The seat belt is designed for safety in a motor vehicle and should be worn to prevent severe injuries. But, the seat belt itself can be an injury factor in combination with deceleration forces applied to fixation points of mobile viscera. Here, we present a 23-year-man with traumatic transection of the appendix, highly mobile viscera, following seat belt injury.
Appendix ; Deceleration ; Motor Vehicles ; Seat Belts* ; Viscera

Placenta surface cyst classified subamniotic hematoma, subchorionic hematoma and subchorionic cyst by histological finding. These cysts did not affect the obstetrical outcome according to the previous report. However, we experienced that the subamniotic cyst compressed the umbilical cord to result in fetal deceleration. We report this case with brief review of literature.
Deceleration ; Hematoma ; Placenta ; Prenatal Diagnosis ; Umbilical Cord

Sternal fractures are most common in drivers of motor vehicles whose anterior chest hits the steering wheel during sudden deceleration. Sternal fractures may result in mediastinal hematoma secondary to bone marrow oozing. The hematoma usually resolves itself without complications, so an anterior mediastinal hematoma causing tamponade is rarely reported. We describe a case of blunt chest trauma resulting in a sternal fracture with a resultant anterior mediastinal hematoma and mediastinal tamponade.
Bone Marrow ; Deceleration ; Hematoma ; Motor Vehicles ; Thorax*

BACKGROUND: Hemodynamic and functional evaluation with Doppler and tissue Doppler study as a part of comprehensive echocardiography is essential but normal reference values have never been reported from Korean normal population especially according to age and sex. METHODS: Using Normal echOcaRdiographic Measurements in a KoreAn popuLation study subjects, we obtained normal reference values for Doppler and tissue Doppler echocardiography including tricuspid annular velocities according to current guidelines and compared values according to gender and age groups. RESULTS: Mitral early diastolic (E) and late diastolic (A) velocity as well as E/A ratio were significantly higher in women compared to those in men. Conversely, mitral peak systolic and late diastolic annular velocity in both septal and lateral mitral annulus were significantly lower in women compared to those in men. However, there were no significant differences in both septal and lateral mitral early diastolic annular (e') velocity between men and women. In both men and women, mitral E velocity and its deceleration time as well as both E/A and E/e' ratio considerably increased with age. There were no significant differences in tricuspid inflow velocities and tricuspid lateral annular velocities between men and women except e' velocity, which was significantly higher in women compared to that in men. However, changes in both tricuspid inflow and lateral annular velocities according to age were similar to those in mitral velocities. CONCLUSION: Since there were significant differences in Doppler and tissue Doppler echocardiographic variables between men and women and changes according to age were even more considerable in both gender groups, normal Doppler echocardiographic values should be differentially applied based on age and sex.
Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Female ; Hemodynamics ; Humans ; Male ; Reference Values

BACKGROUND AND OBJECTIVES: Left ventricular (LV) diastolic function can be evaluated by obtaining parameters from Doppler analysis of the mitral inflow, which are known to change with increase in age. Pulsed Doppler myocardial imaging (DMI) analysis of mitral annular velocity has been proposed as a more accurate method for evaluation of LV diastolic function. This study sought to find out the age-associated changes in parameters of LV diastolic function acquired from pulsed DMI analysis of the mitral annulus in a large group of heathy Korean adults. MATERIALS AND METHODS: Two hundred and eighty-nine apparently healthy Korean subjects who visited the Center for Health Promotion for routine health checkup were studied. All went through pulsed DMI by echcardiography for acquisition of velocities in the septal, lateral, anterior, and inferior annuli of the mitral valve. Peak early diastolic velocity (Em), peak late diastolic velocity (Am), and their ratio (Em/Am) were obtained and their correlation with age was evaluated. Doppler flow analysis of mitral inflow was also performed. Peak early and late diastolic flow velocity (E and A), deceleration time (DT) and isovolumic relaxation time (IVRT) were assessed and their relationship with increase in age was also evaluated. RESULTS: Mean age of the subjects was 55.7+/-10.9. Em velocities of all portions of mitral annulus showed good correlation with age, showing continuous decline with increase in age (R=-0.60, -0.58, -0.59, -0.58 for septal, lateral, anterior and inferior annuli, respectively, p<0.01). Am velocities showed a significant but minimal increase with increase in age in all of the sampled positions. Em/Am ratio also showed a significant decline similar to the change in Em velocities. The A velocity and E/A ratio obtained from mitral inflow Doppler analysis showed a significant decline and DT and IVRT showed a significant increase with increase in age. CONCLUSION: Parameters of left ventricular diastolic function evaluated by pulsed DMI show significant changes that correlate well with increase in age. This supports the finding that left ventricular diastolic function continuously declines with increase in age.
Adult* ; Aging ; Deceleration ; Health Promotion ; Humans ; Mitral Valve ; Relaxation

