bluuebunny/crossref_metadata_2025 huggingface dataset:
Angina pectoris due to possible vasospasm of small coronary arteries
Authors: Kawakami Koichi , Shimada Toshio , Nakayama Kazuaki , Nagasaka Yukihiro , Tsukihashi Hironori , Murakami Rinji , Morioka Shigefumi , Moriyama Katsutoshi
Published: February 2009

Recently, the presence of vasospasm in small coronary arteries is speculated in animals and humans. A 40‐year‐old female patient complained of chest pain at rest. Left ventriculogram showed normal wall motions. Left and right coronary arteries were also normal. After methylergometrine maleate was selectively administered to a right coronary artery, she complained of chest pain, and ST‐segment elevation was detected in leads II, III, and aVF of ECG. Right coronary arteriography was performed immediately, but no coronary stenosis was found. The next day, methylergometrine maleate was again administered intravenously and the patient complained of chest pain, but no ischemic changes were observed in ECG. Thallium‐201 myocardial scintigraphy followed immediately. Apical perfusion defect was detected in stress image. In the delayed image, it showed complete redistribution. Three days later, catheterization and scintigraphy were performed at the same time. When methylergometrine maleate was administered to the left coronary artery, she complained of chest pain within a few minutes of the injection; however, ECG remained unchanged. 201Tl myocardial scintigraphy was performed immediately. In the stress image, it showed apical perfusion defect as shown in the intravenous methylergometrine maleate injection study. It also showed complete redistribution in the delayed image. Apical perfusion defect can be attributed to myocardial ischemia of left coronary artery, which are too small to be detected by conventional coronary arteriography. Vasospasm in small coronary arteries may be involved in this phenomenon.
Restenosis following coronary angioplasty
Authors: Karas Steven P. , Santoian Edward C. , Gravanis Michael B.
Published: February 2009

Restenosis is the most important problem limiting the success of coronary angioplasty. Clinically, restenosis is seen in approximately one‐third of patients undergoing percutaneous transluminal coronary angioplasty. Several clinical and angiographic risk factors have been identified which may contribute to the development of restenosis. Histopathologic studies indicate that restenosis is characterized by intimal proliferation of smooth muscle cells in a loose connective tissue matrix. These intimal lesions are associated predominantly with the nonatheromatous portion of the vessel wall. Thinning of the media of the plaque‐free wall and marked fragmentation of the internal elastic lamina are also seen. Traumatic injury of the vessel wall during angioplasty probably triggers a series of cellular and subcellular events which may ultimately lead to myointimal proliferation and restenosis. Although the exact mechanism by which this occurs is unknown, several factors may enhance smooth muscle cell growth and therefore may play a role in the development of restenosis. These include platelet deposition, mechanical stretching of the media, inflammation of the vessel wall, the activity of growth factors, and alterations in vessel geometry. These possible mechanisms of restenosis suggest several potential ways to limit the proliferative response to vascular injury. Anticoagulants and platelet antagonists, direct inhibitors of smooth muscle proliferation, anti‐inflammatory agents, growth factor inhibitors, and new devices which improve final vessel geometry are currently being tested as methods to curb restenosis. Unfortunately, no treatment has yet been shown to reduce significantly the rate of restenosis following angioplasty. The problem of restenosis will most likely be solved by better understanding of the basic molecular and biologic phenomena involved in vascular injury and repair.
Early predictors of smoking cessation after myocardial infarction
Authors: Di Tullio M. , Granata D. , Broccolino M. , Recalcati F. , Zaini G. , Belli C. , Taioli E.
Published: February 2009

The determinants of long‐term smoking cessation were evaluated in 80 patients who smoked cigarettes and survived a myocardial infarction. All patients underwent a program of rehabilitation and secondary prevention including in‐hospital counseling and physician‐guided reinforcing sessions at 1, 3, and 6 months after discharge. At 18 months of follow‐up, 53 patients (66.3%) had quit smoking. Variables associated with smoking cessation were duration of hospital stay ≥19 days (79 vs. 48%; p<0.005) and peak creatine phosphokinase (CPK) elevation ≥500 U/l (76 vs. 54%; p<0.05). Males tended to quit in higher proportion than females (68 vs. 44%). Age, prior myocardial infarction, other cardiovascular risk factors, infarction location, Killip class at entry, and duration of stay in coronary care unit did not significantly affect the quitting rates. Logistic regression analysis singled out the duration of hospital stay as a significant predictor of smoking cessation (p<0.005). Early and intensive secondary prevention during the hospital stay is crucial in promoting sustained smoking cessation after myocardial infarction.
Impaired left ventricular filling during ST‐segment depression provoked by dipyridamole infusion in patients with syndrome X
Authors: Nadazdin Aleksandar , Shahi Manjit , Foale Rodney A.
Published: February 2009

