[Congenital heart defects: single ventricle with pulmonary valve stenosis and malposition of the great blood vessels]. / Kongenitalna srcana mana: jedinstveni ventrikul sa stenozom plucne valvule i malpozicijom velikih krvnih sudova.

A case of two: 21 years and 39 years old male patients with congenital heart disease: Single Ventricle with pulmonary valve stenosis and L-malposition of the great vessels. In the first case the diagnosis of congenital pulmonic stenosis & tricuspid regurgitation was established after birth and during the previous period. In the second case the diagnosis of VSD was established during the recruiting checkup, when he was 18 years old. Detailed non-invasive cardiologic examination was performed (transthoracic & transoesophageal echocardiography) and the diagnosis of Single Ventricle with pulmonary valve stenosis & L-malposition of the great vessels: Double-Inlet Left Ventricle with severe symptoms (21 years old & supraventricular paroxysmal tachycardia) with middle symptoms (39 years old) were established in both cases.

[Trandolapril in the prevention of the sequelae of left ventricular systolic dysfunction after acute myocardial infarct]. / Trandolapril u prevenciji posljedica sistolne disfunkcije lijevog ventrikula poslije akutnog infarkta miokarda.

Left ventricle systolic dysfunction and congestive heart failure after AMI are still a great problem in cardiology. Introduction of angiotensin converting enzyme (ACE) inhibitors after AMI has been a new step in therapy of the left ventricle systolic disfunction. Some long term studies have proved influence of ACE inhibitors on reduction of mortality, severe congestive heart failure (CHF), and reinfarction. The importance of administration of a remedy once daily has been emphasized, and the pharmacokinetics and pharmacodynamics of trandolapril in the left ventricle dysfunction and CHF has been described. TRACE study proved influence of long-term once daily administration of trandolapril on significant reduction of total and cardiovascular mortality, reduction of sudden death, reduction of severe and resistant CHF and reduction or relay of reinfarction. A good risk/benefit ratio has been found.

[Atrial myxomas--echophonocardiographic characteristics]. / Miksomi atrija--ehofonokardiografske karakteristike.

Myxomas (MY) of the atria are benign tumors of the heart usually originated from the interatrial septum. Moving of these tumors into the blood stream cause obstruction of the atrio-ventricular valves and appearance of pathological sounds and murmurs. The main goal of this study is analysis of echophonocardiographic examinations in 4 patients with left atrial myxomas and in one patient with right atrial myxoma. In all the cases, the oval tumor masses with diastolic movements from the atrium towards the ventricle and obstruction of the atrial ventricular ostium were clearly visualized on two-dimensional echocardiography (2D). Simultaneous M-mod echocardilographic and phonocardiographic examinations showed individual phases of myxoma movement and occurrence of sounds. In the patients with left atrial myxoma, echophonocardiography documented the splitting of the first sound (0.05-0.06 sek), protomesosystolic murmur, occurrence of tumor "hit" in the early diastole (0.08-0.11 sec after second heart sound) and a presystolic murmur above the tricuspid valve were found. In all the patients, surgical removal of myxoma was successfully performed followed by disappearance of the symptoms and pathological sounds, which was confirmed on both echocardiogram and phonocardiograms.

Late diastolic tumor "plop" in an asymptomatic case of right atrial myxoma.

Myxomas of the right atrium are rare tumors of the heart. They have been almost always described as symptomatic tumors. Auscultation and phonocardiography have been revealed tumor "plop" (P) as an early diastolic phenomenon, but the late "plop" has not be described. The aim of the case report is to present late diastolic tumor "plop" in an asymptomatic case of right atrial myxoma. A thirty year old man without any subjective symptoms was admitted to the clinic because of a murmur found during a routine examination when applying for a new job. Two dimensional echocardiography showed slightly enlarged right atrium with a myxoma in it. M-mode echocardiogram taken from parasternal short axis plane revealed a wide cluster of echoes in the right atrium moving into the right ventricle inflow tract in diastole. Simultaneous phonocardiogram showed splitting of the first sound (0.06 sec.). The tumor "plop" occurred in late diastole, 0.22 seconds after the second sound (S2) and coincided with maximum tumor protrusion into the right ventricle. After successful operation of the tumor without catheterisation, echophonocardiographic finding has become quite normal.

An approximation of stenotic aortic valve area by phonomechanocardiographic method: the comparative study of noninvasive methods.

