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An intrapericardial aneurysm of the left atrial wall in a 28-year-old man is reported. This is a rare congenital anomaly. The patients are usually identified by clinical signs, when complications such as cardiac arrhythmias and systemic embolism occur. Clinical findings including the ECG are non-specific. Cardiomegaly and unusual configuration of the heart are consistantly found, but are not pathognomonic. The diagnosis is usually confirmed by angiocardiography. Echocardiography, computed tomography and/or MRI can contribute to the diagnosis. Operation seems to be indicated if complications are to be avoided.

In 10 cases of dilated cardiomyopathy the HLA-loci (A, B, C, DR) and marker expression on lymphocytes were studied. In this group the T4/T8-ratio was decreased and interleukin-2-expression was increased in relation to normals or patients with chronic coronary heart disease, respectively. 9 patients had the HLA-A1 or HLA-A2-locus in their siblings. In correlation analysis between immunological and hemodynamic parameters a good correlation of the number of NK-cells to the ejection fraction (r = 0.79) and negative correlation of helpercells (CD4) to the cardiac output were found (r = -0.80). The results of this attempt suggest an immunological pathogenesis of the dilated cardiomyopathy.

Despite the small cohort of patients with HOCM could be shown that the routine application of the conventional and colour Doppler echocardiography after myectomy is indicated and reasonable. The modern echocardiography is able to assess with high individual reliability the therapeutic aim of myectomy--drastic reduction of the intracavitary pressure gradient. Significant changes were also the results in the systolic acceleration time (TPVS/LVET standardized on the LVET and the diastolic measuring parameters VmaxE, ATE and TVIE/TVIA), the importance of which is partly still fully open.

In 42 patients with coronary heart disease within a left heart catheterization by means of coronarography and conventional angiocardiography in each case before and after GTN digital subtraction angiographies of the left ventricle were performed with central venous injection of 20 ml visotrast with a flow of 16-18 ml/s. A DVI2-CV system of the firm Philips served as investigation device. In general between the angiocardiography and the digital subtraction angiographies the following results were obtained for EF 0.81, EDV 0.71, and ESV 0.88. When evaluating only the finally examined 22 patients the correlations improve for all parameters (EF: 0.89, EDV: 0.82, ESV: 0.90). Furthermore is was shown that the volumes are underestimated by 8-10%. The quantification of the regional movement of the wall according to the radial axis method did not results in any significant differences between the digital subtraction angiographies and the angiocardiography. The effects of GTN on the global and regional functional parameters appear somewhat more distinct in the digital subtraction angiographies than in the angiocardiography and are partly significant only in the first one. The influence of the experience of the investigator, the cardial state of the patient and other influential factors on the quality of the digital subtraction angiocardiographies are described and discussed. Therefore we regard the digital subtraction angiography as method of choice in indications to right heart catheterization without coronary angiography.

For the characterization of the left-ventricular thickness of the wall, of the diameter and of the functional parameters in obesity in a short-term investigation on 18 extremely adipose female normotonics and 17 normotonics with normal weight the echocardiographic investigation in the M-mode in the short parasternal axis was performed. The women with overweight had a by 28% (p less than 0.001) greater fractional shortening, a by 8% (p less than 0.01) greater ejection fraction, a by 23% (p less than 0.05) greater stroke volume and a by 34% (p less than 0.001) greater cardiac output as well as a by 13% smaller left-ventricular end-systolic volume than normotonic women with normal weight. Index of stroke volume and cardiac output did not differ. The women with overweight had a significantly larger left-ventricular end-diastolic diameter and a thicker interventricular septum as well as a larger thickness of the left-ventricular posterior wall in the systole. The results allowed the conclusion that changed left-ventricular parameters both with regard to the form and to the function in obesity per se might be the expression of the physiological adaptation to an increased requirement and the borderlines to the transition into a disturbed left-ventricular function and development of a left-ventricular hypertrophy were not fixed. Long-term studies should bring further explanation concerning these problems.

Systolic time intervals were measured with 55 middle aged healthy normal weight and 76 healthy overweight probands in two positions (standing and lying). In 39 adipose patients and 55 normal weight subjects an ergometric work was carried out. A significant difference between normal and extremely adipose subjects without cardiac diseases could not be noticed with regard to the preejection index. Preejection period and left ventricular ejection time showed significant differences in both positions between normal and overweight probands, independent of blood pressure. In overweight patients there was a significantly decreased heart work load. The preejection index of adipose patients with a work load below 76 watts amounted to a mean value of 1,04. A work load of 100 watts was reached by only half of the adipose patients. In 32 adipose subjects with a heart work load above 75 watts the regulation of heart-rate and blood-pressure was not different from that of normal weight persons. Muscle blood flow was measured by 133Xenon-Clearance after Lassen et al. The measurement of the 133Xenon-Clearance of the arm muscle at rest in 29 adipose patients resulted in significantly lower values compared with normal weight persons.