The left ventricular filling and regional wall motion patterns were compared in 6 normal subjects, 20 patients with coronary artery disease, and 10 patients with syndrome X by means of Doppler and two‐dimensional echocardiography during high‐dose (0.9 mg/kg body weight in 10 min) dipyridamole infusion. During the procedure none of the normal subjects had chest pain or significant ST depression (>0.1 mV) whereas 10 of 20 patients with coronary artery disease had ST depression, 3 with chest pain. Six patients with syndrome X had ST depression, 5 with chest pain. Regional wall motion abnormalities were identified in 6 patients with coronary artery disease who had ST depression but none were detected in normals or in patients with syndrome X. Compared with normals (−2.1±3.5%) there was a significant difference in percentage decrease in the peak early filling velocity in patients with coronary artery disease and ST depression (−10.3±6.2%; p<0.01) and in patients with syndrome X and ST depression (−9.4±6.9%; p<0.05). These findings indicate that, in the presence of dipyridamole‐induced ST depression, patients with syndrome X have an abnormal left ventricular filling pattern similar to that observed in patients with coronary artery disease. This suggests that myocardial ischemia occurs in patients with syndrome X but the absence of regional wall motion abnormality suggests that it is diffuse.
Cytomegalovirus myocarditis in transplanted heart verified by endomyocardial biopsy
Authors: Partanen J. , Nieminen M. S. , Krogerus L. , Geagea A. , Lautenschlager I. , Aarnio P. , Mattila S.
Published: February 2009

Cytomeglovirus infections are common disorders after heart transplantations. Manifestation of the virus without a clinical disease is still more prevalent. Differentiation of clinical infections from cytomegalovirus activations without major pathogenetic importance issues a challenge in the follow‐up of patients with cardiac transplants. The case describes a 56‐year‐old female patient with a multiple organ lethal infection and myocarditis due to cytomegalovirus diagnosed during life with endomyocardial biopsy.
Effect of the combination of low‐dose mexiletine and metoprolol on ventricular arrhythmia
Authors: Ravid Shmuel , Lampert Steven , Graboys Thomas B.
Published: February 2009

Antiarrhythmic drug therapy is often ineffective or poorly tolerated. Combining antiarrhythmic agents with different electrophysiologic properties may have a synergistic antiarrhythmic effect when compared with each drug alone. If a lower dose of each drug can be used, combination therapy may also result in lower incidence of side effects. The goal of our study was to assess the complementary effect of low‐dose mexiletine and metoprolol, when compared with either drug alone. Ten patients with frequent ventricular arrhythmias including 7 patients with nonsustained ventricular tachycardia were evaluated in an open‐label sequential study. The response to drug therapy was evaluated by 24‐h continuous EKG monitoring, exercise stress testing, and echocardiogram after each treatment. Combination therapy effectively reduced ventricular arrhythmias in 8 patients (80%) in contrast to only 1 patient (10%) on metoprolol alone and 4 patients (40%) on mexiletine alone. In 5 patients (71 %) ventricular tachycardia was abolished. The number of couplets was reduced from 51 ± 39 to 1.9±2.4 (p<0.01) and total premature ventricular beats from 7790 ±9047 to 597±515 (p = 0.06). Combination therapy was well tolerated without proarrhythmia or precipitation of congestive heart failure. It is concluded that low‐dose mexiletine combined with metoprolol is effective in suppressing ventricular arrhythmias in selected patients, and enhances the antiarrhythmic effect of either drug alone without significant side effects.
The detection of myocardial ischemia by thallium‐201 myocardial scintigraphy in patients with multiple coronary arterioventricular connections
Authors: Kawakami Koichi , Shimada Toshio , Yamada Sachiko , Murakami Rinji , Morioka Shigefumi , Moriyama Katsutoshi
Published: February 2009

The question of whether myocardial ischemia could be induced in 5 patients with multiple coronary arterioventricular connections by thallium‐201 (201Tl) exercise stress myocardial scintigraphy was investigated. Both ST‐T changes on ECG and transient myocardial perfusion defects in myocardial scintigrams were observed in 2 patients (40%). In previous reports, all multiple coronary arterioventricular connections, which were shown in angiograms, have been regarded as either Thebesian veins or embryonic sinusoids. However, it is unlikely that Thebesian veins cause myocardial ischemia judging from anatomy. If the vessels cause myocardial ischemia, they should be regarded as multiple coronary arterioventricular fistula. Angiography itself cannot differentiate multiple coronary arterioventricular fistula from Thebesian veins or remnants of embryonic sinusoids. Exercise stress myocardial scintigraphy has a high potential to detect myocardial ischemia due to intracoronary steal. Exercise stress myocardial scintigraphy was used to demonstrate myocardial ischemia in multiple coronary arterioventricular connections. It is concluded that exercise stress myocardial scintigraphy is a reliable test to differentiate multiple coronary arterioventricular fistula from Thebesian veins or remnants of embryonic sinusoids in clinical practice.
Regression of left ventricular mass in systemic hypertension
Authors: Georgiou Demetrios , Brundage Bruce H.
Published: February 2009

The importance of treatment in systemic hypertension and cardiovascular morbidity and mortality has been established. Although systemic hypertension is the most important factor in the pathogenesis of left ventricular hypertrophy, other factors such as catecholamines and renin‐angiotensin system may be involved. Increased left ventricular mass causes reduction in coronary reserve and may lead to acute ischemic events. Equally efficacious antihypertensive agents may have diverse effects on left ventricular hypertrophy and left ventricular function. New tomographic techniques with improved spatial resolution are emerging in the evaluation of left ventricular mass and may therefore provide better assessment of changes in left ventricular mass. With improved measures of left ventricular mass the question as to whether regression of left ventricular mass provides an additional benefit beyond control of blood pressure in hypertensive individuals may be finally answered.
Which ventricular tachycardia is dangerous?
Authors: John Camm A. , Gusoy Sinan , Brugada Ramon , Brugada Josep , Brugada Pedro , Andries Erik
Published: February 2009

