Biomedical subjects
Publications and source records attributed to L Bloch.
A Soviet nuclear pacemaker is described. It is a large VOO bipolar pacemaker, probably nonprogrammable. It has unique electrode connectors. No isotope leak or excessive radiation hazard was detected. Because we had no knowledge of its end-of-life markers and because of the impossibility of assuming long-term safety, the device was removed.
A 26-year-old woman with severe pliable mitral stenosis underwent successful balloon mitral valvuloplasty at the end of the second trimester of pregnancy. The indication for intervention was severe shortness of breath during most daily activities, despite combined beta-blocker and diuretic treatment (FC III, NYHA). After use of a 2 x 19 bifoil balloon there was significant clinical and hemodynamic improvement. Shortness of breath disappeared, the mean mitral valve diastolic gradient decreased from 24 to 7 mmHg and the mitral valve area increased from 0.8 to 1.8 cm. There were no complications of the treatment, and estimated radiation exposure of the fetus was less than 0.2 rad. Subsequent abdominal ultrasound examination revealed normal fetal functioning. 2.5 months after mitral dilatation delivery was normal. Balloon mitral valvuloplasty may safely be used instead of surgery as a palliative procedure for relief of symptoms in pregnant women with severe pliable mitral stenosis.
Quinidine was combined with propranolol to restore sinus rhythm in cases of paroxysmal atrial fibrillation (PAF) in 42 patients. The treatment was started with propranolol and quinidine at a test oral dose of 10 mg and 0.2 g, respectively, thereafter a dose of 0.4 g of quinidine and 10 mg of propranolol every two hours was added. The procedure was stopped when sinus rhythm was achieved, or when the administered quinidine reached the total dose of 1.6 g. Sinus rhythm was restored in 37 patients. The side effects were gastrointestinal disorders in 16 patients, atypical ventricular tachycardia in one case, and embolism of the left femoral artery in another patient.
A new diagnostic method for idiopathic hypertrophic sub-aortic stenosis (IHSS), using synchronized ECG gated 201Tl myocardial scintigraphy, is described. Twenty patients previously diagnosed as IHSS were evaluated by sequential three-view ECG gated 201Tl and 45 degrees left anterior oblique multigated (MUGA) cardiac blood pool imaging (Group A). The results were compared with two control groups: 20 patients with no previous history of heart disease (Group B), and 20 patients with coronary ischaemic heart disease (Group C). We suggest the following combination of scintigraphic signs as typical and diagnostic to obstructive IHSS: Elevated left ventricular ejection fraction (mean 83.9% +/- 6.15S.D. versus 72.5% +/- 5.35S.D. and 51.2% +/- 13.65S.D. in Groups B and C respectively); Systolic left ventricular cavity obliteration (71% of obstructive IHSS patients versus 0% in Groups B and C); A ratio of more than 1.3:1 in septal to free wall thickness (100% of patients with IHSS); Perfusion/wall-motion mismatch of septum was demonstrated in all (100%) of patients with IHSS (versus 0% in Group B and 10% in Group C). We suggest this last finding as a new specific diagnostic sign for IHSS, with the ability to differentiate between patients with ischaemic coronary heart disease and IHSS patients; whilst both groups may present chest pains, the first group was characterized by 'matching' of perfusion and motion of the affected myocardial wall while the patients with IHSS had 'mismatching' of these parameters. We suggest gated 201Tl myocardial scintigraphy as an additional sensitive tool for the early diagnosis and evaluation of IHSS patients.
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