EZOFAGOKARDIOGRAFYYa (Greek oisophagos a gullet + kardia heart + grapho to write, represent) — the graphic registration of the movements of heart which is carried out through a gullet.
Use E. in a polikardiogra-fichesky research (see Polikardiografiya) allows to register the movements of the left auricle (ezofagoatriogramm) and to study phase structure of its systole that matters for diagnosis of mitral heart diseases. It is established that in a form of a curve ezofagoat-riogramma it is possible to judge a condition of sokratitelny function of the left auricle.
A contraindication to a research are heavy heart failure, tendency to fibrinferments and embolisms, the general serious condition of the patient, an acute esophagitis.
For E. use the thin rubber or polyvinyl chloride probe, one end to-rogo terminating in a small thin-walled rubber bulb enter on necessary depth into a gullet, and connect another to the data-acquisition equipment, napr, a manometrical prefix to electronic recorders for record of the pressure curve in cardial cavities; use piezosensors less often (see Pjezografiya). At use of the multichannel registering devices the ezofagokar-diogramma is registered along with an ECG, FKG, the apical cardiogram, the carotid sphygmogram, and also with apekskardio-grammy (see the Cardiography) that facilitates interpretation of an ezofagokar-diogramma and interpretation of its separate waves.
AA. carry out in lying situation after preliminary anesthesia of a mucous membrane of a throat 1 — 2% by solution of Dicainum. For record of reductions of the left auricle (esophago-atriogrammy) the sensor is entered into a gullet on depth of 30 — 40 cm from edge of cutters; reductions of a left ventricle (ezofagoventrikulogramma) — on 35 — 45 cm; pulsations of an aorta (ezofa-goaortogramma) — on 20 — 30 cm.
On a normal ezofagoatriog-ramma (fig. 1) distinguish three waves. The first — the wave of reduction of an auricle designated as a wave And,
Fig. 1. Ezofagoatriogramma is normal (below), registered synchronously with the electrocardiogram (above): And — the wave
corresponding to an auricular systole; In — a ventricular wave; D — a wave of filling of auricles.
arises in 0,05 sec. after the beginning of a tooth P on an ECG and comes to an end on average in 0,13 sec. The second wave — ventricular, designated as a wave In, begins on average in 0,05 sec. after the beginning of a tooth of Q on an ECG, is quite often doubled (then its second top is designated as a wave C). The origin of a wave In is connected with build-up of pressure in the left auricle owing to a progibaniye in his cavity of the slammed left atrioventricular or mitral valve in the period of isometric contraction of a left ventricle. The subsequent decrease in a curve matches on time a phase of bystry exile of blood from a left ventricle. It is explained by reduction of volume of heart and a nek-eye an otkhozhdeniye of the left auricle from a gullet. The third wave of D is caused by passive filling of the left auricle from pulmonary veins and on time corresponds to a phase of slow exile of blood from a left ventricle and a postsphygmic interval. The termination of its platoobrazny top matches the moment of opening of the mitral valve, and the descending knee of this wave — a phase of bystry filling of a left ventricle at the beginning of a diastole. This wave is followed by small gradual raising of a curve, with -
Fig. 2. Ezofagoatriogramma (below) and the electrocardiogram (at the top of) the patient with insufficiency of the mitral valve:
recession of a curve between waves of B and D is superficial.
replying to slow filling of the left auricle from pulmonary veins when inflow of blood to it prevails over outflow in a left ventricle. It is established that the ezofagoatriogramma quite precisely reflects changes of pressure in the left auricle. Registration of an ezofagoventrikulogramma of essential practical value has no. The normal ezofagoaortogramma is similar to a curve pulsation of an aorta and is characterized by the big positive wave arising during exile of blood from a left ventricle in an aorta.
Changes of an ezo-fagoatriogramma at mitral heart diseases are of the greatest practical interest. At insufficiency of the mitral valve the hollow between a ventricular wave (V) and a wave of filling of an auricle (D) is expressed badly (fig. 2), and in hard cases of a wave of B and D merge, forming one big wave reflecting the strengthened filling of the left auricle as from pulmonary veins, and a reversed current of blood from a left ventricle. The ascending knee of this wave often has the small jags caused probably by the arising turbulences of a blood-groove and corresponding to noise of mitral insufficiency. Its top quite often matches the II cardiac sound. The wave comes to an end with abrupt recession.
At a mitral stenosis on an ezo-fagoatriogramma increase in amplitude and duration of a wave And (fig. 3), and also shortening and reduction of the steepness of the descending part of a wave/), reflecting a phase of bystry
Fig. 3 is in most cases noted. Ezofagoatriogramma (below) and the electrocardiogram (at the top of) the patient with a mitral stenosis: amplitude of a wave And is increased in comparison with a wave of D: the steepness of recession of a wave of D is reduced; In — a ventricular wave.
fillings of a left ventricle from; auricles. At heavier degree of a stenosis the top and the beginning of the descending knee of a wave of D form earlier, than normal that is caused by earlier opening of the mitral valve owing to supertension in the left auricle. At the combined mitral defect on an ezofagokardiogramma signs of both defects are found, but in most cases the signs characteristic of insufficiency of the mitral valve come to light more accurately.
Bibliography: D e x t I r G. Ya. Electrocardiographic diagnosis, M., 1966; Smetnev A. S., etc. Transesophageal electric cardiac activation in diagnosis of Bouveret's nadzhell7-dochkovy diseases, Cardiology of t "
No. 11, page 13, 1983.'" ’
A. L. Grebenev, And. A. Yakubovich.