Severe tricuspid valve stenosis. A cause of silent mitral stenosis.

The diastolic rumbling murmur of mitral stenosis (MS) may be attenuated in the presence of low cardiac output, right ventricular enlargement, Lutembacher's syndrome, pulmonary emphysema, and obesity. In this report we would like to stress that the presence of tricuspid stenosis (TS) is an additional significant cause of silent MS. The clinical material consisted of 73 patients with rheumatic TS who had undergone cardiac surgery. Five of these cases had clinical findings of TS without auscultatory findings of MS. They were found to have severe MS at the time of operation and to require mitral valve surgery. At cardiac catheterization the mean diastolic gradient (MDG) across the mitral valve (MV) was less than 3 mmHg and pulmonary arterial systolic pressure was 29-42 mmHg. The MDG across the tricuspid valve was 6-17 mmHg. In conclusion, TS can mask clinical and hemodynamic findings of MS. The reason for this is the mechanical barrier imposed by TS proximal to the MV.

[His-bundle electrographic localization of a complete intra-His AV block in a patient with congenital corrected transposition of the great vessels]. / His-Bündel-elektrographische Lokalisierung eines kompletten Intra-His-AV-Blocks bei einem Patienten mit angeborener, korrigierter Transposition der grossen Arterien.

Patients with corrected congenital transposition of the large arteries (CCT) often develop atrioventricular (AV) conduction disturbances, which may lead to syncope or sudden death. This report is concerned with our findings in a 24-year-old man with a CCT accompanied by a small ventricular septal defect and a complete AV block. While published case reports of electrophysiologically investigated third-degree AV blocks show conduction disturbances proximal to the bundle of His, we found the block to be localized in the intra-His region, which makes the case a rarity.

Pulmonary arteriovenous fistulas. Case presentations and clinical recognition.

This report describes characteristic features and clinical presentation of six young patients (ranging in age from five to 25 years) with various congenital forms of pulmonary arteriovenous fistulas as well as one 21-year old patient with traumatic intrapulmonary arteriovenous fistula. The former six patients were cyanotic, had clubbing of the digits and exertional dyspnea; two, additionally, had telangiectasia. All patients underwent cardiac catheterization and pulmonary angiography. None had pulmonary hypertension. Angiographically, four had diffuse arteriovenous fistulas in both lungs (Figures 1 and 3 to 5) and two had arteriovenous fistulas localized in one pulmonary segment. Four patients were additionally studied with radionuclide angiography and pulmonary perfusion scintigraphy. In three of these, substantial right-to-left shunt in the region of the lungs was detected; the diagnosis could not be established in only one of the latter with a small traumatic intrapulmonary arteriovenous shunt of less than 10%. While noninvasive methods provide adjunctive diagnostic support, pulmonary angiography is still required to assess, with certainty, the nature and localization of the lesion. In cyanotic patients with no evidence of cardiac disease, differential diagnostic consideration should be given to pulmonary arteriovenous fistulas.

Occlusive thromboaortopathy (Takayasu's disease): clinical findings and angiographic classification.

We report the findings in 26 cases of occlusive aortopathy (Takayasu's disease) encountered during eight years. The mean age was 25.3 years and female to male ratio was 2.7:1. Chest and local pain, fever, hypertension (70%) and absent pulses were accompanied by high erythrocyte sedimentation rate (ESR) 38 to 126 mm, eosinophilia 4 to 26%. All immunological tests were negative except tuberculin-test (PPD) with 65% positive. EKG was normal in three cases, 23 showed left ventricular hypertrophy, ST-T changes in two and acute myocardial infarction in two cases. The classification: Type I cervico-brachial or arch type with five cases, type II thoraco-abdominal type with six cases, type III peripheral type with four cases and generalized types combination of two or more of three types and/or pulmonary artery involvement, showed good correlation with clinical findings and prognosis. The occlusive aortopathy is an inflammatory disease of unknown origin, an auto-immune or genetic etiology may be involved.

