bluuebunny/crossref_metadata_2025 huggingface dataset:
Self‐Assembly of a Chiral Lipid Gelator Controlled by Solvent and Speed of Gelation
Authors: Xue Pengchong , Lu Ran , Yang Xinchun , Zhao Li , Xu Defang , Liu Yan , Zhang Hanzhuang , Nomoto Hiroyuki , Takafuji Makoto , Ihara Hirotaka
Published: August 2009

Glutamine derivative1with two‐photon absorbing units has been synthesized and was found to show gelation ability in some solvents. Its self‐assembly in the gel phase could be controlled by the solvent and speed of gelation. For example, in DMSO the organogelator self‐assembled into H‐aggregates with weak exciton coupling between the aromatic moieties. On the other hand, in DMSO/diphenyl ether (1:9, v/v) the molecules formed 1D aggregates, but with strong exciton coupling due to the small distance between the chromophores. Moreover, the formation of these two kinds of aggregates could be adjusted by the ratio of DMSO to diphenyl ether. In DMSO/toluene, DMSO/butanol, DMSO/butyl acetate, and DMSO/acetic acid systems similar results were observed. Therefore, conversion of the packing model occurs irrespective of the nature of the solvent. Notably, a unique sign inversion in the CD spectra could be realized by controlling the speed of gelation in the DMSO/diphenyl ether (1:9, v/v) system. It was found that a low speed of gelation induces the gelator to adopt a packing model with strong π–π interactions between the aromatic units. Moreover, the gels, when excited at 800 nm, emit strong green fluorescence and the quantum chemical calculations suggest that intramolecular charge transfer leads to two‐photon absorption of the gelator molecule.
Comparative cardiac effects of hemodialysis and continuous ambulatory peritoneal dialysis
Authors: Alpert M. A. , Van Stone J. , Twardowski Z. J. , Ruder M. A. , Whiting R. B. , Kelly D. L. , Madsen B. R.
Published: August 2009

To assess the comparative cardiac effects of hemodialysis and continous ambulatory peritoneal dialysis (CAPD), we performed M‐mode echocardiography prior to and immediately following hemodialysis on 56 patients and during the dwell phase of CAPD on 39 patients. Hemodialysis produced a significant increse in the mean velocity of circumferential fiber shortening (V̄CF, an index of left ventricular systolic function) in patients with low V̄CF prior to dialysis, but resulted in no significant change in V̄CF in patients with normal predialysis V̄CF. Hemodialysis produced a significant increase in V̄CF in patients with a normal predialysis left ventricular end‐diastolic volume index (LVEDVI), but resulted in no significant change in V̄CF in patients with left ventricular dilatation prior to dialysis. Hemodialysis produced a significant decrease in mean LVEDVI and mean stroke index, but resulted in no significant change in mean cardiac index due to a reflex increase in heart rate. Mean LVEDVI, mean stroke index, and V̄CF values in patients on CAPD were not significantly different from those observed immediately following hemodialysis. Mean cardiac index and mean heart rate were significantly lower in CAPD patients than in posthemodialysis patients. Pericardial effusion was observed in 25% of hemodialysis patients and 5% of CAPD patients (p<0.05). We conclude (1) the effects of hemodialysis on left ventricular performance are variable and depend in part on predialysis left ventricular volume and left ventricular systolic function, (2) except for a lower cardiac index, left ventricular hemodynamics for CAPD patients resemble those of posthemodialysis patients, and (3) pericardial effusion occurs with significantly higher frequency in patients on hemodialysis than in those on CAPD.
Short‐term effect of nifedipine on effort tolerance in patients with angina pectoris
Authors: Flugelman M. Y. , Shefer A. , Halon D. A. , Witt H. , Gotsman M. S.
Published: August 2009

The short‐term effect of oral nifedipine on effort tolerance was tested in 10 patients with effort angina pectoris and a positive effort test (GXT). The patients had four symptom‐limited GXTs, using the Bruce protocol, on each day of the study at 0800, 1000, 1400, and 1800 hours. They received four doses of 10 mg oral nifedipine on one day and four doses of placebo on the other, each dose given half an hour prior to each GXT. Values with nifedipine were compared to values with placebo at the same time during each day. Nifedipine improved effort tolerance by 0.5 ± 0.6 min (p=NS) on the first GXT (mean ± SEM), by 1.2 ± 0.6 min (p=NS) on the second GXT, by 1.0 ± 0.3 min (p < 0.01) on third GXT, and by 1.3 ± 0.3 min (p < 0.01) on the fourth GXT. Improvement of effort tolerance was associated with a fall in resting blood pressure and less ST depression; these changes were statistically significantly only on the fourth GXT, which may indicate a cumulative effect of subsequent doses of nifedipine.
Extracranial mycotic aneurysms in infective endocarditis
Authors: Mansur A. J. , Grinberg M. , Leāto P. P. , Chung C. V. , Stolf N. A. G. , Pileggi F.
Published: August 2009

