Orthodeoxia-platypnea due to intracardiac shunting--relief with transcatheter double umbrella closure.

The safety and efficacy of transcatheter clamshell occlusion of patent foramen ovale for relief of severe arterial desaturation and dyspnea in the upright position due to intracardiac shunting were examined in eight patients with excessive risk of surgical patent foramen ovale closure. All patients had successful reduction of intracardiac shunting with an immediate rise in oxygen saturation > or = 95% by implantation of a clamshell device on the atrial septum. Despite two early incidents of device embolization, retrieval and immediate re-implantation, and one patient with nonsustained atrial and ventricular arrhythmias, there were no adverse clinical sequelae.

Is there always a role for radical prostatectomy in the treatment of localized prostate cancer?

The efficacy of radical prostatectomy on localized prostate cancer is well documented. However if a high risk for patients suffering from prostate cancer and effectiveness of treatment would be documented, the advantage of the therapy on the natural history of the disease must be demonstrated. Johansson et al.

Early and 1-year survival rates in acute myocardial infarction complicated by cardiogenic shock: a retrospective study comparing coronary angioplasty with medical treatment.

Cardiogenic shock remains a frequently lethal complication of acute myocardial infarction. Early revascularization of the infarct-related artery by coronary angioplasty has been suggested to significantly improve patient survival. In-hospital and 1-year survival was assessed in 50 patients hospitalized for acute myocardial infarction complicated by cardiogenic shock.

Role of alpha blockers in the treatment of BPH: a critical review of clinical results.

Benign prostatic hyperplasia (BPH) is a benign disease characterized in a high percentage by cervico-urethral disorders. With regard to the obstructive aspect, this is the result of two components: mechanic and dynamic. The mechanic component is a direct consequence of the obstruction caused by enlargement of the prostate gland and the urethral deformation.

Transesophageal echocardiographic guidance of closed mitral commissurotomy.

We describe the utility of transesophageal echocardiography in a patient undergoing emergent closed mitral commissurotomy. Two-dimensional images provided an assessment of valve morphology and mobility while Doppler echocardiography was used to monitor the occurrence of mitral regurgitation and changes in valve gradient and area.

Effects of dobutamine on Gorlin and continuity equation valve areas and valve resistance in valvular aortic stenosis.

Previous studies demonstrated changes in aortic valve area calculated by the Gorlin equation under conditions of varying transvalvular flow in patients with valvular aortic stenosis (AS). To distinguish between flow-dependence of the Gorlin formula and changes in actual orifice area, the Gorlin valve area and 2 other measures of severity of AS, continuity equation valve area and valve resistance, were calculated under 2 flow conditions in 12 patients with AS. Transvalvular flow rate was varied by administration of dobutamine.

Percutaneous balloon valvotomy for the treatment of isolated tricuspid stenosis.

A 46-year-old woman with isolated tricuspid stenosis complained of increasing fatigue and dyspnea on exertion. Exercise Doppler echocardiography reproduced her symptoms and revealed a marked increase in trans-tricuspid gradient. Successful percutaneous balloon tricuspid valvotomy was performed, with resolution of her symptoms.

Transesophageal Doppler echocardiography of pulmonary venous flow: a new marker of mitral regurgitation severity.

Pulmonary venous flow varies with different cardiac conditions. Flow patterns in response to mitral regurgitation have not been well studied, but flows may vary enough to differentiate among different grades of regurgitation. Accordingly, pulmonary venous flow velocities were recorded in 50 consecutive patients referred for outpatient (n = 26) or intraoperative (mitral valve repair; n = 24) echocardiographic examination for mitral regurgitation.

Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension.

Objective: To assess the prognostic significance of left ventricular mass and geometry in initially healthy persons with essential hypertension.

Design: An observational study of a prospectively identified cohort.

Setting: University medical center.

Percutaneous balloon valvotomy for patients with mitral stenosis: initial and follow-up results.

Percutaneous double balloon mitral valvotomy (PMV) was performed in 25 patients with severe mitral stenosis who were followed for at least 6 months after the procedure. There were 22 women and 3 men, with a mean age of 51 +/- 14 years (range, 27 to 74). Hemodynamic and angiographic findings were evaluated before and after PMV and clinical status was assessed at follow-up.

Effect of nitrendipine in mild or moderate essential hypertensive subjects with type II diabetes.

The antihypertensive effect of nitrendipine, 20 mg once daily was studied in 30 patients with mild or moderate hypertension and type II diabetes mellitus under metabolic control. Blood pressure was measured at the end of a 15-day washout period from previous antihypertensive treatment and on the 15th, 30th, 60th, and 90th day of treatment. Systolic blood pressure and diastolic blood pressure were significantly reduced by nitrendipine.

Modulation of murine in vitro immune response by verapamil (V).

Functionally distinct lymphocyte subsets differ with regard to necessary activation signals. In selected circumstances lymphocyte activation has been shown to be critically dependent upon transcellular calcium influx. Whether calcium plays a central role in the activation of all lymphocytes remains to be determined.

Atrial septal defect after percutaneous mitral balloon valvuloplasty: immediate results and follow-up.

