Echocardiographic practice in a large metropolitan area.

A survey performed concerning echocardiography in a metropolitan area. Of 110 hospitals in the area, 62 reported having echocardiographic facilities. Echocardiographic physicians and/or technicians from 41 of these hospitals responded to questionnaires designed to determine the following: (1) educational background and credentials of technicians, (2) average salaries of technicians, (3) role of the physician and technician in the performance and reporting of echocardiograms, (4) volume, cost, and method of storage of echocardiograms, and (5) number and type of echocardiographic units in use.

Diagnosis of intracardiac thrombi in mitral stenosis and left ventricular dysfunction. Use of selective coronary arteriography.

Neovascularization of the left atrial appendage on selective coronary arteriography implying left atrial thrombus occurred in five of 20 patients with mitral stenosis, and is consistent with the incidence of left atrial thrombi in mitral stenosis determined both surgically and post mortem. The presence of a thrombus was confirmed at surgery in the two patients operated on. Selective coronary arteriography with attention to the presence or absence of left atrial neovascularization is suggested for the full evaluation of mitral stenosis.

Partial right-sided congenital pericardial defect with herniation of right atrium and right ventricle.

In an unusual case of right-sided pericardial defect with herniation of the right atrium and right ventricle, cardiac blood pool isotope imaging is introduced as a new, noninvasive diagnostic procedure. Surgery which consisted of excision of right-sided pericardium relieved the chest pain which was the only symptom the patient had prior to surgery.

Thyrotoxicosis and lactate-producing angina pectoris with normal coronary arteries.

Three patients with thyrotoxicosis are described, in whom the presenting symptom was severe cardiac pain at rest or on effort and who were admitted to hospital with suspected or proven myocardial infarction. All patients were studied by selective coronary arteriography and left ventriculography after thyroid function tests which confirmed thyrotoxicosis. There was no demonstrable disease of the major coronary arteries in any of the patients, yet myocardial infarction and left ventricular aneurysm were shown to be present in 1, and there was definite electrocardiographic evidence of ischaemia in all 3.

An unusual form of late stenosis after aortic valve replacement with a cloth-covered Starr-Edwards prosthesis.

A 24-year-old man presented with late stenosis of a cloth-covered Starr-Edwards valve (model 2320). Fibrous ingrowth occurred at the inflow orifice of the valve and all three struts were adherent to the aortic wall, creating a "tunnel" form of obstruction. The stenotic valve was replaced with a porcine heterograft, and the small aortic root was enlarged with a Dacron patch.

Hypertrophic cardiomyopathy with midventricular obstruction associated with mitral stenosis: partial relief of the obstruction by papillary muscle and trabecular resection.

A patient is reported with hypertrophic cardiomyopathy where midventricular obstruction was found in association with mitral stenosis. Partial relief of the intraventricular obstruction was obtained by extensive papillary and trabecular muscle resection in the mid-left ventricular area, in conjunction with mitral valve replacement with a porcine heterograft.

Comparison of single and biplane ejection fractions in patients with Ischaemic heart disease.

Simultaneous biplane left ventriculography was performed in 59 patients with ischaemic heart disease. A comparison was made of the frontal (EFF), lateral (EFL), and biplane (EFB) ejection fractions. Discrepancies between the three measurements in the same patient were frequent observed.

Mid-ventricular obstruction: a variant of obstructive cardiomyopathy.

In two patients with clinical and catheterization findings of hypertrophic obstructive cardiomyopathy, the level of intraventricular obstruction was found to be in the mid-ventricular area rather than at the junction of the inflow and outflow tracts. One patient died suddenly shortly after unsuccessful outflow tract myectomy. In vivo recognition of this probably rare variant form of obstructive cardiomyopathy rests mainly on the angiograhic appearance of the left ventricle and on the recording of pressures in multiple sites of the left ventricular cavity.