We postulated that the abnormal shape, size, and function of the right heart and adjoining ventricular septum in adults with Ebstein's anomaly of the tricuspid valve might in turn alter the shape and function of the left ventricle. Seven adult patients with uncomplicated Ebstein's anomaly were studied. Left ventricular geometry was determined by two-dimensional echocardiography. Left ventricular function was assessed by treadmill exercise and radionuclide angiography at rest and with exercise. Paradoxic ventricular septal motion was consistently present. Left MethodsSeven sequential patients were selected from the Adult Congenital Heart Disease Program of the UCLA Hospital and Clinics. The criterion for selection was uncomplicated Ebstein's anomaly of the right (tricuspid) atrioventricular valve (situs solitus, atrioventricular, and ventriculoarterial concordance, intact ventricular septum, and absent right ventricular outflow obstruction). Studies were performed during one outpatient visit after informed consent was obtained. The protocol was approved by the UCLA Human Subject Protection Committee.There were four male and three female patients, 15 to 59 years old (mean 35.7). Four patients were asymptomatic. Three had supraventricular arrhythmias, and two were on antiarrhythmic medications. Two were cyanotic due to right-to-left interatrial shunts (table 1). Patient 5 was studied before and 1 year after tricuspid valve replacement, and patient 7 had a ventricular demand pacemaker (VVI mode).Each patient had a complete physical, chest roentgenographic, and 12-lead scalar electrocardiographic examination.

SUMMARY The effect of ,B-adrenergic blockade with oral propranolol on resting, exercise and postexercise ventricular performance was evaluated using multiple-gated equilibrium cardiac blood pool images in normal volunteers and patients with coronary artery disease. Propranolol produced no detectable effect on basal left ventricular function in normal subjects at doses producing intermediate (160 mg propranolol/day) and maximal (434 ± 99 mg propranolol/day) # blockade and in patients with coronary artery disease at clinically effective antianginal doses (162 ± 47 mg propranolol/day). During exercise, a dose-related, negative inotropic effect was observed in normal subjects: 160 mg propranolol/day produced a small but statistically insignificant decline in exercise left ventricular performance, whereas maximal , blockade significantly depressed the left ventricular response to exercise. In patients with coronary artery disease, propranolol's effect on exercise ventricular performance depended on the presence or absence of ischemic dysfunction during exercise. In patients with an ischemic functional response to exercise, propranolol significantly improved regional and global performance during and after exercise; in coronary artery disease patients with a normal response to exercise, propranolol had no significant effect on exercise and postexercise ventricular function. These results imply increased sensitivity to the effects of, blockade in ischemic myocardium. In coronary artery disease patients with an abnormal response to exercise and in normal volunteers during , blockade, propranolol's effect on exercise left ventricular performance was independent of changes in ventricular preload and afterload related to heart rate and blood pressure.BETA-ADRENERGIC BLOCKADE with propranolol has been shown to relieve symptomatic ischemic heart disease1'-and limit experimental infarct size.' 6 Presumably, these effects are achieved by improvement in the balance of oxygen supply and demand by inhibition of catecholamine-mediated increases in heart rate, blood pressure and inotropic state. Because an improved balance in oxygen supply and demand would result in reduced regional ischemia, ,B-adrenergic blockade with propranolol might actually improve mechanical performance in ischemic zones despite its negative inotropic effect on nonischemic myocardium. Supportive evidence for this possibility has been obtained from studies tion during acute myocardial ischemia or infarction has yielded contradictory results.'2 14 To date, no studies have been published in man evaluating the effect of fl-adrenergic blockade on mechanical performance in regionally ischemic myocardium. The present study was designed to evaluate the effects of ,B-adrenergic blockade with oral propranolol on resting, exercise and postexercise regional and global left ventricular performance as evaluated by multiple-gated equilibrium cardiac blood pool imaging. The goals of the study were to compare the effects of f-adrenergic blockade on ischemic and nonischemic m...

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