Harry Goldberg

Left Ventricular Abnormalities in Prolapsed Mitral Leaflet Syndrome Review of Eighty-Seven Cases

Eighty-seven patients with proven mitral leaflet prolapse were studied emphasizing cardiodynamics and left ventricular asynergy. Significant associated features were female preponderance (83%), skeletal anomalies (pectus excavatum, straight back, scoliosis, narrow antero-posterior diameter of the chest), and anomalous coronary arteries (cork-screw patterns, short left main coronary artery, anomalous origin of the coronary arteries). Prolapse of the tricuspid leaflets was found in 15 (54%) who had right ventriculography. Five types of abnormal left ventricular systolic contraction patterns were seen in 82% of the cases and these were categorized as: 1) “ballerina foot” pattern (vigorous posteromedial contraction with anterior convexity), 2) “hour glass” pattern (vigorous ring-like contraction involving the middle portion of the left ventricle), 3) inadequate long axis shortening, 4) posterior akinesis, and 5) cavity obliteration pattern. The over-all left ventricular performance was normal generally, as indicated by normal values for functional parameters including left ventricular end-diastolic pressure, cardiac index, ejection fraction, contractility index (stroke work per end-diastolic volume) and pre-ejection period/left ventricular ejection time (PEP/LVET). The myocardial component of the syndrome of prolapsed mitral (and/or tricuspid) leaflets is expressed as asynergistic patterns of ventricular motion and usually does not impair over-all cardiac dynamics.

Silent Coronary Artery-Left Ventricular Fistula: A Disorder of the Thebesian System?

Two cases with abnormal elec trocardiogram were found to have the unusual direct communication between the coronary artery and left ventricular chamber without any manifestations of the other reported coronary arterial fis tula.

Influence of exercise on arrhythmias induced by digitalis-diuretic therapy in patients with atrial fibrillation

Abstract Serial low-level treadmill exercise testing was performed by 20 ambulatory patients with atrial fibrillation to provoke and study drug-related arrhythmias. All 20 were receiving long-term digitalis therapy; 19 were also receiving potassium-losing diuretic agents, and 3 had hypokalemia. The subjects were selected on the basis of resting electrocardiograms compatible with strong digitalis effects: prominent ST-T-U changes, intermittently occurring junctional beats, controlled ventricular rates (range 40 to 70/min) or ventricular premature beats. Arrhythmias suggesting digitoxicity were induced by exercise in all 20 subjects. Those occurring most often were junctional tachycardia with or without Wenckebach exit block, frequent ventricular premature beats and bigeminy. Idioventricular rhythm was induced in two subjects and ventricular parasystole in one. After withdrawal of digitalis and diuretic agents, subsequent exercise tests demonstrated increased ventricular rates, a decrease in ST-T-U changes and in the occurrence of most arrhythmias. In 18 patients, brief runs of junctional tachycardia persisted but occurred less often. Low-level exercise testing provides a simple method for provoking latent cardiac irritability in patients with suspected digitalis and diuretic toxicity; serial exercise testing after withdrawal of the drugs can demonstrate the devolution of arrhythmias.

Mean velocity of circumferential fiber shortening in prolapsed mitral leaflet syndrome.

In 26 patients with mitral valve prolapse, ventricular function was evaluated by mean velocity of circumferential fiber shortening (MVCF) as measured along the basilar, middle and apical axes. Significantly increased rates of MVCF were found in patients with mitral prolapse along the basilar axis (1.75 ± 0.23 circ/sec) and middle axis (2.09 + 0.34 circ/sec) (P < 0.025 and P < 0.05, respectively). Patients with mitral valve prolapse and regurgitation demonstrated a significant increase in MVCF along the basilar axes (1.72 ± 0.15 circ/sec) (P < 0.05). Asynergy appears to have a negative effect on the MVCF along the middle axis. The MVCF was found not to be related to clinical findings, symptoms or electrocardiographic changes. The mechanism for the increase in MVCF in patients with mitral valve prolapse remains unsettled.

Cavernous lymphohemangioendothelioma of the right atrium: a case report

The authors report a successful resection of a rare cystic tumor in the right atrium, discovered in an asymptomatic patient with atrial fibrillation. The cystic nature of the tumor was characterized by two-dimensional echocardiogram preoperatively. The site of attachment and movement of the tumor were clearly shown by cine computed tomography preoperatively. The tumor contained numerous endothelium-lined cavernous channels and groups of red blood cells. These features are distinctly different from those of other cystic tumors.