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Left ventricular volume was determined in 12 healthy volunteers using a newly developed two-dimensional echocardio-graphic delineation method. The results were compared with those of magnetic resonance imaging, which served as the method of reference. Left ventricular end-diastolic volume was 123 ± 12 ml, echocardiographically defined, and 121 ± 12 ml calculated with magnetic resonance imaging. End-systolic volume was 41 ± 7 ml on echocardiography and 37±6 ml on magnetic resonance imaging. Left ventricular ejection fraction was 67 ± 4%, echocardiographically defined, and 70 ± 5%, calculated with magnetic resonance imaging. There was no statistical difference for any of the measured parameters. Interstudy and inter-observer variability was minimal. In conclusion, in healthy volunteers left ventricular volume was accurately defined, using this newly developed two-dimensional echocardiographic delineation method. During endocardial delineation a dynamic display is continuously available on a second window, allowing precise visual edge-detection. Moreover, corrections can be made easily and quickly. These two advantages enhance the accuracy of the method, even in cases of poor echogenicity. [ABSTRACT FROM PUBLISHER]

Thrombolytic therapy salvages jeopardized myocardium and preserves left ventricular function. Therefore, a beneficial effect on exercise tolerance and haemodynamic adaptation to exercise can be anticipated. In the present study the results of bicycle exercise tests, performed at 10 to 14 days and at more than 1 year after infarction, were compared between patients randomized double blindly to recombinant tissue plasminogen activator (rt-PA) or placebo. At 2 weeks, the maximal heart rate (140 vs 130 beats. min P=0.017), systolic blood pressure (169 vs 161 mmHg, P=0.018) and pressure-rate product (22907 vs 20865 beats. minmmHg, P=0.0025) were higher in rt-PA treated patients (n=145) than in controls (n=142). At a mean follow-up of 16 months, rt-PA patients (n=126) performed a higher total and peak work load (733 vs 600 Watts. min, P=0.027 and 133 vs 100 Watts, P=-0.036, respectively) than control patients (n=122). During both exercise tests the incidence of clinical or electrocardiographic signs of ischaemia was similar. Multiple regression analysis indicated that age and end-systolic volume were predictors of peak pressure-rate product at 2 weeks (R=0.11, P=0.0001). Age, sex and left ventricular ejection fraction at discharge were independent predictors of peak work load at 2 weeks (R=0.32, P=0.0001) and the square root of peak work load at 16 months (R=0.39, P=0.001). These findings suggest that an improved left ventricular function in the thrombolysis group plays a role in the better exercise capacity observed in rt-PA treated patients. [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 50000 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. [ABSTRACT FROM PUBLISHER]

The clinical value of intracoronarv electrography for the detection ofmyocardial ischaemia was assessed during coronary angioplasty and compared to a standard technique of surface ECG monitoring. In 73 patients undergoing single lesion angioplasty, an iniracoronarv electrogram and four representative surface ECG leads were obtained. During angioplasty of the left anterior descending artery leads, I, V V V were recorded. For the circumflex artery leads I, a V, a VF, V and for the right coronar artery leads II, III, a VF, V were monitored. Eight patients were excluded due to transient intraventricular conduction disturbances during balloon inflation; 65 patients remained for further analysis. Out of a total of 154 balloon inflations (35 in the circumflex, 71 in the left anterior descending and 48 in the right coronary artery), the percentage that produced a≥ mm ST segment elevation, the time to the appearance of a≥ mm ST segment elevation and the maximal ST segment elevation were recorded. During inflations in the circumflex artery, the respective values of these three parameters were 20%, 22·6±11·5 and 0·37±0·80 mm in V the most sensitive surface lead, versus 70% (<0·001), 14·4±9·6 s (<0·01 and 5·82±6·35 mm (<0·0001) on the intracoronary electrogram. For left anterior descending inflations the corresponding values in V the most sensitive surface lead, were 61%, 26·2±13·2 s and 2·08±2·32mm versus 74% (NS), 18·3±12·4s (<0·001) and 5 (<0·0001) on the intracoronary tracing. For right coronary artery inflations the corresponding values in V the most sensitive surface lead, were 77%, 22·2±12·8 s and 2·31±1·65mm versus 32% (<0·0001), 29·8±26·3 (NS) and 1·18±2·19mm (<0·05 Keeping in mind that only four surface leads were monitored, these data suggest that intracoronary electrography is helpful for adequate nonitoring of ischaemia during circumflex angioplasty. During left anterior descending angioplasty it adds some additional information, but it appears superfluous during right coronary angioplasty. [ABSTRACT FROM PUBLISHER]

The clinical value of intracoronarv electrography for the detection ofmyocardial ischaemia was assessed during coronary angioplasty and compared to a standard technique of surface ECG monitoring. In 73 patients undergoing single lesion angioplasty, an iniracoronarv electrogram and four representative surface ECG leads were obtained. During angioplasty of the left anterior descending artery leads, I, V V V were recorded. For the circumflex artery leads I, a V, a VF, V and for the right coronar artery leads II, III, a VF, V were monitored. Eight patients were excluded due to transient intraventricular conduction disturbances during balloon inflation; 65 patients remained for further analysis. Out of a total of 154 balloon inflations (35 in the circumflex, 71 in the left anterior descending and 48 in the right coronary artery), the percentage that produced a≥ mm ST segment elevation, the time to the appearance of a≥ mm ST segment elevation and the maximal ST segment elevation were recorded. During inflations in the circumflex artery, the respective values of these three parameters were 20%, 22·6±11·5 and 0·37±0·80 mm in V the most sensitive surface lead, versus 70% (<0·001), 14·4±9·6 s (<0·01 and 5·82±6·35 mm (<0·0001) on the intracoronary electrogram. For left anterior descending inflations the corresponding values in V the most sensitive surface lead, were 61%, 26·2±13·2 s and 2·08±2·32mm versus 74% (NS), 18·3±12·4s (<0·001) and 5 (<0·0001) on the intracoronary tracing. For right coronary artery inflations the corresponding values in V the most sensitive surface lead, were 77%, 22·2±12·8 s and 2·31±1·65mm versus 32% (<0·0001), 29·8±26·3 (NS) and 1·18±2·19mm (<0·05 Keeping in mind that only four surface leads were monitored, these data suggest that intracoronary electrography is helpful for adequate nonitoring of ischaemia during circumflex angioplasty. During left anterior descending angioplasty it adds some additional information, but it appears superfluous during right coronary angioplasty. [ABSTRACT FROM PUBLISHER]

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]

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 α-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]