[Equivalent occlusion of the left main coronary artery--case report]. / Ekwiwalent niedroznosci pnia lewej tetnicy wiencowej--opis przypadków.

In the paper two cases are described of patients in whom during angiography coexistent occlusion of the left descending artery and left circumflex artery was found. ECG and echocardiography in both cases were not indicating such a high coronary vessel defect. In both patients angiography was performed leading in one case to development of shock with fatal outcome.

[Percutaneous transluminal coronary angioplasty--personal experience]. / Przezskórna plastyka tetnic wiencowych--doswiadczenia wlasne.

Percutaneous transluminal coronary angioplasty was employed in a group of 178 patients (151 males and 27 females) aged 24 to 68 years (mean 42 +/- 12 years). Stable angina was diagnosed in 136 patients, unstable angina in 38, and an acute infarct in 4. In 150 patients there was one, in 25 two and in 5 patients 3 target stenoses. Lesions were localised in the left anterior descending artery in 130 cases, in the circumflex artery in 32 cases and in the right coronary artery in 49 cases. The attempts to dilate 78 stenoses with a fixed-wire, non-guided system was successful in 78% of cases. Success rate with the over-the-wire system was 85%. In total, we successfully dilated 173 patients, i.e. 82%. The highest success rate, 85%, was achieved in lesions localized in the left anterior descending artery and lowest in lesions localized in the left circumflex artery. Success rate in the groups with stable and unstable coronary artery disease was similar. Complications occurred in 6% of the cases. Experience of the operators involved in PTCA is an important factor influencing the success rate. In the first year of using this technique, good results were achieved in 48% of patients, in the second year in 63%. During the next two years 86% of the stenoses were successfully dilated.

Evolution of the electrocardiographic changes in patients with hypertrophic cardiomyopathy.

In 75 patients with hypertrophic cardiomopathy (HCM) followed for a mean period of 5.5 years (range 2-20 years), evolution of the electrocardiographic (EKG) changes was assessed. Progression of EKG abnormalities occurred in 35 patients (47%). It was manifested by an increase in precordial QRS voltage in 33 patients, development of new P-wave mitral in 11 patients, and development or disappearance of pathologic Q waves in 14 patients. With follow-up times greater than 5 years, 5-8 years, and greater than 8 years, EKG progression was present in 27, 41, and 80% of patients, respectively. Age less than 30 years at the beginning of study and left ventricular outflow obstruction predisposed to EKG progression within 5-8 years. Patients with progressive EKG changes were more prone to experience clinical deterioration than those without EKG progression (63 vs. 15%, p less than 0.001). With chronic verapamil administration, progression of EKG abnormalities occurred insignificantly less often than with propranolol treatment (35 vs. 64%, p = 0.20). It is concluded that with long-term follow-up, HCM tends to progress in a significant proportion of adult patients.

[Circulating immune complexes in hypertrophic cardiomyopathy and ischemic heart disease]. / Krazace kompleksy immunologiczne w kardiomiopatii przerostowej i chorobie niedokrwiennej serca.

In 32 patients (pts) with hypertrophic cardiomyopathy (HC), 20 pts with ischaemic heart disease (IHD) and 30 healthy controls, the levels of circulating immune complexes (CIC), immunoglobulins A, G and M, C3c and C4 components of the complement, as well as haemolytic activity of the complement were measured. CIC were assessed using two different methods: a) precipitation with 3% polyethylene glycol with subsequent spectrophotometric measurement of protein content in the precipitate, and b) binding with J-125 labelled staphylococcal +protein ++ A. Pts with HC showed a statistically significant increase in concentration of IgM and the immune complexes (shown with both methods) together with a decrease in C4 and hemolytic activity of the complement. In addition an analysis carried out for each individual patient showed that in some cases an increase in immune complexes concentration was paralleled by a decrease in IgG, C4 and haemolytic activity of the complement. This may suggest that in these pts activation of the complement through the classical pathway can occur. In pts with IHD an increase in immune complexes concentration was demonstrated by precipitation method only. Immune globulines and complement components were within limits for the control group. This suggests that in IHD the complement system is not engaged. Our findings indicate that in HC mechanisms other than those present in myocardial ischaemia must be engaged in inducing changes in the immune system.

[Possibilities of echocardiographic evaluation of hemodynamic disorders in hypertrophic cardiomyopathy]. / Mozliwosci echokardiograficznej oceny zaburzen hemodynamicznych w kardiomiopatii przerostowej.

In a group of 59 patients with hypertrophic cardiomyopathy relationship between echocardiographic parameters (interventricular septal thickness, left ventrical diastolic diameter, presence of SAM, distribution of hypertrophy) and certain hemodynamic measurements (diastolic compliance, left ventricular end-diastolic pressure, intraventricular pressure gradient, mean wall thickness and left ventricular mass index) were assessed. Substantial elevation of left ventricular end-diastolic pressure (LVEDP greater than 20 mmHg) was significantly more prevalent among patients with small left ventricular diameter and gross septal hypertrophy. Extensive ventricular hypertrophy (Maron type III) was not characterized by any distinctive hemodynamic pattern. Presence of SAM reaching interventricular septum was indicative of left ventricular outflow obstruction.

[Relation between echocardiographic image and the electrocardiogram in hypertrophic cardiomyopathy]. / Zaleznosc miedzy obrazem echokardiograficznym a elektrokardiogramem w kardiomiopatii przerostowej.

Authors analyzed the correlation between anatomic changes estimated by echocardiographic examination and electrocardiographic recordings in group of 104 patients with hypertrophic cardiomyopathy. It was stated that morphological type III by Maron (8) is characterized, in comparison with other types, by significantly lower percentage of right ventricular hypertrophy and higher percentage of QTc interval prolongation, whereas percentage of patients with mitral or left ventricular hypertrophy was insignificantly higher. P Mitrale was significantly more often observed in patients with left ventricular diastolic dimension less than 35 mm. Generally ecg recordings had no distinct markers of the extent and localization of hypertrophic changes. Authors conclude that the unmistakable recognition of the anatomical type of hypertrophy basing on electrocardiogram is possible.