Rotational excursion of heart in massive pericardial effusion studied by phased-array echocardiography

We have observed rotational excursion, comprising anteroposterior and right to left movement of the heart, and cardiac twist around the long axis in 2 patients with massive pericardial effusion, using a phased-array echocardiograph recently developed in this country. Sagittal real-time cross-sections showed only the anteroposterior swing motion, but horizontal cross-sections revealed a counterclockwise rotational excursion and cardiac twist during this rotational excursion. The rotational excursion consisted of a rapid and almost straight movement right and posteriorly in systole, and a slow arcing excursion left and anteriorly in diastole. The speed of this movement was not uniform. The heart disclosed dominant counterclockwise twisting motions in mid to late systole and in late diastole, synchronous with atrial contraction. These movements were described relative to an external system of co-ordinates. Controls, consisting of a normal healthy subject, and cases with mitral stenosis, mitral regurgitation, and hypertrophic cardiomyopathy, did not show any rotational excursion. In the latter 2 diseases, cardiac twists were observed, but they were less dominant than in cases with massive pericardial effusion.