To evaluate the changes of Doppler echocardiographic parameters of left ventricular(LV) filling in hypertensive subjects, 34 patients(M : F=17 : 17) with and without LV hypertrophy and 19 healthy, age-matched control subjects(M : F=10 : 9) were examined by M-mode, 2 dimensional and Doppler echocardiography. From the Doppler recording, A2 D(time from second heart sound to the onset of early diastolic mitral flow), peak velocity at early diastole(E) and late diastole(A), ratio of E to A velocity, diastolic filling times, early diastolic deceleration rate(EDDR) and flow velocity integral(FVI) were measured. In the patients without LV hypertrophy, A2 D only was significantly prolonged(127+/-21 vs 83+/-24 msec P<0.01) as compared with the normal subjects, but the patients with LV hypertrophy had more prolonged A2 D(149+/-31 vs 83+/-24 msec P<0.01), higher late diastolic peak velocity(A : 0.58+/-0.17 vs 0.47+/-0.09m/sec, P<0.01) and lower E/A velocity ratio(0.95+/-0.19 vs 1.24+/-0.29, P<0.01) than the normal subjects. There was a significant correlation between A2 D and LV muscle mass index in entire patients with hypertension(r=0.42P<0.01). These data suggest that A2D is the earliest parameter indicating abnormality of LV diastolic function and E/A ratio is not likely to be a definite index of LV diastolic dysfunction but rather be a reliable index of LV hypertrophy in hypertensive patients with preserved LV systolic funtion.
Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Heart Sounds ; Humans ; Hypertrophy

There is no doubt that the diastolic dysfunction of the left ventricular plays an important role in the pathophysiogy of clinical heart faliure in some patients, if not all, and that many hypertensive subjects manifest diastolic dysfunction of the left ventricle in its early hypertensive stage. But yet, it is not clear which paramenter is most sensitive and/or specific, and consistent with pathophysiologic states. In order to have an insight into the problems, 30 hypertensives and 30 normotensive subjects were studied by phonocardiogram and pulsed Doppler echocardiogram at the left ventricular inflow and then isovolumic relaxation time(A2D time), early diastolic deceleration time(EDDT), early diastolic deceleration rate(EDDR), late diastolic time(LDT), E.A velocity ratio[E/A(v)]and E/A area ratioA(a)] were measured and calculated. And the values of each parameters of different groups were subgrouped according to the severity of the hypertension(Group A:mild, B:moderate and C:severe hypertension) and according to the LV mass(Group D:LVMI<125g/m2, GroupE:LVMI> or =125g/m2) were compared with those of the normal control subjects and also between each subgroups. The results were as follows : 1) In the 30 normotensive subjects, A2D time was averaged out 60.8+/-12.5msec, E/A(v) 1.55+/-0.59, E/A(a) 2.61+/-1.35, EDDT 1.35+/-37.8msec, EDDR8.3+/-4, 6m/sec2 and LDT 151+/-42.2msec. 2) In group A, A2D time was significantly prolonoged(82.5+/-26.0msec, p<0.005) and E/A(v) markedly decreased(1.12+/-0.40, p<0.05) compared to those of normotensive group. 3) In group B, A2D time was significantly prolonged(78+/-20.8msec, p<0.005), and E/A(v)(0.92+/-0.42, p<0.005) and EDDR(4.9+/-1.5m/sec2, p<0.05) were significantly decreased compared to those of the control group. 4) In group C, A2D and EDDT were increased(p<0.005, p<0.05 respectively) while E/A(v) and EDDR decreased(p<0.01, p<0.05 respedtively), while E/A(v) and EDDR decreased(p<0.01, p<0.005 respectively). 5) In group D, A2>D and EDDT were significantly prolonged(p<0.005), while E/A(v), E/A(a) and EDDR wer significantly decreased(p<0.005, p<0.05 respectively). 6) In group E, A2D and EDDT were significantly increased(p<0.005, p<0.05 respectively), while E/A(v) and EDDR significantly decreased(p<0.005, p<0.05 respectively). Above results suggest that diastolic function of the left ventricle can be deteriorated in the hypertensive subjects before systolic dysfunction is apparent even in the mild hypertensives and in the patients devoid of hypertensive hypertrophy of the left ventricle.
Deceleration ; Heart ; Heart Ventricles ; Humans ; Hypertension* ; Hypertrophy ; Relaxation

