Biomedical subjects
Publications and source records attributed to N Roguin.
A patient with Behçet's disease developed the rare complications of pericarditis and, two months later, superior vena caval obstruction. The latter complication was investigated by angiography to exclude other causes. As a result of this investigation the caval obstruction was managed conservatively, the symptoms and signs improving spontaneously.
Five children with polysplenia syndrome are described. Cardiac catheterization or postmortem examination revealed the following cardiac anomalies: interruption of the inferior vena cava with azygos (or hemiazygos) continuation to the left superior vena cava and a single atrium or a large atrial septal defect in all five children; a ventricular septal defect in three; and a primitive ventricle in one case. Other anomalies found were: central liver in all five; a right-sided stomach in three; and multiple small spleens and bilateral left, bilobed lungs--found on autopsy--in two of the children. In four of the five patients, whose ECG was available, a negative P wave was present in leads II, III and AVF. This leftward and superiorly directed P wave axis should suggest a diagnosis of polysplenia syndrome in an infant with congenital heart disease. The cardiac anomalies are surgically correctable; therefore, early recognition of this syndrome is of practical importance.
In 34 out of 36 patients with apical right ventricular endocardial pacing, primary ischaemic ST alterations were observed during the early stage of acute myocardial infarction. These ST changes, indicating acute injury, were detected in the paced beats in inferior and in anterior infarct. The primary ST changes were consistent only during the early stages of acute myocardial infarction and were not detected when the electrode tip was not in the apex of the right ventricle. It is suggested that the primary ST changes should be used to diagnose acute myocardial infarction in paced patients.
A 22-year-old woman with a right atrial myxoma prolapsing to the right ventricle is described. The haemodynamic findings were similar to those of cases of prolapsing myxoma of the left atrium; a notching on the ascending limb of the right ventricular pressure curve, and an initial negative, irregular deflection on the pulmonary artery pressure curve with a pronounced rise in the mean right atrial pressure (18 mmHg) were found. On deep inspiration there was a significant deepening of the y descent from 12 mmHg to 2 mmHg, indicating a changing, dynamic obstruction of the right ventricle inflow tract. These haemodynamic features can be helpful in the diagnosis of prolapsing right atrial myxoma.
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The follow-up of 80 patients above the age of 70 years with implanted pacemakers is described. These patients were the most advanced in age from a total group of 150 with implanted pacemakers. Their ages ranged from 70 to 87 years, with an average of 75.4 years; 50 were male and 30 were female. An epicardial electrode was implanted in 13 patients and an endocardial electrode in 67. The pacemaker was implanted in 76 patients for symptomatic atrioventricular block and in four patients for sick-sinus syndrome. Two patients (2.5 per cent) died during the postoperative period and 19 patients within a period of 3 months to 6 years after the implantation. The survival rates were: 1 year, 90.0 per cent; 2 years, 82.1 per cent; 3 years, 74.1 per cent; 4 years, 67.2 per cent; 5 years, 58.3 percent. These survival rates were surprisingly similar, for the first 3 years of follow-up, to those of our and others' previous studies, which included all age groups. The survival rates in the most advanced age groups decreased in comparison only in fourth and fifth years after the implantation. There was no evidence of new episodes of myocardial infarction among this group of patients during the follow-up period. We conclude that even in patients of the most advanced age groups the implantation of an endocardial pacemaker significantly prolongs life, improves its quality, and this at a low operative risk.
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A patient with papillary muscle disease caused by myocardial infarction was studied before and after injection of phenylephrine. The pulmonary wedge pressure was normal at rest. However, pressures and murmur changes, occurring spontaneously and after injection of phenylephrine, suggested that intermittent severe mitral regurgitation contributed significantly to the recurrent episodes of acute left heart failure presented by this patient.
Myocardial tissue from the left ventricle of two children with congenital atrioventricular block and recurrent Admas-Stokes attacks was obtained during the procedure of epicardial pacemaker implantation and studied with the electron microscope. One patient had a familial cardiomyopathy, the other had no clinical abnormality apart from the conduction defect. Proliferation of mitochondria was common in both cases. Focal interstitial fibrosis and pronounced proliferation of transverse tubules were found in the myocardial cells of the patient with familial cardiomyopathy. Deep invaginations of the sarcolemmma with formation of intracytoplasmic channels were present in the second case. The possibility that the numerous transverse tubules could serve as additional pathways for impulse conduction is discussed.
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