Myocytes' apoptosis and proliferation in endomyocardial biopsy as prognostic factors in terminal heart failure.

The aim of the preliminary study was to evaluate the role of apoptosis and proliferation of myocytes in order to predict the prognosis and optimal treatment of patients with end-stage dilated cardiomyopathy. Endomyocardial biopsy was performed during open-heart surgery (reductive annuloplasty of double orifice) in 19 patients with end-stage dilated cardiomyopathy. The terminal deoxynucleotidyl transferase d-UTP-biotin nick-end labelling (TUNEL) method was used for the detection of apoptosis, and immunohistochemical methods were used for the evaluation of inhibitor of apoptosis such as proto-oncogene Bcl-2 (B-cell lymphoma gene), and proliferative markers such as proliferation cell nuclear antigen (PCNA) and Ki-67 proliferative antigen. The increased percentage of apoptotic myocytes and decreased expression of bcl-2 is associated with earlier death after surgery. Increased expression of proliferation markers of myocytes in patients who survived seven years after surgery compared to those who died within three years suggest that adult cardiomyocytes are not terminally differentiated and this might represent potential growth reserve of the diseased heart. Based on our preliminary study we may conclude that myocytes' apoptosis and proliferative activity might help us to predict the prognosis and optimal treatment of patients with end-stage dilated cardiomyopathy.

Local pulmonary malformation caused by bilateral coronary artery and bronchial artery fistulae to the left pulmonary artery in a patient with coronary artery disease.

At 10 years of age and again at 25, our patient had been treated for pulmonary tuberculosis due to the presence of a localized pulmonary shadow. Coronary angiography at age 59 revealed 3 fistulous communications: from the right and circumflex coronary arteries and from the left bronchial artery. All 3 emptied into the same recipient artery, the distal part of a left pulmonary artery branch, which produced substantial left-to-right shunt. On computed tomography, cystic formations could be seen in the pulmonic area. The pulmonary tuberculosis for which this patient had been treated in his youth was in the same part of the lung where the shunt was discovered. Our conclusion is that the initial diagnosis was in error.

Unusual subclavian steal phenomenon.

A patient who had undergone myocardial revascularization with a saphenous vein graft to the left anterior descending artery and a left internal thoracic (mammary) artery graft to the 1st diagonal branch presented with an unusual form of subclavian steal syndrome. Occlusion of both the left subclavian and the left anterior descending arteries caused retrograde flow through the internal thoracic artery to the distal subclavian artery; the blood flow was supplied by the vein graft via the distal left anterior descending artery and diagonal branch.

Angiographic evidence of coronary artery ectasia: our experience.

The purpose of this angiographic study was to make a review of patients with coronary artery ectasia (CAE) and to compare the average coronary artery diameters of proximal, middle and distal segments of the following three groups of coronary arteries: Group E (ectatic segments in patients with CAE and ischaemic heart disease), Group E-n (presumably normal segments in the same group of patients) and Group N (normal coronary arteries of control patients). It was found that distal segments of all three coronary arteries and the middle segment of the circumflex artery in Group E-n were significantly narrower than the corresponding segments in Group N (p = 0.001 or less than 0.05 respectively), which suggested the arteriosclerotic origin of both, CAE and distal coronary artery involvement.

Pericardial mesothelioma.

The case of a 44-year old man, never exposed to asbestos, who died from a pericardial mesothelioma is described. The diagnosis was made by surgical examination. Two weak transient episodes of amelioration, the first accomplished with pronison administration and the other one by radiotherapy, were registered.

Mitral valve replacement for lupus valvulitis.

This paper describes a 47-years old patient with the history of lupus valvulitis for six and a half years, who had implantation of a Starr-Edwards prosthesis for a mitral insufficiency four years ago. This case represents the longest survival reported so far after mitral valve replacement for lupus valvulitis.

Felty's and Sjögren's syndromes and hypertrophic obstructive cardiomyopathy (case report).

Our findings refer to a female patient with Felty's and Sjögren's syndromes and hypertrophic obstructive cardiomyopathy. The rheumatoid granuloma found in the left ventricle at autopsy and the absence of other conditions which may be manifested by hypertrophic obstructive cardiomyopathy suggest that the case studied, probably represents an extraarticular manifestation of Felty's and Sjögren's syndromes.

Lown-Ganong-Levine syndrome associated with Mahaim nodoventricular fibers.

A patient with Lown-Ganong-Levine syndrome, in whom electrophysiologic evaluation revealed nodoventricular accessory connections, is described. The resting electrocardiographic pattern, which is unusual in patients with Mahaim type of preexcitation, was due to relatively short A-H and H-V intervals. Electrophysiologic study is indispensable for exact diagnosis in patients with preexcitation syndromes.

The value of echocardiography in assessing the severity of mitral stenosis.

In a group of 24 patients having pure mitral stenosis, the relation between the echo parameters of the mitral valve and pressures in the pulmonary circulation was studied. On the basis of the authors' results, it was concluded that the sensitivity of one-dimensional echocardiography for the assessment of the severity of mitral stenosis can be further improved by measuring not only the widely accepted parameters, such as the diastolic closing velocity and the motion amplitude of the AML, but also by taking into account the echodiameter of the mitral orifice. Besides, careful observation of the motion pattern of the PML might be of use for distinguishing between a mild and moderate degree of mitral stenosis.