Tuberculous pericarditis.

A patient with a 5-month history of pericardial effusion and unsuccessful steroid treatment was found at pericardial exploration to have thickened pericardium adhered to the heart. After anterior pericardiectomy, histologic examination revealed severe granulomatous pericarditis resulting from infection with Mycobacterium tuberculosis. Despite the pericardiectomy and antituberculous therapy, the patient continued to have symptoms, including bilateral pleural effusions, 4 days after discharge from the hospital.

Doppler echocardiography in normal functioning valve prostheses.

Even though there has been some criticism regarding the Doppler evaluation in prosthetic valves because of inter-observer and intra-observer variability, among other factors, and Doppler study has a tendency to have falsely high gradients compared to invasive studies, especially mechanical aortic prostheses, Doppler evaluation can provide reliable hemodynamic information about valve function. This test may be particularly useful if used serially, when baseline values are known. Doppler measurement of gradient and valve area has an expected normal range that is specific for the prosthetic type, size, anatomical position, and chronological age.

Atrial natriuretic peptide response to ionic and nonionic contrast left ventriculography.

Atrial natriuretic peptide (ANP) levels were measured prior to and at 1 and 5 minutes postcontrast left ventriculography with an ionic contrast agent (diatrizoate), and a nonionic agent (iopamidol) and the results were compared. Since ionic contrast agents have been found to cause an increase in left ventricular end-diastolic pressure (LVEDP) and nonionic agents have been found to have less of an effect on LVEDP, we investigated the response of ANP levels, which have been found to increase secondary to increased LVEDP (atrial pressure), with both agents. A group of 38 patients who were scheduled for left heart catheterization for suspected coronary artery disease was included (19 in each group) and blood samples for ANP levels were drawn from the left ventricles.