Arthur de Carvalho Azevedo

Early stage of tricuspid stenosis

Abstract Twelve patients are presented with rheumatic valve lesions and a typical tricuspid diastolic rumble presenting inspiratory accentuation. All the patients, except one, were in sinus rhythm. No tricuspid diastolic gradient was found when they were first catheterized. An intracardiac diastolic rumble with inspiratory accentuation was recorded in the right atrium or ventricle, or both. Five of the patients were recatheterized after an interval of 1 to 3 years, and, although the clinical picture was unchanged, small tricuspid gradients were recorded. A diminution of cardiac output and an increase of right atrial mean pressure were also observed. It should be accepted that, at an early stage of tricuspid stenosis, a tricuspid gradient may be absent while the auscultatory and phonocardiographic signs may be the only indication of the tricuspid lesion.

Severe pulmonary artery hypertension due to an anomaly of the pulmonary arteries

Abstract The case of a 19 year old girl in heart failure with symptoms of severe pulmonary hypertension which dated from childhood is presented. The main findings in the cardiologic study were a normal radiotranslucency in both lungs, and severe right atrial and ventricular hypertrophy in electrocardiogram. On cardiac catheterization there was a severe pulmonary hypertension with normal “wedge” pressure in the left lung. It was, however, impossible to advance the catheter into the distal branches of the right pulmonary artery: there was blocking of the catheter in the right hilum. The proximal right pulmonary artery pressure also was markedly elevated. Two angiocardiograms were made, and both showed a dilated main pulmonary artery, visible and constricted left pulmonary artery branches, and a diminutive right pulmonary artery branching from the dilated main artery, with visible branches only for the upper right lung. Pulmonary function study showed a reduced maximal breathing capacity due to the diminution of the vital capacity with a normal residual capacity. It is emphasized that, except data from the angiocardiograms and the catheterization of the right pulmonary artery, nothing in the clinical picture suggested the anomalies of the right pulmonary arteries. This fact would seem to indicate that every patient with a picture of pulmonary hypertension of unknown etiology should have angiocardiograms before a clinical diagnosis of “essential pulmonary hypertension” is made.