Surgery in children with atrial septal defects without cardiac catheterization

We describe the results of surgical repair of atrial septal defects in 36 children who did not undergo pre-op cardiac catheterization. These cases were seen at the Hospital de Cardiologia y Neumología Dr. Luis Méndez del Centro Médico Nacional. There were 24 (67%) females and twelve (33%) males. The mean age was 6.4 +/- 2.4 years with a range from three to thirteen. All cases had auscultatory findings typical of atrial septal defect. Five patients with associated tricuspid murmur (chest film showed grade I cardiomegaly in 21 (58.3 per cent), grade II cardiomegaly in fifteen (41.7 percent). Pulmonary artery shadow was normal in 24 (66.6 percent) and increased in twelve (33.3%). Pulmonary blood flow was increased in all of them. Electrocardiogram showed sinus rhythm in 35 (97.2%). In one instance left atrial rhythm; all EKGs demonstrated right axis deviation, complete right bundle branch block and right ventricular hypertrophy with diastolic overload. Only three had right atrial hypertrophy. The M-mode echocardiogram showed right ventricular dilatation in all and paradoxically septal motion in 26 (72.2%). Two-dimensional echo with the subxiphoid view allowed direct visualization of the defect in all cases. We performed contrast echocardiogram in eight cases and Doppler echocardiogram in six of them. Cardiac surgery findings were ostium secundum atrial septal defect in 34 (94.4%). Two of them also had partial anomalous venous connection. All had uneventful recovery. We conclude that in typical atrial septal defects operative repair is feasible without prior cardiac catheterization.     

Echocardiographic and pulsed Doppler features in glycogen storage disease type II of the heart (Pompe's disease).

Two cases of cardiac glycogen storage disease type II are described: the first one, male aged 3 months, presented with generalized muscular hypotonia and decreased deep tendon reflexes; a 2/6 systolic murmur was audible at the left sternal border; chest X-ray and ECG were consistent with left ventricular hypertrophy; an echocardiogram disclosed an impressive and diffuse cardiac hypertrophy; the pump function appeared preserved and the estimated ejection fraction was about 70%. Pulsed wave Doppler demonstrated a normal envelope of mitral flow with E/A ratio = 1.27 in averaged 20 beats. The patient died suddenly at 6 months of age. The second patient was a female 4 months old with generalized muscular hypotonia. ECG and chest X-ray were consistent with left ventricular hypertrophy; 2D echocardiogram showed diffuse hypertrophy with estimated ejection fraction of 68% and an almost normal aspect of the mitral flow curve, with E/A ratio of 1.18. This child died at 13 months of age of cardiopulmonary insufficiency. In both cases the diagnosis was made by muscular biopsy and biochemical tests (alpha 1-4 glucosidase deficiency). We stress the fact that, despite the severe and diffuse hypertrophy, the pump function and the ventricular filling did not seem compromised.     

Hypertrophic myocardiopathy (II). 24-hour electrocardiographic monitoring and its relation to the echocardiographic characteristics

Seventy-two patients with hypertrophic cardiomyopathy were evaluated by 24 hours of electrocardiographic ambulatory monitoring. The results were related to echocardiographic extent of hypertrophy, left ventricular outflow obstruction at rest, and transmitral flow parameters. Also, the symptoms and functional classification of NYHA were related to ventricular arrhythmias. Ventricular arrhythmias were detected in 68% of our patients: high degree of ventricular ectopia in 26 (36.1%), and ventricular tachycardia in 14 (19.4%). Most important supraventricular arrhythmias were: atrial fibrillation in 7 patients, atrial flutter in one, and supraventricular tachycardia in five. Asymmetric hypertrophy type I of Maron classification showed the lower number of ventricular arrhythmias. High degree of ventricular arrhythmias were more frequent in patients with: apical hypertrophy, worse functional classification of NYHA (I: 20%; II: 50%; III: 80%), and in patients with impaired distensibility detected by Doppler (80.7% vs 56.7%; p less than 0.05). There was no relationship between left ventricular outflow obstruction at rest and ventricular arrhythmias.     

