[Correlation of functional indices of the left ventricle with structural changes in the myocardium]. / Otnoshenie na funktsionalnite pokazateli na liavata kamera kum strukturnite izmeneniia y miokarda.

11 with dilatative cardiomyopathy, 9 with valvular disease and 3 with ischemic heart disease--a full intracardial examination including right ventricular endomyocardial biopsy was performed. The most severe disorders of the hemodynamic parameters were found in the group of patients with dilatative cardiomyopathy. The pressure in the pulmonary artery was the highest of all groups of patients. The initial meane values of the systolic, diastolic and the average pressure were 5.73, 2.53 and 3.73 kPa and after left ventriculography was performed they were 6.80, 3.60 and 5.07 kPa respectively. The values of the ejection fraction were the lowest of all groups of patients. The left ventricular volume was greatly increased. The average telediastolic volume index was 235 ml/m2 and the average telesystolic volume index was 173 ml/m2. The velocity indices were greatly decreased--the average velocity of the circumferential fibers contraction was 0.45 circ/s and the ratio dp/dt was 1062 mm Hg/s. All patients were with normal coronary arteries. The very poor indices of 4 patients indicates for cardiac transplantation are of special interest. In the patients with valvular disease various degree of lowered hemodynamic parameters were found corresponding to the structural changes of the myocardium. In the third group of 3 patients with ischemic heart disease and severe disorders in the left ventricular function massive fibrous changes in the myocardium were found.

[Coronary radiography in patients with valvular cardiopathies and stenocardia]. / Koronarografiiata pri bolni s klapni kardiopatii i stenokardiia.

Seventy patients with valvular cardiopathies were performed selective coronarography besides the routine hemodynamic examination during the period 1973-1983. Those 70 patients could be subdivided in the following way: 46 with aortic, 17 - with mitral-aortic and 7 with mitral valvular lesion. Their average age is 46,15 +/- 1,42. Considerable changes (stenosis over 50% of at least one artery of the three main ones) were established in 9 patients (12,85%). The average age of the patients with the changes is 47,44 +/- 1,64. Angina pectoris had 57 out of 70 patients (81,42%). The mean telediastolic pressure of left ventricle of the patients with coronary alterations was 3,94 +/- 0,63 kPa (29,6 +/- 4,71 mm Hg) whereas the others, with intact coronary arteries had a mean telediastolic pressure of 2,6 +/- 0,43 kPa (19,43 +/- 3,26 mm Hg). Out of the nine patients with coronary changes--6 were males and 3--females. All had aortic valvular lesions--four with high degree stenosis, there--with high degree insufficiency and two--with mixed defect. The authors think that the systematic coronarographic investigations of the patients that are to have valvular prosthetization, is not necessary.

[Left atrial myxoma descending deeply into the cavity of the left ventricle]. / Miksom na liavoto predsurdie, spuskasht se dulboko v kukhinata na liavata kamera.

A female patient, aged 59 is reported with a myxoma of the left auricle, pedunculated deep in left cardiac ventricle. Myxoma was echocardiographically diagnosed and confirmed by left atriography. On the fourth day after the diagnosis of myxoma, with a high efficiency of all examinations and organizational measures the patients was successfully operated.

[Cardiovascular changes in the Marfan syndrome]. / Surdechno-sudovi promeni pri sindroma na Marfan.

Marfan's syndrome in its complete and incomplete forms takes very often a course with cardiac complications, predetermining the fate of such patients. The incomplete forms often present difficulties for the timely etiological elucidation of the cardiac changes leading to a retardation in the prescribing a rational regime to the patients and timeliness of the operation treatment. The authors' team own observations are reported on 10 patients with Marfan's syndrome, one with complete form and nine--incomplete forms, all of them with cardiac complications; two with mitral insufficiency, three with aortic insufficiency, four with aortic and mitral insufficiency and one with aortic, mitral and tricuspidal insufficiency; seven of the patients had aneurysm at the initial part of the aorta, manifested to various degrees and one--dysplasia of aorta. Rhythm disturbances were found in one of the patients. One of the patients underwent operation--prosthesis of mitral and aortic valve--with good results. Three of them died of severe total cardiac insufficiency.

[Clinical diagnostic problems in myxoma of the left atrium]. / Kliniko-diagnostichni problemi pri miksom na liavoto predsurdie.

The difficulties in the diagnosis of left auricle myxoma are discussed, proceeding from seven patients, observed by the authors. In two of them the diagnosis was confirmed by EchoCG and intracardial investigation (left atriography), in three--it was realized by exploratory thoracotomy, and in one of them proceeded directly into operation with extracorporal circulation (ECC), the second was radically operated (with ECC) after one month and the third died during operation due to acute obturation of mitral ostium by an extremely big myxoma; the other two patients were also successfully operated, the diagnosis being preoperatively made. Two patients died of cardiac failure, their diagnosis made at necropsy. The atypical and fast development of a mitral defect, progressing cardiac decompensation unsusceptible to treatment, are stressed to have a diagnostic significance in myxoma of left auricle as well as the effect of body position upon the morbid symptoms, discrepancy between the size of the left auricle and the type and stage of the manifested valvular disease, corresponding to the ECG manifestation of the same in the juxtaposition with the manifestation of the ventricular hypertrophy, etc. EchoCG examination and the left (contrast) atriography are of a high diagnostic value.

[Significance of sinus rhythm for ventricular function]. / Vurkhu znachenieto na sinusoviia ritum za kamernata funktsiia.

The changes in hemodynamics in conditions of dosed loading prior to and post cardioversion were followed up in 21 patients with valvular defects or atherosclerotic myocardiosclerosis and absolute arrhythmia with auricular fibrillation. In conditions of auricular fibrillation all the patients showed data about a deteriorated ventricular function (increased arterial-venous difference--tachycardia), both at rest and at dosed loading. One week after the sinus rhythm restoration, a considerable improvement of ventricular function was observed, at rest and loading (normal arterial-venous difference, higner minute and beat volume), suggesting the favourable effect of the restored sinus activity. The improved ventricular function is due to the restored auricular contraction, together with the restoration of rhythmic cardiac activity.