Severity of mitral regurgitation assessed by echocardiography. Reliability and limitations

To assess whether echocardiography may represent a useful mean to evaluate the degree mitral regurgitation (DR), left ventricular diastolic internal dimension (LVIDd), left atrial dimension (LAD), and velocity of circumferential fiber shortening (Vcf) were compared to DR assessed by left ventriculography in 48 patients with primary (n = 21) and cardiomyopathic (n = 27) valvular incompetence. In patients with good left ventricular contractility, i.e. with Vcf values above 1.02, a significant positive linear correlation was found between LVIDd and DR (LVIDd = 5.38 + 0.45DR; r = 0.72; p less than 0.001). In contrast, in patients with depressed left ventricular function, i.e. with Vcf values below 1.02, LVIDd did not correlate to DR. In either group LAD and Vcf did not correlate to DR. Thus, echocardiography may provide useful semiquantitative information concerning DR only in patients with preserved left ventricular performance.     

Ruptured abdominal aortic aneurysm. Treatment and review of eighty-seven patients

Between 1954 and 1973 at the Texas Heart Institute, eighty-seven patients underwent operation for resection of ruptured abdominal aortic aneurysms. Included in this series were eighty-one men and six women who ranged in age from forty-four to eighty-four years. Hospital mortality, including intra- and postoperative mortality (within thirty days of operation), was 21 per cent. Mortality for men was 19.8 per cent and for women, 33.3 per cent.The lower mortality indicates that abdominal aortic aneurysms should be excised electively. When rupture does occur, aggressive surgical treatment can produce gratifying results.     

Intracardiac repair of isolated ventricular septal defects below two years of age.

Experience with closure of ventricular septal defect in 32 patients under two years is presented. Indications for correction were: (a) intractable heart failure; (b) persistence of progression of pulmonary artery hypertension; (c) failure of pulmonary artery banding; (d) elective closure after banding. In all but one case, the correction was done under the surface induced deep hypothermia with limited cardiopulmonary bypass and total circulatory arrest. Mortality and morbidity of the pulmonary artery banding procedure and of early closure discussed. For the corrective procedure the mortality was 3%. It is emphasized that whenever clinical or hemodynamic data support persistence or progression of pulmonary artery hypertension, corrective repair should be performed without delay. It is further suggested that pulmonary artery banding should be restricted to patients with ventricular septal defect and associated coarctation of the aorta and to patients with multiple muscular ventricular septal defects.     

Effects of A1 adenosine receptor blockade by bamiphylline on ischaemic preconditioning during coronary angioplasty

OBJECTIVE: The role of A₁ adenosine receptors in preconditioning in humansis unknown. To establish whether bamiphylline, a selective antagonistof A₁ adenosine receptors, abolishes ischaemic preconditioningin man, 36 consecutive patients undergoing single-vessel coronaryangioplasty were randomized to receive intravenous infusionof bamiphylline (5 mg. kg^–1)or placebo (0·9% NaCl)immediately prior to the procedure. DESIGN: The mean values (±1 SD) of ST segment shifts on the surfaceand intracoronary electrocardiograms were measured at the endof the first and second balloon inflations, both 2 min long.The severity of cardiac pain was obtained at the same time usinga visual analogue scale. RESULTS: In bamiphylline-treated patients, the mean ST segment shiftand the severity of cardiac pain during the second inflationwere similar to those during the first inflation (14±15vs 16±16mm, ns and 31±28 vs 31± 29, ns,respectively). Conversely, in placebo-treated patients boththe mean ST segment shift and the severity of cardiac pain duringthe second inflation were significantly less than those duringthe first inflation (10±6 vs 17±7mm, P<0·001and 25±21 vs 39±31mm, P<0·01, respectively).Thus, bamiphylline abolishes ischaemic preconditioning observedin man during repeated coronary balloon inflations. CONCLUSION: These results suggest that, in this setting, ischaemic preconditioningis mediated, at least in part, by A adenosine receptors.     

Cellular adhesion molecules and peripheral arterial disease

Cellular adhesion molecules (CAMs), by mediating the recruitment of circulating leukocytes to the blood vessel wall and their subsequent migration into the subendothelial spaces, play a crucial role in all stages of atherosclerosis. Soluble forms of CAMs, probably derived from proteolytic shedding, are present in the circulation and their blood levels parallel the amount expressed on the cell surface. In patients with peripheral arterial disease (PAD), increased levels of soluble CAMs have been found during exercise-induced claudication, are associated with the presence, the severity and the extent of atherosclerosis in the arteries of the lower limbs, and portend a worse outcome. These findings have provided new insights into the pathophysiology of PAD and its consequences. However, further large population studies are needed to firmly establish whether increased levels of circulating CAMs give additive information to current risk assessment approaches, and to verify whether PAD patients with elevated levels of circulating CAMs would benefit from any specific therapy.