[Principal criteria for interpretation and evaluation of coronary arteriography].
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In 120 P. with ischemic heart disease, left ventricolar wall motion was analyzed from the left ventriculogram in a regular sinus beat as compared to the first beat following one or more premature ventricular contractions (PExP). The response of asynergic segment to PExP was determined with a qualitative as wall as a quantitative technique. Of a total of 225 asynergic segments, 62% showed a positive response to PExP. In the absence of pathologic Q waves in the electrocardiogram, the response was positive in 77% and negative in 23% of the cases. In the presence of Q waves, PExP was present only in 33% of the cases (p less than 0.001). In respect to the severity of asynergy, 68% of 145 hypokinetic segments and 52% of 80 akinetic-dyskinetic segments responded to PExP; in the presence of pathologic Q waves, the number of positive responses decreased to 36% in the case of segmental hypokinesis, and to 31% in the case of more severe asynergy. The study of PExP has appeared as an useful diagnostic technique, capable of detecting a residual myocardial function in left ventricular asynergic segments, even in the presence of electrocardiographic signs of infarction.
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The case is presented of a 31 year old man with anteroseptal myocardial infarction, whose chest X-ray showed an anomalous protrusion along the left cardiac border. After 6 months, the increase in size of such protrusion lead to left ventriculographic and coronariographic examination: the presence of a large nonfistulous bisaccular coronary aneurysm was documented along the anterior descending branch of the left coronary artery. Cardiac surgery consisted in resection of the coronary aneurysm and of the left ventricular post-infarction area, and was followed by good surgical and angiocardiographic result. Histological examination showed the wall of the coronary aneurysm to be composed of collagenous bands in the absence of elastic components, with hemosiderin and fibrino-hematic deposits and scattered granulocytic infiltrates. An infective etiology is hypothesized for the coronary parietal lesion, leading to a coronary pseudo-aneurysm an subsequent myocardial infarction.
An invasive (left ventricular pressure recording) and a noninvasive technique (M-mode echocardiography) were combined during the hemodynamic study of 15 patients with various degrees of left ventricular impairment, in order to provide left ventricular function parameters independent from contrast studies. Left ventricular pressure, dimension and wall thickness changes were continuously digitized on a computer system, which was able to derive the ventricular pressure-dimension loop and to calculate the midwall equatorial stress at end-diastole and peak-systole. The parameters derived from the loop (diastolic work, net systolic work, cycle efficiency) and midwall meridional and circumferential stresses were compared with the results of contrast ventriculography and with the wall hypertrophy index. Diastolic work appeared to be correlated with the systo-diastolic volume change; systolic work correlated with the ejection fraction; the cycle efficiency was inversely correlated with both end-diastolic and end-systolic volumes and directly correlated with the hypertrophy index. Midwall stress, both end-diastolic and peak-systolic, was strongly and positively correlated with ventricular volumes, while it decreased with increasing hypertrophy. Systolic stress increased with decreasing ejection fraction. The combined echo-pressure technique, through the evaluation of the pressure-dimension loop and the calculation of wall stress, can generate data of left ventricular function that allow a more complete assessment of left ventricular impairment.
A computer program is presented apt to be run on a personal computer. The program allows a computer-guided cardiological examination of standard quality, permits a rapid recall of patients data and makes it possible to obtain statistical analyses.
A case of cardiac amyloidosis is described in which clinical and scintigraphic findings were those of ischemic heart disease. Electrocardiogram disclosed low voltages in the peripheral leads and a pattern of anterior pseudo-myocardial infarction. 2D-echocardiography showed thickened cardiac walls and a "granular sparkling" appearance of the septum. The curve of the left ventricular diastolic pressure suggested impaired ventricular relaxation without a true dip-plateau morphology. Stains for amyloid of rectal biopsy specimens were negative. Histological study of left ventricular endomyocardial biopsy indicated the presence of basophilic material among the myocytes; at ultrastructural examination this infiltrating substance resulted to be amyloid. This case stresses the effectiveness of ultrastructural investigation of left ventricular endomyocardial biopsy in the diagnosis of infiltrative and/or metabolic cardiac disorders.
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Ten patients with angiocardiographic and hemodynamic evidence of discrete subvalvular aortic stenosis were examined by M-mode-echocardiography. Different echocardiographic patterns were identified: the most frequent appeared an abnormal systolic movement of aortic valve leaflets, less frequently a discrete linear echo was observed in the outflow tract of the left ventricle; in one case the echocardiogram showed no abnormality of the left ventricular outflow tract or aortic valve morphology. In half of the cases the left ventricular outflow tract was narrowed. No correlation was found between echocardiographic measurements and severity of the subaortic lesion, as expressed by peak systolic pressure difference between the left ventricle and the aorta. It is concluded that M-mode-echocardiography: - may furnish helpful criteria in the diagnosis of discrete subaortic stenosis, but the absence of such criteria does not allow to exclude the existence of the malformation; - is not quantitatively useful in the assessment of subaortic stenosis.
The AA. relate the results of an echocardiographic study carried out on some patients with mitral stenosis associated or not with mitral regurgitation or with other valvular disease. Ten patients who had to undergo to surgical commissurotomy, were studied before and in the early post-operative period. The M-mode echocardiography appeared to be always available to diagnose the mitral stenosis, but not to quantify it. On the other side the two dimensional echocardiography is proven to be a useful method in the quantitative study of the mitral area and particularly when it is applied in the evaluation of the surgical results of comparing the pre and post-operative examinations. The data obtained were analysed with statistical method.
The case is presented by a 54 year-old woman, studied because of a clinical diagnosis of mitral valve disease, in which echocardiographic and angiocardiographic examination afforded the diagnosis of left atrial tumor. The surgical finding was of a large myxoma implanted on the atrial septum and prolapsing into the mitral opening and engaging with a branch into an atrial septal defect of the cavalis superior type. Some considerations are made on the times of possible origin and growth of the tumor; the complete absence of the increased pulmonary flow in the presence of a large interatrial communication suggested an early beginning of the tumor that, obstructing the defect, might have hindered the hemodynamic derangement.
The echocardiographic features of a case of postinfarction pseudoaneurysm of the left ventricle are described. M-mode echocardiography displayed an echo-free space behind the posterior left ventricular wall and two-dimensional echocardiography defined the saccular contour of the pseudoaneurysm and its probable communication with the ventricular cavity. A second echocardiographic examination--a week later--revealed a marked enlargement of the pseudoaneurysm and a characteristic fast backward early systolic motion of the ventricular wall interposed between left ventricular cavity and the saccular aneurysm; this motion is interpreted as a passive displacement of the ruptured wall during ventricular systole, and allows a differential diagnosis with similar echocardiographic M-mode aspects, due to pericardial effusion, pleural effusion or pericardial cysts. Echocardiography findings were confirmed by angiocardiography and the surgery. Echocardiography seems to be a safe method for early non-invasive diagnosis of left ventricular pseudoaneurysm.
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