Alfred Szamosi

PLASMINOGEN ACTIVATOR INHIBITOR IN PLASMA: RISK FACTOR FOR RECURRENT MYOCARDIAL INFARCTION

Measurements of haemostatic function and metabolic and angiographic indices of risk were included in a prospective cohort study of variables predictive of recurrences within 3 years in 109 unselected men with a first myocardial infarction (MI) before the age of 45. In the course of follow-up, 16 patients had at least one reinfarction (fatal recurrences in 9 and nonfatal in 7) and 1 died suddenly. High plasma concentrations of the fast-acting plasminogen activator inhibitor were independently related to reinfarction along with dyslipoproteinaemia involving VLDL and HDL, poor left ventricular performance, and multiple-vessel coronary artery disease. Besides being independently associated with reinfarction in the present population, high triglyceride levels were possibly connected with a predisposition to thrombosis through a coexisting high level of plasminogen activator inhibitor. The data indicate that reduced fibrinolytic capacity due to increased plasma levels of the plasminogen activator inhibitor predisposes to reinfarction in a complex interplay with atherogenic factors, multiple coronary lesions, and compromised left ventricular function.

Coronary Ostial Stenosis

Coronary ostial stenosis developing after aortic valve replacement is a clinically well-recognized entity. This non-atheromatous intimal proliferation may be limited to the proximal part of the coronary artery, probably as a complication of intra-operative coronary perfusion. It may also occur in association with widespread intimal thickening in the aortic root, presumedly as a reaction to turbulence around aortic ball valve prostheses. We have encountered this process in 2/508 patients (0.4%), who underwent aortic valve replacement with the Bjork-Shiley tilting disc valve prosthesis. The coronary perfusion technique was identical in all the operations. Both the above-mentioned patients experienced disabling angina pectoris within 5 months of valve replacement and had developed a short stenosis proximally in the main left coronary artery. Both were relieved by coronary artery bypass grafting. Our first 160 consecutive aortic valve replacements with the Bjork-Shiley prosthesis were analysed with reference ...

Evaluation of the 21 Mm Björk-Shiley Tilting Disc Valve in Patients with Narrow Aortic Roots: A Clinical, Haemodynamic and Angiographic Study

Nineteen out of 23 consecutive patients with aortic valvular lesions and narrow aortic roots, operated upon with the 21 mm Bjork-Shiley tilting disc valve prosthesis, were subjected to a clinical and haemodynamic pre- and postoperative study. An angiographic examination was carried out after valve replacement.The total mortality was 1/23 patients (4%). Clinical improvement was found in 17/19 patients (89%) after surgery. No thrombo-embolic episodes occurred during the follow-up period.The main response to aortic valve replacement was an obvious reduction of the pressure load of the left ventricle as indicated by the marked decreases in left ventricular systolic pressure and stroke work. These changes were most pronounced at rest and accompanied by reduction of distressing symptoms, increase in working capacity and decrease in cardiac enlargement. Unloading of the left ventricle after aortic valve replacement did not influence heart rate, heart rhythm, stroke volume and kinetics of the central circulation ...

Comparison of Kay's and De Vega's Annuloplasty in Surgical Treatment of Tricuspid Incompetence: Clinical and Haemodynamic Results in 62 Patients

This paper compares the late results of Kays and de Vegas annuloplasty in the management of tricuspid incompetence. The operations were done in 62 consecutive patients during the nine-year period 1969-77 and included simultaneous correction of acquired valvular lesions (58/62) and congenital malformations (4/62). Kays bicuspidalization and de Vegas annular plication were performed in 27 vs. 35 patients and these two groups were similar in the most important respects. Tricuspid regurgitation was recognized in 44/62 patients (71%) before surgery, whereas in 18/62 patients (29%) it was diagnosed at intra-operative exploration. The majority of cases (84%) were functional in origin and 16% had anatomical lesions causing or contributing to significant incompetence. Most of the patients (90%) belonged to functional class III or IV (N.Y.H.A.) before operation. The type of tricuspid repair had no bearing on early (11% vs. 14%) and late mortality (5.8%/year vs. 5.0%/year). Re-evaluation in 50 patients showed that Kays bicuspidalization and de Vegas annular plication gave similar and good late result in about 70% of the cases. The risk of over-correction was low in that only 1/30 cardiac catheterization revealed signs of mild tricuspid stenosis. Recurrent or residual tricuspid incompetence is probably related to the severity of the individual cases. Some of these failures were evident already on the patients discharge from hospital but, unfortunately, not predictable from the pre- or intra-operative evaluations.

