European journal of cardiology最新文献

Serum catalytic concentrations of total creatine kinase (CK) and its more heart-specific isoenzyme CK-MB were studied in 25 consecutive patients subjected to isolated mitral valve replacement (Björk--Shiley prosthesis). Heart and skeletal muscle CK and CK-MB content was determined in 10 cases. The postoperative serum levels did not reflect differences in myocardial CK-MB content between patients. CK-MB as a percentage of total CK at peak serum CK-MB (16 +/- 1%) (mean +/- SEM) was of similar order as the percentage of CK-MB in the myocardium (papillary muscle 20.9 +/- 1.3%, right auricle 18.2 +/- 0.5%). A small proportion of CK-MB was present in all skeletal muscle samples examined (diaphragm 4.2 +/- 0.6%, rectus abdominis 0.4 +/- 0.1%), indicating that the total CK level should also be taken into account in attempts to determine the origin of a raised postoperative serum CK-MB activity. The degree of postoperative CK-MB elevation was related to the duration of operation and of aortic cross-clamping. Perioperative myocardial infarction occurred in one patient, and serum CK-MB kinetics in this patient, with a biphasic enzyme curve, differed from those in the other patients.

The responses of resistance and capacitance vessels of skin and muscle, and of blood pressure to reflex influences mediated by the sympathetic system were investigated in a group of 63 male patients in a chronic phase of myocardial infarction. In the group of patients with MI, as compared to the controls: (1) the reactive increase of systolic BP and heart rate was significantly smaller but longer lasting after cessation of the stimuli; (2) the vasoconstrictory reactions in skin were significantly prolonged in resistance as well as in capacitance segments of vascular bed; and (3) the resting blood flow in muscle was significantly lower and the vasodilatation during an emotional reaction was less pronounced and shorter. Possible underlying mechanisms of this vasomotor pattern are discussed.

The electrophysiological effects of the beta-adrenergic blocking agent penbutolol (4 mg i.v.) were studied in 15 patients by means of intracardiac recording using the extra-stimulus technique and rapid atrial pacing. The following effects were observed. (1) Significant prolongation of the sinus cycle length (16%). (2) Significant prolongation of the AV-nodal conduction time during sinus rhythm (12%). (3) Significant prolongation of the AV-nodal conduction time with increasing atrial pacing rate (16--29%). At 150/min, 4 of 7 patients with intact AV-conduction under baseline conditions developed second degree AV-block 15 to 30 min after penbutolol administration. (4) Significant prolongation of the effective refractory period of the AV-node (19%). Penbutolol had no effect on the intraventricular conduction, on intraatrial conduction or on the corrected sinus node recovery time.

The effect of chronic adjunctive vasodilator therapy was assessed in 14 symptomatic patients with idiopathic cardiomyopathy. Thirteen of the 14 patients improved by one or more in the New York Heart Association functional class, one remained unchanged. Three became asymptomatic (class I). Noninvasive and invasive (hemodynamic) parameters before and after vasodilators were assessed. The echocardiographic findings of septal and posterior wall thickness of 1.2 cm or greater were the best predictors of good response in our patients who subsequently became asymptomatic.

Three hearts sharing the anatomical peculiarity of a horizontal interventricular septum are described. In one, both great vessels originate from the superior right ventricle, in the other the great arteries are connected normally, the third one shows a single aortic trunc. It is concluded that the horizontal interventricular septum has to be considered as an independent cardiac deformity occurring with most types of ventriculoarterial connections. Assuming rotation of the bulboventricular loop around a base-apex-axis as the basic ontogenetic event one can trace this morphology back to its original layout. It is, therefore, possible to classify each case according to the usual nomenclature regarding the horizontal septum and the upstairs-downstairs arrangement of the ventricles as an addition. This embryological event of rotation is considered the product of a restraightening process of the previously looped cardiac tube.

