M- mode echocardiographic features of severe aortic valve endocarditis

We describe and discuss the M-mode echocardiographic featuresin 10 patients with infective endocarditis of the aortic valverequiring surgery. Operative findings and aortic valve histologywere obtained in each case. Vegetations were visualized in sixout of seven patients (86%) with proven vegetations while pre-existingaortic valve disease masked their echocardiographic recognitionin one patient. Diastolic echoes indistinguishable from vegetationswere recorded from the ragged edge of a perforated aortic cuspin one patient who at operation had no demonstrable vegetations.Left, ventricular outflow tract (LVOT) echoes were seen in fivepatients. Non-vibrating LVOT echoes were identified as vegetationswhile rapidly vibrating LVOT echoes were recorded from a flailaortic cusp. Premature mitral valve closure (PMVC) was seenin five out of seven patients (70%) with a short (< fourmonth) history of severe aortic re gurgitation. Subannular aneurysmswere detected in three out of five patients (60%) with thiscomplication. Increased septal and left ventricular posteriorwall motion suggestive of severe aortic regurgitation was seenin each case. The detection of a flail aortic valve leaflet, PMVC and subannularaneurysms indicates the need for surgery. The demonstrationof vegetations defines a further subgroup of patients who shouldbe managed in a centre with facilities for cardiac surgery.Echocardiography obviated the need for pre-operative cardiaccatheterization in nine out of 10 patients (90%).     

AA genotype of IL‐8 −251A/T is associated with low PaO2/FiO2 in critically ill patients and with increased IL‐8 expression

Background and Objective: Interleukin‐8 (IL‐8) is a central chemokine in acute respiratory distress syndrome (ARDS), and the IL‐8 gene contains a functional single nucleotide polymorphism (SNP) ?251A/T in its promoter region. We hypothesized that IL‐8 ?251A/T SNP is associated with PaO₂/FiO₂ in critically ill patients. Methods: We conducted genetic‐association studies in intensive care units at academic teaching centres using a derivation septic shock cohort (vasopressin and septic shock trial (VASST), n = 467) and a validation post‐cardiopulmonary bypass surgery cohort (CPB, n = 739) of Caucasian patients. Patients in both cohorts were genotyped for IL‐8 ?251A/T. The primary outcome variable in both cohorts was the fraction of patients who had a PaO₂/FiO₂ < 200. IL‐8 mRNA expression was measured in genotyped lymphoblastoid cells in vitro. Results: The frequency of the patients with PaO₂/FiO₂ <200 was significantly greater in patients who had the AA genotype of ?251A/T than in patients who had the AT or TT genotypes in both VASST (AA = 60.8% vs AT and TT = 53.8% and 48.0%, P = 0.038) and the CPB cohort (AA = 37.0% vs AT and TT = 27.0% and 26.0%, P = 0.039). Patients having the AA genotype had a higher probability to remain on mechanical ventilation (P = 0.047) in the first 14 days. Lymphoblastoid cells having the AA genotype had significantly higher IL‐8 mRNA expression than cells having the AT or TT genotype (P = 0.022). Conclusions: Critically ill Caucasian patients who had the AA genotype of IL‐8 ?251A/T had an increased risk of PaO₂/FiO₂ <200. The AA genotype was associated with greater IL‐8 mRNA expression than the AT or TT genotypes.     

The effect of beta2adrenergic blockade on serum potassium and glucose levels during open heart surger

Changes in serum potassium and glucose levels during cardiopuimonarybypass were studied in 20 ± patients undergoing coronaryartery bypass surgery. Ten had previously been treated withpropranolol and 10 with metoprolol using mean daily dosagesof 244 and 215 mg respectively. In the propranolol group therewas a mean rise in serum potassium of l.13 mmol7/l (P= <0.01)whereas there was no significant. change in the metoprolol group.In both groups there was an initial rise in blood glucose whichremained elevated in the propranolol group but fell towardsnormal in the metoprolol group. Metabolic changes due to beta1adrenergic blockade are not generally recognized but may haveprofound clinical significance in some patients.     

Improved selection of patients for aneurysmectomy by combined phase and amplitude analysis of gated cardiac scintigraphy

Twelve patients undergoing left ventricular aneurysmectomy werestudied by combined phase and amplitude analysis of gated bloodpool scintigraphy before and after operation, to establish whetherthe presence of paradoxical systolic movement, as defined bythis method, influenced the result of surgical treatment. There was a significant increase in the ejection fraction afteroperation in those patients with paradoxical systolic movementand no improvement in those with akinesis. The extent of theincrease in ejection fraction was related to the size of paradoxicalsegment resected. It is argued that this improvement in leftventricular function reflects a reduction in the left ventricularend diastolic volume and improved efficiency of ejection ofthe stroke volume, resulting from resection of the scar. Combined phase and amplitude analysis may help in selectingpatients most likely to benefit from aneurysmectomy