Ventricular tachycardia as a complication of annular subvalvular ventricular aneurysm in a Caucasian woman

A Caucasian female patient with repetitive attacks of ventriculartachycardia and fibrillation caused by annular submitral leftventricular aneurysm is reported. During a follow-up periodof six years after aneurysmectomy, the patient remained symptom-free.     

Determination of left ventricular volume by two-dimensional echocardiography: comparison with magnetic resonance imaging

Left ventricular volume was determined in 12 healthy volunteersusing a newly developed two-dimensional echocardio-graphic delineationmethod. The results were compared with those of magnetic resonanceimaging, which served as the method of reference. Left ventricularend-diastolic volume was 123 ± 12 ml, echocardiographicallydefined, and 121 ± 12 ml calculated with magnetic resonanceimaging. End-systolic volume was 41 ± 7 ml on echocardiographyand 37±6 ml on magnetic resonance imaging. Left ventricularejection fraction was 67 ± 4%, echocardiographicallydefined, and 70 ± 5%, calculated with magnetic resonanceimaging. There was no statistical difference for any of themeasured parameters. Interstudy and inter-observer variabilitywas minimal. In conclusion, in healthy volunteers left ventricularvolume was accurately defined, using this newly developed two-dimensionalechocardiographic delineation method. During endocardial delineationa dynamic display is continuously available on a second window,allowing precise visual edge-detection. Moreover, correctionscan be made easily and quickly. These two advantages enhancethe accuracy of the method, even in cases of poor echogenicity.     

Treatment of prosthetic tricuspid valve thrombosis with recombinant tissue-type plasminogen activator

Recombinant tissue-type plasminogen activator (rt-PA) was admministeredintravenously to a 64-years old female with thrombotic malfunctionof a Björk–Shiley prosthetic tricuspid valve. 150mg of single-chain rt-PA was infused over 8 hours followed byan additional dose of 50 mg over the next 8 hours. At the endof the first infusion, restoration of normal valve functionwas demonstrated by fluoroscopic and echo-Doppler examinations.Mild systemic activation of the fibrinolytic system occurred,with a decrease of fibrinogen and ₂-antiplasmin to 53% and 33%,respectively, of the preinfusion value at the nadir.     

The impact of fibrinolytic therapy for ST-segment-elevation acute myocardial infarction

Summary.  As privileged witnesses of the initiation and widespread use of reperfusion therapy the authors review the history of fibrinolytic therapy and of tissue-plasminogen activator (t-PA) more particularly and the current indications for its use in the era of mechanical reperfusion.     

Effect of Short Atrioventricular Delay on Cardiac Output

RONASZEKI, A., ET AL.: Effect of Short Atrioventricular Delay on Cardiac Output. Short atrioventricular (AV) delay modifies late diastolic filling dynamics. The effect of this change on cardiac output [CO) was studied in closed chest, AV blocked canine preparations (N: 10), during AV sequential pacing (80 bpm). CO (thermodilution technique) and transmitral flow velocity (TMFV, pulsed-wave Doppler) were measured and compared (paired t-test) on the basis of TMFV pattern, when atrial contraction (A wave) started just after early diastolic transmitral flow deceleration [PR:219 ± 25 ms, mean ± SD) and when A wave occurred at the end of late diastole and shortened due to the next ventricular contraction (PR: 56 ± 11 ms). The short AV delay resulted in 12.0 ± 5.9% decrease of CO, reflecting the interrupted late diastolic atrial transport. Properly timed atrial contraction is necessary for optimal AV sequential pacing.     

Effects of a standardized wheat bran preparation on biliary lipid composition and bile acid metabolism in young healthy males

The effects of adding bran to the normal diet on biliary lipid composition and bile acid metabolism in a group of young healthy males was studied. A chemically standardized coarse wheat bran product, with serum lipid lowering properties, in a dose of 0.5 kg-1 body weight per day was used. Bran feeding for 4 or 8 weeks did not change biliary lipid and biliary bile acid composition. Faecal bile acid and neutral sterol composition was similar before and after 8 weeks of bran. Bile acid kinetics, measured by double isotope dilution after simultaneous injection of [3H]cholic acid and [14C]deoxycholic acid, showed only minor differences before and during bran ingestion. The most surprising finding was an increase in 7 alpha-dehydroxylation fraction (input of deoxycholic acid divided by synthesis of cholic acid) in six out of seven subjects after 4 weeks of brain and in all four subjects after 8 weeks of bran. In conclusion, the bran product we used is not effective in lowering the biliary cholesterol saturation in healthy young males. Nor does it reduce deoxycholate input in our subjects even after 8 weeks of bran.     