Nine of 217 (4.15%) patients with infective endocarditis who were followed from October 1978 to February 1984 had extracranial mycotic aneurysms (MA). Age range of patients was 6–43 years (mean of 24.8 years) and 7 were male. Etiologic agents were Streptococcus viridans (3 cases), Staphylococcus aureus (2 cases), Staphylococcus epidermidis (1 case), and Pseudomonas aeruginosa (1 case). Two patients had negative blood cultures. The MA involved the arteries of the limbs (5 cases), thoracic (3 cases), and abdominal (1 case) arteries. The diagnosis was made by means of physical examination (5 cases), chest roentgenogram (2 cases), ultrasound examination (1 case), and aortography (1 case), at hospital admission (2 cases), early or before antibiotic therapy (2 cases), and from two days to six months after finishing antibiotic therapy (5 cases). All but one patient were operated upon due to MA; bleeding occurred in three cases; surgery was an emergency procedure in one case and performed from 8 to 58 days after the diagnosis of the MA in the others. Signs of infection at surgery were found in one case. In the others, further antibiotic therapy was not administered. There were no limb losses in the peripheral MA. Four patients received surgical treatment for endocarditis. There was one in‐hospital death and another one 6 months later due to heart failure.
Disc dislodgment in björk shiley mitral valve prosthesis: Two successfully operated cases
Authors: Dubernet J. , Irarrézaval M. J. , Urzúaa J. , Maturana G. , Moráan S. , Lema G. , Asenjo F. , Fajuri A.
Published: August 2009

Two patients with Björk Shiley mitral valve replacement had migration and embolization of the occluding disc. One patient suffered migration of the disc a few hours after surgery and the other had a strut fracture with disc translocation six years after the initial operation. Clinical signs in both cases were pulmonary edema, cardiogenic shock, and absence of prosthetic sounds. Both patients were reoperated on an emergency basis, recovering after a complicated postoperative course. They are on functional Class I, 8 and 1 years later, respectively, with their dislodged discs still in the abdominal aorta. The only hope for survival in these patients is emergency reoperation, once the prosthetic mitral valve dysfunction is confirmed.
Recurrent myocardial infarction and unexpected sudden death in a case of d‐loop d‐transposition of the great arteries associated with single coronary artery
Authors: Imaura T. , Nakagawa S. , Koiwaya Y. , Tanaka K. , Saisho K. , Sumiyoshi A.
Published: August 2009

A 40‐year‐old man with d‐loop d‐transposition of the great arteries associated with single coronary artery type 3 by Hvass died unexpectedly. Postmortem study demonstrated myocardial infaraction in the posterior portion of the right ventricle and interventricular septum, and complete obstruction of the proximal right coronary artery. The etiology of the unexpected death is discussed.
Left ventricular diastolic and systolic function during isometric exercise: An echocardiographic study
Authors: Bryhn M. , Castenfors J.
Published: August 2009

Normal subjects of both sexes between 20 and 63 years were examined with M‐mode echocardiography. Blood pressure (BP), heart rate (HR), and left ventricular (LV) diastolic and systolic function were measured at rest and at the end of a standardized maximal isometric handgrip test. BP and HR increased about 25%. This increase in cardiac work had no significant influence on LV systolic function. Diastolic function (myocardial relaxation and maximum rate of LV filling), however, improved significantly. Isometric handgrip test is a suitable exercise test in combination with M‐mode echocardiography. Studies on LV function during exercise may improve the sensitivity for detection of mild LV dysfunction.
Influence of cardiac function on the diuretic and hemodynamic effects of the loop diuretic piretanide
Authors: Hasenfuss G. , Holubarsch C. , Herzog C. , Knauf H. , Just H. , Spahn H. , Mutschler E.
Published: August 2009

The influence of caridac function on the diuretic and hemodynamic effects of the loop diuretic piretanide was investigated in nine patients with congestive heart failure. The diuretic response to piretanide correlated significantly with the pretreatment cardiac index (r=0.90). Furthermore, a significant correlation was found between the pretreatment fractional sodium excretion and the cardiac index (r=0.85). The fractional sodium excretion is reciprocal to the renal sodium and water reabsorption. No change in the hemodynamics was observed prior to the onset of diuresis. At 120 minutes after administration of piretanide, the reduction of mean pulmonary capillary wedge pressure (r=0.88) and mean right atrial pressure (r=0.80) was significantly related to the diuretic response. We conclude that the reduced diuretic response to piretanide in patients with low cardiac index is due to increased renal sodium and water reabsorption. The hemodynamic changes following the administration of piretanide are dependent on the diuresis.
Variable neurohumoral and hemodynamic responses to exercise in patients with exertional angina: Influence of the severity of coronary artery disease
Authors: Fujita T. , Ajisaka R. , Matsumoto R. , Iida K. , Iida K. , Sugishita Y. , Ito I. , Takeda T. , Akisada M.
Published: August 2009

To assess neurohumoral and hemodynamic responses to exercise in patients with exertional angina, we measured plasma norepinephrine (NE) concentrations in 23 patients with exertional angina (with no heart failure) and compared the results with their coronary arteriographic findings. The 23 patients were divided into two groups: 14 cases with multiple vessel disease (MVD) and 9 cases with one‐vessel disease. At resting state there were no significant differences between the two groups in levels of NE. At maximal exercise there were no significant differences between the groups in increases of heart rate, blood pressure, and rate‐pressure product, but exercise‐induced increase of plasma NE (%) was significantly larger in MVD (131.6 ± 95.4%) (mean±SD) than in one‐vessel disease (69.0±45.3%) (p<0.01). In conclusion, plasma NE responses to exercise differ between patients with multiple vessel disease and patients with one‐vessel disease.
Reliability of standard electrocardiogram in detecting left ventricular asynergy in 315 patients with recent myocardial infarction
Authors: Giannuzzi P. , Giordano A. , Imparato A. , Li Bergolis M. , Tavazzi L.
Published: August 2009