Surgical palliation of tricuspid atresia.

In the 20-year period ending December 31, 1973 we operated on 105 patients for palliation of tricuspid atresia (TA) with reduced pulmonary blood flow. Pott's anastomosis (85), Blalock-Taussig anastomosis (19), intrapericardial aorta (Ao)-to-right pulmonary artery (RPA) (18), Glenn procedure (3) and miscellaneous shunts (2) have been used. Of patients undergoing operation more than 15 years ago, 45% (9/20) are still alive. The over-all operative mortality was 9%. It was highest in patients less than one month of age (7/23, 30%). There were no operative deaths in patients older than 12 months. The median age at first operation for the entire series was five months. Our results indicate the Pott's anastomosis and Ao-to-RPA anastomosis are superior to the Blalock-Taussig anastomosis (BT) for palliation of TA. Of patients surviving BT, 69% (11/16) required reoperation, compared to 22% (17/78) surviving Pott's anastomosis and 13% (2/16) surviving Ao-to-RPA shunts. All three patients undergoing Glenn procedures (superior vena cava-to-RPA anastomosis) required reoperation or died without significant benefit. Ballon atrial septosomy and Pott's anastomosis appear to be indicated for infants less than six months of age, and Ao-to-RPA shunt with simultaneous atrial septectomy (if indicated) for older children.     

The Impact of Pulmonary Venous Hypertension on the Pulmonary Circulation in the Young

Objective and Design. Pulmonary venous hypertension is a well‐characterized cause of pulmonary hypertension in adults, but little is known regarding the relationship between left atrial pressure and pulmonary arteriolar resistance in the young. Also, in adults relief of pulmonary venous hypertension results in a marked fall in pulmonary arteriolar resistance, but this could be different in children because vascular changes are more severe in young patients than adults with mitral stenosis. We inspected records of children at Children's Hospital Boston having mitral balloon valvuloplasty, and patients ≤5 years old having mitral valve replacement, to determine (1) the relationship between left atrial pressure and pulmonary arterial pressure and resistance (n = 94 children, median age 17.8 months) and (2) how pulmonary arteriolar resistance changes after mitral valve replacement. Results. The average indexed pulmonary arteriolar resistance was 7.8 ± 5.9 units and was unrelated to age but was positively related to left atrial pressure. There was great variability in pulmonary arteriolar resistance for any given left atrial pressure. Pulmonary arterial pressure (n = 16) and pulmonary arterial resistance (n = 9) were measured before and after mitral valve replacement (median = 29.4 months old). Despite preoperative indexed pulmonary arterial resistance of ≥5 units in 11 of 15 patients, postoperative pulmonary arterial pressure was substantially lower in all save three, and two patients with high pulmonary arterial pressure still had high left atrial pressure postoperatively (25 mmHg). Conclusions. We conclude that in young children, as in adults, pulmonary arterial resistance generally falls greatly with reduction in left atrial pressure.     

Double inlet ventricle. Lung biopsy findings and implications for management

The lung was biopsied in 20 children with double inlet ventricle and pulmonary hypertension aged 2 months to 14 years. Eleven patients had two patent atrioventricular valves, three atresia of the right valve, and six hypoplasia of the left valve. Severe pulmonary arterial medial hypertrophy occurred in the nine children less than 1 year of age. The findings did not suggest a period of normality after birth when the pulmonary artery might have been banded most effectively. Of the 11 older patients, eight had medial hypertrophy and three intimal proliferation with medial atrophy. Six patients with medial hypertrophy had some reduction in pulmonary arterial pressure after banding. It is recommended that the pulmonary artery be banded as early as possible, and rebanded early if a satisfactory result is not obtained, particularly in patients destined for a Fontan-Kreutzer procedure. Early atrial septectomy should reduce the arterial and venous abnormalities seen in left atrioventricular valve hypoplasia.     

