Cardiovascular diseases最新文献

Persistent atrial paralysis in a patient with complete heart block and mild mitral insufficiency is presented. Left atrial specimens obtained during implantation of a permanent cardiac pulse generator showed evidence of hypertrophy and fibrosis; subcellular degenerative changes ranged from near normal to irreversible, thus suggesting that atrial paralysis may be due to the replacement of normal atrial muscle with nonfunctional fibrous tissue.

After surgery of the aorta and iliac arteries, perioperative information concerning the circulatory status of the legs is vital. In a consecutive series of 71 patients, segmental air plethysmography was used to monitor simultaneously pulse volumes in both legs. Accidental ischemia was detected in four patients, and immediate corrective measures were undertaken. Compared with other methods, plethysmography proved reliable and easy to use.

A simplified technique with the use of intraluminal vessel occluders to prevent collateral flow of blood and cardioplegic solution during saphenous vein distal coronary artery anastomosis is presented here. Additional advantages of this technique are the stenting of vessels to facilitate vessel approximation and the assurance of anastomotic patency.

Real-time ultrasonic echo imaging of peripheral arteries promises to facilitate the management of selected patients with peripheral and extracranial arterial disease. This report outlines the technique of imaging the carotid system and portions of the arteries that supply the lower extremities. It also discusses the normal and pathologic anatomy of these arteries.

In two patients with atypical myxomas of the left atrium, two-dimensional echocardiography furnished valuable diagnostic information. In one patient, who had previously developed an embolism at the right brachial artery, M-mode echocardiography revealed an abnormal band of echoes within the left atrium. Two-dimensional echocardiography showed a globular cluster of echoes that remained within the left atrial cavity throughout the cardiac cycle; left ventricular angiography confirmed the ultrasonic findings of an intraatrial mass. At surgery, a calcified, nonprolapsing myxoma was excised from the interatrial septum. The second patient had clinical as well as M-mode echographic features of mitral stenosis. Cardiac catheterization showed a significant gradient across the mitral valve, but the left ventriculogram was normal except for an unusual pattern of mitral regurgitation. Subsequent two-dimensional echocardiography revealed a mass of echoes that prolapsed through the mitral valve during diastole. At surgery, a left atrial myxoma was found attached to the posterior mitral annulus. Our experience indicates that two-dimensional ultrasound is superior to conventional echocardiography for detecting unusual cardiac masses.

A 48-year-old woman was admitted to our institution with angina pectoris and a systolic murmur. At cardiac catheterization, she was found to have an anomalous origin of the left anterior descending coronary artery from the pulmonary trunk. There was also an associated atrial septal defect and a bicuspid aortic valve.

At the University of Erlangen-Nürnberg, a retrospective study was done of 336 femorotibial bypasses for limb salvage, with a follow-up of 7 years. The indication for arterial reconstruction was severe ischemia in 80.7%. Early good results were obtained in 89.6%, and the mortality rate was 1.5%. The best bypass grafts were the autologous vein and the composite graft, with patency rates of 92%. Five and 7 years after surgery, the cumulative patency rates were 50.7% and 49.1% respectively.