calculated by BMDO1D. Program ( U C L A ) . Regression coefficie~lts were calculated using a linear stepwise regression program (UCLA) with age, surface area, and heart rate as variables. Surface area showed only fair correlation. Furthermore, since surface area is, in turn, a function of height and weight, it involves a redundancy. Omitting surface area, no significant decrease in correlation coefficients was found. Regression coefficients ranged from 0.82 to 0.95 for cardiac output, stroke volume, oxygen consumption, and systemic, total pulmonary, and pulmonary arteriolar resistances. Left ventricular wall and cavity sizes as obtained by angiocardiographic techniques were almost as good (r = 0.75). Arteriovenous oxygen difference, intracardiac pressures, and their derivatives did not correlate well with body measurements. Calculated resistances for both systemic and pulmonary circulations fell with increasing age. Usual interpretation of declining pulmonary resistance is that this is a consequence of changing lumen-to-wall ratios of pulmonary vascular bed. Since systemic resistance parallels this decline, we believe that this is a consequence of the definition of resistance. As systemic blood flow increases with increasing body size, the denominator increases and "resistance" decreases. In the absence of shunts, pulmonary blood flow must parallel any increase in systemic blood flow, pulmonary resistance decreases pari passu.
37. Effect o/ ~-adrenergic substances on the T wave changes in the ECG o/ the normal newborn Leonard Steinfeld ~ and Ivan Dimich, ~
Mount Sinai Hospital, New York, N. Y. Introduced by Horace Hodes
Number 5
part 2
Abstracts
patients. Biplane cineangiocardiography was used to evaluate the timing of shunts throughout the cardiac cycle. The pressures of the two ventricles were recorded on magnetic tape and processed with a digital computer which produced in graphic form the quantitative values of the pressure gradient and simultaneous right and left ventricular pressure derivatives (rate of pressure change). Patients with large left-to-right shunts and slightly elevated right ventricuiar pressures showed almost continuous L-R shunting across the ventricular defect during periods of isovolumic contraction and relaxation. The shunt occurred into the pulmonary artery during systole and into the body of the right ventricle during diastole. Patients with moderately elevated right ventricular pressures demonstrated art isovolumic relaxation right-to-left shunt across the defect with no rightto-left shunt present on arterial dye curves. With equal systemic-pulmonary pressures and large leftto-right shunts, left-to-right shunting across the defect occurred during isovolumic contraction and right-to-left shunting during isovolumic relaxation with additional right-to-left shunting occurring into the aorta during ventricular systole. With pulmonary-systemic resistance ratios greater than 0.75, pressure-flow relationships were similar to tetralogy of Fallot.
35. Contour plot spectral phonocardiography Lowell
W.
Perry, ~ David
E.
Winer, ~
Lewis P. Scott, ~ and Cesar A. Caceres, ~ Heart Disease Control Program, United States Public Health Service, Children's Hospital of The District of Columbia, and George Washington University, Washington, D. C. Introduced by Robert H. Parrott, M . D . One-hundred-two recordings of heart sounds of normal children and of children with heart disease were displayed utilizing a spectral contour plotter (Signatec 701) for the purpose of determining the physical characteristics of these sounds. With the contour plot spectrogram (CPS) the three physical parameters of sound (frequency, intensity, and time) are displayed, frequency on the ordinate and time on the abscissa. Intensity is displayed quantitatively as contour lines which give the CPS the appearance of a topographical map and which allow for the display of a dynamic range of 42 db. The CPS of normal heart sounds consists of regular patterns of sound intensity over distinct frequency ranges. Considerable variation in sound pattern is a Conspicuous feature, not only from beat to beat, but als0 when the same patient is analyzed 'at different times. Heart sounds have an earlier appearance and longer duration when a
965
CPS is compared with other types of phonocardiography. Mitral and aortic valve lesions often are associated with an irregular pattern of the first and second heart sound, respectively. The frequencyintensity characteristics of the murmur of pulmonic stenosis vary with the pressure gradient. The configuration, of the murmur of ventricular septal defect can be related to the magnitude of the left-to-right shunt.
36. Normal standards /or cardiovascular hemodynamics L. Jerome Krovetz, M. B. Mitchell, and G. L. Schiebler, University of Florida College of Medicine, Gainesville, Fla. Over the past 4 years we have studied 35 apparently normal children from one day to 20 years of age. Means, standard deviations, and standard errors were calculated by BMDO1D. Program ( U C L A ) . Regression coefficie~lts were calculated using a linear stepwise regression program (UCLA) with age, surface area, and heart rate as variables. Surface area showed only fair correlation. Furthermore, since surface area is, in turn, a function of height and weight, it involves a redundancy. Omitting surface area, no significant decrease in correlation coefficients was found. Regression coefficients ranged from 0.82 to 0.95 for cardiac output, stroke volume, oxygen consumption, and systemic, total pulmonary, and pulmonary arteriolar resistances. Left ventricular wall and cavity sizes as obtained by angiocardiographic techniques were almost as good (r = 0.75). Arteriovenous oxygen difference, intracardiac pressures, and their derivatives did not correlate well with body measurements. Calculated resistances for both systemic and pulmonary circulations fell with increasing age. Usual interpretation of declining pulmonary resistance is that this is a consequence of changing lumen-to-wall ratios of pulmonary vascular bed. Since systemic resistance parallels this decline, we believe that this is a consequence of the definition of resistance. As systemic blood flow increases with increasing body size, the denominator increases and "resistance" decreases. In the absence of shunts, pulmonary blood flow must parallel any increase in systemic blood flow, pulmonary resistance decreases pari passu.
37. Effect o/ ~-adrenergic substances on the T wave changes in the ECG o/ the normal newborn Leonard Steinfeld ~ and Ivan Dimich, ~
Mount Sinai Hospital, New York, N. Y. Introduced by Horace Hodes