A follow-up study was performed in 82 patients in whom a diagnosis of isolated pulmonary stenosis was established by cardiac catheterization in this laboratory between 1947 and 1961. Only patients who did not have intervening cardiac surgery during the first 5 years were included. The follow-up time was 5–21 years (mean 12.3 years). 51 of the patients had a mild stenosis with a right ventricular systolic pressure of 60 mm Hg or below. Serial heart catheterizations were performed in 36 patients, 20 of whom had mild stenosis. Clinical and hemodynamic progression was found to be limited. It occurred only among those patients with an initial right ventricular systolic pressure of more than 80 mm Hg. In the relatively large group of patients with mild stenosis, no clinical, electrocardiographic, or roentgenographic progression could be detected; the pressure gradients also remained small, though a minor increase in right ventricular systolic pressure was encountered in two children.
In a prospective study of old, terminally ill patients who died from various conditions in a general hospital ward, the autopsy established a very high incidence of silent myocardial infarction. Acute myocardial infarction (AMI), clinically not suspected, was demonstrated at autopsy in 20 of 39 cases. 13 AMIs involved only the subendocardial layers. Severe coronary artery stenosis was three times as frequent among the AMI patients as among the others, but recent coronary artery thrombosis was observed in one case only. Clinical and laboratory observations failed to establish the diagnosis of AMI prior to death.
In a review of 2557 autopsy reports from a general hospital 20 patients, aged 65 or above, have been found to have severe isolated valvular aortic stenosis. The diagnosis was made or suggested clinically in only 5 cases. The clinical findings were often atypical, e.g. the BP amplitude was above 50 mmHg in 9 patients and 4 had a systolic BP of 180 mmHg or more. Left ventricular hypertrophy as evaluated by ECG was, however, present in all examined cases but one. The main cause of death was cardiac in 17 cases, of whom 2 died suddenly and 4 following non‐cardiac surgery. At autopsy significant coronary arteriosclerosis was found in all but 2 patients. In 9 patients acute myocardial infarction was demonstrated—in 2 cases only through a macroscopic enzyme test (Nitro‐BT method).
A review of the symptomatology of right atrial myxoma is given, based on 33 cases from the literature and on two cases studied by us.
This diagnosis should be considered in any patient with isolated right heart failure without pulmonary congestion, pulmonary disease, or pulmonary stenosis.
A tricuspid murmur, intermittent cardiac or cerebral symptoms or radiographic demonstration of non‐valvular intracardiac calcifications should increase the suspicion.
Selective right atrial angiocardiography is the diagnostic method of choice. The diagnosis cannot be excluded without this examination, which always should be performed in any patient with isolated tricuspid valvular disease.
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