The treatment of ventricular arrhythmias remains a major challenge in cardiology. Several very helpful pieces of information can be obtained from the clinical history. The left ventricular function and the hemodynamic effects of a ventricular tachycardia are the two main factors affecting survival. Therefore, if a patient with sustained ventricular tachycardia presents with syncope or cardiac arrest, or if his functional class for dyspnea is III‐IV (NYHA classification), he is a candidate for an implantable defibrillator while otherwise medical therapy is advised.
“The Anti‐Ashman Maneuver”: A bedside method for distinguishing aberrancy from ventricular ectopy
Authors: Goldman Daniel S. , Damato Anthony N.
Published: February 2009

This is a report of a patient who develops new onset atrial fibrillation in the postoperative setting which is further complicated by the presence of wide beats in singles, pairs, and short runs. Presented are the differential diagnosis of these wide beats and a simple bedside maneuver to help distinguish their origin.
Oblique cine MRI for the evaluation of aortic regurgitation: Comparison with cineangiography
Authors: Nishimura Fumiaki
Published: February 2009

The results of oblique cine magnetic resonance imaging (MRI) through a long axis slice of the left ventricle in 40 patients was compared with cineangiography in order to determine the usefulness of cine MR imaging for the evaluation of aortic regurgitation (AR). A diastolic dark low‐intensity flow signal extending from the aortic valve into the left ventricle was seen in all 30 patients with AR, and in none of the 10 patients without AR. The length and area of the low‐intensity signal due to the regurgitant flow were planimetered, and the ratio to the length and area of the left ventricle was calculated. The best correlation with angiography was with the ratio of the area of the low‐intensity signal (ALIS) to the area of the left ventricle (ALV); it correctly classified the degree of regurgitation in 28 of the 30 patients (93.3%). The ALIS/ALV ratio was under 25% in all 11 patients with angiographic mild AR, 26–50% in 10 of the 11 patients with moderate AR, and over 51% in 7 of the 8 patients with severe AR. Thus the results point to a high degree of correlation between long axis oblique cine MRI and cineangiography in the identification of AR and in providing a semiquantitative estimation of its severity.
Changes of diastolic function induced by cigarette smoking: An echocardiographic study in patients with coronary artery disease
Authors: Stork T. , Eichstädt H. , Möckel M. , Bortfeldt R. , Hochrein H. , Müller R.
Published: February 2009

In 28 chronic smokers (11 women, 17 men, 53 ± 10 years old) with coronary artery disease (>75% stenosis), left ventricular (LV) relaxation and filling behavior was assessed before and after inhalation of 0.9 mg nicotine (1 cigarette) by echocardiography. The following acute nicotine‐mediated changes were noted (one‐sided Wilcoxon test): heart rate increased from 67 to 81 beats/min (p>.001); the early diastolic flow (E wave) integral decreased from 49 to 39 mm (p<.001); the late diastolic flow integral (A wave) increased from 36 to 41 mm (p<.01). Consecutively, the ratio between E and A wave flow integrals decreased from 1.4 to 0.9 (p<.001); the atrial contribution to LV filling rose from 42 to 53% (p<.001); and the isovolumetric relaxation period increased from 89 to 122 ms (p<.001). In cigarette smokers with coronary artery disease acute administration of nicotine hence causes a shift of mitral blood flow from early (E wave) to late (A wave) diastole and a prolongation of the isovolumetric relaxation time. Thus, cigarette smoking significantly affects LV diastolic function independently of its role as a risk factor for coronary atherosclerosis.
Chemotherapy‐induced myocardial infarction in a young man with hodgkin's disease
Authors: House Kenneth W. , Simon Sheryl R. , Pugh Reginald P.
Published: February 2009

A 32‐year‐old male with stage IIIA nodular sclerosing Hodgkin's disease and no cardiac risk factors presented with chest pain after receiving chemotherapy consisting of multiple drugs, including vinca alkaloids. He completed an uncomplicated anterior wall myocardial infarction. Coronary angiography documented the absence of significant coronary artery disease. Exercise stress testing with gated scan confirmed loss of anterior wall motion and a decreased left ventricular ejection fraction. Vascular toxicity, including, rarely, myocardial infarction, has been reported following antineoplastic regimens containing vinca alkaloids. Hypercoagulable states, cardiac invasion by tumor, and coronary artery spasm are possible etiologies. Of these, coronary artery spasm appears most likely. Management should include discontinuation of the offending drug and supportive care.
Documentation of successful treatment of prosthetic mitral valve thrombosis with intravenous urokinase infusion for twenty‐four hours
Authors: Chen Henry J. , Schlaifer Jay D. , Guentzel Susan M. , Conti C. Richard
Published: February 2009

Prosthetic valve thrombosis is a life‐threatening situation requiring prompt diagnosis and treatment. Treatment has usually been surgical and has been associated with a high mortality. Thrombolytic therapy is a therapeutic alternative to surgery and has been successful in a number of cases. This report concerns the technique used to diagnose the condition, treatment strategy, and documentation of the results of therapy.
PTCA in patients with stable angina pectoris and multivessel disease: Is incomplete revascularization acceptable?
Authors: De Feyter P. J.
Published: February 2009

