[Therapy of latent cardiomyopathy with verapamil].

In an open, randomized cross-over trial lasting two months, 21 patients with latent cardiomyopathy were either untreated or received verapamil 120 mg three times daily. Angina and dyspnea improved in 14 of the 21 patients. These symptoms worsened in one, remained unchanged in six (P less than 0.

[Radiation burden in heart catheter studies--significance of measures for reducing scatter radiation].

During diagnostic and, more particularly, therapeutic intervention, such as transluminal coronary angioplasty, the operator may be exposed to a considerable degree of scatter radiation. In our study, we measured the level of radiation exposure of the head, unprotected knees and lower legs. A flexible lead screen, attached to the catheterization table (0.

[Measuring the intracoronary pressure gradient--value and methodologic limitations].

Measurements of pressure gradients were performed in a fluid-filled model. The hydrostatically regulated perfusion pressure, as well as the diameter of the tube segments and the regulation of the flow by peripheral resistance, were comparable to conditions in human coronary arteries. Pressure gradients above 20 mm Hg were only measured with a reduction in cross-sectional area of more than 90%.

[Transfemoral valvuloplasty using the balloon catheter in mitral stenosis].

In two female patients (59 and 30 years old) with mitral stenosis, a successful valvuloplasty was carried out with a balloon catheter. After transseptal puncture with determination of the pressure gradient between the left auricle and the left ventricle, the atrial septum was initially dilated with a small balloon and a MediTech balloon catheter with a diameter of 25 mm was pushed forward into the region of the mitral valve via a guide wire. On filling of the balloon, the marked indentation at 3-4 atü hyperbaric pressure initially present could be eliminated.

[Transfemoral valvuloplasty in calcified aortic valve stenosis].

In a 55 year old male patient and a 67 year old woman with calcified aortic valve stenosis, a valvuloplasty was performed via the femoral approach using a large-lumen balloon catheter. The 55 year old patient, who had undergone an aortocoronary bypass operation some years ago, displayed the symptoms of a cardiogenic shock. A surgical intervention would have entailed an additional risk.

[Can beta-receptor blockers trigger coronary spasm?].

Beta-blockers are frequently administered in therapy of arterial hypertension and coronary heart disease. They mostly lead to an asymptomatic increase of peripheral and coronary resistance. Three patients in whom there were indications of a deterioration of myocardial blood flow under beta-blockade were observed within a few weeks.

[Nuclear medicine in determining the shunt in ductus arteriosus Botalli].

In 9 patients with patent ductus arteriosus, quantification of left-to-right shunt was performed with dye dilution curves after peripheral injection and with radionuclide ventriculography. The study was repeated within 7 days after successful transluminal occlusion of the ductus with an Ivalon-plug. Reproducubility of the method could be studied in one patient in whom reopening of the ductus occurred.

[Treatment of hyperkinetic heart syndrome with alinidine and propranolol].

A hyperkinetic heart syndrome has been diagnosed in 10 patients by clinical investigation and right-heart catheterization at rest and during exercise. Subsequently, the patients received 3 X 40 mg alinidine, and 2 X 40 mg propranolol and placebo, each for 2 weeks in a double-blind crossover study. Heart rate at rest (P less than 0.

Transfemoral plug closure of patent ductus arteriosus.

A patent ductus arteriosus should be closed because of its hemodynamic significance and/or the risk of infective endocarditis. Mortality of surgery is low. In adults, however, technical problems can arise due to calcification of the ductus walls.

Systolic anterior movement of the mitral valve and the Venturi effect: an in vitro study.

We constructed two different "mitral valve" models in order to investigate the influence of the Venturi effect on SAM. According to our results, SAM can be caused as a result of a subvalvular obstruction. In this case, the valve itself does not contribute to the degree of outflow tract obstruction (first model).

Calcium antagonist treatment in mild forms of cardiomyopathy.

Twenty-one patients with a mild form of cardiomyopathy (with normal ejection fraction but histologically-confirmed hypertrophy of myocardial cells and/or elevated diastolic pulmonary artery pressure during exercise) received 120 mg verapamil t.i.d.

Long-term observations in mild forms of cardiomyopathy.

24 patients suffering from a mild cardiomyopathy with normal or nearly normal ejection fraction and histologic evidence of cardiac fiber hypertrophy were followed-up over 5.5 +/- 1.9 years.

10-year results and survival of patients with hypertrophic cardiomyopathy treated with calcium antagonists.

Hypertrophic cardiomyopathy is characterized by progredient myocardial hypertrophy causing ventricular systolic and diastolic dysfunction. Long-term results of beta-blocker therapy have been disappointing. Neither the impaired ventricular filling or the prognosis are improved.

Effects of nifedipine and propranolol combined therapy in patients with hypertrophic cardiomyopathy.