The immediate effects of a single rehabilitation program were appraised in 55 patients with stabilized myocardial infarction (40 inferior and 15 anterior). Subjects were submitted to functional evaluation before and after 20 sessions of interval training on different types of apparatus (cyclorowing, treadmill, bicycle ergometer) and divided into three groups comprising 32, 15 and 8 patients respectively. In both inferior and anterior localization of coronary disease, the predictive value of the energetic indexes Ei1 and Ei2 indicated the improvement in physical fitness resulting from exercise training. For each type of infarct, 15% of the cases studied showed no such improvement after both short- and long-term training. Early changes in energetic indexes are positively correlated with the results of functional evaluation program. Where training is not beneficial, these indexes may therefore be used to help define session by session individualized programs.

Cases of mitral valve aneurysm determined during the patient's lifetime have not yet been described in literature. Using a mechanical sector scanner we were able to diagnose a mitral valve aneurysm in a 22-yr-old man suffering from rheumatic aortic steno-insufficiency. The real-time, cross-sectional image showed an aneurysm which was limited to the proximal part of the anterior mitral leaflet. During diastole the reflow of blood from the insufficient aorta determined an enlargement of the aneurysm towards the left atrial cavity. Bacterial vegetation which protruded from the aortic valvular surface and which was responsible for abnormal echoes in the M-mode in the left outflow tract was also detected. The patient died of irreversible cardiac insufficiency caused by the infectious endocarditis, and upon autopsy the echocardiographic diagnosis was confirmed.

The appearance and gradual progression of atrioventricular (A-V) block in the presence of the Wolff-Parkinson-White (WPW) syndrome is an intriguing phenomenon. The vast majority of the reports up to date describe persistence of preexcitation in the face of partial or complete heart block. We describe a patient with severe coronary artery disease, in whom WPW disappeared suddenly, transiently at first, during coronary bypass surgery, and then permanently, probably as a result of an acute myocardial infarction, and in whom all the sinus beats during relentlessly progressive heart block were conducted through the normal A-V conduction system only.

Fifty-five children in 6 diagnostic groups were followed with repeated echocardiographic examinations during the first postoperative year to establish profiles for different congenital cardiac malformations. One year after total correction, patients with Fallot's anomaly, with and without previous shunt, showed an enlargement of the right ventricular dimension (RVD), the left ventricular internal dimension (LVIDd), the aortic root dimension (AOD), and the left atrial dimension (LAD) compared with normal. In patients with ventricular septal defect (VSD), LVIDd was enlarged; in patients who had been operated on previously with pulmonary banding, both RVD and AOD were enlarged. Patients with VSD and pulmonary stenosis (PS) showed enlarged RVD and AOD but small right ventricular outflow tract (RVOT). Patients with secundum atrial septal defect (ASD) had enlarged RVD, AOD, LVIDd, and LAD. Left ventricular function as judged by echocardiography was normal in all groups pre- and postoperatively. The importance of establishing postoperative echocardiographic profiles is illustrated by patients where deviations from expected findings indicated an unsatisfactory result of the operation and the need for reoperation.

A 57-yr-old man with coronary artery disease presented with recurrent sustained ventricular tachycardia. During electrophysiologic study, the following observations suggested His-bundle branches (His-BB) reentry as the underlying mechanism of ventricular tachycardia: (1) the initiation of ventricular tachycardia by a premature ventricular beat was related to the presence of retrograde His--Purkinje conduction (V2H2) delay; (2) the QRS configuration of tachycardia complexes was similar to that of V1 and V2; (3) each QRS complex of tachycardia was consistently preceded by a His bundle deflection with an H-V interval which was equal to or longer than that of sinus beats; (4) atrioventricular dissociation was present during tachycardia; and (5) after procainamide a greater V2H2 delay was required to initiate the tachycardia. The therapeutic implications of identifying and differentiating the His-BB (macro) reentry from micro reentry are discussed.