Impending paradoxical embolism from atrial thrombus: correct diagnosis by transesophageal echocardiography and prevention by surgery.

During recovery from a posterolateral myocardial infarction, a 56 year old patient developed signs of deep vein thrombophlebitis and subsequently of pulmonary embolism. After conventional echocardiography showed masses in both atria, transesophageal two-dimensional echocardiography clearly revealed an elongated mass overriding an atrial septal defect. Impending paradoxical embolism was confirmed at surgery.

Chronic aortic regurgitation: reassessment of the prognostic value of preoperative left ventricular end-systolic dimension and fractional shortening.

The prognostic significance of a preoperative echocardiographic left ventricular end-systolic dimension (ESD) greater than 55 mm and/or fractional shortening (FS) of 25% or less was evaluated retrospectively in 84 patients who had undergone aortic valve replacement for isolated chronic aortic regurgitation due to various causes. Postoperative survival, improvement in symptoms, and echocardiographic evidence of regression of left ventricular dilatation and hypertrophy were compared between patients with a preoperative ESD greater than 55 mm (category 1) and those with an ESD of 55 mm or less (category 2) and between patients with FS of 25% or less (category 3) and those with FS greater than 25% (category 4). Patients in categories 1 and 3 had a higher preoperative left ventricular end-diastolic dimension (EDD) and cross-sectional area than those in categories 2 and 4, respectively, but their preoperative functional impairment (NYHA class) was similar.

[Arrhythmia behavior and sudden heart death in isolated stenoses or obstructions of the anterior interventricular branch].

The incidence and pattern of ventricular arrhythmias recorded with 24 h ambulatory monitoring were studied in 144 patients with angiographically documented stenoses (greater than or equal to 75%) or occlusions of the left anterior descending coronary artery (LAD) and were related to left ventricular wall motion abnormalities. Ambulatory monitoring was performed at the time of coronary angiography and mean follow-up ranged from less than 1 to 5.4 with a mean of 3.

Quantitative determination of regional extravascular lung water and regional blood volume in congestive heart failure.

Regional extravascular lung water (rELW) and blood volume (rBV) in five controls and 14 patients with congestive heart failure (CHF) were measured by constant infusion of H215O and inhalation of 11CO using positron emission tomography (PET). The analysis of 18 regions per patient revealed a relatively homogeneous level of rELW in the controls (mean = 0.11 +/- 0.

[Positron emission tomography of regional extravascular lung water and regional pulmonary blood volume in chronic heart failure].

In 6 controls (group A), 4 patients with moderate congestive heart failure (NYHA II, II-III: group B) and 6 patients with severe heart failure (NYHA III, III-IV, IV: group C) regional lung water (rLW, constant infusion of H2 15O), regional pulmonary blood volume (rPBV, inhaled 11CO) and regional extravascular lung water (rELW = rLW -rPBV) were measured by positron emission tomography. The mean rELW was 0.12 +/- 0.

[Peripheral venous digital subtraction angiography in the follow-up of aortocoronary venous bypass grafts].

36 patients with 68 aorto-coronary venous bypass grafts (45 of which were angiographically patent) were examined via DSA (DV12V, serial mode, Philips) and angiography. Imaging was triggered via R waves, and effected in RAO 30 degrees, LAO 60 degrees, and AP projection. 63 of the 68 grafts were correctly detected (92.

[Bypass surgery 1984: current state and future perspectives in Europe, especially in the Federal Republic of Germany].

The development of bypass surgery in Europe during the last 15 years is briefly reviewed; the slow start has to be attributed mainly to insufficient financing, allowing only university hospitals to perform this type of cardiac surgery in most of the countries of western Europe. In addition, in Europe in the late sixties many university hospitals did not have a division of cardiac surgery. This applies also to the FRG, where cardiac surgery had to be expanded considerably in the seventies.

[Progression of coronary sclerosis. Studies in 19 patients over a 6-year period using quantitative coronary angiography].

The characteristics of progressive coronary artery disease as judged from sequential angiography were quantitatively analysed in 19 patients with stable angina in whom coronary angiograms were repeated after 64-104 months (average 76.5 months). The diameters of at most 15 corresponding segments were measured with a vernier caliper (accuracy: 0.

[Infectious endocarditis: clinical aspects and diagnosis].

In a discussion of infectious endocarditis (IE), the clinical picture, current most important diagnostic methods (especially echocardiography) and prognosis under conservative therapy and valve replacement are described in detail, in the light of experience at the Hanover Medical School in recent years. While the clinical picture is usually typical, at any rate in the early stages of the disease, antibiotic therapy (when started without blood cultures and exact characterization of the germs involved) or severe complications can change the symptoms to the extent that diagnosis becomes very difficult. Apart from blood cultures, echocardiography, is of prime importance in diagnosis, the latter allows demonstration of vegetations either by M-mode or two-dimensional echocardiography (conventional or esophageal) in some 80% of cases.

Is renal involvement a prognostic parameter in patients with infective endocarditis?

Renal involvement (RI)--defined as proteinuria greater than 150 mg per 24 h with haematuria or impaired glomerular filtration rate--was studied in 80 patients with infective endocarditis (IE). Proteinuria was measured quantitatively and further differentiated by the SDS-polyacrylamide-gel electrophoresis. RI was found in 40 patients (50%) with proteinuria from 150 to 8000 mg per 24 h.

[Surgical possibilities in the treatment of ventricular tachycardia].

Medical therapy for recurrent sustained ventricular tachycardia is often disappointing. We report on the direct i.e.

[Determination of regional extravascular lung water in heart failure].

The measurement of regional extravascular lung water (rELW) was evaluated by two double-indicator dilution methods both in normals and in patients with congestive heart failure. 1. Time-activity curves in various regions of the lungs were recorded with a positron camera (Cycl.

[Progression and regression of coronary sclerosis in the angiographic image].

The natural history of coronary artery disease has to be studied by comparing coronary angiograms of the same patient taken at different times. However, conclusions from repeated angiographic studies are fraught with substantial errors mainly because of: 1. patients selection, 2.

[Hemodynamics in ischemia: diastolic phase].

The diastolic portion of the cardiac cycle can be divided into sequential phases: isovolumic ventricular relaxation; rapid ventricular filling; slow, or passive, ventricular filling; and atrial contraction. Contraction and relaxation are to some extent interrelated; however, relaxation is not simply a passive reversal of events during systole. Rather, relaxation is an energy-consuming process which involves dissociation of calcium from the actin-myosin-complex and reuptake of calcium by the sarcoplasmic reticulum.