Double inlet ventricle. Lung biopsy findings and implications for management.

The lung was biopsied in 20 children with double inlet ventricle and pulmonary hypertension aged 2 months to 14 years. Eleven patients had two patent atrioventricular valves, three atresia of the right valve, and six hypoplasia of the left valve. Severe pulmonary arterial medial hypertrophy occurred in the nine children less than 1 year of age. The findings did not suggest a period of normality after birth when the pulmonary artery might have been banded most effectively. Of the 11 older patients, eight had medial hypertrophy and three intimal proliferation with medial atrophy. Six patients with medial hypertrophy had some reduction in pulmonary arterial pressure after banding. It is recommended that the pulmonary artery be banded as early as possible, and rebanded early if a satisfactory result is not obtained, particularly in patients destined for a Fontan-Kreutzer procedure. Early atrial septectomy should reduce the arterial and venous abnormalities seen in left atrioventricular valve hypoplasia.     

Sex Differences in the Hypertensive Population With Chronic Ischemic Heart Disease

Cardiopatía Isquémica Crónica e Hipertensión Arterial en la Práctica Clínica en España (CINHTIA) was a survey designed to assess the clinical management of hypertensive outpatients with chronic ischemic heart disease. Sex differences were examined. Blood pressures (BP) was considered controlled at levels of <140/90 or <130/80 mm Hg in diabetics (European Society of Hypertension/European Society of Cardiology 2003); low‐density lipoprotein cholesterol (LDL‐C) was considered controlled at levels <100 mg/dL (National Cholesterol Education Program Adult Treatment Panel III). In total, 2024 patients were included in the study. Women were older, with a higher body mass index and an increased prevalence of atrial fibrillation. Dyslipidemia, smoking, sedentary lifestyle, and peripheral arterial disease were more frequent in men. In contrast, diabetes, left ventricular hypertrophy, and heart failure were more common in women. BP and LDL‐C control rates, although poor in both groups, were better in men (44.9% vs 30.5%, P<.001 and 33.0% vs 25.0%, P<.001, respectively). Stress testing and coronary angiography were more frequently performed in men.     

Effect of age on coronary circulation after imposition of pressure-overload in rats.

We examined the effects of pressure overload on coronary circulation in young adult (7 months old) and old rats (18 months old). Four weeks after the ascending aorta was banded, in vivo left ventricular pressure was measured to estimate the degree of pressure load. In the two age groups, similar increases in peak left ventricular pressure were observed (113 +/- 7 mm Hg in sham-operated rats versus 160 +/- 11 mm Hg in banded rats of the young adult group; 103 +/- 7 mm Hg in sham-operated rats versus 156 +/- 11 mm Hg in banded rats of the old group). After isolating the hearts, they were perfused with Tyrode's solution containing bovine red blood cells and albumin. Resting coronary perfusion pressure-flow relations and reactive hyperemic response after a 40-second ischemia were obtained under beating but nonworking conditions. In young adult banded rats, significant myocardial hypertrophy was observed at the organ level (124% of controls in left ventricular dry weight/body weight ratio; 119% in left ventricular dry weight/tibial length ratio) and at the cell level. Minimal coronary vascular resistance obtained by the perfusion pressure-peak flow relation during reactive hyperemia increased to 150% of controls, and coronary flow reserve decreased significantly. In contrast, myocardial hypertrophy was not observed at the organ or cell level in old banded rats. However, minimal coronary vascular resistance increased, and flow reserve decreased significantly. Thus, pressure overload with coronary arterial hypertension caused abnormalities of the coronary circulation in old subjects even in the absence of myocardial hypertrophy.     

