Michael Kriwisky

Usefulness of echocardiographically determined mitral leaflet motion for diagnosis of mitral valve prolapse in 17- and 18-year-old men

Mitral leaflet motion during systole was studied by echocardiography in 102 healthy young men. Mean posterior maximal leaflet motion was 2 +/- 1 mm behind the CD line on 2-dimensionally (2-D) directed M-mode examination. On the apical 4-chamber cross-sectional view a mean area of 0.34 +/- 0.24 mm2 was contained by the mitral leaflets above the plane of the mitral anulus. Elevated values on the M-mode view (greater than or equal to 4 mm) compared with the 2-D 4-chamber view (greater than or equal to 0.70 mm2) were discordant, with 90% (18 of 20) of the elevated values found in 1 view only. Thus, there is a wide spectrum of mitral leaflet motion in asymptomatic young men. The value of the echocardiogram in diagnosis of mitral valve prolapse is questionable because any cutoff point between normal and abnormal is arbitrary and the degree of motion has not been shown to correlate with morbidity or mortality.

Verapamil in Ventricular Tachycardia

We compared the effects of verapamil to high dose procainamide on the rate of inducible and spontaneously occurring ventricular tachycardia (VT) in 10 patients. Verapamil induced a significant increase in the rate of tachycardia (R-R interval decreased from 278 +/- 54 to 233 +/- 32 ms, mean +/- SD; p less than 0.025 by paired t test) while procainamide slowed the tachycardia (mean R-R interval was 328 +/- 72 ms, p less than 0.02). Verapamil prevented the induction of sustained VT and was effective as chronic oral antiarrhythmic therapy in 2 patients. The accelerated VT culminated in ventricular fibrillation in 1 patient. It is assumed that verapamil may have either increased conduction velocity or shortened the reentrant cycle. This may be related either to a primary effect of the drug or secondary to increased catecholamine stimulation due to a vasodilatory effect.

Isolated Tricuspid Valve Prolapse

Tricuspid valve prolapse is commonly associated with mitral valve prolapse or other heart abnormalities and is rarely found as an isolated finding. A patient with isolated tricuspid valve prolapse is described which was discovered on routine examination of an asymptomatic pilot.

Sudden death and cerebral anoxia in a young woman with congenital ostial stenosis of the left main coronary artery

We report a 36‐year‐old woman with ventricular fibrillation, subsequent sudden clinical cardiac death, and a prolonged brain anoxia. After a successful resuscitation coronary angiography revealed congenital ostial left main coronary artery (LMCA) stenosis. Surgical anastomosis of the left internal mammary artery (LIMA) to LAD led to a complete recovery. Postoperative electrophysiological examination, mainly programmed ventricular stimulation, failed to excite any rhythm disturbances. Cathet. Cardiovasc. Intervent. 48:67–70, 1999.

Hypovolemia-induced reversible severe mitral regurgitation due to left ventricular outflow tract obstruction.

We describe a hypertensive patient who developed profound cardiogenic shock after treatment with nitrates and diuretics. Echocardiography revealed a marked left ventricular outflow tract obstruction with severe mitral regurgitation that were reversible after aggressive fluid therapy.

Effects of high gravity on cardiac dimensions in trained air crew.

We conclude that there is no difference in LV wall thickness, dimensions, or functional parameters between air crew members who fly high + Gz aircraft and those who fly other types of aircraft. No differences were detected between high +Gz air crew personnel and others in development of structural and functional changes over the short-term course of a flying career.

Constrictive Pericarditis following Coronary-Artery Bypass Grafting in a Patient with Chronic Asymptomatic Pericardial Disease

Constrictive pericarditis is a rare complication of open-heart surgery. We describe a patient who was found at the time of coronary artery bypass surgery to have asymptomatic pericardial thickening and subsequently developed rapidly progressive constrictive pericarditis. At operation for pericardiectomy, the bypass graft to the posterior descending coronary artery was found to be strangled by fibrous tissue while the remaining two bypass grafts were patent. Following pericardiectomy, the patient made a good recovery.