Henrik Arendrup

Revascularization Compared to Medical Treatment in Patients with Silent vs. Symptomatic Residual Ischemia after Thrombolyzed Myocardial Infarction – The DANAMI Study

Aims: The aim was to compare the effect of revascularization to conservative treatment in patients with residual silent and with residual symptomatic ischemia following acute myocardial infarction (AMI). The study was a subanalysis of the DANAMI (DANish AMI) randomized study of invasive vs. conservative treatment in patients with inducible ischemia after thrombolysis in AMI. Methods and Results: One thousand and eight patients were randomized to invasive or conservative treatment, stratified by the type of ischemia: silent, i.e. ST depression during an exercise test prior to discharge in 56%, or symptomatic, i.e. chest pain occurring either spontaneously during admission or during the exercise test, with or without ST changes, in 44%. Compared to a conservative strategy, invasive treatment reduced the incidence of nonfatal reinfarction, after in median 2.4 years, in both symptomatic patients (13.3–7.2%, p < 0.006) and patients with silent ischemia (10.1 vs. 5.7%, p < 0.05), and of admissions with unstable angina in symptomatic (44.5–27.6%, p < 0.0001) and silent ischemia (21.6–13.3%, p < 0.0006). Conclusions:Compared to conservative strategy, invasive treatment reduces the risk of nonfatal reinfarction and hospital admissions for unstable angina in thrombolyzed post-AMI patients with silent as well as symptomatic exercise-induced ischemia.

Deformities of the Female Breasts After Surgery for Funnel Chest

A follow-up study of patients who had undergone surgery for funnel chest in the period 1962 to 1980 revealed that the operation had been performed for cosmetic reasons on four prepubertal girls. A bow-shaped inframammary incision had been attempted in all cases. At follow-up examination, 13 to 17 years later, the scars were situated across the breasts in all four patients. Scars after a pleural drain and removal of the Sulamma struts could also be seen in two of the patients. One patient had undergone plastic surgery for reconstruction of both breasts. In all operative procedures on the thorax in children, a distance of 3 to 5 cm from the areola should be maintained, depending on the patients age, in order to avoid damage to breast tissue. In particular, it would seem advantageous to employ a vertical sternal incision at operation for funnel chest.

Acute Dissection Confined to the Abdominal Aorta

Acute dissection confined to the abdominal aorta is extremely rare. A case is presented in which the condition was lethal. Although the patient had a history of pituitary insufficiency, the etiology was shown to be atherosclerosis.

Direct communication between the pulmonary artery and left atrium.

A case of direct communication between the right pulmonary artery and left atrium is described in a 5-day-old boy, who was successfully operated upon. All the 20 cases reported in the literature have been reviewed, with special reference to diagnosis, surgical treatment and pathoanatomical and embryological findings.

Regression of Infundibular Hypertrophy After Pulmonary Valvulotomy without Myocardial Resection

In the period 1965-1979, 26 patients underwent valvulotomy for congenital pulmonary valve stenosis without ventricular septal defect. Infundibular stenosis was additionally present in 14 of the patients, 12 children and 2 adults, but myocardial resection in the infundibular area was not performed. During the first postoperative year the right ventricular outflow tract underwent normalization in the 12 children and the right ventricular systolic pressure normalized in all 14 patients. No relationship could be demonstrated between the R wave in the precordial lead V1 and the systolic pressure in the right ventricle, the gradient to the pulmonary artery or the extent of subvalvular hypertrophy.