Phonomechanocardiographic and ultrasonocardiographic parameters were compared in the multiplex manner in order to assess a degree of narrowing of the stenotic aortic valve areas. Adult patients with aortic valve stenosis were included in the study. The main condition for admission in the research sample was that the mean rate of circumferential fibre shortening be greater than 1 s-1 i.e. "compensated" preejection period/ejection time ratio (PEP/LVET). The control group were persons as sample stratified from healthy population. A possibility of approximate assessment of valve areas in patients with aortic stenosis is rendered by inserting the phonomechanocardiographic parameters in the modified Gorlin and Gorlin formula, provided that values of the normalised ejection function index (PEP/LVET2) and the ejection-isovolumetric coefficient corrected for pulse transmission time (LVET/IVCT+PTT) are known. The phonomechanocardiographic indexes of the transvalvular aortic pressure gradient and normalised stroke volume correlate curvilinear. The value of the LVET/IVCT + PTT equal or greater than that extrapolated for the given PEP/LVET2 in our formula means critically stenotic aortic valve area below 0.8 cm2. The given approximation could be used as a noninvasive and nongeometric polycardiographic or phonomechanocardiographic pattern for assessing the degree of narrowing of aortic valve area. The aortic valve stenosis is an illness in which a lot is expected from noninvasive cardiologic parameters when a surgical indication is in question. A severe or tight aortic valve stenosis, which required a surgical treatment according to current views, existed when valve area is less than 0.8 cm2 or when the transvalvular aortic systolic pressure gradient is greater than 50 mm Hg or 6.67 kPa, but with normal cardiac index in the same time.(ABSTRACT TRUNCATED AT 250 WORDS)

[Significance of two-dimensional echocardiography in the diagnosis of mitral valve calcification--sensitivity and specificity]. / Znacaj dvodimenzionalne ehokardiografije u dijagnostici kalcifikacija mitralnog zaliska--senzitivnost i specificnost metode.

The effect of two-dimensional echocardiography in assessment mitral valve calcifications was compared to computed tomography (CT) in 50 patients with pure rheumatic mitral stenosis (MS). Echocardiography revealed no mitral calcifications in 23 patients, respectively 46 per cent (grade 0). Twelve patients (24 per cent) had calcifications smaller than 2.5 mm (grade 1). Eleven (22 per cent) had moderate calcifications, smaller than one half of length of the anterior mitral leaflet (grade 2) and four (8 per cent) had calcifications larger than one half of the length of the anterior mitral leaflet (grade 3). The last two groups were thought to have clinically important calcifications. Specificity and sensitivity were examined in comparison to CT. By echocardiography, five (ten per cent) false positive findings were found in the group 2. There were neither false positive nor false negative findings in the last two group. The first group when compared with other three groups showed sensitivity of 100, specificity of 85, and predictive accuracy of 81 per cent. But the first two groups together compared with the last two groups showed sensitivity, specificity and predictive accuracy of 100 per cent.

New noninvasive index of the left ventricular inotropic state.

In order to confirm in clinical material a new contractile index, the systolic circumferential wall stress/end systolic muscle index ratio (SCS/ESMI), there were compared two groups of patients with pressure overload ventricular hypertrophy, with and without global compliance disturbances (Group B1 = 36; Group B2 = 28) and two groups of age and body surface area-matched healthy individuals (Group A1 = 36; Group A2 = 28). The new index of the contractile or muscle function, the SCS/ESMI ratio, was so effective in the research sample as the systolic circumferential wall stress/cavitary volume ratio, the SCS/ESVI. The product of the systolic contractile index, the SCS/ESVI, and ejection fraction (SCI X EF), as an integrated left ventricular parameter, showed that the ejection or pump function reduction was artificial in patients with an increased afterload and normal preload. The confidence limit for the SCI X EF on the level of 95% is 3.5, and for the product of the new systolic muscle index and ejection fraction, the SMI X EF, is 99. The inaugurated functional parameters could serve for revealing "false positive" cardiac failure or they could reveal the true reduction of the muscle contractile cardiac function by the artificially increased and "normal" ejection phase indices.

Cusp pliability of the mitral valve: Doppler-echocardiographic and computer-tomographic study.

In order to study the mitral cusp pliability and calcification "in vivo" on the basis of the difference in the maximal and effective valve area, the Doppler-echocardiographic and computer tomographic method was used. The cusp pliability on the basis of the difference between the maximal and effective mitral valve area in absolute measures of cm2 was significantly smaller in patients with mitral stenosis, but in the deviations from normal indexed values of cusp pliability excluding the influence of the anatomic or maximal orifice area, there were no significant differences (normal values 0.00 +/- 27%). The normal relationship of the difference between the maximal and effective mitral valve area in absolute measures (y = cm2) and the maximal mitral valve area (x = cm2) is formulated with the regression equation: y = 0.317x - 0.245. The linear correlation of the normal mitral valve area and the stroke volume at rest in patients with the normal mitral valve is very tight. The stroke volume is significantly lower in mitral stenosis, and the time-velocity integral in the diastole or the mitral stroke distance was significantly greater. The relationship of the percentual deviation from the normal indexed values of cusp pliability excluding the influence of the anatomic or maximal orifice area, on the one hand, and the computer-tomographic approximation of calcium incrustation in mitral leaflets on the other are defined with a tight linear correlation. One could conclude that the magnitude of cusp pliability or calcification can be approximated by the Doppler-echocardiographic method.