The relationship between asynergy of the left ventricular wall detected by two‐dimensional echocardiography and ECG signs of necrosis (number of Q waves ≥ 40 ms, Wagner's score) was evaluated in 315 patients (NYHA I‐II) 23–90 days after a first Q‐wave myocardial infarction (MI). Poor correlations were found between asynergy and ECG parameters. An ECG anterior MI is an apicoseptal MI by echo (independently of the ECG extent of Q waves) and the ECG is of little or no help in predicting the extent of asynergy to the inferior wall and proximal segments of the septum. An ECG inferior MI is inferoposterior by echo and the ECG has very limited value in predicting the extent of asynergy to the apex and septum. Patients with Q waves in leads II, III, and aVF had more extensive asynergy than those with either 2Q or > 3Q. R/S ≥ 1 in V1 and/or V2 was present in 44% of patients with inferior MI while asynergy of at least one segment of the posterior wall was observed in 94%. In conclusion, standard ECG is sensitive in identifying anterior versus inferior infarct but it is unreliable in predicting the real extent of asynergy of the left ventricle, particularly in inferior infarcts.
Diltiazem and Propranolol Combination for the Treatment of Chronic Stable Angina Pectoris
Authors: O'Hara M. J. , Khurmi N. S. , Bowles M. J. , Raftery E. B.
Published: August 2009

To examine the benefits and risks of combined diltiazem and propranolol therapy, 23 patients who had completed a double‐blind placebo‐controlled cross‐over comparison between diltiazem and propranolol and who continued to develop angina despite treatment were studied. The patients received the previous dose of diltiazem (180 or 360 mg/day) combined with propranolol 120 mg daily for 4 weeks and if they still developed angina on exercise testing, they went on to propranolol 240 mg daily for a further 4 weeks. Efficacy and safety were evaluated by computer‐assisted maximal treadmill tests, ambulatory heart rate monitoring, and resting systolic time intervals at the end of each 4‐week treatment period. Lowdose combination therapy abolished treadmill angina in 6 patients, but 2 patients had to be withdrawn. The highdose combination abolished treadmill angina in 5 of 15 patients. The exercise time and 1‐mm ST depression time increased with each increment of combination therapy in patients on both doses of diltiazem. The resting, maximal, and ambulatory heart rates progressively decreased with each increment of combined therapy. Left ventricular function, as evaluated clinically and by the systolic time intervals, was not impaired, but severe sinus bradycardia (heart rate <40 beats/min) appeared in 3 patients. Two died during 6 months of follow‐up. Only 11 of the 23 patients completed 6 months of combined therapy without an adverse reaction. Although combined dilitiazem and propranolol therapy relieved angina and increased exercise tolerance in patients refractory to single drug therapy, it should be used with caution in such patients, since bradycardia can pose serious problems.
Myocardial bridging of coronary arteries associated with an impending acute myocardial infarction
Authors: Bestetti R. B. , Finzi L. A. , Amaral F. T. V. , Secches A. L. , Oliveira J. S. M.
Published: August 2009

A 57‐year‐old woman developed severe substernal chest pain radiating to the left arm accompanied by pallor and marked diaphoresis. These symptoms appeared at rest, lasted 45 minutes, and terminated spontaneously. The patient had been treated for mild hypertension during the last 6 months. An ECG tracing obtained at the beginning of treatment was unremarkable. However, an ECG tracing recorded shortly after the end of the symptoms showed T‐wave inversion in all anterior leads. Coronary arteriography was then performed and showed no fixed obstructive coronary artery disease. Nonetheless, a lengthened and constricted myocardial bridging of both the left anterior descending coronary artery and its major diagonal branch was detected. Also, the left anterior descending coronary artery was observed to be very short, terminating before the cardiac apex. The left ventricle was hypertrophied. The patient was treated with a beta‐blocking agent which eliminated all symptoms. An ECG tracing obtained about three months after the onset of the clinical picture was normal. Our findings suggest that marked myocardial ischemia at rest does occur in patients having myocardial bridges under special circumstances, such as lengthened and constricted myocardial bridging of a short coronary artery which supplies a hypertrophied ventricle. This anomaly should be taken into account as a possible cause of a threatened myocardial infarction, which may be successfully treated with a beta‐blocking agent.
Pulmonary vascular disease in secundum atrial septal defect in childhood: An unusual evolution
Authors: Dupuis C. , Vaksmann G. , Mycinski C. , Rey C.
Published: August 2009

Reported is a case of a 16‐month‐old girl with an isolated atrial septal defect in whom severe pulmonary hypertension has developed in 26 months in spite of an important functional gradient across the pulmonic valves at a first catheterization. Individual susceptibility to an increased pulmonary blood flow is evoked.
Plasma atrial peptide concentration during acute changes in cardiac filling pressure induced by a contrast agent
Authors: Porter C. B. , Gumprecht E. , Geer P. G. , Goetz K. L.
Published: August 2009

Left ventricular end‐diastolic pressure and the concentration of atrial peptides in plasma were measured before and after the administration of contrast material into the left ventricle of 12 patients during cardiac catheterization. A positive relationship between changes in left ventricular end‐diastolic pressure and the circulating level of atrial peptides was found in all 12 patients. Increases in plasma atrial peptide levels were detected within less than one minute after injection of the contrast agent. We conclude that the release of atrial peptides in the human is modulated rapidly by changes in atrial pressure. The rapid release of peptides from the atria in response to an increase in atrial pressure, coupled with evidence that atrial peptides reduce cardiac filling pressure, is consistent with the possibility that the atrial peptides may serve as part of a negative feedback system that enables the heart to influence its own filling pressure.
Programmed ventricular stimulation in coronary artery disease and dilated cardiomyopathy: Influence of the underlying heart disease on the results of electrophysiologic testing
Authors: Gonska B.‐D. , Bethge K.‐P. , Kreuzer H.
Published: August 2009

