European Heart Journal

BECKER, A., E.

doi: 10.1093/eurheartj/14.1.1pmid: 8432276

Article PDF first page preview Close This content is only available as a PDF. © 1993 The European Society of Cardiology

HOFFMANN,, E.;MATTKE,, S.;DORWARTH,, U.;MÜLLER,, D.;HABERL,, R.;STEINBECK,, G.

doi: 10.1093/eurheartj/14.1.57pmid: 8432293

Abstract A new technique for catheter ablation of atrioventricular (AV) conduction, using temperature-controlled radiofrequency energy and a bipolar asymmetrical electrode configuration, was applied to 12 patients (mean age, 48 ± 15 years; range, 18–69 years) with medically refractory atrioventricular nodal reentrant tachycardia (AVNRT) or rapid atrial rhythms. The energy source was a 500 kHz generator with automatic power regulation to a preselected temperature of 80 °C. A specially designed 7 F bipolar asymmetric thermo-catheter was used for ablation in all cases. The endpoints of the procedure were: first-degree AV block in patients with AVN R T and third-degree block in patients with atrial fibrillation or flutter. Energy was applied over a range of 1–14 times per patient. After a mean follow-up of 8±4 months, third- or first degree AV block persisted in eight patients. In comparison to constant-power radiofrequency ablation, where impedance rises are commonly observed, no impedance rise or coating of the electrode occurred during any of the 97 energy applications in this study. Variable wall contact of the electrode was identified in 20 of 97 applications by a slow temperature rise or a drop in temperature and frequent power adjustments. Thus, monitoring temperature and automatic power regulation may help to reduce the total delivered energy. Temperature control during radiofrequency energy avoids coagulum formation and consequently the associated potential hazards of constant-power application. Radiofrequency energy, catheter ablation, temperature control, supraventricular tachycardias, Av node This content is only available as a PDF. © 1993 The European Society of Cardiology

OHSHIMA,, H.;KAWASHIMA,, E.;OGAWA,, Y.;TOBISE,, K.;ONODERA,, S.

doi: 10.1093/eurheartj/14.1.132pmid: 8432281

Abstract We report a case of a large right atrial myxoma. With the use of transoesophagal echocardiography, several cysts were idntifield within the tumour and necrotic tissue was differentiated from myxomatous tissue according to its echo-level. Transoesophageal echocardiography was very useful for the precise diagnosis of cardiac tumour and demonstration of the inner structure. Transoesophageal echocardiography, right atrial myxoma, inner structure This content is only available as a PDF. © 1993 The European Society of Cardiology

TRANCHESI,, B.;SANTOS, R., D.;CARAMELLI,, B.;GEBARA,, O.;BARBOSA,, V.;BELLOTTI,, G.;PILEGGI,, F.

doi: 10.1093/eurheartj/14.1.90pmid: 8432299

Abstract The combination of captopril and nitroglycerin early after acute myocardial infarction (AMI) could lead to a dangerous decrease in blood pressure coronary perfusion. To evaluate the safety aspects and haemodynamic effects of this combination, we studied 36 first ‘Q wave’ thrombolysed anterior wall AMI patients during the 24 h following the onset of symptoms. Afterwards, thrombolysis patients received a continuous infusion of nitroglycerin and were submitted to pulmonary artery catheterization. Those patients with mean arterial pressure (MAP) ≥ 70 mmHg, cardiac index ≥ 2.21. min−1.m−2, and wedge pressure ≥ 10 mmHg were included and randomized to receive 6.25 mg of captopril every 6 h on the first day and 12.5 mg qid on the second f MAP ≥ 70mmHg (group 1). A second group (group 2) received a placebo. Haemodynamic parameters were determined after 1, 6 and then every 6 h up to 48 h after basal measurements. Significant differences were observed only for the MAP and the rate-pressure product (reduction in group 1 values, P <0.05). However, MAP was maintained within acceptable limits. Our data support the fact that the combination of captopril and nitroglycerin in the early hours of a non-complicated anterior wall AMI is safe, and could guarantee its use in large clinical trials to determine the effects on left ventricle remodelling and survival after AMI. Myocardial infarction, thrombolysis, captopril, nitroglycerin, haemodynamic study This content is only available as a PDF. © 1993 The European Society of Cardiology

TAKENAKA,, T.;HORIMOTO,, M.;FUJIWARA,, M.

doi: 10.1093/eurheartj/14.1.129pmid: 8432280

Abstract A 54-year-old man suffering from effort angina pectoris had an anomalous origin of the left anterior descending coronary artery (LAD) from the right sinus of Valsalva (RSV). The anomalous LAD with a small ostium and without other significant narrowing initially ran into the interventricular septum and subsequently the anterior interventricular groove. Coronary angiography during the anginal attack induced by ergometer exercise testing revealed neither an enhanced narrowing of the LAD ostium, nor myocardial squeezing of the LAD at the interventricular septum level, nor coronary vasospasm. Myocardial ischaemia associated with an anomalous aortic origin of the LAD from the RSV is extremely rare, especially when the vessel runs a septal course. In the present case, the ostial stenosis of the anomalous LAD, probably due to developed atherosclerosis, seemed to be the most likely cause of the exertional angina. Coronary artery anomaly, effort angina pectoris, ostial stenosis This content is only available as a PDF. © 1993 The European Society of Cardiology

SWAN, J., W.;NORELL,, M.;YACOUB,, M.;MITCHELL, A., G.;ILSLEY,, C.

