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[Anomalous origin of the left coronary artery from the pulmonary trunk with myocardial infarction and severe left ventricular dysfunction in infancy--assessment of myocardial damage using SPECT studies with 201TlCl and 123I-BMIPP].

A 4-month-old male infant with Bland-White-Garland (BWG) syndrome complicated myocardial infarction was reported. Signs included tachypnea, coughing, and failure to thrive. However, there was no sign of myocardial infarction. A chest radiograph revealed cardiomegaly (CTR = 65%) and electrocardiogram showed abnormal Q waves in I, aVL, V6 leads. Cardiac catheterization and angiography revealed marked dilatation of left ventricle (end-diastolic volume = 384 ml/m2) and extremely depressed ejection fraction (16%), confirming the diagnosis of BWG syndrome. A 201TlCl-myocardial SPECT demonstrated apical defect and hypoperfusion in the anterolateral, inferoposterior walls, whereas 123I-beta-methyl-p-iodophenylpentadecanoic-acid (123I-BMIPP) SPECT showed a wider defect area. SPECT studies with 201TlCl and 123I-BMIPP, are useful to assess myocardial viability more accurately in BWG syndrome.

Coronary Vessel Anomalies↗

[Effect of prolonged administration of beta-blockers on the hemodynamics of patients who have sustained a myocardial infarct].

The effect of prolonged treatment with the beta-blocker trimepranol on left-ventricular function was assessed in patients who survived myocardial infarction. Pulmonary arterial catheterization with a floating catheter was used for hemodynamic investigation. Hemodynamic parameters were compared in the treated (20 patients) and control (20 patients matched for age and infarction site) groups. The treated patients showed a reduction in heart rate and cardiac output at rest, as well as stress-induced elevation of the pulmonary arterial pressure and peripheral resistance. Patients with pulmonary hypertension often demonstrated changes of the pressure curve in the pulmonary artery as a possible manifestation of stress-induced mitral regurgitation. Prolonged treatment with trimepranol is associated with increased incidence of pulmonary hypertension in myocardial infarction survivers. The clinical significance of this observation is yet to be established by further studies. Stress-induced mitral regurgitation associated with a mitral subvalvular dysfunction may occasionally be the cause of elevated pulmonary blood pressure.

Cardiac Output↗

Pulmonary tumor embolism presenting as infarcts on computed tomography.

Pulmonary tumor embolism is a rare cause of respiratory failure in patients with cancer and is only infrequently diagnosed during life. Chest radiographs are usually normal. Dilated and beaded peripheral pulmonary arteries may be present on computed tomography scans. The authors describe an unusual case of pulmonary tumor embolism presenting on computed tomography scans as bilateral, peripheral, wedge-shaped opacities. On autopsy, these opacities corresponded to areas of pulmonary infarction.

Female↗

["Pericardial" friction rubs in pulmonary embolism (author's transl)].

In a series of sixty-five patients with pulmonary embolism, the main clinical feature was a systolic and diastolic friction rub in three cases. Such friction rubs are found in 1 to 5% of patients with pulmonary embolism. The characteristics of the rub are identical to those of pericardial friction rubs. According to some authors, a friction rub indicates massive pulmonary embolism. However, a friction rub may be found in less severe cases if embolization involves the paracardiac lobes or segments. The rub may be caused by one or the other of the following mechanisms. Severe pulmonary embolism or a free blood clot floating in the right atrium or ventricle may produce a sound resembling a friction rub. More often, a genuine pleuro-pericardial or pericardial friction rub originates in an inflammatory reaction to a contiguous pulmonary infarct. It is important to establish accurate diagnosis of pulmonary embolism in spite of a pericardial friction rub because of the therapeutic implications. Anticoagulant therapy in sufficient dosage must not be withheld in this situation.

Adult↗