On 55 healthy test persons with normal weight and 76 healthy middle-aged obese test persons the measurement of systolic time intervals was performed standing and lying. In 39 obese patients and 55 test persons with normal weight a load ergometry was carried out. No significant difference between persons with normal weight and extreme overweight was recognized with regard to the index of tension. However, there were clear differences between persons with normal and overweight as to the time of tension and left-ventricular ejection time lying and standing, independent of the behaviour of blood pressure. In persons with overweight a significantly lower cardiac output was found. The index of tension of obese persons with a degree of efficacy below 75 Watt was on an average 1.04. Only half of the persons with overweight reached a degree of efficacy of 100 Watt. In 32 obese persons with a degree of efficacy of more than 75 Watt the regulation of frequency and blood pressure did not differ from that of persons with normal weight.

The development of new antiarrhythmic drugs allows to a certain extent the performance of a differential therapy and prophylaxis. This also concerns the lidocaine-like substance mexiletine, which according to Vaughan-Williams is to be classified into class I B of the antiarrhythmic drugs with direct membrane effect. It is effective in disturbances of the ventricular rhythm also in oral therapy, which in most cases are more life-endangering than the supraventricular ones. In own examination in 21 of 26 patients a complete or far-reaching suppression of accumulated extrasystoles and particularly of ventricular tachycardias could be achieved by an oral long-term therapy with 600--800 mg mexiletine. In the acute experiment short-term infusions were not effective in patients with ventricular tachycardias, since apparently no sufficient plasma level was obtained, wherefore also a following permanent drop infusion is recommended. The rate of side-effects was insignificant and in no case led to a withdrawal of the therapy.

36 normotensive obese and 23 hypertensive obese were treated with an isokaloric reduction diet of 800 kcal/a day under clinical conditions over a 4-week span. Blood pressure and cardiac performance were investigated by means of non-invasive techniques such as systolic time intervals (STI) and calculated indices. A significant decrease was established in systolic time intervals such as left ventricular ejection time and total electromechanical systole, systolic and diastolic blood pressure, myocardial oxygen consumption and cardiac output. Heart rate, preejection index and stroke volume were not diminished under dietary treatment. No decrease of all parameters was found in obese normotensives with a weight reduction greater than 5% after dietary treatment.

In individual cases the computed tomography renders possible the ascertainment of the coarctation of the aorta. Despite modified examination method (secondary section technique, continuous application of contrast medium) the reliability is insignificant. Therefore, the method cannot be recommended for the primary diagnostics of the coarctation of the aorta. The computed tomography is extraordinarily suited for the detection of aneurysms of anastomoses after operation of coarctations of the aorta. In 50 computed-tomographic examinations of 48 patients 11 times an aneurysm could be ascertained. This high proportion of late postoperative complications is above all to be traced back to the surgical suture material used in the sixties. There were only two falsely positive findings, in which cases also here relevant pathological changes were present. The computed tomography can more exactly than the aortography adopt a definite attitude to the question of the dissection of prostheses or to pseudoaneurysms.

A myopathy which sporadically appeared in a young male corresponds clinically, electromyographically, histologically and cardiologically to the rare picture of the X-chromosomally recessive benign myopathy with early contractures. The coordination to the clinical picture mentioned and the genetic advice, taking into consideration the X-chromosomally recessive heredity, are discussed and proved.

For the reduction of the functional obstruction of the left-ventricular outflow in hypertrophic obstructive cardiomyopathy since 1978 in selected cases conventional VAT cardiac pacemakers with shortened AV retardation time have been implanted. On the basis of 4 casuistics the insufficient adaptation of these systems to unexpectedly appearing disturbances of the cardiac rhythm is demonstrated. Thus already extreme sinus bradycardias lead to parasystole by the unchangeably given asynchronous basic frequency of the pacemakers. Furthermore, all tachycardiac supraventricular arrhythmias and retrograde atrium activations evoke haemodynamically unfavourable and partly even threatening ventricular tachycardies caused by the pacemakers. Control ECG made under these conditions are frequently inexactly interpreted by the continuing intact natural AV conduction and technical defects of the pacemakers are assumed. The individual diagnostic steps necessary for the assessment of the function of the devices and the inevitable immediate therapeutic measures are, therefore, explained. Finally the demands to more modern differentiated physiological pacemaker systems are derived which should be used in patients with hypertrophic obstructive cardiomyopathy.

The influence of hyperthyreosis on the cardiac function was investigated by means of non-invasive methods (radiocardiography, echocardiography, Tc-99m- und Tl-201-scintigraphy of the myocardium) and invasive methods (coronary angiography). Independent of age an increase of the frequency was always existing, a significant increase of the filling of the ventricle, of SI and HI was shown only by younger patients. With the help of the echocardiography local and global disturbances of kinetics, by means of the Tl-201-scintigraphy of the myocardium disturbances of the myocardial perfusion could be proved. For the circulating plasma catecholamines noradrenalin, adrenalin and dopamine values were established lying in the lower region of the normal. The effects of an increase of the thyroid hormone on the number and/or sensitivity of the membrane-bound beta-adrenoceptors of the heart as well as the independent of its effect of the SDH on the obtaining of myocardial energy are discussed.

It is reported on an at present 32-year-old male patient, in whom at the age of 30 years an excessive mediastinal lipoma was excised. For 12 years the cardiological diagnosis was not clear and could completely be clarified only with the help of the computed tomography of the heart.