In order to evaluate the clinical and prognostic significance of programmed ventricular stimulation (PVS), 100 patients were investigated. Twenty‐four of 51 patients with coronary artery disease and 22 out of 49 with dilated cardiomyopathy had clinical ventricular tachycardia (VT). The study protocol included 24‐h Holter ECG, cardiac catherterization and angiography, and PVS employing 1 and 2 premature extrastimuli and incremental pacing. In patients with coronary artery disease, VT was induced in 67% with prior VT and in 18% without such episodes (p<0.01). In dilated cardiomyopathy, however, patients with and without clinical VT did not differ with regard to VT inducibility (18% vs. 15%, NS). The inducibility of monomorphic sustained VT—most frequently induced in VT patients—was significantly higher in patients with coronary artery disease (p<0.05). Polymorphic nonsustained VT (in both coronary artery disease and dilated cardiomyopathy) was only initiated in patients without clinical VT. In patients with coronary artery disease, left ventricular ejction fraction could be correlated to clinical arrhythmia (p<0.001), while induced VT could only be correlated to depressed left ventricular function in patients with left ventricular aneurysm. Neither clinical nor induced VT could be correlated to left ventricular ejection fraction in patients with dilated cardiomyopathy. During a mean follow‐up of 21 months, 7 patients died from sudden cardiac death. Six of them had clinical VT, but in only 1 patient with coronary artery disease was VT initiated. There was no apparent difference in the antiarrhythmic therapy of the patients with sudden death with respect to the surviving population. In conclusion, the response to PVS with the stimulation protocol applied is different in patients with coronary artery disease and dilated cardiomyopathy. The prognostic significance of the results obtained from PVS remains uncertain.
Ventricular premature beats on holter monitoring in patients admitted with chest pain, in whom acute myocardial infarction is not confirmed. The prognostic value and relationship to scars or ischemia on thallium‐201 scintigraphy
Authors: Madsen J. K. , Sørensen J. N. , Kromann‐Andersen B. , Kjeldgaard K.‐M. , Christoffersen K. , Van Duijvendijk K. , Reiber J. H. C.
Published: August 2009

Ambulatory 24‐h Holter monitoring was carried out in 198 patients who had been admitted because of suspected acute myocardial infarction (AMI) due to chest pain, but in whom AMI was not confirmed. During a follow‐up period of 12‐24 months (median 14 months) 16 cardiac events (i.e., nonfatal AMI or cardiac death) occurred. Ventricular premature beats (VPBs) were found in 65.2% of the patients, complex VPBs in 28.8%. Pairs of VPBs which were seen in 10.0% of the patients were the only important type of VPBs significantly related to an impaired prognosis. Thallium‐201 scintigraphy was performed in 144 of the patients. VPBs were significantly related to scar formation (i.e., to permanent defects, but not to ischemia, specifically, to transient defects). It is concluded that ventricular arrhythmias in this patient category indicate presence of chronic ischemic heart disease, and that pairs of VPBs seem to identify patients at risk for cardiac events.
Comparative diagnostic value of a new computerized vectorcardiographic method (cardiogoniometry) and other noninvasive tests in medically treated patients with chest pain
Authors: Meier A. , Høflin F. , Herrmann H. J. , Wolf C. , Gurtner H. P. , Røsler H.
Published: August 2009

The diagnostic value of cardiogoniometry (CGM), a new computerized vectorcardiographic method, for the identification of coronary artery disease was compared with other noninvasive tests in 48 medically treated patients with chest pain. Coronary angiography revealed one‐vessel disease in 18, two‐ or three‐vessel disease in 21, and normal coronary arteries in 9 patients. Cardiogoniometry was less sensitive (63%) than thallium‐201 (201TI) scanning (82%), but slightly more sensitive than the exercise ECG (50%) or a recently proposed parameter of exercise performance (50%). On the other hand, specificity was comparable among these tests (exercise ECG 78%, thallium‐201 scanning 72%, CGM 67%, new parameter of exercise performance 66%). Moreover, the false negative rate of noninvasive testing was reduced from 8 to 3% when CGM was added to thallium‐201 scanning and exercise ECG. Our findings indicate that in view of the easier feasibility with computerized technology, the future role of vectorcardiographic methods such as CGM in the noninvasive diagnosis of coronary artery disease should be redefined.
Intravenous flecainide acetate for the clinical management of paroxysmal tachycardias
Authors: Nathan A. W. , Hellestrand K. J. , Camm A. J. , Bexton R. S. , Hellestrand K. J.
Published: August 2009

