New approach in treatment of cardiac decompensation in U. S. S. R.

Based on Meerson's fundamental work^3,4 on the genesis of ventricular hypertrophy and decompensation, Russian investigators supplemented the conventional therapy of cardiac decompensation with preparations related to the synthesis of protein and nucleic acids. The merit of the supplemental treatment was shown in the clinical course as well as in various objective criteria (blood chemistry, hemodynamics, systolic parameters, ECG). The reported results are highly significant and their method merits trial in other centers.     

Traumatic aneurysm of left anterior descending coronary artery with fistulous opening into left ventricle and left ventricular aneurysm after stab wound of chest: Report of case with successful surgical repair

A patient survived a stab wound of the heart, and an aneurysm of the left anterior descending coronary artery developed with a fistulous communication into the left ventricle and a postinfarction ventricular aneurysm. All lesions were successfully repaired by surgery 4 years later. Preoperatively the patient suffered from angina pectoris presumably due to a coronary arterial “steal syndrome” and recurrent myocardial infarction presumably due to coronary embolism from thrombi formed within the coronary aneurysm. The combination of a coronary arterial aneurysm and a coronary arterial-left ventricular fistula produced a diastolic murmur that disappeared after surgery.     

Repair of mitral regurgitation: An 11 year experience

One hundred thirty-three patients who underwent measured asymmetric annuloplasty for mitral regurgitation have been followed up for up to 11 years. The procedure has a very small operative risk and, for patients with rheumatic heart disease, a very low late mortality and morbidity rate. Early good results have been sustained for this follow-up period. Late breakdown of the repair has not been seen after 3 years unless infection or recurrent rheumatic fever intervened, nor has significant late stenosis been seen as a result of measured annuloplasty. These findings suggest that when the valve is repaired by this technique, competency is assured and an adequate orifice results.     

Digoxin disposition in obesity: Clinical pharmacokinetic investigation

Olgoxin pharmacokinetics were studied in 16 obese (mean ± SD weight, 100.2 ± 36.8 kg) and 13 control (64.6 ± 10.5 kg) subjects. all subjects had normal renal function and no other coexisting disease. After administration of 0.75 mg digoxin by intravenous intusion, multiple plasma samples obtained over the 96 hours following infusion were analyzed for digoxin concentration by radloimmunoassay. Pharmacokinetic parameters were determined by weighted iterative nonlinear least squares regression analysis. Elimination half-life ($\text{t}\text{1}\text{2}$) was not different between obese and control groups (35.6 ± 10.5 vs 41.2 ± 16.7 hours). Absolute volume of distribution (Vd) also was not different (981 ± 301 vs 937 ± 397 liters), nor was total clearance of digoxin (328 ± 82 vs 278 ± 87 ml/min). Elimination $\text{t}\text{1}\text{2}$ was significantly negatively correlated with clearance among all subjects (r = ?0.46; p < 0.01). Using percent ideal body weight (IBW) as a measure of obesity, no correlation was found between percent IBW and Vd (r = 0.03). Thus digoxin is simllarly distributed into IBW in obese and normal weight subjects, and there is no significant distribution of digoxin into excese body weight over IBW. In addition, there is no difference in total metabolic clearance or elimination half-life between obese and control subjects. Digoxin loading and maintenance dosage should be calculated on the basis of IBW, which reflects lean body mass, rather than TBW, which reflects adipose tissue weight in addition to lean body mass.     

Two-dimensional echocardiographic evaluation of discrete subaortic stenosis from the apical long axis view

M-mode and standard two-dimensional (2DE) left parasternal long axis echocardiographic examination of the left ventricular outflow tract (LVOT) was evaluated exclusively with respect to its utility in identifying discrete subaortic stenosis (SUB-AS). Important details of the anatomy of the subaortic area may also be obtained from 2DE apical long axis imaging. Accordingly, 18 patients with discrete SUB-AS were prospectively evaluated by M-mode and 2DE. The M-mode findings included narrowing of the LVOT and early systolic closure of the aortic valve. However, these findings were variable and highly dependent upon scan speed, fluid flow dynamics, and beam angulation. 2DE findings varied using the standard long axis view at the left parasternal border, depending upon the type of obstruction present. A discrete membrane produced linear echoes adjacent and parallel to the interventricular septum beneath the aortic valve. Fibromuscular obstruction produced a localized dense ridge of echoes in the LVOT. These findings were not apparent in five patients studied. In these patients, the 2DE apical long axis view was employed to image the subaortic area. From this tomographic crosssection a fibrous membrane was imaged as a linear echo parallel to the aortic valve. The membrane extended across the LVOT from the ventricular septum to the anterior leaflet of the mitral valve. The 2DE apical long axis view therefore provides an additional approach in the evaluation of patients with discrete SUB-AS.     

Torsade de pointes ventricular tachycardia a complication of disopyramide shared with quinidine

Two cases of documented torsade de pointes ventricular tachycardia in association with the use of disopyramide are described. One patient had previously experienced an episode suggestive of quinidine induced ventricular tachycardia while the other developed ventricular tachycardia during quinidine treatment which was later exacerbated and sustained by the administration of disopyramide. Both patients exhibited as prolonged QTc or QUc interval at the time of the arrhythmia. These cases suggest that a propensity to ventricular arrhythmias induced by quinidine may identify individuals who are likely to develop similar arrhythmias during disopyramide treatment as well.     

Tissue expander-stimulated lengthening of arteries for the treatment of midaortic syndrome in children

Background

Midaortic syndrome (MAS) is a rare condition characterized by stenosis of the abdominal aorta. Patients with disease refractory to medical management will usually require either endovascular therapy or surgery with use of prosthetic graft material for bypass or patch angioplasty. We report our early experience with a novel approach using a tissue expander (TE) to lengthen the normal native arteries in children with MAS, allowing primary aortic repair without the need for prosthetic graft material.

Outcomes of preinjury anticoagulation in patients with traumatic rib fractures

Background

Anticoagulant and antiplatelet agents (ACAP) have been shown to negatively affect trauma patients.