doi: 10.1093/eurheartj/14.1.65pmid: 8432294

Abstract Accelerated coronary artery disease following cardiac transplantation remains an important obstacle to long-term survival and the correct management strategy remains unclear. This observational, prospective study was designed to examine the feasibility of using percutaneous transluminal coronary angioplasty (PTCA) in the treatment of post-transplant coronary disease. Thirteen consecutive patients were selected from the total population of 276 transplant recipients who underwent routine coronary angiography between 1987 and 1990. Selection of patients was on angiographic criteria alone and PTCA was performed to all accessible stenoses with more than 80% luminal narrowing. PTCA was performed using standard angioplasty equipment and procedure as considered appropriate for the individual lesion. A successful PTCA was defined as more than 30% reduction in luminal narrowing and a residual narrowing of less than 50%. Restenosis was defined as a loss of 50% or more of the gain achieved at the time of successful PTCA or more than a 30% increase in narrowing at the site of stenosis. A total of 31 lesions were dilated in this group and a successful result was achieved in 29 of these (93%) and in 12 of the 13 patients. The one patient with failed PTCA underwent later successful coronary artery bypass grafting to complete revascularization. Four of the 13 patients have had two angioplasty procedures, two for restenosis and two for disease progression in other sites. One patient died 15 months after the initial PTCA and remaining 12 were asymptomatic with good exercise tolerance and ventricular function at a mean of 19 months (range 1–39 months) following first PTCA. Thus, PTCA can be considered a feasible form of treatment for significant single and multiple vessel disease in selected cardiac transplant recipients. Further study is required to assess the effect of this early intervention on long-term mortality. Percutaneous transluminal coronary angioplasty, coronary artery disease, orthotopic cardiac transplantation This content is only available as a PDF. © 1993 The European Society of Cardiology

GRAJEK,, S.;LESIAK,, M.;PYDA,, M.;ZAJAC,, M.;PARADOWSKI,, ST.;KACZMAREK,, E.

doi: 10.1093/eurheartj/14.1.40pmid: 8432290

Abstract In 103 hearts with various forms of cardiac muscle hypertrophy the following parameters were estimated: diameter, length, volume, density and number of myocytes, and density of myocyte nuclei. The values of all histometric parameters correlated well with left ventricular (LV) weight up to 350g. In heavier hearts these parameters remained approximately of the same magnitude. The number of myocytes was significantly higher in hearts with LV weight above 250g. The influence on LV weight of age, coronary artery diameters, degree of atherosclerosis, weight and percent of fibrous tissue was also evaluated. On the basis of a linear discriminant function, hearts were divided into three classes: (1) LV weight ≤250 g (absence of hyperplasia, hypertrophy only); (2) LV weight 251–350 g (hypertrophy + signs of hyperplasia); (3) LV weight >350 g (marked signs of hyperplasia). The percent of fibrosis increased proportionally to LV weight. Where LV weight was above 250 g there was a subsequent increase in the mean percent of fibrosis (approx. 26%). This phenomenon (plateau of percent fibrosis) is the result of an increased number of myocytes (myocyte hyperplasia). We suggest that, independent of aetiology, in all hearts above 350 g (patients with congestive heart failure) the hyperplasia phenomenon exists. Myocyte hypertrophy, myocyte hyperplasia, cardiac hypertrophy This content is only available as a PDF. © 1993 The European Society of Cardiology

HORNER, S., M.;BELL, J., A.;SWANTON, R., H.

doi: 10.1093/eurheartj/14.1.138pmid: 8432282

Abstract A case of infected right atrial thrombus is described. Right atrial thrombus is difficult to diagnose and is associated with a high mortality. When it is additionally infected, antibiotics alone are not sufficient treatment and the thrombus should be surgically removed. Echocardiography, thrombus, heart, infection, iatrogenic This content is only available as a PDF. © 1993 The European Society of Cardiology

BIRNBAUM,, Y.;SCLAROVSKY,, S.;MAGER,, A.;STRASBERG,, B.;RECHAVIA,, E.

doi: 10.1093/eurheartj/14.1.4pmid: 8432289

Abstract In a substantial percentage of patients with acute myocardial infarction, especially in those with inferior wall involvement, no ST elevation is detected on the electrocardiogram. In many of them, ST depression is found in leads oriented to remote segments of the heart. The importance of those reciprocal changes for early diagnosis of acute inferior myocardial infarction in patients without ST elevation has not been stressed. In order to find the prevalence of reciprocal ST depression, we evaluated the admission electrocardiograms of 107 consecutive patients with evolving first acute inferior mvocardial infarction. Ninety-three patients had ST elevation of at least 0.1 mV in at least one of the inferior leads: II, III or a VF (group A) and in 14 patients ST displacement did not reach 0·1 mV in any of these leads (group B). In both groups, reciprocal ST depression occurred more frequently in a VL than in any other lead. Only three patients had no ST depression in a VL. in eight patients (7·5% ST depression in a VL was the sole early electrocardiographic sign of the inferior infarction, a VL is the only lead that is facing the superior part of the left ventricle and thus is the only lead that is truly opponent to the inferior wall. It seems that ST depression in a VL, by contrast to that in the precordial leads, is found in the majority of patients with evolving inferior wall myocardial infarction and is not influenced by extension of the infarclion to the right ventricle or to the posterior wall. We conclude that transient ST depression in a VL is a sensitive early electrocardiographic sign of acute inferior wall myocardial infarction. Acute inferior wall myocardial infarction, electrocardiogram, aVL, reciprocal changes, diagnosis This content is only available as a PDF. © 1993 The European Society of Cardiology

MACHECOURT,, J.;DUMOULIN,, J.;CALOP,, J.;FORONI,, L.;TERISSE, M., P.;HENON,, T.;VANZETFO,, G.;DENIS,, B.;BASSAND, J., P.;CASSAGNES,, J.

doi: 10.1093/eurheartj/14.1.75pmid: 8432296