The Left Atrial V-Wave After Mitral Valve Replacement

Abnormal ν-waves in the left atrium were observed after mitral valve replacement in the absence of clinical or angiographical signs of mitral regurgitation at rest. the ν-waves were accentuated during exercise and it was considered important to establish whether mitral regurgitation was responsible or not. A method for left ventricular angio-graphy during exercise was developed. A comparison of left atrial ν-waves in patients with intact mitral valves was made.The v-wave was related to the mean left atrial pressure in patients after mitral valve replacement and in patients with intact mitral valve function. It was observed that these two groups of patients had the same relationship between u-wave and mean pressure in the left atrium and thus the marked u-waves seen after mitral valve replacement were of the expected amplitudes, as predicted from the left atrial mean pressure.Left ventricular angiography during exercise was per- formed in five patients and a slight but haemodynamically insignificant regurg...

Key enzymes of myocardial energy metabolism in papillary muscle of patients with mitral valve disease—relation to left ventricular function

Metabolic adaptations were studied in papillary muscle from 18 patients undergoing open-heart surgery for mitral valve disease. Analyses were made of myoglobin (MG), the enzymes lactate dehydrogenase (LD) with its isoenzymes, glyceraldehyde phosphate dehydrogenase (GAPDH), phosphofructokinase (PFK), citrate synthase (CS) and creatine kinase (CK) with its isoenzymes MB (CK-MB) and mitochondrial CK (CK-MIT). Myocardial function was assessed with left ventricular angiography. Positive and significant correlations were found between enzymes of oxidative metabolism, i.e. CS on the one hand and MG (r = 0.76), LD1 (r = 0.68), CK-MIT (r = 0.86) and CK-MB (r = 0.65) on the other. Indicators of glycolysis--PFK, GAPDH and LD3--varied independently of CS. LD3% was directly related to GAPDH (r = 0.66). In a sub-group of 12 patients with isolated mitral regurgitation due to myxomatous valve degeneration, LD3% rose (r = 0.72) with increasing myocardial derangement which, however, showed no relationship with any other marker. Thus the capacities of oxidative and glycolytic pathways did not co-vary. Volume load appeared not to affect oxidative capacity, while the anaerobic fraction of glycolysis was increased.

Parietal Fibroplastic Endocarditis (Loeffler's Disease): Radiological and Surgical Aspects in Connection with a Case Report

In a case of parietal fibroplastic endocarditis (Loefflers disease), changes can be demonstrated by angiocardiography. After almost one year of marked progress, a second angiocardiography demonstrated a progression of the thrombus masses almost completely filling the right ventricle. At surgery, it was possible to remove the granulation masses and find a layer of dissection so that the fibroplastic endocardial membrane could be removed from the entire inside of the right ventricle and over the tricuspid valves, letting only soft myocardium remain. The patient improved rapidly and the results of surgery were confirmed by postoperative angiocardiography.Loeffler (1936 and 1947) described a disease called endocarditis parietalis fibroplastica. It consisted of a thickening of the parietal endocardium of both ventricles with mural thrombosis but with no changes of the valves. The disease was often accompanied by eosinophilia. Loeffler believed that the disease was related to endocarditis lenta and reported th...

Presystolic Mitral Regurgitation in Severe Aortic Incompetence Observed by Cineangiography

Four patients with severe isolated aortic regurgitation following bacterial endocarditis showed an early diastolic ‘functional mitral stenosis’ with a maximal pressure difference across the valve of 5

Reconstruction of the Anomalous Left Coronary Artery Within the Main Pulmonary Artery

Successful reconstruction of the anomalous origin of the left coronary artery from the pulmonary artery was performed in a 27-year-old man. A patch of glutaraldehyde-treated bovine pericardium was used to construct a tunnel within the main pulmonary artery, connecting a created aortopulmonary window to the ostium of the left coronary artery. Angiography one month after the operation demonstrated patency of the tunnel. The procedure is suitable when direct re-implantation of the left coronary artery into the aorta is impossible for technical reasons.

Clinical value of pulmonary needle biopsy in diagnosis of pulmonary carcinoma.

In 92 consecutive pulmonary needle biopsies, preliminary diagnoses on the basis of radiological and clinical data were compared with cytological reports. Three groups emerged. In the first, of 43 cases with radiological changes typical for primary lung carcinoma and no clinical data making other diagnosis a plausible alternative, the cytologist found carcinoma cells in 37 and malignant lymphoma cells in one. A further 3 cases proved to be carcinomas at the histological examination. Two cases were not carcinomas. In the second group, where 30 patients displayed radiological changes less typical for primary diagnoses, or clinical/anamnestical data also supported alternative diagnoses, the cytologist found malignancies in 8 cases, carcinoid in one and no signs of malignancy in 21 cases. In 19 cases the patients were considered radiologically to have no malignancies. Malignant cells were found in none. It is concluded that in a certain group of patients, the diagnosis of pulmonary carcinoma can be made with reasonable accuracy from radiological and clinical data alone. Needle aspiration biopsy and similar techniques are of questionable value as routine procedures when the probability of this diagnosis is already very high on other grounds. Their use should be reserved for cases where plausible diagnostic alternatives are present.