Se Do Cha

Prolapse of Both Mitral and Tricuspid Leaflets in Systolic Murmur-Click Syndrome

Abstract Thirteen patients with proved prolapsed mitral leaflets were selected for right ventriculography to visualize their tricuspid valves. Twleve patients without prolapse were studied as controls. Six had late systolic prolapse of the tricuspid leaflets, most evident with the inferior leaflet. In one patient a clinical clue to the presence of tricuspid pathology was the appearance of a mid-late systolic murmur at the lower left sternal border after inspiration. Whether due to a primary derangement of valve anatomy or to vigorous or asynergistic ventricular contraction, the syndrome of prolapsed leaflets with myocardopathy can involve both atrioventricular valves.

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.

Transcatheter Embolization of Hepatic Arteriovenous Fistula in Osler-Weber-Rendu Disease — A Case Report:

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) is asso ciated with arteriovenous fistulas throughout the body that can cause hemody namic abnormalities. Owing to their size and extent, surgical repair is often not feasible. A patient referred for presumed valvular heart disease is described. On the basis of oximetry data at cardiac catheterization, a large intrahepatic arterio venous fistula was discovered by aortography. This finding and a history of recurrent epistaxis were consistent with Osler-Weber-Rendu disease. Owing to the size of the fistula, embolization of the right hepatic artery with Gianturco coils was chosen as treatment, with resultant symptomatic improvement and decreased arteriovenous shunting.

Intracardiac phonocardiography in tricuspid regurgitation: relation to clinical and angiographic findings.

Intracardiac phonocardiograms were obtained from the right atrium in order to study the relation between the clinical signs of tricuspid regurgitation, intracardiac murmurs and the degree of regurgitation demonstrated on right ventriculography with use of a preshaped catheter. In five patients with no heart disease, right ventriculograms showed no evidence of tricuspid regurgitation and intracardiac phonocardiograms in the right atrium demonstrated no murmur. Among 35 patients with valvular heart disease, a Carvallo sign (increased intensity of systolic murmur during inspiration) was present in 19 and absent in 16. All 19 patients with a Carvallo sign had variable degrees of tricuspid regurgitation on right ventriculography, and intracardiac phonocardiograms were positive for tricuspid regurgitation in 18. Among 16 patients with an absent Carvallo sign, neither right ventriculography nor intracardiac phonocardiography was indicative of tricuspid regurgitation in 5. Five patients had 1+ regurgitation and the intracardiac phonocardiogram was positive in three of these five patients. The other six patients showed 3+ to 4+ regurgitation and the intracardiac phonocardiogram was positive for tricuspid regurgitation in all. In conclusion, (1) the Carvallo sign is a reliable indicator of tricuspid regurgitation but its absence does not rule it out, and (2) right ventriculography using a preshaped catheter and intracardiac phonocardiography are useful in detecting clinically unrecognized tricuspid regurgitation.

Phentolamine for Primary Pulmonary Hypertension

Excerpt To the editor: In the May issue, Ruskin and Hutter (1) reported a case of primary pulmonary hypertension in a patient who showed impressive symptomatic and hemodynamic improvement after a t...

The vectorcardiogram in prolapsed mitral leaflet myocardopathy

Summary The vectorcardiograms (VCG) of 87 cases of prolapsed mitral leaflets syndrome were analyzed with reference to clinical, electrocardiographic and catheterization data. A total of 36.8% of electrocardiograms and 72.4% of vectorcardiograms displayed abnormal T changes. T loop changes included abnormal T vector directions, wide QRS-T angles and increased T vector magnitudes. Abnormal QRS loops were seen in 30 (34.5%) VCG. All thirty-two patients with chest pain had normal selective coronary arteriograms. It is believed, therefore, that these primary T vector abnormalities are not ischemic and that they are related to some myocardial changes of unknown etiology.

Coronary Cineangiography to Diagnose Tricuspid Regurgitation

Evaluation of tricuspid regurgitation (TR) is important because of its presence in patients with ischemic, pulmonic and rheumatic heart disease. All of the techniques which aid in the diagnosis of TR at the bedside, as well as the non-invasive and invasive techniques have certain limitations. Even the angiographic assessment of the presence and degree of TR is limited by the catheter traveling the tricuspid valve prior to the injection of contrast material.1 1 The purpose of this study is to describe an angiographic technique which may be helpful in the diagnosis of TR utilizing coronary cineangiography. Subjects and Methods

The relationship of carotid sinus stimulation to exercise testing

This review is an attempt to demonstrate the safety and usefulness of the simple maneuver of carotid sinus stimulation with selected subjects undergoing exercise tests. In a variety of circumstances the addition of CSP before or after treadmill walking can yield clinically relevant information relating to arrhythmias, conduction disturbances, symptoms, and pacemakers. Further applications and benefits of these combined procedures remain to be clarified and expanded for judicious application with attention to safeguards.