Diagnosis of the Mitral Lesion in Patients with Giant Left Atria

Nixon, P.G.F.; Ikram, Hamid

doi:10.1136/thx.18.4.307

Cited by 3 publications

(5 citation statements)

References 16 publications

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“…The results of the investigations were compared with the findings obtained by similar techniques in the cases of mitral incompetence that have been reported by the authors (Nixon and Snow, 1962).…”

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confidence: 73%

“…When the residual volume of a chamber is small, a large volume must be regurgitated into it before the down-slope of the dilution curve is slowed (Emanuel, Lacy, and Newman, 1959); and enlargement of the residual volume increases the distortion of the dilution curve by increasing the amount of blood exposed to mixing with the regurgitated indicator (Levinson, Carleton, and Abelmann, 1959). In mitral stenosis with aneurysmal dilatation of the left atrium the residual volume of the left atrium is greatly increased, and the dye curve is severely distorted ( Figure) in the absence of any appreciable regurgitation (Nixon and Snow, 1962;Nixon and Ikram, 1963). It is quite likely that a smaller residual volume is contained in the active left ventricle of severe aortic incompetence without failure than in the fibrillating left atrium of severe mitral incompetence, and it is to be expected that the residual volume and the dilution curve distortion will increase in aortic incompetence when heart failure supervenes.…”

Section: Resultsmentioning

confidence: 99%

“…The technique of heart catheterization differed from the method previously described (Nixon, 1960) in that a catheter was introduced percutaneously into the aorta and the Braunwald test (Braunwald and Morrow, 1958) for the assessment of aortic regurgitation was performed. The ratio of least concentration to recirculation peak concentration (CL/CR, was calculated directly from the ear-piece dilution curve obtained by injecting dye into the left atrium.…”

mentioning

confidence: 99%

“…The ratio of least concentration to recirculation peak concentration (CL/CR, was calculated directly from the ear-piece dilution curve obtained by injecting dye into the left atrium. The gradient of the down-slope of the curve of primary circulation, the mean circulation time, and the cardiac output were calculated in the manner previously described (Nixon and Snow, 1962).…”

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confidence: 99%

“…FINDINGS IN SEVERE AORTIC INCOMPETENCE AND IN MITRAL INCOMPETENCE The results of the examination of the arterial dilution curves and the estimates of the left atrial size are shown in theTable,together with the calculations from the published(Nixon and Snow, 1962) cases of mitral incompetence.…”

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confidence: 99%

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Arterial Indicator-dilution Curves in Aortic Incompetence

Snow¹,

Nixon²

1963

Thorax

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confidence: 73%

Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Arterial Indicator-dilution Curves in Aortic Incompetence

Snow¹,

Nixon²

1963

Thorax

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Mitral regurgitation measured by continuous infusion of 133xenon

Morch

Klein

Richardson

et al. 1972

The American Journal of Cardiology

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Left heart catheterization with special reference to the transseptal method.

Nixon¹,

Ikram²

1966

Heart

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In the early nineteen-fifties the emergence of cardiac surgery called for accurate diagnosis, and it became necessary to catheterize the left side of the heart. The left atrium was entered by needles inserted through the tracheal wall, the suprasternal notch, and the back of the chest; and the left ventricle was entered by needle puncture, or by the passage of a catheter from the left atrium or the aorta (Lancet, 1957). These methods had diagnostic limitations or disadvantages, and dangers that restricted their use to hospitals where thoracic surgeons were available to deal with the complications (P. Wood, 1961, personal communication).In 1959 John Ross jun. described atrial septal puncture as a means of entering the left side of the heart, and early in 1960 one of us reported a series of 57 patients (Nixon, 1960). This series has now been extended to 508, and the results suggest that the technique may be safe enough to be performed with right heart catheterization in the physician's catheter laboratory.Nearly every patient investigated was a candidate for the surgical treatment of his heart disease, and the need for an accurate estimate of the morbid physiological changes justified a small risk when the alternative course was to operate, or to withhold surgical treatment, on the basis of a diagnosis that was something less than exact. The majority of the patients had mitral valvar disease, and the number investigated reflects the inaccuracy of the traditional methods of diagnosing the various syndromes of obstruction and incompetence. SUBJECTS AND METHODSThe patients' ages lay between 5 and 72 years. Of the 508 patients, 376 had mitral valvar disease with or without coincidental aortic lesion; 84 had aortic valvar disease, and 48 had a variety of congenital and acquired heart diseases. The majority of the mitral patients had systolic murmurs or a previous heart operation, and the investigation was done to assess the relative importance of various factors: stenosis, re-stenosis, regurgitation, "the myocardial factor", coincidental aortic disease, or pulmonary vascular changes.Acting under the firm belief that tension and fear predispose the subject of left heart catheterization to complications, great attention was paid to the mental preparation of the patient. Before the investigation he was made familiar with the catheterization laboratory where, from choice, the preliminary clinical examination and heart-sound recordings were carried out; and he came to know the various doctors, nurses, and technicians. The procedures that would require the patient's co-operation were carefully explained and rehearsed beforehand. A quiet demeanour, equanimity, and competence were required from the laboratory staff. Tachycardia and dyspnoea prevent the recording of diagnostic tracings, and, if necessary, investigation was deferred until medical treatment abolished tachycardia, allowed the patient to hold his breath without difficulty for at least 20 seconds, and enabled him to lie flat, or nearly flat, without discomfort.A hi...

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Diagnosis of the Mitral Lesion in Patients with Giant Left Atria

Cited by 3 publications

References 16 publications

Arterial Indicator-dilution Curves in Aortic Incompetence

Arterial Indicator-dilution Curves in Aortic Incompetence

Mitral regurgitation measured by continuous infusion of 133xenon

Left heart catheterization with special reference to the transseptal method.

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