ABSTRACT
Accepted clinical views about the natural history of aortic stenosis are based on surprisingly little hemodynamically documented data, and further information in unlikely to be forthcoming in the modern surgical era. Therefore, follow-up data were obtained on 42 adult patients with isolated valvular aortic stenosis catheterized at Georgetown University Hospital who did not undergo early valve replacement. Of 32 symptomatic patients, 23 had moderate or severe stenosis and were followed until death or for an average of 64.4 months after catheterization. The prognosis was more ominous than previously reported. Mortality rates from onset of symptoms were 26% at one year, 48% at two years, and 57% at three years. Fifty-six % of deaths occurred suddenly, within hours of new symptoms. Asymptomatic patients with moderate or severe stenosis did not share the high mortality rate of those with symptoms. Eight such patients were followed for an average of 69.8 months, and none died.
Subject(s)
Aortic Stenosis, Subvalvular/diagnosis , Cardiomyopathy, Hypertrophic/diagnosis , Hemodynamics , Adult , Aged , Aortic Stenosis, Subvalvular/complications , Aortic Stenosis, Subvalvular/mortality , Cardiac Catheterization , Female , Heart Failure/complications , Humans , Male , Middle Aged , Myocardial Infarction/complications , Prognosis , Shock, Cardiogenic/complicationsABSTRACT
Certain observations are described in four elderly women with massive mitral anular calcific deposits, small thick-walled left ventricles and diastolic gradients between pulmonary artery wedge position (or left atrium) and left ventricle. All four patients had some degree of obstruction to left ventricular outflow. Examination at necropsy (two patients) or at operation (one patient) disclosed only focal fibrous thickening of the mitral leaflets without commissural or chordal fusion. By auscultation, none had mitral opening snaps, only two had loud first heart sounds and only one had a mitral diastolic rumble. Hemodynamic documentation of a diastolic gradient between pulmonary artery wedge position (or left atrium) and left ventricle in the presence of massive mitral anular calcific deposits and in the absence of diffuse disease of the mitral leaflets has not been demonstrated previously. The diastolic gradients are considered to result from the combination of the large mitral anular calcific deposits and the small, thick-walled, noncompliant left ventricles.
Subject(s)
Calcinosis/complications , Cardiomegaly/complications , Hemodynamics , Mitral Valve Stenosis/etiology , Aged , Blood Pressure , Calcinosis/pathology , Calcinosis/physiopathology , Cardiomegaly/pathology , Cardiomegaly/physiopathology , Female , Humans , Mitral Valve Stenosis/pathology , Mitral Valve Stenosis/physiopathologyABSTRACT
A new technique using infrared light for the transmission of heart sounds and murmurs is described. This method enables the simultaneous transmission of heart sounds and murmurs to large groups of persons without the need for hard-wire connections to the amplifying device. The method facilitates teaching of cardiac auscultation at the bedside as well as in the setting of conferences, seminars or postgraduate education programs.
Subject(s)
Audiovisual Aids , Education, Medical , Heart Auscultation , Group Processes , Humans , Teaching/methodsSubject(s)
Heart Septal Defects, Atrial/diagnosis , Adult , Aged , Blood Pressure , Cardiac Catheterization , Cyanosis , Diagnosis, Differential , Echocardiography , Electrocardiography , Female , Heart/diagnostic imaging , Heart Murmurs , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/physiopathology , Heart Septal Defects, Atrial/surgery , Heart Sounds , Heart Valve Diseases/complications , Humans , Hypertension/etiology , Male , Middle Aged , Mitral Valve Stenosis/diagnosis , Palpation , Postoperative Complications , Pulse , RadiographyABSTRACT
A 32-year-old man with paradoxical motion of the interventricular septum at the level of the chordae tendineae and with normal right heart hemodynamics is presented. It appears that, in absence of severe left ventricular dysfunction or intraventricular conduction defect, paradoxical septal motion is not entirely specific for right ventricular volume overload and may represent a rare normal variant.
