In 167 patients with congenital and acquired heart disease (ventricular septum defect (VSD), atrial septum defect (ASD), mitral stenosis (MS), mitral insufficiency (MI), combined mitral stenosis and insufficiency (MV) aortic stenosis (AS), aortic insufficiency (AI), combined aortic stenosis and insufficiency (AV), idiopathic hypertrophic subaortic stenosis (HOK) hemodynamic measures (arterial pressure, right and left heart pressures, cardiac output, cardiac index, stroke volume, cardiac work), left ventricular volumes (endiastolic volume, endsystolic volume, ejection fraction, regurgitant flow) and diastolic pressure-volume relationships (on the basis of diastolic pressure-volume changes) were determined during routine right and left heart catheterization and left ventriculography. 1...

Adolescent↗

PubMed1975

[The relationships between left ventricular volumes and ejection fraction in mitral and aortic regurgitation (author's transl)].

In 2 groups of patients with mitral valvular incompetence (MI, n equals 20) and aortic valvular incompetence (AI, n equals 22) intracardiac pressures as well as left ventricular volumes (enddiastolic volume, endsystolic volume, stroke volume, ejection fraction, regurgitant volume) were determined during routine left heart catheterization and left ventriculography. Data obtained were compared with a normal group (N, n equals 20). 1. Enddiastolic volume was increased by 32 per cent (MI) and 180 per cent (AI) respectively in comparison to normal. Endsystolic volume was increased by 85 per cent (MI) and 113 per cent (AI). Total stroke volume exhibited increases by 11 per cent (MI) and 86 per cent (AI) respectively. Regurgitant volume averaged 64 per cent (AI) of total stroke volume, and 47 per cent in MI. Left ventricular ejection fraction was reduced in both groups by about 12-14 per cent. 2. enddiastolic volume was significantly dependent on the amount of regurgitant volume in both groups (MI, AI). Likewise total stroke volume increased with increments in enddiastolic volume. This increase was far mor pronounced (up to 250 per cent of normal) in AI in comparison to MI and may be referred to an effective contribution of the Frank-Starling-Straub-mechanism, induced by increased preload following regurgitation. There existed no correlation between enddiastolic volume or regurgitant volume and the effective forward stroke volume and other parameters of forward pump function (effective cardiac output, cardiac index, external cardiac work). Left ventricular compliance, as determined by diastolic pressure-volume relationships, was nearly the same in the 3 groups (N, MI, AI). 3. Left ventricular ejection fraction was nearly unchanged with increments in enddiastolic volume over a range of enddiastolic volumes up to 400 ml. At higher enddiastolic volume (is greater than 400 ml) decreases were found. In the failing heart with AI left ventricular ejection fraction was reduced even at low enddiastolic volume, exerted by decreases of fibre shortening and contractility. In contrast, in MI ejection fraction decreased with increments of enddiastolic volume over the whole range investigated. The increase in total stroke volume in both groups therefore was produced by increases of enddiastolic volume and to a very small extent by an increase of the ejection fraction. 4. The large contractility reserve in compensated AI may be referred to the altered contraction mechanism in aortic valvular regurgitation associated with i) decrese of isovolumic pressure development and increase of isotonic contraction, ii) increase of diastolic fibre stretch (preload) and iii) decrease of mean wall tension. Contractility reserve was essentially influenced by myocardial contractility. With decreases of contractility consecutively decreases of the total and the effective pump function of the left ventricle may occur despite unchanged contraction form and left ventricular dimensions.

Animals↗

PubMed1975

[Experiment and clinical medicine].

The clinically active scientist is related to his motivation as a doctor. Each result of scientific work has some bearing therapeutically or diagnostically. The sum of countless individual achievements explains the fruitful development of clinical medicine in the last hundred years. In the interests of the patients and medical education, one must be concerned also in future with the complexity of the disease processes and diagnosis and therapy must be carried out with critical consideration.

Animals↗

PubMed1975

[Proceedings: Comparative studies on the expulsion fraction and volume of the left ventricle in mitral and aortic valve regurgitation].

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Aortic Valve Insufficiency↗

PubMed1975

[Coronary disease. I. A correlative study on hemodynamics and contactility in 110 patients].

Hemodynamics measures and indices of myocardial contractility were determined in 110 patients with coronary heart disease. In comparison to a normal group (n=20) right heart pressures (right ventricle, arteria pulmonalis) were increased in coronary heart disease by 48-71%. Systolic aortic pressure was increased by 20-22%. Left ventricular enddiastolic pressure was consideraibly increased by 130%, dependent on the severity degree of coronary artery disease. Cardiac output and cardiac index were decreased at comparable heart rate by 20-33%, dependent on an effective decrease of stroke volume. Isovolumic indices of myocardial contractility (dp/dtmax, t-dp/dtmax, dpmax/IP) WERE REDUCED IN CORONARY HEART DISEASE PARALLEl to the severity degree of coronary artery stenosis. All the hemodynamic chances were most pronounced in a group with left ventricular aneurysm. The results demonstrate that myocardial performance in coronary heart disease is characterized by decreases of pump function and contractility in correlation with the severity degree of coronary artery stenosis.

Adult↗