Of all coronary angioplasties performed nowadays, 40% of the patients have multivessel disease. Angioplasty in patients with multivessel disease can be performed with a high immediate clinical success rate and an acceptable major complication rate. However, complete anatomic revascularization with coronary angioplasty is achieved in only 32 to 59%. This raises concern about the immediate and long‐term outcome of patients in whom incomplete revascularization is achieved. This report reviews the literature and provides evidence that incomplete revascularization with coronary angioplasty is a safe and effective treatment in selected patients with multivessel disease, provided that adequate (functional) revascularization can be achieved. Adequate revascularization includes dilation of all significant lesions supplying large areas of viable myocardium.
The effects of captopril on training in patients with ischemic heart disease
Authors: Macgowan Guy A. , O'Callaghan Declan , Webb Hillary , Horgan John H.
Published: February 2009

We studied a group of 30 patients to determine the effect of captopril on the exercise training response after a period of training in patients with ischemic heart disease but without cardiac failure. The study was a double‐blind placebo‐controlled comparison of captopril and placebo. The patients studied were 28 men and 2 women, mean age 53.6±6.9 years. All were 8 to 12 weeks post‐myocardial infarction or coronary artery bypass surgery. These patients underwent an organized exercise training program consisting of exercise training sessions 3 times weekly for a period of 8 weeks. On commencement and completion of the program patients were assessed for exercise tolerance using submaximal exercise stress testing. Patients were assessed in the untreated state. Both groups showed a statistically significant training effect with increased exercise duration, decreased heart rate for equal workload, increased energy expenditure, and reduced functional aerobic impairment. There was no statistically significant change in systolic blood pressure, but the captopril group alone showed a significant reduction in diastolic blood pressure (p < 0.001). The change in heart rate at rest over the 8‐week period was not significant in both groups. In summary, this study shows that treatment with captopril does not affect the exercise training response in patients with ischemic heart disease undergoing an organized exercise training program.
Multifocal atrial arrhythmia—A frequent misdiagnosis? A correlative study using the computerized ECG
Authors: Varriale Philip , David William , Chryssos Basil E.
Published: February 2009

All computerized ECGs taken over a 17‐week study period were reviewed for the detection of multifocal atrial arrhythmia (MAA)—tachycardia or rhythm—and correlated with the diagnostic statement of the ECG computer system. MAA was identified by the authors in 96 of 11,610 (0.8%) computerized ECGs. In all instances, this specific arrhythmia was misclassified by the computer system as atrial fibrillation. Moreover, during the over‐read, only 27.1% of ECGs were correctly diagnosed by the assigned electrocardiographers blinded to this study. MAA is not an uncommon atrial arrhythmia since it was identified in 14% of computerized ECGs interpreted as atrial fibrillation. This study supports the inference that MAA is indeed frequently misdiagnosed by most physicians and the need for improved ECG computer analysis programs for reliable detection of MAA.
Clinical significance of serum colloid osmotic pressure in relation to pulmonary edema and coronary instability in patients with unstable angina
Authors: Taniguchi Hiroya , Takayama Yasuo , Sugiura Tetsuro , Iwasaka Toshiji , Tamura Teruhiro , Kitashiro Shuji , Izuoka Toshio , Inada Mitsuo
Published: February 2009

Several investigators demonstrated that severe reduction of colloid osmotic pressure (COP) predicts a fatal outcome in patients with cardiopulmonary failure. To evaluate the clinical significance of COP in relation to pulmonary edema, we studied 117 patients with unstable angina admitted in the hospital within 24 h after the chest pain. The mean COP of all 117 patients was 24.8±3.7 mmHg. COP was significantly lower in patients with pulmonary edema, according to the chest x‐ray findings, compared with the patients without it. Among 26 patients with emergency coronary arteriography, a fairly good correlation was observed between coronary jeopardy score and COP (r=–0.57, p<0.005). Furthermore, COP in patients who survived 26 months after the hospital discharge was significantly higher than that of the nonsurvivors. Thus, measurement of COP is advised for monitoring patients with unstable angina.
Effects of captopril on regional segment motion during acute coronary occlusion
Authors: Cosin J. , Rivera M. , Solaz J. , ándiz A. Hern , és F. Andr
Published: February 2009

The effects of captopril on myocardial segment function in different degrees of transient coronary occlusion were studied using ultrasonic dimension gauges in 15 open‐chest dogs.

The occlusion procedures (OP) were performed on the left anterior descending coronary artery (LAD) in eight dogs and on the left circumflex coronary artery (Cx) in seven dogs. To measure the changes in segment shortening in the subendocardium we used eight dogs (ischemic and control zones: four dogs LAD and four dogs Cx). To measure the changes in wall thickening we used seven dogs (ischemic and control zones: three dogs LAD and four dogs Cx). Total coronary OP lasting 1 min and partial OP (70–80%) lasting 1 min and 2 min 30 s, before and after captopril (0.25 mg/kg i.v.) were performed. Left ventricular pressure, dP/dt, coronary flow, and ECG were monitored.

