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This report describes a 69-year-old Japanese woman with bilateral forearm thrombophlebitis that developed soon after transvenous permanent pacemaker insertion. Intravenous administration of urokinase and heparin rapidly resolved fever, painful forearm swelling and inflammatory findings. Digital subtraction venograms revealed a brachiocephalic vein thrombosis. A ten-month treatment with warfarin and ticlopidine resulted in the complete restoration of venous flow. Although thrombophlebitis associated with transvenous permanent pacemaker insertion has a relatively low incidence (0.3%), prompt diagnosis and treatment with anticoagulant and/or thrombolytic agents are important for the late clinical outcome in cases with deep venous thrombosis.

The effects of chronic instrumentation on regional myocardial performance and regional myocardial blood flow were studied in 8 mongrel dogs. Regional segment lengths were measured by an ultrasonic dimension gauge technique at two areas of the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX). Regional myocardial blood flow was measured by a tracer microsphere technique. These measurements were repeated while the animals were conscious on the 4th, 11th, 21st and 28th days after instrumentation. On the 4th day, the heart rate was rather high and regional shortening at both the LAD and LCX areas remained suppressed. After the 11th day, hemodynamic variables such as heart rate, left ventricular pressure and regional wall motion were fairly constant. Regional myocardial blood flow and its distribution were also constant throughout the experimental period. Fibrosis of the epicardium invariably induced by surgical procedures did not affect the distribution of regional blood flow as compared with that of the interventricular septum. Thus, a stable hemodynamic state was recorded after the 11th day following surgical manipulation and the implantation of sensors and catheters did not affect the level of regional myocardial blood flow or its distribution at rest. Such long term reproducible measurements of regional wall motion and regional myocardial blood flow may facilitate chronic studies of cardiovascular physiology.

This report describes a case with flail right and noncoronary cusps due to bacterial endocarditis, diagnosed with real-time two-dimensional echocardiography. Real-time two-dimensional phased array sector scanner demonstrated 2 cugdel-shaped lesions in the region of the left ventricular outflow tract through the aortic root, pendulating upward and downward floating along the blood stream. This study shows that the real-time two-dimensional echocardiography is a very useful noninvasive tool in the early diagnosis of flail aortic valve.

Long-term prognosis of 90 patients with vasospastic angina without significant coronary artery disease (less than 50% reduction in luminal diameter) was examined for a mean follow-up period of 4 years. All patients had episodes of angina at rest and were treated with calcium antagonists. One patient developed myocardial infarction and 2 died suddenly during the follow-up period. In the patient with myocardial infarction, there was an abrupt worsening of angina prior to the infarction despite therapy with a calcium antagonist. One of the sudden death patients discontinued his calcium antagonist before his death. Of the sudden death patients, one had ventricular tachycardia and the other had a complete atrioventricular block during an anginal attack. The incidence of such serious arrhythmias was higher (p less than 0.01) in sudden death patients (2/2) than that in survivors (6/88). The treatment with calcium antagonists reduced the severity and frequency of angina in all patients. These results suggest that long-term prognosis of vasospastic angina without significant coronary artery disease is good as characterized by the low incidence of myocardial infarction and death and the favorable response to treatment with calcium antagonists.

The change in the left atrial dimension during diastole was examined in patients with mitral stenosis using echocardiography. The left atrial emptying fraction (LAEF), defined as the ratio of enddiastolic dimension to endsystolic dimension of the left atrium, was 0.65 +/- 0.03 (mean +/- SE) for normal subjects, 0.86 +/- 0.01 for low grade mitral stenosis, and 0.92 +/- 0.01 for high grade stenosis. The LAEF correlated well with mitral valve area index (r = -0.70), but the correlation between E-F slope of the anterior mitral leaflet and mitral valve area index was less significant (r = 0.48). In patients who received mitral valve replacement the LAEF and the left atrial dimension significantly improved. The left atrial emptying fraction is an easily obtainable and reliable index to estimate the severity of mitral stenosis, even in patients who have undergone mitral valvular surgery.