Intravenous flecainide acetate (2 mg/kg) was administered to 40 patients undergoing routine electrophysiological evaluation for the investigation of recurrent paroxysmal tachycardias. Ten patients had recurrent atrial flutter, 11 patients had recurrent atrial fibrillation, one of whom also had paroxysmal left atrial tachycardia, and 19 patients had recurrent ventricular tachyarrhythmias (17 with recurrent ventricular tachycardia and 2 with recurrent fascicular tachycardia). Flecainide was administered during tachycardia (over 5 to 10 minutes) to all patients with atrial flutter, to 10 patients with atrial fibrillation, and to 17 patients with ventricular tachyarrythmias. In the remaining 3 patients with illsustained arrhythmias flecainide was administered during sinus rhythm and reinitiation of tachycardia was then attempted. Flecainide restored sinus rhythm in only 2 patients with atrial flutter (20%), in 9 patients with atrial fibrillation (90%), in 12 patients with ventricular tachycardia (80%), and in one of the 2 patients with fasicular tachycardia. Flecainide also successfully terminated the left atrial tachycardia. Two patients experienced proarrhythmic side effects during flecainide administration, one of whom required intervention by cardioversion. Minor dose effects included oral paresthesia, transient drowsiness or dizziness, and occasional visual blurring. Flecainide acetate is an effective antiarrhythmic agent for the acute termination of recent onset paroxysmal atrial and ventricular tachyarrhythmias.
Hemodynamics and myocardial oxygen metabolism of pulsus alternans in patients with dilative cardiomyopathy
Authors: Hasenfuss G. , Holubarsch C. , Heiss H. W. , Bonzel T. , Funfack M. , Revenaugh M. , Meinertz T. , Just H.
Published: August 2009

The hemodynamic and myocardial energetic changes due to pulsus alternans were investigated by left and right heart catheterization and by oxygen consumption measurements in three patients with dilative cardiomyopathy. In all three patients, pulsus alternans developed after intravenous administration of the phosphodiesterase inhibitor enoximone. Following enoximone (Patients 1/2/3), left ventricular peak systolic pressure was reduced, in the respective patients, from 100/103/115 mmHg (normal beat) to 91/96/94 mmHg (strong beat) and further to 59/80/85 mmHg (weak beat); left ventricular end‐diastolic pressure was reduced from 24/23/22 mmHg (normal beat) to 5/10/6 mmHg (strong beat) and further to 3/7/4 mmHg (weak beat). Cardiac output increased by an average of 16%. Heart rate increased by an average of 12%. Stroke work (during pulsus alternans mean between strong and weak beats) did not change (<5%) in any of the three patients. Arterial‐coronary‐sinus oxygen content difference decreased by 5%/13%/22%, respectively. Myocardial oxygen consumption per beat decreased in Patient 1 by 18%, in Patient 2 by 8% and remained unchanged in Patient 3. It is concluded that pulsus alternans occurred in consequence of alternating systolic performance. The alternation in systolic performance most probably resulted from a disturbance in excitation‐contraction coupling induced by enoximone. The pronounced reduction of left ventricular preload following administration of enoximone may have augmented further the differences between the strong and the weak beat. A disturbance in myocardial oxygen metabolism was ruled out as the cause of pulsus alternans in these patients.
Maladaptation after successful revascularization in anginal patients without transmural infarction
Authors: Sato I. , Takaki H. , Keta K. , Haze K. , Ohe T. , Shimomura K.
Published: August 2009

In order to eluciate how peripheral or cardiac function maladaptations play a role in deconditioning after coronary bypass surgery, we have evaluated effects of successful coronary artery bypass grafting (CABG) and percutaneous transluminal angioplasty (PTCA) on exercise capacity in anginal patients without myocardial infarction. Symptom‐limited treadmill exercise tests were performed in 46 patients before and after CABG and in 28 patients before and after PTCA. None of the patients carried out a cardiac rehabilitation program after their discharge. PTCA patients showed significant improvement of exercise capacity, from 6.4 ±1.6 to 10.5±2.5 METs in 4 weeks after PTCA, and even elderly PTCA patients showed improvement from 6.0±1.1 to 10.3±2.5 METs. However, the exercise capacity of CABG patients improved only from 5.9±1.4 to 8.5±3.1 METs in the first 6 months after CABG, and from 5.9±1.7 to 10.0±3.6 METs thereafter. The 15 elderly CABG patients showed only slight increase of physical activity, from 6.0±1.7 to 6.9±1.9 METs in the first 6 months after CABG and from 6.3±1.9 to 8.7±2.9 METs thereafter. Furthermore, 6 of 15 elderly CABG patients showed no improved exercise capacity after CABG. There was no correlation between the duration of anginal symptoms before CABG and exercise capacity before or after CABG. These findings suggest that CABG itself and/or physical restriction during admission produces peripheral function maladaptation and may be the main contributors to deconditioning after CABG, especially in elderly patients. This deconditioning can be treated by a rehabilitation program after the discharge.
Reproducibility of myocardial thallium‐201 washout in studies applying a standardized dipyridamole stress protocol
Authors: Siostrzonek P. , Dudczak R. , Schmoliner R.
Published: August 2009