BACKGROUND AND OBJECTIVES: Atrioventricular plane displacement (AVPD) has been used for evaluating systolic function. However, its relations with other echocardiographic variables reflecting diastolic function are not well documented. This study was designed to assess the relations between AVPD and those echocardiographic variables known to reflect diastolic function, especially using mitral annulus velocity. SUBJECTS AND METHODS: Eighty-seven patients with normal left ventricular (LV) systolic function (normal echocardiography group (Group I, n=44), concentric left ventricular hypertrophy (LVH) group (Group II, n=43)) and 51 patients with LV dysfunction (Group III) were studied. To evaluate the correlation with echocardiographic variables reflecting LV systolic and diastolic function, we measured mitral inflow velocity and mitral annulus Doppler tissue velocity. RESULTS: AVPD was correlated negatively with age, the ratio of early diastolic mitral inflow velocity and early diastolic mitral annulus velocity (E/E'), isovolumic relaxation time, and E/A ratio. AVPD was correlated positively with deceleration time, ejection fraction, and systolic mitral annulus velocity (S'). By multivariate analysis, AVPD was independently correlated with S' (beta=0.4, p<0.001) and E' (beta=0.5, p<0.001) in the normal LV function group, and with S' (beta=0.6, p<0.001) and E/E'(beta=-0.3, p=0.005) in the LV dysfunction group. CONCLUSION: AVPD may be used as a diagnostic tool for evaluating LV diastolic function.
Deceleration ; Echocardiography ; Humans ; Hypertrophy, Left Ventricular ; Multivariate Analysis ; Relaxation

BACKGROUND: Left ventricular diastolic dysfunction is often observed in hypertensive patients with normal left ventricular systolic function and can cause heart failure symptoms. Doppler echocardiography has become a standard tool for examining left ventricular diastolic function. This study was performed to evaluate the left ventricular diastolic function in hypertensive patients with normal left ventricular systolic function and to determine the changes in left ventricular diastolic function after antihypertensive treatment. METHODS: Mitral inflow and pulmonary venous Row velocities were evaluated by transthoracic pulsed-wave Doppler study in patients with hypertension before antihypertensive treatment(n= 50) and after antihypertensive treatment for 4 months(n=24). The patients were randomly assigned to group I to receive ACE inhibitor or group II to receive other antihypertensive drugs. RESULTS: Before antihypertensive treatment, mitral inflow E/A ratio was 0.94+/-0.27, decele- ration time was 222+/-47 msec, and pulmonary venous flow S/D ratio was 1.62+/-0.42. Follow- up Doppler study was completed in 24 patients after 4 months of antihypertensive treatment. Mitral inflow E/A ratio was significantly increased(0.96+/-0.24 vs. 1.16+/-0.25, p<0.001), but deceleration time showed no significant changes. Pulmonary venous flow S/D ratio was signi- ficantly decreased(1.75+/-0.27 vs. 1.50+/-0.24, p<0.001). There was no significant difference in changes in mitral inflow E/A ratio, deceleration time and pulmonary venous flow S/D ratio between ACE inhibitor group and other antihypertensive group. CONCLUSION: There was some improvement in left ventricular diastolic function in patients with hypertension after 4 months of antihypertensive treatrnent. But, there was no significant difference in changes in diastolic parameters between ACE inhibitor group and other antihy- pertensive group.
Antihypertensive Agents ; Deceleration ; Echocardiography, Doppler ; Heart Failure ; Humans ; Hypertension*

BACKGROUND: Infarct size determines left ventricular (LV) systolic and diastolic dysfunctions after acute myocardial infarction, and also may affect the recovery from functional impairment. We studied the differences of LV remodeling and changes of systolic and diastolic functions of LV during two weeks after acute myocardial infarction, according to Killip class at admission. METHODS: Echocardiographic examinations were performed within two days (23.9+/-2.3 hours), and two weeks after the attack in 27 patients with acute myocardial infarction, and the results were compared with those of 19 controls. Patients were divided into two groups according to Killip class at admission; 18 patients in Killip class I (group I) and 9 patients in Killip class II to IV (group II). Group II had larger infarct, reflected by higher levels of peak serum cardiac enzymes. RESULTS: LV systolic function was more depressed in group II. Regional wall motion score index decreased in group I after two weeks, but not in group II. LV systolic and diastolic volume indexes increased after two weeks in group II but not group I. E/A ratio of mitral inflow was less than 1, and isovolumic relaxation time was prolonged in group I immediately after the attack. Group II had E/A>1 and shorter deceleration time (DT) of mitral inflow, and higher peak reverse flow velocity associated with atrial contraction (AR) of pulmonary venous flow than those of controls immediately after the attack. In group II, E/A ratio was greater, DT was shorter, peak systolic/diastolic flow velocity ratio of pulmonary venous flow was less, and AR was higher than those of controls after two weeks. CONCLUSION: Infarct size affected remodeling and changes of systolic and diastolic functions of LV after acute myocardial infarction. In patients with large infarct, LV was dilated and regional wall motion was not improved during two weeks. Restrictive pattern of LV filling, which was more aggravated during two weeks, was noted immediately after the attack. In patients with small infarct, LV was not dilated and regional wall motion was improved during two weeks. LV filling pattern showed relaxation abnormality.
Deceleration ; Echocardiography ; Heart Ventricles* ; Humans ; Myocardial Infarction* ; Relaxation