血管紧张素Ⅱ受体拮抗剂对原发性高血压患者左心室肥厚和舒张功能的影响

目的　应用超声心动图评价血管紧张素 1型受体 ( AT1 )拮抗剂对原发性高血压患者左心室肥厚和舒张功能的影响。方法　分别于 AT1 拮抗剂 (氯沙坦 )治疗前和治疗 6个月后 ,对 3 0例原发性高血压患者进行超声心动图检查。 M型超声心动图测量舒张末期左心室内径、室间隔和左心室后壁厚度 ,计算左心室重量指数 ;在心尖左心长轴切面上 ,用多普勒超声心动图测量二尖瓣口舒张早期峰值速度 E、舒张晚期峰值速度 A和 E峰减速时间 ,并计算E/A比值。结果　氯沙坦治疗 6个月后 ,左心室重量指数从 12 4± 2 1g/m2减低为 10 2± 2 2 g/m2 ( P<0 .0 0 1) ;E/A比值 ( 1.2 5± 0 .2 7)明显高于服用前 ( 0 .94± 0 .2 6,P<0 .0 0 1) ,E峰减速时间从 2 2 1± 3 2 ms下降到 180± 2 7ms( P<0 .0 0 1)。结论　 AT1 拮抗剂氯沙坦治疗 6个月使原发性高血压患者左心室肥厚得到消退 ,并改善了其舒张功能     

Left atrial systolic force in hypertensive patients with left ventricular hypertrophy: the LIFE study

In hypertensive patients without prevalent cardiovascular disease, enhanced left atrial systolic force is associated with left ventricular hypertrophy and increased preload. It also predicts cardiovascular events in a population with high prevalence of obesity. Relations between left atrial systolic force and left ventricular geometry and function have not been investigated in high-risk hypertrophic hypertensive patients. Participants in the Losartan Intervention For Endpoint reduction in hypertension echocardiography substudy without prevalent cardiovascular disease or atrial fibrillation (n = 567) underwent standard Doppler echocardiography. Left atrial systolic force was obtained from the mitral orifice area and Doppler mitral peak A velocity. Patients were divided into groups with normal or increased left atrial systolic force (>14.33 kdyn). Left atrial systolic force was high in 297 patients (52.3%), who were older and had higher body mass index and heart rate (all P < 0.01) but similar systolic and diastolic blood pressure, in comparison with patients with normal left atrial systolic force. After controlling for confounders, increased left atrial systolic force was associated with larger left ventricular diameter and higher left ventricular mass index (both P < 0.01). Prevalence of left ventricular hypertrophy was greater (84 vs. 64%; P < 0.001). Participants with increased left atrial systolic force exhibited normal ejection fraction; higher stroke volume, cardiac output, transmitral peak E velocities and peak A velocities; and lower E/A ratio (all P < 0.01). Enhanced left atrial systolic force identifies hypertensive patients with greater left ventricular mass and prevalence of left ventricular hypertrophy, but normal left ventricular chamber systolic function with increased transmitral flow gradient occurring during early filling, consistent with increased preload.     

Relation between echocardiographically determined left atrial size and atrial fibrillation.

In an attempt to define quantitatively the relation between left atrial size and atrial fibrillation, echocardiography was used to study 85 patients with isolated mitral valve disease, 50 patients with isolated aortic valve disease, and 130 patients with asymmetric septal hypertrophy. In all three groups of patients, atrial fibrillation was rare when left atrial dimension was below 44 mm (3 of 117 or 3%) but common when this dimension exceeded 40 mm (80 of 148 or 54%). In addition, when left atrial dimension exceeds 45 mm, cardioversion, while initially successful, is unlikely to produce sinus rhythm that can be maintained at least six months. These data suggest that left atrial size is an important factor in the development of atrial fibrillation and in determining the long term result of cardioversion. The pathophysiologic mechansim most consistent with this is that a chronic hemodynamic burden initially produces left atrial enlargement which in turn predisposes to atrial fibrillation. Only prospective studies will determine definitively whether these observations will be useful in decisions concerning prophylactic anticoagulation and elective cardioversion.     