Thallium‐201 (201T1) washout analysis was proposed as an adjunctive tool to improve the detection of coronary artery disease (CAD). Since reproducibility of 201T1 washout in dipyridamole (DPM) stress studies is unknown, this item was evaluated in 32 patients (24 with CAD, 8 without CAD), who were scintigraphed twice within 1–2 weeks. At 2 minutes following DPM infusion (0.5 mg/kg/5 min), 2 mCi 201T1 were injected. Global and segmental washout were calculated by comparing circumferential profiles of respective background‐corrected stress (left anterior oblique (LAO) 45°: 8 min postinfusion (p.i.), 35 min p.i.; anterior (ANT): 17 min p.i.; LAO 70°: 26 min p.i.) and redistribution (4 h p.i.) images. Whereas visual findings were comparable for study I and II, reproducibility of 201T1 washout was low, indicated by comparing variances among patients with variance between studies, which were 28.8 and 71.2% of total variance, respectively. Mean differences of segmental washout between the studies ranged from 9.75 to 19.24% with only minor differences with regard to the different views and segments evaluated. Variability was lower using the intermediate instead of the initial scintigram as reference for the redistribution image (12.87±11.64% vs. 18.59±14.43%, n = 85; p<0.01). Variability was higher for nonstenosed compared to stenosed segments (14.54 ± 11.41%, n=32 vs. 9.89±8.03%, n=28, p<0.05). Correspondent with results of visual interpretation, variance of relative differences of washout values between neighboring segments was lower than variance statistically expected from variability of washout values between study I and II (12.79%, n=216 vs. 21.55%, n=270; F=2.76, p<0.01). It is suggested, that considerable washout variability might explain the controversially discussed diagnostic value of 201T1 washout analysis in DPM stress studies.
The possible etiology of the vibratory systolic murmur
Authors: Darazs B. , Butterworth A. M. , Hesdorffer C. S. , Ziady F.
Published: August 2009

Between January and September 1985, 476 patients underwent two‐dimensional and M‐mode echocardiography. Left ventricular bands were noted in 104 of these individuals. Of these patients, 89 (85.6%) were referred for evaluation of a systolic murmur. In view of this high incidence of association between left ventricular bands and systolic murmurs, we decided to perform a prospective analysis on patients with the classical vibratory systolic murmur (Still's murmur) which is commonly found in children and young adults. The incidence of left ventricular bands would be compared with a group of individuals in whom no cardiac murmurs could be detected. It was hoped in this way to possibly determine whether there was a definite relationship between the vibratory systolic murmur and left ventricular bands. Echocardiographs were performed using an Advanced Technical Laboratories machine and gain settings were adjusted such that all artefacts and normal structures could easily be distinguished from the ventricular bands. The ventricular bands were divided into two types. Of significance, we felt, were those which crossed the left ventricular outflow tract and which could therefore have been responsible for the production of turbulence and thus a murmur reminiscent of the Still's murmur. This type of left ventricular band was noted in 76% of our patients with Still's murmurs as opposed to only 14% of the individuals without any murmur (p<0.001). This statistically significant difference led us to conclude that left ventricular bands might be the cause of the Still's murmur. Further investigation, particularly with Doppler studies would be required to confirm this interesting association.
Serum myoglobin in detection of myocardial necrosis in patients with “coronary insufficiency”
Authors: Almog C. , Isakov A. , Burke M. , Shapira I. , Ayalon D.
Published: August 2009

Myoglobin, an oxygen‐binding protein, is synthesized exclusively in striated and cardiac muscle, and is normally found in blood. Serum myoglobin determination has been used in the diagnosis of acute myocardial infarction. Experimental work has shown that myoglobin is released only after muscular necrosis. This prospective study included 101 patients: 62 with acute coronary insufficiency, 16 with acute myocardial infarction, and 23 controls. In all the patients with infarction the serum myoglobin levels were elevated. None of the controls showed serum myoglobin above normal. In patients with coronary insufficiency the peak serum myoglobin ranged from normal to 280 ng/ml. Half of all the patients with coronary insufficiency had a significant elevation of serum myoglobin (p<0.001). The obvious explanation of this finding is that myocardial necrosis to some extent develops in cases of so‐called coronary insufficiency. Furthermore, this study confirms previous findings that serum myoglobin assessment constitutes a very early marker of myocardial damage.
Pulmonary atresia with ventricular septal defect in adult patients
Authors: Sudhir K. , Gupta S. Krishna , Abraham A. K. , Cherian M. P. , Reddy N. K. , Cherian M. K.
Published: August 2009

Hemodynamic data and angiograms of 15 adult patients with pulmonary atresia and ventricular septal defect were reviewed to assess the pulmonary circulation and other associated features. The most common variety of pulmonary atresia was that of pulmonary valve, main pulmonary artery, and the confluence of pulmonary arteries (6 cases, 40%). The collateral vessels to the lungs were well developed in all cases; selective injections into the collateral vessels were of great value in their delineation. The left ventricle was well developed in 11 cases (73.3%). Congestive heart failure was seen in 8 (53.3%), tricuspid regurgitation in 10 (66.7%), and aortic regurgitation in 7 (46.7%) cases. The long survival in these patients was related to the favorable anatomy of central pulmonary arteries (12 cases, 80%) and adequate pulmonary collateral circlation.
Long‐term treatment of hypertension with the calcium channel blocker diltiazem
Authors: Klein W.
Published: August 2009

A group of 48 patients with essential mild to moderate hypertension were treated with the calcium‐channel blocker diltiazem (90–270 mg/day) for one year. Adequate blood pressure control was achieved in all patients. No tolerance developed during the one‐year treatment period. The drug is almost free from side effects. Very few patients develop fluid retention, which can be controlled by adding a diuretic.
Torsade de pointes due to coxsackie B3 myocarditis
Authors: Sareli P. , Schamroth C. L. , Passias J. , Schamroth L.
Published: August 2009

Viral myocarditis may present with a variety of electrocardiologic aberrations. Torsade de pointes, a potentially malignant ventricular arrhythmia associated with prolongation of the QT interval has not been described in patients with acute viral myocarditis. This report details this finding in a patient with coxsackie B3 myocarditis in whom symptomatic torsade de pointes was documented.
Combined unilateral pulmonary artery agenesis and contralateral peripheral pulmonary artery stenosis
Authors: Schamroth C. L. , Sareli P. , Dean H.
Published: August 2009