Percutaneous mitral balloon valvuloplasty was performed in 150 patients. There were 124 women and 26 men (mean age 53 +/- 1 years). A left to right shunt through the created atrial communication was present in 28 patients (19%) after valvuloplasty.

Effect of predialysis verapamil on intradialytic blood pressure in chronic hemodialysis patients.

Decreased left ventricular compliance because of hypertrophy or fibrosis may contribute to hypotension during hemodialysis. While calcium channel blockade may reduce intradialytic hypotension in patients with left ventricular hypertrophy and refractory pulmonary congestion, it is unknown whether such an effect might be seen in unselected hemodialysis patients. Verapamil (40 mg) or a placebo was given 1 hour before hemodialysis to 10 patients in a double-blind crossover study.

Transesophageal echocardiography in percutaneous balloon valvuloplasty for mitral stenosis.

As percutaneous mitral valvuloplasty gains wider acceptance, appropriate selection of patients for this procedure continues to be important. The presence of atrial thrombus is a contraindication, and transesophageal echocardiography provides optimal visualization of the left atrium and atrial appendage to assess for the presence of thrombus. This case report describes a patient in whom left atrial thrombus was suspected based on standard precordial echocardiography.

Simultaneous low level treadmill exercise and intravenous dipyridamole stress thallium imaging.

Intravenous dipyridamole-thallium imaging unmasks ischemia in patients unable to exercise adequately. However, some of these patients can perform limited exercise, which, if added, may provide useful information. Treadmill exercise combined with dipyridamole-thallium imaging was performed in 100 patients and results compared with those of 100 other blindly age- and sex-matched patients who received dipyridamole alone.

Echocardiographic detection of pressure-overload left ventricular hypertrophy: effect of criteria and patient population.

To evaluate the performance of M-mode echocardiography for detection of pressure-overload left ventricular hypertrophy (LVH), we tested the sensitivity of previously defined sex-specific upper limits of normal echo LV measurements in 31 patients with necropsy-proven pressure-overload LVH and determined the prevalence of LVH detected by each echo criterion in 316 employed patients with uncomplicated hypertension, 100 patients with hypertension evaluated in a referral center, and 38 hospital patients with moderate to severe (WHO class 2) hypertension. Echo measurements were LV mass (LVM), LVM index (LVMI), cross-sectional area (CSA), septal and posterior wall thickness (IVST and PWT), LV internal dimension (LVID), and relative wall thickness (RWT). Prevalences of echo LVH were as follows.

Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings.

In a previous study of 543 patients we developed, using echocardiographic left ventricular mass as the reference standard, two new sets of criteria that improve the electrocardiographic diagnosis of left ventricular hypertrophy (LVH). One set of criteria, which is suitable for routine clinical use, detects LVH when the sum of voltage in RaVL + SV3 (Cornell voltage) exceeds 2.8 mV in men and 2.

Cost-effectiveness of echocardiography and electrocardiography for detection of left ventricular hypertrophy in patients with systemic hypertension.

Although echocardiography is more accurate than electrocardiography for detection of left ventricular hypertrophy, it is also more expensive, making it uncertain whether echocardiography is cost-effective for detection of this abnormality in hypertensive patients. Accordingly, the sensitivity of M-mode echocardiographic and electrocardiographic criteria for left ventricular hypertrophy was determined in necropsied patients with anatomic hypertrophy of mild (n = 26), moderate (n = 21) or severe (n = 46) degree, and the prevalence of each degree of hypertrophy was determined in 561 hypertensive adults drawn from clinical and employed population samples. The sensitivity of echocardiographic left ventricular mass index criteria was 57% in necropsied patients with mild hypertrophy and 98% in patients with moderate or severe hypertrophy.

Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men.

To assess whether echocardiographic and electrocardiographic detection of left ventricular hypertrophy could predict cardiovascular morbid events in patients with uncomplicated essential hypertension, we followed 140 men for a mean of 4.8 years. Initial echocardiographic measurements of left ventricular mass were normal (less than 125 g/m2 body surface area) in 111 patients and revealed hypertrophy in 29 patients.

Performance of primary and derived M-mode echocardiographic measurements for detection of left ventricular hypertrophy in necropsied subjects and in patients with systemic hypertension, mitral regurgitation and dilated cardiomyopathy.

To determine which M-mode echocardiographic (echo) measurement best detects left ventricular (LV) hypertrophy, the sensitivity and specificity of upper normal limits of echo LV anatomic measurements (previously shown to have 97% specificity in living normal subjects) were tested in 60 necropsied patients with anatomic hypertrophy and in 28 necropsied patients with normal left ventricles. The prevalence of hypertrophy by each echo criterion was determined in 165 living patients with systemic hypertension, mitral regurgitation or dilated cardiomyopathy. The best separation between patients with normal vs increased necropsy LV mass was obtained using sex-specific echo LV mass index criteria (overall accuracy = 73 of 88 patients, 83%).

Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria.

To develop improved electrocardiographic criteria of left ventricular hypertrophy, individual electrocardiographic voltage measurements were compared with echocardiographic left ventricular mass in a "learning series" of 414 subjects. The strongest independent relations with left ventricular mass were exhibited by the S wave in lead V3, the R wave in lead a VL and the T wave in lead V1 (each p less than 0.001), and by age and sex.