Unusual presentation of aneurysm of aorta.

An unusual case of a saccular aneurysm of arch of aorta, masquerading as pulmonary artery branch stenosis, proved by cardiac catheterisation and angio cardiography is presented.

Coagulation studies in rheumatic heart disease.

The clotting characteristics of pulmonary and systemic blood were studied in 10 patients with chronic rheumatic mitral valve disease complicated by atrial fibrillation and in seven patients with aortic valve disease in sinus rhythm. A haemostatic basis for the association of rheumatic mitral valve disease with thrombotic emboli was sought. Both groups of patients showed differences in platelet function between pulmonary and systemic arterial blood. In patients with mitral valve disease aggregation of platelets was significantly greater in pulmonary than in systemic arterial blood at rest; the converse was true during exercise. In aortic valve disease platelet aggregation was greater in systemic than in pulmonary arterial blood at all times. Only the patients with mitral valve disease showed changes in blood coagulation during passage through the lungs and left heart; there was a small but statistically significant shortening in partial thromboplastin time in systemic as compared with pulmonary arterial blood both at rest and during exercise. Similarly, the effects of exercise on the various haemostatic factors measured were largely confined to the patients with mitral valve disease; in these patients exercise stimulated an increase in factor VIII in pulmonary arterial blood and an increase in platelet adhesiveness and aggregability in left heart blood. These changes provide a basis for the suggestion that in patients with rheumatic mitral valve disease, unlike those with aortic valve disease, there is an increased thrombotic tendency in blood in the left heart which is particularly pronounced during exercise.

Clinical and hemodynamic results of mitral valve replacement with autologous fascia lata grafts. Studies in patients with competent prostheses.

Nine patients with severe mitral disease were studied before and six months after mitral valve replacement with a three-cusp stented prosthesis using fresh autologous fascia lata tissue. Only patients in whom there was no auscultatory and angiographic evidence of incompetence of the replaced valve were selected for restudy. All patients claimed a marked improvement in their exercise capacity after operation and there was a significant reduction in radiographic heart size. The cardiac output at rest and the response to exercise were both reduced before operation and were unchanged after valve replacement. The elevated pulmonary arterial and wedge pressures were significantly reduced after operation in all patients both at rest and during exercise, but in no instance were the postoperative exercise values within normal limits. Left ventricular end-diastolic pressure was within normal limits at rest and during exercise in all patients after valve replacement but the average pressure gradient across the fascia lata valve was 6+/-1 mm Hg at rest and 18+/-3 mm Hg during exercise. These findings indicate that altough replacement of the diseased mitral valve with a competent fascia lata prosthesis afforded substantial symptomatic relief, reduction of cardiac enlargement and a lowering of the pulmonary vascular pressures, this artificial valve offered a significant obstruction to left ventricular diastolic filling, particularly during exercise.

Comparison of adrenergic beta-blocking drugs in angina pectoris.

The symptomatic, electrocardiographic, and haemodynamic effects of two adrenergic beta-blocking drugs, oxprenolol and propranolol, have been compared in equipotent intravenous doses in six patients with uncomplicated angina pectoris during treadmill exercise. The method of comparison included double-blind assessment and analysis with placebo control and randomized serial comparison in each patient. Both drugs produced an equal amelioration in symptoms in most of the patients. This was closely correlated with improvement in the electrocardiographic changes and a significant reduction in the exercising heart rate and systemic arterial pressure. This method of double-blind combined subjective and objective assessment carries distinct advantages in the comparative assessment of drug treatments in angina pectoris.