Tilt Training: A Treatment for Malignant and Recurrent Neurocardiogenic Syncope

The treatment of neurocardiogenic syncope is insufficient in many cases. We hypothesized that the repeated exposure of the cardiovascular system to orthostatic stress could have a therapeutic effect on the regulation of cardiovascular reflex mechanisms. We have started a program of tilt training for heavily symptomatic patients. After hospital admission, patients were tilted daily (60-degree inclination), until syncope, or until a maximum of 45–90 minutes. The patients were instructed to continue a program of daily tilt training at home: two 30-minute sessions of upright standing against a vertical wall. No medication was prescribed. A total of 260 tilt table sessions were performed in 42 patients. The first tilt test was positive after 21 ± 13 minutes. The syncope was cardioinhibitory in 14 cases, vasodepressor in 19, mixed in 9. At the time of hospital discharge, 41 patients could support 45 minutes of head-up tilting. After a mean follow-up time of 15.1 (SD 7.8) months, 36 patients remained completely free of syncope. Syncope still occurred in one patient and presyncope in four patients. One patient died from an extensive myocardial infarction. The abnormal autonomic reflex activity of neurocardiogenic syncope can be remedied by a program of continued tilt training without the administration of drugs. This new treatment has proven to be effective for the vasodepressor and the cardioinhibitory type of syncope.     

Metallic Surface Treatment Using Electrochemical Polishing Decreases Thrombogenicity and Neointimal Hyperplasia of Coronary Stents

An abundant healing response resulting in a more pronounced neointimal hyperplasia compared to conventional balloon angioplasty remains the most important clinical problem after coronary stent implantation. In the present study the potential beneficial effect of metal surface treatment using electrochemical polishing on stent thrombogenicity and neointimal hyperplasia was evaluated in a rat A‐ V model and a porcine coronary model. An electrochemical polishing system was developed to improve surface characteristics of stainless steel stents. Topographic scanning of the stent surface using a profilometer type Taylor Holson Form Taylsurf 120L showed a significant effect on R, (arithmetic mean of the roughness height) (0.14 vs 0.04 μm: P < 0.001) and R_t (maximum rouhgness height between a peak and a valley for the sampling length) (1.44 vs 0.43 μm: P < 0.001). Thrombogenicity of polished stents (n = 6) was compared to nonpolished stents (n = 5) in a rat A ‐ V shunt model using ¹²⁵I fibrinogen and ⁵¹Cr‐labeled platelets. Total clot weight after 30 minutes was significantly lower in the polished stents (32.1 + 2.8 vs 18.1 + 4.4: P < 0.001). Also ¹²⁵I fibrinogen deposition was significantly lower in the polished stents (1.30 + 0.07 vs 0.66 + 0.04: P < 0.001). Platelet deposition, however, was not significantly reduced (12.7 + 3.4 vs 9.87 + 1.9, NS). Subsequently, the effect of electrochemical polishing on neointimal hyperplasia was evaluated in a porcine coronary model. Polished (n =10) and nonpolished stents (n =10) were randomly implanted in the right coronary artery of healthy pigs. Neointimal hyperplasia was significantly decreased in the polished stents (0.6 + 0.28 vs 0.9 + 0.34 mm²: P <0.01). Electrochemical polishing oj coronary stents results in decreased thrombogenicity and neointimal hyperplasia after stent implantation in different animal models.     

Association between Cardiac Autonomic Function and Coping Style in Healthy Subjects

The link between personality and cardiac function is insufficiently characterized. We postulated that in a healthy population, cardiac autonomic function is linked to coping style. In 276 healthy volunteers, between the ages of 18 and 71, the Utrecht Coping List was used to evaluate different coping strategies. Trait anxiety was scored by the Spielberger State Trait Anxiety Inventory. A 24-hour Holter recording was used to calculate heart rate variability (HRV). For HRV parameters and coping mechanisms this study demonstrated gender-specific differences and correlations with age. In men (n = 141) higher active coping was associated with less global autonomic activity or SDANN (r_s=−0.27, P < 0.001). This relationship was most prevalent in young (18–30 years) men (r_s=−0.45, P < 0.005). Higher expression of negative emotions or anger was related to both higher vagal (r_s= 0.23 for rMSSD, P < 0.01) tone and higher LF power (r_s= 0.23, P < 0.01). In young men expression of negative emotions or anger was associated with LF power (r_s= 0.37, P < 0.01) and in middle-aged (31–50 years) men with vagal tone (r_s= 0.43 for rMSSD, P < 0.005) and heart rate (r_s=−0.41, P < 0.005). Higher comforting ideas was related to higher LF power (r_s= 0.23 for LF power, P < 0.005), and this especially in middle-aged men (r_s= 0.37, P < 0.01). In women (n = 135), no significant correlations between coping style and HRV indices were found. We conclude that in normal individuals, at least in men, our findings suggest a relationship between coping style and cardiac autonomic function.