Total coronary OP (1 min) changed segment shortening (18% LAD; 14% Cx) and wall thickening (19% LAD; 18% Cx) to values of dyskinesis (–3% and –4% for shortening; –6% and –5% for thickening). Captopril improved regional function maintaining positive values for shortening (4% LAD; 3% Cx) and thickening (0.3% LAD; 4% Cx). Similar responses were obtained during partial OP and captopril. Results suggest that captopril produced a significant improvement in the regional function parameters affected by ischemia both in total and partial obstructions.
Coronary heart disease risk factors in hansen's disease sufferers
Authors: Diamantopoulos Emmanuel J. , Anthopoulos Lambros P. , Moulopoulos Spyridon D.
Published: February 2009

In the frame of an epidemiologic study of Hansen's disease (HD) sufferers, several risk factors have been investigated which might explain the high prevalence of coronary heart disease (CHD) among HD patients. The data analyzed in the present study are derived from 293 HD patients (157 men and 136 women). The patients, after having completed a WHO adopted questionnaire, were given a complete physical examination, a resting and an exercise electrocardiogram, and biochemical as well as hematological examinations. Coronary HD patients, when compared to noncoronary HD patients, showed statistically significant differences in the following parameters: (1) mean age, (2) mean concentration of the electrophoretic fraction of α‐lipoproteins, (3) deviation from mean weight, (4) prevalence of hypertension, and (5) prevalence of the borderline lepromatous form of HD. However, the differences found when comparing other parameters, such as blood pressure, smoking, diabetes mellitus, total cholesterol, triglycerides, pre‐β and β‐lipoproteins, uric acid, erythrocyte sedimentation rate, ABO blood groups, etc., did not reach the level of significance.

These findings suggest that HD sufferers are a special population subgroup with reference to CHD risk factors, differing in many ways from the general population.
Anatomy, histology, and pathology of coronary arteries: A review relevant to new interventional and imaging techniques—Part I
Authors: Waller Bruce F. , Orr Charles M. , Slack John D. , Pinkerton Cass A. , Van Tassel James , Peters Thomas
Published: February 2009

In the last 15 years, intense interest has focused on various interventional pharmacologic and mechanical forms of therapy for the treatment of atherosclerosis coronary artery disease. Many techniques and devices (dilating balloons, perfusion catheters, thermal probes and balloons, lasers, atherectomy devices, stents, intravascular ultrasound) have been used or are under study for future use. Many of these techniques and devices require an understanding of histologic and pathologic features of the coronary arteries and diseases which affect them. This article reviews selective areas of anatomy, histology, and pathology relevant to the use of various new interventional techniques.1,2 Part I of this review will focus on anatomic aspects of the epicardial coronary artery system, coronary arterial distribution, myocardial supply, and histologic features of the normal coronary artery.
Isolated left main coronary stenosis and mediastinal irradiation
Authors: Chinnasami Bernard R. , Schwartz Robert C. , Pink Stuart B. , Skotnicki Robert A.
Published: February 2009

This report draws an association between mediastinal irradiation and isolated left main coronary artery stenosis. The report highlights two patients who developed selective left main coronary artery stenosis post mediastinal treatment. In the animal model, it has been shown that high serum cholesterol levels at the time of, or soon after, irradiation are necessary to initiate arteriosclerotic plaque formation.
Anomalous origin of left coronary artery from the pulmonary artery: Evolution of left ventricular function and perfusion after surgery in a 44‐year‐old man
Authors: Nony Patrice , Beaune Jacques , Champsaur GÉRard , Bozio AndrÉ , Age Colette , Fontana JÉRǑMe , Tissot Alain
Published: February 2009

Anomalous origin of left coronary vessel from the pulmonary artery is an almost universally fatal form of congenital heart disease unless appropriate corrective surgery is performed at an early age. A case was diagnosed in a symptomatic 44‐year‐old man who presented an impairment of systolic left ventricular function. The abnormality was successfully treated with ligation of the left coronary artery combined with left internal mammary artery anastomosis. Left ventricular function improved dramatically six months after surgery, both at rest and during exercise. Such an evolution suggests that surgery may be indicated not only in infants but also in adults with this congenital heart abnormality.
Ventricular tachycardia of right bundle‐branch block—left axis deviation morphology and organic heart disease
Authors: Rechavia Eldad , Strasberg Boris , Kusniec Jairo , Sclarovsky Samuel
Published: February 2009

Most series of patients with ventricular tachycardia (VT) of right bundle‐branch block (RBBB)‐left axis deviation (LAD) morphology include young individuals with no overt evidence of structural heart disease. In the present report, the clinical and electrophysiologic findings in two patients with verapamil‐responsive VT and organic heart disease are described.
Transcatheter management of cyanotic congenital heart defects: A review
Authors: Rao P. Syamasundar
Published: February 2009

In this review, the role of transcatheter methods in the management of cyanotic congenital heart defects is discussed. In patients with interventricular right‐to‐left shunting secondary to pulmonary outflow tract obstruction (most commonly tetralogy of Fallot), balloon dilatation may be an effective palliative procedure in a substantial proportion of patients, obviating the need for a palliative shunt. We would recommend this if the patient's size or cardiac anatomy makes that patient an unsuitable candidate for safe total surgical correction. Infundibular myectomy with atherectomy catheter in tetralogy of Fallot patients may become a useful adjunct in the management of these infants. Cyanotic children with interatrial right‐to‐left shunt secondary to severe valvar pulmonary stenosis respond to balloon pulmonary valvuloplasty in a manner similar to mat seen with isolated pulmonary valve stenosis. In these patients, balloon valvuloplasty is the treatment of choice and may be corrective in most cases. In patients with a narrowed Blalock‐Taussig shunt, balloon angioplasty may improve pulmonary oligemia and systemic arterial hypoxemia and may obviate the need for a second systemic‐to‐pulmonary artery shunt. Balloon angioplasty is recommended if the patient's cardiac defect is not amenable to surgical correction at a low risk either because of the size of the patient or because of the complexity of the cyanotic heart defect. In patients with pulmonary valve atresia, initial opening of the atretic pulmonary valve by either laser or surgery with subsequent balloon dilatation is potentially beneficial in reducing the total number of surgical procedures that these children are likely to require. However, further clinical trials are needed prior to their general use.
Hemofiltration as treatment for patients with refractory heart failure
Authors: Inoue Teruo , Sakai Yoshihiko , Morooka Shigenori , Takayanagi Kan , Hayashi Terumi , Takabatake Yutaka
Published: February 2009

