Hemodynamic compromise (tricuspid stenosis and insufficiency) caused by an unruptured aneurysm of the sinus of Valsalva.

A patient is described with an unruptured aneurysm of the noncoronary sinus of Valsalva that occupied the right ventricular inflow tract and caused dynamic tricuspid stenosis and insufficiency. Results of two-dimensional echocardiography delineated the anatomy of the aneurysm and pulsed Doppler examination provided evidence that the aneurysm was unruptured. The unruptured aneurysm was resected successfully.

Should coronary artery bypass be delayed following successful direct coronary artery streptokinase thrombolysis during evolving myocardial infarction?

The effect of deferring immediate coronary artery bypass was evaluated in two groups of similar patients having successful direct coronary artery thrombolysis with streptokinase in the treatment of evolving myocardial infarction. Within 6 hours of onset of myocardial infarction, 140 patients underwent immediate cardiac catheterization and infusion of intracoronary streptokinase up to 500,000 units. Of those patients having restoration of orthograde coronary blood flow coupled with immediate evidence of myocardial salvage, 31 patients (group I) had immediate coronary artery bypass and 34 patients (group II) had coronary artery bypass deferred.

The inaccuracy of aortic valve systolic flutter as a screening test for significant aortic stenosis.

The noninvasive assessment of the severity of aortic stenosis is difficult. A recent description of systolic flutter of aortic valve leaflets as a screening test for severe aortic stenosis was applied to a group of patients who had undergone catheterization. As opposed to the previous report, we found this an inaccurate, nonspecific, and insensitive aid for the differentiation of significant versus nonsignificant aortic stenosis; and feel that its validity should be studied further before wide application.