Unilateral absence of a pulmonary artery is a rare congenital malformation. This report details the finding in two cases of this anomaly associated with peripheral stenosis of the contralateral pulmonary artery.
“Three‐level shock” in ablation‐refractory paroxysmal atrial fibrillation
Authors: Pop T. , Treese N. , Erbel R. , Von OLSHAUSEN K. , Meyer J.
Published: August 2009

His‐bundle ablation is a very effective method to control drug‐refractory supraventricular arrhythmias. We present a 69‐year‐old woman with paroxysmal atrial fibrillation, in whom several attempts of unipolar and bipolar His‐bundle ablation were ineffective. Ultimately a stable 2/1 atrioventricular block was induced when three successive shocks of 400 W were applied. The first shock was given in that position with the largest His‐potential deflection. The other two shocks were applied at catheter positions more distal and more proximal from the first one, respectively. We suppose that the initial lack of success was due to an atypical atrioventricular junction anatomy.
An unusual complication of the le veen shunt: A right atrial ventricular chamber pseudotumor
Authors: Gosse P. , Guez S. , Roudaut R. , Deville C. , Dallocchio M.
Published: August 2009

We report the case of a right atrial‐ventricular chamber thrombus discovered four years after insertion of a Le Veen shunt for treatment of refractory ascites. A two‐dimensional echocardiogram, performed after the discovery of an isolated systolic murmur, demonstrated a ‘tumorlike’ mass seated in both the right atrium and the right ventricle. The mass was surgically removed and histologic examination confirmed that it was a thrombu developed at the tip of the catheter. We propose that two dimensional echocardiography should be performed periodically for the survey of such intracardiac devices.
Left ventricular aneurysm: A review
Authors: Ba'Albaki H. A. , Clements S. D.
Published: August 2009

The vast majority of left ventricular aneurysms (LVA) are secondary to corondary artery disease. The natural history of LVA is now better understood. The increasing use of noninvasive techniques has allowed earlier recognition and better appreciation of LVA genesis and pathophysiology. Improvements in surgical anesthesia and techniques have resulted in more successful LVA surgery. This article reviews the pathogenesis, natural history, and complications of LVA. Surgical indications and available treatment options in the management of patients with LVA and severe symptoms are presented. Left ventricular pseudoaneurysm (false aneurysm) will also be discussed.
A new device for balloon inflation during valvuloplasty: A perliminary reoport
Authors: Hill J. A. , Martin D. B. , Carr A. M.
Published: August 2009

A new device using a lever concept has been designed to facilitate rapid inflation and deflation of balloons during valvuloplasty. This report summarizes and illustrates the design features of the balloon inflation device as well as in vitro results of testing of times for balloon inflation, deflation, and bursting.
Lymphocyte subsets in acute rheumatic fever and rheumatic heart disease
Authors: Bhatia R. , Narula J. , Reddy K. S. , Koicha M. , Malaviya A. N. , Pothineni R. B. , Tandon R. , Bhatia M. L.
Published: August 2009

Lymphocyte subsets in 53 patients with acute rheumatic fever and 78 patients with chronic rheumatic heart disease were compared with 20 normal control subjects and 39 patients suffering from uncomplicated streptococcal pharygitis to obtain information about the pathogenesis of the disease. Twenty patients with rheumatic fever were followed for 24 weeks to evaluate changes occuring over the course of the disease. Total leukocyte and lymphocyte counts were increased in patients with rheumatic fever and to a lesser extent in those with rheumatic heart disease, when compared with controls. The difference between the two groups was significant. Patients with acute rheumatic fever had an increased number of B cells and a smaller increase in total T and T‐helper‐inducer (CD‐4) cells. The proportion of B cells increased, while that of T‐suppressor‐cytotoxic (CD‐8) cells fell. An increased number and proportion of B cells was also seen in patients with rheumatic heart disease. Total T and T‐helper lymphocyte percentages and numbers were significantly higher in patients with rheumatic fever compared with those of patients with rheumatic heart disease. Follow‐up studies at 6, 12, and 24 weeks revealed no significant differences from the entry point studies, although there was a trend toward reduction in the degree of derangement from normal values. Patients with uncomplicated streptococcal pharyngitis, however, did not show perturbations in the T‐cell and T‐subset counts. Our study suggests that the immunoregulatory defect in acute rheumatic fever is characterized by a relative reduction of suppressor T cells with an absolute increase in helper T cells and B cells, resulting in an increased cellular as well as humoral immune response. The persistent alteration in B cells in the patients with chronic rheumatic heart disease suggests an ongoing immunoinflammatory process during the apparently quiescent phase.
Exercise time: A possible source of misleading results during long‐term pharmacological studies by multiple stress testing in coronary artery disease
Authors: Romano  , Carella G. , Di Maro T. , Caiazzo M. R. , Chiariello  , Condorelli M. , Cotecchia M. R. , De Arcangelis
Published: August 2009

