[Role of echocardiography and radioisotopic scintigraphy during transesophageal atrial pacing].
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Biomedical subjects
Publications and source records attributed to A Chiddo.
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UNLABELLED: This study was undertaken to assess the reliability of two simplified echocardiographic methods (Method A and B) in evaluating ejection fraction (E.F.) in patients with left ventricular wall motion abnormalities (WMA). Method A was obtained with a microprocessor that allows the superimposition of a calibrated ellipse to left ventricular end-diastolic and end-systolic silhouettes; the shape of the ellipse was modified to obtain the best superimposition of the ellipse outline to the endocardium. E.F. was then obtained with the formula: VD-VS/VD where VD and VS were the ellipse volumes at end-diastole and end-systole. In method B E.F. was obtained averaging 3 regional E.F. obtained with a longitudinal axis and 3 different transverse diameters. In a group of 40 patients with WMA and excellent 2D echo images the correlation between echocardiographic and angiographic values was r = 0.76 for method A and r = 0.92 for method B. Method B was also tested in a group of 25 consecutive unselected patients with left ventricular WMA; in this group the correlation with angiographic values of E.F. was r = 0.84. IN CONCLUSION: in patients with WMA method B must be preferred because it is easier to perform and presents a better correlation with angiographic data than method A.
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In order to assess the reliability of some recently proposed methods for angiographic diagnosis and quantification of mitral valve prolapse (MVP), the left ventricular silhouettes obtained by cineangiography in 48 patients with typical auscultatory and M-mode MVP findings were examined. The following methods were tested in 40 angiographic studies that were found to be of good technical quality: method of Farry et al. (1975), of Smith et al. (1978), of Engel et al. (1978), of Spindola-Franco et al. (1979). In 23 cases a two-dimensional echocardiographic study was also performed and Engel's angiographic criteria were utilized to quantify the MVP. The angiographic and echocardiographic data were correlated in 13 cases in which it was possible to obtain both good quality echocardiographic and adequate angiographic (end-systolic identification of the two mitral valve commissures) studies. The following conclusions can be drawn: a correct angiographic quantification of the extent of bulging requires both end-diastolic and end-systolic identification of both anterolateral and posteromedial commissures; in spite of the good quality of the angiographic studies a correct end-systolic identification of the two commissures is obtainable in less than 50% of cases, which obviously restricts considerably the applicability of any objective method; among the tested angiographic methods only the Engel's method (evaluation of the distance between the plane of the mitral valve and the most protruding point of the prolapsed leaflets) showed a satisfactory diagnostic sensitivity (75% in RAO projection, 89.5% LL projection, 100% utilizing both projections); angiography is not suitable for a quantitative classification of the MVP in mild, moderate and severe forms; such a possibility, on the contrary, seems to be offered by two-dimensional echocardiography provided that Engel's angiographic are adopted.
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Electrophysiological changes produced by intravenous (0.1 mg/kg) metoprolol, a new selective beta 1-blocking agent devoid of intrinsic activity, were studied in 16 subjects with estimated normal impulse formation and conduction. The most important effects were sinus bradycardia, mild increase of sinoatrial conduction time, depression of intranodal conduction, and prolongation of AV node refractory periods. Sinus node recovery time and atrial refractory periods were unmodified. Infranodal conduction and the refractory periods of the His-Purkinje system, as well as of the bundle-branches, were unchanged. These effects are compared with those observed after intravenous propranolol, pindolol, and oxprenolol.
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Electrophysiologic modifications produced by intravenous administration of 0.1 mg/Kg Oxprenolol were studied in 16 subjects with estimated normal impulse formation and conduction. Significant effects were sinus bradycardia, mild increase of sino-atrial conduction time, depression of intranodal conduction and prolongation of A-V node refractory periods. Sinus node recovery time and atrial refractory periods were unchanged. Infranodal conduction and the refractory periods of the His-Purkinje system, as well as of the bundle branches, were unchanged. These effects are compared with those observed after intravenous Propranolol and Prindolol.
The acute electrophysiologic effects of intravenous Bunaphtine 1,5 mg/kg body weight, a new antiarrhythmic drug, were studied in 19 subjects with estimated normal impulse formation and conduction. Significant effects were sinus bradycardia, prolongation of atrial refractory periods, depression of intranodal and infranodal conduction and prolongation of His-Purkinje system refractory periods. These properties are compared with those of amiodarone and quinidine and form the basis for a correct use of Bunaphtine in the management of arrhythmias.
The acute electrophysiological effects of intravenous verapamil (0.15 mg/kg body weight) were studied in 21 subjects with estimated normal impulse formation and conduction. Significant effects were sinus cycle shortening, depression of intranodal conduction and prolongation of AV node refractory periods. Sinus node recovery time, sinoatrial conduction time, atrial refractory periods, infranodal conduction, His--Purkinje system, and bundle branch refractory periods were unchanged. The clinical implications of these properties are discussed.