Out of a pacemaker population of 392 patients, 90 (23%) have been found to have sinoatrial syndrome. Their ages ranged from 22 to 86 years, and averaged 66 for men and 70 for women. The male-to-female ratio was 1 : 1.6. Before pacemaker implantation, syncopal attacks had occurred in 54 %, dizziness without syncope in 31 % and tachyarrhythmias in 57 %. Atrial or paroxysmal supraventricular tachycardia had been recorded in 33 %, atrial fibrillation or flutter in 28 %, and ventricular tachycardia in 11%. First and/or second degree AV block was found in 36%. Coronary heart disease was present in 61% and 20% had had myocardial infarction. Cardiomyopathy and previous carditis were other associated heart diseases. Sinoatrial syndrome was the only manifestation of heart disease in 20%. Follow-up time after pacemaker implantation ranged from 3 months to 7 years, mean 23 months. Syncopal attacks were stopped in 48 of 49 patients, dizziness was relieved in all 28 patients and tachyarrhythmias were controlled by combined drug treatment in 43 of 51 patients. Nineteen patients died during the follow-up, most of them of cerebrovascular events or myocardial infarction. Associated coronary heart disease was especially frequent in this group. The death of one patient was caused by a run-away pacemaker. Other pacing failures were due to electrode movement or premature battery exhaustion. There was no mortality associated with pacemaker implantations or replacements. These results strongly support the view that pacemaker treatment most effectively controls symptoms of sinoatrial syndrome when drug treatment fails.
Ž. Background: The purpose of surgical closure of atrial septal defect ASD is to relieve the cardiovascular system from a haemodynamic burden. Excessive amounts of atrial peptides are released in congestive heart failure, valvular diseases and congenital heart diseases. Aims: To examine whether patients after surgical repair of ASD have higher concentrations of Ž . Ž . N-terminal atrial natriuretic peptide ANP-N than age-, sex-and body mass index BMI -matched control subjects. Methods: Medical history, physical examination, standard 12-lead electrocardiogram, and ANP-N concentrations were obtained in 65 Ž . adult patients operated for ASD at the age of 21 " 13 years mean " standard deviation , 21 " 6 years after surgical closure of ASD. Sixty-seven healthy subjects matched for age, sex and BMI served as controls. Results: In the patients serum ANP-N was Ž . higher than in the control subjects 0. Ž 2 analysis showed that age at operation was strongly associated with the post-operative ANP-N concentration r s 0.25, . Ps 0.0002 . Conclusion: ASD patients have higher ANP-N concentrations late after surgical repair. Hormone levels correlate with age at operation. Our finding supports the clinical praxis of operating on these patients in their childhood and adolescence. ᮊ
We found some high-quality systematic reviews. There was evidence on the potential of invasive treatments to provide symptomatic relief. Surgery seems to provide a longer-lasting effect than percutaneous interventions with bare metal stents or without stents. Evidence in favor of drug-eluting stents so far is based on short-term follow-up and mostly on patients with single-vessel disease.
Late after uncomplicated seclusion of ostium secundum defect patients operated at >24 years have more symptoms than those operated on at an earlier age. Residual lesions are common. Mitral regurgitation is more frequent in patients operated on at >24 years. Our findings support the clinical consensus of operating on these patients in their childhood and adolescence.
This study demonstrated a rare anomaly of a persistent left superior vena cava draining into the left atrium in a patient with developing left-to-right shunt caused by bicuspid aortic stenosis. The venous system, including the coronary sinus, was otherwise normal. We believe that, in this anatomic situation, a marked increase in left ventricular impedance caused a moderate left-to-right shunt from the left atrium into the left innominate vein. At operation, the aortic valve was replaced with a mechanical prosthesis and the anomalous vein was ligated. The convalescence was uneventful.
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