Hemofiltration was performed in 15 patients with refractory congestive heart failure. All of these patients had oliguria, although intensive treatment with diuretics, digitalis, vasodilators, and catecholamines was prescribed. Hemofiltration was performed under hemodynamic monitoring in 14 patients. The water removal by hemofiltration decreased pulmonary arterial pressure, pulmonary capillary wedge pressure and right atrial pressure. Despite these hemodynamic improvements, nine patients (60%) died within one month after the start of hemofiltration; the causes were fatal arrhythmia in three, renal failure in two, sepsis in one and irreversible cardiogenic shock in three. Oliguria for over 15 h or a serum creatinine concentration of more than 4.0 mg/dl at the start of hemofiltration related to poor prognosis. In view of these results, hemofiltration for refractory heart failure should be started earlier and performed carefully in order to avoid arrhythmia, cardiogenic shock, and other complications.
Histologic evidence of myocardial damage in apparently healthy subjects with ventricular arrhythmias and myocardial dysfunction
Authors: Contini C. , Berti S. , Levorato D. , Bongiorni M. G. , Baratto M. T. , Arlotta C. , Piacenti M , Pozzolini A. , Paperini L. , Kraft G. , Biagini A.
Published: February 2009

The association of ventricular arrhythmias and myocardial dysfunction could be considered an early step toward cardiomyopathy; therefore, we studied 28 patients in NYHA class I and II, characterized by complex ventricular arrhythmias (VA) on 24‐h Holter monitoring and volumetric and/or contractile abnormalities on a standard two‐dimensional echocardiogram (2‐D echo). All patients underwent radioisotopic angiography, 20 patients complete hemodynamic study, and 15 patients endomyocardial biopsy. Ambulatory ECG monitoring showed the presence of frequent premature ventricular contractions in 14 patients (50%) and episodes of ventricular tachycardia in 16 patients (57%). 2‐D echo showed mono‐ or biventricular enlargement and dyssynergies in 25 patients (89%) (left ventricle in 6, right ventricle in 11, both in 8). Two patients showed only left ventricle enlargement and one patient isolated left ventricular dyssynergies. Radioisotopic angiography showed mono‐ or biventricular ejection fraction reduction in 24 patients (85%) and regional dyssynergies in 24 patients (85%) in accordance with 2‐D echo. Hemodynamic study showed in all patients normal coronary arteries, and right and left angiography confirmed enlargement and/or regional dyssynergies. Endomyocardial biopsy was abnormal in 11 of 15 patients: various degrees of hypertrophy, parcellar fibrosis, and adipogenic infiltration were found. Our preliminary data suggest that the simultaneous occurrence of ventricular arrhythmias and ventricular dyssynergies and/or enlargement in patients without apparent clinical heart disease may represent an early stage of dilated cardiomyopathy.
Hemodynamic findings during exercise on a bicycle ergometer following balloon valvuloplasty of pulmonary stenosis in children and adolescents
Authors: Zellmer S. , Graevinghoff L. , Keck E. W.
Published: February 2009

Eleven patients (4 female, 7 male), age range 3.3 to 24.8 years (mean 11.10 years) treated for isolated pulmonary stenosis underwent cardiac catheterization and percutaneous transluminal balloon valvuloplasty (PTVP). The right ventricular systolic pressure (RVSP) before valvuloplasty ranged from 31 to 127 mmHg (mean 79 mmHg) decreasing to 28 to 62 mmHg (mean 42 mmHg) immediately after the dilatation. The peak systolic gradient of the pulmonary valve (Ap RV‐PA) before valvuloplasty ranged from 22 to 107 mmHg (mean 61 mmHg) and decreased to a range of 14 and 45 mmHg (mean 23 mmHg) immediately after the dilatation. Balloon valvuloplasty was performed using balloons of 13 to 31 mm in diameter. On 11 patients cardiac catheterization and Doppler echocardiography were repeated between 11 months and 5.3 years (mean 3.11 years) after the balloon valvuloplasty showed a further significant fall in the gradient of pressure. The right ventricular systolic pressure ranged from 20 to 51 mmHg (mean 31.7 mmHg) while the transpulmonary gradient varied from 3 to 24 mmHg (mean 11.6 mmHg). At the time of follow‐up examination the patients were aged between 7.2 and 25.7 years (mean 15.9 years). On average the second catheterization was performed 3.11 years following the first hemodynamic study. The follow‐up examination encompassed clinical examination, electrocardiogram, Doppler echocardiography, and right heart cardiac catheterization. During right heart cardiac catheterization the children exercised on a bicycle ergometer for three min at 50 or 100 W depending on their body surface area. During this exertion, pressures of the right ventricle and the pulmonary artery as well as heart rate and oxygen saturation were recorded. Right ventricular systolic pressure increased from 34 to 85 mmHg (mean 57.4 mmHg). The gradient between the right ventricle and the pulmonary artery increased from 10 to 35 mmHg (mean 25 mmHg). All patients tolerated the procedure well and no complications were observed. It was concluded that percutaneous balloon valvuloplasty is a safe and effective method of relieving right ventricular obstruction due to moderate or severe valvular pulmonary stenosis.
Anatomy, histology, and pathology of coronary arteries: A review relevant to new interventional and imaging techniques—Part III
Authors: Waller Bruce F. , Orr Charles M. , Slack John D. , Pinkerton Cass A. , Van Tassel James , Peters Thomas
Published: February 2009