高血压病心律失常发生机制的临床分析

目的分析高血压病心律失常的发生机制。方法对100例高血压病患者和20例健康者的超声心动图、24小时动态心电图和临床资料进行比较。结果(1)高血压病患者的左心房(左房)增大,并随年龄增大,高血压病史延长,左房扩大越明显,发生严重房性心律失常几率也越高。高龄组发生持续性房颤为30.77%,显著高于其他年龄组。(2)室性心律失常发生率为36%(36例),房性心律失常发生率为85%(85例)。(3)多元回归分析显示:高血压病患者房性心律失常的发生与左房的大小、二尖瓣返流、左室大小以及左室质量指数相关,尤其与左房大小的相关性更明显,室性心律失常与左房、二尖瓣返流、主动脉瓣返流、左室质量指数相关性不显著,而与左室腔大小相关。结论(1)年龄、高血压病史、左房大小是影响高血压房性心律失常的重要因素,二尖瓣返流、左室增大、左室质量指数增高也与发生房性心律失常相关。(2)高血压患者室性心律失常发生率低于房性心律失常,高血压离心性心脏扩大比向心性肥厚更容易发生室性心律失常。     

完全性肺静脉异位引流患儿临床及尸检分析

目的 :探讨儿童完全性肺静脉异位引流 (TAPVC)的临床及尸检特征性改变。方法 :回顾性总结我院 1980～ 2 0 0 0年间收治的 2 3例TAPVC患儿的临床表现、心电图、胸片、心脏超声、心导管检查、手术及尸检资料。结果 :2 3例TAPVC患儿中属心上型 17例 (占 74 % ) ,心内型 6例 (占 2 6 % ) ,其中伴有动脉导管未闭 (PDA) 6例 ,房间隔缺损 (ASD) 11例 ,卵圆孔未闭 5例 ,室间隔缺损 (VSD) 2例 ,二尖瓣发育不良 1例。 2 3例患儿中 5例经内科保守治疗后好转出院 ,4例放弃治疗 ;3例施行纠治术 ,2例痊愈出院 ,1例死亡 ;死亡 12例 (5 2 % ) ,年龄均 <6个月 ,其中 10例尸检年龄为 2 4d～ 4个月 ,均发现有肺静脉梗阻性病变。结论 :TAPVC在先心病中并不少见 ,常伴发一些临床综合征及其他心脏畸形 ,大多在婴幼儿即有症状 ,本组病例中 5 2 %死于 6个月以内 ,特别是患肺血管梗阻性病变者 ,多于数日或 3～ 4个月内死亡 ,极易误诊为新生儿肺炎 ,尸检中才得以证实。心脏超声、心导管及选择性心血管造影术是常用的有效确诊手段     

Doppler echocardiographic evaluation of pulmonary artery flow after modified Fontan operation: importance of atrial contraction

Doppler echocardiography was used to evaluate blood flow in the pulmonary artery in 14 patients 2 to 42 months (mean (SD) 17 (12) months) after a modified Fontan operation incorporating a direct atriopulmonary anastomosis. Preoperatively six patients had tricuspid atresia, six had a double inlet left ventricle, and two had pulmonary atresia with an intact ventricular septum. The postoperative rhythm was sinus in 11 patients, junctional in one, ventricular pacing in one, and atrioventricular sequential pacing in one. In one patient the Doppler trace was unsatisfactory for analysis. In all patients forward flow in the pulmonary artery had biphasic peaks related to both atrial and ventricular contraction. The mean (SD) peak flow velocity that was synchronous with atrial contraction was 80 (30) cm/s and that synchronous with ventricular contraction was 74 (23) cm/s. The atrial contribution to total pulmonary artery flow, assessed by velocity-time integrals, varied between 22% and 73% (mean (SD) 45 (14)%). In patients with tricuspid atresia the mean (SD) peak flow velocity with atrial contraction was 90 (27) cm/s and that with ventricular contraction was mean (SD) 68 (24) cm/s. In patients with double inlet left ventricle the mean (SD) peak flow velocity was 67 (36) cm/s with atrial contraction and 80 (25) cm/s with ventricular contraction. The atrial contribution to total pulmonary blood flow in patients with tricuspid atresia was significantly higher (53 (11)%) than in those with double inlet left ventricle (37 (14)%). Pulmonary artery flow after modified Fontan operation was biphasic and was related to both atrial and ventricular contraction. The atrial contribution to pulmonary blood flow is greater in patients with tricuspid atresia than in those with a double inlet left ventricle. The mechanism of the second peak related to ventricular contraction is unknown.     

