Mitral valve areas determined by two-dimensional planimetry, pressure half-time and proximal flow convergence region reliably correlated with size of the anatomic orifice. The flow area method provided a less reliable correlation.
Summary
A sample of 930 children, between 9 years and 15 years old from six Italian towns, were studied. Their family history of allergy, personal allergy and medical history, current allergy symptoms, exposure to environmental allergens, feeding as infants, and their parents’ occupations were recorded. They were skin‐prick tested (SPT) with a range of common allergens. A subject was defined as atopic if at least one SPT caused a weal greater than 3 mm diameter. The association between the recorded information and atopy was investigated by logistic multiple regression. Atopy was positively associated with: high density housing; medium or high exposure to environmental allergens; a history of rhinitis, asthma or atopic eczema; male gender; and a history of breast‐feeding. It was independent of infectious diseases, vaccinations and operations, social class and family history. Thus, there was no evidence of a genetic factor in atopy, other than sex.
The takotsubo syndrome is a clinical entity that can mimic an acute myocardial infarction. It is characterised by anginal chest pain with ST-T elevation in precordial leads, without coronary obstruction at angiography; its distinctive feature is a peculiar pattern of left ventricular contraction, with expansion of the apical segments and basal hyperkinesis, also known as 'apical ballooning'. This syndrome usually has a good prognosis, with normalisation of the left ventricular contraction impairment within several days, although Japanese authors have described two cases of free left ventricular wall rupture in these patients.We describe a case of apical ballooning syndrome complicated by left ventricular rupture in a Caucasian old female. To our knowledge, this is the first-ever case of a fatal outcome in the Caucasian population, due to free wall ventricular rupture, and confirms that the takotsubo syndrome may lead to a fatal cardiac event.
We studied 76 patients with congenital heart disease, whose ages ranged from 2 to 39 years. The following investigations were carried out pre-operatively and post-operatively in all patients : visual acuity, cycloplegic refraction, orthoptic examination, examination of the fundus. Where collaboration was sufficient the following were also studied: kinetic and static perimetry, adaptation perimetry, colour vision, electroretinography. There were no differences before and after operation of visual acuity, adaptation perimetry, refraction, electroretinography or of the fundus. Post-operative changes were only found in 4 of the 65 patients in whom perimetry was performed. By comparison, an identical study of patients with acquired heart disease showed the percentage of functional ocular changes to be higher in this group.Key w w h : heart -congenital heart disease -extracorporeal circulation.Of all the possible consequences of heart surgery, neurological and neurophthalmic complications cause the most problems post-operatively, despite the use of the most advanced techniques available. Many papers in the literature attempt to discover the underlying pathogenetic mechanism. Bass & Langmore (1969) regarded the following factors to be important in the aetiology-hypoxia causing inadequate
For noninvasive evaluation of anatomy and flow characteristics of internal mammary artery graft (IMA-graft), 2D echo-Color-Doppler (CDE) was performed in 60 patients (54 M, 6 F, mean age 54.1 +/- 6.9 y), who underwent coronary angiography 20.1 +/- 13 months after a coronary artery bypass graft (CABG). CDE was performed, using an echocardiographic unit equipped with a 5 MHz linear transducer. In all patients, measurements of IMA-graft diameter (mm), and peak systolic and diastolic flow velocity (cm/sec) were obtained at baseline and also in 16 patients after dipyridamole infusion (0.54 mg/Kg/min) and in 10 patients after sublingual nitroglycerin (NTG) (0.4 mg). Angiography showed the IMA-graft patency in 58/60 patients (96.8%). A typical biphasic flow was displayed by CDE in 49/58 patients (84.4%) with angiographic patency. Dipyridamole infusion increased both IMA-graft diameter and peak diastolic flow velocity (PDFV) from 2.28 +/- 0.51mm to 2.9 +/- 0.42mm and from 19.4 +/- 6.2 cm/sec to 93.9 +/- 29 cm/sec, respectively (p < 0.0001). No significant modifications of peak systolic flow velocity (PSFV) were observed. NTG increased PDFV from 29.11 +/- 8 cm/sec to 41.88 +/- 7.20 cm/sec (p < 0.005), while diameter and PSFV showed no statistically significant modifications. CDE is a useful diagnostic tool for noninvasive evaluation of IMA-graft patency both early after surgery and during long-term follow-up. CDE pharmacological stress improves the sensibility of the technique and it can provide indirect information about pathophysiology of recipient coronary vessel.
To examine the effects of dobutamine on pulsed‐Doppler left ventricular filling indices and its utility for evaluation of CAD we studied 14 patients with normal coronary arteries (Group 1) and 39 patients with significant CAD (>70% diameter stenosis). Patients with coronary artery disease (CAD) were divided into two groups: patients with one‐vessel coronary disease (Group 2); and those with multivessel CAD (Group 3). After stopping cardioactive treatment, patients underwent incremental dobutamine stress (5, 10, 20, 30 and 40 μg/kg/min) during pulsed‐Doppler interrogation of diastolic filling with simultaneous heart rate and blood pressure measurements. The following transmitral Doppler variables were measured at baseline and at peak‐dose of dobutamine: peak early (E) and peak atrial (A) velocity; E/A ratio; acceleration time (AT) and deceleration time (DT) of E wave; isovolumic relaxation time (IVRT); and time–velocity integral (TVI). Two‐dimensional echocardiography was performed to detect regional asinergy and analyzed using a 16 segment model. Results: Normals and CAD patients showed comparable changes in heart rate and blood pressure (P=NS between groups). Intergroup analysis of the changes of transmitral flow showed the significant changes for these indices (P<0.001): E velocity (−2.78±10.04, 12.4±9.4 and 16.47±10.65 cm/s); AT of E wave (1.66±2.47, −5.2±1.38 and −4.66±2.39 m/s2); DT of E wave (−0.23±0.18, 0.2±0.2 and 0.2±0.28 m/s2); and TVI of transmitral flow (−1.26±0.7, 3.5±1.75 and 4.1±1.66 cm), respectively for Groups 1, 2 and 3. All other transmitral Doppler variables showed insignificant changes (P=NS) to dobutamine between groups. It is important that the significance of these changes were the same for patients with one‐vessel and those with multivessel coronary disease. In conclusion, during dobutamine stress testing, patients with CAD, had an abnormal response of these transmitral Doppler indices: E wave; AT of E wave; DT of E wave; and the TVI of transmitral flow. The abnormal responses of these Doppler indices of left ventricular filling are more accurate markers of significant single vessel CAD than new wall motion abnormalities during conventional DSE.
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