A survey of uncommon forms of coronary arteries.

Among 854 coronary angiograms, we found the following abnormalities of the coronary arteries. Three cases had nonatherosclerotic coronary artery aneurysms. One case, a 27-year-old man with a diffuse lesion, expired after two episodes of myocardial infarction. In 2 other cases the lesions were localized and the patients underwent successful coronary bypass surgery. In 2 cases, a small vascular network was found: a 23-year-old man with pheochromocytoma who also had myocardial injury and pulmonary edema, and a case with contusio cordis who had angina pectoris but had normal coronary arteries. In 3 cases the coronary arteries originated abnormally from the aorta. A congenital right coronary artery-right ventricular fistula was detected in a 17-year-old female with multiple cardiac abnormalities. Abnormally wide coronary arteries were also found in 17 cases with apical hypertrophy, a form of hypertrophic nonobstructive cardiomyopathy.

A case of asymmetrical apical hypertrophy which is a form of hypertrophic nonobstructive cardiomyopathy with giant negative T-waves.

Clinical, hemodynamic, electrocardiographic (ECG), echocardiographic, left ventricular (LV), and coronary angiographic (CA) findings are reported in a case with apical hypertrophy (AH), a form of hypertrophic nonobstructive cardiomyopathy (HNCM). The most striking symptom was chest pain and the most conspicuous electrocardiographic finding consisted of giant negative T waves, reaching an amplitude of 4.0 mV. Echocardiography revealed an apical thickness of the septum and posterior wall of 40 mm; this was significantly greater than septal and posterior free wall thickening in the LV outflow area. The anterior motion (SAM) of the anterior mitral leaflet, was present, and, in hemodymic investigation, the isoproterenol test was negative. The left ventricular end-diastolic pressure (LVEDP) and the EF were elevated. In the LV angiogram from the right anterior oblique position (RAO), the LV free wall thickness at the apex was significantly thicker than at the outflow tract level. The patient had dilated coronary arteries. We conclude that these findings are typical for AH (HNCM) and it seems that hypertrophic obstructive cardiomyopathy (IHSS, MO), and hypertrophic non-obstructive cardiomyopathy (ASH, AH) are different manifestations of a wide spectrum of hypertrophic cardiomyopathy.

[Rheumatic tricuspid stenosis--a clinical overview with surgical considerations]. / Die rheumatische Trikuspidalstenose--Eine klinische Ubersicht einschliesslich operativer Ergebnisse.

73 patients are reported on who ad different and multiple valvular heart lesions, always including tricuspid stenosis (TS). The pre- and postoperative hemodynamic and clinical findings are presented (as well as the results of surgical treatment). The conclusion is arrived at that TS is frequently involved in rheumatic valvular heart disease and that it needs special attention. It should be confirmed by simultaneous measurements of the right ventricular and right atrial pressures. The surgical results are encouraging. Tricuspid commissurotomy is the favored method, leaving the least gradient. Surgical mortality was 2.7%. Postoperative clinical improvement could be seen in 96% of all patients.

[Dose-effect comparison of antihypertensive combinations with and without alpha-methyldopa]. / Dosis-Wirkungsvergleich antihypertensiver Kombinationen mit und ohne Alpha-Methyldopa

In an open clinical trial, 30 compensated cardiac patients with essential hypertension were selected and randomly distributed. Treatment was given by means of two combinations of active agents, one containing 0.15 mg reserpine, 15 mg mefruside and 150 mg inositol nicotinate and the other 0.10 mg reserpine, 10 mg mefruside and 125 mg alpha-methyldopa. A randomized control group of 30 patients with essential hypertension received 0.15 mg reserpine, 15 mg mefruside and 150 mg isositol nicotinate exclusively over the same treatment period. By substituting only 125 mg alpha-methyldopa for 150 mg inositol nicotinate, the reserpine-mefruside portion can be reduced by one third while still obtaining the same antihypertensive effect.