Radiofrequency ablation in auricular flutter. Predictive factors of primary success and medium term results

Ninety-one consecutive patients underwent radiofrequency ablation of chronic or paroxysmal atrial flutter. The average age of the patients was 66. There was a previous history of atrial fibrillation in 38% of cases and of cardiac surgery in 14.3% of cases. The primary success rate was 79% (92% in cases of common flutter). The predictive factors of success were the type of flutter (p < 0.001), left ventricular (p < 0.01) and left atrial dimensions (p < 0.01) at echocardiography. The length of the cavo-tricuspid isthmus measured by echocardiography had no influence on the initial result but, in primary success, did affect the parameters of the procedure (duration and number of applications of radiofrequency energy). After an average of 11 +/- 2 months, sinus rhythm was maintained in 67% of patients. There were recurrences of flutter in 27.5% of cases and of atrial fibrillation in 5.5% of cases: 85% of these episodes occurred during the first six months after ablation. A second procedure was carried out in 12 patients for recurrence of flutter (92% primary success rate). After an average follow-up of 8.4 months, 4 patients had a recurrence and required a third procedure (100% success rate). In cases of failure of ablation, the rhythm was converted by a shock or atrial pacing: 47.3% of these patients remained in sinus rhythm with antiarrhythmic therapy with a 12 month follow-up. Radiofrequency ablation of atrial flutter is, therefore, a safe method, the difficulty of which is mainly related to anatomical factors: the medium-term results are better than those of other therapeutic methods.     

Doppler echocardiographic evaluation of pulmonary artery flow after modified Fontan operation: importance of atrial contraction.

Doppler echocardiography was used to evaluate blood flow in the pulmonary artery in 14 patients 2 to 42 months (mean (SD) 17 (12) months) after a modified Fontan operation incorporating a direct atriopulmonary anastomosis. Preoperatively six patients had tricuspid atresia, six had a double inlet left ventricle, and two had pulmonary atresia with an intact ventricular septum. The postoperative rhythm was sinus in 11 patients, junctional in one, ventricular pacing in one, and atrioventricular sequential pacing in one. In one patient the Doppler trace was unsatisfactory for analysis. In all patients forward flow in the pulmonary artery had biphasic peaks related to both atrial and ventricular contraction. The mean (SD) peak flow velocity that was synchronous with atrial contraction was 80 (30) cm/s and that synchronous with ventricular contraction was 74 (23) cm/s. The atrial contribution to total pulmonary artery flow, assessed by velocity-time integrals, varied between 22% and 73% (mean (SD) 45 (14)%). In patients with tricuspid atresia the mean (SD) peak flow velocity with atrial contraction was 90 (27) cm/s and that with ventricular contraction was mean (SD) 68 (24) cm/s. In patients with double inlet left ventricle the mean (SD) peak flow velocity was 67 (36) cm/s with atrial contraction and 80 (25) cm/s with ventricular contraction. The atrial contribution to total pulmonary blood flow in patients with tricuspid atresia was significantly higher (53 (11)%) than in those with double inlet left ventricle (37 (14)%). Pulmonary artery flow after modified Fontan operation was biphasic and was related to both atrial and ventricular contraction. The atrial contribution to pulmonary blood flow is greater in patients with tricuspid atresia than in those with a double inlet left ventricle. The mechanism of the second peak related to ventricular contraction is unknown.     

