Robert H. Franch

M-mode echocardiography in constrictive pericarditis

M-mode echocardiograms from 40 patients with proven constrictive pericarditis and 40 subjects without evidence of cardiac disease were reviewed for features previously described in constrictive pericarditis. In this large series, no single feature of the M-mode echocardiogram could be considered diagnostic, although a pattern of normal left ventricular size and systolic function, mild left atrial dilation, flattened diastolic left ventricular posterior wall motion and abnormal septal motion was found in most patients. It is concluded that the M-mode echocardiogram can provide findings suggestive of constrictive pericarditis but must be used in conjunction with hemodynamic and other studies to establish the diagnosis.

Hemodynamic Effects of Anemia with and without Plasma Volume Expansion

Hypervolemic anemia and normovolemic anemia were produced in dogs. Cardiac outputs increased comparably with similar degrees of anemia in the hypervolemic and normovolemic animals. No significant association between right atrial mean pressure and cardiac output was found. Right atrial and pulmonary arterial pressures increased in a degree comparable to blood volume increase. Systemic mean pressures did not change significantly; there was a significant decrease in total peripheral resistance. The results are consistent with the concept that the increase in cardiac output occurring with hypervolemic anemia is related primarily to the anemia and not to the increase in blood volume.

Tricuspid and Pulmonary Valve Obstruction Relieved by Removal of a Myxoma of the Right Ventricle

A 30 year old woman complained of progressive fatigue and was noted to have systolic and diastolic murmurs. At cardiac catheterization, pressure gradients were found across the tricuspid and pulmonary valves. Selective angiocardiography demonstrated a large, mobile right ventricular intracavitary filling defect. Three months after surgical removal of a right ventricular myxoma, no evidence of residual valve obstruction was noted on pressure pullback recordings or cineangiocardiograms, and the cardiac output had doubled. Clinical improvement was good.

The importance of slice location on the accuracy of aortic regurgitation measurements with magnetic resonance phase velocity mapping

Although several methods have been used clinically to evaluate the severity of aortic regurgitation, there is no purely quantitative approach for aortic regurgitant volume (ARV) measurements. Magnetic resonance phase velocity mapping can be used to quantify the ARV, with a single imaging slice in the ascending aorta, from through-slice velocity measurements. To investigate the accuracy of this technique,in vitro experiments were performed with a compliant model of the ascending aorta. Our goals were to study the effects of slice location on the reliability of the ARV measurements and to determine the location that provides the most accurate results. It was found that when the slice was placed between the aortic valve and the coronary ostia, the measurements were most accurate. Beyond the coronary ostia, aortic compliance and coronary flow negatively affected the accuracy of the measurements, introducing significant errors. This study shows that slice location is important in quantifying the ARV accurately. The higher accuracy achieved with the slice placed between the aortic valve and the coronary ostia suggests that this slice location should be considered and thoroughly examined as the preferred measurement site clinically.

Production of Increased Right-to-Left Shunting by Rapid Heart Rates in Patients with Tetralogy of Fallot

A patient with tetralogy of Fallot who developed cyanosis and tachypnea during spontaneous attacks of paroxysmal atrial tachycardia had an increase in right-to-left shunting with a fall in arterial oxygen saturation from 96 to 43%. Duplication of the fast heart rate by atropine and atrial pacing reproduced these hemodynamic changes, while slowing the rate with propranolol reversed this effect. Subsequently, six patients with mild tetralogy of Fallot underwent rapid atrial pacing during cardiac catheterization. This primary increase in heart rate resulted in a fall in systemic oxygen saturation, an increase in percent right-to-left shunt, and an increase in the right ventricular outflow pressure gradient. These data suggest that further narrowing of the right ventricular infundibulum may occur during tachycardia. This experience indicates that paroxysmal atrial tachycardia should be added to the conditions that can cause increased cyanosis in some patients with tetralogy of Fallot. Other tachycardias may also augment right-to-left shunting.

Echocardiographic diagnosis of tetralogy of Fallot

The echocardiographic features of tetralogy of Fallot were defined in 25 patients with this malformation proved by cardiac catheterization. The echocardiographic characteristic that was present in all patients and that was most sensitive was the abrupt ending of the interventricular septal echoes with the aorta overriding the ventricular septal defect. The following additional echocardiographic features were frequently demonstrated in these 25 patients: right ventricular enlargement (20 patients), hypertrophy of the interventricular septum (20 patients), diminution of the right ventricular outflow tract (21 patients) and widening of the aorta (24 patients). The suggestion is made that the most specific echocardiographic pattern of tetralogy of Fallot is the finding of several echocardiographic abnormalities rather than the single feature of aortic overriding. Recognition of the altered anatomic relation coupled with a complete echocardiographic evaluation of all cardiac structures is a reliable means of diagnosing tetralogy of Fallot.

Idiopathic calcified apical aneurysm of the left ventricle in an asymptomatic child

To our knowledge, this is the eighth reported case of isolated, idiopathic, noncontractile apical left-ventricular aneurysm in the child. Referral to the physician is likely to be made because of a systolic murmur, unusual cardiac contour, cardiomegaly, or apical calcification on chest x-ray or, rarely, a systemic embolus. Heart failure is uncommon. The electrocardiogram shows abnormal Q-waves and/or inferior and lateral ST-T changes. Careful image intensification fluoroscopy will demonstrate apical calcification in one-half of the cases.

Mechanism of Pressor Response to l-Norepinephrine During Hemorrhagic Shock

Dogs were bled 50 ml./min. until mean systemic pressure approximated 35 mm. Hg. Blood pressure was maintained at this level for 30 min. l-Norepinephrine was then infused in amounts sufficient to increase systemic blood pressure to twice the shock level or more. Measurements of systemic blood pressure, right atrial and pulmonary arterial pressures and of direct Fick cardiac output were made in the control period, during shock, during norepinephrine infusion, and following discontinuation of norepinephrine. Both cardiac output and peripheral resistance increased during the infusion of norepinephrine.

Ventricular septal defect related to ice-pick injury of the heart: Report of a case studied by cardiac catheterization

Abstract This appears to be a case of ventricular septal defect directly related to ice-pick injury of the heart. The site of defect seems well localized by right heart catheterization.

Early diastolic sound of constrictive pericarditis

In two patients with constrictive pericarditis an absent or faint early diastolic sound became prominent with squatting, phenylephrine infusion or injection of contrast medium and was obliterated by nitroglycerin. The lability of the sound allowed correlations to be made with acute changes in the right ventricular pressure curve. By eliciting an otherwise inaudible early diastolic sound, squatting may be a useful bedside maneuver in the diagnosis of constrictive pericarditis.