In the last 15 years, intense interest has focused on various interventional, pharmacologic, and mechanical forms of therapy for the treatment of atherosclerotic coronary artery disease. Many techniques and devices (dilating balloons, perfusion catheters, thermal probes and balloons, lasers, atherectomy devices, stents, intravascular ultrasound) have been used or are under study for future use. Many of these techniques and devices require an understanding of histologic and pathologic features of the coronary arteries and diseases which affect them. This article reviews selective areas of anatomy, histology, and pathology relevant to the use of various new interventional techniques.1,2 Part III of this four‐part review focuses on eccentric and concentric plaques, formation of coronary thrombus, and status of the “infarct artery” after mechanical and pharmacologic forms of acute reperfusion therapy.
Comparison of exercise electrocardiography and dobutamine echocardiography
Authors: Martin Timothy W. , Seaworth John F. , Johns Joseph P.
Published: February 2009

It is uncertain whether dobutamine echocardiography is a better test than exercise electrocardiography for the detection of coronary disease in patients who can exercise. We compared the hemodynamics, sensitivity, and specificity of these tests in 24 patients, 16 with coronary disease and 8 controls. The tests were performed within six weeks of one another and were interpreted without knowledge of other clinical data. The exercise electrocardiogram was considered abnormal if the patient developed one mm of ST‐segment depression, while the dobutamine test (up to 40 μg/kg/min) was considered abnormal if the patient developed ST‐segment depression or a left ventricular wall motion abnormality. Exercise testing resulted in a higher heart rate (145±29 vs. 110±24, p<0.001) and blood pressure (176±31 vs. 148±24, p<0.001). Dobutamine testing was 25% more sensitive than exercise testing (94 vs. 69%, 95% confidence interval for difference is 0 to 50%, p=0.09), while exercise testing was 38% more specific (88 vs. 50%, 95% confidence interval for difference is –3 to 79%, p=0.14). We conclude that exercise results in a higher heart rate and blood pressure than dobutamine infusion. Differences in sensitivity and specificity are inconclusive, but indicate that the sensitivity of exercise testing is, at best, equivalent to dobutamine testing, while any increase in specificity with dobutamine testing, compared with exercise testing, would not be clinically significant.
Noninvasive evaluation of left ventricular performance by the shortest distance between mitral leaflets coaptation and interventricular septum at end‐systole
Authors: Ohte Nobuyuki , Narita Hitomi , Hashimoto Takeshi , Takase Rie , Kobayashi Kenji , Akita Sachie , Fujinami Takao
Published: February 2009

We attempted to evaluate left ventricular performance from the shortest distance between the mitral leaflets coaptation and the interventricular septum at endsystole (MVC‐IVS distance). The subjects were 37 patients with coronary artery disease (CAD) with prior myocardial infarction (MI), 8 with CAD without prior MI, 22 with atypical chest pain, and 4 with aortic regurgitation. The MVC‐IVS distance was measured on a two‐dimensional echocardiogram obtained from the parasternal or apical long‐axis view and frozen at end‐systole. Left ventricular end‐systolic volume and end‐diastolic volume were obtained by left ventriculography, and the left ventricular ejection fraction was calculated. A significant positive correlation was observed between the MVC‐IVS distance and the end‐systolic volume (r=0.83, p<0.001); a close correlation was found between the left ventricular end‐systolic volume and ejection fraction by monoexponential fitting (r= –0.91, p<0.001). Thus, a significant negative correlation was observed between the MVC‐IVS distance and the left ventricular ejection fraction (LVEF) (r= –0.83, p<0.001). An MVC‐IVS distance of 30 mm suggests diagnosis of left ventricular dysfunction (LVEF < 50%) with high sensitivity (94.4%) and specificity (90.6%), while a value <30 mm suggests that the left ventricular performance is likely to be normal. Thus one can easily evaluate the left ventricular performance noninvasively using this new index.
Anatomy, histology, and pathology of coronary arteries: A review relevant to new interventional and imaging techniques‐part iv
Authors: Waller Bruce F. , Orr Charles M. , Slack John D. , Pinkerton Cass A. , Tassel James Van , Peters Thomas , Waller Bruce
Published: February 2009