Correlates of left atrial size in hypertensive patients with left ventricular hypertrophy: the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study

Left ventricular hypertrophy has been suggested to mediate the relation between hypertension and left atrial enlargement, with associated risks of atrial fibrillation and stroke. However, less is known about correlates of left atrial size in hypertensive patients with left ventricular hypertrophy. We assessed left atrial size by echocardiography in 941 hypertensive patients, age 55 to 80 (mean, 66) years, with electrocardiographic left ventricular hypertrophy at baseline in the Losartan Intervention For Endpoint reduction in hypertension study. Enlarged left atrial diameter (women, >3.8 cm; men, >4.2 cm) was present in 56% of women and 38% of men (P<0.01). Compared with the 512 patients with normal left atrial size, the 429 patients with enlarged left atrium more often had mitral regurgitation, atrial fibrillation, and echocardiographic left ventricular hypertrophy. They also had higher age, systolic blood pressure, pulse pressure, weight, body mass index, left ventricular internal chamber dimension, stroke volume, and mass and lower relative wall thickness and ejection fraction (all, P<0.05). In logistic regression analysis, left atrial enlargement was related to left ventricular hypertrophy and eccentric geometry; greater body mass index, systolic blood pressure, and age; female gender; mitral regurgitation; and atrial fibrillation (all, P<0.05). Thus, left atrial size in hypertensive patients with electrocardiographic left ventricular hypertrophy is influenced by gender, age, obesity, systolic blood pressure, and left ventricular geometry independently of left ventricular mass and presence of mitral regurgitation or atrial fibrillation.     

The heart and ankylosing spondylitis

We studied 40 consecutive patients with Ankylosing Spondylitis from the cardiological point of view through non-invasive methods. Fourteen (35%) patients had some kind of cardiovascular complication as shown by any of the used methods. a) Symptoms: fifteen (37.5%) refered nonspecific chest pain, five (12.5%) dyspnea on exertion and four (10%) frecuent palpitations. b) Physical Examination: two patients (5%) had aortic regurgitation and two (5%) mitral valve disease. c) Electrocardiogram: in seven (17.5%), left ventricular hypertrophy was detected, in two (5%) left atrial hypertrophy and in seven (17.5%) some type of conduction disturbance. d) Chest X Ray: six (15%) had left ventricular hypertrophy, one (2.5%) left atrial hypertrophy and two (5%) dilated ascending aorta. e) Echocardiogram: two cases (5%) had aortic dilatation and other two (5%), mitral valve disease. In three patients (7.5%) pericardial effusion was found, which in our series, it is more frecuent than has been reported up until now in the literature.     

Physiological hypertrophy of the heart and atrial natriuretic peptide during rest and exercise

The influence of physiological cardiac hypertrophy on the concentration of plasma atrial natriuretic peptide was studied in six male athletes and six normally active, matched control men. They were examined by echocardiography during a graded exercise test on a bicycle ergometer. Plasma atrial natriuretic peptide was measured at rest, at each workload until exhaustion, and 15 and 30 minutes after the exercise test. Echocardiography showed that the athletes had a significantly larger left atrium, left ventricular end diastolic diameter, left ventricular posterior wall, interventricular septum, left ventricular ejection fraction, and left ventricular mass than the controls. The athletes performed significantly more work than the control group--325 W v 277 W. The plasma concentration of atrial natriuretic peptide rose by a mean factor of 2.76 (range 1.78-4.28) in all men from rest to maximum exercise. There were no differences between the athletes and the controls in the concentrations of plasma atrial natriuretic peptide at rest, at any workload, or at maximum workload. Neither was there any difference in the increase in plasma atrial natriuretic peptide between the groups. There was no correlation between the plasma concentrations of atrial natriuretic peptide and any of the variables measured by echocardiography. In healthy young men plasma atrial natriuretic peptide rises by a factor of about 2.8 during maximum exercise and the size of the chambers on the left side of the heart or left ventricular hypertrophy does not seem to influence the concentration of plasma atrial natriuretic peptide at rest or during exercise.