[Combined myocardial infarct of the left and right ventricle]. / Kombinovani infarkt miokarda leve i desne komore.

Combined myocardial infarction of left and right ventricle (CMILRV) of inferoposterior localization represents simultaneous acute necrosis of both myocardial ventricles and belongs, due to associated and frequent complications, to more severe damages of the myocardium with high mortality. Our group consisted of 100 patients of both sexes, mean age of 67.4 years, of which 50 were with inferoposterior left ventricular infarction and 50 with CMILRV of the same localization. The diagnosis was confirmed clinically, by ECG, by the analysis of enzymes, echocardiographically and scintigraphically using radionuclide ventriculography with 99Tcm PyP. Selective coronarography was performed in all the survived patients, and autopsy of the dead. On the basis of clinical presentation of some forms of dynamic weakness of the heart, in acute stage of CMIRLV, we have established that there are 4 categories of these patients, so that each of these groups represents also a special clinical form, which are: 1. CMIRLV without signs of heart failure, established in 20 (40%) cases, which clinically and prognostically do not differ from inferoposterior left ventricular infarction. 2. CMIRLV with predominant failure of the right ventricle was found in 17 (34%) of the patients with a specific clinical feature and the way of treatment. 3. CMIRLV with marked failure of the left ventricle, found in 8 (16%) of the patients, which required combined treatment measures. 4. CMIRLV with general heart failure, established in 5 (10%) cases, is characterized by cardiogenic shock and falls into the most severe forms of this kind of myocardial infarction. Total mortality in the patients with CMILRV was 10% (5.50), that is 40% (2.5) in both the second and the fourth subgroup, 20% (1/5) in the third group, while in the first one as well as in the control group with inferoposterior infarction there was no mortality. Good knowledge of the above mentioned clinical forms of CMILRV are necessary prerequisite for application of specific and corresponding therapeutic measures and the best prevention of associated complications and high mortality of such patients.

[Use of 99mTc-pyrophosphate and coronarography in the diagnosis of simultaneous myocardial infarct of the right and left cardiac ventricles]. / Primena 99mTc-pirofosfata i koronarografije kod dijagnostikovanja istovremenog infarkta desne i leve komore srca.

Myocardial scintigraphy was performed using 99m-Tc-pyrophosphate in 50 patients with suspected coexisting right ventricular and left inferior ventricular heart infarction and in 50 patients with left inferior ventricular infraction only. In all survived patients additional selective coronarography was performed and in all died patients autopsy was performed. The aim of the study was to evaluate reliability of myocardial scintigraphy using 99m-Tc-pyrophosphate in the diagnosis of coexisting infarction of both heart ventricles. In a group of patients with coexisting right and left ventricular infarction (45 proved by coronarography, and 5 by autopsy), scintigraphic finding was confirmed in 46 (93%) patients. In all 50 patients with left inferior ventricular infarction, scintigraphic finding was confirmed in 48 of them by coronarography and in 2 by autopsy (100%). Of 4 patients with false negative scintigraphic finding 2 were treated with fibrinolytic therapy immediately after admission and in 2 diffuse occlusive changes were found on all three blood vessels by coronarography. It has been concluded that myocardial scintigraphy using 99m-Tc-pyrophosphate is a very sensitive (92%), specific (100%), exact (96%), simple and safe diagnostical method in detecting coexisting acute infarction of both heart ventricles.

Evaluation of diagnostic reliability of radionuclide phlebography using 99mTc-MAA to detect deep venous thrombosis; its role in establishing indications for inferior vena cava filter implantation.

Radionuclide phlebography (RNP) of the lower extremities and pelvis was performed using 99mTc-MAA in 40 patients with pulmonary thromboembolism. Deep venous thrombosis (DVT) was found in all patients, more frequently in the right calf and in the left iliac veins in 20 patients (55%). RNP and contrast phlebography (CP) were performed in 18 patients and confirmed the presence of DVT in all cases. The greatest specificity of RNP was obtained in the left (92.4%) and in the right pelvis (80%). In 12 of 18 patients in whom a cava filter was implanted, specificity of RNP was 100% for the left thigh and 91.7% for other localizations. In establishing indications for cava filter implantation, RNP should be performed prior to CP and bilaterally, but in case of non-indicated CP, RNP findings should be sufficient.

[The role of radionuclide phlebography in the detection of deep venous thrombosis in the lower extremities and pelvis and in establishing indications for implantation of a caval filter]. / Uloga radionuklidne flebografije u otkrivanju tromboze dubokih vena donjih ekstremiteta i karlice u postavljanju indikacija za ugradnju kava-filtera.

In all 40 patients with pulmonary thromboembolism (PTE) radionuclide phlebography (RNP) detected deep venous thrombosis (DVT), most commonly in the left iliac veins, in 20 (50%). RNP and contrast phlebography (CP) were performed in 18 patients and RNP sensitivity was found in 100% in all localizations of DVT and the largest specificity was obtained in the left side of the pelvis, in 92%. In 12 out of 18 patients cava filter was implanted and BNP specificity in the left upper leg reached 100% and in the right one 89.3%. In establishing indications for cava filter implantation RNP should be performed first so that by detecting embologenous TDV localizations the risk of jatrogenous PTE at cava filter implantation would be avoided or CF, if necessary.

[Value of the stress test in the evaluation of the severity of ischemic heart disease]. / Vrednost testa opterecenja u proceni tezine ishemijske bolesti srca.

Loading test was used in 156 patients with ischemic heart disease and the results of their selection are presented. In all patients occlusive coronary disease was detected by selective coronarography. They were divided in three groups. Two groups of patients had a high risk ischemic heart disease requiring surgical revascularization of the myocardium and selective coronarography. The first of these two groups comprised 48 patients with significant stenosis of the main tree of the coronary artery and the second comprised 35 patients with equivalent stenosis of this artery. The third group comprised 73 patients with ischemic heart disease of small risk in whom occlusive changes of the coronary arteries were of distal localization. The statistically significant difference was found between the two groups of patients with high risk and the third group with small risk according to early development of ST depression in the first minutes of loading, its degree, number of leads with ST depression, form and its maintenance after cessation of loading. The difference was also significant regarding the submaximal pulse rate and systolic blood pressure during loading test. It has been concluded that by using loading test as a functional diagnostic method patients with a high risk ischemic heart disease can be selected stressing the advantage of physiology over morphology.

[Massive pulmonary thromboembolism--case report]. / Masivna plucna tromboembolija--prikaz naseg slucaja.

This paper presents a case with massive pulmonary embolism which has been successfully treated at the V.M.A. Belgrade. The diagnosis of massive pulmonary thromboembolism by right heart catheterization was confirmed and urgent surgery was performed. The pulmonary embolus was surgically removed under extra corporeal circulation, given successful reanimation and anesthesia. Postoperatively was treated by mechanical ventilation, inotropic drugs and anticoagulant therapy. The presentation of this case is justified because in well organized cardiosurgical units, the urgent surgery gives most satisfactory results.