In the last 15 years, intense interest has focused on various interventional pharmacologic and mechanical forms of therapy for the treatment of atherosclerosis coronary artery disease. Many techniques and devices (dilating balloons, perfusion catheters, thermal probes and balloons, lasers, atherectomy devices, stents, intravascular ultrasound) have been used or are under study for future use. Many of these techniques and devices require an understanding of histologic and pathologic features of the coronary arteries and diseases which affect them. This article reviews selective areas of anatomy, histology, and pathology relevant to the use of various new interventional techniques. Part IV of this review will focus on congenital coronary artery anomalies Myocardial bridges, coronary aneurysm, emboli, and dissection and clinical implications regarding echocardiographic imaging techniques.
Triggered activity as arrhythmogenic mechanism after myocardial infarction: Clinical and electrophysiologic study of one case
Authors: Wiesfeld Ans C. P. , Cruns Harry J. G. M. , Van Veldhuisen Dirk J. , Lie Kong I. , Van Gilst Wiek H.
Published: February 2009

In a woman with an old infarction and sustained ventricular tachycardia, tachycardias were only inducible after short‐long RR sequences. After isoprenaline, tachycardias became incessant and all were preceded by short‐long RR sequences. This strongly suggests that triggered activity plays a role in initiation of ventricular tachycardias in postinfarction patients.
QT‐interval abnormalities in hypertrophic cardiomyopathy
Authors: Dritsas Athanase , Sbarouni Eftichia , Gilligan David , Nihoyannopoulos Petros , Oakley Cella M.
Published: February 2009

To examine whether QTc and QTc dispersion across the leads of a surface electrocardiogram (ECG) are different in patients with hypertrophic cardiomyopathy (HCM) compared with normal subjects, we measured QT and calculated QTc in all 12 leads of a surface ECG in 24 patients with HCM and in 20 age‐ and sex‐matched normal control subjects. Maximal QTc was prolonged in HCM patients (465±24 ms) compared with controls (410±20 ms) (p<0.001). QTc dispersion defined as the difference of maximum‐minimum QTc was also greater in HCM patients (71±21 ms) compared with normals (35±11 ms) (p<0.001). A correlation was found between the degree of left ventricular hypertrophy expressed by the maximal wall thickness and maximal QTc (r=0.48, p<0.02). However, QTc dispersion did not correlate with maximal wall thickness. Thus, patients with HCM show a prolonged QTc (>440 ms) and increased QTc dispersion compared with normal subjects. In addition, the degree of left ventricular hypertrophy correlates with maximal QTc. The presence of a prolonged QT with increased regional dispersion may be associated with the occurrence of serious ventricular arrhythmia and sudden death in HCM.
Cardiac pathology in 2007 consecutive forensic autopsies
Authors: Waller Bruce F. , Waller Bruce , Catellier Michele J. , Clark Michael A. , Hawley Dean A. , Pless John E.
Published: February 2009

The incidence of various types of cardiovascular disease was evaluated in 2007 consecutive forensic patients. Cardiovascular deaths accounted for 22.8% of the study patients and atherosclerotic coronary heart disease was the most common type of cardiac disease (18%). Among subjects dying of atherosclerotic coronary disease, sudden death was three times more frequent than acute myocardial infarction. Expected cardiac findings included the incidence of severe coronary atherosclerosis (21%), floppy mitral valves (5%), and congenital bicuspid aortic valves (1%). Major cardiac findings occurred in 32% and minor cardiac findings were found in 40%. Only 17% of hearts were anatomically normal. An unexpected cardiac necropsy finding included the high frequency of myocardial bridges (23%). Unexpected cardiac findings included the low incidence of acute myocarditis (0.6%) and common finding of tunneled epicardial coronary arteries (“myocardial bridges”) (23%).
ACE inhibitors and regression of left ventricular hypertrophy
Authors: Gilbert Brian W.
Published: February 2009

Left ventricular hypertrophy (LVH) is a common condition and a powerful independent risk factor for coronary heart disease, congestive heart failure, and other cardiac morbidity. It is associated with the male sex and advancing age. Its most common cause is hypertension, and many antihypertensive agents induce regression of LVH. Angiotensin‐converting enzyme (ACE) inhibitors have been shown to reverse LVH by a mechanism as yet unknown. Reduction in afterload and other hemodynamic abnormalities by reduction of blood pressure is clearly a factor, but ACE inhibitors also block adrenergic action and other sympathetic nervous system influences, and the reduction in angiotensin II produces many effects. By inhibiting this potent vasoconstrictor and suppressing its degradation of the powerful vasodilator bradykinin, and by promoting sodium and water excretion, ACE inhibitors contribute to the restoration of normal ventricular function. Angiotensin II promotes protein synthesis in myocardial myocytes, and blocking this action may arrest the hypertrophic process. To determine the effect of angiotensin II on LVH and normalization of LV function, a study is now underway evaluating the effects of lisinopril, a new lysine analog of enalapril, and a diuretic agent in the treatment of hypertension LVH.
Cholesterol and lipoproteins: Beyond atherogenesis
Authors: Kuhn Frederick E. , Mohler III Emile R. , Rackley Charles E.
Published: February 2009

Although much emphasis has been placed on the role of cholesterol and lipoproteins in atherosclerotic plaque formation, recent studies suggest that lipids have other vascular actions which may contribute to the pathogenesis of myocardial ischemia. These include deleterious effects of lipids on platelet and endothelial cell function, coagulation, fibrinolysis, and prostacyclin metabolism. The purpose of this report is to review recent data regarding the nonatherogenic effects of lipids and provide insight as to how lipid lowering might contribute to clinically important improvements in vascular biology.