Leslie M. Eber

Echocardiographic Diagnosis of Idiopathic Hypertrophic Cardiomyopathy without Outflow Obstruction

The echocardiographic findings of eight patients with hypertrophic cardiomyopathy without outflow obstruction (HMC) and of 15 normal (Norm) individuals are presented.The characteristic features in HMC were: (1) interventricular septal width much greater than normal (HMC = 2.5 ± 0.3 cm, Norm = 1.0 ± 0.2 cm, P < 0.005); (2) normal or only slightly increased posterior left ventricular wall thickness; (3) the ratio of interventricular septal to posterior wall thickness ≧2.0; (4) ejection fraction greater than normal (HMC = 0.76 ± 0.08, Norm = 0.68 ± 0.06, P < 0.025); (5) reduced velocity of the early diastolic closing motion of the anterior mitral leaflet (HMC = 60 ± 23 mm/sec, Norm = 124 ± 29 mm/sec, P < 0.005); (6) absence of abnormal systolic movement of the anterior mitral valve, as seen in hypertrophic obstructive cardiomyopathy. The diagnosis of hypertrophic cardiomyopathy can be made with echocardiography, even when outflow tract obstruction of the left ventricle is absent.

Human coronary artery size during life. A cinearteriographic study.

The diameters of large epicardial coronary arteries were measured by quantitative cinearteriography in 99 patients. Average coronary size was larger than normal in patients with lesions associated with left ventricular hypertrophy and∕or dilation. The size of the coronary arteries supplying the left ventricle was normal in patients with pure mitral stenosis and in those with the “floppy mitral valve syndrome” (when mitral regurgitation was slight or absent). The left coronary artery was larger than the right coronary artery in 83% of cases. Measurement of coronary artery size is a simple and useful extension of coronary arteriography.

Left Ventricular Hypertrophy Diagnosed by Echocardiography

Abstract Echocardiography was used to differentiate left ventricular hypertrophy due to hypertrophic cardiomyopathy (20 cases) from that due to aortic valvular stenosis (10 cases) or systemic hypertension (10 cases). In aortic stenosis or hypertension symmetrical left ventricular hypertrophy was demonstrated with greater than normal thickness of both the ventricular septum and the posterior ventricular wall. The ratio of septal-to-posterior ventricular-wall thickness (mean ± S.D.) was the same as normal (1.2 ± 0.1). In hypertrophic cardiomyopathy, asymmetrical left ventricular hypertrophy was demonstrated with gross septal thickening (22.5 ± 3.4 mm) and a normal or slightly increased thickness of the posterior left ventricular wall (10.4 ± 2.0 mm). The ratio of septal-to-posterior left-ventricular-wall thickness (2.2 ± 0.2) was greater than that in aortic stenosis or systemic hypertension (p<0.005). The ventricular septum was disproportionately hypertrophied in hypertrophie cardiomyopathy regardless of th...

Paradoxical Motion of Interventricular Septum in Left Bundle Branch Block

Abnormal interventricular septal motion, with pre-ejection posterior motion and anterior motion away from the posterior left ventricular wall during ejection, was demonstrated by echocardiography in 14 out of 17 cases with complete left bundle branch block (LBBB). Two of 14 cases had intermittent LBBB and showed abnormal septal motion only during LBBB. Of the control group of 49 patients without LBBB but with cardiac disorders similar to the cases with LBBB, only two showed abnormal septal motion. However, pre-ejection motion was not seen in these two cases. During right ventricular pacing abnormal septal motion was observed in three out of ten cases. It is suggested that conduction abnormalities are responsible for abnormal septal motion in LBBB; normal septal motion in most cases with right ventricular pacing may be due to different conduction pathways not affecting the septum.

Ischemia in aortic stenosis: Hemodynamic prediction

The records of 12 patients with aortic stenosis previously studied by Fallen et al. in 1967 before and after infusion of isoproterenol were reviewed to assess the value of hemodynamic indexes in predicting myocardial ischemia--defined as less than 5 percent transmyocardial lactate extraction or lactate production. Potential subendocardial blood supply was estimated from a diastolic pressure-time index (DPTI), calculated from the tension-time index (TTI). The ratio DPTI/TTI was used to estimate the supply/demand relation. Of eight patients with aortic stenosis but without associated coronary artery disease, four (Group A) metabolized lactate normally after administration of isoproterenol, and four (Group B) had biochemical evidence of ischemia. Three of four patients (Group C) with aortic stenosis and associated coronary artery disease had abnormal glycolysis after administration of isoproterenol. Calculated aortic valve areas were comparable in all groups. In patients with aortic stenosis alone, abnormal lactate metabolism occurred whenever DPTI/TTI was less than 0.30 (P smaller than 0.01) (Group B). Two of three patients with aortic stenosis and associated coronary artery disease (Group C) showed abnormal lactate metabolism when DPTI/TTI was greater than 0.6; this ratio was below 0.3 in the third patient. These results suggest that the supply/demand relation calculated from these readily obtained indexes may be useful (1) in predicting in which patients with aortic stenosis ischemia will develop, (2) in distinguishing the role played by associated coronary artery disease, and (3) as an adjunct to calculation of valve area since the quantitation of associated aortic regurgitation is not necessary.

Echocardiographic diagnosis of a mobile, pedunculated tumor in the left ventricular cavity

A mobile left ventricular tumor was detected by echocardiography. The tracing showed a cluster of echoes in the left ventricular cavity corresponding to the location of the tumor as seen in angiograms. At surgery the tumor was attached to the interventricular septum by a thin fibrous stalk.

Dose reduction low pulse-rate fluoroscopy.

Dose reduction low pulse-rate fluoroscopy may be accomplished by integrating a magnetic video disk recorder into an x-ray system. Playback of the stored television image between x-ray pulses results in a flicker-free continuous image with actual dose reduction ranging from 2 to 60 times, depending on the pulse rate used. This system was applied successfully to cardiac catheterization and selective coronary arteriography, resulting in an estimated average dose reduction of over 2 times.

Interpretation of the serum enzyme changes following cardiac catheterization and coronary angiography

Abstract The changes in the serum enzymes following cardiac catheterization and coronary angiography remain the subject of controversy and their value in the diagnosis of complicating acute myocardial infarction (AMI) has been questioned. In order to evaluate this problem serum glutamic oxaloacetic transminase (SGOT), creatine phosphokinase (CPK), and lactic dehydrogenase (LDH) were determined before (PRE-) and 24 hours after (POST-) 70 uncomplicated studies. Intramuscular premedications were used in 50 (Group I) and 20 had oral premedications or none (Group II). The changes in SGOT and LDH were trivial, and the POST values remained within the normal range. The CPK increased significantly in 68 per cent of patients in Group I, while in Group II it increased insignificantly within the normal range. The mean enzyme values from 20 patients admitted to the Coronary Care Unit with straightforward AMI 24 hours after the chest pain were clearly and significantly higher than all the mean POST values; however, there was considerable overlap of the individual CPK values with those of Group I. With this understanding the serum enzymes remain a valuable adjunct to the diagnosis of AMI complicating coronary arteriography.

105mm Serial Photofluorography of the Coronary Arteries

Coupling of a modern dual mode image intensifier with a l05mm spot-film camera has resulted in resolution approaching that available in studies obtained with large film-changers. In comparison to the large film-changer techniques, use of this system in the investigation of coronary artery disease has yielded studies of excellent quality with greater safety and less expense to the patient. Recommendations are made concerning radiological techniques and processing. The 105mm photofluorographic technique may be applied in other forms of selective arteriography when the area of interest is relatively small.