Sing San Yang

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.

Aneurysm of the membranous portion of the ventricular septum

Abstract Two cases of aneurysm of the membranous portion of the ventricular septum are presented. This brings the total number of reported cases to 110. Both patients were asymptomatic and the clinical findings were those of coexisting ventricular sepal defect. The diagnosis was established on cardiac catheterization and selective angiocardiography with injection of dye into the left atrium or left ventricle. The anomaly was confirmed at surgery and corrected successfully in both cases.

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.

Clinical and hemodynamic findings following calf aortic valve transplantation for human aortic valve: A preliminary report

Abstract Calf aortic valve transplantation for the human aortic valve has been performed in 20 patients and the patients have been followed up to nine months. The condition of all surviving patients showed improvement as indicated by symptomatic relief, reduction in heart size and auscultatory changes. The hemodynamic studies revealed no aortic valvular gradient at rest. The valve was competent in all but 2 in whom it was of little dynamic significance. Left ventricular performance improved. There was no thromboembolism related to the heterograft. No evidence of host rejection was demonstrated. Our continued use of calf aortic valve is based on its easy availability and favorable short-term results of heterotransplantation. Further investigation will be made to determine its long-term results and ultimate fate. No claim is made as to its superiority over valve prosthesis or homograft until such time when long-term follow-up indicates so. It is speculated that relative deepness of the cusps of the calf aortic valve may allow more surface area of contact between the cusps than those of the human aortic valve. It is hoped that this may minimize the incidence of aortic regurgitation, should the valve cusps retract.

What happens to aortic regurgitation after mitral commissurotomy

a patient with acquired multivalvular lesions, one is faced with a problem of deciding whether or not correction of one lesion initially would improve the patient’s condition sufficiently to reduce the risk of subsequent operation upon the remaining valvular defect, should this be necessary. The decision is certainly difficult to make, since amelioration of one lesion may result in accentuation of the other.6 Thus in cases of mitral stenosis associated with aortic

Cyanotic Congenital Heart Disease: Clues and Approach To Diagnosis

* From the Department of Cardiology, Deborah Hospital, Browns Mills, N. J., and the LMR Cardio-Pulmonary-Renal Laboratories of Albert Einstein Medical Center, Northern Division, Philadelphia, Pa. The differential diagnosis of cyanosis in an infant is of paramount importance, because the therapeutic approach is dependent on the nature of the lesion. When approached methodically, with the use of known information regarding clinical features and pathology of right-to-left shunts, the challenge of diagnosis in this area may be met with a high degree of accuracy. The goal of this review is to present salient clues to diagnoses encountered in clinical situations. These important clues may be found in the history, physical examination, roentgenogram, phonogram and electrocardiogram, as well as in well-planned and well-executed hemodynamic and angiocardiographic studies. They will enable a physician to reach, in the majority of the

Clinical and Physiologic Evaluation of Residual Ventricular Septal Defects

Improvements in anesthesia, extracorporeal perfusion, surgical techniques and increasing knowledge of pathologic anatomy and physiology have resulted in a steady reduction of the mortality rate of open heart repair of ventricular septal defects. In addition, the incidence of iatrogenic heart block and residual or recurrent ventricular septal defects have likewise been reduced. 1-8 Despite the above improvements, a certain percentage of residual or reopened shunts occur. It is therefore important to determine the predisposing factors favoring their occurrence. It is the purpose of this paper to determine the incidence of residual ventricular septal defects (RVSD) and its relation to the preoperative hemodynamic data, method of repair and size of the defect estimated at the time of surgery.