European journal of cardiology最新文献

Our experience with the use of a fresh antibiotic sterilized aortic root homograft inlayed into the right ventricular outflow tract is described. With this technique, compression of the graft between the sternum and heart has been avoided and residual right ventricle to distal pulmonary artery pressure gradients have been small. The functional status of the survivors is good over a follow-up period of up to 3 yr. The advantages of this approach compared with a conventionally placed heterograft conduit or an outflow tract gusset are discussed.

Features of the P, QRS and T waves in the normal 12-lead ECG have been measured and the information displayed is estimated to be 75% redundant. The high level of redundancy results in an excessive volume of superfluous data. A simple 4-electrode 3-lead X-Y-Z system has been developed and is proposed for wide use in electrocardiology. The electrodes are anatomically orthogonal rather than electrically orthogonal. In a clinical test using only 3 of the standard leads, 95 of 100 records could be adequately interpreted. This high level of satisfactory interpretation with 3 leads has been experienced by other investigators. The 4-electrode system is currently being used for studies in high fidelity electrocardiology. It is suggested that a more appropriate name for vectorcardiogram (VCG) would be correlocardiogram (CCG). The 4-electrode system would simplify and be useful for this application. A simple 4-electrode 3-lead X-Y-Z system would facilitate the teaching recording and interpretation of ECG information by eliminating excessive redundant data. Evaluation of this lead system by other investogators is invited.

In 94 patients with prominent left axis deviation, there was a marked disparity in the mean angles determined by the maximum magnitude of the deflections and that determined by areas. There was also considerable variation in the angle of the maximum vector in the frontal plane (frontal plane angle) and the angle of 50 msec vector in the frontal plane. Similar results were observed in 17 cases of ostium primum atrial septal defect. These differences contrasted with the findings in a normal group of 50 subjects where a close correlation was found. The initial vector was directed to the right in approximately 80% of normals and 60% of the patients with LAD indicative of conduction defects in the left anterior fascicular or its distal ramifications. We conclude that a rightward orientation of the 5--10 msec vector (i.e. causing a Q wave in lead 1) should not be required for diagnosis of left anterior fascicular block. The spatial orientation of the initial vector was always anterior in the control subjects. In these 'normals', as well as in the patients with left axis deviation, the initial vector varied markedly in its azimuth direction (right or left) when superiorly directed; but when inferiorly directed in the normal subjects it was virtually always directed rightward. From these data we were unable to construct rigid criteria which would reliably distinguish aberrant excitation patterns manifested by gross left axis deviation in the electrocardiograms of patients with established heart disease from subjects without defined heart disease. Old infarction patterns, anterior, inferior, and lateral were not obscured by the associated anterior fascicular block.

Evaluation of left ventricular performance in aortic stenosis, aortic regurgitation and mitral regurgitation from the stroke work/left ventricular mass ratio. Europ. J. Cardiol., 10/4, 279--294. 132 patients with a pure valvular dysfunction affecting a single orifice, namely aortic stenosis, aortic or mitral regurgitation, were studied. All patients, including 20 control subjects, underwent hemodynamic examination of both right and left heart chambers including left cineangiography. Using the stroke work index/myocardial mass ratio (SWI/MLV), for which the limits in normal subjects are narrow (0.81 +/- 0.03 . g-1) it was possible to divide these patients into three groups: Group I (SWI/MLV greater than 0.87 gm . g-1) characterized by a proportionately greater increase in stroke work index than myocardial mass (hyperfunctioning ventricle). Group II (0.87 gm . g-1 greater than or equal to SWI/MLV greater than or equal to 0.75 gm . g-1) characterized by a parallel increase in stroke work index and myocardial mass (normally functioning ventricle). Group III (SWI/MLV less than 0.75 gm . g-1) for which the increase in myocardial mass was proportionately greater than that of the stroke work index (hypofunctioning ventricle). As one progresses from group I to III, there is a concomitant fall in ventricular function with decreased mean velocity of circumferential fiber shortening (VCF), ejection fraction (EF) and increased enddiastolic volume (EDV) together with the hypertrophy of the left ventricle during the last stage. We conclude that the SWI/MLV ratio is an easy to calculate index, independent of the unerlying dysfunction, which evaluates left ventricular function by taking into account the myocardial mass.

59 patients with suspected infective endocarditis on a natural valve were studied by M-Mode echocardiography to determine the specificity of the ultrasonic technique in detecting valvular vegetations. All echocardiograms were read independently by two observers who were unaware of the final diagnosis. Among 40 patients who later proved not to have infective endocarditis, two (5%) were diagnosed by echocardiography as having either possible or probably vegetation by at least one observer. Both patients with a false positive diagnosis of vegetation had pre-existing valvular pathology, the presence of which greatly complicated the interpretation of the echocardiogram. Inter-observer disagreement occurred in 5 of the 59 studies (8.5%). The results of this study suggest that caution should be exerted in the echocardiographic diagnosis of vegetation in patients with pre-existing valvular pathology.

One of mono-zygotic twins who had the asplenia syndrome with severe cardiac malformations is described, the other twin being normal. This is the first documented case of situs ambiguus in mono-zygotic twins. The relationship of situs ambiguus to situs inversus, which has previously been described in a number of mono-zygotic twin pairs (some concordant and some discordant) is unclear.

An extremely rare congenital abnormality is reported in which the anterior descending branch of the left main coronary artery arises independently from the pulmonary trunk in a young patient who presented with unstable angina. Its clinical presentation, angiographic identification and surgical treatment are described. It appears to be a distinct entity with few of the features of the classical form of anomalous origin of the left main coronary artery.

An important question after clinical auxiliary heart transplantation is whether controlled pacing of both hearts is desirable in order to protect the diseased recipient heart. A comparison of the effects of spontaneous beating with three types of pacing (random, simultaneous and sequential) was undertaken in an isolated perfused working double rat heart. The two hearts were attached to each other by the atria, in a way comparable to the clinical situation. During controlled sequential pacing of both normal hearts, the peak systolic pressure fell and diastolic pressure rose, but the combined cardiac output did not changes. In contrast, during simultaneous pacing, systolic pressure rose, diastolic pressure fell and coronary flow was less than with sequential pacing, but the oxygen uptake was higher. Hence the effects of sequential pacing could be expected to be beneficial when function of one of the hearts was depressed by left main coronary artery ligation. During sequential pacing the cardiac output was significantly improved from 10 to 30 ml/min (P less than 0.001) and coronary flow rose. Myocardial oxygen consumption increased from 80 to 110 microliters/g/min (P less than 0.05). Thus sequential pacing could improve the severely depressed hemodynamics of the coronary-ligated heart in the presence of an auxiliary heart. The increased myocardial oxygen consumption is viewed as a beneficial effect of increased diastolic perfusion pressure and was not associated with increased enzyme release. It is concluded that the effects of sequential pacing warrant assessment in clinical auxiliary heart transplantation.

A patient with acute inferior and anteroseptal myocardial infarction initially developed a 2 : 1 AV block with alternate conducted ventricular complexes showing aberrancy, and later Wenckebach-type, 2nd-degree AV block with aberrancy of the beats following a long diastolic pause. Intracavitary recording suggested that aberrancy was related to an intraventricular block. ECG and VCG recordings excluded the site of block as being in the main bundles or in the fascicles of the left bundle. The patient therefore showed evidence for a 2 : 1 and later a phase 4 peripheral block, defined also as a peri-infarction block because of the underlying etiology of the block. The block could be localized in the posterior wall of the right ventricle, by the marked rightward and posterior orientation of the middle and terminal electrical forces evident in the vectorcardiogram.