Fifteen (14 male and one female) patients with hypertrophic cardiomyopathy, ranging from 22 to 67 (mean: 45.5) years of age were treated with oral nifedipine and propranolol for 6 to 24 (mean:18) months. Twelve of the patients had been pretreated with a mean oral dose of 560 mg verapamil for 60 up to 93 (mean: 78.

Long-term treatment of hypertrophic cardiomyopathy with verapamil or propranolol in matched pairs of patients: results of a multicenter study.

The effects of a 2-year treatment with high-dose propranolol (mean, 340 +/- 135 mg/day) and verapamil (mean, 493 +/- 136 mg/day) were compared in two groups of patients with hypertrophic cardiomyopathy. Both groups were broadly identical at the beginning of the trial and were formed of matched pairs. Out of 137 patients entering the study, 37 pairs completed the 2 year follow-up.

Long wire technique--experience with 100 procedures.

Derived from more than 1000 procedures the long wire technique has proven to facilitate coronary angioplasty. Maneuvering of the wire is unhindered because the wire is introduced without balloon catheter. Optimal contrast display is possible during crossing of the stenosis.

Myocardial biopsy in patients with hypertrophic cardiomyopathy: correlations between morphologic and clinical parameters and development of myocardial hypertrophy under medical therapy.

Left ventricular biopsies from 38 patients with hypertrophic cardiomyopathy (HOCM 28, HNCM 10) were investigated to evaluate possible correlations between morphological and clinical parameters. No correlation was found between the degree of myocardial hypertrophy (muscle cell diameter), nuclear size of the myocytes, fibrous tissue content and various clinical data such as pressure gradient, left ventricular end-diastolic pressure, Sokolow index and heart volume. In 11 patients with HOCM, a second biopsy was performed after medical therapy (verapamil, n = 9; propranolol, n = 2) over 33 +/- 12 months.

Long-term treatment of severe chronic heart failure with captopril: a double-blind, randomized, placebo-controlled, long-term study.

Twenty-three patients with severe heart failure (NYHA classes III and IV) on treatment with digitalis and diuretics were additionally treated in a randomized double-blind study over a 6-month period with captopril (n = 12; mean daily dose 84 mg) or a placebo (n = 11) and were then reexamined. In the captopril group, the left-ventricular filling pressure decreased by 9 mm Hg (from 23 to 14) at rest and 6 mm Hg (from 35 to 29) during exercise. In the placebo group, there was an increase of 4 mm Hg (from 25 to 29) at rest and 7 mm Hg (from 33 to 40) during exercise; p less than 0.

Coulometric high-performance liquid chromatographic analysis of morphine in biological fluids.

A simple method is described for the determination of morphine in biological fluids (plasma and urine) by high-performance liquid chromatography with coulometric detection. The detector consists of three porous electrodes which are arranged in a way to give maximum selectivity and sensitivity. Quantitation of morphine is performed using naloxone as the internal standard.

[Successful angioplasty of a coronary stenosis followed angiographically for 9 years].

A short 80% peripheral stenosis of the anterior interventricular branch which remained unchanged for nine years was successfully dilated by transluminal balloon coronary angioplasty using long-wire technique with angiographically demonstrated reduction of the stenosis to 30%. The patient has since been without symptoms, even on severe physical exertion. It has previously been thought that increasing hardening of the atheroma of a long-standing stenosis prevented successful lasting dilatation.

[Regional myocardial ischemia in the conscious dog under echocardiography control].

Regional myocardial dysfunction is a very sensitive and early parameter of myocardial ischemia. One minute occlusion of the left anterior descending (LAD (n = 8) and circumflex coronary artery (CCA) (n = 8) by means of hydraulic occluders was performed in 10 chronically instrumented conscious dogs. In a left ventricular cross-section diastolic and systolic area (DA, SA) and area shortening (AS) as well as regional function of 6 radial sectors were evaluated with 2D echocardiography.

Effects of bepridil on regional myocardial ischemia and comparison with verapamil.

This study was designed to assess the efficacy of bepridil in reducing regional myocardial ischemia and to compare its efficacy with that of verapamil. Forty-five anesthetized, open-chest dogs were subjected to three 5-minute occlusions of the left anterior descending coronary artery (LAD), each followed by 45 minutes of reperfusion. Eleven dogs (group 1) served as controls.

[Transluminal angioplasty of stenosis of mammary artery bypass].

Experience with transluminal angioplasty, frequently reported for venous bypass stenosis, has so far been limited for mammary-artery bypasses. In a 53-year-old man with severe triple-vessel coronary disease, two stenoses in the venous bypass with four peripheral anastomoses and one stenosis in the mammary-artery bypass were successfully dilated. Bypass surgery and transluminal coronary angioplasty can, as this case demonstrates, complement one another.