[Determination of the examination planes in two-dimensional sector echocardiography (author's transl)].
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Biomedical subjects
Publications and source records attributed to A Schaede.
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Myocardial perfusion scintigraphy by means of the microsphere technique is a valuable method for detecting regional myocardial scars. The use of the microsphere technique is indicated in all patients who have had myocardial infarction and before coronary bypass operations. In a certain group of patients with severe but atypical angina pectoris and a normal coronary arteriogram and in some arrhythmias the perfusion scintigram can provide information on changes coronary microcirculation. The assessment of myocardial blood flow redistribution under pharmacological intervention is a further indication for the microsphere technique.
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Secundum ASD was diagnosed in five members of three generations of one family. Three of them had prolonged A-V conduction. These findings and those reported in the literature suggest that the combination of secundum ASD with prolonged A-V conduction is an autosomal dominant hereditary disease.
While coronary angiography was within normal limits in three patients with recurrent severe attacks of angina and non-transmural postero-lateral wall myocardial infarction, myocardial perfusion scintigraphy demonstrated an abnormal distribution pattern. In addition to recanalised thrombosis, embolism or spasm, abnormalities in the microcirculation are possible causes of the discrepancy between the coronary arteriogram and the scintigram. Myocardial perfusion scintigraphy is of particular diagnostic significance in this group of patients with coronary heart disease but normal coronary angiography. Treatment in the presence of this finding consists of administration of platelet-aggregation inhibitors.
In 7 patients with arrhythmias of various origin the myocardial scintigram displayed either a diffuse or circumscript defect of the perfusion. The coronary arteriogram was normal in all patients. The localized defect of the perfusion in 2 patients was in the region of the upper part of the interventricular septum. Both had a left bundle brunch block. A correlation between the perfusion defect and the electrophysiological abnormality seems probable. The perfusion defect in one of the patients is most probably caused by a previous myocarditis followed by fibrous changes. In the other 6 patients the cause for the perfusion defect is not obvious. A history of myocarditis is missing. The presence of "small vessel disease" in those patients has however to be considered. Our results point to the relation between an abnormality of the microcirculation and arrhythmias in younger patients.
A supraventricular re-entry tachycardia was successfully treated in a patient with WPW and sick-sinus syndrome by permanent rapid atrial pacing and ventricular demand pacing. The use of a demand pacemaker with bipolar electrode avoided slow ventricular rates resulting from second degree A-V block during rapid atrial pacing. The trigger system of this pacemaker was not disturbed by unipolar atrial stimulation. Ventricular rates responded satisfactorily to physical and to emotional stress as a result of improved A-V conduction in these circumstances. Rapid atrial pacing has prevented the re-entry tachycardia. In an emergency the atrial pacemaker can be inhibited by a magnet, but otherwise discharges permanently at a constant rapid rate.
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A numerical index was developed for reproducible and comparative judgement of the degree of coronary sclerosis. This graded index method takes into account the amount of stenosis as well as its distance from the ostium. 152 selective coronary angiograms were evaluated by this method. There was a close correlation between the degree of sclerosis and collaterals; the index of 63 patients with collaterals was 3.5 times that of patients without collaterals. Anastomoses and collaterals showed typical localisations depending on the antomical position of stenoses. For the evaluation of the clinical importance of collaterals, a classification into one, two and three vessel disease is not adequate; the reduction in perfusion cannot be reliably estimated and should be judged by a more detailed index method.
In contrast to secondary occlusion idiopathic thrombosis of the superior vena cava occurs rarely. With a good collateral flow through anatomically preformed venous channels the clinical picture may have an insidious course obscuring diagnosis. Collateral circulation via upper oesophageal varices is commonly overlooked. Anticoagulants should be given to prevent progression. Surgically vein transplants, by-pass operations, and thrombectomy have been tried. Follow-up in 4 patients shows that even without surgical intervention the prognosis is good despite the danger of haemorrhage from the varices.
In patients aged 24 to 45 years with angina pectoris, pathological changes in the exercise electrocardiogram and a normal coronary angiogram, a disturbance of the pattern of myocardial perfusion could be demonstrated in addition by scintigraphy. The cause of this disturbance of myocardial perfusion is unknown. Myocardial scintigraphy is indicated (1) to demonstrate an otherwise undetectable disturbance in the blood flow of the myocardium with a morphologically normal coronary system, (2) in subtotal coronary stenosis before the decision to perform a coronary bypass operation is made, (3) in cases of anginal syndrome with normal coronary angiograms.
A methodical introduction of the measurement of regional myocardial microperfusion is given. Based on the results of selective coronary perfusion scintigraphy in this technique two isotopes are injected into the same coronary artery with a characteristic time interval between the two injections. The influence of the coronary active drug on regional myocardial microperfusion can be measured, when the second isotope is injected after a time interval corresponding to the maximum drug effect. The second isotope then marks the actual regional microperfusion under the influence of the drug. The two isotopes can be discriminated by their characteristic energy spectra and then quantitatively be compared. The scans are taken in different positions and then compared with the corresponding coronarograms and left ventriculograms.
The influence of Dipyridamol and Oxyfedrin on regional myocardial precapillary microperfusion patterns was investigated in groups of 15 and 13 patients by means of selective double lable perfusion scintigraphy. Automatic impulse rate integration allows the comparison of different perfusion areas in the same scintigram as well as the comparison of different identical regions in different scintigrams. The scans were taken in two positions (frontal and l.a.o.). Microperfusion patterns were measured before and after the intravenous application of the drug. We found a typical shift of the microperfusion patterns with both medicaments. Under the influence of Oxyfedrin and Dipyridamol there was an increase of the relative microperfusion intensity in the vicinity of the major arteries but there were great differences as to the degree of their reaction maximum. Besides the results of the groups some typical cases are demonstrated. The method allows a satisfactory measurement of differences in the regional precapillary myocardial perfusion under the influence of coronary active drugs. We believe that statements on physiologic and pathologic functions are possible.
Significance and technique of roentgenologic and nuclear medicine methods for evaluation of coronary artery disease and myocardial perfusion are presented. Some routinely used methods in nuclear medicine are briefly discussed concerning the evaluation of left ventricular function.
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