Protein C levels in ischaemic heart disease.

Protein C is a circulating glycoprotein with anticoagulant properties. Functional and immunological levels of protein C were determined in 34 cases of ischaemic heart disease and 12 healthy age-matched controls. The sensitive colorimetric assay was used to determine the functional levels and ELISA for antigenic levels. Mean protein C activity and antigenic levels were found to be elevated in these patients as compared to controls. Protein C levels in the three individual subgroups-acute myocardial infarction, previous myocardial infarction and chronic stable angina pectoris-were also raised as compared to controls. The elevation was significant in the case of the acute myocardial infarction group. These results further support the hypothesis that the body synthesises increased amounts of protein C in ischaemic heart disease to compensate for the hypercoagulable state that exists in this disorder, thus playing a protective role.

Type D double aortic arch. Double aortic arch with interruption of its left component proximal to the site of origin of left common carotid artery.

Type D double aortic arch in a five year old boy (with interruption of left arch proximal to left common carotid artery)--with persistent ductus arteriosus and stenosis of right and left pulmonary arteries diagnosed during life is reported. At surgery for P.D.A., the anatomy was confirmed. There was no vascular ring. Types A, B and C double aortic arches with interruption of left arch respectively distal to P.D.A., proximal to P.D.A. and proximal to left subclavian artery have already been reported. Ours happens to be the first case of type D double aortic arch diagnosed ante-mortem and confirmed at surgery.

A case of ST-segment and T-wave alternans.

A 45-year-old man was admitted to the Government General Hospital, Madras, India, for Prinzmetal's angina. His condition was not responding to the combined treatment of isosorbide dinitrate and propranolol hydrochloride he had been taking one week before admission to the hospital. During his stay in the intensive care unit, 23 episodes of ST-segment elevation occurred. Three episodes showed ST-segment and T-wave alternans, a phenomenon, which, to our knowledge, have not been described. The patient was treated with verapamil hydrochloride and phenoxybenzamine hydrochloride, and he responded well. His condition continued to be stable during a two-year follow-up. A review of the literature and a discussion of this ECG phenomenon is presented.

Plain roentgenographic estimation of pulmonary vascular pressures: an improved technique: a catheter-correlated study of 215 patients with mitral valvular disease.

Our improvement on Turner's technique enabled more accurate plain x-ray estimation of pulmonary venous pressure (PVP) up to 60 mm and of systolic pulmonary arterial pressure (PAP) up to 150 mm in 215 patients catheterized for mitral valvular disease. Our improvement comprises (1) five main pulmonary artery (MPA) grades 0 to IV according to its area and volume; (2) modified pressure values assigned for MPA and kinetic energy of the right ventricle (required to pump blood into the pulmonary arterial bed) according to MPA grades; and (3) nine PVP grades from 0 to 8 with corresponding assigned PVP values. These modifications have enhanced the accuracy of the technique up to 85 to 95%.

Plain roentgenographic estimation of systolic pulmonary artery pressure by the pulmonary arterial angle method.

Chest roentgenograms of 125 patients (115 with pure or predominant mitral stenosis) were studied by the pulmonary arterial angle method to estimate systolic pulmonary artery pressure without prior knowledge of catheterization data. First the angle between the line drawn along the right upper lobe artery and the tangent drawn along the point of junction of superior and lateral borders of the right pulmonary artery was determined. Next the angle between the right middle lobe artery and the descending pulmonary artery is determined. The difference between these angles equals systolic pulmonary artery pressure. Catheter and angle values were identical in 26 patients. There was a 1- to 5-mm difference in 70, a 6- to 10-mm difference in 18, an 11- to 15-mm difference in 8, and a difference greater than 15 mm in 3.

Surgical correction of a rare variant of cor triatriatum.

Cor triatratum is a rare congenital malformation. Problems in diagnosis and surgery arise due to associated anomalies such as atrial septal defects and anomalous pulmonary venous drainage. A 21-year-old man proved to have a rare variant of cor triatiatum in which both the upper and lower compartments of the left atrium communicated with the right atrium through two separate atrial septal defects. In addition, he had anomalous drainage of the right superior pulmonary vein into the superior vena cava. Intracardiac repair was undertaken successfully.