Vasomotion and nitric oxide bioactivity in diseased coronary arteries.

Atheromatous coronary stenoses are no longer considered to be passive structures, instead having the capacity for dynamic, often transient, change which may take the form of constriction or dilatation in response to either endogenous or external stimulation.

Vasomotion of coronary arteries: from nitrates to nitric oxide.

The vascular endothelium is a source of substances particularly nitric oxide that act in a paracrine fashion either to contract or relax smooth muscle cells and this function is disturbed in atherosclerotic arteries. The endothelium derived nitric oxide contribute in the basal vasomotor tone of epicardial normal and atheromatous coronary coronary arteries, and of atheromatous coronary stenoses in patients with stable angina. Nitrates, by acting indirectly to increase cGMP in smooth muscle cells, dilate most coronary stenoses and normal coronary segments, decrease left ventricular afterload and diastolic filling pressure and improve the distribution of coronary flow to subendocardial zone. Large and small epicardial coronary vessels responded differently to endothelium-dependent and independent vasodilators.

Percutaneous pulmonary valvuloplasty in an octogenarian with calcific pulmonary stenosis.

We describe a patient in whom calcific pulmonary vascular stenosis was diagnosed at the age of 84 years. Valve stenosis was relieved by percutaneous transluminal pulmonary valvuloplasty. To our knowledge, PTPV performed at this age has not been previously reported.

Single coronary artery associated with annuloaortic ectasia and ventricular septal defect.

A 60-year-old man with a single left coronary artery associated with an annuloaortic ectasia and a ventricular septal defect is described. He presented with severe heart failure and underwent open-heart surgery during which all these entities were confirmed.

Serum and bile digoxin levels in patients subjected to cholecystectomy with or without choledochostomy.

Digoxin levels were measured perspectively in the serum of 12 patients subjected to cholecystectomy and in serum and bile (Kehr) of 15 patients who underwent cholecystectomy plus choledochostomy in order to assess adequate digitalization. All patients were volunteers with no cardiac problems. In the cholecystectomy group serum digoxin levels increased in all patients from the second to the fourth postoperative day (P = 0.0001), while in patients with choledochostomy both serum and bile digoxin levels displayed wide variations. This last finding was associated with signs reflecting inadequate digitalization, probably due to significant digoxin losses through the choledochostomy.

Determination of left ventricular residual function by analysis of post-extrasystolic beat in mitral stenosis.

Residual function of the left ventricle was assessed in 25 patients with mitral stenosis and a normal left ventriculogram. The post-extrasystolic beat (R2) in sinus rhythm (nine patients) and the first beat after an early beat (R2) in atrial fibrillation (16 patients) were analysed angiocardiographically. Five subjects with a normal heart (controls) were also studied. The results are expressed as percentage changes in left ventricular contractility from the beat preceding the extra beat (R1) to the beat R2. In the control group the mean changes from R1 to R2 were: end diastolic volume +68.3% (increase), end systolic volume -21.7% (decrease), ejection fraction +36.2%, mean systolic ejection rate +22.1%, and mean velocity of circumferential fibre shortening +31%. A significant increase in proportional systolic shortening of all left ventricular axes was found in R2 compared with R1. In five patients with sinus rhythm and nine with atrial fibrillation the results fell within the normal range. In the remaining patients the beat R2 indicated signs of poor left ventricular function. The mean changes from R1 to R2 in the patients with sinus rhythm and those with atrial fibrillation were respectively: end diastolic volume +47.8% and +36.6%, end systolic volume +20% and +27%, ejection fraction +12.5% and +6.2%, mean systolic ejection rate -23.3% and -30.2%, and mean velocity of circumferential fibre shortening -25.5% and -39.2%. The increase in the left ventricular axial systolic shortening was not significant. Thus analysing a post-extrasystolic beat in sinus rhythm of the beat following an early beat with a long diastole in atrial fibrillation is a valuable method of determining the residual function in patients with mitral stenosis who have a normal left ventriculogram in basic rhythm.

Autonomic neuropathy in leprosy.

The integrity of the autonomic control of the cardiovascular system was studied in 21 patients with lepromatous leprosy and in ten normal people using several simple tests based on cardiovascular reflexes. Impairment of both parasympathetic and sympathetic function was demonstrated in the lepromatous patients.