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Recombinant tissue-type plasminogen activator (rt-PA) was admministered intravenously to a 64-years old female with thrombotic malfunction of a Björk–Shiley prosthetic tricuspid valve. 150 mg of single-chain rt-PA was infused over 8 hours followed by an additional dose of 50 mg over the next 8 hours. At the end of the first infusion, restoration of normal valve function was demonstrated by fluoroscopic and echo-Doppler examinations. Mild systemic activation of the fibrinolytic system occurred, with a decrease of fibrinogen and α2-antiplasmin to 53% and 33%, respectively, of the preinfusion value at the nadir. [ABSTRACT FROM PUBLISHER]

A Caucasian female patient with repetitive attacks of ventricular tachycardia and fibrillation caused by annular submitral left ventricular aneurysm is reported. During a follow-up period of six years after aneurysmectomy, the patient remained symptom-free. [ABSTRACT FROM PUBLISHER]

A consecutive series of 14 708 coronary arteriograms, performed between 1 April 1975 and 1 August 1983 was examined for the presence of coronary artery fistulas. The incidence was 0.13. There was 1 traumatic and 19 congenital cases. All fistulas were small and of little haemodynamic significance. No symptoms or complications could be ascribed to these fistulas. In the large majority no continuous or other murmurs suggested their presence. The large majority arose from the proximal anterior descending artery and emptied in the pulmonary artery. Surgical treatment for these fistulas is not indicated [ABSTRACT FROM PUBLISHER]

The value of non-invasive, clinical variables in predicting short-term outcome after acute myocardial infarction has been prospectively studied using multivariate analysis in a learning population of 1724 patients and a validation sample of 588 cases. Early risk stratification ofCCU mortality could be made with 89-4% accuracy by using 7 simple clinical variables (Killip class, systolic blood pressure, heart rate, age, intraventricular conduction disturbances, localization of infarction and obesity index) recorded on admission. A discriminant function formula could also be constructed resulting in a maximal classification of 89-3% and predictive values of 91-8% and 77-9%, respectively, for 28-day survival and early death prediction in the learning population. Accuracy figures dropped only slightly (I to 5%) in the independent test set. Predictions could be made with a high degree of accuracy, especially in the upper and lower ranges of the discriminant risk score. This investigation demonstrates that a fairly good estimation of prognosis can be made by means of discriminant analysis of clinical findings gathered routinely in most CCU's. [ABSTRACT FROM PUBLISHER]

Single coronary artery is a rare congenital anomaly of the coronary arteries where only one coronary artery arises from the aortic trunk by a single coronary ostium, supplying the entire heart. A database consisting of the angiographic reports of 50,000 consecutive coronary angiographies performed in adult patients in the University Hospital of Leuven between March 1973 and August 1991 was searched for the diagnosis of single coronary artery. All films concerned were reviewed and classified according to their anatomical type. Thirty-three cases of single coronary artery were retrieved, yielding an incidence of 0.066%. Patient characteristics and clinical data are described, with a discussion on the pathological importance of this finding.

Coronary blood flow velocity and coronary flow reserve can be assessed in humans using a coronary Doppler catheter and the vasodilator papaverine. Although it is a safe, elegant and reproducible technique, serious complications can occur. Coronary flow reserve assessment in a 49-year-old man with a critical stenosis in the proximal part of the circumflex artery was complicated by a papaverine-induced ventricular arrhythmia. Several features of the present case report support papaverine-induced disturbances of the repolarization phase as the pathophysiological mechanism: a 'torsade de pointes' pattern of the tachycardia, the lengthening of the QT-interval, the appearance of a new U-wave and the presence of additional risk factors (hypokalaemia and alcalosis). Patients presenting additional risk factors for this complication should be excluded from coronary flow reserve assessment.

Repeat coronary arteriography was performed in 100 patients with angiographically proven coronary artery disease, because of worsening symptoms (n = 67), persistent stable angina (n = 22) or other reasons (n = 11). The mean interval between the studies was 34.6 months (range 6-99). No patient had interim coronary artery bypass surgery. Progression of coronary artery disease was demonstrated in 60 patients and was correlated in bivariate analysis with the time interval between coronary arteriograms (P less than 0.0001) and with the interim clinical evolution (P less than 0.01). The incidence of progression was similar in the coronary arteries. Moderate lesions (40-70% narrowing) had the highest progression percentages. New significant lesions in previously normal arterial segments were rare. A multivariate analysis of 18 possible predictors revealed three independent variables correlated with progression of coronary artery disease: time interval (P less than 0.0001) and change in functional class (P less than 0.02) between coronary arteriograms, as well as the presence of clinical diabetes (P less than 0.03). Other risk factors and a change of individual risk factors between coronary arteriograms were not correlated with progression of coronary artery disease. Using the results of the multivariate analysis, the evolution of coronary artery disease was correctly predicted in only 72 patients. Following the repeat coronary arteriogram, coronary artery bypass surgery was proposed to 62 patients, 26 of whom needed more distal anastomoses for optimal myocardial revascularization. Because of the important therapeutic implications and the lack of reliable predictors, an aggressive follow-up of patients with known coronary artery disease seems warranted.

A consecutive series of 14 708 coronary arteriograms, performed between 1 April 1975 and 1 August 1983 was examined for the presence of coronary artery fistulas. The incidence was 0.13. There was 1 traumatic and 19 congenital cases. All fistulas were small and of little haemodynamic significance. No symptoms or complications could be ascribed to these fistulas. In the large majority no continuous or other murmurs suggested their presence. The large majority arose from the proximal anterior descending artery and emptied in the pulmonary artery. Surgical treatment for these fistulas is not indicated.

The value of non-invasive, clinical variables in predicting short-term outcome after acute myocardial infarction has been prospectively studied using multivariate analysis in a learning population of 1724 patients and a validation sample of 588 cases. Early risk stratification of CCU mortality could be made with 89.4% accuracy by using 7 simple clinical variables (Killip class, systolic blood pressure, heart rate, age, intraventricular conduction disturbance, localization of infarction and obesity index) recorded on admission. A discriminant function formula could also be constructed resulting in a maximal classification of 89.3% and predictive values of 91.8% and 77.9%, respectively, for 28-day survival and early death prediction in the learning population. Accuracy figures dropped only slightly (1 to 5%) in the independent test set. Predictions could be made with a high degree of accuracy, especially in the upper and lower ranges of the discriminant risk score. This investigation demonstrates that a fairly good estimation of prognosis can be made by means of discriminant analysis of clinical findings gathered routinely in most CCU's.