The assessment of chronic pharmacological of stable angina requires serial exercise stress. It is well known that exercise tolerance can be by the training effect of performing repeated. Our study investigated the values of heart rate, blood pressure, rate‐pressure product, and of exercise at 0.1 mV ST depression during exercise the same parameters plus the maximal ST‐segment at peak exercise, collected from three tests. The first and second were performed at one‐week before, and the third (75 days after the first), was after a double‐blind study with a drug versus. We found a significant increase of exercise at 0.1 mV ST depression and at peak exercise, while of 12 patients increased exercise duration from the to the third test. Individual variability of exercise showed increasing values, ranging from 0 to 71% vs. third test). In contrast, the ratio of heart rate and blood pressure did not differ between the tests. data criticized the use of mean values of exercise time pharmacological studies; moreover, individual could affect results independently of drug or placebo. These findings should be taken into in order to exclude misleading results.
EKG screening program for school athletes
Authors: Lacorte M. A. , Boxer R. A. , Gottesfeld I. B. , Singh S. , Strong M. , Mandell L.
Published: August 2009

Hypertrophic cardiomyopathy is the most common cardiovascular cause of sudden death in adolescent athletes. The electrocardiogram is abnormal in more than 90% of these individuals. An EKG screening program was developed in order to ascertain the role of the electrocardiogram in identifying athletes at risk for sudden death. A training program was created to instruct school nurses on how to perform electrocardiograms. A questionnaire/consent from was sent to the parents of the athletes. This form asked basic questions concerning the child's past medical history and family history. The electrocardiograms were interpreted by staff pediatric cardiologists. A total of 1,424 students, ages 13 to 18, had 12‐lead electrocardiograms performed. In 88.8% the electrocardiogram was normal and the health screening questionnaire revealed no abnormalities in family or personal medical history. In 6.5% of the students, the family history or screening blood pressure recording justified further evaluation. In 72 students abnormalities on the electrocardiogram were noted (5.1%). There were 87 abnormalities noted in the 72 students. Conduction disturbances and arrhythmias were the most common abnormalities noted. In 12 students evidence of ventricular hypertrophy was found. Echocardiograms and stress tests were normal in these individuals. No student was found to have hypertrophic myopathy and no student was restricted from participating in competitive athletic activities. Despite the apparent negative results of this program there were benefits of the screening project. The program resulted in a closer working relationship between school health officials and a major health care facility. The program also served as a useful teaching tool for the school nurses. The screening electrocardiogram also provided a measure of reassurance to families of youngsters participating in competitive athletics. The authors believe an EKG screening program for school athletes is a useful endeavor.
Hyperthyroid‐induced atrial flutter‐fibrillation with profound sinoatrial nodal pauses due to small doses of digoxin, verapamil, and propranolol
Authors: Talley J. D. , Wathen M. S. , Hurst J. W.
Published: August 2009

Atrial fibrillation due to hyperthyroidism is characterized by a rapid ventricular reponse which is typically resistant to digoxin therapy. We report a patient with flutter‐fibrillation who developed cyclic sinus node dysfunction with profound ventricular pauses in response small doses of digoxin, verapamil, and propranolol, which resolved with discontinuation of the medications. Caution is necessary to avoid paradoxical ventricular when treating hyperthyroid‐induced atrial fibrillation.
Myxomatous mitral valve degeneration complicating asymptomatic cor triatriatum
Authors: Wong C.‐K. , Leung W. H. , Cheng C. H. , Lau C. P. , Cheung D. L. C.
Published: August 2009

Cor triatriatum presenting in adulthood is extremely rare. This paper reports a case of cor triatriatum initially masquerading as mitral stenosis, which was later complicated by myxomatous mitral valve degeneration with severe regurgitation, which necessitated mitral valvular replacement. To the authors' knowledge, such a combination has not been reported in the literature.
Atrial pacing and thallium‐201 scintigraphy in patients with chest pain: Correlation with coronary anatomy
Authors: Stratmann H. G. , Mark A. L. , Walter K. E. , Williams G. A.
Published: August 2009

Atrial pacing and thallium‐201 scintigraphy were performed in 72 patients referred for evaluation of chest pain. Coronary artery disease (CAD) was present in 63 patients, as documented by cardiac catheterization performed at the same time or within 2 months of atrial pacing. Nine patients had no or insignificant (< 50% stenosis) CAD. The sensitivity of pacing‐induced angina for CAD was 51%, and was 49% for ST depression. Specificities were 89% and 78%, respectively. A reversible perfusion defect was seen in 54% of patients with CAD (specificity 89%), and a fixed defect in 29% (specificity 100%). The sensitivity of an abnormal thallium‐201 scan (one or more reversible or fixed defects) was 79% (p < 0.05 compared to angina or ST depression). Combined sensitivity of ST depression and/or an abnormal thallium‐201 scan was 87%. There were no significant changes in any of these sensitivities as the number of vessels with CAD increased. Thallium‐201 scintigraphy correctly identified 11 of 19 (58%) patients with single‐vessel disease as having CAD in only one vessel, but underestimated the extent of disease in all but a few patients with multivessel disease. The sensitivity of perfusion imaging to identify lesions in specific vessels ranged from 27% (circumflex) to 57% (right coronary artery). Specificities were 100% for circumflex, 78% for anterior descending, and 83% for right coronary artery lesions. The sensitivity of a reversible defect or an abnormal thallium‐201 scan did not change significantly as the degree of stenosis in the vessel perfusing a myocardial segment increased, nor did it differ between lesions involving the proximal or nonproximal segments of a vessel. Fixed perfusion defects were significantly more frequent in segments perfused by occluded vessels than those with subtotal stenoses. Addition of thallium‐201 scintigraphy to the atrial pacing test increases sensitivity for detection of CAD. The test is limited, however, in its ability to define the extent or severity of CAD, or to identify specific vessels with CAD.